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Examines the expression of endothelin receptors, ET[sub A] and ET[sub B], in human decidua during pregnancy. Significant positive correlation between expression of ET[sub B] and laminin alpha[sub 2] light chain; Reduction of ET[sub A] in the stroma in the third trimester of pregnancy; Up-regulation of ET[sub B] during the progesterone-dependent process of decidualization.

Complaints of excessive menstrual bleeding (menorrhagia) have a substantial impact on gynaecological services and in most cases no organic pathology is identified. Up to 50% of women who present with menorrhagia have blood losses within the normal range. Medical therapy is indicated for patients who do not wish surgery, or for whom surgery is unsuitable. Nonsteroidal anti-inflammatory drugs and tranexamic acid offer a simple therapy to be taken during menses, with reductions in menstrual blood loss (MBL) of 25-35% and 50% respectively. Danazol and the gonadatrophin-releasing hormone analogues are highly effective, but their side-effects make them suitable only for short-term use. The combined oral contraceptive pill and the levonorgestrel intrauterine system give reductions in MBL of 50% and 80%, with additional contraceptive cover. Cyclical progestogens are the most commonly prescribed therapy in the United Kingdom but they are ineffective for the management of ovulatory menorrhagia unless taken at high doses (10-15 mg daily) for 3 weeks out of 4.

Objective: To compare the efficacy and acceptability of the levonorgestrel intrauterine system and norethisterone for the treatment of idiopathic menorrhagia., Design: A randomised comparative parallel group study., Setting: Gynaecology outpatient clinic in a teaching hospital., Participants: Forty-four women with heavy regular periods and a measured menstrual blood loss exceeding 80 ml., Methods: Twenty-two women had a levonorgestrel intrauterine system inserted within the first seven days of menses, and 22 women received norethisterone (5 mg three times daily) from day 5 to day 26 of the cycle for three cycles., Main Outcome Measures: The main outcome measure was the change in objectively assessed menstrual blood loss after three months of treatment., Results: When menstrual blood loss at three months was expressed as a percentage of the control, the levonorgestrel intrauterine system reduced menstrual blood loss by 94% (median reduction 103 ml; range 70 to 733 ml), and oral norethisterone by 87% (median reduction 95 ml; range 56 to 212 ml). After three cycles of treatment 76% of the women in the levonorgestrel intrauterine system group wished to continue with the treatment, compared with only 22% of the norethisterone group., Conclusions: Both the levonorgestrel intrauterine system and oral norethisterone in this regimen provided an effective treatment for menorrhagia in terms of reducing menstrual blood loss to within normal limits. The levonorgestrel intrauterine system was associated with higher rates of satisfaction and continuation with treatment, and thus offers an effective alternative to currently available medical and surgical treatments for menorrhagia.

Immunocytochemistry was used to localize endothelial (eNOS) and inducible (iNOS) nitric oxide synthase in human uterine tissues collected at various stages of the menstrual cycle, after exposure to exogenous progestagens, and in early pregnancy. Endothelial NOS-like immunoreactivity was detected in all specimens in endothelial cells lining blood vessels in the myometrium and endometrium, and in endometrial glandular epithelial cells. Inducible NOS-like immunoreactivity was also demonstrated in glandular epithelial cells. For both eNOS and iNOS there was considerable variation in the intensity of epithelial cell staining between samples, which was not related to the stage of the menstrual cycle at which the tissue was collected. Messenger RNA for eNOS and iNOS was detected by reverse transcription-polymerase chain reaction (RT-PCR) using total RNA purified from isolated endometrial gland fragments. Immunoreactivity for eNOS and iNOS was not present in endometrial stroma throughout the menstrual cycle, but iNOS-like immunoreactivity was seen in decidualized stromal cells both following treatment with exogenous progestagen (intrauterine L-norgestrel) and in tissues obtained in the first trimester of pregnancy. The detection of protein and mRNA for eNOS and iNOS in normal human endometrium suggests that NO may play a role in the local control of endometrial function.