Inhibition of Ovulation in the Human 235 



B. Effects on the Endometrium 



The effect of Enovid on the endometrium shows other very interesting and 

 striking aspects. After only 3 or 4 days of medication, we observe the glandu- 

 lar changes which are found 3 or 4 days after ovulation in a normal, untreated 

 cycle. 



Typical are mobilization of the nuclei toward the luminal border of the 

 cells and beginning edema of the stroma. If the medication, started on cycle- 

 day 5, is continued for 8 days, we get a postovulatory 8-day tissue, with 



H R GUARD M.D. 



Fig. 2. Time diflferential in development of endometrial glandular epithelium in steroid- 

 treated vs. untreated women. (Reproduced by permission from Pincus, G., J. Rock, 

 C.-R. Garcia, E. Rice-Wray, M. Paniagua and I. Rodriguez, Fertility Control with 

 Oral Medication. Am. J. Obst. & Gynec. 75, 1333-1346, 1958.) 



decrease of secretion by the cells. We used to think that the presence of 

 secreted material in the dilated glands, characteristic of this phase, indicated 

 continued secretory activity. We are now taught by Bartelmez (42) that this 

 material is not being actively secreted but is merely the accumulation in the 

 glands of previously secreted material unable to pass out because progesterone 

 has inactivated the formerly contractile myometrium. This phase, then, as 

 pointed out by Bartelmez, is properly designated "progestational", not 

 "secretory". 



Dr. H. R. Guard of Bombay, who was working here as a Research Fellow 

 with us, as well as with Dr. Pincus, made a schematic drawing (Fig. 2) from 

 some of our slides to illustrate the characteristic sequence of changes in the 

 glands during the normal ovulatory cycle. These changes, worked out by a 

 number of investigators, including our own group (43^5), are compared in 

 the schema with changes during medication with Enovid. This comparison 

 has been published previously (26, 27). 



