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A Biological Model for the Regulation of Peri-Implantational Hemostasis and Menstruation

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Abstract

Objective

TO delineate the physiologic mechanisms whereby the human endometrium maintains hemostasis during endovascular trophoblast invasion hut permits menstrual hemorrhage.

Methods

Experimental results are presented that are relevant to developing a comprehensive biological model for studying peri-implantational hemostasis and menstruation.

Results

A marked increase in the expression of tissue factor (TF) and type-1 plasminogen activator inhibitor (PAI-1) and an inhibition of tissue-type and urokinase-type plasminogen activators (tPA and uPA, respectively), matrix metalloproteinases (MMP), and endothelin-1 (ET-1) expression accompany progestin-induced decidualization of estrogen-primed endometrial stromal cells both in vivo and in vitro. The presence of these important regulators of hemostasis, fibrinolysis, extracellular matrix (ECM) turnover, and vascular tone in decidualized human stromal cells and decidual cells isolated from gestational endometrium suggests a mechanism to explain the absence of hemorrhage during invasion of the endometrial vasculature by trophoblasts. Conversely, progesterone withdrawal reduces TF and PAI-1 expression and increases tPA, uPA, MMP, and ET-1 expression accounting for the hemorrhage, enhanced fibrinolysis, ECM degradation, and ischemic spiral arterial vascular injury characterizing menstruation.

Conclusion

Perivascular decidualized endometrial stromal cells are spatially and temporally positioned to promote endometrial hemostasis during implantation but, paradoxically, promote the hemorrhage of menstruation via their hormone-regulated expression of hemostatic, proteolytic, and vasoactive proteins. (J Soc Gynecol Invest 1996;3:159-65)

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA

    Charles J. Lockwood MD (Professor and Chairman) & Frederick Schatz PhD

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  1. Charles J. Lockwood MD
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  2. Frederick Schatz PhD
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Additional information

This work was supported in part by grants from the National Institutes of Health, nos. R29-HD24540 01A1 and 1R01 -HD 33234-01 (CJL).

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Lockwood, C.J., Schatz, F. A Biological Model for the Regulation of Peri-Implantational Hemostasis and Menstruation. Reprod. Sci. 3, 159–165 (1996). https://doi.org/10.1177/107155769600300401

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