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Apoptosis, Proliferation, and Sex Hormone Receptors in Superficial Parts of Human Endometrium at the End of the Secretory Phase¹

Department of Obstetrics and Gynecology and Mid Sweden Research and Development Center, Sundsvall Hospital (M.D.); the Departments of Oncology (K.B.), Pathology (S.C., P.W.), and Obstetrics and Gynecology (T.B.), University of Umea, 901 85 Umea, Sweden

Address all correspondence and requests for reprints to: Prof. Torbjörn Bäckström, Department of Gynecology and Obstetrics, University Hospital of Northern Sweden, 901 85 Umea, Sweden. E-mail: torbjorn.backstrom{at}obstgyn.umu.se

Apoptosis with one regulator, Bcl-2, and proliferation with the marker Ki-67 were studied in 75 endometrial biopsies representing superficial parts of endometrium from 35 regularly menstruating women premenstrually and menstrually. Hormonal withdrawal was studied in serum samples and potentiated in epithelium by the decreasing 17ß-estradiol and progesterone receptor scores 4 days premenstrually. The apoptotic index increased 2 days before the onset of menstruation and peaked on the second menstrual day. The high apoptotic index together with low proliferation in endometrial epithelium at the end of the menstrual cycle are similar to the involution process seen in other hormone-dependent organs. In stroma, the apo-ptotic index increased later, at the onset of menstruation, and the increase was lower than that in epithelium. The Ki-67 index increased during the last 3 days of the secretory phase, parallel with an increasing progesterone receptor score and decreasing Bcl-2 staining, and peaked at the onset of menstruation. The findings in stroma concur with high proliferation at the end of the menstrual cycle and high cell turnover during menstruation, suggesting the participation of stroma in the renewal process of endometrium.

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