Regulation of human endometrial function: mechanisms relevant to uterine bleeding
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Regulation of human endometrial function: mechanisms relevant to uterine bleeding Hilary OD Critchley*1, Rodney W Kelly2, David T Baird1 and Robert M Brenner3 Address: 1Department of Reproductive and Developmental Sciences, University of Edinburgh, Centre for Reproductive Biology, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK, 2Medical Research Council Human Reproductive Sciences Unit, Centre for Reproductive Biology, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK and 3Oregon National Primate Research Center, 505 NW 185th Avenue, Beaverton, OR 97006, USA Email: Hilary OD Critchley* - [email protected] * Corresponding author
from Basic and applied biology of the primate reproductive tract: in honor of the career of Dr Robert M Brenner Portland, Oregon, USA. 16–17 August 2005 Published: 9 October 2006 Reproductive Biology and Endocrinology 2006, 4(Suppl 1):S5
doi:10.1186/1477-7827-4-S1-S5
Basic and applied biology of the primate reproductive tract: In honour of the career of Dr Robert M. Brenner
Robert M Brenner Reviews http://www.biomedcentral.com/content/files/pdf/1477-7827-4-S1-info.pdf© 2006 Critchley et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract This review focuses on the complex events that occur in the endometrium after progesterone is withdrawn (or blocked) and menstrual bleeding ensues. A detailed understanding of these local mechanisms will enhance our knowledge of disturbed endometrial/uterine function – including problems with excessively heavy menstrual bleeding, endometriosis and breakthrough bleeding with progestin only contraception. The development of novel strategies to manage these clinically significant problems depends on such new understanding as does the development of new contraceptives which avoid the endometrial side effect of breakthrough bleeding.
Introduction The uterus plays a pivotal role in the key events of primate reproduction, implantation, and in the absence of pregnancy, menstruation. Preparation of the endometrium for implantation is a consequence of exposure of this steroid target tissue to estradiol and progesterone [1,2]. Absence of pregnancy, demise of the corpus luteum and the subsequent fall in circulating progesterone leads to degradation and shedding of the superficial layer of the endometrium. Menstruation is a process of tissue injury and subsequent repair involving a complex interplay between the endocrine and local immune system [3,4]. It is well known that progesterone is the steroid critical for endometrial differentiation, but the specific determinants of endometrial
receptivity and the complex molecular and cellular interactions involved are matters o
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