Inflammation, leukocytes and menstruation

Menstruation has many of the features of an inflammatory process. The complexity and sequence of inflammatory-type events leading to the final tissue breakdown and bleeding are slowly being unravelled. Progesterone has anti-inflammatory properties, and its rapidly declining levels (along with those...

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Bibliographic Details
Published in:Reviews in endocrine & metabolic disorders 2012-12, Vol.13 (4), p.277-288
Main Authors: Evans, Jemma, Salamonsen, Lois A.
Format: Article
Language:English
Subjects:
Animals
Decidua - enzymology
Decidua - immunology
Decidua - metabolism
Diabetes
Endocrinology
Endometrium - enzymology
Endometrium - immunology
Endometrium - metabolism
Female
Humans
Internal Medicine
Leukocytes - enzymology
Leukocytes - immunology
Leukocytes - metabolism
Medicine
Medicine & Public Health
Menstruation - immunology
Menstruation - metabolism
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Summary:Menstruation has many of the features of an inflammatory process. The complexity and sequence of inflammatory-type events leading to the final tissue breakdown and bleeding are slowly being unravelled. Progesterone has anti-inflammatory properties, and its rapidly declining levels (along with those of estrogen) in the late secretory phase of each non-conception cycle, initiates a sequence of interdependent events of an inflammatory nature involving local inter-cellular interactions within the endometrium. Intracellular responses to loss of progesterone (in decidualized stromal, vascular and epithelial cells) lead to decreased prostaglandin metabolism and loss of protection from reactive oxygen species (ROS). Increased ROS results in release of NFκB from suppression with activation of target gene transcription and increased synthesis of pro-inflammatory prostaglandins, cytokines, chemokines and matrix metalloproteinases (MMP). The resultant leukocyte recruitment, with changing phenotypes and activation, provide further degradative enzymes and MMP activators, which together with a hypoxic environment induced by prostaglandin actions, lead to the tissue breakdown and bleeding characteristic of menstruation. In parallel, at sites where shedding is complete, microenvironmentally-induced changes in phenotypes of neutrophils and macrophages from pro- to anti-inflammatory, in addition to induction of growth factors, contribute to the very rapid re-epithelialization and restoration of tissue integrity.
ISSN:1389-9155
1573-2606
DOI:10.1007/s11154-012-9223-7