A role for menstruation in preconditioning the uterus for successful pregnancy
Abstract
Menstruation is widely viewed as serving no purpose other than to reinitiate the endometrial cycle in the absence of pregnancy. Yet, it is striking that cyclic endometrial decidualization followed by menstrual shedding is confined to the few species, including human beings, where placenta formation entails deep trophoblast invasion of maternal tissues and its vasculature. Both menstruation and pregnancy are inflammatory conditions that cause a degree of physiological ischemia-reperfusion tissue injury, albeit much more so in pregnancy. Thus, the emergence of cyclic menstruation may not have been an evolutionary coincidence but serves to protect uterine tissues from the profound hyperinflammation and oxidative stress associated with deep placentation, a process known as preconditioning. The concept of menstrual preconditioning provides a novel paradigm for understanding how reproductive disorders impact on pregnancy outcome. For example, endometriosis could be viewed as a disorder of exaggerated menstrual preconditioning that confers protection against placentation-related disorders, such as preeclampsia.
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In adult life, endometriosis can be related to uterine preconditioning by cyclic menstruations acting as a priming mechanism.
“In adult life, endometriosis can be related to uterine preconditioning by cyclic menstruations acting as a priming mechanism (39).”
From Pathogenesis of deep endometriosis (2017) · cites this paper as [39]
Menstrual preconditioning implies that P withdrawal bleedings or menstruations evolved in the human because of the need to initiate decidualization in the absence of pregnancy and protect uterine tissues from the profound hyperinflammation and oxidative stress associated with deep placentation.
“Menstrual preconditioning implies that P withdrawal bleedings or menstruations evolved in the human because of the need to initiate decidualization in the absence of pregnancy and protect uterine tissues from the profound hyperinflammation and oxidative stress that are associated with deep placentation (39).”
From Pathogenesis of deep endometriosis (2017) · cites this paper as [39]
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“Menstrual preconditioning reduces progesterone resistance The concepts of “ontogenetic progesterone resistance” and of “menstrual preconditioning” infer that the human uterus may start out as a relatively immature organ that acquires the competence for deep placentation in response to dynamic remodeling events trigger…”
BackgroundSelf-citation
- Authors
- Brosens, J. J., Parker, M. G., McIndoe, A., Pijnenborg, R., & Brosens, I. A.
- Affiliations
- Imperial College London (GB)
- KU Leuven (BE)
- Leuven Institute for Fertility and Embryology (BE)
- Corresponding author
- Brosens, Jan J.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2009-06
- Volume
- 200
- Issue
- 6
- Pages
- 615.e1-615.e6
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2073882976
- Cited by
- 166
- References
- 54
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 7 · 2023: 10 · 2022: 8 · 2021: 14 · 2020: 8 · 2019: 8 · 2018: 12 · 2017: 9 · 2016: 11 · 2015: 9 · 2014: 13 · 2013: 9 · 2012: 4
- FWCI
- 5.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Keywords
- menstruation, endometrial receptivity, endometrial decidualization, placentation, trophoblast invasion, ischemia-reperfusion injury, oxidative stress, inflammation, endometriosis, preeclampsia, pregnancy outcomes
- MeSH terms
- Endometriosis, Female, Humans, Menstruation, Placentation, Pre-Eclampsia, Pregnancy, Uterus, Endometrial Neoplasms
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