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Vascular changes in the cycling and early pregnant uterus
Noura Massri, … , Ripla Arora, Nataki C. Douglas
Noura Massri, … , Ripla Arora, Nataki C. Douglas
Published June 8, 2023
Citation Information: JCI Insight. 2023;8(11):e163422. https://doi.org/10.1172/jci.insight.163422.
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Review

Vascular changes in the cycling and early pregnant uterus

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Abstract

Uterine vascular remodeling is intrinsic to the cycling and early pregnant endometrium. Maternal regulatory factors such as ovarian hormones, VEGF, angiopoietins, Notch, and uterine natural killer cells significantly mediate these vascular changes. In the absence of pregnancy, changes in uterine vessel morphology and function correlate with different stages of the human menstrual cycle. During early pregnancy, vascular remodeling in rodents and humans results in decreased uterine vascular resistance and increased vascular permeability necessary for pregnancy success. Aberrations in these adaptive vascular processes contribute to increased risk of infertility, abnormal fetal growth, and/or preeclampsia. This Review comprehensively summarizes uterine vascular remodeling in the human menstrual cycle, and in the peri- and post-implantation stages in rodent species (mice and rats).

Authors

Noura Massri, Rachel Loia, Jennifer L. Sones, Ripla Arora, Nataki C. Douglas

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Figure 1

Comparison of the human menstrual cycle and rodent estrous cycle.

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Comparison of the human menstrual cycle and rodent estrous cycle.
(A) Th...
(A) The human menstrual cycle is divided into the proliferative (follicular) phase and the secretory (luteal) phase. Under the influence of ovarian estrogen (blue line) in the follicular phase, the endometrium regenerates, endothelial cells proliferate, and vascular permeability increases. Mid-cycle, a surge in luteinizing hormone results in follicle rupture, ovulation of the oocyte, and formation of the corpus luteum. In the secretory phase, progesterone (red dashed line) regulates stromal cell decidualization and increases endometrial edema in preparation for embryo implantation. In the absence of embryo implantation, the corpus luteum demises, and estrogen and progesterone levels fall. This is followed by menstruation and the start of another menstrual cycle. (B) The rodent estrous cycle is composed of four different phases: proestrus, estrus, metestrus, and diestrus. In the proestrus phase, which lasts between 21 and 32 hours, estrogen increases. The estrus phase and ovulation follow the proestrus phase. The estrus phase lasts 12–48 hours. The formation of the corpus luteum following ovulation marks the shift from an estrogen- to a progesterone-dominated stage. The metestrus and diestrus phases represent the secretory phases of the cycle. The metestrus phase lasts 8–24 hours, while the diestrus phase lasts 48–72 hours.

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