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The pattern of prostaglandins (PGs) synthesized by persistent proliferative endometrium of women with excessive menstrual bleeding (greater than 50 ml) associated with anovulatory cycles was compared to endometrium collected from women with normal menstrual blood loss (less than 50 ml). Levels of PGF2 alpha in normal and persistent proliferative endometrium were lower than the levels of PGF2 alpha found in normal secretory endometrium (P less than 0.005 for both normal and persistent proliferative endometria). When incubated with exogenous [1-14C]arachidonic acid (9.1 nmol), normal secretory endometrium synthesized more PGF2 alpha and PGE2 than did normal proliferative endometrium, but the amounts of PGF2 alpha and PGE2 released by persistent proliferative endometrium were similar to those obtained by normal secretory endometrium. These findings suggest that persistent proliferative and normal secretory endometria have the same PG synthetase activity, and that the low endogenous concentrations of PGF2 alpha in the former arise from a lack of endogenous precursor. PGF2 alpha has predominantly vasoconstricting properties, and a reduced capacity to synthesize this PG by persistent proliferative endometrium may result in excessive menstrual bleeding, as was suggested by the inverse correlation between the ratio of the endogenous concentrations of PGF2 alpha and PGE and the menstrual blood loss (r = -0.7; P less than 0.005; n = 26).

17 beta-estradiol and progesterone were administered to post-menopausal women to determine their effects in vivo on the capacity of human endometrium to synthesize prostaglandins (PGs) F2 alpha and E. Basal amounts of PGF2 alpha and PGE synthesized by endometrium exposed to 17 beta-estradiol and progesterone were significantly higher than the levels produced by endometrium exposed to 17 beta-estradiol alone (p less than 0.02 for both PGs). Levels found in the former endometrium were broadly comparable to levels in secretory endometrium and in the latter to amounts found in proliferative endometrium of spontaneous, ovulatory cycles.

Concentrations of prostaglandin F2 alpha (PGF2 alpha) and prostaglandin E (PGE) were measured in endometrium from 18 women with ectopic pregnancies. In the nine pregnancies not associated with vaginal bleeding or an intra-uterine contraceptive device (IUCD; intact ectopics), concentrations of PGF2 alpha (12.8 +/- 7.4 (S.E.M.) ng/g) and PGE (4.7 +/- 3.0 ng/g) were similar to those in decidua from nine intra-uterine pregnancies of comparable gestational age (14.4 +/- 4.4 and 8.2 +/- 2.2 ng/g respectively). In both ectopic and intra-uterine pregnancies concentrations of prostaglandins were significantly lower than those found in endometrium throughout the normal menstrual cycle (P < 0.01). In nine ectopic pregnancies with associated vaginal bleeding and/or an IUCD, concentrations of PGF2 alpha and PGE were significantly higher than in the intact group (P < 0.05), although the concentration of PGF2 alpha remained significantly lower than levels in normal secretory endometrium (P < 0.05). These results suggested that suppression of endometrial synsthesis of prostaglandin during early pregnancy may be mediated systemically rather than through a local action of the conceptus.

Endometrium collected from 18 normal women at various stages of the menstrual cycle was maintained in organ culture for periods of 6 days. Both prostaglandin F2 alpha (PGF2 alpha) and PGE were detected in medium from late proliferative (days 10-14; n = 13) and late secretory (days 20-26; n = 5) endometria cultured in the absence of exogenous steroids. During the first 48 h in culture, the output of PGF2 alpha by secretory endometrium was significantly greater than that of proliferative tissue. The addition of 17 beta-estradiol to the culture medium at doses ranging from 1.0-100.0 ng/ml induced a significant increase in the output of PGF2 alpha by secretory but not proliferative endometria. The addition of progesterone at doses ranging from 5.0-500.0 ng/ml significantly reduced the output of PGF2 alpha and PGE by both proliferative and secretory endometria and prevented the 17 beta-estradiol-stimulated increase in PGF2 alpha output by secretory tissue.

The concentrations of PGF2 alpha, PGE2 and 6-oxo-PGF1 alpha were measured in human uterine tissues during the menstrual cycle. The concentrations of all PGs in endometrium were greater than in myometrium. PGF2 alpha, which was found in the greatest concentrations, was high in the mid-secretory phase in both endometrium and myometrium. The concentration of PGE2 did not vary during the menstrual cycle in either tissue. The biosynthetic capacity of endometrium to produce both PGF2 alpha and PGE2 was significantly greater in the mid than the late secretory phase in the presence of exogenous arachidonic acid. Also, in spite of low endogenous concentrations, both endometrium and myometrium were able to produce significant amounts of 6-oxo-PGF1 alpha during a 30 minute incubation. The possible significance of this late secretory decline in the capacity of the endometrium to produce PGF2 alpha and PGE2 is discussed.

The endogenous concentrations of prostaglandins F2 alpha (PGF 2 alpha) and E (PGE) were measured during the luteal phase of the menstrual cycle in the endometrium from 14 women with unexplained menorrhagia (measured menstrual blood loss in excess of 50 ml) and 15 women with normal menses (blood loss 50 ml or less). Although there was no significant difference in the PGF 2 alpha/PGE ratio between the two groups, this ratio was significantly lower in the endometrium from eight of the women whose blood loss exceeded 90 ml (p less than 0.05). There was a significant inverse correlation between the PGF 2 alpha/PGE ratio and blood loss (r = 0.36, p less than 0.025). The synthetic capacity of the endometrium was assessed by incubation of the tissue with 14C arachidonic acid. Endometria from nine women with unexplained menorrhagia synthesized more PGE2 than PGF 2 alpha, whereas the converse was true with 11 control endometria. Consequently the PGF2 alpha/PGE2 ratio was significantly reduced in the former group (p less than 0.025). Oestradiol-17 beta (200 microM) and to a greater extent 2 hydroxy oestradiol (200 microM) increased the total prostaglandin synthesis by the endometria, but did not significantly alter the PGF2 alpha/PGE2 ratio. These results suggest that excessive blood loss may be associated with a shift in the endometrial conversion of prostaglandin endoperoxide from PGF2 alpha to PGE2.

The ability of broken cell preparations of human endometrium, myometrium and a mixture of endometrium and myometrium to convert 14C arachidonic acid to prostaglandins (PG's) was compared. Endometrium metabolished arachidonic acid predominantly to a mixture of PGF2 alpha and PGE2. A similar weight of myometrium showed relatively little activity, the major product identified was 6 oxo PGF1 alpha. However, a combination of endometrium and myometrium showed an enhanced conversion of arachidonic acid to 6 oxo PGF1 alpha associated with a decreased production of PGF2 alpha and PGE2. This suggests that human endometrium and myometrium differ in their ability to metabolize arachidonic acid and in their ability to convert the endoperoxides formed, to PG's.

The synthesis of prostanoids from arachidonic acid incubated with endometrium alone or together with myometrium was studied in women with excessive menstrual blood-loss (range 57--186 ml, median 86 ml). Production of prostaglandins F2 alpha, E2, and D2 was similar to that observed for the endometrium of women with normal periods (range 5--50 ml; median 11 ml). However, the endometrium from women with excessive menstrual blood-loss was more effective than endometrium from women with normal menstrual blood-loss at enhancing the production by a control preparation of myometrium of 6-oxo-prostaglandin F1 alpha, the stable metabolite of prostacyclin. The ability of the uterus to generate prostacyclin, a prostaglandin known to inhibit platelet aggregation and stimulate vasodilatation, may influence the degree and duration of menstrual bleeding.