Is neonatal uterine bleeding involved in the pathogenesis of endometriosis as a source of stem cells

Capsule:
Endometrial bleeding in the neonate, an event totally neglected by modern investigators, may play a role in the pathogenesis of at least early onset endometriosis and represent a potential source of endometrial stem cells. The bleeding is a well-established phenomenon occurring at the end of the first week, but is more often occult than visible. The structure and functional obstruction of the endocervical canal in the fetus at term suggest increased likelihood of retrograde flow of the endometrial shedding.

Authors:
Ivo Brosens, M.D., Ph.D., Giuseppe Benagiano, M.D., Ph.D.

Volume 100, Issue 3, Pages 622-623, September 2013

Abstract:

Endometrial bleeding in the neonate, an event totally neglected by modern investigators, may play a role in the pathogenesis of at least early onset endometriosis and represent a potential source of endometrial stem cells. The bleeding is a well-established phenomenon occurring at the end of the first week, but is more often occult than visible. The structure and functional obstruction of the endocervical canal in the fetus at term suggest increased likelihood of retrograde flow of the endometrial shedding.

  • Jashoman Banerjee

    This interesting theory may provoke further studies in neonates immune profile, peritoneal inflammatory profile as well as a possible role of transabdominal ultrasound in the neonates with h/o bleeding which may corelate to sonographic changes in the uterus.

    • Ivo Brosens

      Thank you for the interesting comments. Ultrasound offers today the possibility of investigating the overt or occult uterine bleeding that occurs in one third of the neonates. We now can investigate the occurrence of endometrial reflux at time of birth. Adolescent endometriosis can be very severe as shown by recent studies and therefore it is important to investigate the potential link with neonatal uterine bleeding.
      Your comments are appreciated.
      Ivo Brosens, Leuven, Belgium

  • Dan Martin

    Marsh may be misquoted. March documented stroma and glandular structures in postmenarcheal, but not in premenarcheal in Table 1. I do not find a contradicting mention of this in the body. The body refers to Table 1. If there was a subsequent, published clarification, please reference that.

    This can also be interpreted to mean that 1) premenarcheal inflammatory lesions may predispose to postmenarcheal endometriosis based on 2 of 5 patients or 2a) that premenarcheal inflammatory lesions and/or 2b) surgical treatment of premenarcheal inflammatory lesions may protect from postmenarcheal endometriosis since 3 of 5 did not need subsequent surgery.

    “Clear and red lesions” is not a classical appearance and has also been chlamydia associated inflammatory condition.

    Dan Martin, MD, Memphis, Tennessee

    • Ivo Brosens

      Thanks for the comments. What Marsh and Laufer described is very much supporting the modern view that peritoneal and ovarian endometriosis starts with implantation of shedding and implantation of progenitor epithelial and stromal cells. With the onset of premenarchal ovarian activity the dormant lesion is not expected to show glandular structures as in the adult,
      More data and discussion on the potential link between neonate uterine bleeding and pre-menarcheal and adolescent endometriosis are presented in the publication:
      Brosens I. et al. (2013) Neonatal uterine bleeding as antecedent of pelvic endometriosis. Human Reproduction 2013;28,2893-2897.

      Ivo Brosens, Leuven, Belgium

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