Endometrial apoptosis in patients with dysfunctional uterine bleeding

Aims: To assess glandular apoptosis in the zona functionalis of proliferati ve phase endometrium in normal individuals and in patients with dysfunction al uterine bleeding (DUB). Methods and results: Routinely processed, haematoxylin and eosin-stained en dometrial biopsies were assessed in 26 patients with symptomatic menstrual abnormality, mainly menorrhagia, and in 2-2 controls. All biopsies were in the proliferative phase and had been reported as within normal limits and c onsistent with the menstrual cycle dates provided. Apoptotic and mitotic fi gures were counted in a minimum of 100 transversely sectioned endometrial g lands in all cases. In 16 biopsies (12 DUB and four controls) apoptosis was further assessed using the in situ terminal deoxynucleotidyl-transferase m ediated 2'-deoxyuridine-5'-triphosphate (dUTP) nick-end labelling (TUNEL) m ethod. Apoptotic figures were identified in most control biopsies averaging 5.6/100 glands, and were significantly increased in biopsies from patients with DUB averaging 13.9/100 glands. There was no difference in mitotic fig ure counts. Apoptoses tended to be clustered within adjacent glands in both groups and individual glands exhibited both mitotic and apoptotic activity , Application of the TUNEL method gave broad agreement with morphological a ssessment although approximately 20-25% of typical apoptotic figures were n ot labelled. Conclusions: Endometrial glandular apoptosis is present in most normal prol iferative phase biopsies and appears increased in some cases of DUE. The si gnificance of this finding is not known but increased apoptosis may serve a s a morphological marker of abnormal endometrial development in otherwise n ormal biopsy specimens.