The fibrinolytic enzyme system in cervical mucus

Diffusable proteins of the mucosa of the human cervix, uterus, and fallopian tubes: distribution and variations during the menstrual cycle

The secretory proteins of the mucosa of the cervix, uterus, and fallopian tubes were investigated by measuring the proteins that were released by isolated mucosal areas. Initial screening disclosed that the immunoglobulins IgG and IgA were released in measurable quantities, but that IgM and the secretory (T) piece of IgA were either absent or present only in trace amounts. Relatively low levels of diffusable total complement activity and the C3 component of complement were present, whereas the C1q, C1r, and C4 components were either absent or present only in trace quantities. No neutral proteinase activity was present, but lysozyme, plasminogen activator, alpha 1-antitrypsin, and alpha 1x-antichymotrypsin could be found in reasonable amounts. The site of secretion, concentration, and cyclic variation of the proteins that diffused from the mucosal sites in measurable quantities were studied. The types and amounts of protein secreted by a particular site in the cervix, uterus, or fallopian tube varied from those of protein from other sites, even within the same organ. During the menstrual cycle, variations occurred in the amount of protein secreted by each mucosal site. However, whether an increase or a decrease in the release of a particular protein took place varied with each protein, even at the same site. The mucosal sites also differed from each other in their response to the phase of the menstrual cycle, that is, whether more or less protein was released, even sites within the same organ. The conclusion is that each organ and even different sites within an organ can respond independently from each other to changes in hormone levels, producing different types and amounts of secretory proteins. The amount of diffusable protein produced by an individual site during the menstrual cycle depends on the type of protein as well as the mucosal site.

An ultrastructural study of menstrual blood in normal menstruation and dysfunctional uterine bleeding

Menstrual fluid was obtained from the uterine cavity and vagina in 20 women within the first 48 h of menstruation. Ten of the women had normal menstrual cycles and blood loss and ten were patients with dysfunctional uterine bleeding. The menstrual samples were examined by electron microscopy for the presence of fibrin and platelets and nearly all were found to contain both fibrin and aggregating platelets. By a simple quantitative system no differences in fibrin and platelet content were found between samples collected from the uterine cavity or the vagina. Likewise no difference was found in the morphology of fibrin and platelets between women with normal menstrual loss and patients with dysfunctional uterine bleeding.

Fibrin and platelets in menstrual discharge before and after the insertion of an intrauterine contraceptive device

Eighteen samples of menstrual blood, taken before and after the insertion of an intrauterine contraceptive device (IUD), were collected from the uterine cavity during the first 32 hours of menstruation and studied with light and electron microscopy for the presence of fibrin and platelets. In 12 of the 18 samples extravascular fibrin and platelet aggregates with a high degree of transformation were found. Intravascular thrombi were seen in pieces of tissue in two preinsertion samples. The absence of any intravascular platelets or fibrin was the only consistent difference in postinsertion samples compared to preinsertion samples. This study demonstrates that, contrary to the current belief, clot formation and platelet aggregation do occur in menstrual blood. This process is uninfluenced by the presence of an IUD.

Lactate dehydrogenase in human cervical mucus: correlation with ovulation, influence of ovarian steroid hormones, and isozyme pattern

The glycolytic enzymes, lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase, and hexokinase in cervical mucus of 96 ovulatory women were serially measured daily during the menstrual cycle. Among all of the enzymes, the cyclic changes in LDH activity were the most significant, being high during the proliferative phase, gradually decreasing to the lowest level around ovulation, and then increasing markedly again. Estrogen inhibited cervical mucus LDH activity; progestrone accelerated it. Examination of the LDH isozyme pattern showed that H-LDH (H-subunit of LDH), being predominant throughout the cycle, apparently carries some responsibility for the cyclic change in LDH activity. In a comparison of LDH activity with the serum luteinizing hormone (LH) peak, the activity level nadir of LDH usually appeared between 1 day before and 1 day after the serum LH peak, pointing to the advantage of daily measurement of cervical mucus LDH activity for predicting the potential day of conception.

Cyclic changes of cervical mucus enzymes related to the time of ovulation. I. Alkaline phosphatase

The concentration of alkaline phosphatase in cervical mucus was serially determined during a menstrual cycle in five normal ovulatory women and correlated with the time of ovulation as monitored by the basal body temperature and radioimmunoassay of serum lutenizing hormone (LH), progesterone, and estradiol. The activity of alkaline phosphatase decreased significantly at midcycle just prior to the LH surge and began to rise after ovulation. Self-detection of cervical mucus alkaline phosphatase may provide a practical method of ovulation prediction.