Apoptosis has been shown to be an important regulator of endometrium function. To study the regulation of apoptosis in the endometrium during the normal menstrual cycle, the expression of the apoptosis related proteins Bcl-2 and Bax and their correlation to serum estradiol and progesterone, as well as to a replication-related antigen Ki-67 were analyzed. Nine uterine tissue samples and thirty-nine endometrial biopsy specimens were studied. Apoptosis was studied quantitatively by Southern blot analysis of internucleosomal cleavage of genomic DNA, and qualitatively by using in situ 3'-end labeling of fragmented DNA, and Bcl-2, Bax and Ki-67 were detected and quantified immunohistochemically. Apoptotic cells were mostly detected in the glandular epithelium of late secretory and menstruating endometrium. Immunostaining of Ki-67 was detected predominantly in proliferative endometrium. The expression of Bcl-2 was high in proliferative endometrium and decreased in the secretory phase, being very low or absent in the mid- and late secretory and menstruatory phases. Similarly, Bax expression also decreased, but was still present throughout the secretory phase. In human endometrium, apoptosis occurs predominantly in the late secretory and menstrual phases, and is related to alterations in the expression of Bcl-2 and Bax. A decrease in the Bcl-2/Bax ratio in the early secretory phase precedes DNA fragmentation and may predispose the cells to apoptosis.