Reverse development of the functional layer of the endometrium during the secretion phase. Diseases associated with proliferation

Today, one of the most common tests in the field of functional diagnostics is histological examination of endometrial scraping. To carry out functional diagnostics, the so-called “line scraping” is often used, which involves taking a small strip of the endometrium using a small curette. The entire female menstrual cycle is divided into three phases: proliferation, secretion, bleeding. In addition, the phases of proliferation and secretion are divided into early, middle, and late; and the bleeding phase - for desquamation, as well as regeneration. Based this study, we can say that the endometrium corresponds to the proliferation phase or some other phase.

When assessing the changes that occur in the endometrium, one should take into account the duration of the cycle, its main clinical manifestations(absence or presence of postmenstrual or premenstrual bleeding, duration menstrual bleeding, volume of blood loss, etc.).

Proliferation phase

The endometrium of the early stage of the proliferation phase (the fifth to seventh day) has the form of straight tubes with a small lumen; on its cross section, the contours of the glands are round or oval; the epithelium of the glands is low, prismatic, the nuclei have oval shape, located at the base of the cells, intensely colored; The surface of the mucosa is lined with cuboidal epithelium. The stroma includes spindle-shaped cells with large nuclei. But the spiral arteries are weakly tortuous.

In the middle stage (eighth to tenth day), the surface of the mucosa is lined with high prismatic epithelium. The glands are slightly convoluted. There are many mitoses in the nuclei. A mucus border may appear at the apical edge of certain cells. The stroma is edematous and loosened.

In the late stage (eleventh to fourteenth day), the glands acquire a tortuous outline. Their lumen is already expanded, the nuclei are located at different levels. In the basal part of some cells, small vacuoles that contain glycogen begin to appear. The stroma is juicy, its nuclei increase, are colored and rounded with less intensity. The vessels become convoluted.

The described changes are characteristic of normal menstrual cycle, may be observed in pathology

during the second half monthly cycle during an anovulatory cycle;
with dysfunctional uterine bleeding due to anovulatory processes;
in the case of glandular hyperplasia - in different areas endometrium.

When tangles of spiral vessels are detected in the functional layer of the endometrium corresponding to the proliferation phase, then this indicates that the previous menstrual cycle was two-phase, and during the next menstruation the process of rejection of the entire functional layer did not occur, it only underwent reverse development.

Secretion phase

During the early stage of the secretion phase (fifteenth to eighteenth day), subnuclear vacuolization is detected in the epithelium of the glands; are pushed into the central departments nuclear cells; the nuclei are located on the same level; The vacuoles contain glycogen particles. The lumens of the glands are dilated; traces of secretion may already be revealed in them. The endometrial stroma is juicy and loose. The vessels become even more tortuosity. A similar structure of the endometrium is usually found with the following hormonal disorders:

in case of defective corpus luteum at the end of the monthly cycle;
in case of delayed onset of ovulation;
in the case of cyclic bleeding that occurs due to the death of the corpus luteum, which has not reached its prime stage;
in the case of acyclic bleeding, which is caused by the early death of the still defective corpus luteum.

During the middle stage of the secretion phase (nineteenth to twenty-third day), the lumens of the glands are expanded and their walls are folded. Epithelial cells are low, filled with secretion, which is separated into the lumen of the gland. A decidua-like reaction begins to appear in the stroma during the twenty-first to twenty-second day. The spiral arteries are sharply tortuous and form tangles, which is one of the most reliable signs of an absolutely complete luteal phase. This endometrial structure can be observed:

with increased prolonged function of the corpus luteum;
due to reception large dosages progesterone;
during early date intrauterine pregnancy;
in case of progressive ectopic pregnancy.

During the late stage of the secretion phase (twenty-fourth to twenty-seventh day), due to regression of the corpus luteum, the juiciness of the tissue is minimized; the height of the functional layer decreases. The folding of the glands increases, obtaining a sawtooth shape. There is a secret in the lumen of the glands. The stroma has an intensely expressed perivascular decidua-like reaction. Spiral vessels form coils that are closely adjacent to each other. On the twenty-sixth to twenty-seventh days, the venous vessels are filled with blood with the appearance of blood clots. Infiltration of leukocytes appears in the stroma of the compact layer; Focal hemorrhages appear and increase, as well as areas of edema. This condition must be differentiated from endometritis, when the cellular infiltrate is located mainly around the glands and vessels.

Bleeding phase

In the phase of menstruation or bleeding, the desquamation stage (twenty-eighth - second day) is characterized by an increase in changes that are noted for the late secretory stage. The process of endometrial shedding begins from the superficial layer and has focal character. Desquamation ends completely by the third day of menstruation. Morphological feature monthly phase the detection of collapsed star-shaped glands in necrotic tissue appears. The regeneration process (the third or fourth day) is carried out from the tissues of the basal layer. By the fourth day, the mucous membrane is normally epithelialized. Impaired endometrial rejection and regeneration can be caused by slow processes or incomplete endometrial rejection.

The abnormal state of the endometrium is characterized by so-called hyperplastic proliferative changes (glandular cystic hyperplasia, glandular hyperplasia, adenomatosis, mixed form of hyperplasia), as well as hypoplastic conditions (non-functioning, resting endometrium, transitional endometrium, hypoplastic, dysplastic, mixed endometrium).

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The endometrium is the mucous layer that lines the inside of the uterus. Its functions include ensuring implantation and development of the embryo. In addition, the menstrual cycle depends on the changes occurring in it.

One of important processes occurring in a woman’s body, endometrial proliferation occurs. Disturbances in this mechanism cause the development of pathology in the reproductive system. The proliferative endometrium marks the first phase of the cycle, that is, the stage that occurs after the end of menstruation. During this stage, endometrial cells begin to actively divide and grow.

Proliferation concept

Proliferation is the active process of cell division in a tissue or organ. As a result of menstruation, the mucous membranes of the uterus become very thin due to the fact that the cells that make up the functional layer are rejected. This is what determines the process of proliferation, since cell division renews the thinned functional layer.

However, proliferative endometrium does not always indicate normal functioning reproductive system women. Sometimes it can occur in the event of pathology development, when cells divide too actively, thickening slime layer uterus.

Causes

As mentioned above, natural cause the appearance of proliferative endometrium - the end of the menstrual cycle. The rejected cells of the uterine mucosa are excreted from the body along with the blood, thereby thinning the mucous layer. Before the next cycle occurs, the endometrium needs to restore this functional area of the mucosa through the process of division.

Pathological proliferation occurs as a result of excessive stimulation of cells by estrogen. Consequently, when the mucous layer is restored, endometrial division does not stop and the walls of the uterus thicken, which can lead to the development of bleeding.

Process phases

There are three phases of proliferation (with its normal course):

Early phase. It occurs during the first week of the menstrual cycle and at this time it can be detected on the mucous layer epithelial cells, as well as stromal cells.
Middle phase. This stage begins on the 8th day of the cycle and ends on the 10th. During this period, the glands enlarge, the stroma swells and loosens, and the cells stretch epithelial tissue.
Late phase. The proliferation process stops on the 14th day from the beginning of the cycle. At this stage, the mucous membrane and all glands are completely restored.

Diseases

The process of intensive division of endometrial cells can fail, as a result of which cells appear beyond required quantity. These newly formed “building” materials can combine and lead to the development of tumors such as proliferative endometrial hyperplasia.

It is a consequence of hormonal disruption in the monthly cycle. Hyperplasia is a proliferation of endometrial and stromal glands and can be of two types: glandular and atypical.

Types of hyperplasia

The development of such an anomaly occurs mainly in women at menopausal age. The main reason is most often a large number of estrogens, which affect endometrial cells, activating their excessive division. With the development of this disease, some fragments of the proliferative endometrium acquire a very dense structure. In particularly affected areas, the compaction can reach 1.5 cm in thickness. In addition, the formation of proliferative type polyps on the endometrium located in the organ cavity is possible.

This type of hyperplasia is considered precancerous condition and is found most often in women during menopause or in old age. In young girls, this pathology is diagnosed very rarely.

Atypical hyperplasia is considered to be a pronounced proliferation of the endometrium, which has adenomatous sources located in the branching of the glands. Examining scrapings from the uterus, one can detect a large number of tubular epithelial cells. These cells can have both large and small nuclei, and in some they can be stretched. In this case, the tubular epithelium can be either in groups or separately. The analysis also shows the presence of lipids on the walls of the uterus, it is their presence that is important factor in making a diagnosis.

Transition from atypical glandular hyperplasia to cancer occurs in 3 women out of 100. This type of hyperplasia is similar to endometrial proliferation during a normal monthly cycle, however, during the development of the disease, there are no decidual tissue cells on the uterine mucosa. Sometimes the process of atypical hyperplasia can be reversed, however, this is only possible under the influence of hormones.

Symptoms

With the development of proliferative endometrial hyperplasia, following symptoms:

The menstrual functions of the uterus are disrupted, manifested by bleeding.
There is a deviation in the menstrual cycle, in the form of intense cyclic and prolonged bleeding.
Metrorrhagia develops - unsystematic and non-cyclical bleeding of varying intensity and duration.
Bleeding occurs between periods or after their delays.
Observed breakthrough bleeding with the release of clots.
Constant occurrence bleeding provokes the development of anemia, malaise, weakness and frequent dizziness.
An anovulatory cycle occurs, which can cause infertility.

Diagnostics

Due to similarity clinical picture glandular hyperplasia with other pathologies diagnostic measures are of great importance.

Diagnosis of endometrial hyperplasia of the proliferative type is carried out using the following methods:

Studying the patient's history and complaints related to the time of onset of bleeding, its duration and frequency. Accompanying symptoms are also studied.
Analysis of obstetric and gynecological information which include heredity, pregnancy, contraceptive methods used, past illnesses(not only gynecological), operations, diseases transmitted through sexual contact, etc.
Analysis of information about the beginning of the menstrual cycle (patient’s age), its regularity, duration, pain and profuseness.
Bimanual examination performed by a gynecologist vaginal examination.
Gynecological smear collection and microscopy.
Prescription of transvaginal ultrasound, which determines the thickness of the uterine mucosa and the presence of proliferative endometrial polyps.
Determination using ultrasound of the need for an endometrial biopsy to make a diagnosis.
Carrying out separate curettage using a hysteroscope, which performs scraping or complete removal pathological endometrium.
Histological examination scrapings to determine the type of hyperplasia.

Treatment methods

Therapy for glandular hyperplasia is carried out various methods. It can be either operative or conservative.

Surgical treatment of pathology of the proliferative type of the endometrium involves complete removal of areas that have undergone deformation:

The cells affected by the pathology are scraped out from the uterine cavity.
Surgical intervention by hysteroscopy.

Surgical intervention is provided in the following cases:

the patient’s age allows her to perform the reproductive function of the body;
the woman is “on the threshold” of menopause;
in cases of presence heavy bleeding;
after detection of a proliferative type on the endometrium

The materials obtained as a result of curettage are sent for histological analysis. Based on its results and in the absence of other diseases, the doctor may prescribe conservative therapy.

Conservative treatment

This therapy involves certain methods of influencing pathology. Hormone therapy:

Oral hormonal combined contraceptives are prescribed and should be taken for 6 months.
A woman takes pure gestagens (progesterone preparations), which help reduce the body's secretion of sex hormones. These medications should be taken for 3-6 months.
A gestagen-containing intrauterine device, affecting endometrial cells in the body of the uterus. The validity period of such a spiral is up to 5 years.
Prescribing hormones intended for women over 35 years of age, which also have a positive effect on treatment.

Therapy aimed at general strengthening body:

Taking complexes of vitamins and minerals.
Reception iron-containing preparations.
Purpose sedatives.
Carrying out physiotherapeutic procedures (electrophoresis, acupuncture, etc.).

Moreover, to improve general condition for patients with excess body weight are developed therapeutic diet, as well as activities aimed at physically strengthening the body.

Preventive actions

Measures to prevent the development of proliferative endometrial hyperplasia may be as follows:

regular examination by a gynecologist (twice a year);
taking preparatory courses during pregnancy;
selection of suitable contraceptives;
Immediately consult a doctor if any disturbances in the functioning of the pelvic organs occur.
quitting smoking, alcohol and others bad habits;
regular feasible physical exercise;
healthy eating;
careful monitoring of personal hygiene;
reception hormonal drugs only after consultation with a specialist;
avoid abortion procedures by using necessary means contraception;
take place annually full examination body and if a deviation from the norm is detected, immediately consult a doctor.

To avoid relapses of proliferative type endometrial hyperplasia, it is necessary:

regularly consult with a gynecologist;
undergo examinations by a gynecologist-endocrinologist;
consult with a specialist when choosing methods of contraception;
lead a healthy lifestyle.

Forecasts

The prognosis for the development and treatment of endometrial proliferative gland hyperplasia directly depends on the timely detection and treatment of the pathology. By contacting your doctor for early stages disease, a woman has a high chance of being completely cured.

However, one of the most serious complications hyperplasia can become infertility. The reason for this is a failure hormonal levels, leading to the disappearance of ovulation. Timely diagnosis of the disease and effective therapy will help to avoid this.

Very often there are cases of recurrence of this disease. Therefore, a woman needs to regularly visit a gynecologist for an examination and follow all his recommendations.

The endometrium of the proliferative type is an intensive growth of the mucous uterine layer, occurring against the background of hyperplastic processes caused by excessive division of the cellular structures of the endometrium. With this pathology, gynecological diseases develop and reproductive function is disrupted. When faced with the concept of proliferative endometrium, it is necessary to understand what this means.

Endometrium - what is it? This term refers to the mucous layer lining the inner uterine surface. This layer is complex structural structure, which includes the following fragments:

glandular epithelial layer;
main substance;
stroma;
blood vessels.

The endometrium performs important functions in the female body. It is the mucous uterine layer that is responsible for attachment ovum and the onset of a successful pregnancy. After conception, the endometrial blood vessels provide the fetus with oxygen and essential nutrients.

Proliferation of the endometrium promotes the growth of the vascular bed for normal blood supply to the embryo and the formation of the placenta. During the menstrual cycle, a number of cyclic changes occur in the uterus, divided into the following successive stages:

Endometrium in the proliferation phase - characterized by intensive growth due to the proliferation of cellular structures through their active division. In the proliferation phase, the endometrium grows, which can be completely normal physiological phenomenon, part of the menstrual cycle, and a sign of dangerous pathological processes.
Secretion phase - at this stage, the endometrial layer is prepared for the menstrual phase.
Menstrual phase, endometrial desquamation - desquamation, rejection of the overgrown endometrial layer and its removal from the body with menstrual blood.

To adequately assess the cyclic changes of the endometrium and the extent to which its condition corresponds to the norm, it is necessary to take into account factors such as the duration of the menstrual cycle, the stages of proliferation and the secretive period, the presence or absence of dysfunctional uterine bleeding.

Phases of endometrial proliferation

The process of endometrial proliferation includes several successive stages, which corresponds to the concept of normality. The absence of one of the phases or failures in its course may mean the development of a pathological process. The entire period takes two weeks. During this cycle, follicles mature, stimulating the secretion of the hormone estrogen, under the influence of which the endometrial uterine layer grows.

Highlight next stages proliferation phases:

Early - lasts from 1 to 7 days of the menstrual cycle. At the early stage of the phase, the uterine mucosa changes. Epithelial cells are present on the endometrium. Blood arteries practically do not twist, and stromal cells have a specific shape that resembles a spindle.
The middle phase is a short phase, occurring between the 8th and 10th days of the menstrual cycle. The endometrial layer is characterized by the formation of certain cellular structures formed during indirect division.
The late stage lasts from 11 to 14 days of the cycle. The endometrium is covered with convoluted glands, the epithelium is multilayered, the cell nuclei have round shape and large sizes.

The stages listed above must meet the established norm criteria, and they are also inextricably linked with the secretory phase.

Phases of endometrial secretion

The secretory endometrium is dense and smooth. Secretory transformation of the endometrium begins immediately after completion of the proliferation stage.

Experts distinguish the following stages of secretion of the endometrial layer:

Early stage - observed from 15 to 18 days of the menstrual cycle. At this stage, secretion is very weakly expressed, the process is just beginning to develop.
Middle stage secretion phase - occurs from 21 to 23 days of the cycle. This phase is characterized by increased secretion. A slight suppression of the process is noted only at the end of the stage.
Late - for the late stage of the secretion phase, suppression of secretory function is typical, which reaches its peak at the onset of menstruation itself, after which the process of reverse development of the endometrial uterine layer begins. The late phase is observed in the period from 24-28 days of the menstrual cycle.

Proliferative diseases

Proliferative endometrial diseases - what does this mean? Typically, the secretory type endometrium poses virtually no threats to a woman’s health. But the mucous uterine layer during the period proliferative phase grows intensively under the influence certain hormones. This condition carries a potential danger in terms of the development of diseases caused by pathological, increased division of cellular structures. The risks of developing tumors, both benign and malignant, increase. Among the main pathologies of the proliferative type, doctors identify the following:

Hyperplasia- pathological proliferation of the uterine endometrial layer.

This disease is manifested by such clinical signs as:

menstrual irregularities,
uterine bleeding,
pain syndrome.

With hyperplasia, the reverse development of the endometrium is disrupted, the risks of infertility increase, reproductive dysfunction and anemia develop (against the background of heavy blood loss). The likelihood of malignant degeneration of endometrial tissue and the development of cancer also increases significantly.

Endometritis - inflammatory processes, localized in the area of the mucous uterine endometrial layer.

This pathology manifests itself:

uterine bleeding,
heavy, painful menstruation,
vaginal discharge of a purulent-bloody nature,
aching pain localized in the lower abdomen,
painful intimate contacts.

Endometritis also negatively affects reproductive functions female body, provoking the development of complications such as problems with conception, placental insufficiency, the threat of miscarriages and spontaneous abortion in the early stages.

Uterine cancer- one of the most dangerous pathologies, developing in the proliferative period of the cycle.

IN to the greatest extent this malignant disease patients are susceptible to age category over 50 years old. The disease manifests itself as active exophytic growth simultaneously with concomitant infiltrating germination into muscle tissue. The danger of this type of oncology lies in its practically asymptomatic course, especially in early stages pathological process.

First clinical sign are leucorrhoea - vaginal discharge mucous in nature, but, unfortunately, most women do not pay much attention to this.

Such people should be wary clinical symptoms, How:

uterine bleeding,
pain localized in the lower abdomen,
increased urge to urinate,
bloody vaginal discharge,
general weakness and increased fatigue.

Doctors note that most proliferative diseases develop against the background of hormonal and gynecological disorders. The main provoking factors include endocrine disorders, diabetes, uterine fibroids, endometriosis, hypertension, overweight bodies.

To the group increased risk gynecologists include women who have undergone abortions, miscarriages, curettage, surgical interventions on the organs of the reproductive system, abusing hormonal agents contraception.

For warning and timely detection similar diseases It is necessary to monitor your health, and be examined by a gynecologist at least 2 times a year for the purpose of prevention.

The danger of suppressing proliferation

Inhibition of proliferative processes in the endometrial layer is a fairly common phenomenon, characteristic of the menopause and the decline of ovarian functions.

In patients reproductive age this pathology is fraught with the development of hypoplasia and dysmenorrhea. During processes of a hypoplastic nature, thinning of the mucous uterine layer occurs, as a result of which the fertilized egg cannot attach normally to the wall of the uterus, and pregnancy does not occur. The disease develops against the background of hormonal disorders and requires adequate, timely medical care.

Proliferative endometrium - a growing mucous uterine layer, can be a manifestation of the norm or a sign of dangerous pathologies. Proliferation is characteristic of the female body. During menstruation, the endometrial layer is shed, after which it is gradually restored through active cell division.

For patients with reproductive disorders, it is important to take into account the stage of endometrial development when performing diagnostic examinations, because in different periods indicators may differ significantly.

The hysteroscopic picture of the unchanged endometrium depends on the phase of the menstrual cycle (in the reproductive period) and the duration of menopause (in the postmenopausal period). As is known, the control of the normal menstrual cycle occurs at the level of specialized neurons of the brain, which receive information about the condition external environment, convert it into neurohormonal signals (norepinephrine), which subsequently enter the neurosecretory cells of the hypothalamus.

In the hypothalamus (at the base of the third ventricle), under the influence of norepinephrine, gonadotropin-releasing factor (GTRF) is synthesized, which ensures the release of hormones of the anterior pituitary gland into the bloodstream - follicle-stimulating hormone (FSH), luteinizing hormone (LH) and lactotropic (prolactin, PRL) hormones. Role of FSH and LH in the regulation of the menstrual cycle is quite clearly defined: FSH stimulates the growth and maturation of follicles, LH - steroidogenesis. Under the influence of FSH and LH, the ovaries produce estrogens and progesterone, which, in turn, cause cyclic transformations in the target organs - the uterus, fallopian tubes ah, vagina, and also in the mammary glands, skin, hair follicles, bones, adipose tissue.

The secretion of estrogen and progesterone by the ovaries is accompanied by cyclic transformations in both the muscular and mucous membranes of the uterus. In the follicular phase of the cycle, hypertrophy of myometrial cells occurs, and in the luteal phase, their hyperplasia occurs. In the endometrium, the follicular and luteal phases correspond to periods of proliferation and secretion (in the absence of conception, the secretion phase is replaced by a desquamation phase - menstruation). The proliferation phase begins with slow growth of the endometrium. The early proliferative phase (up to 7-8 days of the menstrual cycle) is characterized by the presence of short elongated glands with narrow lumens, lined with columnar epithelium, in the cells of which numerous mitoses are observed.

There is rapid growth of spiral arteries. The middle proliferative phase (up to 10-12 days of the menstrual cycle) is characterized by the appearance of elongated convoluted glands and moderate edema of the stroma. Spiral arteries become tortuous due to their faster growth compared to endometrial cells. In the late phase of proliferation, the glands continue to enlarge, become sharply convoluted, and acquire an oval shape.

IN early phase secretion (the first 3-4 days after ovulation, until the 17th day of the menstrual cycle), further development of the glands and expansion of their lumen are observed. In epithelial cells, mitoses disappear, and the concentration of lipids and glycogen in the cytoplasm increases. The middle stage of secretion (19-23 days of the menstrual cycle) reflects the transformations characteristic of the heyday of the corpus luteum, i.e. period of maximum gestagenic saturation. The functional layer becomes higher and is clearly divided into deep (spongy) and superficial (compact) layers.

The glands expand, their walls become folded; A secretion appears in the lumen of the glands, containing glycogen and acidic glycosaminoglucuronglycans (mucopolysaccharides). The stroma with the phenomena of a perivascular decidual reaction, in its interstitial substance the amount of acidic glycosaminoglucuronglycans increases. Spiral arteries are sharply tortuous, forming “tangles” (the most reliable sign, determining the luteinizing effect).

Late stage of secretion (24-27 days of the menstrual cycle): during this period, processes associated with regression of the corpus luteum and, consequently, a decrease in the concentration of hormones produced by it are observed - the trophism of the endometrium is disrupted, its degenerative changes are formed, morphologically the endometrium regresses, signs of its ischemia appear . At the same time, the juiciness of the tissue decreases, which leads to wrinkling of the stroma of the functional layer. The folding of the walls of the glands intensifies.

On the 26-27th day of the menstrual cycle in surface layers of the compact layer, lacunar expansion of capillaries and focal hemorrhages into the stroma are observed; due to the melting of the fibrous structures, areas of separation of the cells of the stroma and the epithelium of the glands appear. Similar condition endometrium is called “anatomical menstruation” and immediately precedes clinical menstruation.

In the mechanism of menstrual bleeding important attributed to circulatory disorders caused by prolonged spasm of the arteries (stasis, blood clots, fragility and permeability vascular wall, hemorrhage into the stroma, leukocyte infiltration). The result of these transformations is necrobiosis of the tissue and its melting. Due to the dilation of blood vessels that occurs after a long spasm, a large amount of blood enters the endometrial tissue, which leads to rupture of blood vessels and rejection (desquamation) of necrotic sections of the functional layer of the endometrium, i.e. to menstrual bleeding.

The regeneration phase is quite short and is characterized by the regeneration of the endometrium from the cells of the basal layer. Epithelialization wound surface comes from the marginal parts of the glands basement membrane, as well as from the unrejected deep sections of the functional layer.

Normally, the uterine cavity has the shape of a triangular slit, in upper divisions which opens the mouths of the fallopian tubes, and its lower section through internal hole communicates with the cervical canal. It is advisable to evaluate the endoscopic picture of the uterine mucosa during an undisturbed menstrual cycle taking into account the following criteria:
1) the nature of the mucosal surface;
2) the height of the functional layer of the endometrium;
3) the condition of the endometrial tubular glands;
4) structure of mucosal vessels;
5) the condition of the orifices of the fallopian tubes.

During the early phase of proliferation the endometrium is pale pink or yellow-pink, thin (up to 1-2 mm). The excretory ducts of the tubular glands are clearly visualized and evenly distributed. A dense vascular network is identified through the thin mucosa. In some areas they are illuminated minor hemorrhages. The mouths of the fallopian tubes are free, easily identified in the form of oval or slit-like passages, localized in the recesses of the lateral sections of the uterine cavity.

1 - the mouth of the fallopian tube is free, defined as a slit-like passage

IN mid and late proliferation phases the endometrium acquires a folded character (thickened longitudinal and/or transverse folds are visualized) and a bright pink uniform hue. The height of the functional layer of the mucosa increases. The lumen of the tubular glands becomes less noticeable due to the tortuosity of the glands and moderate edema of the stroma (in the preovulatory period the lumen of the glands is not determined). Mucosal vessels can be identified only in the middle phase of proliferation; in the late stage of proliferation, the vascular pattern is lost. The orifices of the fallopian tubes, in comparison with the early phase of proliferation, are less clearly defined.

1 - endocervix; 2 - fundus of the uterus; 3 - the mouth of the fallopian tube; in this phase, the lumen of the glands is less noticeable, but the vessels can be identified

IN early phase of secretion The endometrium is distinguished by a pale pink tone and a velvety surface. The height of the functional layer of the mucosa reaches 4-6 mm. During the heyday of the corpus luteum, the endometrium becomes succulent with multiple folds that have a flat top. The spaces between the folds are defined as narrow gaps. The orifices of the fallopian tubes, due to severe swelling and folding of the mucosa, are often not visualized or are barely noticeable. Naturally, the vascular pattern of the endometrium cannot be detected. On the eve of menstruation, the endometrium acquires a bright, intense shade. In this period, dark purple layers are identified, freely hanging into the uterine cavity - fragments of rejected endometrium.

in the indicated period, dark purple layers are identified, freely hanging into the uterine cavity - fragments of rejected endometrium (1)

IN first day of menstruation a large number of mucous fragments are determined, the color of which varies from pale yellow to dark purple, as well as blood clots and mucus. In areas with complete rejection of the functional layer, numerous pinpoint hemorrhages are visualized against a pale pink background.

In the postmenopausal period, involutive processes progress in the reproductive system of women, caused by a decrease in the regenerative potential of cells. Atrophic processes are observed in all organs of the reproductive system: the ovaries shrink and become sclerotic; the weight of the uterus decreases, its muscular elements are replaced by connective tissue; The vaginal epithelium becomes thinner. In the first years of menopause, the endometrium has a transitional structure, characteristic of the premenopausal period.

Subsequently (as the ovarian function progressively declines), the resting non-functioning endometrium is transformed into an atrophic one. In low atrophic endometrium, the functional layer is indistinguishable from the basal layer. The wrinkled compact stroma, rich in fibers, including collagen, contains small single glands lined with low single-row columnar epithelium. The glands look like straight tubes with a narrow lumen. There are simple and cystic atrophy. Cystically dilated glands are lined with low, single-row columnar epithelium.

Hysteroscopic picture in postmenopause is determined by its duration. In the period corresponding to the transitional mucosa, the latter is characterized pale pink, weak vascular pattern, single point and scattered hemorrhages. The mouths of the fallopian tubes are free, and near them the surface of the uterine cavity is pale yellow with a dull tint. The atrophic endometrium has a uniform pale or pale yellow color, the functional layer is not identified. The vascular network is often not visualized, although mucosal varicose veins may be observed. The uterine cavity is sharply reduced, the mouths of the fallopian tubes are narrowed.

With induced endometrial atrophy due to the influence of exogenous hormones (the so-called glandular hypoplasia with glandular-stromal dissociation), the surface of the mucosa is uneven (“cobblestone-like”), yellow-brown in color. The height of the functional layer does not exceed 1-2 mm. Deep stromal vessels are visible between the “cobblestones”. The mouths of the fallopian tubes are well visualized, their lumen is narrowed.

The study of the endoscopic anatomy of the endometrium and the walls of the uterine cavity allows not only to evaluate cyclic changes in the mucous membrane of patients examined for infertility, but also to carry out differential diagnosis between normal and pathological transformation of the endometrium. Briefly, the main provisions of this chapter can be presented as follows:

proliferation phase:

1) the surface of the mucosa is smooth, the color is pale pink;
2) the height of the functional layer of the endometrium is within 2-5 mm;
3) excretory ducts glands are visualized and evenly distributed;
4) the vascular network is dense but thin;
5) the mouths of the fallopian tubes are free;

secretion phase:

1) the surface of the mucosa is velvety, with numerous folds, the color is pale pink or pale yellow;
2) the height of the functional layer of the endometrium is within 4-8 mm;
3) the excretory ducts of the glands are not identified due to stromal edema;
4) the vascular network is not determined;
5) the mouths of the fallopian tubes are often not visualized or barely noticeable;

endometrial atrophy:

1) the surface of the mucosa is smooth, the color is pale pink or pale yellow;
2) the height of the functional layer of the endometrium is less than 1 mm;

4) the vascular pattern is weakly expressed or not defined;
5) the mouths of the fallopian tubes are free, but narrowed;

induced endometrial atrophy:

1) the surface of the mucosa is uneven (“cobblestone-like”), the color is yellow-brown;
2) the height of the functional layer of the endometrium is up to 1-2 mm;
3) the excretory ducts of the glands are not identified;
4) deep stromal vessels are visible between the “cobblestones”;
5) the mouths of the fallopian tubes are free, but narrowed.

A.N. Strizhakov, A.I. Davydov

The endometrial proliferation stage is a natural process of the monthly female cycle. But not always clear changes can lead to negative consequences. Today there is not a single set of measures that would help prevent the appearance of the disease in the uterus.

Proliferative endometrium - what is it? To understand this issue, you should start with the functions of the female body. Throughout the menstrual cycle, the inner surface of the uterus undergoes some changes. These changes are cyclical in nature and primarily affect the endometrium. This mucosal layer lines the uterine cavity and is the main supplier of blood to the organ.

Endometrium and its significance

The structure of this part of the uterus is quite complex.

It consists of:

glandular and integumentary layers of the epithelium;
main substance;
stroma;
blood vessels.

Important! The main function of the endometrium is to create the best conditions for survival in the uterine organ.

That is, it creates a microclimate in the cavity that is optimal for the embryo to attach and develop in the uterus. Thanks to the implementation of such processes after conception has occurred, the amount of blood arteries and glands. They will become part of the placenta and will deliver oxygen and nutrition to the fetus.

Over the course of a month, changes occur in the uterine organ, which mainly affect the internal mucous membrane.

There are 4 phases of the cycle:

proliferative;
menstrual;
secretory;
presecretory.

Return to zmystMenstrual, proliferative, presectoral and sectoral phases

During this period, two-thirds of the endometrial layer dies and is rejected. But immediately, as soon as menstruation begins, this membrane begins to restore its structure. By the fifth day she is fully restored. This process is possible due to the division of cells of the basal ball of the endometrium. In the first week, the endometrium has a very thin structure.

This stage has two periods. Early lasts from 5 to 11 days, late - from 11 to 14 days. At this time, rapid growth of the endometrium occurs. From the time of menstruation until the moment of ovulation, the thickness of this membrane increases 10 times. The early and late stages differ in that in the first case the inner surface of the uterus has a low columnar epithelium and the glands have a tubular structure.

During the second option proliferative stage the epithelium becomes higher, the glands find a long wavy shape. It begins on the 14th day of the monthly cycle and lasts 7 days. That is, the first week after ovulation. This is the time when, in the epithelial cells, the nuclei move towards the passage of the tubules. As a result of such processes, at the base of the cells themselves there remain free places, in which glycogen accumulates.

During this period, the endometrial glands increase significantly. They acquire a twisted, corkscrew-like shape, and papillary outgrowths appear. As a result, the structure of the cover becomes saccular. The glandular cells become larger and secrete a mucous substance. It stretches the lumen of the canals. The spindle-shaped connective tissue cells of the stroma become large polygonal. Lipids and glycogen accumulate in them.

The highest stage of endometrial development has a dense superficial, middle spongy and inactive basaltic ball.

The proliferative stage of the endometrium is combined with a period of follicular activity of the ovaries.

Return to the topicPeculiarities of endometrial proliferation

Hysteroscopy of the proliferative type of endometrium depends on the day of the cycle. In the early period (the first 7 days) it is thin, even, and has a pale pink tint. In some places, small hemorrhages and non-rejection of membrane fragments are visible. The shape of the uterus can change depending on the woman's age.

In young women, the bottom of the organ may protrude into its cavity and have a depression in the area of the corners. An inexperienced doctor may mistake this structure for a saddle-shaped or bicornuate uterus. But with this diagnosis, the septum drops quite low, sometimes it can reach internal pharynx. Therefore, to confirm this pathology, it is better to undergo research in several different clinics. IN late period the endometrial layer becomes thick and saturated pink color with a white tint, the vessels are no longer visible. During this period of proliferation, in some areas the membrane may have thickened folds. It is at this stage that the mouth of the fallopian tubes is examined.

Return to mystuproliferative diseases

During the period of endometrial proliferation, increased cell division occurs. Sometimes the process itself fails, resulting in an excess amount of newly formed tissue, which can lead to the appearance of a tumor, for example, endometrial hyperplasia. The latter develops as a result hormonal disorders menstrual cycle. It turns out to be proliferation of stromal and endometrial glands. This disease has two forms: glandular and atypical.

Return to zmistZalozista and atypical endometrial hyperplasia

This pathology occurs mainly in women of menopausal age. The reason for the development this disease There may be hyperestrogenism or a long period of action of estrogens on the endometrium, provided their amount in the blood is low. With this diagnosis, the endometrium has a thick structure and protrudes into the organ cavity in the form of polyps.

The morphology of glandular cystic hyperplasia is presented a large number cells of columnar (less often cubic) epithelium. These particles are larger in shape than normal cells; therefore, the nucleus and basophilic cytoplasm are also larger. Such elements accumulate in groups or create gland-like structures. A feature of this form of proliferative type endometrial hyperplasia is that there is no further distribution of newly formed cells. Such a pathology very rarely degenerates into a malignant tumor.

This type of disease is referred to as precancerous. It occurs mainly during menopause, in old age. In young women, this pathology is not observed. Atypical hyperplasia is a pronounced proliferation in the endometrium with adenomatous foci consisting of branching glands. When conducting a study, you can find a large number of large columnar epithelial cells that have large nuclei with smaller nucleoli. The ratio of nucleus to cytoplasm (basophilic) remains virtually unchanged. In addition, there are large cells that have a slightly enlarged nucleus and a very large cytoplasm. There are also clear cells with lipids, and based on their presence, a disappointing diagnosis is made.

Atypical glandular hyperplasia develops into cancer in 2-3 patients out of a hundred. Columnar epithelial cells in this case can be located either separately or in groups. Similar elements are present during the proliferative phase of the monthly cycle without pathology, but during the disease there are no cells of decidual tissue. Sometimes atypical hyperplasia can have the opposite process. But this is possible only in the case of hormonal influence.