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

Today, one of the most common tests in the field of functional diagnostics is a histological examination of endometrial scrapings. For functional diagnostics, the so-called “stroke scraping” is often used, which involves taking a small strip of the endometrium with 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 phase of proliferation or some other phase.

When evaluating 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 blood compartments, duration menstrual bleeding, volume of blood loss, etc.).

Proliferation phase

The endometrium of the early stage of the proliferation phase (fifth-seventh day) has the form of straight tubes with a small lumen; on its transverse 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 stained; The mucosal surface 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 tortuous. There are many mitoses in the nuclei. On the apical edge of certain cells, a border of mucus may be revealed. The stroma is edematous, loosened.

In the late stage (eleventh to fourteenth day) the glands get a tortuous outline. Their lumen is already expanded, the nuclei are located at different levels. In the basal section of some cells, small vacuoles containing glycogen begin to appear. The stroma is juicy, its nuclei increase, stain and round with less intensity. Vessels become convoluted.

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

• during the second half monthly cycle with an anovulatory cycle;
• with dysfunctional uterine bleeding due to anovulatory processes;
• in 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; vacuoles are pushed into central departments nucleus cells; nuclei are located on the same level; vacuoles contain particles of glycogen. The lumens of the glands are enlarged, traces of secretion may already be revealed in them. The stroma of the endometrium is juicy, loose. The vessels become even more tortuosity. A similar structure of the endometrium is usually found in such 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 the flowering stage;
• in the case of acyclic bleeding, which is due to the early death of an still inferior corpus luteum.

During the middle stage of the secretion phase (nineteenth to twenty-third days), the lumen of the glands is expanded, they have folded walls. Epithelial cells are low, filled with a secret that is separated into the lumen of the gland. In the stroma during the twenty-first to twenty-second day, a decidua-like reaction begins to appear. Spiral arteries are sharply tortuous, form tangles, which is one of the most reliable signs of an absolutely full luteal phase. This structure of the endometrium can be noted:

• with increased prolonged function of the corpus luteum;
• due to admission large dosages progesterone;
• during early term uterine pregnancy;
• in the case of a progressive ectopic pregnancy.

During the late stage of the secretion phase (twenty-fourth to twenty-seventh day), due to the 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, getting a sawtooth shape. In the lumen of the glands is a secret. The stroma has an intense 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 by leukocytes of the appearance of a compact layer in the stroma; focal hemorrhages arise and grow, as well as areas of edema. This condition must be differentiated from endometritis, when the cellular infiltrate is located mainly around the glands and blood vessels.

Bleeding phase

In the phase of menstruation or bleeding for the stage of desquamation (twenty-eighth - second day), the increase in changes that are noted for the late secretory stage is characteristic. The process of rejection of the endometrium begins with the surface layer and has focal character. Fully desquamation ends by the third day of menstruation. Morphological feature monthly phase the detection of collapsed stellate glands in necrotic tissue appears. The regeneration process (third-fourth day) is carried out from the tissues of the basal layer. By the fourth day, the normal mucosa is epithelialized. Impaired rejection and regeneration of the endometrium can be caused by slow processes or incomplete rejection of the endometrium.

The abnormal state of the endometrium is characterized by the 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 taking place in it.

One of important processes occurring in the body of a woman, the proliferation of the endometrium favors. Violations 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.

The concept of proliferation

Proliferation is an 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 have been shed. This is what causes 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 case of the development of pathology, when cells divide too actively, thickening slime layer uterus.

Causes

As mentioned above, natural cause the occurrence of proliferative endometrium - the end of the cycle of menstruation. Rejected cells of the uterine mucosa are excreted from the body along with the blood, thereby thinning the mucous layer. Before the next cycle comes, the endometrium needs to restore this functional area of ​​\u200b\u200bmucosa through the process of division.

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

Process phases

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

1. early phase. It proceeds during the first week of the menstrual cycle and at this time on the mucous layer can be found epithelial cells, as well as stromal cells.
2. 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 cells are elongated epithelial tissue.
3. 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 in excess required amount. These newly formed "building" materials can combine and lead to the development of tumors such as endometrial proliferative hyperplasia.

It is a consequence of a hormonal breakdown in the monthly cycle. Hyperplasia is a proliferation of glands of the endometrium and stroma, it can be of two types: glandular and atypical.

Types of hyperplasia

The development of such an anomaly occurs mainly in women in menopausal age. The main reason is most often a large number of estrogens, which act on 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 seal can reach 1.5 cm in thickness. In addition, the formation of a proliferative type of polyps located in the cavity of the organ is possible on the endometrium.

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

Transition from atypical glandular hyperplasia to cancer occurs in 3 out of 100 women. This type of hyperplasia is similar to the proliferation of the endometrium during a normal monthly cycle, however, during the development of the disease, decidual tissue cells are absent on the uterine mucosa. Sometimes the process of atypical hyperplasia can be reversed, however, this is possible only under the influence of hormones.

Symptoms

With the development of hyperplasia of the proliferative endometrium, there are the following symptoms:

1. Violated menstrual functions of the uterus, manifested by bleeding.
2. There is a deviation in the menstrual cycle, in the form of intense cyclic and prolonged bleeding.
3. Metrorrhagia develops - unsystematic and non-cyclical bleeding of varying intensity and duration.
4. Bleeding occurs between periods or after their delays.
5. Observed breakthrough bleeding with the release of clots.
6. Constant occurrence bleeding provokes the development of anemia, malaise, weakness and frequent dizziness.
7. 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 following methods:

1. The study of the anamnesis and complaints of the patient related to the time of onset of bleeding, their duration and frequency. Accompanying symptoms are also studied.
2. 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.
3. Analysis of information about the beginning of the menstrual cycle (age of the patient), its regularity, duration, pain and profusion.
4. Conducting a bimanual gynecologist vaginal examination.
5. Collection of a gynecological smear and its microscopy.
6. The appointment of transvaginal ultrasound, which determines the thickness of the uterine mucosa and the presence of proliferative endometrial polyps.
7. Determination by ultrasound of the need for an endometrial biopsy for diagnosis.
8. Carrying out separate curettage using a hysteroscope that performs scraping or complete removal pathological endometrium.
9. Histological examination scrapings to determine the type of hyperplasia.

Treatment Methods

Treatment for glandular hyperplasia various methods. It can be both operational and conservative.

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

1. The cells affected by pathology are scraped out of the uterine cavity.
2. Surgical intervention hysteroscopy method.

Surgical intervention is provided in the following cases:

• the age of the patient allows you to perform the reproductive function of the body;
• the woman is "on the verge" of menopause;
• in cases of presence heavy bleeding;
• after detection on the endometrium of the proliferative type

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

Conservative treatment

Such therapy provides for certain methods of influencing pathology. Hormone therapy:

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

therapy aimed at general strengthening body:

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

In addition, in order to improve general condition overweight patients develop therapeutic diet, as well as activities aimed at physical strengthening of the body.

Preventive actions

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

• regular examination by a gynecologist (twice a year);
• taking preparatory courses during pregnancy;
• selection of suitable contraceptives;
• Seek immediate medical attention if any abnormalities occur in the functioning of the pelvic organs.
• cessation of smoking, alcohol and other 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 recurrence of endometrial hyperplasia of the proliferative type, 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 hyperplasia of the glands of the proliferative type of the endometrium directly depends on the timely detection and treatment of the pathology. Turning to a doctor for early stages diseases, 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 the failure hormonal background 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.

Endometrium of the proliferative type is an intensive growth of the mucous membrane of the uterine layer, occurring against the background of hyperplastic processes caused by excessive division of the cellular structures of the endometrium. With this pathology, diseases of a gynecological nature develop, reproductive function is disturbed. Faced with the concept of a proliferative type of 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;
• base material;
• stroma;
• blood vessels.

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

The proliferation of the endometrium contributes to the growth of the vascular bed for normal blood supply to the embryo and the formation of the placenta. During the menstrual cycle, a series of cyclical changes occur in the uterus, subdivided into the following successive stages:

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

For an adequate assessment of cyclic changes in the endometrium and how its condition corresponds to the norm, it is necessary to take into account such factors as the duration of the menstrual cycle, the stages of proliferation and the secret period, the presence or absence of uterine bleeding of a dysfunctional nature.

Phases of endometrial proliferation

The process of endometrial proliferation includes several successive stages, which corresponds to the concept of the norm. 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.

Allocate next steps proliferation phases:

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

The stages listed above must meet the established criteria of the norm, 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 the completion of the proliferation stage.

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

1. Early stage - observed from 15 to 18 days of the menstrual cycle. At this stage, secretion is very weak, the process is just beginning to develop.
2. middle stage secretion phase - proceeds 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.
3. Late - for the late stage of the secretion phase, suppression of secretory function is typical, which reaches its peak at the time of 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.

Diseases of a proliferative nature

Endometrial diseases of the proliferative type - what does it mean? Usually, the endometrium of the secretory type practically does not pose any threat to the health of a woman. But the mucous uterine layer in the period proliferative phase grows rapidly 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 the formation of tumor neoplasms, both benign and malignant, increase. Among the main pathologies of the proliferative type, doctors distinguish the following:

Hyperplasia- pathological growth 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, anemia (against the background of abundant blood loss) develop. It also significantly increases the likelihood of malignant degeneration of endometrial tissues, the development of cancer.

endometritis - inflammatory processes localized in the area of ​​the mucous uterine endometrial layer.

This pathology manifests itself:

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

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

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

IN most given malignant disease patients are susceptible to age category over 50 years old. The disease is manifested by active exophytic growth simultaneously with concomitant infiltrating ingrowth into muscle tissues. The danger of this type of oncology lies in its almost asymptomatic course, especially on early stages pathological process.

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

These should be of concern 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. Among the main provoking factors include endocrine disorders, diabetes, uterine fibroids, endometriosis, hypertension, overweight body.

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

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

Danger of inhibition of proliferation

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

In female patients reproductive age this pathology fraught with the development of hypoplasia and dysmenorrhea. During processes of a hypoplastic nature, thinning of the mucous membrane of the uterine layer occurs, as a result of which the fertilized egg cannot normally be fixed in 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 during diagnostic examinations, because in different periods scores can vary 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 you know, the management of the normal menstrual cycle occurs at the level of specialized brain neurons that receive information about the state 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 (FSH), luteinizing (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 stimulates steroidogenesis. Under the influence of FSH and LH, the ovaries produce estrogens and progesterone, which, in turn, cause cyclic transformations in target organs - the uterus, fallopian tubes ah, the vagina, as well as in the mammary glands, skin, hair follicles, bones, adipose tissue.

The secretion of estrogens and progesterone by the ovaries is accompanied by cyclic transformations both in the muscular and mucous membranes of the uterus. In the follicular phase of the cycle, hypertrophy of myometrial cells occurs, in the luteal phase - their hyperplasia. 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 the desquamation phase - menstruation). The proliferative 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 a cylindrical epithelium, in the cells of which numerous mitoses are observed.

There is a rapid growth of the spiral arteries. The middle proliferative phase (up to 10-12 days of the menstrual cycle) is characterized by the appearance of elongated tortuous glands and moderate edema of the stroma. The spiral arteries become tortuous due to their faster growth compared to endometrial cells. In the late phase of proliferation, the glands continue to increase, 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. Mitoses disappear in epithelial cells, 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, distinctly divided into deep (spongiform) and superficial (compact) layers.

The glands expand, their walls become folded; a secret containing glycogen and acidic glycosaminoglucuronglycans (mucopolysaccharides) appears in the lumen of the glands. Stroma with the phenomena of perivascular decidual reaction, in the interstitial substance it increases the amount of acid glycosaminoglucuronglycans. Spiral arteries are sharply tortuous, form "tangles" (the most sure sign, which determines the luteinizing effect).

Late stage of secretion (24-27 days of the menstrual cycle): during this period, processes associated with the 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 disturbed, its degenerative changes are formed, morphologically the endometrium regresses, signs of its ischemia appear . This reduces the juiciness of the tissue, which leads to wrinkling of the stroma of the functional layer. Folding of the walls of the glands increases.

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

In the mechanism of menstrual bleeding importance is given to circulatory disorders caused by prolonged spasm of the arteries (stasis, blood clots, fragility and permeability vascular wall, hemorrhage in the stroma, leukocyte infiltration). The result of these transformations are tissue necrobiosis and its melting. Due to the expansion 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 the necrotic sections of the functional layer of the endometrium, i.e. to menstrual bleeding.

The regeneration phase is rather short and is characterized by the regeneration of the endometrium from the cells of the basal layer. epithelialization wound surface originates from the marginal glands basement membrane, as well as from the non-torn off deep sections of the functional layer.

Normally, the uterine cavity has the shape of a triangular slit, in upper divisions which the mouths of the fallopian tubes open, and its lower section through inner 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 state of the tubular glands of the endometrium;
4) the structure of the mucosal vessels;
5) the state of the mouths of the fallopian tubes.

In the early phase of proliferation endometrium pale pink or yellow-pink, thin (up to 1-2 mm). The excretory ducts of the tubular glands are clearly visualized, evenly spaced. A dense vascular network is identified through the thin mucosa. Illuminated in some areas small hemorrhages. The mouths of the fallopian tubes are free, easily defined 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 phases of middle and late proliferation the endometrium acquires a folded character (thickened longitudinal and / or transverse folds are visualized) and a bright pink uniform shade. 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 - the bottom 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 juicy with multiple folds that have a flat top. The gaps between the folds are defined as narrow gaps. The mouths of the fallopian tubes are often not visualized or barely noticeable due to the pronounced edema and folding of the mucosa. 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 the torn endometrium.

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

IN first day of menstruation a large number of scraps of mucous 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 petechial hemorrhages are visualized against the background of a pale pink hue.

In the postmenopausal period in the reproductive system of women, involutive processes progress due to a decrease in the regenerative potential of cells. Atrophic processes are observed in all organs of the reproductive system: the ovaries shrink and sclerosis; the mass of the uterus decreases, its muscular elements are replaced by connective tissue; the epithelium of the vagina becomes thinner. In the early years of menopause, the endometrium has a transitional structure characteristic of the premenopausal period.

In the future (as the progressive fading of ovarian function) resting non-functioning endometrium is transformed into atrophic. 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 cylindrical epithelium. The glands look like straight tubes with a narrow lumen. Distinguish between simple and cystic atrophy. Cystically enlarged glands are lined with low single-row cylindrical epithelium.

Hysteroscopic picture in postmenopause is determined by its duration. In the period corresponding to the transitional mucosa, the latter is characterized by 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. 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 atrophy of the endometrium due to exposure to exogenous hormones (the so-called glandular hypoplasia with glandular-stromal dissociation), the mucosal surface is uneven ("cobblestone"), yellow-brown in color. The height of the functional layer does not exceed 1-2 mm. Between the "cobblestones" deep stromal vessels are visible. 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 assess the cyclic changes in the mucosa 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 within 2-5 mm;
3) excretory ducts glands are visualized, evenly spaced;
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 within 4-8 mm;
3) the excretory ducts of the glands are not identified due to edema of the stroma;
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"), 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 proliferation stage of the endometrium 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 onset 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. During the entire menstrual cycle, the inner surface of the uterus undergoes some changes. These changes are cyclic in nature and concern mainly the endometrium. This mucosal layer lines the uterine cavity and is the main supplier of blood to the organ.

Endometrium and its importance

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

It consists of:

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

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

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

Within a month, changes occur in the uterine organ, which mainly relate to the internal mucous membrane.

There are 4 phases of the cycle:

• proliferative;
• menstrual;
• secretory;
• presecretory.

Back to zmistuMenstrual, 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 shell begins to restore its structure. Until the fifth day, she is fully restored. This process is possible due to cell division 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, there is a rapid growth of the endometrium. From the time of menstruation to 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 cylindrical epithelium and the glands have a tubular structure.

During the second option proliferative stage the epithelium becomes higher, the glands also find a long wavy shape. It starts 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 remain free places where glycogen is stored.

During this period, the endometrial glands increase significantly. They acquire a twisted corkscrew shape, papillary outgrowths appear. As a result, the structure of the cover becomes saccular. Glandular cells become larger and secrete a mucous substance. It stretches the lumen of the channels. Fusiform connective tissue cells of the stroma become large polygonal. They store lipids and glycogen.

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

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

Back to zmistuFeatures of endometrial proliferation

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

In young representatives, the bottom of the organ may protrude into its cavity and have a recess in the area of ​​\u200b\u200bthe corners. An inexperienced doctor may mistake such a structure for a saddle-shaped or bicornuate uterus. But with such a diagnosis, the septum falls quite low, sometimes it can reach internal os. Therefore, to confirm this pathology, it is better to undergo a study in several different clinics. IN late period endometrial layer becomes thick, becomes 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 an examination of the mouth of the fallopian tubes is carried out.

Return to zmistuproliferative diseases

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

Back to Zmistu Zalozista and atypical endometrial hyperplasia

This pathology occurs mainly in menopausal women. The reason for the development this disease there may be hyperestrogenism or a long period of action of estrogens on the endometrium, provided that 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 a cylindrical (rarely cubic) epithelium. These particles are larger than normal cells, respectively, the nucleus and basophilic cytoplasm are also large. Such elements accumulate in groups or create glandular structures. A feature of this form of endometrial hyperplasia of the proliferative type 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, a large number of large cells of a cylindrical epithelium can be found, they have large nuclei with smaller nucleoli. The ratio of the nucleus to the cytoplasm (basophilic) remains practically unchanged. In addition, there are large cells that have a slightly enlarged nucleus and a very large cytoplasm. There are also light cells with lipids, based on their presence, and a disappointing diagnosis is made.

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