The late stage of proliferation is what. Endoscopic anatomy of the uterine mucosa. Diagnosis of pathologies of the endometrium

endometrial hyperplasia is an overgrowth of the lining of the uterus. Doctors believe that this is not yet a disease, but special condition- a malfunction of the body, which is caused by hormonal disorders. Its manifestations: prolonged delay in menstruation, after which there is profuse bleeding, bloody issues in the middle of a cycle. But often hyperplasia does not cause any symptoms and is discovered incidentally during ultrasound.

The main danger is that although endometrial hypertrophy is a benign formation, it can degenerate into a malignant cancerous tumor.

Is there a high risk of getting sick?

What happens in the body?

If this well-established system fails, then the cells of the inner layer of the uterus divide very actively. But they are not brought out in time, because there is no menstruation. As a result, the endometrium becomes thicker. Changes in it can be varied. In some women, only certain sections of the mucosa increase: outgrowths and polyps form. In others, the endometrium thickens evenly.

But the growth of the endometrium cannot last long. After a few months, the uterus still dumps it. Then there is profuse bleeding. If the cause of endometrial hyperplasia is not eliminated, then everything repeats again and again.

Anatomy of the uterus

The uterus is an empty muscular organ. It is made up of smooth muscles that we cannot consciously control. Its walls are thick, dense and elastic. This allows the uterus to stretch during pregnancy and reliably protect the fetus. The inner space of the uterus is small, it can hold 5-7 ml of fluid.

The organ itself looks like an inverted triangle, flattened front and back. Its base is turned upwards and is located above the place where the fallopian tubes enter. Bottom part narrows and passes into the isthmus, and lower into the cervix. This area is denser and has more connective tissue. Inside the cervix passes the cervical canal, which opens from above into the uterine cavity, and from below into the vagina. During childbirth, the baby comes out of the uterus in this way.

The uterus is located in the lower abdomen. It is located between bladder, which lies in front of it, and the rectum, which is behind. The uterus is small: height 8 cm, width up to 4 cm, thickness 2 cm. In nulliparous women, its weight is about 40 g, and in those who have already given birth to a child, it is 2 times more.
The uterus is attached to the walls of the pelvis by several ligaments. They hold the body in place and prevent it from falling.

The structure of the uterus

1. Outer serosa - perimetrium. It is formed from the sheet of peritoneum, which lines abdominal cavity and covers the internal organs. In places, the perimetrium fuses tightly with the muscle layer, while in other areas it is loosely attached. This allows the uterus to stretch better. On the anterior surface and on the sides of the cervix lies adipose tissue.
2. Middle muscle layer - myometrium. It is the thickest and consists of non-striated smooth muscle fibers that intertwine in different directions. There are also elastic fibers and connective tissue fibers. This provides additional protection to the fetus. There are three layers in the myometrium
   • Outer - longitudinal layer of muscle fibers. Fuses with the serous membrane.
   • Middle - circular or vascular layer. The muscles here look like rings, many vessels lie in their thickness, mainly veins.
   • Inner - longitudinal layer. It is the thinnest and is located under the mucous layer.
3. Mucous membrane - endometrium. Consists of a columnar epithelium that lines the inner surface of the uterus. Also included are simple tubular glands and a thin plate of connective tissue.

The structure of the endometrium

The endometrium consists of two layers: functional and basal.

On the surface is a layer called functional. It is very sensitive to the sex hormones that control its changes. After menstruation, the thickness of this layer is 1 mm. By the end of the cycle, it increases to 6-8 mm and exfoliates during the next menstruation.

functional layer performs many functions. Its surface is flat, smooth, without folds. cover her ciliated cells. Each of them has up to 500 thin cilia. Together they oscillate and create waves that help move the fertilized egg.

There are also simple tubular glands, which secrete a special mucous secret. This substance provides normal work uterus and prevents its inner walls from sticking together.

Endometrial stroma– special kind connective cells arranged in a grid. Under the influence of hormones, they change and perform different functions: provide nutrition, protect against damage, produce collagen and participate in the rejection of the upper layer.

Vessels of the surface layer in different phases cycles change a lot. At first, they straighten, and closer to menstruation, they twist spirally. When pregnancy occurs, it is these vessels that form the placenta, which brings nutrients to the embryo.

Under the surface layer is basal . The main function is to restore the endometrium after "critical" days. It does not respond so sensitively to hormonal changes and changes little throughout the cycle.
This layer contains "bubble cells", from which ciliated cells of the surface layer are subsequently formed. The stroma of the basal layer is dense and consists of connective tissue cells.

What affects the growth of the endometrium?

• Estrogens normally produced in the first half of the menstrual cycle - the first 2 weeks. They are responsible for the restoration of the endometrium after menstruation and its growth (proliferation).
• Progesterone appears in the second half of the cycle in the third week. It stops the growth of the mucosa, starts the secretion phase - prepares the ground for the attachment of the embryo.

If there is too much estrogen, then growth occurs constantly. And because of the deficiency of progesterone, the growth of endometrial cells does not stop.

How does menstruation and endometrial rejection occur?

At the end of the cycle, if pregnancy has not occurred, the corpus luteum of the ovary abruptly stops producing hormones. This causes a spasm of the vessels of the uterus, its cells experience oxygen starvation and start to die.

The walls of blood vessels become more permeable. Leukocytes pass through them liquid part blood that permeates the endometrium. After a period of constriction, the arterioles dilate dramatically: the vessels rupture and bleeding occurs.

The stroma contains granular cells. Before menstruation, they secrete special substances that exfoliate the functional layer. It comes out with blood.

Special enzymes, which are formed during the breakdown of the mucous membrane, do not allow blood to clot.

What is endometrial hypertrophy

Now let's figure out what the term hypertrophy means. This is an increase in the volume and mass of the layers that make up the endometrium. This process begins from the first day after menstruation and ends before the next critical days - this is normal physiological hypertrophy.

If for some reason menstruation has not occurred, then the growth of the endometrium continues. Now not only the size of the cells is increasing, but also their number. This is called hyperplasia. This condition is out of the norm and requires treatment.

The mechanism of development of hyperplasia

These processes are regulated by ovarian hormones. If a woman does not have enough progesterone, then ovulation does not occur on time, and then menstruation. At the same time, the endometrium thickens due to increased cell division, which normally should not be.

An excess of estrogen hormones in the blood leads to the growth of glands that are located in the thickness of the endometrium. A high level of progestogens causes an increased division of the stroma.

Reasons for the development of hyperplasia

Violation metabolic processes . The cause may be disorders of fatty and carbohydrate metabolism, obesity. The fact is that adipose tissue can produce estrogens. Some common diseases also increase the risk of hyperplasia. it diabetes, chronic diseases liver, hypertension.

Diseases endocrine glands : adrenal, pancreas and thyroid cause malfunction of the ovaries or the endometrium itself. This may lead to enhanced growth cells.

Age-related changes in the genitals cause endometrial hyperplasia. He becomes more sensitive to the action of hormones. This pathology occurs in 60% of women during menopause and after it. She often calls severe bleeding and the appearance of tumors. There is also a high risk of developing the disease in adolescent girls during puberty.

Inflammation of the uterus and other genital organs cause hyperplasia. It can be the result of sexually transmitted infections, intrauterine contraceptives(spirals). Inflammation leads to the fact that many immune cells gather in the tissues of the uterus. They cause endometrial cells to actively divide.

Curettage and frequent abortions, as well as congenital defects in the development of the uterus - these are also factors that cause the growth of the endometrium. They lead to the fact that the endometrial receptors become insensitive to the action of progesterone. Therefore, the cells continue to multiply, even if the hormones are normal.

Job disruption immune system . There is a version that the cause of endometrial hyperplasia may be the malfunction of immune cells. They mistakenly attack slime layer uterus, and this causes abnormal division of its cells.

Genetics. There is also a hereditary predisposition to hyperplasia. If the mother had the disease, then her daughters may have such problems.

Types of endometrial hypertrophy

glandular form
Refers to benign changes and is considered the easiest. This means that the probability of developing cancerous tumors in this case is small, only 2-6%. The cells of the glands are actively dividing, and the endometrium becomes thicker. The glands are located unevenly, but in groups. They can be closely pressed to each other. There are no stroma cells between them. Tubular glands from straight lines become sinuous, expand. But at the same time, their contents are freely allocated.

Glandular cystic form
If the cells at the mouth of the gland grow strongly, they block the outflow of mucus. It takes the form of a cyst - a bubble filled with fluid. These changes occur under the influence of estrogen hormones.

cystic form
This form has much in common with glandular cystic. Glandular cells grow strongly and the glands themselves increase in size. They become like bubbles. But unlike the previous variants of the development of the disease, inner part The gland is lined with normal epithelium. Such cysts can degenerate into cancerous tumors.

Focal form
The growth of endometrial cells does not occur evenly, but in separate foci. These areas of the mucosa are more sensitive to the action of hormones, so the cells here divide more actively. Elevations are formed on the endometrium with altered glands and cyst-like formations. If cell reproduction begins in a polyp, then it greatly increases in size. The diameter of the foci can be from a few millimeters to several centimeters. There is a risk of the formation of a cancerous tumor at the site of the focus. If the changes occur evenly over the entire surface of the endometrium, then this form is called diffuse.

Atypical form (adenomatosis)
It is considered the most dangerous of all options for the development of the disease. Endometrial hyperplasia with atypia most often leads to cancer. According to some reports, the risk of rebirth is more than 50%. Therefore, in this case, it is recommended to remove the uterus. Changes take place not only in the functional, but also in the basal layer. The cells of the stroma and glands are actively dividing and rebuilding. They often mutate. They become atypical. Cells change their structure and the structure of the nucleus.

The choice of treatment depends on the form of the disease. If in the glandular form you can get by with hormones, then with an atypical form during menopause, it is necessary to remove the uterus.

Symptoms and signs of endometrial hyperplasia

Symptoms of endometrial hyperplasia.

1. Menstrual disorders. This is the most common symptom of the disease. The cycle goes astray, menstruation becomes irregular. Bloody discharge is often heterogeneous. Blood clots and particles of overgrown mucosa that has exfoliated may appear.
2. Painful periods (dysmenorrhea). This phenomenon is quite common in 70% of women. But if earlier menstruation passed painlessly, and from a certain period, each cycle arises discomfort is a sign of violation. Pain during menstruation is caused by vasospasm and increased pressure inside the uterus. Especially when a large amount of functional layer exfoliates.
3. Sanitary secretions before and after menstruation occur with polyps. With this form of the disease, the walls of the vessels become brittle, and the liquid component of the blood comes out through them.
4. Bloody spotting in the middle of the menstrual cycle. A decrease in the amount of estrogen leads to exfoliation of the mucosa. But it is not rejected all, as during menstruation, but in small areas. The discharge is not as plentiful as during menstruation. They occur after exercise or sex.
5. Delayed menstruation, which ends in heavy bleeding . Menstruation does not start on time, and a large amount of estrogen causes endometrial cells to grow further. But, in the end, there comes a moment when the amount of hormones drops, and the uterus is nevertheless freed from the enlarged mucosa. And then the entire functional layer, which has already reached a thickness of 2-3 cm, is released outward along with a large amount of blood.
6. Infertility. Hormonal changes that occur with endometrial hyperplasia interfere with ovulation. Therefore, the chances of fertilizing the egg are very small. If this still happened, then the egg simply cannot take root in the uterus. After all, the affected endometrium is poor soil and cannot form the placenta.
7. Prolonged and profuse bleeding during menstruation regular cycle . In this case, bleeding continues for more than 7 days. This is due to the fact that special enzymes prevent blood from clotting.

Diagnosis of endometrial hyperplasia

Treatment of endometrial hyperplasia

Medical treatment

Combined oral contraceptives

Synthetic analogues of progesterone

Since endometrial hyperplasia occurs due to a lack of progesterone, its use can save a woman from this disease. An artificially created sex hormone acts in the same way as the one that is produced in the body. It is able to normalize the menstrual cycle.

The use of gestagens helps women of any age and with any form of endometrial hyperplasia. However, during the reception, spotting between periods may occur.

Treatment lasts 3-6 months. The best results are given by Duphaston and Norkolut preparations.

Gonadotropin-releasing hormone antagonists (AGnRG)

These modern drugs allow to reduce the production of female sex hormones estrogens, which cause the growth of the endometrium. After the use of these agents, cell division slows down, and the thickness of the mucosa decreases. This process is called endometrial atrophy. Thanks to AGnRH, infertility and hysterectomy can be avoided.

The drugs are easy to dose and easy to use. They can be injected once a month (Goselerin, Leuprorelin). There is also AGnRH in the form of a nasal spray (Buselerin or Nafarelin). They help a lot of women.

For the first two weeks, a woman may feel a slight deterioration in her condition. This is because estrogen levels rise during this period. But then their production stops and improvement occurs, menstrual bleeding becomes regular and painless. The duration of treatment is 4-10 weeks.

Treatment with surgical methods

This is one of the main methods of treatment and diagnosis of endometrial hyperplasia. The procedure lasts about 20 minutes and is performed under intravenous anesthesia. The doctor, using a special surgical instrument - a curette, removes the superficial functional layer of the endometrium. In fact, the doctor does in 20 minutes what happens during menstruation in 5 days.

Cryodestruction

This is the "freezing" of hyperplastic areas of the endometrium with the help of low temperatures. Cold causes cell death (necrosis). Then the area destroyed by the cold is torn off and comes out.

Laser ablation or cauterization

Cauterization with a laser or an electrosurgical instrument heated to high temperatures. Areas of hyperplasia are destroyed and then independently exit the uterus. After such a procedure, the mucosa is restored naturally, as after menstruation.

Removal of the uterus or hysterectomy

Complete removal uterus is carried out only with complex atypical forms. Often it is prescribed to women during menopause, when the risk of developing cancer increases. If there are no changes in the ovaries, then they are left in place.
Complete removal of the uterus, fallopian tubes and ovaries is carried out with adenomatosis, if the woman has ended menopause. And also in the case when cancer cells are detected.

In most cases, after any operation, hormonal drugs are prescribed. They can improve the condition of a woman and prevent the re-growth of the endometrium.

What is endometrial hypertrophy in menopause?

This condition is observed in almost 70% of women at this age. Changes occur because hormonal changes occur at menopause and estrogen levels rise. In addition, after the age of 40, the likelihood of developing cancerous tumors increases. Therefore, a woman needs to be especially attentive to her health.

The following factors increase the risk of developing endometrial hyperplasia:

• diabetes
• high blood pressure
• early start menopause
• excess weight
• chronic liver disease
• uterine fibroids, ovarian cysts, mastopathy
• hereditary tendency

The first step is an ultrasound. If the thickness of the endometrium is 6-7 mm, then a second examination is prescribed after 3-6 months. In the event that the thickness is more than 8 mm, treatment is necessary, and if more than 10 mm, then separate curettage.

Treatment of endometrial hyperplasia in menopause

1. Hormone treatment. For many women, it gives excellent results and eliminates the need for surgery. Preparations Megestrol acetate, Medroxyprogesterone are taken for a long time, 3-6 months. Periodically, ultrasound is done to determine if there is improvement and, if necessary, adjust the dose of medication.
2. Surgery:
   • Cauterization by laser (ablation). Performed if the endometrium grows in foci or in the form of polyps
   • Scraping with a surgical curette (curettage). The functional layer of the endometrium is removed.
   • Removal of the uterus (sometimes with appendages). Assign in the event that a tendency to the formation of a cancerous tumor is detected.
3. Combined treatment . At menopause, it is prescribed first hormonal treatment while areas of hypertrophy are reduced. This makes the operation less traumatic.

Is it necessary to do scraping with endometrial hypertrophy?

Before scraping, a number of tests are prescribed:

• general blood analysis;
• blood clotting test (coagulogram);
• cardiogram of the heart;
• blood tests for hepatitis, syphilis, HIV,
• smear on the purity of the vagina.

Why do scraping?

For diagnosis, after scraping, tissue particles are sent to the laboratory. There they are carefully studied under a microscope. They determine whether there are cysts, whether the structure of the glands is disturbed, and whether the cells are prone to mutation that leads to cancer. After such a study, the necessary medications are prescribed. This is the most exact method diagnosis of endometrial hyperplasia. Since with ultrasound or endoscopy, the doctor may not notice violations.

Scraping with therapeutic purpose allows you to quickly get rid of polyps and hyperplastic epithelium. This is the fastest and effective method treatment. This procedure is especially necessary for women who have not been helped by hormones.

Curettage with endometrial hyperplasia can be carried out under the control of vision or a hysteroscope. It is a thin tube with a small camera attached to the end. Such a device allows you to control the process on the screen and evaluate the quality of work so as not to miss anything.

Curettage is carried out with a curette. it surgical instrument, similar to a small spoon with a pointed edge on a long thin handle.

Curettage is considered small gynecological operation. It is done very often and most women have gone through it. The procedure lasts less than 20 minutes and is done under intravenous anesthesia. Therefore, the woman does not feel pain. On the same day she can return home.

After scraping, antibiotics are usually prescribed to prevent inflammation. After the analysis is done, the doctor may prescribe hormonal drugs to prevent recurrent endometrial hyperplasia.

How to treat endometrial hypertrophy with folk remedies?

Universal complex of celandine and vegetable juice

1st month. Every day you need to drink 100 g of freshly squeezed juice from beets and carrots. It is better to drink beetroot juice in the morning on an empty stomach, carrot juice before dinner. In addition, 1 tbsp should be taken twice a day. flaxseed oil before meals.
Once every two weeks, it is necessary to do douching with infusion of celandine. To prepare one portion of the infusion, 50 g of fresh celandine grass should be poured over 2 liters of boiling water. Let it brew for 12 hours. Before douching, warm the infusion to body temperature.

2nd month. 150 ml of aloe tincture is added to daily juice therapy. To prepare it, you need to take 400 g of juice from aloe leaves mixed with the same amount of honey. Pour the resulting mixture into 0.7 liters of Cahors and let it brew for 15 days.
Also in the second month, the infusion of the boron uterus (mother) is added. 2 tbsp dry grass pour 1 liter of boiling water. Insist 3 hours.
Douching continues without change.

3rd month. They continue to take juices, flaxseed oil, aloe and infusion of boron uterus. Stop douching.

4th month . Treatment begins with a week break. In the future, for a month, the treatment is reduced to taking oil from flax seeds and tinctures of boron uterus.
This complex tool strengthens the immune system, improves the condition of the genitals and urinary system. The production of hormones and the condition of the endometrium are normalized.

Stinging nettle

Nettle contains unique phytohormones similar to those of women. Therefore, this herb in all its forms has favorable influence on women's health.

Nettle alcohol tincture - Ideal for full recovery hormonal system among women. To prepare the tincture, you need to pour 100 g of crushed nettle leaves into 400 g of medical alcohol. Let it brew in a dark place for 10 days. Strain and take 1 tsp. with a little water. Consume in the morning and evening after meals.

There should be improvement within a week. general condition. Gradually, the hormonal processes of the body stabilize. It is usually necessary to drink the tincture for 1 month.

Nettle decoction. To prepare a decoction, young nettle leaves are taken and poured with boiling water at the rate of: 1 liter of water per 100 g of leaves. Take a decoction of 100 g 5 times a day on an empty stomach.

Herbal decoction

Most effective folk remedy from endometrial hyperplasia, herbal collection is considered. Its composition in equal proportions includes: calamus, knotweed, cinquefoil root, nettle leaves, as well as ½ servings of serpentine and shepherd's purse.

To prepare a decoction, you need to take 4 tbsp. collection of herbs. Pour into an enamel pan and pour 1 liter of boiling water. Boil for 3-5 minutes. After that, wrap the dishes with a towel and leave for 3 hours.

Drink a decoction once a day, 200 ml in small sips. The course of treatment lasts 2 months. Use the collection for one month, then with a break for a week. And again a month of treatment. The first effects will be felt after 2 weeks. If the effect is not noticeable after the end of treatment, then the course can be repeated after a two-week break.

Is pregnancy possible with endometrial hypertrophy?

Let's explain. Endometrial hyperplasia is a complex disease. This is not only a thickening of the uterine mucosa, but also serious deviations in the production of hormones. All glands internal secretion that secrete hormones are interconnected. Violations simultaneously occur in the hypothalamus, pituitary gland and ovaries. This causes an excess of estrogen and a lack of progesterone. As a result, a woman does not ovulate - an egg does not enter the uterus from the follicle. This means that fertilization is also impossible.

Also, for the onset of pregnancy, it is necessary that the fertilized egg is introduced into the lining of the uterus. But with hyperplasia, the endometrium is so altered that the egg simply cannot do this.
Healthy endometrium and normal production of female sex hormones is necessary condition women's health and pregnancy. Therefore, it is necessary to regularly visit a gynecologist once a year. Women over 45 are advised to do this every six months. Such preventive examinations will help to identify any changes in the early stages and easily get rid of them.

Early stage of the proliferation phase. In this phase of the menstrual cycle, the mucosa is traced in the form of a narrow echo-positive strip ("traces of the endometrium") of a homogeneous structure, 2-3 mm thick, located centrally.

Colpocytology. The cells are large, light, with medium-sized nuclei. Moderate folding of cell edges. The number of eosinophilic and basophilic cells is approximately the same. Cells are placed in groups. There are few leukocytes.

Histology of the endometrium. The surface of the mucous membrane is covered with flattened cylindrical epithelium, which has a cubic shape. The endometrium is thin, there is no division of the functional layer into zones. The glands look like straight or several winding tubes with a narrow lumen. On transverse sections, they have a round or oval shape. The epithelium of the glandular crypts is prismatic, the nuclei are oval, located at the base, stain well. The cytoplasm is basophilic, homogeneous. The apical edge of the epithelial cells is even, clearly defined. On its surface, using electron microscopy, long microvilli are determined, which contribute to an increase in the surface of the cell. The stroma consists of spindle-shaped or stellate reticular cells with delicate processes. Little cytoplasm. It is barely noticeable around the nuclei. In stromal cells, as well as in epithelial cells, single mitoses appear.

Hysteroscopy. In this phase of the menstrual cycle (up to day 7 of the cycle), the endometrium is thin, even, pale pink, in some areas shine through small hemorrhages, you can see single areas of the endometrium of a pale pink color, which are not torn away. The eyes of the fallopian tubes are well traced.

Middle phase of proliferation. The middle stage of the proliferation phase lasts from 4-5 to 8-9 days after menstruation. The thickness of the endometrium continues to grow up to 6-7 mm, its structure is homogeneous or with a zone of increased density in the center - a zone of contact between the functional layers of the upper and lower walls.

Colpocytology. A large number of eosinophilic cells (up to 60%). Cells are scattered. There are few leukocytes.

Histology of the endometrium. The endometrium is thin, there is no separation of the functional layer. The surface of the mucous membrane is covered with high prismatic epithelium. The glands are somewhat tortuous. The nuclei of epithelial cells are locally located on different levels, numerous mitoses are observed in them. Compared with the early phase of proliferation, the nuclei are enlarged, less intensely stained, some of them contain small nucleoli. From the 8th day of the menstrual cycle, a layer containing acidic mucoid forms on the apical surface of the epithelial cells. Alkaline phosphatase activity increases. The stroma is swollen, loosened, a narrow strip of cytoplasm is visible in the connective tissues. The number of mitoses increases. The vessels of the stroma are solitary, with thin walls.

Hysteroscopy. In the middle stage of the proliferation phase, the endometrium gradually thickens, becomes pale pink in color, and the vessels are not visible.

Late stage of proliferation. AT late stage phase of proliferation (lasts about 3 days), the thickness of the functional layer reaches 8-9 mm, the shape of the endometrium, as a rule, is drop-shaped, the central echo-positive line remains unchanged throughout the first phase of the menstrual cycle. Against the general echo-negative background, it is possible to distinguish short, very narrow echo-positive layers of low and medium density, which reflect the delicate fibrous structure of the endometrium.

Colpocytology. The smear shows predominantly eosinophilic superficial cells(70%), few basophils. In the cytoplasm of eosinophilic cells, granularity is found, the nuclei are small, pyknotic. There are few leukocytes. Characterized by a large amount of mucus.

Histology of the endometrium. Some thickening of the functional layer, but no division into zones. The surface of the endometrium is lined with high columnar epithelium. The glands are more tortuous, sometimes corkscrew-like. Their lumen is somewhat expanded, the epithelium of the glands is high, prismatic. The apical margins of the cells are smooth and distinct. As a result of intensive division and an increase in the number of epithelial cells, the nuclei are at different levels. They are enlarged, still oval, contain small nucleoli. Closer to the 14th day of the menstrual cycle, you can see a large number of cells containing glycogen. The activity of alkaline phosphatase in the epithelium of the glands reaches the highest degree. The nuclei of connective tissue cells are larger, rounded, stained less intensely, an even more noticeable halo of cytoplasm appears around them. The spiral arteries that grow from the basal layer at this time already reach the surface of the endometrium. They are still slightly curvy. Under the microscope, only one or two adjacent peripheral vessels are determined.

Psteroscopy. In the late phase of proliferation, the time on the endometrium in certain areas is determined in the form of thickened folds. It is important to note that if menstrual cycle proceeds normally, then in the proliferation phase the endometrium may have a different thickness, depending on the localization - thickened in days and back wall uterus, thinner on the front wall and in the lower third of the body of the uterus.

Early stage of the secretion phase. In this phase of the menstrual cycle (2-4 days after ovulation), the thickness of the endometrium reaches 10-13 mm. After ovulation, due to secretory changes (the result of the production of progesterone by the menstrual corpus luteum of the ovary), the structure of the endometrium becomes homogeneous again until the onset of menstruation. During this period, the thickness of the endometrium increases faster than in the first phase (by 3-5 mm).

Colpocytology. Characteristic deformed cells are wavy, with curved edges, as if folded in half, the cells are located in dense clusters, layers. Cell nuclei are small, pycnotic. The number of basophilic cells is growing.

Histology of the endometrium. The thickness of the endometrium moderately increases compared to the proliferation phase. The glands become more tortuous, their lumen is expanded. Most feature phases of secretion, in particular its early stage - the appearance of subnuclear vacuoles in the epithelium of the glands. Glycogen granules become large, cell nuclei move with basal departments in the central (indicates that ovulation has occurred). The nuclei, pushed aside by vacuoles to the central parts of the cell, are initially located at different levels, but on the 3rd day after ovulation (day 17 of the cycle), the nuclei that lie above the large vacuoles are located at the same level. On the 18th day of the cycle, in some cells, glycogen granules move to the apical regions of the cells, as if bypassing the nucleus. As a result of this, the nuclei again descend to the base of the cell, and glycogen granules are placed above them, which are located in the apical parts of the cells. The nuclei are more rounded. Mitoses are absent. The cytoplasm of the cells is basophilic. Acid mucoids continue to appear in their apical regions, while the activity of alkaline phosphatase decreases. The stroma of the endometrium is slightly swollen. The spiral arteries are tortuous.

Hysteroscopy. In this phase of the menstrual cycle, the endometrium is swollen, thickened, and forms folds, especially in the upper third of the uterine body. The color of the endometrium becomes yellowish.

Middle stage of the secretion phase. The duration of the middle stage of the second phase is from 4 to 6-7 days, which corresponds to the 18-24th day of the menstrual cycle. During this period, the greatest severity of secretory changes in the endometrium is noted. Sonographically, this is manifested by a thickening of the endometrium by another 1-2 mm, the diameter of which reaches 12-15 mm, and in its even greater density. At the border of the endometrium and myometrium, a rejection zone begins to form in the form of an echo-negative, clearly defined rim, the severity of which reaches a maximum before menstruation.

Colpocytology. Characteristic folding of cells, curved edges, accumulation of cells in groups, the number of cells with pyknotic nuclei decreases. The number of leukocytes moderately increases.

Histology of the endometrium. The functional layer becomes higher. It is clearly divided into deep and superficial parts. The deep layer is spongy. It contains highly developed glands and a small amount of stroma. The surface layer is compact, it contains less tortuous glands and many connective tissue cells. On the 19th day of the menstrual cycle most of nuclei is located in the basal part of epithelial cells. All nuclei are rounded, light. The apical section of the epithelial cells becomes dome-shaped, glycogen accumulates here and begins to be released into the lumen of the glands by apocrine secretion. The lumen of the glands expands, their walls gradually become more folded. The epithelium of the glands is single-row, with nuclei located basally. As a result of intense secretion, the cells become low, their apical edges are indistinctly expressed, as if with teeth. Alkaline phosphatase disappears completely. In the lumen of the glands is a secret that contains glycogen and acid mucopolysaccharides. On the 23rd day, the secretion of the glands ends. A perivascular decidual reaction of the endometrial stroma appears, then the decidual reaction acquires diffuse character, especially in the superficial parts of the compact layer. The connective tissue cells of the compact layer around the vessels become large, round and polygonal in shape. Glycogen appears in their cytoplasm. Islets of predecidual cells are formed. A reliable indicator of the middle stage of the secretion phase, which indicates a high concentration of progesterone, are changes in the spiral arteries. The spiral arteries are sharply tortuous, form "coils", they can be found not only in the spongy, but also in the superficial parts of the compact layer. Until the 23rd day of the menstrual cycle, the tangles of the spiral arteries are most clearly expressed. Insufficient development of "coils" of spiral arteries in the endometrium of the secretory phase is characterized as a manifestation of a weak function of the corpus luteum and insufficient preparation of the endometrium for implantation. The structure of the endometrium of the secretory phase, the middle stage (22-23 days of the cycle), can be observed with prolonged and increased hormonal function of the menstrual corpus luteum - persistence of the corpus luteum, and in early dates pregnancy - during the first days after implantation, with uterine pregnancy outside the implantation zone; with progressive ectopic pregnancy evenly in all parts of the mucous membrane of the body of the uterus.

Hysteroscopy. In the middle phase of the secretion stage, the hysteroscopic picture of the endometrium does not differ significantly from that in the early phase of this stage. Often, the folds of the endometrium acquire a polypoid shape. If the distal end of the hysteroscope is placed close to the endometrium, the ducts of the glands can be examined.

Late stage of the secretion phase. Late stage of the second phase of the menstrual cycle (lasts 3-4 days). In the endometrium, there are pronounced trophic disorders due to a decrease in the concentration of progesterone. Sonographic changes in the endometrium associated with polymorphic vascular reactions in the form of hyperemia, spasms and thrombosis with the development of hemorrhages, necrosis and others dystrophic changes, a slight heterogeneity (spotting) of the mucosa appears due to the appearance of small areas (dark "spots" - zones of vascular disorders), the rim of the rejection zone (2-4 mm) becomes clearly visible, and the three-layer structure of the mucosa characteristic of the proliferative phase is transformed into a homogeneous tissue. There are cases when the echo-negative zones of the endometrial thickness in the preovulatory period are mistakenly regarded by ultrasound as its pathological changes.

Colpocytology. The cells are large, pale-colored, foamy basophilic, without inclusions in the cytoplasm, the contours of the cells are indistinct, vague.

Histology of the endometrium. The folding of the gland walls is enhanced, it has a dust-like shape on longitudinal sections, and a star-like shape on transverse sections. The nuclei of some epithelial gland cells are pyknotic. The stroma of the functional layer is wrinkled. Predecidual cells are brought together and diffusely distributed around the spiral vessels throughout the compact layer. Among the predecidual cells are small cells with dark nuclei - endometrial granular cells, which are transformed from connective tissue cells. On the 26-27th day of the menstrual cycle, lacunar expansion of capillaries into the stroma is observed in the surface areas of the compact layer. In the premenstrual period, spiralization becomes so pronounced that blood circulation slows down and stasis and thrombosis occur. The day before the onset of menstrual bleeding, the state of the endometrium occurs, which Schroeder called "anatomical menstruation." At this time, you can find not only dilated and blood-filled vessels, but also their spasm and thrombosis, as well as small bonfire hemorrhages, edema, and leukocyte infiltration of the stroma.

Psteroscopy. In the late phase of the secretion stage, the endometrium acquires a reddish tint. Due to the pronounced thickening and folding of the mucosa, the eyes of the fallopian tubes can not always be seen. Before the menstruation itself, the appearance of the endometrium can be mistakenly interpreted as a pathology of the endometrium (polypoid hyperplasia). Therefore, the time of hysteroscopy must be fixed for the pathologist.

Bleeding phase (desquamation). During menstrual bleeding due to a violation of the integrity of the endometrium due to its rejection, the presence of hemorrhages and blood clots in the uterine cavity, the echographic picture changes over the days of menstruation as parts of the endometrium with menstrual blood depart. At the beginning of menstruation, the rejection zone is still visible, although not entirely. The structure of the endometrium is heterogeneous. Gradually, the distance between the walls of the uterus decreases and before the end of menstruation, they "close" to each other.

Colpocytology. In the smear foamy basophilic cells with large nuclei. A large number of erythrocytes, leukocytes, endometrial cells, histocytes are found.

Histology of the endometrium(28-29 days). Tissue necrosis, autolysis develops. This process begins with the surface layers of the endometrium and is of a bonfire character. As a result of vasodilation, which occurs after a long spasm, a significant amount of blood enters the endometrial tissue. This leads to rupture of blood vessels and detachment of necrotic sections of the functional layer of the endometrium.

Morphological features characteristic of the endometrium menstrual phase, are: the presence in the tissue permeated with hemorrhages, areas of necrosis, leukocyte infiltration, a partially preserved section of the endometrium, as well as tangles of spiral arteries.

Hysteroscopy. In the first 2-3 days of menstruation, the uterine cavity is filled with a large number of fragments of the endometrium from pale pink to dark purple, especially in the upper third. In the lower and middle third of the uterine cavity, the endometrium is thin, pale pink in color, with small punctate hemorrhages and areas of old hemorrhages. If the menstrual cycle was full, then by the second day of menstruation, almost complete rejection of the uterine mucosa takes place, only small fragments of the mucosa are determined in some of its sections.

Regeneration(3-4 days of the cycle). After rejection of the necrotic functional layer, regeneration of the endometrium from the tissues of the basal layer is observed. The epithelialization of the wound surface occurs due to the marginal sections of the glands of the basal layer, from which epithelial cells move to the wound surface in all directions and close the defect. With normal menstrual bleeding in a normal biphasic cycle, all wound surface epithelized on the 4th day of the cycle.

Hysteroscopy. During the regeneration stage, against a pink background with areas of mucosal hyperemia, small hemorrhages shine through in some areas, single areas of the endometrium of a pale pink color can be found. As the endometrium regenerates, areas of hyperemia disappear, changing color to pale pink. The corners of the uterus are well visible.

Article outline

Endometrium - the inner mucosa of the uterus, penetrated by a thin and dense network of blood vessels. She supplies reproductive organ blood. Proliferative endometrium - mucous membrane, which is in the process of rapid cell division before the start of a new menstrual cycle.

The structure of the endometrium

The endometrium has two layers. Basic and functional. The basal layer practically does not change. It promotes the regeneration of the functional surface during the menstrual cycle. It consists of cells as close as possible to each other, equipped with a thin but dense vascular network. up to one and a half centimeters. Unlike the basal layer, the functional layer is constantly changing. Because during menstruation, labor activity, during surgery, diagnosis, it is damaged. There are several cyclic stages of functional endometrium:

1. proliferative
2. Menstrual
3. Secretory
4. Presecretory

The stages are normal, successively replace each other, according to the period that passes in the body of a woman.

What is the normal structure

The state of the endometrium in the uterus depends on the phase of the menstrual cycle. When the proliferation time comes to an end, the main layer reaches 20 mm, and is practically immune to the influence of hormones. When the cycle is just beginning, the endometrium is smooth, pinkish in color. With focal areas of the active layer of the endometrium that has not separated from the last menstruation. In the next seven days, there is a gradual thickening of the proliferative endometrial membrane, due to active cell division. The vessels become smaller, they hide behind the grooves that appear due to the heterogeneous thickening of the endometrium. The mucous membrane is thickest on the posterior uterine wall, at the bottom. On the contrary, the "children's place" and the anterior uterine wall changes minimally. The mucous layer is about 1.2 centimeters. When the menstrual cycle ends, normally the active cover of the endometrium is completely torn off, but as a rule, only part of the layer is torn off in some areas.

Forms of deviation from the norm

Violations of the normal thickness of the endometrium occur either due to a natural cause, or are pathological in nature. For example, in the first seven days after fertilization, the thickness of the endometrial cover changes - the baby's place becomes thicker. In pathology, thickening of the endometrium occurs during abnormal cell division. As a result, an extra mucous layer appears.

What is endometrial proliferation

Proliferation is a phase of rapid cell division in tissues that does not exceed the standard values. During this process, the mucosa regenerates and grows. New cells are not atypical, they form normal tissue. Proliferation is a process characteristic not only of the endometrium. Some other tissues also undergo a proliferation process.

Causes of proliferation

The reason for the appearance of the proliferative type of endometrium is due to the active rejection of the active layer of the uterine mucosa. After that, it becomes very thin. And it must be regenerated before the next menstruation. The active layer is updated during proliferation. Sometimes, she has pathological causes. For example, the process of proliferation occurs with endometrial hyperplasia. (If you do not treat hyperplasia, it prevents you from getting pregnant). With hyperplasia, active cell division occurs, and thickening of the active layer of the uterine mucosa.

Phases of endometrial proliferation

Endometrial proliferation is an increase in the cell layer through active division, during which organic tissues grow. At the same time, the mucous layer in the uterus thickens during normal cell division. The process lasts up to 14 days, it is activated by the female hormone - estrogen, synthesized during the maturation of the follicle. Proliferation consists of three stages:

• early
• middle
• late

Each stage lasts a certain period of time, and manifests itself differently on the mucous layer of the uterus.

Early

The early stage of endometrial proliferation lasts from five to seven days. During this period, the endometrial cover is covered with a cellular epithelial layer of a cylindrical type. The glands are dense, straight, thin, round or oval in diameter. The epithelial glandular layer is located low, the cell nuclei at the base, oval, painted in a bright red hue. Connecting cells(stroma) - have a spindle shape, their nuclei are large in diameter. The blood vessels are almost straight.

Medium

The middle stage of proliferation comes on the eighth - tenth day of the cycle. The epithelium is lined with tall prismatic epithelial cells. At this time, the glands bend a little, the nuclei turn pale, become larger, and are located at different levels. The number of cells formed through indirect division increases. The connective tissue swells and becomes loose.

Late

The late stage of proliferation begins at 11 or 14 days. The endometrium of the late stage of the phase is significantly different from what it is at the early stage. The glands acquire a sinuous shape, cell nuclei at different levels. The epithelial layer is one, but it is multi-rowed. Vacuoles with glycogen mature in cells. Vascular mesh sinuous. Cell nuclei are rounded and become larger. The connective tissue is poured.

Phases of secretion

Secretion is also divided into three stages:

1. Early - from 15 to 18 days of the cycle.
2. Average - 20-23 days of the cycle, at this time the secretion is most active.
3. Late - from 24 to 27 days, when the secretion fades.

The secretory phase is replaced by the menstrual phase. It is also divided into two periods:

1. Desquamation - from the 28th day to the 2nd day of the new cycle, if the egg is not fertilized.
2. Recovery - from 3 to 4 days, until the active layer is completely rejected, and before the start of a new proliferation process.

After passing through all the stages, the cycle repeats again. This happens before pregnancy, menopause, if there are no pathologies.

How to Diagnose

Diagnosis will help determine the signs of proliferation of the pathological type. There are several ways to diagnose proliferation:

1. visual inspection.
2. Colposcopic examination.
3. Cytological analysis.

To avoid serious illnesses You need to visit your gynecologist regularly. Pathology can be seen during a routine gynecological examination. Other methods allow you to more accurately determine the cause of abnormal proliferation.

Diseases associated with proliferation

The endometrium in the proliferation phase is actively growing, cell division occurs under hormonal influence. During this period, the appearance of pathologies due to the rapid growth of cells is possible. Tumors may appear, tissues will begin to grow, and so on. Diseases can appear if something goes wrong during the cyclic phases of proliferation. In the secretory phase, the development of membrane pathologies is almost impossible. Most often, during cell division, hyperplasia of the uterine mucosa develops, which in some cases can lead to infertility and cancer of the reproductive organ.

The disease provokes a hormonal failure that occurs during the period of active cell division. As a result, its duration increases, there are more cells, and the mucous membrane becomes much thicker than normal. Treatment of such diseases should be timely. The most commonly used medication, physiotherapy. In severe cases, resort to surgical intervention.

Why does the proliferation process slow down?

Inhibition of endometrial proliferation processes or insufficiency of the second stage of the menstrual cycle is distinguished by the fact that cell division stops or passes much more slowly than usual. These are the main symptoms of impending menopause, deactivation of the ovaries and cessation of ovulation. it normal phenomenon characteristic before menopause. But, if inhibition occurs in a young woman, then this is a sign of hormonal instability. This pathological phenomenon must be treated, it leads to the cessation of the menstrual cycle ahead of time and the inability to become pregnant.

Endometrium - the mucous inner layer of the uterus, which forms optimal conditions for attachment gestational sac and changing its thickness during the menstrual period.

The minimum thickness is observed at the beginning of the cycle, the maximum - in its last days. If fertilization does not occur during the menstrual cycle, there is a detachment of the epithelium and the withdrawal of the unfertilized egg with the menstrual cell.

Speaking in an accessible language, we can say that the endometrium affects the volume of secretions, as well as the frequency and cyclicity of menstruation.

In women, under the influence of negative factors, thinning of the endometrium is possible, which not only negatively affects the attachment of the embryo, but can also lead to infertility.

In gynecology, there are cases of arbitrary miscarriage if the egg was placed on thin layer. Competent gynecological treatment is enough to eliminate problems that negatively affect conception and the safe course of pregnancy.

Thickening of the endometrial layer (hyperplasia) is characterized by a benign course and may be accompanied by the appearance of polyps. Deviations in the thickness of the endometrium are detected when gynecological examination and scheduled examinations.

In the absence of symptoms of pathology, as well as infertility, treatment may not be prescribed.

Forms of hyperplasia:

• Simple. Glandular cells predominate, leading to the appearance of polyps. Drugs are used for treatment and surgical intervention.
• Atypical. Accompanied by the development of adenomatosis (malignant disease).

menstruation cycle in women

In the female body, changes occur every month that help create optimal conditions for conceiving and bearing a child. The period between them is called the menstrual cycle.

On average, its duration is 20-30 days. The beginning of the cycle is the first day of menstruation.

At the same time, the endometrium is updated and cleansed.

If during the menstrual cycle in women there are deviations, then this indicates serious violations in the body. The cycle is divided into several phases:

• proliferation;
• secretion;
• menstruation.

Proliferation refers to the processes of reproduction and division of cells that contribute to the growth of the internal tissues of the body. During the proliferation of the endometrium in the mucous membrane of the uterine cavity, normal cells begin to divide.

Such changes can take place during menstruation or have a pathological origin.

Duration of proliferation averages up to two weeks. In the body of a woman, estrogen begins to increase intensively, which produces an already mature follicle.

This phase can be divided into early, middle and late stages. At an early stage (5-7 days) in the uterine cavity, the surface of the endometrium is covered with epithelial cells that have a cylindrical shape.

In this case, the blood arteries remain unchanged.

Classification of endometrial hyperplasia

According to the histological variant, several types of endometrial hyperplasia are distinguished: glandular, glandular-cystic, atypical (adenomatosis) and focal (endometrial polyps).

Glandular hyperplasia of the endometrium is characterized by the disappearance of the division of the endometrium into functional and basal layers. The border between the myometrium and the endometrium is clearly expressed, an increased number of glands is noted, but their location is uneven, and the shape is not the same.

Every month, a woman's body undergoes hormonal changes. cyclic fluctuations. One of the manifestations of such changes is menstrual bleeding. But this is only the visible part of a complex mechanism aimed at maintaining reproductive function women. It is very important that the mucous layer of the uterus - the endometrium - has a normal thickness throughout the entire cycle. What is the thickness of the endometrium before menstruation, during and after them is considered normal?

What happens in the female body every month?

The normal menstrual cycle consists of three phases: proliferation, secretion, desquamation (menstruation). During each of them, changes occur in the ovaries and endometrium, caused by fluctuations in hormones (estrogen, progesterone, pituitary hormones). Therefore, on different days of the cycle, as well as during menstruation, the thickness of the endometrial layer changes.

For example, the thickness of the endometrium before menstruation is much greater than in the first days after it. The normal duration of the menstrual cycle is 28 days, during which time the uterine mucosa should fully recover.

Changes in the endometrium in the proliferation phase

The proliferation phase consists of early, middle and late stages. At an early stage of the proliferation phase, immediately after menstruation, the endometrium should be no more than 2-3 mm. During this period, at the beginning of the menstrual cycle, the regeneration of the endometrium begins due to the cells of the basal layer. Visually, the uterine mucosa of this stage is thin, pale pink, with single small hemorrhages.

The middle stage starts on the 4th day menstrual cycle. There is a gradual increase in the thickness of the endometrium, on the 7th day after menstruation it is 6-7 mm. The duration of this period is up to 5 days.

At a late stage, the normal thickness of the endometrium is 8-9 mm. This stage lasts three days. At this stage, the uterine mucosa loses its uniform structure. It becomes folded, while areas of thickening of certain zones are observed. For example, the endometrium is somewhat denser and thicker in the fundus and on the posterior wall of the uterus, slightly thinner on its anterior surface. This is due to the preparation of the mucosa for implantation of the fetal egg.

This video presents detailed information about the course of menstruation:

What changes in the endometrium occur during the secretion phase?

In this phase, there are also early, middle and late stages. It starts 2-4 days after ovulation. Does this phenomenon affect the thickness of the endometrium? At an early stage of secretion, the endometrium has a minimum thickness of 10, a maximum of 13 mm. The changes are primarily related to increased production progesterone in the corpus luteum of the ovary. The mucosa increases even more significantly than in the proliferation phase, by 3-5 mm, becomes swollen, acquires a yellowish tint. Its structure becomes homogeneous and no longer changes until the onset of menstruation.

The middle stage lasts from the 18th to the 24th day of the menstrual cycle, is characterized by the most pronounced secretory changes in the mucous membrane. For this moment normal thickness endometrium is a maximum of 15 mm in diameter. The inner layer the uterus becomes as dense as possible. When conducting ultrasound during this period, you can notice an echo-negative strip on the border of the myometrium and endometrium - the so-called rejection zone. This zone reaches its maximum before menstruation. Visually, the endometrium is swollen, due to folding, it can acquire a polypoid appearance.

What changes occur in the late stage of secretion? Its duration is from 3 to 4 days, it precedes menstrual bleeding, and usually occurs on the 25th day of monthly cycles. If the woman is not pregnant, then the corpus luteum involution occurs. Due to the reduced production of progesterone in the endometrium, pronounced trophic disorders occur. When performing ultrasound during this period, the heterogeneity of the endometrium is clearly visible, with areas dark spots, zones of vascular disorders. This picture is caused by vascular reactions occurring in the endometrium, leading to thrombosis, hemorrhage, and necrosis of mucosal areas. The rejection zone on ultrasound becomes even more distinct, its thickness is 2-4 mm. Capillaries in the layers of the endometrium on the eve of menstruation become even more expanded, spirally convoluted.

Their tortuosity becomes so pronounced that it leads to thrombosis and subsequent necrosis of mucosal areas. These changes are called "anatomical" menstruation. Immediately before menstruation, the thickness of the endometrium reaches 18 mm.

What happens in the desquamation phase?

During this period, the functional layer of the endometrium is rejected. This process begins on the 28-29th day of the menstrual cycle. The duration of this period is 5-6 days. Variants of deviations from the norm for one or two days are possible. The functional layer looks like areas of necrotic tissue; during menstruation, the endometrium is completely rejected in 1-2 days.

At various diseases uterus, delayed rejection of mucosal sites can be observed, this affects the intensity of menstruation and its duration. Sometimes during menstruation there is very heavy bleeding.

If the bleeding has increased, you should consult a gynecologist. This should be especially remembered during the first menstruation after a miscarriage, as this may mean that particles of the fetal egg remain in the uterus.

Additional information about menstruation is provided in the video:

Does menstruation always start on time?

Sometimes there are situations when there is an untimely onset of menstruation. If pregnancy is excluded, then this phenomenon is called a delay in menstruation. The main reason for this condition is a hormonal imbalance in the body. Some experts consider the normal delay in a healthy woman up to 2 times a year. They can be quite common for teenage girls who have not yet established a menstrual cycle.

Factors that may lead to this condition:

1. chronic stress. It can provoke a violation of the production of pituitary hormones.
2. Overweight or, conversely, a sharp weight loss. In women who lose weight rapidly, menstruation may disappear.
3. Inadequate dietary intake of vitamins and nutrients. This can happen with a passion for weight loss diets.
4. Significant physical exercise. They can lead to a decrease in the production of sex hormones.
5. Gynecological diseases. Inflammatory diseases in the ovaries lead to disruption of hormone production.
6. Diseases endocrine organs. For example, menstrual disorders are often found in the pathology of the thyroid gland.
7. Operations on the uterus. Often a delay in menstruation occurs after an abortion.
8. After spontaneous abortion. In some cases, curettage of the uterine cavity is additionally performed. After a miscarriage, the endometrium does not have time to recover, and a later onset of menstruation occurs.
9. Reception hormonal contraceptives. After their cancellation, menstruation may occur later than 28 days later.

The average delay is usually up to 7 days. With a delay in menstruation for more than 14 days, it is necessary to once again undergo a diagnosis for the presence of pregnancy.

If there is no menstruation for a long time, 6 months or more, they talk about amenorrhea. This phenomenon occurs in women during menopause, rarely after an abortion, when the basal layer of the endometrium was damaged. In any case, in case of violation of the normal menstrual cycle, it is necessary to consult a gynecologist. This will allow timely detection of the disease and start its treatment.