Early proliferation what. Types of endometrial hypertrophy. The secretion phase of the menstrual cycle

The main purpose of the endometrium is to create conditions for conception and successful pregnancy. The endometrium of the proliferative type is characterized by a significant proliferation of mucous tissue due to intensive cell division. As is known, throughout menstrual cycle the inner layer lining the uterine cavity undergoes changes. This happens monthly and is a natural process.

The structural structure of the endometrium consists of two main layers - basal and functional. The basal layer is little affected by changes, since it is designed to restore the functional layer during the next cycle. Its structure is cells tightly pressed to each other, penetrated by multiple blood-supplying vessels. is in the range from 1 - 1.5 cm. The functional layer, on the contrary, changes regularly. This is due to damage occurring during menstruation, during childbirth, from surgical interventions during abortion and diagnostic manipulations. There are several main phases of the cycle: proliferative, menstrual, secretory and presecretory. These alternations should occur regularly and in accordance with the functions that the female body needs in each particular period.

Normal structure of the endometrium

In different phases of the cycle, the state of the endometrium in the uterus varies. For example, by the end of the proliferation period, the basal mucous layer increases to 2 cm and almost does not respond to hormonal influences. In the initial period of the cycle, the uterine mucosa is pink, smooth, with small areas of incompletely separated functional layer formed in the previous cycle. For next week occurs proliferative type, caused by cell division.

Blood vessels hide in the folds arising from the unevenly thickened layer of the endometrium. The largest layering of the mucosa in the endometrium of the proliferative type is observed on back wall uterus and its fundus, and the anterior wall and part children's place below remains almost unchanged. The mucosa in this period can reach a thickness of 12 mm. Ideally, by the end of the cycle, the functional layer should be completely rejected, but this usually does not happen and rejection occurs only in the outer areas.

Forms of deviation of the structure of the endometrium from the norm

Differences in the thickness of the endometrium from normal values ​​occur in two cases - for functional reasons and as a result of pathology. Functional manifests itself at an early stage of pregnancy, a week after the process of fertilization of the egg, in which the child's place thickens.

Pathological causes are due to a violation of the division of the correct cells, resulting in the formation of excess tissues, leading to the formation of tumor formations, for example, the resulting endometrial hyperplasia. Hyperplasia is usually classified into several types:

• , with the absence of a clear separation between the functional and basal layers, with an increased number of glands of various shapes;
• in which part of the glands form cysts;
• focal, with proliferation of epithelial tissue and the formation of polyps;
• , characterized by an altered structure in the structure of the endometrium with a decrease in the number of connective cells.

The focal form of atypical hyperplasia is dangerous and can develop into cancerous tumor uterus. Most often, such a pathology occurs.

Stages of development of the endometrium

During the menstrual period, most of the endometrium dies, but almost simultaneously with the onset of a new menstruation, its restoration begins with the help of cell division, and after 5 days the structure of the endometrium is considered to be completely renewed, although it continues to be thin.

The proliferative stage goes through 2 cycles - an early phase and a late one. The endometrium during this period is able to grow and from the beginning of menstruation to ovulation, its layer increases 10 times. During the first stage, the membrane inside the uterus is covered with a cylindrical low epithelium with tubular glands. During the passage of the second cycle, the endometrium of the proliferative type is covered with a higher layer of the epithelium, and the glands in it lengthen and acquire a wavy shape. During the presector stage, the endometrial glands change their shape and increase in size. The structure of the mucosa becomes saccular with large glandular cells that secrete mucus.

The secretory stage of the endometrium is characterized by a dense and smooth surface and basalt layers that do not show activity.

Important! The stage of the endometrium of the proliferative type coincides with the period of formation and

Feature of proliferation

Every month, changes occur in the body, designed for the moment of pregnancy and the period of the onset of gestation. The period of time between these events is called the menstrual cycle. The hysteroscopic state of the endometrium of the proliferative type depends on the day of the cycle, for example, in the initial period it is even and thin enough. Late period makes significant changes in the structure of the endometrium, it is thickened, has a bright pinkish color with a white tint. In this period of proliferation, it is recommended to examine the mouth of the fallopian tubes.

Proliferative diseases

During the proliferation of the endometrium in the uterus, intensive cell division occurs. Sometimes in the regulation of this process, disturbances occur as a result of which dividing cells form an excess of tissues. This condition threatens the development of oncological neoplasms in the uterus, disorders in the structure of the endometrium, endometriosis and many more pathologies. Most often, the examination reveals endometrial hyperplasia, which can have 2 forms, such as glandular and atypical.

Forms of hyperplasia

The glandular manifestation of hyperplasia in women occurs at an older age, during periods of menopause and after it. With hyperplasia, the endometrium has a thickened structure and polyps formed in the uterine cavity protruding into it. Epithelial cells in this disease are larger than normal cells. With glandular hyperplasia, such formations are grouped or form glandular structures. It is important that this form does not produce further division of the formed cells and, as a rule, rarely takes a malignant direction.

The atypical form refers to precancerous conditions. In youth, it does not occur and manifests itself during menopause in older women. During the examination, it is possible to notice an increase in the cells of the cylindrical epithelium with large nuclei and small nucleoli. Lighter cells with lipid content are also detected, the number of which is directly related to the prognosis and outcome of the disease. atypical glandular hyperplasia accepts malignant form in 2-3% of women. In some cases, it can begin to reverse development, but this only happens when treated with hormonal drugs.

Therapy for illness

flowing without major changes in the structure of the mucosa, usually treatable. For this, research is carried out using diagnostic curettage, after which the taken samples of mucous tissues are sent to the laboratory for analysis. If an atypical course is diagnosed, surgical operation with scraping. If it is necessary to preserve reproductive functions and preserve the ability to conceive after curettage, the patient will be forced to long time accept hormonal preparations with progestins. After the disappearance of pathological disorders in a woman, pregnancy most often occurs.

Proliferation always means the intensive growth of cells, which, having the same nature, begin their simultaneous development in one place, that is, they are located locally. In female cyclic functions, proliferation occurs with regularity and throughout life. During menstruation, the endometrium is shed and then restored by cell division. Women who have any abnormalities in reproductive functions or detected pathologies should take into account what phase of proliferation the endometrium is in during an ultrasound examination or when performing diagnostic scrapings from the uterus. Since in different periods cycle, these indicators can differ significantly from each other.

Collapse

The endometrium is the outer mucous layer that lines the uterine cavity. It is completely hormone-dependent, and it is he who undergoes the greatest changes during the menstrual cycle, it is his cells that are rejected and come out with the secretions during menstruation. All these processes proceed in accordance with certain phases, and deviations in the passage or duration of these phases can be considered pathological. Proliferative endometrium - a conclusion that can often be seen in the description of ultrasound - is the endometrium in the proliferative phase. About what this phase is, what stages it has and what it is characterized by, is described in this material.

Definition

What it is? The proliferative phase is the stage of active cell division of any tissue (while its activity does not exceed normal, that is, it is not pathological). As a result of this process, tissues are restored, regenerated, and grow. When dividing, normal, non-atypical cells appear, from which healthy tissue is formed, in this case, endometrium.

But in the case of the endometrium, this is a process of active increase in the mucosa, its thickening. Such a process can be caused by both natural causes (phase of the menstrual cycle) and pathological.

It is worth noting that proliferation is a term applicable not only to the endometrium, but also to some other tissues in the body.

The reasons

The endometrium of the proliferative type often appears because during the course of menstruation many cells of the functional (renewal) part of the endometrium were rejected. As a result, he became significantly thinner. The features of the cycle are such that for the onset of the next menstruation, this mucous layer must restore its thickness of the functional layer, otherwise there will be nothing to update. This is exactly what happens in the proliferative stage.

In some cases, such a process can be caused by pathological changes. In particular, endometrial hyperplasia (a disease that can, without proper treatment, lead to infertility), is also characterized by increased cell division, leading to a thickening of the functional layer of the endometrium.

Phases of proliferation

Proliferation of the endometrium normal process, which occurs with the passage of several stages. These stages are always present in the norm, the absence or violation of the course of any of these stages indicates the beginning of the development of the pathological process. The phases of proliferation (early, middle and late) differ depending on the rate of cell division, the nature of tissue growth, etc.

The whole process takes about 14 days. During this time, the follicles begin to mature, they produce estrogen, and it is under the action of this hormone that growth occurs.

Early

This stage occurs approximately from the fifth to the seventh day of the menstrual cycle. On it, the mucous membrane has the following features:

1. Epithelial cells are present on the surface of the layer;
2. The glands are elongated, straight, oval or round in cross section;
3. The glandular epithelium is low, and the nuclei are of intense color, and are located at the base of the cells;
4. Stroma cells are spindle-shaped;
5. The blood arteries are not tortuous at all or are minimally tortuous.

The early stage ends 5-7 days after the end of menstruation.

Medium

This is a short stage that lasts approximately two days from the eighth to the tenth day of the cycle. At this stage, the endometrium undergoes further changes. It acquires the following features and characteristics:

• epithelial cells that line outer layer endometrium, have a prismatic appearance, they are high;
• The glands become slightly more tortuous compared to the previous stage, their nuclei are less brightly colored, they become larger, there is no steady tendency to any of their location - they are all on different levels;
• The stroma becomes edematous and loose.

The endometrium of the middle stage of the secretion phase is characterized by the appearance of a certain number of cells formed by the method of indirect division.

Late

The endometrium of the late stage of proliferation is characterized by convoluted glands, the nuclei of all cells of which are located at different levels. The epithelium has one layer and many rows. Vacuoles with glycogen appear in a number of epithelial cells. The vessels are also tortuous, the state of the stroma is the same as in the previous stage. Cell nuclei are round and large. This stage lasts from the eleventh to the fourteenth day of the cycle.

Phases of secretion

The secretion phase occurs almost immediately after proliferation (or after 1 day) and is inextricably linked with it. It also distinguishes a number of stages - early, middle and late. They are characteristic of typical changes that prepare the endometrium and the body as a whole for the menstrual phase. The endometrium of the secretory type is dense, smooth, and this applies to both the basal and functional layers.

Early

This stage lasts approximately from the fifteenth to the eighteenth day of the cycle. It is characterized by a weak expression of secretion. At this stage, it is just beginning to develop.

Medium

At this stage, secretion proceeds as actively as possible, especially in the middle of the phase. slight fading secretory function observed only at the very end of this stage. It lasts from the twentieth to the twenty-third day

Late

The late stage of the secretion phase is characterized by a gradual extinction of the secretory function, with a complete convergence to nothing at the very end of this stage, after which the woman begins menstruation. This process lasts 2-3 days in the period from the twenty-fourth to the twenty-eighth day. It is worth noting a feature that is characteristic of all stages - they last for 2-3 days, while the exact duration depends on how many days are in the menstrual cycle of a particular patient.

Proliferative diseases

The endometrium in the proliferation phase grows very actively, its cells divide under the action of various hormones. Potentially, this condition is dangerous development various kinds diseases associated with pathological cell division - neoplasms, tissue growths, etc. Some failures in the process of passing through the stages can lead to the development of pathologies of this type. At the same time, the secretory endometrium is almost completely not subject to such danger.

The most typical disease that develops as a result of a violation of the phase of mucosal proliferation is hyperplasia. This is a condition of pathological growth of the endometrium. The disease is quite serious and requires timely treatment, as it causes severe symptoms (bleeding, pain) and can lead to complete or partial infertility. The percentage of cases of its degeneration into oncology, however, is very low.

Hyperplasia occurs with violations in hormonal regulation division process. As a result, cells divide longer and more actively. Slime layer thickens considerably.

Why does the proliferation process slow down?

Inhibition of endometrial proliferation processes is a process, also known as insufficiency of the second phase of the menstrual cycle, characterized by the fact that the proliferation process is not active enough or does not go at all. This is a symptom of menopause, ovarian failure and lack of ovulation.

The process is natural and helps predict the onset of menopause. But it can also be pathological if it develops in a woman reproductive age, this indicates a hormonal imbalance that needs to be addressed, as it can lead to dysmenorrhea and infertility.

Cyclic changes in the endometrium under the influence of steroid hormones

The mucous membrane of the fundus and body of the uterus morphologically the same. In women of the reproductive period, it consists of two layers:

1. Basal layer 1 - 1.5 cm thick, located on inner layer myometrium, the reaction to hormonal effects is weak and inconsistent. The stroma is dense, consists of connective tissue cells, rich in argyrophilic and thin collagen fibers.

   The endometrial glands are narrow, the epithelium of the glands is cylindrical single-row, the nuclei are oval, intensely stained. The height varies from the functional state of the endometrium from 6 mm after menstruation to 20 mm at the end of the proliferation phase; the shape of the cells, the location of the nucleus in them, the outlines of the apical edge, etc., also change.

   Among the cells of the cylindrical epithelium, large vesicle-shaped cells adjacent to the basement membrane can be found. These are the so-called light cells or "bubble cells", representing immature cells of the ciliated epithelium. These cells can be found in all phases of the menstrual cycle, but their greatest number is noted in the middle of the cycle. The appearance of these cells is stimulated by estrogens. In atrophic endometrium, light cells are never found. There are also cells of the epithelium of the glands in a state of mitosis - an early stage of prophase and wandering cells (histiocytes and large lymphocytes), penetrating through the basement membrane into the epithelium.

   In the first half of the cycle, additional elements can be detected in the basal layer - true lymphatic follicles, which differ from inflammatory infiltrates in the presence of the germinal center of the follicle and the absence of focal perivascular and / or periglandular, diffuse infiltrate from lymphocytes and plasma cells, other signs of inflammation, as well as clinical manifestations the last one. There are no lymphatic follicles in the children's and senile endometrium. The vessels of the basal layer are not sensitive to hormones and do not undergo cyclic transformations.

2. functional layer. The thickness varies from the day of the menstrual cycle: from 1 mm at the beginning of the proliferation phase, to 8 mm at the end of the secretion phase. Possesses high sensitivity to sex steroids, under the influence of which it undergoes morphofunctional and structural changes throughout each menstrual cycle.

   The mesh-fibrous structures of the stroma of the functional layer at the beginning of the proliferation phase up to the 8th day of the cycle contain single delicate argyrophilic fibers, before ovulation their number rapidly increases and they become thicker. In the secretion phase, under the influence of endometrial edema, the fibers move apart, but remain densely located around the glands and blood vessels.

   AT normal conditions branching of the glands does not occur. In the secretion phase, additional elements are most clearly indicated in the functional layer - a deep spongy layer, where the glands are more closely located, and a superficial - compact one, in which the cytogenic stroma predominates.

   The surface epithelium in the proliferation phase is morphologically and functionally similar to the epithelium of the glands. However, with the onset of the secretion stage, such biochemical changes, which cause easier adhesion of the blastocyst to the endometrium and subsequent implantation.

   Stroma cells at the beginning of the menstrual cycle are spindle-shaped, indifferent, there is very little cytoplasm. By the end of the secretion phase, part of the cells, under the influence of the hormone of the corpus luteum of menstruation, increases and changes into predecidual (the most correct name), pseudodecidual, decidua-like. Cells that develop under the influence of the hormones of the corpus luteum of pregnancy are called decidual.

   The second part decreases, and endometrial granular cells containing high-molecular peptides similar to relaxin are formed from them. In addition, there are single lymphocytes (in the absence of inflammation), histiocytes, mast cells(more in the secretion phase).

   The vessels of the functional layer are highly sensitive to hormones and undergo cyclic transformations. The layer has capillaries, which in the premenstrual period form sinusoids and spiral arteries, in the proliferation phase they are slightly tortuous, do not reach the surface of the endometrium. In the secretion phase, they elongate (height of the endometrium to the length of the spiral vessel as 1:15), become more tortuous and spirally twist in the form of balls. The greatest development is achieved under the influence of the hormones of the corpus luteum of pregnancy.

   If the functional layer is not rejected and the endometrial tissues undergo regressive changes, then the tangles of spiral vessels remain even after the disappearance of other signs of the luteal effect. Their presence is a valuable morphological sign of the endometrium, which is in a state of complete reverse development from the secretory phase of the cycle, as well as after a violation of early pregnancy - uterine or ectopic.

Innervation. The use of modern histochemical methods for the detection of catecholamines and cholinesterase made it possible to detect in the basal and functional layers of the endometrium nerve fibers, which are distributed throughout the endometrium, accompany the vessels, but do not reach the surface epithelium and epithelium of the glands. The number of fibers and the content of mediators in them changes throughout the cycle: adrenergic influences predominate in the endometrium of the proliferation phase, and cholinergic influences predominate in the secretion phase.

Endometrium of the isthmus of the uterus reacts to ovarian hormones much weaker and later than the endometrium of the body of the uterus, and sometimes does not react at all. The mucous isthmus has few glands that run obliquely and often form cystic extensions. The epithelium of the glands is low cylindrical, elongated dark nuclei almost completely fill the cell. Mucus is secreted only into the lumen of the glands, but is not contained intracellularly, which is typical for the cervical epithelium. The stroma is dense. In the secretory phase of the cycle, the stroma is slightly loosened, sometimes a mild decidual transformation is observed in it. During menstruation, only the superficial epithelium of the mucous membrane is rejected.

In underdeveloped uteruses, the mucous membrane, which has structural and functional features isthmic part of the uterus, lines the walls of the lower and middle parts of the body of the uterus. In some underdeveloped uterus, only in its upper third, a normal endometrium is found, capable of responding according to the phases of the cycle. Such anomalies of the endometrium are observed mainly in hypoplastic and infantile uterus, as well as in the uterus arcuatus and uterus duplex.

Clinical and diagnostic value: localization of the endometrium of the isthmic type in the body of the uterus is manifested by the sterility of the woman. In the event of pregnancy, implantation in a defective endometrium leads to deep ingrowth of villi into the underlying myometrium and to the occurrence of one of the most severe obstetric pathologies - placenta increta.

mucous membrane cervical canal. Has no glands. The surface is lined with a single-row high cylindrical epithelium with basally located small hyperchromic nuclei. Epithelial cells intensively secrete intracellular mucus, which impregnates the cytoplasm - the difference between the epithelium of the cervical canal and the epithelium of the isthmus and body of the uterus. Under the cylindrical cervical epithelium there may be small rounded cells - reserve (subepithelial) cells. These cells can transform into both cylindrical cervical epithelium and stratified squamous, which is observed in endometrial hyperplasia and cancer.

In the proliferation phase, the nuclei of the cylindrical epithelium are located basally, in the secretion phase - mainly in the central sections. Also, in the phase with excretion, the number of reserve cells increases.

The unchanged dense mucosa of the cervical canal is not captured during curettage. Pieces of loosened mucous membrane come across only with its inflammatory and hyperplastic changes. Scrapings very often reveal polyps of the cervical canal crushed by a curette or not damaged by it.

Morphological and functional changes in the endometrium
during the ovulatory menstrual cycle.

Classification of the phases of the menstrual cycle (according to Witt, 1963)

This classification most closely matches modern ideas about changes in the endometrium in certain phases of the cycle. It can be applied in practice.

1. Proliferation phase
   • Early stage - 5-7 days
   • Middle stage - 8-10 days
   • Late stage - 10-14 days
2. Secretion phase
   • Early stage (first signs of secretory transformations) - 15-18 days
   • The middle stage (the most pronounced secretion) - 19-23 days
   • Late stage (beginning regression) - 24-25 days
   • Regression accompanied by ischemia - 26-27 days
3. Bleeding phase (menstruation)
   • Desquamation - 28-2 days
   • Regeneration - 3-4 days

When assessing the changes occurring in the endometrium according to the days of the menstrual cycle, it is necessary to take into account: the duration of the cycle in this woman (in addition to the most common 28-day cycle, there are 21-, 30- and 35-day cycles) and the fact that ovulation during a normal menstrual cycle can occur between the 13th and 16th day of the cycle. Therefore, depending on the time of ovulation, the structure of the endometrium of one or another stage of the secretion phase changes somewhat within 2-3 days.

Proliferation phase

It lasts an average of 14 days. It can be extended or shortened within about 3 days. In the endometrium, changes occur that occur mainly under the influence of an ever-increasing amount of estrogenic hormones that are produced by a growing and maturing follicle.

• Early phase of proliferation (5 - 7 days).

  The glands are straight or slightly curved with a rounded or oval outline in cross section. The epithelium of the glands is single-row, low, cylindrical. The nuclei are oval, located at the base of the cell. The cytoplasm is basophilic and homogeneous. individual mitoses.

  Stroma. Fusiform or stellate reticular cells to delicate processes. There is very little cytoplasm, the nuclei are large, they fill almost the entire cell. random mitoses.

• The middle phase of proliferation (8 - 10 days).

  The glands are elongated, slightly convoluted. The nuclei are sometimes located at different levels, more enlarged, less stained, some have small nucleoli. There are many mitoses in the nuclei.

  The stroma is edematous, loosened. In cells, a narrow border of the cytoplasm is more distinguishable. The number of mitoses increases.

• Late phase of proliferation (11 - 14 days)

  The glands are significantly convoluted, corkscrew-shaped, the lumen is dilated. The nuclei of the epithelium of the glands are at different levels, enlarged, contain nucleoli. The epithelium is stratified, but not stratified! In single epithelial cells, small subnuclear vacuoles (they contain glycogen).

  The stroma is juicy, the nuclei of connective tissue cells are larger and rounded. In cells, the cytoplasm is even more distinguishable. Few mitoses. Spiral arteries growing from the basal layer reach the surface of the endometrium, slightly tortuous.

diagnostic value. Endometrial structures corresponding to the proliferation phase observed under physiological conditions in the first half of a 2-phase menstrual cycle may reflect hormonal disorders if they are found in the second half of the cycle (this may indicate an anovulatory, single-phase cycle or an abnormal, prolonged proliferation phase with delayed ovulation in a biphasic cycle), with endometrial glandular hyperplasia in various areas of the hyperplastic uterine mucosa, and with dysfunctional uterine bleeding in women any age.

Secretion phase

The physiological phase of secretion, directly related to the hormonal activity of the menstrual corpus luteum, lasts 14 ± 1 days. Shortening or lengthening of the secretion phase by more than 2 days in women reproductive period considered functionally pathological. Such cycles are sterile.

Biphasic cycles, in which the secretory phase ranges from 9 to 16 days, are often observed at the beginning and end of the reproductive period.

The day of ovulation occurred can be determined by changes in the endometrium, which consistently reflect first increasing and then decreasing function of the corpus luteum. During the 1st week of the secretion phase, the day of ovulation occurred is diagnosed by changes in the epithelium of eelosis; on the 2nd week, this day can be most accurately determined by the state of the endometrial stroma cells.

• Early stage (15-18 days)

  On the 1st day after ovulation (15th day of the cycle) microscopic signs the effect of progesterone on the endometrium is not yet detected. They appear only after 36–48 hours, i.e. on the 2nd day after ovulation (on the 16th day of the cycle).

  The glands are more convoluted, their lumen is expanded; in the epithelium of the glands - subnuclear vacuoles containing glycogen - a characteristic feature of the early stage of the secretion phase. Subnuclear vacuoles in the epithelium of the glands after ovulation become much larger and are found in all epithelial cells. Nuclei pushed aside by vacuoles central departments cells, at first they are at a different level, but on the 3rd day after ovulation (17th day of the cycle), the nuclei lying above the large vacuoles are located at the same level.

  On the 4th day after ovulation (18th day of the cycle), in some cells, the vacuoles partially move from the basal part past the nucleus to the apical part of the cell, where glycogen also moves. The nuclei again find themselves at different levels, descending to the basal part of the cells. The shape of the nuclei changes to a more round one. The cytoplasm of cells is basophilic. In the apical sections, acidic mucoids are detected, the activity of alkaline phosphatase is reduced. There are no mitoses in the epithelium of the glands.

  The stroma is juicy, loose. At the beginning of the early stage of the secretion phase in the superficial layers of the mucous membrane, focal hemorrhages are sometimes observed that occurred during ovulation and are associated with a short-term decrease in estrogen levels.

  diagnostic value. The structure of the endometrium of the early stage of the secretion phase reflects hormonal disorders, if observed in the last days of the menstrual cycle - with a delayed onset of ovulation, during bleeding with shortened incomplete two-phase cycles, during acyclic dysfunctional uterine bleeding. It is noted that bleeding from the postovulatory endometrium is especially often observed in women in menopause.

  Subnuclear vacuoles in the epithelium of the endometrial glands are not always a sign indicating ovulation has occurred and the secretory function of the corpus luteum has begun. They may also occur:

  • under the influence of corpus luteum progesterone
  • in menopausal women as a result of the use of testosterone after pretreatment with estrogen hormones
  • in the glands of mixed hypoplastic endometrium with dysfunctional uterine bleeding in women of any age, including menopause. In such cases, the appearance of subnuclear vacuoles may be related to adrenal hormones.
  • as a result of non-hormonal treatment of disorders menstrual function, during novocaine blockade upper cervical sympathetic ganglia, electrical stimulation of the cervix, etc.

  If the occurrence of subnuclear vacuoles is not associated with ovulation, they are contained in some cells of individual glands or in a group of endometrial glands. The vacuoles themselves are often small.

  For the endometrium, in which subnuclear vacuolization is the result of ovulation and the function of the corpus luteum, the configuration of the glands is primarily characteristic: they are tortuous, dilated, usually of the same type and correctly distributed in the stroma. Vacuoles are large, same sizes are found in all glands, in every epithelial cell.

• The middle stage of the secretion phase (19-23 days)

  In the middle stage, under the influence of hormones of the corpus luteum, reaching highest function, secretory transformations of the endometrial tissue are most pronounced. The functional layer becomes higher. It is clearly divided into deep and superficial. The deep layer contains highly developed glands and a small amount of stroma. The surface layer is compact, containing less convoluted glands and many connective tissue cells.

  In the glands on the 5th day after ovulation (day 19 of the cycle), most of the nuclei are again in the basal part of the epithelial cells. All nuclei are rounded, very light, vesicular (this type of nuclei is hallmark which distinguishes the endometrium of the 5th day after ovulation from the endometrium of the 2nd day, when the epithelial nuclei are oval and darkly colored). The apical section of the epithelial cells becomes dome-shaped, glycogen accumulates here, which has moved from the basal sections of the cells and now begins to be released into the lumen of the glands by apocrine secretion.

  On the 6th, 7th and 8th day after ovulation (20th, 21st, 22nd day of the cycle), the lumen of the glands expands, the walls become more folded. The epithelium of the glands is single-row, with basally located nuclei. As a result of intense secretion, the cells become low, their apical edges are indistinctly expressed, as if with notches. Alkaline phosphatase completely disappears. In the lumen of the glands is a secret containing glycogen and acid mucopolysaccharides. On the 9th day after ovulation (23rd day of the cycle), the secretion of the glands ends.

  In the stroma on the 6th, 7th day after ovulation (20th, 21st day of the cycle), a perivascular decidual reaction appears. The connective tissue cells of the compact layer around the vessels become larger, acquire rounded and polygonal outlines. Glycogen appears in their cytoplasm. Islets of predecidual cells are formed.

  Later, the predecidual transformation of cells spreads more diffusely throughout the entire compact layer, mainly in its superficial sections. The degree of development of predecidual cells varies individually.

  Vessels. The spiral arteries are sharply convoluted, forming "balls". At this time, they are found both in the deep sections of the functional layer, and in the superficial sections of the compact one. The veins are dilated. The presence of tortuous spiral arteries in the functional layer of the endometrium is one of the most reliable signs that determine the luteal effect.

  From the 9th day after ovulation (23rd day of the cycle), the edema of the stroma decreases, as a result of which the tangles of the spiral arteries, as well as the surrounding predecidual cells, are more clearly identified.

  During the middle stage of secretion, implantation of the blastocyst occurs. Best conditions for implantation represent the structure and functional state of the endometrium on the 20-22nd day of the 28-day menstrual cycle.

• Late stage of the secretion phase (24 - 27 days)

  From the 10th day after ovulation (on the 24th day of the cycle), due to the beginning of the regression of the corpus luteum and a decrease in the concentration of hormones produced by it, the endometrial trophism is disturbed and degenerative changes. On the 24-25th day of the cycle, the initial signs of regression are morphologically noted in the endometrium, on the 26-27th day this process is accompanied by ischemia. In this case, first of all, the juiciness of the tissue decreases, which leads to wrinkling of the stroma of the functional layer. Its height during this period is 60-80% of the maximum height that was in the middle of the secretion phase. Due to the wrinkling of tissues, the folding of the glands increases, they acquire pronounced stellate outlines in transverse sections and sawtooth in longitudinal sections. The nuclei of some epithelial cellular glands are pycnotic.

  Stroma. At the beginning of the late stage of the secretion phase, the predecidual cells converge and are more clearly defined not only around the spiral vessels, but also diffusely throughout the entire compact layer. Among the predecidual cells, endometrial granular cells are clearly detected. For a long time, these cells were taken for leukocytes, which began to infiltrate the compact layer a few days before the onset of menstruation. However, later studies found that leukocytes penetrate into the endometrium immediately before menstruation, when already altered vessel walls become sufficiently permeable.

  From the granular cell granules in the late stage of the secretion phase, relaxin is released, which contributes to the melting of the argyrophilic fibers of the functional layer, thus preparing the menstrual mucosal rejection.

  On the 26-27th day of the cycle, lacunar expansion of capillaries and focal hemorrhages in the stroma are observed in the surface layers of the compact layer. Due to the melting of fibrous structures, areas of separation of the cells of the stroma and epithelium of the glands appear.

  The state of the endometrium, thus prepared for disintegration and rejection, is called "anatomical menstruation." This state of the endometrium is detected a day before the onset of clinical menstruation.

Bleeding phase

During menstruation, desquamation and regeneration processes occur in the endometrium.

• Desquamation (28-2nd day of the cycle).

  It is generally accepted that in the implementation of menstruation important role play changes from spiral arterioles. Before menstruation, due to the regression of the corpus luteum at the end of the secretion phase, and then its death and a sharp decline in hormones, structural regressive changes increase in the endometrial tissue: hypoxia and those circulatory disorders that were caused by prolonged spasm of the arteries (stasis, blood clots, brittleness and permeability vascular wall, hemorrhage in the stroma, leukocyte infiltration). As a result, the twisting of the spiral arterioles becomes even more pronounced, the blood circulation in them slows down, and then, after a long spasm, vasodilation occurs, as a result of which a significant amount of blood enters the endometrial tissue. This leads to the formation of small, and then more extensive hemorrhages in the endometrium, to rupture of blood vessels, and rejection - desquamation - of necrotic sections of the functional layer of the endometrium, i.e. to menstrual bleeding.

  Causes uterine bleeding during menstruation:

  • decrease in the level of gestagens and estrogens in peripheral blood plasma
  • vascular changes, including increased permeability of the vascular walls
  • circulatory disorders and concomitant destructive changes in the endometrium
  • release of relaxin by endometrial granulocytes and melting of argyrophilic fibers
  • leukocyte infiltration of the stroma of the compact layer
  • occurrence of focal hemorrhages and necrosis
  • increase in protein content and fibrinolytic enzymes in endometrial tissue

  A morphological feature characteristic of the endometrium of the menstrual phase is the presence of collapsed stellate glands and tangles of spiral arteries in the decaying tissue riddled with hemorrhages. On the 1st day of menstruation in a compact layer among the areas of hemorrhages can still be discerned individual groups predecidual cells. also in menstrual blood contain the smallest particles of the endometrium, which retain the viability and ability to implant. Direct evidence of this is the occurrence of endometriosis of the cervix when the flowing menstrual blood gets on the surface. granulation tissue after diathermocoagulation of the cervix.

  Fibrinolysis of menstrual blood is due to the rapid destruction of fibrinogen by enzymes released during the decay of the mucous membrane, which prevents menstrual blood from clotting.

  diagnostic value. Morphological changes in the endometrium beginning desquamation can be mistaken for manifestations of endometritis that develops in the secretory phase of the cycle. However, when acute endometritis dense leukocyte infiltrate of the stroma also destroys the glands: leukocytes, penetrating through the epithelium, accumulate in the lumen of the glands. For chronic endometritis focal infiltrates consisting of lymphocytes and plasma cells are characteristic.

• Regeneration (3-4 days of the cycle).

  During the menstrual phase, only separate sections of the functional layer of the endometrium are rejected (according to the observations of Prof. Vikhlyaeva). Even before the complete rejection of the functional layer of the endometrium (in the first three days of the menstrual cycle), epithelialization already begins wound surface basal layer. On the 4th day, epithelialization of the wound surface ends. It is believed that epithelialization can occur through the growth of epithelium from each gland of the basal layer of the endometrium, or due to the growth of glandular epithelium from areas of the functional layer that have been preserved from the previous menstrual cycle. Simultaneously with the epithelialization of the surface of the basal layer, the development of the functional layer of the endometrium begins, it thickens due to the coordinated growth of all elements of the basal layer, and the uterine mucosa enters an early stage of proliferation.

  The division of the menstrual cycle into proliferative and secretory phases is conditional, because. a high level of proliferation is maintained in the epithelium of the glands and stroma in early phase secretions. Only the presence of progesterone in the blood high concentration by the 4th day after ovulation leads to a sharp suppression of proliferative activity in the endometrium.

  Violation of the relationship between estradiol and progesterone leads to the development of pathological proliferation in the endometrium in the form of various forms of endometrial hyperplasia.

The pace of life forces you to be active: a friend's wedding, a meeting with school friends, a trip to the sea, romantic dates...

But there are days when, for obvious reasons, your freedom is limited.
It is during this period that the menstrual cup will help you a lot, thanks to which you will have time to do everything you have in mind, without slowing down and without changing habits.

So what is this thing? This is a container for collecting secretions, which may have different shape, texture and color. It can be made from different materials and have different tails. But its main task is to make your critical period more comfortable without hitting the budget.

Installs just like a tampon, does not require frequent monitoring

Unlike tampons and other hygiene products, a menstrual cup does not betray its presence even to you. It takes shape inside the body and you don't feel it at all.
cap is absolutely neutral. It maintains the natural balance of the flora, does not leave fibers and does not allow liquid to come into contact with internal environment. Thus, it is more physiological for the body than other hygiene products.
In addition, the cap is quite an economical thing. Having bought only once, you will forget about other means for several years.

If our arguments seem insufficient to you, you can read real reviews our clients.

Why should you buy it in our store?

We have been working since 2009, and we advise girls on a daily basis. Use the form feedback. We have the widest selection. And this is not surprising, because we know that you are different, each with its own characteristics. Therefore, we always have a product that will suit you perfectly.
We offer the most low price on the market. And if you can find cheaper, write via the feedback form, and we will sell you at this price.
We provide cheap delivery, and we carry it out throughout Russia. You can choose the most convenient one.

Silicone cap. Where could I buy? Internet shop

We invite you to learn more about the advantages over pads and tampons, to find out how different brands differ: MeLuna (meluna) with a ball, with a ring, with a stem,

Content

The endometrium covers the entire uterus from the inside and is distinguished by a mucous structure. It is updated monthly and performs several important functions. The secretory endometrium has numerous blood vessels that supply blood to the body of the uterus.

The structure and purpose of the endometrium

The endometrium in its structure is basal and functional. The first layer remains practically unchanged, and the second regenerates the functional layer during menstruation. If there are no pathological processes in the woman's body, then its thickness is 1-1.5 centimeters. The functional layer of the endometrium changes regularly. Such processes are associated with the fact that during menstruation in the uterine cavity separate sections of the walls exfoliate.

Damage appears during labor, during mechanical abortion or diagnostic sampling for histology.

The endometrium performs an extremely important function in the body of a woman and helps the successful course of pregnancy. The fruit is attached to its walls. The embryo receives nutrients and the oxygen necessary for life. Thanks to the mucous layer of the endometrium, the opposite walls of the uterus do not stick together.

menstruation cycle in women

AT female body every month there are changes that help create optimal conditions to conceive and bear 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 deviations are noted, then this indicates serious disorders 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 stage. 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.

The middle stage (8-10 days) is characterized by the lining of the mucosal plane with epithelial cells that have a prismatic appearance. The glands are distinguished by a light tortuous shape, and the core has a less intense shade, increases in size. Appears in the uterine cavity great amount cells resulting from division. The stroma becomes edematous and rather loose.

The late stage (11-15 days) is characterized by a single-layer epithelium, which has many rows. The gland becomes tortuous, and the nuclei are located at different levels. Some cells contain small vacuoles that contain glycogen. The vessels are distinguished by a tortuous shape, the cell nuclei gradually acquire a rounded shape and greatly increase in size. The stroma becomes engorged.

The endometrium of the uterus of the secretory type can be divided into several stages:

• early (15-18 days of the menstrual cycle);
• medium (20-23 days, pronounced secretion is observed in the body);
• late (24-27 days, secretion gradually fades in the uterine cavity).

The menstrual phase can be divided into several periods:

1. Desquamation. This phase runs from the 28th to the 2nd day of the menstrual cycle and occurs when fertilization has not occurred in the uterine cavity.
2. Regeneration. This phase lasts from the third to the fourth day. It begins before the complete separation of the functional layer of the endometrium, along with the beginning of the growth of epithelial cells.

normal structure

Hysteroscopy helps the doctor examine the uterine cavity to assess the structure of the glands, new blood vessels and determine the thickness of the endometrial cell layer.

If research is carried out in different phases menstrual cycle, the result of the examination will be different. For example, by the end of the proliferation period, the basal layer begins to increase, so it does not respond to any hormonal influences. At the very beginning of the cycle period, the internal uterine mucosa has a pinkish tint, a smooth surface and small areas of an incompletely separated functional layer.

At the next stage, the endometrium of the proliferative type begins to grow in the woman's body, which is associated with cell division. Blood vessels are located in folds and result from uneven thickening of the endometrial layer. If there are no women in the body pathological changes, then the functional layer should be completely rejected.

Deviation forms

Any deviations in the thickness of the endometrium arise as a result of functional causes or pathological changes. Functional disorders appear on early dates pregnancy or a week after fertilization of the egg. In the uterine cavity, the child's place gradually thickens.

Pathological processes arise as a result of chaotic division healthy cells, which form excess soft tissues. In this case, neoplasms and tumors of a malignant nature are formed in the body of the uterus. These changes most often occur as a result of hormonal failure in endometrial hyperplasia. Hyperplasia comes in several forms.

1. glandular. In this case, there is no clear separation between the basal and functional layers. The number of glands increases.
2. Glandular cystic form. A certain part of the glands forms a cyst.
3. Focal. In the uterine cavity, epithelial tissues begin to grow and numerous polyps form.
4. Atypical. In the body of a woman, the structure of the structure of the endometrium changes and the number of connective cells decreases.

Endometrium of the uterus secretory type appears in the second phase of the menstrual cycle, in case of conception, it helps fertilized egg attach to the wall of the uterus.

secretory type

During the menstrual cycle, most of the endometrium dies, but when menstruation occurs, it is restored by cell division. After five days, the structure of the endometrium becomes renewed and is quite thin. The endometrium of the uterus of the secretory type has an early and late phase. It has the ability to grow and increases several times with the onset of menstruation. In the first stage, the inner lining of the uterus is covered with a cylindrical low epithelium, which has tubular glands. In the second cycle, the endometrium of the uterus of the secretory type is covered with a thick layer of epithelium. The glands in it begin to lengthen and acquire a wavy shape.

In the stage of the secretory form, the endometrium changes its original shape and significantly increases in size. The structure of the mucous membrane becomes saccular, glandular cells appear, through which mucus is secreted. The secretory endometrium is characterized by a dense and smooth surface with a basal layer. However, he is not active. The secretory type of the endometrium coincides with the period of formation and further development follicles.

In the cells of the stroma, glycogen gradually accumulates, and a certain part of them is transformed into decidual cells. At the end of the period, the corpus luteum begins to involute, and the work of progesterone stops. In the secretory phase of the endometrium, glandular and glandular cystic hyperplasia may develop.

Causes of glandular cystic hyperplasia

Glandular cystic hyperplasia occurs in women different ages. In most cases, formations occur in the secretory type of the endometrium during the period of hormonal changes.

To congenital causes glandular cystic hyperplasia include:

• hereditary genetic abnormalities;
• hormonal failure during puberty in adolescents.

Acquired pathologies include:

• problems of hormonal dependence are endometriosis and mastopathy;
• inflammatory processes in the genitals;
• infectious pathologies in the pelvic organs;
• gynecological manipulations;
• curettage or abortion;
• violations in the proper functioning of the endocrine system;
• excess body weight;
• polycystic ovaries;
• arterial hypertension;
• depressed function of the liver, mammary gland and adrenal glands.

If in the family one of the women was diagnosed with glandular cystic hyperplasia of the endometrium, then other girls need to be especially attentive to their health. It is important to regularly come for a preventive examination to the gynecologist, who will be able to determine in time possible deviations or pathological disorders in the uterine cavity.

Clinical manifestations

Glandular cystic hyperplasia, which is formed in the secretory endometrium, is manifested by the following symptoms.

• Menstrual disorders. Smearing bloody issues between periods.
• The discharge is not profuse, but with bloody dense clots. With prolonged blood loss, patients may experience anemia.
• soreness and discomfort in the lower abdomen.
• Lack of ovulation.

Pathological changes can be determined at the next preventive examination at the gynecologist. Glandular cystic hyperplasia of the secretory endometrium does not resolve on its own, so it is important to seek help from a qualified doctor in time. Only after a comprehensive diagnosis, the specialist will be able to prescribe therapeutic treatment.

Diagnostic methods

Glandular cystic hyperplasia of the secretory endometrium can be diagnosed using following methods diagnostics.

• Diagnostic examination by a gynecologist.
• Analysis of the patient's history, as well as the determination of hereditary factors.
• Ultrasound examination of the uterine cavity and pelvic organs. A special sensor is inserted into the uterus, thanks to which the doctor examines and measures the endometrium of the uterus of a secretory type. And also he checks for polyps, cystic formations or knots. But, ultrasound procedure does not give maximum exact result Therefore, other methods of examination are prescribed for patients.
• Hysteroscopy. Such an examination is carried out with a special medical optical apparatus. During the diagnosis, differential curettage of the secretory endometrium of the uterus is done. The received sample is sent to histological examination, which will determine the presence pathological processes and type of hyperplasia. This technique should be carried out before the onset of menstruation. The results obtained are the most informative, so gynecologists will be able to put the correct and accurate diagnosis. With the help of hysteroscopy, it is possible not only to determine the pathology, but also to perform surgical treatment of the patient.
• aspiration biopsy. During a gynecological examination, the doctor makes a scraping of the secretory endometrium. The resulting material is sent for histology.
• Histological examination. This diagnostic method determines the morphology of the diagnosis, as well as the type of hyperplasia.
• Laboratory studies on the level of hormones in the body. If necessary, hormonal disorders are checked in thyroid gland and adrenals.

Only after careful and comprehensive survey doctor can put correct diagnosis and prescribe effective treatment. The gynecologist will individually select medicines and their exact dosages.