Proliferative phase. Normal endometrial histology. Forms of deviation of the endometrial structure from the norm

During the menstrual cycle, called the proliferative phase, the structure of the uterine mucosa has, in general terms, the character described above. This period begins shortly after the menstrual bleeding, and, as the name itself shows, during this period proliferative processes occur in the uterine mucosa, leading to the renewal of the functional part of the mucous membrane that was rejected during menstruation.

As a result of reproduction fabrics, preserved after menstruation in the remnants of the mucous membrane (that is, in the basal part), the formation of the lamina propria of the functional zone begins again. From the thin mucous layer preserved in the uterus after menstruation, the entire functional part is gradually restored, and, thanks to the proliferation of the glandular epithelium, the uterine glands also lengthen and enlarge; however, in the mucous membrane they still remain smooth.

The entire mucous membrane gradually thickens, acquiring its normal structure and reaching an average height. At the end of the proliferative phase, cilia (kinocilia) of the surface epithelium of the mucous membrane disappear, and the glands prepare for secretion.

Simultaneously with the phase proliferation During the menstrual cycle, the follicle and egg cell mature in the ovary. Follicular hormone (folliculin, estrin), secreted by the cells of the Graafian follicle, is a factor that determines proliferative processes in the uterine mucosa. At the end of the proliferation phase, ovulation occurs; In place of the follicle, the corpus luteum of menstruation begins to form.

His hormone has a stimulating effect on the endometrium, causing changes that occur in the subsequent phase of the cycle. The proliferation phase begins on the 6th day of the menstrual cycle and continues until the 14-16th day inclusive (counting from the first day of menstrual bleeding).

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Secretion phase of the uterine cycle

Under stimulating influence hormone corpus luteum (progesterone), which meanwhile is formed in the ovary, the glands of the uterine mucosa begin to expand, especially in their basal sections, their bodies twist like a corkscrew, so that in longitudinal sections the internal configuration of their edges takes on a sawtooth, jagged appearance. A typical spongy layer of the mucous membrane appears, characterized by a spongy consistency.

The epithelium of the glands begins secrete mucus, containing a significant amount of glycogen, which in this phase is also deposited in the bodies of glandular cells. From some connective tissue cells of the compact layer of the mucous membrane, enlarged polygonal cells with weakly stained cytoplasm and nucleus begin to form in the tissue of the lamina propria.

These cells are scattered in fabrics singly or in the form of clusters, their cytoplasm also contains glycogen. These are the so-called decidual cells, which, in the event of pregnancy, multiply even more in the mucous membrane, so that their large number is a histological indicator of the initial phase of pregnancy (histological examination of pieces of the uterine mucosa obtained during chiretage - removal of the fertilized egg with a curette).

Carrying out such research is of great importance especially when determining ectopic pregnancy. The fact is that changes in the mucous membrane of the uterus also occur in the case when a fertilized egg cell, or rather a young embryo, nidates (grafts) not in its normal place (in the mucous membrane of the uterus), but in some other place outside the uterus (ectopic pregnancy).

Changes in hormonal levels (the content of estrogen and progesterone in the blood on different days of the ovarian cycle directly affect the condition of the endometrium, mucous membrane of the fallopian tubes, cervical canal and vagina. The mucous membrane of the uterus undergoes cyclic changes (menstrual cycle). In each cycle, the endometrium undergoes menstrual, proliferative and secretory phase.In the endometrium, there are functional (disappearing during menstruation) and basal (preserving during menstruation) layers.

Proliferative phase

The proliferative (follicular) phase - the first half of the cycle - lasts from the first day of menstruation until the moment of ovulation; at this time, under the influence of estrogens (mainly estradiol), proliferation of cells of the basal layer and restoration of the functional layer of the endometrium occur. The duration of the phase may vary. Basal body temperature is normal. Epithelial cells of the glands of the basal layer migrate to the surface, proliferate and form a new epithelial lining of the endometrium. In the endometrium, the formation of new uterine glands and the ingrowth of spiral arteries from the basal layer also occur.

Secretory phase

The secretory (luteal) phase - the second half - lasts from ovulation until the start of menstruation (12-16 days). The high level of progesterone secreted by the corpus luteum creates favorable conditions for embryo implantation. Basal body temperature is above 37 °C.

Epithelial cells stop dividing and hypertrophy. The uterine glands expand and become more branched. Glandular cells begin to secrete glycogen, glycoproteins, lipids, and mucin. The secretion rises to the mouth of the uterine glands and is released into the lumen of the uterus. Spiral arteries become more convoluted and approach the surface of the mucous membrane. In the superficial parts of the functional layer, the number of connective tissue cells increases, in the cytoplasm of which glycogen and lipids accumulate. Collagen and reticular fibers form around the cells. Stromal cells acquire features of decidual cells of the placenta. Thanks to such changes in the endometrium, two zones are distinguished in the functional layer: compact - facing the lumen, and deeper - spongy. If implantation has not occurred, a decrease in the content of ovarian steroid hormones leads to twisting, sclerosis and a decrease in the lumen of the spiral arteries supplying the upper two-thirds of the functional layer of the endometrium. As a result, blood flow in the functional layer of the endometrium deteriorates - ischemia, which leads to rejection of the functional layer and genital bleeding.

Menstrual phase

The menstrual phase is the rejection of the functional layer of the endometrium. With a cycle duration of 28 days, menstruation lasts 5+2 days.

W. Beck

"Phases of the menstrual cycle" article from the section

The inner layer of the uterus is called the endometrium. This fabric has a complex structural structure and a very important role. The reproductive functions of the body depend on the condition of the mucous membrane.

Every month throughout the cycle, the density, structure and size of the inner layer of the uterus changes. The proliferation phase is the very first stage of the natural transformations of the mucous membrane that begin. It is accompanied by active cell division and proliferation of the uterine layer.

The state of the proliferative endometrium directly depends on the intensity of division. Disturbances in this process lead to abnormal thickening of the resulting tissues. Too many cells have a negative impact on health and contribute to the development of serious diseases. Most often, when examined in women, glandular endometrial hyperplasia is detected. There are other, more dangerous diagnoses and conditions that require emergency medical attention.

For successful fertilization and a trouble-free pregnancy, cyclic changes in the uterus must correspond to normal values. In cases where an atypical structure of the endometrium is observed, pathological deviations are possible.

It is very difficult to find out about the unhealthy state of the uterine mucosa by symptoms and external manifestations. Doctors will help with this, but to make it easier to understand what endometrial proliferation is and how tissue proliferation affects health, it is necessary to understand the features of cyclical changes.

The endometrium consists of functional and basal layers. The latter consists of tightly adjacent cellular particles penetrated by numerous blood vessels. Its main function is to restore the functional layer, which, if fertilization fails, peels off and is excreted with the blood.

The uterus cleanses itself after menstruation, and the mucous membrane during this period has a smooth, thin, even structure.

The standard menstrual cycle is usually divided into 3 stages:

1. Proliferation.
2. Secretion.
3. Bleeding (menstruation).

At each of these stages there is a specific one. We recommend reading our article for more detailed information.

In this order of natural changes, proliferation comes first. The phase begins approximately on the 5th day of the cycle after the end of menstruation and lasts 14 days. During this period, cellular structures multiply through active division, which leads to tissue proliferation. The inner layer of the uterus can increase up to 16 mm. This is the normal structure of the endometrial layer of the proliferative type. This thickening helps to attach the embryo to the villi of the uterine layer, after which ovulation occurs, and the uterine mucosa enters the secretion phase in the endometrium.

If conception has occurred, the corpus luteum is implanted into the uterus. If a pregnancy fails, the embryo stops functioning, hormone levels decrease, and menstruation begins.

Normally, the stages of the cycle follow each other in exactly this sequence, but sometimes failures occur in this process. For various reasons, proliferation may not stop, that is, after 2 weeks, cell division will continue uncontrollably and the endometrium will grow. Too dense and thick inner layer of the uterus often leads to problems with conception and the development of serious diseases.

Proliferative diseases

Intensive growth of the uterine layer during the proliferative phase occurs under the influence of hormones. Any disruption in this system prolongs the period of cell division activity. An excess of new tissue causes uterine cancer and the development of benign tumors. Background pathologies can provoke the occurrence of diseases. Among them:

• endometritis;
• cervical endometriosis;
• adenomatosis;
• uterine fibroids;
• uterine cysts and polyps;

Hyperactive cell division is observed in women with identified endocrine disorders, diabetes mellitus and hypertension. The condition and structure of the uterine mucosa are negatively affected by abortion, curettage, excess weight, and abuse of hormonal contraceptives.

Hyperplasia is most often diagnosed against the background of hormonal problems. The disease is accompanied by abnormal growth of the endometrial layer and has no age restrictions. The most dangerous periods are puberty and... In women under 35 years of age, the disease is rarely detected, since hormonal levels at this age are stable.

Endometrial hyperplasia has clinical signs: the cycle is disrupted, uterine bleeding is observed, and constant pain appears in the abdominal area. The danger of the disease is that the reverse development of the mucous membrane is disrupted. The size of the enlarged endometrium does not decrease. This leads to infertility, anemia, and cancer.

Depending on how effectively the late and early stages of proliferation occur, endometrial hyperplasia can be atypical and glandular.

Glandular hyperplasia of the endometrium

High activity of proliferative processes and intensive cell division increases the volume and structure of the uterine mucosa. With pathological growth and thickening of glandular tissues, doctors diagnose glandular hyperplasia. The main reason for the development of the disease is hormonal disorders.

There are no typical symptoms. The symptoms that appear are characteristic of many gynecological diseases. Most women's complaints are related to conditions during menstruation and after menstruation. The cycle changes and is different from previous ones. Heavy bleeding is painful and contains clots. Often discharge occurs outside the cycle, which leads to anemia. Serious blood loss causes weakness, dizziness and weight loss.

The peculiarity of this form of endometrial hyperplasia is that the newly formed particles do not divide. The pathology rarely transforms into a malignant tumor. Nevertheless, this type of disease is characterized by indomitable growth and loss of function typical of tumor formations.

Atypical

Refers to intrauterine diseases that are associated with hypoplastic processes of the endometrium. The disease is mainly detected in women after 45 years of age. In every third out of 100, the pathology develops into a malignant tumor.

In most cases, this type of hyperplasia develops due to hormonal disruptions that activate proliferation. Uncontrolled division of cells with a disrupted structure leads to the growth of the uterine layer. In atypical hyperplasia, there is no secretory phase, as the size and thickness of the endometrium continues to grow. This leads to long, painful and heavy periods.

Severe atypia is a dangerous condition of the endometrium. Not only does active cell proliferation occur, the structure and structure of the nuclear epithelium changes.

Atypical hyperplasia can develop in the basal, functional, and simultaneously in both layers of the mucosa. The last option is considered the most severe, since there is a high probability of developing cancer.

Phases of endometrial proliferation

It is usually difficult for women to understand what the phases of endometrial proliferation are and how a violation of the sequence of stages is associated with health. Knowledge about the structure of the endometrium helps to understand the issue.

The mucosa consists of a ground substance, a glandular layer, connective tissue (stroma) and numerous blood vessels. From about the 5th day of the cycle, when proliferation begins, the structure of each of the components changes. The entire period lasts about 2 weeks and is divided into 3 phases: early, middle, late. Each stage of proliferation manifests itself differently and takes a certain time. The correct sequence is considered the norm. If at least one of the phases is absent or there is a malfunction in its course, the likelihood of pathologies developing in the lining inside the uterus is very high.

Early

The early stage of proliferation is days 1-7 of the cycle. The mucous membrane of the uterus during this period begins to gradually change and is characterized by the following structural transformations of tissue:

• the endometrium is lined with a cylindrical epithelial layer;
• blood vessels are straight;
• the glands are dense, thin, straight;
• cell nuclei have a rich red color and oval shape;
• the stroma is oblong, spindle-shaped.
• The thickness of the endometrium in the early proliferative phase is 2–3 mm.

Average

The middle stage of the proliferative endometrium is the shortest, usually on the 8th–10th day of the menstrual cycle. The shape of the uterus changes, noticeable changes occur in the shape and structure of other elements of the mucosa:

• the epithelial layer is lined with cylindrical cells;
• the kernels are pale;
• the glands are elongated and curved;
• connective tissue of loose structure;
• the thickness of the endometrium continues to grow and reaches 6–7 mm.

Late

On days 11–14 of the cycle (late stage), the cells inside the vagina increase in volume and swell. Significant changes occur in the uterine lining:

• the epithelial layer is high and multilayered;
• some of the glands elongate and have a wavy shape;
• the vascular network is tortuous;
• cell nuclei increase in size and have a rounded shape;
• the thickness of the endometrium in the late proliferative phase reaches 9–13 mm.

All of these stages are closely related to the secretion phase and must correspond to normal values.

Causes of uterine cancer

Cancer of the uterus is one of the most dangerous pathologies of the proliferative period. In the early stages, this type of disease is asymptomatic. The first signs of the disease include copious mucous discharge. Over time, signs such as pain in the lower abdomen, uterine bleeding with endometrial fragments, frequent urge to urinate, and weakness appear.

The incidence of cancer increases with the onset of anovulatory cycles, characteristic of people over 45 years of age. During premenopause, the ovaries still produce follicles, but they rarely mature. Ovulation does not occur, and accordingly, the corpus luteum does not form. This leads to hormonal imbalance - the most common cause of cancer.

At risk are women who have not had pregnancy or childbirth, as well as those with identified obesity, diabetes mellitus, metabolic and endocrine disorders. Background diseases that provoke cancer of the reproductive organ are polyps in the uterus, endometrial hyperplasia, fibroids, and polycystic ovaries.

Diagnosis of oncology is complicated by the condition of the uterine wall in case of cancerous lesions. The endometrium becomes loose, the fibers are located in different directions, and the muscle tissue is weakened. The boundaries of the uterus are blurred, polyp-like growths are noticeable.

Regardless of the stage of the pathological process, endometrial cancer is detected by ultrasound. To determine the presence of metastases and the location of the tumor, hysteroscopy is used. In addition, the woman is recommended to undergo a biopsy, x-ray and a series of tests (urine, blood, hemostasis study).

Timely diagnosis makes it possible to confirm or exclude the growth of a tumor, its nature, size, type and degree of spread to neighboring organs.

Treatment of the disease

Treatment of cancerous pathology of the uterine body is prescribed individually, depending on the stage and form of the disease, as well as the age and general condition of the woman.

Conservative therapy is used only in the initial stages. Women of reproductive age with diagnosed stage 1–2 disease undergo hormonal therapy. During the course of treatment you need to undergo regular tests. This is how doctors monitor the state of the cell nucleus, changes in the structure of the uterine mucosa and the dynamics of the development of the disease.

The most effective method is considered to be removal of the affected uterus (partial or complete). To eliminate single pathological cells after surgery, a course of radiation or chemical therapy is prescribed. In cases of rapid growth of the endometrium and rapid growth of a cancerous tumor, doctors remove the reproductive organ, ovaries and appendages.

With early diagnosis and timely treatment, any of the therapeutic methods gives positive results and increases the chances of recovery.

Early stage of the proliferation phase. In this phase of the menstrual cycle, the mucous membrane can be 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-colored, 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.

Endometrial histology. The surface of the mucous membrane is covered with flattened columnar 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 somewhat winding tubes with a narrow lumen. In cross sections they have a round or oval shape. The epithelium of the glandular crypts is prismatic, the nuclei are oval, located at the base, and stain well. The cytoplasm is basophilic, homogeneous. The apical edge of the epithelial cells is smooth and clearly defined. On its surface, using electron microscopy, long microvilli are identified, which contribute to an increase in the surface of the cell. The stroma consists of spindle-shaped or stellate reticular cells with delicate processes. There is little cytoplasm. It is barely noticeable around the nuclei. In stromal cells, as in epithelial cells, single mitoses appear.

Hysteroscopy. In this phase of the menstrual cycle (up to the 7th day of the cycle), the endometrium is thin, smooth, pale pink in color, small hemorrhages are visible in some areas, and isolated areas of the endometrium are visible in a pale pink color that have not been rejected. The eyes of the fallopian tubes are clearly visible.

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

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

Endometrial histology. 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 located in places at different levels, and numerous mitoses are observed in them. Compared to the early phase of proliferation, the nuclei are enlarged, less intensely colored, and some of them contain small nucleoli. From the 8th day of the menstrual cycle, a layer containing acidic mucoids forms on the apical surface of epithelial cells. Alkaline phosphatase activity increases. The stroma is swollen, loosened, and a narrow strip of cytoplasm is visible in the connective tissues. The number of mitoses increases. The stromal vessels are single, with thin walls.

Hysteroscopy. In the middle stage of the proliferation phase, the endometrium gradually thickens, becomes pale pink, and no vessels are visible.

Late stage of proliferation. In the late stage of the proliferation phase (lasts approximately 3 days), the thickness of the functional layer reaches 8-9 mm, the shape of the endometrium is usually teardrop-shaped, the central echo-positive line remains unchanged throughout the first phase of the menstrual cycle. Against a 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 contains predominantly eosinophilic superficial cells (70%), few basophilic ones. In the cytoplasm of eosinophilic cells there is granularity, the nuclei are small and pyknotic. There are few leukocytes. Characterized by a large amount of mucus.

Endometrial histology. There is some thickening of the functional layer, but there is no division into zones. The surface of the endometrium is covered with tall 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 edges of the cells are smooth and distinct. As a result of intensive division and increase in the number of epithelial cells, the nuclei are at different levels. They are enlarged, still oval, and 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 its highest level. The nuclei of connective tissue cells are larger, rounded, less intensely colored, and 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 tortuous. Under the microscope, only one or two peripheral vessels located nearby are identified.

Psteroscopy. In the late phase of proliferation, certain areas of the endometrium appear as thickened folds. It is important to note that if menstrual cycle proceeds normally, then in the proliferation phase the endometrium can have different thicknesses, depending on the location - thickened in the days and posterior wall of the uterus, thinner on the anterior wall and in the lower third part of the uterine body.

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. The cell nuclei are small and pyknotic. The number of basophilic cells increases.

Histology of the endometrium. The thickness of the endometrium increases moderately compared to the proliferation phase. The glands become more tortuous, their lumen is expanded. The most characteristic sign of the secretion phase, in particular its early stage, is the appearance of subnuclear vacuoles in the epithelium of the glands. Glycogen granules become large, cell nuclei move from the basal to the central sections (indicating that ovulation has occurred). The nuclei, pushed aside by vacuoles into the central sections of the cell, are initially located at different levels, but on day 3 after ovulation (day 17 of the cycle), the nuclei that lie above large vacuoles are located at the same level. On the 18th day of the cycle, in some cells glycogen granules move to the apical sections of the cells, as if bypassing the nucleus. As a result of this, the nuclei again descend down to the base of the cell, and glycogen granules are located above them, which are located in the apical parts of the cells. The kernels are more rounded. There are no mitoses in them. The cytoplasm of the cells is basophilic. Acid mucoids continue to appear in their apical sections, while alkaline phosphatase activity decreases. The endometrial stroma is slightly swollen. 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 secretion phase. The duration of the middle stage of the second phase is from 4 to 6-7 days, which corresponds to days 18-24 of the menstrual cycle. During this period, the greatest severity of secretory changes in the endometrium is observed. Echographically, this is manifested by a thickening of the endometrium by another 1-2 mm, the diameter of which reaches 12-15 mm, and 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 its 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 increases moderately.

Endometrial histology. 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 the nuclei are located in the basal part of the epithelial cells. All kernels are round and 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 basally located nuclei. As a result of intense secretion, the cells become low, their apical edges are vaguely expressed, as if with teeth. Alkaline phosphatase completely disappears. In the lumen of the glands there is a secret that contains glycogen and acidic mucopolysaccharides. On day 23, the secretion of the glands ends. A perivascular decidual reaction of the endometrial stroma appears, then the decidual reaction becomes diffuse, 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. Islands 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. Spiral arteries are sharply tortuous, form “skeins”, 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 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 the early stages of pregnancy - during the first days after implantation, with intrauterine pregnancy outside the implantation zone ; with progressive ectopic pregnancy evenly in all parts of the mucous membrane of the uterine body.

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, endometrial folds take on a polyp-like shape. If the distal end of the hysteroscope is placed tightly to the endometrium, the glandular ducts can be seen.

Late stage of the secretion phase. Late stage of the second phase of the menstrual cycle (lasts 3-4 days). In the endometrium, pronounced trophic disorders occur 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 other dystrophic changes, slight heterogeneity (spotting) of the mucosa appears due to the appearance of small areas (dark “spots” - zones of vascular disorders), becomes clearly visible the rim of the rejection zone (2-4 mm), and the three-layer structure of the mucosa, characteristic of the proliferative phase, is transformed into a homogeneous tissue. There are cases when echo-negative zones of the endometrial thickness in the preovulatory period are mistakenly assessed by ultrasound as pathological changes.

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

Endometrial histology. The folding of the walls of the glands is enhanced, it has a dust-like shape on longitudinal sections, and a star-like shape on transverse sections. The nuclei of some epithelial cells of the glands are pyknotic. The stroma of the functional layer shrinks. Predecidual cells are close together and located around the spiral vessels diffusely throughout the compact layer. Among the predecidual cells there 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, in the superficial areas of the compact layer, lacunar expansion of capillaries into the stroma is observed. In the premenstrual period, spiralization becomes so pronounced that blood circulation slows down and stasis and thrombosis occur. A day before the onset of menstrual bleeding, a state of the endometrium occurs, which Schroeder called “anatomical menstruation.” At this time, you can find not only dilated and congested blood vessels, but also spasm and thrombosis, as well as small 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 cannot always be seen. Just before menstruation, the appearance of the endometrium can be mistakenly interpreted as endometrial pathology (polypoid hyperplasia). Therefore, the time of hysteroscopy must be recorded 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 during the days of menstruation as parts of the endometrium with menstrual blood are discharged. 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” with each other.

Colpocytology. The smear contains foamy basophilic cells with large nuclei. A large number of erythrocytes, leukocytes, endometrial cells, and histocytes are also found.

Endometrial histology(28-29 days). Tissue necrosis and autolysis develop. This process begins from the superficial layers of the endometrium and is flammable in nature. As a result of vasodilation, which occurs after a prolonged 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 signs characteristic of the endometrium of the menstrual phase are: the presence of tissue permeated with hemorrhages, areas of necrosis, leukocyte infiltration, a partially preserved area 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 endometrial scraps 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, with pinpoint hemorrhages and areas of old hemorrhages. If the menstrual cycle was full, then already before the second day of menstruation there is almost complete rejection of the uterine mucosa, only in certain areas of it small fragments of the mucous membrane are detected.

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. Epithelization of the wound surface occurs due to the marginal glands of the basal layer, from which epithelial cells move in all directions onto the wound surface and close the defect. With normal menstrual bleeding under conditions of a normal two-phase cycle, the entire wound surface is epithelialized on the 4th day of the cycle.

Hysteroscopy. During the regeneration stage, against a pink background with areas of hyperemia of the mucosa, small hemorrhages are visible in some areas, and isolated areas of the endometrium of a pale pink color may be encountered. As the endometrium regenerates, areas of hyperemia disappear, changing color to pale pink. The angles of the uterus are clearly visible.

The mucous membrane of the uterus lining its cavity. The most important property of the endometrium is its ability to undergo cyclic changes under the influence of changing hormonal levels, which is manifested in a woman by the presence of a menstrual cycle.

The endometrium is the mucosal layer lining the uterine cavity. That is, it is the mucous membrane of a woman’s internal hollow organ, intended for the development of an embryo. The endometrium consists of stroma, glands and integumentary epithelium, and has 2 main layers: basal and functional.

• The structures of the basal layer are the basis for the regeneration of the endometrium after menstruation. The layer is located on the myometrium and is characterized by a dense stroma, which is filled with numerous vessels.
• The functional thick layer is not permanent. He is constantly exposed to hormonal levels.

Genetics, as well as molecular biology and clinical immunology, are constantly evolving. Today, it is these sciences that have been able to significantly expand the understanding of cellular regulation and intercellular interaction. It was possible to establish that proliferative cellular activity is affected not only by hormones, but also by a variety of active compounds, including cytokines (peptides and a whole group of hormone-like proteins) and arachidonic acid, or rather its metabolites.

Endometrium in adults

A woman's menstrual cycle lasts approximately 24-32 days. In the first phase, under the influence of estrogen hormones, proliferation (growth) of the glands occurs. The secretion phase begins under the influence of progesterone (after the follicle ruptures and the egg is released).

While the epithelium is being rebuilt under the influence of hormones, changes are also observed in the stroma. Leukocyte infiltration can be seen here, the spiral arteries are slightly enlarged.

Changes in the endometrium that occur during the menstrual cycle should normally have a clear sequence. Moreover, each phase should have an early, middle and late stage.

If changes in the structures of the endometrium during the cycle do not occur in a clear sequence, then dysmenorrhea most often develops and bleeding appears. The consequence of such disorders can be, at a minimum, infertility.

Disturbances in the hormonal background can be caused by disturbances in the functioning of the central nervous system, pathologies of the ovaries, adrenal glands, pituitary gland and/or hypothalamus.

Endometrium during pregnancy

Throughout her life, a woman’s hormones actively influence the cellular receptors of the uterine mucosa. During the period of time when any hormonal shift occurs, the growth of the endometrium also changes, which often leads to the development of diseases. All kinds of proliferative disorders arise mainly under the influence of hormones produced by the adrenal glands and ovaries.

Pregnancy and the endometrium are closely related, because even the attachment of a fertilized reproductive cell is possible only to the mature walls of the uterus. Before implantation of the fertilized egg, a decidua formed from stromal cells appears in the uterus. It is this shell that creates favorable conditions for the life of the embryo.

Before implantation, the secretory phase predominates in the endometrium. Stromal cells are filled with biologically active substances, including lipids, salts, glycogen, trace elements and enzymes.

During implantation, which takes approximately two days, hemodynamic changes are observed, and significant changes are observed in the endometrium (glands and stroma). In the place where the fertilized egg is attached, blood vessels dilate and sinusoids appear.

Changes in the endometrium and maturation of the fertilized egg must occur simultaneously, otherwise the pregnancy may be terminated.

Diseases of the uterine mucosa are common. In addition, pathologies of this kind are diagnosed in both children and adults; they can be practically asymptomatic, easily treatable, or, for example, on the contrary, provoke extremely unpleasant health consequences.

If we consider the most common diseases of the endometrium, then we should immediately note various hyperplastic processes. It is these disorders that predominantly occur against the background of hormonal imbalance, often before menopause. The clinical picture of such disorders is bleeding, the uterus most often enlarges, and the mucous layer thickens.

Changes in endometrial structures, the appearance of formations - all this may indicate a serious malfunction, which is important to eliminate as soon as possible in order to prevent the development of complications.

Transformation of the endometrium is certainly a complex biological process that affects almost the entire neurohumoral system. Hyperplastic processes (HPE) are focal or diffuse tissue proliferation, which affects the stromal and most often glandular components of the mucous membrane. Metabolic and endocrine disruptions also play a significant role in the pathogenesis of HPE. Thus, it is worth highlighting dysfunctions of the thyroid gland, immune system, fat metabolism, etc. That is why the majority of women with obvious hyperplastic processes of the endometrium are diagnosed with a certain degree of obesity, diabetes mellitus and some other diseases.

Not only hormonal imbalances can provoke the development of endometrial hyperplastic processes. Immunity plays a role in this matter, as do inflammatory and infectious changes affecting the mucous membrane, and even problems with tissue reception.

As for symptoms, endometrial hyperplastic processes can manifest as bleeding and pain in the lower abdomen, although often the problem has no obvious signs. Mostly hyperplastic processes in the uterine mucosa are accompanied by a lack of ovulation, which gives rise to such a sign of pathology as infertility.

Endometrial hyperplasia

In the medical field, endometrial hyperplasia is changes in the structures and/or pathological growth of the glands. These are also violations that may include:

• improper distribution of glands;
• structural deformation;
• growth of endometrial glands;
• there is no division into layers (namely, the spongy and compact parts are taken into account).

Endometrial hyperplasia mainly affects the functional layer; the basal part of the uterine mucosa is affected in rare cases. The main signs of the problem are an increased number of glands and their expansion. With hyperplasia, the ratio of glandular and stromal components increases. And all this happens against the background of the absence of cell atypia.

According to statistics, a simple form of endometrial hyperplasia degenerates into cancer only in 1-2% of cases. A complex form is several times more likely.

Polyps of the mucous layer of the uterine cavity

Most endometrial hyperplastic processes are polyps, which are diagnosed in 25% of cases. Such benign formations appear at any age, but are mainly of concern in the period before or after menopause.

Taking into account the structure of the endometrial polyp, several types of formations can be distinguished:

• glandular polyp (can be basal or functional);
• glandular-fibrous;
• fibrous;
• adenomatous formation.

Glandular polyps are diagnosed mainly in women of reproductive age. Glandular-fibrous - before menopause, and fibrous most often in the postmenopausal period.

At the age of 16-45 years, polyps can appear both against the background of endometrial hyperplasia and on normal mucosa. But after menopause, benign formations (polyps) are most often single; they can reach enormous sizes, protrude from the cervix and even disguise themselves as neoplasms of the cervical canal.

Endometrial polyps appear mainly against the background of hormonal imbalance, which involves progesterone and estrogens. Doctors note the fact that polyps in women of reproductive age can develop after various surgical interventions on the uterus. The appearance of polyps is also associated with inflammatory diseases of the internal genital organs.

Clinical manifestations indicating a polyp in the uterus are varied, but most often a woman experiences disruptions in the menstrual cycle. The pain symptom is rarely bothersome. Such a sign can appear only in some cases, for example, with necrotic changes in the formation. Endometrial polyps are diagnosed using ultrasound and hysteroscopy. Surgery is used to treat polyps. Polyps are treated primarily by a gynecologist, although consultations with an endocrinologist, venereologist and some other specialized specialists are possible.

Endometrial cancer and precancer are two different concepts and it is important to be able to distinguish between them. Only a competent attending physician can determine the type of endometrial disorders, based on the results of diagnostic procedures and some other factors.

Endometrial precancer is adenomatous polyps and hyperplasia with pronounced atypia, in which the cells may have an irregular shape, structure, etc. The following morphological features can be attributed to atypia of the uterine mucosa:

• Blood vessels are unevenly distributed and thrombosis and/or stasis may be present.
• The stroma is edematous.
• The number of glands that are located too close to each other increases. Sometimes the glands have pathological elongated projections.
• With slight atypia, the cytoplasm is basophilic. With obvious atypia - oxyphilic.
• Hyperchromic nuclei, which may have an uneven or even distribution of the chromatin itself.

Without effective medical supervision and timely therapy, endometrial hyperplasia in its simple form degenerates into cancer in 7-9% of cases (subject to the presence of atypia). As for the complex form, the indicators here are not reassuring and they reach 28-30%. But it is important to know that the appearance of precancer is influenced not only by the morphological form of the disease, but also by various concomitant pathologies, for example, those associated with the internal genital organs, the thyroid gland, etc. The risks increase if a woman with endometrial hyperplastic processes suffers from obesity, She was diagnosed with uterine fibroids, polycystic ovary syndrome or, for example, disorders of the hepatobiliary system, diabetes mellitus.

Diagnosis of endometrial pathologies

Hysterosalpingography, as well as transvaginal ultrasound, are considered the most common diagnostic methods prescribed for endometrial pathologies. As for a more in-depth examination, in this case separate curettage and hysteroscopy can be performed. The attending physician can make a diagnosis at any stage of diagnostic studies, but it can be accurately verified only after analyzing the results of a histological examination.

Hysteroscopy is an accurate diagnostic procedure that allows you to fully visually assess the condition of the uterine cavity, its cervical canal and the mouth of the tubes. The manipulation is performed using an optical hysteroscope.

Hysteroscopy for endometrial hyperplasia or other hyperplastic processes of the uterine mucosa is prescribed by the attending physician; the information content of this method is about 70-90%. Hysteroscopy is used to detect pathology, determine its nature, and location. The method is also indispensable for curettage, when diagnostics of this type are prescribed before the procedure and immediately after, to control the quality of its implementation.

It is impossible to independently diagnose problems with the mucous membrane of the uterine cavity, even if the patient has the results of ultrasound or hysteroscopy. Only the attending physician, taking into account the patient’s age, the presence of concomitant chronic diseases and some other factors, will be able to accurately make the correct diagnosis. Under no circumstances should you try to determine the disease yourself, much less treat the disease without consulting a doctor. Alternative medicine is not relevant in this case and can only aggravate an already complex health condition.

Transvaginal ultrasound scanning is an absolutely safe non-invasive diagnosis. The modern method makes it possible to almost accurately identify problems associated with the structures of the endometrium, although the information content of the procedure may be influenced by some factors, including the age of the patient, the presence of some concomitant gynecological diseases and the type of hyperplastic processes. Endometrial ultrasound is best performed in the first days after the menstrual cycle. But it is not possible to accurately distinguish glandular type endometrial hyperplasia from atypical endometrial hyperplasia using such a diagnosis.

Endometrium: Normal levels after menopause may vary depending on various factors.

• A median uterine echo of up to 4-5 mm in thickness can be considered normal if a woman’s menopause occurred no more than five years ago.
• If the postmenopausal period began more than five years ago, then a thickness of 4 mm can be considered the norm, but subject to structural homogeneity.

Endometrial polyps in the uterus most often appear on ultrasound as ovoid or almost round inclusions with increased echo density. The information content of diagnostics for polyps is more than 80%. The capabilities of endometrial ultrasound can be increased by contrasting the cavity.

Ultrasounds are performed both in private clinics and in some state-run outpatient clinics. You should take this fact into account and ask your treating specialist about the best options for choosing an institution.

Also, the doctor can individually prescribe additional diagnostic methods if there are doubts regarding the diagnosis.

Endometrial biopsy

Aspirate from the uterine cavity can be examined using cytological and histological analyses. Aspiration biopsy is often used as a control method for hormonal treatment, when the effectiveness of drug therapy is determined using a special procedure. For malignant processes of the uterine mucosa, a biopsy allows you to accurately determine and make a diagnosis. The method helps to avoid curettage, which is performed for diagnosis.

Hyperplastic processes of the endometrium: treatment

In women of all age groups with endometrial pathologies, treatment should be comprehensive. The attending physician will definitely develop an individual program and prescribe therapy, including, possibly, for:

• stopping bleeding;
• full restoration of the menstrual cycle in women of childbearing age;
• achieving subatrophy and atrophy of the uterine mucosa in women over 45 years of age.

Relapse prevention also plays an important role.

Therapy for hyperplastic processes in menstruating women usually consists of hormonal treatment, which is prescribed after diagnosis.

• In the case when a woman of reproductive age is diagnosed with endometrial hyperplasia (without cellular atypia), the following drugs are most often prescribed: combined oral contraceptives in tablets, Norethisterone and/or Dydrogesterone, Medroxyprogesterone, HPC (hydroxyprogesterone capronate).
• If hyperplasia is accompanied by cell atypia, then the following may be prescribed: Danazol, Gestrinone, Buserelin, Diferelin, Goserelin, etc.

It is important to take into account possible infectious causes of the development of hyperplastic processes, because in this case, hormonal medications may be completely ineffective.

If there is a relapse of hyperplastic processes (without obvious atypia) of the uterine mucosa, and hormonal medications do not have the desired therapeutic effect, then under certain conditions the attending physician may prescribe endometrial ablation. This minimally invasive procedure is an alternative to classic endometrial curettage. During its implementation, the mucous membrane is removed or destroyed. But ablation is recommended only for those women over 35 years of age who do not plan to become pregnant again.

If a woman of reproductive age is diagnosed with uterine fibroids or adenomatosis in combination with hyperplastic processes of the uterine mucosa, then this is not a contraindication for ablation. Although doctors believe that the presence of such problems in a woman can negatively affect the results of treatment.

In the case when a patient is diagnosed with an atypical form of endometrial hyperplastic processes, hormonal therapy is ineffective and a relapse occurs, surgical intervention is prescribed. Which operation will be recommended is decided only by the attending physician, taking into account the characteristics of the patient’s health condition, the presence of concomitant chronic diseases and even her age. The operation is prescribed on an individual basis. It could be:

• Intervention on the ovaries (wedge resection) in women with polycystic ovary syndrome.
• Adnexectomy (for ovarian neoplasms that are hormone-producing in nature).
• Hysterectomy.

Modern medicine offers many effective ways to carry out successful operations. But it is impossible to say in absentia which surgical intervention is suitable for a particular patient. Only a competent doctor, taking into account the results of diagnostic studies and the woman’s age, will be able to prescribe truly correct therapy.

Treatment of hyperplastic processes in perimenopause

Premenopause is a stage at which the processes of extinction of ovarian functions already occur and ovulation stops. This period begins approximately after 40-50 years. Its duration is about 15-18 months. At the very beginning of premenopause, the intervals between menstruation increase, their duration and abundance decrease.

If a patient is diagnosed with endometrial hyperplasia, for example, treatment will initially involve hysteroscopy combined with endometrial curettage, which is performed solely for diagnostic purposes. Next, therapy is prescribed taking into account the morphological characteristics of the endometrium and the presence of gynecological diseases. The drug treatment regimen and the list of hormonal medications will also depend on the patient’s desire to maintain her menstrual cycle.

Among the medications, it is worth highlighting Norethisterone, Dydrogesterone, Medroxyprogesterone, Danazol, Gestrinone, Buserelin, Diferelin, Goserelin, etc. They are prescribed depending on the presence or absence of atypia.

During pre- and perimenopause, ablation may be prescribed. Hysteroscopic surgery is performed in cases where there are constant relapses of hyperplasia of the mucous membrane of the uterine cavity (without cellular atypia), and hormonal treatment cannot be prescribed due to any extragenital disease.

Management of postmenopausal patients with endometrial hyperplasia

If a postmenopausal woman has bleeding and there is a suspicion of endometrial pathology, a diagnostic separate curettage is prescribed. If the problem appears for the first time, then it is prescribed for hyperplastic processes. If a hormone-producing ovarian mass is detected, surgical removal of the uterus and appendages is recommended. Recurrence of hyperplastic processes in the uterus in women can be the reason for prescribing extirpation of the organ with appendages. If for some reason this operation is contraindicated for a postmenopausal woman, then therapy with gestagens or ablation of the mucous layer is allowed. At this moment, it is very important to monitor the patient’s condition and constantly conduct diagnostic echography. An endometrial biopsy is also prescribed.

During hormone therapy, the attending physician comprehensively recommends antiplatelet agents, hepatoprotectors and anticoagulants in order to significantly reduce the risks of complications.

Targeted polypectomy is a modern and effective method of treating women diagnosed with an endometrial polyp. Complete removal of the formation is allowed only under hysteroscopic control. In addition, such an intervention should involve not only mechanical endoscopic instruments, but also laser technologies, as well as electrosurgical elements.

Doctors recommend excision of the formation electrosurgically in cases where the polyp is determined to be parietal and fibrous. It is also important to note the fact that premenopausal women are recommended to combine polypectomy with ablation of the mucous layer. After the endometrial polyp in the uterus is removed, hormones are prescribed. Moreover, therapy can have a different application regimen, which is tailored to the patient’s age and the morphological characteristics of the distant formation.

Synechiae inside the uterus

Intrauterine adhesions can partially or completely affect the organ cavity. Doctors put forward three main theories regarding the causes of this pathology:

• injuries;
• infections;
• and neurovisceral factors.

The main reason for the appearance of synechiae is mechanical damage to the basal part of the mucous membrane of the uterine cavity. Such injuries are possible during inaccurate curettage, abortion, and childbirth. The appearance of synechiae is often observed in patients after a frozen pregnancy or various surgical interventions on the uterus.

In terms of their symptoms, synechiae inside the uterus are specific. Signs of a problem may include amenorrhea and/or hypomenstrual syndrome.

Such adhesions cause infertility in women; they often prevent the fetus from developing, which is why miscarriage occurs. According to medical experts, even small synechiae in the uterus can negatively affect, for example, IVF.

Synechiae are determined using some diagnostic procedures. In this case, ultrasound, hysteroscopy, and increasingly hysterosalpingography are used.

Synechiae are treated only with dissection. Moreover, the type of operation will always depend on the degree of patency of the uterine cavity and the type of fusion.

If it occurs after such a surgical intervention, then the woman is at risk for complications during pregnancy or delivery.

Over the past few decades, the number of patients suffering from uterine cancer has been constantly increasing, which is likely a consequence of the fact that women are living longer and, accordingly, are going through menopause for a longer period. The age of women affected by endometrial cancer ranges on average from 60 to 62 years.

The disease can develop in two pathogenetic variants - autonomously and as a hormone-dependent disease.

Autonomously developing endometrial cancer is found in less than 30% of cases. It is observed in those women who do not have disturbances in the functioning of the endocrine system. The problem develops along with atrophy of the mucous membrane when a high level of estrogen is not observed in the first period of the menstrual cycle.

It is believed that the occurrence of autonomous endometrial cancer is influenced by depression of the immune system. Depressive immune changes consist of a significant decrease in the number of T-lymphocytes, when their forms sensitive to theophylline are inhibited, as well as a significant increase in the number of lymphocytes whose receptors are blocked.

Typically, the autonomous form of the disease appears in women after 60 years of age. No risk factors have been identified for this type of disease. It is often observed in thin elderly patients, while hyperplastic processes are not previously observed. There is a frequent history of bleeding due to mucosal atrophy. The tumor is poorly differentiated, insensitive to hormonal treatment, metastasis and penetration into the myometrium occurs early.

The hormone-dependent type of the disease can be traced in approximately 70% of morbidity cases. Its pathogenesis is influenced by prolonged hyperestrogenism, which often appears as a consequence:

• anovulation;
• neoplasms in the ovaries;
• excessive peripheral conversion of androgens to estrogens - (observed in diabetes and obesity);
• effects of estrogen (observed during hormone replacement therapy with estrogen and treatment of breast malignancies with tamoxifen, resulting in the formation of metabolites with active estrogens).

For hormone-dependent endometrial cancer, the following risk factors exist:

• infertility and absence of childbirth throughout life;
• late menopause;
• overweight;
• diabetes;
• hereditary predisposition to a disease with metabolic endocrine pathogenesis - breast, ovarian, uterine, colon cancer;
• neoplasms in the ovaries;
• carrying out estrogen monotherapy in the period after menopause;
• Tamoxifen (an antitumor drug) is used to treat breast cancer.

Cancer classification

Uterine cancer is classified based on how widespread it is. Classification is based on clinical parameters and/or histological results.

The classification of the disease is used before surgery or in the case of inoperable patients. Depending on the stage, endometrial cancer is classified as follows:

• Stage 0 - formation in situ.
• Stage 1 - formation is limited to the body of the uterus.
• 2 - does not extend beyond the boundaries of the uterine body, but directly affects the cervix of the hollow organ.
• 3 - penetrates the pelvis and grows within its boundaries.
• 4 - extends beyond the boundaries of the pelvis and can affect nearby organs.
• 4A - the formation grows in the tissue of the rectum or bladder.

Histological data make it possible to distinguish the following morphological stages of the disease:

• Stage 1A - located directly in the endometrium.
• 1B - tumor penetration into the muscle layer is no more than 1/2 of its thickness.
• 1C - tumor penetration into the muscle layer by more than 1/2 of its thickness.
• 2A - the formation affects the glands of the cervix.
• 2B - formation affects the stroma.
• 3A - the tumor penetrates the serous uterine membrane, metastasis to the ovaries or fallopian tubes is observed.
• 3B - the formation penetrates the vaginal area.
• 3C - metastases to the pelvic and/or para-aortic lymph nodes.
• 4A - the formation affects the mucous membrane of the bladder or intestines.
• 4B - distant metastases appear.

The doctor, based on the above classification and the data obtained after histology, draws up an appropriate treatment plan for patients (in the postoperative period).

In addition, there are 3 degrees of cancer differentiation, which depends on how severe the cellular atypia is. Differentiation happens:

• high;
• moderate;
• low.

Clinical picture of cancer

To a certain extent, the manifestation of the disease is associated with menstruation. In patients with a preserved cycle, endometrial cancer often manifests itself in the form of heavy and prolonged, usually acyclic menstrual bleeding. But in 75% of cases, endometrial cancer begins in the period after menopause and causes bloody discharge, which can be spotty, scanty, or copious. During this period, they appear in 90% of patients, and only 8% of patients do not have any clinical symptoms of the development of a malignant tumor. You should know that in addition to bloody discharge, there may also be purulent vaginal discharge.

Pain occurs quite late, when endometrial cancer penetrates into the pelvis. If the infiltrate compresses the kidneys, pain is most often felt in the lumbar region.

Postmenopausal women are recommended to undergo an ultrasound examination of the pelvic organs, which should be performed annually. For women at risk of endometrial cancer, ultrasound is indicated once every 6 months. This allows pathologies such as cancer and endometrial hyperplasia to be recognized in time and optimal treatment to begin.

A homogeneous endometrium is the norm, and if even small inclusions are detected in its echo structure, the doctor suspects pathology and refers the patient to diagnostic curettage of the mucous membrane under the control of hysteroscopy. Also considered a pathology is an endometrial thickness of more than 4 mm (if postmenopause occurs early, then more than 5 mm).

If there are clear echographic signs of malignant changes in the endometrium, the doctor prescribes a biopsy. Curettage of the mucous part for diagnosis and a hysteroscopy procedure are also often indicated.

If a woman has irregular menstrual cycles, there are signs of pathological changes in the endometrium, and bleeding is observed during the period after menopause, then diagnostic endometrial curettage and hysterocervicoscopy are necessary. In 98% of cases, hysteroscopy performed after menopause is informative, and a thorough histological analysis of scrapings makes it possible to definitively determine the disease.

When the diagnosis is established accurately, the woman is carefully examined to determine what stage the disease is at and to select the optimal therapeutic tactics. In addition to laboratory tests, as well as gynecological examinations, the following is carried out:

• echography of all organs located in the abdominal cavity;
• colonoscopy and cystoscopy, chest x-ray, CT (computed tomography) and other studies, if necessary.

Treatment of patients with endometrial cancer is prescribed based on the stage of the disease and the condition of the woman. Patients who have distant metastasis, the tumor has extensively spread to the cervix, has grown into the bladder and/or rectum, are inoperable. As for those patients who require surgery, for 13% of them surgical treatment is contraindicated, due to the presence of concomitant diseases.

Surgical treatment of the disease involves removal of the uterus along with the appendages. In the first stages of endometrial cancer development, a special operation may be prescribed in which the integrity of the organ is not violated, that is, the uterus is removed through the vagina.

Lymphadenectomy is necessary because metastases that penetrate the lymph nodes do not respond to hormones.

The advisability of lymphadenectomy is dictated by the presence of at least one of the following risk factors:

• spread of the tumor into the muscular layer of the uterus (myometrium) by more than 1/2 of its thickness;
• spread of formation to the isthmus/cervix;
• the tumor extends beyond the boundaries of the uterus;
• the diameter of the formation exceeds 2 cm;
• if cancer with low differentiation, clear cell or papillary cancer, as well as serous or squamous cell type of the disease is diagnosed.

If the pelvic lymph nodes are affected, metastasis to the lumbar lymph nodes is detected in 50-70% of patients.

If a well-differentiated disease is diagnosed in stage 1A, radiation therapy is not required; in all other cases it is indicated, sometimes in combination with hormone therapy, which makes the treatment more effective.

Treatment of the disease in the 2nd stage of its development may include extended removal of the uterus, followed by radiation and hormonal therapy. The doctor independently draws up a treatment regimen that will be most effective for the patient. The treating specialist may first carry out appropriate therapy, and then surgery. In both cases, the result is almost the same, but the first is preferable, since it makes it possible to more accurately determine at what stage the cancer process is.

Treatment of the disease, which is at stages 3 and 4 of its development, is selected only on an individual basis. Usually it begins with surgical intervention, during which the maximum possible reduction of the formation itself is ensured. After the operation, hormonal and radiation therapy (with subsequent correction, if necessary) is prescribed in combination.

Prognosis for oncology

The prognosis for patients suffering from uterine cancer largely depends on the stage of the disease. In addition, the following factors are important:

• woman's age;
• type of tumor from a histological point of view;
• size of education;
• tumor differentiation;
• depth of penetration into the muscle layer (myometrium);
• extension to the cervix;
• presence of metastases, etc.

The prognosis worsens as the patient's age increases (it has been proven that survival rates also depend on age). Primary preventive measures to prevent endometrial cancer are usually aimed at eliminating factors that could potentially lead to the occurrence of the disease, namely:

• weight loss for obesity;
• compensation for diabetes mellitus;
• normalization of reproductive function;
• complete restoration of menstrual function;
• elimination of all causes leading to anovulation;
• correct and timely surgical intervention for feminizing formations.

Preventive measures of the secondary type involve timely diagnosis and optimal treatment of all, including precancerous, pathological processes occurring in the endometrium. In addition to well-chosen treatment and a thorough annual (or once every 6 months) examination with mandatory transvaginal echography, it is necessary to regularly see a leading specialist and monitor your health.

Diagnosis and treatment of endometrial pathologies is the competence of a gynecologist-endocrinologist, especially if problems arise against the background of hormonal imbalance. Also, for example, in case of endometrial cancer, you will need to consult an oncologist or surgeon.

If a woman is bothered by constant or periodic pain in the lower abdomen, bleeding appears regardless of the phase of the menstrual cycle, then it is advisable to immediately seek help from her local gynecologist. If this is not possible, you can initially visit a therapist, who, if necessary, will refer the patient for consultation to a more specialized specialist.

Table of contents of the topic "Ejaculation (ejaculation). Reproductive function of the female body. Ovarian cycle. Menstrual cycle (uterine cycle). Female sexual intercourse.":
1. Ejaculation (ejaculation). Regulation of ejaculation. Seminal fluid.
2. Orgasm. The orgasmic stage of male sexual intercourse. Stage of resolution of male sexual intercourse. Refractory period.
3. Reproductive function of the female body. Female reproductive function. The stage of preparation of a woman’s body for fertilization of an egg.
4. Ovarian cycle. Oogenesis. Phases of the cycle. Follicular phase of the ovulatory cycle. Function of follitropin. Follicle.
5. Ovulation. Ovulatory phase of the ovulatory cycle.
6. Luteal phase of the ovulatory cycle. Corpus luteum phase. Yellow body. Functions of the corpus luteum. Menstrual corpus luteum. Corpus luteum of pregnancy.
7. Luteolysis of the corpus luteum. Lysis of the corpus luteum. Destruction of the corpus luteum.
8. Menstrual cycle (uterine cycle). Phases of the menstrual cycle. Menstrual phase. Proliferative phase of the menstrual cycle.
9. Secretory phase of the menstrual cycle. Menstrual bleeding.
10. Female sexual intercourse. Stages of female sexual intercourse. Sexual arousal in a woman. Excitement stage. Manifestations of the excitement stage.

Menstrual cycle (uterine cycle). Phases of the menstrual cycle. Menstrual phase. Proliferative phase of the menstrual cycle.

Menstrual cycle (uterine cycle)

The preparation of the female body for gestation is characterized by cyclic changes in the endometrium of the uterus, which consist of three successive phases: menstrual, proliferative and secretory - and are called the uterine, or menstrual, cycle.

Menstrual phase

Menstrual phase with a uterine cycle duration of 28 days, it lasts an average of 5 days. This phase is bleeding from the uterine cavity that occurs at the end of the ovarian cycle if fertilization and implantation of the egg do not occur. Menstruation is the process of shedding the endometrial layer. The proliferative and secretory phases of the menstrual cycle involve the processes of endometrial repair for possible implantation of the egg during the next ovarian cycle.

Proliferative phase

Proliferative phase varies in duration from 7 to 11 days. This phase coincides with follicular and ovulatory phases of the ovarian cycle, during which the level of estrogens, mainly est-radiol-17p, in the blood plasma increases. The main function of estrogens in the proliferative phase of the menstrual cycle is to stimulate cell proliferation of organ tissues reproductive system with the restoration of the functional layer of the endometrium and the development of the epithelial lining of the uterine mucosa. During this phase, under the influence of estrogens, the endometrium of the uterus thickens, the size of its mucus-secreting glands increases, and the length of the spiral arteries increases. Estrogens cause proliferation of the vaginal epithelium and increase mucus secretion in the cervix. The secretion becomes abundant, the amount of water in its composition increases, which facilitates the movement of sperm in it.

Stimulation of proliferative processes in the endometrium is associated with an increase in the number of progesterone receptors on the membrane of endometrial cells, which enhances proliferative processes in it under the influence of this hormone. Finally, an increase in the concentration of estrogen in the blood plasma stimulates the contraction of smooth muscles and microvilli of the fallopian tubes, which promotes the movement of sperm towards the ampullary part of the fallopian tubes, where fertilization of the egg should occur.

The total duration of the cycle is 28 days, but in some cases it can last up to 35 days. It depends on the individual characteristics of the female body.

The phases of the menstrual cycle are classified according to the nature of the cyclic changes occurring in the ovaries and endometrium (menstrual, proliferative and secretory). The follicular or menstrual stage begins on the first day of menstruation and is characterized by the production of gonadotropin-releasing hormone in the hypothalamus of the brain. GnRH, in turn, stimulates the secretion of follicle-stimulating hormone and luteinizing hormone.

The menstrual phase is accompanied by bloody discharge from the uterine cavity. If fertilization of the egg does not occur, the endometrial layer is rejected, this is accompanied by bleeding, which can last 3-7 days. Women are bothered by nagging, aching pain in the lower abdomen.

About 20 follicles begin to form in the ovaries, but usually only one (dominant) matures, reaching a size of 10–15 mm. The remaining cells undergo reverse development - artresia. The follicle continues to grow until LH surges. This ends the first phase of the menstrual cycle; its duration is 9–23 days.

Ovulatory phase

On the 7th day of the cycle, the dominant follicle is determined, which during the growth process reaches 15 mm and secretes estradiol.

The second phase of the menstrual cycle lasts 1–3 days and is accompanied by an increased release of luteinizing hormone. LH causes an increase in the level of prostaglandins and proteolytic enzymes, which promote perforation of the follicle capsule with the subsequent release of a mature egg. This process is called ovulation. A sharp increase in LH secretion can be observed from 16 to 48 hours, the release of the egg usually occurs after 24–36 hours.

Sometimes phase 2 of the menstrual cycle is accompanied by ovulatory syndrome. Rupture of the follicle and the leakage of a small amount of blood into the pelvic cavity is accompanied by pain in the lower abdomen on one side. Brown spotting may appear, and basal temperature rises. Such symptoms persist for up to 48 hours. Acute pain syndrome is observed in women suffering from chronic inflammatory diseases of the gynecological organs, and in the presence of adhesions.

The timing of ovulation is unstable; endocrine disorders, concomitant diseases, and psychoemotional disorders can affect it. Typically, follicle rupture occurs on days 6–16 of the menstrual cycle, which is 28 days. If the cycle lasts 35 days, then ovulation may occur on days 18–19.

The next phase of menstruation lasts from the moment of ovulation until the start of menstruation, lasting 14 days. After the release of the egg, the follicle begins to accumulate fat cells and luteal pigment, gradually turning into the corpus luteum. This temporary endocrine gland produces estradiol, androgens and progesterone.

Changes in hormonal balance affect the condition of the endometrium (inner layer of the uterus). The luteal phase is characterized by the proliferation of endometrial cells that secrete hormones. During this period, the uterus prepares for implantation of a fertilized egg.

If pregnancy occurs, the corpus luteum begins to intensively produce progesterone. This hormone:

• promotes relaxation of the walls of the uterus;
• prevents its contraction;
• responsible for the secretion of breast milk.

The production of hormones by the corpus luteum continues until the placenta is formed.

If pregnancy does not occur, the temporary gland stops working and is destroyed, this leads to a decrease in the level of progesterone and estrogen. Necrotic destruction of cells occurs in the endometrial tissues, edematous processes are observed, and menstruation begins.

The suppression of FG and LH secretion stops, gonadotropins stimulate follicle maturation, and a new ovarian cycle begins.

Uterine cyclic processes

The duration of the uterine cycle corresponds to the duration of the ovarian cycle. Cyclic changes in the condition of the uterus are classified:

• The menstrual period (desquamation) is accompanied by rejection of the endometrium and its release with blood from the opened vessels. The duration of this stage is 3–7 days. The period of desquamation coincides with the death of the corpus luteum.
• The regeneration phase begins during the period of desquamation, approximately on the 5th–6th day. Restoration of the functional layer of the epithelium occurs due to the proliferation of gland remnants located in the basal layer.

• The proliferative phase coincides with the follicular and ovulatory stages of the ovarian cycle. This stage begins with the growth of the follicle and its production of estrogens. Hormones promote epithelial renewal and proliferation of mucosal cells from the tissues of the uterine glands. The thickness of the epithelium increases 3–4 times, and the size of the tubular glands of the uterus also increases, but they do not secrete secretions.
• The secretory stage is accompanied by the beginning of secretion production by the uterine glands. This period coincides with the development of the corpus luteum in the ovaries, and lasts from days 14 to 28 of the menstrual cycle. During the secretory phase, protrusions form in the walls of the uterus. A supply of microelements begins to be deposited in the mucous membrane, and enzyme activity increases. Thus, favorable conditions are created for the development of the embryo. If fertilization does not occur, the corpus luteum is destroyed, the functional layer of the endometrium is rejected and menstruation begins.

The vagina also undergoes cyclical changes. With the onset of the follicular phase, the epithelium of the mucous membranes begins to grow, and the secretion of mucin in the cervix increases. Cervical mucus thins and becomes similar to egg white, and the acidity level of the discharge changes. This is necessary for easier movement of sperm and increase their life expectancy. Epithelial cells in the vagina reach their maximum thickness with the onset of ovulation, the mucous membrane has a loose consistency. In the luteal phase, proliferation stops and desquamation occurs under the influence of progesterone.

Varieties

There are two types of desquamation:

• physiological (occurs on the skin and some glandular organs);
• pathological (occurs under the influence of inflammation on the mucous membranes or other processes).

Causes

Desquamation as a permanent phenomenon can be observed on the surface of the skin. During the process of skin desquamation, epidermal cells are removed. Physiological desquamation is also found during secretory processes that occur in some glandular organs. For example, the desquamation phase is observed in the mammary gland at the end of the lactation period.

As a pathological phenomenon, this process occurs during inflammation of the abdominal organs and mucous membranes. In this case, there is a violation of intercellular connections and detachment of the epithelium. As a rule, desquamated cells die, but sometimes they show viability and are capable of proliferative and phagocytic activity. An example is the vascular endothelium or alveolar pulmonary epithelium.

Due to disturbances in nervous trophism, the occurrence of exudative diathesis, the effects of helminthic infestations, and the appearance of diseases of the digestive system, desquamation of the tongue may occur.

Desquamation of the endometrium is observed when hormones act on the mucous membrane of the vagina and uterus. This process begins at the end of the menstrual cycle. During this period, the functional layer of the endometrium is rejected. The duration of this process usually does not exceed 5-6 days. The functional layer is areas of necrotic tissue, which is completely rejected during menstruation. At the beginning of the menstrual cycle, the desquamation phase of the endometrium ends.

Desquamation as a diagnostic method

Desquamation may be performed as a way to diagnose certain diseases. Thus, desquamation of the skin is often used to identify candidiasis, cancer and other disorders. A popular method for diagnosing benign and malignant neoplasms in the oral cavity is desquamation of the epithelium of the tongue. In this case, the smallest particles are scraped off for detailed examination. If the rules of this procedure are violated, desquamative glossitis develops.

Treatment

The process of physiological desquamation is considered normal and therefore does not require treatment. As for the pathological process, in this case therapy involves getting rid of the cause that led to the disorders (relieving the inflammatory process, etc.).

The endometrium consists of two layers: functional and basal. The functional layer changes its structure under the influence of sex hormones and, if pregnancy does not occur, is rejected during menstruation.

Proliferative phase

The beginning of the menstrual cycle is considered to be the 1st day of menstruation. At the end of menstruation, the thickness of the endometrium is 1-2 mm. The endometrium consists almost exclusively of the basal layer. The glands are narrow, straight and short, lined with low columnar epithelium, the cytoplasm of the stromal cells is almost the same.

As estradiol levels increase, a functional layer is formed: the endometrium prepares for embryo implantation. The glands lengthen and become convoluted. The number of mitoses increases. As they proliferate, the height of the epithelial cells increases, and the epithelium itself changes from single-row to multirow by the time of ovulation. The stroma is swollen and loosened, with increased cell nuclei and cytoplasmic volume. The vessels are moderately tortuous.

Secretory phase

Normally, ovulation occurs on the 14th day of the menstrual cycle. The secretory phase is characterized by high levels of estrogen and progesterone. However, after ovulation, the number of estrogen receptors in endometrial cells decreases. Endometrial proliferation is gradually inhibited, DNA synthesis decreases, and the number of mitoses decreases. Thus, progesterone has a predominant effect on the endometrium in the secretory phase.

Glycogen-containing vacuoles appear in the endometrial glands, which are detected using the PAS reaction. On the 16th day of the cycle, these vacuoles are quite large, present in all cells and located under the nuclei. On the 17th day, the nuclei, pushed aside by vacuoles, are located in the central part of the cell. On the 18th day, vacuoles appear in the apical part, and nuclei in the basal part of the cells, glycogen begins to be released into the lumen of the glands by apocrine secretion. The best conditions for implantation are created on the 6th-7th day after ovulation, i.e. on the 20-21st day of the cycle, when the secretory activity of the glands is maximum.

On the 21st day of the cycle, the decidual reaction of the endometrial stroma begins. The spiral arteries are sharply tortuous; later, due to a decrease in stromal edema, they are clearly visible. First, decidual cells appear, which gradually form clusters. On the 24th day of the cycle, these accumulations form perivascular eosinophilic couplings. On the 25th day, islands of decidual cells are formed. By the 26th day of the cycle, the decidual reaction becomes maximum. About two days before menstruation, the number of neutrophils that migrate there from the blood sharply increases in the endometrial stroma. Neutrophil infiltration is replaced by necrosis of the functional layer of the endometrium.

The uterine menstrual cycle occurs in the uterus - a cycle of changes in the endometrium.

Cyclic changes in the endometrium concern its functional (surface) layer, consisting of compact epithelial cells, and the intermediate layer, which are rejected during menstruation.

The basal layer, which is not rejected during menstruation, ensures the restoration of desquamated layers.

Based on changes in the endometrium during the cycle, the proliferation phase, the secretion phase and the bleeding phase (menstruation) are distinguished.

Transformation of the endometrium occurs under the influence of steroid hormones: the proliferation phase - under the predominant action of estrogens, the secretion phase - under the influence of progesterone and estrogens.

Proliferation phase(follicular) lasts an average of 12-14 days starting from the 5th day of the cycle (Fig. 2.5). During this period, a new surface layer is formed with elongated tubular glands lined with columnar epithelium with increased mitotic activity. The thickness of the functional layer of the endometrium is 8 mm.

Secretion phase (luteal) associated with the activity of the corpus luteum, lasts 14 days (±1 day) (Fig. 2.6). During this period, the epithelium of the endometrial glands begins to produce secretions containing acidic glycosaminoglycans, glycoproteins, and glycogen.

Secretion activity becomes highest on the 20-21st day. By this time, the maximum amount of proteolytic enzymes is detected in the endometrium, and decidual transformations occur in the stroma (cells of the compact layer enlarge, acquiring a round or polygonal shape, glycogen accumulates in their cytoplasm). A sharp vascularization of the stroma is noted - the spiral arteries are sharply tortuous, forming “tangles” found throughout the functional layer. The veins are dilated. Such changes in the endometrium, noted on days 20-22 (days 6-8 after ovulation) of the 28-day menstrual cycle, provide the best conditions for implantation of a fertilized egg.

By the 24-27th day, due to the onset of regression of the corpus luteum and a decrease in the concentration of hormones produced by it, endometrial trophism is disrupted with a gradual increase in degenerative changes in it. Granules containing relaxin are secreted from the granular cells of the endometrial stroma, which prepares menstrual rejection of the mucous membrane. In the superficial areas of the compact layer, lacunar expansion of capillaries and hemorrhages into the stroma are noted, which can be detected 1 day before the onset of menstruation.

Menstruation includes desquamation and regeneration of the functional layer of the endometrium. Due to regression of the corpus luteum and a sharp decrease in the content of sex steroids in the endometrium, hypoxia increases. The onset of menstruation is facilitated by prolonged spasm of the arteries, leading to blood stasis and the formation of blood clots. Tissue hypoxia (tissue acidosis) is aggravated by increased endothelial permeability, fragility of vessel walls, numerous small hemorrhages and massive leukocyte infiltration. Lysosomal proteolytic enzymes released from leukocytes enhance the melting of tissue elements. Following a prolonged spasm of blood vessels, their paretic dilation occurs with increased blood flow. At the same time, there is an increase in hydrostatic pressure in the microvasculature and rupture of the walls of blood vessels, which by this time have largely lost their mechanical strength. Against this background, active desquamation of necrotic areas of the functional layer occurs. By the end of the 1st day of menstruation, 2/3 of the functional layer is rejected, and its complete desquamation usually ends on the 3rd day.

Regeneration of the endometrium begins immediately after the rejection of the necrotic functional layer. The basis for regeneration are the epithelial cells of the stroma of the basal layer. Under physiological conditions, already on the 4th day of the cycle, the entire wound surface of the mucous membrane is epithelialized. This is followed again by cyclic changes in the endometrium - the phases of proliferation and secretion.

Consecutive changes throughout the cycle in the endometrium - proliferation, secretion and menstruation - depend not only on cyclic fluctuations in the levels of sex steroids in the blood, but also on the state of tissue receptors for these hormones.

The concentration of nuclear estradiol receptors increases until the middle of the cycle, reaching a peak towards the late period of the endometrial proliferation phase. After ovulation, there is a rapid decrease in the concentration of nuclear estradiol receptors, continuing until the late secretory phase, when their expression becomes significantly lower than at the beginning of the cycle.

The regulation of local concentrations of estradiol and progesterone is mediated to a large extent by the appearance of various enzymes during the menstrual cycle. The content of estrogens in the endometrium depends not only on their level in the blood, but also on their formation in the tissue. A woman's endometrium is capable of synthesizing

During the menstrual cycle, called the proliferative phase, the structure of the uterine mucosa has, in general terms, the character described above. This period begins shortly after the menstrual bleeding, and, as the name itself shows, during this period proliferative processes occur in the uterine mucosa, leading to the renewal of the functional part of the mucous membrane that was rejected during menstruation.

As a result of reproduction fabrics, preserved after menstruation in the remnants of the mucous membrane (that is, in the basal part), the formation of the lamina propria of the functional zone begins again. From the thin mucous layer preserved in the uterus after menstruation, the entire functional part is gradually restored, and, thanks to the proliferation of the glandular epithelium, the uterine glands also lengthen and enlarge; however, in the mucous membrane they still remain smooth.

The entire mucous membrane gradually thickens, acquiring its normal structure and reaching an average height. At the end of the proliferative phase, cilia (kinocilia) of the surface epithelium of the mucous membrane disappear, and the glands prepare for secretion.

Simultaneously with the phase proliferation During the menstrual cycle, the follicle and egg cell mature in the ovary. Follicular hormone (folliculin, estrin), secreted by the cells of the Graafian follicle, is a factor that determines proliferative processes in the uterine mucosa. At the end of the proliferation phase, ovulation occurs; In place of the follicle, the corpus luteum of menstruation begins to form.

His hormone has a stimulating effect on the endometrium, causing changes that occur in the subsequent phase of the cycle. The proliferation phase begins on the 6th day of the menstrual cycle and continues until the 14-16th day inclusive (counting from the first day of menstrual bleeding).

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Secretion phase of the uterine cycle

Under stimulating influence hormone corpus luteum (progesterone), which meanwhile is formed in the ovary, the glands of the uterine mucosa begin to expand, especially in their basal sections, their bodies twist like a corkscrew, so that in longitudinal sections the internal configuration of their edges takes on a sawtooth, jagged appearance. A typical spongy layer of the mucous membrane appears, characterized by a spongy consistency.

The epithelium of the glands begins secrete mucus, containing a significant amount of glycogen, which in this phase is also deposited in the bodies of glandular cells. From some connective tissue cells of the compact layer of the mucous membrane, enlarged polygonal cells with weakly stained cytoplasm and nucleus begin to form in the tissue of the lamina propria.

These cells are scattered in fabrics singly or in the form of clusters, their cytoplasm also contains glycogen. These are the so-called decidual cells, which, in the event of pregnancy, multiply even more in the mucous membrane, so that their large number is a histological indicator of the initial phase of pregnancy (histological examination of pieces of the uterine mucosa obtained during chiretage - removal of the fertilized egg with a curette).

Carrying out such research is of great importance especially when determining ectopic pregnancy. The fact is that changes in the mucous membrane of the uterus also occur in the case when a fertilized egg cell, or rather a young embryo, nidates (grafts) not in its normal place (in the mucous membrane of the uterus), but in some other place outside the uterus (ectopic pregnancy).

It is the duty of every woman to know about it and be able to feel her body.

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What is menstruation?

Menstruation(from Latin mensis - month, menstruus - monthly), menstruation or regula are part of the menstrual cycle of the female body. During menstruation, the functional layer of the endometrium (uterine lining) is shed, accompanied by bleeding. The countdown of the menstrual cycle begins on the first day of menstruation.

Why do we need periods?
The menstrual process is a period when the uterine epithelium is renewed every month.

During this process, irreversible changes occur in the epithelium, and it is removed from the body, since it can no longer be used. Instead, a new epithelium is formed in the body, which is successfully involved in internal processes.

Functional purpose:

Degeneration of cells. The menstrual process allows you to renew epithelial cells, which provides an important role for a girl’s reproductive ability.

Natural protective. The menstrual process involves a separate layer of the uterus, which is responsible for analyzing problems in eggs that are not fertilized and preventing the implantation of these eggs. Such eggs are excreted from the body along with the epithelium every month.

Menstrual blood does not clot and has a darker color than the blood circulating in the vessels. This is explained by the presence of a set of enzymes in menstrual blood.

Menstrual blood is the liquid discharge from the vagina during menstruation. Strictly speaking, a more correct term is menstrual fluid, since its composition, in addition to blood itself, includes the mucous secretion of the glands of the cervix, the secretion of the vaginal glands and endometrial tissue.

The average volume of menstrual fluid released during one menstrual cycle is, according to the Great Medical Encyclopedia, about 50-100 milliliters.

However, the individual spread ranges from 10 to 150 and even up to 250 milliliters.

This range is considered normal; more abundant (or, conversely, scanty) discharge may be a symptom of the disease. Menstrual fluid is reddish-brown in color, slightly darker than venous blood.

The amount of iron lost through menstrual blood is relatively small for most women and cannot on its own cause symptoms of anemia.

In one study, a group of women exhibiting symptoms of anemia were examined using an endoscope. It turned out that 86% of them actually suffered from various gastrointestinal diseases (such as gastritis or duodenal ulcers, in which bleeding occurs in the gastrointestinal tract).

This diagnosis may have been missed due to erroneous attribution of iron deficiency to menstrual blood loss. However, regularly heavy menstrual bleeding in some cases can still lead to anemia.

Menstruation (and menstrual cycles in general) usually do not occur during pregnancy and lactation. And the absence of menstruation at the expected time is a common symptom that suggests pregnancy.

During menstruation, a woman may experience physical discomfort. Before menstruation, you may experience irritability, drowsiness, fatigue, a slight increase in heart rate, and during menstruation - a slight slowdown in heart rate.

Premenstrual syndrome

Some women experience emotional changes associated with menstruation.

Sometimes there is irritability, a feeling of fatigue, tearfulness, and depression. A similar range of emotional effects and mood shifts are also associated with pregnancy and may be due to a lack of endorphins.

Estimates of the incidence of premenstrual syndrome range from 3% to 30%. In certain rare cases, in individuals prone to psychotic disorders, menstruation may trigger menstrual psychosis.

It is important to know the days of your cycle, the description of which will help you get to know yourself better.

Every woman should know the female cycle by day, what happens on these days, because it will show when you are ready to conceive, when you are passionate or, on the contrary, cold, why your mood changes so much:

On the 1st day The uterus throws out the spent endometrium, that is, bleeding begins.

A woman may experience malaise and pain in the lower abdomen. To reduce pain, you can take No-shpu, Buscopan, Belastezin, Papaverine.

On the 2nd day heavy sweating begins.

On day 3 the uterus is very open, which can contribute to infection. On this day, a woman can also become pregnant, so sex should be protected.

From the 4th day The mood begins to improve, efficiency appears, as menstruation is nearing completion.

What is the cycle by day in the second half?

days, beginning from 9th to 11th day considered dangerous, you may become pregnant.

They say that at this time you can conceive a girl. And on the day of ovulation and immediately after it is suitable for conceiving a boy.

At 12th Every day, women's libido increases, which entails a strong sexual desire.

When does the second half start?

From 14 days, when the egg begins to move towards the male principle, ovulation occurs.

On the 16th day a woman may gain weight as her appetite increases.

Until 19 days the possibility of becoming pregnant remains.

From the 20th day“safe” days begin. What are “safe days”? Exactly! "Safe" - in quotes!

These days, the possibility of getting pregnant decreases. Many women ask the question: is it possible for a woman to get pregnant before her menstrual cycle? The probability is low, but no one can give a complete guarantee.

The period of menstruation can change under the influence of many factors. No woman has an even cycle throughout her life. Even a cold, fatigue or stress can change it.

Many doctors warn that the body is capable of “giving out” repeated ovulation, so even 1 day before your period you can conceive a baby.

Menopause

Age of onset menopause(cessation of menstruation): the norm is 40-57 years, most likely - 50-52 years.

In temperate climates, menstruation lasts for an average of 50 years, after which menopause occurs; At first the regulations disappear for several months, then they appear and disappear again, etc.

There are, however, women who maintain menstruation until they are 70 years old. From a medical point of view, menopause is considered to have occurred if menstruation has been completely absent for a year.

What is the menstrual cycle?

Menarche.

First appearance of menstruation (menarche) in a woman it occurs at an average age of 12-14 years (with a range from 9-11 years to 19-21 years). Menstruation in hot climates begins between 11 and 15 years of age. In temperate climates - between 12 and 18 years of age and in cold climates - between 13 and 21 years of age.

The age of menarche reveals certain racial differences: for example, a number of studies have shown that Negroids experience menarche earlier than Caucasians living in the same socio-economic conditions.

After the first menstruation, the next one may be 2 or 3 months later. Over time, the menstrual cycle becomes established and lasts 28 days, but a cycle length of 21 to 35 days is normal. Only 13% of all women have a cycle of exactly 28 days. Menstruation lasts approximately 2-8 days. All discharge comes from the vagina.

On average, menstrual cycles usually begin between ages 12 and 15 and continue until approximately 45 to 50 years of age.

Since menstrual cycles are a consequence of changes in the ovary associated with the formation of oocytes, a woman is fertile only during the years that she has menstrual cycles. This does not mean that sexual activity stops with the onset of menopause - only fertility disappears.

For practical reasons, the beginning of the menstrual cycle is considered to be the day when menstrual bleeding appears.

Menstrual discharge consists of collapsing endometrium mixed with blood from ruptured blood vessels.

Before the onset of menstruation, the following phenomena are observed:

• nagging pain in the sacrum, often in the lower back;
• headache;
• fatigue, weakness;
• nipple sensitivity;
• weight gain;
• Sometimes mucous discharge occurs.

Selection by day:

• 1 day - scanty discharge;
• 2.3 days - abundant;
• Day 4.5 - reduction in discharge;
• 6-7 days - cessation of menstruation.

The menstrual phase lasts on average for 3-4 days. It is followed by two other phases of the menstrual cycle - the proliferation phase and the secretion phase (luteal phase, or corpus luteum phase).

The secretion phase begins after ovulation and lasts about 14 days. The duration of the proliferation phase is variable, averaging 10 days.

So, the menstrual cycle is usually called a period of time, the beginning of which is consideredfirst day of menstruation, and at the end - the day before the next menstrual flow appears.

The normal menstrual cycle of a healthy woman has four phases, each lasting about 7 days. The duration of the entire cycle is 28 days. However, the duration of the menstrual cycle of 28 days is an average figure.

For each individual woman it can vary both up and down. But a cycle that lasts from 21 to 35 days is also considered normal.

If the cycle does not fit into these time periods, this is not the norm. In this case, you should contact a gynecologist and undergo a comprehensive examination under his guidance.

Phases of the menstrual cycle in more detail

The menstrual cycle consists of several phases. The phases of changes in the ovaries and endometrium are different. Each of them has its own characteristics and characteristics.

The preparation of the female body for gestation is characterized by cyclic changes in the endometrium of the uterus, which consist of three successive phases: menstrual, proliferative and secretory - and are called the uterine, or menstrual, cycle.

Menstrual phase - the first phase of the cycle

The menstrual phase, with a uterine cycle lasting 28 days, lasts an average of 5 days. This phase is bleeding from the uterine cavity that occurs at the end of the ovarian cycle if fertilization and implantation of the egg do not occur.

Menstruation is the process of shedding the endometrial layer. The proliferative and secretory phases of the menstrual cycle involve the processes of endometrial repair for possible implantation of the egg during the next ovarian cycle. The most unpleasant and often painful phase.

Proliferative or follicular phase - second phasecycle

The proliferative phase varies in duration from 7 to 11 days. This phase coincides with the follicular and ovulatory phases of the ovarian cycle, during which the level of estrogens, mainly est-radiol-17p, in the blood plasma increases.

The main function of estrogens in the proliferative phase of the menstrual cycle is to stimulate cell proliferation of tissues of the organs of the reproductive system with the restoration of the functional layer of the endometrium and the development of the epithelial lining of the uterine mucosa.

Proliferative (follicular) phase- the first half of the cycle - lasts from the first day of menstruation until the moment of ovulation. At this time, under the influence of estrogens (mainly estradiol), proliferation of cells of the basal layer and restoration of the functional layer of the endometrium occur.

The duration of the phase may vary. Basal body temperature is normal. Epithelial cells of the glands of the basal layer migrate to the surface, proliferate and form a new epithelial lining of the endometrium. In the endometrium, the formation of new uterine glands and the ingrowth of spiral arteries from the basal layer also occur.

During this phase, under the influence of estrogens, the endometrium of the uterus thickens, its mucus-secreting glands increase in size, and the length of the spiral arteries increases. Estrogens cause proliferation of the vaginal epithelium and increase mucus secretion in the cervix.

The secretion becomes abundant, the amount of water in its composition increases, which facilitates the movement of sperm in it.

At the beginning of the menstrual cycle, a woman’s body exhibits a very low concentration of the female hormones estrogen. Such a low level becomes a stimulus for the hypothalamus to produce special releasing hormones, which subsequently act on the pituitary tissue. It is in the pituitary gland that two main hormonal substances are produced that regulate the monthly cycle - follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

These chemicals enter the bloodstream and reach the woman's ovarian tissue. As a result of this interaction, the ovaries begin to produce the same estrogens that are not enough in the body in the first days of the menstrual cycle. A high level of estrogen in the blood is necessary for the process of active growth of follicles (female germ cells) to start in the ovaries.

Stimulation of proliferative processes in the endometrium is associated with an increase in the number of progesterone receptors on the membrane of endometrial cells, which enhances proliferative processes in it under the influence of this hormone. Finally, an increase in the concentration of estrogen in the blood plasma stimulates the contraction of smooth muscles and microvilli of the fallopian tubes, which promotes the movement of sperm towards the ampullary part of the fallopian tubes, where fertilization of the egg should occur.

Every month, several such cells begin to mature in the female body, among which one dominant follicle stands out. It is the process of maturation and growth of the follicle that formed the basis for naming the first stage of the menstrual cycle, which is called follicular.

The duration of this stage may vary for each woman, but on average, with a 28-day cycle, follicle maturation takes about 14 days. The longer this stage lasts, the longer the woman’s entire menstrual cycle.

This period is considered the most unpredictable and the most “tender”. It is during the proliferative phase that the body responds sharply to all negative phenomena occurring to it.

Stress or illness can easily stop the process of follicle maturation and thereby lengthen the cycle, or, conversely, lead to rejection of the endometrium that has just begun to recover (imitation of menstruation).

Towards the end of the follicular phase, the level of FSH decreases, the middle of the cycle begins, and the body prepares for ovulation.

Video of the mechanisms of the menstrual cycle

Ovulation is the third phase of the menstrual cycle

It begins after a sharp surge of LH (luteinizing hormone), so-called luteinizing burst. After the dominant follicle bursts, an egg is released and begins its movement along the fallopian tube.

Once outside the follicle, the egg enters the fallopian or fallopian tubes (this process is called ovulation). The inner surface of the tubes is covered with villi, thanks to the movement of which the egg moves into the uterine cavity, preparing for fertilization and implantation.

Under the influence of LH, the cervical mucus softens and becomes looser, due to which sperm are freeprevent entry into the uterine cavity and tubes. The lifespan of an egg is 12-48 hours (while sperm live up to 5 days). If ovulation does not occur during this period, the egg dies.

Ovulation can be calculated and determined by the signs listed below:

1. The woman begins to experience strong sexual desire.
2. Basal temperature rises.
3. The number of discharges increases, they become mucous, viscous, but remain light and are accompanied by other symptoms.
4. Moderate, nagging pain may occur in the lower back.

If at this moment the egg and sperm meet, an embryo is formed and the woman can become pregnant.

As mentioned above, during the second stage the dominant follicle grows actively and rapidly. During this time, its size increases approximately five times, as a result of which the enlarged cell protrudes beyond the ovarian wall, as if protruding from it.

The result of such protrusion is the rupture of the follicle membrane and the release of the egg, ready for further fertilization. It is at this stage of the menstrual cycle that the most favorable period for conceiving a child begins.

Luteal (secretory) - the fourth phase of the menstrual cycle

Secretory (luteal) phase- second half - lasts from ovulation until the start of menstruation (12-16 days). The high level of progesterone secreted by the corpus luteum creates favorable conditions for embryo implantation. Basal body temperature is above 37 °C.

Changes occurring in the ovaries

The production of luteinizing hormone stops as suddenly as it began, immediately after ovulation. In place of the follicle, the corpus luteum is formed - a kind of endocrine organ that produces the pregnancy hormone - progesterone.

Changes occurring in the uterus

Progesterone promotes abundant blood supply to the already enlarged endometrium. The mucous membrane becomes softer and “stickier”, due to which the fertilized egg easily attaches to it.

If fertilization does not occur, the corpus luteum dies, progesterone ceases to be released, therefore, the endometrium is not supplied with blood so intensively, which leads to its death. The surface layer of the endometrium is torn off and, together with the dead egg, is released out. The first phase of the menstrual cycle begins - the poorest phase of female hormones, so women often become irritable and aggressive during menstruation.

In healthy women, ovulation occurs approximately in the middle of the menstrual cycle. By adding three days before and after ovulation, we get the optimal days for conceiving a child. The fact is that sperm can enter the uterine cavity before ovulation, but given their long life, fertilization can occur even if sexual contact took place 4-5 days before ovulation.

Women suffering from inflammatory diseases of the pelvic organs and endocrine disorders also have irregularities in the menstrual cycle. And even if its duration and regularity have not changed, some of the phases may shift or even fall out of the cycle.

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

Sexual intercourse during menstruation

It has long been believed that due to increased vulnerability to various types of infections, sexual activity should be avoided during menstruation. According to modern recommendations, sexual activity during menstruation is not contraindicated, but due to a possible increased risk of transmitting sexually transmitted infections, it is recommended to use a condom.

Menstrual disorders

Menstrual irregularities are quite common and boil down to:

• Cessation or suspension (amenorrhea).
• Rejected or displaced bleeding (menstruatio vicaria).
• Strengthening (menorrhagia).
• Painful menstruation (dysmenorrhea, old algomenorrhea).

Suspension of menstruation depends on various conditions.

Conception stops the normal flow of blood and constitutes a physiological cause. Menstruation may stop when there is any significant loss of blood from another part of the body, in which case the menstrual blood is retained or removed by other means.

When stopping menstruation, it is necessary to keep in mind the reason that caused this abnormality. If after a cold, after emotional unrest, menstruation does not occur for a long time, then you need to see a doctor. Mechanical delay of menstruation deserves special mention; it occurs when the entrance to the vagina narrows, or when the vagina itself and the cervix narrow.

Sometimes bleeding appears in some part distant from the uterus, from the latter the flow can either be reduced or stopped, this phenomenon is called additional or deviated menstruation ( vicarious menstruation).

In such cases, discharge usually occurs in places without skin, for example in wounds, ulcers; also in the mucous membrane, eg mouth, nose.

Generally speaking, there is not a single point on the surface of the body where additional menstruation would not be observed. In this case, phenomena that are usual for menstruation take place in the ovaries.

At menorrhagia the flow is increased.

This happens with diseases of the uterus or neighboring organs:

• with inflammation of the uterus,
• with erosion of the cervix,
• when the broad ligaments are engorged, etc.;
• sometimes there are no uterine disorders, and increased discharge depends on the general deterioration of health.

Dysmenorrhea are called menstruation accompanied by pain.

With them, blood clots often pass away. During treatment, they pay attention to the cause that supports the irregularity of menstruation and try to eliminate it.

Features of personal hygiene during menstruation.

It is extremely important for women to maintain genital hygiene during menstruation.

Of course, you need to constantly monitor the cleanliness of your body, but if you have your period, then you should do this much more carefully.

It is recommended to wash the external genitalia at least 2-3 times a day with warm water and soap (washing), and wash in the shower daily. Warm baths, heating pads, and pain relievers can reduce the discomfort of painful menstruation.

A woman’s performance during this period is preserved to some extent, but increased physical activity, hypothermia and overheating should be avoided.

Alcohol and spicy foods are contraindicated, since the latter increase uterine bleeding due to the rush of blood to the abdominal organs.

Rules of conduct during menstruation.

• Wash yourself several times a day.
• Change underwear whenever it gets dirty.
• Use special hygienic pads or tampons. Change them during the day at least once every 3 hours.
• Don't sleep with a tampon. This can lead to inflammation of the vagina.
• Or use one made from medical silicone. The bowl must be emptied at least once every 12 hours. You can sleep with a hypoallergenic menstrual cup.
• Eat right, take vitamins. They will help cope with psychological discomfort.

What is the difference between menstrual hygiene products? Which means are better?

As mentioned above, to maintain personal hygiene, teenage girls and women use disposable pads attached to their underwear and/or tampons inserted into the vagina.

In both cases, the tissue of the pad or tampon absorbs menstrual fluid, which in a humid and warm environment can cause the development of harmful pathogens and inflammation of the vagina, as well as the cause of TSS (Toxic Shock Syndrome).

In European countries, the USA and Canada, and now in Russia, reusable ones (service life up to 5 years) are becoming increasingly popular as personal hygiene products. This type of hygiene product does not absorb secretions, but collects them, so you can safely use the cup for up to 12 hours without replacement.

The cup practically hermetically protects the vagina, so you can swim with it in the pool and open water without fear of water getting inside and causing infection.

This means it can protect you all night or all day, no matter what you do!

Also, now reusable eco-pads made from natural materials are justifiably quickly gaining popularity.

After all, some women categorically do not want to use hygiene products that need to be inserted into themselves. For different reasons. Therefore, menstrual cups and tampons may not be suitable for them.

Women's health certainly does not improve from the use of pharmaceutical disposable hygiene products, because... there are a number of problems that they can cause... What to do?

Just for such a case, they are suitable as a convenient and more reliable and safe alternative.

Advantages of reusable pads:

• Saving. The manufacturer claims that with careful use, the service life is up to 5 years.
• Caring for the environment. The monthly amount of waste is reduced.
• Benefit for health. Many women got rid of annoying itching and thrush by simply abandoning disposable synthetic hygiene products made from petroleum products using bleaches, fragrances, etc...
• Pleasant tactile sensations. They breathe.
• They do not create a greenhouse effect. Doesn't stick to the body.
• Do not cause discomfort or irritation.
• More reliable than disposable pads. They absorb better and more. They don't leak.
• They have a waterproof layer of waterproof material.
• The natural composition of the vast majority of reusable pads is cotton, viscose, bamboo, microfiber.

Where can I buy a menstrual cup?

This is truly a wonderful invention! The best thing that was invented for women.

After all, 99% of those women who have tried a menstrual cup only regret that they only learned about such an ultra-modern product for feminine intimate hygiene only now!

After all, there are no gynecological contraindications for healthy women to use cups. Not at all!

And there are so many advantages of using a menstrual cup (compared to traditional feminine intimate hygiene products), we counted more than 30 of them, that they are all included in a separate article on our blog, which you can go to.

For maximum comfort, intimate hygiene also requires special products that can be gentle on microflora without causing dryness and irritation.

What product to use when washing or taking a shower should be determined individually; in many ways, the girl’s skin type plays a big role here.

For example, you should understand that any product has a highly alkaline composition and puts a lot of pressure on the skin, adding new tension to the body and preventing relaxation.

If a girl has dry skin, then the more alkali there is in the product, the more irritation of the skin it will lead to.

In such cases, it is recommended to refuse to use soap and give preference to gel products. Gels will remove all contaminants from intimate areas more gently, without causing the skin a new degree of irritation.

A wonderful product for daily use is a gentle intimate gel. .

The special formula gently cares for the skin and has a preventive and rejuvenating effect. Unlike ordinary gels and soaps, the product does not cause allergies or irritation. It contains provitamin B5, chamomile extract and aloe vera gel.

Chamomile extract helps relieve irritation and redness. The intimate gel has a delicate texture and a neutral odor. Foams well and is easily washed off even with a small amount of water. Gives cleanliness, a feeling of freshness and a feeling of comfort throughout the day.

The neutral formula allows you to maintain the natural pH balance. Does not contain aggressive surfactants (SLS, SLES)

We always have in stock a simply gigantic assortment of menstrual cups from various manufacturers.

Germany, Finland, Spain, Russia, China. Anatomical shape, with valve, cup sets...

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

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

Proliferation concept

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

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

Causes

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

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

Process phases

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

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

Diseases

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

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

Types of hyperplasia

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

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

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

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

Symptoms

With the development of proliferative endometrial hyperplasia, the following symptoms are observed:

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

Diagnostics

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

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

1. Studying the patient's history and complaints related to the time of onset of bleeding, its duration and frequency. Accompanying symptoms are also studied.
2. Analysis of obstetric and gynecological information, which includes heredity, pregnancy, contraceptive methods used, previous diseases (not only gynecological), operations, diseases transmitted through sexual contact, etc.
3. Analysis of information about the beginning of the menstrual cycle (patient’s age), its regularity, duration, pain and profuseness.
4. Conducting a bimanual vaginal examination by a gynecologist.
5. Gynecological smear collection and microscopy.
6. Prescription of transvaginal ultrasound, which determines the thickness of the uterine mucosa and the presence of proliferative endometrial polyps.
7. Determination using ultrasound of the need for an endometrial biopsy to make a diagnosis.
8. Carrying out separate curettage using a hysteroscope, which scrapes or completely removes the pathological endometrium.
9. Histological examination of scrapings to determine the type of hyperplasia.

Treatment methods

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

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

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

Surgical intervention is provided in the following cases:

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

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

Conservative treatment

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

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

Therapy aimed at general strengthening of the body:

• Taking complexes of vitamins and minerals.
• Taking iron supplements.
• Prescribing sedative medications.
• Carrying out physiotherapeutic procedures (electrophoresis, acupuncture, etc.).

In addition, to improve the general condition of overweight patients, a therapeutic diet is developed, as well as measures aimed at physically strengthening the body.

Preventive actions

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

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

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

• regularly consult a gynecologist;
• undergo examinations by a gynecologist-endocrinologist;
• consult a specialist when choosing contraceptive methods;
• lead a healthy lifestyle.

Forecasts

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

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

Cases of relapse of this disease are very common. Therefore, a woman needs to regularly visit a gynecologist for an examination and follow all his recommendations.