Early stage of secretion. Phase proliferation of the menstrual cycle. Phase secretion of the uterine cycle

the menstrual cycle is a complex, biologically programmed process in the body of a woman aimed at ripening the egg and (with its fertilization) the possibility of implantation in the uterus cavity for further development.

Functions of menstrual cycles

The normal functioning of the menstrual cycle is due to the three components:

cyclic changes in the hypothalamus - pituitary system - ovaries;

cyclic changes in hormonal-dependent organs (uterine, uterine pipes, vagina, lactic glands);

cyclic changes in the nervous, endocrine, cardiovascular and other organism systems.

Changes in the body of a woman throughout the menstrual cycle are two-phase character, which is associated with the growth and ripening of the follicle, ovulation and the development of the yellow body in the ovaries. Against this background, cyclic changes in the endometrium of the uterus are also occurred as a target of action of all sex hormones.

The main function of the menstrual cycle in the body of a woman is reproductive. With an indispensable fertilization, the functional layer of the endometrium is rejected (in which the fertilized egg should be shed), and bleeding is appear - menstruation. Menstruation as it should be ends the next cyclic process in the body of a woman. The duration of the menstrual cycle is determined from the first day of the cycle of the menstruation until the first day of the next menstruation. The most common menstrual cycle is 26-29 days, but it can be from 23 to 35 days. The cycle is ideal, whose value is 28 days.

Levels of the Menstrual Cycle

Regulation and organization of the entire cyclic process in the body of a woman are carried out at 5 levels, each of which is regulated by the overlying structures by the feedback mechanism.

The first level of the menstrual cycle

This level is represented directly by the sexual organs, lactic glands, hair follicles, leather and adipose tissue, which is the impact of the hormonal status of the body. The impact is provided by certain receptors to the sex hormones located in these organs. The number of receptors to steroid hormones in these organs varies depending on the phase of the menstrual cycle. At the same level of the reproductive system, an intracellular mediator - CAMF (cyclic adenosine monophosphate) can be attributed, which regulates metabolism in target tissue cells. This includes prostaglandins (intercellular regulators) that implement their effect through the CAMF.

Phases of menstrual cycles

The phases of the menstrual cycle are distinguished, during which certain changes occur in the endometrium of the uterus.

Menstrual Cycle Proliferation Phase

Phase of proliferation, the essence of which is the growth of glands, stroma and endometrial vessels. The beginning of this phase falls on the end of menstruation, and its duration is on average 14 days.

The growth of the glands and the growing stroma occur under the influence of the gradually increasing concentration of estradiol. The view of the glands resembles straight tubes or several convoluted tubes with a straight lumen. A network of argirophilic fibers is located between stroma cells. This layer has little spiral artery. By the end of the phase of the proliferation of the endometrium gland become convulsions, sometimes they are corkscrew, their lumen is somewhat expanding. Often in the epithelium of individual glands, small subnuclear vacuoles containing glycogen can be detected.

Spiral arterys growing from the basal layer reach the surface of the endometrium, they are a few convolutions. In turn, the network of argirophilic fibers concentrates in the stroma around the endometrium glands and blood vessels. By the end of this phase, the thickness of the functional layer endometrial is 4-5 mm.

Phase secretion of the menstrual cycle

Phase of secretion (luteinova), the presence of which is associated with the functioning of the yellow body. By duration, this phase takes 14 days. In this phase, the epithelium of the glands formed into the previous phase occurs, and they begin to produce a secret containing acidic glycosaminoglycans. Initially, secretory activity is small, whereas in the future it increases an order of magnitude.

In this phase of the menstrual cycle on the endometrium surface, focal hemorrhages occurred during ovulation and associated with a short-term decrease in estrogen levels.

In the middle of this phase, the maximum concentration of progesterone and an increase in estrogen levels are noted, which leads to an increase in the functional layer of the endometrium (its thickness reaches 8-10 mm), and its distinct division into two layers. The deep layer (spongy) is represented by a large number of strongly convinced glands and a small amount of stroma. The dense layer (compact) is 1/4 thickness of the entire functional layer, it contains fewer glands and more connecting cells. In the lumen of glands in this phase, there is a secret containing glycogen and sour mucopolysaccharides.

It was noted that the secretion peak falls on the 20-21th day of the cycle, then the maximum number of proteolytic and fibrinolytic enzymes is revealed. On the same days, decidual-like transformations arise in the stroma of endometrial (the cells of the compact layer become larger, glycogen appears in their cytoplasm). Spiral arterys are even more convulsions at this point, form the cracks, also marks the expansion of the veins. All these changes are aimed at creating optimal conditions for the implantation of a fetal egg. It was on the 20-22th day of the 28-day menstrual cycle that the optimal time comes for this process. On the 24-27th day, the regression of the yellow body occurs and a decrease in the concentration of hormone produced by him. This leads to disturbances of endometrial trophy and gradually increasing degenerative changes in it. The size of the endometrium decreases, the stromter of the functional layer is wrinkled, the folding of the walls of the glands is enhanced. From the graincal cells of etometrial stroma, granules containing relaxin are distinguished. Relaxin is involved in relaxing the arginil fibers of the functional layer, thus preparing the menstrual rejection of the mucous membrane.

On the 26-27th day of the menstrual cycle in the surface layers of the compact layer there are lacunar expansions of capillaries and focal hemorrhages in stroma. This state of the endometrium is observed per day before the start of menstruation.

Phase bleeding menstrual cycle

The bleeding phase consists of desquamation and endometrial regeneration processes. Relief and the death of the endometrium leads to the further regression and the death of the yellow body, which causes a decline in the content of hormones, as a result of which hypoxic changes are progressing in endometrials. Due to the long-term spasm of the arteries, blood stasis is observed, the formation of thromboms, the permeability and fragility of the vessels increase, which leads to the formation of hemorrhages in the endometrium. Full rejection (desquamation) endometrial occurs by the end of the third day of the cycle. After that, regeneration processes begin, and with the normal course of these processes on the fourth day of the cycle, the wound surface of the mucous membrane is epithelized.

Second Level of Menstrual Cycle

This level is represented by sexual glands of the female organism - ovaries. It is responsible for the growth and development of the follicle, ovulation, the formation of a yellow body, the synthesis of steroid hormones. For a long time in the female body, only a small part of the follicles passes the development cycle from premority to the pre-amulator, ovulates and turns into a yellow body. In each menstrual cycle, only one follicle completely matures. The dominant follicle in the first days of the menstrual cycle has a diameter of 2 mm, and by the time of ovulation, its diameter increases to 21 mm (on average for fourteen days). The volume of follicular fluid increases almost 100 times.

The structure of the premordial follicle is represented by an egg, surrounded by one next to the flatbed cells of the follicular epithelium. In the ripening of the follicle, an increase in the size of the egg itself occurs, and the cells of the epithelium are multiplied, as a result, forming a grainy layer of the follicle. Follicular fluid appears due to secretion of the grainy shell. The egg cell is pushed with liquid to the periphery, it is surrounded by several rows of granules cells, an eggproof holmik occurs ( Cumulus oophhorus.).

In the future, the gap of the follicle and the output of the egg in the uterine pipe cavity. The follicle rupture is provoked by a sharp increase in the estradiol content of the follicularity of the hormone, prostaglandins and proteolytic enzymes, as well as oxytocin and relaxin in the follicular fluid.

On the site of a broken follicle formed a yellow body. It synthesizes progesterone, estradiol and androgens. Of great importance for the further flow of the menstrual cycle has the formation of a full-fledged yellow body, which can be formed only from a preventive follicle containing a sufficient amount of granular cells with a high content of receptors to luteinizing hormone. The immediate synthesis of steroid hormones is carried out by cells of granules.

The derivative of the substance from which steroid hormones is synthesized is cholesterol coming with blood flow to the ovary. It is started and adjusting this process follicle-sustamulating and luteinizing hormones, as well as enzyme systems - aromatases. With a sufficient amount of steroid hormones, a signal is received about the termination or reduction of their synthesis. After completing the yellow body of its function, its regression and diefing occurs. An important role in this process plays oxytocin that has luteolytic action.

Third level of menstrual cycle

Presented the level of front lipophysis (adenogipid). Here the synthesis of gonadotropic hormones - follicle-suite (FSH), luteinizing (LH), prolactin and many other (thyrotropic, thyrotropin, somatotropin, melanotropin, etc.) is carried out. The luteinizing and follicle-wing hormones are in their structure of glycoproteins, prolactin - polypeptide.

The main target for the action of FSH and LH is the ovary. FSH stimulates the growth of the follicle, the proliferation of the cells of granules, the formation of LH receptors on the surface of the magnet cells. In turn, LH stimulates the formation of androgens in the cell cells, as well as the synthesis of progesterone in luteinized granulose cells after ovulation.

Prolctin also stimulates the growth of the mammary glands and regulates the lactation process. It has a hypotensive effect, gives a fatobilizing effect. An unfavorable point is to increase the level of prolactin, as this inhibits the development of follicles and steroidogenesis in the ovaries.

Fourth Menstrual Cycle

The level of the hypotalamus hypophysotropic zone is presented - ventromedial, arousate and domdomial nuclei. They are in the synthesis of hypophisotropic hormones. Since follyiberin is not highlighted and at the moment is not synthesized, then they use the abbreviation of the general group of hypothalamic gonadotropic liberins (GT-RT). Nevertheless, it is known that the release-hormone stimulates the release of both LH and FSH anterior lipophise.

GT-RG hypotalamus comes at the endings of axons, closely in contact with the capillaries of the medial elevation of the hypothalamus, into the circulatory system, combining the hypothalamus and pituitary. A feature of this system can be called the possibility of blood flow in both directions, which is important in implementing the feedback mechanism.

Regulation of synthesis and receipts in the bloodstream GT-RG is quite complex, it matters the level of estradiol in the blood. It is noted that the magnitude of the GT-RG emissions in the preventive period (against the background of the maximum separation of estradiol) is significantly higher than in the early folliculine and lutein phase. Also noted the role in the regulation of the synthesis of prolactin of dopaminergic structures of the hypothalamus. Dopamine slows down the separation of prolactin from the pituitary.

Fifth level of menstrual cycle

The level of the menstrual cycle is presented with supegipothalamic cerebral structures. These structures perceive pulses from the external environment and from interoreceptors, transmit them through the system of transmitters of nerve pulses into the neurosecretory cores of the hypothalamus. In turn, the conducted experiments prove that in the regulation of the function of hypothalamic neurons secreting GT-RT, the leading role belongs to dopamine, noraderennylin and serotonin. And the function of neurotransmitters is performed by the neuropeptides of morphine-like action (opioid peptides) - endorphins (END) and enkephalins (ENC).

Also in the regulation of the menstrual cycle, the cerebral bark is not played. There are data on the participation of amygdaloid nuclei and the limbic system in the neurohumoral regulation of the menstrual cycle.

Features of the regulation of the menstrual cycle

As a result, summing up all the above described, it can be concluded that the regulation of the cyclic menstrual process is a very complex system. Regulation inside this system itself can be carried out both along the long feedback loop (GT-RT - the neural cells of the hypothalamus) and the short loop (the front proportion of the pituitary gland - the hypothalamus) or even ultrashort (GT-RT - the nervous cells of the hypothalamus).

In turn, feedback may be negative, and positive. For example, with a low level of estradiol in the early follicular phase, the highlight of the front fraction of the pituitary is enhanced - negative feedback. An example of a positive feedback is the peak of estradiol selection that causes the emission of FSH and LH. An example of the ultra-screwing of a negative connection may be an increase in the secretion of GT-RT with a decrease in its concentration in neurosecretory neurons of the hypothalamus.

Features of the regulation of the menstrual cycle

It should be noted that in the normal functioning of cyclic changes of the genital organs, an important value is given by cyclic changes in other organs and systems of the body of a woman, for example, the predominance of brake reactions of the central nervous system, a reduction in motor reactions, etc.

In the proliferation phase of the endometrial of the menstrual cycle, the predominance of parasympathetic, and in the secretory phase - the sympathetic departments of the autonomic nervous system are noted. In turn, the state of the cardiovascular system during the menstrual cycle is characterized by wave-like functional oscillations. Currently, it is proved that in the first phase of the menstrual cycle, the capillaries are somewhat narrowed, the tone of all vessels is elevated, and the blood flow is fast. And in the second phase of the capillaries, on the contrary, somewhat expanded, the tone of the vessels is reduced, and the blood current is not always uniform. Changes in blood system are noted.

Pathologist diagnostics of the endometrium status on biopsies / spitters V.A. Topchieva O.I. ; under. ed. prof. OK. Khmelnitsky. - Leningrad.

Diagnosis on biopsies endometrial is often great difficulties due to the fact that the same very similar microscopic picture of the endometrium is due to various reasons (O.I. Topchiyeva 1968). In addition, endometrial fabric is characterized by an exceptional variety of morphological structures, depending on the level of steroid hormones, secret-generable ovaries, and under the pathological conditions associated with the violation of endocrine regulation.

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Pathological diagnostics of the status of endometrials on biopsies: Methodical recommendations / Snidishmen V.A., Topchieva O.I. -.

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/ Spanking V.A. Topchieva O.I. -.

Pathoanatomic diagnostics of biopsies endometrial states

Accurate microscopic diagnostics on endometrial scrapings is of great importance for the daily work of the obstetrician-gynecologist. Biopsy (zoops) endometrials make up a significant part of the material sent by obstetric and gynecological hospitals for microscopic examination.

Diagnostics on biopsies of endometrial often represents great difficulties due to the fact that the same very similar microscopic picture of the endometrium is due to various reasons (O. I. Topchiyeva 1968). In addition, endometrial fabric features an exceptional variety of morphological structures, depending on the level of steroid hormones secreted by the ovaries, and in the pathological conditions associated with the violation of endocrine regulation.

Experience shows that the responsible and complex diagnosis of changes in the endometrium in the scrapings turns out to be full only if there is close contact in the work between the pathologist and the gynecologist.

The use of histochemical methods, along with the classical morphological methods of the study, significantly expands the possibilities of pathologist diagnostics and includes such histochemical reactions as a reaction to glycogen, alkaline and acid phosphatases, monoaminoxidase, and others. The use of these reactions allows you to more accurately assess the degree of disruption of estrogen balance and gestagens in the body Women, and also makes it possible to determine the degree and nature of the hormone sensitivity of the endometrium in hyperplastic processes and tumors, which is of great importance when choosing methods for the treatment of these diseases.

Methods of obtaining and preparation of material for research

Important for proper microscopic diagnostics on endometrial scrapings has the observance of a number of conditions during the material fence.

The first condition is the correct definition of time that is most favorable for the production of scraping. There are the following testimony for scraping:

• a) during sterility with suspicion of insufficiency of the function of the yellow body or an inhibular cycle - the scrapets takes 2-3 days before menstruation;
• b) with menorage, when slow motion of the endometrium mucosa is suspected; Depending on the duration of bleeding, the scrapets takes 5-10 days after the start of menstruation;
• c) with dysfunctional uterine bleeding type metro angry scraping should be taken immediately after the start of bleeding.

The second condition is technically correct implementation of the scraping of the uterus. The "accuracy" of the response of the pathologist largely depends on how the endometrium scraping is taken. If small, fragmented pieces of fabric come to study, it is extremely difficult or even impossible to restore the endometrium structure. This is eliminable with the right piece of scraping, the purpose of which is to obtain large unrecorded strips of the tissue of the mucous membrane. This is achieved by the fact that after holding a Kyu Retka along the wall of the uterus, it should be taken from the cervical of the canal each time, and the intricate the tedious of the muzzo is carefully folded into the gauze. In the event that the curette is not excreted every time, the mucosa separated from the wall during repeated movements of the cureti is crushed and part of it remains in the uterine cavity.

Full Diagnostic scraping of the uterus is made. After the expansion of the cervical canal is up to 10 numbers of the hegara expander. Usually scraping is carried out separately: first-cervical canal, and then the uterus cavity. The material is placed in a fixing liquid into two separate banks, marked from where it is taken from.

In the presence of bleeding, especially in women in the menopausal period or in menopause, you should scroll through the small curette of the tube angles of the uterus, remembering that it is precisely in these sites that the polynomials of the endometrium can be localized, in which the maligancy areas are most often found.

If, when scraping from the uterus, a large amount of tissue was removed, then it is necessary to send the entire material to the laboratory, and not part of it.

Tsugi. or so-called Rancheyskets They are taken in cases where it is necessary to determine the reaction of the uterus mucous membrane in response to the secretion of hormones with ovaries, to control the results of hormone therapy, when finding out the causes of the sterility of a woman. To obtain TsUGs, use a small curette without prior expansion of the cervical canal. When taking the TsUGA, it is necessary to carry out a curette until the bottom of the uterus, so that in the strip of the bar neighboring. The mucous membrane is up to bottom, that is, the lining all the separations of the uterus. To obtain the correct response of the Histologist on the Cugu, as a rule, it is enough to have 1-2 endometrium strips.

In no case should the TSG methodology should not be used in the presence of uterine bleeding, since in such cases it is necessary to have endometrium to study from the surface of all the walls of the uterus.

Aspiration biopsy - Obtaining pieces of endometrium tissue by suction from the uterine cavity can be recommended for mass prophylactic examinations of women in order to identify prematubic states and endometrial cancer in "increased risk groups". At the same time, the negative results of aspiration biopsy do not allow! With confidence, reject the initial forms of asymptomatic flowing cancer. In this regard, if the uterine cancer is suspected, the most reliable and uniquely shown diagnostic method remains [Full scraping of the uterine cavity (V. A. Mandelstam, 1970).

After the work of biopsy, a doctor sending material for the study must fill accompanying Direction L about the form offered by us.

The direction should indicate:

• a) the duration of the menstrual cycle, characteristic of this woman (21-28, or 31 days, cycle);
• b) the start date of bleeding (in the period of expected menstruation, ahead of time or late). In the presence of menopause or amenorrhea, it is necessary to specify its duration.

These are the value of the following data

• a) the constitutional type of patient (obesity is often accompanied by pathological changes in endometrial),
• b) endocrine disorders (diabetes, changes in the function of the thyroid gland and adrenal cortex),
• c) Did the patient of hormone therapy be subjected to what a hormone and which dosage?
• d) whether methods of hormonal contraception were used, the duration of using contraceptives.

Histological treatment Material 6IOs includes fixation in a 10% neutral solution of formalin, followed by dehydration and pouring to paraffin. You can also use the accelerated method of filling in paraffin on G.A. Merculus with fixation in formalin, heated to 37 ° C in thermostat in For 1-2 hours.

In everyday work, it is possible to limit the painting preparations with hematoxylin-eosin, van-Gizon, Mud Charmina or Alziane Oitam.

For a more subtle diagnosis of the state of the endometrium, especially in solving questions about sterility related to the defective ovarian function, as well as to determine the hormone-sensitivity of the endometrium in hyperplastic processes and tumors, it is necessary to use histochemical methods that allow to identify glycogen, to evaluate the activity of acidic, alkaline phosphatases and A number of other enzymes.

Cryostatic sections The endometrium obtained from non-fixed tissue, frozen at a temperature of liquid nitrogen (-196 °) can be used not only for research using conventional histological methods of color (hematoxylin-eosin, etc.), but also to determine the content of glycogen and the activity of enzymes in morphological structures mucous uterus.

For histological and histochemical studies with biopsy endometrial on cryostatic sections, the pathoanatomy laboratory must be equipped with the following equipment: MK-25 cryostat, liquid nitrogen or carbon dioxide ("dry ice"), Dewar vessels (or household thermos), pH meter, refrigerator on + 4 ° C, thermostat or water bath. To obtain cryostat sections, you can use the method developed by V.A. Polyshnikhnikov with employees (1974).

According to this method, the following stages of the preparation of cryostat sections are distinguished:

1. Endometrial pieces (without pre-washing with water and without fixation) are placed on a strip of filter paper moistened with water, and gently lowered into liquid nitrogen by 3-5 seconds.
2. Filter paper with frozen in nitrogen pieces of endometrial are transferred to the cryostat chamber (-20 ° C) and carefully with a few drops of water are fitted to the microtomes to the system.
3. 10 μm thick cuts obtained in a cryostate are mounted in a cryostat chamber to chilled substantive or covering glasses.
4. Framing of sections is carried out by melting of sections, which is achieved with the touch of the warm finge of the K.Nizhny surface of the glass.
5. Glass with flashes quickly (should not be made to frozen again) removed from the cryostat chamber, dried in air. And fixed in 2%, the glutaraldhyde solution (or vapor form) or in the formaldehyde mixture - alcohol - acetic acid - chloroform ratio in the 2: 6 ratio : 1: 1.
6. Fixed media are stained with hematoxylin-eosin, dehydrated, enlighten and enter into polystyrene or balm. The choice of the level of the studied histological structure of the endometrium is performed on time preparations (non-fixed cryostat sections) painted with toluidine blue or methylene blue and water prisoners. Their manufacturing takes 1-2 minutes.

For histochnotic determination of the content and localization of glycogen dried in air, cryostatic sections are fixed in cooled to + 4 ° C for 5 minutes, dried in air and painted according to the Mac-Manusa (Pier 1962).

To detect hydrolytic enzymes (acid and alkaline phosphatase), cryostat sections are used, fixed in cool to a temperature of + 4 ° C 2%. Neutral formal solution for 20-30 minutes. After fixing, the sections are rinsed in water and immersed in an incubation solution to identify the activity of acidic or alkaline phosphatases. The acid phosphatase is determined by Barkarka and Anderson (1963), and alkaline phosphatase - Berstone (BERSTON, 1965). Before conclusion, sections can be hematoxylin. Store drugs are necessary in the dark.

Changes in endometrials observed throughout the two-phase menstrual cycle

The mucous membrane of the uterus, lining her various sections - the body, and cervical, - has typical and functional features in each of these departments.

The endometrium of the bodies of the uterus consists of two layers: basal, deeper, located directly on the myometry of the I. Fast-functional.

Basal The layer contains a few narrow glands lined with cylindrical single-row epithelium whose cells have oval, intensively staining kernel hematoxylin. The reaction of the tissue of the basal layer on hormonal exposure is poorly and inconsistently.

From the fabric of the basal layer, the functional layer is regenerated after various disorders of its integrity: rejection into the menstrual phase of the cycle, during dysfunctional bleeding, after abortion, childbirth, and also after scraping.

Functional The layer is a cloth with a special, biologically due to high sensitivity to sex steroid hormones-estrogen and gestagenam, under the influence of which its structure and function changes.

The height of the functional layer in half-green women varies depending on the phase of the menstrual cycle: about 1 mm at the beginning of the proliferation phase and up to 8 mm in the secretion phase-at the end of the 3rd cycle week. In this period, a deep, spongy layer is most distinctly denoted in the functional layer, where the glands are closer, and the surface-compact, in which cyto-gene stromas prevails.

The basis of cyclic changes of the morphological picture of the endometrium observed during the menstrual cycle lies the ability of genital steroids-estrogen to cause characteristic changes in the structure and behavior of the tissue of the mucous membrane of the uterus.

So, Estrogen Stimulate the proliferation of glasses of glands and stroma, contribute to regenerative processes, possess the vasodilatory action and increase the permeability of endometrial capillaries.

Progesterone It has an action on endometrium only after the prior effect of estrogen. Under these conditions, gestagens (progesterone) cause: a) secretory changes in glands, b) decidual reaction of stroma cells, c) the development of spiral vessels in the functional layer of endometrial.

The above morphological features were based on the morphological division of the menstrual phase and stage data cycle.

According to modern ideas, the menstrual cycle is divided into:

• 1) Phase proliferation:
  • Early Stage - 5-7 Day
  • Central Stage - 8-10 Day
  • Late stage - 10-14 days
• 2) secretion phase:
  • Early Stage (the first signs of secretory transformations) - 15-18 day
  • Central Stage (the most pronounced secretion) - 19-23 days
  • Late stage (starting regression) - 24-25 days
  • Regress with ischemia - 26-27 days
• 3) Bleeding phase - menstruation:
  • Deskvamation - 28-2 day
  • Regeneration - 3-4 days

In assessing changes occurring in endometrials, respectively, the days of the menstrual cycle, must be considered:

• 1) the duration of the cycle in this woman (28- or 21-day cycle);
• 2) the term of ovulation that occurred, which in normal conditions is observed on average from 13th to the 16th day of the cycle; (Therefore, depending on the time of ovulation, the structure of the endometrial of one or another stage of the secretion phase fluctuates r; limits of 2-3 days).

Phase proliferation lasts 14 days, however, and in physiological conditions it can be elongated or shortened within 3 days. Changes observed in the endometrical phase of proliferation arise as a result of the action of the growing amount of estrogen secreted by the growing and ripening follicle.

The most pronounced morphological changes in the proliferation phase are marked in glands. At an early stage, the glands have a view of a straight or cast of convolve tubes with a narrow lumen, the contours of the glands are rounded or oval. The epithelium glands is a single-row low cylindrical, core oval, are located at the base of the cells are intensively painted with hematoxylin. In the late stage of the gland acquire winding, sometimes corkscrew outlines with a slightly advanced lumen. The epithelium becomes high prismatic, a large number of mitoses are observed. As a result of intensive division and increase the number of core epithelial cells, they are at different levels. For the epithelium cells of the early phase of the proliferation, the absence of glycogen and moderate activity of alkaline phosphatase is characteristic. By the end of the phase of the proliferation in the glands, the appearance of small dust-like glycogen granules and the high activity of alkaline phosphatase is noted.

In the stroma endometrial during the phase of proliferation there is an increase in dividing cells, as well as thin-walled vessels.

The structures of the endometrium corresponding to the proliferation phase observed in physiological conditions in the first half of the two-phase nicla can reflect.Gormonal disorders if they are detected:

• 1) during the second half of the menstrual cycle; This may indicate an annevulatory single-phase cycle or on an abnormal, elongated phase of proliferation with the late ovulation. In a two-phase cycle:
• 2) with iron hypeometrium hyperplasia in various sections of a hyperplasned mucous membrane;
• 3) Three dysfunctional uterine bleeding in women at any age.

The secretion phase, directly associated with the hormonal activity of the menstrual yellow body and the corresponding secretion of progesterone, lasts 14 ± 1 days. The shortening or elongation of the secretion phase is more than two days, in women in the reproductive period, should be considered as a pathological state, since such cycles are sterile.

Throughout the first week, the phase of secretion of the day of ovulation is determined by changes in the epithelium glands, while in the second week this day is most accurate to be determined by the state of the endometrium stroma cells.

So, on the 2nd day after ovulation (16th day of the cycle) in the epithelium glands appear Subnuclear vacuoles. On the 3rd day after ovulation (17th day of the cycle), subnuclear vacuoles push the kernels into the apical cells of the cells, as a result of which the latter are on the same level. On the 4th day after ovulation (18th day of the cycle), the vacuole is partially moving from the basal departments to the apical and the 5th day (19th day of the cycle) almost all vacuoles move to the apical cells of the cells, and nuclei are shifted to the basal Little departments. In the next 6th, 7th and 8th days after ovulation, i.e., on the 20th, 21st and 22nd days of the cycle in the cells of the epithelium glands, the pronounced processes of the apocryne secretion are noted, as a result of which apical " Paradise cells have as if notched, uneven. The absurpenses of the glands during this period are usually expanded, filled with eosinophilic secret, the walls of the glands become folded. On the 9th day after ovulation (23rd day of the menstrual cycle), the secretion of the glands is over.

The use of histochemical methods made it possible to establish that subnuclear vacuoles contain large granules of glycogen, which throughout the early and at the beginning of the average stage of secretion phase is thrown by apocryan secretion into the absurdity of the glands. Along with the glycogen in the lumen of the glands, acidic mucopolysaccharides are also contained. As the glycogen accumulates and the secretion of it in the absurd of the glands, a distinct decrease in the activity of alkaline phosphatase in the epithelium cells, which almost completely disappears to 20-23 day of the cycle.

In stroma Characteristic changes for the secretion phase begin to appear on the 6th, 7th day after ovulation (20th, 21st day of the cycle) in the form of a perivascular decidua-like reaction. This reaction in the cells of the strass of the compact layer is most pronounced and is accompanied by an increase in cell cytoplasm, they acquire polygonal or rounded outlines, glycogen accumulation is observed. The secretion phase characteristic of this stage is also the appearance of spiral vessels, not only in the deep departments of the functional layer, but also in the surface compact layer.

It should be emphasized that the presence of spiral arteries in the endometrium functional layer is one of the most reliable signs that determine the full gestagne effect.

On the contrary, subnuclear vacuolaization in the epitheliums of the glands is not always a sign indicating that the ovulation has occurred and the secretion of progesterone in the yellow body.

Subnuclear vacuoles can sometimes be detected in the glands of mixing of the hypoplastic endometrial at D.Is-functional uterine bleeding in women of any age, including the period of menopause (O. I. Topchieva, 1962). However, in endometrial, where the occurrence of vacuoles is not criticized with ovulation, they are contained in separate glands or in the gland group is usually only in the cells. Vacuol themselves have a different value, most often they are small.

In the late stage of the secretion phase, from the 10th day after Ov-Lyashiya, i.e., on the 24th day of the cycle, in whey, with the start of the yellow body regression and a decrease in the level of progesterone in the blood in the endometrium, morphological signs of regression are observed, and on 26 And on the 27th day they join signs of ischemia. As a result of wrinkling, the stroma of the functional layer of the gland acquire star-shaped outlines on transverse sections and saws on longitudinal.

In the phase of bleeding (menstruation) in endometrials, desquamation and regeneration processes occur. The morphological feature characteristic of the endometrial of the menstrual phase is the presence, in the penetrated hemorrhages, the disintegrating tissue of the sleeved glands or their fragments, as well as the trangles of the spiral arteries. Full rejection of the functional layer usually ends on the 3rd day of the cycle.

The endometrial regeneration occurs due to the proliferation of the cells of the basal departments of the glands and ends for 24-48 hours.

Changes endometrial in disruption of the endocrine function of the ovaries

From the point of view of etiology, pathogenesis, as well as taking into account the clinical symptoms, morphological changes in endometrials arising from violation of the endocrine function of the ovaries can be divided into three groups:

1. Changes endometrial in violation of secretion Estrogenic hormones.
2. Changes in endometrials in violation of secretion progestive hormones.
3. Changes in the mixed type endometrial, in which structures reflecting the impact of estrogen and progestative hormones are simultaneously found.

Regardless of the nature of the violations of the endocrine function of the ovaries listed above, the most common symptoms with which clinicians and morphologists are found are Uterine bleeding and amenorrhea.

A special place in its extremely important clinical meaning is occupied by uterine bleeding in women in menopause Since among a variety of reasons that binding such bleeding, about 30% are malignant endometrial neoplasms (V.A. Madelshtam 1971).

1. Changes in endometrial in violation of the secretion of estrogenic hormones

Violation of the secretion of estrogenic. Normonov manifests itself in two basic forms:

a) in the insufficient number of estrogen and the formation of non-functioning (resting) endometrial.

In physiological conditions, the restochy endometrium briefly exists during menstrual cycles-after the regeneration of the mucous membrane before the start of proliferation. Non-functioning endometrium. Also also in women of elderly, when the hormonal function of the ovaries is eased and is the stage of transition to atrophic endometrium. Morphological signs of non-functioning endometrials - glands have the kind of straight or slightly convoluted tubes. Epithelium is low, cylindrical, basophilina cytoplasm, elongated kernels, occupy most of the cell. Mitoses are absent or found extremely rare. Stromrom is rich in cells. When proteinating these changes, the endometrium from the non-functioning turns into atrophic with small glands lined with cubic epithelium.

b) in the long secretion of estrogen from persistent follicles, accompanied by anoint monophasic cycles. The elongated single-phase cycles arising from the long-term persistence of the follicle lead to the development of the dormriconal proliferation of endometrial type Ironistical or iron phones hyperplasia.

As a rule, endometriums under the vocal proliferation is thickened, its height reaches 1-1.5 cm or more. Microscopically lacks the separation of endometrial on the compact layers and spongy, there is also no correctness of the distribution of the glands in the stroma; Characters of cyutally applied glands. The amount of glands (more precisely ferrused tubes) does not increase (as opposed to atypical iron hyperplasia - adenomatosis). But due to the enhanced proliferation of the gland, they acquire an argument form and on a cut, passing through separate turns of one and that. More than a glandular tubule, the impression of a large amount of glands is created.

The structure of the iron hyperplasia of the endometrium, which does not contain a car-shaped extended glands, is called ". Excellent hyperplasia".

Depending on the severity of proliferative processes, the ferrous hyperplasia of the endometrium is divided into "active" and "rest" (which correspond to the states of "acute" and "chronic" estrogen). For the active form, a large number of mitoses are characterized in both the cells of the epithelium gland and in the cells of stroma, the high activity of alkaline phosphatase and the appearance of the clusters of "bright" cells in the glands. All these signs indicate intensive estrogen. The stimulation ("acute estrogen").

The "resting" form of iron hyperplasia corresponding to the state of "chronic estreaction" occurs in conditions of long-term exposure to the low level of estrogenic hormones. Under these conditions, the endometrium fabric acquires the similarity of the similarity of S.-binding, non-functioning endometrial: the epithelium cores are intensely painted, basophilic cytoplasm, mitoses are very rare or not found at all. The "resting" shape of the hardware hyperplasia is most often observed in the menopacteric period - when the ovarian function is fired.

It should be remembered that the occurrence of iron hyperplasia-especially its active form-in women after many years. After the occurrence of menopause, with a tendency to relapses, should be regarded as an unfavorable factor in relation to the possible occurrence of endometrial cancer.

It is also necessary to be borne in mind that the discharmal. The endometrium proliferation may occur in the presence of cilioepithelial and pseudomocyne cysts of the ovary, both malignant and benign, as well as in some other ovary neoplasms, for example, with a Brenner tumor (M. F. Glazunov 1961).

2. Changes to endometrial in violation of the secretion of gestagens

The violation of the secretion of the hormones of the menstrual yellow body appears both. In the form of the insufficient secretion of progesterone, and when it is enhanced and long secretion (the persistence of the yellow body).

Hypolyteine \u200b\u200bcycles in the insufficiency of the yellow body in 25% of cases are shortened; Ovulation usually occurs in a timely manner, but the secretory phase can be shortened to 8 days. The menstruation is associated with the premature death of an inferior yellow body and stopping the secretion of protesterone.

Histological changes in endometrials in hypolyteinic cycles are inenenial and insufficient secretory transformation of the mucous membrane. Thus, for example, unless before the onset of menstruation, Yaa 4th week of the cycle, along with glands, peculiar to the late stage of the secretion phase, there are glands, sharply lagging in their secretory function and corresponding only to the beginning phasesecretion.

Pre-comdonal transformations of connective tissue cells are being expressed extremely weakly or absent at all, spiral vessels are underdeveloped.

Persistence of a yellow body may be accompanied by a full secretion of progesterone. And the elongation of the phase of secretion. In addition, there are cases with reduced progesterone secretion with a coarse yellow body.

In the first case, changes arising in endometrials were named Ultranchanstrual hypertrophy and have similarities with structures observed during the pregnancy of the early term. The mucule is thickened to 1 cm, the secretion is intense, there is a pronounced decidua-like transformation of the stroma and the development of spiral arteries. Differential diagnosis with disturbed pregnancy (in women of reproductive age) is extremely difficult. The possibility of the occurrence of such changes and endometrials of women of the menopausal period (which pregnancy can be excluded).

In the case of a decrease in the hormonal function of the yellow body, when it is subjected to incomplete gradual regression, the process of rejection of the endometrium slows down and is accompanied by an elongation phase bleeding in the form of menorahia.

The microscopic pattern of the endometrium scrapings obtained during such bleeding after the 5th day, it seems very motley: the sections of necrotic tissue are found in the scraping, sections in the state of reverse development, secretory and proliferative endometrium. Such changes in endometrials can be detected in women with acyclic dysfunctional mortgage bleeding in the menopausal period.

Sometimes the effect of low concentrations of progesterone leads to a slowdown in its rejection, involution, i.e., the reverse development of deep departments of the functional layer. This process creates conditions for returning the endometrium to the initial structure, which was before the start of cyclic changes and occurs three amenorrhea, due to the so-called "hidden cycles" or hidden menstruation (E. I. Kvater 1961).

3. Endometrium "Mixed Type"

Endometrium is called mixed if it contains structures in its fabric, simultaneously reflecting the impact of estrogen and gestagenic hormones.

Two forms of mixed endometrials are distinguished: a) mixed hypoplastic, b) mixed hyperplastic.

The structure of mixed hypoplastic endometrial represents a motley picture: the functional layer is poorly developed and is represented by the iron of an indifferent type, and the tact of sections with secretory changes, mitoses are extremely rare.

Such endometries occurs in women of reproductive age with the pituitary glands, in women in a menopausal period with dysfunctional uterine bleeding, during bleeding in menopause.

An endometrial gland hyperplasia with pronounced signs of the effects of gestage hormones can be attributed to the hyperplastic mixed endometry. If among the tissues of the iron hyperplasia of the endometrium along with typical glands reflecting the estrogen effect, there are areas with groups of ammond glands, in which secretory signs, then such an endometrial structure is called a mixed form of iron hyperplasia. Along with the secretory changes in the glands, there are also changes in the stroma, namely: focal deciduous conversion of connective tissue cells and the formation of spiral vessels.

Preiodine and Endometrial Cancer

Despite the greater inconsistency of data on the possibility of endometrial cancer against the background of iron hyperplasia, most of the authors believe that the possibility of direct transition of iron hyperplasia in endometrial cancer is unlikely (A. I. Silver 1968; J. V. Bokhmai 1972), but unlike the usual (Typical) Endometrium Hyperplasia Atypical Form (adenomatosis) is considered by many researchers as a presets (A. I. Silver 1968, L. A. Novikova 1971, etc.).

Adenomatosis is a pathological proliferation of endometrial, in which traits characteristic of hormone hyperplasia are lost and atypical structures that have similarities with malignant growths appear. Adenomatosis is separated by the prevalence of diffuse and focal, and according to the severity of proliferative processes - on the unaware and pronounced forms (B.I. Iron, 1972).

Despite the significant variety of morphological signs of adenomatosis, most of the forms found in the practice of the pathologist has a number of characteristic morphological signs.

The glands are very convulsions, often have. Meal branches with numerous papillary protrusions in the lumen. Sevements of the gland are closely located near each other, almost not separated by the connective tissue. Epithelial cells have large or oval, elongated, pale painted kernels with signs of polymorphism. The structures corresponding to the endometrial adenomatosis can be detected by a large length or limited areas against the background of the endometrium glandular hyperplasia. Sometimes in the glands are detected by the nest of the arranged groups of light cells having a morphological similarity with a flat epithelium - adenosacanthosis. The foci of pseudo-globular structures are sharply excluded from the cylindrical epithelium of glands and connective tissue stroma cells. Such foci can occur not only with adenomatosis, but also at the endometrium adenocarcinoma (adenocantoma). In some rare adenomatosis forms in the epithelium of the glands, a large number of "bright" cells (fixed epithelium) is accumulated.

Significant difficulties arise from a morphologist when trying to conduct differential diagnosis between prolonged proliferative forms of adenomatosis and highly differentiated embodiments of endometrial cancer. For pronounced adenomatosis forms, an intensive proliferation and an atipatism of ferrous epithelium is characterized in the form of an increase in cell size and nuclei, which allowed Hertigu et al. (1949) Name such forms of adenomatosis of the "zero stage" of endometrial cancer.

However, due to the lack of clear morphological criteria for this form of endometrial cancer (unlike the similar shape of the cervical cancer), the use of this term in the diagnosis of endometrial scrapings is not justified (E. Novak 1974, B. I. Zheleznov 1973).

Endometrial cancer

Most of the existing classifications of epithelial malignant endometrial tumors are based on the principle of the severity of the tumor differentiation (M.F. Glazunov, 1947; P.V. Simpovsky and O.K. Khmelnitsky, 1963; E.N. Petrovsky, 1964; N. Karavsky , 1969).

The same principle is based on the first international classification of endometrial cancer developed by the World Health Organization Expert Group (Polesen and Taylor, 1975).

According to this classification, the following morphological forms of endometrial cancer are distinguished:

• a) adenocarcinoma (highly moderate and low-differentiated forms).
• b) lateral (mesonephroid) adenocarcinoma.
• c) flat-cell carcass.
• d) iron-flat flower cell (mucoepidermoid) cancer.
• e) undifferentiated cancer.

It must be emphasized that more than 80% of the malignant epithelial tumors of the endometrium are adenocarcinoma of varying degrees of differentiation.

A distinctive feature of tumors with histological structures of highly differentiated endometrial cancers is that the glandular tumor structures, although they have signs of atypics, nevertheless resemble the usual endometrial epithelium. The ferret of the epithelium endometrium with papillary growth is surrounded by scarce layers of connective tissue with a minor amount of vessels. The glands are highlighted with high and low-prismatic epithelium with a weakly pronounced polymorphism and relatively rare mitosis.

As the differentiation decreases, ferrous cancers lose signs characteristic of endometrial epithelium, the ferrous structures of alveolar, tubular or papillary structure, which do not differ in their structure from ferrous cancers of other localization begin to prevail.

According to histochemical features, highly differentiated ferrous cancers resemble the endometrium epithelium, since it contains glycogen in a significant percentage and give a reaction to alkaline phosphatase. In addition, the indicated forms of endometrial cancer have high sensitivity to hormone therapy with synthetic gestagenis preparations (17-oxyprogesterone Kapronoate), under the action of which secretory changes are developing in tumor cells, glycogen is accumulated, alkaline phosphatase activity is reduced (V. A. Sanishnikov, Ya. V. Bochman, O. F. Che-Peak 1976). Significantly less than the similar differentiation effect of gestagenov develops in cells of moderately-effect-rented endometrial cancers.

Changes in endometrials when prescribing hormonal drugs

Currently, estrogen and gestagenov preparations for the treatment of dysfunctional uterine bleeding are widely used in gynecological practice for the treatment of dysfunctional uterine bleeding, as well as contraceptives.

Using various combinations of estrogen and gestagens can be artificially obtained in human endometrial morphological changes inherent in the phase of the menstrual cycle with normally functioning ovaries. The principles underlying the hormone therapy of dysfunctional uterine bleeding and amenorrhea are based on common laws, characteristic of estrogen and gestagenis on normal human endometrials.

The introduction of estrogen leads, depending on the duration and dose, to the development of proliferative processes in the endometrium, up to the iron hyperplasia. With prolonged use of estrogen on the background of proliferation, abundant acyclic uterine bleeding may occur.

The introduction of progesterone in the proliferative phase of the cycle leads to the braking of the proliferation of the epithelium glands and suppresses ovulation. The effect of progesterone to the proliferating endometrium depends on the duration of the introduction of the hormone and manifests itself in the form of the following morphological changes:

• - Stage of "Stopped Proliferation" in the glands;
• - atrophic changes in glands with decidu-like transformation of stroma cells;
• - Atrophic changes in the epithelium glands and stroma.

With the joint introduction of estrogen and gestagens, changes in endometrial depend on the quantitative ratio of hormones, as well as the duration of their administration. Thus, for the endometrium proceeding, the daily dose of progesterone, causing secretory changes in glands in the form of accumulation of glycogen granules, is 30 mg. In the presence of a pronounced iron hypertension hyperplasia to achieve a similar effect, it is necessary to introduce 400 mg.Progesterone daily (Dallenbach-Helvig, 1969).

For the morphologist and clinician-gynecologist, it is important to know that the selection of dosages of estrogen and gestagennes in the treatment of disorders of the menstrual cycle and the pathological states of the endometrium should be carried out under histological control, by the fence of repeated endometrial tsugs.

When using combined hormone contraceptives in the normal endometrium, women occur regular morphological changes, depending first of all from the duration of the use of the drug.

First of all, there is a shortening of the proliferative phase with the development of defective glands, in which abortive secretion is developing. These changes are related to the fact that when receiving these drugs, the gestagens contained in them inhibit the processes of proliferation in glands, as a result of which the latter do not reach their full development, as is the case at a normal cycle. Secretor changes developing in such glands have an abortive unexpected character,

Another typical feature of changes in endometrials in the reception of hormonal contraceptives is a sharply pronounced foci, the distruting of the morphological picture of the endometrium, namely: the existence of various but degrees of maturity of glands and stroma, not corresponding to the day of the cycle. These patterns are characteristic of both proliferative and secretory phases of the cycle.

Thus, when receiving combined hormonal contraceptives in the endometrium of women, pronounced deviations from the morphological picture of the endometrium of the corresponding phases of the normal cycle occur. However, as a rule, after the abolition of drugs, the gradual and complete restoration of the morphological structure of the mucous membrane is observed (the exception is only cases when the drugs were taken very long - 10-15 years).

Changes in endometrials arising during pregnancy and its interruption

With the occurrence of pregnancy, the implantation of a fertilized egg - blastocysts occurs on the 7th day after ovulation, i.e. on the 20th - the 22nd day of the menstrual cycle. At this time, the overdometrium strassment reaction is still very weak. The most rapid formation of decidual tissue occurs in the implantation zone blastocysts. As for the endometrium changes outside the implantation, the decidual tissue becomes distinctly expressed only from the 16th day after ovulation and fertilization, i.e., when menstruation has already been delayed for 3-4 days. This is observed in endometrials equally both during pregnancy uterine and ectopic.

In the decidual shell, the cutting wall of the uterus in all its length, with the exception of the blastocyst implantation zone, distinguish the compact layer and spongy layer.

In the compact layer of deciduals of the fabric in the early pregnancy, there are two types of cells: large, bubble-shaped with a pale-colored core and smaller cells of oval or polygonal shape with a darker core. Large decidual cells are the final form of the development of small cells.

The spongiosis layer differs from the compact extremely strong development of glands, which closely add to each other and form a fabric, the general view of which can have some similarity with the adenoma.

With histological diagnosis on scraps and tissues that highlighted spontaneously from the uterine cavity, it is necessary to distinguish between the cells of the trophoblast from decidual cells, especially when the question is about the differential diagnosis between the uterine and ectopic pregnancy.

Cells trophoblast The components of the reservoir, polymorphic with the predominance of small polygonal. There are no vessels, fibrous structures, leukocytes in the reservoir. If there are single major syntial formations among the cells that make up the reservoir, it immediately decides the question of belonging to his trophoblast.

Cells Decidual Fabrics also have different sizes, but they are larger, oval. Homogenic cytoplasm, pale; Bubble cores. In the reservoir of decolation fabrics contain vessels and leukocytes.

With a pregnancy impairment, the formed cloth decidual O. Babes is necrotic and is usually completely discouraged. If pregnancy is violated in early terms, when the decidual fabric is even finally undeveloped, it is subjected to reverse development. An undoubted sign that the endometrium fabric was subjected to reverse development after pregnancy disturbed in early terms, the presence in the functional layer of clubs of spiral arteries. A characteristic, but not an absolute sign is also the presence of the arya-stella phenomenon (the appearance of cells with a very large hyperchromic kernel).

With a violation of pregnancy, one of the most important issues on which the morphologist has to be answered is the question of uterine or ectopic pregnancy. The absolute signs of the uterine pregnancy are the presence of a chorion vault, decidual fabric with invasion of chorial epithelium, the deposition of fibrinoid in the form of foci and heavyness in the decidual tissue and in the walls of venous vessels.

In cases where a decidual fabric is detected in the scraping without chorion elements, it is possible in the uterine and at ectopic pregnancy. In this regard, both a morphologist and a clinician doctor should be remembered that if the scraping was made not earlier than 50 days after the former last menstruation, when the area of \u200b\u200bthe arrangement of the fetal egg is large enough, then in the uterine form of pregnancy, the chorion naval is detected almost always. The absence of them gives reason to assume an ectopic pregnancy.

With an earlier period of pregnancy, the absence in the scrap elements of Chorion does not always indicate an ectopic pregnancy, since it is impossible to exclude unnoticed spontaneous miscarriage: during bleeding, a small flicer egg could be entirely standing out before scraping.

All-Union Scientific and Methodical Center for the Pathology Manufacture of Human Morphology Institute of AMN USSR
Leningrad State Order of Lenin Institute of Improvement of Doctors. CM. Kirov
I Leningrad Orders of the Labor Red Banner Medical Institute. I. P. Pavlova

Editor - Professor O. K. Khmelnitsky

Plan article

Endometrium is the inner mucosa of the uterus, penetrated by a thin and thick grid of blood vessels. It supplies a child blood organ. The endometrium of the proliferative type - mucosa in the process of rapid cell division before the new menstrual cycle starts.

Endometrial structure

In endometrials two layers. Basal and functional. The basal layer almost does not change. It contributes to the regeneration of the functional surface during the menstrual cycle. It consists of cells as adjacent to each other, equipped with a thin but dense vascular grid. up to one and a half centimeters. In contrast to the basal, the functional layer is constantly changing. Because during menstruation, generic activity, in surgical intervention, diagnosis, it is damaged. There are several cyclic stages of functional endometrial:

1. Proliferative
2. Menstrual
3. Secretoric
4. Prescecretoric

Stages are normal, consistently replace each other, according to the period passing in the body of a woman.

What structure is normal

The state of endometrial in the uterus depends on the phase of the menstrual cycle. When the proliferation time comes to an end, the main layer comes to 20 mm, and practically immune to the influence of hormones. When the cycle is just beginning, the endometrium is smooth, pinkish shade. With focal sites, not separated by the active layer of endometrial remaining from past menstruation. In the next seven days there is a gradual thickening of the proliferative endometric shell, due to the active cell division. Vessels are less, they are hiding behind the grooves, which appear due to inhomogeneous thickening of the endometrium. The thicker is the thickness of the mucous cover on the rear saint wall, at the bottom. On the contrary, the "kindergage" and the front uterine wall changes minimally. The mucous layer is about 1, 2 centimeters. When the menstrual cycle is completed, then the active cover of the endometrium is completely discounted completely, but as a rule, only part of the layer on some sites is rejected.

Forms deviation from the norm

Disorders of the normal thickness of the endometrium happens either for a natural reason, or have a pathological character. For example, in the first seven days after fertilization, the thickness of the endometric cover changes - the child's place becomes thicker. In pathology, the thickening of the endometrium happens during the incorrect cell division. As a result, an extra mucosa layer appears.

What is endometrial proliferation

Proliferation is the phase of rapid cellular division in tissues that do not exceed the normative indicators. During this process, the mucosa is regenerated, and expands. New cells are not atypical type, normal tissue is formed. Proliferation - the process is characteristic not only for endometrial. Some other fabrics also pass the proliferation process.

Causes of proliferation

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

Flashing of endometrial proliferation

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

• early
• middle
• late

Each stage lasts a certain period of time, and manifests itself in different ways on the mucous meter of the uterus.

Early

The early stage of the endometrium proliferation lasts from five to seven days. During this period, the endometric cover is staminated by a cellular epitheal layer of cylindrical type. The glands are dense straight, thin, in the diameter have a rounded or oval shape. The epitial iron layer is located low, the cell cores at the base, oval, painted in a bright red shade. Connecting cells (stromes) - have a spindle-shaped shape, they have a large diameter nucleus. Blood vessels are practically straight.

Average

The middle stage of proliferation comes to the eighth - the tenth of the cycle. Epithelium was lined with high prismatic cells of the epithelium. At this time, the glands are slightly bent, the kernels are pale, become larger, located at different levels. The number of cells generated through indirect division increases. The connecting fabric swells and becomes loose.

Late

Late proliferation stage begins with 11 or 14 days. The endometrium of the late phase stage is significantly different from what he is on the earlier. The glands acquire a winding shape, cell cores at different levels. The epitial layer is one, but it is multiple. In the cells ripen vacuole with glycogen. Vascular grid winding. Cell kernels are rounded and become greater. Connecting cloth nanite.

Phase secretion

Secretion is also divided into three steps:

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

The change in the secretory phase comes menstrual. It is also divided into two periods:

1. Deskvamation - from 28 days 2 days of a new cycle, if the egg cell fertilized.
2. Restoration - from 3 to 4 days, until the active layer is completely rejected, and before the new proliferation process.

After passing all the stages, the cycle is repeated again. This is happening before the occurrence of pregnancy, menopause, if there are no pathologies.

How to diagnose

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

1. Visual inspection.
2. Colposcopic inspection.
3. Cytological analysis.

To avoid serious diseases, you need to regularly attend a gynecologist. Pathology can be seen during the usual gynecological inspection. Other methods allow you to more accurately determine the cause of incorrect proliferation.

Proliferation Diseases

Endometrium in the proliferation phase is actively growing, cell division occurs under hormonal influence. During this period, the appearance of pathologies occurring due to the rapid growth of cells. Tumors may appear, the fabric will begin to grow and so on. Diseases may appear if during the cyclic phases during proliferation that something went wrong in the secretory phase, the development of pathologies of the shell is practically excluded. Most often, during cell division, hyperplasia of the uterine mucous membrane develops, which in some cases can lead to infertility and cancer of the elementar body.

The disease provokes a hormonal failure occurring during the period of active cell division. As a result, its durability increases, cells become larger, and the mucous membrane becomes much thicker. Treatment of such diseases should be timely. Most often medication, physiotherapeutic treatment. In serious cases, they resort to surgical intervention.

Why slows down the proliferation process

The braking of the processes of the endometrium proliferation or the insufficiency of the second stage of the menstrual cycle is allocated by the fact that cell division stops or is much slower than usual. These are the main symptoms of the impending menopause, deactivating the ovaries and the termination of ovulation. This is a normal phenomenon characteristic of the climax. But if the braking occurs at a young woman, this is a sign of instability of a hormonal background. This pathological phenomenon should be treated, it leads to the termination of the menstrual cycle ahead of time and the impossibility of becoming pregnant.

Turn

Endometrium is an outer mucosa layer lining the uterus. It is completely hormone-dependent, and it is he who is subjected to the greatest changes during the menstrual cycle, it is its cells that are rejected and come out with the discharge during menstruation. All these processes go in accordance with certain phases, and deviations in the passage or duration of these phases can be considered pathology. Proliferative endometrium is a conclusion that can often be seen in the Uzi description is an endometrium in the proliferative phase. The fact that this phase is what stages is and what is characterized, told in this material.

Definition

What it is? The proliferative phase is the stage of active division of cells of any tissue (in this case, its activity does not exceed normal, that is, it is not pathological). As a result of this process, the tissue is restored, regenerated, expand. During division, normal, neatatic cells appear, from which a healthy tissue is formed, in this case, endometrium.

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

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

Causes

The endometrium of the proliferative type, often appears because the many cells of the functional (updating) part of the endometrium rejected during the menstruation. As a result, he threaded significantly. The features of the cycle are such that for the onset of the following menstruation, this mucous layer must restore its thickness of the functional layer, otherwise it will be updated. This is what happens in the proliferative stage.

In some cases, such a process may be caused by pathological changes. In particular, endometrial hyperplasia (a disease capable of, without appropriate treatment, lead to infertility) is also characterized by reinforced cell division leading to the thickening of the endometrial functional layer.

Phase proliferation

Endometrial proliferation is a normal process that occurs with the passage of several stages. These stages are always present in the norm, the absence or violation of the flow of some of these stages speaks of the beginning of the development of the pathological process. Phases of proliferation (early, medium and late) differ depending on the rate of cell division, the nature of the growth of tissues, etc.

Total process lasts about 14 days. During this time, follicles begin to ripen, they produce estrogen, and it is under the action of this hormone and growing.

Early

This stage proceeds from the fifth to the seventh day of the menstrual cycle. The mucosa has the following signs on it:

1. On the surface of the layer there are epithelial cells;
2. The glands are elongated, straight, in cross section oval or round;
3. Irony epithelium is low, and the kernel of intense color, and are at the base of the cells;
4. Stroma cells have the form of spindle;
5. Circuit artery is not a sortie at all or sorties minimally.

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

Average

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

• Epithelial cells with which the outer layer of endometrial is enjoyed have a prismatic look, they are high;
• The glands become slightly more convicted compared to the previous stage, their kernels are less brightly painted, they become more sustainable trends to any arrangement there are no - they are all at different levels;
• Stroma becomes edema and loose.

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

Late

The endometrium of the late stage of proliferation is characterized by convulsive glands, the kernel of all cells of which are located at different levels. Epithelium has one layer and many rows. In a number of epithelium cells, vacuoles with glycogen appear. The vessels are also convinced, the state of the stroma is the same as in the previous stage. Cells of cells round, large size. There is such a stage from the eleventh to the fourteenth day of the cycle.

Phase secretion

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

Early

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

Average

At this stage, secretion proceeds as actively as possible, especially in the middle of the phase. A small fading of secretory function is observed only at the very end of this stage. She lasts with twentieth to twenty-third day

Late

For the late stage of the secretion phase, a gradual extinction of a secretory function is characteristic, with complete consequence to not at the very end of this stage, after which the woman starts periods. This process lasts 2-3 days in the period from twenty-fourth to twenty-eighth day. It is worth noting the peculiarity characteristic of all stages - they last 2-3 days, while the exact duration depends on how many days in the menstrual cycle of a particular patient.

Proliferative diseases

Endometrium in the proliferation phase is very actively growing, its cells are divided under the action of various hormones. Potentially this condition is dangerous by the development of various kinds of diseases associated with the pathological division of cells - neoplasms, tissue growths, etc. The development of pathologies of this type can cause some faults in the process of passing stages. At the same time, the secretory endometrium of such a danger is almost completely impossible.

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

Hyperplasia occurs in violations in the hormonal regulation of the division process. As a result, the cells are divided longer and more actively. The mucous layer is much thickened.

Why is the braking of proliferation processes?

The inhibition of endometrial proliferation processes is a process, also known as the insufficiency of the second phase of the menstrual cycle, characterized by the fact that the proliferation process is not actively or does not go well. This is a symptom of Klimaks, extinction of the ovarian function and the absence of ovulation.

The process is natural and helps to predict the onset of climax. But maybe it is pathological, if it develops in a woman of reproductive age, it speaks of a hormonal imbalance that needs to be eliminated, as it can lead to dysmanifier and infertility.

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During the menstrual cycle, called proliferative phase, the structure of the uterus mucous membrane has the above character in general. This period comes shortly after the menstrual separation of blood, and, as the name itself shows, proliferative processes leading to updating the functional part of the mucous membrane in the mucous membrane of the uterus occur.

As a result of breeding fabrics, preserved after menstruation in the residues of the mucous membrane (that is, in the basal part), the formation of the own plate of the functional zone begins again. From the thin mucosa layer, preserved in the uterus after menstruation, the entire functional part is gradually restored, and, due to the reproduction of ferrous epithelium, the uterine glands are also extended and also increased; However, in the mucous membrane, they still remain smooth.

The whole mucosa is gradually thickens, acquiring your normal structure and reaching medium height. The cilia (cinylony) of the surface epithelium of the mucous membrane at the end of the proliferative phase is disappearing, and the glands are prepared for secretion.

Simultaneously with phase proliferation The menstrual cycle in the ovary occurs ripening the follicle and egg cell. Follicular hormone (Follikulin, Estrin), isolated by the cells of the graon of the follicle, is a factor that determines the proliferative processes in the mucous membrane of the uterus. At the end of the proliferation phase, ovulation occurs; In place of the follicle, the yellow body of menstruation begins to form.

His hormone It has a stimulating effect on the endometrium, causing changes occurring in the subsequent phase of the cycle. The proliferation phase begins on the 6th day of the menstrual cycle and continues until the 14th day of the day inclusive (counting from the first day of the menstrual blood branch).

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Phase secretion of the uterine cycle

Under stimulating influence gormon. The yellow body (progesterone), which is formed in the ovary, begin to expand the glands of the uterus mucosa, especially in their basal departments, their corks are twisted, so that on the longitudinal sections, the internal configuration of their edges acquires a saw-shaped, geek. There is a typical spongy layer of the mucous membrane, characterized by spongy consistency.

Epithelium glands begins select the mucosal secretcomprising a significant amount of glycogen, which in this phase is deposited in the bodies of ferrous cells. Of some connective tissue cells of the compact layer of the mucous membrane, increased polygonal cells with a weakly colored cytoplasma and the kernel begin to form in the tissue of their own mucous plate.

These cells are scattered in fabrics A single or in the form of clusters, in their cytoplasm also contains glycogen. These are the so-called decidual cells, which in the case of the occurrence of pregnancy further multiply in the mucous membrane, so that their large quantity is a histological indicator of the initial phase of pregnancy (histological examination of pieces of the uterine mucous membrane obtained at the potential - removal of the fetic egg to the curette).

Conducting such research It is of great importance, especially when determining ectopic pregnancy. The fact is that changes in the mucous membrane of the uterus also occur when a fertilized egg cell, or rather the young embryo, is not in normal place (in the uterus mucous membrane), but at any other place outside the uterus (ectopic pregnancy).

Normal Histology Endometry

Cyclic endometrial changes under the influence of steroid hormones

The mucous membrane of the bottom and body of the uterus Morphologically monotype. In women of the reproductive period, it consists of two layers:

1. Basal layer A thickness of 1 - 1.5 cm is located on the inner layer of myometrium, the reaction to the hormonal effect is expressed weakly and inconstant. Stroma dense, consists of connective tissue cells, rich in arginophile and thin collagen fibers.

   Endometrium glands are narrow, epithelium glands cylindrical single-row, oval kernels, intensively painted. The height changes from the functional state of the endometrium from 6 mm after menstruation up to 20 mm at the end of the phase of the proliferation; Also the shape of the cells, the location of the kernel in them, the outlines of the apical edge, etc.

   Among the cells of the cylindrical epithelium, large bubbite cells can be detected adjacent to the basement membrane. These are the so-called light cells or "cells - bubbles" representing immature cells of the fiscal epithelium. These cells can be detected in all phases of the menstrual cycle, but their largest number is marked in the middle of the cycle. The appearance of these cells is stimulated by estrogen. In atrophic endometrial, light cells are never detected. There are also cells of the epithelium gland in mitosis - early proofased stage and wandering cells (histiocytes and large lymphocytes) penetrating through the basal membrane in the epithelium.

   In the first half of the cycle in the basal layer, additional elements can be discovered - true lymphatic follicles, differ from inflammatory infiltrates by the presence of an embryonic center of the follicle and the absence of focal perivascular and \\ or periglandular, diffuse infiltrate from lymphacitis and plasma cells, other signs of inflammation, as well as clinical manifestations of the latter . In children's and senile endometry, there are no lymphatic follicles. The vessels of the basal layer in sensitivity to hormones do not possess and the cyclic transformations are not subjected.

2. Functional layer. The thickness ranges from the day of the menstrual cycle: from 1 mM initial phase of proliferation, up to 8 mm at the end of the secretion phase. It has high sensitivity to sex steroids, under the action of which morphofunctional and structural changes are undergoing throughout each menstrual cycle.

   Mesh fibrous structures of the functional layer at the beginning of the proliferation phase until the 8th day of the cycle contain single gentle arginil fibers, to ovulation, the number of them quickly increases and they become thicker. In the secretion phase, under the influence of edema, fiber endometrials are moved, but remain densely located around the glands and vessels.

   In normal conditions, branching glands does not occur. In the secretion phase in the functional layer, additional elements are most distinctly indicated - a deep spongy layer, where the glands are more closely located, and the surface is compact, in which the cytogenic style prevails.

   Surface epithelium in the proliferation phase is morphologically and is functionally similar to the epithelium of the glands. However, with the beginning of the stage of secretion, such biochemical changes occur in it, which determine the lighter adhesion of blastocysts with endometrial and subsequent implantation.

   Stromic cells initially the menstrual cycle spindle-shaped indifferent, cytoplasm is very small. By the end of the secretion phase, part of the cells under the influence of the hormone of the yellow body of menstruation increases and varies to the predocidal (most correct name), pseudodetal, deciduous. Cells that develop under the influence of the hormones of the yellow body of pregnancy are called degidual.

   The second part decreases, and endometrial granular cells containing high molecular weight peptides like relaxes are formed. In addition, single lymphocytes are located here (in the absence of inflammation), histiocytes, obese cells (more in the secretion phase).

   The vessels of the functional layer have high sensitivity to hormones, are subjected to cyclic transformations. The layer has capillaries, which in the premenstrual period form sinusoids and spiral artery, in the phase of the proliferation of little, do not reach the surface of the endometrium. In the secretion phase, the height of the endometrium to the length of the spiral vessel is 1:15), become more convulsive and spirally twisted in the form of clubs. The greatest development is achieved under the influence of the Hormones of the Yellow Body of Pregnancy.

   If the functional layer does not turn back and, the endometrium tissues are subjected to regressive changes, the tangles of spiral vessels remain and after the disappearance of other signs of the lutein effect. The presence of them is a valuable morphological sign of the endometrium, which is in a state of completed reverse development from the secretory phase of the cycle, as well as after the pregnancy of the early term - uterine or ectopic.

   Innervation. The use of modern histochemical methods The detection of catecholamines and cholinesterase will be detected in the basal and functional layers of endometrial nerve fibers, which are distributed throughout the endometry, accompany vessels, but do not reach the surface epithelium and epithelium glands. The number of fibers and the content of mediators in them varies during the cycle: adrenergic, and the phase of secretion predominate in the phase of the proliferation phase - cholinergic influences.

   Endometry is the fermenter of the uterus Reacts to ovarian hormones significantly less and later the endometrium of the body of the uterus, and sometimes it does not respond at all. The mucosa has few glazes that pass in the oblique direction and often form cystal extensions. Epithelium Low cylindrical glands, elongated dark nuclei almost completely performed the cell. The mucus is released only in the absurd of the glands, but does not contain intracellularly, which is typically for cervical epithelium. Stroma dense. In the secretory phase, the sturge cycle is slightly loosened, sometimes there is a weakly pronounced decidual transformation. During menstruation, only the surface epithelium of the mucous membrane is rejected.

   In underdeveloped masks, the mucous membrane, which has the structural and functional features of the end of the uterus, lifts the walls of the lower and middle parts of the uterine body. In some underdeveloped masks, only in its upper third, normal endometrium is detected, capable of reacting according to the cycle phases. Such endometrial anomalies are celebrated mainly in hypoplastic and infantile utensils, as well as in the Uterus Arcuatus and Uterus Duplex.

   Clinical and diagnostic value: The localization of the endometrium of the ethimic type in the body of the uterus is manifested by the sterility of a woman. In the event of a pregnancy, implantation in defective endometrium leads to deep rustling of the vigorous to the miometrium and to the emergence of one of the most severe obstetric pathologies - Placenta Increta.

   The mucous membrane of the cervical canal. Glands has no. The surface is enjoyed by a single-row high cylindrical epithelium with basal-located small hyperchromic nuclei. Epithelial cells intensively distinguish the Intracellular mucus contained, which impresses the cytoplasm - the difference between the epithelium of the cervical canal from the height of the isthmus and the bodies of the uterus. Under the cylindrical cervical epithelium can be small rounded cells - backup (subepithelial) cells. These cells can be transformed into a cylindrical cervical epithelium, and in a multilayer flat, which is observed with endometrial hyperplasia and cancer.

   In the proliferation phase of the cylindrical epithelium, basal is located, in the secretion phase - mainly in the central departments. Also, the number of reserve cells increases in the phase from the extraction.

   The unchanged dense mucosa of the cervical canal during scraping is not captured. The pieces of the loose mucous membrane are covered only with its inflammatory and hyperplastic changes. In the scrapings, fragmented by curette or intact polyps of the cervical canal are very often found.

   Morphological and functional changes in endometrial
   throughout the ovulatory menstrual cycle.

   The menstrual cycle indicates the time interval from the 1st day of the previous menstruation to 1-day subsequent. The menstrual cycle of a woman is due to rhythmic repetitive changes in the ovaries (ovarian cycle) and in the uterine (uterine cycle). The uterine cycle is directly dependent on the ovarian and is characterized by natural changes in endometrial.

   At the beginning of each menstrual cycle in both ovaries, several follicles ripen simultaneously, but the ripening process of one of them proceeds somewhat more intensively. Such a follicle moves to the surface of the ovary. With full ripening, the fatigue wall of the follicle is broken, the egg cell is thrown out of the ovary and falls into the pipe funnel. This egg exit process is called ovulation. After ovulation, usually coming on the 13th - 16 day of the menstrual cycle, the follicle is differentiated into the yellow body. Its cavity falls out, the granolascent cells are converted into lutein.

   In the first half of the menstrual cycle, the ovarian produces an increasing amount of predominantly estrogenic hormones. Under their influence, the proliferation of all elements of the tissue of the functional layer of the endometrium is the proliferation phase, the folliculine phase. It ends around 14 days with a 28-day menstrual cycle. At this time in the ovary there is an ovulation and subsequent formation of a menstrual yellow body. The yellow body releases a large amount of progesterone, under the influence of which in endometrial prepared by estrogen, morphologic and functional changes occur, characteristic of the secretion phase - lutein phase. It is characterized by the presence of a secretory function of glands, a predecidual reaction of stroma and the formation of a spiral convulsion vessels. The transformation of the endometrium phase of proliferation into the secretion phase is called differentiation or transformation.

   If there was no fertilization of the egg and implantation of blastocysts, then at the end of the menstrual cycle, the regression and death of the menstrual yellow body occurs, which leads to a drop in the titer of ovarian hormones that support the blood flow of the endometrium. In this regard, angiospasm, hypoxia of endometrial tissues, necrosis and menstrual rejection of the mucous membrane are arisen.

   Classification of the phases of the menstrual cycle (by WITT, 1963)

   This classification most accurately complies with modern ideas about changes in endometrial in separate phases of the cycle. It can be used in practical work.

   1. Phase proliferation
      • Early Stage - 5-7 Day
      • Central Stage - 8-10 Day
      • Late stage - 10-14 days
      • Phase secretion
        • Early Stage (the first signs of secretory transformations) - 15-18 day
        • Central Stage (the most pronounced secretion) - 19-23 days
        • Late stage (starting regression) - 24-25 days
        • Regress, accompanied by ischemia - 26-27 days
        • Phase bleeding (menstruation)
          • Deskvamation - 28-2 day
          • Regeneration - 3-4 days

        When evaluating changes occurring in endometrials, respectively, the days of the menstrual cycle, it is necessary to take into account: the duration of the cycle in this woman (except for the most common 28-day cycle, there are 21-, 30- and 35-day cycles) and what ovulation with a normal menstrual cycle It may occur between 13 and 16 days of the cycle. Therefore, depending on the time of ovulation, the structure of the endometrium of a particular phase of the secretion varies somewhat within 2-3 days.

        Phase proliferation

        It continues on average 14 days. It can be elongated or shortened within about 3 days. Changes occur in endometrials, which arise mainly under the influence of an increasing number of estrogenic hormones, which are produced by a growing and ripening follicle.

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

          The glands are straight or slightly curved with a rounded or oval contour on the cross section. The epithelium glands is a low, cylindrical. Oval cores are located at the base of the cell. Baseball cytoplasm, homogeneous. Separate mitoses.

          Stroma. Spit-shaped or star reticular cells to gentle proceedings. The cytoplasm is very small, the kernel are large, perform almost the entire cage. Casual mitoses.

        • The average phase of proliferation (8 - 10 day).

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

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

        • Late Phase Proliferation (11 - 14 day)

          The glands are significantly sortie, corkscrew, lumen expanded. The core of the epithelium glands at a different level, increased, contain nucleoli. Epithelium multi-row, but not multi-layered! In single epithelial cells, small subnuclear vacuoles (in them glycogen).

          The sturge of the juicy, the core of the connective tissue cells is larger, rounded. There are even more cytoplasm in cells. Little mitosis. Spiral artery, growing from the basal layer reach the surface of the endometrium, is slightly reproached.

          Diagnostic value. The structures of the endometrium, the appropriate phase of proliferation, observed in physiological conditions in the first half of the 2-phase menstrual cycle, can reflect hormonal disorders if they are found in the second half of the cycle (this may indicate an inhibular, single-phase cycle or on an abnormal, elongated proliferation phase with Bezing ovulation with a two-phase cycle), with the iron hypeometrium hyperplasia in various sections of the hyperplasned mucous membrane of the uterus and during dysfunctional uterine bleeding in women at any age.

          Phase secretion

          The physiological phase of secretion directly associated with the hormonal activity of the menstrual yellow body lasts 14 ± 1 days. The shortening or elongation of the phase of secretion is more than 2 days in women in the reproductive period is considered in the functionality of the pathological. Such cycles are sterile.

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

          The day of ovulation occurred can be determined by changes in endometrials that are consistently reflected at the beginning of the increasing, and then the reduction of the yellow body function. During the 1st week, the phase of secretion of the day of the ovulation is diagnosed by changes in Eleases epithelium; On the 2nd week, this day is most accurate to be determined by the state of the etndometrium stroma cells.

          • Early Stage (15-18 day)

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

            Glands are more convinced, their lumen is expanded; In the epithelium glands - subnuclear vacuoles containing glycogen - a characteristic sign of the early phase of secretion. Subnuclear vacuoles in the epithelium glands after ovulation are becoming much larger and found in all cells of the epithelium. The kernels pushed by vacuoles to the central cells of the cells are first located at a different level, but on the 3rd day after ovulation (17th day of the cycle), the kernels lying on large vacuoles are located at one level.

            On the 4th day after ovulation (the 18th day of the cycle), some vacuole cells are partially moving from the basal part of the core into the apical part of the cell, which moves and glycogen. The nucleus is reappearing at various levels, dropping to the basal part of the cells. The shape of the core varies on more round. Baseball cell cytoplasm. Sour mucoids are detected in the apical departments, alkaline phosphatase activity is reduced. Mitoses in the epitheliums are missing.

            Stroma juicy, loose. At the beginning of the early phase of the secretion phase in the surface layers of the mucous membrane, there are sometimes focal hemorrhages that occurred during ovulation and associated with a short-term decrease in estrogen levels.

            Diagnostic value. The structure of the endometrium of the early stage of the secretion phase reflects hormonal disorders, if it is observed in the last days of the menstrual cycle - with the initiation of ovulation, during bleeding during short-range two-phase cycles, during acyclic dysfunctional uterine bleeding. It was noted that bleeding from post-dealership endometrial is particularly often observed in women in the menopacteric period.

            The subnuclear vacuoles in the epitheliums of the endometrial glands are not always a sign indicating the ovulation and the beginning of the seventory function of the yellow body. They can also arise:

            • under the influence of the progesterone of the Yellow Body
            • in women in menopause, as a result of the use of testosterone after preliminary training with estrogen hormones
            • in the glands of mixed hypoplastic endometrial in dysfunctional uterine bleeding in women of any age, including the period of menopause. In such cases, the appearance of subnuclear vacuoles may be associated with adrenal hormones.
            • as a result of the non-mertonal treatment of menstrual disorders, during the novocaine blockade of the upper cervical sympathetic ganglia, the electrical stimulation of the cervix, etc.

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

              For an endometrial in which subnuclear vacuolaization is the result of ovulation and the function of the yellow body, primarily characterized by the configuration of the glands: they are winding, are expanded, usually the same type and are properly distributed in stroma. Vacuoles are large, have the same dimensions, found in all glands, in each epithelial cell.

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

              In the middle stage, under the influence of the hormones of a yellow body reaching the highest function, the secretory transformations of the endometrium fabric are most pronounced. The functional layer becomes higher. It is clearly divided into deep and superficial. In the deep layer contain highly developed glands and a small amount of stroma. The surface layer is compact, it is removed in it less convinced glands and many connective tissue cells.

              In the glands on the 5th day after ovulation (19 day of the cycle) most of the cores are again in the basal part of the epithelial cells. All kernels are rounded, very bright, bubbles (this type of nuclei is a characteristic feature that distinguishes the endometrium of the 5th day after ovulation from the endometrium of the 2nd day, when the core of the epithelium oval and dark painted). The apical department of epithelial cells becomes domed, glycogen accumulates here, moving from basal cells of cells and now a beginner stand out into the absurdity of the glands by apocryan secretion.

              On the 6th, 7th and 8th day after ovulation (20, 21, 22nd cycle), the glands of the glands are expanding, the walls become more folded. The epithelium glands is single-row, with basal nuclei. As a result of intensive secretion, the cells become low, their apical edges are inflexible, as if with jar. Alkaline phosphatase completely disappears. In the lumen of the glands there is a secret containing glycogen and sour mucopolysaccharides. On the 9th day after ovulation (23rd cycle), the secretion of the glands ends.

              In the stroma on the 6th, 7th day after ovulation (20, 21st cycle) there appears perivascular decidual reaction. Connectant cells of the compact layer around the vessels are becoming larger, acquired rounded and polygonal outlines. Glycogen appears in their cytoplasm. The islands of predocidal cells are formed.

              Later, the predoscident transformation of the cells spreads more diffusively throughout the compact layer, mainly in its surface departments. The degree of development of predocidal cells individually fluctuates.

              Vessels. Spiral artery sharply reproach, form "balls". At this time, they are detected both in the deep departments of the functional layer and in the surface departments of compact. Viennes are expanded. The presence of convicted spiral arteries in the functional layer of endometrial is one of the most reliable signs of the determining lutein effect.

              From the 9th day after ovulation (the 23rd day of the cycle), the swelling of the stroma decreases, as a study, the tweeters of spiral arteries are more clearly designated, as well as their pre-compensation cells.

              During the middle stage of secretion, blastocyst implants occurs. The best conditions for implantation represent the structure and functional state of the endometrial on 20-22 days of the 28-day menstrual cycle.

            • Late stage of secretion phase (24 - 27 day)

              From 10 days after ovulation (on the 24th day of the cycle), due to the beginning of the regression of the yellow body and a decrease in the concentration of hormone produced by him, the endometrium trigis is violated and degenerative changes are gradually growing. On the 24-25 day of the cycle in endometrials morphologically, initial signs of regression are noted, on July 26-27, this process is accompanied by ischemia. At the same time, the juicability of the tissue is reduced, which leads to wrinkling the stroma of the functional layer. Its height during this period is 60-80% of the maximum height, formerly in the middle of the secretion phase. Due to the wrinkling of tissues, the folding glands increases, they acquire pronounced star outlines on transverse sections and sawn on the longitudinal. The nuclei of some epithelial cells are picnotic.

              Stroma. At the beginning of the late stage of the secretion phase, predocidal cells come closer and more clearly defined not only around the spiral vessels, but also dithofusno throughout the compact layer. Endometrial granular cells are clearly detected among pre-coming cells. For a long time, these cells were taken for leukocytes, which started infiltrating the compact layer for another few days before the start of menstruation. However, later research establishes that leukocytes penetrate the endometrium immediately before menstruation, when the aligned walls of the vessels become fairly permeable.

              From the granules of granular cells in the late stage of secretion phases, relaxin is released, which contributes to the melting of the argirophilic fibers of the functional layer, thus preparing the menstrual rejection of the mucous membrane.

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

              The state of the endometrium prepared in such a way to decay and rejection is called "anatomical menstruation". Such a state of endometrial is detected per day before the start of clinical menstruation.

              
              

              Phase bleeding

              During the menstruation in endometrials, desquamation and regeneration processes occur

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

                It is believed that changes from the spiral arterioles play an important role in the implementation of menstruation. In front of the menstruation, due to the regens of the yellow body at the end of the phase, and then its death and a sharp decline of hormones, structural regressive changes in the endometrium tissue are growing: hypoxia and those circulatory disorders, which were due to the long-term spasm of arteries (stas, blood clotting, The brittleness and permeability of the vascular wall, hemorrhage in stroma, leukocyte infiltration). As a result, the twisting of the spiral arteriole becomes even more pronounced, the circulation of blood in them slows down, and then after a long spasm, the extension of blood vessels occurs, as a result of which a significant amount of blood comes into the endometrium fabric. This leads to the formation of small, and then more extensive hemorrhages in endometrials, to the rupture of vessels, and rejection - desquamation - necrotic departments of the endometrium functional layer, i.e. to menstrual bleeding.

                Causes of uterine bleeding during menstruation:

                • recession of the level of gestagens and estrogen in the plasma of peripheral blood
                • vascular changes, including increase in the permeability of vascular walls
                • blood impairment and related destructive changes endometrial
                • extraction of relaxin endometrial granulacitis and the melting of argicilic fibers
                • leukocyte infiltration of stroma compact layer
                • the emergence of focal hemorrhages and necrosis
                • improve the content of protein and fibrinolytic enzymes in endometrial tissue

                  The morphological feature characteristic of the endometrium of the menstrual phase is the presence of the disintegrating fabrics of the spiral arteries of the spiral arteries permeated with hemorrhages. In the 1st day of menstruation in a compact layer among hemorrhage sites, individual groups of precommunical cells can be distinguishable. Also in the menstrual blood contained the finest particles of endometrial, preserving the viability and ability to implantation. The direct proof of this is the occurrence of the endometriosis of the cervix when the resulting menstrual blood appears on the surface of the granulation tissue after the cervical diathermocoagulation.

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

                  Diagnostic value.The morphological changes of the endometrium began the desquamation to erroneously can be taken for the manifestations of endometritis, developing into the secretory phase of the cycle. However, with acute endometritis, the thick leukocytar infiltrate stroma destroys the glands: leukocytes, penetrated through the epithelium, accumulate in the groom's lumets. For chronic endometritis, focal infiltrates consisting of lymphocytes and plasma cells are characteristic.

                • Regeneration (3-4 cycle day).

                  During the menstrual phase, only certain sections of the functional endometrial layer (according to the observations of prof. Wychlaeva) are rejected. Even before complete rejection of the functional endometrial layer (in the first three days of the menstrual cycle), epithelialization of the wound surface of the basal layer is already begins. On the 4th day, the epithelization of the wound surface ends. It is believed that epithelialization can occur by developing the epithelium from each gland of the endometrium base layer, or due to the growth of ferrous epithelium from the sections of the functional layer, which remained from the preceding menstrual cycle. Simultaneously with the epithelization of the surface of the basal layer, the development of the functional layer of the endometrium begins, it is thickening due to the agreed growth of all elements of the basal layer, and the uterus mucosa enters the early stage of proliferation.

                  The division of the menstrual cycle on the proliferative and secretory phase is conditionally, because The high level of proliferation is preserved in the epithelium glands and stroma in the early phase of secretion. Only the appearance of progesterone in high concentrations to the 4th day after ovulation leads to a sharp suppression of proliferative activity in endometrial.

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

                  Options for the normal structure of the endometrium

                  Endometrium with normal functional properties (cyclic transformations and preparedness to implantation blastocysts) can have different buildings.

                  The basal layer may be:

                  • very low and places are barely determined between the funkuional layer and the myometrium
                  • high containing a large amount of glands, some of which can be cystic extended

                    The boundary between the basal layer and the myometrium may be:

                    • strank
                    • uneven, as a result of immersion in the myometrium of individual sections of the fabric of the basal layer in the form of processes. The similar histological structure of the endometrium is observed with internal endometriosis and adenomy. These cases can be diagnosed on the endometrium scraping if there are pieces consisting of the components of the endometrium and myometrium in the form of a single tissue.

                      The functional endometrial layer happens:

                      • Various in height, which is particularly clearly detected in the late phase of the proliferation phase, when the thickness of the mucous membrane may vary from 5 to 12 mm.
                      • The amount of glands may be different. Sometimes the stromas is noticeably dominated.
                      • In the phase of secretion and in the proliferation phase there may be single cystal expanded glands. Such an extension occurs as a result of uneven stroma density or secret delay in the wake of the gland.
                      • The surface of the mucous membrane can be unequal: smooth, wavy, folded, sometimes with high protrusions in the absurd of the uterus. Sometimes these ledges erroneously can be accepted for endometrial polyps. The diagnosis of the polypa is easily excluded if there are no fibrous connecting tissue and vessels with thickened hyalinized walls for the legs of the polyp.
                      • The unevenness of the secretory function of the glands: single glands or groups whose structure corresponds to earlier stages of secretion phases. Such a difference occurs in the endometrium of women of the prelimacteric period, still retaining the correct menstrual cycle.
                      • Different level of rejection of the functional layer in the menstrual phase of the cycle. It is believed that the functional layer is rejected entirely up to the basal. Recent data indicate that not the entire functional layer is rejected, but only its surface areas, while the main departments located are more deeply preserved and are subjected to a peculiar reverse development process. Both of these types of rejection should be considered as individual variants of the norm if the course of the menstrual phase is not clinically disturbed (there is no hyperpolymenorrhea and dysmenorrhea)

                        Age changes endometrial.

                        Before talking about the age-related changes of the endometrium, consider, in order to avoid confusion, the term-chicient climetheat.

                        Climacteries (climax, menopausal period) is a transitional period in the life of a woman from the reproductive phase with regular ovulatory cycles and corresponding cyclic changes in the reproductive system to a state after stopping menstruation. During this period, age changes dominate the reproductive system and are characterized by a gradual decline and "shutdown" of the ovarian function. Initially, the reproductive and then hormonal function is disturbed, which is manifested by the cessation of menstruation. Reproductive aging is a long process that begins with a sharp decline in fertility after 35 years long before menopause, which occurs about 50 years.

                        The following phases are distinguished in menopacteria:

                        • transition to menopause - Premenopause
                        • menopause is the last independent menstruation. Its date is set retrospectively, after 12 months of lack of menstruation. The age of the patient is on average equal to 50 years.
                        • perimenopause - a period from the appearance of the first menopausal symptoms up to 2 years after the last independent menstruation (premenopause and 2 years postmenopause)
                        • postmenopause - begins with menopause and ends at 65-69 years

                          The temporal parameters of the climetherium phases are somewhat conditional and individual, however, they reflect morpho-functional changes in various links of the reproductive system. There are changes in the hypothalamic-pituitary-ovarian system characteristic of each climethery phase. Allocation of these phases is more important for clinical practice. Clinically, they are manifested by a decrease or termination of the ability to conceive, changing the nature of menstrual cycles and the termination of menstruation. In addition, the early symptoms of estrogen-deficient state, the so-called climacteric syndrome, may be the appearance of the early symptoms.

                          The release of the period of perimenopause from a clinical point of view is extremely important, since it was during this period that the oscillation of the estradiol level is still possible, which clinically can manifest themselves "premenstrual-like" sensations (the loading of the mammary glands, the severity of the abdomen, in the lower back, etc.). Sometimes there are cases of "restoration" of regular menstrual cycles after 1 - 1.5 years of menopause. In such cases, it is necessary to manifest oncological alertness.

                          Endometrium in the perimenopausal period.

                          In the perimenopausal period in histological structures of the endometrium, they discover:

                          • In the premenopausal period:
                            • signs of annotulatory (single-phase) cycles that can alternate with two-phase
                            • transition endometrium, which combines signs of non-functioning endometrium (there are no signs of the effect of estrogenic hormones) with signs of moderately pronounced hardware hyperplasia, that of its shape, which occurs during the long-term effects of weak concentrations of only estrogenic hormones.
                            • Uneven distribution of glands in stroma, some glands are cystic expanded
                            • In some glands, the multiple arrangement of the nuclei of the epithelium, in other single row
                            • Easternactive stroma density in different sections

                              Transition endometrium is usually found in the scraps obtained by scraping about climacteric bleeding, which are often preceded by amenorrhea for 1-2 months and more.

                            • Ultranrum or secretory hypeclasia Endometrium, which is the result of increased stimulation by progesterone
                            • Postmenopausal period:
                              • in the early years, transitional endometrium
                              • then, due to the continuing extinction of the ovarian function - low atrophic endometrium (restless, non-functioning), indistinguishable from basal. In a crossed compact stroma rich in fibers, among which there are also collagen, containing a few glands lined with a single-row low cylindrical epithelium. The glands have the kind of straight tubes with a narrow lumen.

                            Distinguish endometrial atrophy:

                            • easy
                            • cystic, when cystic extended glands are lined with a single-row cylindrical epithelium, lower than those who are seduced by the rest of the glands
                            • with signs of age-related atrophy - gland cystallically expanded, epithelium with a multi-row nuclear location. The nuclei are shrivened, there are no mitoses in them, fibrosis is expressed in stroma.

                              Such a state should be considered as a reflection of the state of the ovarian function, which was during the climacteric period and at present these structures remain, as if fixed in senile endometry. Such endometrium can be mistakenly accepted for ferrous hyperplasia arising from a woman in postmenopausal period.

                              In the occurrence of bloody secretions in women, long in a state of postmenopause, instead of atrophic endometrial, endometrium can be detected with signs of influence on the genital steroid hormones. The source of the formation of hormones in such cases may be cells and hormone-forming ovarian tumors, as well as endocrine impaired adrenal glands. For such women, it is necessary to establish the most careful and constant surveillance.

                              Histochemical changes in endometrials during the ovulatory menstrual cycle.

                              Due to the increasing method of determining the histochemical changes in endometrials for most

Exist 3 types of gonadotropin secretion: Tonic, cyclic and episodic, or pulsating. Tonic, or basal, the secretion of gonadotropins is regulated by negative feedback, and the cyclic - the mechanism of positive feedback involving estrogen. The pulsing secretion is due to the activity of the hypothalamus and the release of gonadoliberins.

The development of the follicle in the first half of the cycle is carried out thanks to the tonic secretion of FSH and LH.

FSH it leads to synthesis in a certain follicle of estrogen, which, increasing the number of receptors to FSH, contribute to its accumulation (by binding to its receptors), further ripening the follicle and increase the secretion of estradiol. The increase in the secretion of estradiol leads to the braking of FSG education. Other follicles at this time are subjected to atresia. The concentration of estradiol in the blood reaches a maximum in the pre-shift period, which leads to the release of a large number of gonadoliberin and the subsequent peak of the release of LG and FSH. The pre-deputy increase in LG and FSH stimulates the gap of the grappa of bubble and ovulation.

LG it is the main regulator of steroid synthesis in the ovaries. Receptors to LH are localized in luteal cells. It activates enzymes involved in progesterone biosynthesis. Under the influence of LH in the ovaries, the amount of cholesterol required for hormone synthesis is increasing. Thus, in the yellow body under the influence of LH, steroidogenesis processes in the section of the cholesterol conversion in Preventionalone are enhanced.

The increase in the level of LG and FSH leads to the braking of their synthesis and release, and the increased concentration of gonadoliberin in the hypothalamus inhibits its synthesis and release into the portal system of pituitary. Adrenaline and norepinephrine stimulate the release of gonadoliberin. Cholecystokinin, gastrin, neurotenzine, opioids and somatostatin inhibit the release of Gonadoliberin.

Roleprolactin - Rights of the mammary glands and lactation regulation. This is carried out by stimulating the synthesis of lactalbumin, fats and carbohydrates of milk. Prolactin also regulates the formation of a yellow body and developing progesterone them, affects the water-salt exchange, delaying water and sodium in the body, enhances the effects of aldosterone and vasopressin, increases the formation of the fat from carbohydrates.

Oxytocin selectively acts on the smooth muscles of the uterus, causing its reduction in childbirth. Under the influence of high concentrations of estrogen, the sensitivity of the receptors to oxytocin increases sharply than and the increase in the contractile activity of the uterus before childbirth is explained. The participation of oxytocin in the lactation process is to enhance the reduction of mioiphelial cells of the mammary glands, due to which milk is increased. The increase in oxytocin secretion, in turn, occurs under the influence of pulses from the cervical receptors, as well as the mechano gearceptors of the nipples of the chest when breastfeeding.

1. Menstrual cycle (ovarian and uterine).

The ovarian cycle consists of two phases- follicular and luteinova, which are separated by ovulation and menstruation.The duration of the ovarian (menstrual) cycle is normal varies from 21 to 35 days.

INfollicular phase under the influence of FSH, it is stimulated by the growth and development of one or several priority follicles, as well as differentiation and proliferation of granulose cells. FSH also stimulates the growth and development of primary follicles, producing estrogen cells of follicular epithelium. The estradiol, in turn, increases the sensitivity of the cells of the granolasis to the action of FSH. Along with estrogen, small amounts of progesterone are secreted. Of the many beginners, the growth of follicles of final maturity will reach only 1, less often - 2-3. Gonadotropin pre-shifted emissions determines the ovulation process itself. The volume of the follicle increases rapidly in parallel with the thinning of the wall of the follicle. Watching within 2-3 days before ovulation, a significant increase in the level of estrogen is due to the death of a large number of mature follicles with the release of follicular fluid. High concentrations of estrogen on the negative feedback mechanism inhibit the secretion of FSH pituitary. Owlial emission of LG and in the smallestness of FSH is associated with the existence of a mechanism for the positive feedback of ultra-high concentrations of estrogen and the level of LH, as well as with a sharp drop in the level of estradiol for 24 hours of preceding ovulation.

Ovulation eggs it occurs only in the presence of LH or chorionic gonadotropin. Moreover, FSH and LH act as synergists during the development of the follicle, and at this time of the cell cells are actively secreted by estrogens.

After ovulation, there is a sharp decrease in the level of LH and FSH in serum. From the 12th day of the second phase of the cycle, a 2-3-day increase in the level of FSH in the blood is noted, which initiates the ripening of a new follicle, while the concentration of LHs over the entire second phase of the cycle tends to decrease.

The cavity of the composed follicle falls down, and the walls are collected in the folds. Due to the rupture of the vessels at the time of ovulation, hemorrhage occurs in the cavity of the post-dealer follicle. In the center of the future of the yellow body there is a connecting scar - stigma

Ovulatory emission of LG and the subsequent maintenance of a high level of hormone for 5-7 days activates the process of proliferation and ferrous metamorphosis of the grainy zone cells with the formation of luteane cells, i.e. Becoming lutein phase ovarian cycle.

The epithelial cells of the grain layer of the follicle intensively multiply and, accumulating lipochromes, turn into luteane cells; The shell itself is richly vasculated. The vascularization stage is characterized by a rapid reproduction of granules epithelial cells and intensive turmoil between them capillaries. The vessels penetrate the cavity of the post-dealer follicle from the side thecae. internae. in the lutein fabric in the radial direction. Each cell of the yellow body is richly equipped with capillaries. The connecting tissue and blood vessels, reaching the central cavity, fill it with blood, envelop the latter, limiting the layer of luteane cells. In the yellow body - one of the highest levels of blood flow in the human body.The formation of this unique network of blood vessels ends for 3-4 days after ovulation and coincides with the flourishing period of the yellow body function (Bagavandossp., 1991).

Angiogenesis consists of three phases: fragmentation of an existing basal membrane, migration of endothelial cells and their proliferation in response to a mitogenic incentive. Angogenic activity is under the control of the main growth factors: fibroblast growth factor (FRF), epidermal growth factor (EFR), platelet growth factor (FRT), insulin-like growth factor-1 (IFR-1), as well as cytokines, such as tumor necrotic factor (TNF) and interleukins (IL-1; IL-6) (Bagavandossp., 1991).

From this point on, the yellow body begins to produce significant amounts of progesterone. Progesterone temporarily inactivates the positive feedback mechanism, and the secretion of gonadotropins is monitored only by the negative effect of estradiol. This leads to a decrease in the level of gonadotropins in the middle of the yellow body phase to the minimum values \u200b\u200b(Ericsksong.f., 2000).

The progesterone synthesized by the cells of the yellow body inhibits the growth and development of new follicles, and also participates in the preparation of endometrials to the introduction of a fertilized egg, reduces the excitability of myometrium, suppresses the effect of estrogens to endometrials in the secretory phase of the cycle, stimulates the development of decidual tissue and the growth of alveoli in the milk glands. The serum concentration of progesterone corresponds to a rectal (basal) temperature plateau (37.2-37.5 ° C), which underlies one of the methods of diagnostics of ovulation and is a criterion for estimating the fullness of the lutein phase. At the basis of raising basal temperature there is a decrease under the influence of progesterone peripheral blood flow, which reduces heat loss. The increase in its blood content coincides with the increase in the basal body temperature, which is an ovulation indicator.

Progesterone, being an antagonist of estrogen, limits their proliferative effect in endometrial, myometry and vaginal epithelium, causing stimulation of secretion by iron endometrials of the secretion of glycogen, reducing the stroma of the submissible layer, i.e. Causes characteristic changes of the endometrium necessary for implantation of the fertilized egg. Progesterone reduces the tone of the muscles of the uterus, causes them to relax. In addition, progesterone causes proliferation and development of the mammary glands and during pregnancy contributes to the oppression of the ovulation process. If fertilization did not happen, then after 10-12 days the regression of the menstrual yellow body comes, if the fertilized egg was introduced into the endometrium and the resulting blastuly began to synthesize xg, then the yellow body becomes yellow body pregnancy.

The cells of the yellow body granolas are secreted by a polypeptide hormone relaxing, which takes important participation in the birth period, causing relaxation of the pelvic bonds and relaxation of the cervix, and also increases the synthesis of glycogen and the water delay in myiometry, while reducing its contractile ability.

If the egg fertilization has not happened, the yellow body goes into the reverse development stage, which is accompanied by menstruation.Luteane cells are subjected to dystrophic changes, decrease in size, and the picnosis of the nuclei is observed. The connecting tissue, rotating between the decaying lutein cells, replaces them, and the yellow body gradually turns into a hyaline formation - a white body.

Regens period of the yellow body it is characterized by a pronounced decrease in the levels of progesterone, estradiol and Inhibin A. Reducing the levels of Ingin A and estradiol, as well as the increase in the frequency of pulses of the secretion of GN-RGs ensure the predominance of FSH secretion over LH. In response to the increase in the level of FSH, the pool of antral follicles is finally formed, of which the dominant follicle will be selected. Prostaglandinf 2 A, oxytocin, cytokines, prolactin and radicals 0 2 have a luteolytic effect, which may be the basis for the development of yellow body deficiency in the presence of an inflammatory process in the appendens. Menstruation occurs against the backdrop of the yellow body regression. By graduation, estrogen and progesterone levels reach their minimum. Against this background, the activation of the tonic center of the hypothalamus and pituitary is the activation and increase in secretion mainly FSH, which activates the growth of follicles. Increasing the level of estradiol leads to stimulation of proliferative processes in the basal layer of endometrial, which ensures adequate endometrial regeneration.

Cyclic changes in endometryit concerns its surface layer consisting of compact epithelial cells, and intermediate, which are twisted during menstruation.

As you know, it is distinguished by Iphase - the proliferation phase (early stage - the 5-7th day, the average - 8-10th day, late -10-14th day) andiii, the phase of secretion (early -15-18 day , the first signs of secretory transformations; The average - 19-23 day, the most pronounced secretion; late - 24-26th day, starting regression, regress with ischemia - 26-27th day), IIIIFase, bleeding phase or menstruation ( Deskvamation - 28-2rd day and regeneration - 3-4th day).

Fine phase proliferation lasts 14 days . The changes arising in this phase are due to the action of the growing amount of estrogen secreted by the growing and ripening follicle (Khmelnitskyo.k., 2000).

In the early stage of the phase of proliferation(5-7th day cycle) Endometrium is thin, the division of the functional layer on the zone is absent, the surface of it is enclosed by a flattened cylindrical epithelium having a cubic shape. Irony crypts in the form of straight or slightly convulsive tubes with a narrow lumen, on transverse sections have a round or oval shape. The epithelium of ferrous crypt prismatic, the oval kernels are located at the base, are well stained, the apical edge of epithelial cells in the light microscope seems to be smooth, clearly defined.

In the middle stage of the phase of proliferationthe activity of alkaline phosphatase in endometrial is growing. In the stroma, the phenomena of edema, bursting. The cytoplasm of the stromal cells becomes more distinguishable, the kernels are detected quite clearly, compared with the early stage the number of mitoses is growing. Stromom vessels are still single, with thin walls.

In the late phase of the proliferation phase(11-14th day of the cycle) There is some thickening of the functional layer, but there is still no division into zones. The endometrium surface is lined with high cylindrical epithelium. Ferrous structures acquire a more reputable, corkscrew shape, more closely adjacent to each other than in previous stages. Epithelium of ferrous crypt - high cylindrical. The apical edges are presented with light microscopy smooth, clear. At the same electron microscopy, microvills are detected, which are dense cytoplasmic processes covered with plasma membrane. By increasing in size, they create an additional area for the distribution of enzymes. Just in this stage, alkaline phosphatase activity reaches its maximum (Topchiyeva O.I. et al., 1978).

At the end of the proliferation phasewith a light-optical study, small subnuclear vacuoles are detected, in which small granules of glycogen are determined. Glycogen in this stage is formed in connection with the pre-shift secretion of the Gestagennes in the follicle maturity. The spiral artery of the stroma, which grow up from the basal layer into the average phase of the proliferation phase, is not very strong, therefore, only one or two cut across the vessel with thin walls (Topchiyeva OI et al., 1978; Zheleznov B. I., 1979).

Thus, estrogens simultaneously with the proliferation of epithelium cells are stimulated during the proliferation phase, the development of the cell's secretory apparatus, preparing it for further complete function in the secretion phase. This explains the sequence of events having a deep biological meaning. That is why without the prior effect of estrogen on endometrium progesterone practically does not work. Today it was revealed that progesterone receptors that provide sensitivity to this hormone are activated by the preceding effect of estrogen.

Phase secretion lasts 14 daysdirectly connected with the hormonal activity of the yellow body and the corresponding secretion of progesterone. Shortening or elongation of the secretion phase by more than two days in women in reproductive age should be considered as a pathological state, since such cycles are usually applied to annevulatory. The oscillations of the secretory phase from 9 to 16 days may occur at the beginning or at the end of the reproductive period, i.e. When becoming or fading a mother-ovarian cycle.

In the diagnosis of the 1st week of the secretory phase, changes in epitheliums are of particular importance, allowing to talk about the ovulation. The characteristic changes in the 1st week in the epithelium are associated with the growing function of the yellow body. On the 2nd week, the last ovulation is most accurately determined by stroma cells. Changes in the 2nd week in stroma are associated with the highest function of the yellow body and the advancing of its regression and reducing the concentration of progesterone.

In the early stage of secretion phases(on the 15-18th day of the cycle) The endometrium thickness increases significantly compared with the proliferation phase. The most characteristic sign of the offensive phase of secretion is its early stage - is the appearance of subnuclear vacuoles in the epitheliums. In the usual light-optical study, the manifestation of secretion in the form of subnuclear vacuoles is usually observed on the 16th day of the cycle, which indicates the accomplished ovulation and the pronounced hormonal function of the menstrual yellow body. By the 17th day of the cycle (3rd day after ovulation), glycogen granules are contained in most glands and are located at one level in the basal sections of cells under the nucleus. As a result, the kernels over vacuoles are also located in a row. Then on the 18th day (4th day after ovulation) glycogen granules move to the apical cells of the cells, as if by combining the kernel. As a result, the nucleus again as if lowered down to the base of the cell. Often, the core term in various cells appear at different levels. Their form changes and their form - they become more rounded, mitoses disappear. The cytoplasm of cells becomes basophilic, acidular mucopolysaccharides are detected in the apical part.

The presence of subnuclear vacuoles is a sign of accomplished ovulation. However, it must be remembered that they are clearly detected with light microscopy after 36-48 hours after ovulation. It should be borne in mind that subnuclear vacuoles can be observed at other situations characterized by progesterone. At the same time, however, they will not be detected by the same type in all glands, and their shape and the value will be different. So, often subnuclear vacuoles are found in separate glands in the tissue of "mixed" hypoplastic and hyperplastic endometrial.

Along with the subnuclear vaculation for the early stage of the secretion phase, a change in the configuration of ferrous crypt is characterized: they are winding, are expanded, the same type and are properly located in a loose, several edema stroma, which indicates the action of progesterone on the stromal elements. Spiral artery in the early stage of secretion phases acquire a more convulse appearance, however, "clubs" characteristic of subsequent stages of secretion are not yet observed.

In the middle stage of the secretion phase(19-23th day of the cycle) In endometrials, the most pronounced secretory transformations are noted, which occur as a result of the highest concentration of yellow body hormones. The functional layer is thickened. It clearly sends a division to spongiosis (spongy) or deep and compact or surface layers. In the compact layer, ferruginous crypts are less than a crimson, stroma cells predominate, the epithelium, the lining surface of the compact layer, the high prismatic, not secreting. Breeding crypts of corkscrew shapes are quite closely adjacent to each other, their lumens are increasingly expanding, especially by the 21-22th day of the cycle (that is, to the 7-8th day after ovulation) and become more folded. The process of excretion of glycogen by apocryne secretion in the granular clearance ends to the 22nd cycle (8th day after ovulation), which leads to the formation of large, stretched glands filled with well-discerned when painting on glycogen fine granules.

In the stroma in the middle stage of secretion phases, a decidual-like reaction occurs, which is noted mainly around the vessels. Then the decidual reaction from the island type acquires diffuse character, especially in the surface sections of the compact layer. Connectual cells become large, rounded or polygonal shape, resemble the view of the end pavement, on the 8th day after ovulation, glycogen is detected in them.

The most accurate indicator of the average phase of secretion, indicating the high concentration of progesterone, are changes in spiral arteries, which in the middle stage of secretion sharply cry and form "balls". They are found not only in spongy, but also in the most superficial sections of the compact layer, since from the 9th day after the ovulation of the swelling of the stroma decreases, then by the 23rd day of the cycle of the spiral arteries, the most clearly pronounced. The presence of developed spiral vessels in the functional layer of endometrial is considered one of the most reliable signs that determine the full progesterone effect. The weak development of "clubs" of spiral vessels in the endometrium of the secretory phase is regarded as a manifestation of insufficiency of the function of the yellow body and insufficient endometrial preparedness to implantation.

As indicated O.I. Topchiyeva et al. (1978), the structure of the endometrium of the secretory phase of the middle stage on the 22-23rd cycle day can be observed with a long and increased hormonal function of the menstrual yellow body, i.e. In the persistence of a yellow body (in such cases, a comprehensive and decrease and decidual-like transformation of stroma, as well as the secretory function of the glands), or in the early periods of pregnancy during the first days after implantation - during uterine pregnancy beyond the implantation zone; and evenly in all parts of the mucous membrane of the uterus body during progressive ectopic pregnancy.

Late stage of secretion phase(The 24-27th day of the cycle) comes in the event that the fertilization of the egg did not occur and the pregnancy did not come. In this case, on the 24th day of the cycle (10th day after ovulation), endometrial trophy due to the beginning of the regression of the yellow body and, accordingly, a decrease in the concentration of progesterone is broken, and a number of dystrophic processes develop in it, i.e. In endometrials there are changes in a regressive nature.

With ordinary light-optical microscopy 3-4 days before the expected menstruation (on the 24-25th day of the cycle) there is a decrease in the endometrium juice due to the loss of liquid them, the stroma of the functional layer is observed. The glands due to the wrinkling of the etndometrium are becoming even more folded, closely arranged each other and are purchased on longitudinal sections of piluctal, and on transverse - star outlines. Along with the glands in which the secretory function has already stopped, there is always a certain amount of glands with the structure corresponding to the earlier stages of the secretory phase. The epithelium of ferrous crypt is characterized by uneven coloring nuclei, some of which are picnotic, in the cytoplasm there are small drops of lipids.

During this period, in the stroma, predoscidal cells come closer to each other and are detected not only in the form of islands around the trangles of spiral vessels, but also diffuse throughout the entire compact layer. Among pre-comid cells, small cells are found with dark nuclei - endometrial granular cells, which, as shown electron microscopic studies, are transformed from connective tissue cells, i.e. Larger predocidal cells that are located preferably in the compact layer. At the same time, the depletion of the cells of the glycogen, the kernels are becoming picnotic.

On the 26-27th day of the cycle in stroma, it is possible to detect the expansion of capillaries and hemorrhage in surface layers. This is due to the fact that, as the cycle develops, the spiral arterioles are lengthened faster than the endometrium thickness increases, so that the vessels adapt to the endometry by increasing the uplifiers. In the premenstrual period, the spiralization becomes such a pronounced, which slows down blood flow and causes stas and thrombosis. This moment, along with a number of other biochemical processes, explains endometrial necrosis and dystrophic changes in blood vessels, which lead to menstrual bleeding. Shortly before the start of menstruation, the extension of the vessels is replaced by spasm, which explains the effect of various types of toxic spree products of protein or other biologically active substances against the background of the progestone level.

Phase bleeding, menstruation(28-4th day of the cycle), is characterized by a combination of desquamation and regeneration processes.

Uterus

- Hollow smooth muscle body of the pear-shaped form, gluable in the front seat. The uterus is distinguished by the body, experiencing and cervix. The upper convex part of the body is called the bottom of the uterus. The uterine cavity has a triangle shape, in the upper corners of which openings of the uterine pipes are opened. At the bottom of the uterus, narrowing, goes into the experiencing and ends with an internal zev.

Cervix

- This is a narrow cylindrical shape bottom of the uterus. It distinguishes the vaginal part, which goes into the vagina below the arches, and the overexpassed top part, located above the arch. Inside the cervix, a narrow cervical (cervical) channel is 1-1.5 cm long, the top department of which ends with an internal zev, and the lower - external. The cervical channel contains a mucous tube that prevents the penetration of microorganisms from the vagina to the uterus. The length of the uterus in an adult woman is an average of 7-9 cm, the thickness of the walls is 1-2 cm. The mass of the non-embled uterus is 50-100 g. The walls of the uterus consist of three layers. The inner layer is the mucous membrane (endometrium) with a set of glands, covered with fiscal epithelium. Two layers are distinguished in the mucous membrane: a layer adjacent to the muscular shell (basal), and the surface layer is functional, which is subjected to cyclic changes. Most of the wall of the uterus is the middle layer - muscular (myometrium). The muscular shell is formed by smooth muscle fibers, constituting the outer and inner longitudinal and medium circular layers. Outdoor - serous (perimetry) layer is a peritoneum covering the uterus. The uterus is located in the cavity of a small pelvis between the bladder and the rectum at the same distance from the pelvis walls. The body of the uterus is tilted by the kepened, to the symphysu (uterus agent), has a stupid angle in relation to the neck (anteflexia of the uterus), an open kepened. The cervix is \u200b\u200btraversed by the kice, the outer zev adjoins the back of the vagina.

The fallopian tubes

start from the angles of the uterus, go to the sides to the side walls of the pelvis. Have a length of 10-12 cm, a thickness of 0.5 cm.

The walls of the pipes consist of three layers: an internal mucous membrane, covered with a single-layer fiscal epithelium, whose cilia is flickering towards the uterus, medium-muscular and outdoor - serous. The pipe is distinguished by an interstitial part, passing in the thickness of the uterus wall, the exemplary is the most narrowed middle part and an ampularly - an extended part of the pipe ending the funnel. The edges of the funnels have the kind of fringe - Fambriy.

Ovarian

these are paired glands of the almond-shaped form, the size of 3.5-4, 1-1.5 cm, weighing 6-8 g. They are located on both sides of the uterus, behind the wide ligaments, attaching to their rear leaves. The ovary is covered with a layer of epithelium, under which a protein shell is located, a cortical substance is deeper, in which there are numerous primary follicles in different stages of development, yellow bodies. Inside the ovary is located a brain layer consisting of connective tissue with numerous vessels and nerves. In the period of puberty in the ovaries, the ripening process and the exit to the abdominal cavity of mature eggs capable of fertilization occurs every month. This process is aimed at implementing a reproductive function. The endocrine function of the ovaries is manifested in the development of sex hormones, under the influence of which during puberty takes place the secondary sexual characteristics and genital organs. These hormones participate in cyclic processes that prepare the body of a woman to pregnancy.

Bound apparatus of genital organs and small pelvic fiber

The suspension apparatus of the uterus consists of bundles, which include paired round, wide, veronegotaz and their own ovarian ligaments. Round ligaments depart from the corners of the uterus, the koaden from the uterine pipes, go through the groove channel, are attached in the area of \u200b\u200bthe lannoy articulation, attracting the bottom of the uterus ahead (Ansvership). Wide ligaments are departed in the form of dual leaflets of peritoneum from the ribs of the uterus to the side walls of the pelvis. In the upper departments of these bundles are the uterine pipes, ovaries are attached to the rear leaves. Voroncotase ligaments, being a continuation of wide ligaments, go from the pipe funnel to the pelvis wall. Ovarian's own bonds go from the bottom of the Zatka Zada \u200b\u200band below the emergence of the uterine pipes are attached to the ovaries. The fixing apparatus includes sacriven, basic, uterine-bubble and bubble-pubic ligaments. Sweet-sackers are departed from the rear surface of the uterus in the field of body transition to the neck, cover the rectum on both sides and attached on the front surface of the sacrum. These ligaments attract the cervix to the Zatka. The main ligaments go from the lower uterus to the side walls of the pelvis, the uterine-bubble - from the lower separation of the swearing, to the bladder and further to the symphysus, like bubble-pubic. The space from the side departments of the uterus to the pelvis walls occupies the incoming parameter fiber (parameter), in which the vessels and nerves pass.

Physiology of the female sexual system

The female genital system has four specific functions: menstrual, sex, childbearing and secretory.

Menstrual cycle Rhythmically repeated complex changes in the sexual system and in the entire body of women who prepare it to pregnancy are called. The duration of one menstrual cycle is considered from the first day of the last menstruation until the first day of subsequent menstruation. On average, it is 28 days, less frequently 21-22 or 30-35 days. The duration of menstruation is normally 3-5 days, blood loss - 50-150 ml. Menstrual blood is of dark color and not coagulated. Changes during the menstrual cycle are most pronounced in the organs of the sexual system, especially in the ovaries (ovarian cycle) and the mucous membrane of the uterus (uterine cycle). An important role in the regulation of the menstrual cycle belongs to the hypothalamic-pituitary system. Under the influence of the hypothalamus raising factors in the front share of the pituitary gland, gonadotropic hormones, stimulating the function of the genital glands: follicle-suite (FSH), luteinizing (LG) and luteotropic (LTG). FSH contributes to the ripening of follicles in the ovaries and products of the follicular (estrogenic) hormone. LH stimulates the development of a yellow body, and LTG is the production of a yellow body hormone (progesterone) and the secretion of the mammary glands. In the first half of the menstrual cycle, the production of FSH is dominated, in the second half - LG and LTG. Under the influence of these hormones, cyclic changes occur in the ovaries.

Ovarian cycle.

This cycle is 3 phases:

1) the development of the follicle - the follicular phase;

2) breaking the ripe follicle - the ovulation phase;

3) Development of a yellow body - Lutein (progesterone) phase.

In the follicular phase of the ovarian cycle, the ripening of the follicle occurs, which corresponds to the first half of the menstrual cycle. There are changes in all components of the follicle: the increase, ripening and division of the egg, rounding and reproduction of the cells of the follicular epithelium, which turns into a grain shell of the follicle, the differentiation of the connecting shell on the exterior and internal. In the thicker, the follicular fluid accumulates, which moves the cells of the follicular epithelium on one side to the egg, on the other - to the wall of the follicle. Follicular epithelium surrounding the egg cell is called radiant vents. With ripening, the follicle produces estrogenic hormones that have a complicated effect on the genitals and the entire body of a woman. During puberty, they cause the growth and development of the genital organs, the appearance of secondary sexual signs, during the period of sexual maturity - an increase in the tone and excitability of the uterus, the proliferation of the cell mucosa cells. Promote the development and function of the mammary glands, we awaken the sexual sense.

Ovulation It is called the process of breaking the mature follicle and the yield from its cavity of the ripened egg, covered with a shiny shell and surrounded by cells of a radiant crown. The egg fell into the abdominal cavity and then in the uterine tube, in an ampular department of which fertilization occurs. If fertilization did not happen, then after 12-24 hours, the egg begins to collapse. Ovulation occurs in the middle of the menstrual cycle. Therefore, this time is the most favorable for conception.

The phase of the development of a yellow body (Luteinovaya) takes the second half of the menstrual cycle. On the site of a broken follicle after ovulation, a yellow body producing progesterone is formed. Under its influence, secretory transformations of the endometrium necessary for implantation and the development of the fruit egg are. Progesterone lowers the excitability and the reduction of the uterus, thereby contributing to pregnancy, stimulates the development of the parenchyma of the mammary glands and prepares them to secrete milk. In the absence of fertilization at the end of the lutein phase, the reverse development of the yellow body comes, the products of progesterone ceases, and the ripening of a new follicle begins in the ovary. If fertilization occurred and pregnancy occurred, the yellow body continues to grow and operate during the first months of pregnancy and is called yellow Body Pregnancy.

Matchy cycle.

This cycle comes down to changes in the uterus mucosa and has the same duration with the ovarian. It distinguishes two phases - proliferation and secretion followed by rejection of the endometrium functional layer. The first phase of the uterine cycle begins after the rejection (desquamation) endometrials during menstruation ends. In the proliferation stage, the epithelization of the wound surface of the uterus mucosa due to the epithelium of the basal layer gland is. The functional layer of the mucous membrane of the uterus is sharply thickened, endometrial glands acquire winding outlines, their lumen expands. The block phase of the endometrium coincides with the follicular phase of the ovarian cycle. The secretion phase takes the second half of the menstrual cycle, coinciding with the phase of the development of a yellow body. Under the influence of the hormone of the yellow body of progesterone, the functional layer of the uterine mucous membrane is even more loosened, thickened and clearly divided into two zones: spongy (spongy), bordering a basal layer, and more superficial, compact. In the mucous membrane, glycogen, phosphorus, calcium and other substances are postponed, favorable conditions for the development of the embryo, if fertilization occurred. In the absence of pregnancy at the end of the menstrual cycle, the yellow body in the ovary dies, the level of sex hormones is sharply reduced, and the functional layer of the endometrium, which has reached the secretion phase, is rejected and menstruation occurs.

Under the action of ovarian hormones in the mucous membrane, changes occur. If no fertilization occurred, then the yellow body dies and the mucosa is rejected, menstruation begins. Functional layer rejection is called phase desquamation.After rejecting the functional layer in the uterine cavity, the wound surface is formed, which for 3-5 days epithelisses due to the epithelial cells of the basal layer of the endometrium.

The process of etipalization of the wound surface of the uterus is called phase regeneration.The regeneration phase continues normally 3-5 days. From the moment of complete etipalization of the wound surface, menstruation ends.

In the future, under the influence of estrogen hormones until the middle of the menstrual cycle, that is, from the 1st to the 14th day at a 28-day menstrual cycle, the functional layer is growing. In functional growth, glands are formed, but they do not function. This phase of the uterine cycle is called phase proliferation.

In the 2nd half of the menstrual cycle from the 15th to the 28th day, the influence of gestagens hormones begin to function the glands of the functional layer of the endometrium. The secret of these glands serves as a nutrient medium for a fetal egg at the time of its implantation (that is, vaccinations) and is called motinal milk.If the fertilization did not happen, then the menstrual cycle is repeated again.

Sex system of man.

Select outdoor genitals men and internal genitals. Outdoor sexual authority belongs: Sexual member and scrotum. The internal genital bodies include: testicles, seed-winning ducts, prostate gland and seed bubbles. The genital system of men is associated with the urinary system, and the urethra, is both a seed-alone tract.

Anatomy of external genital organs.

Penis.In the penis, they allocate: root, body and head. The length of the penis 5-8cm, in the state of excitation (erection), the length of the penis is 12-15 cm. The body of the penis consists of 2 cavernous bodies and the 1st spongy body, which ends with the head. The urethra passes in the spongy body and normally opens on the head of the penis. Cave bodies have a large amount of lacuna (cavities), which in the period of sexual excitement are filled with blood. Outside, the floor is covered with skin, which is easily shifted, excess skin closes the head of the penis and is called extreme flesh.On the back surface in the area of \u200b\u200bthe head, the skin is attached in the form of a longitudinal fold and is called bridle.In extreme flesh, the secret is produced, which is called smegma. Smegma has carcinogenic properties.

Scrotum -skin-muscular organ, in the cavities of which are arranged eggs, appendages and the initial separation department of the seed rope. The scrotum skin is pigmented, covered with rare hair, contains a significant amount of sweat and sebaceous glands, the secret of which has a specific smell, is rich innervated. The basic function of the scrotum is the creation of optimal conditions for the vital activity of the testicles, maintaining a constant temperature at the level of 34 - 34.5 degrees along C. (thermostat function).

Endometrium consists of two layers: functional and basal. The functional layer changes its structure under the action of sex hormones and, if the pregnancy has not come, is rejected during menstruation.

Proliferative phase

The beginning of the menstrual cycle is considered the 1st day of menstruation. At the end of menstruation, the endometrium thickness is 1-2 mm. Endometrium consists almost only from the basal layer. The glands are narrow, straight and short, lined with low cylindrical epithelium, the cytoplasm of stroma cells is almost not different.

As the estradiol level increases, a functional layer is formed: endometrium is prepared for embryo implantation. The glands are lengthened and become convulsions. The number of mitoses increases. As proliferation, the height of the epithelial cells increases, and the epithelium itself from the single-row becomes multiple to the moment of ovulation. The style of edema and loosened, the cell kernels and the volume of cytoplasm increase in it. The vessels are moderately crimped.

Secretor phase

Ovulation occurs on the 14th day of the menstrual cycle. The secretory phase is characterized by a high level of estrogen and progesterone. However, after ovulation, the number of estrogen receptors in endometrial cells is reduced. The endometrium proliferation is gradually braked, the synthesis of DNA is reduced, the number of mitoses decreases. Thus, preferential influence on endometrium in the secretory phase has progesterone.

In the glands of the endometrium, containing vacuole glycogen appear, which are detected using a chic reaction. On the 16th day of the cycle, these vacuoles are quite large, there are in all cells and are under the nuclei. On the 17th day, the kernels, pushed by vacuoles, are located in the central part of the cell. On the 18th day, vacuoles are in the apical part, and the nuclei - in the basal part of the cells, glycogen begins to stand out in the absurdity of the glands by apocryan secretion. The best conditions for implantation are created on the 6--7th day after ovulation, i.e. On the 20-21th day of the cycle, when the secretory activity glands is maximal.

On the 21st day of the cycle begins the decidual reaction of the endometrium stroma. Spiral arteries are sharply represented, later due to a decrease in the edema of stroma, they are visible clearly. 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, segments of decidual cells are formed. By the 26th day of the cycle, the decidual reaction becomes the maximum. Approximately two days before menstruation in the stroma endometrial increases sharply the number of neutrophils that migrate there from the blood. Neutrophilic infiltration is replaced by necrosis of the endometrium functional layer.

The main way to neutralize ammonia.

4.Cophered: concept, classification, examples.

Answer:

P. 210.

2) ovarian cycle:

1 - Folliculic phase: the development of follicles, secretion of estrogen and ovulation

2- Lutein phase: the yellow body functions, progesterone is secreted

3- phase of the Involution of the Yellow Body: the secretion of estrogen and progesterone stops

folliculine phase:FSH causes ripening of follicles and the formation of estrogen. The release of estrogen in the bloodstream is oppressing the secretion of FSH and stimulates the formation of LH, which provides ovulation and progesterone products, the transition to the next phase.

lutein phase: A yellow body is formed, which produces progesterone, which acting into the blood, inhibits the secretion of the LG and stimulates the selection of prolactin. Prolactin supports progesterone products and stimulates the development of the mammary glands. If the egg cell is not fertilized or not implanted, the transition to 3 phases begins. If fertilized, then pregnancy comes.

phase Involution of the Yellow Body: The yellow body is subjected to reverse development, progesterone products are progressively reduced. The low level of estrogen and progesterone in the blood leads to the fact that the production of follyiberin and FSH re-activated, and, therefore, the folliculine phase begins.

The ovarian cycle phases correspond to certain changes in the uterus, due to sex hormones - the uterine phases.

Matchy cycle:

1- Proliferative phase: estrogens, isolated during the ripening of the follicle, act on endometrium, causing proliferation of the epithelium of the uterus, an increase in the contractile activity of myometrium.

2-secretory phase: Estrogens endometrium under the influence of progesterone secretes the mucus, it is necessary for the implantation of an egg;

3-menstrual phase: progesterone products continues, which depresses the production of LH. The decrease in LG causes rejection of the mucous membrane, bleeding.

3) Ammonia neutralization is carried out by the following paths:

a) rehabilitation amination (unnecessarily, although it provides the formation of some amino acids)

b) the formation of amides asparaginic and glutamic acid - asparagine and glutamine. This process takes place in the nervous, muscle tissue and in the kidneys; Catalysts - asparaginsintetase and glutaminesintytase.

c) The formation of ammonium salts occurs in the renal fabric, where ammonia is delivered in the form of asparagine and glutamine. Here they are hydrolyzed, forming asparat and glutam, and ammonia is released. Ammonia is neutralized by the formation of ammonium salts, and they are removed with urine.

d) The synthesis of urea is the main way to neutralize and remove ammonia - is carried out in the liver. Proceeds in several reactions:

1 - Synthesis of carbomil - phosphate; Enzyme - carboylphosphosinttosis.

2 - carboyl phosphate interacts with ornithin, forming citrullin; Catalyst - Ornithinekarboylphosfatransferase.

3 - Citrullin interacts with aspatrut, forming arginine suction.

4 - Argininsuccinate splits on Fumarat and Arginine.

5 - Arginine under the action of Arginase splits hydrolytically on urea and ornithine.

The urea is a harmless compound, it is synthesized in the liver, the violation of which leads to a slowdown in the process, reduce the content of urea in the blood and reduce the selection with urine.

4) coenzymes -these are substances needed by some enzymes for the manifestation of activity. They directly participate in the chemical reaction catalyzed by the enzyme.

Classification:

a) inorganic (metal ions, some anions)

b) organic

Metal ions are calcium, magnesium, potassium, zinc, iron ions. They are involved in: stabilization of a tertiary or quaternary structure, in the binding or catalysis of the substrate.

Distinguish the coenses Nucleotide nature, tetrapyrrolo coenses and coenses - Vitamin derivatives.

Coenference - Nucleotides -in the composition of transferases participate in the transfer of phosphate, pyrophosphate, adenilate, in transformations of sugars.

Tetrapirrol coenses Identical to the GEY in hemoglobin; Participate in the transport of electrons as part of cytochromes, peroxidases.

Coenses - Vitamins Participate in a variety of chemical exchange reactions. For example, a coenses of vitamin B 1 (thiamine) - thiamineidiphosphate, catalyzes the decarboxylation reaction.

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

Every month, the density, structure and size of the internal layer of the uterus change throughout the entire cycle. Phase proliferation is the very first stage of the beginning of the natural transformations of the mucous membrane. It is accompanied by an active cellular division and the growth of the uterine layer.

The state of the endometrial of the proliferative type directly depends on the intensity of the division. Disorders in this process lead to an abnormal thickening of the resulting tissues. Too much cells negatively affects health and promotes the development of serious diseases. Most often, during the examination, women's iron hyperplasia is detected. Other, more dangerous diagnoses and states requiring emergency medical care are possible.

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

Learn about the unhealthy state of the mucous meat through symptoms and external manifestations is very difficult. Doctors will help, but that it is easier to understand that such an endometrial proliferation and how the growing fabric affects health, it is necessary to understand the features of cyclic changes.

Endometrium consists of functional and basal layers. The latter is tightly adjacent cell particles peam up with numerous blood vessels. The main function is to restore the functional layer, which, with a failed fertilization, exfoliates and is derived with blood.

The uterus after menstruation is self-cleaning, and the mucosa during this period has a smooth, thin, smooth structure.

The standard menstrual cycle is made to divide in 3 stages:

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

In such a manner of natural changes, proliferation is in the first place. The phase begins approximately from the 5th day of the cycle after the end of menstruation and lasts 14 days. During this period, cellular structures are multiplied by active division, which leads to the growth of tissues. The inner layer of the uterus can increase to 16 mm. This is the normal structure of the endometrial proliferative type layer. Such thickening contributes to the fastening of the embryo to the pillocks of the uterine layer, after which ovulation occurs, and the mucosa of the uterus passes into the secretion phase in the endometrium.

If the conception occurred, the yellow body is implanted in the uterus. With a failed pregnancy, the embryo ceases to function, the hormone level decreases, menstruation begins.

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

Proliferative diseases

The intensive growth of the uterine layer during the proliferative phase occurs under the action of hormones. Any failure in this system extends the period of cell division activity. The overabundance of new tissues becomes the cause of body cancer and the development of benign tumor formations. Wrivery the occurrence of diseases are capable of background pathologies. Among them:

• endometritis;
• endometriosis of the cervix;
• adenomatosis;
• myoma uterus;
• cysts and uterus polyps;

Hyperactive cell division is observed in women with detected endocrine disorders, diabetes and hypertensive disease. The abortion, scraping, overweight, abuse of hormonal contraceptives affect the condition and structure of the mucous membrane.

Against the background of hormone problems, hyperplasia is most often diagnosed. The disease is accompanied by an abnormal growth of the endometrial layer and has no age limit. The most dangerous periods are puberty and. In women under 35 years, the disease is rarely detected, as the hormonal background at this age is distinguished by stability.

Endometrium hyperplasia has clinical signs: the cycle is broken, uterine bleeding are observed, constant pain in the abdomen area appear. The danger of the disease is that the reverse development of the mucosa is broken. The dimensions of the scorched endometrial do not decrease. This leads to infertility, anemia, oncological diseases.

Depending on how the late and early stages of proliferation are effective, endometrial hyperplasia can be atypical and iron.

Endometrium iron hyperplasia

The high activity of proliferative processes and intensive cell division increases the volume and structure of the mucous membrane. In pathological growth and thickening of ferrous tissues, doctors diagnose ferrous hyperplasia. The main reason for the development of the disease is hormonal disorders.

Typical symptoms do not. Manifestations are characteristic of many gynecological diseases. Basically, women's complaints are associated with states during menstruation and after menstruation. The cycle changes and differs from the previous ones. Abundant bleeding is accompanied by painful sensations and contain bunches. Often, the allocation go beyond the cycle, which leads to anemia. Serious bloodstures cause weakness, dizziness and weight loss.

The feature of this form of the endometrial hyperplasia is that the new-forming particles are not divided. Pathology is rarely transformed into a malignant tumor. Nevertheless, this type of disease is characterized by typhic for tumor formations for the unemployment of growth and loss of function.

Atypical

Refers to intrauterine diseases that are associated with endometrial hypoplastic processes. Basically, the disease is revealed in women after 45 years. Each third of 100 pathology develops into a malignant tumor.

In most cases, this type of hyperplasia develops due to hormonal failures activating proliferation. The uncontrolled division of cells with a disturbed structure leads to the growth of the uterine layer. With atypical hyperplasia, the secretory phase is absent, since the size and thickness of the endometrium continue to grow. This leads to long, painful and abundant menstruation.

Pronounced atypia refers to the dangerous states of the endometrium. Not only active breeding of cells occurs, the structure and structure of the nuclear epithelium is changing.

Atypical hyperplasia is capable of developing in basal, functional and immediately in both layers of mucous. The latter option is considered the hardest, since the likelihood of cancer is high.

Flashing of endometrial proliferation

Typically, women are difficult to understand what the endometrium proliferation phases are and as a violation of the sequence of stages is associated with health. To understand the question help knowledge about the structure of the endometrium.

The mucosa consists of a basic substance, a ferrous layer, connective tissues (stroma) and numerous blood vessels. From about the 5th day of the cycle, when proliferation begins, the structure of each of the components is modified. The entire period lasts about 2 weeks and is divided into 3 phases: early, middle, late. Each of the stages of proliferation is manifested differently and occupies a certain time. The correct sequence is considered the norm. If at least one of the phases is missing or noted failure in its course, the probability of developing pathologies in the shell inside the uterus is very high.

Early

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

• endometrium is lined with a cylindrical epithelial layer;
• blood vessels straight;
• the glands are dense, thin, straight;
• cell kernels have a rich red color and oval shape;
• stromas are oblong, spindle-shaped.
• endometrial thickness in the early polypripal phase - 2-3 mm.

Average

The average stage of the proliferative type endometrial is the shortest, usually this is the 8-10th day of the menstrual cycle. The form of the uterus changes, noticeable changes occur in the form and structure of other elements of the mucous:

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

Late

On the 11-14th day of the cycle (late stage), the cells inside the vagina increase in volume and swell. Significant changes occur with the uterine shell:

• epithelial layer high and multilayer;
• part of the glands is extended and has a wavy shape;
• vascular grid winding;
• cell nuclei increase in size and have a rounded form;
• endometrial thickness in the late proliferative phase reaches 9-13 mm.

All listed stages are closely related to the secretion phase and must correspond to the indicators of the norm.

Causes of body cancer

The uterus body cancer refers to the most dangerous pathology of the proliferative period. In the early stages, this type of disease proceeds asymptomatic. The first signs of the disease include abundant mucous allocations. Over time, such signs appear as pain at the bottom of the abdomen, uterine bleeding with endometrial fragments, frequent urge to urination, weakness.

The incidence of cancer increases with the advent of annotulatory cycles characteristic of age from 45 years. In the premenopause, the ovaries still identify follicles, but they rarely ripen. Ovulation does not occur, respectively, the yellow body is not formed. This leads to a hormone imbalance - the most common reason for the formation of cancer tumors.

In the risk group, who did not have pregnancy and childbirth, as well as with identified obesity, diabetes mellitus, exchange and endocrine disorders. The background diseases provoking the body cancer of the parent body are polyps in the uterus, endometrial hyperplasia, mioma, ovarian polycystosis.

The diagnosis of oncology complicates the state of the uterine wall with cancer defeats. Endometrium becomes loose, the fibers are located in different directions, muscle tissue is weakened. The borders of the uterus are blurred, polypo-shaped growths are noticeable.

Regardless of the pathological process, endometrial cancer is detected when ultrasound. To determine the presence of metastasis and the localization of the tumor, resort to hysteroscopy. In addition, a woman is recommended to undergo a biopsy, radiography and pass a number of analyzes (urine, blood, hemostasis study).

Timely diagnosis makes it possible to confirm either eliminate the growth of tumor neoplasm, its nature, size, type and degree of distribution to neighboring bodies.

Diseard therapy

Treatment of cancer pathology of the bodies of the uterus is prescribed individually, depends on the stage and form of the disease, as well as the age and general state of the woman.

Conservative therapy applies only at the initial stages. Women of reproductive age with a detected disease of the 1st stage conduct hormonal therapy. Throughout the course of treatment, you need to regularly pass tests. So doctors track the condition of the cell nucleus, changes in the structure of the mucous membrane and the dynamics of the disease.

The most efficient method is considered to remove the affected uterus (partial or complete). To eliminate single pathological cells after the operation, a course of radiation or chemical therapy is assigned. In cases of rapid growth of endometrial and rapid increase in cancerous tumor, doctors remove a native body, ovaries and appendages.

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

The debt of every woman is to know about him and be able to feel their body.

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What is menstruation?

Menstruation (from lat. Mensis - month, Menstruus - monthly), monthly or regulated - part of the menstrual cycle of women. When menstruation, the functional layer of endometrial (mucosa of the uterus) is rejected, accompanied by bleeding. From the first day of menstruation begins the countdown of the menstrual cycle.

Why do you need monthly?
The menstrual process is a period when the uterine epithelium is updated during each month.

When this process flows in the epithelium, changes are irreversible, and it is excreted from the body, as it cannot be used more. In fact, a new epithelium is formed in the body, which is successfully involved in internal processes.

Functional purpose:

Cell rebirth. The menstrual process allows you to update the cells of the epithelium than it provides an important role for the reproductive ability of the girl.

Natural protective. In the menstrual process, a separate layer of the uterus is involved, which is responsible for analyzing the problems in egg cells, which are not fertilized, and interferes with the implantation of the egg data. Such eggs are outlined from the body together with the epithelium every month.

Menstrual blood Not cooled and has a more dark color than blood circulating in vessels. This is due to the presence of enzymes in the menstrual blood.

Menstrual blood is called liquid discharge from the vagina during menstruation. Strictly speaking, a more correct term is a menstrual liquid, since its composition, in addition to the blood itself, includes a mucous secret of the gloomy of the cervix, the secret of the gloa of the vagina and the endometrium fabric.

The average volume of the menstrual fluid released during one menstrual cycle is, according to a large medical encyclopedia, about 50-100 milliliters.

However, individual scatter lies in the range from 10 to 150 and even up to 250 milliliters.

This range is considered normal, more abundant (or, on the contrary, scarce) selection can be a symptom of the disease. The menstrual liquid has a reddish-brown color, slightly darker than venous blood.

The amount of iron lost with menstrual blood for most women is relatively small and cannot in itself cause symptoms of anemia.

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

This diagnosis could be not delivered due to the erroneous assignment of iron deficiency at the expense of the menstrual loss of blood. However, regular abundant menstrual bleeding in some cases can still lead to anemia.

Menstruation (and generally menstrual cycles) Usually do not occur during pregnancy and lactation. And the absence of menstruation at the expected time is a conventional symptom, which allows pregnancy to assume.

During menstruation, a woman may experience physical discomfort. Before menstruation, irritability, drowsiness, fatigue, a slight increase in pulse can be observed, during menstruation - some slowdown of the pulse.

Premenstrual syndrome

Some women experience emotional shifts associated with menstruation.

Sometimes irritability, feeling of fatigue, federation, depression is observed. A similar range of emotional effects and sentiment shifts is also associated with pregnancy and can be explained by the disadvantage of endorphins.

Estimates of the occurrence of premenstrual syndrome fluctuate from 3% to 30%. In certain rare cases, menstruation can provoke menstrual psychosis in individuals inclined to psychotic disorders (English)

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

The female cycle of the day, what happens these days should every woman know, because he will show when you are ready for conception when passionate or the opposite is cold, why the mood changes so:

In the 1st day The uterus throws out the endometrium served, that is, the bleeding begins.

A woman can feel ailment, pain in the abdomen. To reduce painful sensations, you can take "No-Shpu", "Buckopan", "Beastesin", "Papaverin".

In 2nd day Starting strong sweating.

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

From 4th day Begins to improve the mood, health appears, since the monthly needs to be completed.

What is a cycle of days in the second half?

Days starting out from the 9th to the 11th day They are considered dangerous, you can get pregnant.

It is said 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.

In 12th The day is increasing the libido of women, which entails a strong sexual attraction.

When does the second half begins?

From 14 daysWhen the egg will start moving towards male start, ovulation occurs.

In the 16th day A woman can gain weight, as it enhances her appetite.

Until 19 days The ability to get pregnant.

From 20th day Start "safe" days. What are "safe days"? Exactly! "Safe" - in quotes!

These days are reduced the opportunity to get pregnant. Many women ask a question: Is it possible to get pregnant to a woman in front of the menstrual cycle? The probability of small, but no one can give a complete guarantee.

The period of menstruation may vary under the action of many factors. No woman has a smooth cycle throughout life. It can be changed even a cold illness, fatigue or stress.

Many doctors warn that the body is able to "issue" re-ovulation, so even 1 day before the month you can conceive a baby.

Menopause

Age of the offensive menopause (termination of menstruation): Norm - 40-57 years, most likely - 50-52 years.

In a moderate climate of menstruation, an average of up to 50 years continues, after which menopause comes; At first, regulates disappear for several months, then appear and disappear again, etc.

There are, however, women who preserve menstruation up to 70 years. From a medical point of view, menopause is considered to be coming if during the year of menstruation was completely absent.

What is the menstrual cycle?

Menarche.

The first appearance of menstruation (Menarche) The woman occurs in 12-14 years old, (with a scatter from 9-11 years before 19-21). Menstruation in the hot climate begins between 11 and 15 years of life. In a temperate climate - between 12 and 18 and in the cold - between 13 and 21, life.

The age of Menarche detects certain racial differences: so, in a number of research it was shown that Negroids Menarche comes earlier than in the europeanoids living in the same socio-economic conditions.

After the first menstruation, the next one can be after 2 or 3 months. Over time, the menstrual cycle is installed and lasts 28 days, but the duration of the cycle from 21 to 35 days is normal. Only 13% of all women cycle is exactly 28 days. Menstruation lasts about 2-8 days. All allocations occur from the vagina.

Menstrual cycles on average are usually beginning between 12 and 15 years of life and continue up to about 45-50 years.

Since menstrual cycles are a consequence of changes in the ovary associated with the formation of oocytes, a woman has fertility only for those years while she has menstrual cycles. This does not mean that sexual activity stops with the onset of menopause - at the same time only fertility disappears.

Of the practical considerations, the beginning of the menstrual cycle consider those days when menstrual bleeding appears.

Menstrual isolation consists of a destructive endometrial mixed with blood from torn blood vessels.

Before you begin menstruation, such phenomena are observed:

• pulling pain in the sacrum, often in the lower back;
• headaches;
• fatigue, Breaky;
• sensitivity of nipples;
• weight gain;
• sometimes the discharge of mucous secretions occurs.

Allocation by day:

• 1 day - scarce allocations;
• 2.3 day - abundant;
• 4.5 days - reduction of secretions;
• 6-7 days - termination of menstruation.

The menstrual phase continues on average for 3-4 days. It follows two other phases of the menstrual cycle - the phase of the proliferation and phase of secretion (the lutein phase, or the phase of the yellow body).

The secretion phase begins after ovulation and goes about 14 days. The duration of the proliferation phase is variable, constituting an average of 10 days.

So, the menstrual cycle is customary to call a segment of time, the beginning of which is considered The first day of the occurrence of menstruationAnd the end is the day before the advent of the following menstrual secretions.

Normal menstrual cycle of a healthy woman has four phases, each of which lasts about 7 days. The duration of the entire cycle is 28 days. However, the duration of the menstrual cycle 28 days is averaged figure.

Each single woman has a woman can vary both in the big and smaller side. But the cycle that lasts from 21 to 35 days is also considered normal.

If the cycle does not fit into these time segments, it is not the norm. In this case, it is worth contacting the gynecologist and pass a comprehensive examination under his leadership.

The phases of the menstrual cycle Read more

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

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

Menstrual phase - the first phase of the cycle

The menstrual phase with the duration of the uterine cycle of 28 days continues on average 5 days. This phase is a bleeding from the uterine cavity, which occurs at the end of the ovarian cycle, if the feroticization and implantation of the egg cell occurs.

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

Proliferative or follicular phase - second phasecycle

The proliferative phase varies on duration from 7 to 11 days. This phase coincides with the follicular and ovulatory phases of the ovarily cycle, during which the level of estrogen increases, mainly EST radiol-17r, in blood plasma.

The main function of estrogen in the proliferative phase of the menstrual cycle is the stimulation of the cell proliferation of the tissues of the reproductive system organs with the restoration of the endometrium functional layer and the development of the epithelial liner of the uterine mucous membrane.

Proliferative (follicular) phase - The first half of the cycle - lasts from the first day of menstruation until ovulation. At this time, the influence of estrogen (mainly estradiol) occur proliferation of the base layer cells and the restoration of the functional endometrial layer.

The duration of the phase can vary. Basal body temperature is normal. The epithelial cells of the grooves of the basal layer migrate to the surface, proliferate and form a new epithelial endometrium lunch. In endometrials also occur the formation of new uterine glands and the rotation of the spiral arteries from the basal layer.

In this phase, under the influence of estrogen, the endometrium of the uterus occurs, an increase in its glands, secreting mucus, grows the length of the spiral arteries. Estrogens cause proliferation of the vaginal epithelium, strengthen the secretion of mucus in the cervix.

The secretion becomes abundant, the amount of water increases in its composition, which makes it easier for spermatozoa in it.

At the beginning of the menstrual cycle in the body of a woman there is a very low concentration of female hormones of estrogen. Such a low level becomes an incentive for the hypothalamus to develop special rilizing hormones, which affect the further tissue of the pituitary gland. It is in the pituitary gland that two main hormonal substances regulating the monthly cycle are produced - follicle-sucking (FSH) and luteinizing hormones (LH).

These chemicals come to the blood and reach women's ovarian fabrics. As a result of such interaction, the ovarian begins to produce the same estrogens, which are not in the body in the first days of the menstrual cycle. The high level of estrogen in the blood is necessary in order for the ovaries to start the process of active growth of follicles (female genital cells).

Stimulation of proliferative processes in endometrial is associated with an increase in the number of progesterone receptors on the membrane of the endometrial cells, which increases the proliferative processes in it under the influence of this hormone. Finally, an increase in the concentration of estrogen in the blood plasma stimulates the reduction of smooth muscles and the microhorusin of phallopy pipes, which contributes to the promotion of sperm in the direction of the ampular dial of phallopying pipes, where the oxygellation fertilization should occur.

Each month in the female body, several such cells begin to ripen at once, among which one dominant follicle is distinguished. It is the process of ripening and growth of the follicle to lay the basis for the name of the name of the name of the menstrual cycle, which is called follicular.

The duration of this stage may be different from each woman, but on average, with a 28-day cycle, the ripening of the follicle takes about 14 days. The longer this stage lasts, the longer the entire menstrual cycle of a woman.

This period is considered the most unpredictable and most "gentle". It is in the proliferative phase that the body sharply responds to all negative phenomena taking place with it.

Stress or disease can easily stop the ripening process of the follicle and thereby lengthen the cycle, or on the contrary, lead to a rejection just started its restoration endometrial (imitation of menstruation).

By the end of the follicular phase, the FSH level decreases, the middle of the cycle occurs, the body is prepared for ovulation.

Video mechanisms of the menstrual cycle

Ovulation - the third phase of the menstrual cycle

It begins after a sharp emission of LH (luteinizing hormone), so-called luteinizing explosion. After the dominant follicle bursts, an egg flow comes out of it and starts its movement in the uterine tube.

Outside the follicle, the egg fell in phallopyes or uterine pipes (this process is called ovulation). The inner surface of the pipes is removed by VILLINS, due to the movement of which, the egg is moving into the uterine cavity, preparing for fertilization and implantation.

Under the action of LH, the cereal mucus softens and becomes more loose, due to which the spermatozoa befrequently fall into the uterus and pipes. Lifetime of the egg cell 12-48 hours (while spermatozoa live up to 5 days). If no ovulation occurred during this period, the egg cell perishes.

Ovulation can be calculated and defined on the features listed below:

1. Woman begins to experience a strong sexual desire.
2. The basal temperature rises.
3. The number of sections is increasingThey become mucous, drig, but remain light and accompanied by other symptoms.
4. Moderate, drawing pain may occur in the lower back.

If at this moment there is a meeting of the egg and spermatozoa, it is formed a germ, and a woman can become pregnant.

As mentioned above, throughout the second stage, the dominant follicle is actively and growing rapidly. During this time, its size increases about five times, as a result of which the enlarged cell acts beyond the limits of the wall of the ovary, as if protruding from it.

The result of such a protrusion becomes the rupture of the follicle shell and the output of the egg, ready for further fertilization. It is at this stage of the menstrual cycle that the most favorable period comes to conceive a child.

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

Secretor (Lutein) phase - The second half - continues from ovulation before the start of menstruation (12-16 days). The high level of progesterone secreted by the yellow bodies creates favorable conditions for the implantation of the embryo. Basal body temperature above 37 ° C.

Changes occurring in the ovaries

The production of luteinizing hormone ceases as suddenly, as started immediately after ovulation. In place of the follicle, a yellow body is formed - a peculiar endocrine organ that produces a hormone of pregnancy - progesterone.

Changes occurring in the uterus

Progesterone contributes to abundant blood supply to the endometrium in size. The mucous is becoming softer and "sticky", due to which the fertilized egg is easily attached to it.

In the event that no fertilization occurred, the yellow body dies, the progesterone ceases to stand out, therefore, the endometrium does not bust so intensively, which leads to his death. The surface layer of the endometrium is rejected and together with the deceased egg is allocated outward. The first phase of the menstrual cycle begins - the most poor on women's hormones, so there are often women during menstruation and are irritable and aggressive.

In healthy women, ovulation accounts for approximately the middle of the menstrual cycle. By adding three days before and after ovulation, we get optimal days to conceive a child. The fact is that spermatozoa can get into the uterine cavity to ovulation, but given their long life, fertilization can occur even if the sexual contact occurred 4-5 days before ovulation.

Women suffering from inflammatory diseases of the small pelvis organs and endocrine disorders have both disorders in the menstrual cycle. And even if its duration and regularity has not changed, they can shift or even fall out of the cycle of some of the phases.

The division of the menstrual cycle on the proliferative and secretory phase is conditionally, because The high level of proliferation is preserved in the epithelium glands and stroma in the early phase of secretion. Only the appearance of progesterone in high concentrations to the 4th day after ovulation leads to a sharp suppression of proliferative activity in endometrial.

Sexual intercourse

For a long time it was believed that due to increased vulnerabilities for various kinds of infections should be avoided by sexual life during menstruation. According to modern recommendations, sexual life during menstruation is not contraindicated, but due to a possible increase in the risk of transferring sexual infections, it is recommended to use a condom.

Menstrual disorders

Menstruation violations are quite frequent and reduced to:

• Termination or suspension (amenorrhea).
• Defined or displaced bleeding (Menstruatio Vicaria).
• Strengthening (menorriage).
• Painful menstruation (dysmenorrhea, statute. Algomenorrhea).

Suspending menstruation depends on different conditions.

The conception ceases the usual expansion of blood and is a physiological cause. Menstruation may stop with any significant blood loss by another part of the body, in this case menstrual blood is delayed or deleted by other paths.

When stopping menstruation, it is necessary to keep in mind the reason that caused this abnormality. If after a cold, after mental unrest, menstruation does not occur for a long time, then you need to appeal to the doctor. Special mention deserves the latency of menstruation mechanical way; It happens with the narrowing of the entrance to the vagina, with the narrowing of the vagina itself and the cervix.

Sometimes bleeding appear in any part removed from the uterus, from the last expiration can be either reduced or discontinued, such a phenomenon is called additional or deflected menstruation ( vicar Menstruation).

In such cases, the expiration occurs usually in places devoid of skin, for example, in wounds, ulcers; Also in the mucous membrane, such as mouth, nose.

In general, speaking, there is not a single point on the surface of the body, on which additional menstruation would be observed. At the same time, in the ovaries there are a phenomenon, ordinary for menstruation.

For menorragia Expiration increased.

This happens in diseases of the uterus or neighboring organs:

• with inflammation of the uterus,
• in the erosion of the cervix,
• with nanity with blood wide ligaments, etc.;
• sometimes there are no any frustration of the uterus, and the enhanced expiration depends on the general deterioration of health.

Dysmenoroei Called menstruation accompanied by pain.

With them often bleeding bunches. In the treatment, pay attention to the cause that supports the malfunction of menstruation, and they try to eliminate it.

Features of personal hygina during menstruation.

Women is extremely important to abide by genital hygiene during menstruation.

Of course, you need to constantly monitor the purity of your body, but if you have menstruation, then it is worth doing it much more carefully.

It is recommended for at least 2-3 times a day. Exterior genital organs wash with warm water with soap (arms), daily wash under the shower. Warm baths, heating, painkillers, can reduce unpleasant sensations in painful menstruation.

The working capacity of a woman during this period is some extent, it should be avoided with increased physical exercise, hypothermia and overheating.

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