The endometrium is the mucous layer that lines the uterus from the inside. Its function is to ensure the implantation and development of the embryo. In addition, the menstrual cycle depends on the changes occurring in it.
One of the important processes in a woman’s body is the proliferation of the endometrium. Violations in this mechanism cause the development of pathology in the reproductive system. The proliferative endometrium marked the first phase of the cycle, that is, the stage that comes after the end of menstruation. During this stage, endometrial cells begin to actively divide and grow.
The concept of proliferation
Proliferation is an active process of dividing cells of a tissue or organ. As a result of menstruation, the mucous membranes of the uterus become very thin due to the rejection of the cells that make up the functional layer. This is precisely the reason for the proliferation process, since cell division renews the thinned functional layer.
However, the proliferative endometrium does not always indicate the normal functioning of the female reproductive system. Sometimes it can occur in the case of pathology, when cells divide too actively, thickening the mucous layer of the uterus.
As mentioned above, the natural cause of the proliferative endometrium is the end of the menstruation cycle. The rejected cells of the uterine mucosa are excreted from the body along with blood, thereby thinning the mucous layer. Before the next cycle, the endometrium needs to restore this functional area of the mucous membrane with the help of the division process.
Pathological proliferation occurs as a result of excessive stimulation of cells with estrogen. Consequently, when the mucosal layer is restored, the division of the endometrium does not stop and a thickening of the walls of the uterus occurs, which can lead to the development of bleeding.
Phases of the process
There are three phases of proliferation (in its normal course):
- Early phase It occurs during the first week of the menstrual cycle and at this time epithelial cells as well as stromal cells can be found on the mucous membrane.
- Middle phase This stage begins on the 8th day of the cycle and ends on 10. During this period, the glands enlarge, the stroma swells and loosens, and the cells of the epithelial tissue are drawn out.
- Late phase. The process of proliferation stops at 14 days from the beginning of the cycle. At this stage, the mucous membrane and all glands are fully restored.
The process of intensive division of endometrial cells may fail, as a result of which cells appear in excess of the required number. These newly-formed “building” materials may combine and lead to the development of tumors such as proliferative endometrial hyperplasia.
It is a consequence of hormonal breakdown in the monthly cycle. Hyperplasia is a proliferation of the glands of the endometrium and stroma, there may be two types: glandular and atypical.
Types of hyperplasia
The development of such an anomaly occurs mainly in women in menopausal age. The main reason most often becomes a large number of estrogens, which affect endometrial cells, activating their excessive division. With the development of this disease, some fragments of the proliferative endometrium acquire a very dense structure. On particularly affected areas, the seal can reach 1.5 cm in thickness. In addition, the formation on the endometrium of a proliferative type of polyps located in the organ cavity is possible.
This type of hyperplasia is considered a precancerous condition and is most often found in women during menopause or in old age. In young girls, this pathology is diagnosed very rarely.
Atypical hyperplasia is a pronounced proliferation of the endometrium, which has adenomatous sources located in the branching glands. Examining the uterus scrapings can detect a large number of tubular epithelium cells. These cells can have both large and small nuclei, in addition, some of them can be stretched. In this case, the tubular epithelium can be both in groups and separately. The analysis also shows the presence of lipids on the walls of the uterus; it is their presence that is an important factor in the diagnosis.
The transition from atypical glandular hyperplasia to oncological disease occurs in 3 women out of 100. This type of hyperplasia is similar to the proliferation of endometrium during a normal monthly cycle, however, there are no decidual cells on the uterine mucosa during the development of the disease. Sometimes the process of atypical hyperplasia can be reversed, however, this is possible only under the influence of hormones.
With the development of proliferative hyperplasia of the endometrium, the following symptoms are observed:
- Menstrual functions of the uterus, which are manifested by bleeding, are impaired.
- There is a deviation in the menstrual cycle, in the form of intense cyclic and prolonged bleeding.
- Metrorrhagia develops - unsystematic and non-cyclical bleeding of varying intensity and duration.
- Bleeding occurs between menstruation or after their delays.
- Breakthrough bleeding with clots is observed.
- The constant occurrence of bleeding provokes the development of anemia, malaise, weakness and frequent dizziness.
- There is an anovulatory cycle that can cause infertility.
Due to the similarity of the clinical picture of glandular hyperplasia with other pathologies, diagnostic measures are of great importance.
Diagnosis of proliferative endometrial hyperplasia is carried out by the following methods:
- Study of the history and complaints of the patient related to the time of onset of bleeding, their duration and frequency. The accompanying symptoms are also being studied.
- Analysis of obstetric and gynecological information that includes heredity, pregnancy, methods of contraception used, past diseases (not only gynecological), operations, diseases transmitted as a result of sexual contact, etc.
- Analysis of information about the beginning of the menstrual cycle (patient's age), its regularity, duration, pain and profusion.
- Conducting bimanual vaginal examination by a gynecologist.
- Fetal gynecological smear and its microscopy.
- Appointment of transvaginal ultrasound, which determines the thickness of the uterine mucosa and the presence of proliferative endometrial polyps.
- Ultrasound determination of the need for endometrial biopsy for diagnosis.
- Separate curettage with a hysteroscope, scraping or completely removing the pathological endometrium.
- Histological examination of scrapings to determine the type of hyperplasia.
Therapy of glandular hyperplasia is carried out by various methods. It can be both operational and conservative.
Surgical treatment of the pathology of the proliferative type of the endometrium provides for the complete removal of areas subjected to deformation:
- Scraping of diseased cells from the uterus is done.
- Surgical intervention using hysteroscopy.
Surgical intervention is provided in the following cases:
- the age of the patient allows you to perform the reproductive function of the body,
- a woman is "on the threshold" of menopause,
- in cases of heavy bleeding,
- after the proliferative type of glandular polyps is detected on the endometrium
The scraping materials are sent for histological analysis. According to its results and in the absence of other diseases, the doctor may prescribe conservative therapy.
This therapy provides for certain methods of influence on the pathology. Hormone therapy:
- Oral hormonal combined contraceptives are prescribed, which should be taken 6 months.
- A woman takes pure gestagens (progesterone drugs) that help reduce the body's release of sex hormones. These drugs should be taken 3-6 months.
- A progestogen-containing intrauterine device is inserted, which acts on the endometrial cells in the body of the uterus. The validity of such a spiral is up to 5 years.
- The prescription of hormones intended for women over 35 years old also has a positive effect on treatment.
Therapy aimed at general strengthening of the body:
- Reception of vitamins and minerals.
- Iron supplementation.
- The appointment of sedative drugs.
- Conducting physiotherapy procedures (electrophoresis, acupuncture, etc.).
In addition, to improve the general condition of patients with overweight develop a therapeutic diet, as well as activities aimed at the physical strengthening of the body.
Measures to prevent the development of proliferative endometrial hyperplasia may be as follows:
- regular examination by a gynecologist (twice a year),
- going through preparatory courses during pregnancy,
- selection of suitable contraceptives
- prompt access to a doctor if any abnormalities occur in the work of the pelvic organs.
- stopping smoking, alcohol and other bad habits,
- regular exercise,
- healthy food
- careful monitoring of personal hygiene,
- taking hormonal drugs only after consulting a specialist,
- avoid abortion procedures, using the necessary contraception,
- annually undergo a full examination of the body and if a deviation from the norm is detected, immediately consult a doctor.
To avoid recurrence of proliferative endometrial hyperplasia, it is necessary to:
- regularly consult a gynecologist,
- undergo examinations at the gynecologist-endocrinologist,
- consult with a specialist when choosing methods of contraception,
- lead a healthy lifestyle.
The prognosis of the development and treatment of hyperplasia of proliferative endometrial glands is directly dependent on the timely detection and treatment of pathology. Turning to the doctor in the early stages of the disease, a woman has a high chance of being completely cured.
Nevertheless, infertility can be one of the most serious complications of hyperplasia. The reason for this is the failure of hormonal levels, leading to the disappearance of ovulation. To prevent this, timely diagnosis of the disease and effective therapy will help.
Very often there are cases of recurrence of this disease. Therefore, a woman should regularly visit a gynecologist to conduct an examination and follow all his recommendations.
Features of the proliferation of the endometrium
For successful fertilization and trouble-free pregnancy, cyclical changes in the uterus must be consistent with normal values. In cases where there is an atypical structure of the endometrium, pathological abnormalities are possible.
It is very difficult to learn about the unhealthy state of the uterine lining by symptoms and manifestations. Doctors will help in this, but in order to make it easier to understand what endometrial proliferation is and how tissue proliferation affects health, it is necessary to understand the features of cyclic changes.
Endometrium consists of functional and basal layers. The latter is a tight-fitting cellular particles, infused with numerous blood vessels. Its main function is to restore the functional layer, which, if fertilization failed, exfoliates and is excreted with blood.
The uterus after menstruation is self-cleaning, and the mucosa during this period has a smooth, thin, even structure.
The standard menstrual cycle can be divided into 3 stages:
- Bleeding (monthly).
At each of these stages there is a certain rate of endometrial thickness. More information is recommended to read in our article.
In this order of natural changes, proliferation comes first. 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 by active division multiply, which leads to the growth of tissues. The inner layer of the uterus can increase up to 16 mm. This is the normal structure of the proliferative endometrial layer. Such thickening contributes to the attachment of the embryo to the villi of the uterine layer, after which ovulation occurs, and the uterine mucosa enters the secretion phase in the endometrium.
If conception has occurred, the corpus luteum is implanted in the uterus. With a failed pregnancy, the embryo stops functioning, the level of hormones decreases, menstruation begins.
Normally, the stages of the cycle follow each other exactly in this sequence, but sometimes fails occur in this process. For various reasons, proliferation may not stop, that is, after 2 weeks, cell division will continue unchecked, and the endometrium will grow. Too dense and thick inner layer of the uterus often leads to problems with conception and the development of serious diseases.
Glandular hyperplasia of the endometrium
The high activity of proliferative processes and intensive cell division increases the volume and structure of the uterine lining. With pathological growth and thickening of glandular tissues, doctors diagnose glandular hyperplasia. The main cause of the development of the disease are hormonal disorders.
There are no typical symptoms of glandular hyperplasia. Manifesting signs characteristic of many gynecological diseases. Most women’s complaints are related to conditions during menstruation and after menstruation. The cycle is changing and different from the previous ones. Abundant bleeding accompanied by pain and contain clots. Often the discharge goes out of cycle, leading to anemia. Serious blood loss causes weakness, dizziness and weight loss.
The peculiarity of this form of endometrial hyperplasia is that the newly formed particles do not divide. Pathology rarely transforms into a malignant tumor. Nevertheless, this type of disease is characterized by growth indomitability and loss of function typical of tumor formations.
Atypical hyperplasia refers to intrauterine diseases that are associated with endometrial hypoplastic processes. Basically, the disease is detected in women after 45 years. Every third out of 100 pathology develops into a malignant tumor.
In most cases, this type of hyperplasia develops due to hormonal disruptions that activate proliferation. Uncontrolled division of cells with impaired structure leads to the proliferation of the uterine layer. In atypical hyperplasia, the secretory phase is absent, as the size and thickness of the endometrium continues to grow. This leads to long, painful and heavy menstruation.
Severe atypia refers to dangerous states of the endometrium. There is not only active reproduction of cells, the structure and structure of the epithelium of the nucleus changes.
Atypical hyperplasia can develop in the basal, functional, and simultaneously in both layers of the mucous membrane. The latter option is considered the most severe, since the likelihood of developing cancer is high.
Endometrial proliferation phases
It is usually difficult for women to understand what is the phase of proliferation of the endometrium and as a violation of the sequence of stages associated with health. To understand the question helps the knowledge of the structure of the endometrium.
The mucosa consists of the main substance, glandular layer, connective tissue (stroma) and numerous blood vessels. From about the 5th day of the cycle, when proliferation begins, the structure of each of the components changes. The whole period lasts about 2 weeks and is divided into 3 phases: early, medium, late. Each of the stages of proliferation manifests itself differently and takes a certain time. The correct sequence is considered normal. If at least one of the phases is missing or there is a failure in its course, the probability of developing pathologies in the membrane inside the uterus is very high.
The early stage of proliferation is the 1st to 7th day of the cycle. The mucous membrane of the uterus during this period begins to change gradually and is characterized by the following structural tissue transformations:
- the endometrium is lined with a cylindrical epithelial layer,
- blood vessels are straight,
- glands are dense, thin, straight,
- cell nuclei are saturated red and oval,
- stroma oblong, fusiform shape.
- endometrial thickness in the early polyferative phase - 2-3 mm.
The middle stage of the proliferative endometrium is the shortest, usually the 8–10th day of the menstrual cycle. Форма матки меняется, происходят заметные изменения в форме и структуре других элементов слизистой:
- the epithelial layer is lined with cylindrical cells,
- pale kernels
- glands elongated and bent,
- connective tissue loose structure
- endometrial thickness continues to grow and reaches 6-7 mm.
On the 11–14th day of the cycle (late stage), cells inside the vagina increase in volume and swell. Significant changes occur with the uterine membrane:
- the epithelial layer is high and multi-layered,
- part of the glands lengthens and has a wavy shape,
- the vascular grid is sinuous,
- cell nuclei increase in size and have a rounded shape,
- endometrial thickness in the late proliferative phase reaches 9–13 mm.
All of these stages are closely related to the secretion phase and must comply with the norms of the norm.
Causes of Uterine Cancer
Cancer of the body of the uterus belongs to the most dangerous pathology of the proliferative period. In the early stages, this type of disease is asymptomatic. The first signs of the disease include abundant mucous discharge. Over time, signs such as abdominal pain, uterine bleeding with endometrial fragments, frequent urination, weakness appear.
The incidence of cancer increases with the advent of anovulatory cycles characteristic of the age of 45 years. In premenopausal ovaries still secrete follicles, but they rarely mature. Ovulation does not occur, respectively, the yellow body is not formed. This leads to hormonal imbalance - the most common cause of cancer.
In the risk group there are women who have not had pregnancy and childbirth, as well as those with obesity, diabetes, metabolic and endocrine disorders. Background diseases that cause cancer of the body of the reproductive organ are polyps in the uterus, endometrial hyperplasia, myoma, polycystic ovary.
Diagnosis of oncology complicates the condition of the uterine wall in cancer lesions. The endometrium becomes loose, the fibers are arranged in different directions, the muscle tissue is weakened. The boundaries of the uterus are blurred, visible polypous growths.
Regardless of the stage of the pathological process, endometrial cancer is detected by ultrasound. To determine the presence of metastases and tumor localization, resort to hysteroscopy. In addition, the woman is recommended to undergo a biopsy, x-rays and a series of tests (urine, blood, hemostasis).
Timely diagnosis makes it possible to confirm or exclude the growth of a tumor neoplasm, its nature, size, type and extent of spread to neighboring organs.
Treatment of cancer of the uterus is assigned individually, depending on the stage and form of the disease, as well as the age and general condition of the woman.
Conservative therapy is used only in the initial stages. Women of reproductive age with the revealed disease of the 1st – 2nd stage are given hormonal therapy. During the course of treatment should be regularly tested. So doctors track the state of the cell nucleus, changes in the structure of the uterine mucosa and the dynamics of the disease.
The most effective method is the removal of the affected uterus (partial or complete). To eliminate single pathological cells after surgery, a course of radiation or chemical therapy is prescribed. In cases of rapid growth of the endometrium and a rapid increase in cancer, doctors remove the genital organ, ovaries and appendages.
With early diagnosis and timely treatment, any of the therapeutic methods gives positive results and increases the chances of recovery.
What it is? The proliferative phase is the stage of active cell division of any tissue (while its activity does not exceed the normal, that is, it is not pathological). As a result of this process, tissues are restored, regenerated, expanded. During division, normal, non-typical cells appear, from which healthy tissue is formed, in this case, the endometrium.
But in the case of endometrium, this is the process of actively increasing the mucous membrane, its thickening. Such a process can be caused both by natural causes (phase of the menstrual cycle) and pathological ones.
It should be noted that proliferation is a term applicable not only to the endometrium, but also to some other tissues in the body.
The proliferative endometrium often appears because during the menstruation many cells of the functional (renewed) part of the endometrium were rejected. As a result, he significantly thinned. Features of the cycle are such that for the onset of the next menstruation, this mucous layer must restore its thickness of the functional layer, otherwise there will be nothing to be updated. This is what happens in the proliferative stage.
In some cases, such a process can be caused by pathological changes. In particular, endometrial hyperplasia (a disease capable, without appropriate treatment, to lead to infertility), is also characterized by enhanced cell division, leading to a thickening of the endometrial functional layer.
The secretion phase occurs almost immediately after proliferation (or after 1 day) and is inextricably linked with it. It also distinguishes a number of stages - early, middle and late. They are characterized by a number of typical changes that prepare the endometrium and the body as a whole for the menstrual phase. The endometrium of the secretory type is dense, smooth, and this applies both to the basal and functional layers.
This stage lasts from about the fifteenth to the eighteenth day of the cycle. It is characterized by a weak expression of secretion. At this stage, it is just starting to develop.
At this stage, secretion proceeds as actively as possible, especially in the middle of the phase. A slight extinction of the secretory function is observed only at the very end of this stage. It lasts from the twentieth to the twenty third day
For the late stage of the secretion phase, a gradual extinction of the secretory function is characteristic, with complete disappearance at zero at the very end of this stage, after which the woman begins menstruation. This process lasts 2-3 days from the twenty-fourth to the twenty-eighth day. It is worth noting a feature characteristic of all stages - they last for 2-3 days, while the exact duration depends on how many days in the menstrual cycle of a particular patient.
Endometrium in the phase of proliferation is very actively expanding, its cells divide under the action of various hormones. Potentially, this condition is dangerous by the development of various types of diseases associated with abnormal cell division - neoplasms, tissue overgrowth, etc. Some kind of malfunction may occur in the process of passing the stages to the development of pathologies of this type. At the same time, the secretory endometrium is almost completely unaffected.
The most typical disease that develops as a result of violation of the proliferation phase of the mucous membrane is hyperplasia. This is a condition of endometrial abnormal growth. The disease is quite serious and requires timely treatment, as it causes severe symptoms (bleeding, pain) and can lead to complete or partial infertility. The percentage of cases of its reincarnation in oncology, however, is very low.
There is hyperplasia in cases of disturbances in the hormonal regulation of the fission process. As a result, cells divide longer and more actively. The mucous layer is significantly thickened.
Why is the inhibition of proliferation processes?
The inhibition of the processes of proliferation of the endometrium is a process, also known as insufficiency of the second phase of the menstrual cycle, characterized by the fact that the proliferation process is not active enough or not at all. This is a symptom of menopause, ovarian failure and lack of ovulation.
The process is natural and helps predict the onset of menopause. But it can also be pathological if it develops in a woman of reproductive age, this suggests a hormonal imbalance that needs to be corrected, since it can lead to dysmenorrhea and sterility.
Endometrial proliferation: what is it
In order to understand this process, it is necessary to study the anatomy and physiology of the female body. In the uterine mucosa throughout the entire cycle cyclical changes occur. These changes primarily concern the endometrium. Endometrium plays a significant role in the functioning of the uterus.
The role of the endometrium in the reproductive function of women
The structure of the endometrial layer is quite complex. The structure of the endometrium includes such structures:
- Ferrous and outer layer of epithelium,
- Main substance
- Vascular bed.
The main function of the endometrium is to ensure the implantation of the embryo and its further successful development. Endometrium contributes to normal homeostasis in the uterus, which ensures the normal functioning of the fetus. The proliferation of the endometrium leads to the growth of the vascular bed, which improves the blood supply to the fetus. These vascular structures will subsequently become part of the placenta.
During the whole month, cyclical changes occur in the uterus. They include the following stages:
- Stage of proliferation,
- Pre-secretory stage
- Sector stage,
- Stage of menstrual flow.
In order to correctly assess the cyclic changes of the endometrium, the cycle duration and its clinical features (the presence of dysfunctional uterine secretions, the duration of the secretion phase, the volume of menstrual bleeding during the month) should be taken into account.
Early stage of endometrial proliferation
Early proliferation of the endometrium accounts for 5-7 days of the menstrual cycle. This phase is histologically characterized by the fact that a cubic epithelium is located on the mucosal surface, the glands of the inner layer of the uterus are rectangular tubes with a narrow lumen. When conducting a cross section, the glands that are in the early stage of proliferation have the form of oval or rounded structures. In this case, the endometrium consists of a prismatic epithelium. At the early stage of proliferation, the epithelium has a small height, the cells contain oval nuclei, which are localized in the basal part of the cells. At the same time they have an intense color. For the early stage of proliferation, it is characteristic that the stroma includes spindle-shaped cells with large nuclei. At the same time, arteries are distinguished by spiral crimps.
Middle stage endometrial proliferation
The endometrium of the middle phase of proliferation is observed on the 8-10th day of the menstrual cycle. The development of a high prismatic epithelium is detected on the mucosal surface, the endometrial fragments of the proliferation phase in the middle stage are characterized by a slight development of the glands. In the nuclei of cells can be noted the presence of multiple mitoses. The middle stage of proliferation of the endometrium is characterized by the presence of the apical part of the mucous rim. The stroma has an edematous loosened structure.
Endometrium late phase proliferation phase
Late proliferation of the endometrium is observed on the 11-14 day of the cycle. Endometrium of the late phase of proliferation is characterized by the fact that the glands acquire a tortuous shape. The glands have a wide lumen, and their nuclei are at different levels. In the basal divisions, small-diameter vacuoles may appear, which contain glycogen. Endometrial late-stage proliferation differs juicy stroma with large nuclei. At the same time, the nuclei acquire a rounded shape and a less intense color. The stroma is juicy, the nuclei are enlarged, rounded and less intensely stained. Fragments of the endometrial proliferation phase at a later stage have convoluted vessels.
How to diagnose endometrial fragments of the proliferation phase
One of the most informative methods for diagnosing proliferative changes in the endometrium is hysteroscopy with a biopsy. Each phase of the menstrual cycle is characterized by its own histological picture. Histologically, the early stage of proliferation of the endometrium is characterized by the presence of thin pink epithelium. There are areas with foci of hemorrhage and shell fragments that have not been rejected.
Histologically, the middle stage of endometrial proliferation differs from the early one in that the number of mitoses increases significantly at this stage. Also, there are single vessels with thinned walls.
Histologically, late proliferation of the endometrium is characterized by a thickening of the endometrial functional layer. At this stage there is no division into zones of division.
The structural structure of the endometrium consists of two main layers - the basal and functional. The basal layer is not very susceptible to change, as it is intended to restore the functional layer during the subsequent cycle. Its structure is tightly pressed to each other cells, pierced with multiple blood vessels. Normally, the basal layer is in the range of 1–1.5 cm. The functional layer, on the contrary, changes regularly. This is due to damage occurring during menstruation, childbirth, from surgical interventions during abortions and diagnostic procedures. There are several main phases of the cycle: proliferative, menstrual, secretory and pre-secretory. These alternations should occur regularly and in accordance with the functions that are necessary for the female body in each specific period.
Normal endometrial structure
At different phases of the cycle, the state of the endometrium in the uterus is different. For example, by the end of the proliferation period, the basal mucous layer increases to 2 cm and hardly reacts to hormonal effects. In the initial period of the cycle, the mucous membrane of the uterus is pink, smooth, with small areas of incompletely separated functional layer formed in the last cycle. Over the next week there is a proliferation of the endometrium of the proliferative type, caused by cell division.
Blood vessels are hidden in the folds caused by the unevenly thickened layer of the endometrium. The largest layering of the mucous membranes in the proliferative endometrium is observed on the back wall of the uterus and its bottom, while the front wall and part of the children's place at the bottom remains almost unchanged. The mucosa in this period can reach a thickness of 12 mm. Ideally, by the end of the cycle, the functional layer should be completely rejected, but this usually does not happen and rejection occurs only on the outer sections.
Forms of deviation of the endometrial structure from the norm
Differences in the thickness of the endometrium from normal values occur in two cases - for functional reasons and as a result of pathology. Functional is manifested in the early gestational age, a week after the fertilization process of the egg, at which there is a thickening of the children's place.
Pathological causes are due to impaired division of the right cells, resulting in excessive tissue, leading to the formation of tumor formations, for example, endometrial hyperplasia resulting from hormonal failure. Hyperplasia can be attributed to several types:
- ferrous, with no clear separation between the functional and basal layers, with an increased number of glands of various shapes,
- glandular cystic form, in which cysts form part of the glands,
- focal, with proliferation of epithelial tissue and the formation of polyps,
- atypical, characterized by a modified structure in the structure of the endometrium with a decrease in the number of connecting cells.
The focal form of atypical hyperplasia is dangerous and can develop into a cancer of the uterus. Most often, this pathology occurs in women during menopause.
Stages of endometrial development
During the menstrual period, most of the endometrium dies off, but almost simultaneously with the onset of menstruation, its recovery begins with cell division, and after 5 days the structure of the endometrium is considered completely renewed, although it continues to be thin.
The proliferative stage goes through 2 cycles - the early phase and the late phase. The endometrium during this period is able to grow and from the onset of menstruation until the completion of ovulation, its layer increases 10 times. During the first stage, the membrane inside the uterus is covered with a cylindrical low epithelium with tubular glands. With the passage of the second cycle of the proliferative endometrium type is covered with a higher layer of epithelium, and the glands in it lengthen and become wavy. During the presector stage, endometrial glands change their shape and increase in size. The structure of the mucosa becomes saccular with large glandular cells that produce mucus.
The secretory stage of the endometrium is characterized by a dense and smooth surface and basalt layers that are not active.
Important! The endometrial stage of proliferative type coincides with the period of formation and development of follicles.
Every month, changes occur in the body, intended for the moment of the onset of pregnancy and the period of the beginning of gestation. Промежуток времени между этими событиями получил название менструального цикла. Гистероскопическое состояние эндометрия пролиферативного типа зависит от дня цикла, например, в начальном периоде он ровный и достаточно тонкий.The late period makes significant changes in the structure of the endometrium, it is thickened, has a bright pinkish color with a white tinge. In this period of proliferation, it is recommended to examine the mouth of the fallopian tubes.
Forms of hyperplasia
Glandular manifestation of hyperplasia in women occurs at an older age, during periods of menopause and after it. In hyperplasia, the endometrium has a thickened structure and polyps formed in the uterus, protruding into it. Epithelial cells with this disease are larger than normal cells. When glandular hyperplasia similar formations are grouped or form glandular structures. It is important that such a form does not further divide the cells formed and, as a rule, rarely takes a malignant direction.
Atypical form refers to precancerous conditions. In youth, it does not occur and manifests itself in the period of menopause in older women. During the examination it is possible to notice an increase in the cells of the cylindrical epithelium having large nuclei and small nucleoli. Also revealed lighter cells with lipids, the number of which is directly related to the prognosis and outcome of the disease. Atypical glandular hyperplasia takes on a malignant form in 2-3% of women. In some cases, it may begin to reverse development, but this happens only during treatment with the use of hormonal drugs.
Endometrial hyperplasia, occurring without major changes in the structure of the mucous, is usually treatable. To do this, conduct a study with the use of diagnostic curettage, after which the samples of mucous tissues are sent to the laboratory for analysis. If an atypical course has been diagnosed, surgery is performed with curettage. If it is necessary to preserve reproductive functions and preserve the abilities to conceive after curettage, the patient will have to take hormonal preparations with progestins for a long time. After the disappearance of pathological disorders in women most often begins pregnancy.
Proliferation always means intensive growth of cells that, having the same nature, begin simultaneous development in one place, that is, locally located. In female cyclic functions, proliferation occurs with regularity and throughout life. During menstruation, the endometrium is rejected, and then it is restored by cell division. Women who have any abnormalities in reproductive functions or pathologies found should consider the phase of proliferation in which the endometrium is located during an ultrasound examination or during diagnostic uterus scrapings. Since in different periods of the cycle, these figures may differ significantly from each other.
What structure is normal
The condition of the endometrium in the uterus depends on the phase of the menstrual cycle. When the time of proliferation comes to an end, the main layer reaches 20 mm, and is almost immune to the influence of hormones. When the cycle is just beginning, the endometrium is smooth, pinkish. With focal areas not separated the active layer of the endometrium remaining from previous menstruation. Over the next seven days, the proliferative endometrial membrane is gradually thickened due to active cell division. Vessels become smaller, they hide behind grooves that appear due to inhomogeneous thickening of the endometrium. The mucous membrane on the posterior uterine wall, at the bottom, is thicker. On the contrary, the “baby seat” and the anterior uterine wall changes minimally. The mucous layer is about 1, 2 centimeters. When the menstrual cycle is completed, the normal endometrial cover is normally rejected completely, but usually only part of the layer is rejected in some areas.
Forms of deviation from the norm
Disruption of the normal thickness of the endometrium occurs either for a natural reason, or have a pathological nature. For example, in the first seven days after fertilization, the thickness of the endometrial cover changes - the children's place becomes thicker. In pathology, endometrial thickening occurs during abnormal cell division. As a result, an extra mucous layer appears.
What is the proliferation of the endometrium
Proliferation is a phase of rapid cell division in the tissues, not exceeding the standard values. During this process, the mucous is regenerated and expands. New cells are not atypical type, they form normal tissue. Proliferation is a process not only characteristic of the endometrium. Some other tissues also undergo the process of proliferation.
The reason for the appearance of the proliferative endometrium type, due to the active rejection of the active layer of the uterine mucosa. After that, it becomes very thin. And should be regenerated before the next menstruation. The active layer is renewed during proliferation. Sometimes, it has pathological causes. For example, the proliferation process occurs with endometrial hyperplasia. (If you do not treat hyperplasia, then this makes it difficult to get pregnant). With hyperplasia, active cell division occurs, and the active layer of the mucous membrane of the uterus thickens.
Why proliferation slows down
The inhibition of the processes of proliferation of the endometrium or the insufficiency of the second stage of the menstrual cycle is distinguished by the fact that cell division stops or goes much slower than usual. These are the main symptoms of impending menopause, ovarian deactivation and cessation of ovulation. This is a normal phenomenon, characteristic before menopause. But, if inhibition occurs in a young woman, then this is a sign of hormonal instability. This pathological phenomenon must be treated, it leads to the termination of the menstrual cycle ahead of time and the inability to become pregnant.
Purpose and structure of the endometrium
According to the structure of the endometrium can be divided into two layers: basal and functional.
The peculiarity of the first layer is that it almost does not change and is the basis for the regeneration of the functional layer in the next menstrual period.
The layer consists of cells closely adjacent to one another, connecting tissues (stroma), supplied with glands and a large number of branched blood vessels. In the normal state, its thickness varies from one to one and a half centimeters.
In contrast, the basal functional layer is constantly experiencing changes. This is due to damage to its integrity as a result of exfoliation during blood flow during menstruation, childbirth, artificial abortion, curettage during diagnosis.
Endometrium is designed to perform several functions, the main of which is to provide the necessary conditions for the onset and successful pregnancy, when the number of glands and blood vessels in the placenta structure increases. One of the purposes of the children's place is to supply the embryo with nutrients and oxygen. Another function is to prevent sticking of the opposite walls of the uterus.
Phases of the menstrual cycle
In the female body changes occur every month, during which favorable conditions for conception and bearing are created. The period between them is called the menstrual cycle and lasts from 20 to 30 days. The beginning of the cycle is the first day of menstruation.
Any abnormalities that occurred during this period indicate the presence of any irregularities in the woman’s body. The cycle is divided into three phases:
Proliferation - the process of cell reproduction by division, leading to the growth of body tissues. Endometrial proliferation is an increase in the tissues of the mucous membrane inside the uterus as a result of the division of normal cells. The phenomenon can occur as part of the menstrual cycle, and have a pathological origin.
The duration of the proliferation phase is about 2 weeks. The changes that occur in the endometrium during this period are due to an increase in the number of the hormone estrogen, which is produced by the maturing follicle. This phase includes three stages: early, middle and late.
For the early stage, which lasts from 5 days to 1 week, the following is characteristic: the surface of the endometrium is covered with cylindrical epithelial cells, the glands of the mucous layer resemble straight tubules; , have an oval shape and intense color. Cells connecting tissues (stroma) of spindle shape with large nuclei. The blood arteries are almost not tortured.
The middle stage, which starts on the eighth - tenth day, is inherent in the fact that the mucosal plane is covered with high epithelial cells of a prismatic appearance.
The glands take a slightly twisted shape. Kernels lose their color, increase in size, are at different levels. A large number of cells obtained by indirect division appear. The stroma becomes loose and edematous.
For the late stage, which lasts from day 11 to day 14, it is characteristic that the glands become tortuous, the nuclei of all cells are at different levels. The epithelium is single-layered, but with multiple rows. In some cells, small vacuoles appear that contain glycogen. Vessels become winding. The nuclei of cells take a more rounded shape and greatly increase in size. Strom poured.
The secretory phase of the cycle is divided into stages:
- early, lasting from 15 to 18 day of the cycle,
- average, with the most pronounced secretion, occurring from 20 to 23 days,
- late (fading secretion), coming from 24 to 27 days.
The menstrual phase consists of two periods:
- desquamation occurring from the 28th to the 2nd day of the cycle and occurring in the event that fertilization did not occur,
- regeneration, which lasts from 3 to 4 days and begins before the complete separation of the functional layer of the endometrium, but together with the beginning of the growth of epithelial cells of the proliferation phase.
The normal structure of the endometrium
With the help of hysteroscopy (examination of the uterine cavity), it is possible to assess the structure of the glands, to assess the degree of occurrence of new blood vessels in the endometrium, to determine the thickness of the cell layer. In different phases of the menstrual period, the results of examinations differ from each other.
Normally, the basal layer has a thickness of from 1 to 1.5 cm, but may increase to 2 cm at the end of the proliferation phase. On the hormonal effects of his reaction is weak.
During the first week, the inner mucous surface of the uterus is smooth, painted in a light pink color, with small particles of the unseparated functional layer of the last cycle.
In the second week, there is a proliferation of the endometrium of the proliferative type associated with the active division of healthy cells.
It becomes impossible to view the blood vessels. Due to the uneven thickening of the endometrium, folds appear on the inner walls of the uterus. In the proliferation phase, the back wall and the bottom normally have the thickest mucous layering, and the anterior wall and the lower part of the children's place are the thinnest. The thickness of the functional layer ranges from five to twelve millimeters.
Normal, there should be a complete rejection of the functional layer almost to the basal. In reality, a complete separation does not occur, only external areas are rejected. If there are no clinical disorders of the menstruation phase, then it is an individual norm.
Deviations from the norm
The discrepancy between the thickness of the endometrium and indicators of the norm can appear for two reasons: functional and pathological. The functional reason is the beginning of pregnancy, when there is an increase in the thickness of the inner surface of the baby. Such a change occurs a week after the onset of fertilization of the egg.
The pathological cause is the failure of the cell division process, which results in an excessive amount of new tissue. This excess leads to the appearance of tumors, an example of which is endometrial hyperplasia. It appears due to hormonal disruption in menstruation.
There are several types of hyperplasia:
- ferrous (the boundary between the basal and functional layers is absent, the number of glands is growing, their forms are different),
- glandular cystic (some glands become cystic),
- focal (tissues grow with integumentary and glandular epithelium, glandular and fibrous polyps are formed),
- atypical (the structure of the endometrium changes, the number of connective cells decreases).
Glandular and glandular-cystic hyperplasia rarely leads to malignant tumors. The latter two types are the most dangerous and threaten with oncology, they can often develop into uterine cancer.
Most often this pathology occurs in the proliferative phase of the endometrium, women in menopausal age (over fifty years old) suffer from it.
Endometrium - what is it? This term refers to the mucous layer lining the internal uterine surface. This layer has a complex structural structure, which includes the following fragments:
- glandular epithelial layer,
- main substance
- blood vessels.
Endometrium performs important functions in the female body. It is the mucous uterine layer that is responsible for the attachment of the ovum and the onset of a successful pregnancy. After conception, blood endometrial vessels provide the fetus with oxygen and essential nutrients.
Endometrial proliferation contributes to the growth of the vascular bed for the normal blood supply to the embryo and the formation of the placenta. During the menstrual cycle, a series of cyclic changes occur in the uterus, divided into the following successive stages:
- Endometrium in the proliferation phase — characterized by intensive growth due to reproduction of cellular structures through their active division. In the proliferation phase, the endometrium grows, which can be both a completely normal physiological phenomenon, part of the menstrual cycle, and a sign of dangerous pathological processes.
- Secretion phase - at this stage the endometrial layer is prepared for the menstrual phase.
- The menstrual phase, endometrial desquamation - desquamation, rejection of the enlarged endometrial layer and its removal from the body with menstrual blood.
For an adequate assessment of cyclic changes of the endometrium and how well its condition is normal, factors such as the duration of the menstrual cycle, the stage of proliferation and the secret period, the presence or absence of uterine bleeding of a dysfunctional nature must be taken into account.
Endometrial proliferation phases
The process of endometrial proliferation includes several successive stages, which corresponds to the concept of the norm. The absence of one of the phases or failures in its course can mean the development of a pathological process. The whole period takes two weeks. During this cycle, follicles mature, stimulating the secretion of the hormone estrogen, under the action of which the growth of the endometrial uterine layer takes place.
The following stages of the proliferation phase are distinguished:
- Early - lasts from 1 to 7 days of the menstrual cycle. At the early stage of the phase, the mucous membrane of the uterus changes. Epithelial cells are present on the endometrium. The blood arteries practically do not coil, and the stromal cells have a specific shape resembling a spindle.
- Medium - a short phase that occurs between the 8th and 10th days of the menstrual cycle. The endometrial layer is characterized by the formation of certain cellular structures formed during indirect division.
- The late stage continues from the 11th to the 14th day of the cycle. The endometrium is covered with convoluted glands, the epithelium is multi-layered, the cell nuclei have a rounded shape and large size.
The stages listed above must meet the established criteria of the norm, and they are inextricably linked with the secretory phase.
Endometrial secretion phases
Secretory endometrium differs in density and smoothness. Secretory transformation of the endometrium begins immediately after the completion of the proliferation stage.
Experts identify the following stages of secretion of the endometrial layer:
- Early stage - observed from 15 to 18 days of the menstrual cycle. At this stage, the secretion is very weak, the process is just beginning to develop.
- The middle stage of the secretion phase - runs from 21 to 23 days of the cycle. This phase is characterized by increased secretion. Slight suppression of the process is noted only at the completion of the stage.
- Late - for the late stage of the secretion phase, the suppression of the secretory function is typical, which reaches its peak at the onset of menstruation, after which the process of reverse development of the endometrial uterine layer begins. The late phase is observed in the period from 24-28 days of the menstrual cycle.
Danger of suppressing proliferation
Торможение пролиферативных процессов эндометриального слоя — довольно распространенное явление, характерное для климактерического периода и угасания яичниковых функций.
У пациенток репродуктивного возраста данная патология чревата развитием гипоплазии и дисменореи. During the processes of hypoplastic nature, the mucous uterine layer is thinning, as a result of which the fertilized egg cannot normally fix in the wall of the uterus, and pregnancy does not occur. The disease develops against the background of hormonal disorders and requires adequate, timely medical care.
A proliferative endometrium is an expanding mucous uterine layer, it may be a manifestation of the norm or a sign of dangerous pathologies. Proliferation is characteristic of the female body. During the period of menstruation, the endometrial layer is rejected, after which it is gradually restored by active cell division.
For patients with impaired reproductive functions, it is important to consider the stage of endometrial development when conducting diagnostic examinations, since in different periods the indicators may have significant differences.