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    Endometrial dating images

    To ensure a maximum amount of tissue for morphological reading, the specimen should be placed on a piece of lens paper or some other adhesive tissue and then immersed in the fixative.By this means, all of the tissue fragments remain tightly attached to the lens paper, rather than floating in the fixative, and no tissue will be lost for histologic examination.Such a condition, also called irregular shedding, is presumably associated with a persistent corpus luteum from a recent or remote intrauterine or ectopic pregnancy and with relatively increased blood progesterone levels.Because of the stabilizing effect of progesterone on lysosomal enzymes and prostaglandins, menstrual breakdown may be delayed, prolonged, and extensive.Taking an endovaginal ultrasonography of the uterus may solve this dilemma.If the aspirator is 'blocked' at the lower uterine segment (internal os), traction may be applied on the uterus with either a single-toothed tenaculum or preferably an Emmet tenaculum placed about half a centimetre into the anterior endocervical canal. The pathology requisition should contain all pertinent information, including date of last menstrual period.Also, because proliferation precedes the ovulatory period, dating proliferative endometrium gives the clinician no relevant information on whether ovulation is occurring.The daily changes in the endometrium during the postovulatory period were, in the past, considered significant enough from one day to another to provide accurate evaluation of the endometrial cycle.

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    These physiologic variations occur in the preovulatory phase, as tight programming of postovulatory events fixes the postovulatory interval at about 14 days.

    Because of this interplay of structure, function, and ovarian hormonal stimuli, the endometrium is considered one of the most sensitive indicators of the hypothalamic-pituitary-ovarian hormonal axis. Estradiol promotes endometrial proliferation, whereas after ovulation, progesterone converts estradiol-primed endometrium into secretory tissue.

    As a result, morphologic evaluation of the endometrium is used in diagnostic evaluation of infertile patients to determine whether ovulation is occurring (Fig. Postovulatory estradiol amplifies the progesterone effect, and after withdrawal of both estradiol and progesterone, the endometrial mucosa breaks down and regenerates within the period of menstruation.

    Morphologically, the endometrium is one of the most dynamic target tissues in women.

    Its cyclic structural changes mirror changes in metabolic functions, and both are regulated by ovarian estradiol and progesterone. Schematic representation of steroid hormone-morphologic interactions during the endometrial cycle.

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