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Endometrium
Illu cervix.jpg
Uterus and uterine tubes. (Endometrium labeled at center right.)
Details
Latin tunica mucosa uteri
Identifiers
Gray's p.1262
MeSH A05.360.319.679.490
Dorlands
/Elsevier
Endometrium
TA A09.1.03.027
FMA FMA:17742
Anatomical terminology

The endometrium is the inner mucous membrane of the mammalian uterus.

Structure[edit]

Histology[edit]

High magnification micrograph of decidualized endometrium due to exogenous progesterone (oral contraceptive pill). H&E stain.
Low magnification micrograph of decidualized endometrium. H&E stain.

The endometrium consists of a single layer of columnar epithelium resting on the stroma, a layer of connective tissue that varies in thickness according to hormonal influences. Simple tubular uterine glands reach from the endometrial surface through to the base of the stroma, which also carries a rich blood supply of spiral arteries. In a woman of reproductive age, two layers of endometrium can be distinguished. These two layers occur only in endometrium lining the cavity of the uterus, not in the lining of the uterine (Fallopian) tubes:[1]

  • The functional layer is adjacent to the uterine cavity. This layer is built up after the end of menstruation during the first part of the previous menstrual cycle. Proliferation is induced by estrogen (follicular phase of menstrual cycle), and later changes in this layer are engendered by progesterone from the corpus luteum (luteal phase). It is adapted to provide an optimum environment for the implantation and growth of the embryo. This layer is completely shed during menstruation.
  • The basal layer, adjacent to the myometrium and below the functional layer, is not shed at any time during the menstrual cycle, and from it the functional layer develops.

In the absence of progesterone, the arteries supplying blood to the functional layer constrict, so that cells in that layer become ischaemic and die, leading to menstruation.

It is possible to identify the phase of the menstrual cycle by observing histological differences at each phase:

Phase Days Thickness Epithelium
Menstrual phase 1–4 Thin Absent
Proliferative phase 4–14 Intermediate Columnar
Secretory phase 15–28 Thick Columnar. Also visible are helicine branches of uterine artery

Chorionic tissue can result in marked endometrial changes, known as an Arias-Stella reaction, that have an appearance similar to cancer.[2] Historically, this change was diagnosed as endometrial cancer and it is important only in so far as it should not be misdiagnosed as cancer.

Function[edit]

The endometrium is the innermost glandular layer and functions as a lining for the uterus, preventing adhesions between the opposed walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the menstrual cycle or estrous cycle, the endometrium grows to a thick, blood vessel-rich, glandular tissue layer. This represents an optimal environment for the implantation of a blastocyst upon its arrival in the uterus. The endometrium is central, echogenic (detectable using ultrasound scanners), and has an average thickness of 6.7 mm.

During pregnancy, the glands and blood vessels in the endometrium further increase in size and number. Vascular spaces fuse and become interconnected, forming the placenta, which supplies oxygen and nutrition to the embryo and fetus.

Cycle[edit]

The endometrial lining undergoes cyclic regeneration. Humans and the other great apes display the menstrual cycle, whereas most other mammals are subject to an estrous cycle. In both cases, the endometrium initially proliferates under the influence of estrogen. However, once ovulation occurs, in addition to estrogen, the ovary will also start to produce progesterone. This changes the proliferative pattern of the endometrium to a secretory lining. Eventually, the secretory lining provides a hospitable environment for one or more blastocysts.

If the blastocyst does not implant and provide feedback to the body with human cortico gonadotropin [hCG] and continued feedback through pregnancy with placental progesterone and estrogen, the endometrial lining is either reabsorbed (estrous cycle) or shed (menstrual cycle). In the latter case, the process of shedding involves the breaking down of the lining, the tearing of small connective blood vessels, and the loss of the tissue and blood that had constituted it through the vagina. The entire process occurs over a period of several days. Menstruation may be accompanied by a series of uterine contractions; these help expel the menstrual endometrium.

In case of implantation, however, the endometrial lining is neither absorbed nor shed. Instead, it remains as decidua. The decidua becomes part of the placenta; it provides support and protection for the gestation.

If there is inadequate stimulation of the lining, due to lack of hormones, the endometrium remains thin and inactive. In humans, this will result in amenorrhea, or the absence of a menstrual period. After menopause, the lining is often described as being atrophic. In contrast, endometrium that is chronically exposed to estrogens, but not to progesterone, may become hyperplastic. Long-term use of oral contraceptives with highly potent progestins can also induce endometrial atrophy.[3][4]

In humans, the cycle of building and shedding the endometrial lining lasts an average of 28 days. The endometrium develops at different rates in different mammals. Its formation is sometimes affected by seasons, climate, stress, and other factors. The endometrium itself produces certain hormones at different points along the cycle. This affects other portions of the reproductive system.

Pathology[edit]

  • Asherman's syndrome, also known as intrauterine adhesions occurs when the basal layer of the endometrium is damaged by instrumentation (e.g., D&C) or infection (e.g., endometrial tuberculosis) resulting in endometrial sclerosis and adhesion formation partially or completely obliterating the uterine cavity.

Thin endometrium may be defined as an endometrial thickness of less than 8 mm. It usually occurs after menopause. Treatments that can improve endometrial thickness include Vitamin E, L-arginine and sildenafil citrate.[5]

Gene expression profiling using cDNA microarray can be used for the diagnosis of endometrial disorders.[6] The European Menopause and Andropause Society (EMAS) released Guidelines with detailed information to assess the endometrium. [7]

An endometrial thickness (EMT) of less than 7 mm decreases the pregnancy rate in in vitro fertilization by an odds ratio of approximately 0.4 compared to an EMT of over 7 mm. However, such low thickness rarely occurs, and any routine use of this parameter is regarded as not justified.[8]

Other clinical uses[edit]

Triple-line endometrium measuring 7mm.

Observation of the endometrium by transvaginal ultrasonography is used when administering fertility medication, such as in in vitro fertilization. At the time of embryo transfer, it is favorable to have an endometrium of a thickness of between 7 and 14 mm with a triple-line configuration,[9] which means that the endometrium contains a hyperechoic (usually displayed as light) line in the middle surrounded by two more hypoechoic (darker) lines. A triple-line endometrium reflects the separation of the stratum basalis and functionalis layers, and is also observed in the periovulatory period secondary to rising estradiol levels, and disappears after ovulation.[10]

Additional images[edit]

See also[edit]

References[edit]

  1. ^ Blue Histology - Female Reproductive System. School of Anatomy and Human Biology - The University of Western Australia http://www.lab.anhb.uwa.edu.au/mb140/CorePages/FemaleRepro/FemaleRepro.htm Accessed 20061228 20:35
  2. ^ Arias-Stella, J. (Jan 2002). "The Arias-Stella reaction: facts and fancies four decades after.". Adv Anat Pathol 9 (1): 12–23. doi:10.1097/00125480-200201000-00003. PMID 11756756. 
  3. ^ Deligdisch, L. (1993). "Effects of hormone therapy on the endometrium". Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 6 (1): 94–106. PMID 8426860.  edit
  4. ^ William's Gynecology, McGraw 2008, Chapter 8, Abnormal Uterine Bleeding
  5. ^ Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N (April 2010). "Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium". Fertil. Steril. 93 (6): 1851–8. doi:10.1016/j.fertnstert.2008.12.062. PMID 19200982. 
  6. ^ Tseng, L.; Chen, I.; Chen, M.; Yan, H.; Wang, C.; Lee, C. (2010). "Genome-based expression profiling as a single standardized microarray platform for the diagnosis of endometrial disorder: an array of 126-gene model". Fertility and Sterility 94 (1): 114–119. doi:10.1016/j.fertnstert.2009.01.130. PMID 19328470.  edit
  7. ^ Dreisler E, Poulsen LG, Antonsen SL, Ceausu I, Depypere H, Erel CT, Lambrinoudaki I, Pérez-López FR, Simoncini T, Tremollieres F, Rees M, Ulrich LG. (2013). "EMAS clinical guide: Assessment of the endometrium in peri and postmenopausal women". Maturita 75 (2): 181–90. doi:10.1016/j.maturitas.2013.03.011. PMID 23619009. 
  8. ^ Kasius, A.; Smit, J. G.; Torrance, H. L.; Eijkemans, M. J. C.; Mol, B. W.; Opmeer, B. C.; Broekmans, F. J. M. (2014). "Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis". Human Reproduction Update 20 (4): 530–541. doi:10.1093/humupd/dmu011. ISSN 1355-4786. 
  9. ^ Zhao, Jing; Zhang, Qiong; Li, Yanping (2012). "The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles". Reproductive Biology and Endocrinology 10 (1): 100. doi:10.1186/1477-7827-10-100. ISSN 1477-7827. 
  10. ^ Baerwald, A. R.; Pierson, R. A. (2004). "Endometrial development in association with ovarian follicular waves during the menstrual cycle". Ultrasound in Obstetrics and Gynecology 24 (4): 453–460. doi:10.1002/uog.1123. ISSN 0960-7692. 

External links[edit]


Original courtesy of Wikipedia: http://en.wikipedia.org/wiki/Endometrium — Please support Wikipedia.
This page uses Creative Commons Licensed content from Wikipedia. A portion of the proceeds from advertising on Digplanet goes to supporting Wikipedia.
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3311 news items

UN News Centre

UN News Centre
Wed, 26 Nov 2014 10:00:00 -0800

A high body-mass index is a known risk factor for cancers of the oesophagus, colon, rectum, kidney, pancreas, gall bladder, postmenopausal breast, ovary and endometrium, as well as for other non-communicable diseases, notably cardiovascular disease ...
 
Oncology Nurse Advisor
Wed, 26 Nov 2014 09:15:00 -0800

According to a new study published in the journal The Lancet Oncology, researchers from the International Agency for Research on Cancer have found that nearly half a million new cases of cancer each year are a result of high body mass index (BMI).
 
National Institutes of Health (press release)
Tue, 25 Nov 2014 05:18:45 -0800

In their study, the researchers used a computer-based technology known as machine learning to analyze the gene activity of samples of tissue taken from the endometrium — the inner lining of the uterus. Machine learning allows computers to learn from ...
 
helpmeoutDOC News - A consistent flow of medical news
Wed, 26 Nov 2014 02:07:30 -0800

Obesity has been known as a culprit for heart disease and diabetes, and people with high body mass index (BMI) have a higher risk factor for cancers affecting the esophagus, colon, rectum, kidneys, pancreas, gallbladder, breasts, ovaries and endometrium.

International Business Times, India Edition

International Business Times, India Edition
Wed, 26 Nov 2014 15:37:30 -0800

While obesity in women led to cancers of colon, breast and endometrium; in men it contributed to the development of kidney and colon cancers. Czech Republic (5.5%), Jordan (4.5%), UK (4.4%) and Malta (4.4%) were some of the countries that reported a ...
 
Times of India
Wed, 26 Nov 2014 14:41:15 -0800

It was being used for treating a range of problems like congenital anomalies inside the uterus, in treatment of excessive menstrual bleeding, recurrent abortions, tuberculosis, and cancer of lining of uterus wall (endometrium). It has become a 'see and ...
 
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Tue, 25 Nov 2014 11:41:15 -0800

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Wed, 26 Nov 2014 01:44:44 -0800

BMI (High Body Mass Index) is known to be a threat for cancers that affect the colon, kidneys, breasts, endometrium, ovaries, gallbladder, pancreas and esophagus. The new research, analyzing data from 2012, claims that 3.6 percent of the worldwide ...
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