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The endometrial cycle
After ovulation the corpus luteum secretes both oestrogen and progest and these bring about progestational changes in the endometrium. metrial cells contain specific receptors for progesterone, which are in by oestrogens, therefore progesterone can only act on endometrium has been primed by oestrogen. The cells of the glandular epith show specific changes. Early in this phase their nuclei become p towards the lumina of the glands by sub nuclear vacuoles cont glycogen. Later the secretion is passed out of the cells into the lu . the glands which become filled with debris containing mucus and giy and the cell nuclei take up their former positions near the basement brane. The glands become extremely tortuous and theirepitheliump into their lumina to give a scalloped appearance. Hypertrophy 0 stroma cells continues until they resemble the decidual cells of pre Near the surface in the stratum compactum the stromal cells are cl packed, and the necks of the glands are straight. The deeper s spongiosum is almost entirely composed of convoluted glands ande ately coiled arterioles, with comparatively few stromal cells.
Menstruation
Towards the end of the cycle the concentrations of oestrogen and gesterone fall. There is rapid shrinkage of the thickness of the endom with leucocytic infIltration. Many of the arterioles show intense v striction, and some of the coiled arterioles become kinked as the metrium shrinks so that there is stasis of blood flow in them. From to time some of the arterioles relax, and bleeding occurs throu necrosed walls of vessels in the functional layer of the endomet which leads to its disintegration. The basal layer is not involved in changes and it is not shed with the rest of the endometrium; it is from layer that regeneration takes place. The blood which is shed withfr
of endometrium clots in the uterine cavity, but the coagulum is dis by plasmin before it is discharged through the cervix, unless the ra bleeding is very rapid.
The endometrium, and to a less extent the myometrium, is ab synthesize prostaglandins from arachidonic acid by the action of enzyme cyclo-oxygenase, especially during the luteal phase of the Endometrial production of prostaglandins depends on the leve oestrogen and progesterone, but details of this still need elucida
It is likely that the arteriolar contraction and endometrial ne which has been described in the preceding section is caused by p glandins. Excessive bleeding from the disintegrating endometri prevented by continuing vasoconstriction, myometrial contraction, local aggregation of platelets with deposition of fibrin around Different prostaglandins have different actions (see p. 240), but in II menstruation it is probable that PGFza has the dominant effect.
uteal phase
After ovulation the corpus luteum secretes both oestrogen and progest and these bring about progestational changes in the endometrium. metrial cells contain specific receptors for progesterone, which are in by oestrogens, therefore progesterone can only act on endometrium has been primed by oestrogen. The cells of the glandular epith show specific changes. Early in this phase their nuclei become p towards the lumina of the glands by sub nuclear vacuoles cont glycogen. Later the secretion is passed out of the cells into the lu . the glands which become filled with debris containing mucus and giy and the cell nuclei take up their former positions near the basement brane. The glands become extremely tortuous and theirepitheliump into their lumina to give a scalloped appearance. Hypertrophy 0 stroma cells continues until they resemble the decidual cells of pre Near the surface in the stratum compactum the stromal cells are cl packed, and the necks of the glands are straight. The deeper s spongiosum is almost entirely composed of convoluted glands ande ately coiled arterioles, with comparatively few stromal cells.
Menstruation
Towards the end of the cycle the concentrations of oestrogen and gesterone fall. There is rapid shrinkage of the thickness of the endom with leucocytic infIltration. Many of the arterioles show intense v striction, and some of the coiled arterioles become kinked as the metrium shrinks so that there is stasis of blood flow in them. From to time some of the arterioles relax, and bleeding occurs throu necrosed walls of vessels in the functional layer of the endomet which leads to its disintegration. The basal layer is not involved in changes and it is not shed with the rest of the endometrium; it is from layer that regeneration takes place. The blood which is shed withfr
of endometrium clots in the uterine cavity, but the coagulum is dis by plasmin before it is discharged through the cervix, unless the ra bleeding is very rapid.
The endometrium, and to a less extent the myometrium, is ab synthesize prostaglandins from arachidonic acid by the action of enzyme cyclo-oxygenase, especially during the luteal phase of the Endometrial production of prostaglandins depends on the leve oestrogen and progesterone, but details of this still need elucida
It is likely that the arteriolar contraction and endometrial ne which has been described in the preceding section is caused by p glandins. Excessive bleeding from the disintegrating endometri prevented by continuing vasoconstriction, myometrial contraction, local aggregation of platelets with deposition of fibrin around Different prostaglandins have different actions (see p. 240), but in II menstruation it is probable that PGFza has the dominant effect.
In the case of women who are taking the combined oral contracep . and in some spontaneous cycles, ovulation does not occur but bleeding takes place. Because of inhibition of the pituitary by concentration of oestrogen the secretion of FSH is reduced, the oe concentration then falls, regression of the endometrium takes pia vasoconstriction and necrosis, and withdrawal bleeding occurs in way as in normal menstruation. The endometrium shows no luteal and it is not so completely denuded as in normal menstruation.
Clinical features of menstruation
Menstruation begins (the menarche) at puberty, which normally between the ages of 11 and 15 years, and continues through childbearing period of life, ending at the menopause which usually between the ages of 47 and 53.
The menstrual cycle averages 28 days and as a rule follows a rhythm, but variations of between 21 and 35 days may be acc normal. Irregular and infrequent cycles may occur for a few mon puberty.
Each menstrual period lasts on average 4 to 5 days, but the du the flow and the amount of blood lost vary considerably in . women. It is impossible to defme a standard of normal loss; w average loss over the whole period may be 40 ml (ranging from 80 ml) an increase or prolongation of the usual loss for an indi of more significance than the actual amount. The menstrual flow of partially haemolysed blood, mucus and cellular debris. It is scanty and viscid at fIrst, later becoming bright red, and finally towards the end of the period. Small clots and fragments of endo may be seen, but large clots are only passed when the bleeding is e Normally blood clot is dissolved by plasmin as it is formed in th of the uterus, so that the lochia remains fluid. If the bleeding is h blood passes through the cervix and clots in the vagina, and the time for the enzyme to act on any clot which is formed in the ute
During menstruation uterine contractions cause slight dilatatio cervical canal and expel the menstrual products. The contractions control the loss of blood. Menstruation, especially in younger
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parous women is not infrequently accompanied by painful ute' tractions. Such pain, if it is sufficient to call for medical advice, is de as dysmenorrhoea, and is discussed on p. 246.
Premonitory symptoms, such as pelvic discomfort and ba soreness of the breasts, headache and general malaise, may so precede the period. There may be a gain of weight of 1 kg or more of retention of water and sodium chloride. If these symptoms are s to make the patient seek medical help, they are referred to as menstrual tension syndrome. Treatment is described on p. 249.
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khurram akhtar
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