Hysteroscopy is normal
Last reviewed: 23.04.2024
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Hysteroscopic picture in the normal menstrual cycle and during the postmenopause
Endometrium in the proliferation phase. The hysteroscopic picture of the endometrium in the proliferation phase depends on the day of the menstrual-ovarian cycle. In the phase of early proliferation (before the 7th day of the cycle), the endometrium is thin, even, pale pink in color, small hemorrhages are visible in some areas, single unrebelled areas of the pale pink endometrium are visible. The mouth of the fallopian tubes is easily examined by a telescope with a viewing angle of 30 °. As the telescope approaches the mouth, the image increases; since the pressure on the mouth increases, it then opens, then closes. In young patients, the bottom of the uterus as it flows into its cavity (bulging) with depressions in the area of corners of the uterus. This is often mistakenly regarded as a saddle or bicornuate uterus. In fact, with the two-horned uterus, the septum usually descends low, and sometimes reaches the region of the internal pharynx. If the telescope immediately hits the right or left side of the cavity, the diagnosis may be erroneous.
Gradually (starting from the 9-10th day of the cycle) the endometrium thickens, becomes more succulent, pale pink, the vessels are not visible. In the phase of late proliferation, the endometrium can be defined in certain areas in the form of thickened folds. You can inspect the ovaries of the fallopian tubes. It is important to note that in the normal menstrual cycle in the proliferation phase, the endometrium can have a different thickness depending on localization: thickened in the bottom and posterior wall of the uterus, thinner on the anterior wall and in the lower third of the uterine body.
2-3 days before menstruation, the endometrium acquires a reddish hue. Due to the pronounced thickening and folding of the endometrium of the orifice of the fallopian tubes, one can not always see it.
In this phase, the endometrium can easily be damaged by a Gegar dilator or hysteroscope, which can lead to bleeding from the endometrium.
If the end end of the hysteroscope is placed close to the endometrium, you can examine the ducts of the glands.
On the eve of menstruation, the appearance of the endometrium can be mistakenly interpreted as a manifestation of the pathology of the endometrium (polypoid hyperplasia) (Figure 5-13). Therefore, the time of hysteroscopy should be recorded for the pathomorphologist.
Endometrium during menstruation. In the first 2-3 days of menstruation, the uterine cavity is filled with a large number of fragments of the endometrium from pale pink to dark purple, especially in the upper third.
In the lower and middle third of the uterine cavity the endometrium is thin, pale pink, with small-point hemorrhages and areas of old hemorrhages. With a full-fledged menstrual cycle, almost complete rejection of the mucous membrane of the uterus occurs by the second day of menstruation, only small fragments of the mucous membrane are determined on individual sites (usually in the womb floor).
Atrophy of the endometrium is normal in postmenopausal women. The mucous membrane is thin, pale, and the ovaries of the fallopian tubes, which have a round or slit shape, are more clearly visible.
Sometimes, through the thin endometrium, varicose veins appear through the veins. Often against the background of atrophy of the endometrium, there are intrauterine synechia, mainly in the area of the uterine tubes and the womb.
Sometimes the cause of the appearance of bloody discharge during the postmenopause may be the rupture of the endometrial vessel against the background of hypertension. In this case, when hysteroscopy against the background of an atrophic, thin, pale endometrium, a hemorrhage site is visible, the size and color of which depends on the size of the ruptured vessel and the time elapsed since the hemorrhage.
Atrophic endometrium has a very characteristic appearance in diabetic patients during the postmenopause. Against the background of a thin endometrium, many small-scale petechial hemorrhages of dark purple and brown color (marble type) are seen. Apparently, such changes can be explained by trophic disturbances of the vascular wall. At the slightest injury, the hysteroscope of the endometrium begins to bleed.
Endocervix. The cervical canal is fusiform, connected through the outer yoke with the vagina, and through the internal pharynx - with the uterine cavity. The inner throat has a well-defined muscular ring.
The mucous membrane of the cervical canal consists mainly of cubic epithelium penetrating into the stroma with the formation of deep and branched tubular glands. The surface of the mucosa forms deep cracks and grooves.
In postmenopausal folding of the mucous membrane disappears, the surface becomes smoother. Fibrous fibers are examined, sometimes whitish-colored synechia. Also there are small cysts (pseudo-cysts) with a transparent whitish wall and mucous contents of bluish-grayish color.
The mucous membrane of the cervical canal is sometimes represented in the form of small polypoid growths. Single polyps of the cervical canal are clearly seen, it is necessary to determine the location of the polyp's foot for its targeted and complete excision. The telescope must be inserted into the cervical canal with special care under the eyesight control in order to avoid its trauma and the formation of a false path.
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