Hysteroscopy was normal

Hysteroscopic picture during normal menstrual cycle and postmenopause

Endometrium in the proliferative phase. The hysteroscopic picture of the endometrium in the proliferative phase depends on the day of the menstrual-ovarian cycle. In the early proliferation phase (up to the 7th day of the cycle), the endometrium is thin, smooth, pale pink, in some areas small hemorrhages are visible, single un-rejected areas of the endometrium of a pale pink color are visible. The mouths of the fallopian tubes are easily examined with a telescope with a viewing angle of 30°. When the telescope approaches the mouth, the image increases; since the pressure on the mouth increases, it opens and then closes. In young patients, the fundus of the uterus seems to protrude into its cavity (bulge) with depressions in the area of the corners of the uterus. This is often mistakenly assessed as a saddle-shaped or bicornuate uterus. In fact, with a bicornuate uterus, the septum usually descends low, and sometimes reaches the area of the internal os. If the telescope immediately enters the right or left side of the cavity, the diagnosis may be erroneous.

Gradually (starting from the 9th-10th day of the cycle), the endometrium thickens, becomes more juicy, pale pink, and the vessels are not visible. In the late proliferation phase, the endometrium can be determined in some areas as thickened folds. The mouths of the fallopian tubes can be examined. It is important to note that in a normal menstrual cycle, in the proliferation phase, the endometrium can have different thicknesses depending on the location: thicker in the bottom and back wall of the uterus, thinner on the front wall and in the lower third of the body of the uterus.

2-3 days before menstruation, the endometrium acquires a reddish tint. Due to the pronounced thickening and folding of the endometrium, the openings of the fallopian tubes cannot always be seen.

In this phase, the endometrium is easily damaged by a Hegar dilator or hysteroscope, which can lead to bleeding from the endometrium.

If the end of the hysteroscope is placed close to the endometrium, the ducts of the glands can be seen.

On the eve of menstruation, the appearance of the endometrium can be mistakenly interpreted as a manifestation of endometrial pathology (polypoid hyperplasia) (Fig. 5-13). Therefore, the time of hysteroscopy must be recorded for the pathologist.

Endometrium during menstruation. In the first 2-3 days of menstruation, the uterine cavity is filled with a large number of fragments of 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 menstrual cycle, by the 2nd day of menstruation, almost complete rejection of the mucous membrane of the uterus occurs, only in certain areas (usually in the bottom of the uterus) are small fragments of the mucous membrane determined.

Endometrial atrophy is a normal condition in women during the postmenopausal period. The mucous membrane is thin, pale, the openings of the fallopian tubes are more clearly visible, having a round or slit-like shape.

Sometimes varicose veins are visible through the thinned endometrium. Often, against the background of endometrial atrophy, intrauterine adhesions are found, mainly in the area of the mouths of the fallopian tubes and the fundus of the uterus.

Sometimes the cause of bloody discharge during the postmenopausal period may be a rupture of an endometrial vessel against the background of hypertension. In this case, during hysteroscopy, against the background of an atrophic, thin, pale endometrium, a hemorrhage area is visible, the size and color of which depend on the size of the ruptured vessel and the time that has passed since the hemorrhage.

Atrophic endometrium has a very characteristic appearance in patients with diabetes mellitus in the postmenopausal period. Against the background of thin endometrium, numerous small-point petechial hemorrhages of dark-purple and brown color (marble type) are visible. Apparently, such changes can be explained by trophic disorders of the vascular wall. With the slightest trauma from a hysteroscope, the endometrium begins to bleed.

Endocervix. The cervical canal has a spindle-shaped form, connects through the external os with the vagina, and through the internal os - with the uterine cavity. The internal os has a well-defined muscular ring.

The mucous membrane of the cervical canal consists mainly of cuboidal epithelium, penetrating into the stroma to form deep and branched tubular glands. The surface of the mucous membrane forms deep crevices and grooves.

In postmenopause, the folding of the mucous membrane disappears, the surface becomes smoother. Fibrous fibers are visible, sometimes whitish synechia. There are also small cysts (Nabothian cysts) with a transparent whitish wall and bluish-gray mucous contents.

The mucous membrane of the cervical canal is sometimes presented in the form of small polypoid growths. Single polyps of the cervical canal are clearly visible, it is necessary to determine the location of the polyp stalk for its targeted and complete excision. The telescope must be inserted into the cervical canal with special care under visual control to avoid injury and the formation of a false passage.

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