Functional methods of diagnosis in gynecology

Functional diagnostic methods in gynecology allow to diagnose abnormalities of the sexual apparatus, and also are important for monitoring the results of functional therapy.

Measurement of basal temperature

The test is based not on the hyperthermic effect of progesterone. The latter has a direct effect on the center of thermoregulation located in the hypothalamus. Therefore, with an increase in the secretion of progesterone in the second half of the normal menstrual cycle, the basal temperature increases by 0.4-0.8 ° C. A stable biphasic type of temperature indicates the occurrence of ovulation and the presence of a functionally active yellow body.

Basal temperature is measured by the same thermometer in the morning on an empty stomach, without getting out of bed, for 10 minutes. The obtained data are plotted graphically. In all cases of normal changes in the basal temperature in the folliculina phase of the cycle, it is below 37 ° C, and after ovulation it rises to 37.1-37.3 ° C, rarely up to 37.6 ° C.

Most often, before the rise in temperature, there is a short-term decrease (0.3-0.4 °), which in time corresponds to ovulation. 1-2 days before the onset of menstruation, the basal temperature again decreases.

To determine the nature of the temperature curve, it is necessary to measure the temperature during 3 menstrual cycles. If the basal temperature in the 2 nd phase of the cycle increased by 0.2-0.3 ° C, this indicates a deficiency in the function of the yellow body. A rapid rise in temperature 2-3 days before the onset of menstruation is associated with insufficiency of both progesterone and estrogens. Monophase temperature in the range of 36.5-36.9 ° C with slight fluctuations indicates anovulatory cycle. A persistent increase in temperature within 37.2-37.4 ° C for 18 days and more or 7 days after the delay of another menstruation with a regular menstrual cycle may be in the case of pregnancy. With a normal course of pregnancy, the basal temperature remains elevated throughout the first 4 months. A decrease in temperature often indicates a threat of termination of pregnancy. During this test, remember that the basal temperature can increase with chronic infections, as well as with pathological changes in the higher sections of the central nervous system, hyperthyroidism.

The basal or rectal (in the rectum) temperature a woman measures daily by herself with an eel, without getting up from bed for 10 min throughout the menstrual cycle. Basal temperature in a healthy woman varies depending on the phase of the menstrual cycle. In the ovulatory cycle with complete first and second phases, the basal temperature rises by 0.5 ° C immediately after ovulation and remains at this level for 12-14 days. The rise in temperature is due to the thermogenic effect of progesterone on the center of thermoregulation.

To establish the nature of the temperature curve, it is necessary to measure the basal temperature for 3 cycles.

Study of cervical mucus

During the normal menstrual cycle, the physicochemical properties of the mucus and the amount of secretion are subject to characteristic changes (from 60 mg / day to the early follicle in the new phase to 700 mg / day during the ovulation period). By the same period, the activity of some mucus enzymes increases and its fluidity, associated with a decrease in viscosity, appears. Phenomena of the pupil, fern, and cervical mucus tension are based on changes in the secretion and refractive power of the cervical mucus.

The phenomenon of the pupil is associated with changes in the amount of mucus depending on the hormonal saturation of the body and the tone of the cervix. On the 8th-9th day of the menstrual cycle, vitreous transparent mucus appears in the enlarged outer opening of the cervical canal. When the ray of light is directed, the outer yawn with a protruding droplet of mucus seems dark and resembles a pupil. The amount of secreted mucus and the diameter of the external throat are progressively increasing, reaching a maximum for ovulation, then they decrease to a minimum in the late luteal phase.

The test is evaluated on a three-point system:

1. presence of a dark point - 1 point (+) - early follicular phase;
2. presence of a dark point - 0.2-0.25 cm - 2 points (++) - medium follicular phase;
3. presence of a dark point - 0,3-0,35 cm - 3 points (+++) - ovulation (maximum production of estrogens).

After ovulation with a decrease in the secretion of estrogens, the pupil's symptom gradually weakens and disappears by the 20th or the 23rd day of the menstrual cycle.

The presence of a weakly expressed phenomenon of the pupil during the menstrual cycle indicates hypoestrogenism, its preservation during the cycle at a high level (3 points) - about hyperestrogenia, at a level of 2 to 3 points - about the inadequacy of the function of the yellow body. With erosion, endocervicitis, old ruptures of the cervix, the test is uncharacteristic.

The phenomenon of fern (arborization test) is based on the ability of the cervical mucus to form crystals when dried. The cause of crystallization is considered to be changes in the physicochemical properties of mucus under the influence of estrogens (interaction of sodium chloride with polysaccharides, colloids and mucin, pH of mucus).

The material is taken with an anatomic tweezers, which are inserted into the cervical canal to a depth of 0.5 cm. The resulting drop of mucus is transferred to a slide and dried. Evaluation is performed under a microscope at low magnification. Even at 2 points (++), a clear picture of the leaf is visible, at 3 (+++) - the crystals form large leaves that extend at an angle of 90 °, with thick stems. With the full function of the yellow body in the luteal phase of the cycle, the fern phenomenon gradually disappears. The presence of the phenomenon of fern during the entire menstrual cycle indicates a high secretion of estrogens and the absence of the luteal phase (anovulatory cycle with follicle persistence), its absence during the examination may indicate estrogen deficiency.

Tension of the cervical mucus - varies during the menstrual cycle. The maximum coincides with the maximum production of estrogens in ovulation. Slime is collected by inserting the root canal into the cervical canal. The tool is then removed and tension determined by careful dilution of the brushes. Slime is stretched into a thread, the length of which is measured in centimeters. The higher the production of estrogens, the longer the thread of mucus. The test is evaluated on a three-point system:

• 1 point (+) - thread length up to 6 cm;
• 2 points (++) - the length of the thread is 8-10 cm;
• 3 points (+++) - the length of the thread is 15-20 cm.

At 3 points the maximum production of estrogens in the body is noted (during the ovulation period). In the luteinic phase of the cycle, the slime tension again decreases.

Symptom of stretching the cervical mucus

The symptom of stretching the cervical mucus depends on the production of estrogen by the ovaries. Using tweezers take mucus from the cervical canal, dilute the jaws and measure the length of the mucosa. The maximum stretching of the mucosa occurs at the time of ovulation and reaches 10-12 cm.