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Endometrial dating

Traditionally, the first day of menstruation is taken as day 1 of an idealised 28-day cycle while ovulation is conventionally timed at day 14.

Variation in the cycle is usually due to differences in the proliferative phase as collapse of the secretory phase into menstruation if fertilisation does not take place is relatively more predictable than the proliferative phase.

The stroma becomes looser and more oedematous, becoming most prominent at days 20-22.

1-2 days following ovulation, there is a peak of luteinising hormone and increased progesterone, which brings on the secretory changes.

The early interval phase is therefore indistinguishable from late proliferative phase without biochemical corrobation.

The histologic features of what constitutes “normal” endometrium change with a woman’s age, through the premenarchal, reproductive, perimenopausal, and postmenopausal years.

During the reproductive years, the cyclical hormonal changes of the menstrual cycle provide a continuously changing morphologic phenotype that is “normal.” In biopsy specimens, the combination of these cyclical changes along with artifacts and limited sampling can make normal patterns difficult to interpret.

In the mid-secretory phase (days 5-11 post-ovulation or days 19-25 of the cycle), the glands remain dilated, but become more irregular with a papillary or saw-tooth appearence.

The vacuoles move to a supranuclear position and the contents may be seen within the lumina.

In LPD, circulating progesterone levels are decreased and not sufficient to promote full secretory differentiation of the endometrium.

A repeat biopsy taken during the same period of the following cycle will further confirm an abnormally short corpus luteum life span.

These changes are presumably due to the poor development of the corpus luteum.

According to most investigators, measurements of serum progesterone levels rather than histological dating of the endometrium provide for the best assessment of LPD (see discussion later in this chapter).

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