endometrium

Endometrium
Uterus and uterine tubes. (Endometrium labeled at center right.)
Latin	tunica mucosa uteri
Gray's	subject #268 1262
MeSH	Endometrium
Dorlands/Elsevier	Endometrium

The endometrium is the inner membrane of the mammalian uterus.

Function

The endometrium is the innermost glandular layer and functions as a lining for the uterus, preventing adhesions between the opposed walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the menstrual cycle or estrous cycle, the endometrium grows to a thick, blood vessel-rich, glandular tissue layer. This represents an optimal environment for the implantation of a blastocyst upon its arrival in the uterus. The endometrium is central, echogenic (detectable using ultrasound scanners), and has an average thickness of 6.7mm.

During pregnancy, the glands and blood vessels in the endometrium further increase in size and number. Vascular spaces fuse and become interconnected, forming the placenta, which supplies oxygen and nutrition to the embryo and fetus.

Cycle

The endometrial lining undergoes cyclic regeneration. Humans and the great apes display the menstrual cycle, whereas most other mammals are subject to an estrous cycle. In both cases, the endometrium initially proliferates under the influence of estrogen. However, once ovulation occurs, in addition to estrogen, the ovary will also start to produce progesterone. This changes the proliferative pattern of the endometrium to a secretory lining. Eventually, the secretory lining provides a hospitable environment for one or more blastocysts. If a blastocyst implants, then the lining remains as decidua. The decidua becomes part of the placenta; it provides support and protection for the gestation.

If there is inadequate stimulation of the lining, due to lack of hormones, the endometrium remains thin and inactive. In humans, this will result in amenorrhea. After menopause, the lining is often described as being atrophic. In contrast, endometrium that is chronically exposed to estrogens, but not to progesterone, may become hyperplastic. Long-term use of oral contraceptives with highly potent progesterone can also induce endometrial atrophy.^[1][2]

In humans, the cycle of building and shedding the endometrial lining lasts an average of 28 days. The endometrium develops at different rates in different mammals. Its formation is sometimes affected by seasons, climate, stress, and other factors. The endometrium itself produces certain hormones at different points along the cycle. This affects other portions of the reproductive system.

Histology

High magnification micrograph of decidualized endometrium due to exogenous progesterone (oral contraceptive pill). H&E stain.

Low magnification micrograph of decidualized endometrium. H&E stain.

The endometrium consists of a single layer of columnar epithelium resting on the stroma, a layer of connective tissue that varies in thickness according to hormonal influences. Simple tubular uterine glands reach from the endometrial surface through to the base of the stroma, which also carries a rich blood supply of spiral arteries. In a woman of reproductive age, two layers of endometrium can be distinguished. These two layers occur only in endometrium lining the cavity of the uterus, not in the lining of the Fallopian tubes:^[3]

• The functional layer is adjacent to the uterine cavity. This layer is built up after the end of menstruation during the first part of the previous menstrual cycle. Proliferation is induced by estrogen (follicular phase of menstrual cycle), and later changes in this layer are engendered by progestrone from the corpus luteum (luteal phase). It is adapted to provide an optimum environment for the implantation and growth of the embryo. This layer is completely shed during menstruation.
• The basal layer, adjacent to the myometrium and below the functional layer, is not shed at any time during the menstrual cycle, and from it the functional layer develops.

In the absence of progesterone, the arteries supplying blood to the functional layer constrict, so that cells in that layer become ischaemic and die, leading to menstruation.

It is possible to identify the phase of the menstrual cycle by observing histological differences at each phase:

Chorionic tissue can result in marked endometrial changes, known as an Arias-Stella reaction, that have an appearance similar to cancer.^[4] Historically, this change was diagnosed as endometrial cancer and it is important only in so far as it should not be misdiagnosed as cancer.

Pathological conditions

Adenomyosis is the growth of the endometrium into the muscle layer of the uterus (the myometrium).

Endometriosis is the growth of endometrial tissue outside the uterus.

Endometrial cancer is the most common cancer of the human female genital tract.

Asherman's syndrome, also known as intrauterine adhesions occurs when the basal layer of the endometrium is damaged by instrumention (e.g. D&C) or infection (e.g. endometrial tuberculosis) resulting in endometrial sclerosis and adhesion formation partially or completely obliterating the uterine cavity.

Thin endometrium may be defined as an endometrial thickness of less than 8 mm. It usually occurs after menopause. Treatments that can improve endometrial thickness include Vitamin E, L-arginine and sildenafil citrate.^[5]

Gene expression profiling using cDNA microarray can be used for the diagnosis of endometrial disorders.^[6]

See also

• Menstrual cycle
• Estrous cycle

Additional images

• 

  The initial stages of human embryogenesis

• 

  Vertical section of mucous membrane of human uterus.

• 

  Endometrioid adenocarcinoma from biopsy. H&E stain.

• 

  Micrograph of the endometrium.

• 

  Micrograph of decidualized endometrium due to exogenous progesterone. H&E stain.

• 

  Micrograph of decidualized endometrium due to exogenous progesterone. H&E stain.

• 

  Micrograph showing endometrial stromal condensation, a finding seen in menses.

References

1. ^ Effects of hormone therapy on the endometrium, http://www.ncbi.nlm.nih.gov/pubmed/8426860
2. ^ William's Gynecology, McGraw 2008, Chapter 8, Abnormal Uterine Bleeding
3. ^ Blue Histology - Female Reproductive System. School of Anatomy and Human Biology - The University of Western Australia http://www.lab.anhb.uwa.edu.au/mb140/CorePages/FemaleRepro/FemaleRepro.htm Accessed 20061228 20:35
4. ^ Arias-Stella, J. (Jan 2002). "The Arias-Stella reaction: facts and fancies four decades after.". Adv Anat Pathol 9 (1): 12–23. PMID 11756756. 
5. ^ Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N (April 2010). "Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium". Fertil. Steril. 93 (6): 1851–8. doi:10.1016/j.fertnstert.2008.12.062. PMID 19200982. 
6. ^ Tseng, L.; Chen, I.; Chen, M.; Yan, H.; Wang, C.; Lee, C. (2010). "Genome-based expression profiling as a single standardized microarray platform for the diagnosis of endometrial disorder: an array of 126-gene model". Fertility and sterility 94 (1): 114–119. doi:10.1016/j.fertnstert.2009.01.130. PMID 19328470.  edit

External links

• SUNY Figs 43:05-15 - "The uterus, uterine tubes and ovary with associated structures."
• Histology at BU 18902loa - "Female Reproductive System uterus, endometrium"
• Swiss embryology (from UL, UB, and UF) gnidation/role02
• Histology at OU 20_01
• Histology at utah.edu. Slide is proliferative phase - click forward to see secretory phase