CHAPTER 19
Female Reproductive System
381
Figure 19-10A.
Menstrual phase of the endome-
trium, uterus (days 1–4 of the cycle).
H&E,
3
13;
insets
3
93
The wall of the
uterus
includes the
endometrium
, the
myometrium
, and
serosa
. The endometrium, the mucosa
of the uterus, is composed of a surface epithelium and
simple tubular
uterine glands
within a stroma of con-
nective tissue. The endometrium consists of the
basalis
(basal layer)
and the
functionalis (functional layer)
. The
functionalis is near the lumen and undergoes changes
during the menstrual cycle. During the
menstrual phase
,
the functionalis sloughs off as a result of
ischemia
and
necrosis
caused by contraction of the coiled arteries.
This occurs when fertilization does not take place and
the corpus luteum atrophies, causing the levels of
estro-
gen
and
progesterone
to fall. The menstrual phase is the
initial stage of the menstrual cycle; the endometrium
will begin to recover at the end of the menstrual phase.
Endometrium
Endometrium
Endometrium
Myometrium
Myometrium
Myometrium
Functionalis
Functionalis
Functionalis
Basalis
Basalis
Basalis
Sloughed
Sloughed
gland
gland
Sloughed
gland
Uterine
Uterine
glands
glands
Uterine
glands
Myometrium
Myometrium
Myometrium
Arteries in the
Arteries in the
myometrium
myometrium
Arteries in the
myometrium
A
Endometrium
Endometrium
Endometrium
Luminal surface
Basalis
Basalis
Basalis
Straight
Straight
uterine glands
uterine glands
Straight
uterine glands
Straight
Straight
uterine glands
uterine glands
Straight
uterine glands
Mitotic
Mitotic
figures
figures
Mitotic
figures
Lumen of
Lumen of
gland
gland
Lumen of
gland
Glandular epithelium
Glandular epithelium
Glandular epithelium
Myometrium
Myometrium
Myometrium
B
Luminal
Luminal
surface
surface
Luminal
surface
Endometrium
Endometrium
Endometrium
Myometrium
Myometrium
Myometrium
Basalis
Basalis
Basalis
Functionalis
Functionalis
Functionalis
Uterine
Uterine
glands
glands
Uterine
glands
Lumen of
Lumen of
uterine glands
uterine glands
Lumen of
uterine glands
Coiled arteries
Coiled arteries
Coiled arteries
Stroma
Stroma
Stroma
Lumen of
Lumen of
uterine gland
uterine gland
Lumen of
uterine gland
C
Uterus
Figure 19-10B.
Proliferative phase of the endome-
trium, uterus (days 5–14 of the cycle).
H&E,
3
18;
inset (
upper
)
3
68; inset (
lower
)
3
293
The
proliferative phase
follows the menstrual phase.
The epithelium, uterine glands, and connective tissue
of the functionalis are rebuilt by proliferation and dif-
ferentiation of cells that remained in the basalis. At this
stage, the uterine glands are straight and have narrow
lumens as shown here; the surface of the endometrium
is smooth. The epithelial lining of the uterine glands
commonly appears as
pseudostrati±
ed
columnar
epithelium
because of proliferation of the lining cells.
Mitotic ±
gures
are occasionally seen (
inset
). The glands
open onto the luminal surface of the uterus. During the
proliferative phase, the changes in the endometrium are
driven by
estrogens
that are produced by the granulosa
cells of the developing follicles.
Figure 19-10C.
Secretory phase of the endome-
trium, uterus (days 15–28 of the cycle).
H&E,
3
14;
insets
3
89
The
secretory phase
begins shortly after ovulation occurs.
It is infl uenced by
progesterone
produced by the corpus
luteum. At this stage, the endometrium becomes thick-
est (6–7 mm), and the uterine glands are coiled and have
large sacculated lumens. The
upper inset
shows tortuous
glands with large, irregular, sawtooth-shaped lumens.
The
lower inset
shows coiled arteries found in the endo-
metrial stroma. These coiled arteries are also called
spiral
arteries
and extend transiently from the basalis into the
functionalis of the endometrium. The coiled arteries arise
from arcuate arteries of the myometrium. During the
secretory phase, these spiral arteries become elongated
and highly coiled and extend into the functionalis of
the endometrium. The arcuate arteries also give rise to
straight arteries that permanently supply the basalis.
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