Pathology > Gynecologic > Uterine Corpus > Physiologic Conditions
Objectives Anat & Hist Physiologic Cond. Infections Benign Cond. Benign Neoplasms Premalignant Cond. Malignant Neoplasms

II. Physiologic (hormonal) conditions

Objectives:

After completing this section you will be able to:

  • list common physiologic hormonal changes that affect the endometrium
  • relate histologic features with mode of action of associated sex hormone

  1. Postmenopausal

Loss of estrogenic stimulation after menopause leads to atrophy of the endometrial glands and stroma and the endometrium becomes thin.

Histologically, there are scanty, small glands in a dense stroma. If the anovulatory cycles and uninterrupted estrogen secretion that occurs during menopause results in mild hyperplasia of the endometrium, cystic atrophic glands showing no proliferative activity are seen.

  1. Oral contraceptives

Oral contraceptives produce a range of endometrial changes depending on the type, potencies and dosages of estrogenic and progestational agents used, the duration and whether the drugs are given in sequential or combined regimen or whether the progestin is given alone. In the sequential method, pills containing estrogen and progestin are taken each day for 20 to 21 days. Estrogen is taken each day for 15 to 16 days followed by progestin for 5 days in the sequential method. Progestin only contraceptives can be taken as low-dose progestin pill ("minipill’), given as a depot i.m. injection or as an implant. The use of sequential pills has been discontinued and only the effects of combined pill and progestin only contraceptives will be discussed.

Histology

Combined pills produce a markedly shortened proliferative phase with poorly developed glands lined by a single layer of low columnar to cuboidal cells. Secretory changes do not develop appreciably but stromal decidualization occurs resulting in discordant appearance between glands and stroma with small inactive glands scattered in stroma showing decidual reaction. Numerous granular lymphocytes are also present.

Long-term use results in endometrial atrophy with sparse, narrow glands lined by flattened epithelium set in a spindle-cell stroma with no evidence of decidual reaction.

The effects produced by progestins used alone are similar to the combined pill but atrophy develops earlier. Some women on the "minipill" and depot progestin develop amenorrhea and restoration of ovulation after cessation of contraception may be delayed for a prolonged period.

Norplant is a long-acting reversible contraceptive method. Levonorgesterol is introduced as a subdermal implant and small amounts are released at a constant rate for up to 5 years. The main endometrial effect is glandular atrophy and stromal decidualization. There is no delay in restoring ovulation.

Question: What major risk is associated with progestin-only contraceptive?

 

Objectives Anat & Hist Physiologic Cond. Infections Benign Cond. Benign Neoplasms Premalignant Cond. Malignant Neoplasms