Tests of functional diagnostics of ovarian activity
Endocrinology / / May 23, 2016
in clinical practice to determine the functional activity of the ovaries there are a number of tests, of which the most revealing are: histological examination of scrapings of the endometrium, cytological examination of vaginal smears, measuring rectal temperature, the study of the phenomenon of "pupil" and symptoms of "fern", the study in the urineestrogen and pregnanediol gonadotropins.
study of endometrial histology
In the normal menstrual cycle, endometrium under the influence of estrogen hormones produced by the ovary undergoes proliferation, after the onset of ovulation, under the influence of progesterone the endometrium undergoes secretory transformation.
If excretion of estrogen is low, proliferative changes in the endometrium are not expressed;if estrogen stimulation is absent, the endometrium undergoes atrophy.
In the case of long-term permanent estrogen stimulation without progesterone influence endometrial proliferative changes gradually increase, leading to hypertrophy and hyperpl
study of the cytological picture of vaginal smears
In smears from the vagina are 4 kinds of cells:
1. surface layer of cells, which come near to the quadrilateral shape with small kernels;smears occur at good estrogenic stimulation.
2. Cells interlayer triangular shape with larger kernels than the surface;smears occur at moderate estrogenic stimulation.
3. Parabasal cells are round or oval, with large nuclei;smears occur by lowering of estrogen stimulation.
4. Basal cells are round shaped, small quantities with large round nuclei occur at dramatically reduced estrogenic stimulation.
Just as endometrium, vaginal epithelium susceptible cyclic variations during the normal menstrual cycle.
In the first half of the cycle, under the influence of estrogen maturing follicle epithelium of vaginal proliferates, its cells grow and differentiate, in smears appear the most mature of the surface layer of cells with small pyknotic nuclei.After ovulation, under the influence of progesterone produced by the corpus luteum of the ovary, the upper layers of surface cells begin to be rejected, smears appear in intermediate layers of cells with curled edges.
Throughout the life of the woman vaginal epithelium responds to the amount of hormonal stimulation, present in a woman's body.So, in violation of ovarian activity and, in particular, with a decrease in estrogen stimulation of the vaginal mucosa becomes thinner, atrophies, appear in smears the cells of the lower layers of the vaginal epithelium - basal and parabasal.At high or prolonged estrogen stimulation smears appear large, flat surface cells with small pyknotic nuclei.
Thus, based on the cellular composition of vaginal smears in women of reproductive age can judge the activity of the ovaries.The appearance in smears of the lower row of vaginal epithelial cells is diagnostic of a weak estrogenic stimulation due to the reduced activity of the ovaries.Poliferativny type of smear, consisting of cells of the surface layer is a good indicator of estrogenic stimulation.
study of rectal temperature
In women with normal menstrual cycle curve rectal temperature (with daily measurement of her morning in a basal metabolic rate) biphasic.Prior to ovulation rectal temperature below 37 °, after ovulation rectal temperature is increased by 0,6-0,8 ° compared to the proliferation phase.Monophasic rectal temperature (without lifting above 37 °) will indicate a defective hormonal ovarian function - the lack of ovulation and corpus luteum phase.
phenomenon of "pupil" and "fern»
During the menstrual cycle, the cervix is also cyclical changes.Estrogenic stimulation causes increased secretion of mucus in the cervix, which causes a positive symptom of "pupil" and a symptom of "fern".
Since the 8-9 th day of the normal cycle, the external opening of the cervix cervical canal expands, and it appears glassy, clear mucus.View disclosed the external os with a drop of mucus serving of it, resembles the pupil (a symptom of "pupil" OA Golubeva).
In the luteal phase, this phenomenon disappears completely.If put on the glass strip the mucus of the cervix, after drying under a microscope you can see a distinct pattern resembling fern.The progesterone phase "fern leaf" cycle, as it loses its ramifications, and then crystallized completely disappears.
lack of mucus in the cervix throughout the menstrual cycle, indicate a lack of estrogenic activity of the ovaries.
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Research excretion of gonadotropins, estrogens and pregnandiol urine
Studies allocation of gonadotropins in the urine are used to distinguish the primary lesion of the ovaries or pituitary as the cause of menstrual disorders.For clinical purposes, the most commonly used definition of common gonadotropins by weight of immature uterus.This test is a measure of the combined action of follicle stimulating hormone (FSH) and luteinizing hormone (LH) hormones.To distinguish more subtle violations methods exist separate determination of FSH and LH, but these methods are time-consuming and for clinical purposes are rarely used.
Determination of estrogen excretion in urine is a good indicator of ovarian function.But this requires dynamic monitoring of the release of estrogen over the cycle, as the effect of physiological fluctuations of production and excretion of estrogen in the different phases of the cycle of a single definition of excretion does not reflect these fluctuations.Since the release of estrogen research is very time-consuming, they are not widely used, but only in certain cases, as a rule, along with other tests of functional diagnostics.The basic definition of the most common methods are the method of Brown estrogen and Ittrich method.
pregnandiol is a metabolite of progesterone that can be detected in urine.
Since progesterone itself in the urine is not, on the value of production of progesterone is usually judged by the urinary excretion pregnandiol.But we must remember that pregnandiol metabolite may be also some steroid derived from the adrenal cortex, so in some diseases of the adrenal cortex (eg, congenital virilizing adrenal hyperplasia) increased excretion pregnandiol.In order to judge the activity of the corpus luteum is expedient to study pregnandiol 2-3 times during the cycle - in the follicular and necessarily in its secretory phase.The most common method for determining pregnandiol is Klopper method, Michie u.Brown.