From Big Medical Encyclopedia

MENSTRUAL CYCLE (Latin. menstrualis monthly) — the physiological process in a female body which is characterized by three main components: cyclic changes in system of neurohumoral regulation, cyclic changes in ovaries (and respectively in secretion of sex hormones) and cyclic changes in hormonal and dependent bodies of a reproductive system (a uterus, uterine tubes, a vagina, mammary glands); the specified cyclic changes are followed by fluctuations of a functional state nervous, endocrine, cardiovascular and other systems of an organism.

Biol, value of the changes connected with M. in c., consists in implementation of reproductive function: maturing of an ovum, its fertilization and implantation of a germ in a uterus (formation of a placenta). If fertilization of an ovum does not happen, funkts, the layer of an endometria is torn away and from a genital tract there are blood allocations called by periods (so-called monthly clarifications of a uterus). According to V. F. Snegirev, the periods are «monthly childbirth by unfertilized egg».

M. begins c. in the period of puberty (in 11 — 16 years) and; proceeds up to 45 — 50 years. The first periods (menarche) appear at the girls living in a midland of the European part of the USSR, on average in 12 years 9 months (± 1 year). According to Yu. F. Borisova (1964), regular M. of c. is established at 70,8% of girls, 6 months later at once — at 9,2%, in 12 months — at 3,3%, in 2 years — at 1,7%, at the others later. Duration of periods in this period occurs 2 — 3 days at 13%, 3 — 5 days — at 62,3%, 5 — 7 days — at 22,4%, from 7 to 10 — 15 days — at 2,3% of girls.

M. of c is conditional. is defined from the first day of the come periods to first day of the following periods. M.'s duration of c. at women of childbearing age (18 — 45 years) fluctuates in fiziol, limits from 21 to 35 days. At 54% of healthy women M.'s duration of c. makes 26-29 days, at 20% — 23-25 (shorter cycles meet less often), at 18% — 30 — 35 days. Ideal consider M. c., proceeding 28 days since at the same time especially strict frequency of cyclic changes is observed. In climacteric (see), characterized by the gradual termination of menstrual function, periods often become irregular; later menopauses (see) they stop absolutely.

Normal M. of c. it is characterized by two-staging of hormonal ratios in an organism of the woman, i.e. consecutive dominance of activity of sex hormones — estrogen and progesterone. In the first phase M. of c. — phase of maturing and growth of a follicle (synonym: the oestrogenic phase, a follikulinovy phase) — proceeding 13 — 14 days, up to a vykhozhdeniye from an ovary of a mature ovum (ovulation), as much as possible prevails activity estrogen (see), in the increasing quantities produced by cells of a granular layer of the ripening follicle. In the second phase M. of c. — a phase of a yellow body (a synonym a lyuteinovy phase) — activity prevails progesterone (see), the yellow body produced by lyuteinovy cells. Maturing of a follicle comes to the end ovulation (see), after a cut processes of education begin yellow body (see), therefore normal, two-phase, M. of c. is called also ovulatory cycle. Under the influence of estrogen there is a development of vessels, growth of a stroma and glands of an endometria (morfol, a phase of proliferation of a uterine cycle), increase in a stroma of a myometrium of a uterus, its rhythmic reductions. Under the influence of progesterone there is a secretory transformation of an endometria (morfol. phase of secretion of a uterine cycle), decrease in a tone of muscles of a uterus — i.e. the processes preparing a uterus for implantation of a germ and education placentae (see).

M of c., at Krom there is no ovulation, is called anovulatory cycle (see); he is at healthy women of childbearing age after the delivery and abortions during a certain span, at girls in the period of puberty { usually alternating with ovulatory) and at women in a climacteric.

Neurohumoral regulation

Neurohumoral regulation of all functions of a reproductive system, including M. of c., there is to participation of a cerebral cortex, subcrustal structures (preferential limbic system and a hypothalamus), a hypophysis, ovaries, and also uterus, vaginas, mammary glands.

Sexual distinctions of neurohumoral regulation are shown at the level of a hypothalamus. There are data that the sexual differentiation of a hypothalamus occurs at the end of the antenatal period. The sexual differentiation on female type is characterized by the fact that in a hypothalamus there is a tonic (basal) secretion in the beginning hypothalamic neurohormones (see) — rileasing-factors and gonadotropic hormones (see), against the background of a cut gradually there are cycle variations of their secretion. At a differentiation on men's type there is only a tonic secretion of gonadotropic hormones without undulations of their level. From hypothalamic neurohormones lyuliberin stimulates secretion luteinizing hormone (see), and folliberin — development follicle-stimulating hormone (see).

Existence mutual funkts, bonds between a cerebral cortex and a reproductive system is shown by classical experiments of I. P. Pavlov, M. K» to Petrova on studying of influence of castration on function of the highest nerve centers, and also is confirmed by a possibility of development of conditioned reflexes from receptors of generative organs and change of features of reflex reactions depending on funkts, conditions of an organism.

Frequency of processes during M. of c. it is provided with mechanisms of self-control. Interrelation of function of the central links of neuroendocrinal regulation of M. of c. and secretions of gonadotropic hormones with processes of secretion by ovaries of estrogen, progesterone and androgens (see) it is carried out by mechanisms of the double feed-back including the negative and positive two-phase bonds which are shown in a certain sequence. Experimental and the wedge, data show that tonic release of the follicle-stimulating and luteinizing hormones from a front share of a hypophysis is defined first of all by the level of content in blood 17 - beta oestradiol, in a little smaller degree — the maintenance of androgens and progesterone. Level of secretion of gonadotropic hormones rhythmic fluctuates. The peak of secretion, i.e. the maximum secretion, luteinizing hormone is one of the main releasers of an ovulation.

Fig. 1. The scheme of a 28-day menstrual cycle (shooters showed interaction of hormones of a hypophysis and ovary): And — cyclic changes and the sequence of secretion of hormones of a hypophysis; not shaded diagrammatic representation of a hypophysis corresponds to the surpassing secretion of follicle-stimulating hormone (FSG), slanting shading — secretions of the luteinizing hormone (LH), direct shading — secretions of luteotropic hormone (LTG, prolactin); B — cyclic changes in an ovary; 1,2 — a phase of maturing of a follicle, 3,4 — an ovulation and a phase of a yellow body, and also the beginning of maturing of a new follicle; In — cyclic changes of release of hormones the ripening follicle and a yellow body; — a two-phase curve of basal temperature: in a phase of maturing of a follicle it does not exceed 37 °, from the moment of an ovulation and in a phase of a yellow body basal temperature higher than 37 °; D — cyclic changes in an endometria to respectively two phases of a menstrual cycle; 1 — glands (change of their size and secretion); 2 — veins; 3 — arteries (increase in their length and crimpiness); figures below correspond to days of a menstrual cycle.

In fig. 1 interaction of hormones of a hypophysis and ovary during a 28-day menstrual cycle is schematically shown. In the first half of M. of c. increase of level of follicle-stimulating hormone stimulates in the beginning, and then oppresses growth, maturing and hormonal activity of a follicle; in the second half of M. of c. (after an ovulation) the accruing secretion of luteinizing hormone, and then and prolactin (see) stimulates in the beginning, and then oppresses products of progesterone a yellow body. If conception does not happen, all cyclic processes in a reproductive system repeat in the same rhythm.

Cyclic changes in a reproductive system

Cyclic changes in a reproductive system to respectively two phases M. of c. most clearly are shown in ovaries, and also in a mucous membrane of a uterus and a vagina, uterine tubes and mammary glands.

Changes in ovaries (an ovarian cycle) — set funkts. and morfol, turning into them proceeding cyclically according to what change the level of maintenance of sex hormones in biol, liquids and ratios between the main fractions of estrogen, progesterone and androgens in an organism.

The Primordialny follicles which are formed in ovaries (see) the girl even during pre-natal development, consist of the oocyte (ovum) surrounded with one layer of a follicular epithelium. By the birth of the girl of such follicles is to 400 000, however during the reproductive period of life of women only 300 — 400 of total number of primordialny follicles develop to a preovulatory stage, the others are exposed to an atresia at different stages of development. Cyclic changes in ovaries begin with maturing of a primordialny follicle (during one M. of c. only one of follicles reaches a full maturity).

In the course of its maturing cells of the follicular epithelium surrounding an ovum get a cubic form, breed and, being located in several rows, form a granular cover, or a layer (stratum granulosum), cells a cut produce estrogen. In an oocyte there is a bystry increase of RNA and protein synthesis and ultrastructural changes in an ooplazma and an oolemma; the ovum increases in sizes. To a mode of formation of primary follicle growth of an oocyte comes to an end. In granulosa cells specific receptors to follicle-stimulating hormone and oestradiol appear, sensitivity of their adenilattsiklazny system to follicle-stimulating hormone increases, also receptors to testosterone appear. In process of increase in the diameter up to 150 — 200 microns primary follicle migrates in deeper and more vaskulyarizirovanny layers of an ovary.

The breeding granulosa cells begin to produce follicular liquid, thanking a cut in the ripening follicle the cavity is formed; in this stage of development the follicle is called a secondary follicle or a graafovy follicle. Around the ripening follicle are formed of cells of mesenchymal fabric connective tissue internal (tunica int.) and outside (tunica ext.) covers. Cells of an internal cover remind the epithelial cells containing fatty inclusions; cells of an outside cover — fibroblasts. The mature follicle by the time of an ovulation reaches 10 — 20 mm.

In the course of maturing of a secondary follicle formation of the enzymes causing process of aromatization of predecessors of sex hormones is stimulated in cells of a granular layer, receptors to luteinizing hormone, prolactin are formed and to prostaglandins (see). In follicular liquid mucopolysaccharides and proteins of plasma collect. Concentration of follicle-stimulating hormone is rather constant regardless of day M. of c., concentration of luteinizing hormone increases in process of growth of a follicle, concentration of prolactin decreases and becomes low in the big ripening follicle. Concentration of estrogen in follicular liquid is much higher, than in a blood plasma.

It is established that prostaglandin F 2 alpha brakes products of progesterone in granular cells and influence on them of follicle-stimulating and luteinizing hormones oppresses, and E2 prostaglandin stimulates formation of progesterone and, perhaps, regulates function of granular cells.

The first meiotic division of an ovum happens to the subsequent reduction of chromosome number in the last stage of maturing of a follicle; by the time of an ovulation the ovum is ready to the second division. Maturing of a follicle comes to the end in 13 — 14 days; after that it is broken off (there is an ovulation), the ovum together with a part of the granular cover surrounding it is thrown out an abdominal cavity and in normal conditions gets into a uterine tube.

In the next days after an ovulation growth of granular cells amplifies, to-rye, increasing in a size, get a yellowish shade (formation of a lipokhromny pigment). At the same time from an internal cover blood vessels get into granular; on site the burst follicle in 3 — 4 days after an ovulation arises yellow body (see). The cavity of a follicle is closed by imposings of fibrin on the point of fracture, cells of a granular layer quickly breed by direct and indirect division and turn into lyuteinovy cells of a yellow body.

Changes of secretion: gonadotropic and sex hormones. Basal secretion of luteinizing hormone makes no more than 12 MME/ml, ovulatory peak apprx. 50 MME/ml. The ovulatory peak of luteinizing hormone in some cases corresponds to the most low level of basal temperature. The first increase in content of follicle-stimulating hormone in blood is noted at the beginning of a cycle with the subsequent decrease at further stages of a growth phase and maturing of a follicle, the peak of secretion corresponds to M.'s middle of, usually matches peak of secretion of luteinizing hormone and makes apprx. 30 MME/ml. Content of prolactin fluctuates during M. of c. in quite wide limits; the peak of its secretion manages to be found only at daily definition of prolactin in blood after 12 hours of day.

During maturing of a follicle ovaries excrete in blood generally oestradiol (see); at the beginning of the first phase M. of c. content of oestradiol in blood does not exceed 100 pg/ml, the maximum increase before an ovulation to 290 pg ml. In the first 7 — 10 days M. of c. excretion of estrogen with urine low and the sum of all three fractions (estrone, oestradiol and estriol) in daily urine makes less than 5 mkg. From the 11th day excretion of estrogen increases; after ovulatory peak it decreases, again raising in the period of blossoming of a yellow body.

According to cyclic changes of activity of a yellow body the content of progesterone in blood fluctuates; the maximum of its contents is noted in a phase of a yellow body.

Fig. 2. Curve contents of gonadotropic and sex hormones in a blood plasma during a menstrual cycle: and — luteinizing hormone; — follicle-stimulating hormone; in — Prolaktin; — oestradiol-17-beta; d — progesterone. On ordinate axis concentration of hormones is designated.

Average figures of maintenance of gonadotropic and sex hormones in blood serum of healthy women of childbearing age in different days M. of c. are presented in fig. 2; day of an ovulation is designated «About», and other days by M. in c. count from «About» with signs — (The I phase) and + (the II phase).

Sensitivity of receptors in cells of generative organs to sex hormones is defined by the regulating influence of these hormones on contents in a cellular kernel nucleinic to - t, on permeability of cellular and nuclear membranes. Getting through cellular membranes, sex hormones contact specific receptor proteins, and the formed complex moves from cytoplasm to a kernel of a cell. Under the influence of estrogen, progesterone regulation of proliferative processes and blood circulation in bodies effectors is carried out.

Changes of an endometria (a uterine cycle) — consecutive funkts, and morfol, transformations funkts, a layer of a mucous membrane uterus (see), occurring in all its components (in glands, a stroma and vessels). Morfol, changes in an endometria take place three phases: the phase of desquamation (periods) lasting 1 — 4 day and regeneration of an endometria (proceeds the first 5 — 6 days from the beginning of periods) corresponds to the beginning of death of a yellow body and maturing of a new follicle in an ovary: the phase of proliferation corresponds on time to a growth phase and maturing of a follicle in an ovary; a phase of secretion — a phase of a yellow body of M. of c. Due to the identity morfol, phases of a uterine cycle it is offered to distinguish three stages of a phase of proliferation and three stages of a phase of secretion: early, average and late. Morfol, the characteristic of an endometria — according to phases and stages — see the table «The Main Histologic Changes of an Endometria during a 28-day Menstrual Cycle».

Table. The main histologic changes of an endometria during a 28-day menstrual cycle on Wynn (R. WYNN, 1977)

Fig. 3. Microscopic picture of changes of an endometria according to phases of a menstrual cycle: 1 — an endometria in a stage of early proliferation; glands of an endometria (are specified by an arrow) have the direct form; 2 — an endometria in a stage of late proliferation; glands of an endometria (are specified by shooters) considerably izvita; 3 — an endometria in an average stage of a phase of secretion; gleams of glands (2) are expanded; glands (1) have the sawtooth form; 4 — an endometria in a late stage of a phase of secretion; glands (2) get even more sawtooth form, the quantity of a secret (2) decreases.

The phase of proliferation begins after the termination of periods and the layer of an endometria consists in growth of glands, a stroma and vessels thanks to what it is gradually filled torn away funkts. In an early stage of a phase of proliferation (fig. 3,1) there is a proliferation of an epithelium of glands of a basal layer. Glands of an endometria have an appearance of straight lines or several gyrose tubules with a direct gleam, an epithelium their cylindrical, oval kernels are located at the different level, is preferential at the basis of cells. Apical edges of epithelial cells uneven, in a gleam of gland depart long fleecy shoots of cytoplasm in the form of a brush border from them that is connected with education in these sites of an alkaline phosphatase. Between stromal cells the network of argyrophil fibers is located, spiral arteries there is not enough izvita.

In an average stage of a phase of proliferation epithelial cells have the high prismatic form, glands slightly gyrose, in epithelial cells of glands from the 8th day of M. of c. strongly the quantity of an alkaline phosphatase increases. At apical edge of nek-ry epithelial cells the slime containing acid mucoids can be found in the form of a border.

In a late stage of a phase of proliferation (fig. 3, 2) of gland of an endometria get twisting outlines, sometimes they are shtoporoobrazna, their gleam extends. The ferruterous epithelium continues to proliferate. Activity of an alkaline phosphatase in epithelial cells of glands reaches high degree, in basal departments of nek-ry cells of a ferruterous epithelium the small vacuoles containing a glycogen are found. The network of argyrophil fibers concentrates in a stroma around glands of an endometria and blood vessels, spiral arteries several more izvita, than in the previous stages of proliferation. Thickness funkts, a layer by the end of a phase of proliferation reaches 4 — 5 mm.

The phase of secretion is characterized by the fact that the epithelium of glands begins to develop the secret containing acid glikozaminoglikana, glycoproteins, a glycogen. In an early stage of a phase of secretion the gleam of glands is a little expanded, in basal departments of epithelial cells of glands of an endometria there are large vacuoles which are pushing aside a kernel in the central part of cells. In vacuoles the glycogen in the form of powdered granularity is found. For the 18th day M. of c. gleams of glands are expanded more, in nek-ry epithelial cells of a vacuole move ahead from basal in an apical part of cells. Spiral arteries become more twisting, than in a late stage of a phase of proliferation.

In an average stage of a phase of secretion (fig. 3, 8) funkts, the layer of an endometria is accurately divided into two layers: spongy, adjoining on a basal layer, and dense, superficial; thickness funkts, a layer reaches 8 — 10 mm, the tight coat makes 1/4 — 1/5 thickness funkts, a layer. In a spongy layer there are a lot of glands, a small amount of a stroma, in a tight coat, on the contrary, it is less glands, it is more than connective tissue cells. Epithelial cells of glands low, their kernels are located basally, the most part of a cell is filled with a secret, to-ry separates in a gleam of gland. The most advanced stage of secretion is found on 20 — the 21st day of M. of c. The alkaline phosphatase these days is almost not defined; the amount of acid phosphatase increases. By 20th day in an endometria the maximum quantity of proteinolitichesky and fibrinolitic enzymes is observed. With 21 — the 22nd day in a stroma of an endometria there are detsidualnopodobny transformations: cells of a tight coat become large, a rounded or polygonal shape, in their cytoplasm the glycogen appears. Spiral arteries and arterioles sharply of an izvita, form balls, veins are expanded. On 22 — the 23rd day M. of c. the largest volume funkts, a layer is noted. Stromal cells increase in volume, get a polygonal form, remind decidual cells of pregnancy with a big puzyreobrazny kernel. Therefore a mucous membrane of a uterus by the end of a secretory phase call predetsidualny since it is prepared for implementation of an oospore.

The late stage of a phase of secretion (fig. 3, 4) is characterized by changes of regressive character, a stroma of a tight coat of an infiltrirovan leukocytes; veins in surface layers of an endometria are expanded, crowded with blood, in them blood clots are formed; there are focal hemorrhages, in nek-ry sites hypostasis of fabric.

The phase of desquamation (periods) is characterized by rejection of all funkts, a layer of an endometria then again its regeneration from cells of a basal layer of an endometria begins.

Developing of menstrual bleeding is caused by a number of factors. The following concept is most accepted. After the termination of function of a yellow body there is a sharp reduction of maintenance of sex hormones (estrogen and progesterone) that affects change of blood circulation in vessels of an endometria; in the beginning there is an expansion, and then a spasm of arteries — intake of blood in spiral-shaped vessels decreases, increases permeability of their walls, the tight coat infiltrirutsya by leukocytes. Stagnation of blood in vessels and delay of a blood-groove is led to build-up of pressure in vessels, there is a rupture of their walls, bleeding begins. Narrowing of arterioles of a mucous membrane of a uterus continues during 48 hours after the beginning of periods, during periods the greatest changes of a tone and permeability of vessels of small caliber are observed. At the same time there are destructive changes in an endometria: there are zones of a necrosis and focal hematomas, the maintenance of a protein of lytic and fibrinolitic enzymes increases.

Changes of a neck of uterus. It is established that in a growth phase and maturing of a follicle the isthmus of a uterus is expanded and shortened, in a phase of a yellow body it is narrowed that is of great importance in differential diagnosis istmiko-cervical insufficiency (see). Crimpiness of glands of a mucous membrane of the channel of a neck of uterus amplifies, they remind cracks or tunnels; the ferruterous courses open to the canal of a neck. Ferruterous epithelium high, cylindrical; kernels are located at the basis of epithelial cells. The ferruterous epithelium of the channel of a neck of uterus produces a mucous secret, to-ry forms a so-called cervical mucous stopper.

Cyclic changes in a neck of uterus throughout M. of c. hl consist. obr. in cyclic activity of glands of a mucous membrane of the channel of a neck, in change of quantity and composition of cervical slime. Changes of cervical slime play an important role in preparation of process of fertilization; they can serve as objective criterion funkts, conditions of a female reproductive system. Cervical slime represents biol, the Wednesday consisting to 99% of the liquid containing organic and inorganic compounds in the form of proteins, mucoids and salts. Macromolecules of cervical slime at the beginning of M. of c. have reticulation, the distance between separate cells of slime makes 2 — micron. In the middle of M. of c. cervical slime has a fibrillar structure, its fibrils are located in parallel, forming as if the sticks divided by cracks with a diameter up to 30 — 35 microns; during an ovulation there is a reduction of a tension of fibrils of slime. Education in slime of the long parallel threads sliding the friend on the friend received the name of a symptom of a tension (this symptom indicates an oestrogenic saturation of an organism); parallel arrangement of long threads, and also physical. - chemical changes of cervical slime in the middle of a cycle provide transport of sperm. At the same time in a sexual path of the woman occur morfol., fiziol., biochemical, transformations of spermatozoa (kapasitation).

At women of childbearing age from 20 to 60 mg of cervical slime are within a day developed. The quantity it is small at the beginning of M. of c., and to the middle it reaches a maximum. During this period cervical slime contains cations (Na, Mg, Ca, Cu, Mn) and anions (Cl, PO4, SO4). Total quantity of sodium chloride in slime during M. of c. constantly. Increase in viscosity of cervical slime is connected with calcium ions, presence of ions of sodium causes a phenomenon of a spinnbarkeit in the form of a figure of a leaf of a fern, degree of manifestation of crystallization reflects a saturation of an organism estrogen. In a phase of a yellow body cervical slime is more homogeneous on structure, almost or at all does not form fibrilla, the distance between separate cells of slime makes 4 — 6 microns, during the drying of a smear slime has amorphous structure.

In slime of a neck of uterus there are antibodies, to-rye are formed in a reproductive system or get to cervical slime from circulatory system. In contents of a gleam of cracks between folds of a mucous membrane of a neck immunoglobulins A, M, G, and also Hemagglutinins A, B are found, O. Sinteziruyushchiyesya local plasmocytes immunoglobulins A, M and G through cellular membranes get into space between epithelial cells, contact a cervical secret and are excreted in a layer of the slime covering an epithelium, forming thus protection of an organism against microorganisms of a vagina.

Changes of a mucous membrane of a vagina, expressiveness of processes of keratinization of an epithelium are depending on the level of oestrogenic influences, and also from quantitative ratios in an organism of estrogen, progesterone and androgens.

Fig. 1 — 4. Four types of the cytologic reactions of a vulval smear characterizing the content of estrogen in an organism. Fig. 1. The first type — in a smear the basal cells and leukocytes characterizing sharp insufficiency of estrogen. Fig. 2. The second type — in a smear basal and intermediate cells, and also leukocytes — considerable insufficiency of estrogen. Fig. 3. The third type — in a smear intermediate cells, a small amount of superficial not keratosic cells — moderate insufficiency of estrogen prevail. Fig. 4. The fourth type — in a smear only keratosic cells — the high content of estrogen.

In a phase of maturing of a follicle proliferative processes are observed: the epithelium of a vagina bulks up, layer of a mucous membrane with division on deep, intermediate and superficial (keratosic) layers is formed funkts. Depending on a ratio and the level of maintenance of sex hormones extent of keratinization of a multilayer flat epithelium reaches various expressiveness; at dominance of estrogen keratosic and keratosic cells of an epithelium are found, at moderate deficit of estrogen — cells of a medine of a mucous membrane, at deep deficit — basal and parabasal cells. At tsitol, a research it is accepted to distinguish in this regard four types of smears of vulval contents (see. Vagina and tsvetn. fig. 1 — 4).

Changes in uterine tubes also happen cyclically — see. Uterine tubes .

Changes in mammary glands. Under the influence of dominance in an organism of estrogen (a growth phase of follicles) channels of mammary glands increase in length and have an appearance of tubules; their trailer departments — an acinus — develop and become branchy under the prevailing influence of progesterone (a phase of a yellow body), the volume of all mammary gland at the same time increases a little. At the infertility caused by anovulatory cycles (lack of an ovulation) and disturbances of formation of a yellow body, an acinus of mammary glands develops insufficiently and the mammary gland externally has the cone-shaped form. At the specified disturbances it is reasonable to make mammography only in the first phase M. of c.

The general changes in an organism

During M. of c. there are cyclic changes funkts, conditions of many systems. These cyclic changes at healthy women are in limits fiziol, borders. At complex studying funkts, conditions of c. N of page in different phases of a cycle (conditioned reflexes, limit of sensibility of acoustical, skin and muscular analyzers, EEG, etc.) are noted nek-paradise a tendency to dominance of brake reactions during periods, decrease in force of motor reactions; noticeable fluctuations in a condition of century of N of in separate phases M. of c. it is noted. Cycle variations of function of century of N of page also happen in limits fiziol, borders; in a growth phase of a follicle dominance of a tone parasympathetic, and in a phase of a yellow body — a sympathetic part of a nervous system is noted.

A condition of cardiovascular system during M. of c. it is characterized wavy funkts, fluctuations — a so-called vascular rhythm of an organism. So, in a growth phase and maturing of a follicle capillaries of an organism are a little narrowed, the tone of all vessels is raised, a blood flow bystry, the background at a kapillyaroskopiya a light pink, oscillographic index is lowered. Vascular reactions to cold irritation are intensive and long. In a phase of a yellow body capillaries of an organism extend a little, the tone of vessels is lowered, venous and arterial parts of capillaries are well distinguishable, a venous part is wider; the blood flow is not always uniform, vascular reflexes are shorter and weaker, the oscillographic index is raised. Just before periods capillaries are in a spastic state, a background at a kapillyaroskopiya muddy, the tone of arterioles is raised, the oscillographic index increases.

The composition of blood is subject to cycle variations morfol, and biochemical. The hemoglobin content and quantity of erythrocytes are highest in the first day M. of c., the lowest hemoglobin content for the 24th day, erythrocytes — by the time of an ovulation. Fluctuations of maintenance of microelements are clear; so, according to Page X. Hakimova and M. G. Ioskovich (1979), the greatest number of copper in blood serum is found in the period of an ovulation (107,9±33 mkg of %), zinc — in the last days of blossoming of a yellow body (720,3 ±11,5 mkg of %). In the first phase M. of c. there is a delay of excretion of nitrogen, sodium, liquid; in the second phase the raised excretion of sodium is observed (without removal of potassium), the raised diuresis is noted. In the period of periods there is a nek-swarm a decrease in a prothrombin ratio, the maintenance of thrombocytes and increase in amount of fibrinolitic enzymes in blood.

Mood swings and emergence a nek-swarm of irritability at women in the days preceding periods, especially when changes of c are known. the N of page, endocrine system leave for fiziol, limits. At nek-ry women such phenomena arise soon after an ovulation, remain during all phase of a yellow body and get patol, character (see. Premenstrual syndrome ). In the period of an ovulation a certain number of women has so-called menstrual pains, bleedings — a so-called syndrome of an ovulation, or a syndrome of the thirteenth day — see. Ovulation .

Methods of a research

Tests for determination of level of secretion of sex hormones and cyclic changes of an endometria, a mucous membrane of the channel of a neck of uterus and a vagina allow to find out function of ovaries.

Fig. 4. Schedules of options of ovulatory rise in curve standard basal temperature during a menstrual cycle: and — bystry — slow, in — stupeneobrazny. On abscissa axis days of a cycle are designated.

One of the most widespread tests of studying of function of ovaries is definition basal (in a rectum) temperatures; this method is based on the pyrogenic effect of progesterone. Measurement of basal temperature (it is possible to take temperature in a vagina) is performed within 5 — 8 min., daily in the morning at the same time (without getting up). At ovulatory M. of c. the curve of basal temperature has two-phase character (fig. 4): equal, not exceeding 37 °, the level of temperature in the first half of M. of c.; since M.'s middle of c., i.e. since the beginning of a phase of a yellow body, the level of temperature increases on 0,6 — 0,8 °. Monophase (without rise higher than 37 ° in the second half of M. of c.) basal temperature indicates defective function of a yellow body and, perhaps, lack of an ovulation. During periods basal temperature decreases. Features of temperature shifts are caused not only by the content of progesterone, but also fluctuations of content of estrogen in the period of an ovulation. Decrease in basal temperature in the first half of M. of c. connect with impact on the temperature-controlled center of estrogen, contents to-rykh at the time of ovulatory peak reaches a maximum; to the term of an ovulation there corresponds, apparently, the beginning of temperature increase in the middle of a cycle. Therefore the test of basal temperature gives an idea of consecutive influence of sex hormones, i.e. of hormonal ratios during M. to c.

For definition of existence of an ovulation the research of basal temperature has rather auxiliary value, but allows to judge its character and function of a yellow body retrospectively.

About funkts, a condition of ovaries (at an amenorrhea, endocrine infertility, dysfunctional uterine bleedings) it is possible to judge by results gistol, researches of an endometria. At an undisturbed rhythm of periods the diagnostic scraping is recommended to be made in the second half of M. of c., is closer to the term of periods, at acyclicity of periods — in a bleeding time, at suspicion of an endometritis — not later than the last two-three days than M. to c., since emergence of small-celled infiltration in the days preceding desquamation of an endometria can complicate identification patol, changes. At a diagnostic scraping all is subject to removal funkts, the layer, a partial scraping (receiving Zug) can be applied only to control of results of treatment. At insufficient maturing of follicles and low level of secretion of estrogen proliferative processes in an endometria are expressed poorly, the endometria can be atrophied. At high and long oestrogenic stimulation without influence of progesterone considerable proliferative changes are possible, up to a hyperplasia of an endometria. At insufficient products of progesterone in the second phase of a cycle in an endometria insufficiency of secretory transformations can be found. For assessment of a condition of an endometria and definition of compliance morfol, changes of an endometria to cyclic processes in an ovary, and also estimates of hormonal ratios during M. of c. widely use the table.

Change of secretion of cervical slime depending on degree of an oestrogenic saturation of an organism formed the basis of a phenomenon of a pupil — one of the most available a wedge, tests of definition of activity of ovaries. At normal M. of c. on 8 — the 9th day an outside opening of the cervical channel (an ostium of the uterus, T.) extends and in it vitreous transparent slime appears — at natural and, especially, artificial lighting it reminds a pupil of an eye. In the next days there is a gaping of an outside uterine pharynx of the cervical channel and the amount of cervical slime increases. By the time of an ovulation diameter of an outside opening of a neck reaches 1/4 — 1/3 cm. The symptom of a pupil disappears on 20 — the 25th day of M. of c.

Fig. 5. Drugs of the cervical slime changing crystallization during a menstrual cycle: and — the 10th day, the arrangement of crystals like a leaf of a fern is noticeable; biv — the 14th and 15th day (ovulation), a spinnbarkeit it is most expressed (figures of a leaf of a fern); — the 22nd day (blossoming of a yellow body), the smear takes an amorphous form.

The phenomenon of a leaf of a fern allows to specify an oestrogenic saturation of an organism, and also existence of an ovulation: after an ovulation crystals of cervical slime begin to break up (at the women suffering from a cervicitis, uterine bleedings; at virgins it is possible to investigate smears of slime from a nasal cavity since nasal slime crystallizes identically cervical slime). The phenomenon of crystallization of cervical slime in the form of a leaf of a fern is received as follows: the droplet of slime taken by tweezers is transferred to a dry slide plate and dried on air within 40 min. From 1st to the 5th day M. of c. drugs have an amorphous appearance, crystals are not formed; with 6 — the 8th day crystallization begins to appear, for the 10th day it is already noticeable; the maximum expressiveness of a figure from crystals is reached by the time of an ovulation (14 — the 15th day). In a phase of blossoming of a yellow body (on 21 — the 22nd day) the smear takes an amorphous form (fig. 5).

The described sequence of changes of a symptom of a pupil and phenomenon of crystallization of cervical slime against the background of two-phase character of curve basal temperature indicates a normal (two-phase) menstrual cycle with fiziol, fluctuations of level of oestrogenic influences in the first and its second half. At anovulation or lack of a yellow body, its insufficiency (a defective two-phase cycle) expressiveness of the specified symptoms allows to estimate extent of disturbance of secretion of estrogen in ovaries: strengthening of oestrogenic influences (at preservation of a symptom of a pupil and phenomenon of a fern in the second half of M. of c.) or their insufficiency (at weak expressiveness of these symptoms in various terms of M. of c.).

For studying of hormonal ratios during M. of c. the method of a research of vulval contents is widely used tsitol (see. Vagina, methods of a research ). The changes of cellular structure of contents of a vagina characterizing degree of a differentiation of a multilayer flat epithelium of a vulval wall under the influence of sex hormones are the basis for assessment of a kolpotsitogramma. For this purpose use the indexes specifying percentage in a vulval smear of cells of various layers of a vulval wall. The index is estimated in the way soschityvat 100, 200 and 500 cells in a kolpotsitogramma.

The following indexes are more often applied for hormonal cytodetection. 1. Index of Maturing (IM); registers in the form of a formula where at the left the quantity of parabasal and basal cells is specified, in the middle — intermediate, on the right — the quantity of superficial cells expressed as a percentage. At a sharp mucosal atrophy of a vagina owing to low oestrogenic stimulation it is possible to observe so-called shift to the left (IS — 100/0/0), and at proliferation — shift to the right (IS — 0/20/80 or even 0/0/100). 2. The Kariopiknotichesky Index (KI) — a percentage ratio of all separated keratosic cells with pyknotic kernels and cells with a large diameter of a kernel. In normal M. of c. the average value of KI before approach of periods is equal to 30%, after the termination of periods (at the beginning of a growth phase of a follicle) - 20 — 25%, by the time of an ovulation — within 60 — 85%. 3. The Eosinophilic Index (EI) is equal to the relation of the mature separated cells with eosinophilic coloring of cytoplasm to mature superficial cells with basphilic coloring of cytoplasm expressed as a percentage. Increase or reduction of EI is an indicator of an oestrogenic saturation (intensity oestrogenic stimulations).

Fig. 6. Curves of fluctuations of kariopiknotichesky and eosinophilic indexes during a menstrual cycle [H.Zinser]: 1 — a kariopiknotichesky index; 2 — the relation of an eosinophilic index to kariopiknotichesky; 3 — an eosinophilic index. On abscissa axis days of a cycle are designated; on ordinate axes: at the left — sizes of indexes, on the right — fractional figures for measurement of the relations of indexes.

According to M. G. Arsenyeva (1977), at the II extent of proliferation of KI makes from 1 to 30%, EI — from 1 to 20%; at the III degree — KI from 30 to 50%, EI from 20 to 50%; at the IV degree — KI from 50 to 80%, EI from 50 to 70%; at the V degree — KI from 80 to 100%. Cycle variations of kariopiknotichesky and eosinophilic indexes are shown in fig. 6.

At uterine bleedings, inflammatory processes in a vagina and a neck of uterus, including at virgins, it is possible to carry out tsitol, a research of an urocheras (urotsitogramma) since the mucous membrane of a back wall of a bladder and an upper part of an urethra and a mucous membrane of a vagina are equally subject to influence of estrogen and progesterone; respectively, changes of number and a type of cells both in a smear from a vagina, and in an urocheras during M. are identical to c. (uniformity is connected with a community of development of uric and sexual systems).

For objective assessment of M. of c. at women of childbearing age kolpotsitologichesky researches should be combined with other tests funkts, diagnoses, studying them in dynamics.

At a research of function of ovaries, identification of time and character of an ovulation, specification of features of growth disorder and maturing of follicles and funkts, activity of a yellow body can gain the fullest impression by daily determination of content in blood and (or) urine of gonadotropic and sex hormones during one-two M. c.

For early detection of disturbances of M. of c. each woman is recommended to conduct a so-called menstrual calendar (menotsiklogramma) — to monthly celebrate the first day of M. of c. and duration of periods.

Disturbances of a menstrual cycle

Reasons of disturbances of M. of c. happen heavy inf. diseases, nutritional dystrophy, hypovitaminoses, intoxications and prof. of harm, cardiovascular diseases, diseases of blood, liver, kidneys. M.'s disturbances c. hypothalamic genesis can arise because of a mental injury, a nerve strain, bruises and a contusion of a brain. M.'s frustration c. are also display of endocrine diseases (a diabetes mellitus, a hypothyroidism, a toxic craw, a hyperplasia of cortical substance of adrenal glands), diseases of a hypophysis, etc. Reason of disturbances of M. of c. there can be inflammatory diseases of a uterus and appendages, the injuries of a uterus connected with intrauterine manipulations.

According to Teter (J. Teter, 1968), from the point of view of a pathogeny of disturbances of M. of c., it is necessary to distinguish primary defeat of gipotalamo-pituitary system and primary disease of ovaries, and also a uterus.

Depending on at what level M.'s regulation is broken by c., distinguish the following types of frustration of M. of c.: cortical and hypothalamic, pituitary, ovarian, uterine, M.'s disturbances c., connected with diseases of a thyroid gland and with diseases of adrenal glands.

At M.'s disturbance c. the central genesis, napr, at psychogenic influences, first of all cyclic release of luteinizing hormone at preservation of basal secretion suffers; it causes development of follicles, but without ovulation. At defeat of a hypothalamus of dysfunction of ovaries can have various character. Disturbances of gonadotropic stimulation lead to the fact that in ovaries development of follicles stops; it is followed by falloff of secretion of estrogen. Primary damage of ovaries can be various: from funkts, insufficiency to fibrosis of cortical substance and sharp reduction of number of primordialny follicles.

Clinical frustration of M. of c. are shown in the form of two main forms — amenorrheas (see) and dysfunctional uterine bleedings (see). In addition to lack of periods (patol, amenorrheas), a wedge, a picture of disturbances of M. of c. it is characterized by change of intensity and rhythm of periods — reduction or increase in intervals between them, strengthening of intensity of a krovootdeleniye, chaotic character of periods, emergence of uterine bleedings.

The following characteristic manifestations are possible: D) changes of amount of the blood which is emitted during periods: plentiful periods (hypermenorrhea) or scanty periods (hypomenorrhea), and also scanty and short periods (opsooligomenorrhea); 2) disturbances of duration of periods: long periods, more than 6 — 7 days (polymenorrhea) or short, 1 — 2 day (oligomenorrhea); 3) disturbances of a rhythm: frequent periods, when M. of c. it is less than 21 day (proyomenoreya), and rare — M. of c. St. 35 days, sometimes up to 3 months (opsomenorrhea). The hypomenorrhea is often combined with an oligomenorrhea and an opsomenorrhea that is called hypomenstrual a syndrome; it hypofunction of an adenohypophysis and ovaries, an adrenogenital syndrome, sclerocystic ovaries are the reason.

A menorrhagia call the periods which are characterized by big blood loss lasting up to 12 days. The menorrhagia is observed quite often in the period of puberty and in a climacteric, and also against the background of hron, debilitating diseases; it can be connected with a hysteromyoma, hron, inflammatory diseases of a mucous membrane of a uterus, polipozy an endometria. The term «dysmenorrhea» one authors designate all frustration and M.'s complications of c., others — the periods which are followed by a pain syndrome and the general vegetative and neurotic frustration, and under the term «algomenorrhea» — the painful periods which are not followed by the general frustration (see. Algodismenorey ).

Vikariiruyushchy periods call periodic emergence of the extrauterine blood allocations caused, however, by influence of sex hormones, napr, cyclic nasal or intestinal bleedings in days of the expected periods in the absence of blood allocations from a genital tract. Vikariiruyushchy periods arise at an aplasia of a uterus or after its removal more often.

At all disturbances of M. of c. identification of their reasons and the corresponding treatment is necessary. E.g., at a hypomenstrual molimina treatment of a basic disease is carried out, according to indications appoint the hormones, physical therapy and other methods promoting M.'s recovery c. Success of treatment of a menorrhagia depends on examination and elimination of the reason which caused it. At infantility and a secondary hypo-ovaria the balanced diet and fortifying treatment is important. At a menorrhagia are applied as well symptomatic means: the iron preparations, drugs strengthening function of a hemopoiesis, styptic means at severe bleeding — injections of ergotamine and Pituitrinum, etc.

Hygiene of the woman consists in careful observance of rules of personal hygiene during periods. The woman can perform usual work, but it is necessary to avoid overfatigue, a physical overstrain, overcooling, and also overheating of a body. The careful toilet of external genitals is necessary (see. Personal hygiene, hygiene of the woman ). In the period of periods the sexual intercourses and syringings of a vagina are prohibited. On industrial productions offices for a gigabyte are organized. procedures that is especially necessary during periods.

Bibliography: Arsenyev M. G. Kolpotsitologicheskiye of a research in diagnosis and therapy of endocrine gynecologic diseases, page 8, M., 1977; Gynecologic endocrinology, under the editorship of K. N. Zhmakin, page 5, M., 1976; Mandelstam A. E. Semiotics and diagnosis of female diseases, page 69, L., 1976; The Guide to clinical endocrinology, under the editorship of V. G. Baranov, page 5, L., 1977; Sokolova 3. Item, etc. Content of prolactin at a normal menstrual cycle, Akush, and ginek., No. 5, page 10, 1979; Teter E. Hormonal disturbances at men and women, the lane with polsk., Warsaw, 1968; Tr at t to about N. S. and d river. Content of gonadotropic and steroid hormones in dynamics of a menstrual cycle, Akush, and ginek., No. 7, page 4, 1977; U f e of J. Hormon-therapie in der Frauenheilkunde, B., 1972; W y n n R. Histology and ultrastructure of the human endometrium, in book: Biol, of the uterus, ed. by R. Wynn, p. 341, N. Y. — L., 1977, bibliogr.

E. M. Vikhlyaeva.