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It is not necessary to date the endometrium during the proliferative phase.
During this period, daily morphologic alterations are not sufficiently distinctive to provide adequate benchmarks for accurate dating.
In cases of clinical membranous dysmenorrhea, the endometrial biopsy should be taken on cycle days 5–10.
Such a condition, also called irregular shedding, is presumably associated with a persistent corpus luteum from a recent or remote intrauterine or ectopic pregnancy and with relatively increased blood progesterone levels.
Because of the stabilizing effect of progesterone on lysosomal enzymes and prostaglandins, menstrual breakdown may be delayed, prolonged, and extensive.
In premenopausal women with regular menstrual cycles, histological preparations include the upper portion of the functional layer of the endometrium.
This is necessary, for in most instances morphological changes occur in the functionalis as opposed to the basalis layer, and, by inference, provide a clinically useful diagnosis.
In LPD, circulating progesterone levels are decreased and not sufficient to promote full secretory differentiation of the endometrium.
A repeat biopsy taken during the same period of the following cycle will further confirm an abnormally short corpus luteum life span.In contrast, secretory-phase endometrium often demonstrates subtle changes and, in many cases, combinations of morphologic changes, resulting in most instances in errors of 4–5 days.The pathologist can improve this to 2–3 days, however, by acquiring expertise in endometrial dating (all cases of normal endometria are to be dated regardless of reasons for sampling), and by basing the dating on those endometrial morphologic alterations that represent the most advanced phase of the menstrual cycle.In cases in which little or no tissue is obtained but the endometrium was penetrated with the aspirator, a repeat procedure should be performed.If the repeat aspiration still yields little tissue, one can assume severe endometrial atrophy or obstructing endometrial polyp.The major morphologic criteria useful for dating the endometrium throughout the cycle are presented in Fig. In routine dating, the pathologist should avoid bias by evaluating the histologic section before reading the clinical information.After examining the specimen, the pathologist should attempt to correlate histology with clinical history.Steroid hormone control of endometrial, epithelial, stromal, and presumably endothelial cells is mediated by estrogen receptors and progesterone receptors. They have high affinity to bind estradiol and progesterone, respectively.These steroid receptors are specific proteins concentrated exclusively in the nuclei of both endometrial epithelial and stromal cells, as well as the endothelial cells of stromal capillaries. This chapter contains a review of the technical procedures for handling endometrial tissues and a discussion of the morphologic aspects of the endometrium, focusing on the interpretation and understanding of the physiomorphology of the endometrial cycle.For example, if an endometrial biopsy contains changes consistent with postovulatory days (POD) 2, 3 and 4, the pathologist should report the diagnosis as ' POD 4 or 18-day secretory endometrium'.Endometrial biopsies are not to be taken at the onset of bleeding in the following two conditions: if luteal phase defect (LPD) is suspected clinically and is desired to be confirmed histologically, when the biopsy should be taken between POD 7 (21st) and POD 9 (23rd) cycle days to demonstrate a 3–4 day delay in endometrial maturation; or if there are asynchrony of gland/stromal development and dissimilar maturation in different regions of the endometrial specimen.