Publication: Üreme çağındaki kadınlarda menstruasyon fazlarına göre uterus ve endometriumda oluşan anatomik ve fizyolojik değişikliklerin transvaginal renkli doppler ultrasonografi ile incelenmesi
Abstract
Bu çalışma SSK Göztepe Eğitim Hastanesi Kadın Hastalıkları ve Doğum Polikliniğine başvuran üreme çağında sağlıklı 50 kadın üzerinde yapıldı. Olgular dorsal litotomi pozisyonunda tranvaginal renkli Doppler ultrason ile araştırıldı. Her olguda menstruasyon siklusunun folliküler, periovulatuvar ve luteal fazlarını kapsayacak şekilde toplam 8-10 transvaginal sonografi (TVS) uygulaması yapıldı. Aynı zamanda her olgudan östradiol (E2), progesteron (P), folikül stimüle edici hormon (FSH) ve lüteinleştirici hormon (LH) ölçümleri için periferik venöz kan örnekleri alındı. Uterus ve over hacimleri 3 boyutun, 2 sagital ve 1 transvers planda bulunan değerlerin özel hacim formülüne uygulanması ile bulundu. Endometrium kalınlığı için, endometriumun önde ve arkada myometriumla birleştiği yerde belirlenen ekojenik ara yüz arasındaki mesafe ölçüldü. Menstruasyon sırasında FSH maksimum düzeye ulaşırken, serum E2 düşük seviyelerde bulundu. FSH stimülasyonu ile ovarium folikülleri ovulasyon gününe kadar hızla gelişerek dominant folikül büyüklüğüne ulaştı (ortalama çap 21.5 mm). Buna paralel olarak serum E2 konsantrasyonu ovulasyon fazında maksimum düzeye (ort. 1012 pmol/ l) erişti. P'un serum konsantrasyonu LH yükselmesi ile birlikte ve menstruasyonun +6 gününde maksimum (50.3 nmol/ l) oldu. Bütün siklus boyunca uterus hacminde devamlı artma görüldü. Uterusun ön-arka çapı ise aynı derecede değişklik göstermedi. Endometrium hacim artışı endometrium kalınlık artışı ile paralellik gösterdi. Serum E2 artışını yansıtan ve TV Doppler sonografi ile basitçe ölçülebilen dominant folikül gelişmesi, endometrium kalınlığı ve uterusun ön-arka çapının ölçümleri, uterus ile ilgili anatomik ve fizyolojik sapmaları doğru bir şekilde ortaya koyabilen parametreler olduğu görüldü. EVALUATION OF ANATOMICAL AND PHYSIOLOGICAL CHANGES IN THE UTERUS AND ENDOMETRIUM IN TERMS OF MENSTRUAL PHASES BY TRANSVAGINAL COLOR DOPPLER SONOGRAPHY IN REPRODUCTIVE AGE WOMEN
This study was performed on 50 healthy women in their reproductive ages who were admitted to the Gynecology and Obstetrics Clinic at SSK Göztepe Training Hospital. Cases were investigated at dorsal lithotomy position with transvaginal color Doppler ultrasound. A total of 8 to 10 transvaginal sonography (TVS) was taken in every menstrual cycle case including follicular, periovulatory, and luteal phases. Peripheric venous blood samples were collected in each case for the measurements of estradiol (E2), progesterone (P), and follicle stimulating hormone (FSH) levels at the same time. Uterine and ovarian volumes were found according to a specific volume formula which were calculated with 3 dimensions, 2 sagittal, and 1 transverse plane. For endometrial thickness, the distance between the intermediate echogenic face was measured which was determined at the anterior and posterior myometrial junction. Serum E2 was found in low levels while FSH reached a maximum level during menstruation. Ovarian follicles grew up rapidly and reached a dominant follicle size until the ovulation day with FSH stimulation (mean diameter 21.5 mm) in association with the maximum serum E2 concentration (mean 1012 pmol/ l) during the ovulation phase. Serum progesterone concentration together with LH increase was found a maximum level (50.3 nmol/ l) on +6 menstrual day. Uterine volume was found to be increased constantly during the whole cycle. The antero-posterior diameter of the uterus was found to be unchanged at the same degree. Endometrial volume increase showed a correlation with endometrial thickness measurement. The reflection of serum E2 increase and simple measurement of the dominant follicle growth with the TV Doppler sonography, and measurements of endometrial thickness and antero-posterior diameter of the uterus, anatomical and physiological deviations with respect to the uterus were seen to be the real measurable parameters.
This study was performed on 50 healthy women in their reproductive ages who were admitted to the Gynecology and Obstetrics Clinic at SSK Göztepe Training Hospital. Cases were investigated at dorsal lithotomy position with transvaginal color Doppler ultrasound. A total of 8 to 10 transvaginal sonography (TVS) was taken in every menstrual cycle case including follicular, periovulatory, and luteal phases. Peripheric venous blood samples were collected in each case for the measurements of estradiol (E2), progesterone (P), and follicle stimulating hormone (FSH) levels at the same time. Uterine and ovarian volumes were found according to a specific volume formula which were calculated with 3 dimensions, 2 sagittal, and 1 transverse plane. For endometrial thickness, the distance between the intermediate echogenic face was measured which was determined at the anterior and posterior myometrial junction. Serum E2 was found in low levels while FSH reached a maximum level during menstruation. Ovarian follicles grew up rapidly and reached a dominant follicle size until the ovulation day with FSH stimulation (mean diameter 21.5 mm) in association with the maximum serum E2 concentration (mean 1012 pmol/ l) during the ovulation phase. Serum progesterone concentration together with LH increase was found a maximum level (50.3 nmol/ l) on +6 menstrual day. Uterine volume was found to be increased constantly during the whole cycle. The antero-posterior diameter of the uterus was found to be unchanged at the same degree. Endometrial volume increase showed a correlation with endometrial thickness measurement. The reflection of serum E2 increase and simple measurement of the dominant follicle growth with the TV Doppler sonography, and measurements of endometrial thickness and antero-posterior diameter of the uterus, anatomical and physiological deviations with respect to the uterus were seen to be the real measurable parameters.