[Endometrial biopsy in hormonal imbalance]

Despite the new techniques of biochemical evaluation of steroid hormones in the plasma and urines, the endometrial biopsy remains an easy valuable method of evaluation of ovarian activity. The clinical indications of the endometrial biopsy are mainly a history of sterility or an abnormal uterine bleeding if we exclude the diagnosis of cancer. Different technical procedures should be followed carefully in order to get a valuable answer. The biopsy should be taken at the right time of the cycle which means 10 to 12 days after ovulation. The danger of interrupting a pregnancy is minimal but in a case of sterility, the biopsy can be performed 4 to 6 days after ovulation to prevent any interference with a early pregnancy. Proper fixation, embedding and staining must be the rule. A fragment of the middle layer of the functionalis must be present to evaluate accurately the hormonal stimulation. Isthmic or cervical tissues are unsuited for functional diagnosis. The existence of an endometritis or the administration of steroid hormones are clinical circumstances which prevent any functional evaluation. The normal menstrual cycle can be divided into different functional phases: the early, the middle and the late proliferative phases, and the early and late secretory phases followed by the menstruation period. The different cellular components of the endometrial mucosa will exhibit various changes corresponding to each of the phases. The interpretation of the endometrial biopsy lies in the correlation between the observed image and the image corresponding to that date of the cycle. The functional disturbances are associated with absent, deficient or excessive function of the ovarian hormonal secretion. The endometrial mucosa will reflect these anomalies revealing atrophic, hypoplastic or hyperplastic conditions of the glandular and stromal components. It is essential to obtain the clinical informations including the knowledge of any hormone administration to provide a valuable diagnosis. Properly interpreted, the endometrial biopsy remains a very useful technique in the study of hormonal ovarian disturbances.