Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENDOMETRIUM”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1995

Immunohistochemical characterization of proliferation, oestrogen receptor and progesterone receptor expression in endometriosis: comparison of eutopic and ectopic endometrium with normal cycling endometrium.

Recent studies examining oestrogen and progesterone receptor status and the proliferative activity of endometriotic lesions have produced conflicting reports. This study aimed to clarify the receptor status and proliferative activity of eutopic and ectopic endometrium from women with endometriosis and endometrium from normal women. Progesterone and oestrogen receptor expression and proliferative activity were studied in eutopic and ectopic endometrium from 30 women with endometriosis and in endometrium from 30 normal cycling women using microwave-pretreated paraffin-embedded sections stained with an avidin-biotin peroxidase technique. Progesterone and oestrogen receptor expression in the control endometrium did not differ from that of eutopic endometrium from women with endometriosis. Oestrogen receptor expression in ectopic endometrium increased from the proliferative to the late secretory phase. Epithelial progesterone receptor expression decreased during the cycle. Oestrogen receptor expression in both epithelium and stroma of ectopic endometrium was significantly higher than in eutopic endometrium throughout the cycle. In contrast, stromal progesterone receptor expression tended to be reduced in ectopic endometrium compared with eutopic tissue. Epithelial progesterone receptor expression was increased in ectopic endometrium but only in the late secretory phase. Although proliferative activity in the epithelium of control and eutopic endometrium was reduced from the proliferative to the late secretory phase, stromal activity did not vary. The proliferative activity in ectopic endometrium remained low and constant throughout the cycle. In the proliferative and early secretory phases, the proliferative activity of eutopic endometrium was increased compared with ectopic endometrium, but in the late secretory phase, levels were comparable. These findings challenge previous reports which have suggested that oestrogen receptors are reduced in ectopic tissue. This may have clinical implications for the development of novel treatments for endometriosis.

Case-Control Studies↗
PubMed2000

Progesterone induction of 17beta-hydroxysteroid dehydrogenase type 2 during the secretory phase occurs in the endometrium of estrogen-dependent benign diseases but not in normal endometrium.

In the human endometrium, inactivation of 17beta-estradiol to estrone is catalyzed by 17beta-hydroxysteroid dehydrogenase type 2 (17betaHSD2). Previous studies have shown that the 17betaHSD2 activity in the endometrium is elevated during the secretory phase, as compared with the level during the proliferative phase, and that the elevation is in response to progesterone via the progesterone receptors. Recently, it has been demonstrated that aromatase cytochrome P450, the enzyme responsible for estrogen biosynthesis, is not present in the endometrium obtained from normal menstruating women with cervical cancer in situ showing no other gynecological disease (defined as "disease free"), but present in the endometrium obtained from patients with endometriosis, adenomyosis, and/or leiomyomas (defined as "diseased"). However, the previous 17betaHSD studies have been performed without distinguishing between disease-free and diseased endometria. We, therefore, analyzed 17betaHSD2 distinguishing between disease-free and diseased endometria. During the proliferative phase, the abundance of messenger RNA (mRNA) and activity of 17betaHSD2 were comparable in both disease-free and diseased endometrium. However, during the secretory phase, while the abundance of mRNA and activity of 17betaHSD2 increased 4- to 6-fold in diseased endometrium, the 17betaHSD2 remained unchanged in the disease-free endometrium. Kinetic studies showed that the Km was identical among the four groups of endometria, suggesting that the elevation of 17betaHSD2 simply resulted from increased mRNA transcription. Organ culture of proliferative endometria in the presence of progestins resulted in the stimulation of 17betaHSD2 in diseased endometria via the progesterone receptors, whereas disease-free endometrium was not stimulated by progestins. These results suggest that the previous paradigm that 17betaHSD2 activity in the endometrium is elevated during the secretory phase is confined to diseased endometrium but not to disease-free endometrium and that the estrogen metabolism is altered in the endometria of the patients with estrogen-dependent benign diseases.

17-Hydroxysteroid Dehydrogenases↗
PubMed2003

Immunoexpression of hepatocyte growth factor and c-Met receptor in the eutopic endometrium predicts the activity of ectopic endometrium.

OBJECTIVE: To investigate the mitogenic and angiogenic activity of the eutopic and ectopic endometrium throughout the menstrual cycle and to examine whether the activity of the eutopic endometrium is useful to predict greater activity of the ectopic endometrium. DESIGN: Controlled clinicopathologic study using intact tissue. SETTING: Nagasaki University School of Medicine, Nagasaki, Japan. PATIENT(S): Fifteen infertile women with pelvic endometriosis and 10 women without endometriosis undergoing laparoscopy. INTERVENTION(S): Biopsies from the ectopic endometrium and the corresponding eutopic endometrium were collected. Immunohistochemical staining was performed using respective antibodies, and a computer analyzed modified quantitative-histogram (Q-H) score was used to quantify immunostaining. MAIN OUTCOME MEASURE(S): The immunoreactions of hepatocyte growth factor (HGF), its receptor, c-Met, vascular endothelial growth factor (VEGF), proliferating cell nuclear antigen (PCNA), and von Willebrand factor (VWF) in eutopic and ectopic endometrium were examined, and their relation with different revised American Society for Reproductive Medicine (r-ASRM) stages and the morphology of endometriosis was evaluated. RESULT(S): The immunoexpressions of HGF and c-Met were significantly higher in the eutopic endometrium of patients with endometriosis than in that of controls. The Q-H scores of HGF, c-Met, VEGF, PCNA, and microvessel density (MVD) were markedly higher in red peritoneal lesions when compared with other lesions. The Q-H scores did not reveal r-ASRM stage-dependent variation in any of these markers. We observed a significant correlation between the immunoexpressions of HGF, c-Met, and PCNA or microvessel counts. When we combined the Q-H scores of the glandular epithelium and stroma, we found that increased activity of the eutopic endometrium as measured by the immunoreaction of HGF, c-Met, VEGF, PCNA, and MVD was similar to highly active red lesions and was significantly higher than that of controls and other lesions. CONCLUSION(S): Immunoexpression of HGF and c-Met in the eutopic endometrium of patients with pelvic endometrioisis is possibly useful to predict greater activity of the ectopic endometrium.

Adult↗
PubMed1998

Placental protein 14 in endometrium during menstrual cycle and effect of early luteal phase mifepristone administration on its expression in implantation stage endometrium in the rhesus monkey.

Placental protein 14 (PP14) is a glycoprotein which is secreted by secretory phase endometrium and decidua in women. Despite the suggestion that PP14 is involved in the process of endometrial maturation for blastocyst implantation, our understanding in this regard is poor. In the present study, the concentrations and distribution patterns of immunodetectable PP14 in the endometrium during proliferative and secretory phases of normal ovulatory menstrual cycles, as well as in implantation stage endometrium in naturally mated ovulatory cycles with or without early luteal phase mifepristone treatment, were investigated using the rhesus monkey as a primate model. Immunopositive PP14 was observed mainly in epithelial cells of glands and it was detected in one major immunopositive band at Mr 28 kDa in tissue homogenate and spent medium. The area of immunopositive precipitation of PP14 in glands was minimal in follicular phase endometrium, and was higher (P < 0.01) in early, mid- and late luteal phase endometrium compared with that in pre- and periovulatory phases of the cycle, but there was no change in its area profile in the glandular compartment throughout the luteal phase. Immunopositivity for PP14 in luminal contents of gland displayed an increasing profile from early to late secretory phases. Thus, the concentrations and the distribution of immunodetectable PP14 in luteal phase endometrium of the rhesus monkey showed marked similarity with those of human endometrium during the natural menstrual cycle. Although there was no marked change in the band characterstics for the protein in implantation stage endometrium following early luteal phase mifepristone treatment, it was markedly decreased (P < 0.01) in tissue homogenate and in vitro spent medium along with a lesser (P < 0.02) degree of immunoprecipitation in the glands in implantation stage samples of mifepristone treatment group compared with that in control group samples. Thus, the contragestional effect of early luteal phase mifepristone treatment appears to be associated with a decrease in the concentration of immunodetectable PP14 in implantation stage endometrial glands and its secretion in the rhesus monkey. It remains to be seen whether this decline is caused from direct antiprogesterone action on endometrial glands during progesterone dominance, or secondarily from associated retarded development of endometrium.

Animals↗
PubMed1996

Immunohistochemical characterization of stromal leukocytes in ovarian endometriosis: comparison of eutopic and ectopic endometrium with normal endometrium.

OBJECTIVE: To compare stromal leukocyte subpopulations in different phases of the menstrual cycle in eutopic and ectopic endometrium from women with ovarian endometriosis and in control endometrium. DESIGN: Retrospective immunohistochemical study. SETTING: Department of Pathology, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom. PATIENTS: Paraffin-embedded tissue blocks from 30 patients with endometriosis and 30 control blocks from patients undergoing hysterectomy for nonendometrial pathology were retrieved from archive files. MAIN OUTCOME MEASURE: Quantitative assessment of defined stromal leukocyte subpopulations in eutopic, ectopic and control endometrium at different stages of the menstrual cycle. RESULTS: In the proliferative and early secretory phases, ectopic endometrium contained elevated numbers of CD45+, CD3+, and CD43+ cells but reduced percentages of CD68+ macrophages. The proportions of granulated cells were reduced in ectopic endometrium throughout the cycle. No differences were noted between eutopic endometrium from women with endometriosis and control endometrium. CONCLUSION: Differences between eutopic and ectopic leukocyte subpopulations with the exception of large granular lymphocytes may be due to the lack of cyclicity demonstrated by endometriotic lesions.

Endometriosis↗
PubMed1997

Increased expression of complement component 3 in human ectopic endometrium compared with the matched eutopic endometrium.

OBJECTIVE: To compare the gene expression of complement component 3 (C3) in human eutopic and ectopic endometrium. DESIGN: A prospective, controlled study. SETTING: Academic hospital. PATIENT(S): Women with documented endometriosis. INTERVENTION(S): Eutopic and ectopic endometrial tissues were collected simultaneously at laparoscopy. MAIN OUTCOME MEASURE(S): Detection of C3 messenger RNA (mRNA) by in situ hybridization and C3 protein by immunohistochemistry and Western blot. RESULT(S): Expression of C3 mRNA increased in ectopic endometrium compared with that in the matched eutopic endometrium. The quantitative analysis of C3 mRNA by grain count (mean +/- SE) showed 175.60 +/- 40.02 and 39.97 +/- 8.17 grains per micron2 in ectopic and eutopic glands, respectively, and 67.65 +/- 29.82 and 15.02 +/- 5.80 grains per micron2 in ectopic and eutopic stroma, respectively. Expression of C3 mRNA in ectopic glands was significantly higher than that in eutopic glands. The pattern of immunoreactive staining of C3 protein was consistent with that of C3 mRNA. A higher level of C3 protein in ectopic endometrium than eutopic endometrium was detected by immunohistochemistry and Western blot. CONCLUSION(S): Expression of C3 mRNA and protein significantly increased in human ectopic endometrium compared with that in the matched eutopic endometrium.

Adult↗
PubMed1998

Intraepithelial leukocytes in endometriosis and adenomyosis: comparison of eutopic and ectopic endometrium with normal endometrium.

Intraepithelial leukocytes (IEL) are recognized as an important component of most mucosal surfaces but have received scant attention in the human female reproductive tract. The aim of the present study was to characterize, quantify and compare IEL populations in normal endometrium (n = 30) and in eutopic and ectopic (endometriotic or adenomyotic lesions) endometrium from women with endometriosis (n = 30) or adenomyosis (n = 15) at different menstrual cycle phases in order to assess the role of IEL in these common but poorly understood disorders. IEL populations were examined in formalin-fixed, paraffin-embedded sections using a streptavidin-biotin-peroxidase complex technique and quantified in relation to epithelial cell numbers. IEL in control endometrium and eutopic endometrium in endometriosis and adenomyosis varied during the menstrual cycle, with CD45+, CD43+ and CD56+ cells increasing from the proliferative to the late secretory phase. IEL were elevated in surface compared with glandular epithelium in the proliferative and early secretory phases. Throughout the menstrual cycle there were no significant differences in IEL between eutopic and ectopic endometrium in adenomyosis. Endometriotic foci, however, contained elevated levels of CD45+, CD3+ and CD8+ cells and reduced numbers of CD56 + cells compared with the corresponding eutopic endometrium and these did not vary with menstrual cycle phase. In contrast, ectopic endometrium in adenomyosis showed some cyclical changes with CD56+ cells increasing significantly in the late secretory phase. It is possible these differences may play a role in the pathogenesis of endometriosis and the associated complications.

Antibodies, Monoclonal↗
PubMed1998

Fibrinolytic factors in endometriotic tissue, endometrium, peritoneal fluid, and plasma from women with endometriosis and in endometrium and peritoneal fluid from healthy women.

OBJECTIVE: To determine whether there is a difference in fibrinolytic compounds in endometriotic tissue, endometrium, peritoneal fluid (PF), and plasma from women with endometriosis and in endometrium and PF from healthy women. DESIGN: Prospective study. SETTING: Two university clinics. PATIENT(S): Regularly menstruating women with and without endometriosis. INTERVENTION(S): Tissue samples, PF, and blood were collected at surgery performed for clinical reasons. MAIN OUTCOME MEASURE(S): The antigen concentrations of plasminogen activators and plasminogen activator inhibitors (PAls) in tissue homogenates, PF, and plasma were assayed by ELISA. RESULT(S): The concentrations of urokinase plasminogen activator (u-PA) and PAI-1 were higher in endometrium from women with endometriosis than in endometrium from controls and even higher in endometriotic tissue than in endometrium from both groups. In PF, the concentration of PAI-2 was higher in women with endometriosis than in controls. CONCLUSION(S): The high concentrations of u-PA and PAI-1 in endometrium from women with endometriosis might facilitate implantation of endometrial cells and the high concentration in endometriotic tissue might contribute to their invasive growth. The inflammatory reaction may contribute to the high concentration of PAI-2.

Adult↗
PubMed1996

Morphological and functional aspects of the endometrium of asymptomatic post-menopausal women: does the endometrium really age?

The morphological and functional aspects of the endometrium were investigated in 28 asymptomatic post-menopausal women to evaluate the ageing phenomenon of this tissue. Haematoxylin-eosin staining showed an atrophic endometrium in 12 cases and a hyperplastic endometrium in the other 16 cases. Masson's trichrome identified moderate fibrosis in all post-menopausal endometrial stroma. Immunohistochemical analyses were performed on the endometrial specimens to evaluate the distribution of the capillary system, the cellular proliferation index and the presence of oestrogen and progesterone receptors. Our data showed a discrepancy between the morphological pictures and the functional aspects of the post-menopausal endometrium. In fact, the morphological pictures suggested an involution of this tissue according to the increase in collagen fibres, the decrease in vascular distribution and the frequent atrophic patterns. On the other hand, data from steroid receptors and the cell proliferation index suggest that post-menopausal endometrium is an active structure. So, endometria from normal post-menopausal women appear to be in a more quiescent state than in a really atrophic condition. This leads to the question: does the endometrium really age?

Aged↗
PubMed1992

Immunohistochemical localization of androgen receptor in the human endometrium, decidua, placenta and pathological conditions of the endometrium.

The immunohistochemical localization of the androgen receptor in the human endometrium at various stages of the menstrual cycle and post-menopausal period, in decidua and placenta of early pregnancy, and in several pathological conditions of the endometrium has been investigated. At any phase of the menstrual cycle, both endometrial glandular cells and endometrial stromal cells showed positive nuclear staining. Endometrial stromal cells of the functional layer showed stronger staining than those of the basal layer, but endometrial glandular cells of both layers showed the same staining intensity. There was little staining in myometrium. Even after menopause, endometrial glandular and stromal cells showed the same staining pattern as the basal layer of pre-menopausal endometrium and the staining intensity of endometrial stromal cells was weak. In decidua and placenta of early pregnancy, decidual and trophoblastic cells showed positive staining and there was no staining in the stromal cells of placenta. The expression of the androgen receptor was also detected in adenomyosis, endometriosis and endometrial carcinoma. Although the proliferation and differentiation of endometrium are mediated mainly by oestrogen and progesterone receptors, the androgen receptor may play some role in modulating these changes. These results suggest that it may be involved in both physiological and pathological changes of the endometrium.

Adult↗
PubMed2000

[Expression of bcl-2 in the normal endometrium and endometrium of adenomyosis].

Using immunohistochemical ABC staining, we detected the expression and role of bcl-2 in normal endometrium(n = 17) and eutopic and ectopic endometrium with adenomyosis(n = 16) during the menstrual cycle. The first result was that the expressions of bcl-2 in the eutopic endometrium were the same as the normal endometrium, showing predominantly in the glandular epithelial cells, and obviously cyclic changes throughout the menstrual cycle. This result suggests that these changes may be regulated by ovarian hormone and play an important role in the proliferation and physiologic death of normal endometrial glandular epithelial cells to regulate the menstrual cycle. Bcl-2 expression in the glandular cells of ectopic endometrium of adenomyosis had no cyclic change and bcl-2 staining had remained in the whole menstrual cycle. The second result suggests that the above mentioned phenomena may play an important role in the pathogenesis of adenomyosis.

Adult↗
PubMed1983

Human endometrium in cell culture: a new method for culturing human endometrium as separate epithelial and stromal components.

The present study describes a simple method for culturing human endometrium as separate epithelial and stromal components. Fifty-two samples of normal human endometrium have been initiated in tissue culture: endometrium from both the proliferative and luteal phases of the menstrual cycle showed satisfactory growth in vitro with a success rate of about 94%. Epithelial cultures remained viable for 60 days, while from stromal cells it was possible to establish cell lines. Both cell types possessed estrogen receptors. Epithelial cells showed no clear estrogen or progesterone response. Our observations suggest that this simple method for culturing human endometrium may serve as a tool in further investigations.

Connective Tissue↗
PubMed1977

Glycogen estimation by a rapid enzymic method in very small samples of human endometrium: glycogen content in the endometrium of infertile patients during the menstrual cycle.

An enzymic method using alpha-glucosidases was adapted for measuring glycogen in very small samples (3 mg) of human endometrium. The method is useful as a clinical test of the physiologic function of human endometrium. The glycogen content of the endometrium of normal and infertile patients was measured during the menstrual cycle. The maximal content in both groups was observed between the 16th and 23rd days of the cycle, but the glycogen content of the infertile group was significantly lower (P less than 0.005). These results confirm the reports of others. Endometrial glycogen and urinary pregnanediol levels in 32 infertile patients were measured on day 7 after ovulation. The glycogen content of the endometrium of 21 of these patients, who showed normal excretion of urinary pregnanediol (greater than or equal to 2 mg/day), was significantly higher than that of the other 11 patients who showed low excretion of urinary pregnanediol (less than 2 mg/day) (P less than 0.005). This finding suggests that there is a high correlation between the function of the corpus luteum and endometrial glycogen deposition.

Clinical Enzyme Tests↗
PubMed1988

Limited hormonal responsiveness of ectopic endometrium: histologic correlation with intrauterine endometrium.

In order to assess the hormonal responsiveness of ectopic endometrium, 438 unselected endometrial implants and corresponding intrauterine endometrium from 196 patients were evaluated and classified by standard endometrial dating criteria. Only 13% of the endometrial implants were histologically synchronous with the corresponding intrauterine endometrium. Both proliferative and secretory implants were present in relatively constant proportions throughout the menstrual cycle, demonstrating a lack of correlation with cyclic endogenous hormones. A significant percentage (range, 25% to 49%) of endometrial implants displayed some form of local hemorrhage irrespective of the menstrual cycle timing. Sixty percent of the patients had evidence of hemorrhage in at least one implant. In women receiving hormonal therapy at the time of surgery, the proportion of endometrial implants that were histologically in concert with the corresponding endometrium ranged from 0% to 33%. In early pregnancy and menopause, 50% and 31% of endometrial implants were histologically similar, respectively. These data indicate that the hormonal responsiveness of endometrial implants is unpredictable and inconsistent.

Adolescent↗
PubMed2001

Expression of the chemokines, monocyte chemotactic protein (MCP)-1 and MCP-2 in endometrium of normal women and Norplant users, does not support a central role in macrophage infiltration into endometrium.

The endometrium contains many leukocytes, including macrophages, the numbers varying with the time of the menstrual cycle and being maximal peri-menstrually. The long-acting progestogenic contraceptive Norplant, has a high rate of discontinuation due to uterine bleeding; this is associated with large numbers of endometrial macrophages. Monocyte chemotactic proteins (MCP) act to recruit and activate monocytes into sites of inflammation. This study compared the cellular localization of endometrial MCP-1 and MCP-2 across the normal menstrual cycle and in users of Norplant. Both MCP-1 and MCP-2 were present in normal endometrium, but with very different patterns of cellular location and considerable variability between individuals. MCP-1 of epithelial origin was present in 77% of tissues, while stromal staining was present in 52% and vascular staining in 34% of samples. MCP-1 was also released from both epithelial and stromal cells in culture. MCP-2 staining was predominantly epithelial and was found in 52% of tissues while stromal staining was present in only 3/56 samples. Vascular staining of MCP-2 was found in 2/56 samples. The epithelial staining was mostly punctate and sometimes within uterine secretions. No correlation of staining for MCP-1 or -2 with the phase of the cycle was found in any cellular compartment. Very little immunoreactive MCP-1 or MCP-2 was detected in endometrium from Norplant users regardless of morphological subtype. These distributions do not support a role for either MCP-1 or MCP-2 in the migration of macrophages into the endometrium and suggest that these cytokines may have other functions in this tissue.

Cells, Cultured↗
PubMed1981

[Aspiration cytology of the endometrium for the early diagnosis of carcinoma of the endometrium in its precursors (author's transl)].

In 783 patients from age 38 to 83 aspiration cytology of the endometrium was carried out and compared to microscopic findings of the endometrium from the curettages. The samples were obtained from women with post-menopausal and pre-menopausal bleeding and from women without bleeding prior to hysterectomy for various indications. In 49.% of the cases adenocarcinoma of the endometrium was detected, and in 4.2% of the cases pre-cancerous lesions such as adenomatous or atypical glandular hyperplasia of the endometrium and of the endocervix were observed.

Adenocarcinoma↗
PubMed1988

The activity of calcium dependent and calcium independent phospholipase A2 in normal endometrium and in endometrium from women suffering from menorrhagia and polycystic ovary syndrome.

The activity of 2 phospholipase A2 enzymes, PLA2(i) and PLA2(ii) was measured in endometrium in women with regular menstrual cycles without evidence of pathology and in those complaining of menstrual disturbances. There was a significant 4-fold increase in PLA2(i) activity in secretory phase endometrium (mean +/- SD: 32.7 +/- 9.5 pmol per mg protein/minute) compared to that of the proliferative and menstrual phases (9.5 +/- 4.9 and 6.1 +/- 2.6 pmol per mg protein/minute, respectively) but PLA2(ii) activity was variable and not related to the stage of the cycle (range: 4.0-97.0, 18.7-110.3 and 0.1-85.5 pmol per mg protein/minute for proliferative, secretory and menstrual phases, respectively). There was no significant difference between normal subjects and those with menorrhagia with respect to the mean activities of either isoenzyme at any stage of the cycle. Women with polycystic ovary syndrome (PCO) had markedly higher endometrial PLA2(ii) activity than normal subjects. The evidence of this study suggests that PLA2(ii) is not implicated in unexplained menorrhagia, but our preliminary findings indicate that the high level of PLA2(ii) activity found in the endometrium of women with PCO might be a marker of abnormal endometrial function.

Adult↗
PubMed1992

Microcarcinoma of the endometrium: a mapping study with special reference to cytologic atypia in the endometrium.

In order to elucidate the basis for the development of an endometrial carcinoma, we looked for microcarcinomas measuring < 5 mm in greatest diameter, and studied their histologic characteristics and those of the neighboring endometrium. Using serial step section methods, two microcarcinomas were detected. A microcarcinoma was found in one of 14 uteri resected for atypical hyperplasia and the other was found in one of 114 uteri resected for endometrial carcinoma. The neighboring endometrium of the former was adenomatous and had atypical hyperplasia and that of the latter was atrophic and contained atypical glands characterized by cytologic atypia and not by architectural changes. The findings may suggest endometrial carcinomas to have two pathogenetic forms: a carcinoma associated with hyperplasia and occurring in premenopausal women, a second carcinoma associated with atrophic endometrium and occurring in postmenopausal women. Atypical glands in atrophic endometria may indicate that endometrial specimens from postmenopausal women should be carefully screened for cytologic atypia.

Adenocarcinoma↗