Stromal fragments meaning7/4/2023 ![]() ![]() In advanced cases, thrombosis of venules, breakdown and bleeding.Ectatic venules with or without markedly thickened spiral arterioles.Decidualized stroma (large cells, abundant cytoplasm, prominent cell borders) with occasional stromal mitoses and lymphocytes.Mostly inactive glands, rarely with marked secretory features (Arias-Stella-like).Progestogen only: 3 morphologic patterns of response, dependent on dose and duration of progestin as well as endogenous estrogen levels, which may be coexistent and overlapping ( Expert Rev Clin Pharmacol 2020 13:1103).Gonadotropin releasing hormone agonists: used for ovulation induction, treatment of endometriosis, pre-endometrial ablation and preoperative treatment of large leiomyomas.Mifepristone: mainly for medical termination of early pregnancy also for the treatment of leiomyomas and pain secondary to endometriosis.Ulipristal acetate: used for management of endometriosis and preoperative treatment of uterine leiomyomas (recommendation in November 2020 by European Medicines Agency to restrict use due to rare risk of serious liver injury) ( European Medicines Agency: Ulipristal acetate 5mg medicinal products ).Selective progesterone receptor modulators:.Bazedoxifene: treatment of osteoporosis.Raloxifen: treatment and prevention of postmenopausal osteoporosis.Tamoxifen: treatment of hormone receptor positive breast cancer in premenopausal women, breast cancer prevention in patients with ductal carcinoma in situ.Selective estrogen receptor modulators:.Testosterone: gender affirming hormone therapy for gender transition.Tibolone: menopausal symptoms, endometriosis, prevention of osteoporosis.Danazol: treatment of endometriosis, menorrhagia, symptomatic leiomyomas.Indications for estrogen or progestogen therapy include contraception, irregular vaginal bleeding, infertility, polycystic ovarian syndrome, hirsutism, postmenopausal symptoms, adjuvant treatment for breast and endometrial carcinoma, gender dysphoria and congenital abnormal sexual development.Gonadotropin releasing hormone (GnRH) agonists: reduce gonadotropin levels which suppresses ovulation and secretion of ovarian hormones causing hypoestrogenism.Selective progesterone receptor modulators (SPRM): bind to progesterone receptors with agonist, antagonist or mixed agonist / antagonist activity.Bazedoxifene (third generation): estrogen antagonist in uterus.Raloxifene (second generation): estrogen antagonist in uterus.Clomiphene (first generation): estrogenic or antiestrogenic activity, competitively binding to hypothalamic estrogen receptors and causing an increase in follicle stimulating hormone (FSH) and luteinizing hormone (LH), which induces ovulation.Tamoxifen (first generation): estrogen antagonist (breast) or agonist (endometrium), effect depends on estradiol concentration, dose and duration of use as well as menopausal status.Selective estrogen receptor modulators (SERM): competitive inhibitors of estrogen binding to estrogen receptors.Testosterone: androgenic effect on endometrium.Tibolone: estrogenic and progestogenic activity with weak androgenic effect.Gestrinone: combined androgenic, antiestrogenic and antiprogestogenic effects.Danazol: weak androgen and weak progestin effects due to main metabolite, ethisterone.Combined: progestogens have a protective effect on endometrium by downregulating estrogen receptors and thus limiting response to estrogens.Estrogen only: leads to endometrial proliferation with increased risk for endometrial hyperplasia and carcinoma.Suppresses release of gonadotropins, thereby inhibiting follicular development and preventing ovulation.Combined: estrogen (ethinyl estradiol) and progestogen (progestin).Results in thickening of cervical mucus, thinning of endometrium (low and high dose) or inhibition of follicular development and ovulation (high dose). ![]() Progestogen only: oral, subdermal implant, intramuscular injection or intrauterine device (IUD) containing a progestin (e.g., levonorgestrel or medroxyprogesterone acetate).Morphologic changes arise secondary to the effect of exogenous hormones on estrogen or progesterone receptors in the endomyometrium ( Expert Rev Clin Pharmacol 2020 13:1103, Menopause 2018 25:1033, Contraception 2015 91:360). ![]()
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