Secretory endometrium - Uterus and endometrium -

This article will help you read and understand your pathology report for secretory endometrium.

by Adnan Karavelic, MD FRCPC, updated on August 30, 2020

Quick facts:
  • Secretory endometrium means that the cells on the inside of the uterus are producing substances necessary to support implantation of an egg should conception occur.
  • Secretory endometrium is a normal part of the menstrual cycle.
The anatomy of the uterus and endometrium

The uterus is a hollow muscular organ located in the female pelvis between the urinary bladder and the rectum (the lower end of the large bowel). The upper part of the uterus (fundus) is attached to the fallopian tubes while the lower part is connected to the vagina through the uterine cervix.  Functions of the uterus include nurturing the baby, and holding it until the baby is mature enough for birth.

The walls of the uterus are made up of three layers:

  1. Endometrium – The endometrium forms the inner lining of the uterus. The endometrium is made up of endometrial glands lined by one layer of columnar epithelium and surrounded by endometrial stroma.
  2. Myometrium – The myometrium is the middle layer and is made up of smooth muscle which allows the uterus to change size and contract.
  3. Perimetrium– The perimetrium is a thin layer of tissue that surrounds the outside of the uterus.

Gynecological tract

Changes seen during the menstrual cycle

The endometrium is hormone-responsive which means it changes in response to hormones released during the menstrual cycle. Following every menstrual period (menses) the endometrium grows to a thick, blood vessel-rich, glandular tissue layer, providing an optimal environment for a fertilized egg.

If the fertilization does not occur, the endometrium breaks down, leaving only the bottom layer (basal layer) and many open blood vessels. This leads to a temporary bleed and discharge of blood and endometrial tissue through the vagina (menstruation, menstrual period, menstrual flow). Once the menstruation is over, the endometrium starts growing again, and the cycle repeats.

During the menstrual cycle, the endometrium grows under the influence of two major hormones – estrogen and progesterone. In the first part of the menstrual cycle, between menses and ovulation (ovulation is when a mature egg is released from the ovary, pushed down the fallopian tube, and is made available to be fertilized), the endometrium grows under the influence of estrogen. This is also known as proliferative endometrium.

What is secretory endometrium?

Secretory endometrium is a normal non-cancerous change seen in the tissue that lines the inside of the uterus. It is a normal finding in women of reproductive age.

After ovulation, the endometrium grows under the influence of progesterone. During this phase, the endometrial glands become long and twisted, and the secretion starts. Pathologists call this phase the secretory endometrium.

Secretory endometrium

These changes occur during the fertile age, which for most women starts at early teens, and lasts until the age of 45-55. Menstrual flow might occur every 21 to 35 days and usually lasts two to seven days.

How do pathologists make this diagnosis?

The diagnosis of secretory endometrium is usually made after a small sample of tissue is removed from the endometrium during a procedure called an endometrial biopsy or uterine curetting.

Common reasons for these procedures include:

  • Abnormal (dysfunctional) uterine bleeding.
  • Postmenopausal bleeding.
  • Screening for endocervical or endometrial cancer.
  • Endometrial dating.
  • Follow up of previously diagnosed endometrial hyperplasia.
  • Endometrial or endocervical polyps.
  • Infertility.

The diagnosis of secretory endometrium means that your pathologist saw specific features including an increased amount of tissue, twisted glands, and secretions when your tissue sample was examined under the microscope.

Post ovulation day (POD)

The microscopic changes that take place in the endometrium allow your pathologist to determine how many days it has been since ovulation occurred. This information is called the post ovulation day and it is especially important for women trying to become pregnant. You may see the post ovulation date described in your report.

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