The corpus luteum on an ultrasound examination of the ovaries: characteristics, indicators and nuances of diagnosis. Corpus luteum on ultrasound

This is a temporary gland in the ovary of a woman, formed at the site of the follicle from which the mature egg came out. And they called it that because it is filled with a yellow liquid containing hormones. Without the corpus luteum, pregnancy and normal childbearing are impossible.

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How does the corpus luteum appear

Regularly, every month, an egg matures in one of the ovaries of a woman of childbearing age. It develops in the follicle during the first half of the menstrual cycle. After maturation, the follicle bursts, and the egg is released into the abdominal cavity. This process is called ovulation.

While the egg moves through the fallopian tube, a corpus luteum forms at the site of the ruptured follicle, which produces estrogen and progesterone. The latter is especially important - after all, it is he who prepares the woman's body for conception and pregnancy.

In the second half of the menstrual cycle, the corpus luteum actively produces progesterone, which promotes pregnancy. If fertilization does not happen, then the corpus luteum atrophies, the level of progesterone drops sharply and menstruation begins. And in the ovary, the process of maturation of the next follicle is initiated.

Functions of the corpus luteum

Under influence progesterone(it is also called the hormone of pregnancy) the endometrium of the uterus grows and swells, preparing for the implantation of a fertilized egg - the zygote. The fallopian tubes contract slowly, pushing the zygote forward, the cervix dilating to allow the passage of a large female germ cell.

But progesterone, on the contrary, relaxes the muscles of the uterus, preventing it from contracting. Under the influence of the hormones of the corpus luteum, the glands of the uterus first secrete a mucous secretion that increases the permeability of spermatozoa, and later another, which promotes the introduction of the zygote into the uterine wall. The uterus itself is preparing for active expansion.

Progesterone inhibits the maturation of the next follicles and prepares the woman's nervous system for bearing a child. In a woman's breasts, alveoli begin to develop - glands that produce milk.

The functioning of the corpus luteum itself is controlled by hCG(human chorionic gonadotropin), produced by the membrane of the embryo. Thus, if fertilization does not occur, the corpus luteum does not receive an "order" to grow further and degrades.

If conception has occurred, then the corpus luteum will develop and produce hormones until the placenta is fully formed, up to about -16 weeks of pregnancy. Then the child's place will take over the production of progesterone and estrogen, and the corpus luteum is reduced. However, in some women, it persists until the very birth.

With an ectopic pregnancy, the corpus luteum grows slowly. This is due to the fact that the embryo attached in the wrong place (tube wall, ovary, abdominal cavity ...) does not have the opportunity to develop normally. The chorion (sheath) does not grow properly, so hCG is released in insufficient quantities.

What are the violations in the development of the corpus luteum

The main deviations in the normal formation of the corpus luteum are:

functional insufficiency;
- cyst.

Both diagnoses are made after comprehensive examinations, which include ultrasound, blood tests for progesterone and hCG levels, gynecological examination, study of the basal temperature chart. A woman is not at risk from ultrasound during pregnancy - at the moment, ultrasound is the most informative and absolutely safe method for studying the condition of the fetus. It can be carried out as many times as necessary and at any stage of pregnancy.

A corpus luteum cyst is considered a benign disease and rarely requires treatment. But the insufficiency or absence of the corpus luteum is better to detect as early as possible, because this pathology threatens to terminate the pregnancy in the early stages or further development of placental insufficiency.

Hypofunction of the corpus luteum during pregnancy

Insufficiency of the function of the corpus luteum during pregnancy is a very serious violation. It leads to the impossibility of becoming pregnant, to spontaneous abortions, to a threat to the life of the fetus if the placenta has formed with deviations from the norm.

An incomplete cycle of the corpus luteum phase is one of the causes of infertility. If the corpus luteum develops for less than ten days and dies, then the amount of progesterone produced by it is simply not enough to prepare the mother's body for pregnancy. The zygote may not have time to penetrate the wall of the uterus during this time. Or the uterus will reject it as a foreign organism if the hormonal background is formed incorrectly.

Insufficiency of the corpus luteum during pregnancy is a reason for emergency medical intervention. Functional insufficiency of the corpus luteum means that it produces less hormones, primarily progesterone, than is necessary for the normal development of pregnancy. Progesterone deficiency can significantly affect the formation of the placenta and the nutrition of the fetus. But more often than not, low pregnancy hormone levels lead to miscarriage in the first or second trimester.

Lack of corpus luteum during pregnancy

Sometimes the corpus luteum is not visualized at all on ultrasound, although the fact of pregnancy has been established. As a rule, this indicates a very small corpus luteum during pregnancy and requires immediate hormonal correction. The normal size of the corpus luteum is 1-3 cm. If it is smaller, then less hormones enter the mother's body. This means that the life of the unborn child is in real danger.

Treatment for functional insufficiency or absence of the corpus luteum

Treatment of the disease is carried out with hormonal preparations, as a rule, containing progesterone. There are a lot of such drugs, but only a professional doctor can determine which one is right for you after conducting various tests and examinations.

With hormone therapy, not only the dosage is important, but also the time of taking the medication. If the insufficiency of the corpus luteum is the cause of infertility, then the doctor will prescribe hormonal drugs after ovulation. You need to know the exact time of ovulation, because progesterone suppresses it.

If you have already had miscarriages and there is a suspicion of corpus luteum hypofunction, then at the first signs of pregnancy, you should consult a doctor. When confirming the diagnosis, it will be necessary to correct the hormonal background in order to maintain the pregnancy. It will take a long time to be treated, until the placenta is fully formed. Naturally, treatment should be accompanied by constant monitoring of the level of hormones in the blood.

Sometimes the corpus luteum develops incorrectly. The walls of the follicle, from which the mature egg came out, begin to thicken and stretch, and the inner cavity is filled with serous fluid. A tumor-like formation is formed - a cyst of the corpus luteum. However, you should not panic - a corpus luteum cyst never degenerates into a malignant formation.

Causes of a corpus luteum cyst can be:

• disturbances in the functioning of the lymphatic and circulatory systems of the ovaries;
• infectious diseases of the genital organs;
• taking hormonal drugs;
• harmful working conditions, bad habits;
• stress;
• extreme diets.

In most cases, the cyst does not interfere with the development of pregnancy and does not require medical intervention, because it is a modified corpus luteum and secretes sex hormones in sufficient quantities. Usually, after two or three months, it begins to dissolve by itself and disappears completely.

The size of the cyst usually does not exceed 6-9 cm, it rarely causes concern to the pregnant woman. But the doctor will still observe her, and the woman will recommend moderate exercise and gentle sex so as not to cause a cyst rupture or twisting of her leg.

Diagnosis of a corpus luteum cyst is carried out using ultrasound, gynecological examination, hormonal analysis, laparoscopy. A woman may feel pulling pains in the lower abdomen or side. If the pain is always localized in one side, then this may be a symptom of an ovarian cyst. Another sign is menstrual irregularities, bleeding outside of critical days.

The corpus luteum cyst can be eliminated by itself, so usually it is not touched, but only observed. If there is no hope for spontaneous atrophy, then the cyst is removed using laparoscopy.

Rupture of a cyst is the most serious complication of this disease. It is accompanied by acute pain, bleeding and requires surgical intervention. A ruptured unhealed cyst can lead to the development of an acute infection of the internal organs.

Torsion of the cyst pedicle also requires surgical treatment, since squeezing the tissues leads to their necrosis.

Thus, the main danger associated with the corpus luteum during pregnancy is its lack of functionality. But you should not be upset - the level of development of modern medicine allows you to help women bear a healthy child, even with insufficiency of the corpus luteum. Just in this case, in order to maintain the pregnancy, you may need to take hormonal drugs. And only a doctor can choose their dosage - trust him.

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The corpus luteum on ultrasound after ovulation is a natural process in the female body, which means the release of a mature egg and a high chance of conception. By the time of the onset of menstruation, the temporary gland self-destructs, the effect on the body of progesterone, which causes acne in many women, increases, breast tenderness during PMS decreases, and a new cycle begins.

The second name of the corpus luteum (VT) is the luteal gland.

What methods will help to find out about the presence of a corpus luteum

There are two ways to find out about the existence of a temporary gland:

1. Ultrasound procedure. The most reliable method that allows you to clearly see the picture of what is happening on the monitor, determine the size, the likelihood of conception, the effect of VT on the reproductive organs.
2. Analysis for the hormone progesterone. Relying on this method alone is not enough, because there are situations with hormonal failure.

If a woman is tracking ovulation in order to get pregnant, then the most common solution is to use both methods at the same time.

Corpus luteum after ovulation on ultrasound

On ultrasound, the gland looks like a round, soft sac located on one of the ovaries or on 2 at once. In the latter case, multiple pregnancy is likely with successful fertilization of the egg.

After ovulation has taken place, the gland appears almost immediately, gradually increasing in size. To assess the state of reproductive function, especially the ovaries, it is recommended to do an ultrasound three times per cycle:

• on day 7-10 of the cycle. At this time, the mucous membrane of the uterus is quite thin and allows you to see hidden pathologies, and the ovaries after the last menstruation are “refreshed”;
• on the 14-16th day of the cycle. The follicle is just starting to grow, so the study is assigned to find out if there is ovulation, pathology, development or not;
• on day 22-24 of the cycle. The preparation of the body for menstruation begins, so experts look at the changes in the ultrasound picture after ovulation: what happens to the follicle, has it turned into a cyst, has it disappeared, etc.

A three-time study will accurately show the picture of the functioning of the genital organs, and will also indicate the specific day of ovulation, because the individuality of each organism knows no boundaries: the follicle can begin to develop much earlier than the 14th day of the cycle, and later than the 24th.

Table of sizes of the corpus luteum after ovulation based on the conclusion of the ultrasound:

If the size of the luteal gland at the end of the monthly cycle is from 12 to 15 mm, then this indicates the reverse development of VT. The value of 24-30 mm indicates the possible presence of a normal pregnancy. From 30 mm or more - the appearance, in which case therapy is prescribed and pregnancy planning is postponed. But if it has already come, they are carefully monitored during the first trimester. There is no serious threat.

The constant presence of the luteal gland also speaks of cystic formation. The normal duration of the "life" of VT is 13-14 days, until the onset of menstruation.

What does the absence of the luteal gland mean?

If there is no corpus luteum in the ultrasound picture, the probable causes include:

1. Anovulatory cycle or late ovulation. If the gland is not visible, then ovulation will either not happen at all, or it will happen later.
2. . The follicle did not mature, did not grow to its size, stopped developing, did not break, turning into a formation that often disappears on its own in the next cycle with a temporary failure (if follicular cysts appear systematically or are poorly absorbed, the reason lies in the woman's reproductive health).
3. Infertility and other diseases of the small pelvis. Follicles may not develop at all. In this case, a thorough examination, search for the root cause, and its elimination are necessary.

Every woman has anovulatory cycles during which the corpus luteum is absent - this is a normal and natural process. However, the occurrence of anovulatory cycles systematically is a serious reason to undergo an examination.

The work of the female reproductive system depends on many factors, in particular on the condition and functions of the ovaries. Currently, there are a large number of ways to assess them, which can be divided into two groups: the study of the hormonal profile (the amount of progesterone, luteinizing and follicle-stimulating hormones, estradiol, and so on), instrumental diagnostics (ultrasound, CT, MRI, biopsy). One of the important components of an ultrasound examination is the study of the corpus luteum.

This is a temporary (provisional) organ that is formed in the ovary from the follicle (the precursor of the egg) in the 2nd phase of the cycle (from 13-15 days) and remains until the onset of menstruation in the absence of conception. The corpus luteum plays a major role in maintaining pregnancy by producing progesterone. This means that if the formation of this organ or any of its pathologies is disturbed, the reproductive system suffers. A woman cannot bear a fetus due to an early termination of pregnancy. One of the best methods for assessing the condition of the corpus luteum is ultrasound.

Indications

Ultrasound examination of the corpus luteum is assigned to the patient in several cases:

How to define menorrhagia? This condition manifests itself in women in several ways:

• An increase in the amount of separated blood during menstruation - hypermenorrhea;
• A significant increase in the duration of menstrual bleeding - polymenorrhea;
• Irregularity of menstruation or its irregular rhythm.

As a rule, these options are combined with each other, which makes it possible to detect menorrhagia when collecting complaints.

An isolated ultrasound examination of the corpus luteum is not performed - during the procedure, the entire structure of the ovaries is examined. As a rule, such an ultrasound is combined with doplerometry (the study of the state of blood flow).

Preparing for an ultrasound

For better visualization, it is necessary to eliminate possible obstacles in the path of the ultrasonic signal. To this end, 2 days before the procedure, the patient is advised to exclude certain foods from the diet that contain a large amount of fiber, which reduces the amount of gases in the intestinal cavity. These include:

• Any vegetables and fruits, as well as juices and other dishes prepared from them;
• Corn, millet, oatmeal, pearl barley;
• Rye bread.

You should also know that immediately before the diagnosis, the patient's bladder must be full. It will serve as a "landmark" in the study of the ovaries. This means the following:

• a few hours before the procedure, the patient is prescribed a plentiful drink;
• You should not empty your bladder until the end of the ultrasound.

Such an ultrasound examination of the corpus luteum takes 10-20 minutes. After it is carried out, the girl removes the remains of the gel from the surface of the skin and is allowed to urinate.

Normal ultrasound picture

The corpus luteum on ultrasound looks like a homogeneous structure, without cavities, with clear, even boundaries. Its presence should be determined after 12-16 days of the menstrual cycle. When pregnancy occurs, it persists until the placenta is formed. If conception did not occur, it means that it is destroyed at the end of the second phase or during the onset of menstruation.

The pathologies of this temporary organ will manifest themselves in 2 main options:

• Violation of its formation - in this case, the corpus luteum is absent in the corresponding phase of the cycle;
• Volumetric formations (most often cysts or tumors), in which the contours and uniformity of the organ change.

Other changes in the corpus luteum on ultrasound are extremely rare.

Volumetric formations

In 5% of patients with any violation of the menstrual cycle, this volumetric formation in the form of a cyst is diagnosed. It is formed from a burst follicle located in the ovary. Such a process does not pose a danger to the health of the girl and often disappears by itself, overgrown with connective tissue. The threat may be a complication of the cyst - bleeding, which can be quite intense and aggravate the course of the disease.

In this case, the corpus luteum on ultrasound may look like this:

• Against the background of the corpus luteum, a "bright spot" is determined - a hypoechoic formation in the form of a cavity. It can be in the form of a single undivided formation or have a fine-mesh structure, due to connective tissue partitions;
• Against the background of a “bright spot”, areas of increased density (hyperechoic), which are clots of clotted blood, can be determined;
• With severe bleeding, the “bright spot” may be completely absent. Instead, a rounded formation with clear boundaries of increased density (hyperechoic) may be located. This is a cyst that is completely filled with clotted blood. It is easy to confuse it with a benign tumor. Differential diagnosis is performed by CT or biopsy.

The tactics of treatment are determined after additional diagnostics (determination of hormonal status, dopplerography) and the final diagnosis. It is optimal to evaluate the corpus luteum on ultrasound in dynamics (in the 1st and 2nd phases of the cycle), to increase the reliability of the procedure.

Ultrasound examination of the corpus luteum is one of the components of ovarian ultrasound, which must be studied in case of violation of the reproductive function in a woman. The most common pathologies include a violation of the formation of this provisional organ or its volumetric formations. The tactics of treatment is determined individually in each case and can be represented by both hormonal therapy and surgical intervention.

What is the corpus luteum in gynecology and why is it necessary? What does the corpus luteum in the ovary mean

The cyclic work of the female body determines the possibility of the functioning of the reproductive system. During the period from one menstruation to another, changes occur in the gonads. The ovary forms a dominant follicle, from where it subsequently emerges. In place of the ruptured follicle, a corpus luteum is formed - this is a temporary gland designed to support the cycle until the next menstruation or pregnancy if it occurs.

• The corpus luteum in the ovary - what does it mean in gynecology
• When does the corpus luteum form after ovulation?
• Phases of the corpus luteum
• VT sizes by cycle days
• Formation of the luteal body after ovulation
• What is the gravid corpus luteum
• What does VT look like on ultrasound?
• The severity of the blood flow of the corpus luteum

What is the corpus luteum in gynecology

The corpus luteum is a temporary structure in the ovary, which consists of a reddish-orange parenchyma and is formed after the release of the egg at the site of the dominant follicle. Thanks to the yellow pigment, the temporary gland got its name.

Normally, the formation of glandular formation begins immediately. The main function of education is the production of progesterone and the production of a small amount of estrogen. A corpus luteum appears in the ovary where the egg was released. If the process of ovulation is started in both gonads, then the corpus luteum appears from both sides at once.

The corpus luteum will appear exactly at . As soon as the follicle opens under the influence of the hormonal background and releases the egg, at this moment the gland of temporary secretion will begin to form. The period of functioning of the luteal region is variable and depends on conception.

After fertilization, the temporary gland remains in the ovary for several months. In the early stages, it maintains the uterus in a favorable condition for conception. As soon as the placenta is formed, the corpus luteum will begin to dissolve. Its cells degenerate and connective tissue sprouts in this area, like a scar. In the absence of an embryo in the uterine cavity, the glandular formation persists until the onset of menstruation.

If a luteal cyst has formed (a large corpus luteum with hemorrhage), then there may be a slight delay in MC, and the cystic formation itself goes away within several cycles.

Ovulation cannot occur without the formation of a corpus luteum. In this case, a temporary gland is sometimes formed without rupture of the dominant follicle.

Phases of the corpus luteum

The corpus luteum gradually changes over the course of two weeks after ovulation. Postovulatory transformation includes several phases:

• proliferation - after the rupture of the follicle, its walls are collected in folds, where there is an active increase in granulosa cells;
• vascularization - the formation of blood flow with the germination of blood vessels in the thickness of the temporary gland;
• flourishing - accompanied by maximum hormonal activity and is characterized by pronounced blood flow and proliferation of lymphatic vessels;
• regression - if there is no fetal egg in the uterus, then the temporary gland decreases, and a small scar forms in its place.

The size of the corpus luteum after ovulation by day of the cycle: table

A temporary gland is formed at the site where the rupture of the follicle occurred. It can be either the right ovary or the left ovary.

From the first hours after the release of the female gamete, the luteal body grows, reaching its maximum, and then, in the absence of pregnancy, undergoes a reverse change. Its exact size is shown by ultrasound of the small pelvis. Comparison with the norm from the table provides a basis for assessing the functioning of the hormonal background.

Table 1. The size of the corpus luteum by day

Due to the fact that the length of the cycle in women is variable and depends on the duration of the first phase, it is customary to correlate the size of the corpus luteum not with the days of the cycle, but with the days after ovulation.

What happens to the corpus luteum after ovulation

After ovulation, the endometrium undergoes final preparation for embryo implantation. The corpus luteum is responsible for this process, which begins to grow after the release of the female gamete. The further fate of the gland of temporary secretion is determined within one week after ovulation.

1. If pregnancy occurs, then the corpus luteum continues to function. The gravid corpus luteum maintains the uterus in a relaxed state and does not allow the myometrium to activate the contractile function. Thanks to progesterone, the embryo attaches and develops further. After 12-16 weeks, the placenta will take over its function.
2. If, then the gland works for 10-14 days. Gradually, it undergoes a reverse transformation and disappears before menstruation. In the next cycle, the process is repeated.
3. After a miscarriage, iron also undergoes regression. Often due to insufficiency of the luteal phase, when the corpus luteum is small and cannot perform the assigned functions of maintaining pregnancy. If the causes of miscarriage are different, then the corpus luteum lives in the ovary for 2-8 weeks and disappears on its own after a while.

The outcome of pregnancy is influenced by many factors, among which is the full work of the corpus luteum.

Many women are unaware of the existence of this gland, which is re-formed every month in their body.

Without it, the birth and development of a new life is impossible, therefore, in the first trimester of pregnancy, the work of the corpus luteum requires control and, if necessary, correction.

The corpus luteum is a temporary gland that forms in the ovary and produces "pregnancy hormones".

During ovulation, the follicle in which the egg matured ruptures and yellow tissue begins to grow in its place.

In this color, it is colored by a special pigment - lutein, therefore the corpus luteum is also called luteal.

The corpus luteum synthesizes a hormone - progesterone, which prepares the body for a possible conception.

The presence of a corpus luteum during the period of the alleged delay is an indirect sign of pregnancy.

There are several stages in the development of the corpus luteum:

• Origin.

The corpus luteum is formed only in the ovary in which ovulation occurred. In some cases, if 2 eggs mature, a corpus luteum is formed in each ovary.

Visualization of two yellow bodies on ultrasound is one of the signs of twin pregnancy.

• A period of growth and development.

The duration of the first 2 phases of the corpus luteum in total does not exceed 4 days.

• Progesterone production.

The corpus luteum turns into a full-fledged endocrine gland, which begins.

• degradation of the corpus luteum.

If conception does not take place, after a few days the luteal body decreases in size and resolves. It completely disappears by the beginning of the next menstrual cycle.

To maintain its work, it is necessary, which is produced by the fetal membranes of the embryo. That is, to preserve the corpus luteum, pregnancy is necessary.

The luteal body is responsible for the production of hormones until the 12-16th week of pregnancy, then the placenta takes over this function. At the beginning of the second trimester of pregnancy, after the final formation of the placenta, the corpus luteum resolves.

Sometimes its preservation is observed throughout the entire period of bearing a child, and such cases are not a pathology.

Resizing

In the first weeks of pregnancy, the corpus luteum intensively produces hormones and increases to the size of a large cherry.

By the end of the first trimester, the size of the corpus luteum begins to decrease, and then it completely disappears.

They support the normal development of pregnancy until the placenta begins to produce the required amount of hormones. Not only the dosage is important, but also the time of taking the drugs, so it is impossible to start hormone therapy without a doctor's prescription.

The effect of a corpus luteum cyst on pregnancy

The size of the corpus luteum, exceeding the upper limit of the norm, indicates the occurrence of a cyst. During ultrasound, a neoplasm 30-90 mm in size, filled with fluid, is diagnosed.

The causes of cystic corpus luteum during pregnancy are not fully understood. The likelihood of its development increases in case of violations of blood and lymph circulation in the ovary.

The corpus luteum cyst does not adversely affect the course of pregnancy, since it does not affect the ability of the corpus luteum to synthesize progesterone.

Depending on which ovary the corpus luteum has formed, the cyst can cause pain in the right or left side of the abdomen. The pain gets worse during exercise, intercourse, or brisk walking.

A complication of a corpus luteum cyst can be its rupture or torsion.

In the first case, its contents will enter the abdominal cavity, in the second case, tissue death (necrosis) of the cyst will begin. These pathologies are eliminated with the help of surgical intervention, while the pregnancy is preserved.

The cyst of the corpus luteum requires additional control using ultrasound to monitor the dynamics of its development. In most cases, it resolves on its own along with the corpus luteum in the second trimester of pregnancy.

Is pregnancy possible without a corpus luteum: why is it not visualized on ultrasound?

In some cases, the patient may be faced with two mutually exclusive diagnoses: there is pregnancy, but there is no corpus luteum.

The formation of the luteal body is a mandatory sign of ovulation. Therefore, the absence of the corpus luteum throughout the entire menstrual cycle means anovulation, which makes pregnancy impossible.

The corpus luteum may not be visualized on ultrasound for 2 reasons:

• an outdated apparatus that does not allow the doctor to see the corpus luteum;
• the small size of the corpus luteum, which is a sign of hormonal deficiency. This condition requires appropriate treatment.

Progesterone support is not prescribed only according to the results of ultrasound. Blood test results are needed to confirm hormone deficiency.

The full functioning of the corpus luteum is a necessary link in the chain of factors responsible for the favorable development of pregnancy. If violations in his work are detected, there is no need to be upset: drug support and monitoring of the condition of the expectant mother will allow pregnancy to proceed without complications.