Normal endometrial histology. Causes of thin endometrium and features of treatment of pathology

Endometrial hyperplasia is excessive growth of the layer lining the uterus from the inside. This layer undergoes constant cyclic changes associated with a woman's menstrual cycle.

The endometrium consists of blood vessels connective tissue and 2 layers of epithelium (lower basal and upper functional). It is the functional layer that is actively involved in menstruation.

How common is endometrial hyperplasia?

Endometrial hyperplasia is a fairly common pathology, occurring in 5 percent of gynecological patients. This diagnosis has become increasingly common in recent years. various reasons. The life expectancy of women has increased, the number of patients with metabolic syndrome and other pathologies has increased, ecological situation worsened. All this affects the reproductive health of the population. Most often, hyperplasia occurs in teenage girls or in women during premenopause, that is, when hormonal changes occur in the body.

How is hyperplasia related to the menstrual cycle?

The normal menstrual cycle consists of 3 phases:

• increase in the thickness of the functional layer of the endometrium - proliferation
• endometrial maturation - secretion
• rejection of the functional layer leading to bleeding - desquamation

The first phase begins on the first day of menstruation. Approximately in the middle of the cycle, ovulation occurs - the process of the release of an egg from the ovary; during this period, a woman can pay attention to. If fertilization does not occur at this moment, then under the influence of hormones the functional layer along with the egg is rejected - menstruation occurs, and bloody issues. All processes during the menstrual cycle are controlled by sex hormones:

• cause proliferation
• - secretion

In addition, during proliferation, planned cell death occurs - apoptosis, which prevents the endometrium from growing larger than necessary. This only happens if the woman has ovulated, that is, when the ratio of hormones allows it to occur. If there was no ovulation (anovulatory cycle), there is a prolonged effect of estrogen on the endometrium and it thickens - as a result, endometrial hyperplasia is formed.

Why does it occur?

The triggering factor for the development of endometrial hyperplasia is an absolute or relative increase in the content of estrogen in the blood - hyperestrogenism, which occurs for various reasons:

• age-related changes in the central regulation of sex hormones - changes in the amount of estrogen before menopause
• hormonal disorders - excess estrogen with progesterone deficiency
• hormone-producing ovarian tumors, polycystic ovary syndrome
• improper use of hormonal medications
• ), diagnostic curettage
• hereditary predisposition
• inflammatory processes of the female genital organs
• accompanying illnesses- hypertension, breast diseases, obesity, diabetes mellitus, thyroid diseases.

What types of hyperplasia exist?

According to the type of structure, scale of distribution and the presence of abnormal cells, all hyperplastic processes of the endometrium are divided into groups:

• Glandular cystic endometrial hyperplasia
• Endometrial polyps (focal form of hyperplasia)
  • Ferrous
  • Glandular-cystic
  • Glandular fibrous
  • Adenomatous
• Atypical endometrial hyperplasia (adenomatosis)

Glandular forms of hyperplasia are characterized by a large number of glands, sometimes forming cysts. The structure of cells in such a lesion is not disturbed. The symptoms of glandular endometrial hyperplasia and cystic forms are absolutely the same. With the atypical form of hyperplasia (adenomatosis and adenomatous polyp), changes occur in the structure of cells that begin to divide with high speed, as a result of which the number of glands grows very quickly.

Can hyperplasia turn into cancer?

Hyperplastic processes should always cause oncological suspicion, but only in a few cases are they malignant. There are certain conditions under which hyperplasia is considered a precancerous condition:

• atypical hyperplasia at any age. According to statistics, in 40 percent of cases without treatment, such hyperplasia becomes malignant and endometrial cancer occurs.
• frequently recurring glandular hyperplasia in postmenopause
• glandular hyperplasia with dysfunction of the hypothalamus at any age, as well as with metabolic syndrome.

Metabolic syndrome - special condition organism in which the ability of the immune system to attack cancer cells sharply reduced, and the tendency to hyperplasia is high. It is characterized by diabetes and obesity.

What symptoms occur with endometrial hyperplasia?

Uterine bleeding

The most noticeable and common symptom of endometrial hyperplasia is

• More than half of patients note delays in menstruation for 1-3 months, which are replaced by prolonged bleeding of varying intensity.
• IN in rare cases bleeding can be cyclical, that is, manifest itself in the form of heavy and prolonged menstruation,
• Most often, patients report an unstable menstrual cycle for a long time, which causes bleeding.
• In 5 percent of cases, bleeding occurs against the background of an absolute absence of menstruation.

Metabolic syndrome

An important concomitant of endometrial hyperplasia is metabolic syndrome. In such cases, the symptoms of bleeding include:

• obesity
• hyperinsulinemia
• symptom complex of male traits - the appearance of increased hair growth, changes in voice timbre and other signs of the action of male hormones

Other common symptoms

Women with hyperplasia often name other companions of the disease:

• secondary infertility - absence of pregnancy after a year of regular unprotected sexual activity
• - early miscarriages
• chronic inflammatory diseases of the genital organs
• mastopathy and fibroids

Other, less common symptoms

• contact bleeding during sexual intercourse or hygiene procedures
• cramping (more often with polyps)

What research is needed to determine it?

• History. It is necessary to tell the doctor in detail about the features of the menstrual cycle: at what age menstruation began, how long and how long it lasts, whether there were any irregularities or delays. Anamnesis will allow the specialist to determine all the symptoms of endometrial hyperplasia of the uterus.
• Transvaginal ultrasound in the first phase of the cycle (on days 5-7). The examination determines the thickness of the endometrium, its homogeneity and structure. Hyperplasia can be suspected if the thickness is more than 7 mm. If the endometrium is thicker than 20 mm, then the doctor may assume malignant process. If the bleeding is prolonged, then an ultrasound is performed regardless of the day of the menstrual cycle.
• Hysteroscopy and separate diagnostic curettage(cleaning) – simultaneously play the role of research and treatment. Read about the condition.
• Study of hormone levels in the blood if metabolic syndrome or polycystic ovary syndrome is suspected. Usually the levels of FSH, LH, estradiol, testosterone, and progesterone are determined. And also possibly the level of adrenal and thyroid hormones.
• Mammography - often the doctor prescribes an X-ray examination of the mammary glands to exclude proliferative processes.

For endometrial hyperplasia, the informative value of ultrasound with a vaginal sensor is estimated at 68%, and hysteroscopy at 94%.

Treatment of endometrial hyperplasia

Therapy for hyperplastic processes depends on the woman’s age, characteristics of the endometrium, and concomitant diseases. For endometrial hyperplasia, treatment can be carried out in several ways.

• Hormonal agents

These include estrogen-progestin drugs, pure gestagens, gonadotropin-releasing hormone agonists and antagonists, androgen derivatives. These drugs are prescribed only by a doctor, individually and strictly according to indications. The doctor takes into account all possible contraindications to taking hormonal drugs: rheumatism, thrombophlebitis, hypertension, diabetes mellitus, diseases of the biliary tract and liver, smoking and alcohol increase the risk of developing side effects. Before therapy and during treatment, the condition should be examined and monitored immune system, vascular, endocrine glands, liver, blood tests are taken.

• “Minor” or conservative surgery

Removal of the endometrium (functional and basal layers) using a resectoscope. A controversial method, as it results in frequent relapses of the disease and is contraindicated if atypia is suspected.

• Surgery

This is the removal of the uterus with or without the ovaries. Indications for surgical intervention:

• inefficiency conservative treatment in precancerous forms of hyperplasia
• recurrent cases of precancerous hyperplasia
• contraindications to hormone treatment
• atypical hyperplasia in peri and postmenopausal women

Stage I of treatment - curettage

The first stage is therapeutic and diagnostic curettage of the uterine mucosa under the control of a hysteroscope (cleaning) and examination of the resulting material in cytological laboratories.

Curettage - removal of the functional layer of the endometrium along with those present in it pathological formations. The examination is carried out under anesthesia, visualization of the contents of the uterine cavity is carried out using a special device - a hysteroscope. This optical system, equipped with a light source, having a channel for introducing surgical instruments into the uterus. Thanks to the hysteroscope, the curettage procedure is safe and effective.

The cleaning itself is carried out using a curette, and sometimes a mechanism is used to stop bleeding. The functional layer of the endometrium is completely removed, the contents of the uterine cavity are sent for histological examination, which will determine the nature of the process and tactics further treatment endometrial hyperplasia after curettage.

Stage II of treatment

Depending on the results of histological examination, drug therapy is prescribed to prevent relapses. For this purpose, hormonal hormones are used medicines, taken in a certain dosage and according to suitable regimens.

Treatment of glandular cystic hyperplasia

• For girls during puberty and women under 35 years of age, medications containing estrogens and gestagens, for example. Preference is given to single-phase drugs with progesterone, which have a continuous effect on the endometrium, preventing its growth. Treatment lasts from three months to six months. Glandular cystic endometrial hyperplasia usually does not recur with proper therapy.
• In women from 35 years of age to perimenopause (the process of stopping menstruation). The therapy uses gestagens, without the use of estrogen-containing components. Hormones are prescribed in the second phase of the menstrual cycle, from 14 to 26 days after curettage or from the beginning of menstruation. Endometrial hyperplasia is usually treated with duphaston and utrozhestan. Therapy also lasts 3-6 months.
• In postmenopausal women (after menstruation has stopped). Hyperplasia at this age is a rare phenomenon, usually associated with hormone-producing ovarian formations. For endometrial hyperplasia in menopause, treatment should be prescribed only after a thorough examination of the ovaries (ultrasound and, if necessary, laparoscopic examination). If there are no tumors, then 17-hydroxyprogesterone caproate is prescribed at a dosage of 125 mg 2 times a week for six to eight months. After completion of therapy, it is necessary to perform an endometrial biopsy and examine the resulting sample in the laboratory.

Treatment of atypical hyperplasia

Women of reproductive age and perimenopause. The treatment of choice is gonadotropin releasing hormone agonists for six months. Some drugs must be taken every day (buserelin acetate), some have a prolonged effect and require taking once every 28 days.

After 6 months from the start of treatment, repeated endometrial curettage with histological examination is usually required. In addition, each month of treatment ends with an ultrasound examination, which monitors the thickness of the endometrium (less than 5 mm).

When atypical hyperplasia is combined with fibroids or metabolic syndrome, surgical treatment with careful examination of the ovaries is necessary. The condition of the mammary glands requires constant monitoring.

Plan dispensary observation with atypical hyperplasia:

• Endometrial ultrasound once a month
• curettage with histological examination every 3 months
• Ultrasound of the ovaries every 3 months (with Doppler ultrasound)
• Breast ultrasound and mammography every 6 months
• symptom control metabolic syndrome(cholesterol and blood glucose)

Postmenopausal women are shown surgical treatment with a thorough examination of the ovaries.

Complications and prevention

Prevention of hyperplasia	Complications
avoid induced abortion Be examined by a gynecologist 2 times a year timely diagnosis and treatment of diseases of the female genital organs reduction of risk factors - control blood pressure for hypertension, diabetes, weight loss for obesity lead healthy image life - yoga, fitness, Bodyflex, good nutrition and rest	chronic anemia due to bleeding infertility transition to cancer of an atypical form of hyperplasia most often - relapse of the disease

Frequently asked questions to a gynecologist

Is it possible to cure endometrial hyperplasia using traditional methods?

Treatment folk remedies endometrial hyperplasia has no scientific basis. Usually the use of such methods is simply useless, and sometimes it can be harmful. For example, if a patient is allergic to certain herbs used in traditional treatment endometrial hyperplasia. In addition, some plants contain so-called phytoestrogens, which can aggravate the process of growth of the inner layer of the uterus.

Is it possible to get pregnant if diagnosed with hyperplasia?

Pregnancy with severe diffuse endometrial hyperplasia usually does not occur or ends early miscarriage. The thing is that a fertilized egg must attach firmly to the embryo in order to develop. inner wall uterus, forming the placenta in the future. Hyperplastically altered endometrium does not create necessary conditions for such implementation. Hormonal treatment and curettage allow you to “renew” the inner layer of the uterus, making pregnancy possible. In some cases, additional treatment may be necessary to achieve pregnancy.

Is it possible to delay treatment for endometrial hyperplasia?

The hyperplastic process is not always accompanied dangerous bleeding, but often carries a hidden threat. Risk of malignancy, infertility, chronic anemia requires an immediate visit to the doctor at the first symptoms. In case of endometrial hyperplasia, herbal treatment, many physical procedures and self-administration of medications without prescription from a specialist are unacceptable. Competent and timely treatment will restore reproductive health and well-being.

Is it possible to do curettage for hyperplasia? nulliparous woman, will there be problems with pregnancy?

If hyperplasia is detected, curettage must be done; the chances of getting pregnant after such treatment will be much greater.

Is it always necessary to clean a polyp?

If the polyp is single, then they are often limited to removing this formation, without curettage.

For the treatment of endometrial hyperplasia, I was prescribed buserelin, injected into the “ artificial menopause" Is there a risk of not coming out of this menopause in the future?

No, the effect of buserelin is reversible. Only removal of the ovaries and chemotherapy can bring menopause closer.

I am 35 years old, IVF was planned, but during the examination they discovered an endometrial polyp, removal of the formation was prescribed. When can I join the IVF program?

After removal of the polyp, you can immediately enter into the ovulation stimulation protocol.

She underwent treatment for endometrial polyp due to hyperplasia. The doctor said that it was necessary to get tested for sexually transmitted infections. Is this necessary?

There is evidence that mycoplasma and chlamydial infections contribute to the recurrence of endometrial polyps. Infections need to be treated.

I am 50 years old. Curettage revealed atypical endometrial hyperplasia. Is it necessary to remove the uterus or can ablation be performed?

Endometrial ablation is the removal of the entire inner layer while preserving the uterus. The method is non-traumatic, but after it it is very difficult to assess the condition of the uterus, and a tumor can be missed. At this age and with this diagnosis, removal of the uterus is recommended.

On the 2nd day after the “cleansing”, scanty bleeding continues. Is this normal?

My diagnosis is endometrial hyperplasia, curettage is planned in 2 weeks. Is it possible to have sex now?

Yes, you can, if there is no pain or contact bleeding.

Based on the results of the ultrasound, the doctor suspected endometrial hyperplasia and suggested performing a core biopsy. What is this procedure?

The Pipelle test is performed on an outpatient basis to examine the structure of the endometrium. Using a special instrument, a column of tissue is removed and examined for hyperplasia. If the test reveals changes, you will be recommended hysteroscopy with curettage. If the biopsy results are negative, then the ultrasound should be repeated on days 5-7 of the next cycle.

Uterine hyperplasia of the cystic or glandular type is considered a precancerous condition. Without timely treatment, the pathology develops into a malignant tumor. Why does it develop and by what signs can it be recognized?

Endometrial structure

With excessive growth of the inner layer of cells lining the uterus, the development of endometrial hyperplasia begins, one of the fairly common pathologies of the reproductive system. female system. According to statistics, the percentage of cases is growing every year. And there are reasons for this: wide use among women with metabolic syndrome, deterioration of the environmental situation, high level stress.

Uterine hyperplasia is closely associated with hormonal changes, and therefore the peak incidence rates are observed during premenopause and adolescence.

Why is this happening?

The condition of the endometrium, the inner layer of the uterus, depends on the menstrual cycle. In a healthy woman, in the first phase the functional layer of the endometrium grows, and in the second it matures. If fertilization has not occurred, at the third stage the functional layer is rejected and normal menstrual bleeding begins.

But all phases of the cycle are controlled by hormones, and when the body produces an excess amount of estrogen against the background of progesterone deficiency, cyclic processes are disrupted. the endometrial layer begins to grow rapidly. Its structure:

1. Upper functional, sensitive to hormonal changes, covered with ciliated cells. Their vibrations enable the fertilized egg to move. By the end of the cycle, its thickness reaches 8 mm, and after menstrual bleeding it decreases to 1 mm. The functional layer contains stroma - a reticular structure of connective tissue that performs nutritional, protective, and collagen-forming functions. The surface layer is covered with blood vessels.
2. The basal layer of the endometrium is located below the superficial layer. Its task is to restore the endometrium. In its thickness there are special vesicular cells, which are then transformed into ciliated cells of the functional layer.

If the number of cells of the glands, stroma, and epithelium increases, the endometrium grows, their size increases, and uterine hyperplasia develops.

Prerequisites

In addition to the fact that adolescents and premenopausal women are at risk for the disease, hyperplasia at any age can be caused by a number of unfavorable factors, which can destabilize hormonal levels. These include:

• Incorrect use of oral contraceptives.
• Mastopathy, polycystic ovary syndrome.
• Exchange disorders endocrine diseases.
• Age over 50 years.
• Inflammatory processes, sexually transmitted infections, intrauterine contraceptives.
• Curettage, abortions.
• Heredity.

It is believed that one of the main reasons for the development of endometrial hyperplasia of the uterus is disturbances in the immune status.

The disease occurs in 5% of women with gynecological problems, and its likelihood increases with age and the approach of the premenopausal period.

Types of pathology

Endometrial hyperplasia refers to benign diseases. It may cause iron deficiency anemia, general weakness, problems with conception and pregnancy.

There are several types of pathology:

• Adenomatous develops against the background of hormonal imbalance. With uneven growth on the surface. May develop into malignancy. For treatment, hormonal therapy is used for up to six months. In case of relapses, surgical intervention is indicated for older patients.
• Glandular develops after abortions, curettage and other medical procedures. Endocrine diseases and uncontrolled use of oral contraceptives can also be provoking factors. At the beginning of treatment, a diagnostic curettage is performed, after which hormonal therapy is prescribed.
• Cystic type - pathological proliferation of vesicular cavities with normal cellular structure. It is not inclined to transform into a malignant neoplasm, but it gives a serious complication - infertility. Treated with hormonal drugs. Recurs often.
• The focal type is uneven polypous growths. Without treatment, it can degenerate into a malignant neoplasm.
• Hyperplasia of the basal layer is a rare type of pathology, usually observed in patients over 40 years of age. They are thickened lesions, inside of which there is a densely overgrown stroma with curved blood vessels. Not prone to malignancy (malignancy).
• Atypical endometrial hyperplasia is the most severe and dangerous form, precancerous condition. The reason for the development of this type can be frequent hormonal imbalances, chronic diseases reproductive system, endocrine disorders, infections. In the treatment of the atypical form, only surgical intervention with complete removal of the uterus and appendages is used.

According to statistics, hyperplasia transforms into cancer in almost 30% of cases.

It is important not to ignore the signs of the disease and seek help from specialists in a timely manner.

General symptoms

On initial stage Uterine hyperplasia does not manifest itself in any way and can be detected by chance during an ultrasound examination. Organ cavity for a long time insensitive to pain, and therefore the woman does not complain.

Afterwards, the main symptom of the disease appears – bleeding. It can be cyclical or acyclic in nature.

Cyclic, abundant, lasting more than 7 days. With the further development of the disease, one menstruation follows immediately after another. With this type of bleeding, there may be no discharge for 4 to six months. Afterwards, against the background of an unstable cycle and complete absence menstrual flow Intense bleeding begins, heterogeneous in structure, with a large number of clots and particles of exfoliated mucosa.

Endometrial hyperplasia is manifested by the second symptom - pain during menstruation, especially in the first days.

Additional signs of the disease also include:

1. Bloody or spotting discharge between menstruation after sexual intercourse and physical activity.
2. Delays in the onset of menstruation, which ends in heavy bleeding.
3. Long-term (more than a week) and heavy bleeding during menstruation with an established, regular cycle.

Women with a hereditary predisposition and benign tumors of the genital organs are at risk for the disease. The situation worsens with age, when protective reserves in the body become less and less.

In elderly patients, endometrial hyperplasia can develop into a malignant neoplasm. Therefore, women over 50 years of age should undergo routine inspection, even if nothing bothers them. This is especially true for women with arterial hypertension, diabetes mellitus, overweight bodies.

Survey

To make an accurate diagnosis, a standard examination, hysteroscopy, diagnostic curettage, ultrasonography.

Transvaginal ultrasound is prescribed on days 5–7 of the cycle, and it determines the thickness and structure of the endometrium. To clarify the type of hyperplasia, a scraping of the mucous membrane and a cytological smear are taken.

The patient undergoes tests for the content of hormones in the blood (estradiol, testosterone, progesterone, luteinizing hormone) and a general clinical analysis for the level of hemoglobin and red blood cells.

Conservative therapy

The problem is treated by a gynecologist-endcrinologist. Several groups of hormonal drugs are used, and the dose is selected individually.

Treatment for endometrial hyperplasia includes:

1. Combined oral contraceptives (Regulon, Yarina, Janine) for a course of six months or more. The drugs are prescribed to young patients because curettage is usually contraindicated for them. Contraceptives make the cycle regular and less heavy.
2. Synthetic analogues of progesterone (Duphaston, Norkolut). Indicated for women of all types age groups and for all forms of hyperplasia. The course of treatment is from 3 to 6 months.
3. Gonadotropin-releasing hormone agonists in the form of injections and nasal sprays (Goselerin, Nafarelin). Reduce the production of estrogen, slow down the growth of endometrial cells. The course of treatment is from 5 to 12 weeks.

With the help of conservative hormonal therapy, the development of pathology is stopped, and symptoms go away in patients. If the drugs are taken strictly according to the regimen prescribed by the doctor and under constant supervision, the likelihood of a complete recovery with preservation of reproductive function is high.

Surgery

When atypical cells are detected as a result of histological analysis, a hysterectomy is prescribed - removal of the uterus. It is produced only in difficult cases women during menopause. In postmenopause, when malignant cells are detected, complete removal uterus with fallopian tubes and ovaries. After surgical intervention Any type of hormone-containing medications is indicated. They improve the condition of the endometrium and prevent the development of relapses.

Women of childbearing age undergo a therapeutic and diagnostic method - curettage with removal of the superficial functional endometrial layer.

Hyperplasia is a serious pathology, and most of its cases lead to infertility. But if a woman seeks medical help on time, and after comprehensive survey undergoes a course of treatment, full recovery is sure to occur.

The uterus is a unique organ in which the unborn child develops. In order for the conditions to be as comfortable as possible, the mucous membrane lining it, equipped with a network of blood vessels, is renewed every month. Through them the growing organism receives nutrients and oxygen. The embryo enters the uterus precisely when the thickness of the functional layer of the mucous membrane is maximum, and its structure is most suitable for implantation and consolidation ovum. The fetus develops correctly only in a healthy, complete endometrium.

Content:

The structure of the endometrium and stages of its development

The endometrium is the mucous membrane of the uterus that covers its wall from the inside. Thanks to changes that regularly occur in its structure, a woman has menstruation. This lining is designed to allow the fertilized egg to remain in the uterine cavity and develop normally. After it is implanted into the mucous membrane, the placenta grows, through which the fetus is supplied with blood and nutrients necessary for its growth.

The mucous membrane of the uterus consists of 2 layers: basal (directly adjacent to the muscles) and functional (superficial). The basal layer exists constantly, and the functional layer changes in thickness every day due to the processes of the menstrual cycle. The thickness of the functional layer determines whether the embryo can take hold and how successfully its development will occur.

During a cycle, changes in endometrial thickness normally go through several stages. The following phases of its development are distinguished:

1. Bleeding (menstruation) is the rejection and removal of the functional layer from the uterus, associated with damage to the blood vessels of the mucosa. This phase is divided into the stages of desquamation (detachment) and regeneration (the beginning of the development of a new layer of basal cells).
2. Proliferation is the growth of the functional layer due to the growth (proliferation) of tissue. This process occurs in 3 stages (they are called early, middle and late).
3. Secretion is the phase of development of glands and a network of blood vessels, filling the mucous membrane with secretory fluids. An increase in the thickness of the mucosa occurs due to its swelling. This stage is also divided into early, middle and late stages.

Size is influenced by hormonal processes occurring in different periods cycle. The age of the woman matters, her physiological state. Deviations from the norm may appear in the presence of diseases and injuries in the uterus, or circulatory disorders. Leads to pathologies hormonal disbalance. Normal indicators have a fairly wide range, since for each woman they are individual and depend on the length of the cycle and other characteristics of the body. A value outside the specified limits is considered a violation.

Why and how the uterine mucosa is measured

The measurement is carried out using ultrasound. The study is carried out in different days cycle. This makes it possible to establish the cause of menstrual disorders, detect tumors and other neoplasms in the uterus that affect the thickness and density (echogenicity) of the mucosa, as well as its structure.

An important point is to determine these indicators on the days of ovulation during infertility treatment. In order for the fertilized egg to implant in the uterus, the thickness of the functional layer should not be less than 7 mm. Its value in this case is determined approximately on the 23-24th day of the cycle, when it is maximum.

Such a study is carried out when examining women of any age.

Normal thickness of the functional layer on different days of the cycle

During the cycle, the thickness of the mucous membrane changes literally every day, however, there are average thickness indicators that can be used to determine the extent to which the condition reproductive health women corresponds to the norm.

As can be seen from the table below, with the onset of menstrual bleeding (in the first two days of the cycle), the thickness of the mucous membrane reaches a minimum (about 3 mm), after which its gradual growth begins. At the regeneration stage, a new layer is formed due to the division of basal cells. The thickness normally reaches its maximum value (on average 12 mm) a few days after ovulation. If fertilization has occurred (on the 15-17th day of the cycle), then by this moment (after 21 days) conditions are created in the uterus that are most favorable for implantation of the embryo into its wall.

Table of normal thickness of the uterine mucosa

Dimensions of the functional layer of the mucosa during pregnancy

If fertilization does not occur, then last days cycle, the thickness of the endometrium decreases as it detaches.

If conception has taken place, then normally its thickness remains at the same level in the first days, and then it begins to thicken, and at 4-5 weeks the figure is 20 mm. At this stage of pregnancy, a tiny fertilized egg can already be seen on an ultrasound.

If a woman experiences a delay, even if the pregnancy test gives a negative result, its occurrence can be judged by the increase in the thickness of the mucosa, starting from 14-21 days after implantation of the embryo.

Dimensions of the functional layer during menopause

The onset of menopause is associated with sharp drop the level of female sex hormones in the body, which leads to changes in the condition of the mucous membranes, a decrease in the thickness of the endometrium (up to its atrophy), and the disappearance of menstruation. During this period, the thickness of the functional layer normally does not exceed 5 mm. Exceeding the norm indicates the occurrence of pathological processes (formation of cysts, polyps, malignant tumors).

Video: Changes in the condition of the uterine mucosa during the menstrual cycle

Pathologies

During the development of the functional layer, the following disturbances may occur:

• excessive uneven growth (hyperplasia) of the endometrium;
• insufficient thickening of the mucosa in the 2nd half of the cycle (endometrial hypoplasia);
• endometriosis - the growth of the mucous membrane and the entry of its particles into neighboring tissues and organs, which leads to disruption of their functioning;
• adenomyosis - germination of the epithelium into the muscular layer of the uterine wall;
• disruption of the structure of the mucous membrane due to the formation of polyps (its growth in individual foci), the formation cancerous tumors;
• abnormal development of the endometrium in the presence of foreign elements in the uterine cavity (contraceptive device, threads left after surgery);
• disruption of the structure of the functional layer as a result of the formation of adhesions or scars remaining after curettage of the uterus;
• abnormal growth of the mucous membrane around particles of the fertilized egg that were not completely removed during abortion.

The main pathologies that usually lead to serious illnesses and infertility are endometrial hyperplasia and hypoplasia. The causes of deviations from the norm are most often hormonal imbalance.

Endometrial hyperplasia

If the thickness of the functional layer of the endometrium is too large (up to 26 mm), its density increases, the structure becomes heterogeneous, which complicates the implantation of a fertilized egg and the occurrence of other processes necessary for the normal development of the fetus.

The consequences of hyperplasia are cycle disorders, increased duration and intensity of menstruation, the appearance of intermenstrual bleeding, and anemia. Excessive growth of the endometrium can cause the formation of polyps and endometriosis.

Treatment for hyperplasia is carried out both with medication and surgically(by curettage of the uterine cavity). When choosing a technique, the woman’s age, her desire to have children, and the degree of growth of the mucous membrane are taken into account.

Drug therapy (mainly for young women) is carried out using oral contraceptives, as well as drugs with a high content of progesterone. In this way, they achieve a decrease in the concentration of estrogens, which promote endometrial growth. In this case, the thickness of the endometrium is controlled by the days of the cycle.

Endometrial hypoplasia

If the membrane is too thin, then pregnancy does not occur, since, firstly, the fertilized egg cannot attach to the wall, and secondly, having no connection with circulatory system mother, the embryo does not receive nutrition, as a result of which it dies a few days after formation. If the thickness of the mucous membrane is too small, inflammatory and infectious diseases in the uterus, as it becomes less protected from the penetration of microbes.

If such deviations from the norm occur at a young age, this is manifested by a late onset of puberty and weak development of external sexual characteristics. Hypoplasia is often the cause ectopic pregnancy(fixation of the embryo in the neck, in the abdominal cavity).

Treatment for this pathology is carried out by restoring hormonal levels using drugs containing increased doses of estrogens. To improve blood circulation, small doses of aspirin are prescribed, as well as various physiotherapeutic procedures.

Video: Why the endometrium is too thin. Consequences and treatment

Content

Examining the uterine body, gynecologists often detect endometrial hyperplasia, which implies thickening of the inner layer due to the active proliferation of stromal cells, as well as the glandular component.

In fact, the fact that the endometrium is thick occurs in about 5% of women with a history of gynecological diseases. However, the prevalence of endometrial thickening among patients of different age groups is not uniform. Typically, pre-menopausal women have a risk of developing thick endometrium in the range of two to ten percent.

Changed rhythm of life, increase in its immediate duration, hormonal disorders, decreased immunity, various pathologies somatic nature cause thickening of the endometrium of the uterus.

The uterine body consists of three interconnected layers:

• interior;
• average;
• outer.

The outer layer of the uterus is represented by perimetry. In another way, this layer is also called the serous membrane. The middle uterine layer, the myometrium, is the muscular lining of the uterus. This layer is essential for the adequate functioning of the reproductive system. Thanks to the myometrium, the uterus has the ability to increase many times during pregnancy and contract during menstruation and childbirth.

Of particular interest to gynecologists is the inner mucous layer of the uterus, called the endometrium. It is noteworthy that the endometrium is heterogeneous in its structure and consists of two layers:

• basal or internal, germinal;
• functional or external.

The basal layer is dense and elastic. It is characterized by the relative constancy of its cellular composition both quantitative and qualitative. The basal layer is formed by collagen fibers and connective tissue elements. It is known that the basal layer reacts poorly to the influence of sex hormones. However, it is precisely this structure that causes the necessary restoration of the endometrium after menstruation.

The functional layer, on the contrary, is affected by hormones. Under their influence, the necessary changes in both structure and thickness occur by day of the cycle. The functional layer contains many glands and vessels.

During the first phase of the cycle outer layer prepares for a possible pregnancy, increasing in volume. If conception does not occur, these changes are eliminated in the second phase. As a result, the outer layer is rejected and removed from the uterus in the form of bloody discharge. The cellular elements of the basal layer make it possible to restore the resulting structural disturbances.

Gynecologists emphasize that the presence of thick epithelium should not be considered as a separate pathology. This pathological process occurs due to a violation of adequate hormonal regulation.

Absolutely all processes occurring in the uterine cavity are controlled by sex hormones and directly depend on their correct ratio. If the required ratio is violated, the maturation and subsequent rejection of the endometrium occurs in a distorted rhythm, which also affects the cycle.

Thickening of the inner layer of the uterus has many types and clinical manifestations. Thick endometrium is considered a benign process. However, the possibility of developing atypia cannot be excluded.

Causes

As with any pathological process, there are certain causes and factors that provoke thickening in the endometrium. First of all, we are talking about hormonal disorders.

It has been established that excessive estrogen production affects the pathological growth or proliferation of the functional layer. This, in turn, causes cycle disruptions.

It can be concluded that pathologies leading to hormonal disorders also provoke thickening of the functional layer of the endometrium. The following factors influence the increased production of estrogen:

• pathologies of organs that carry out hormonal function, hypothalamus-pituitary system;
• PCOS;
• ovarian tumors that cause excessive hormone production;
• diseases of the thyroid, pancreas and adrenal cortex;
• obesity;
• immunity disorders;
• hypertension;
• long-term uncontrolled use of COCs and other hormonal drugs;
• surgical interventions, for example, curettage, abortion.

The processes of endometrial thickening and infertility are closely interrelated. Hormonal imbalances cause a lack of ovulation, and a lack of progesterone and an increase in estrogen predispose to thickening of the endometrium.

Such important organ How the liver utilizes estrogens in the female body. Consequently, disturbances in the functioning of the liver also gradually lead to hyperestrogenism.

In a third of patients with diseases of the biliary tract and liver can be diagnosed thick endometrium.

Scientists have found that thickening of the uterine mucosa can be considered a pathology, which has a genetic predisposition as a cause. Pathologies in the mother such as fibroids and polyps are often detected in the daughter over time.

The factors and causes of the appearance of thick endometrium cannot be considered absolute and their presence does not mean that pathology must necessarily develop. It is noteworthy that the combination of certain pathologies, for example, hypertension, obesity and diabetes mellitus affects the endometrium more favorably than in the case of their separate course.

Gynecologists note that thick endometrium is the result of a rather complex and long-term interaction of both general and local changes.

Clinical picture

Manifestations of the pathological process depend on many factors and, therefore, are not always expressed to the same extent. Thickening can be realized due to the proliferation of various elements in the endometrium.

Thickening of endometriotic tissue comes in several varieties.

1. Glandular. The thick endometrium is formed by the glandular component. At the same time, the glands have a tortuous shape and are distinguished by the uniformity of their increase.
2. Glandular-cystic. In medical sources the term “ simple hyperplasia" This variety resembles the glandular type. The only difference is the formation of cysts.
3. Atypical. This is a precancerous condition that can pose a threat to life and health. Atypical thickening implies adenomatosis. Doctors identify atypical cells in the endometrium. This thickening can be either focal, which is called an adenomatous polyp, or diffuse. Transition precancerous condition into cancer is observed in 10% of patients.
4. Focal. In another way, such a thick endometrium is called a polyp. There is local thickening of the endometrium in areas that are most sensitive to hormonal influences. The endometrium grows in height, because with its intensive growth cannot go beyond the pathological focus. Initially, a small compaction is formed, which develops into a polyp. Such formations often degenerate.

The clinical picture depends on the nature of hormonal disorders. The severity of the manifestations is not the same. In some cases, asymptomatic progression of endometrial thickening is observed.

Among characteristic features can be distinguished:

• anovulatory bleeding after a missed period, characterized by abundance and duration;
• minor intermenstrual bleeding;
• spotting after menopause.

During menstruation, pain in the lower abdomen may occur. Big size a polyp can cause cramping pain. As a rule, the cause of such pain is necrosis of the polyp.

With thick endometrium, infertility often develops. However, it cannot be said that infertility is considered as a cause of endometrial thickening. Thick endometrium and infertility are a consequence of the anovulatory cycle.

Abundant uterine bleeding may cause the development of anemia. This dangerous condition manifests itself in pallor, weakness, brittle hair and nails and poses a threat to health.

Effect on conception and pregnancy

Every fifth patient with a history of infertility is diagnosed with thick endometrium. It is known that a diffuse type of thickening of hormonal etiology is the cause of infertility, since pregnancy with such a pathology is impossible.

The mechanism of conception comes down to two necessary conditions:

• the presence of ovulation, which implies the readiness of the reproductive system for fertilization;
• endometrium prepared for implantation of the fertilized egg.

In the first phase of the menstrual cycle, physiological growth of the endometrium is observed under the influence of estrogens. Pregnancy can only occur during a two-phase cycle, during which the dominant hormones change.

With thickening, severe hyperestrogenism and a lack of progesterone are noted. This causes anovulation. As a result, the endometrium develops pathological changes, which are the reason for excluding pregnancy.

In rare cases, thick endometrium does not have hormonal reasons, but appears during a normal two-phase cycle with the presence of ovulation. This situation often occurs with focal thickening. In this case, pregnancy can proceed in accordance with two options.

1. Implantation of an egg on a healthy area of ​​the mucosa. If there is a formation of small size, pregnancy develops safely. Removal of the tumor occurs after childbirth. If there is a threat, the polyp can be removed at the beginning of pregnancy.
2. Introduction of fertilized egg near the polyp. In this case, pregnancy will not develop. Pregnancy is also not observed if the growth is located in the path of the egg in the uterus.

For neoplasms pregnancy may be complicated by bleeding.

Thickening of the mucosa cannot be considered as a cause of absolute infertility. With properly selected therapy, the thick endometrium regresses.

Focal hyperplasia

This pathology involves the formation of polyps inside the body of the uterus. Polyps are represented by the following structural parts:

• leg:
• body.

A polyp consists of epithelial cells and, depending on its composition, has several varieties:

• glandular, with a pronounced number of glands;
• glandular-fibrous, formed connecting view fabrics;
• fibrous, formed only by connective tissue.

The greatest danger is the adenomatous type of neoplasm. This is a glandular type that has signs of precancer, that is, atypia.

Typically, polyps are detected in women aged 35 to 50 years. Glandular formations are typical for patients of reproductive age, while adenomatous or fibrous formations are typical for women before and after menopause. In general, focal thickening can be detected at any age.

Focal thickening has the same causes as diffuse thick epithelium. The causes include hyperestrogenism and the anovulatory cycle, which differs in one phase. In rare cases, formations may develop during a normal two-phase cycle.

The causes predisposing to the development of polyps are:

• trauma to the uterine cavity due to abortion, curettage, intrauterine device;
• spontaneous abortion and difficult childbirth;
• endocrine disorders;
• somatic diseases;
• disorders associated with the functioning of the immune system.

Polyps can develop on both changed and unchanged mucosa. Women with a history of obesity and hypertension are at risk. Moreover, the formations in these representatives more often degenerate into a malignant tumor.

Signs of polyps include:

• cycle disorders;
• leucorrhoea in the case of a significant size of the formation;
• pain syndrome;
• infertility.

If a polyp appears in the absence of diffuse thickening, the woman may be bothered by intermenstrual bleeding, an increase in the volume of blood loss during critical days. Patients before menopause experience bleeding in the middle of the cycle. Women after menopause also notice slight spotting. If the tumor enlarges or necrosis develops, cramping pain may occur.

Gynecologists note that clinical picture with thick endometrium also depends on concomitant gynecological diseases uterus. The hormonal status and age of the woman have a significant influence.

Sometimes the symptoms of a polyp are similar to those of endometriosis or uterine fibroids. In such cases, there is a need for differential diagnosis.

Diagnostics

The presence of thick endometrium can be confirmed or refuted through a set of various diagnostic methods, which include both instrumental and laboratory research. Thickening can be suspected based on the patient’s characteristic complaints.

Laboratory diagnostics

As a rule, identifying the cause of the pathology and detecting concomitant diseases helps laboratory methods. In particular, you can obtain information about the presence of a two-phase cycle and ovulation. Thus, it is possible to identify the main cause of infertility. The patient is asked to perform an analysis of the content of sex hormones over time. Significant value has an assessment of the functioning of the thyroid gland. That is why doctors prescribe a test for thyroid hormone levels.

Ultrasound of the pelvic organs

This is one of the most important methods diagnostics to identify thick endometrium. The study is carried out at the beginning of the cycle after the end of menstruation and helps:

• determine the size and configuration of the uterine body;
• assess mucosal thickening;
• identify characteristic thickening structural changes mucous membrane;
• diagnose polyps;
• detect concomitant fibroids or adenomyosis.

When the uterus thickens, it appears as an expanded or deformed cavity. The thickness of the mucosa in the presence of pathology can exceed 15 mm, and in patients after menopause - 5 mm. In addition, when hyperplasia thickens, uneven thickening is usually diagnosed.

Hysteroscopy

This procedure is a study performed using a hysteroscope. During hysteroscopy, you can visually assess the uterine cavity and also identify:

• gland changes;
• thickening;
• neoplasms;
• fibroids;
• adenomyosis;
• inflammation.

If indicated, the doctor may take a tissue sample for histological examination.

Diagnostic curettage

The examination is carried out either before menstruation or on the first day of menstruation. Diagnosis is performed under the direct supervision of a hysteroscope. Then the material obtained in this way is sent to the laboratory for histological examination.

Curettage has both diagnostic and therapeutic purposes. The gynecologist removes not a separate section of the mucous membrane, but the entire thick endometrium. Mechanical removal mucous membrane helps eliminate hyperplasia. Gynecologists claim that the information content of the technique is more than 90%.

Diagnostics allows us to differentiate benign and pathological process, type of changes, in particular, type of neoplasm.

Treatment

Thick endometrium requires treatment due to the likelihood of transformation into a malignant tumor. Elimination of thickening is recommended regardless of the patient’s age. In case of infertility, the elimination of thick endometrium can help restore reproductive function.

To determine treatment tactics, it is necessary to conduct a diagnosis. The age of the patient and the presence of concomitant pathologies are essential when choosing the optimal tactics.

Elimination of thick endometrium is possible using the following tactics:

• surgical;
• conservative.

Surgical tactics

Hysteroscopy and curettage - effective types minor surgical intervention on the uterine cavity in the presence of thickening. The use of manipulations is recommended in patients who are in reproductive age and the period before menopause. IN emergency Curettage and hysteroscopy are performed for bleeding and polyps. The manipulation is carried out in a hospital setting with mandatory general anesthesia.

However, the manipulations eliminate the thick endometrium without affecting the cause. If the causes of thickening are not eliminated, relapses may occur.

Conservative Tactics

With help medicinal methods bleeding can be eliminated, ovulation and normal cycle length can be restored. Drug tactics are based on hormonal treatment.

The purpose of hormonal treatment:

• suppression of proliferation and thickening of the endometrium of the uterus;
• impact on organs that are responsible for hormonal function.

Choosing hormone therapy carried out by a doctor, guided by examination data. Despite well-chosen therapy, endometrial hyperplasia of the uterus often regresses for various reasons.

As part of complex hormonal therapy for thick uterine mucosa, the following are also used:

• hemostatic drugs;
• painkillers;
• uterotonics;
• immunostimulants;
• vitamins.

Drug therapy may also be indicated before surgical intervention in the presence of inflammation.

If the thick endometrium of the uterus is precancerous, treatment can only be surgical. In the most difficult cases, the uterus is removed. This procedure is called a hysterectomy.

In case of uterine tumors, they are removed, followed by curettage and histological examination of the resulting material. After surgery on the uterus, they are sometimes prescribed hormonal drugs.

A thick endometrium does not always mean precancerous pathology. However, thickening of the uterine mucosa requires timely detection and subsequent treatment due to the risk of uterine cancer.

Article outline

Female reproductive system - complex mechanism, in which each organ must clearly perform its function. The importance of the uterus cannot be underestimated; the unborn child develops in it. In order for a woman to perform reproductive function, her health was fine, the inner mucous layer of the uterus (endometrium) is renewed monthly. Only a healthy layer is able to create conditions for the development of the baby. In this article we will figure out what the thickness of the endometrium should be by day of the cycle; it is important for a woman to know this, since only if the internal mucous layer is healthy can a fertilized egg be implanted in it.

Endometrial structure

The endometrium contributes to the implementation of the menstrual cycle mechanism. Another of its tasks is to ensure maximum suitable conditions to secure a fertilized egg in the uterus, its full development, and obtain everything necessary from the mother’s body.

Consists of 2 layers:

1. basal – layer directly adjacent to the uterine walls;
2. functional - the surface layer that is shed during menstruation. The basal layer ensures its complete restoration before the start of the next cycle.

The hormonal background of the female body is responsible for the thickness and structure of the internal mucous layer. It increases monthly - this happens during the 2nd phase monthly cycle. The process of its blood supply also increases. This indicates that the organ is ready to receive the fertilized egg. Rejection of the functional layer occurs when a woman does not become pregnant - menstruation begins.

Stages of endometrial development

The process of cyclical changes in the uterus in a woman’s body occurs monthly. The size of the endometrium differs depending on the stage of the monthly cycle. There is a division of the menstrual cycle into phases:

1. bleeding stage - desquamation;
2. phase of change in the basal area - proliferation;
3. growth of the functional surface - secretion.

At the 1st stage, the rejection process begins, the upper (functional) layer is removed. First, detachment occurs, then the restoration process begins. A new layer begins to actively develop from the cells of the basal layer.

At the second stage, the functional layer grows and tissues grow. There are only 3 stages that he goes through every month - early, middle, late.

At the third stage, blood vessels and glands develop. The mucous membrane thickens, this is facilitated by its swelling. The process is also divided into 3 stages - early, middle, late. In gynecology, there are average norms for the size of the mucous layer of the uterus.

How and why to measure the thickness of the mucous layer

It is impossible to find out the thickness of the endometrium during a routine examination with a gynecologist. The specialist prescribes an ultrasound examination, designed to be carried out on certain days of the menstrual cycle. During the process, the doctor sees the condition of the uterus, can detect neoplasms located in the organ, and factors affecting the thickness and density of the endometrium. Study the structure of the mucous membrane.

Women who are faced with the problem of conception or infertility should definitely know these indicators. An ultrasound is prescribed on the days of ovulation. Thickness readings change daily during the monthly cycle. Experts have approximately average values ​​that can show the state of a woman’s reproductive function and what problems there are.

A special table has been developed that has such indications, from which a specialist can see how much the patient’s indicators differ from the approximate indicators of the norm. It should be noted that a deviation or pathology is considered to be a large difference between the existing and average indicators from which specialists base themselves.

Table of norms

Endometrial development phase	Day of the cycle (stage of development)	Thickness index (mm)
Bleeding	Desquamation – 1-2 days of the cycle	5-9
	Regeneration – 3-4 days	2-5
Proliferation	Early stage – 5-7 days of the cycle	3-7
	Middle stage – 8-10 days	7-10
	Late stage – 11-14 days	10-14
Secretion	Early stage – 15-18	10-16
	Middle stage – 19-23	10-18
	Late stage – 24-27	10-17

The probability depends on the size of the endometrium future pregnancy. Next, let's figure out how many millimeters its thickness should be, creating favorable conditions for fertilization.

Norms for phases of the menstrual cycle

The endometrium grows in accordance with the phases of the cycle. Ultrasound allows you to track indicators, it is prescribed in different periods menstrual cycle, because the thickness of the mucous layer differs according to the phases of the cycle. The results of the study allow the specialist to evaluate internal state organ. Depending on the size of the endometrial layer, the specialist makes a diagnosis. There is an average that is considered normal, but in each individual case it may differ.

Bleeding phase

The beginning of a woman's cyclic period coincides with the first day of menstruation. Bleeding occurs as a result of the functional layer coming out. It can last 4-7 days. The stage is divided into 2 periods:

1. rejection;
2. regeneration.

Rejection occurs on days 1-2 of menstruation, the endometrium reaches 5-9 mm. On days 3-5, the regenerative process begins. The inner layer begins to grow, showing a minimum thickness of 3 mm.

Proliferative phase

Starts on day 5 of the cycle. Its duration is up to 14-16 days. The endometriotic layer increases. In the second phase of the cycle there are 3 periods:

1. early - from 5 to 7 days of the cycle. On the 5th day, the layer thickness is 5-7 mm, on the 6th day – 6 mm, on the 7th day – 7 mm;
2. medium - during this period the endometrium begins to actively grow and thicken. On day 8 its size is 8 mm. The end of the stage occurs on the 10th day of the cycle, size 10-12 mm;
3. final - this stage ends the period of proliferation, it lasts from 10 to 14 days of the cycle. The thickness of the functional layer increases, the height inner shell the uterus reaches 10-12 mm. The process of maturation of follicles in the egg begins. The diameter of the follicle on the 10th day is 10 mm, on the 14-16th day it is approximately 21 mm.

Secretory

This period is important for the female body. It lasts from the 15th to the 30th day. It is divided into early, middle, late stages. At this time, the structure of the inner mucous layer of the uterus changes significantly.

1. Early restructuring lasts from 15 to 18 days. Gradually, slowly, the process of growth of the mucous layer occurs. Values ​​may vary, on average 12-16 mm.
2. The average period lasts from 19 to 24 days of the cycle. The standard thickness is up to 18 mm. The inner layer thickens. Normally, a woman should not exceed this indicator. On average it can be 14-16 mm.
3. The late stage begins on the 24th day of the cycle and ends on the first day of the new phase. There is a gradual decrease in the shell, the normal thickness during this period is on average up to 12 mm, it is possible that the dimensions will be lower. During this period, the mucous layer is densest.

Normal for delay

When menstruation is delayed, its cyclic period lengthens. Often this provokes hormonal imbalance. Factors such as stressful situations cannot be ruled out. poor nutrition, Problems endocrine system, gynecological diseases.

During the delay process, the body does not produce the necessary hormones, the size of the uterine epithelium remains at the level of the secretion phase. The average value is 12-14 mm. This indicator does not decrease, the process of rejection and menstruation do not occur.

Thickness before menstruation

The endometrium is in the secretion phase before menstruation. Its approximate size is 1.2 cm. Estrogen and progesterone act on the functional layer, causing rejection. During the process of rejection, the endometrial lining thins by about 3-5 mm, and one of its levels is lost.

During pregnancy

If the egg is not fertilized, the functional layer peels off during menstruation. If a woman becomes pregnant, then the normal thickness of the endometrial layer in the first days remains at the same level. After a few weeks, the figure rises to 20 mm. After a month of pregnancy, an ultrasound may show a small fertilized egg.

If a woman experiences a delay, and pregnancy tests show a negative result, you can find out about it by the level of enlargement of the mucous membrane, 2-3 weeks after the embryo attaches to the walls of the uterus.

What to do if the thickness does not match

The discrepancy in endometrial thickness is detected by the doctor during an ultrasound. It is often observed during pregnancy, the mucous membrane becomes overgrown with blood vessels. By the 2nd week of pregnancy, the layer grows to 2 or more centimeters. Any changes in thickness may be pathological. There are two types of violations:

• – drugs with a large amount of estrogens are used for therapy. Aspirin is also prescribed in small quantities. Leeches, acupuncture, and physiotherapy have proven themselves well in the treatment of pathology. Experts note stimulation of endometrial growth when using sage;
• hyperplasia – hormonal drugs are used as drug therapy. It's possible surgery(scraping) of an excessively large mucous layer. In the most severe cases, a woman is offered hysterectomy. Combination therapy(curettage and hormonal drugs) show good results.

The mucous layer undergoes the greatest changes during menstruation; female sex hormones contribute to this. If there is no hormonal imbalance, menstruation proceeds without deviations.

In menopause

Menopause becomes a reason that provokes changes in the condition of the mucous membrane, a decrease in the endometrial layer (sometimes atrophy), and the cessation of menstruation. The normal layer in menopause is 5 mm. If the indicator is exceeded, there is a risk of developing pathologies.

Endometrium when taking COCs

The use of COCs has become a common occurrence in the life of a modern woman. However, few people know what happens to the body when taking contraceptives and how they prevent conception. To understand this, you need to understand how oral contraceptives work:

1. During ovulation, a mature egg moves into the fallopian tube, where fertilization occurs with seminal fluid. Contraceptives suppress the maturation process, so the egg is dormant and ovulation does not occur.
2. Taking birth control pills makes the mucus in the cervix too thick, which prevents sperm from entering the uterus. Therefore, even in cases where a woman forgets to take the pill, the risk of becoming pregnant is extremely low, even if ovulation has occurred.
3. Poor peristalsis fallopian tubes, which is caused by contraceptives, reduces the likelihood of seminal fluid reaching the egg.
4. COCs have a direct effect on the endometrium. In a normal state, the fertilized egg enters the uterus and attaches to the endometrium. After menstruation, in the first half of the menstrual cycle, the endometrium is restored. During the second half of the cycle, it actively grows, ensuring the successful attachment of the egg to the walls of the uterus. However, under the influence of contraceptives, the restoration of the mucous layer is inhibited - fertilization becomes impossible, even if it has occurred, the fertilized egg has no opportunity to gain a foothold.

At what thickness is curettage performed?

The endometrium consists of 2 layers - functional, basal. It is the functional layer and the vessels underneath that a woman sees when she menstruates. If fertilization does not occur, this layer peels off and comes out during menstruation, blood appears as a result of rupture of blood vessels. With hyperplasia, an increase in the layer and its cells occurs.

When the endometrial layer reaches 26 mm, its structure changes, active cell division occurs, it is necessary to do curettage, which helps eliminate heavy bleeding that accompanies menstruation. This prevents the formation of malignant cells and hormone therapy reduces the risk of relapse.

Pathologies

Among the most common pathologies of the endometrium, experts note two – hypoplasia and hyperplasia. Both pathologies have different characteristics and treatment methods.

Hyperplasia

is a pathology during which there is a thickening of the upper (functional) layer of the uterine mucosa up to (26 mm), compaction, and a change in structure. Hyperplasia prevents and does not allow the fertilized egg to settle in the uterus, and the fetus does not have the opportunity to develop.

Pathology often provokes a disruption in menstruation, its duration and intensity of discharge are disrupted. It often provokes the development of anemia; a woman experiences bleeding during the period between menstruation of varying intensity. An enlarged endometrial layer often becomes the root cause of the appearance of polyps and other neoplasms.

Hypoplasia

The thinned endometrial membrane does not allow a woman to realize her reproductive function - to become a mother. Hypoplasia prevents the egg from attaching to uterine wall. The egg does not receive necessary nutrition, which is provided by a system of blood vessels, which is why the fetus dies some time after formation. Thin mucosa often causes the development of inflammatory, infectious processes in the uterus, as it becomes less protected from the penetration of various microorganisms. Hypoplasia often causes poor development of the external genitalia and ectopic pregnancy.

The process of changing the endometrium is one of the most important in a woman’s body. He goes through all periods correctly if hormonal balance fine. When the first deviations appear or your health worsens, you should consult a doctor. Maintaining your health - important task, to which every woman should pay sufficient attention.