The reproductive health of a woman depends on many factors. Of great importance in the ability to conceive and bear a child is the endometrium, which has the property to change during the woman’s menstrual cycle. But there are situations in which, under the influence of various factors, pathological conditions arise in the endometrium, for example, its heterogeneity. What does this mean and what treatment is used for this disease, we will analyze in the article.
Endometrium is the lining of the uterus that lines its inner surface. It is rich in multiple blood vessels. The thickness of the endometrium varies throughout the cycle under the influence of hormonal levels. Normally, it has a relatively homogeneous structure, the same density and approximately the same thickness. Immediately after menstruation, the endometrium thickens, preparing to attach a fertilized egg. If this does not happen, the functional layer is rejected and along with the blood leaves the body, after which the basal layer is restored.
But sometimes there are situations in which, during an ultrasound diagnosis, the doctor determines the untimely heterogeneity of the endometrium. What does it mean? This condition indicates hormonal disruptions or serious inflammatory processes.
Currently, experts identify two types of endometrial heterogeneity, depending on the causes of this condition and its effect on the woman's body. Consider more:
- Normal heterogeneity of the uterine lining, which is characteristic of a particular phase of the menstrual cycle or the stage of pregnancy. It is a variant of the norm and does not require adjustment. Heterogeneous endometrium in the second phase of the cycle may indicate the development of certain diseases. Additional diagnostics required.
- Pathological heterogeneity of the endometrium. Does not depend on the menstrual cycle and the presence of pregnancy. It requires an early determination of the causes of development and the determination of effective therapy.
Sometimes the heterogeneous structure of the congenital endometrium is detected.
Consider the normal indicators of the endometrium depending on the phase of the menstrual cycle (see table).
Endometrium - Description and Functions
The composition of the endometrium includes epithelial cell layers lining the uterus, and deeper stroma, including the secretory glands. Each layer is characterized by the presence of a large number of blood vessels, through which a sufficient amount of blood is supplied. A large number of these vessels and arteries reach the surface layers due to myometrium and form a capillary network in the stroma.
During menstruation, significant changes occur in the body, and it is under their influence that every month a woman faces menstrual bleeding. Menstruation is a kind of signal that everything is in order with the state of the female body and that the reproductive function is not impaired.
Endometrium undergoes significant changes throughout the entire menstrual cycle.
Many women complain that the first day of menstruation is abundant and this occurs as a result of endometrial detachment. After this process is completed, the force of bleeding gradually subsides and the names at this moment the surface layer of uterine tissue begins to grow anew.
Video about what is endometriosis.
Usually in the middle of a cycle in a healthy female body, ovulation occurs and this process ends with the onset of the next stage of the menstrual cycle, which is accompanied by a gradual thickening of the endometrium. This condition of the uterine cavity indicates the readiness of the female body to the onset of a possible pregnancy. In the event that fertilization occurs, the uterus is already well prepared to attach the egg.
Regulatory Endometrial Indicators
Regulatory Endometrial Indicators
In the first days of menstruation, the heterogeneous structure is typical for the surface of the uterine layer, and the thickness varies from 5 to 8 mm. On the third day of the cycle, the process of endometrial transformation develops and its structure acquires good echogenicity. The size of this surface tissue becomes approximately 3-5 mm. Toward the end of menstruation, the structure of the endometrium increases significantly, its density increases, and its dimensions reach 7–9 mm.
On the eighth day of menstruation, the tissue is an echogenic structure, the dimensions of which reach 8-100 mm. It is this size that remains with her until the end of the menstrual cycle, and when the endometrial standards comply with the phase of the cycle, it can be said that a favorable environment is created in the uterus to attach a fertilized egg.
There are several reasons for the deviations of the surface of the uterine layer with the day of the cycle:
- Changes in the hormonal background of the female body.
- Improper curettage of the uterus, resulting in injuries of a different nature.
- Pathological condition of the uterus, that is, it is underdeveloped.
- Violation of the process of blood movement in the uterus, and in the pelvic organs.
Causes of pathology
The main causes of endometrial heterogeneity
The main method of diagnosing the condition of the uterus cavity is still ultrasound, which should be carried out after menstruation.
A heterogeneous endometrium is often detected in the research process, and such a pathological condition may develop for a number of reasons:
- Progression in the female body adenomyosis which is accompanied by the proliferation of cells in the muscle layer. The heterogeneity of the endometrium suggests that black growths have appeared in the layers of the uterus - cysts that cause changes of a different nature.
- The development in the uterine cavity of submucous memes, which is accompanied by an increase in the size of the organ.
- The formation of polyps leads to the fact that there is an uneven growth of the surface of the uterine layer, as well as its thickening.
- The appearance of malignant tumors in the uterine cavity is accompanied by a heterogeneous structure. Signs of such a pathology coincide with the symptoms of fibroids.
In addition, the identification of a heterogeneous layer may indicate the development of the inflammatory process, which requires mandatory treatment.
Often, in this pathological condition of the uterus, a curettage procedure is carried out, which can be used both as a treatment method and for diagnostic purposes.
In the event that a violation of the homogeneity of the uterine layer was a consequence of an abortion, the treatment is carried out with the help of hormonal preparations. Heterogeneous endometrium is often evidence of the development in the female body of any pathology that requires mandatory treatment. In any case, to prevent the development of various gynecological pathologies, it is important to visit a specialist at least once a year.
Causes of deviations
The main reason for the heterogeneity of the endometrium are hormonal disorders. During menstruation, progesterone is active. Under his influence, the inner layer of the uterus is several times enlarged and updated. Estrogen has a different role. This hormone prevents the growth of mucous tissues. With a balanced, healthy hormonal background, the density, thickness and structure of the endometrium correspond to the normal values. If one of the hormones begins to predominate, a failure is noted, the probability of the onset and progression of diseases of the reproductive system increases.
Among other reasons provoking deviations in the structure of the inner layer, can be identified:
- circulatory disorders of the mucosa,
- scraping, abortions, endoscopic surgery,
- hypoplasia (underdevelopment) and uterine myoma,
- long-term use of antibiotics.
In cases where endometrial heterogeneity is not physiologically temporary, physicians evaluate the condition as pathological. The final conclusion is done only after an ultrasound.
Violation of the structure and thickness of the uterine mucosa can be triggered by diseases such as:
- submucous myoma (benign neoplasm),
- adenomyosis (cell proliferation in the muscle layer of the uterus),
- polyps and cystic formations
- endometriosis and endometritis,
- hyperplasia (structural deformation and pathological growth of the glands of the functional layer),
- malignant tumors.
Inflamed uneven endometrium adversely affects the well-being and health of women. Many of the pathologies indicated hinder normal conception and the course of pregnancy. Cancers can be life-threatening and require immediate treatment.
Heterogeneous state of the endometrium, as any disease, is characterized by symptomatic manifestations. They are few and most non-specific. Abdominal pain, no menstruation, weakness - all these are common symptoms that characterize the most diverse pathologies of the uterus, including the heterogeneity of its mucous membrane.
In the initial stages, symptoms rarely occur. Changes in the structure of the mucous tissues may not manifest clinically, but as the pathology progresses, the symptoms become noticeable and noticeable. Usually, a woman suffers from acute pain during menstruation and regular failures of the menstrual cycle.
The intensity and severity of symptoms depend on the causative factor that provoked the heterogeneity of the endometrium.
Research and diagnostics
At usual examination, the state of the endometrium is difficult to determine. Pathological changes are detected by ultrasound, which is done after menstruation. Detailed analysis allows to establish the density, thickness and structure of the endometrium. During the study, the doctor studies the echogenicity of the structure of the mucous membrane of the uterus, can reveal tumors and other problems affecting reproductive functions.
In addition to local ultrasound, the doctor may prescribe curettage. With a detected thickening and structural heterogeneity, this type of surgical intervention is used for treatment and diagnosis.
In addition, for a more complete and detailed analysis, specialists of a different profile can be involved in a diagnostic examination. This is due to the fact that the cause of many gynecological diseases are disorders of other systems and organs.
In order to prevent the development of heterogeneity of the mucous tissue of the uterus, gynecologists recommend to be more attentive to their health. Do not ignore painful symptoms, delayed menstruation, cycle failures and other disturbing symptoms. A late visit to a doctor may cause heavy bleeding, endometrial rupture, infertility, and other complications.
It is very important to take tests in time, undergo ultrasound examinations and be responsible for taking the prescribed drugs to restore the endometrium. These recommendations apply to women of any age. Regular visits to the doctor and professional diagnostics reduce the likelihood of developing pathological disorders, and in cases of identified abnormalities they can cope with the disease more quickly and without serious complications.
The prevention of diseases of the uterus and other parts of the reproductive system should be given close attention. Once a year a woman should definitely do an ultrasound of the pelvic organs. Examination by a gynecologist should be done every six months. Donating smears is also necessary, especially for women at risk.
If necessary, the doctor will give a referral to a blood test for hormones. An important role in the prevention of diseases is given to barrier contraception. If you experience unpleasant sensations during menstruation, you should consult a doctor.
General information about the endometrium
Endometrium is the internal uterine mucous membrane, which plays the leading role in ensuring the normal course of physiological monthly changes in women of reproductive age.
Its high saturation with blood vessels, the ability to build up thickness and change the structure in the direction of loosening under the action of hormones, provides the conditions for strengthening the fertilized egg and preparing the uterus for a potential pregnancy. If fertilization has not occurred, the lush and overgrown endometrial layer is removed from the uterus by separating its functional sublayer, menstruation begins and a new phase of the cycle begins.
In what condition is the endometrial layer, as it is updated, you can learn from the results of diagnosis using ultrasound examination, conducted in different phases of the menstrual cycle. Ultrasound examination helps to establish the parameters of the thickness, density, structural structure of the endometrial layer of the uterus, and to identify the level of possible deviations.
The principle of action of ultrasonic medical equipment is based on the echolocation properties of tissues, that is, their ability to reflect the sound, which is called echogenicity. The higher the density of the organ tissue, the brighter the display in color on the monitor screen. If the endometrium is heterogeneous, an experienced specialist will immediately note this. To determine the state of the endometrium, the doctor relates its performance to the phase of the patient's cycle.
It is not the endometrium heterogeneity itself that is important, but its condition on certain days of the cycle.
Normally, in women in reproductive age, the parameters of the endometrium reveal a certain dynamism. In contrast to the endometrium in menopause, the functional uterus sublayer reveals a tendency to heterogeneity in the phases of the cycle.
If you observe it during one cycle, then, on average, you can see the following picture:
- During the first days of the ultrasound cycle, the endometrial tissue is displayed as a heterogeneous structure that perfectly conducts sound waves and has a lower echogenicity with a thickness of 8-10 mm,
- echogenicity increases during the 3-4th day, the rate of the endometrial layer - a maximum of 5 mm,
- for 5-7 days there is a thickening of up to 6 mm, the echo is slightly reduced,
- for the 8-10th day, an increase in the thickness of the endometrial layer up to 10 mm (or within 5–9 mm) and an increase in the level of echogenicity,
- From the 11th to the 18th days of the cycle, the enlarged endometrium has a thickness of 8-15 mm with an average level of echogenicity,
- From the 19th to the 23rd day, the inner layer grows to a maximum of 12-16 mm,
- after the 24-26th day, the thickening decreases to 9-12 mm.
Thus, inhomogeneous endometrium is the norm when the level of changes corresponds to certain phases of the cycle.
As for the state of the endometrium in menopause, it is significantly different from what happens in women of reproductive age. You can learn more about the thickness of the endometrium in menopause and postmenopause by clicking on the link. Climax is the period when the structure of the endometrium changes. The functional sublayer of the endometrium in menopause becomes thinner, and the basal sublayer remains mostly. Therefore, its thickness is in the range of 5-6 mm, the endometrium is homogeneous, its condition is characterized by structural constancy. The characteristic of the endometrium in menopause is marked mainly by the accumulation of mucous inclusions.
Normal echo density of the uterine layers is characterized by the homogeneity of their echostructure, according to the intensity of the level of the response of the tissues of the uterus to the action of ultrasound, it corresponds to the response of the tissues of a healthy liver.
Endometrium is the lining of the uterus, which is enriched with blood vessels. The size of the inner layer of the uterus helps in determining the disease that can even threaten a woman’s life. The thickness of the endometrium varies depending on various factors, but in some cases this may be the norm.
For women of childbearing age, a normal endometrium at different phases of the cycle has its own characteristics:
- Phase 1 - Start of the cycle. The thickness of the endometrium varies from 5 to 9 mm. The sound is excellent, and there are no divisions into layers.
- Phase 2 - Mid-cycle. Endometrial consolidation occurs. The echo is reduced, but the permeability of the sound remains quite high.
- 3 phase - End of the cycle. There is a separation of the endometrium into layers with hyperechoic inclusions that reach 9-10 mm. It is also worth noting that this is the most favorable phase for conception.
And for women in the postmenopausal stage, the thickness of the inner lining of the uterus is not less than 6 mm with a smooth structure.
In general, the endometrium normally has a somewhat homogeneous structure, that is, it is equally compacted and also approximately thickened depending on the phase of the cycle. However, it is worth noting that in rare cases, a heterogeneous inner layer of the uterus may be the physiological norm, but this is mainly indicative of dangerous disturbances in the body.
Причины увеличения толщины эндометрия (паталогического и нормального)
В полости матки находится эндометрий – слизистая оболочка. Каждый месяц она отслаивается, в результате чего у женщины начинаются месячные. Speaking of the endometrium, it is characterized by the presence of such a structure: a layer having a constant thickness and a structure having stem cells as part, and the layer responsible for the recovery after menstruation is basal.
Another layer has constant changes under the influence of female sex hormones, it is called functional. In the ovaries, hormone production is observed in various volumes, depending on the days of the cycle, the thickness of the endometrium on the 19th day of the menstrual cycle becomes the thickest, during this period it can be from 14 to 19 millimeters.
Endometrial changes depending on the cycle
As many of us know, in order for a fertilized egg to gain a foothold in the uterine cavity, the endometrium must be thickened. If this does not happen, the endometrium itself remains thin, even if fertilized, the egg cell will not be able to properly fixate in the uterine cavity, as a result of which pregnancy simply does not occur.
Why endometrial thickness may deviate from the norm?
Endometrium can strongly deviate from its norm, and the indicators can be either up or down. For a woman, both of these indicators are harmful. In the event that the endometrium is too thin, then this pathology is called endometrial hypoplasia. In fact, this phenomenon may arise as a result of the following reasons:
1 Frequent abortions,
2 Inflammation in the uterus,
3 Wearing an intrauterine device for a long time
4 The presence of infectious diseases
5 Poor blood supply to the pelvic organs.
Usually a woman with hypoplasia can never have children. In this case, it will be necessary to treat the causes of this problem, to restore the endometrium. Also, an excessive thickening of the endometrial layer, which is called hypertrophy, also poses a great danger to women's health.
Why does endometrial thickness increase?
Hypertrophy - an increase in the mass and volume of the layers of the endometrium, is normal from the first for menstruation until the next menstruation.
However, in the event that menstruation does not come, while the uterus has enlarged sizes, the endometrium begins to increase in size, this situation can cause hyperplasia.
In this case, the woman is recommended to be sure to see a doctor.
If we talk about glandular-cystic hypertrophy, then in this case the development of cells at the beginning of the gland is observed, the outflow of mucus closes, the gland begins to resemble a bubble, inside which there is a liquid (cyst).
In this case, the cause of this phenomenon is the hormone estrogen. Speaking about cystic hypertrophy, it should be noted that it resembles a glandular-cystic, but inside the glands remains normal epithelium.
In some situations it can turn into cancer.
Focal hypertrophy is a disease in which endometrial cells begin to grow unevenly, foci. As a result of their high sensitivity to hormones, they begin active division, there are elevations from the glands, which in appearance also resemble cysts. In the event that this phenomenon occurs inside a polyp, then they begin to grow very quickly.
The size of such foci can range from a few centimeters to several millimeters, while there is a high probability of their transformation into cancer. If the growth begins completely over the entire surface of the endometrium, this is called diffuse hypertrophy.
Of all the types of hypertrophy, the atypical form is considered the most dangerous. In most cases, on the background of the development of this form occurs oncology. There is a proliferation of cells including the basal layer, they can undergo mutations, thereby obtaining the name - atypical cells.
They undergo strong changes, changing structure and core.
Symptoms and signs of endometrial hyperplasia
In most cases, the disease has no symptoms, since the uterus almost does not perceive the pain. The woman feels well, she has no failures in the menstrual cycle. If we talk about the visible manifestations of the disease, then these include:
1 During menstruation, large blood clots are observed,
2 Menstruation are very painful, there may be vasospasm, increased intrauterine pressure,
3 In the presence of polyps in a woman before and after menstruation, there may be secretions of a blood-like nature. There are cracks in the walls of blood vessels through which blood is seeping,
4 In the middle of the cycle may appear bleeding, they are not abundant, but can occur after exercise and sex,
5 Delayed menstruation after which there is severe bleeding. As a result of the delay, the growth of the endometrium occurs, but when the amount of hormones drops in the blood, the enlarged uterus begins to reject the grown mucous membrane,
6 Infertility. Often this disease is manifested in the inability of a woman to conceive a child. The reason lies in the lack of the possibility of proper formation of the placenta,
7 Long, strong periods that do not end after 7 days.
In that case, if you were able to see at least one of the symptoms similar to yours, then it is necessary to immediately consult a doctor, as the disease has gone far. In this case, after passing the necessary tests, treatment with medication will be prescribed.
If you breastfeed for a long time, then the woman also has a thickening of the endometrium. But in this case, the condition cannot be considered pathology. With prolonged lactation, the likelihood of endometrial oncology is reduced by 95%, provided that the woman breastfed for 13 to 24 months. That is why it is recommended to breastfeed the baby as long as possible.
If endometrial thickening occurs due to hormonal changes
On average, in a healthy woman, the thickness of the endometrium varies from 3 to 6 mm. If the thickness exceeds these figures, this is not always a sign of a disease. Anxiety is worth beating only if its value is significantly different from the indicators recommended during this period of the cycle.
These characteristics affect the ability to conceive and carry a healthy child. And it is possible to diagnose endometrial thickening using ultrasound of the pelvic organs. If its thickness exceeds the norm, then this may be evidence of the onset of any pathological process in the uterine cavity.
It should be understood that interpreting the results of ultrasound is necessary depending on the phase of the monthly cycle:
1 early stage of the proliferation phase falls on 5-7 days from the onset of menstruation, while the thickness of the endometrium should be about 5 mm,
2 the endometrium of the middle phase of proliferation is observed on the 8-10th day of the cycle and its indicators can vary in the range from 6 to 12 mm,
3 late proliferation accounts for 11-14 days from the onset of menstruation, which means that the thickness of the mucous layer of the uterus should be about 11 mm (fluctuations 7-14 mm),
4 in the period from 15 to 18 days of the cycle in most healthy women of reproductive age ovulation occurs, this is the phase of early secretion. The thickness of the endometrium is still growing, although it is already noticeably slower than before. The normal rate during this period varies from 10 to 15 mm (average 12 mm),
5 in the phase of medium secretion, which falls on the 19-23 day of the cycle, the endometrium reaches its maximum value and stops growing. Its value is 11-18 mm, the average is 14 mm,
6 on the 24-27th day of the cycle, the late secretion phase begins, at which the thickness of the endometrium gradually decreases, reaching 12 mm (fluctuations are 10-18 mm).
Such changes are completely natural and are observed in all healthy women of the reproductive period. If on any day of the cycle the thickness of the endometrium exceeds 19 mm, then it is necessary to look for the cause of this pathology.
Symptoms and signs of endometrial hypoplasia
The following symptoms are characteristic of this pathology:
1 Intense pain during menstruation, which prevents a woman from leading a normal life.
2 Irregular monthly cycle.
3 Scantiness, smearing character of menstrual discharge or, on the contrary, their abundance, which leads to the appearance of symptoms of iron deficiency anemia.
4 Lack of sexual discharge during intercourse.
5 Late onset of menses.
6 The instability of the monthly cycle.
7 Poor hair in the genital area.
8 Disruptions of early pregnancy in the early stages.
11 Weak secondary sexual characteristics.
12 Spotting after intercourse.
Underdevelopment of the endometrial functional layer often leads to absolute infertility, since the egg cell simply has no place to catch. Treatment in this case should begin as soon as possible, otherwise serious complications cannot be avoided.
What changes in the endometrium can be considered pathological?
Natural variations in endometrial thickness associated with the monthly cycle should not be a cause for concern. However, there are pathological changes triggered by hormone-dependent diseases. The most characteristic signs of such illnesses are hyperplasia (excessive growth of the mucous membrane of the uterus) and hypoplasia (endometrial underdevelopment).
What to do if you have symptoms characteristic of endometrial hyperplasia.
To begin with, you should consult with a specialist who can confirm the diagnosis and select a course of treatment depending on the patient’s health status, her age and type of disease.
Endometrial hyperplasia leads to a thickening of the walls of the uterus and an increase in its volume. This occurs as a result of excessive proliferation of stromal and glandular elements of the endometrium. The thickening of the inner layer of the uterus in most cases accompanies this disease.
Hyperplasia can be diagnosed using ultrasound of the pelvic organs; in a healthy woman, at the beginning of the cycle, the thickness of the endometrium should reach 6 mm. In this case, the difference from the norm even in 1 mm should alert the doctor and become a reason for re-diagnosis.
If this indicator is twice the norm, the doctor prescribes diagnostic curettage, which allows sampling of the mucous membrane for histological examination and identification of the cause of the pathology.
Since endometrial hyperplasia is a hormone-dependent disease, in most cases it is also treated with hormonal preparations.
The thickness of the endometrium within 12-15 mm is often a sign of cancer. If the growth of the uterine mucosa does not stop at this indicator, then most experts tend to hysterectomy - surgical removal of the uterus, since ignoring the problem can be fatal.
The thickness of the endometrium, reaching 21 mm, is a characteristic sign of cancer tumors. The highest rate recorded by the medical community was 24 mm. In the presence of such a pathology, it is necessary to resort to emergency removal of the uterus and conduct a course of chemotherapy to combat cancer.
Heterogeneous structure of the endometrium: norm or pathology
Women's reproductive health depends on the condition of the endometrium. This term is called the tissue covering the inner layer of the uterus.
Changes in the mucous are observed throughout the entire menstrual cycle, and in many cases this is considered the physiological norm.
But pathological structural abnormalities are also possible when a heterogeneous endometrium is a sign of abnormalities in the body. Most often this occurs under the influence of hormonal disorders and inflammatory processes.
Heterogeneity of the endometrium - norm or pathology?
Endometrium is a tissue that lines the surface of the uterus cavity from the inside. It contains a large accumulation of blood vessels and it is this layer of tissue that plays a leading role during menstruation. In the event that a specialist diagnoses a heterogeneous endometrium, this may indicate a progression in the woman’s body for any abnormalities.
At the onset of menstruation, detachment of this layer of tissue and its exit from the uterus is observed. A dangerous and alarming signal is the heterogeneity of the endometrium, since it may indicate a variety of inflammatory processes and changes in the hormonal background of the female body.
Characteristics of heterogeneous endometrium - norm and pathology
Heterogeneous endometrium can be the result of both the physiologically normal course of natural processes in the female body, and one of the indicators of pathological changes in the uterus.
What is the difference between the characteristic indicators of the norm of the endometrial layer and the signs of pathology, and when is a heterogeneous endometrium considered to be a symptom of a developing disease? To understand this, you need to know the mechanism of changes that endometrium undergoes throughout the entire menstrual cycle, and why certain deviations may occur.
Most patients of reproductive age are prescribed a course of drug therapy aimed at stabilizing the hormonal levels responsible for the state of the endometrium. For these purposes, the following drugs are used:
- Combined contraceptive means (hormonal) - contribute to the normalization of the menstrual cycle and the renewal processes of the uterine mucous layer.
- Progesterone - is aimed at suppressing the excessive activity of the hormone estrogen without a concomitant decrease in its performance. This kind of drugs stabilize the cyclical nature of the renewal of the uterine endometrial layer and its structural state.
- Antagonists of the hormone gonadotropin-releasing (gonadorelin) - contributes to the formation of artificial menopause for the purpose of degradation and rejection of thickened endometrium.
The duration of treatment is on average from 3 months to six months. All drugs, their dosage and pattern of use should be determined exclusively by the gynecologist individually.
Coagulation is a minimally invasive surgical procedure aimed at cauterization of pathological foci of growth. For these purposes, the following techniques are used:
- Electrocoagulation - cauterization of overgrown endometrial tissues by exposure to high-frequency current pulses. This procedure is quite traumatic, but because of its versatility and affordable cost is often used.
- Laser coagulation is the most gentle and safe technique. Pathological areas are eliminated by focused laser exposure. Laser therapy is characterized by the presence of such advantages as the absence of risks of bleeding, complications of an infectious nature, painlessness, but this procedure is rather expensive.
- Cryodestruction - exposure to low temperature conditions. The technique is carried out using liquid nitrogen. Differs in availability and high rates of efficiency.
Cauterization is performed during the hysteroscopy procedure. Miniature surgical instruments are inserted into the uterine cavity of the patient with the help of a special apparatus - a hysteroscope. Properly performed coagulation gives stable positive results and does not require long-term rehabilitation.
Endometrium: thickness and irregularities
Endometrium - This is the inner mucous membrane of the uterus, lining its cavity and richly supplied with blood vessels. It plays the main role in the menstrual cycle, but its main function is to create conditions conducive to the implantation of the ovum in the uterus.
In the endometrium there are two layers - the basal and functional. During menstruation, the functional layer is rejected, but due to the unique regenerating ability of the basal layer, it is restored in the next cycle.
The endometrium is sensitive to hormones, so in the second phase of the menstrual cycle, it is significantly thickened, the blood supply is more abundant. Thus, preparation for embryo implantation takes place.
But if the pregnancy does not occur, then the functional layer is rejected, and menstruation begins.
For the onset of pregnancy is important endometrial thicknessdetermined by ultrasound. Depending on the phases of the cycle, it varies.
- In the phase of early proliferation (5-7 days of the cyclea) thickness ranges from 3-6 mm, averaging 5 mm.
- On 8-10 days of the cycle (mean proliferation) the endometrium thickens somewhat - on average up to 8 mm (fluctuations 5-10 mm).
- In the late proliferation phase (11-14 days) the endometrium thickens to 11 mm (fluctuations 7-14 mm).
- For the early secretion phase (15-18 days) characteristic fluctuations in the range of 10-16 mm, averaging 11 mm.
- In the medium secretion phase (19-23 daysa) the endometrium reaches a maximum thickness of 14 mm on average (fluctuations of 10–18 mm).
- On 24-27 days of the cycle (late secretion) the thickness of the endometrium slightly decreases - an average of 12 mm (fluctuations 10-17 mm).
Среди нарушений структуры эндометрия принято выделять гиперплазию (утолщение) и гипоплазию («тонкий» эндометрий).
Для гиперплазии (ГЭ) характерно изменение желез и стромы слизистой оболочки матки. Это избыточное разрастание эндометрия, при котором он становится значительно толще, чем в норме.
Hyperplastic processes occur against the background of hormonal disorders, which are characterized by an excessive amount of estrogen and progesterone deficiency.
Women with diabetes and other metabolic disorders leading to obesity are most susceptible to the disease. As well as patients with arterial hypertension.
Endometrial hyperplastic processes are often combined with diseases such as uterine fibroids, genital endometriosis, and chronic inflammatory processes of the female genital organs.
More often, EH is asymptomatic, but dysfunctional uterine bleeding may occur during anovulatory cycle. As a rule, after a delay of a menses or in a normal cycle. Often, the diagnosis of EH is set when a woman begins to be examined for infertility.
The lack of pregnancy in the case of HE is due to two factors:
- lack of ovulation associated with hormonal disorders,
- impossibility of implantation of the embryo in the diseased mucous membrane of the uterus.
Treatment of EH is medication, which is based on hormonal preparations, and surgical, which removes the endometrial layer. In severe hyperplasia, removal of the uterus may be required. Often, complex treatment is necessary - removal of the endometrial layer and subsequent low-dose maintenance hormone therapy.
Endometrium is the mucous membrane of the uterus, which is directly responsible for the process of implantation of the embryo.
The thickness and structure of the lining of the uterus is constantly changing throughout the menstrual cycle, and even a completely healthy woman can not be perfectly homogeneous. Therefore, if the doctor indicates in the map the heterogeneity of the lining tissues, then it is necessary to clarify the nature of the problem:
- Uneven thickening or thinning,
- With hyperechoic or anechoic inclusions,
- Sharpness of contours
- The presence of asymmetry.
During the monthly cycle, the thickness of the endometrium of a healthy woman can vary between 5-19 mm. But if during the passage of ultrasound on different days of the cycle, the structure of the lining remains unchanged, this should be the reason for prescribing a hormogram and selecting further treatment.
In a healthy woman between the ages of 18 and 45, during the normal menstrual cycle, the following changes in the thickness of the lining of the uterus occur:
- The first days of monthly discharge: 0.5-0.9 cm,
- 3-4 day: in the range of 0.3-0.5 cm
- Until the 7th day: 0.6-0.9 cm,
- Until the 10th day: 0.8-1.0 cm,
- Up to the 14th day: up to 1.3 cm
- On the 18th day: up to 1.6 cm
- On the 23rd day: up to 2.1 cm (changes by + - 4 mm),
- On the 27th day: the lining layer becomes thinner to 1.0-1.8 cm.
Of course, these figures are approximate and depend on the length of the cycle, the nature of the discharge and even genetic predisposition.
What deviations may indicate endometrial heterogeneity?
If the lining thickness in different parts of the uterus differs by no more than 5 mm., Then this is considered a standard variant, although the diagnostician can write a comment about the heterogeneous endometrium in the card.
But if a specialist in ultrasound diagnostics notices anechoic (those that do not reflect sound waves) areas, he will definitely give direction to further examinations.
For example, if a thickening was found only on one part of the uterus, then focal hyperplasia is diagnosed.
Such a heterogeneous structure usually develops due to hormonal imbalance (an excess amount of estrogen in the face of progesterone deficiency). Focal hyperplasia is usually accompanied by the growth of myomas, the development of inflammatory diseases, so you should not ignore the treatment.
If the diagnostician revealed focal thinning of the lining of the uterus, then hypoplasia is diagnosed. Such a deviation can be a serious obstacle to the normal conception, because there are not so many ways to “increase” the endometrium.
The main reasons for this deviation:
- Chronic stress
- Disorders of blood flow to the uterus (both congenital and acquired),
- Atrophy (underdevelopment) of the uterus,
- Damage to the lining during surgery,
- Infectious and inflammatory diseases.
So, in itself a heterogeneous endometrium is not a disease. The gynecologist will be able to make the final diagnosis only after a set of additional diagnostic tests.
Endometrium and its participation in conception
Endometrium is called the inner mucous membrane of the uterus, represented by the covering-glandular epithelium, the system of blood vessels, connective tissue. The purpose of the endometrium is to provide a comfortable microclimate for the occurrence and course of pregnancy during the implantation of the ovum.
Endometrial activity is regulated by the hormonal background of the female body. Before the onset of menstruation, this layer thickens, the number of glands that improve blood flow increases. All this is necessary to ensure the possibility of becoming pregnant. After conception, the endometrial vessels recede to the placenta, through which nutritional components and oxygen will be delivered to the fetus.
Such characteristics of the endometrium as its size, degree of formation, structure, affect the onset of pregnancy and its course.
Estradiol, a female hormone synthesized by the ovaries during follicle maturation, affects the maturation and effectiveness of the endometrium.
The required concentration of estradiol in the body of a woman every month participates in the maturation of the endometrium and the formation of progesterone receptors in it.
It is important to know that progesterone is a hormone produced in the 2 nd half of the perinatal period by the corpus luteum, which is formed instead of a broken egg follicle and is necessary for maintaining pregnancy.
Normal conception proceeds as follows: approximately in the middle of the monthly cycle, in a fully mature egg cell, the sheath (follicle) breaks. After which it enters the abdominal cavity, moving towards the fallopian tube. Being hooked on the villi, she waits for her to merge with the male reproductive cell for fertilization.
When a woman’s semen’s sexual fluid appears in a woman’s body, fertilization takes place. Of the thousands of sperm, only one can penetrate the defense of the egg and merge with it into a coherent whole.
For some period, the egg cell will still be in the fallopian tube, and when it is transformed into a fetal egg, it will sink into the uterine cavity with a grown fluffy and dense endometrium and grow into its walls.
The day when the ovum is implanted into the uterine wall by means of the lining layer of the endometrium is considered to be the day when pregnancy appears.
In the situation of non-occurrence of conception in the current monthly cycle, the endometrium is rejected by the uterus. The latter is removed from the cavity in the form of bloody menstrual flow. In them there is also a dead egg and an unwanted corpus luteum. However, with the new monthly cycle, the egg cell will mature again, the endometrium will grow, and so on. And so it will be before menopause.
The study of the norms of the endometrium for conception
Pregnancy may occur with an endometrial thickness of 7 mm. Indicators below this norm for the occurrence and preservation of pregnancy are not considered.
The thickness of the endometrium takes dimensions according to the day of the cycle: 5-7 days corresponds to a value of 3-6 mm, 8-10 days - from 5 to 10 mm, in 11-14 days - 7-14 mm, in 15-18 days - from 10 up to 16 mm, in 19-23 days - from 10 to 18 mm, in 24-27 days - from 10 to 17 mm.
With a protracted cycle, deviations from the norm are possible. For menstruation, the value is 5-9 mm.
By the end of the month (approximately on day 5), the regeneration process takes place, the size of the mucous layer is 0.2-0.3 cm.
The size of the endometrium for conception should be at least 1.1-1.2 cm. This value of this indicator is considered the norm.
The fertile period ends on the 18th day. With a shortened monthly cycle, the end of the fertile period corresponds to the 12th day. These points are taken into account in the artificial insertion of the embryo, in IVF. On 19-23 days, there is a new stage, the thickness reaches a maximum of 1-2.1 cm and the egg of the egg easily attaches to the walls of the uterus. By the 24-27th day, the endometrium becomes thinner to 1 cm. At menopause, the layer thickness is 5 mm. In women of age, the reproductive function is extinguished, and sex hormones require replenishment. Pathology appears in the uterus.
If the endometrium does not mature or does not correspond to the tabulated indicators of the norm on specific days of the cycle, then this leads to female infertility. This can manifest itself in the following situations:
- Insufficient synthesis of hormones involved in the formation of the endometrium with normal structure and size, is a congenital abnormality.
- There are failures in hormonal terms.
- Defects of the blood supply in the area of the uterus acquired or congenital nature.
- At the time of curettage during abortion, the endometrium was injured.
The problem of infertility in this case can be resolved by effective treatment after accurately identifying the cause of impaired endometrial development. What contributes to a considerable extent the timely diagnosis of the endometrial layer thickness.
Normalization of the thickness of the endometrium with drugs
Deviation in the size of the endometrial layer is not yet a sentence, because it is subject to medical adjustment. With proper selection of drugs it is possible to increase this layer to the required size. Its thickness is fundamental and at conception in a natural way, and with the method of extracorporal fertilization. This is due to the fact that in both situations the embryo is implanted into the uterus without the direct influence of the human factor and only due to the support of this inner layer and the necessary concentration of hormones responsible for the pregnancy.
In order to increase the level of the hormone estrogen in the female body, which directly affects the thickening of the endometrium and the increase in its thickness, hormone therapy is prescribed. These can be injections of synthetic estradiol or Proginova, Divigel. In addition, the homeopathic drug Gormel is prescribed. The latter has a mild action aimed at self-production by the female body of the required level of estrogen.
The formation and maturation of the endometrium contribute to Duphaston, Utrozhestan. They contain hormone progesterone. It is in the second half of the menstrual cycle that the yellow body synthesizes to promote survival.
Also, when diagnosing the size of the inner layer of the uterus, it is important to eliminate STIs. Besides the fact that they can negatively affect conception, they also prevent the growth of the desired thickness of the endometrium.
The structure of the endometrium and the stages of its development
Endometrium is the lining of the uterus, which covers the inside of the wall. Due to the changes that occur regularly in its structure, women have menstruation. This shell is designed so that the fertilized egg can be kept in the uterus and develop normally. After it is implanted in the mucous membrane, the placenta grows, through which the fetus is supplied with the blood and beneficial substances necessary for its growth.
The mucous membrane of the uterus consists of 2 layers: the basal (directly adjacent to the muscles) and functional (surface). The basal layer exists constantly, and the functional layer varies in thickness every day due to the processes of the menstrual cycle. The thickness of the functional layer determines whether the embryo can gain a foothold, how successfully its development will take place.
During the course of the cycle, changes in the thickness of the endometrium normally go through several stages. There are the following phases of its development:
- Bleeding (menstruation) - rejection and removal from the uterus of the functional layer associated with damage to the blood vessels of the mucous membrane. This phase is subdivided into the desquamation (detachment) and regeneration stages (the beginning of the development of a new layer of basal cells).
- Proliferation - the increase of the functional layer due to the growth (proliferation) of tissue. This process occurs in 3 stages (they are called early, middle and late).
- Secretion - the phase of development of the glands and the network of blood vessels, filling the mucous membrane with secretory fluids. The increase in mucosal thickness occurs due to its swelling. This stage is also divided into the early, middle and late stages.
The sizes are influenced by the hormonal processes occurring in different periods of the cycle. Matters the age of the woman, her physiological state. Deviations from the norm can appear in the presence of diseases and injuries in the uterus, circulatory disorders. Hormonal disruption leads to pathologies. Indicators of the norm have a rather large variation, since for each woman they are individual and depend on the cycle length and other features of the organism. A violation is a value that exceeds the specified limits.
For what and how is uterine mucosa measured
Measurement is performed using ultrasound. The study is conducted on different days of the cycle. This allows you to establish the cause of menstrual disorders, to detect tumors and other neoplasms in the uterus, which affect the thickness and density (echogenicity) of the mucous membrane, as well as its structure.
An important point is the determination of these indicators in the days of ovulation in the treatment of infertility. In order for the fertilized egg to gain a foothold 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 23-24 day of the cycle, when it is maximum.
Such a study is made when examining women of any age.
Normal functional layer thickness on different days of the cycle
During the cycle, mucous thickness varies literally every day, however, there are average thickness values, which can be used to determine how well the woman’s reproductive health condition is normal.
As can be seen from the table below, with the onset of menstrual bleeding (during the first two days of the cycle), mucosal thickness reaches a minimum (approximately 3 mm), after which its gradual growth begins. At the stage of regeneration, the formation of a new layer occurs due to the division of basal cells. The maximum value (an average of 12 mm) thickness normally reaches a few days after ovulation. If fertilization has occurred (on the 15-17th day of the cycle), then by this time (after 21 days) the conditions most favorable for implantation of the embryo into its wall are created in the uterus.
Uterine mucosa thickness table is normal
The size of the functional layer of the mucous during pregnancy
If fertilization does not occur, then in the last days of the cycle, the thickness of the endometrium decreases as it peels off.
If conception took 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 on the ultrasound you can already see a tiny fertilized egg.
If a woman has a delay, even if the pregnancy test gives a negative result, its occurrence can be judged by increasing the thickness of the mucous membrane, starting as early as 14-21 days after the implantation of the embryo.
Dimensions of the functional layer during menopause
The onset of menopause is associated with a sharp drop in the level of female sex hormones in the body, which leads to a change in the state of the mucous membranes, a decrease in the thickness of the endometrium (up to its atrophy), the disappearance of menstruation. During this period, the functional layer thickness normally does not exceed 5 mm. Excess rates indicate the occurrence of pathological processes (the formation of cysts, polyps, malignant tumors).
Video: Changes in the state of the uterine lining during the menstrual cycle
During the development of the functional layer, the following disorders may occur:
- excessive uneven growth (hyperplasia) of the endometrium,
- insufficient thickening of the mucous in the 2nd half of the cycle (endometrial hypoplasia),
- endometriosis - proliferation of the mucous membrane and the penetration of its particles on the adjacent tissues and organs, which leads to disruption of their functioning,
- adenomyosis - germination of the epithelium in the muscle layer of the uterus wall,
- violation of the structure of the mucous membrane due to the formation of polyps (spreading it in separate foci), the formation of cancer,
- abnormal development of the endometrium in the presence in the uterus of the uterus of foreign elements (contraceptive helix, threads left after surgery),
- violation of the structure of the functional layer as a result of the formation of adhesions or scars left after curettage of the uterus,
- abnormal growth of the mucous around the particles of the ovum that were not completely removed during the abortion.
The main pathologies, which, as a rule, lead to the occurrence of serious diseases and infertility, are endometrial hyperplasia and hypoplasia. The reasons for deviations from the norm most often is hormonal failure.
Если оболочка слишком тонкая, то беременность не наступает, так как, во-первых, плодное яйцо не может закрепиться в стенке, а во-вторых, не имея связи с кровеносной системы матери, зародыш не получает питания, в результате чего погибает через несколько дней после образования. If the mucous membrane is too small, inflammatory and infectious diseases can occur in the uterus, as it becomes less protected from germs.
If such deviations from the norm occur at a young age, this is manifested by a late onset of puberty, a weak development of external sexual characteristics. Hypoplasia is often the cause of ectopic pregnancy (fixation of the embryo in the neck, in the abdominal cavity).
Treatment for this pathology is carried out by restoring hormonal levels with the help of drugs containing higher doses of estrogen. To improve blood circulation, small doses of aspirin are prescribed, as well as various physiotherapeutic procedures.
Thin endometrium (or hypoplasia)
In some women, the thickness of the endometrium remains consistently thin throughout the entire menstrual cycle, due to the presence of chronic endometritis, insufficient blood supply to the endometrium, or a disturbance in the estrogen receptors in the endometrium.
The problem of "thin" endometrium is detected using ultrasound monitoring, which allows to evaluate changes in the thickness and structure of the endometrium. Unfortunately, this form of endometrial dysfunction is poorly treatable and is rather temporary.
Thus, obstetricians and gynecologists prescribe high doses of estrogen and low doses of aspirin. A good endometrial response is caused by physiotherapy and some forms of alternative medicine (hirudotherapy, acupuncture) by improving blood circulation in the pelvis.
The positive effect of sage on endometrial growth has been established.
Treatment of any endometrial disorder should begin with identifying and eliminating the causes that led to such. Therefore, we advise you not to waste time on self-treatment and contact a gynecologist in a timely manner.
Normal endometrial thickness in menopause and the development of endometrial hyperplasia
Endometrium is the inner layer of the uterus, very sensitive to hormonal changes in the body. Many women have a disease called endometriosis. It is accompanied by many complications and is difficult to treat.
The proliferation or pathological thinning of the endometrium is the problem faced by a huge number of women. During menopause, hormonal adjustment begins, which can affect the endometrium, causing it to change.
Endometrium: functions and normal menopause thickness
Endometrium is the internal mucous membrane of the uterus, which is abundantly supplied with blood vessels.
The endometrium is a unique internal mucous layer of the uterus. It is equipped with a large number of blood vessels and has 2 sublayers: basal and functional. The basal layer remains constant, but the functional changes under the action of the hormone.
During the cycle, the thickness of the endometrium is constantly changing.
Then the thickness will be sufficient, either fertilization and implantation take place, or menstruation - the rejection of the endometrial functional layer, which is then restored and grows with the beginning of a new cycle.
The thickness of the endometrium in menopause is rapidly decreasing due to hormonal changes. The endometrium becomes thinner and thinner and as a result comes menopause, which is characterized by the absence of menstruation, and the end of the reproductive period of the woman.
The main function of the endometrium is to create a favorable environment for the implantation of the embryo. It is for this reason that any diseases associated with endometrium are often accompanied by infertility. The embryo cannot attach to the diseased layer.
Also, the endometrium performs barrier and protective functions.
It protects the walls of the uterus, does not allow them to stick together and fall. If a woman was not pregnant, her uterus is smaller, and the cavity is so small that the walls touch each other and do not stick together thanks to the endometrium.
During the cycle, the thickness of the endometrium varies. Normally, it reaches its maximum thickness (18 mm) by the end of the cycle, by the 23rd day. Closer to menstruation, he again becomes a little less.
When menopause occurs (the period before the cessation of menstruation and menopause), the endometrium becomes thinner and this is considered normal. It must reach a thickness of 5 mm for menopause to occur.
If this does not happen, they talk about endometrial hyperplasia, which is a pathological condition during menopause and leads to various complications.
Causes and signs of abnormal endometrial thickness in menopause
Endometrial hyperplasia is a pathological proliferation of endometrial cells
During menopause, they only talk about endometrial hyperplasia, since the reduction of this layer during menopause is normal.
However, if the endometrium during menopause is more than 5 mm thick, they are talking about a pathological condition requiring treatment.
Almost always the reason is a violation of the hormonal background, which controls the growth of the endometrium. This condition can be asymptomatic for a long time or manifest as breakthrough bleeding, pain in the lower abdomen.
Endometrial hyperplasia, as well as endometriosis, can be determined only by ultrasound.
There are varieties of endometrial hyperplasia:
- Ferruginous. Glandular hyperplasia of the endometrium is considered a benign disease, accompanied by proliferation and thickening of the glandular tissue due to improper location of the glands. With timely treatment, prognosis is favorable.
- Cystic. A more serious disease that may be a consequence of the glandular form. At the same time, cysts and neoplasms are formed in the endometrium, which may eventually degenerate into a malignant tumor.
- Basal. This is a very rare and serious disease that is difficult to treat. The basal layer of the endometrium rarely grows, as a rule, it is unchanged, and is also difficult to treat with hormone therapy.
- Polypiform. In this disease, the endometrium thickens not over the entire surface of the uterus, but focally. Foci are located where endometrial polyps form. This condition is often accompanied by bleeding and is treated by curettage, which is also a diagnostic procedure.
- Atypical. The most dangerous hyperplasia, which is rare, but still occurs in women during menopause. At the same time, endometrium grows very actively, and the cells quickly regenerate. It is difficult to treat this disease, it is often necessary to resort to surgical removal of the uterus in order to avoid cancer.
Ultrasound of the uterus during menopause - an effective method for diagnosing the state of the endometrium
If a woman visits a doctor with complaints of bleeding and pain during menopause, she must undergo a series of diagnostic procedures before making a diagnosis and treatment. In the case of endometrial hyperplasia, the examination should be comprehensive.
It includes a gynecological examination, a blood test, a smear, an ultrasound scan, and some invasive procedures that will help clarify the diagnosis and the type of hyperplasia:
- Ultrasound. This procedure is considered essential when diagnosing endometrial hyperplasia. To assess the thickness of the endometrium, transvaginal ultrasound is performed. The procedure is performed using a special nozzle, which is painlessly inserted into the vagina. If the endometrium is more than 5 mm during menopause, the ultrasound procedure is repeated several more times within six months. When the endometrial thickness is 8-10 mm, treatment and curettage are usually already prescribed.
- Diagnostic curettage. This procedure is both diagnostic and therapeutic. It is performed under anesthesia. The entire uterus cavity is scraped, after which the woman stops bleeding after a while. The contents of the uterus are sent to histology to determine the presence of cancer cells.
- Biopsy. Endometrial biopsy will be informative only if the endometrium is not enlarged foci, but completely over the entire surface of the uterus. This procedure will help determine the exact thickness of the endometrium, pathological processes in it, and cancer. The procedure is performed using a pipe that is a flexible thin tube with a piston. Getting into the uterus, the pipe absorbs small particles of the endometrium.
- X-ray of the uterus and fallopian tubes. This procedure is very informative in identifying tumors, polyps in the uterus and adhesions in the fallopian tubes. The procedure is invasive, because before the image the uterus is filled with a contrasting substance. The procedure is unpleasant, but should not cause pain.
Medical and surgical treatment
Only a doctor can prescribe the correct treatment of the pathology depending on the severity of the disease.
Serious diseases such as endometritis and endometriosis are not recommended to be treated exclusively with folk remedies at home. They can be cured only with the help of hormonal therapy, and sometimes with the help of surgical intervention.
Before starting treatment, the doctor determines the cause of the disease and the type of hyperplasia. Since the endometrium is very sensitive to changes in the hormonal background, various pathologies must also be treated with the help of hormones.
Female hormones during menopause fail. With an increased amount of estrogen and low - progesterone, the endometrium is thickened.
The risk group includes women with diabetes and overweight, who already have hormonal problems. As hormonal therapy, hormonal contraceptives like Logest, Regulon, etc. are prescribed.
They are prescribed courses up to six months for the normalization of hormonal levels. It is proved that taking these drugs does not provoke endometriosis.
Often, when the endometrium is thickened, drugs like Duphaston and Utrogestin are prescribed.
These are hormonal drugs, progesterone analogues. As mentioned above, the endometrium is sensitive to hormones and expands with a lack of progesterone. They are considered safe and prescribed for the normalization of hormonal levels, even during pregnancy. Dosage prescribed by a doctor. The course of treatment for endometriosis lasts a long time from six months to 9 months.
More information about endometrial hyperplasia can be found in the video:
For surgical intervention resort only in extreme cases. First, curettage is prescribed. If there is no progress, they can prescribe a laparoscopy, in which the foci of endometrial growth are dotted with a laser.
If the treatment does not bring results, there is a risk of cancer, the uterus is removed. There are several types of such operations. Depending on the severity of the disease and the consequences, either the uterus, the uterus and cervix, or the cervix and all nearby lymph nodes are removed.
Consequences and Prevention
In reproductive age, endometriosis can lead to infertility. During menopause, this disease is dangerous reincarnation in a malignant neoplasm. With age, the risk of cancer increases, and the thickening of the endometrium, its inflammation and polyps are a precancerous condition.
Complications of endometrial thickening can be adhesions in the fallopian tubes, ovarian cysts. Any endometrial disease is associated with sex hormones. If hormones continue to undergo changes, it can lead to the formation of cysts in the ovaries.
To avoid health problems during menopause, you need to adhere to preventive measures:
- Regular inspections. During the period of menopause and in front of her, a woman should visit the gynecologist every six months. The doctor should examine the patient, prescribe an ultrasound or a blood test for hormones. It is very important to monitor the level of hormones in order to undergo treatment without complications.
- Proper nutrition. Doctors are constantly talking about the benefits of proper nutrition. Nutrition indirectly affects hormone levels, and also directly affects weight, which is also important. Overweight women are at risk of endometriosis.
- Lack of abortion and infections. Trauma to the uterus during abortions, as well as various sexually transmitted infections and STDs increase the likelihood of endometrial growth.
- It is believed that prolonged use of the intrauterine device provokes endometriosis. For this reason, women who have chosen this remedy are advised to regularly undergo an examination by a gynecologist and change the spiral in time.
It is worth remembering that for any manifestations of endometriosis or endometritis, you should consult a doctor. Uterine bleeding is always an alarming symptom, which is not recommended to be ignored.
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As is known, the cyclic period of a woman always begins with the first day of menstrual bleeding. This bleeding is associated with rejection of the functional layer of the endometrial sheath. This period of time lasts on average from five to seven days, includes two periods: the stage of desquamation (rejection) and regeneration. Endometrial thickness by cycle days in the first phase:
- In the stage of rejection on 1 and 2 day of the cycle, the thickening is from 0.5 cm to 9 mm. On the M-echo, we see hypoechoicity of the mucous membrane (decrease in density), since a layer is lost. Accompanied by bleeding.
- In the stage of recovery or regeneration, which occurs on the third - fifth days, the epithelium shows the smallest height, respectively days, only 3 mm (on the third day) and 5 (on the fifth).
The proliferation stage starts from day 5 and lasts up to 14–16 days. Endometrium grows, rebuilt, prepares for ovulation, fertilization and implantation of the egg. Three periods, including different dates:
- From the 5th to the 7th day of the phase (early proliferative stage) - the normal epithelium of the uterus on the M-echo is hypoechogenic (density is reduced), its height is from 5 to 7 mm. On the sixth day - 6, on the seventh about 7 millimeters.
- In the average proliferative period, the mucous membrane changes as follows: thickens, expands. On day 8, it is already 8 mm high. This stage ends on the 10th day, the epithelium reaches a value of 1 centimeter (10–12 millimeters).
- From day 10 to day 14, the proliferation stage ends. The inner lining of the uterus at this point is normally between 10 and 12–14 mm in height (almost 1.5 centimeters). The density of the layer increases, which is manifested by an increase in echogenicity. In addition, at this time begins the maturation of the follicles in the egg. On day 10, the follicle is 10 mm in diameter, by 14–16 days already up to 21 millimeters.
This period is the longest and most important. It runs from 15 days to 30 (with a normal duration of the cycle). It can also be early, middle and late. The structure changes significantly:
- From 15 to 18 days begins early restructuring. The mucous layer grows slowly, gradually. On average, the values are different. It thickens from 12 to 14–16 mm. On the M-echo layer looks like a drop. Along the edges is hyperechogenic, and in the center the density is reduced.
- The average period of secretion runs from 19 to 24 days. The endometrial envelope is maximally thickened to a level of 1.8 centimeters; it should not be greater than this value. The average value for a given time is from 14 to 16 mm.
- Finally, the late secretory stage lasts from day 24 until the beginning of the next first phase. Gradually decreases the size of the shell to about 12 mm or slightly below. The peculiarity is that it is at this time that the highest density of the mucous layer is, we see a hyperechoic uterine region.
With a delay
When a girl has a menstruation delay (onset of bleeding), her cyclic period is prolonged. The most common cause is hormonal failure. The reasons for this are: stress, eating disorders: not so much the diet, as consumption of vitamins, gynecological diseases, endocrine diseases, and so on.
When the delay does not produce the necessary hormones, the uterine epithelium remains in size, which was in the secretion phase (12 to 14 tenths of a centimeter), and does not reduce its height to the required value. There is no rejection, respectively, do not begin monthly.
Endometrium before menstruation
Before the monthly mucosa is in the period of secretion. It is about the size of 12 mm (1.2 centimeters). Under the influence of estrogen and progesterone, the functional layer is affected, and it is rejected. The endometrial membrane, losing one of the levels, is thinned to 3-5 mm.
Changes in the thickness of the endometrium are presented in the table:
Video: Why endometrium is too thin. Consequences and treatment
The main sign of proliferation is a significant thickening of the endometrium of the uterus. Its thickness can vary depending on the days of the cycle, however, when it remains for a long time more than the maximum, it is a reason to suspect pathology. How is the thickness of endometrium in hyperplasia related to the degree of development of this disease and the probability of its transition to cancer?
As mentioned above, the day of the cycle has a great influence on the volume of the endometrial layer. Depending on it, the volume may differ several times. The table below shows the normal values of this indicator on a particular day of the cycle, as well as the pathological values that occur with this diagnosis.
Что означает неоднородная структура эндометрия матки?
Эндометрий неоднородный — что это значит? Прояснить эту тему поможет квалифицированный врач-гинеколог. Эндометрий — это ткань, выстилающая внутреннюю поверхность матки. She is rich in blood vessels and plays an important role in the monthly cycle of a woman.
The heterogeneity of this tissue suggests that there are some inflammatory diseases or hormonal disorders in the body. For physicians, the heterogeneity of the endometrium is a signal that there are some deviations in the functioning of the organism in general and of the female reproductive system, in particular.
Endometrium inhomogeneous - what does it mean? To clarify this topic will help a qualified gynecologist. Endometrium is the tissue lining the inner surface of the uterus. She is rich in blood vessels and plays an important role in the monthly cycle of a woman.
The heterogeneity of this tissue suggests that there are some inflammatory diseases or hormonal disorders in the body. For physicians, the heterogeneity of the endometrium is a signal that there are some deviations in the functioning of the organism in general and of the female reproductive system, in particular.
Causes of the phenomenon
There are 2 layers of endometrium - basal and functional. In the period of menstruation, the functional exfoliates, and the basal is restored in the period of the next cycle. In simple terms, the functional layer is the same basal layer, which is simply compacted under the influence of hormones in phase 2 of the menstrual cycle.
This is due to the fact that the body is preparing for a possible conception. If it does not occur, then the excess part of the basal layer, functional, just exfoliates (begin monthly). Endometrial detachment usually occurs on the 3-5th day of menstruation.
For those who are preparing to conceive, information about the thickness of the endometrium is necessary. You can learn about this only with the help of ultrasound, remembering that during different periods of the cycle the thickness changes.
The thickness of the endometrium and its structure in women in reproductive age is much larger and more complicated than those in the postmenopausal stage. In women in the postmenapause period, only 1 layer is preserved - the basal layer.
Another reason for changing the endometrium may be pregnancy. During this period, the doctor constantly monitors the state of the uterus and mucous membranes, and changing its structure is considered normal and does not require medical treatment.
With women in the postmenopausal period, everything is simple. They endometrium is considered normal if its thickness is not less than 6 mm, and it has a smooth structure. And in women of reproductive age, the normal endometrium at different stages of the monthly cycle has different characteristics:
- The beginning of the cycle is the 1st stage. Endometrium inhomogeneous. Its thickness is 5-9 mm. Excellent sound passes. Separation into layers is not observed.
- The middle of the cycle - stage 2. Endometrium compacted. The echo is reduced, although the conductivity of the sound remains very high.
- End of cycle - 3 period. There is a pronounced division into layers, super echogenicity. Size - 9-10 mm. This stage is the most important because it creates the most favorable environment for the attachment of the egg.
In some women, endometrial development does not coincide with the phases of the menstrual cycle. This is primarily due to such factors:
- possible hormonal disruption,
- scraping injury,
- insufficient development of the uterus,
- poor circulation in the uterus or pelvic organs.
Symptoms of this disease are not very defined, but a woman and a doctor should be alerted:
- violation of the menstrual cycle,
- pain during menstruation.
If an ultrasound examination revealed endometrial heterogeneity, the gynecologist can diagnose the following diseases after additional examinations:
- adenomyosis of the uterus - this disease is associated with the occurrence of tumors in the uterus (cysts),
- submucous myoma - a kind of benign tumor, which leads to an increase in uterus size,
- polyps (growth on the leg, which has a structure similar to the endometrium, but leads to an increase in the size of the uterus),
- cancer (it is quite difficult to diagnose uterine cancer, especially in the early stages, since cancerous growth is very similar to myoma).
If the diagnosis is endometrial heterogeneous, it means that there is an inflammatory process in the body. This can not be ignored. Perhaps the doctor will recommend a procedure for curettage (for polyps, curettage is mandatory). Scraping is not a very complicated procedure. Its essence is to remove the functional layer of the endometrium, which is then restored.
It is usually carried out a few days before menstruation. But care should be taken, as an improper operation can lead to:
- inflammatory process,
- uterine bleeding,
- endometrial formation disorder (excessive curettage).
After surgery, the doctor must prescribe antibiotics. Small bleeding or bleeding within a few weeks is considered normal.
The heterogeneous structure of the endometrium is diagnosed after medical abortion. In this situation, curettage is not prescribed, because the endometrium is very thin.
The recovery process after the operation lasts a month, but doctors try to speed it up, because it is at this time that the female body is prone to infections. They recommend a course of hormonal treatment even if there is no endometrial growth.
Heterogeneity of the endometrium can cause infertility.
In addition to curettage, other procedures can be prescribed by doctors - endometrial aspiration and hysteroscopy.
There are certain measures that can prevent the development of this disease.
Attentive attitude to sexuality, protection from infections and unwanted pregnancy.
Examination by a gynecologist 1 time per year with the delivery of a smear (to women of reproductive age).
Examination by a gynecologist and an ultrasound examination once a year for women during menopause. This is a mandatory requirement, as they are in a special risk group.
In any case, every woman should be attentive to her health, not to neglect visits to the gynecologist, to pass tests in time. All these simple actions will lead to the possibility of timely diagnosing any pathology and undergoing the necessary course of treatment.
If the endometrium is heterogeneous, what can it mean? - Home treatment
Heterogeneous endometrium - is the first signal that there are any deviations. Endometrium is the tissue that lines the surface of a woman’s uterus from the inside. She is well equipped with blood vessels and occupies a prominent place in the menstrual cycle.
In the process of menstruation, the endometrium peels off and leaves with blood.
The heterogeneity of the tissue can signal that there are inflammatory processes in the woman’s body or hormonal changes have occurred, and long-term use of antibiotics is also the cause of the heterogeneity.
General information about the endometrium
In this fabric, there are two types of layers:
In the period of the onset of menstruation, the second layer (functional) is rejected, but the first layer (basal) is then restored in the next cycle.
You must know that the endometrium has a strong sensitivity to hormones, respectively, in the second period of the menstrual cycle, this tissue thickens.
This leads to the fact that there is a preparation for embryo adoption, in cases where fertilization does not occur, the functional layer is discarded and then the menstrual periods simply go.
In order for fertilization to occur, it is very important to know the thickness of the endometrium, it can be determined only by performing an ultrasound. The thickness varies depending on which phase of the cycle.
The structure and thickness of the endometrium in women who can give birth, is very different from the structure in those who are in postmenopausal women.
In postmenopausal women, as a rule, this tissue consists of a single layer (basal). That is why the endometrium has a small thickness (less than 6 mm) and a uniform structure.
In women of reproductive age, rejection occurs approximately from 3 to 5 days from the beginning of menstruation.
In postmenopausal women, normal endometrium can be considered if its size is at least 6 mm, the structure is homogeneous. Thickness becomes less due to the increase in the age category. In certain cases, echogenicity is a reflection of the uterine cavity itself in women characterized by direct accumulation of mucus or secretions in the lumen itself.
Back to endometrium
On the first days of the menstrual cycle, the endometrium has a non-uniform structure, it passes sound without interference, the total thickness is 5-9 mm. Currently there is no separation into layers.
On the third day of the cycle, the endometrium begins to resemble education with good echogenicity, the size of which is about 3-5 mm.
On the fifth day, you can notice a large increase in the structure itself, it becomes dense, and the size becomes about 7-9 mm, the previously mentioned echogenicity begins to decrease, and the conductivity of the sound, respectively, increases.
On the eighth day, changes are observed: the endometrium becomes a hyperechoic structure, the size reaches 9-10 mm. Approximately this size is fixed until the end of the menstrual cycle. Endometrium, which is normal according to the phase of the cycle, forms a good environment for the attachment of the ovum to occur.
There are several reasons why there may be a discrepancy with the day of the cycle:
Return to the deviation
Ultrasound examination is prescribed to the patient for about 5-7 days from the moment the menstrual period began. This is due to the fact that during the menstrual cycle the structure and thickness of the endometrium begins to change significantly.
Why is the endometrium heterogeneous, what does this mean and what diseases can cause it?
If endometrium is diagnosed with a heterogeneous structure, then an inflammatory process may have arisen in the uterus. Do not let everything take its course. It may be necessary to resort to scraping the endometrium.
The curettage procedure is prescribed when an inhomogeneous structure or thickening of the endometrium is detected by ultrasound examination. Neoplasms, such as endometrial polyps, can also be seen.
This type of intervention can be performed to diagnose or treat a disease. The operation is as follows: removal of the mucous membrane of the uterus, but only a certain part (functional layer). After a certain time, the process of restoring the sprouts, which remained.
Endometrial curettage can be compared to menstruation, but which occur due to instrumental intervention. As a rule, surgical intervention is prescribed a couple of days before the onset of bleeding. This operation takes about 20 minutes. You should not ignore the complications that may occur after:
- inflammatory process in the uterus,
- accumulation of blood in the uterus,
- excess scraping.
They are extremely rare, but as a preventive measure, doctors prescribe the use of special antibiotics. It is considered the norm if there may be bleeding after a surgery for several hours, and discharge is smeared for about a week.
Having a heterogeneous structure can be the result of a medical abortion, and discharge can disturb a woman for a month.
In this case, there is no need for curettage, as the endometrium is too thin. You just need to undergo hormone therapy.
After this operation, it is necessary to follow certain rules so that the body can recover as quickly as possible. The recovery process usually lasts about 1 month.
In certain situations, physicians do everything to speed up this process, since the endometrium is quite thin and very vulnerable to infection with various infections. In addition, perhaps this factor is the main reason that a woman cannot become pregnant.
In cases where after the curettage procedure there is no increase in the endometrial layer, doctors prescribe a course of hormonal therapy.
In addition to curettage, endometrial suction and hysteroscopy are also performed.
It must be remembered that the late diagnosis of the heterogeneous structure of the endometrium can lead to bad consequences.