What is an endometrial biopsy. How is it performed. Who might need this procedure. What are the potential side effects and benefits of an endometrial biopsy. How does it relate to endometrial cancer diagnosis and prevention.

Understanding the Endometrium and Its Role in Reproductive Health

The endometrium is the inner lining of the uterus, playing a crucial role in the menstrual cycle and pregnancy. This specialized tissue undergoes cyclical changes in response to hormonal fluctuations, preparing the uterus for potential implantation of a fertilized egg. When pregnancy doesn’t occur, the endometrium is shed during menstruation.

An endometrial biopsy involves the removal of a small sample of this tissue for microscopic examination. This procedure serves as a valuable diagnostic tool for various uterine conditions, including endometrial cancer.

The Importance of Endometrial Health

Maintaining a healthy endometrium is essential for:

• Regular menstrual cycles
• Successful implantation of embryos
• Prevention of uterine abnormalities
• Early detection of endometrial cancer

Indications for Endometrial Biopsy: When Is It Necessary?

Healthcare providers may recommend an endometrial biopsy for various reasons. Common indications include:

• Heavy or prolonged menstrual bleeding
• Irregular menstrual cycles
• Postmenopausal bleeding
• Abnormal uterine bleeding in women taking tamoxifen for breast cancer
• Thickened endometrial lining detected on ultrasound
• Evaluation of infertility

Is an endometrial biopsy recommended for all women? No, this procedure is typically performed on women over 35 years old who experience specific symptoms or have risk factors for endometrial abnormalities. It is not performed on pregnant women.

The Endometrial Biopsy Procedure: What to Expect

An endometrial biopsy is usually an outpatient procedure performed in a doctor’s office. The process typically takes between 5 to 15 minutes and often does not require anesthesia. Here’s what patients can expect:

1. The patient is positioned on an examination table with feet in stirrups.
2. A speculum is inserted into the vagina to visualize the cervix.
3. The cervix is cleaned with an antiseptic solution.
4. A thin suction tube is inserted through the cervix into the uterus.
5. A small tissue sample is collected from the endometrium.
6. The sample is sent to a pathology lab for analysis.

Are there any preparations required before the procedure? Patients should inform their healthcare provider about any medications they’re taking, especially blood thinners. Some doctors may recommend taking over-the-counter pain relievers before the biopsy to minimize discomfort.

Potential Side Effects and Recovery After Endometrial Biopsy

While an endometrial biopsy is generally safe, patients may experience some side effects:

• Cramping similar to menstrual cramps during and after the procedure
• Light bleeding or spotting for a few days
• Mild discomfort or pain

To promote healing and reduce the risk of infection, patients are typically advised to:

• Avoid using tampons
• Refrain from douching
• Abstain from sexual intercourse for a few days
• Avoid swimming, hot tubs, and baths for about a week

How long does recovery take after an endometrial biopsy? Most women can return to their normal activities within a day or two. However, it’s essential to follow the specific post-procedure instructions provided by your healthcare provider.

Interpreting Endometrial Biopsy Results: What They Mean for Your Health

Endometrial biopsy results are typically available within a week. The pathologist examines the tissue sample for any abnormalities, including:

• Endometrial hyperplasia (thickening of the uterine lining)
• Precancerous changes
• Endometrial cancer
• Hormonal imbalances
• Infection or inflammation

Normal results indicate no signs of cancer or other abnormalities. Abnormal results may require further testing or treatment, depending on the specific findings.

How accurate is an endometrial biopsy in diagnosing endometrial cancer? Endometrial biopsy is considered the most accurate test for diagnosing endometrial cancer, with a high sensitivity and specificity. However, in some cases, additional tests may be necessary to confirm the diagnosis.

Endometrial Cancer: Understanding the Connection to Endometrial Biopsies

Endometrial cancer is the most common type of uterine cancer. It typically develops in postmenopausal women, with more than 95% of cases occurring in women over 40. Early detection through procedures like endometrial biopsy can significantly improve treatment outcomes.

Risk Factors for Endometrial Cancer

Several factors can increase a woman’s risk of developing endometrial cancer:

• Obesity
• Diabetes
• High blood pressure
• Estrogen-only hormone replacement therapy
• Family history of endometrial, colorectal, or breast cancer
• Early onset of menstruation or late menopause
• Nulliparity (never having given birth)
• History of infertility or irregular periods

Can endometrial cancer be prevented? While not all cases of endometrial cancer can be prevented, certain lifestyle choices and medical interventions can help reduce risk:

• Maintaining a healthy weight
• Regular exercise
• Balanced diet low in red meat and high in fruits and vegetables
• Use of combination hormone therapy (estrogen plus progestin) when necessary
• Use of oral contraceptives, which can reduce risk by up to 50%

The Role of Endometrial Biopsy in Fertility Evaluation

For women struggling with infertility, an endometrial biopsy can provide valuable insights into potential uterine factors affecting conception. The procedure can help identify:

• Hormonal imbalances affecting endometrial receptivity
• Structural abnormalities of the endometrium
• Chronic endometritis (inflammation of the endometrium)
• Luteal phase defects

How does an endometrial biopsy impact fertility treatment decisions? Results from an endometrial biopsy can guide fertility specialists in developing personalized treatment plans, potentially improving the chances of successful conception and implantation.

Endometrial Receptivity Analysis (ERA)

An advanced application of endometrial biopsy in fertility treatment is the Endometrial Receptivity Analysis (ERA). This test uses genetic markers to determine the optimal time for embryo transfer during in vitro fertilization (IVF) cycles, potentially increasing the likelihood of successful implantation.

Advances in Endometrial Biopsy Techniques and Technologies

As medical technology progresses, endometrial biopsy techniques continue to evolve, offering improved patient comfort and diagnostic accuracy. Some recent advancements include:

• Pipelle biopsy: A minimally invasive technique that often requires no dilation of the cervix
• Hysteroscopy-guided biopsy: Allows for direct visualization of the uterine cavity during sampling
• Molecular analysis of biopsy samples: Provides detailed genetic information about endometrial tissue
• Liquid-based cytology: Improves the quality of cell samples for analysis

How do these advancements benefit patients? These new techniques can lead to more accurate diagnoses, reduced discomfort during the procedure, and potentially earlier detection of endometrial abnormalities.

The Future of Endometrial Diagnostics

Ongoing research in endometrial health is exploring non-invasive alternatives to traditional biopsies, such as:

• Blood-based biomarkers for endometrial cancer screening
• Advanced imaging techniques for detailed endometrial assessment
• Artificial intelligence-assisted analysis of endometrial samples

These developments may eventually lead to more accessible and less invasive methods for monitoring endometrial health.

Endometrial Health Beyond Cancer: Other Conditions Detected by Biopsy

While endometrial biopsy is crucial for cancer detection, it can also diagnose various other uterine conditions, including:

• Endometriosis: When endometrial tissue grows outside the uterus
• Adenomyosis: Endometrial tissue grows into the muscular wall of the uterus
• Endometrial polyps: Benign growths in the uterine lining
• Uterine fibroids: Non-cancerous tumors in the uterus
• Chronic endometritis: Long-term inflammation of the endometrium

How does early detection of these conditions impact treatment outcomes? Identifying these conditions early through endometrial biopsy can lead to more effective treatment strategies, potentially preserving fertility and improving overall quality of life for affected women.

Hormonal Imbalances and Endometrial Health

Endometrial biopsy can also provide insights into hormonal imbalances affecting the uterine lining. This information is valuable for diagnosing and treating conditions such as:

• Polycystic ovary syndrome (PCOS)
• Thyroid disorders
• Luteal phase defects
• Anovulation

By identifying these hormonal issues, healthcare providers can develop targeted treatment plans to restore endometrial health and improve reproductive outcomes.

Patient Education and Empowerment: Making Informed Decisions About Endometrial Health

Understanding the importance of endometrial health and the role of endometrial biopsy empowers women to make informed decisions about their reproductive health. Key points for patients to remember include:

• Regular gynecological check-ups are essential for early detection of uterine abnormalities
• Promptly report any unusual bleeding or changes in menstrual patterns to your healthcare provider
• Discuss your individual risk factors for endometrial cancer with your doctor
• Consider lifestyle modifications to reduce your risk of endometrial cancer
• Don’t hesitate to ask questions about endometrial biopsy or other diagnostic procedures

How can women actively participate in maintaining their endometrial health? By staying informed, maintaining open communication with healthcare providers, and adhering to recommended screening guidelines, women can take an active role in preserving their endometrial and overall reproductive health.

Support and Resources for Women Undergoing Endometrial Biopsy

For women facing an endometrial biopsy, various support resources are available:

• Patient education materials from reputable medical organizations
• Support groups for women with gynecological health concerns
• Online forums and communities for sharing experiences and advice
• Counseling services for those dealing with anxiety related to medical procedures

These resources can provide emotional support, practical advice, and additional information to help women navigate the endometrial biopsy process with confidence.

What Is It, Procedure, Side Effects & Results

Overview

What is an endometrial biopsy?

An endometrial biopsy is a medical procedure in which a small piece of tissue from the lining of the uterus (the endometrium) is removed for examination under a microscope. The removed tissue is examined for cancer or any other cell abnormalities.

Why is an endometrial biopsy done?

An endometrial biopsy is done to help your doctor find out the cause of problems leading to heavy or irregular bleeding. It is the most common test done to diagnose endometrial cancer. Though it is a simple office procedure, it needs to be performed by a provider who has experience in performing the test. The biopsy also lets your doctor check to see if your body’s endometrial hormone levels are balanced.

Who might need an endometrial biopsy?

Endometrial biopsies are typically done on women over the age of 35. It cannot be done on pregnant women. Sometimes a biopsy will be done on a woman who is having trouble getting pregnant to see if the infertility is linked to a problem with the endometrium.

What symptoms might suggest you need an endometrial biopsy?

If you have any of the following, your provider may recommend an endometrial biopsy:

• Heavy or very long menstrual periods.
• Irregular menstruation.
• Bleeding after menopause.
• Abnormal bleeding in women taking tamoxifen, a breast cancer medicine.
• Thickened uterine lining, determined by an ultrasound.

Test Details

How is an endometrial biopsy done?

An endometrial biopsy is usually done in your doctor’s office. It is most often done without anesthesia. You will be placed with your feet in stirrups.

Your doctor will insert a speculum into the vagina to hold it open so that your cervix can be viewed (similar to a Pap test). Your cervix will then be cleaned with a special solution. Another instrument may be used to hold the cervix steady, while a very thin suction tube is inserted into the uterus to collect the tissue sample. The tissue will then be sent to a pathologist for analysis of the cells.

You will be advised not to use tampons, douche or have intercourse in the days after your test. Some providers may also ask that you avoid swimming, going in a hot tub or taking baths for about a week after the procedure. Your doctor will review the exact instructions with you after the procedure.

You may experience cramping similar to menstrual cramps during and after the procedure. You may be prescribed an over-the-counter pain reliever such as ibuprofen or acetaminophen to deal with the pain.

The whole procedure usually takes between five and 15 minutes.

Results and Follow-Up

What are the benefits of an endometrial biopsy?

An endometrial biopsy is the most common and accurate test used to diagnose endometrial cancer. The lab should have the results in about a week. Your physician will share the results with you and go over a treatment plan depending on the results.

Endometrial (Uterine) Cancer: Overview, Risk Factors, Prevention

What Is Endometrial Cancer?

Cancer can affect the uterus, the hollow, pear-shaped organ where a baby grows. The uterus is lined with a special tissue called the endometrium. When cancer grows in this lining, it is called endometrial cancer. Most cancers of the uterus are endometrial cancer.

If left untreated, endometrial cancer can spread to the bladder or rectum, or it can spread to the vagina, fallopian tubes, ovaries, and more distant organs. Fortunately, endometrial cancer grows slowly and, with regular checkups, is usually found before spreading very far.

What Are the Risk Factors for Endometrial Cancer?

Endometrial cancer usually happens in women past menopause. More than 95% of endometrial cancer happens in women over 40. Postmenopausal women have a high risk for endometrial cancer if they:

• Got their first period early
• Went through menopause late
• Are obese
• Have diabetes or high blood pressure
• Have few or no children
• Have a history of infertility, irregular periods, or abnormal cells in the endometrium (called endometrial hyperplasia)
• Have a family history of endometrial, colorectal, or breast cancer

Women taking the drug tamoxifen to treat or prevent breast cancer have a slightly higher risk of endometrial cancer. But women who have taken birth control pills are only half as likely to have endometrial cancer after menopause.

Women who take estrogen-only hormone replacement therapy have a higher risk of developing endometrial cancer. So women who have not had a hysterectomy should not be taking estrogen-only hormone replacement therapy.

Rare ovarian tumors can make estrogen and increase a woman’s chance of having endometrial cancer.

High-fat diets, especially containing red meat, can increase the risk of cancer, including endometrial and colon cancer.

Can Endometrial Cancer Be Prevented?

Most endometrial cancer cannot be prevented. But there are certain things women can do to lower their risk. Taking birth control lowers the risk, but first talk with a doctor about possible pros and cons. Being healthy, eating well, and watching your weight may help lower the risk.

Uterine (Endometrial) Cancer | Memorial Sloan Kettering Cancer Center

Uterine (endometrial) cancer is the most common cancer of the female reproductive system, with more than 49,500 Americans diagnosed with the disease each year. It tends to develop after menopause, when a woman is between the ages of 50 and 60.

The uterus is a hollow, pear-shaped organ in a woman’s pelvis in which a fetus grows after conception. Most cancers begin in the lining of the uterus, which is called the endometrium. Rarer forms develop within the actual muscle of the uterine wall; this is called uterine sarcoma and is managed differently.

Types of Uterine Cancer

There are many different types of uterine cancer. Each type varies in the way it behaves and how it should be managed. For this reason, we often ask our specialists in pathology to review findings.

• Endometrioid adenocarcinoma: This type of uterine cancer forms in the glandular cells of the uterine lining. It accounts for as much as 75 percent of all uterine cancers. Endometrioid adenocarcinoma is commonly detected early and has a high cure rate.

• Serous adenocarcinoma: These tumors are more likely to spread to lymph nodes and other parts of the body. About 10 percent of uterine cancers diagnosed are of this type.

• Adenosquamous carcinoma: This rare form of uterine cancer has elements of both adenocarcinoma and carcinoma of the squamous cells that line the outer surface of the uterus.

• Carcinomasarcoma: This rare form of uterine cancer was previously thought to be a type of uterine sarcoma. However, it is now felt to be a uterine (endometrial) cancer. It has elements of both adenocarcinoma and sarcoma. These tumors have a high risk of spreading to the lymph nodes and other parts of the body.

Every year, more than 1,300 women with some form of gynecologic cancer come to Memorial Sloan Kettering Cancer Center for treatment, including nearly 300 women with uterine cancer. We tailor our comprehensive care to each woman’s specific needs.

Uterine cancer is both common and, in many cases, curable.

Why Choose MSK for Uterine Cancer Care?

We take a multidisciplinary team approach to diagnosing and treating uterine cancer, and our results with surgery for women with advanced-stage or recurrent disease are among the best in the world. Many women choose minimally invasive operations that enable them to go home the same or the following day and offer such benefits as decreased pain and relatively fast recovery.

Our innovative approach to identifying and removing only the necessary lymph nodes during surgery is an option that many women with early-stage uterine cancer select. For women whose cancers are more advanced and require additional treatments following surgery, our medical oncologists are investigating chemotherapy regimens using novel drugs and drug combinations available through our clinical trials.

Our Fertility Preservation experts can often guide women to options that help preserve fertility before undergoing treatment.

Cancer of the Endometrium | Endometrial Cancer Causes & Symptoms

Endometrial cancer, one of the most common gynecologic cancers, starts in the lining of the uterus. When found early, endometrial cancer can usually be cured. Most endometrial cancer occurs after menopause, so regular pelvic exams and Pap tests should not be discontinued after periods stop.
Should endometrial cancer be diagnosed, the multidisciplinary Gynecologic Oncology team at Beaumont offers surgery, including minimally invasive laparoscopic procedures, radiation and hormone therapy, as individually appropriate. Women can also rely on the support of our compassionate and highly skilled staff to meet emotional and medical needs.

For more information about Beaumont’s

gynecology oncology

program, or a referral to an oncologist near you, call our Physician Referral Service at

800-633-7377

.

What is endometrial cancer?

The lining of the uterus is called the endometrium. Cancer of the endometrium, the most common cancer of the female reproductive organs, is a disease in which malignant (cancerous) cells are found in the endometrium. Endometrioid cancer is a specific type of endometrial cancer.

Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called sarcoma of the uterus. About 95 percent of all endometrial cancers are adenocarcinomas. Endometrial cancer is highly curable when found early. According to the American Cancer Society (ACS), about 54,870 cases of cancer of the uterine body will be diagnosed in the US during 2015.

What are risk factors for endometrial cancer?

The following have been suggested as risk factors for endometrial cancer:

• early menarche – starting monthly periods early – before the age of 12
• late menopause (after the age of 52)
• infertility (inability to become pregnant)
• never having children
• obesity
• being treated with tamoxifen for breast cancer
• estrogen replacement therapy (ERT) for treatment of effects of menopause
• diet high in animal fat
• diabetes
• age 40 or over
• Caucasian women
• family history of endometrial cancer or colon cancer (hereditary nonpolyposis colon cancer (HNPCC)
• personal history of breast cancer
• personal history of ovarian cancer
• prior radiation therapy for pelvic cancer

What are the symptoms of endometrial cancer?

The following are the most common symptoms of endometrial cancer. However, each individual may experience symptoms differently. Symptoms may include:

• bleeding or discharge not related to your periods (menstruation)
• post-menopausal bleeding
• difficult or painful urination
• pain during intercourse
• pain and/or mass in the pelvic area
• weight loss

Cancer of the endometrium often does not occur before menopause. It usually occurs around the time menopause begins. The occasional reappearance of bleeding should not be considered simply part of menopause.

The symptoms of endometrial cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How can endometrial cancer be prevented?

The exact cause of endometrial cancer is not known. However, physicians believe that avoiding the known risk factors, when possible, using oral contraceptives, controlling obesity, and controlling diabetes are the best ways to lower the risk of developing endometrial cancer.

How is endometrial cancer diagnosed?

Diagnosis includes a medical history and physical examination, including a pelvic examination to feel the vagina, rectum, and lower abdomen for masses or growths. A Pap test may be requested as part of the pelvic examination. The diagnosis of cancer is confirmed only by a biopsy. Several tests may be used to diagnose endometrial cancer, including:

• internal pelvic examination – to feel for any lumps or changes in the shape of the uterus
• Pap test (Also called Pap smear.) – a test that involves microscopic examination of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation. However, because cancer of the endometrium begins inside the uterus, problems may not be detected using a Pap test. Therefore, in some cases, an endometrial biopsy will be performed.
• endometrial biopsy – a procedure in which an endometrial tissue sample is obtained by using a small flexible tube that is inserted into the uterus. The tissue sample is examined under a microscope to determine if cancer or other abnormal cells are present. An endometrial biopsy procedure is often performed in a physician’s office.
• dilation and curettage (Also called D & C) – a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.
• transvaginal ultrasound (Also called ultrasonography.) – an ultrasound test using a small instrument, called a transducer, that is placed in the vagina. The physician may perform a biopsy if the endometrium looks too thick.

Treatment for endometrial cancer

Specific treatment for endometrial cancer will be determined by your physician based on:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

The choice of treatment depends on the stage of cancer – whether it is confined in the endometrium, or has spread to other parts of the uterus or other parts of the body. Generally, treatment for patients with cancer of the endometrium includes one or more of the following:

• surgery, including:
  • hysterectomy – surgical removal of the uterus.
  • salpingo-oophorectomy – surgery to remove the fallopian tubes and ovaries.
  • pelvic lymph node dissection – removal of some lymph nodes from the pelvis.
  • laparoscopic lymph node sampling – lymph nodes are removed through a viewing tube called a laparoscope, which is inserted through a small incision in the abdomen.
• radiation therapy
  Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:
  • external radiation (external beam therapy) – a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
  • internal radiation (brachytherapy, implant radiation) – radiation is given inside the body as close to the cancer as possible. Tiny tubes that contain substances that produce radiation, called radioisotopes, are inserted through the vagina and left in place for a few days. Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Hospitalization is required when an internal radiation implant is in place. In some cases, both internal and external radiation therapies are used.
• hormone therapy
  In some cases, hormones can kill cancer cells, slow the growth of cancer cells, or stop cancer cells from growing. Hormone therapy as a cancer treatment involves taking substances to interfere with the activity of hormones or to stop the production of hormones.

Before you begin hormone therapy, your physician may recommend a hormone receptor test. This lab test is performed on the uterine tissue to determine if estrogen and progesterone receptors are present. A hormone receptor test can help to predict whether cancer cells are sensitive to hormones.

This test measures the amount of certain proteins (called hormone receptors) in cancer tissue. Hormones (such as estrogen and progesterone that occur naturally in the body) can attach to these proteins. If the test is positive, it is indicating that the hormone is probably helping the cancer cells to grow. In this case, hormone therapy may be given to help keep the hormone away from the cancer cells. If the test is negative, the hormone does not affect the growth of the cancer cells and other effective cancer treatments may be given. Always discuss the results of the hormone receptor test with your physician.

Progesterone (pill) may be given as hormone therapy for endometrial cancer. Tamoxifen may also be used to treat advanced endometrial cancer.

Endometrial Cancer | Uterine Cancer

Endometrial cancer starts in the lining of the uterus. It is the most common type of uterine cancer and highly curable when detected early. Symptoms include abnormal vaginal bleeding, pelvic pain, and pain during sex or urination. The most common symptom is vaginal bleeding in a woman who is in menopause and no longer has periods.

You will have a physical exam. If your doctor suspects cancer, you may have a pap test, ultrasound, or biopsy. Biopsy is most often the only certain way to tell if cancer is present. If it is present, you may have a body MRI, body CT, chest x-ray, or PET scan to see if it has spread. Treatment depends on whether the cancer is only present in the uterine lining. Options include total hysterectomy, radiation therapy, chemotherapy, and/or hormone therapy.

What is endometrial cancer?

Endometrial cancer starts in the endometrium – the lining of the uterus. It is the most common type of uterine cancer and highly curable when detected early.

The exact cause of endometrial cancer is unknown. However, higher estrogen levels may be a risk factor. Other potential factors include:

• Diabetes
• Estrogen therapy
• Infertility
• Infrequent menstrual cycles
• Obesity
• Never being pregnant

Abnormal vaginal bleeding is the most common symptom of endometrial cancer. Other symptoms include:

• Pelvic area pain
• Pain during sex
• Difficulty or pain when urinating

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How is endometrial cancer diagnosed and evaluated?

Your doctor will ask about your medical history and symptoms. You will also have a physical exam.

If your doctor suspects cancer, you may have more exams, including:

• A Pap test, also called a pap smear, scrapes cells from the cervix for lab analysis.
• Ultrasound uses sound waves to produce pictures of the inside of the body. In transvaginal ultrasound, the doctor inserts a device into the vagina for a better view of the uterus. Sonohysterography injects sterile saline through the cervix into the uterus. This helps provide more detail.
• Biopsy removes tissue samples from the uterus for lab analysis. A biopsy is most often the only certain way to tell if cancer is present.

If cancer is present, one or more of the following exams can find if it has spread:

• Body MRI produces detailed pictures of your uterus, lymph nodes and other abdominal tissues. Your doctor may give you an injection of contrast material to make lymph nodes and other tissues show up more clearly. MRI is useful for disease staging and treatment planning.
• Body CT scan produces detailed pictures of your pelvis, abdomen, or chest. Your doctor may give you an injection of contrast material to make lymph nodes and other tissues show up more clearly. CT can show cancer in the uterus, lymph nodes, lungs, and elsewhere.
• Chest x-ray produces x-ray images of the lungs.
• PET scan uses a small amount of radioactive material to help determine the extent of your cancer. PET scans can be superimposed with CT or MRI images to produce special views. These views can lead to more precise diagnoses.

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How is endometrial cancer treated?

Treatment depends on the stage of the cancer and whether it is only present in the uterine lining. Cancer that has spread requires different treatment than cancer that has not. Treatments include:

• Total hysterectomy surgically removes the uterus, cervix, ovaries and fallopian tubes. It is often the most common way to cure early stage endometrial cancer. However, a woman may no longer become pregnant after treatment.
• Patients may have radiation therapy after surgery or instead of surgery. Vaginal cuff brachytherapy, is when radioactive material is placed next to the post-hysterectomy surgical scar at the top of the vagina. External beam therapy (EBT) is delivered from outside the body. In patients with inoperable endometrial cancer, the doctor places the radiation source inside or next to the tumor.
• Your doctor may use chemotherapy with radiation therapy to treat cancer that has spread or has an increased risk of returning. This may be given after surgery, or later if there is spread of cancer.
• Hormone therapy treats cancer that has hormone receptors for estrogen, progesterone, or both. Progesterone is the most common drug for hormone therapy.

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This page was reviewed on November, 15, 2019

Histology at SIU

Histology at SIU

Uterus

The uterus is lined by a thick mucosa, the endometrium,
surrounded by a thick wall of smooth muscle, the myometrium.
 

The endometrium consists of a simple columnar
epithelium, forming numerous tubular glands, supported by a thick vascular stroma.
 Both glands and stroma undergo extensive changes during the menstrual
cycle.

The endometrium
is functionally subdivided into two layers.

• The stratum functionalis is a thick superficial layer that is
  sloughed off during menstruation and grows anew during each cycle.  It
  is therefore a temporary tissue with an “unfinished”
  appearance — not quite as tidily organized as the mucosal tissues in
  most other organs.  The stroma more closely resembles embryonic
  mesenchyme than typical lamina propria.
• The stratum basalis consists of permanent stromal tissue and
  deep ends of the uterine glands.  These tissues remain through each
  cycle and serve as sources for cells during regrowth of the superficial
  stratum functionalis.

When the stratum functionalis is present (i.e, when it has not just be
sloughed off), there is no distinct morphological boundary between these
two layers.

During
the proliferative phase, when the stratum functionalis is growing,
the endometrial glands have a relatively smooth contour and mitotic figures
are common.

In
contrast, when the endometrial glands have matured in the secretory phase,
their contour is more tortuous and the epithelium consists of mature secretory
cells.

The
endometrium is highly vascular, and the blood vessels also participate in
the menstrual cycle.  Distal vessels are sloughed off, while the spiral
arteries (named for their helical shape) retract into the stratum basalis
and constrict to limit blood loss during menstruation.  The spiral
arteries then extend again (like springs) as the stratum functionalis regenerates.
 

The myometrium consists
of smooth muscle, organized into poorly-defined layers with bundles of fibers
interwoven in varying directions.  In response to hormonal changes pregnancy,
the myometrium undergoes both hyperplasia (more smooth muscle
cells) and hypertrophy (larger smooth muscle cells).

Comments and questions: [email protected]

SIUC / School
of Medicine / Anatomy / David
King

https://histology.siu.edu/erg/uterus.htm
Last updated:  3 September 2021 / dgk

Endometrial Biopsy – American Family Physician

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor. org, the AAFP patient education website.

Information from Your Family Doctor

Am Fam Physician. 2001 Mar 15;63(6):1137-1138.

What is endometrial biopsy?

Endometrial biopsy is a safe and effective method for evaluating the tissue lining the inside of the uterus (or womb). A plastic catheter is slipped into the uterus, and a small amount of the endometrial lining is suctioned into the catheter. This technique has been demonstrated to provide a tissue sample equal to or superior to the older dilatation and curettage (D&C) procedure.

Why is endometrial biopsy performed?

Endometrial biopsy is performed to evaluate the uterus lining for the presence of cancer or precancerous cells. Most women who have this procedure done have abnormal uterine bleeding or prolonged absence of their periods (amenorrhea). Other women who undergo this procedure include those on hormones (taking estrogen but not progesterone) or those at high risk for endometrial cancer (hereditary nonpolyposis colorectal cancer).

Is endometrial biopsy painful?

It can be uncomfortable. The placement of the thin plastic catheter inside the uterus can produce cramping. Take four 200-mg tablets of ibuprofen (brand names: Advil, Motrin, Nuprin) with some food about an hour before coming to the office for the procedure. To reduce the discomfort from instruments used during the procedure, the cervix can be sprayed with a numbing medicine. The numbing spray may sting for a few seconds. The entire procedure takes just a few minutes, and most women tolerate the procedure well.

What complications may develop after endometrial biopsy?

You may experience vaginal bleeding for a few days following the procedure. If you are pregnant at the time of the procedure, the pregnancy can be damaged, so before the procedure tell your doctor if there is a possibility that you are pregnant. Some women may develop infection in the uterus or fallopian tubes any time an instrument is placed into the uterus, but this is rare following endometrial biopsy. Rarely, a hole can be made in the wall of the uterus by the thin plastic catheter, especially if the uterus is angled up or down.

What happens to the sample that is removed from the lining of my uterus?

The sample is sent to the hospital for examination by a subspecialist physician called a pathologist. The cells from the tissue are examined under the microscope, and the pathologist can determine if cancerous or precancerous cells are present. Your doctor’s office will contact you once the report of the tissue examination is completed.

Following Endometrial Biopsy

1. If you have any discomfort after the procedure, you may take ibuprofen, three 200-mg tablets three times a day with food. Acetaminophen (brand name: Tylenol) can also be taken but is not as effective in reducing the uterine cramping.

2. You may drive home following the procedure, unless additional medications have to be given in the office to complete your procedure.

3. Some vaginal bleeding or spotting is common following the procedure. If you experience heavy bleeding, please call your doctor.

4. Infection following the procedure is uncommon but report any complaints that would suggest an infection, such as pain in the lower abdomen or vagina, or a foul-smelling vaginal discharge. Your doctor may prescribe an antibiotic for a few days following the procedure to prevent infection.

5. Please do not place anything in your vagina and avoid sex (intercourse) for one week following the procedure.

6. A nurse will call you with the report of the tests done on the tissue removed from your uterus. You may be asked to take hormones if abnormal cells are detected. Your doctor will talk to you about the best treatment strategy for you when you return to the office for a follow-up visit in a few weeks.

90,000 Thin endometrium – factor of infertility and IVF ineffectiveness

The endometrium is the inner mucous layer of the uterus, to which the embryo is attached during the development of pregnancy. The thinning of this layer is called the “thin” endometrium. The condition prevents adequate fixation of the fertilized egg. There are many reasons for the development of the problem, but the main one is chronic inflammation. Successful diagnosis and treatment of “thin” endometrium is possible only in a modern clinic.The correct approach to the problem allows you to conceive and bear a healthy child.

Causes of thin endometrium in a woman

There is no generally accepted concept of “thin endometrium”. In medicine, it is customary to consider different parameters of endometrial thickness as an unfavorable criterion for carrying a pregnancy. Authors in the literature argue that tissue thickness less than 8 mm minimizes the chance of successful embryo implantation into the uterine cavity, and the effectiveness of IVF with this parameter is only 15%.

Main reasons for a decrease in endometrial thickness:

• Chronic inflammation in the endometrial tissue
• Inflammatory diseases of the pelvic organs
• Autoimmune endometritis as a consequence of previous inflammation
• Change in hormonal balance
• Past injuries
• Follicular ovarian cyst
• Polycystic ovary
• Developmental defects of the uterus
• Postponed instrumental abortion
• Adhesions (synechia) in the uterine cavity
• History of medical errors and surgical interventions on the uterus

The causes and treatment of “thin” endometrium are still being actively studied in order to form the most effective protocols for eliminating infertility and success in IVF.

Only proven, modern methods of thin endometrium therapy are used at the Leib Medic clinic.

Diagnostics of the thin endometrium

Thinning of the endometrium may not be symptomatic. Clinical manifestations largely depend on the causes of the development of the problem. With hormonal disruptions, there will be a delay in menstruation, with inflammation – moderate periodic pain, with anovulation – amenorrhea (absence of menstruation).

Ultrasound examination allows to suspect endometrial hypoplasia. However, it alone is not enough. On an ultrasound, the doctor will determine the discrepancy between the thickness of the endometrium and the phase of the menstrual cycle.

The gold standard for thin endometrial diagnostics is hysteroscopy followed by biopsy. The doctor conducts a visual examination of the uterus using a special apparatus and selectively collects tissue sections. After hysteroscopy, the material is examined by a pathologist, whose main task is to detect or exclude signs of chronic inflammation. Modern methods are used to assess the number of endometrial receptors that recognize hormones and the number of protrusions (pinopodia) that recognize the embryo.

Effective methods of treating thin endometrium

There is no single approach to the treatment of patients with a thin endometrium. The variety of methods of therapy indicates insufficient global knowledge of the problem.

The Leib Medic clinic uses groups of drugs that have proven their effectiveness:

1. Antibacterial
2. Immunostimulants
3. Estrogen preparations
4. Circulatory stimulants

The approach to patients is individual and aimed at eliminating the cause of endometrial thinning.Girls with anovulation (no ovum is formed) have a tissue thickness of 5-6 mm, but when deciding on the resumption of physiological ovulation, the tissue thickens and returns the ability to fix the embryo.

How to build up the endometrium for conception?

The search for a clear answer to the question: how to build up a thin endometrium is still ongoing, but some effective techniques are already available in modern reproductive health clinics.

In the normal menstrual cycle, the thickness of the endometrium is constantly changing.This is taken into account during treatment.

Normal indicators of endometrial thickness in different phases of the menstrual cycle

The approach to endometrial augmentation should be comprehensive. The therapy is carried out in 2 stages:

1. Identification of causes and their elimination. Most often, you have to fight chronic tissue inflammation and use drugs: antibiotics, immunomodulators, anti-inflammatory. Funds are used both systemically and locally. In the case of hormonal changes, the cause of the problem is found out. Adhesions, cysts, hormone-producing tumors are removed surgically.
2. Restoration of the functionality of the endometrium. Long phase, which can take 2-3 months.Traditionally, this stage includes physical therapy. It enhances blood circulation, accelerates metabolic processes, quick regeneration, as well as reflexology and hirudotherapy.

Is it possible to get pregnant with a thin endometrium?

Pregnancy and thin endometrium are compatible concepts, since it cannot be said that this problem completely excludes the possibility of embryo implantation into the uterine tissue. However, even the attachment of a fertilized egg to the thin endometrium does not guarantee a normal pregnancy with a successful birth, the same applies to IVF.

Main complications that can occur in pregnant women with a thin endometrium:

• Early spontaneous abortion
• Premature birth at a later date
• Fetal growth retardation
• Placental insufficiency
• Preeclampsia (dangerous late gestosis)

This means that when establishing a diagnosis of “thin endometrium” it is better not to take risks, but to undergo a course of treatment before planning a pregnancy.

Videos

The thin endometrium is still not fully understood problem requiring clinical research and experiments. However, it is reliably known that insufficient tissue thickness significantly reduces the likelihood of a successful pregnancy and delivery, and also increases the risk of failed IVF. Therefore, if you suspect a thin endometrium, it is necessary to conduct a comprehensive examination and treatment, the purpose of which is to develop pregnancy, carry and give birth to a healthy baby.

Non-hormonal method of treating thin endometrium (CO2 and N2)

New non-hormonal method of treating thin endometrium with a mixture of gases CO ₂ and N ₂

Thin endometrium (hypoplasia) is a condition that is diagnosed in about 1/3 of women of childbearing age. Endometrium is the mucous membrane of the inner lining of the uterus, the thickness of which in normal condition is 8-12 mm. It is to the endometrium that the embryo is attached, therefore, if its thickness is less than 7 mm., this poses a serious threat to pregnancy.

To achieve the desired pregnancy, a combination of a normal embryo (fertilized egg) and a receptive endometrium, in which the developing embryo is implanted, is required.

Thus, a thin endometrium is a common cause of a significant decrease in the possibility of pregnancy. An endometrial thickness of less than 7 mm gives the lowest chance of conception. The causes of a thin endometrium are:

– chronic metroendometritis (inflammation of the mucous membrane of the uterine cavity)

– interventions in the uterine cavity – abortion, curettage of the mucous membrane

– insufficient production of the hormone estradiol, which is responsible for the growth of the endometrium

– congenital malformation of the female genital organs, infantilism.

– a history of surgical operations on the uterus or ovaries;

– abuse of emergency contraception.

Thin endometrium is a condition that requires compulsory treatment, which can be conservative or surgical.

At the Federal State Budgetary Institution Scientific Center for Obstetrics and Gynecology and Perinatology named after Akd. V.I. Kulakova a new method of treating women has been developed by irrigating the endometrium with a mixture of gases CO ₂ and N ₂ , under the influence of which blood circulation in the mucous membrane is improved and the thickness of the basal and functional layers of the endometrium gradually increases. The local effect of CO ₂ on a limited area of ​​tissues is accompanied by an increase in volumetric blood flow, an increase in the rate of blood oxygen extraction by tissues and an increase in metabolism, restoration of receptor sensitivity, an increase in reparative processes and activation of fibroblasts. Nitrogen in the body is one of the main biogenic elements that make up the most important substances of living cells, proteins and nucleic acids, amino acids, hemoglobin, etc.

Treatment of the thin endometrium with a mixture of gases CO ₂ and N ₂ is carried out on 7,9,11 days of the cycle in the absence of bloody discharge from the uterus.

During treatment, it is necessary to carry out an ultrasound examination of the endometrium.

90,000 Thin endometrium – health articles

Table of Contents

“Thin” endometrium is a condition in which the thickness of the inner layer of the uterus during
ovulation
is less than 7 mm (normal values ​​are 8-12 mm). This condition is bad for
on a successful pregnancy. “Thin” endometrium is not independent
disease, but a consequence of various internal disorders.

Medsi doctors are successfully treating pathology. At the same time, they use both traditional and
and modern
techniques. This allows you to achieve a good effect of therapy with minimal risks for the female
reproductive
health.

Causes of thin endometrium of the uterus

Thinning of the endometrium is triggered by an imbalance of progesterones and estrogens.

At the moment, pathology is recorded quite often.Its main cause is violation
hormonal levels. Thinning of the endometrium is triggered by an imbalance of progesterones and estrogens.

Symptoms

If a woman is not planning to conceive or is not pregnant, identifying the problem is difficult. Usually
suspicions
in the presence of pathology arise from a gynecologist in case of frequent miscarriages. The doctor also suspects a violation
can in the absence of pregnancy in the case of its long planning.Looking for reasons
infertility
a specialist can detect a thin layer of the endometrium.

Nevertheless, a woman can suspect a pathology on her own.

If any of the symptoms of a “thin” endometrium appears, you should make an appointment with a gynecologist.

Symptoms of the “thin” endometrium (like some other diseases) are:

• Insignificant and short menses
• painful intercourse
• decreased libido
• overpressure
• headaches and unstable emotional background
• joint and muscle pain
• Spotting outside of menstruation
• Feeling of “fullness” of the breast
• increased sweating
• tide

Important! If any of these symptoms of a “thin” endometrium appear, an appointment should be made.
appointment
gynecologist. A visit to a doctor is especially relevant if a woman is planning to conceive. Should
understand that the endometrium grows rather slowly, and the treatment will be long.

Diagnostics

To make an accurate diagnosis, a woman undergoes a comprehensive examination.

To make an accurate diagnosis, a woman undergoes a comprehensive examination, which includes:

1. Blood test for hormonal levels
2. Urinalysis
3. Ultrasound of the uterus
4. Endometrial studies (histological, immunohistochemical, molecular genetic, etc.)etc.)
5. Diagnostics of the microflora of the uterine cavity (including pathogenic)

Diagnostics allows not only to identify a pathological condition, but also to determine its causes. Only
after the examination, the woman can be prescribed adequate therapy.

Methods for the treatment of thin endometrium of the uterus

Surgical treatment of the thin endometrium is currently being carried out under the guidance of hysteroscopy
(therein
office).

Proven therapies include:

1. Taking hormonal drugs
2. Physiotherapy procedures
3. Therapeutic massage
4. Gymnastics
5. According to indications, complex anti-inflammatory therapy can be prescribed, including
   antibacterial

The listed methods of treatment can improve blood flow and eliminate inflammation.They stabilize
the general condition of the patient. Hormonal treatments are especially effective. It is selected by the doctor taking into account
individual characteristics of a woman and other factors.

Surgical interventions are performed if the endometrium is thinner than normal and does not grow with hormonal
therapy
and other measures taken. Operations are aimed at diagnosing synechia of the uterine cavity
and their elimination.

Surgical treatment of the thin endometrium is currently being carried out under the guidance of hysteroscopy
(therein
office). With hysteroscopy, a visual examination of the walls of the uterine cavity occurs, if pathology is detected
(for example, synechiae or polyp), they are removed.

Any therapeutic procedures and drug treatment are carried out in combination with proper nutrition
and a healthy lifestyle. A woman is advised to spend more time in the fresh air, get rid of
from excess weight (if any), give up fast food, carbonated drinks
and harmful
habits, eat foods rich in phytoestrogens (natural hormones).

Only in this case can one expect that the thin endometrium will be thickened and
pregnancy.

Advantages of contacting MEDSI

Our specialists provide not only diagnostics, but also treatment of the detected
pathologies.

• Qualified Personnel. Our doctors have extensive professional experience gained
  in Russia
  and abroad.They have all the necessary knowledge and skills and successfully carry out treatment
  thin walls of the endometrium
• Expert diagnostics. For its implementation in clinics, innovative equipment is used.
  It
  guarantees high accuracy of any examinations
• Provision of a full range of services. Our specialists provide not only diagnostics,
  but also the treatment of detected pathologies
• Individual approach. We offer an integrated approach and take into account all the factors that can
  become
  barriers to the birth of a baby
• Comfortable treatment. The department created an atmosphere of comfort and harmony. There are spacious
  halls, there are modern rooms for consultations and examinations
• Involvement of specialists of related profiles. If necessary, the woman will be supported by
  not only a gynecologist, but also an endocrinologist, a doctor of functional diagnostics, ultrasound, etc.

If you are planning to treat thin endometrium in our center, call
by number +7 (495) 7-800-500
Our specialist will answer all questions and make an appointment with the doctor. Also for the record
you can use the SmartMed app.

• Experienced Reproductive Health Professionals
• Wide range of medical services
• Laboratory of Assisted Reproductive Technologies (ART)

Our doctors

Head of the Department of Assisted Reproductive Technologies, Reproductologist

Doctor of the first qualification category

Fertility specialist

Fertility specialist

Candidate of Medical Sciences

90,000 Answers to popular questions about endometriosis

Popular questions about the problem.

Endometriosis is a gynecological disease in which tissue morphologically and functionally similar to the endometrium grows abnormally outside the uterus.

What types of endometriosis exist, what organs can be affected?

There are two types of endometriosis: genital – fragments of the endometrium (heterotopia) are found in the uterus, cervical canal, on the ovaries or uterine (fallopian) tubes, and extragenital – the process affects the pelvic peritoneum, abdominal wall, bladder, intestines and others organs.Genital endometriosis is divided into two types: internal (only the uterus is affected) and external (heterotopies affect other organs of the reproductive system: ovaries, fallopian tubes, sacro-uterine ligaments).
How to recognize diseases in yourself? What symptoms should alert you?
Sometimes endometriosis can be asymptomatic, so it can only be diagnosed during regular examinations. Some of the signs unambiguously indicate this pathology:

• Pelvic pain.
• Painful periods.
• Pain during intercourse.
• Painful bowel movements or urination.
• Profuse and prolonged menses.
• Posthemorrhagic anemia. It occurs due to chronic blood loss during menstruation.
• Infertility.

Who is susceptible to the disease, what factors contribute to the disease?

Does the likelihood of getting sick increase with age?

Endometriosis is a common gynecological disease that affects women of reproductive age, but it can occur in girls during the onset of menstrual function and in women during menopause.The factors behind the development of endometriosis are still unclear. Some experts believe that in some women, menstrual blood with endometrial particles enters the abdominal cavity and fallopian tubes (retrograde menstruation) and then becomes attached to the tissues of various organs, which provokes the pathological process. In addition, a certain structure of the fallopian tubes, suppressed immunity, surgical interventions on the uterus, and heredity can contribute to the occurrence of endometriosis.

The disease is hereditary, can there be a predisposition to it?

Since the likelihood of a hereditary predisposition to this disease is high, such patients need to observe preventive measures.After any surgical interventions, you should be observed by a gynecologist in order to prevent negative changes in the reproductive system in time.
Why is endometriosis dangerous?
The consequences of endometriosis can be adhesions in the small pelvis and abdominal organs, ovarian cysts, and later – infertility. In addition, heavy blood loss during menstruation leads to anemia, weakness, and irritability. The biggest danger is the degeneration of foci of endometriosis (ovarian endometrioma) into a malignant tumor.

Is pregnancy possible with endometriosis?

The probability of infertility with this diagnosis is about 40%. With endometriosis, the likelihood of miscarriage and spontaneous miscarriage increases, which is why constant supervision of a specialist is necessary.

Methods of treatment. Is it possible to completely cure the disease or only to suspend it?

Endometriosis therapy depends on the patient’s age, the number of pregnancies and childbirth, the prevalence of the disease, its location, manifestation, concomitant pathologies, etc.Treatment of this pathology can be medical, surgical (laparoscopic removal of endometriosis foci and organ preservation or radical) and combined.
Endometriosis is a dangerous female ailment, only early diagnosis and timely therapy will help to fully cope with it. The indicators of complete recovery are good health, absence of pain and other subjective complaints and relapses, and in women of childbearing period – restoration or preservation of reproductive function.

Disease prevention

The key to a complete recovery of endometriosis is a timely visit to a specialist at the first sign.

Preventive measures:

• specific examination of adolescents and women with complaints of painful menstruation;

90,013 observation of women after surgery on the uterus;

• timely treatment of acute and chronic pathology of the genitals;
• taking oral hormonal contraceptives.

An attentive attitude to one’s health, regular medical examinations and timely treatment of gynecological pathology make it possible to identify endometriosis at the very initial stage or to avoid its occurrence altogether.

Make an appointment with a gynecologist for the treatment of endometriosis by calling the contact center +7 (495) 775 75 66, via the online registration form and at the clinic’s registry.

Thin endometrium. Ways to solve problem

According to domestic and foreign authors, the prevalence of infertility reaches 10-15%, in some regions of Russia – 20%, and the frequency of spontaneous miscarriage in the first trimester of pregnancy remains at the level of 16% [1].The decrease in female fertility has many reasons, among which the share of the uterine factor of infertility in the isolated or combined variant accounts for 24-62%. It is known that the prevalence of pathological changes in the endometrium in infertility reaches 88%, with ineffective attempts at in vitro fertilization (IVF) – 77.5% [2, 3]. It has now been established that the state of the endometrium plays an important role in the causes of infertility and miscarriage in women. The thickness and maturity of the endometrium are clearly visible with ultrasound with a vaginal sensor.Before implantation, its thickness should be at least 8 mm [4, 5]. It is known that the thinner the endometrium, the less chances of a favorable pregnancy outcome. Therefore, in modern literature there is the term “thin endometrium”, since it is he who is the most complex and completely unexplored phenomenon in modern reproductology. Sufficient thickness of the endometrium is very important for the normal implantation of the embryo in the uterine cavity [6]. It is important to note that the pregnancy rate decreases in patients with low uterine blood flow, which indicates a close relationship between uterine blood supply and endometrial receptivity [7, 8].

Methods of treatment aimed at increasing the thickness of the endometrium include anti-inflammatory therapy, intensive prescription of estrogen and progesterone drugs, drugs that improve uterine blood flow, surgery, physiotherapy [9]. However, recent analyzes of the accumulated clinical material indicate the insufficient effectiveness of the proposed treatment methods in order to increase the thickness and receptivity of the endometrium and, most importantly, safety.For many years, methods of intrauterine exposure have been developed, which have mainly anti-inflammatory and immunomodulatory properties, therefore, they are more acceptable in the practice of preliminary preparation of the endometrium. Methods for improving the morphofunctional state of the endometrium directly in the fertile cycle are limited, but their reasonable application can increase the success of both spontaneous conception and programs of assisted reproductive technologies [10]. This required a search for new approaches to solving the problem of treating patients with a thin endometrium and further scientific and practical research.

We have patented a method of treating patients with a thin endometrium using autoplasma containing platelets. Autoplasm containing platelets was injected intrauterinely in an amount of 0.5-1 ml and paracervically to a depth of 0.5 cm, into the submucosal layer, with a volume of 1.5 ml on one side and on the other at 17 and 19 hours [11].

Non-toxic or immunoreactive autoplasma containing platelets accelerates natural regeneration mechanisms due to the presence of growth factors in platelets.

In addition, platelet-containing autoplasma modulates and regulates the function of primary growth factors. This property distinguishes platelet autoplasma growth factors from recombinant growth factors, each of which is responsible for a separate regeneration mechanism.

The aim of study is to increase the thickness and structure of the endometrium in patients with “thin endometrium” and infertility by intrauterine irrigation with platelet-containing autoplasma and paracervical submucosal administration for successful pregnancy.

Material and methods

We examined 40 women aged 25 to 35 years with primary or secondary infertility and the presence of a “thin endometrium” that does not respond to previous hormonal stimulation or physiotherapy treatment. The average age of the patients was 27 years. All patients underwent a comprehensive examination, including the collection of anamnestic data, standard clinical and laboratory studies, a study of the hormonal profile on the 2-3rd day of the menstrual cycle, ultrasound of the pelvic organs on the 5th-7th day of the menstrual cycle, dopplerometry and pipe-biopsy of the endometrium on the 7-11th day of the menstrual cycle.

Efficiency control was carried out by ultrasound monitoring with measurement of endometrial thickness and Doppler blood flow on the 7th, 9th and 12th days of the menstrual cycle. All patients on the 8th day of the menstrual cycle were randomized into 2 groups: with a moderate delay in the development of the endometrium – M-echo ≥5 mm ( n = 24) and an extreme delay in the development of the endometrium – M-echo <5 mm ( n = 16). Each of the groups, depending on the therapy received, was divided into two more. Patients of the 1st subgroup ( n = 14) with a moderate delay in the development of the endometrium during treatment with hormone replacement therapy (HRT) received intrauterine irrigation and submucosal administration of autoplasma containing platelets; The 2nd subgroup ( n = 10) with a moderate delay in the development of the endometrium consisted of patients who received HRT as monotherapy, without stimulation of regeneration by platelet autoplasma.The third subgroup ( n = 8) included patients with an extreme delay in endometrial development (M-echo <5 mm), who also underwent intrauterine irrigation and paracervical submucosal administration of autoplasma containing platelets during treatment with HRT. Patients of the 4th subgroup ( n = 8) with an extreme delay in endometrial development received only HRT preparations.

In the prospective fertile cycle, especially when stimulating ovarian function, in women with “thin endometrium”, the use of HRT preparations (estrogens) is justified.We used transdermal forms of estrogens (Divigel), which have a number of advantages over oral administration of estradiol due to their high bioavailability and the possibility of easy dose variation. Estradiol preparations can also be prescribed at the stage of preparation for the fertile cycle in cases where the cause of the “thin endometrium” is ovarian insufficiency. The dose was selected individually under ultrasound control (the value of the M-echo of the endometrium). Estrogens were prescribed on a 21-day schedule, during the last 10 days they were combined with progestins (dydrogesterone 10–20 mg / day, micronized progesterone 200 mg / day).

Intrauterine and paracervical administration of autoplasma containing platelets was carried out as a pregravid preparation, against the background of HRT, in the late proliferation phase (9th or 10th day) of the menstrual cycle once during 3 menstrual cycles. The undoubted advantage of the introduction of autoplasma containing platelets is an increase in the blood supply to the mucous membrane of the uterine body, as well as a combined anti-inflammatory effect with an improvement in growth functions, which allows treatment in compliance with the principle of “proliferation without inflammation”.In the study of endometrial biopsies, the following immunohistochemical markers were determined: transforming growth factor (TGF) and vascular endothelial growth factor (VEGF).

It is important to recognize not only long-term, not less than 6 months, preservation of the effect of therapy, but also the growth of positive dynamics. This indicates the ability of autoplasma containing platelets to restore the own regenerative potential of the female reproductive organs.

Statistical processing of the data obtained to determine the differences in the thickness of the endometrium in the comparison groups was carried out using the method of comparison of parameters according to Student.Differences were considered statistically significant at p <0.05.

Results

Baseline monitoring showed similar disturbances in endometrial maturation in all patients. A significant ( p <0.05) increase in the thickness of the endometrium in the proliferative phase of the cycle compared with the initial indicators was noted after therapy using irrigation of the uterine cavity with autoplasma containing platelets, already at the 3rd month of observation in the 1st and 3rd th subgroups, while HRT alone did not give a significant effect.The obtained positive result persisted until the 6th month of observation in the 3rd subgroup and progressed even more in the 1st. Thus, the effect of platelet-containing autoplasma on the endometrium turned out to be more significant in comparison with therapy that included only HRT preparations.

During an immunohistochemical study in patients treated for “thin endometrium” with autoplasma containing platelets in the 1st and 3rd subgroups, an increase in the expression of the most important regulators of regeneration TGF – 5.1 ± 0.4 and VEGF – 4 was determined, 7 ± 0.9 compared with the expression of those in patients of the 2nd and 4th subgroups, where only HRT was performed, 1.9 ± 0.1, 1.8 ± 0.5 and 1.7 ± 0.1, respectively , 1.5 ± 0.5, due to which there was an increase in the blood supply in the uterine mucosa and stimulation of the growth of the endometrium.

Doppler imaging in the 1st and 3rd subgroups showed uniform vascularization of the endometrium and sub-endometrial layer, and in the 2nd and 4th subgroups, there was a decrease in endometrial blood flow and the absence of sub-endometrial blood flow.

The pregnancy rate was estimated in 20 women with infertility, 12 of them received a course of stimulation of ovulation (previous attempts at stimulation were unsuccessful). Pregnancy occurred in 11 (55%) patients: in 7 of 7 women of the 1st subgroup, in 1 of 5 patients of the 2nd subgroup, in 3 of 4 patients of the 3rd subgroup, in the 4th subgroup of women, pregnancy did not occur. who.In 4 patients of the 1st subgroup, pregnancy occurred at the 3rd month of treatment, in the rest of the patients of this subgroup, pregnancy occurred at the 4th month. In patients of the 3rd subgroup, pregnancy occurred at the 5th month of treatment.

Comparison of intergroup differences in the effectiveness of therapy is not possible due to the small number of observations and significant differences in factors of infertility in the groups. However, a trend has emerged. The high potential of intrauterine irrigation with platelet-containing autoplasma as a means of preparing for the restoration of fertility in women with infertility should be recognized.

Conclusion

The use of procedures for irrigation of the endometrium of the uterine cavity with autoplasma containing platelets, and its introduction into the submucous space paracervically in patients with “thin endometrium” showed that the method has a positive effect, and in most patients there is a significant growth of the endometrium by the end of treatment. The thickness of the endometrium in the examined subgroups was significantly greater than in the comparison subgroups ( p <0.05). Thus, such therapy can be recommended for use in the practice of an obstetrician-gynecologist when preparing patients for an in vitro fertilization program.

A method of treating patients with “thin endometrium” by intrauterine irrigation with autoplasma containing platelets and its paracervical submucosal administration is an effective, minimally invasive, fairly simple and safe treatment method that does not require complex equipment. Provides patients with a low degree of pain and no complications.

Contribution of authors:

Concept and research design – E.N. Kravchenko, O.Yu Tsygankova;

Collection and processing of material – O.Yu. Tsygankov, K.P. Cropmaer;

Statistical data processing – O.Yu. Tsygankov, K.P. Cropmaer;

Text writing – O.Yu. Tsygankov;

Editing – O.Yu. Tsygankov, K.P. Cropmaer

The authors declare no conflicts of interest.

90,000 Endometriosis, symptoms and treatment, endometriosis of the body and cervix and ovaries

What is endometriosis?

Often, under the influence of external factors, changes occur in our body that are imperceptible at first glance, but very dangerous to health.Particular attention should be paid to diseases affecting the female reproductive system. One such disease that affects the endometrial tissue (the inner tissue of the uterus) is increasingly seen in young women and is called endometriosis.

Endometriosis is characterized by the proliferation of endometrial cells outside the main tissue layer and a significant increase in the thickness of the walls of the affected organ. The cells of the endometrial tissue are sensitive to monthly hormonal influences and also bleed like the underlying tissue of the uterus.

In the process of such bleeding, irritation and inflammation of the tissues adjacent to the endometrial cells occurs, which is characterized by severe pain and constant discomfort. However, the consequences of endometriosis are much more dangerous than it might seem at first glance: the development of deep inflammatory processes, the formation of cancer cells and even infertility are possible.

• Internal factors of the organism;
• Genetic predisposition;
• Metaplasia of the affected tissue (transition from one type of tissue to another).

Internal factors of the body include: immunity disorders, hormonal disorders, stress and toxic effects. A decrease in immunity, in principle, significantly increases the body’s sensitization to various diseases, especially to diseases that affect the female reproductive system. Violations of the regulatory function of immunity leads to the fact that the endometrial tissue of the uterus quickly and freely grows into the body of the uterus.

Hormonal disorders can also lead to the development of the disease.In the course of a number of studies, it was found that in the majority of patients with endometriosis, the level of steroid hormones in the blood is significantly increased against the background of a decrease in the level of progesterone. This leads to a decrease in the influence of the androgenic function of the adrenal glands and, as a result, the endometrial tissue begins to grow.

Experts identify the familial form of endometriosis, when the disease is transmitted through the female line at the genetic level. As a result of the research, a specific marker gene was identified, which determines the body’s sensitivity to common factors and the possibility of developing endometriosis.

The causes of metaplasia are still not clear, but the fact of the transition of endometrial tissue to another type of tissue has been proven. Perhaps the point is the toxic influence of external factors, such as smoking, alcohol and drug use.

Depending on the localization of the disease, experts distinguish several forms of endometriosis:

• Genital form – generalized damage to the organs and peritoneum of the small pelvis. Endometrial cells grow slightly, affecting adjacent organs, causing a change in their functions and thickening of the physiological walls;
• Extragenital form – the spread of endometrial tissue outside the organs of the reproductive system.In this case, the intestines, stomach walls, organs of the urinary system, and even the lungs are affected;
• Combined form – develops with simultaneous genital and extragenital form. It is considered one of the most difficult forms of the disease, since it is necessary to carry out complex treatment aimed at the simultaneous elimination of both subforms.

Specialists of the GMS Clinic Center for Obstetrics and Gynecology say: most often the combined form develops from another untreated or completely untreated form of endometriosis.So that in the future you do not have to deal with several forms at once, strictly follow the doctor’s instructions and stop treatment only when the doctor says.

Due to the fact that genital endometriosis is most common, it was decided to classify the disease according to smaller characteristics for further selection of the optimal treatment.

Adenomyosis – the spread of endometrial tissue into the muscle tissue of the uterus and other genital organs, can be divided into 4 stages:

• At the first stage, a superficial lesion of the mucous membranes occurs before the germination of endometrial cells into the myometrium;
• The second stage involves the deeper layers of the myometrium.The disease spreads to the middle of the muscle tissue;
• At the third stage, there is a total defeat of the endometrium up to the serous tissue;
• The fourth stage is characterized by the spread of endometrial tissue to the parienteral peritoneum and ingrowth into it.

The first and second stages respond to treatment much better than the fourth, in which the option of surgical intervention is already being considered. That is why the specialists of our clinic of obstetrics and gynecology advise not only to regularly visit a doctor for the prevention and diagnosis of the current state of the body, but also in no case to delay the visit to the doctor if any of the symptoms is detected.

90,000 causes, signs, diagnosis, how to treat

Endometriosis is a serious problem for many women. The disease leads to a decrease in the quality of life, makes you suffer from pain, and sometimes interferes with the onset of the desired pregnancy. However, the reasons for its appearance still raise many questions among scientists. Radmila Borisovna Prokhorenko, a gynecologist at the Expert Clinic, Irkutsk, told us about the diagnosis and treatment of endometriosis.

– Radmila Borisovna, what is endometriosis?

– This is a disease associated with pathological proliferation outside the uterine cavity of tissue similar in morphological and functional properties to the endometrium.Distinguish between internal genital endometriosis (or adenomyosis), when tissue grows into the muscular layer of the uterus (myometrium), and external genital endometriosis – the location of pathological foci outside the uterus (ovaries, fallopian tubes, peritoneum, vagina). With extragenital endometriosis, other organs are affected (lungs, bladder, intestines, skin).

– Endometriosis and endometritis – the same thing or not?

– These are different diseases. With endometritis, the endometrium becomes inflamed (by the way, the “it” suffix usually indicates inflammatory diseases), with endometriosis, pathological growth occurs.

– What is the difference between endometriosis and endometrial hyperplasia?

– With hyperplasia, the endometrium thickens, but does not go beyond the uterus and does not grow into the muscle layer.

– What are the causes of endometriosis?

– Endometriosis is a disease with unknown etiology. There are several theories of the occurrence of the disease, but none of them is absolutely reliable.

– Are there any factors that suggest that the patient is at increased risk for endometriosis?

– Yes, and the data is constantly changing.Previously, increased risk factors included smoking, drinking alcohol, drinking coffee, and low body mass index. Further research has shown that they do not play a special role. All significant factors are associated with estrogen synthesis. The risk group includes women who have not realized reproductive function for a long time (did not give birth), those who started menstruating early.

– On what grounds can a woman suspect that she has endometriosis?

– Clinical signs of endometriosis are pain during menstruation (especially worse over time), in some cases, menstrual irregularities.Infertility can also be a sign of endometriosis.

– What examinations are prescribed for suspected endometriosis?

– Competent interviewing and examination of the patient makes it possible to suspect endometriosis. In addition, instrumental methods are used to diagnose endometriosis. A very informative method is transvaginal ultrasound. The sensitivity, specificity and accuracy of MRI diagnostics reaches 95%. The use of hysteroscopy is recommended to diagnose endometrial hyperplasia and exclude endometrial cancer.At certain localizations of the pathological process, laparoscopy may also be required.

– Is endometriosis life-threatening? If so, with what?

– Hopefully modern women won’t endure pain for so long. But in the absence of treatment, the progression of the disease, damage to neighboring organs, there is a significant decrease in the quality of life, up to the patient’s disability.

– How to treat endometriosis of the uterus and other organs? What methods does modern medicine have?

– Hormone therapy is an effective method of treatment for endometriosis.In some cases, surgery is required. The operation can be both organ-preserving and with the removal of the affected organ. Treatment tactics depend on the location and prevalence of the pathological process.

– What complications can endometriosis lead to?

– When the endometrium grows into the deep layers of the uterus, uterine bleeding may begin, leading to anemization of the patient. When localized in the fallopian tubes, ovaries, peritoneum, the adhesion process, infertility becomes a complication.When the intestines, ureter are squeezed or germinated in them, the function of these organs is impaired.

– Can a woman with endometriosis get pregnant and carry a baby?

– Yes. This ailment does not always lead to reproductive dysfunctions. The likelihood of infertility depends on the location, the prevalence of the pathological process, as well as on the accompanying factors. For example, if there are problems with the maturation of follicles, endometriosis can become an additional factor preventing conception.There are cases when pregnancy occurred spontaneously, although the patient was not treated for endometriosis.

For information:

Prokhorenko Radmila Borisovna

Graduated from Irkutsk State Medical University in 1996 with a degree in General Medicine.

1996 – 1998 – internship in the specialty “Obstetrics and Gynecology” on the basis of the MUZ City Hospital No. 2, Bratsk.

2016 – GBOU DPO “IGMAPO” of the Ministry of Health of the Russian Federation, advanced training “Basics of temporary disability and medical and social expertise.