What is the uterus and its role in female reproductive health. How does the endometrium function during the menstrual cycle. What are common conditions affecting the uterine lining. How is endometrial health maintained and monitored.

The Uterus: A Vital Organ in Female Reproduction

The uterus, also known as the womb, is a crucial organ in the female reproductive system. Located in the pelvic region, this pear-shaped muscular structure plays a pivotal role in menstruation, pregnancy, and childbirth. But what exactly makes the uterus so important?

The uterus consists of three main layers:

• The perimetrium: The outer layer that covers the uterus
• The myometrium: The middle muscular layer
• The endometrium: The inner lining of the uterus

Among these layers, the endometrium is particularly significant as it undergoes cyclical changes in response to hormonal fluctuations during the menstrual cycle.

The Endometrium: The Dynamic Lining of the Uterus

The endometrium is the innermost layer of the uterus, and its primary function is to support pregnancy. During each menstrual cycle, the endometrium thickens in preparation for a potential embryo implantation. If pregnancy doesn’t occur, this lining is shed during menstruation.

The endometrial cycle consists of three phases:

1. Proliferative phase: The endometrium thickens under the influence of estrogen
2. Secretory phase: The endometrium becomes more vascular and glandular due to progesterone
3. Menstrual phase: If pregnancy doesn’t occur, the endometrium is shed

Understanding these phases is crucial for comprehending various uterine conditions and maintaining reproductive health.

Endometrial Hyperplasia: When the Uterine Lining Overgrows

Endometrial hyperplasia is a condition characterized by an overgrowth of the uterine lining. This condition can occur when there’s an imbalance of hormones, particularly an excess of estrogen without adequate progesterone to counterbalance it.

There are different types of endometrial hyperplasia:

• Simple hyperplasia without atypia
• Complex hyperplasia without atypia
• Simple hyperplasia with atypia
• Complex hyperplasia with atypia

The presence of atypia (abnormal cells) increases the risk of progression to endometrial cancer. How is endometrial hyperplasia diagnosed? Typically, it’s detected through endometrial biopsy or dilation and curettage (D&C) procedures.

Hormonal Influences on Endometrial Health

Hormones play a crucial role in maintaining endometrial health. Estrogen and progesterone are the primary hormones influencing the endometrium. Estrogen promotes the growth of the endometrial lining, while progesterone prepares it for potential pregnancy.

Hormonal imbalances can lead to various uterine conditions. For instance, an excess of estrogen without adequate progesterone can result in endometrial hyperplasia. Conversely, insufficient estrogen, as seen in menopause, can lead to endometrial atrophy.

Hormonal Therapy and the Endometrium

Hormone therapy, often used to manage menopausal symptoms, can impact endometrial health. Women taking estrogen-only therapy have an increased risk of endometrial hyperplasia and cancer. To mitigate this risk, progestin is typically added to the regimen for women who still have their uterus.

Monitoring Endometrial Health: Diagnostic Tools and Procedures

Regular monitoring of endometrial health is crucial, especially for women at higher risk of uterine conditions. What are the common diagnostic tools used to assess endometrial health?

• Transvaginal ultrasound: This non-invasive procedure can measure endometrial thickness and detect abnormalities
• Endometrial biopsy: A small sample of the endometrium is taken for microscopic examination
• Hysteroscopy: A thin, lighted telescope is inserted through the cervix to view the uterine cavity
• Dilation and curettage (D&C): This procedure involves dilating the cervix and scraping tissue from the uterine lining

These diagnostic tools help healthcare providers detect and diagnose various uterine conditions, including endometrial hyperplasia, polyps, and cancer.

Uterine Cancer: Understanding the Risks and Early Detection

Uterine cancer, particularly endometrial cancer, is the most common gynecological cancer. Certain factors can increase the risk of developing uterine cancer:

• Obesity
• Diabetes mellitus
• Polycystic ovary syndrome (PCOS)
• Never having been pregnant
• Late menopause
• Certain medications like tamoxifen

Early detection is crucial for successful treatment. Abnormal vaginal bleeding, especially after menopause, is often the first sign of uterine cancer. Regular gynecological check-ups and prompt reporting of unusual symptoms can aid in early diagnosis.

Endometrial Intraepithelial Neoplasia (EIN)

Endometrial Intraepithelial Neoplasia (EIN) is a precancerous condition of the uterine lining. It’s characterized by an overgrowth of abnormal cells in the endometrium. How does EIN differ from endometrial hyperplasia? While both involve overgrowth of the endometrium, EIN has a higher risk of progressing to cancer.

Maintaining Endometrial Health: Lifestyle Factors and Preventive Measures

Maintaining endometrial health is crucial for overall reproductive well-being. Several lifestyle factors can influence endometrial health:

• Maintaining a healthy weight: Obesity is a risk factor for endometrial hyperplasia and cancer
• Regular exercise: Physical activity can help balance hormones and maintain a healthy weight
• Balanced diet: A diet rich in fruits, vegetables, and whole grains may reduce the risk of uterine conditions
• Limiting alcohol consumption: Excessive alcohol intake has been linked to increased estrogen levels
• Managing chronic conditions: Proper management of conditions like diabetes and PCOS can help maintain endometrial health

Regular gynecological check-ups are essential for early detection of any abnormalities. Women should report any unusual bleeding or pelvic pain to their healthcare provider promptly.

Contraceptive Methods and Endometrial Health

Certain contraceptive methods can have protective effects on endometrial health. For instance, combined oral contraceptives and progestin-releasing intrauterine devices (IUDs) can reduce the risk of endometrial hyperplasia and cancer. How do these contraceptives protect the endometrium? They provide a consistent hormonal environment that prevents excessive endometrial growth.

The Uterus Beyond Reproduction: Lesser-Known Functions

While the uterus is primarily known for its role in reproduction, it serves other important functions in the female body. What are some of these lesser-known roles of the uterus?

• Supporting pelvic organs: The uterus helps maintain the position of other pelvic organs
• Contributing to sexual function: The uterus plays a role in sexual pleasure and orgasm for some women
• Influencing hormonal balance: The uterus is both influenced by and contributes to the body’s hormonal milieu

Understanding these additional functions highlights the importance of uterine health beyond reproductive years.

The Uterus and Menopause

As women approach menopause, the function of the uterus changes. The decline in estrogen levels leads to changes in the endometrium, often resulting in irregular menstrual cycles. After menopause, the endometrium typically becomes thin and inactive. However, postmenopausal women should still be vigilant about uterine health, as conditions like endometrial cancer can still occur.

Advances in Uterine Health Research and Treatment

Medical research continues to advance our understanding of uterine health and improve treatment options. Some recent developments include:

• Improved imaging techniques for more accurate diagnosis of uterine conditions
• Minimally invasive surgical procedures for treating uterine fibroids and other benign conditions
• Targeted therapies for endometrial cancer based on genetic profiling
• Advancements in fertility preservation techniques for women undergoing cancer treatment

These advancements offer hope for better management of uterine conditions and improved outcomes for women’s reproductive health.

The Future of Uterine Health Care

The field of uterine health care is evolving rapidly. Emerging areas of research include:

• Personalized medicine approaches based on individual genetic and hormonal profiles
• Development of non-invasive diagnostic tools for early detection of uterine conditions
• Exploration of the uterine microbiome and its impact on reproductive health
• Innovative therapies for managing endometriosis and other chronic uterine conditions

These developments promise to revolutionize how we approach uterine health care in the coming years.

The Global Perspective on Uterine Health

Uterine health issues affect women worldwide, but access to care and treatment options can vary significantly across different regions and socioeconomic groups. In many developing countries, lack of access to regular gynecological care and screening can lead to delayed diagnosis of uterine conditions.

Global initiatives aim to improve women’s health by:

• Increasing awareness about uterine health and the importance of regular check-ups
• Improving access to diagnostic tools and treatments in underserved areas
• Promoting research on uterine health issues specific to different populations
• Addressing cultural barriers that may prevent women from seeking gynecological care

These efforts are crucial for reducing disparities in uterine health outcomes globally.

Cultural Perspectives on Uterine Health

Cultural beliefs and practices can significantly influence how women perceive and manage their uterine health. In some cultures, menstruation and uterine health issues are taboo subjects, which can prevent women from seeking necessary care. How can healthcare providers address these cultural barriers? By providing culturally sensitive care and education, healthcare systems can improve uterine health outcomes across diverse populations.

Integrative Approaches to Uterine Health

While conventional medical treatments remain the cornerstone of uterine health care, many women are exploring integrative approaches to support their uterine health. These may include:

• Acupuncture: Some studies suggest it may help manage menstrual irregularities and pelvic pain
• Herbal remedies: Certain herbs are traditionally used to support uterine health, though scientific evidence varies
• Mind-body practices: Techniques like yoga and meditation may help manage stress and its effects on hormonal balance
• Nutritional approaches: Specific dietary changes may support hormonal balance and uterine health

While these approaches can complement conventional treatments, it’s crucial to discuss any alternative therapies with a healthcare provider to ensure safety and efficacy.

The Role of Stress in Uterine Health

Chronic stress can have significant impacts on uterine health. High stress levels can disrupt hormonal balance, potentially leading to menstrual irregularities and exacerbating conditions like endometriosis. How can women manage stress to support uterine health? Incorporating stress-reduction techniques like regular exercise, adequate sleep, and relaxation practices can be beneficial for overall reproductive well-being.

Empowering Women: Education and Advocacy for Uterine Health

Empowering women with knowledge about their uterine health is crucial for promoting early detection and prevention of uterine conditions. Educational initiatives can focus on:

• Teaching women about normal menstrual patterns and when to seek medical attention
• Providing information about risk factors for uterine conditions and preventive measures
• Encouraging regular gynecological check-ups and screenings
• Promoting open dialogue about uterine health issues to reduce stigma

Advocacy efforts can also play a crucial role in improving uterine health care by pushing for better research funding, improved access to care, and policies that support women’s health.

The Importance of Self-Advocacy in Uterine Health

Women play a crucial role in their own uterine health care through self-advocacy. This involves being aware of one’s body, recognizing unusual symptoms, and actively participating in healthcare decisions. How can women become better self-advocates? By educating themselves about uterine health, maintaining open communication with healthcare providers, and not hesitating to seek second opinions when necessary.

In conclusion, understanding the uterus and its functions is crucial for maintaining overall reproductive health. From the dynamic changes of the endometrium during the menstrual cycle to the potential development of conditions like endometrial hyperplasia, knowledge empowers women to take proactive steps in their health care. Regular check-ups, awareness of risk factors, and prompt attention to unusual symptoms are key to maintaining uterine health. As research continues to advance, we can look forward to improved diagnostic tools and treatment options, offering hope for better management of uterine conditions and enhanced quality of life for women worldwide.

Endometrial Hyperplasia | ACOG

Cells: The smallest units of a structure in the body. Cells are the building blocks for all parts of the body.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Dilation and Curettage (D&C): A procedure that opens the cervix so tissue in the uterus can be removed using an instrument called a curette.

Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum.

Endometrial Biopsy: A procedure in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick.

Endometrial Intraepithelial Neoplasia (EIN): A precancerous condition in which areas of the lining of the uterus grow too thick.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries.

Hormone Therapy: Treatment in which estrogen and often progestin are taken to help relieve symptoms that may happen around the time of menopause.

Hormones: Substances made in the body to control the function of cells or organs.

Hysterectomy: Surgery to remove the uterus.

Hysteroscopy: A procedure in which a lighted telescope is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Menstrual Cycle: The monthly process of changes that occur to prepare a woman’s body for possible pregnancy. A menstrual cycle is defined as the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle.

Menstrual Periods: The monthly shedding of blood and tissue from the uterus.

Menstruation: The monthly shedding of blood and tissue from the uterus that happens when a woman is not pregnant.

Obesity: A condition characterized by excessive body fat.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Ovulation: The time when an ovary releases an egg.

Perimenopause: The time period leading up to menopause.

Polycystic Ovary Syndrome (PCOS): A condition that leads to a hormone imbalance that affects a woman’s monthly menstrual periods, ovulation, ability to get pregnant, and metabolism.

Progesterone: A female hormone that is made in the ovaries and prepares the lining of the uterus for pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Tamoxifen: An estrogen-blocking medication sometimes used to treat breast cancer.

Transvaginal Ultrasound Exam: A type of ultrasound in which the device is placed in your vagina.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

The uterus | Canadian Cancer Society

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   The uterus

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Diagram of the female reproductive system

Diagram of the structure of the uterus

The uterus receives a fertilized egg and protects the fetus (baby) while it grows and
develops. The uterus contracts to push the baby out of the body during birth.

Every month, except when a woman is pregnant or has reached menopause, the lining of the
uterus grows and thickens in preparation for pregnancy. If the woman doesn’t get
pregnant, the lining is shed through the cervix into the vagina and out of the body.
This is called menstruation. This process continues until menopause.

• American Cancer Society. Endometrial (Uterine) Cancer. 2015: http://www.cancer.org/acs/groups/cid/documents/webcontent/003097-pdf.pdf.

• American Society of Clinical Oncology. Uterine Cancer. 2014: http://www.cancer.net/cancer-types/uterine-cancer/view-all.

• Martini FH, Timmons MJ, Tallitsch RB. Human Anatomy. 7th ed. San Francisco: Pearson Benjamin Cummings; 2012.

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What is the endometrium? – My Clinic Riga

Endometrium is the inner mucous membrane of the uterine body that lines the uterine cavity. The thickness of the endometrium depends on the age of the woman and the phase of the menstrual cycle. When endometrial-like tissue grows outside the uterine cavity, the condition is called endometriosis.

What is the endometrium?

The wall of the uterus consists of three layers. The first is the serous membrane that covers the outside of the uterus. The second, thickest, is the muscle layer, which provides the ability of the uterus to contract. The third shell is the inner mucous layer or endometrium. It consists of connective tissue cells, epithelium, blood vessels, nerves, immune cells and glands. The endometrium changes not only with a woman’s age, but also under the influence of hormones, therefore it looks completely different at different phases of the menstrual cycle.

Woman’s age and endometrial thickness

Uterine endometrial thickness is assessed during ultrasound examination. This diagnosis is also carried out by My Clinic Riga infertility treatment clinic.

• Adolescent girls who are not yet menstruating have an endometrial thickness of 0.3 to 0.5 mm.
• In women, the thickness of the mucous membrane in the first phase of the cycle is 7-9 mm, and in the second – no more than 15 mm.
• However, in menopausal women taking hormone therapy during menopause, the thickness of the endometrium can be up to 8 mm, and in the rest – up to 5 mm.

If the thickness of the endometrium during menopause exceeds 12 mm, an examination should be carried out to rule out endometrial cancer (cancer of the body of the uterus).

Do you have any questions? Contact us!

Phases of the menstrual cycle and the endometrium

The thickness of the endometrium changes during the menstrual cycle due to changes in the levels of female sex hormones: estrogen and progesterone.

Normally, the endometrium consists of two layers:

• basal, has a constant structure,
• functional, which changes during the cycle.

The menstrual cycle begins on the first day of menstrual bleeding and ends the day before the next menses. It consists of several stages – it starts with the follicular phase, followed by ovulation, and then the luteal phase.

During menstruation, the functional layer of the endometrium peels off and is removed from the body. In the follicular phase, the period of restoration of the functional layer begins, which originates from the basal layer. During this time, the thickness of the normal endometrium increases several times, vascularization is observed and the glands increase – this is how the uterine mucosa prepares for the possible implantation of the embryo. During the ovulation phase, the endometrium continues to thicken. After the release of the egg from the Graafian vesicle, the formation of the corpus luteum begins, which is responsible for the secretion of progesterone and estrogen. Under their influence, the endometrium continues to grow. If fertilization does not occur, the corpus luteum disappears and the concentration of hormones decreases, which leads to the exfoliation of the endometrium during menstruation.

Endometrium after fertilization

Endometrium of the uterus changes its function after fertilization. Under the influence of progesterone, which is secreted by the corpus luteum, the uterine mucosa prepares for the implantation of the embryo. During this time, the tissues are saturated with nutrients to provide the embryo with everything it needs until complete implantation.

How to check the condition of the endometrium?

To check the endometrium, you should consult a gynecologist. The doctor will take a thorough medical history and will perform a transvaginal ultrasound to assess the condition and thickness of the endometrium. Normal mucous membrane is called homogeneous endometrium. If the examination shows abnormalities, the description may indicate the heterogeneity of the endometrial structure, after which the doctor will most likely refer you for further diagnosis. A biopsy of the endometrium may be recommended , i.e. taking a small piece of tissue for histopathological examination. The inside of the uterus can also be assessed using hysteroscopy. Using a hysteroscope camera, the doctor can carefully examine the cervical canal and uterine cavity, and with the help of micromanipulators can remove a small pathology or take a sample for testing.

What is endometriosis?

Endometrium is often confused with endometriosis. The endometrium is the lining of the uterus that every healthy woman has. So what is endometriosis? This is the name of the disease, which is characterized by the presence of the endometrium, that is, the presence of tissues characteristic of the uterine cavity in other organs of the body, where they shouldn’t be. With monthly endometrial detachment and bleeding, this can cause a woman severe pain. Endometriosis is also one of the main causes of female infertility. If the examination confirms the deviations, the specialist will suggest the appropriate treatment. However, endometriosis is not the only disease that affects the endometrium. Other possible diseases of the endometrium: endometritis, endometrial hypertrophy, endometrial atrophy, endometrial cancer, polyps and adhesions in the uterine cavity. In this case, appropriate treatment under the supervision of a specialist is required.

Pathology of the uterine cavity. Causes.

Home » Infertility treatment » Pathology of the uterine cavity. Causes.

The uterus is a pear-shaped muscular organ located in the small pelvis. The uterus is represented by three layers – internal (endometrium, uterine cavity mucosa), middle (myometrium, muscular layer of the uterus), external (serous, visceral peritoneum covering the uterus from the abdominal cavity).

The uterus consists of the body of the uterus and the cervix. The body of the uterus communicates with the vagina through the cervical canal of the cervix and with the abdominal cavity through the fallopian tubes. Of all three layers of the uterus, only the inner lining of the uterine body undergoes cyclic changes – the mucous membrane of the uterine cavity – the endometrium.

The endometrium is divided into 2 layers: functional (upper) and basal (lower). On the first day of menstruation, there is a sharp decrease in the level of progesterone and the rejection of the functional layer of the endometrium occurs, which is manifested by menstrual bleeding. In the first phase of the menstrual cycle (from 1 to 14-16 days of the cycle), under the action of estradiol, proliferation (thickening) of the endometrium occurs up to 11-13 mm. When a smaller size of the endometrium is reached, pregnancy is unlikely or subsequently leads to the threat of termination of pregnancy. After ovulation and due to the changing hormonal background for progesterone, the endometrium matures and prepares for the adoption of a fertilized egg. When pregnancy occurs, under the action of chorionic gonadotropin (hCG), the endometrium continues to function in order to provide the embryo with nutrients. In the absence of pregnancy, endometrial rejection occurs. There are certain limits to the thickness of the endometrium for each day of the menstrual cycle. If the thickness of the endometrium is less than normal, we can talk about thin endometrium (endometrial hypotrophy), with an increase in the size of the thickness of the endometrium, we can talk about pathological thickening of the endometrium (endometrial hyperplasia). Normally, the thickness of the endometrium in the first 2 days after the end of menstruation should be no more than 3 mm, and on periovulatory days, at least 10 mm.

Both congenital anomalies in the development of the uterus and acquired diseases of the uterine cavity are the cause of infertility.

Such developmental anomalies and diseases include the following diseases:

• Unicornuate and bicornuate uterus.
• Hypoplasia (underdevelopment) of the uterus, rudimentary uterus.
• Complete and incomplete septum of the uterine cavity.
• Pathology of the uterine cavity (endometrial hyperplasia, endometrial polyposis, endometrial polyp).
• Endometriosis of the uterus.
• Intramural uterine fibroids with centripetal growth.
• Submucosal uterine fibroids.

The above pathology occurs in 10% of cases of infertility and miscarriage.

Uterine infertility is associated with the presence of pathology not only in the endometrium, but also in the myometrium (the muscular layer of the uterus).

1. Endometrial polyp – pathological focal growth of the uterine mucosa due to inflammatory diseases of the uterine cavity (endometritis), hormonal disorders (hyperandrogenism, hyperestrogenemia, hyperprolactinemia), ovarian tumors (ovarian cysts), uterine tumors (uterine fibroids). An endometrial polyp is a pathological structure in the uterine cavity that prevents the implantation of an embryo. Sometimes the formation of an endometrial polyp occurs without obvious reasons. In this case, the formation of an endometrial polyp is due to the presence of a pathological receptor apparatus that perversely perceives the normal level of female sex hormones. When an endometrial polyp is detected in women planning a pregnancy, surgical treatment should be performed strictly with the help of hysteroresectoscopy. Hysteroresectoscopy is a method of surgical treatment of intrauterine pathology using an electric loop. Only performing hysteresectoscopy in patients of reproductive age makes it possible to avoid recurrence of the endometrial polyp and return to pregnancy planning after 2 months. During hysteroresectoscopy, the pedicle of the polyp is treated with high-frequency energy, which helps prevent the recurrence of the endometrial polyp due to its performance under visual control with high magnification. Performing the removal of a polyp by scraping the uterine cavity in women planning a pregnancy is unacceptable, as this leads to unnecessary trauma to the healthy endometrium around the polyp with the development of infertility and miscarriage.
2. Endometrial hyperplasia is a diffuse thickening of the endometrium with a change in structure that does not correspond to the day of the menstrual cycle. The cause of the development of endometrial hyperplasia is hyperestrogenism, dysfunction of the hypothalamic-pituitary system, diseases of the thyroid gland and adrenal glands. Both endometrial hyperplasia itself and the causes leading to it cause infertility. Treatment of endometrial hyperplasia consists of two stages – surgical and anti-relapse hormonal. In the surgical treatment of endometrial hyperplasia, diagnostic hysteroscopy is necessarily performed first, the diagnosis of endometrial hyperplasia is confirmed or refuted, and only then the issue of the advisability of performing therapeutic and diagnostic curettage of the uterine cavity is resolved. Anti-relapse hormonal treatment is prescribed upon receipt of the results of the histological conclusion and depending on the desire to plan a pregnancy in the near future. In the absence of adequate treatment, atypical endometrial hyperplasia occurs with the subsequent development of endometrial cancer.
3. Intrauterine synechia (adhesions in the uterine cavity) – adhesions of the anterior and posterior walls of the uterus with limitation of the volume of the uterine cavity. In this case, implantation and subsequent pregnancy becomes impossible. Most often, the cause of the development of intrauterine synechia is inflammation in the uterine cavity, trauma to the uterine cavity during abortion or curettage of the uterine cavity, endometriosis of the uterus. The destruction of intrauterine synechia is carried out by hysteroresectoscopy – in the aquatic environment under visual control using an electric loop, adhesions in the uterine cavity are dissected. With pronounced synechia in the uterine cavity, the dissection can be performed in two stages under the control of laparoscopy. After dissection of intrauterine synechia, hormone therapy is necessarily prescribed for 6 months, after which pregnancy planning is carried out.
4. Chronic endometritis is an inflammation of the uterine mucosa after an infection or traumatic interventions in the uterine cavity (complicated childbirth, accompanied by intrauterine intervention – manual examination of the uterine cavity, curettage of the uterine cavity with the remains of placental tissue). Acute endometritis is always accompanied by fever, purulent discharge from the uterine cavity, sharp sharp pains in the lower abdomen. In chronic endometritis, such a clinical picture was not noted – minor pulling or aching pains in the lower abdomen and scanty spotting spotting before and after menstruation are disturbing. The main symptom of endometritis is infertility and miscarriage. Very often, in the presence of chronic endometritis, according to ultrasound of the small pelvis, a thin endometrium is noted. Endometrium in chronic endometritis not only does not reach normal thickness, but also does not undergo cyclic changes. In order to correct endometritis before conception, it is recommended to carry out hormonal and physiotherapeutic treatment along with antibacterial and anti-inflammatory therapy.
5. Endometriosis of the uterus is the penetration and growth of the endometrium into the muscular layer of the uterus. There are diffuse and diffuse-nodular forms of adenomyosis. The main clinical symptoms in the presence of uterine endometriosis are uterine bleeding and debilitating pain in the lower abdomen. In the presence of endometriosis, leading to deformation of the uterine cavity, surgical treatment is performed followed by hormonal treatment.
6. Uterine fibroids – a benign tumor of the muscular layer of the uterus. Like submucosal uterine fibroids, large fibroids prevent pregnancy and gestation. The exact mechanism of the effect of uterine fibroids on the embryo has not been clarified. In the presence of large uterine fibroids and submucosal location, it is required to remove it before planning a pregnancy. Planning for pregnancy after removal of uterine fibroids should be carried out only after 12 months from the date of surgical treatment. Location and size have a very strong influence. In the presence of uterine fibroids of small size and its subserous location, planning of pregnancy and childbirth through the natural birth canal is possible. Most of the drugs used in IVF are contraindicated in the presence of uterine fibroids, as they cause the growth of tumors. The behavior of uterine fibroids during pregnancy is unpredictable, but most often there is an increase in myomatous nodes. In the surgical treatment of uterine fibroids in women of reproductive age, it is always possible to perform the removal of only tumors, that is, to perform a conservative myomectomy.
7. Complete and incomplete septum of the uterine cavity is a congenital anatomical change that most often interferes with the full bearing of pregnancy. When pregnancy attaches to the uterine septum in the early stages, the death of the embryo occurs due to inadequate blood supply. When planning pregnancy, the intrauterine septum is dissected using hysteroresectoscopy, followed by the appointment of hormone therapy. Planning for pregnancy after dissection of a complete or incomplete intrauterine septum should be carried out strictly after 6 months.
8. Thin endometrium can be noted as an individual feature of the patient throughout the entire menstrual cycle or develop as a result of endometritis, uterine endometriosis. Also, a thin endometrium can be the cause of impaired blood supply to the uterus or inferiority of the receptor apparatus of the uterus. In the presence of a thin endometrium, the likelihood of pregnancy is reduced. When planning a pregnancy, the thin endometrium is corrected by the use of hormonal and vascular drugs.
9. Pathology of the uterine cavity is detected and treated by hysteroscopy. This method is divided into two types: diagnostic (to confirm or refute the disease) and surgical (therapeutic). Diagnostic hysteroscopy refers to office hysteroscopy, which does not require general anesthesia. It is carried out on an outpatient basis. The cost of an operation to remove a polyp and uterine fibroids depends on the chosen treatment method, the number and size of formations, their location, comorbidities, and many other factors.