What is the uterus and its lining called. How does the uterus function in the female reproductive system. What is endometrial hyperplasia and how does it affect uterine health. What are the risk factors and treatment options for endometrial hyperplasia.

The Anatomy and Function of the Uterus

The uterus, also known as the womb, is a crucial organ in the female reproductive system. This muscular, pear-shaped organ is located in the pelvic region and plays a vital role in menstruation, pregnancy, and childbirth. But what exactly makes up the uterus, and how does it function?

The uterus consists of three main layers:

1. Perimetrium: The outer layer
2. Myometrium: The middle muscular layer
3. Endometrium: The inner lining

The endometrium is the focus of our discussion, as it undergoes significant changes throughout the menstrual cycle and is susceptible to various conditions, including endometrial hyperplasia.

What is the endometrium?

The endometrium is the innermost layer of the uterus, consisting of glandular tissue and blood vessels. This lining plays a crucial role in the menstrual cycle and pregnancy. During each menstrual cycle, the endometrium thickens in preparation for a potential pregnancy. If fertilization doesn’t occur, the thickened lining is shed during menstruation.

Endometrial Hyperplasia: When the Uterine Lining Grows Too Thick

Endometrial hyperplasia is a condition characterized by an overgrowth of the uterine lining. This thickening can lead to abnormal bleeding and, in some cases, increase the risk of developing endometrial cancer. But what causes this condition, and how can it be identified?

Causes of Endometrial Hyperplasia

The primary cause of endometrial hyperplasia is an imbalance of hormones, particularly an excess of estrogen without sufficient progesterone to counterbalance it. This imbalance can occur due to various factors:

• Obesity
• Polycystic Ovary Syndrome (PCOS)
• Perimenopause and menopause
• Certain medications, including tamoxifen
• Estrogen-secreting tumors

Symptoms and Diagnosis

The most common symptom of endometrial hyperplasia is abnormal uterine bleeding. This may include heavy periods, bleeding between periods, or postmenopausal bleeding. To diagnose the condition, healthcare providers may use several methods:

• Endometrial biopsy
• Transvaginal ultrasound
• Hysteroscopy
• Dilation and curettage (D&C)

Types of Endometrial Hyperplasia and Their Implications

Endometrial hyperplasia is classified into different types based on the presence or absence of cellular changes. Understanding these types is crucial for determining the appropriate treatment and assessing the risk of progression to endometrial cancer.

Simple Hyperplasia without Atypia

This type involves an overgrowth of the endometrium without abnormal cell changes. It has a low risk of progressing to cancer and often resolves on its own or with conservative treatment.

Complex Hyperplasia without Atypia

In this type, the endometrial glands are more crowded and irregular in shape. While the risk of cancer progression is higher than in simple hyperplasia, it’s still relatively low.

Atypical Hyperplasia (Simple or Complex)

When atypical cells are present, the risk of progression to endometrial cancer increases significantly. This type requires more aggressive treatment and close monitoring.

Risk Factors for Endometrial Hyperplasia

Several factors can increase a woman’s risk of developing endometrial hyperplasia. Identifying these risk factors can help in early detection and prevention of the condition.

Hormonal Factors

• Estrogen-only hormone therapy
• Late menopause
• Never having been pregnant
• Irregular menstrual cycles

Health Conditions

• Obesity
• Diabetes mellitus
• Polycystic ovary syndrome (PCOS)
• Thyroid disorders

Lifestyle Factors

• Sedentary lifestyle
• High-fat diet
• Smoking

Treatment Options for Endometrial Hyperplasia

The treatment for endometrial hyperplasia depends on the type of hyperplasia, the woman’s age, overall health, and desire for future fertility. What are the main approaches to managing this condition?

Hormonal Therapy

Progestin therapy is often the first-line treatment for endometrial hyperplasia without atypia. This can be administered in various forms:

• Oral progestin pills
• Progestin-containing intrauterine device (IUD)
• Progestin injections

Surgical Options

For atypical hyperplasia or cases that don’t respond to hormonal therapy, surgical intervention may be necessary:

• Hysterectomy: Complete removal of the uterus
• Endometrial ablation: Destruction of the endometrial lining

Preventing Endometrial Hyperplasia: Lifestyle Changes and Regular Check-ups

While not all cases of endometrial hyperplasia can be prevented, certain lifestyle changes and regular medical check-ups can help reduce the risk and catch any issues early.

Maintaining a Healthy Weight

Obesity is a significant risk factor for endometrial hyperplasia. By maintaining a healthy weight through diet and exercise, women can significantly reduce their risk of developing this condition.

Regular Exercise

Physical activity helps regulate hormones and maintain a healthy weight. Aim for at least 150 minutes of moderate-intensity exercise per week.

Balanced Diet

A diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain hormonal balance and overall health.

Regular Gynecological Check-ups

Annual visits to an obstetrician-gynecologist (OB-GYN) can help detect any abnormalities early. Women should report any unusual bleeding or changes in their menstrual cycle promptly.

The Connection Between Endometrial Hyperplasia and Endometrial Cancer

While endometrial hyperplasia is not cancer, it can be a precursor to endometrial cancer in some cases. Understanding this connection is crucial for proper management and prevention of more serious conditions.

Risk of Progression

The risk of endometrial hyperplasia progressing to cancer varies depending on the type:

• Simple hyperplasia without atypia: Less than 5% risk
• Complex hyperplasia without atypia: 5-10% risk
• Atypical hyperplasia (simple or complex): 20-50% risk

Monitoring and Follow-up

Women diagnosed with endometrial hyperplasia require close monitoring and follow-up care. This may include:

• Regular endometrial biopsies
• Frequent ultrasound examinations
• Ongoing hormonal therapy

Early detection and proper management of endometrial hyperplasia can significantly reduce the risk of progression to endometrial cancer.

Endometrial Hyperplasia in Special Populations

Certain groups of women may require special consideration when it comes to endometrial hyperplasia. How does this condition affect women in different life stages or with specific health conditions?

Postmenopausal Women

In postmenopausal women, any vaginal bleeding is abnormal and should be evaluated promptly. Endometrial hyperplasia in this population often requires more aggressive treatment due to the increased risk of endometrial cancer.

Women with PCOS

Women with polycystic ovary syndrome (PCOS) have a higher risk of developing endometrial hyperplasia due to chronic anovulation and hormonal imbalances. Regular screening and proactive management are crucial for this group.

Young Women and Fertility Preservation

For young women who wish to preserve their fertility, conservative management of endometrial hyperplasia is often preferred. This may involve hormonal therapy and close monitoring rather than surgical intervention.

Understanding the uterus and conditions like endometrial hyperplasia is crucial for women’s health. By recognizing the symptoms, understanding the risk factors, and seeking timely medical attention, women can protect their reproductive health and overall well-being. Regular check-ups, a healthy lifestyle, and open communication with healthcare providers are key to maintaining a healthy uterus and preventing complications like endometrial hyperplasia and endometrial cancer.

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

1. Home

2. org/ListItem”>

   Cancer information

3. Cancer types

4. Uterine

5. What is uterine cancer

6. org/ListItem” aria-current=”page”>

   The uterus

1. Home

2. Cancer information

3. Cancer types

4. org/ListItem”>

   Uterine

5. What is uterine cancer

6. The uterus

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.

Our enewsletter

Enter your email to receive occasional news and important updates!

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.