What is the uterus and how does it function. How does the uterine lining change throughout the menstrual cycle. What are common uterine conditions and their symptoms. How is endometrial hyperplasia diagnosed and treated. What factors increase the risk of uterine cancer. How can women maintain optimal uterine health.

Anatomy and Function of the Uterus

The uterus, also known as the womb, is a crucial organ in the female reproductive system. Located in the pelvic region, this muscular organ plays a vital role in menstruation, pregnancy, and childbirth. But what exactly is the uterus made of, and how does it function?

The uterus consists of three main layers:

• Perimetrium: The outer layer that covers the uterus
• Myometrium: The middle muscular layer
• Endometrium: The inner lining of the uterus

The endometrium is of particular importance as it undergoes significant changes throughout the menstrual cycle. During each cycle, the endometrium thickens in preparation for a potential pregnancy. If fertilization does not occur, this lining is shed during menstruation.

The Role of Hormones in Uterine Function

Hormones play a crucial role in regulating uterine function. Estrogen and progesterone, produced primarily by the ovaries, work in tandem to control the menstrual cycle and prepare the uterus for pregnancy. Estrogen promotes the growth of the endometrium, while progesterone helps maintain it during the latter part of the cycle and early pregnancy.

The Menstrual Cycle and Endometrial Changes

The menstrual cycle is a complex process that prepares the female body for potential pregnancy. But how does the endometrium change throughout this cycle?

1. Menstrual phase: The endometrium is shed if pregnancy doesn’t occur
2. Proliferative phase: Estrogen stimulates the regrowth of the endometrium
3. Secretory phase: Progesterone causes the endometrium to thicken and become more vascular
4. If pregnancy doesn’t occur, the cycle begins again

Understanding these changes is crucial for women’s health, as irregularities in the menstrual cycle can indicate underlying health issues.

Endometrial Hyperplasia: Causes and Risk Factors

Endometrial hyperplasia is a condition characterized by an overgrowth of the uterine lining. This condition can develop when there’s an imbalance of hormones, particularly an excess of estrogen without sufficient progesterone to counterbalance it. But what factors contribute to this hormonal imbalance?

• Obesity: Excess body fat can lead to increased estrogen production
• Polycystic Ovary Syndrome (PCOS): This condition often results in irregular ovulation and hormonal imbalances
• Perimenopause and menopause: Hormonal fluctuations during these stages can lead to endometrial hyperplasia
• Certain medications: Estrogen replacement therapy without progesterone can increase the risk
• Diabetes: Women with diabetes may have higher levels of estrogen

Recognizing these risk factors is crucial for early detection and prevention of endometrial hyperplasia.

Symptoms and Diagnosis of Endometrial Hyperplasia

Endometrial hyperplasia often presents with specific symptoms, but how can women recognize them? The most common sign is abnormal uterine bleeding, which may include:

• Heavier or longer menstrual periods
• Bleeding between periods
• Postmenopausal bleeding

If these symptoms occur, it’s essential to consult an obstetrician-gynecologist (Ob-Gyn) for a proper diagnosis. The diagnostic process typically involves:

1. Physical examination
2. Transvaginal ultrasound to assess endometrial thickness
3. Endometrial biopsy to examine the uterine lining cells
4. Hysteroscopy for a direct view of the uterine cavity

Early diagnosis is crucial as endometrial hyperplasia can sometimes progress to endometrial cancer if left untreated.

Treatment Options for Endometrial Hyperplasia

The treatment of endometrial hyperplasia depends on several factors, including the severity of the condition and the patient’s desire for future fertility. What are the main treatment options available?

• Progestin therapy: Oral medications or intrauterine devices (IUDs) to balance hormones
• Hormone therapy: Combination of estrogen and progestin for menopausal women
• Hysterectomy: Surgical removal of the uterus for severe cases or when fertility is not a concern
• Endometrial ablation: Destruction of the uterine lining for less severe cases

The choice of treatment should be made in consultation with a healthcare provider, considering the individual’s specific circumstances and health goals.

Monitoring and Follow-up Care

After treatment, regular follow-up appointments are crucial to monitor the condition and prevent recurrence. These may include periodic endometrial biopsies or ultrasounds to ensure the effectiveness of the treatment.

The Link Between Endometrial Hyperplasia and Uterine Cancer

Endometrial hyperplasia, particularly when left untreated, can increase the risk of developing uterine cancer. But how significant is this risk, and what factors influence it?

The risk of progression to cancer depends on the type of endometrial hyperplasia:

• Simple hyperplasia without atypia: Less than 5% risk of developing into cancer
• Complex hyperplasia without atypia: 5-10% risk of cancer progression
• Simple or complex hyperplasia with atypia: 20-50% risk of cancer progression

Understanding these risks underscores the importance of early detection and appropriate management of endometrial hyperplasia.

Risk Factors for Uterine Cancer

Several factors can increase a woman’s risk of developing uterine cancer, including:

• Age: Most cases occur in women over 50
• Obesity: Increases estrogen levels in the body
• Hormone replacement therapy: Especially estrogen without progesterone
• Never having been pregnant
• Late menopause
• Certain medical conditions like PCOS or diabetes

Being aware of these risk factors can help women make informed decisions about their health and screening options.

Maintaining Uterine Health: Prevention and Lifestyle Factors

Maintaining optimal uterine health is crucial for overall well-being and reproductive health. But what steps can women take to promote uterine health and reduce the risk of conditions like endometrial hyperplasia and uterine cancer?

• Maintain a healthy weight: Obesity is a significant risk factor for uterine conditions
• Regular exercise: Helps maintain hormonal balance and overall health
• Balanced diet: Rich in fruits, vegetables, and whole grains
• Regular check-ups: Annual gynecological exams can detect issues early
• Hormonal balance: Discuss hormone therapy options with a healthcare provider if needed
• Manage chronic conditions: Proper control of diabetes and other health issues is essential

By incorporating these lifestyle factors and maintaining regular medical care, women can significantly reduce their risk of uterine health issues.

The Importance of Regular Screenings

Regular screenings play a crucial role in early detection of uterine abnormalities. These may include:

1. Pelvic exams
2. Pap smears
3. Transvaginal ultrasounds for high-risk individuals
4. Endometrial biopsies when indicated

Women should discuss appropriate screening schedules with their healthcare providers based on their individual risk factors and medical history.

Emerging Research and Future Directions in Uterine Health

The field of uterine health is continuously evolving, with new research shedding light on various aspects of uterine function and disease. What are some of the emerging areas of study in this field?

• Genetic markers: Identifying genetic predispositions to uterine conditions
• Targeted therapies: Developing more precise treatments for endometrial hyperplasia and cancer
• Hormonal influences: Further understanding the complex interplay of hormones in uterine health
• Fertility preservation: Exploring options for maintaining fertility in women with uterine conditions
• Minimally invasive techniques: Advancing diagnostic and treatment procedures with less invasive methods

These areas of research hold promise for improving diagnosis, treatment, and prevention of uterine conditions in the future.

The Role of Personalized Medicine

Personalized medicine is becoming increasingly important in the field of uterine health. This approach takes into account individual genetic, environmental, and lifestyle factors to tailor prevention and treatment strategies. As research progresses, we can expect more personalized approaches to uterine health management, potentially leading to better outcomes and quality of life for women affected by uterine conditions.

In conclusion, understanding the uterus and its functions is crucial for women’s health. From the basic anatomy to complex conditions like endometrial hyperplasia, knowledge empowers women to make informed decisions about their health. Regular check-ups, healthy lifestyle choices, and awareness of risk factors all contribute to maintaining optimal uterine health. As research continues to advance, we can look forward to more effective and personalized approaches to uterine health care, ultimately improving outcomes 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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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.