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What is the uterine lining called: endometrium | anatomy | Britannica


Risks and causes of womb cancer

Womb cancer is the 4th most common cancer in women in the UK. We don’t know what causes most womb cancers. But there are some factors that can increase your risk of developing it.

What is a risk factor?

Anything that increases your risk of getting a disease is called a risk factor. Different cancers have different risk factors.

Having a risk factor does not necessarily mean that you will develop cancer. Also, not having any risk factors does not mean that you definitely won’t get cancer.

Some factors lower your risk of cancer and are known as protective factors.


The risk of womb cancer increases with age. Most women diagnosed with womb cancer have had their menopause. And almost three quarters of cases of womb cancer are in women aged 40 to 74. 

Being overweight

Being overweight or obese is the biggest preventable risk factor of womb cancer. Being overweight or obese causes around a third of womb cancers. 

Higher levels of oestrogen

Overweight women have higher levels of oestrogen. Fat cells convert hormones into a type of oestrogen. So the more body fat you have, generally the more oestrogen you produce. When more oestrogen is produced, the lining of the womb builds up. When more lining (endometrial) cells are produced, there is a greater chance of one of them becoming cancerous.


Oestrogen is a female hormone. Before the menopause the ovaries make most of the oestrogen a woman needs. Along with another female hormone called progesterone it regulates womens reproductive cycle. 

After the menopause the ovary stops producing hormones. But the body continues to make a small amount of oestrogen. Fat cells also make oestrogen. 

Oestrogen causes the cells in the womb to divide increasing the risk of mistakes being made. So anything that increases the amount of oestrogen in your body increases your risk of womb cancer.

Hormone replacement therapy (HRT)

There are different types of hormone replacement therapy (HRT). Oestrogen only HRT increases the risk of womb cancer. Because of this, doctors normally only prescribe oestrogen only HRT for women who have had surgery to remove their womb (a hysterectomy). 

Combined HRT contains the hormones oestrogen and progesterone. There is evidence that the progesterone part can counteract the cancer causing effects of the oestrogen part. But it depends on the type of combined HRT you take. 


Tamoxifen is a hormone therapy for some types of breast cancer. It can increase womb cancer risk, as it is thought to have a similar effect to oestrogen on the womb. This is a rare side effect of taking it.

And the benefits of taking tamoxifen as part of your treatment for breast cancer outweigh the small risk of womb cancer.

If you are taking tamoxifen, tell your doctor if you have:

  • unexpected vaginal bleeding
  • vaginal bleeding after your periods have stopped 


Several studies show a higher risk of womb cancer in women with diabetes, for both Type 1 and Type 2. This link may be due to being overweight and we need more research to find out about why it increases risk.

Thickened womb lining

Endometrial hyperplasia is a non cancerous (benign) condition where the lining of the womb becomes thicker. You have a higher risk of developing womb cancer if you have this thickening, especially if the extra lining cells are abnormal.

Symptoms of endometrial hyperplasia are heavy periods, bleeding between periods, and bleeding after menopause.

Polycystic ovary syndrome

Women with polycystic ovary syndrome (PCOS) have a hormone imbalance which may cause very irregular periods. Women with PCOS have an increased risk of womb cancer compared to women who don’t have PCOS. The cause of the increase is unclear but it may be due to the hormone imbalance.  

Polycystic ovary syndrome is also linked with insulin resistance, being overweight and type 2 diabetes. These are risk factors for womb cancer. 

Menstrual history

Some factors linked with periods (menstruation) can increase your risk of womb cancer because they cause higher levels of oestrogen. These include: 

  • starting your period at a young age
  • a late menopause

Family History

Research has shown that daughters of women with womb cancer have double the risk of women in the general population.

If you have several close relatives on the same side of the family who have had bowel cancer or womb cancer you may be at increased risk of womb cancer.

Lynch syndrome is an inherited faulty gene linked with an increased risk of some cancers, including bowel cancer and womb cancer. Out of every 100 women who carry this gene fault, 40 to 60 will develop womb cancer at some point in their lives. 

Having had children decreases your risk

Studies show having children lowers womb cancer risk by around a third. The risk decreases with the more children a women has. 

Oestrogen levels are low and progesterone levels are high during pregnancy. During the menstrual cycle, there is oestrogen in the body without progesterone. This is called unopposed oestrogen. 

Unopposed oestrogen increases womb cancer risk. So anything that stops this (such as pregnancy) lowers the risk of womb cancer. 

The contraceptive pill is linked to a reduced risk

The combined pill, the most common type of birth control pill, is linked with a reduced risk of womb cancer. These protective effects are bigger the longer a woman takes the combined pill for. They can continue for decades after she stops taking it. 

Using a non hormonal intrauterine device (IUD or coil) has also been linked with a decreased risk of womb cancer.

Diet and alcohol

Studies have looked at whether diet could affect womb cancer risk. At the moment there are no convincing dietary factors that directly increase or decrease your womb cancer risk. But a healthy diet helps you keep a healthy weight, which in turn reduces the risk of womb cancer. 

Coffee has also been linked to a reduced womb cancer risk. But overall the evidence is not strong.

An analysis of studies hasn’t shown a link between drinking alcohol and the risk of womb cancer. But alcohol increases the risk of many other types of cancer. 

Physical activity

The World Cancer Research Fund has listed physical activity as probably being protective against womb cancer. 

This link may partly be because women who are more active have a lower body weight. Being physically active also helps to control hormones in the body, such as oestrogen and insulin. 

Other possible causes

Stories about potential causes of cancer are often in the media and it isn’t always clear which ideas are supported by evidence. There might be things you have heard of that we haven’t included here. This is because either there is no evidence about them or it is less clear.

Reducing your risk

There are ways you can reduce your risk of cancer.

For detailed information on womb cancer risks and causes

Endometrial Ablation | Johns Hopkins Medicine

What is an endometrial ablation?

Endometrial ablation is a procedure to remove a thin layer of tissue
(endometrium) that lines the uterus. It is done to stop or reduce heavy
menstrual bleeding. But it is only done on women who do not plan to have
any children in the future.

The procedure is not surgery, so you will not have any cut (incision).
Instead your healthcare provider puts small tools through your vagina to
reach your uterus. Your provider has several ways to do the procedure. He
or she can use:

  • Electricity (electrical or electrocautery).
    In this method, your provider uses an electric current that travels
    through a wire loop or roller ball. The current is put on the uterus
    lining to destroy it.
  • Fluids (hydrothermal).
    This method uses heated fluid. It is pumped into the uterus to destroy
    the lining.
  • Balloon therapy.
    Your health care provider puts a thin tube (catheter) into the uterus.
    The catheter has a balloon at the end. Your provider fills the balloon
    with fluid and heats it. The heated fluid destroys the lining.
  • High-energy radio waves (radiofrequency ablation).
    In this method, your provider puts an electrical mesh into the uterus.
    He or she expands it. Then your provider sends an electrical current
    made by radio waves to destroy the lining.
  • Cold (cryoablation).
    Your provider uses a probe with very cold temperature to freeze the
  • Microwaves (microwave ablation).
    Your provider sends microwave energy through a thin probe to destroy
    the lining.

Some endometrial ablations are done using a tool called a hysteroscope.
This tool lets your provider see the inside of your uterus. He or she can
use a camera on the tool to record what is seen.

Why might I need an endometrial ablation?

You may decide to have endometrial ablation if you have heavy or long
periods. You may also have it for bleeding between periods (abnormal
uterine bleeding). In some cases, the bleeding may be so heavy that it
affects your daily activities and causes a low blood count (anemia) because
of it.

Heavy bleeding is described as bleeding that requires changing sanitary
pads or tampons every hour. Long periods are described as lasting longer
than 7 days.

Menstrual bleeding problems may be caused by hormone problems. This is
especially true for women nearing menopause or after menopause. Other
causes include abnormal tissues such as fibroids, polyps, or cancer of the
endometrium or uterus.

Endometrial ablation lessens menstrual bleeding or stops it completely. You
may not be able to get pregnant after endometrial ablation. This is because
the endometrial lining, where the egg implants after being fertilized, has
been removed. Pregnancies that occur after an endometrial ablation are not
normal, therefore it is important to use a reliable form of birth control.
You will still have your reproductive organs.

Your healthcare provider may have other reasons to suggest endometrial

What are the risks of an endometrial ablation?

Possible complications of endometrial ablation include:

  • Bleeding
  • Infection
  • Tearing of the uterine wall or bowel
  • Overloading of fluid into the bloodstream

Tell your healthcare provider if you are:

  • Allergic to or sensitive to medicines, iodine, or latex
  • Pregnant or think you could be. Endometrial ablation during pregnancy
    may lead to miscarriage.

You may have other risks based on your condition. Be sure to discuss any
concerns with your healthcare provider before the procedure.

You may not be able to have an endometrial ablation if you have:

  • Vaginal or cervical infection
  • Pelvic inflammatory disease
  • Cervical, endometrial, or uterine cancer
  • Recent pregnancy
  • Weakness of the uterine muscle wall
  • Intrauterine device (IUD)
  • Past uterine surgery for fibroids
  • Classic or vertical C-section incision
  • Abnormal structure or shape of the uterus

Certain things can make it harder to do certain types of endometrial
ablation. These include:

  • Narrowing of the inside of the cervix
  • Short length or large size of uterus

How do I get ready for an endometrial ablation?

  • Your healthcare provider will explain the procedure to you. Ask him or
    her any questions you have about the procedure.
  • You may be asked to sign a consent form that gives permission to do the
    procedure. Read the form carefully and ask questions if anything is
  • You will be asked to stop eating and drinking (fast) for 8 hours before
    the test. This usually means after midnight.
  • Tell your provider if you are pregnant or think you may be pregnant.
  • Tell your healthcare provider if you are sensitive to or are allergic
    to any medicines, latex, tape, or anesthetic drugs (local and general).
  • Tell your provider about all medicines you are taking. This includes
    prescriptions, over-the-counter medicines, and herbal supplements.
  • Tell your healthcare provider if you have had a bleeding disorder. Also
    tell your provider if you are taking blood-thinning medicine
    (anticoagulant), aspirin, or other medicines that affect blood
    clotting. You may need to stop these medications before the procedure.
  • Your healthcare provider may prescribe medicines to help thin the
    endometrial tissues to get ready for the procedure. You may need to
    take the medicines for several weeks before the procedure.
  • You may be given medicine to help you relax. Because the medicine may
    make you sleepy, you will need to have someone to drive you home.
  • You may want to bring a sanitary pad to wear home after the procedure.
  • Follow any other instructions your provider gives you to get ready.

What happens during an endometrial ablation?

You may have an endometrial ablation in your healthcare provider’s office,
as an outpatient, or during a hospital stay. The way the test is done may
vary depending on your condition and your healthcare provider’s practices.

The type of anesthesia will depend on the procedure being done. It may be
done while you are asleep under general anesthesia. Or it may be done while
you are awake under spinal or epidural anesthesia. If spinal or epidural
anesthesia is used, you will have no feeling from your waist down. The
anesthesiologist will watch your heart rate, blood pressure, breathing, and
blood oxygen level during the procedure.

Generally, an endometrial ablation follows this process:

For ablations using a hysteroscope

  1. You will be asked to remove clothing. You will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. You will lie on an operating table, with your feet and legs supported
    as for a pelvic exam.
  4. Your healthcare provider may put a catheter into your bladder to drain
  5. Your healthcare provider will put a tool (speculum) into your vagina.
    He or she will use it to widen your vagina and see the cervix.
  6. Your provider will clean your cervix with an antiseptic solution.
  7. Your provider may use a type of forceps to hold the cervix steady for
    the procedure.
  8. Your provider will open the cervix by putting in thin rods. Each rod
    will have a wider diameter than the previous one. This process will
    gradually make the cervix opening larger so your provider can put in
    the hysteroscope.
  9. Your healthcare provider will put the hysteroscope through the cervical
    opening and into the uterus.
  10. Your provider may use a liquid or carbon dioxide gas to fill the
    uterus. This will help him or her see it better.
  11. Your provider will put the ablation tool through the hysteroscope. He
    or she will move a roller ball or wire loop with electrical current
    across the uterus lining. This will destroy it.
  12. For hydrothermal ablation, your provider will put a heated liquid into
    the uterus through a catheter. The liquid is pumped around your uterus
    to destroy the lining.
  13. After the procedure is done, your provider will pump any fluid out from
    your uterus and remove the instrument.

For other types of ablations

  1. You will be asked to remove clothing. You will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. You will lie on a procedure table, with your feet and legs supported as
    for a pelvic exam.
  4. Your healthcare provider will put a tool (speculum) into your vagina.
    He or she will use it to widen your vagina and see the cervix.
  5. Your provider will clean your cervix with an antiseptic solution.
  6. The healthcare provider will numb the area using a small needle to
    inject medicines.
  7. Your provider will insert a thin, rod-like tool (uterine sound) through
    the cervical opening. This is to find out how long your uterus and
    cervical canal are. The tool may cause some cramping. The tool will
    then be removed.
  8. With balloon ablation, your provider will put a small balloon through
    the cervical opening and into your uterus. He or she will put hot
    liquid into the balloon to destroy the uterus lining. A computer will
    control the pressure, temperature, and time of the treatment. This may
    cause some mild to strong cramping.
  9. With radiofrequency ablation, your provider will put a special mesh
    through the cervical opening. He or she will expand it to fill the
    uterus. Radio wave energy will be passed into the mesh. This will
    destroy the uterus lining. Suction helps remove liquids, steam, and
    other gases that will be made during ablation. This may cause some mild
    to strong cramping.
  10. For cryoablation, your provider will put a special probe through the
    cervical opening and into the uterus. He or she will place an
    ultrasound transducer on your abdomen. This will guide the cryoablation
    probe to the right areas in the uterus for freezing. This may cause
    some mild to strong cramping.
  11. When the procedure is done, your provider will remove the tools.

What happens after an endometrial ablation?

The recovery process will vary, depending on what type of ablation you had
and the type of anesthesia used.

If you had spinal, epidural or general anesthesia, you will be taken to the
recovery room. Once your blood pressure, pulse, and breathing are stable
and you are alert, you will be taken to your hospital room or sent home. If
you had the procedure as an outpatient, plan to have someone else drive you

If you did not get anesthesia, you will need to rest for about 2 hours
before going home.

You may want to wear a sanitary pad for bleeding. It is normal to have
vaginal bleeding for a few days after the procedure. You may also have a
watery-bloody discharge for several weeks.

You may have strong cramping, nausea, vomiting, or the need to urinate
often for the first few days after the procedure. Cramping may continue for
a longer time.

Do not to douche, use tampons, or have sex for 2 to 3 days after an
endometrial ablation, or as advised by your health care provider.

You may also have other limits on your activity. These may include no
strenuous activity or heavy lifting.

You may go back to your normal diet unless your healthcare provider tells
you otherwise.

Take a pain reliever for cramping or soreness as recommended by your
healthcare provider. Aspirin or certain other pain medicines may increase
the chance of bleeding and should not be taken. Be sure to take only
recommended medicines.

Your healthcare provider will tell you when to return for more treatment or

Tell your healthcare provider if any of these occur:

  • Foul-smelling drainage from your vagina
  • Fever or chills
  • Severe abdominal pain
  • Heavy bleeding, or heavy bleeding longer than 2 days after the
  • Trouble urinating

Your healthcare provider may give you other instructions after the
procedure, based on your situation.

Talk with your healthcare provider about appropriate types of birth control
for you.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or
  • How much will you have to pay for the test or procedure

What is Menstruation? | Get Facts About Having Your Period

What is menstruation?

Menstruation — aka having your period — is when blood and tissue from your uterus comes out of your vagina. It usually happens every month.

What’s the menstrual cycle?

Your menstrual cycle helps your body prepare for pregnancy every month. It also makes you have a period if you’re not pregnant. Your menstrual cycle and period are controlled by hormones like estrogen and progesterone. Here’s how it all goes down:

You have 2 ovaries, and each one holds a bunch of eggs. The eggs are super tiny — too small to see with the naked eye.

During your menstrual cycle, hormones make the eggs in your ovaries mature — when an egg is mature, that means it’s ready to be fertilized by a sperm cell. These hormones also make the lining of your uterus thick and spongy. So if your egg does get fertilized, it has a nice cushy place to land and start a pregnancy. This lining is made of tissue and blood, like almost everything else inside our bodies. It has lots of nutrients to help a pregnancy grow.

About halfway through your menstrual cycle, your hormones tell one of your ovaries to release a mature egg — this is called ovulation. Most people don’t feel it when they ovulate, but some ovulation symptoms are bloating, spotting, or a little pain in your lower belly that you may only feel on one side.

Once the egg leaves your ovary, it travels through one of your fallopian tubes toward your uterus.

If pregnancy doesn’t happen, your body doesn’t need the thick lining in your uterus. Your lining breaks down, and the blood, nutrients, and tissue flow out of your body through your vagina. Voilà, it’s your period!

If you do get pregnant, your body needs the lining — that’s why your period stops during pregnancy. Your period comes back when you’re not pregnant anymore.

When in life do periods start and stop?

At some point during puberty, blood comes out of your vagina, and that’s your first period. Most people get their first period between ages 12 and 14, but some people get them earlier or later than that. There’s no way to know exactly when you’ll get it, but you may feel some PMS symptoms (link to PMS section) a few days before it happens.

If you don’t get your period by the time you’re 16, it’s a good idea to visit a doctor or nurse. Read more about getting your first period.

Most people stop getting their period when they’re between 45 and 55 years old — this is called menopause. Menopause can take a few years, and periods usually change gradually during this time. After menopause is totally complete, you can’t get pregnant anymore. Read more about menopause.

Your period may start and stop around the time it did for other people you’re related to, like your mom or sisters.

Do transgender guys get a period?

Not everybody who gets a period identifies as a girl or woman. Transgender men and genderqueer people who have uteruses, vaginas, fallopian tubes, and ovaries also get their periods.

Having a period can be a stressful experience for some trans folks because it’s a reminder that their bodies don’t match their true gender identity — this discomfort and anxiety is sometimes called gender dysphoria. Other trans people might not be too bothered by their periods. Either reaction is normal and okay.

Sometimes trans people who haven’t reached puberty yet take hormones (called puberty blockers) to prevent all of the gendered body changes that happen during puberty, including periods. And people who already get periods can use certain types of birth control (like the implant or hormonal IUD) that help lighten or stop their periods. Hormone replacement therapy, like taking testosterone, may also stop your period.

If you start taking testosterone, your period will go away. But this is reversible — if you stop taking testosterone, your period will come back. There can be some changes in your menstrual cycle before it stops for good. Periods get lighter and shorter over time, or come when you don’t expect it. You may have spotting or cramping every once in a while until you stop getting your period, and sometimes even after it seems to have stopped — this is normal. Testosterone injections make your periods go away faster than testosterone cream.

If you experience gender dysphoria when you get your period, know that you’re not alone. It may be helpful to check out our resources and find a trans-friendly doctor in your area that you can talk to.

When can I get pregnant during my menstrual cycle?

You have the highest chance of getting pregnant on the days leading up to ovulation (when your ovary releases a mature egg) — these are called fertile days.

Ovulation usually happens about 14 days before your period starts — but everyone’s body is different. You may ovulate earlier or later, depending on the length of your menstrual cycle.

Your egg lives for about 1 day after it’s released from your ovary, and sperm can live in your uterus and fallopian tubes for about 6 days after sex. So you can usually get pregnant for around 6 days of every menstrual cycle: the 5 days before you ovulate, and the day you ovulate. You can also get pregnant a day or so after ovulation, but it’s less likely.

Many people track their menstrual cycles and other fertility signs to help them figure out when they’re ovulating. This is called fertility awareness — some people use it to prevent pregnancy, and others use it to try to get pregnant. Check out our app, which makes it easy to chart your cycle and figure out your fertile days.

Some people have very regular cycles, and other people’s cycles vary from month to month. It’s really common for young people to have irregular periods. Since your period can be unpredictable, it’s hard to know for sure when you’ll ovulate (even if you’re carefully tracking your menstrual cycle). So if you don’t want to get pregnant, use birth control every time you have vaginal sex.

More questions from patients:

What are the menstrual cycle phases?

Your menstrual cycle is your body’s way of preparing for pregnancy every month. It also makes you have a period if you’re not pregnant. Your menstrual cycle is controlled by hormones like estrogen and progesterone.

These are the menstrual cycle phases:


The 1st day of your menstrual cycle starts on the 1st day of your period (AKA menstruation). During your period, blood and tissue from the lining of your uterus flows out of your vagina. If you get your period, it means you didn’t get pregnant during your last cycle. Your uterus doesn’t need the lining to grow a pregnancy, so it sheds the lining.

Follicle Growth

This is when your body starts getting ready for the release of an egg. You have 2 ovaries, and each one holds a bunch of eggs. During your period, follicles (pockets) in your ovaries are stimulated to grow — there’s 1 egg in each of these follicles. During the week or so after your period ends, 1 of the eggs becomes totally mature each month. When an egg is mature, it means it’s ready to be fertilized by a sperm cell.

During this week after your period ends, the lining of your uterus starts getting thick and spongy again — which would either support a pregnancy, or get released through your vagina at the beginning of your next cycle (AKA your period).


During ovulation, the most mature egg is released from the follicle, out of the ovary. Once the egg leaves your ovary, it moves through one of your fallopian tubes towards your uterus. This takes several days. The egg waits for a sperm cell in the uterus for about 24 hours before it dissolves. Because sperm can hang out in the fallopian tubes for several days, pregnancy is most likely from sex that happens in the 6 days leading up to, and including, ovulation.

If your regular menstrual cycle is 28 days long, ovulation usually happens around day 14 — the halfway point in your cycle, about 2 weeks before your period. But everyone’s cycle is different, so it can be really hard to predict when you’ll be ovulating.

Luteal Phase

In the luteal phase, the empty follicle in your ovary (where the egg leaves) makes hormones that tell the lining of your uterus to get ready for a fertilized egg.

If pregnancy doesn’t happen, your body releases hormones that cause the uterine lining to break down. Eventually it flows out of the body, at which point you get your next period — and a new menstrual cycle starts.

Your menstrual cycle lasts from the first day of your period to the first day of your next period. A normal cycle can be as short as 21 days or longer than 35. This makes the average 28 days, but tons of people don’t have a 28 day cycle. The number of days in your cycle can vary from month to month too.

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Menstrual Cycle & Periods | CU Medicine OB-GYN East Denver

Quick look at the menstrual cycle and periods

A woman’s period, or menstruation, is when the lining of the womb sheds, along with blood, exiting through the vagina. When these periods occur regularly, this is referred to as the menstrual cycle.

A period happens if egg fertilization does not occur. This menstruation usually lasts 3-5 days. The average menstrual cycle lasts 28 days, but can range from 21-45 days depending on the woman’s age.

The cause of the monthly period is related to the changes a woman’s body undergoes in ovulating an egg roughly once a month for possible reproduction.

Various treatment options are available for the many women experiencing abnormal (heavy, irregular or painful) periods and other issues.

Why women have periods & what happens to her body

A woman’s period is related to the changes her body undergoes in ovulating an egg for possible fertilization. The period, or menstruation, is when she sheds the lining of the uterus and other blood after her ovulated egg is not fertilized. The uterine lining is no longer needed for an embryo to implant to for pregnancy. When the periods occur with regularity, this is called the menstrual cycle.

Women’s ovaries are in the lower part of the abdomen located on either side of the uterus. The ovaries start to produce hormones around puberty, which causes changes to the lining of the uterus (womb). The period, which is the shedding of the lining, is known as menstruation. For most women, the menstrual period occurs once a month and lasts from three to five days.

The menstrual cycle provides the hormones estrogen and progesterone, which rise and fall during the month to control the cycle. The average menstrual cycle lasts 28 days. But in adults it can range anywhere from 21 to 35 days, and in teens can range from 21 to 45 days.

Estrogen levels begin to rise in the first half of the cycle, which prompts the lining of the uterus to grow and thicken. This lining nourishes the embryo if a pregnancy occurs. During this same time frame, an egg in one of the ovaries begins to mature.

About half way through the menstrual cycle ovulation takes place. Ovulation is when the egg leaves the ovary. The egg will then begin traveling through the fallopian tube toward the uterus. During this time, hormone levels continue to rise and help prepare the wall of the uterus for pregnancy. Women are most likely to get pregnant during the three days prior to, or on the day of ovulation.

Pregnancy occurs if the egg is fertilized by a man’s sperm and the resulting embryo attaches to the uterine wall. If the egg is not fertilized, hormone levels drop, which signals for the next menstrual cycle to begin and the egg will be shed with the uterine lining in the next period.

Is my period normal?

Everyone’s period is different. The amount of blood, called the menstrual flow, could be light, moderate or heavy. The length of the period also varies in women, with most periods lasting between three and five days. As a woman matures, her cycle tends to shorten and become more regular.

In the United States, the average age a girl starts her period is 12, but it can start as early as 8 or as late as 15. The first period tends to start about two years after a girl’s breasts begin to develop. If a girl has not started her period by age 15 or two to three years since breast growth started, she should make an appointment with her healthcare provider.

A woman usually has her periods until menopause, which occurs between the ages of 45 and 55. During menopause a woman stops ovulating (releasing eggs) and can no longer get pregnant.

Problems with periods

The menstrual cycle and a woman’s period can have a range of problems including, pain, irregularity and heavy bleeding. Some common problems women experience with their periods follow.


Lack of a menstrual period. Amenorrhea describes the absence of a period in young women who have not started their period by age 15, or in women who have not had their period for 90 days. This can be caused by eating disorders, excessive exercising, stress or a medical condition. If at any point a woman does not have her period for 90 days, she should see her doctor to check for pregnancy, early menopause or other possible health problems.


Painful periods, including severe cramps. Most teens with dysmenorrhea do not have a serious disease, rather their body is producing too much of a chemical called prostaglandin that causes menstrual cramps. In older women this pain can be caused by various conditions such as endometriosis or uterine fibroids. Women who experience painful periods should speak to their OB-GYN about their symptoms.

Abnormal uterine bleeding (AUB)

Bleeding that is irregular for a woman’s normal menstrual period. AUB can include:

  • Bleeding between periods
  • Bleeding for more days than normal
  • Bleeding after sex
  • Bleeding after menopause
  • Heavy bleeding
  • Spotting anytime in the menstrual cycle.

Abnormal bleeding can be caused by many different issues. When experiencing AUB, it is important for women to see their doctor to begin checking for causes. Some causes are not serious and are easy to treat, but others could be more serious.

Heavy or prolonged bleeding

One of the most common forms of AUB. A woman’s period is considered heavy if there is enough blood to soak a tampon or pad every hour for several consecutive hours. Other symptoms can include passing blood clots larger than a quarter during menstruation, needing to change pads or tampons during the night, or a period that lasts longer than seven days.

If a woman experiences heavy menstrual bleeding, it is important that she see an OB-GYN. Evaluation for irregular, painful or heavy periods might include:

  • Consultation with an OB-GYN to discuss symptoms
  • Pelvic ultrasound to evaluate for structural problems with the uterus
  • Blood tests.

Examples of treatment options for irregular, painful and heavy periods

Hormone therapy

Hormone therapy is often an initial option for treating period issues. Hormones found in birth control pills or IUDs (intrauterine devices) stabilize the lining of the uterus, regulate menstrual cycles or correct hormonal imbalances. They can also reduce pelvic pain, cramping or other symptoms accompanying the menstrual cycle.


Nonsteroidal anti-inflammatory medications (Advil, Motrin, Aleve, ibuprofen) minimize production of prostaglandins, the chemical that causes cramps.

Lysteda (tranexamic acid) is a nonhormonal medication that promotes blood clotting and may be recommended for women experiencing heavy bleeding.


Surgery is recommended when anatomical problems lead to irregular periods, particularly in women who want to have children. It may also be done to remove severe scar tissue (adhesions) in the reproductive tract. In more severe cases, surgery may be used to remove a woman’s uterus to eliminate periods altogether.

Surgeries for period problems may include:

  • D&C (dilation and curettage) – a brief surgical procedure that dilates the cervix and scrapes the lining of the uterus.
  • Hysteroscopy – a minimally invasive procedure that uses a hysteroscope to allow the doctor to see inside the uterus and remove masses from its cavity.
  • Endometrial ablation – a procedure destroying the endometrium (lining of the uterus) to lighten or stop a woman’s period. It is not recommended for women who wish to become pregnant in the future.
  • Hysterectomy – the surgical removal of the uterus and cervix.

Endometrial Hyperplasia | Everyday Health

The condition, though non-cancerous, is sometimes associated with uterine cancer.

Endometrial hyperplasia describes a condition in which the lining of the uterus, called the endometrium, becomes too thick.

The condition itself is not cancerous; however, it sometimes can lead to uterine cancer.

What Causes Endometrial Hyperplasia?

If your body has too much of the hormone estrogen without the hormone progesterone, you may develop endometrial hyperplasia.

To understand how endometrial hyperplasia develops, it may help to first understand how hormonal changes during a typical menstrual cycle affect your uterine lining.

Estrogen is made by the ovaries during the first part of your cycle. That leads to growth of the lining to prepare your body for pregnancy.

However, after an egg is released (ovulation), progesterone increases with the goal of supporting a fertilized egg.

But if pregnancy does not happen, levels of both hormones decline. That decrease in progesterone is what triggers your period, the shedding of the lining.

If you do not ovulate, progesterone is not made and the lining does not shed.

So the lining may keep growing in response to the estrogen and, in time, the cells in the lining can become abnormal.

In some women, the overgrowth, called hyperplasia, can lead to cancer.

Risk Factors

While there are many risk factors that increase the chances of developing endometrial hyperplasia, having one or more of these does not mean that you will develop the condition.

Some common risk factors include:

Endometrial Hyperplasia Symptoms

Abnormal uterine bleeding (heavier than usual bleeding between periods) is the most common symptom.

If you have a menstrual cycle shorter than 21 days, check with your doctor. Count from the first day of your period to the first day of your next one.

If you are post-menopausal, report any uterine bleeding to your healthcare provider.

Endometrial Hyperplasia Diagnosis

If you have abnormal uterine bleeding, your doctor may order certain tests and exams, including:

Endometrial Hyperplasia Types

Your doctor and other healthcare providers will look to see whether certain cell changes are present before diagnosing the exact type of endometrial hyperplasia.

If abnormal changes are found, the diagnosis is called atypical.

If the diagnosis is endometrial hyperplasia, it could be called:

  • Simple hyperplasia (the most benign type)
  • Complex hyperplasia
  • Simplex atypical hyperplasia
  • Complex atypical hyperplasia

Endometrial Hyperplasia Treatment

Endometrial hyperplasia can often be treated with progestin.

This synthetic hormone is given either orally, topically as a vaginal cream, in an injection, or with an intrauterine device.

If you have simple or “mild” hyperplasia, which is the most common type, the risk of it becoming cancerous is very small.

If you have atypical hyperplasia, the chances of cancer developing are higher.

For simple atypical, the chances of it turning into cancer is about 8 percent if left untreated. Complex atypical turns into cancer in 29 percent of untreated cases.

If the diagnosis is atypical, and you are done bearing children, your doctor may recommend removal of the uterus (hysterectomy), as the risk of uterine cancer rises with atypical hyperplasia.

The Menstrual Cycle: Phases of Your Cycle

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Top things to know

  • The menstrual cycle starts with the first day of the period and ends when the next period begins

  • Hormone signals are sent back and forth between the brain and the ovaries

  • The first part of the cycle prepares an egg to be released from the ovary, and builds the lining of the uterus

  • The second part of the cycle prepares the uterus and body to accept a fertilized egg, or to start the next cycle if pregnancy doesn’t happen

The menstrual cycle is more than just the period. In fact, the period is just the first phase of the cycle. The menstrual cycle is actually made up of two cycles that interact and overlap—one happening in the ovaries and one in the uterus. The brain, ovaries, and uterus work together and communicate through hormones (chemical signals sent through the blood from one part of the body to another) to keep the cycle going.

A menstrual cycle starts with the first day of the period and ends with the start of the next period. An entire menstrual cycle usually lasts between 24 and 38 days (1), but the length may vary from cycle to cycle, and may also change over the years. Cycle length changes between menarche (when periods first start during puberty) and menopause (when periods stop permanently) (2,3).

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Understanding the menstrual cycle is important because it can impact the body from head to toe.

Some people notice changes in their hair, skin, poop, chronic disease symptoms, mental health, migraine headaches, or the way they experience sex at different points in the menstrual cycle. It’s also the body’s way of preparing for pregnancy over and over again, so people having penis-in-vagina sex (the kind of sex you can become pregnant from) may want to pay attention to the menstrual cycle. Hormonal methods of birth control prevent some or all of the steps in the cycle from happening, which keeps pregnancy from occurring.

Read on for the breakdown of each phase of the cycle and what is happening in the uterus and in the ovaries.

An overview:

  • Menstruation: The period—the shedding of the uterine lining. Levels of estrogen and progesterone are low.

  • The follicular phase: The time between the first day of the period and ovulation. Estrogen rises as an egg prepares to be released.

  • The proliferative phase: After the period, the uterine lining builds back up again.

  • Ovulation: The release of the egg from the ovary, mid-cycle. Estrogen peaks just beforehand, and then drops shortly afterwards.

  • The luteal phase: The time between ovulation and before the start of menstruation, when the body prepares for a possible pregnancy. Progesterone is produced, peaks, and then drops.

  • The secretory phase: The uterine lining produces chemicals that will either help support an early pregnancy or will prepare the lining to break down and shed if pregnancy doesn’t occur.

Act 1: The first part of the cycle

Uterus: Menstruation

When: From the time bleeding starts to the time it ends.

What: Old blood and tissue from inside the uterus is shed through the vagina.

Each menstrual cycle starts with menstruation (the period). A period is the normal shedding of blood and endometrium (the lining of the uterus) through the cervix and vagina. A normal period may last up to 8 days (1), but on average lasts about 5 or 6 (4).

Ovaries: Follicular phase

When: From the start of the period until ovulation.

What: Signals from the brain tell the ovaries to prepare an egg that will be released.

During the period, the pituitary gland (a small area at the base of the brain that makes hormones) produces a hormone called follicle stimulating hormone (FSH). FSH tells the ovaries to prepare an egg for ovulation (release of an egg from the ovary). Throughout the menstrual cycle, there are multiple follicles (fluid filled sacs containing eggs) in each ovary at different stages of development (5,6). About halfway through the follicular phase (just as the period is ending) one follicle in one of the ovaries is the largest of all the follicles at about 1 cm (0.4 in) (6,7). This follicle becomes the dominant follicle and is the one prepared to be released at ovulation. The dominant follicle produces estrogen as it grows (8), which peaks just before ovulation happens (7). For most people, the follicular phase lasts 10-22 days, but this can vary from cycle-to-cycle (4).

Uterus: Proliferative phase

When: From the end of the period until ovulation.

What: The uterus builds up a thick inner lining.

While the ovaries are working on developing the egg-containing follicles, the uterus is responding to the estrogen produced by the follicles, rebuilding the lining that was just shed during the last period. This is called the proliferative phase because the endometrium (the lining of the uterus) becomes thicker. The endometrium is thinnest during the period, and thickens throughout this phase until ovulation occurs (9). The uterus does this to create a place where a potential fertilized egg can implant and grow (10).

Interlude: Ovulation

When: About midway through the cycle, but this can change cycle-to-cycle. Ovulation divides the two phases of the ovarian cycle (the follicular phase and the luteal phase).

What: An egg is released from the ovary into the fallopian tube.

The dominant follicle in the ovary produces more and more estrogen as it grows larger. The dominant follicle reaches about 2 cm (0.8 in)—but can be up to 3 cm—at its largest right before ovulation (6,7). When estrogen levels are high enough, they signal to the brain causing a dramatic increase in luteinizing hormone (LH) (11). This spike is what causes ovulation (release of the egg from the ovary) to occur. Ovulation usually happens about 13-15 days before the start of the next period (12).

Act 2: The second part of the cycle

Ovary: Luteal Phase

When: From ovulation until the start of the next period.

What: The sac that contained the egg produces estrogen and progesterone.

Once ovulation occurs, the follicle that contained the egg transforms into something called a corpus luteum and begins to produce progesterone as well as estrogen (10,13). Progesterone levels peak about halfway through this phase (14). The hormonal changes of the luteal phase are associated with common premenstrual symptoms that many people experience, such as mood changes, headaches, acne, bloating, and breast tenderness.

If an egg is fertilized, progesterone from the corpus luteum supports the early pregnancy (15). If no fertilization occurs, the corpus luteum will start to break down between 9 and 11 days after ovulation (10). This results in a drop in estrogen and progesterone levels, which causes menstruation. The luteal phase typically lasts about 14 days, but between 9 and 16 days is common (4,12).

Uterus: Secretory Phase

When: From ovulation until the start of the next period.

What: The lining of the uterus releases or secretes chemicals that will either help an early pregnancy attach if an egg was fertilized, or help the lining break down and shed if no egg was fertilized.

During this phase, the endometrium prepares to either support a pregnancy or to break down for menstruation. Rising levels of progesterone cause the endometrium to stop thickening and to start preparing for the potential attachment of a fertilized egg. The secretory phase gets its name because the endometrium is secreting (producing and releasing) many types of chemical messengers. The most notable of these messengers are the prostaglandins, which are secreted by endometrial cells and cause changes to other cells nearby.

Two prostaglandins in particular called, “PGF2α” and “PGE2”, cause the uterine muscle to contract (cramp). The amounts of these prostaglandins rise after ovulation and reach their peak during menstruation (16,17). The cramping caused by this prostaglandin helps trigger the period. If a pregnancy occurs, prostaglandin production is inhibited (18) so that these contractions won’t impact an early pregnancy. If pregnancy does not occur, the corpus luteum stops producing estrogen and progesterone. The drop in hormones, along with the effects of the prostaglandins, cause the blood vessels to constrict (tighten) and tissue of the endometrium to break down (10).

Menstruation begins, and the whole cycle starts all over again.

Understanding your body can improve usage of non-hormonal birth control. Click here to learn more about Clue Birth Control.

This article was originally published on December 12, 2018.

Tests for Endometrial Cancer

Endometrial cancer
is most often diagnosed after a woman goes to her doctor because she has symptoms.

If there’s a possibility you could have endometrial cancer, you should be examined by a gynecologist. This is a doctor trained to diagnose and treat diseases of the female reproductive system. Gynecologists can diagnose endometrial cancer, and sometimes treat it. Specialists in treating cancers of the endometrium and other female reproductive organs are called gynecologic oncologists. These doctors treat all stages
of endometrial cancer.

Medical history and physical exam

If you have any of the symptoms of endometrial cancer (see Signs and Symptoms of Endometrial Cancer), you should see a doctor right away. The doctor will ask about your symptoms, risk factors, and medical history. The doctor will also do a physical exam and a pelvic exam.


Ultrasound is often one of the first tests used to look at the uterus, ovaries, and fallopian tubes in women with possible gynecologic problems. Ultrasound uses sound waves to take pictures of the inside of the body. A small wand (called a transducer or probe) gives off sound waves and picks up the echoes as they bounce off the organs. A computer translates the echoes into pictures.

For a pelvic ultrasound, the transducer is moved over the skin of the lower part of the belly (abdomen). Often, to get good pictures of the uterus, ovaries, and fallopian tubes, the bladder needs be full. That’s why women getting a pelvic ultrasound are asked to drink lots of water before the test.

A transvaginal ultrasound (TVUS) is often better to look at the uterus. For this test, the TVUS probe (that works the same way as the ultrasound transducer) is put into the vagina. Images from the TVUS can be used to see if the uterus contains a mass (tumor), or if the endometrium is thicker than usual, which can be a sign of endometrial cancer. It may also help see if cancer is growing into the muscle layer of the uterus (myometrium).

A small tube may be used to put salt water (saline) into the uterus before the ultrasound. This helps the doctor see the uterine lining more clearly. This procedure is called a saline infusion sonogram or hysterosonogram. (Sonogram is another term for ultrasound.)

Ultrasound can be used to see endometrial polyps (growths)
, measure how thick the endometrium is,
and can help doctors pinpoint the area they want to biopsy.

Endometrial tissue sampling

To find out exactly what kind of endometrial change is present, the doctor must take out some tissue so that it can be tested and looked at with a microscope. Endometrial tissue can be removed by endometrial biopsy or by dilation and curettage (D&C) with or without a hysteroscopy. A gynecologist usually does these procedures, which are described below.

Endometrial biopsy

An endometrial biopsy is the most commonly used test for endometrial cancer and is very accurate in postmenopausal women. It can be done in the doctor’s office. A very thin, flexible tube is put into the uterus through the cervix. Then, using suction, a small amount of endometrium is removed through the tube. The suctioning takes about a minute or less. The discomfort is a lot like menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug (like ibuprofen) before the procedure. Sometimes a thin needle is used to inject numbing medicine (local anesthetic) into the cervix just before the procedure to help reduce the pain.


For this procedure, the doctor puts a tiny telescope (about 1/6 inch in diameter) into the uterus through the cervix. To get a better view of the inside (lining) of the uterus, the uterus is filled with salt water (saline). This lets the doctor look for and biopsy anything abnormal, such as a cancer or a polyp. This is usually done using a local anesthesia (numbing medicine) while the patient is awake.

Dilation and curettage (D&C)

If the endometrial biopsy sample doesn’t provide enough tissue, or if the biopsy suggests cancer but the results are unclear, a D&C must be done. In this outpatient procedure, the opening of the cervix is enlarged (dilated) and a special instrument is used to scrape tissue from inside the uterus. This may be done with or without a hysteroscopy.

This procedure takes about an hour and may require general anesthesia (where drugs are used to put you into a deep sleep) or conscious sedation (drugs are put into a vein to make you drowsy) either with local anesthesia injected into the cervix or a spinal (or epidural). A D&C is usually done in an outpatient surgery area of a clinic or hospital. Most women have little discomfort after this procedure.

Testing endometrial tissue samples

Endometrial tissue samples removed by biopsy or D&C are looked at with a microscope to see if cancer is present. If cancer is found, the lab report will state what type of endometrial cancer
it is (like endometrioid or clear cell) and what grade
it is.

Endometrial cancer is graded on a scale of 1 to 3 based on how much it looks like normal endometrium. (See What Is Endometrial Cancer?) Women with lower grade cancers are less likely to have cancer in other part of their body and are less likely to have the cancer come back after treatment (recur).

Testing for gene and protein changes in the cancer cells

If the doctor suspects hereditary non-polyposis colon cancer (HNPCC) as an underlying cause of the endometrial cancer, the tumor cells can be tested for protein and gene changes. Examples of HNPCC-related changes include:

  • Having fewer mismatch repair (MMR) proteins
  • Defects in mismatch repair genes (dMMR)
  • DNA changes (high levels of microsatellite instability, or MSI-H) that can happen when one of the genes that causes HNPCC is faulty

If these protein or DNA changes are present, the doctor may suggest genetic testing for the genes that cause HNPCC.

Testing the cancer cells for dMMR, MSI-H, and/or a high tumor mutational burden (TMB-H) might also be done to see if treatment with immunotherapy might be an option, especially for more advanced endometrial cancers.

Tests to look for cancer spread

If the doctor suspects that your cancer is advanced, you’ll probably have to have other tests to look for cancer spread.

Chest x-ray

A plain x-ray of your chest may be done to see if cancer has spread to your lungs.

Computed tomography (CT)

The CT scan is an x-ray procedure that creates detailed, cross-sectional images of the inside of your body. For a CT scan, you lie on a table while X-rays are done. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as the camera rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of many slices of the part of your body that’s being studied.

CT scans are not used to diagnose endometrial cancer. But they can help see if the cancer has spread to other organs and to see if it has come back after treatment.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of the inside of the body. This creates cross sectional slices of the body like a CT scanner and it also makes slices that are parallel with the length of your body.

MRI scans are very helpful for looking at the brain and spinal cord. Some doctors also think MRI is a good way to tell whether, and how far, the endometrial cancer has grown into the body of the uterus. MRI scans may also help find enlarged lymph nodes
with a special technique that uses very tiny particles of iron oxide. These are given into a vein and settle into lymph nodes where they can be spotted by MRI.

Positron emission tomography (PET)

In this test radioactive glucose (sugar) is given to look for cancer cells. Because cancers use glucose (sugar) at a higher rate than normal tissues, the radioactivity will tend to collect in the cancer. A scanner can spot the radioactive deposits. This test can be helpful for spotting small collections of cancer cells. Special scanners combine a PET scan with a CT to more precisely locate areas of cancer spread. PET scans are not a routine part of the work-up of early endometrial cancer, but may be used for more advanced cases.

Cystoscopy and proctoscopy

If a woman has problems that suggest the cancer has spread to the bladder or rectum, the inside of these organs will probably be looked at through a lighted tube. In cystoscopy the tube is put into the bladder through the urethra. In proctoscopy the tube is put in the rectum. These exams allow the doctor to look for cancer. Small tissue samples can also be removed during these procedures for testing. They can be done using a local anesthetic but some patients may need general anesthesia. Your doctor will let you know what to expect before and after these tests. These procedures were used a lot in the past, but now are rarely part of the work up for endometrial cancer.

Blood tests

Complete blood count

The complete blood count (CBC) is a test that measures different cells in the blood, such as the red blood cells, the white blood cells, and the platelets. Endometrial cancer can cause bleeding, which can lead to low red blood cell counts (anemia).

CA-125 blood test

CA-125 is a substance released into the bloodstream by many, but not all, endometrial and ovarian cancers. If a woman has endometrial cancer, a very high blood CA-125 level suggests that the cancer has likely spread beyond the uterus.
Some doctors check CA-125 levels before surgery or other treatment. If they’re elevated, they can be checked again to see how well the treatment is working (levels will drop after surgery if all the cancer is removed).

CA-125 levels are not needed to diagnose endometrial cancer, so this test isn’t done on all patients.

Serous cancer of the uterus and endometrium

What is serous carcinoma?

Serous carcinoma is a type of endometrial cancer. It starts with a gland usually found in the tissues that cover the inside of the uterus. Serous carcinoma of the endometrium is an aggressive type of cancer that usually spreads to other parts of the body. More common in women over 50.

Uterus and endometrium

The uterus is a pear-shaped hollow organ located in a woman’s pelvis between the rectum (end of the colon) and the bladder.The upper part of the uterus (fundus) attaches to the fallopian tubes, and the lower part connects to the vagina through the cervix.

The walls of the uterus consist of three layers:

  • The lining of the uterus – The endometrium is the tissue on the inner surface of the uterus. The endometrium is made up of the endometrium. The glands are lined with a single layer of cells that form a barrier called the epithelium. The epithelium is surrounded by a supporting tissue called the endometrium. stroma.
  • Myometrium – The myometrium is the middle layer of smooth muscle that allows the uterus to resize and contract.
  • Perimetry – The perimetry is the thin layer of tissue that surrounds the uterus from the outside.

How does serous endometrial carcinoma begin?

Serous carcinoma is thought to result from a precancerous disorder called serous intraepithelial endometrial carcinoma. Abnormal cells in serous intraepithelial endometrial carcinoma and serous carcinoma appear very similar when examined under a microscope.However, abnormal cells in serous intraepithelial endometrial carcinoma are found only in the epithelium. In contrast, abnormal serous carcinoma cells have spread to the stroma below. The movement of cells from the epithelium to the stroma is called invasion.

How do pathologists make this diagnosis?

Serous carcinoma is usually diagnosed after taking a small sample of endometrial tissue in a procedure called a biopsy or curettage. Once diagnosed, the tumor is removed using a surgical procedure called a hysterectomy.

What to look for in your report after tumor removal

Myometrium invasion

Myometrium is a thick muscle band just below the endometrium. The movement of cancer cells from the endometrium to the myometrium is called the myometrium. invasion. The extent of myometrial invasion will be described in millimeters and as a percentage of the total thickness of the myometrium. Tumors with more myometrial invasion are more likely to spread to other parts of the body. Myometrial invasion is also used to determine tumor staging (see.”Pathological stage” below).

Involvement of the cervical stroma

The cervix is ​​a structure at the very bottom of the uterus. The cervix is ​​directly connected to the endometrium. The wall of the cervix is ​​made up of a tissue called the stroma. Serous carcinoma can develop from the endometrium into the cervix.

After the tumor has been completely removed, your pathologist will take a close look at the cervical tissue to see if there are cancer cells in the cervical stroma. Finding cancer cells in the cervical stroma increases the stage of the tumor.Pathological stage below).

Other involved tissues or organs

Several other organs and tissues are attached directly to or very close to the uterus, including the ovaries, fallopian tubes, vagina, bladder, and rectum. Cancer cells directly invading any of these structures in serous carcinoma are associated with a poor prognosis and will be described in your report.

Lymphovascular invasion

Blood moves through the body through long, thin tubes called blood vessels.Another type of fluid called lymph contains waste products and immune cells that travel through the body through the lymphatic channels.

Cancer cells can use blood vessels and lymph vessels to travel from the tumor to other parts of the body. Moving cancer cells from a tumor to another part of the body is called metastasis.

Before cancer cells can metastasize, they must enter a blood or lymph vessel. This is called lymphovascular invasion.Lymphovascular invasion increases the risk of finding cancer cells in a lymph node or distant part of the body, such as the lungs.


A margin is the normal tissue that surrounds the tumor and is removed along with the tumor during surgery. The fields will be described only in cases where the tumor has spread to the cervical region. stroma or other tissue surrounding the uterus and after removal of the entire tumor.

The limit is called positive if the tumor cells are at the very edge of the cut tissue.A positive margin is associated with a higher risk of tumor recurrence at the same site after treatment. A negative margin means that tumor cells were not observed at any of the cut edges of the tissue.

Lymph node

The lymph node is a small immune organ located throughout the body. Cancer cells can travel from the tumor to the lymph node through lymphatic channels located in and around the tumor (see Lymphovascular invasion above). The movement of cancer cells from a tumor to a lymph node is called metastasis.

Your pathologist will carefully examine all lymph nodes for cancer cells. Lymph nodes that contain cancer cells are often called positive, and those that do not contain cancer cells are often called negative. Most reports indicate the total number of lymph nodes examined and the number of cancer cells, if any.

Lymph nodes on the same side as the tumor are called ipsilateral, and the lymph nodes on the opposite side of the tumor are called contralateral.

The lymph nodes that are examined are usually divided into those in the pelvis and those around a large blood vessel in the abdomen called the aorta. The lymph nodes around the aorta are called paraaortic lymph nodes.

If cancer cells are found in a lymph node, the size of the area affected by cancer will be measured and described in your report.

  • Isolated tumor cells – The area inside the lymph node with cancer cells is less than 0.2 millimeters.
  • Micrometastases – The area inside the lymph node with cancer cells is more than 0.2 millimeters but less than 2 millimeters in size.
  • Macrometastases – The area inside the lymph node with cancer cells is more than 2 millimeters.

Cancer cells found in a lymph node are associated with a higher risk of cancer cells being found in other lymph nodes or in a distant organ such as the lungs.The number of lymph nodes with cancer cells is also used to determine the nodal stage (see Pathologic Stage below).

Pathological stage

The pathologic stage of serous carcinoma is based on the TNM staging system, an internationally recognized system originally established by the American Joint Committee on Cancer. This system uses information about the primary tumor (T), lymph node (N) and distant metastatic disease (M) to determine the complete pathologic stage (pTNM).Your pathologist will examine the tissue presented and assign a number to each part. In general, a higher number means more advanced disease and worse. forecast.

Stage of tumor (pT)

Serous carcinoma has a tumor stage from 1 to 4, depending on the depth of the myometrium. invasion and growth of a tumor outside the uterus.

  • T1 – The tumor affects only the uterus.
  • T2 – The tumor has grown and has affected the stroma of the cervix.
  • T3 – The tumor has grown through the wall of the uterus and is now located on the outer surface of the uterus.OR it has grown to involve the fallopian tubes or ovaries.
  • T4 – The tumor grows directly into the bladder or colon.
Nodal stage (pN)

Serous carcinoma is assigned a nodal stage from 0 to 2 based on examination. lymph node from the pelvis and abdomen.

  • N0 – No cancer cells were found in any of the lymph nodes examined.
  • N1mi – Cancer cells were found in at least one lymph node from the pelvis, but the area with cancer cells did not exceed 2 millimeters (only isolated cancer cells or micrometastases).
  • N1a – Cancer cells have been found in at least one lymph node in the pelvis, and the cancer cells are larger than 2 millimeters (macrometastasis).
  • N2mi – Cancer cells were found in at least one lymph node outside the pelvis, but the area with cancer cells did not exceed 2 millimeters (only isolated cancer cells or micrometastases).
  • N2a – Cancer cells were found in at least one lymph node outside the pelvis, and the cancer cells were larger than 2 millimeters (macrometastasis).
  • NX – No lymph nodes were sent for examination.
Metastatic stage (pM)

Serous carcinoma is assigned metastatic stage 0 or 1, depending on the presence of cancer cells in a distant part of the body (for example, in the lungs). The metastatic stage can only be determined if tissue from a distant site is sent for pathological examination. Since this tissue is rarely present, the metastatic stage cannot be identified and designated as MX.

Jason Wasserman MD, FRCPC (September 21, 2021)

Restoring intimate comfort | CAPITAL CLINIC RIGA

Restoring intimate comfort

After childbirth, as well as during premenopause, menopause and postmenopause, women experience weakening of vaginal tissues, vaginal dryness, atrophy of the vaginal mucosa, urinary incontinence and many other problems.This, even if outwardly not visible, gives women both psychologically unpleasant moments and physical limitations, and can also cause disappointment for herself and her partner when the intensity of sexual pleasure decreases. Vaginal reconstruction with a laser procedure, gynecological injections and intimate plastic surgery may be good solutions to these problems.

For women after childbirth

During childbirth, a woman’s genitals are subject to great changes – the inner layer of the uterus is destroyed, the placenta and lochia are secreted – physiological secretions, internal tissues and vaginal secretions.The cervical canal is stretched, which usually closes 2-3 weeks after delivery, but its tissues are fully restored only within one and a half to two months. Usually, the mucous membrane and muscles of the vagina are restored after 3-4 weeks, however, under the influence of hormonal changes, the mucous membrane is often dry and remains dry for a long time, which can make it difficult to resume sexual activity. For some time after childbirth, there may be violations of urination – a burning sensation and painful sensation when urinating, slight urinary incontinence.Usually, little is said about this, since all attention after childbirth is paid to the baby, forgetting about the comfort of the woman. However, doctors recommend – if these problems – vaginal dryness, urinary incontinence, weakening of the vaginal canal resulting from its stretching, pain in the places of ruptures and seams – continue for a long time, be sure to consult a gynecologist, since modern medicine offers excellent solutions for getting rid of problems. Here both laser technologies and intimate injections come to the rescue.If mild postpartum incontinence is left unaddressed, it can develop to a much greater extent over time, causing a lot more problems. Therefore – do not hesitate and talk about it with your doctor!

For premenopausal, menopausal and postmenopausal women

There are different periods in the life of every woman, and everyone wants to live them beautifully and fully. And although a woman can be attractive and attractive at any age, nature and the fast-moving years take their toll.Nobody can cancel hormonal changes, but the discomfort caused by them nowadays can be eliminated. Vaginal dryness, inflammation caused by it, pain during intercourse, burning sensation, itching, urinary incontinence and weakening of the vaginal canal, prolapse, various changes in the external genital organs – the appearance of age spots, drying out or wrinkling of the outer labia – are the most frequent complaints of women … Thanks to the development of medical technologies, they can all be reduced and eliminated using both laser technologies and gynecological injections and intimate plastics.

Sexual satisfaction for both partners

A weakening of the vaginal canal can form both after childbirth, when it is stretched, especially if the fetus was large or, for example, the birth of twins, and over the years with the aging of a woman. And little is said about it, this is kind of a taboo topic, but you shouldn’t be ashamed to talk about it with your gynecologist, since sexual satisfaction in creating stable and beautiful partnerships is essential – in addition, it is a weakening of the vagina or loss of it firmness refers to both partners, reducing the intensity of sexual pleasure in both men and women.There is even such a diagnosis, which in colloquial English is called Lost Penis Syndrome – in direct translation – the cider of the latent penis. This means that due to prolonged weakening of the woman’s vagina, vaginal orgasm is not possible. And this can have an adverse effect on the couple’s sexual relationship. Once the hardness of the vagina is restored, both partners once again experience the greatest sexual pleasure.

How is vaginal firmness restored?

Not long ago, until laser technology was invented, the hardness of the vagina could be achieved and held only by performing special exercises or performing plastic surgery.In Western culture, vaginal exercises, unlike in the East, are not particularly revered, however, they can be very effective, only a lot of self-discipline and regular exercise are needed. Therefore, laser procedures are a good solution, which is not associated with either time-consuming and regular exercise, or surgery. During them, the CO2 laser affects the tissues, regenerating them, improving their blood supply, promoting the formation of new collagen.By repeating the procedure 3 times (every 4 to 5 weeks), excellent improvement is achieved. And this is recognized and used by women all over the world, assessing the possibilities of restoring the quality of life.

It is essential that these procedures are carried out quickly, do not require special preparation and do not require a recovery period after them. The procedure itself lasts only 7 minutes, thus, it can be included in the plan of a regular working day, since immediately after the procedure, you can go about your daily activities.The procedure takes place without anesthesia and without pain; a woman can only feel warmth at the level of comfort. Also, these laser procedures are performed for women of any age. It should be taken into account that for laser procedures it is necessary to consult a gynecologist, as well as separate studies, which, if necessary, are prescribed by a doctor. The only restriction after the procedure is a week of abstinence from sexual activity and very active sports or from lifting heavy weights.

Injection of fillers based on hyaluronic acid and I-PRF (blood plasma ) in the intimate area

Hyaluronic acid injections are designed to eliminate aesthetic defects in the external genital organs (asymmetry, aging, small volume – hypotrophy, atrophy, loss of skin tone, etc.), eliminate discomfort and discomfort (dryness, itching, burning, painful sex life – dyspareunia, postpartum scars in the perineal region after episiotomies, atrophy of the vaginal mucosa, etc.), improving the quality of sex life and sexual pleasure (injections at point G, to restore the firmness of the vaginal canal and its narrowing both after childbirth and during menopause). As an excellent side effect, stress urinary incontinence reduction of can be mentioned.

For the production of injections into the intimate area, the doctor chooses the appropriate method to solve the corresponding problem using either anesthetic ointment or injections for anesthesia.No pain relievers are required after the injection.

Before making an injection, it is necessary to consult a gynecologist who will conduct an examination, prescribe the necessary examinations and then the most appropriate type and volume of injections.

The result will be visible immediately after the procedure, the full effect is expected within 7-10 days. The impact usually lasts 9-12 months. After that, to maintain the effect, it is advisable to repeat the procedure.

It should be borne in mind that after the procedure 7-14 days, intense physical activity is not recommended – running, cycling, horseback riding.You should refrain from sexual intercourse for 3 days.

I-PRF (blood plasma) injections – this progressive method is already widely used in aesthetic dermatology. Now it is also used in gynecology – to prevent vaginal dryness, reduce postpartum discomfort, scars from tears / cuts, stretch marks, treat chronic diseases of the vulva with an impact directly on the problem area. Injections are also used as adjunctive therapy for the treatment of urinary incontinence after a laser procedure.I-PRF is a structure obtained from a person’s own blood – fibrin, on the matrix of which the cells present in its composition are concentrated – platelets, leukocytes, lymphocytes, monocytes, neutrophils and stem cells (from the peripheral blood flow). They attract growth factors to tissues, assist in the process of their recovery, stimulating collagen synthesis and tissue blood supply for a long time.

During the procedure, after assessing the state of health, blood is taken from a vein (approximately 15-30 ml), after which valuable platelet-rich plasma is released using a centrifuge.The isolated plasma is injected into problem areas by injection.

This is a reliable and effective method without allergic reactions and the risk of infections, since a substance made from the patient’s own blood is used. During the procedure, there is minimal discomfort, since it is carried out with a thin nano-needle, which practically does not cause pain. The first impact is observed within 2-3 weeks with the achievement of the maximum effect within 3 – 5 months.

Plastic for intimate comfort for women

Correction of the labia minora – labiaplasty

Too large or disproportionate labia minora spoil the quality of life for many women.If the labia minora are enlarged and are outside the labia majora, this can interfere with the implementation of many hobbies, limit sports activities, they can be easily injured, rubbed, not to mention the woman’s emotional experiences and discomfort in intimate life. Aesthetic surgery offers a good opportunity for women to correct this defect and improve mood and comfort.

During the operation, the size and, if necessary, the proportions of this organ are corrected.After the operation, special hygiene should be observed, you should regularly wash in the shower, use antiseptics and soft panty liners. The operated area for 3 – 4 days will be sensitive when sitting. The threads will be removed after 10 days. For at least 2-3 weeks, one should refrain from playing sports, swimming, taking a bath and going to the bathhouse. For about 2-3 weeks, one should also refrain from intimate relationships. After the operation, no scars remain, and the sensitivity is not affected.Duration of surgery: 45 minutes – 1 hour. The operation is performed under spinal or general anesthesia.

Gynecology department of Veselības centrs 4 Ltd and Capital Clinic Riga offer laser procedures FemiLift® and MonaLisa Touch®

  • for stress urinary incontinence
  • to restore the hardness of the vaginal canal
  • for elimination of symptoms of menopause
  • for postpartum recovery
  • for vaginal dryness and re-infections
  • to improve the quality of sexual life


Capital Clinic Riga

Duntes Street 15a, Riga

Tel.: 66333333, 29334224


MonaLisa Touch®

LLC “Veselības centrs 4”,

Gynecological Department

K. Barona street 117, Riga

Tel .: 67847109; 67847100


The branch “Clinic of Dermatology” Ltd. “Veselības centrs 4” offers intimate plastics

“Clinic of Dermatology”

Skanstes street 50, Riga, 3rd floor

Tel.: 67847102, 28381189


90,000 What is Decidua?

During pregnancy in mammals, the endometrium or the lining of the uterus is called decidual. This part of the lining of the uterus begins to form as soon as the embryo is implanted, and it plays a major role in the formation of the placenta. Among other things, it helps nourish the embryo before the placenta is fully formed.

About a week after ovulation, the lining of the uterus thickens and forms more blood vessels. It prepares for a possible embryo. If not pregnant, this lining is shed roughly every month during something commonly known as a period.

If a female’s egg is fertilized, it usually enters the uterus, where it is implanted into the wall of the uterus. This action triggers something known as an adverse reaction. In this case, the upper layer of the mucous membrane of the uterus thickens even more.In the area where the embryo is implanted into the uterus, the decidua grows around it and encompasses the embryo. This is known as decidua capsularis.

There are two other main parts of the decidua. The area between the embryo and the wall of the uterus is known as the decidua basalis. All other parts of the decidua in the uterus are known as the decidua pariatalis.

Until the placenta is fully formed, this lining is the main source of nutrition for the fetus. Like the placenta, it also allows waste to escape from the embryo.It also protects the embryo and ensures that it is not destroyed by the mother’s immune system. Female hormones and growth hormones necessary for a healthy pregnancy are also secreted from decidua.

In case of miscarriage, the deciduja is discarded and leaves the body together with the fetus, as in the menstrual period. Sometimes, however, a decidua can be shed without a germ. If this happens, the mother can experience a number of complications and health problems.

Ectopic pregnancy is also called tubal or ectopic pregnancy.During an ectopic pregnancy, the embryo is not implanted into the lining of the uterus, but into another part of the female anatomy. In most ectopic pregnancies, the embryo is implanted into the fallopian tubes, but in some cases it can be implanted into the cervix or other part of the female anatomy.

Sometimes during an ectopic pregnancy, decidua leaves the body, like a miscarriage. However, the embryo will still be implanted into the wall of the fallopian tube. If left unattended, it can cause bloating and rupture of the organ, leading to severe bleeding and possibly death of the mother.


Photodynamic therapy (PDT) is an organ-preserving method for the treatment of oncological diseases, based on the ability of certain substances – photosensitizers – to selectively kill tumor cells under the influence of light.

Patients need to know that dysplasia, non-invasive and early invasive cancers can be completely cured without resorting to mutilation! Photodynamic therapy is an alternative to surgery, radiation and chemotherapy.With dysplasia, non-invasive and early invasive cancer, just one session of photodynamic therapy (PDT) is enough for a complete cure. After a PDT session, all dysplastic and cancer cells die. The mucous membrane heals at the site of treatment within 4-8 weeks. The anatomy and physiology of the organ is fully preserved.

It happens as follows.

First, a special drug is injected into the patient’s vein, which accumulates in the tumor.This stage of treatment is called PHOTOSENSITIZATION.

After a while, the concentration of the photosensitizer in cancer cells becomes much higher than in healthy cells. Thus, it is possible to accurately mark the tumor boundaries on the plane. This stage of treatment is called VIDEO FLUORESCENT LABELING.

At the next stage of treatment, the affected area of ​​the skin or mucous membrane is illuminated with a red laser, the wavelength of which corresponds to the maximum absorption of the photosensitizer.The exposure time depends on the size of the focus. This stage is called PHOTO EXPOSURE.

During photo exposure, photons of light transfer their energy to the molecules of the photosensitizer. And those, in turn, as intermediaries transfer free electrons to oxygen. The oxygen excited in this way begins to actively enter into chemical reactions with other substances in the cells, in the intercellular substance, and in the blood plasma.