What is endometrium, where is it located and main changes

The endometrium is the tissue that lines the uterus internally and its thickness varies over the menstrual cycle according to the variation in the concentration of hormones in the bloodstream.

It is in the endometrium that the embryo implantation occurs, starting the pregnancy, but for this to happen, the endometrium must have the ideal thickness and have no signs of disease. When there is no fertilization, the tissue flakes, and menstruation is characterized.

Endometrial changes by phases

The thickness of the endometrium varies every month in all women of reproductive age, characterizing the phases of the menstrual cycle:

Proliferative phase: Right after menstruation the endometrium is completely peeled and ready to increase in size, this phase is called proliferative, and in this period estrogen promotes the release of cells that increase their thickness, as well as blood vessels and exocrine glands. Secretory phase : In the secretory phase, which occurs during the fertile period, estrogen and progesterone will ensure that the endometrium has all the nutrients necessary for the implantation and nutrition of the embryo. If there is fertilization and the embryo manages to stay in the endometrium, a pink or 'coffee drip' may be seen during her fertile day, but if there is no fertilization, after a few days the woman will menstruate. Know how to recognize the symptoms of fertilization and nesting. Menstrual phase: If fertilization does not occur during the fertile period, which is when the endometrium is at its thickest, this tissue will now enter its menstrual phase and decrease in thickness due to the sudden drop of hormones in the bloodstream and decreased irrigation of the fabric. These changes cause the endometrium to gradually loosen from the uterine wall, giving rise to the bleeding that we know by menstruation.

The endometrium can be evaluated by means of gynecological imaging exams, such as pelvic ultrasound, colposcopy and magnetic resonance imaging, for example, in which the gynecologist checks for any signs of disease or changes in this tissue. Know other exams requested by the gynecologist.

Endometrium in pregnancy

The ideal endometrium for getting pregnant is one that measures about 8mm and is in the secretory phase, because the thin or atrophic endometrium, measuring less than 6mm, is unable to allow the baby to develop. The main cause of thin endometrium is the lack of progesterone, but this can also happen due to the use of contraceptives, infant uterus and injuries after abortion or curettage.

The minimum thickness to get pregnant is 8 mm and the ideal is approximately 18 mm. In women where this does not occur naturally, the doctor may prescribe the use of hormonal medications such as Utrogestan, Evocanil or Duphaston to increase the endometrial thickness, facilitating the implantation of the embryo in the uterus.

The reference thickness of the endometrium after menopause is 5 mm, which can be seen on a transvaginal ultrasound. In this phase, when the thickness is greater than 5 mm, the doctor will order a series of other tests to better assess the woman and be aware of other signs that may reveal possible diseases such as endometrial cancer, polyp, hyperplasia or adenomyosis, for example..

Main diseases affecting the endometrium

Changes in the endometrium may be due to diseases that can be treated and controlled with the use of hormones and, in some cases, surgery. Medical follow-up is essential to avoid complications of each disease, maintain uterine health and increase the chances of becoming pregnant. The most common diseases related to the endometrium are:

1. Endometrial cancer

The most common disease that affects the endometrium is endometrial cancer. This can be easily discovered because its main symptom is bleeding outside of menstruation. In the case of women who have gone through menopause and have been menstruating for 1 year, the symptom is immediately noticed.

For those who have not yet reached menopause the main symptom is an increase in the amount of blood lost during menstruation. You need to be aware of these signs and look for a gynecologist right away, because the sooner the problem is discovered, the greater the chances of a cure. Learn how to identify endometrial cancer.

2. Endometrial polyp

Polyps located in the region of the endometrium are benign and easily perceived because it causes symptoms such as blood loss before or after menstruation or difficulty in becoming pregnant. This change is more common after menopause and usually occurs in women taking medications like Tamoxifen.

Most of the time this disease is discovered in an ultrasound that shows an increase in its thickness. Treatment is the choice of the gynecologist but can be done with the removal through the polyps through surgery, especially if the woman is young and wants to become pregnant, but in many cases it is not necessary to perform surgery, or to take hormonal medications, making a monitoring of the case every 6 months to check for any changes.

3. Endometrial hyperplasia

The increase in the thickness of the endometrium is called endometrial hyperplasia, being more common after 40 years of age. Its main symptom is bleeding outside the menstrual period, in addition to pain, abdominal colic and enlarged uterus, which can be seen on a transvaginal ultrasound.

There are several types of endometrial hyperplasia and not all are related to cancer. Its treatment may involve hormonal medications, curettage or surgery, in the most severe cases. Learn more about endometrial hyperplasia.

4. Adenomyosis

Adenomyosis occurs when the tissue inside the uterine walls increases in size, causing symptoms such as heavy bleeding during menstruation and cramps that make life difficult for women, as well as pain during intimate contact, constipation and abdominal swelling. Its causes are not fully known, but it can happen due to gynecological surgeries or cesarean delivery, for example, in addition, adenomyosis can appear after pregnancy.

Treatment can be done with the use of contraceptives, IUD insertion or surgery to remove the uterus, in the most severe cases, when the symptoms are very annoying and when there is a contraindication to the use of hormonal medications. Learn more about Adenomyosis.