Thickened Endometrium: Causes, Symptoms, and Treatment

What is Thickened Endometrium?

Thickened endometrium refers to an abnormal increase in the thickness of the inner uterine lining. The uterine lining grows and sheds every month during the menstrual cycle. But if the endometrium remains thick for a long time and exceeds the normal range for the woman’s age and menstrual cycle, it is not normal. Sometimes, a hormonal imbalance, such as a high level of estrogen, may be the cause. In other cases, other gynaecological conditions. If you experience irregular bleeding or persistent pain, you must consult a doctor to determine the cause and receive the appropriate treatment.

Normal Endometrial Thickness

The thickness of the endometrium varies during a menstrual cycle due to hormonal changes. Estrogen and progesterone are mainly responsible for changes in the thickness of the uterine lining. A doctor recommends a transvaginal ultrasound to accurately measure endometrial thickness. The normal endometrial thickness range is:

• During the 1st-5th day of menstruation, the thickness ranges from 2-4 mm as the uterine lining sheds during the initial days of the period.
• During the 6th to 14th day of the period, the thickness ranges from 5-7 mm and increases to 11 mm due to elevated estrogen levels.
• During the 15th-28th day, the thickness ranges from 7-16 mm because a thick endometrium is required for proper implantation of the embryo if fertilisation occurs.
• In a postmenopausal woman, the endometrium is 4-5 mm thick. If it is outside the normal range, a woman must consult a doctor.

Causes of Thickened Endometrium

Uterine endometrium may become thick due to different reasons. Some common causes of thickened endometrium are:

• Endometrial thickness can increase abnormally due to a hormonal imbalance. It occurs when estrogen levels increase and progesterone levels decrease. The endometrial lining keeps growing instead of shedding.
• Some women take hormonal therapies or fertility drugs that may increase the thickness of the endometrial lining.
• Women with excess body weight may have elevated estrogen levels due to increased body fat, which can lead to abnormal endometrial growth.
• PCOS or polycystic ovarian syndrome can cause irregular ovulation that leads to excess estrogen exposure and causes thickened endometrium.
• Some women suffer from a condition called adenomyosis in which the endometrial tissue grows into the uterine wall. This can enlarge the uterus and cause endometrial thickening.
• Sometimes fibroids or endometrial polyps grow within the uterus, increasing endometrial thickness.
• During menopause, women experience a hormonal imbalance that may cause thickening of the endometrium.

Symptoms of Thickened Endometrium

Women with thickened endometrium may experience different symptoms. Common symptoms are:

• Women may experience irregular periods. Sometimes periods may skip or occur too frequently.
• Some women experience heavy or prolonged bleeding, which may cause anaemia and weakness.
• If young women experience a thickened endometrium, they may have difficulty conceiving. A thickened endometrium interferes with embryo implantation, causing early miscarriages or infertility.
• Some women experience brown discharge or light bleeding between periods that may indicate endometrial problems.
• Pain and discomfort may occur due to an enlarged uterus.
• Sometimes women experience bleeding after menopause that should be evaluated properly under the guidance of an expert doctor.

Diagnosis of Thickened Endometrium

A thickened endometrium may occur for various reasons. Therefore, proper diagnosis is important. It is a must to evaluate the cause, extent, and pattern of endometrial thickening.

The physician performs a clinical examination and obtains a menstrual history.

The doctor recommends the following diagnostic tests:

• To determine the thickness of the endometrial lining and identify further anomalies, such as fibroids or polyps, a pelvic ultrasound is performed.
• To assess progesterone and estrogen levels, blood tests are done.
• Abnormal cell proliferation in the lining of the uterus is determined using an endometrial biopsy.
• To visualise the endometrial lining and assess its thickness and any abnormal growths, hysteroscopy is performed.

A skilled physician can identify the underlying cause of the thicker endometrium and recommend the most appropriate course of action.

Treatment for Thickened Endometrium

Treatment of thickened endometrium varies from woman to woman. The goals of treatment are to prevent problems, regulate excessive bleeding, and balance hormones.

Treatments for endometrial thickening typically include the following:

• Progesterone medication is given to offset the effects of estrogen and regulate endometrial growth. Hormone balance and period regulation can be achieved by providing oral contraceptives.
• Polyps, fibroids, and areas of uterine thickness can all be removed by hysteroscopy. To control excessive bleeding, remove extra endometrial tissue, and get samples for additional testing, hysteroscopy is performed.

Lifestyle Changes

• The doctor also recommends maintaining a healthy body weight by doing regular exercise.
• In addition, consuming a healthy diet can help manage weight.
• Reduce the consumption of refined sugars and eat foods rich in phytoestrogens such as soy and flaxseeds.

Regular Follow-Up

Regular follow-ups and ultrasound scans are done to prevent recurrence and detect complications.

Thickened Endometrium and Infertility

A thickened endometrium may cause infertility in many women. Both are linked to each other. Therefore, it is essential to understand the relation between thickened endometrium and infertility. Embryo implantation takes place on the endometrium; therefore, a healthy endometrium is necessary for proper implantation and successful pregnancy. But if the endometrial lining becomes excessively thickened, it interferes with the process.

Effect of Thickened Endometrium on Fertility

• The embryo may not attach properly due to increased endometrial thickness or hormonal imbalance.
• Ovulation gets suppressed due to high estrogen levels. It makes the uterine lining non-receptive.
• Irregular periods can lead to continuous endometrial thickening without shedding, disrupting the natural fertility pattern.
• Continuous thickening of the endometrium may lead to uterine inflammation, making it less receptive to embryo implantation.

Therefore, if you are unable to conceive after trying for a year without using protection, you must consult with a doctor. A fertility expert can diagnose the cause of infertility and recommend the proper treatment.

You need to consult a specialist if you are considering in vitro fertilisation, or IVF. A thicker endometrium reduces the likelihood of a successful implantation. A fertility expert may give hormonal medicines or recommend other treatments to correct the thickened endometrium before proceeding to IVF.

Conclusion

The endometrium is the uterine lining that thickens normally each month during menstruation and sheds. However, endometrial thickening needs to be appropriately assessed and treated. To take appropriate action and avoid consequences, it is critical to understand the aetiology, symptoms, and available treatments. A woman needs to see a doctor for routine examinations. A healthy lifestyle, hormonal balance, a balanced diet, and regular monitoring can help to maintain a healthy uterine lining. Women can restore their uterine health with proper diagnosis and care.