Endometrial thickness increases and decreases during the process. Two hormones, estrogen and progesterone , prompt these cycles of endometrial growth and its shedding through menstruation if a pregnancy does not develop.
In this article, we look at the normal range for endometrial thickness, causes of changes, and when to see a doctor. In imaging tests of young females who have not yet begun menstruating, the endometrium is present but smaller than it will be later in life.
According to the Radiological Society of North America RSNA , the endometrium is at its thinnest during menstruation, when it usually measures between 2—4 millimeters mm in thickness. At this phase, the endometrium begins to thicken and may measure between 5—7 mm. As the cycle progresses and moves towards ovulation, the endometrium grows thicker, up to about 11 mm. During this secretory phase , endometrial thickness is at its greatest and can reach 16 mm.
Endometrial thickness is important in pregnancy. Healthcare experts link the best chances for a healthy, full-term pregnancy to an endometrium that is neither too thin nor too thick. This allows the embryo to implant successfully and receive the nutrition it needs.
The endometrium gets thicker as the pregnancy progresses. The RSNA also state that in healthy postmenopausal people, the endometrium typically measures about 5 mm or less. Ultrasound is the most common way to measure the thickness of the endometrium. It is the method that healthcare providers use first, especially if an individual has reported abnormal vaginal bleeding.
One of the more common causes of changes in endometrial thickness is pregnancy. Tamoxifen is a drug that is called a selective estrogen receptor modulator or SERM. SERMs are drugs that affect the estrogen-sensitive parts of your body in different ways. Tamoxifen is often used in the treatment of hormone-sensitive breast cancers because it opposes the effects of estrogen in the breast tissue.
However, Tamoxifen stimulates the estrogen receptors in the lining of the uterus so it acts like an estrogen and can cause endometrial hyperplasia. If you are using hormone replacement therapy or Tamoxifen and you develop abnormal uterine bleeding, it is very important that you see your healthcare provider and be evaluated.
Hormone-producing tumors are not a very common cause of endometrial hyperplasia. However, there are certain usually benign ovarian tumors that produce excess estrogen. When you see your healthcare provider for abnormal uterine bleeding it is likely that you will undergo a biopsy of the lining of your uterus. Your healthcare provider may recommend either an office endometrial biopsy or a minor surgical procedure called a hysteroscopy with a curettage or sampling of the endometrium.
This is a very common office-based gynecologic procedure. In general, it is very well tolerated. Anticipation and anxiety of having the procedure are often much worse than the actual biopsy. If you need to have an endometrial biopsy, it is a good idea to take mg of ibuprofen and have a little snack about an hour before the procedure. You may want to bring a small warm pack or patch with you to also help minimize cramping during and after the procedure.
Your healthcare provider may even give you one at the time of the biopsy. The set-up for the biopsy is the same as for a routine pap smear. After the speculum is placed your healthcare provider will clean off your cervix with a gentle antiseptic.
Likely your healthcare provider will then place a grasper to hold your cervix in place while the small aspirator device is inserted. You will likely experience some discomfort. The discomfort can range from mild period cramps to intense cramping similar to early labor pains.
The good news is the procedure is quite quick and typically lasts less than one minute. Taking ibuprofen before the procedure and using a warm pack during the procedure definitely helps minimize the pain. Your healthcare provider may suggest that you undergo a hysteroscopy and endometrial sampling instead of an endometrial biopsy. This is a same-day surgical procedure and in some gynecologic practices, it is also performed in the office instead of the operating room. The benefit of hysteroscopy is that it allows your healthcare provider to directly observe the lining of the uterus assure that all areas of the endometrium are adequately sampled.
There can be certain situations in which your healthcare provider may suggest this slightly more invasive procedure. Endometrial hyperplasia cannot be diagnosed by a blood test or an ultrasound. However, it is possible that your healthcare provider may recommend certain blood tests to rule out other causes of abnormal uterine bleeding. It is also possible that your healthcare provider may order a transvaginal pelvic ultrasound to help in the diagnosis of the cause of your abnormal uterine bleeding.
Endometrial hyperplasia can only be diagnosed after your endometrium has been sampled and evaluated under the microscope by a pathologist.
When the pathologist looks at the sample of your endometrium under the microscope they look specifically at changes in the two components of your endometrium, the glands and the supportive tissue called stroma. Endometrial hyperplasia is diagnosed when there are more glands relative to stroma than you would find in normal proliferative or cycling endometrium.
The pathologist will then comment on whether there are atypical appearing cells in this abnormally thickened endometrium leading to the two classifications of endometrial hyperplasia:. Endometrial hyperplasia is not endometrial cancer but it is considered a precancerous condition.
In fact, in some cases of significant atypical hyperplasia, a very early stage endometrial cancer may already be present. An mm threshold yields a similar separation between those who are at high risk and those who are at low risk for endometrial cancer.
In postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6. The estimated risk of cancer was sensitive to the percentage of cancer cases that were estimated to occur in women without vaginal bleeding. Doctors recommend this if you no longer want to become pregnant.
There are also a number of more conservative treatments for younger women who do not wish to have a hysterectomy. Your doctor will help you decide which treatment option is best for you. In most cases, endometrial hyperplasia is very treatable.
Work with your doctor to create a treatment plan. If you have a severe type or if the condition is ongoing, you might need to see your doctor more often to monitor any changes. This article was contributed by: familydoctor.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Learn about the symptoms, diagnosis, and treatment of this…. Abnormal uterine bleeding is any heavy or unusual bleeding from the uterus through your vagina. It can occur at…. Endometriosis is a medical condition in which the lining of the uterus grows on the outside of the uterus.
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