Endometrium – structure, endometrial cycle, fertilization, diagnostics, diseases [EXPLAINED]

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The endometrium is the mucosa that naturally lines the uterine cavity. It can have a different thickness depending on the age of the woman and the phase of the menstrual cycle. It happens that the endometrium moves outside the uterine cavity. This is a medical condition known as endometriosis.

The endometrium, or lining of the womb, lines the inside of a woman’s womb. During monthly bleeding, it is the endometrium that gives relief from regular exfoliation. The implantation of the ovum after conception and the proper course of pregnancy depend on the proper functioning of the endometrium. Check what is worth knowing about endometritis!

Endometrium – structure

The uterine wall is made up of three layers. These are:

1. peritoneum – covers the entire organ from the outside;
2. muscular – this is the thickest layer that allows the uterus to contract;
3. mucous – it is located inside the uterus and this is the endometrium.

The structure of the endometrium is similar to that of other mucous membranes. It is made up of epithelial cells, connective tissue and blood vessels, nerves and immune cells. Essential element of the structure of the endometrium there are glands. The functions of the endometrium are related to the division of the endometrium into two layers:

1. basal layer, which lies deep. It has a permanent structure, independent of the phase of a woman’s monthly cycle;
2. a functional layer that alternates between exfoliation and growth. Due to these changes in the structure of the endometrium, it is possible for the embryo to implant in the uterine wall. The reconstruction of the functional layer is possible thanks to the base layer, i.e. the base.

The endometrium changes depending on the phase of the menstrual cycle and the age of the woman. Changes in the thickness of the endometrium can be seen on ultrasound. For girls who are not yet menstruating, the norms of endometrial thickness are 0,3 to 0,5 mm. On the other hand, in mature women, the endometrium may be 7-9 mm in the first phase of the cycle, and even 15 mm in the next.

For menopausal women who take hormone therapy, the endometrium should be up to 8 mm thick. If the thickness of the endometrium exceeds 12 mm on ultrasound, diagnostics for endometrial cancer, i.e. uterine cancer, should be performed.

Find out more: What is the corpus luteum and what is its function?

Endometrium – the endometrial cycle

Endometrial thickness depends on the concentration of female sex hormones: estrogens and progesterone. Fluctuations in these hormones affect structure of the endometrium at any given point in the cycle. The endometrium is made up of two layers – basal and functional. These layers are visible in the luteal phase, i.e. between ovulation and menstruation. At this time, the functional layer begins to exfoliate, and as a result, menstruation begins.

Then the functional layer begins to rebuild from the basal layer. This is due to estrogens, which are intensively produced about 5 days after menstruation. Approx. On the 14th day of the menstrual cycle, ovulation occurs. An egg is released from the ovarian follicle. The follicle then turns into a yellow body. It is responsible for the production of progesterone. Progesterone increases the thickness of the endometrium several times, and the uterine mucosa is ready to receive the embryo. The endometrium stores, inter alia, nutrients. If fertilization fails, the functional layer peels off again and menstruation begins.

These changes are called endometrial cyclewhich consists of three phases:

1. proliferation, or multiplication;
2. secretion or secretion;
3. menstruation, or exfoliation.

Check it out: Curettage – what is it and what is worth knowing about this treatment?

Endometrium – fertilization

When it comes to fertilization of the ovum, the function of the endometrium changes. The progesterone released from the corpus luteum causes the membrane to unfold and turn into a temporal pregnancy which becomes the maternal part of the placenta. Constant flow of blood and nutrients depends on it, which enables the proper development of the fetus.

The temporal layer of the endometrium it consists of a compact and spongy layer. Endometrial tissue is filled with nutrients so that the nesting embryo has food until complete implantation. Moreover, the temporal tissue also plays an immunological role, allowing for the maintenance and termination of pregnancy. This is because immune cells act differently within this tissue and prevent the woman’s body from recognizing the fetus as foreign.

Check it out: Progesterone – deficiency, excess. Progesterone in pregnancy

Endometrium – disease diagnosis

Endometrial research are usually performed by a gynecologist. During the visit, the gynecologist conducts an interview and usually performs a transvaginal ultrasound, which allows him to check the thickness of the endometrium. The ultrasound result may indicate a heterogeneous endometrium, which is not a reason for panic. It should be remembered that the result of an ultrasound examination should always be analyzed on the basis of the history and the results of other tests. Often, a heterogeneous endometrium indicates one of the more common diseases. If the test shows that the endometrium is outside the uterine cavity, this is a sign of endometriosis.

Endometriosis is a condition where the endometrium travels outside the uterine cavity. It can be found in other organs, and because of the monthly shedding and bleeding, it causes severe pain in women. Endometriosis is one of the leading causes of infertility in women. After diagnosing endometriosis, your doctor will suggest appropriate treatment. If in ultrasound examination of the endometrium the doctor finds that some other pathological changes, such as polyps, usually refer the patient for further diagnosis.

Other endometrial tests that may be performed include:

1. endometrial biopsy – this procedure involves taking a piece of endometrial tissue using a special speculum and subjecting it to a microscopic examination. The most common indications for an endometrial biopsy are menstrual disorders, vaginal bleeding (also after menopause), problems with conceiving a child and suspicion of cancer. The test sample can also be taken during curettage of the uterine cavity. Typically, curettage is performed under general anesthesia. The uterine mucosa is then scraped off by a doctor, which is why it is a procedure with a higher risk of complications. However, curettage allows you to take a large sample and gives you a better chance of diagnosing the disease. Recovery after curettage lasts 5 days;
2. hysteroscopy is a surgical procedure. During hysteroscopy, a camera is inserted into the uterine cavity, which allows for a detailed examination of the endometrium, thanks to which all pathological changes, e.g. adhesions or hyperplastic changes, are visible. During the procedure, a sample of endometrial tissue can be taken for biopsy. Thanks to the use of a webcam, the material for endometrial biopsy is collected from specific places that look suspicious. During hysteroscopy, it is also possible to remove e.g. polypy endometrium.

Endometrium – diseases

Endometrial problems They can manifest as menstrual disorders, vaginal bleeding, infertility, problems with conception, or only pain. The most common diseases of the endometrium include:

1. inflammation of the endometrium – endometritis most often develops after gynecological surgeries, such as caesarean section, uterine curettage or hysteroscopy. Endometrial infections can also occur in the postpartum period. Symptoms of endometritis These include lower abdominal pain, fever and vaginal bleeding. Inflammation can also spread to the ovaries and fallopian tubes, and other nearby organs. Bacteria are most often responsible for endometritis, so they are treated with antibiotics;
2. zrosty endometrium – it is scarring within the uterine cavity. Endometrial adhesions can be a complication of surgery, inflammation or childbirth. Endometrial adhesions can be responsible for problems conceiving a baby as well as maintaining a pregnancy. The most serious disease associated with the occurrence of adhesions is Asherman syndromewhich leads to complete atresia of the uterus. First, your period stops and your bleeding becomes thinner and thinner. It could be a consequence of being too strong curettage of the uterus. Treatment consists of removing adhesions surgically;
3. polypy endometrium – they are pediculated structures. They arise from an overgrown endometrium. Polyps are mostly benign in nature, but after removal, they are always microscopically examined, as it happens that cancer cells are found in their vicinity. Polyps usually do not exceed a few centimeters. Endometrial polyps produce no symptoms other than abnormal bleeding. The causes of their formation are not known, but it is suspected that hormonal disorders may be of importance. Endometrial polyps are visible, for example, on ultrasound or hysteroscopy;
4. endometrial hyperplasia – hyperplasia is the excessive growth and multiplication of glandular cells in the endometrium. As a consequence, the endometrium becomes oversized and thick. Overgrown endometrium can make it difficult for a woman to function normally as it can cause heavy bleeding, even between periods. Endometrial hyperplasia is influenced by estrogens, which are not counterbalanced by progesterone and consequently stimulate the endometrium. Endometrial hyperplasia may be evidenced by a thickness greater than 5 mm in postmenopausal women and greater than 8 mm in women receiving hormone replacement therapy. In addition, it is worth performing microscopic examination of the endometrial tissue, because the thickening of the endometrium does not necessarily indicate its growth. In the description of the result, we can read either “growth without atypia” or “atypical growth”. Growth without atopy means that although the endometrium is thickened, the cells are properly built. This result means a low risk of developing cancer. Treatment is based on the introduction of hormone therapy. However, these changes may disappear on their own. On the other hand, atypical endometrial hyperplasia is associated with a high risk of developing into endometrial cancer. Often such a result is an indication for prophylactic removal of the uterus. However, if the patient wishes to become pregnant in the future, hormonal treatment is introduced and monitoring for the appearance of cancer is recommended. Endometrial hyperplasia is more common in people:

1. obese;
2. using estrogen-containing drugs during, for example, hormone replacement therapy;
3. struggling with diseases that cause an increase in the concentration of estrogens;

1. rak endometrium – it is the second most common malignant neoplasm of the female reproductive system. Most often it is diagnosed around 50-70 years of age. The risk of developing the disease is influenced by hormonal disorders (excessively high levels of estrogens). Obese women in the menopausal period are most at risk. During this time, the body produces less sex hormones, so the levels of progesterone also fall. In addition, adipose tissue converts other hormones into estrogens. Therefore, a healthy lifestyle is a very important element endometrial cancer prophylaxis. Early symptoms of endometrial cancer include abnormal uterine bleeding. The earlier the diagnosis, the greater the chances of a cure. You can check the CA 125 antigen, which helps determine your risk of developing endometrial cancer. This test is included in the test packages for women, which you can buy on Medonet Market: Women’s health control – diagnostic blood tests or Neoplastic diseases – risk assessment for women. Treatment is mainly based on surgery. Hormone therapy, chemotherapy and radiotherapy are only complementary treatments. The prognosis depends on the stage of the disease at the time of diagnosis. What risk factors also include:

1. medications that contain estrogens are taken;
2. genetic predispositions;
3. hypertension;
4. Polycystic ovary syndrome;
5. anovulatory cycles;
6. hiperestrogenizmem endo- i egzogennym;
7. diabetes;
8. long treatment of breast cancer with tamoxifen;
9. no children;

1. endometriosis – this is the movement of endometrial tissue outside the uterine cavity. The most common are fallopian tubes, ovaries or other surrounding tissues. However, the endometrium can also be found in the bladder, vagina, large intestine, and even in the brain or lungs. Though the endometrium is misplaced, it is subject to hormones just like the lining of the womb. Therefore, endometriosis can cause severe pain, infertility and pain during intercourse. The disease can also be asymptomatic. The specific cause is unfortunately unknown. Endometriosis is chronic and the disease frequently recurs. Treatment depends on the stage of the disease and the age of the woman. Treatment of endometriosis it is based on the administration of hormones or surgical removal of disease foci. Endometriosis endometriosis treatment it is intended to calm down the effect of estrogens on the endometrium. Therapy is also often based on alleviating the troublesome effects of the disease, such as pain;
2. endometrium atrophy – in this state, the endometrium becomes thin due to the loss of its cells. Endometrial atrophy usually occurs due to the failure of estrogen to stimulate the endometrium. This can happen, for example, after the menopause. Endometrial atrophy in women of reproductive age prevents the embryo from implanting in the uterine wall and leads to secondary infertility. Such a diagnosis requires careful investigation of hormonal disorders, leading to atrophy.

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