The endometrium: everything you need to know about the lining of the uterus
The endometrium is the inner lining of the uterus. Every month before menstruation, it becomes thicker under the effect of hormones and then it desquamates during the period of menstruation. In other words, the breakdown of the endometrium is what causes menstrual bleeding at the end of the menstrual cycle. When the endometrium thickens outside the period of menstruation, it is customary to prescribe examinations to rule out any risk of proliferation of cells sometimes signaling the presence of cancer.
What is the role of the endometrium?
The endometrium is the inner wall of the uterus. Its role is to accommodate a fertilized egg and to protect the embryo during its growth. In the absence of fertilization and therefore pregnancy, the endometrium disintegrates, which causes menstrual bleeding. Then, under the effect of hormones secreted by the ovaries (estrogen), the endometrium is reconstituted during the 28 days of the menstrual cycle.
The endometrium can change size: why?
The thickness of the endometrium can vary throughout a woman's life, from puberty until menopause.
During the period of menstruation, the endometrium is thin. Its size varies from 2 to 4 millimeters thick.
From the 6th to the 14th day of the cycle (proliferative phase) the endometrium becomes thicker. It can measure between 5 and 7 millimeters.
At the time of the release of the egg (14th day of the cycle) reaches its maximum size. It oscillates between 11 and 16 millimeters.
In postmenopausal women, the endometrium measures about 5 millimeters or less.
Possible causes of an endometrium that is too thick or too thin
Possible causes of an endometrium that is too thick include the following:
- endometrial cancer;
- hormone replacement therapy (HRT);
- taking tamoxifen (drug against breast cancer in premenopausal women);
- chronic high blood pressure;
- the presence of polyps;
- diabetes ;
Possible causes of an endometrium that is too thin (7mm or less) include:
- the woman's age;
- medical treatment;
- taking the mini-pill;
- some endometrial diseases (endometriosis, adenomyosis, etc.);
To measure the thickness of the endometrium, the doctor uses ultrasound.
Endometrial cancer: symptoms and treatments
Endometrial cancer is the fourth leading cause of cancer in women. It generally affects postmenopausal women (average age of diagnosis of endometrial cancer: 69 years). Unlike cervical cancer, there is no vaccine to prevent endometrial cancer. According to the INCA (National Cancer Institute), its incidence rate is 10.8 per 100,000. This cancer has a good prognosis (especially in stages IA and stages IB where the cancer is limited to the uterus) because its diagnosis is usually made early.
Symptoms of endometrial cancer are:
- vaginal bleeding in postmenopausal women;
- bleeding outside the period of menstruation in young women;
- nauseating losses;
- pain in the lower abdomen;
- abnormal weight loss.
The risk factors for endometrial cancer are:
- diabetes ;
- hormone-based treatments (oestrogens).
The diagnosis of endometrial cancer requires the following exploration examinations:
- a smear;
- diagnostic hysteroscopy (exploration of the endometrium and cervix using an endoscope);
- a biopsy (sampling of the lesions to specify the exact nature of the tumours);
- a scanner or an MRI (to look for a possible extension of the tumors to other organs).
The treatment of endometrial cancer is based on surgery including a total hysterectomy (removal of the uterus) and sometimes the removal of the ovaries and fallopian tubes.
Depending on the case, other treatments may be prescribed:
- hormone therapy.
When to consult the doctor?
Certain signs coming from the endometrium deserve to be discussed with the doctor. These include the following symptoms:
- abnormal pelvic pain;
- bleeding after menopause;
- menstruation heavy or lasting for a long time;
- irregular menstrual cycles (less than 21 days or more than 38 days);
- spotting between periods.
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