Increased Endometrial Thickness

Increased Endometrial Thickness

What is meant by endometrial thickening?

The endometrial thickness appears thicker than expected on an ultrasound (vaginal or abdominal) (i.e., thicker than expected at a certain time of the menstrual cycle).

What are the causes of a thick endometrial lining on an ultrasound?

** Endometrial hyperplasia

** Polyps in the endometrium

** Early pregnancy

** Placental tissue remains after childbirth

** Endometrial cancer

What is endometrial hyperplasia?

It is an irregular proliferation of endometrial glands, resulting in an increased proportion of glandular cells compared to normal endometrial cells.

Is there a risk associated with endometrial hyperplasia?

It has the potential to develop into endometrial cancer if left untreated, with a 5 percent risk over 20 years.

What are the causes of endometrial hyperplasia or endometrial cancer?

Risk factors:

**Obesity

**Estrogen therapy or estrogen receptor agonists

**Polycystic ovary syndrome

**Family history

**Age over 35

**Never having a baby

**Starting menstruation at a young age

**Delayed menopause

**Smoking

How do endometrial polyps appear?

They appear as localized thickening of the endometrium (i.e., the thickening occurs on one side, while the surrounding endometrium is thin or normal).

How can we identify endometrial thickening resulting from early pregnancy?

By performing a pregnancy hormone test (in blood or urine)

When should we suspect placental remnants in the uterus?

A recent birth followed by intermittent vaginal bleeding that does not stop despite the expected end of the postpartum period, in addition to the presence of thickening on an ultrasound consistent with placental remnants.

What are the symptoms that women experience due to thickening of the uterine lining?

**Irregular vaginal bleeding

**Abdominal pain

**Fever in cases of tumors or placental remnants

How is endometrial hyperplasia suspected?

By measuring the thickness on a vaginal ultrasound with cystic appearance of endometrium

How is endometrial hyperplasia treated?

Depending on age, symptoms, and reproductive desire, treatment may include:

**Hormonal therapy (progesterone) for 6 months and a repeat endometrial biopsy to confirm that the changes have reversed.

**Hysterectomy and oophorectomy

What are the available progesterone forms for treatment of endometrial hyperplasia?

**Pill form

**Liquid form

**Hormonal IUD (Mirena)

How are endometrial polyps treated?

By removing them under anesthesia via a uterine curettage or hysteroscopy, and confirming the diagnosis by sending the sample to a histopathology lab.

Can endometrial polyps recur?

Yes.

Can polyps transform into tumors?

Yes, with a probability not exceeding 1 percent

How is retained placental tissues managed?

**Giving antibiotics

**Performing a surgical evacuation procedure under anesthesia

How is endometrial thickening managed in the presence of a positive pregnancy hormone test?

Repeat a transvaginal ultrasound after 7-10 days to see the gestational sac. If the gestational sac is not detected, repeat the pregnancy hormone test (either the level has decreased, indicating a chemical pregnancy, or the level of the pregnancy hormone has increased, indicating an ectopic pregnancy).

How is endometrial cancer treated?

Hysterectomy, followed by additional radiation/chemotherapy.

Dr Najeeb Layyous  F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist