Changes in the structure of the endometrium. Pathological changes in the endometrium. Normalization of the thickness of the endometrium with medications

Article plan

The endometrium is a special layer that lines the inside of the uterus. According to its structure, it is divided into basal (recovering after menstrual cycle) and functional (rejected during menstruation). Despite the fact that many women do not know what it is, it is the mucous layer that largely determines the course of pregnancy, health reproductive system and well-being in general.

The main function of the endometrium of the uterus is the formation optimal conditions and a medium for attaching a fetal egg inside the uterus. With an altered state of the endometrium (thickening or thinning), there is a high probability of violations in the course of pregnancy, including the threat of miscarriage.

cycle day	Thickness norm, cm	Average thickness, cm
4-8	0,3-0,6	0,5
8-11	Up to 0.8	0,5-0,8
11-15	Up to 1.1	0,7-1,4
15-19	1-1,6	1,1
19-24	Up to 1.4	1,0-1,8
24-27	Up to 1.2	1,0-1,8

Any deviations indicate endometrial diseases that have arisen for various reasons.

Causes of a thin layer

Among the thickness deviations - thin layer(). The disease is expressed in the form of insufficient development of the lower or upper mucous membrane of the uterus and prevents the normal attachment of the egg after fertilization.

Occurs as a result of:

diseases genitourinary system;
Hormonal disorders;
Circulatory disorders;
hereditary factors;
inflammation;
abortion;
Surgical operations;
A number of other factors.

Symptoms in the initial stages of the disease may not appear, and violations can only be detected as a result of a gynecological examination.

Manifestations of endometrial diseases:

Age delay of menstruation;
Pain during menstruation;
Pathologies and disorders of the menstrual cycle (violation of the duration and cyclicity, scanty or abundant discharge);
undeveloped hairline external genital organs;
Weakly expressed secondary sexual characteristics;
Lack of orgasm;
miscarriages;
Not getting pregnant for a long time.

A thin layer interferes with the possibility normal pregnancy and provokes complete infertility. To exclude such possibilities, therapy should be carried out on early stages diseases.

Thickening of the layer (hyperplasia) is characterized by a benign course and may be accompanied by the appearance of polyps. Deviations in thickness are detected during a gynecological examination and prescribed examinations.

In the absence of symptoms of pathology, as well as infertility, treatment may not be prescribed.

Forms of hyperplasia:

Simple. Glandular cells predominate, leading to the appearance of polyps. Treatment is with drugs and surgery.
Atypical. Accompanied by the development of adenomatosis (malignant disease).

Thickening of the layer occurs as a result of:

Constant stress;
Low progestogen level;
Violations in the liver;
Surgical operations on the endocrine glands;
Abortions at late terms;
Sexually transmitted diseases;
Diseases and disorders of the endocrine system;
The development of tumors;
inflammation;
Disorders in the production of hormones;
Taking contraceptives for a long time.

Manifestations of hyperplasia:

Clots when bleeding;
Change in the rhythm of the menstrual cycle;
Abundance and duration menstrual flow unstable;
During sexual intercourse, blood is released.

Types of pathologies and their symptoms

Endometrial diseases are divided into several types, taking into account pathologies.

Endometriosis. Occurs as a result hormonal disorders and leads to the formation of the endometrium in tissues and organs uncharacteristic of its location. Accompanied aching pains, bleeding, discharge after the end of menstruation, blood from anus and in the urine, back pain. Diagnosis includes examinations, urine and blood tests, ultrasound, biopsy. Comprehensive treatment is applied, restoring slime layer to normal thickness.
Endometritis. It is characterized by inflammation in the mucous membrane of the uterus. Occurs as a result infectious diseases, including genital, can be triggered by surgery and childbirth. Accompanied by secretions of blood with pus, pain in the lower abdomen, intoxication of the body. Treatment includes detoxification therapy, the appointment of anti-inflammatory and antibiotic drugs, bed rest abstinence from sexual activity. In case of violations caused by abortion, curettage is prescribed. The duration of treatment is up to ten days. At untimely appeal to doctors, peritonitis, sepsis, infertility, and adhesions may develop. More details in the article "".
Oncology. The development of metastases leads to damage to tissues and organs and can cause fatal outcome. The causes of occurrence are various, including the use of contraceptive drugs. In the early stages, symptoms may not appear. Complex treatment includes surgery. To reduce the risks, a comprehensive examination should be carried out twice a year.
Polyps. Benign neoplasms that violate the thickness of the endometrial layer. Detected by examination and hysteroscopy. The development of the disease is not accompanied characteristic symptoms used for treatment different techniques including folk.
Endometrial cyst. It is located on the ovaries, is diagnosed during examination and ultrasound examination. Deleted surgically, for postoperative rehabilitation use both medications and folk remedies.

How to Diagnose

To establish a comprehensive and accurate diagnosis, appoint various laboratory research, to confirm or deny the assumptions. Studies may include urine and blood tests, vaginal smears, and to exclude errors, ultrasound and histological examination. During the examination, an assessment of the state of the endometrium is carried out, any pathological processes and deviations are revealed.

Please note: patients undergo histology only after the disappearance of symptoms indicating an exacerbation pathological processes.

To assess the condition of the endometrium and find out its thickness, the following research methods are used:

Collection of anamnesis and its analysis;
Gynecological examination;
Transvaginal ultrasound#
Blood test (detailed);
Hysteroscopy;
Tests to detect infections of the uterine cavity.

If as a result preventive examination an increase in the size of the endometrium, or its redness, is found, it is necessary to adhere to bed rest.

At mild pathology, prescribe antispasmodic and analgesic drugs, it is necessary to adhere to a special diet, on lower part apply cold compresses to the abdomen.

Treatment of the endometrium is carried out in several ways:

Conservative (medicated). Medications are prescribed taking into account the stage of the disease, the age of the patient, whether pregnancies are planned in the future.
Surgical. Used in cases of advanced disease.
Folk means. AT this case it is imperative to consult a doctor and choose a course of treatment, taking into account all the available factors and contraindications. You can treat the disease with the use of plantain, rosehip, nettle, yarrow, calendula. These, and a number of other herbs, help stop bleeding. With thickening of the blood, it is possible to prescribe hirudotherapy.

It is worth remembering that the choice of a therapeutic method should be appointed exclusively by the attending physician, since any independent intervention, according to statistics, is 70% fraught with the development of adverse complications.

Physiological endometrial hypertrophy is normal process, which occurs monthly during the intermenstrual period and ends with the onset of either pregnancy, or critical days. If, in the absence of pregnancy, menstruation did not come, the increase in the endometrium of the uterus continues, but now this phenomenon is called hyperplasia and requires treatment. More detailed information you will get about it from our article.

The growth and size of the endometrium are regulated mainly by progesterone and estrogen. The function of the latter is to restore and develop the endometrium after menstruation. Therefore, it is produced in the first and second phase of the cycle.

Progesterones are "included in the process" from the third week. Their task is to stop the increase in the thickness of the endometrium, to prepare it for receiving a fertilized egg. In the normal course, if pregnancy has not occurred, the level of production of these hormones decreases by the end of the cycle, menstruation begins.

If estrogens are produced in excess, progesterone is not able to "fight" with them, the growth of the endometrium continues. The same phenomenon is observed with an insufficient amount of progesterone. It is called endometrial hyperplasia, which externally can manifest itself in three main indicators:

delayed arrival of menses,
heavy bleeding during menstruation
secretions with blood clots in the intermenstrual period.

Sometimes this pathology is asymptomatic and is detected only during an ultrasound examination.

The main danger of hyperplasia is its degeneration from benign to malignant formation.

Causes of endometrial hyperplasia

An increase in the endometrium that goes beyond the normal range is caused by a number of reasons, the main of which are the following:

violation hormonal background, metabolic processes or the functioning of the immune system;
diseases of the endocrine glands;
age-related changes in the reproductive system;
inflammatory processes in the reproductive organs;
hereditary predisposition.

The causes of thick endometrium can also be congenital or acquired (abortion, curettage) uterine defects.

Most common cause hyperplasia is a hormonal disorder characterized by a lack of progesterone and an excess of estrogen. Mastopathy, endometriosis, polycystic, fibroids can provoke such a phenomenon.

Thick endometrium at the beginning of the cycle

The quality of the uterine mucosa is usually judged by its condition in the first phase of the menstrual cycle (on its seventh or eighth day). The optimal thickness of the endometrium during this period is 5 mm. But if at the beginning of the cycle she crossed the eight-millimeter threshold, here we can already talk about a thick endometrium. Such a pathology usually occurs under the influence of a hormonal failure, indicating an insufficient amount of estradiol (responsible for the production of progesterone).

Endometrial enlargement during pregnancy

The size of the endometrium is always in dynamics. Depending on the phase of the menstrual cycle, it can either increase or decrease. Normally, when pregnancy occurs, the thickness of the endometrium should be at least 0.7 cm (ideally - 8-15 mm) and its increase does not stop. By the end of the fifth week, when the ultrasound can be seen fertilized egg, the thickness of the endometrium reaches already about two centimeters.

The size of the endometrium during pregnancy is of fundamental importance, since oxygen and nutrients are “delivered” to the fetus through it.

How to shrink the endometrium

Hyperplasia of the endometrium, like many other pathologies reproductive organs, can be treated (reduced) by three methods:

surgical,
conservative
folk.

At operational method upper shell the endometrium just scrapes out. This is usually done using ultrasound to avoid incomplete removal or perforation of the uterus. Medical treatment involves the application hormonal drugs which are selected individually for each patient.

Content

Main reproductive organ women - the uterus, the most susceptible various kinds traumatic factors. Childbirth, abortion, curettage, dysfunctional bleeding, ill-chosen oral or intrauterine contraception negatively affect the structure of the body. Care must be taken with regard to reproductive health: do not start inflammatory processes, treat existing pathologies, prevent unwanted pregnancy. It is important to maintain the normal structure of the endometrium, and especially the basal layer, due to the elements of which the entire thickness of the inner lining of the uterus is restored. As a result, they create favorable conditions for fertilization and gestation.

The uterus under the microscope

From a histological point of view, the organ has a three-layer structure: inside - endometrium, in the middle - myometrium, outside - perimetrium (serous membrane).

The endometrium can be directly divided into two constituent parts.

Basal - adjacent to the myometrium. The thickness is 1-1.5 mm. Little susceptible hormonal changes. During menstruation, it always remains and is a kind of foundation. Due to the growth of its cells, the thickness and the usual structure of the inner shell are restored. The stroma is represented by connective tissue elements. Contains parts of the glands of the overlying layer, blood vessels, nerve endings.
Functional - rejected monthly. The stroma, glands and vessels are extremely sensitive to the action of steroid sex hormones. The thickness of the endometrial glands, depending on cyclic changes, ranges from 5 to 15 mm.

functional layer has its own special structure: top part compact, and the lower one is spongy.

Main functions

Like any tissue, the endometrium has its own unique features and performs certain tasks:

protects the uterus from adhesion (sticking of the walls);
creates the necessary conditions for implantation;
provides embryonic perfusion;
participates in uteroplacental circulation;
nourishes the placenta.

uterine cycle

The menstrual cycle is the time interval from 1 day of the previous menstruation to 1 day of the present. The normal duration is 21-35 days.

Being under the influence steroid hormones, the endometrium as a target tissue, goes through four successive processes in an average cycle of 28 days.

Desquamation (1-2 days).
Regeneration (2-4 days).
Proliferation (5-14 days).
Secretion (15-28 days).

These cyclic changes- uterine cycle. The result of the regression of the corpus luteum is sharp drop hormones, the spiral arteries of the surface layer of the endometrium spasm, which, in turn, undergoes ischemia and begins to be rejected. The basal layer remains unchanged. This is how the first stage proceeds - desquamation. Trying to restore the bare part, the basal layer supplies cells to reproduce the torn layer - regeneration.

The activity of estrogens increases: menstruation stops, the thickness of the endometrium gradually increases, and dominant follicle ovary - proliferation. Reaching the maximum peak of follicle-stimulating (FSH) and luteinizing (LH) hormones, the egg is released into abdominal cavity. The process is called ovulation. The functional layer acquires the usual two-layer structure, in place of the bursting follicle, corpus luteum producing progesterone - secretion phase. By the end of the period, in the absence of pregnancy, the corpus luteum undergoes a decline in activity, leading to degeneration and deterioration of blood supply - the cascade starts again.

Given the fact that desquamation and secretion occur during menstruation- a normal menstrual cycle is considered biphasic.

Changes under the influence of hormones

After rejection of the surface layer, the uterus is covered from the inside only by the basal plate, 1-2 mm in size. At the beginning of the proliferation stage, the basal layer forms a single-row cylindrical epithelium. The endometrium during this period is characterized by a gradual growth of stratification, the tortuosity of the glands and the frequency of mitoses increase, the stroma loosens. By the time of ovulation, the thickness is 8-10 mm.

In the secretory phase, the functional layer acquires a characteristic structure: compact and spongy parts. Cells increase the number of receptors for progesterone. The glands begin to accumulate and secrete a secret. The arteries are maximally tortuous, glycogen-containing cells accumulate around them - predecidual. The integumentary villous epithelium loses cilia, protrudes outward, and intercellular spaces increase. The above changes in the structure occur on the 21-26th day of the cycle. This period is called the implantation window. best time to connect with the blastocyst.

Accumulation of glycogen - important indicator, by which you can accurately determine the day of the uterine cycle.

From days 1 to 14, the substance is present in the form of small granules, absent in the stroma. Begins to appear in the stroma of the basal shell 2-3 days before ovulation.
From 15 to 21 days, the size of glycogen clumps gradually increases, which line up at the outer pole of the cells.
22 - 23 days glycogen is released into the lumen of the endometrial glands.
From 24 to 27 days, the substance is absent.

Age features of the structure

Most pronounced changes structures of the basal layer of the endometrium are observed during menopause. The inner shell gradually atrophies: there is no habitual stratification, the glands cease to glow the secret, the blood supply decreases, and foci of fibrosis appear. In general, the volume of the organ is reduced by a third.

Another scenario is possible: due to hyperestrogenism (with obesity, liver pathology), the cells of the basal layer regenerate with increased speed, the layer thickens. This state called endometrial hyperplasia. The disease is referred to as background, which means that tissues have the ability to change, transforming into a malignant tumor.

endometrial hyperplasia most frequent pathology period of menopause. On average, 70% of women are affected by it.

Diagnostic tests

To establish the normal or defective structure of the endometrium, the following diagnostic manipulations are required:

vacuum aspiration;
diagnostic curettage;
hysteroscopy with subsequent histological examination of the material obtained;
gene expression profiling for DNA with biocrystals (an expensive method, rarely used in our country).

Most informative method- histological examination. It is carried out with a frozen pregnancy, habitual miscarriage, stillbirth, chronic inflammatory process in the uterus and appendages, dysfunctional bleeding, suspected cancer, after curettage and abortion. In any of the above conditions, the structure of the layers of the endometrium, in particular, the basal one, the presence or absence of atypia is assessed, the cause of the miscarriage is determined.

ultrasound diagnostics

An indispensable research method for determining the thickness and structure of the endometrium. Used after surgical interventions as an assessment of the course of postoperative regeneration, as well as in the presence of complaints, in the case of pathology. Exists special indicator M-echo. This value is understood as the degree of reflection of ultrasound from the wall of the organ or any formation on it. The following M-echo ranges are considered normal: on the 5th-7th day of the cycle the inner layer thickens up to 6 mm, 8-10 to 7-9 mm, 11-16 to 10-12 mm, from 19-23 reaches a maximum of 13-14 mm, and then goes down - decreasing by 1-2 mm. In postmenopausal women, the thickness of the endometrium should not exceed 5 mm.

An additional method used in conjunction with ultrasound is dopplerometry. An assessment of the blood flow of the organ is carried out, the presence of malignant, benign foci of neoplasms is determined.

Pathology

Knowledge of the normal structure of the endometrium is essential to determine pathological conditions reproductive system. The most common pathologies of the inner uterine layer:

adenomyosis - pathological germination of the endometrium in the underlying layers;
endometriosis - proliferation of cells of the inner layer outside the uterus;
Asherman's syndrome - sclerosis of the uterine cavity due to synechia, which begin to form when the basal layer is damaged. As the tissue heals, it is replaced by scar tissue. More often observed after gross manipulations - abortion, curettage, hysteroresectoscopy. At constant inflammatory focus, which melts tissues - tuberculosis, endometritis, cancer.

Unfortunately, not all women know about normal structure the inner layer of the uterus, which provides attachment of the embryo and gestation. It is important to remember that gross intervention leaves an indelible mark on the endometrium, which is not always easy to correct. The consequences of severe pathology of the basal layer, which is not able to perform its functions, can lead to infertility.

Endometritis is an inflammation of the inner layer of the uterus, which occurs under the influence of infections that have got there, is called endometritis. Its cause may be a violation of the acidity of the vaginal environment or the functioning of antibodies and immunoglobulin.

What is endometritis

Endometritis is an inflammatory process that affects the lining of the uterus. It is also possible to spread the area of infection to fallopian tubes and ovaries, which causes salpingo-oophoritis (adnexitis). In the vast majority of cases, endometritis is diagnosed in women of reproductive age.

How does

Endometritis usually occurs due to infections that spread from lower divisions urinary system. From the point of view of pathological processes occurring during inflammation of the endometrium, acute endometritis and chronic endometritis can be distinguished. In situations not related to pregnancy, the precursors of endometritis are pelvic inflammatory disease and gynecological manipulations.

In connection with pregnancy, endometritis occurs as a complication of postpartum infection. Chronic endometritis associated with pregnancy is characterized by the accumulation in the uterine cavity of products left after childbirth or abortion. At the same time, a large volume remains in the uterine cavity after childbirth. wound surface due to a rejected placenta. It represents the entry gate for infection. Chronic endometritis not associated with pregnancy is associated with the presence of such infectious processes like chlamydia, bacterial vaginosis, tuberculosis, etc.

Causes

The structure of the endometrium of the uterus is two-layer: the first layer is called the basal, and the second is the functional. It is in the functional layer that endometritis can develop. This happens as a result of damage to its structure and the penetration of viruses through these damages, leading to serious complications. This is facilitated by the fragility and sensitivity of this layer.
The most common causes of endometrial damage are:

inaccurate douching,
childbirth,
examination of the fallopian tubes,
abortion,
the introduction of the Navy,
probing of the uterine cavity,
scraping of the uterine cavity.

Infections that can lead to endometritis include:

chlamydia,
tuberculosis microbacterium,
coli,
Proteus,
klebsiella,
diphtheria bacillus,
enterobacter,
mycoplasma,
group B streptococci.

Other causes of endometritis development include:

decreased immunity due to stress, overwork, beriberi, chronic poisoning or diseases of the internal organs,
unprotected intercourse during menstruation,
non-compliance with the rules of personal hygiene.

Symptoms

The patient develops pain with endometritis in the lower abdomen, vaginal discharge with bad smell, painful urination.
There are two forms of endometritis:

acute
covert

One of their differences lies in the degree of manifestation of symptoms: the latent form can proceed very sluggishly, and only a thorough and detailed examination of the body can help diagnose it. Symptoms acute endometritis more pronounced, but it is in many ways similar to the manifestations of ailments, characteristic period menstruation, and other painful conditions.
The main symptoms of endometritis include:

pain in the lower abdomen (similar to pain during menstruation),
body temperature 38 - 39°C,
general fatigue of the body,
chills,
depressed emotional state
low levels of leukocytes and ESR in the blood test,
vaginal discharge different nature(smearing, red, brown, purulent),
menstrual disorders (scarcity or abundance),
enlarged and sore uterus.

How to define endometritis? An increase in body temperature is a direct indication of the presence of an inflammatory process in the body. If within 1 - 2 days it is kept at the indicated level, and there are no symptoms of any disease, then you should consult a doctor. It is not recommended to bring down the temperature with tablets.

AT initial stage endometritis in most cases, there are spotting red discharge. After a few days they become purulent and acquire brown color. Lack of treatment leads to the progression of the disease and its spread through the fallopian tubes.

The duration of the time interval between infection and the appearance of the first symptoms depends on the type of endometritis: after natural childbirth it is 4-6 days, with caesarean section - from 1.5 days, and with chronic it can be quite significant (in this case, the disease progresses in the uterine cavity, despite mild symptoms).

signs

If you observe signs of endometritis after caesarean, abortion, other such interference, as well as the above symptoms that are not associated with the course of any disease, urgently seek medical care. Timely diagnosis acute endometritis greatly facilitates the treatment and prevents the development of the disease.

Indirect signs of endometritis can be seen on an ultrasound examination. Experienced doctor will be able to distinguish the symptoms of both the initial stage of the disease and its chronic form. As a rule, echo signs of endometritis are determined by:

degree of enlargement of the uterus;
thickness of the endometrium;
the presence of adhesions in the uterine cavity.

In addition to the echo signs of endometritis, which shows ultrasound examination, the symptoms of the disease are detected in the process of interviewing the patient. As a rule, having studied the complaints of a woman and analyzing the regularity of the menstrual cycle, the doctor will be able to put provisional diagnosis and schedule further testing.

If signs of endometritis on ultrasound do not give complete picture about the severity and development of the disease, then an endometrial biopsy provides much more information. Since the biopsy is quite complex and painful procedure, such an analysis is carried out only in severe cases.

If left untreated, endometritis takes more than severe form and can also cause infertility. It is worth noting that neglected or undertreated endometritis, acquiring chronic form also affects other organs of the human body.

Diagnostics

How to diagnose endometritis? initial stage The diagnosis of endometritis is the analysis by the doctor of the patient's history and the symptoms identified. If the development of the disease is suspected, gynecological examination and palpation of the uterus. It should not be enlarged and painfully responsive to touch.

Otherwise, a smear is taken and material is taken for sowing in order to determine the type and characteristics of the pathogen, as well as its reaction to medications. It is also necessary to carry out biochemical and clinical tests blood. Confirmation of endometritis is the detection of leukocytosis, shift to the left leukocyte formula and acceleration of ESR.

An effective diagnostic tool is the ultrasound of the uterus, in which it is possible to detect an increased thickness of its mucous membrane, pus, blood clots, remnants of placental tissue, changes in tissue echogenicity (symptom of metroendometritis). Quite often, the spread of inflammation reaches the ovaries and fallopian tubes. It is also effectively detected during ultrasound.

Examination of patients with chronic endometritis reveals not only unevenness and thickening of the endometrium, but also adhesions in the uterine cavity. Their danger lies in the possible infertility. The main difficulty in diagnosis chronic endometritis lies in the similarity of its symptoms with manifestations of other diseases of the female genital area. The greatest reliability of the results has a constant sluggish inflammatory process and the constant sowing of the same flora.

With misdiagnosis and subsequent improper treatment the following complications are possible:

adhesive processes,
endometriosis,
neonatal infection,
complications during pregnancy and childbirth,
stillbirth,
miscarriage,
ectopic pregnancy,
HIV infection,
infertility,
cervical erosion,
cervical polyps,
uterine fibroids,
violation of the menstrual cycle.

Endometritis and IVF

After endometritis, the mucous membrane of the uterus, which has undergone inflammation, may not be receptive to conception. This creates certain problems if a woman wants to have a baby. One of the ways to get pregnant is IVF or in vitro fertilization, during which the embryo is artificially grown and implanted in the patient. How effective is the above procedure in the presence of an inflammatory process in the uterus?

Endometritis can be detected using ultrasound, which shows the thickening of the uterus and the presence of fluid in its cavity. Also one of the diagnostic methods is hysteroscopy. Endometritis is treated with antibiotics. a wide range, physiotherapy procedures. Many drugs are injected directly into the uterine cavity.

Doctors often prescribe probiotics, drugs that increase blood clotting and correct the menstrual cycle. After such treatment, a woman can become pregnant after 2-4 cycles. During this period, it is very important to maintain the natural state of the vaginal microflora, to take vitamins. The same should be done during the first trimester of pregnancy. Doctors often advise patients to undergo IVF if they become pregnant. traditional way does not work. However, problems can also arise here due to the following reasons:

embryo quality;
condition of the endometrium.

If a woman is sick or had endometritis, then internal cavity The uterus may not fully recover, as a result of which it rejects the embryo. What to do?
1. First of all, go through full examination and course of treatment. Many women immediately stop taking pills or attending procedures as soon as they feel better. But it is important to cure the disease, and not to eliminate its symptoms!
2. Carefully choose the clinic and the quality of the embryos.
3. Do not settle for a short course of radiation, as this leads to the formation of resistant strains of microorganisms, which may result in sluggish endometritis.
4. Accept vitamin complexes to help the body function better.

It is worth noting that IVF for endometritis is often the only possibility to conceive a child, and this procedure should not be neglected. But, of course, it is better not to combine endometritis and IVF. It is advisable to use in vitro fertilization only after the treatment of endometritis, because in this case the chances of bearing and giving birth healthy baby increase significantly!

Prevention

To avoid the occurrence of this disease, it is necessary to eliminate any risk of bacteria and viruses in the vaginal microflora. Observe constant hygiene. All kinds of infections, including sexually transmitted infections, must be treated in the early stages.

During the period of operable intervention, in fact, both before and after it, women must be given drugs that have an antibacterial effect.

After an abortion and childbirth, be sure to carry out ultrasound procedure uterine cavity. This allows you to detect, and if necessary, remove the remaining blood clots, the placenta or the fetal egg.

Towards prevention postpartum endometritis can be attributed to the earlier attachment of the baby to the mother's breast. Also, the speedy discharge of both from the maternity hospital.

It is necessary to conduct healthy lifestyle life, eat right. Do not allow a decrease in immunity. Frequent change sexual partners can also lead to endometritis. You must use a condom. Oddly enough, but today, it is one of the most reliable methods of contraception, in addition, it does not carry side effects as opposed to hormonal contraceptives.

ultrasound

Ultrasound of the endometrium is very often part of gynecological examination and can be done through the rectum (this is a transrectal ultrasound), the anterior wall of the abdomen (transabdominal ultrasound), or the vagina (transvaginal ultrasound).

Transabdominal ultrasound of the endometrium is performed with a filled bladder, and with transrectal it is desirable to empty the intestines and make an enema an hour before the start of the study.
What is the endometrium

The endometrium is the inner lining of the uterine wall. Its thickness and structure depend on the current phase of the menstrual cycle. If the starting point is to take the first day of menstruation, then on ultrasound the normal endometrium looks like this:

The first 2 days (bleeding, rejection of the epithelium) - a heterogeneous dark structure 5–9 mm thick.
3-4th day (regeneration phase) - a small formation 3-5 mm thick, which has light color due to the increased echo density.
5–7th day (proliferation, early phase) - the endometrium has the appearance of a light strip 6–9 mm thick with a dark rim of 1 mm.
8–10th day (proliferation, middle phase) - in total, the endometrium has a thickness of about 8–10 mm and somewhat resembles a layer cake: in the center there is a light strip 1 mm thick, and below and above it there are darker zones 3 mm thick of medium echo density. All these structures, in turn, are surrounded by a dark rim of reduced echo density 1 mm thick.
11–14th day (proliferation, late phase) - the thickness of the endometrium is 9–13 mm, the picture is similar to the previous one and differs only in that the light strip in the center from the darker zones of medium echo density located above and below begins to separate dark rim, 1 mm thick.

15–18th day - 10–16 mm;
19-23rd day - 10–21 mm (there is a maximum increase in the endometrium);
24-27th day - 10-18 mm.

Diseases when endometrial ultrasound is most often prescribed

Ultrasound of the endometrium is mandatory for the following diseases:

Endometriosis.
hyperplasia of the endometrium.
Endometritis.

Endometriosis is the growth of endometrial tissue outside the uterine cavity, for example, in the tubes, on the surface of the ovaries. With the help of ultrasound, it is quite easy to identify foci of endometriosis, especially on those days when the endometrium is most enlarged.

Endometrial hyperplasia is a companion of hormonal disorders, as well as various forms chronic inflammation and precancerous conditions. In case of suspicion of endometrial hyperplasia, ultrasound is done directly at the time of diagnosis, and also in order to confirm the pathology - after menstruation.

Endometritis is an acute or chronic inflammation inner lining of the uterine wall. It develops as a result of various surgical interventions, abortions, infection. It is almost not difficult to recognize endometritis on ultrasound.

Conclusion

To reduce the risk of endometritis, you should:

lead a healthy lifestyle,
take vitamin complexes,
have a permanent sexual partner,
use condoms,
observe the rules of personal hygiene, especially during menstruation,
do not resort to abortion,
it is mandatory to carry out anti-infective post-abortion and post-natal therapy.

For monthly cycle changes occur in the uterus that affect the endometrium. Its thickness varies different days cycle. Depending on the indicators of the size of the endometrium, doctors will learn about the health of the uterus.

What is the size of the endometrium on different days of the menstrual cycle? What could be the reasons for deviations from the norm?

Endometrium and its structure

The endometrium is the inner lining of the uterus. Its purpose is to create optimal conditions for the attachment of the embryo to the uterine cavity and to ensure normal development fetus.

During the monthly cycle, the size of the endometrium changes under the influence of female sex hormones - progesterone and estradiol.

Estradiol contributes to the maturation and thickening of the uterine layer, progesterone maintains the required thickness until the end of the cycle and in case of fertilization.

The endometrium consists of 2 layers:

Functional. It is this part of the surface of the uterus that is rejected during menstruation and undergoes changes during the monthly cycle.
Basal. This layer is adjacent to the middle uterine covering - the myometrium. It consists of various connective tissues and glands, permeated blood capillaries. At healthy woman its size is constant and is 10-15 mm.

Why and how is endometrial thickness measured?

This article talks about typical ways to solve your questions, but each case is unique! If you want to know from me how to solve exactly your problem - ask your question. It's fast and free!

The thickness of the uterine layer is measured if a woman has problems with reproductive function and a violation of the cycle of menstruation. Indications for clarifying the indicators of the endometrial layer:

periodic delays in menstruation;
lack of menstruation without pregnancy;
heavy or scanty monthly discharge;
problems with conception and gestation.

Endometrial thickness cannot be determined during a routine gynecological examination. Measurements require an ultrasound.

Most best method measurement is a transvaginal examination. Inspection is carried out by inserting the tube of the device directly into the vagina. This method provides the most reliable data. Ultrasound is recommended to be carried out in a period close to ovulation. If it is necessary to measure the size of the mucous layer during a complicated pregnancy, a conventional ultrasound is done.

Table of norms of the endometrium

The parameters of the endometrial layer change throughout the menstrual cycle daily. When deciphering the results, doctors are guided by the norms that the inner uterine layer must comply with on a certain day. The table describes how many cm the layer should be in the norm.

Norms of the endometrium by phases

The endometrial layer goes through several phases of development: initial (bleeding), middle (proliferation), final (secretory). The smallest thickness of the endometrial layer is observed in the bleeding phase, the largest - in the secretion phase.

Bleeding phase

The bleeding phase begins on the first day of the monthly cycle and lasts 5 days. During this period, the old layer is rejected and gradually restored due to the basal layer. Initial phase has two stages:

Rejection. Lasts the first 2 days of the menstrual cycle. During this stage, the thickness of the endometrium reaches 4-9 mm. On ultrasound, it is noticeable that the layer of the epithelium becomes loose, the vessels have increased fragility, bloody discharge begins.
Regeneration. Tissue repair occurs on days 3-5 of the cycle. During this period, the old layer completely exfoliates, and the new one has not yet grown, so the mucous layer acquires the smallest thickness - 2-5 mm.

Proliferation phase

The proliferation stage occurs on the 6-7th day of the menstrual cycle. Throughout the phase, the process of preparing the uterus for possible conception. Under the influence of hormones, the uterine layer grows intensively. The proliferative phase goes through several stages:

Early. From 6 to 7 days, the uterine layer has low density. On the first day of this stage, it reaches 6 mm. Every day, the endometrium increases by about 1 mm. By the end of the stage, it reaches 7-8 mm.
Average. From 8 to 10 days, the uterine layer grows from 8 to 11 mm. At this time, the endometrium begins to grow capillaries and acquires a pink tint.

Late. At the final stage from 11 to 14 days of the cycle, the layer reaches a thickness of 14 mm. The density becomes optimal for fertilization. Simultaneously with the preparation of the uterine layer in the ovaries, the egg matures. Ovulation occurs, which means pregnancy is possible.

secretory phase

The final phase of endometrial development occurs from days 15 to 30 of the menstrual cycle. During this period, progesterone has an active effect on tissue growth. Under its influence, the uterine layer grows and thickens. It becomes overgrown with vessels and acquires functionality that provides nutrition to the embryo if it is attached to the uterus.

Stages of the secretory phase:

early secretion. The uterine layer does not grow as fast as in the previous period. From 15 to 18 days, it thickens to only 16 mm. However, at this time, its structure changes, the tissues most intensively reflect ultrasound at the edges. The shade of the layer is yellow.
Average secretion. The stage runs from the 19th to the 23rd day of the cycle. During this period, the uterine layer reaches its maximum value- 18 mm. From this point on, the endometrium should not continue to thicken.
late secretion. From the 24th to the 28th day of the menstrual cycle, there is a gradual preparation for the future rejection of the uterine layer. The endometrium becomes the most dense, but at the same time it becomes slightly thinner (up to 12 mm). Atrophy of the overgrown endometrium occurs due to the fact that the level of progesterone begins to gradually decrease. Ultrasound shows a change in capillaries, a noticeable gradual formation of blood clots.

Norm with a delay in menstruation

The delay in menstruation occurs for various reasons: pregnancy, nervous tension, gain physical activity hormonal disorders, urinary diseases. A few days before menstruation, the production of hormones that stimulate the growth of the endometrium stops. The uterine layer is about 12 mm. If there is no menstruation, not because of the onset of pregnancy, the thickness of the endometrium is normally 11-13 mm.

If the delay occurred due to pregnancy, progesterone continues to be produced, which stimulates the growth of the inner uterine layer. Approximately 3 weeks after fertilization, the thickness of the endometrium reaches 2 cm. Many ultrasound devices determine the onset of pregnancy at early dates precisely by the increased thickness of the uterine layer.

Norm before menstruation

Before menstruation, the endometrium is at the stage of secretion. A week before menstruation, the thickness of the endometrium reaches its maximum value - 18-20 mm. However, in last days the menstrual cycle, the uterine layer becomes thinner. The uterus prepares for the release of an unnecessary layer of the epithelium, its growth stops. Gradually compacting, the uterine layer becomes thinner. 2-3 days before menstruation, it reaches 12 mm.

Pathological conditions

Deviations in the development of the endometrium occur due to various reasons: operations in the uterine cavity, abortions, miscarriages followed by curettage, caesarean sections, inflammatory diseases reproductive organs, hormonal disorders.

Allocate the following pathologies affecting the inner uterine layer:

Thinning of the endometrium (hypoplasia). It is diagnosed with a deviation from the norm by 0.5-0.8 cm. Most often it occurs due to a lack of androgens and progesterone. At thin endometrium the uterus becomes vulnerable to infections, the process of conceiving and bearing a child is difficult.
Excessive thickness of the uterine layer (hyperplasia). Thickening of the endometrium occurs due to hormonal imbalance. The growth of the inner membranes of the uterus leads to the formation of benign and malignant tumors, infertility.
Endometritis. Inflammation of the endometrium is often observed after surgical operations in the uterine cavity. The infection also penetrates into the uterus during a long-term inflammatory process of the genital organs and the installation of a spiral. The thickness of the uterine layer during inflammation has abnormal indicators.
Endometriosis. Germination of uterine tissues in uncharacteristic places is observed as a result of complications of operations on the uterus.
Uneven growth of the uterine layer. At the same time, in one part of the uterus, the endometrium becomes thicker than normal, and in the other - thinner.
Degeneration of the uterine layer into a malignant tumor.
Seals of the endometrium, the formation of cysts and polyps.

Elimination of pathologies depends on the causes that led to the disease. If the change is caused hormonal failure A woman is prescribed hormone therapy. The lack of estradiol is replenished with the help of Divigel. The ripening of the layer is facilitated by "Utrozhestan" and "Dufaston". Excess uterine tissue is also corrected with hormone-containing drugs.

In the treatment of pathologies, physiotherapy is used: ozokerite therapy, vaginal irrigation, massage, acupuncture. In some cases, with abnormal growth of the endometrium, the extra layer is removed by scraping.