Understanding thickened endometrium: Causes, symptoms, diagnosis, prevention, and treatment

In his latest online article, Mr Mahantesh Karoshi gives us his insights into thickened endometrium. He talks about what it is, the common causes, symptoms, diagnosis, prevention and treatment options.

What is thickened endometrium?

Thickened endometrium is a condition where the lining of the womb (uterus) becomes abnormally thick, even when assessed through ultrasound immediately after the menstrual cycle.

Typically, in women with regular menstrual cycles, the uterine lining appears thin during post-menstrual ultrasounds. However, when the lining is thicker than expected at this stage, it requires further investigation.

Common causes of thickened endometrium

The most common cause of thickened endometrium is hormonal imbalance. Specifically, it occurs due to an excess of oestrogen and/or insufficient progesterone. Both of these hormones play vital roles in the menstrual cycle: oestrogen stimulates cell growth, while progesterone triggers the shedding of these cells. An imbalance can lead to an overgrowth of cells or the development of abnormal cells, known as hyperplasia.

Symptoms of Thickened Endometrium

The primary symptom of thickened endometrium is abnormal uterine bleeding. This can manifest in various ways, including:

• Prolonged or heavy menstrual bleeding.
• Menstrual cycles lasting less than 21 days.
• Intermenstrual bleeding between periods.
• Missing periods for an extended period, often associated with Polycystic Ovary Syndrome (PCOS).
• Post-menopausal bleeding.

Diagnosis and Assessment

A pelvic ultrasound is the key diagnostic tool for measuring the thickness of the endometrium and assessing the regularity of the uterine cavity. It also helps identify whether the thickened lining is spread throughout the womb (global) or localised in certain areas (focal).

Thickened endometrium can have various underlying causes, ranging from hormonal imbalances to pathological conditions. When there's doubt or concern, a hysteroscopy and biopsy of the uterine lining can provide a more detailed assessment. Technological advancements have made hysteroscopy procedures minimally invasive, allowing for precise visualisation and tissue sampling.

Preventing Thickened Endometrium

While not all cases can be prevented, several measures can reduce the risk of developing thickened endometrium:

• Proper use of hormone replacement therapy (HRT) for menopausal women.
• Optimising management of PCOS.
• Maintaining a healthy body weight (BMI).
• Reviewing medications such as tamoxifen or letrozole if prescribed.
• Considering birth control or artificial induction of menstrual cycles for women under 50 who haven't had periods for over six months and aren't pregnant.

Treatment Options

The choice of treatment for thickened endometrium depends on its underlying cause:

Scenario 1: In healthy women with wrongly timed scans, a repeat ultrasound by an experienced sonographer during the postmenstrual period may be sufficient.

Scenario 2: For women with thickened endometrium after their menstrual cycle, a review of their condition is necessary. If they have significant risk factors like obesity, PCOS, family history of uterine or ovarian cancer, or a history of being on certain medications, further investigations like hysteroscopy and biopsy may be needed.

Scenario 3: Postmenopausal women experiencing abnormal bleeding with a thickened uterine lining would likely benefit from a hysteroscopy and biopsy.

Living with Thickened Endometrium

In most cases, thickened endometrium results from functional disorders that can be treated once the cause is correctly identified. Treatment options range from regulating menstrual cycles to using the levonorgestrel intrauterine system in select cases where fertility is not desired. If weight is a contributing factor, a long-term strategy to achieve a healthy body weight can be highly effective.

Endometrial hyperplasia, even though it sounds serious, is generally treatable. Patients may need to work closely with their healthcare provider to create a tailored treatment plan. For those with severe forms of hyperplasia or complex atypical hyperplasia, regular monitoring through ultrasound and surveillance hysteroscopy and biopsies may be necessary for ongoing care.

Mr Mahantesh Karoshi is an esteemed consultant gynaecologist with over 10 years’ experience. You can schedule an appointment with Mr Karoshi on his Top Doctors profile.