Thin Endometrium After D&C: Fertility Concerns and Solutions

Preparing for pregnancy - Endometrial issues after abortion?

Hello doctor, I had a D&C in March, and since then my endometrium has been consistently thin.
After starting traditional Chinese medicine treatment in July, my menstrual cycle has been approximately 35 days, with my period occurring from October 10 to October 15, with normal flow.
On November 4, I received the HPV vaccine and began taking inositol, but my period did not arrive until November 23 to November 25 (a cycle of about 40 days), and the flow was very light, enough to last a whole day on a panty liner (I change it every two hours).
On November 20, during a menstrual induction ultrasound, my endometrium measured 0.6 mm, and I expect my period to arrive on December 28.
However, on December 20, my endometrium measured approximately 0.4 mm.
I would like to ask the following questions:
1.
Could the HPV vaccine or inositol affect my menstrual cycle?
2.
Given that it has been a long time since the abortion and my endometrium is still thin, what examinations do you recommend (I am currently trying to conceive)?
3.
The basal body temperature measurements have not shown a high temperature phase, indicating no ovulation.
Does this suggest poor ovarian function?

P, 20~29 year old female. Ask Date: 2023/12/21

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, generally it does not have an impact.
Let's observe for a while, and if there is no improvement, you may consider consulting an obstetrician-gynecologist for further evaluation.
If there is no fever, it is possible that ovulation is not occurring.
Wishing you good health.

Reply Date: 2023/12/21

More Info

Understanding the implications of a thin endometrium after a dilation and curettage (D&C) procedure is crucial for addressing fertility concerns. Your situation, where you have experienced a consistently thin endometrial lining post-D&C, raises several important questions regarding your menstrual cycle, ovulation, and overall reproductive health.

1. Impact of HPV and Myo-Inositol on Menstrual Cycle: Human Papillomavirus (HPV) vaccination and myo-inositol supplementation are generally not known to directly affect menstrual cycles. HPV vaccines are designed to prevent cervical cancer and do not interfere with hormonal regulation. Myo-inositol, on the other hand, is often used to improve insulin sensitivity and ovarian function, particularly in women with polycystic ovary syndrome (PCOS). While myo-inositol can help regulate menstrual cycles in some women, it is unlikely to be the sole cause of a prolonged cycle or reduced menstrual flow. If you suspect that these treatments are affecting your cycle, it would be wise to discuss this with your healthcare provider.

2. Thin Endometrium and Recommended Investigations: A thin endometrium, particularly one measuring 0.4mm to 0.6mm, can pose challenges for implantation and successful pregnancy. After a D&C, it is not uncommon for the endometrial lining to take time to recover. However, if it remains persistently thin, further evaluation is warranted. You might consider the following assessments:
- Hormonal Evaluation: Checking levels of estrogen, progesterone, and other hormones can help determine if there is an underlying hormonal imbalance affecting your endometrial growth.

- Hysteroscopy: This procedure allows direct visualization of the uterine cavity and can help identify any structural abnormalities, such as scarring (Asherman’s syndrome) or polyps that may be contributing to a thin endometrium.

- Ultrasound Monitoring: Regular ultrasounds can help track the thickness of your endometrium over time and assess its response to any treatments you may be undergoing.

3. Ovulation and Ovarian Function: The absence of a sustained high-temperature phase in your basal body temperature chart suggests that you may not be ovulating regularly. Anovulation can be caused by various factors, including hormonal imbalances, stress, weight fluctuations, or underlying conditions such as PCOS. If you are not ovulating, it can significantly impact your chances of conceiving. A fertility specialist can provide guidance on ovulation induction methods, which may include medications like Clomiphene Citrate or Letrozole, to stimulate ovulation.

In summary, while the recovery of the endometrium after a D&C can vary, persistent thinness warrants further investigation. It is essential to work closely with your healthcare provider to explore the underlying causes of your symptoms and to develop a tailored plan to enhance your fertility. This may include lifestyle modifications, hormonal treatments, or assisted reproductive technologies if necessary. Remember, fertility is a complex interplay of various factors, and addressing each aspect holistically can improve your chances of conception.

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