Abnormal Endometrial Thickening: Causes and Treatment Options

Endometrial hyperplasia

Hello, Doctor.
I have been experiencing prolonged menstrual periods since October 2011.
In October, I took tranexamic acid to stop the bleeding.
In November, my period lasted for 16 days, and my hemoglobin dropped to 10.
The doctor administered progesterone to stop the bleeding.
I then took megestrol every month until January, when I stopped.
As a result, my January period returned to normal, lasting seven days, but then I had bleeding again four days later.
I went to the gynecologist for an ultrasound, and the endometrium was still thicker than normal (but the doctor did not tell me the exact measurement).
I then started taking nordette for 14 days.
Today, which is the 25th day of my menstrual cycle, the ultrasound showed an endometrial thickness of 1.64 cm.
The doctor mentioned that if the bleeding ends and the endometrium is still thick, I will need to undergo a biopsy in the operating room.
I would like to ask why there is this abnormal thickening? Is it due to the use of steroids? I have seen two different doctors; one believes that estrogen treatment is also necessary, while the other thinks that progesterone alone is sufficient.
What medications are typically used to treat this condition? If the endometrium remains thick after menstruation, is it really necessary to perform a biopsy? Thank you.

Celin, 20~29 year old female. Ask Date: 2012/02/11

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the thickness of the endometrium varies throughout the menstrual cycle, being thinnest right after menstruation and reaching its thickest point during the luteal phase after ovulation, just before the next period.
It is recommended to measure the endometrial thickness 2-3 days after menstruation has ended.
If there is a notable increase in thickness at this time, an endometrial biopsy is advised to rule out the possibility of endometrial hyperplasia, as this condition can increase the risk of endometrial cancer.

If the menstrual irregularities are solely due to hormonal imbalances, treatment may involve progesterone or a combination of estrogen, with the specific method and type determined by the cycle days and the physician's preference.
Endometrial hyperplasia is generally associated with conditions such as hypertension or obesity, particularly in cases of prolonged amenorrhea.
The examination typically requires simple intravenous anesthesia for about 5-10 minutes in the operating room, although there are also outpatient procedures using simpler instruments that may have slightly lower accuracy.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2012/02/11

More Info

Abnormal endometrial thickening can be a concerning issue, particularly when it leads to prolonged menstrual bleeding or other symptoms. The endometrium, which is the lining of the uterus, can thicken for various reasons, and understanding these causes is crucial for determining the appropriate treatment options.

Causes of Abnormal Endometrial Thickening
1. Hormonal Imbalances: The most common cause of abnormal endometrial thickening is hormonal imbalance, particularly an excess of estrogen relative to progesterone. This can occur in conditions such as polycystic ovary syndrome (PCOS), obesity, or during perimenopause when ovulation becomes irregular.

2. Endometrial Hyperplasia: This is a condition where the endometrium becomes excessively thick due to prolonged exposure to estrogen without adequate progesterone. It can be classified into simple hyperplasia, complex hyperplasia, and hyperplasia with atypia, the latter being a precancerous condition.

3. Uterine Fibroids or Polyps: These benign growths can also contribute to thickening of the endometrial lining and may cause abnormal bleeding.

4. Medications: Certain medications, including hormonal treatments like progestins or estrogen, can influence endometrial thickness. For instance, if you have been taking megestrol, a progestin, it can help regulate the endometrial lining, but if not balanced with estrogen, it may not be sufficient.

5. Other Medical Conditions: Conditions such as thyroid disorders, diabetes, or liver disease can also affect menstrual cycles and endometrial health.

Treatment Options
1. Hormonal Therapy: The treatment for abnormal endometrial thickening often involves hormonal therapy. Progestins, like the ones you have been taking (megestrol and nordron), are commonly used to counteract the effects of estrogen and help normalize the endometrial lining. If your doctor suggests adding estrogen, it may be to ensure a more balanced hormonal environment, especially if you are experiencing symptoms of estrogen dominance.

2. Monitoring: If the endometrial thickness remains elevated after your menstrual cycle, your doctor may recommend further monitoring through ultrasound or additional imaging studies.

3. Endometrial Biopsy: If the endometrium is still thick after your next menstrual cycle, an endometrial biopsy may be necessary. This procedure involves taking a small sample of the endometrial tissue to check for hyperplasia or cancerous changes. It is a critical step in ruling out serious conditions, especially if there are risk factors present.

4. Surgical Options: In some cases, if hyperplasia is diagnosed or if there are significant abnormalities, surgical options such as dilation and curettage (D&C) or hysteroscopy may be considered to remove the thickened tissue.

5. Lifestyle Modifications: Addressing underlying conditions such as obesity, managing stress, and maintaining a healthy diet can also play a role in regulating menstrual cycles and improving overall hormonal balance.

Conclusion
In your case, the prolonged menstrual bleeding and thickened endometrium warrant careful evaluation. It is essential to follow your doctor's recommendations regarding hormonal treatment and monitoring. If the endometrial thickness does not decrease after your menstrual cycle, an endometrial biopsy is a prudent next step to ensure that there are no serious underlying conditions. Always communicate openly with your healthcare providers about your symptoms and concerns, as they can provide tailored advice based on your specific situation.

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