What is sufficient thickness?
The endometrium is renewed every cycle: after menstruation it is thin, then under the influence of estrogen it grows, and after ovulation under the influence of progesterone it is rebuilt and becomes ready to receive an embryo. It is measured by transvaginal ultrasound on certain days of the cycle. There is no single hard threshold: pregnancies occur even with small thickness, but the likelihood of implantation with pronounced thinning is reduced. Therefore, the doctor evaluates not only millimeters, but also the three-layer structure and blood flow in the vessels of the uterus.
- Thickness varies throughout the cycle
- Measured by transvaginal ultrasound
- The three-layer structure of the mucous membrane is important
- Blood flow in the vessels of the uterus matters
- There is no hard norm threshold
- One measurement is not enough to draw conclusions
Reasons
The most common cause is damage to the basal layer from which the endometrium is restored. It occurs during curettage, especially repeated and performed after childbirth or against the background of inflammation, as well as during intrauterine interventions. The consequence may be the formation of adhesions in the uterine cavity. The second group of reasons is chronic endometritis, which maintains low-grade inflammation and interferes with the growth of the mucosa. Less commonly, a lack of estrogen, impaired blood flow due to fibroids and vascular problems, as well as taking drugs that suppress endometrial growth play a role.
- Curettage and intrauterine interventions
- Intrauterine adhesions
- Chronic endometritis
- Estrogen deficiency
- Impaired blood supply to the uterus
- Taking medications that affect the endometrium
- Consequences of previous infections
How does it manifest itself?
Often the only sign is a change in menstruation: they become scanty, short, sometimes reduced to spotting within one day. With severe adhesions, menstruation may stop completely, and on the days of expected bleeding, pain appears in the lower abdomen, because the rejected tissue does not find a way out. For some women, there are no changes in the cycle, and the problem is discovered only during examination for infertility or repeated failures during embryo transfer.
- Scanty and short menstruation
- Spotting instead of menstruation
- Absence of menstruation with severe adhesions
- Pain on days when bleeding is expected
- Lack of pregnancy with regular sexual activity
- Unsuccessful embryo transfer attempts
What examinations are needed
The assessment begins with a dynamic ultrasound: the thickness and structure of the endometrium is measured in the first and second phases of the cycle, and blood flow is assessed using Doppler sonography. The key method for suspected adhesions and chronic inflammation remains hysteroscopy: the doctor examines the uterine cavity from the inside and at the same time can dissect the adhesions. An endometrial biopsy is needed to confirm chronic endometritis and assess the condition of the mucosa. Additionally, hormones are examined, and if an infection is suspected, appropriate tests are performed.
- Transvaginal ultrasound in dynamics
- Dopplerography of uterine vessels
- Hysteroscopy
- Pipelle endometrial biopsy
- Estradiol and other hormones
- Screening for infections
Treatment and preparation for pregnancy
Treatment depends on the cause, and there is no one-size-fits-all treatment. In case of intrauterine adhesions, they are dissected during hysteroscopy and measures are taken against re-union. Confirmed chronic endometritis is treated as prescribed by a doctor, after which the mucous membrane often begins to respond better. If the estrogen effect is insufficient, estrogen preparations are used according to the schedule, sometimes with a change in the route of administration. Methods to improve blood flow and physical therapy are also used. When preparing for embryo transfer, a reproductive specialist selects a protocol individually, focusing on the response of the endometrium.
- Hysteroscopic dissection of adhesions
- Treatment of chronic endometritis
- Estrogens as prescribed
- Means and methods for improving blood flow
- Physiotherapy according to indications
- Individual preparation protocol for embryo transfer
- Quitting smoking and normalizing weight
