How Is Endometrial Hyperplasia Diagnosed
Many conditions can cause abnormal bleeding. To identify whats causing symptoms, your healthcare provider may order one or more of these tests:
- Ultrasound: A transvaginal ultrasound uses sound waves to produce images of the uterus. The images can show if the lining is thick.
- Biopsy: An endometrial biopsy removes tissue samples from the uterus lining. Pathologists study the cells to confirm or rule out cancer.
- Hysteroscopy: Your provider uses a thin, lighted tool called a hysteroscope to examine the cervix and look inside the uterus. Your provider may perform this procedure along with a dilation and curettage or biopsy. Its most advantageous to couple this with a visually directed dilation and curettage of the endometrium. With hysteroscopy, your provider can see abnormalities within the endometrial cavity and take a targeted biopsy of any suspicious areas.
family history of ovarian, colon, or uterine cancer
Doctors describe endometrial hyperplasia based on the type of cell changes in the uterine lining. There are three categories:
Benign endometrial hyperplasiacell changes in the lining that are not cancer
Endometrial intraepithelial neoplasia precancerous changes in the lining
Endometrial adenocarcinoma, endometrioid type, well differentiatedcancerous changes in the lining
Bleeding during your period that is heavier or lasts longer than usual
Menstrual cycles that are shorter than 21 days
Any bleeding after menopause
The Contraceptive Pill Is Linked To A Reduced Risk
The combined pill, the most common type of birth control pill, is linked with a reduced risk of womb cancer. These protective effects are bigger the longer a woman takes the combined pill for. They can continue for decades after she stops taking it.
Using a non hormonal intrauterine device has also been linked with a decreased risk of womb cancer.
Q: How Does Ultrasound Play A Role In Measuring Endometrial Thickness
A: The main role of ultrasound is to exclude significant tissue or its high negative predictive value. There is no documented prospective trial showing that a thick endometrial echo needs intervention if the patient is healthy and has no bleeding.
Some studies have implied that the thicker the endometrial echo, the more dangerous, but that’s not always true. Most endometrial cancers bleed relatively early with thinner echoes. The thickest endometrial echoes tend to be simple hyperplasia or inactive polyps.
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One Of The Things That Women Fear Most With A Pelvic Ultrasound Is The Finding That Their Uterine Wall Is Thickened Cancer Comes To Mind
And in fact, uterine cancer in most cases begins with a thickened uterine lining.
But this doesnt mean that every case of uterine wall thickening is a harbinger for cancer.
So this then begs the question: If not all cases of uterine wall thickening are cancer, what are the other conditions?
Hyperplasia is a benign thickening of the lining of the uterus, a result of estrogen stimulation without the mitigating effects of progesterone, says Julian Schink, MD, Chief of Gynecologic Oncology, Cancer Treatment Centers of America Medical Director of Gynecologic and Medical Oncology, Midwestern Regional Medical Center.
However, Dr. Schink adds, Hyperplasia unresolved for years can result in endometrial cancer. Thickening of the uterine lining is often just benign hyperplasia, or it can be from benign uterine polyps.
Causes Of A Very Thin Or Thick Endometrial Lining
The thickness of the endometrium changes during a persons menstrual cycle, but other factors can prompt changes as well.
One of the more common causes of changes in endometrial thickness is pregnancy. Women who are having an ectopic pregnancy or who are less than 5 weeks pregnant may show signs of a thickening endometrium.
Cancer of the endometrium or the ovaries is one of the most severe conditions that can lead to an increase in endometrial thickness. According to the , endometrial cancer is the most common cancer affecting a persons reproductive systems. Developing more often in white people than African American people, endometrial cancer is rare in females under 45. The average age at diagnosis is 60.
Other factors contributing to a greater thickness of the endometrium include:
- scar tissue
- endometrial hyperplasia
Endometrial hyperplasia is the medical term for a condition in which the endometrium becomes too thick. This is often related to excessive levels of estrogen or estrogen-like compounds, and not enough progesterone. The condition itself is not cancer, but it can lead to the development of cancer.
It is also possible for the endometrium to be too thin. Researchers define a thin endometrium as 7 mm or less . Typically, experts associate low readings of endometrial thickness with age. However, they report that 5% of people under 40, and 25% of people over 40 had a thin endometrium.
Symptoms Of The Endometrial Hyperplasia In Menopause
In the period of menopause, endometrial hyperplasia can pass asymptomatically.
The main symptoms of endometrial hyperplasia in menopause are â proliferation of the endometrium more than 5 mm in height and an increase in the body of the uterus. During menopause, any uterine bleeding or spotting from the vagina, regardless of their volume , duration and frequency should be perceived as an alarm and a possible symptom of a malignant process.
Common comorbid symptoms include rapid fatigue, weakness, lethargy, frequent headaches, hypertension, disability. When the process is maligned, a sharp decrease in weight is possible.
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Causes Of Thickening Of Uterine Lining After Menopause
Complex is a little thicker than simple, Its estrogen that stimulates the uterine lining, If uterine thickness is abnormal, The condition tends to occur during or after menopause, and while I worried, Simple is a thickened lining without cellular changes, its imperative that the cause be determined, Symptoms of Thickening www.healthline.comEndometrium Thickening: Causes,Author: Sharon LiaoFluid In Uterus After Menopause, or on your cervix, Ive had pap smears that hurt worse than that.
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Treatment For Thickening Of The Uterus
- The treatment of thickened uterus lining may depend on several factors such as the age of a woman, the severity of the symptoms and the risk of developing endometrial cancer.
- Thickening of uterus lining by itself is not cancerous however the risk of it being in precancerous or cancerous stage is high. It is for this reason a woman who is suffering from abnormal thickening of uterus lining should be treated and monitored regularly. Particularly if the woman is her premenopausal or post menopause age.
- If the woman is in her childbearing age, in most cases the treatment of choice is with medications. This may include hormone releasing contraceptives such as birth control patch, birth control pills or insertion of intrauterine device.
- Women in their Peri-menopause and menopausal age may feel better with a course of hormone replacement therapy, which consists of progesterone hormone. However, a long course of this therapy may not be advisable as it may trigger the risk of breast cancer and cardiac ailments. It should always be discussed with the treating doctor before initiating HRT.
- When the medical treatment fails, and if there is a high risk of endometrial cancer, hysterectomy should be always preferred option. Hysterectomy is surgical removal of uterus.
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Symptoms Of Endometrial Hyperplasia
The primary symptom of endometrial hyperplasia is abnormal menstrual bleeding. Contact your doctor if you experience:
- Menstrual bleeding that is heavier or longer lasting than usual.
- Menstrual cycles that are shorter than 21 days.
- Menstrual bleeding between menstrual periods.
- Not having a period .
- Post-menopause uterine bleeding.
Closer Look At Postmenopausal Bleeding And Endometrial
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Bleeding After Menopause: Its Not Normal
Too often I see women with advanced endometrial cancer who tell me they experienced postmenopausal bleeding for years but didnt think anything of it. This shows we need to do a better job educating our patients about what to expect after menopause.
Women need to know postmenopausal bleeding is never normal, and it may be an early symptom of endometrial cancer. Any bleeding, even spotting, should trigger a visit to your doctor as soon as possible. Dont wait to make an appointment until after the holidays or even next week. Do it today.
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How To Treat And Prevent Thickened Endometrium
- In most cases, treat of endometrial hyperplasia involves removal of uterine tissue through dilatation and curettage .
- Postmenopausal women who are taking replacement hormones causing recurrent endometrial thickening should discuss with their gynecologists options which include either supplementing their therapy with progesterone or stopping therapy.
- Premenopausal women who have thickened endometrial may take oral contraceptives or progesterone as prescribed to thin out their endometrial lining.
- Surgical removal of the uterus and other reproductive organs may be advised for some women, particularly those who are postmenopausal or women who are not planning to have children. This will reduce their risk of cancer when their condition does not respond to progesterone therapy.
- Endometrial thickening can also be treated with oral or injectable progestin. It may also be used as a vaginal creamorin an intrauterine device. However, progestin treatment may cause vaginal bleeding similar to menstrual bleeding.
Symptoms Of A Retroverted Uterus
In most cases, a woman suffering from this condition will not experience any kind of symptom. However, in the event that symptoms start to manifest, the most common will be:
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How Is It Diagnosed
To find the cause of your bleeding, the doctor will do a physical exam and review your medical history. You may need one or more of the following tests:
Transvaginal ultrasound: This image helps your doctor check for growths and look at the thickness of your endometrium. TheyÃ¢ll place a small probe into your vagina. It sends off sound waves to create a picture of the inside of your body.
Endometrial biopsy: The doctor uses a thin tube to take a small sample of the tissue that lines your uterus. TheyÃ¢ll send it to a lab where scientists will look for anything unusual, like an infection or cancerous cells.
Sonohysterography: Your doctor may use this test to measure the size of a polyp. TheyÃ¢ll put a saltwater solution inside your uterus to create a clearer ultrasound image.
Hysteroscopy: When the doctor needs to look inside your uterus, theyÃ¢ll use a hysteroscope. This thin, lighted tube has a camera on one end.
D& C : During this procedure, the doctor opens your cervix. They use a thin tool to scrape or suck a sample of the uterus lining. They send this to a lab that will check for polyps, cancer, or a thickening of the uterine lining .
Ultrasound and biopsy are usually done in your doctorÃ¢s office. Hysteroscopy and D& C require anesthesia on one part of or your whole body. YouÃ¢ll either go to a hospital or an outpatient surgical center.
Is 14 Mm Endometrial Thickness Normal Premenopausal
The normal premenopausal endometrial thickness is reported to be 24 mm after menses with an echogenic appearance. At ovulation, the endometrium appears layered and is 1014 mm thick. After ovulation, the endometrium resumes a more uniform echogenic appearance and ranges from 10 to 14 mm in thickness .
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How Is Endometrial Hyperplasia Managed Or Treated
If youre at increased risk of cancer due to atypical endometrial hyperplasia, your healthcare provider may recommend a hysterectomy to remove the uterus. After a hysterectomy, you wont be able to get pregnant. Many people see symptoms improve with less invasive progestin treatments. Progestin comes in many forms:
- Oral progesterone therapy .Progesterone hormonal intrauterine device .
Specialist Answers On Menopausal Cramps And Thickened Uterine Lining
Q1. I am 55 and have been menopausal for four years now. A few months ago, I started having pain that feels exactly like menstrual cramps. It’s getting more frequent. Is this still related to menopause, or something else? Is it normal to feel cramps? I haven’t had any diarrhea.
If by saying menopausal you mean that you havent had a period for four years, then it is not normal to be having pains like menstrual cramps unless, of course, you are on hormone therapy. Without estrogen, your female pelvic organs sort of go into hibernation. Once they are in this quiescent state, they should not cause any symptoms.
You mention diarrhea, and you are correct that a likely source of cramps in a postmenopausal woman is her gastrointestinal tract. You should see a doctor and have this evaluated. In the meantime, keep a diary of what activities and foods might provoke your cramps.
Q2. I have been told that it is very common for postmenopausal women to have a thickened uterine lining. Can you tell me the measurements of this thickening and what they mean? How high does the scale go?
Pam, Rhode Island
In postmenopausal women, the lining of the uterus should really be no thicker than 4 to 5 millimeters. If you are truly postmenopausal and not on hormone therapy which can thicken the uterine lining and your measurement is above 4 to 5 mm, your doctor may want to investigate further.
Learn more in the Everyday Health Menopause Center.
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D Physical Examination Findings
Bilateral lower extremity edema, often accompanied by back pain, is a dismal finding that suggests bulky para-aortic lymphadenopathy with compression of the inferior vena cava. Vaginal exam and cervical exam are normal except in advanced disease. Bimanual palpation may reveal an enlarged uterus with more advanced cases, although this can be difficult to discern given the diseaseâs predilection for obese women. Ascites signifies advanced disease.
How Long For Uterus To Return To Normal Size
Having delivered a baby, it is only fair for you to start wondering when you will start losing the extra weight that was gained during your pregnancy, more so around the stomach area. Given that it took nine months for your body to gain weight, you should have realistic expectations on the length of time that it will take you to lose that stomach. But, with regular exercise routines and a healthy diet, it should not be too long for you to regain your pre-baby body.
When it comes to timeframe related matters, this will be dependent on a number of issues. E.g.
Of course you are going to shed some weight after giving birth. For this, you will need to subtract the weight of the baby, that of the amniotic fluid, and that of the placenta. With all this subtracted, you will find that you will have lost about 12lb, and there is a possibility that you may lose additional pounds after subtracting the weight of the water.
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What Happens At Your Gp Appointment
The GP should refer you to hospital or a special postmenopausal bleeding clinic. You should not have to wait more than 2 weeks to see a specialist.
What happens at your hospital or clinic appointment
A specialist, who may be a nurse, will offer you tests to help find out whatâs causing the bleeding and plan any necessary treatment.
The tests may include:
- a small device being placed in your vagina to scan for any problems
- an examination of your pelvis and vagina a speculum may be inserted into your vagina to hold it open, so the inside of the vagina and the cervix can be seen
- a thin, telescope-like camera being passed up your vagina, through the cervix and into your womb to look for any problems and to take a tissue sample for testing under local or general anaesthetic
- the specialist may press on your tummy and inside your vagina to check for lumps, tenderness or other abnormalities
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Is There A Normal Endometrial Thickness
“Normal” endometrial thickness varies from person to person, as well as throughout the person’s lifecycle. What is normal for an individual will change during childhood, throughout menstruation, during the reproductive years, and after menopause. Health conditions and medical treatments such as hormone replacement therapy can also affect the thickness of the endometrial lining.
The Radiological Society of North America provides the following ranges for “normal” endometrial thickness during:
- Menstruation: 1â4 millimeters
- Proliferative Phase: 5â7 millimeters
- Secretory Phase: 7â16 millimeters
- Menopause: 5 millimeters or less
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Q: Why Might A Clinician Need To Measure Endometrial Thickness In Postmenopausal Patients
A: A healthy, postmenopausal woman doesn’t generally need this measured. The whole purpose of measuring the thickness of the endometrium is to check the cause of unexplained bleeding: a thin, distinct endometrium in women with bleeding excludes the possibility of cancer. There are some who believe that if an endometrium measures thick in a non-bleeding patient, intervention is needed, but this is not at all the case.
Thickening Of Uterus Wall After Menopause
At 54 it’s been over 2 years since I had my last proper period, which was the most awful, heavy, painful period I’ve ever had – this came 11 months after the previous period. Apart from that I just sailed through the menopause without any problems at all, as my periods just became more and more erratic until they just tailed off, finishing with the one from hell! I had a smear 5 weeks ago and happened to mention that in the intervening 2 years and 3 months since that last period I’ve had 3 episodes of spotting. The period was in Oct 14, then in May 15 I had a week of spotting, as if a period was starting but it didn’t. In April 16 I had one day of light brown spotting, then in Sept 16 I had literally a few pale pink spots which lasted a couple of hours, and that was it! I wasn’t at all concerned but the GP sent me for an ultrasound which was today. They couldn’t find the endometrium very well, so gave me a transvaginal ultrasound . The endometrium was found to be thickened…apparently the guidlines say that anything over 3mm should be investigated, and mine is 6. Now I am to be referred to a gynacologist..obviously I’m concerned but is it possible that it’s actually nothing at all? Has anyone else been in this situation?
Thank you, Louise x
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