What is the endometrium? thickening, implantation, types and pathologies

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The endometrium is the mucous layer that internally covers the uterus. Its function is to thicken during the menstrual cycle to allow the embryo to implant and a pregnancy to take place.

At the beginning of each menstrual cycle, if pregnancy has not taken place, the endometrium sheds with menstruation to regrow and renew again.

The role of the endometrium is very important in female fertility and it is also possible that it undergoes some alterations during the reproductive stage of the woman. Therefore, we must take special care with all the factors that could affect the endometrium.

Below you have an index with all the points that we will discuss in this article.

Index

What is the endometrium? Thickening, implantation, types and pathologies

What is the endometrium?

The endometrium is the innermost layer of the uterus, the most important reproductive organ where the baby is born for 9 months.

In order to better understand the function of the endometrium, in this section we describe the 3 uterine layers that exist:

External layer or perimetrium is a serous layer that partially covers the uterus from its external part. Middle layer or myometrium is the muscular wall of the uterus. It has the ability to expand during pregnancy, to allow the growth of the fetus, and to contract so that delivery can take place. Internal layer or endometrium is the mucous epithelium that lines the inside of the uterus.

The main function of the endometrium is to allow the implantation of the embryo, that is, the union in the uterus so that the placenta, the gestational sac and, finally, the umbilical cord through which the fetus will be connected to the mother can begin to develop. .

Layers that make up the uterus

Composition of the endometrium

The endometrium is a very vascularized tissue, of a regenerative nature, which is formed by a multitude of blood vessels and glands that are formed and destroyed in each menstrual cycle.

The endometrium is also divided into two layers:

Base layer in it are the blood vessels and stem cells that generate the functional layer. Functional layer corresponds to the part of the endometrium that grows during the menstrual cycle and finally sheds and expels to the outside in the menstruation.

If the ovule is not fertilized or there is no implantation of the embryo in the uterus, the functional layer of the endometrium becomes necrotic and desquamates at the end of the menstrual cycle producing the bleeding that we know as a rule or menstruation.

This bleeding marks the beginning of a new menstrual cycle, in which the functional layer of the endometrium returns to proliferate thanks to the cells that exist in the basal layer.

Throughout the menstrual cycle, the endometrium undergoes both morphological and functional changes, thanks to the function exerted by the sex hormones secreted by the ovaries. These hormones are estrogen and progesterone.



Thickening in the menstrual cycle

Two main types of endometrium can be distinguished according to the moment of the menstrual cycle:

Endometrium proliferative thanks to the production of estrogen, the functional layer of the endometrium begins to grow by multiplying the cells of the basal layer. More blood vessels and endometrial glands appear. The proliferative phase ranges from the first day of the menstrual cycle to ovulation. Secretory indometomy after ovulation, the corpus luteum remaining in the ovary produces progesterone, which causes the endometrium to mature, causing its thickening. The endometrial glands increase in size and begin to secrete mucus and a substance rich in glycogen. Thus, the ideal environment for implementation is created.

At the end of the secretory phase of the menstrual cycle, around days 26-28, the shedding of the endometrium occurs if there has been no implantation, which causes the rule to fall.

Growth of the endometrium in the menstrual cycle

Parallel to menstruation, a new endometrium is regenerated for the next ovulation. This is the reason why menstruation coincides with the beginning of the proliferative phase of a new menstrual cycle.

If you want to know in more detail the phases of the menstrual cycle in women, we recommend you to visit the following post: Phases of the menstrual cycle.

Implantation in the endometrium

The nesting of the embryo in the endometrium occurs when it has been about 6 or 7 days after fertilization and the embryo is in the blastocyst stage.

For this to happen, it is necessary that there is a perfect synchronization between the embryo and the endometrium, that is, there must be endometrial receptivity.

The endometrium is receptive during the phase known as the window of implantation, which lasts approximately 4 days.

Numerous studies in patients have concluded that the optimal endometrial thickness for implantation should be between 7-10 mm thick. An endometrium of less than 6 mm does not usually allow embryos to implant.

For successful implantation, not only must there be adequate hormone preparation of the endometrium, there must also be a reciprocal dialogue between the tissues of the blastocyst and the uterine mucosa. For this, various growth factors and cytokines must act.

If finally there has been fertilization of the ovule and implantation of the embryo, the secretory endometrium becomes a more specialized endometrium thanks to the effect of estrogen and progesterone: this is what is known as decidualization.

The decidual or decidualized endometrium consists of a specialized structure that will originate the placenta during pregnancy and participate in the exchange of gases and nutrients between the mother and the embryo.

To learn more about the implantation of the embryo, you can access this article: What is embryo implantation?

Endometrial evaluation

The endometrial thickness is a prognostic factor for predicting embryo implantation.

In addition, measuring the endometrial thickness can also provide information about some pathologies or alterations in the endometrium.

The following tests are very useful to measure the thickness of the endometrium, as well as the endometrial receptivity:

Transvaginal ultrasound

The thickness of the endometrium is a marker of the phases of the menstrual cycle.

To consider if the endometrium is normal, it must have a specific thickness depending on the day of the menstrual cycle in which the woman is.

To measure endometrial thickness, gynecologists perform a transvaginal ultrasound. Subsequently, they should assess whether this thickness coincides with the date of the last rule (FUR) that the patient has indicated.

With ultrasound, it is possible to differentiate the following types of endometrium:

Endometrium type 0 during the menstrual phase, the endometrium is hyperechogenic, that is, it is observed as a thin and thin white line

Pathologies and diseases of the endometrium

The alterations of the endometrium can affect the embryonic implantation and the bleeding of menstruation in women.

Therefore, any abnormal signal during the period can make suspect the woman suffering from one of the following endometrial pathologies:

Endometriosis growth of endometrial tissue outside the uterine cavity, as in the ovaries, fallopian tubes, pelvic cavity or even in the bladder. It usually causes a lot of menstrual pain and affects fertility. You can get all the information related to this disease on our specialized page laendometriosis.es Endometrial polyps tissue that protrudes from the endometrium and contains abundant blood vessels and endometrial glands. They can cause metrorrhagia and affect embryonic implantation. Benign uterine tumor of the myometrium. Submucosal fibroids grow into the uterine cavity and affect the endometrium. Although submucosal fibroids are the least frequent, they cause an increase in bleeding and are at risk of becoming malignant.Adenomyosis invasion of endometrial tissue in the muscular layer of the uterus, the myometrium. Adenomyosis causes alterations in bleeding and pain. Endometrial hyperplasia Proliferation of glands in the endometrial mucosa. Endometrial hypertrophy with excessive endometrial thickening or enlargement. Endometrial cancer, endometrial neoplasia or adenocarcinoma. Malignant cell growth in the endometrial tissue. It is the most common type of uterine cancer.

When we encounter symptoms such as abnormal uterine bleeding, it can be any of these alterations: myomas, endometrial polyps, adenomyosis, endometrial hyperplasia or endometrial cancer.

Pathologies that affect the endometrium

To diagnose diseases that affect the endometrium, ultrasound may not be enough. The gynecologist may request additional tests such as the following: a uterine curettage, an endometrial biopsy, a sonohysterography or a hysteroscopy depending on the pathology of which you suspect.

Questions from users

If the endometrium is thickened, is there pregnancy or is it because menstruation comes?

The endometrium thickens so that implantation and pregnancy can take place. If there is no fertilization and implantation, although the endometrium is thickened, there will be no pregnancy and menstruation will occur.

If the endometrium remains thick after a while or if it is excessively thick in the secretory phase, it may be an endometrial hyperplasia and the doctor may prescribe a hormonal treatment to the woman.

How much should the endometrium measure to get pregnant?

The normal thickness of the endometrium after ovulation, when implantation takes place, is 7-10 mm. If the endometrium is too thin or too thick, implantation may be hampered or prevented, since the endometrium is not receptive and, therefore, pregnancy may not occur.

What causes the endometrium to be thick?

The endometrium thickens naturally due to the action of estrogen and progesterone, two hormones that a woman produces in her ovaries during the menstrual cycle.

An excessively thick endometrium may be due to endometrial hyperplasia. This anomaly is usually caused by an excessive production of estrogen but without producing only progesterone. In case you suffer from this pathology, the doctor can administer a hormonal therapy.

With a fine endometrium can pregnancy be achieved? How can you swell?

If the endometrium measures less than 6 mm, it will be difficult to achieve a pregnancy. In this case, the doctor may prescribe to the woman a hormonal medication based on estrogen and progesterone to stimulate the growth of the endometrium.

There are also natural therapies and strategies that women can carry out daily to improve their endometrial thickness. We recommend reading the following article to inform you better: Tips to improve endometrial thickness.

Is it normal to have a thick endometrium at menopause?

Generally, with the arrival of menopause there is an endometrial atrophy, that is, a thinning of the endometrium due to the natural decrease in estrogen levels. In menopause, estrogen is no longer produced and, therefore, there is no menstrual cycle.

If, on the other hand, the endometrium is thick, the doctor should see if it is an endometrial hyperplasia or another pathology.

What is an endometrial carcinoma and what are its symptoms?

Endometrial carcinoma is a frequent cancer in women, especially in those who have entered menopause. It consists of the growth of malignant cells in the endometrial tissue of the uterus. The most frequent symptoms are abnormal vaginal bleeding not associated with menstruation, pelvic pain, and discomfort when urinating or having sex.

As in all types of tumors, a rapid diagnosis of endometrial cancer is essential for effective treatment and no invasion of other locations of the body.

Recommended reading

A displacement of the implantation window in the endometrium is a cause of embryonic implantation failure. If you want to know other factors that may affect implantation, you can continue reading in the following article: Repeated failures of embryo implantation.

There are more pathologies related to the uterus, in addition to those that affect the endometrium. You can get more information about this in the following post: Female sterility due to a uterine factor.

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