What is the thickness of the endometrium? Why does thick endometrium develop? Uterus under a microscope

Each organ of the female reproductive system has its own functions and purpose. The uterus has a special role; it is responsible for the reliable attachment and full development of the embryo.

The endometrial layer lines the uterine cavity from the inside, creates optimal conditions for the fertilized egg and maintains the course of pregnancy. The normal thickness of the endometrium depends on the day of the cycle. The size of the mucosa may be lower or higher than normal. Both conditions are abnormal and require correction.

Women learn about the importance of endometrial size during the menstrual cycle after problems with conception begin or are detected. gynecological diseases. This can be avoided. Modern diagnostic methods allow you to accurately and quickly assess the condition of the uterus and existing deviations. The endometrium can be normalized. To do this, it is necessary to regularly undergo ultrasound examinations, and in case of detected pathologies, be treated under the supervision of a doctor.

Ultrasound examination is the fastest, safest and informative method determining the thickness of the uterine mucosa. During a routine examination by a gynecologist, it is impossible to obtain accurate indicators. Only ultrasound allows one to analyze the echographic signs of the inner layer of the reproductive organ. Doctors observe how the endometrium grows and changes, and also detects pathological changes, including tumor growths.

In the absence of contraindications, specialists resort to the transvaginal method, when the organ is examined through the vagina. The most important condition is to conduct the study on the day prescribed by the doctor. This is due to the fact that the norm of the endometrium on each day of the menstrual cycle is different. Normal mucosal thickness parameters during ovulation differ from thickness parameters before menstruation. The difference is insignificant, but even the slightest deviation affects reproductive capabilities and overall health.

Signs of decreased thickness

A healthy endometrium, the thickness and structure of which corresponds to the day of the cycle, ensures reliable implantation of the embryo, but not all women understand the significance of the measured indicators and pay attention to signs of a decrease in the thickness of the layer. No specific manifestations have been identified, but some symptoms should alert you and be a reason to consult a doctor.

One of the main signs of thinning of the mucous membrane is a disruption of the menstrual cycle, when there are no periods at the appointed time, but delays are observed regularly.

In addition to cyclical deviations, a decrease in thickness may be accompanied by the following manifestations:

• pain in the lower abdomen;
• the presence of bloody clots in the discharge;
• bleeding outside of menstruation.

The mucous layer of the uterus promotes the attachment of the embryo and is the structure that supplies the embryo nutrients. When the endometrium does not correspond to the phase of the cycle and its thickness is insufficient, pregnancy is impossible. The egg simply has no chance of successfully implanting in the uterus. The fertilized egg is rejected, and doctors in such cases diagnose a miscarriage in the early stages. For those wishing to become pregnant, such expert opinions are another missed opportunity to have a child. The situation could have been different if corrective measures thin endometrium were received on time.

Endometrial norms by phase

The endometrium is renewed monthly and has a two-layer structure. The basal (deep) layer does not change and promotes the regeneration of the functional layer, the thickness of which is not constant.

The size of the mucous membrane in the first days of the cycle averages 3–4 mm. The endometrial layer reaches its maximum thickness after the egg has formed and left the follicle. During the period of ovulation, indicators may vary, on average they are 12–19 mm. Once fertilization has taken place, these parameters are optimal for successful attachment and further implantation of the embryo.

In cases where pregnancy does not occur, the overgrown endometrial layer is rejected and comes out during menstruation.

The indicators that are studied to assess the size and structure of the mucosa are considered average, but when comparing the result with the normal thickness of the endometrium of the uterus, they allow us to draw conclusions about the condition of the inner lining and the prospects for conception.

If the hormonal background is in order, the process of mucosal growth sequentially goes through three periods: menstruation (bleeding), proliferation, secretion. Each phase has its own timing, features and functions.

Bleeding phase

During the menstrual phase, if conception fails, the functional layer is torn off and comes out along with the blood. The onset of bleeding is considered the first day of a new cycle. Menstruation lasts 3–7 days. Rejection begins in the first 2 days, the size of the endometrium during this period ranges from 6 mm to 9.

On the 3rd–5th day of the menstrual cycle, gradual tissue regeneration begins. The thickness increases and by the end of the bleeding phase reaches 3 mm. Compliance of the mucous layer with these parameters is considered the norm.

Proliferative phase

Lasts 2 weeks. During this time, the follicles responsible for the production of estrogen have time to mature. This hormone stimulates the active growth of the uterine lining. As a result, the functional layer thickens and by the end of the period its size reaches 11–13 mm. In parallel with the increase in size, the sound permeability of the mucous membrane changes. By the end of proliferation, this figure is 9–11 mm.

Proliferation begins on the fifth day of the cycle. The phase includes early, middle and late stages. All 3 periods must always take place in a clear sequence. The absence or failures in the course of any of the stages indicate the development of pathological processes in the body.

The thickness of the uterine endometrium of 7 mm is considered the threshold for possible fertilization. If the size is smaller, conception does not occur.

In the proliferation phase, the thickness is almost twice as large, but for fertilization this is not the most good period. A woman’s body is vulnerable and reacts to any negative phenomena and irritants. Illness, stress, and overwork can stop the natural maturation of the follicle and provoke untimely rejection of the inner layer of the uterus.

The most favorable time for fertilization is the third (secretory) phase, which begins after endometrial proliferation.

Secretory

Secretion is a period of intensive growth of the mucous membrane. The phase lasts from the 15th to the 30th day and is accompanied by the active production of progesterone, which stimulates the growth of endometrial tissue. The mucous layer increases, swells, becomes dense, spongy and vascular. The shell size can reach 21–26 mm. This is a normal thickness, sufficient for secure attachment and nourishment of the embryo.

The secretory phase includes three stages:

1. Early is the 15th–18th day. The normal thickness parameter for this period is 12 mm.
2. In the mid-secretion phase (from the 19th to the 23rd day), the maximum size of the endometrial layer is observed, after which the thickening stops. The norm for this period is 15–21 mm.
3. The late period of the secretory phase begins on the 24th day from the start of menstruation and lasts 3–4 days. The size of the endometrium begins to decrease and reaches 10–17 mm.

If fertilization does not occur, the menstrual phase begins again and the uterine lining is shed during menstruation. This sequence is considered physiological norm. For all women of reproductive age, these periods are repeated regularly.

Thickness by day of the cycle

Hormonal levels are responsible for the thickness of the functional layer of the endometrium. If an imbalance is not observed, on different days of the cycle the size of the mucous membrane will correspond to normal values.

During menstruation, the endometrium changes noticeably:

• in the first days it is visible in the form of a heterogeneous structure 5–9 mm thick. There is no clear layered composition of the internal lining. This is explained by the fact that during this period the cells are arranged non-standardly;
• 3–4 days of menstruation – the cells acquire a clear structure, echogenicity increases, and the thickness of the endometrial layer decreases to 3–5 mm;
• 5th–7th – normal indicators endometrial thicknesses range from 6 to 9 mm. With the onset of the proliferative stage of the cycle, sound conductivity increases, echogenicity decreases, and the size of the endometrium increases;
• 8–10th – gradual thickening of the mucosa continues. A clear hyperechoic structure appears in the center of the endometrial layer. Thickness standards vary between 8–10 mm;
• 11–14th – the echographic picture remains almost unchanged. This is a late stage of proliferation with a characteristic increase in echogenicity and thickening of the endometrium of the uterus to 9–13 mm;
• 15–18th – the functional lining of the uterus thickens to 10–15 mm. There are no significant changes in the echogenicity and structure of the endometrium;
• 19th–23rd – normal parameter varies from 10 to 18 mm. This is the maximum figure for the entire period. After this, the thickening of the endometrium stops;
• on days 24–28 monthly cycle There is a decrease in the size of the endometrium. Its thickness is reduced to 12 mm; during ultrasound, heterogeneity of the structure and increased echogenicity are noticeable.

Normal for delay

The main ones are considered hormonal disorders. The influence of other factors cannot be excluded, such as stressful situations, gynecological diseases, problems of the endocrine system, unbalanced nutrition.

The cyclic period with late menstruation lengthens. The production of hormones is disrupted. As a result, the size of the endometrium after ovulation does not change and corresponds to the natural level of the secretory phase (12–14 mm).

Possible pathologies

If we analyze the results of ultrasound examinations, digital values endometrial thickness by day of the cycle shows an increasing trend. The growth is gradual - and this is normal. But, unfortunately, not all women have such an ideal picture. The size of the uterine lining often differs from standard values. This happens under the influence of the most various reasons and factors, including:

• hormonal disorders;
• trauma to the mucous and uterine cavity;
• impaired blood circulation;
• inflammatory and infectious diseases uterus.

Endometrial pathologies are detected by ultrasound and during additional laboratory examinations. After the cause of the deviation is determined and confirmed, the doctor prescribes treatment taking into account the stage and type of disease, as well as age, physiological characteristics and the state of the body.

Discrepancy in endometrial thickness is usually divided into 2 types: hypoplasia and hyperplasia.

Hyperplasia

Hyperplasia is the pathological growth of the endometrium. An abnormality in the thickness of the mucous layer of the uterus is reflected in the density. It increases, and the structure becomes heterogeneous. Such changes complicate fetal implantation and other processes that contribute to the normal development of the embryo.

The disease is dangerous because the endometrium, which quickly grows before menstruation, does not come out during menstruation. This may lead to perforation (breakout), heavy bleeding and hospital treatment.

Hyperplasia can be glandular and atypical. The latter form is more dangerous and is considered a precancerous condition.

The main reason for the endometrium not meeting the norms is hormonal imbalances. Thickening is provoked by the active production of estrogen and progesterone deficiency. Other causes include tumors and polycystic ovaries, diseases of the endocrine system, metabolic disorders, prolonged hormone therapy, weakened immunity, abortion and uterine injuries.

Hypoplasia

Abnormally thin endometrium in medicine is defined by the term “”. This disease is a congenital pathology that occurs due to insufficient hormone synthesis.

Hypoplastic endometrium has no symptoms. The disease does not appear until the woman desires to become pregnant. Difficulties may arise with this, and only an experienced doctor can determine what triggered the development of endometrial pathology. Among the signs of the disease are:

• long absence of pregnancy;
• frequent miscarriages;
• late menstruation (after 16 years);
• pathological vaginal discharge;
• irregular periods.

Hypoplasia is not life-threatening, but with a thin endometrium there is practically no chance of carrying a child to term. A thinned membrane prevents pregnancy and complete implantation of the embryo.

Thickness mismatch

Indicators of normal endometrial thickness are individual and depend on the state of the reproductive system, age and other characteristics of the body. Parameters that go beyond the established limits are considered a violation. Similar phenomena observed during miscarriage and the development of gynecological diseases.

The only pleasant reason for the discrepancy in endometrial thickness may be a successful conception. The growth is stimulated by the active production of progesterone (pregnancy hormone). The mucous membrane becomes overgrown with vessels, secretion becomes more abundant, and the endometrial layer increases to 20 mm or more. In other cases, any deviations from the norm are usually classified as pathological conditions.

Complications and consequences

If the ultrasound does not reveal any abnormalities and the thickness of the endometrium is normal, the woman has a chance of becoming pregnant and giving birth healthy baby. Unfortunately, not everyone is attentive to their health. Rare visits to the doctor, ignoring alarming symptoms and self-medication often lead to the development gynecological pathologies, dangerous to the reproductive system. The most serious consequence- this is infertility. The inability to conceive develops due to untimely diagnosis and treatment of progressive diseases.

With hyperplasia in women, the cycle is disrupted, the intensity and duration of monthly discharge increases. Frequent bleeding that occurs between periods leads to anemia. In addition, abnormal growth of the inner lining of the uterus causes endometriosis, cysts, polyps and other neoplasms.

Complications of hypoplasia are no less dangerous. As a rule, they do not appear in the first days and months after diagnosis of the disease. The vulnerability of the thin endometrium facilitates the unhindered penetration of pathogenic microorganisms into the uterine cavity. This causes infectious and inflammatory processes, provokes ectopic pregnancy and frequent miscarriages.

Treatment of disorders

The thickness of the endometrium is successfully corrected. If during an ultrasound examination deviations in the days of the cycle are detected, up or down, the doctor determines the type, stage and echo signs of the pathology.

Treatment of hyperplasia can be medicinal and surgical. The specialist prescribes the dosage and suitable medications after determining the type and extent of the disease. Hormonal therapy using progesterone drugs is considered the most effective. When decreasing estrogen levels the endometrium reaches normal levels.

TO surgical intervention resorted to in cases where conservative methods not effective. Doctors may remove the endometrium. In difficult cases atypical hyperplasia hysterectomy is performed.

The use of hormonal agents also gives good results in the treatment of hypoplasia. The thin layer of the endometrium is corrected by means that contain exceeded doses of the hormone estrogen. If the disease occurs due to inflammatory processes reproductive organs, therapeutic measures aimed at stopping and eliminating the source of inflammation. Severe forms of hypoplasia require surgical intervention.

A woman's reproductive health depends on many factors. The endometrial thickness indicator is one of the most important and significant parameters, since it is with it that the ability to become pregnant, bear and give birth to a child is associated. Regular ultrasounds will help monitor normal and abnormal conditions of the endometrium, as well as identify other gynecological abnormalities.

Endometritis refers to inflammatory diseases of the female reproductive system, which occur in at least half of women of childbearing age (according to some data - in 90%).

Among possible consequences inflammatory processes in the pelvic organs - miscarriage, infertility, chronic pelvic pain syndrome, ectopic pregnancy.

The acute form of the pathology accounts for about 2% of cases of inflammatory diseases, the chronic form – about 14%. Most often, endometritis develops after childbirth.

Is it possible to get pregnant with uterine endometritis? We’ll talk about the main symptoms and signs of the disease, including after childbirth, as well as methods of treating the disease in our review!

What kind of disease is this and why is it dangerous?

Endometritis of the uterus in women - what is it? accessible language? The uterine wall consists of three layers: endometrium, myometrium and perimeter.

The perimetry is one of the layers of the peritoneum and covers the outside of the uterus, the myometrium is formed by smooth muscles, the endometrium or mucous membrane is formed by epithelial tissue.

Endometritis is an inflammatory process in the lining of the uterus.. The endometrium consists of basal and functional layers.

The functional layer is subject to cyclic changes, as hormonal levels change, it grows and is rejected during menstruation.

When pregnancy occurs, rejection of the functional layer does not occur, it ensures the further development of the embryo. The basal or germinal layer ensures the restoration of the functional layer of the endometrium.

With endometritis, it is the germinal layer of the mucous membrane that is involved in the inflammatory process.

Inflammation can progress and spread to the muscular layer of the uterine wall, in such cases, endometritis turns into endomyometritis or metroendometritis.

The disease is infectious in nature, that is, inflammation develops only due to the penetration of the pathogen into the uterine cavity. The development of the disease is facilitated by damage to the mucous membrane. If the immune system is severely weakened or a particularly aggressive infection penetrates, damage to the entire tissue may occur.

Pathogens enter the uterine cavity either from the appendages (descending route) or from the vagina and cervical canal(ascending path).

Normally, the development of infectious processes is prevented by the acidic environment of the vagina, mechanisms of local immune defense (antibodies, immunoglobulins contained in mucus and natural microflora vagina) and partly, the anatomical features of the structure of the reproductive system.

Inflammatory reactions develop against the background of disorders of natural defense mechanisms.

Causes of occurrence in women and risk factors

Inflammatory processes are caused by bacteria, viruses, fungi and protozoa. In most cases, we are talking about a combined pathology, when several infectious agents take part in the development of the disease.

The viral form is caused by some types of papillomaviruses, cytomegalovirus, herpes simplex virus. Infection with fungi of the genus Candida leads to the development of fungal endometritis.

Bacterial endometritis is caused by:

• Enterobacter;
• Klebsiella;
• Streptococcus;
• Gonococcus;
• Proteus;
• Mycoplasma;
• Chlamydia;
• Escherichia coli.

Sometimes cases of infection with pathogens of diphtheria and tuberculosis are detected, as well as microorganisms classified as opportunistic.

Endometritis can also be protozoal in nature; in some cases, the causative agent of the disease is Trichomonas.

Most often, infection occurs through upward path . Infection occurs when two conditions coincide: an open cervical canal and damage to the endometrium.

Among the most probable causes, provoking inflammation of the endometrium:

Sometimes the inflammatory process develops as a concomitant pathology against the background of fibroids, polyps, infectious diseases excretory system, immunodeficiency states, endocrine disorders.

Cases of infection spreading from foci of chronic inflammation through the circulatory or lymphatic system are extremely rare. Most often, gynecologists encounter postpartum endometritis. After spontaneous childbirth, inflammatory processes develop in approximately 20% of cases, after cesarean section - in 45%.

Classification, ICD-10 code, symptoms and treatment

The code for acute endometritis according to ICD-10 is N 71.0, chronic – N 71.1.

In gynecology, according to the course of the disease, three forms of endometritis are distinguished:

• Spicy;
• Subacute;
• Chronic.

Based on their origin, they distinguish between specific and nonspecific endometritis. By specific we mean an inflammatory process caused by pathogenic microorganisms; nonspecific inflammatory reactions are caused by representatives of opportunistic microflora against the background of weakened immunity.

Based on the severity of clinical manifestations, the following degrees of severity of the disease are distinguished:

• Light;
• Moderate;
• Heavy.

How does the acute form manifest?

Symptoms of an acute inflammatory process appear 3-4 days after infection. Manifestations of the disease depend on several factors:

• The nature and aggressiveness of the pathogen;
• Area of ​​endometrial damage;
• Presence of concomitant pathologies;
• Immunity states;
• Predisposing conditions;
• Patient's age.

Most severe course The disease is observed after complicated childbirth, spontaneous abortions, and during the use of an IUD.

The acute form begins with a feeling of heaviness and pain, most often above the pubis, in the middle part of the lower abdomen, less often in the lumbar or sacral area. Sometimes the pain radiates to the legs or under the shoulder blades. The intensity of the sensations ranges from mild to unbearable, the nature of the pain is aching or cramping.

With severe inflammation, there is a risk of developing peritonitis. At the same time with pain syndrome body temperature rises to 39-40 degrees, sweating and chills are possible.

As the disease progresses, other signs of general intoxication appear: lethargy, general weakness, loss of appetite, nausea, and sometimes vomiting.

One of the most characteristic symptoms – copious discharge, mucopurulent, sanguineous or purulent, sometimes with admixtures of blood. During development purulent process The discharge has a distinct unpleasant odor.

Postpartum endometritis may cause bleeding. The addition of a staphylococcal infection leads to the development of a purulent process, and there is a threat of sepsis.

When diagnosing endometritis, anamnesis data is supplemented by data from a gynecological examination and laboratory tests.

The patient needs to pass clinical tests urine and blood, vaginal and cervical smears. Additionally, ultrasound is prescribed, and if indicated, hysteroscopy.

Treatment tactics for acute endometritis are selected individually, depending on predisposing circumstances. If the disease develops due to the use of an IUD, it is removed. After this, the uterine cavity is scraped.

After curettage, the patient is prescribed:

• Antibiotics;
• Antibacterial drugs;
• Anti-inflammatory drugs.

Additionally, desensitizing and restorative therapy is carried out. For antibiotic therapy, drugs are mainly used wide range actions. If anaerobic microflora is detected, Metronidazole or Ornidazole is additionally prescribed; according to indications, vaginal sanitation is carried out.

Purulent processes are indications for the use of infusion therapy with drugs that improve blood fluidity and eliminate intoxication of the body. In severe cases, radical surgery may be required.

As the patient’s condition improves and the inflammatory process subsides, physiotherapeutic treatment is prescribed. The complex of physiotherapeutic procedures includes magnetic therapy, laser therapy, and low-intensity ultrasound.

You can learn about diagnostic measures for urethritis in women, as well as what medications are usually prescribed for its treatment: in this article:

Chronic inflammation

If there is insufficient or untimely treatment an acute pathological process can develop into chronic form. Clinical manifestations are mild, in approximately 40% of cases the disease is asymptomatic.

On chronic endometritis indirectly indicate:

• Heavy or very scanty discharge during menstruation;
• Irregularities in the duration of menstruation;
• Changes in the cyclicity of menstruation;
• Intermenstrual bleeding, mucous, mucopurulent and bloody issues;
• Periodic or constant nagging pain in the lower abdomen;
• Habitual miscarriage, infertility, unsuccessful IVF attempts (with endometritis, attempts to conceive are almost unattainable).

Since the symptoms of the disease are nonspecific, the main diagnostic value have the results of bacteriological and microscopic examinations of the contents of the vagina, uterine cavity, and cervical canal.

Additionally, ultrasound and Doppler ultrasound are performed at the beginning and second half of the menstrual cycle. On days 7-11 of the cycle, hysteroscopy and endometrial biopsy may be recommended.

For chronic inflammation it is used step-by-step treatment. At the first stage, broad-spectrum antibiotics are prescribed in combination with antifungal drugs and Metronidazole.

When a combined infection is detected combinations are prescribed antimicrobial agents and antiseptics. Chronic inflammatory processes of viral origin require the use of antiviral and immunomodulatory drugs.

At the second stage, the patient is prescribed antioxidant, hepatoprotective, metabolic, enzyme preparations, as well as products that improve blood microcirculation.

At the third stage, physiotherapeutic treatment is carried out. The course of treatment may include magnetic therapy, mud therapy, plasmapheresis, and iontophoresis. Additionally, cyclic hormone therapy can be performed.

Postpartum type

How does postpartum endometritis manifest? With postpartum endometritis, the patient is bothered by constant aching pain, prolonged bleeding.

There may be an increase in body temperature and other signs of intoxication. Postpartum endometritis also manifests itself as a slowdown in uterine contractions.

During treatment postpartum endometritis breastfeeding factor is taken into account. In severe cases, the need to refuse breastfeeding cannot be ruled out.

In addition to therapy aimed at eliminating the acute inflammatory process the patient is prescribed oxytocin and no-spa to improve the outflow of secretions from the uterine cavity and improvement of myometrial contractility.

Curettage may be performed to remove the contents of the uterus., vacuum aspiration or comparatively new method– enzymatic curettage.

After caesarean section

In most cases, when inflammatory complications After a caesarean section the following is carried out:

infertility in this article.

Read about the treatment plan chronic cystitis in women, and how to remove unpleasant symptoms in its acute form.

Is pregnancy possible if diagnosed?

Is it possible to get pregnant with endometritis? Pregnancy with endometritis is not excluded, but often inflammatory processes lead to infertility. If uterine endometritis is detected in a timely manner after treatment, reproductive function is restored and there is a chance of pregnancy.

Endometritis of the uterus in women - what it is and whether it can be treated, a specialist will tell you in simple language from the following video:

Prevention

The maximum risk of inflammatory reactions is eliminated when using an IUD, after abortion and cesarean section. For the prevention of endometritis after complex gynecological procedures prescribe a course of antibiotics, which should not be neglected.

It is very important to visit a gynecologist in a timely manner, especially when using intrauterine devices. The practice of preventive examinations increases the chances of early detection and treatment of gynecological diseases.

It is important to carefully observe intimate hygiene and use barrier contraceptives, especially during sexual intercourse during menstruation.

The endometrium is the mucous layer that lines the uterus. Interior The vagina has an extensive network of capillaries. Women know that depending on the day of the menstrual cycle, the endometrium constantly undergoes changes. The processes occur due to the effect of hormones on the endometrium, which also change from day to day of the cycle. Strong changes occur when a woman is of reproductive age, the body is actively preparing for conception each time and possible pregnancy. But not every representative of the fair sex knows what size of the endometrium is considered normal, how to monitor it, why thickness is important and what is pathology.

Normal endometrial thickness: why monitor it?

Normal endometrial thickness for fertilization is always under the influence of female sex hormones. When the size of the uterine inner layer is normal, the embryo implants well into the walls and pregnancy occurs.

In order for the fetus to attach well, the thickness of the endometrium must meet certain indicators, since for successful conception thickness plays an important role. You can determine the thickness using ultrasound examination and echography.

The normal size depends on the menstrual cycle. If there are any deviations or inconsistencies, pregnancy is impossible. You can restore the size to meet the standards using hormonal therapy.

Based on the functional and basal layer, the internal lining of the uterus is formed. The functional layer dies and is rejected at the very beginning of the menstrual cycle. But before the onset of a new cycle, it has the ability to recover thanks to the regenerative abilities of the basal layer.

Therefore, it is so important for successful attachment and conception to form a normal inner layer. The level of female hormones varies depending on the day of the menstrual cycle. The size of the basal layer increases dramatically at the end of the cycle, and after the end it becomes completely thin.

Norm and deviations

How to determine when the uterine endometrium is normal and when there are deviations? The problem can be identified using ultrasound.

For example, if a woman is of reproductive age and has no problems or abnormalities, the normal endometrium should have the following dimensions:

• for the first 2 days of the cycle, when the discharge has already begun, the thickness should be in the range of 0.5-0.9 cm - the desquamation stage;
• when the regeneration phase begins on days 3-4, the dimensions are within 0.3-0.5 cm;
• proliferation on days 5-7, sizes reach 0.6-0.9 cm;
• middle phase on days 8-10 thickness 0.8-1.0 cm;
• late proliferation sizes from 0.9 to 1.3 cm;
• secretion phase, which occurs at the end of the cycle, the size gradually increases, ideal thickness 15-18 days, 1.0-1.6 cm, 19-23 days, 1.0-2.1 cm (varies 10-18 mm), 25 -27 the mucous layer becomes thinner and becomes 1.0-1.8 cm (error 10-17 mm).

In accordance with the standards, it is clear that the condition of the endometrium is constantly changing. For example, if the indicators are higher than the norm, this is not always considered a deviation. As a rule, this happens during a long cycle.

Types: small and large endometrium

Experts often note that the structure of the mucous layer is disrupted. In connection with this, the types of endometrium are distinguished: thin and thick. Therefore, if the size by day of the menstrual cycle exceeds the norm, then this deviation is called hyperplasia. If small endometrium– hypoplasia.

Why are such deviations from the norm in one direction or another dangerous? For hyperplasia slime layer exceeds the average value of indicators if there is a rapid increase in a 20-30 day cycle. It can be assumed that the blastula develops on early pregnancy. Hormonal disorders, in particular an excess of estrogen or a lack of progesterone, can also contribute to the growth. Hyperplasia is often combined with fibroids, endometriosis and other inflammatory diseases, so the diagnosis of hyperplasia can cause a number of complications associated with fertilization.

If the endometrium is small, the hypoplasia layer becomes thin. For example, the norm is 10-14mm, ultrasonography in the middle of the cycle it shows a result of only 6mm. If the indicators do not correspond to the norm or a heterogeneous structure is detected, this is already a pathology. A small endometrium is considered a significant obstacle to successful conception.

P Reasons that provoke thinning of the mucous layer:

• Disturbances in the hormonal background or endocrine system, most often these causes become a catalyst. Problems can be caused by taking medications that contain hormones, and the impact of psycho-emotional stress is also possible.
• Problems with normal blood supply to the uterus, which are congenital or acquired.
• Underdevelopment of the organ - the uterus has deviations associated with the design or structure.
• Damage to the mucous layer during surgical intervention, manipulations in the organ cavity.
• Infections and inflammations.

It has also been proven more than once that a small endometrium can arise at the genetic level. You need to understand that the mucous layer is women's health, so future chances of pregnancy depend on how it grows and functions.

What to do if abnormalities are detected on ultrasound?

Diseases of the endometrium of the uterus and pathologies associated with the mucous layer are common. Therefore, treatment is required for both “thinned” and “thickened” endometrium.

When diagnosed with hyperplasia, treatment is based on taking hormonal drugs. In advanced and severe cases, surgical treatment may be indicated - amputation of the mucous layer. In serious situations, when the disease has spread far beyond normal limits, complete removal of the uterus is possible.

As a rule, more often women need complex treatment, that is, surgery with hormone replacement therapy for preventive purposes.

With a thinned endometrium, the chances of a complete recovery are not so great. This type of problem is difficult to treat. As a rule, experts prescribe an increase in the dose of estrogen and Aspirin (in a minimal dosage).

Physiotherapeutic procedures are also prescribed additionally. It has also justified itself alternative treatment in the form of hirudotherapy and acupuncture. Therapy with the use of sage is possible, which has also proven itself well.

Endometrial thickness 10 mm - what does this mean? The question is most relevant for women who want to become pregnant, as well as for those who are afraid of pregnancy. It is important to know the features female body to keep all changes under control. If you suspect changes, it is important to consult a doctor in time to identify the cause, be it pregnancy or pathology.

Pregnancy: the body changes

If the endometrium is 10 mm, is pregnancy possible? To find out, you need to visit a doctor and do special study- M-echo. It is important to remember that bearing a fetus for the female body is associated with restructuring of systems and changes in hormonal levels. Reproductive system The uterus, in particular, changes most actively. This organ is able to develop in such a way as to cope with the stresses that accompany pregnancy and childbirth.

By its nature, the uterus is hollow, covered from the inside with mucous membrane, scientifically called the “endometrium”. The thickness of the mucous coating changes from day to day. This is influenced by blood supply and hormonal levels. During the menstrual cycle, the body regularly prepares optimal conditions for conception, then renews and renews this “bed” for the embryo. Rejection of the endometrium is the usual menstruation.

Endometrium and pregnancy

From the above, it is clear that the endometrium plays an important role in pregnancy. It is due to this that the conditions for conception are created; the fertilized egg can attach to the uterine wall and remain here, growing into a full-fledged fetus. The observed endometrium of 10 mm during a delay is a guarantee that the fetus was able to attach, and the tissues are used as a building material for the placenta and membranes.

In parallel with what is happening in the female body during conception, the hormonal background changes greatly. The components released into the blood prevent embryo rejection. This is how a woman becomes a future mother.

general information

The table shows the norms for endometrial thickness on different days of a woman’s menstrual cycle.

General indicators and what they mean

Endometrium 10 mm - is this normal? Doctors say that readings exceeding 7 mm are normal. However, science knows of cases where women became pregnant whose mucous membrane was only five millimeters thick. However, in such a situation it is recommended to support pregnancy with medications for the first few weeks. Apply:

• "Utrozhestan".
• "Duphaston".

Most often the first drug is prescribed in the form of vaginal suppositories. Active substance quickly absorbed into the uterine tissue, which has a positive effect on the mucous membrane.

Endometrium: can it be increased?

An endometrium with a thickness of 10 mm is normal and allows you to become pregnant. If, upon examination of the female body, it was revealed that the thickness of the mucous membrane is insufficient, hormonal therapy should be used. The best option doctors select based on individual intolerance and indications for treatment. As a rule, medications containing estradiol are prescribed. In pharmacies these are the following drugs:

• "Proginova" (in tablet form).
• "Femoston" (for oral administration).
• "Divigel" (gel for topical use).

Traditional methods

If the study showed that the thickness of the endometrium is 10 mm, what does this mean? A woman can prepare for pregnancy; her body is normal. If the parameters turn out to be smaller, but no one has any desire to take hormonal drugs, you can resort to traditional therapy, having previously consulted with your doctor.

Eat homeopathic medicines showing good results for growing the endometrium:

• "Gynekohel".
• "Gormel".

On the fifth day of the menstrual cycle, you can brew raspberry leaves and drink the entire first phase instead of tea. It is recommended to include fresh pineapples in your daily menu. Canned ones are also suitable, but they contain very few vitamins, so the effectiveness will be extremely low. It is better to choose ripe fresh pineapples and eat them as much as you want.

At the same time, we must remember that deviation from the norm is not necessarily a reason to panic. All women planning a pregnancy want to know if 10 mm is a diagnosis, a problem for pregnancy, or an indicator that bearing a fetus is impossible. It must be remembered that for some women this may indeed be difficult, while others’ bodies will cope well with the situation, ovulation will be successful, and pregnancy will proceed easily.

Cycles, ovulation and the endometrium

“The endometrium is 10-5 mm - what does this mean?” - this is a question often asked by women, passed the examination gynecologist for reasons unsuccessful attempts get pregnant. It's simple: this is just an indicator of the thickness of the mucous membrane, varying depending on the day of the cycle. You need to understand that this value changes every day and this phenomenon is normal. There is no need to panic, although very thin mucous membrane (5-7 mm) creates certain difficulties for successful ovulation.

However, it’s not always about the endometrium. There are cycles when there is no ovulation. Normally, a woman experiences one or two of these a year. If this does not happen for several cycles in a row, then you need to consult a gynecologist. Usually a test is prescribed for LH + FSH, prolactin, produced thyroid gland hormones.

When should you worry?

In some cases, examination by a gynecologist allows a diagnosis of endometrial hyperplasia to be made. 10mm is not usually a thickness to worry about. But if the tissues covering the uterus thicken up to two centimeters, and sometimes more, it is necessary to begin treatment, as well as take additional tests. First of all, a woman is checked for cancer.

If you suspect hyperplasia, you should consult a gynecologist. The doctor will check the uterus and examine benign changes and take tests to identify the causes. In some cases, endometrium with abnormal thickness is not a sign of hyperplasia.

Ultrasound as a way to measure the endometrium

The question about the situation when the endometrium is 10 mm, what does this mean, is usually asked by women who have undergone an M-echo ultrasound procedure. These days it is considered the most effective for determining the thickness of the mucosa.

The doctor conducting the examination reveals the condition of the uterine mucosa, determines whether the organ is functioning correctly, and if not, finds disturbances in its functioning. During the M-echo, it is determined whether the fertilized egg can implant into the uterine walls.

Endometrial cycles and standards for M-echo

Endometrium 10 mm - what does this mean? Typically, this indicates that a woman is in the middle or end of her menstrual cycle. However, well-known standards have been developed for those women whose menstrual cycle lasts 28 days. It is for this that the table of standard values ​​was given above. If the individual characteristics of the body are such that the cycle is shorter or longer, then this schedule goes astray.

Below is a more general calendar of changes in endometrial thickness.

So, as you can see from the table, you should not be worried about an endometrial thickness of 10 mm, “what does this mean” is not a question that should scare you. More precisely, this means that the female body is normal and ready for pregnancy. If the cycle is shorter than 28 days, the rate of change in parameters is faster; if the cycle is longer, there will be a lag from the average calendar.

Evaluation of M-echo results

Typically, standards depend on the patient’s age, phase of the cycle, medications taken, and many other factors. To identify all the features, the doctor interviews the woman at the appointment.

If you are trying to determine at home whether the thickness of the endometrium is 10 mm - what does this mean, there is a high probability of only confusing and intimidating yourself, finding non-existent diseases, getting nervous, which will lead to hormonal imbalance and rejection of the fertilized egg, if fertilization has already occurred - this often happens on the background severe stress. Therefore, you should not look for diseases or disorders on your own, but it is better to consult an experienced gynecologist. He will be able to tell whether there are definitely deviations or whether the body is completely normal.

M-echo: 8mm

If the menstrual cycle has a standard duration, the woman is in the reproductive period, the normal thickness of the mucous membrane for 10-15 days will be 8 mm. If the parameter persists at other stages of menstruation, the reason may be hormonal therapy. If there is none, the doctor may diagnose hypoplasia. This means that the fertilized egg has little chance of attaching to the uterine wall. For a successful pregnancy, medications that affect the endometrium are prescribed.

There are probably problems if the M-echo showed a mucosal thickness of 8 mm, but the woman is already going through menopause. In this case, additional studies are prescribed, including Doppler ultrasound. The patient is registered and periodically examined over a period of about six months to identify the causes of deviations.

M-echo: 9mm

Usually the mucous membrane reaches this thickness on the 15th day of the cycle. Indicators last on average for about 6 days. At short cycle up to 9 mm, the layer of tissue covering the inside of the uterus can grow before the 15th day, and this will normal situation. If the cycle is longer, then on the 15th day the thickness usually does not yet reach 9 mm, this happens a little later.

M-echo: 10mm

Endometrial thickness 10 mm - what does this mean? Usually this is the second half of the menstrual cycle. If even in the first 15 days of the study it is determined that the thickness of the mucosa reaches ten mm, hyperplasia is possible. This can serve as an indicator of disease or inflammatory process.

If a woman’s reproductive period has come to an end, but the lady is taking hormonal drugs, then the uterine mucosa should reach 10 mm, but in no case exceed this value.

M-echo: 11 mm

This parameter is normal for the second half of the cycle. If the endometrium has not grown to this thickness, the fertilized egg is unlikely to take root in the uterus. It is generally accepted that 11 mm is the minimum indicator allowing successful ovulation. Exceptions are possible, but extremely rare.

But if the thickness of the mucous membrane reaches 11 mm in the first 14 days of the menstrual cycle, doctors prescribe additional tests and conduct a comprehensive diagnosis of the body: this parameter indicates diseases, the nature of which should be urgently determined. Perhaps the cause will be benign neoplasms, but there is a possibility of their malignancy over time.

M-echo: 14 mm

The indicator is normal for the secretory phase, which begins on the 15th day and lasts about five days. If the M-echo showed a 14-mm endometrium at the beginning of menstruation, the reason is pathology. Doctors order tests to identify the causes.

M-echo: 15 mm

This parameter is an extreme normative one, characteristic of reproductive period. Usually the mucous membrane reaches this thickness towards the end of menstruation. If the endometrium has grown to 15 mm earlier, we are probably talking about hyperplasia or another kind of pathology. Doctors make an accurate diagnosis and prescribe treatment.

Endometrial thickness and conception

The endometrium is absolutely necessary for successful ovulation, since it is to it that a fertilized egg can attach. For this stage to be effective, the thickness must reach 11-13 mm. Accordingly, predictions for conception can be made if the thickness of the endometrium is regularly checked and an M-echo is performed during the control menstrual cycle. In order to get pregnant, it is desirable that the mucous membrane be homogeneous.

When the indicator is less than normal (7-8 mm), the fetus will not be able to implant. This can be eliminated by taking hormonal drugs.

The size of the endometrium is directly related to the size of the uterus itself. The latter strongly depends on individual characteristics: for example, how many times a woman became pregnant and gave birth. The uterus changes under the influence of menstruation, becoming smaller at the beginning of the cycle and increasing closer to the period of bleeding. Such changes have no clinical significance.

Summing up

If an ultrasound examination revealed that the thickness of the endometrium is 10 mm, this is not a reason to be scared and panic. In fact, the indicator is completely normal for a certain phase of the cycle. When receiving the results of the study, a woman should visit her treating gynecologist to consult how well her body is. What is normal for some will be regarded by others as hyperplasia or a sign of pathology.

To be able to get pregnant, the endometrium should reach 10-11 mm or more in thickness, but not exceed 15 mm. Correction of indicators is achieved through hormonal therapy under the supervision of the attending physician. You can help further folk remedies, but be sure to consult your doctor first.

Among all malignant neoplasms in women, uterine cancer is the most common, and its incidence and the number of young patients with this diagnosis are growing. Endometrial cancer is the fate of postmenopausal women, average age patients are 55-60 years old, but it can also be detected in young girls of fertile age. Features of hormonal levels during the postmenopausal period contribute to various hyperplastic processes of the endometrium. Such changes in the uterine mucosa most often become the “soil” on which cancer grows.

Since the presence of a tumor is accompanied by clinical manifestations already at early stage, That the number of advanced forms (unlike cervical cancer) is small. The majority of neoplasms are detected quite early (more than 70% in the first stage of the disease), so such a tumor becomes a relatively rare cause of death. Endometrial cancer accounts for about 2-3% of all tumors of the female reproductive system.

Features of the anatomy and physiology of the uterus

Endometrial cancer of the uterus, often called simply uterine cancer, is a tumor that grows from the lining of the organ.

Knowing the basics anatomical structure uterus allows us to more accurately represent the essence of this insidious disease.

The uterus is an unpaired hollow organ, the main purpose of which is bearing a child and subsequent childbirth. It is located in the pelvic cavity, bordering on the front bladder, behind it is the wall of the rectum. This arrangement explains the appearance of a disorder of their function in the pathology of the internal female genital organs.

Body of the uterus ( upper section, directly involved in pregnancy) consists of three layers:

• Endometrium- the inner layer, the mucous membrane lining the surface of the uterus from the inside, subject to cyclical changes under the influence of female sex hormones and intended for favorable implantation of a fertilized egg in the event of pregnancy. Under pathological conditions, the endometrium becomes a source of cancer development.
• Myometrium– a middle, muscular layer that can increase during pregnancy and is extremely important in labor. Tumors of smooth muscle origin (benign leiomyomas and malignant leiomyosarcoma) can grow from the myometrium;
• Serosa- part of the peritoneum that covers the outside of the uterus.

The functioning of the endometrium is maintained through complex interactions between the nervous and endocrine systems. The hypothalamus, pituitary gland and ovaries produce hormones that regulate the growth, development and subsequent rejection of the endometrium during the menstrual phase of the cycle if pregnancy has not occurred. It is violations of the neuroendocrine regulatory mechanisms that most often become the cause of diseases of the female reproductive system, including endometrial cancer.

Risk factors for endometrial tumors

As is known, in healthy tissue the development of a tumor is very unlikely, therefore the presence of disorders and predisposing factors is necessary that will cause a precancerous process and a subsequent tumor.

More often, endometrial cancer occurs in women who are overweight (obese), with diabetes mellitus, arterial hypertension, and among disorders of the female reproductive system the following predominate:

1. Early onset of menstruation;
2. Late onset of menopause;
3. Absence or only childbirth in the past;
4. Infertility;
5. Neoplasms in the ovaries that can synthesize estrogen hormones;
6. Various menstrual cycle disorders.

causes of endometrial cancer of the uterus

It is known that female sex hormones (estrogens) can accumulate in adipose tissue, so their concentration may increase in obesity. This leads to excessive growth (hyperplasia) of the endometrium and polyp formation. Diabetes mellitus is accompanied by significant endocrine and metabolic changes, including those in the genital organs. Pathology of the ovaries, disturbances in the hormonal regulation of the menstrual cycle, including those caused by stress and nervous overload, also contribute to the occurrence of various changes in the uterine mucosa that precede tumors.

In addition, we should not forget about the hereditary factor, when various genetic abnormalities predispose to the development of breast tumors, ovarian or endometrial cancer.

Precancerous changes and causes of endometrial tumors

The main cause of the tumor is most often an increase in estrogen levels, produced in the first phase of the menstrual cycle by the ovaries. These hormones promote the growth of the endometrium, increasing its thickness due to cell proliferation and the formation of convoluted glands necessary for the implantation of a fertilized egg. When there is a lot of estrogens, there is excessive growth of the endometrium (hyperplasia), increased proliferation (reproduction) of endometrial gland cells, which creates conditions for disruption of the division processes and the appearance of a tumor.

The processes that precede cancer are endometrial hyperplasiaand polyp formation. Most mature women have encountered such diagnoses at least once in their lives. The likelihood of tumor development as a result of these processes depends on the nature of the endometrial changes.

There are several types of hyperplasia:

• Simple non-atypical hyperplasia;
• Complex (adenomatous) non-atypical;
• Simple atypical hyperplasia;
• Complex (adenomatous) hyperplasia with atypia.

The first two options are characterized by excessive growth of the uterine mucosa with an increase in the number of glands in it. The term "adenomatous" means the presence large quantity such glands located close to each other and reminiscent of the structure of a benign glandular tumor - adenoma. Since the epithelial cells of the glands in this case do not differ from normal ones, these types of hyperplasia are called non-atypical (not accompanied by cell atypia) and are considered background processes that will not necessarily cause cancer, but may contribute to its development.

Simple and complex hyperplasia with atypia is a precancerous process, that is, the likelihood of developing a malignant tumor with such changes is quite high. Thus, in the presence of complex atypical hyperplasia, cancer develops in more than 80% of patients. Diagnosis of such changes requires special control from gynecologists and appropriate treatment.

Polyps endometrium are focal growths of the mucous membrane and are most often found among elderly women. Since neoplastic (tumor) transformation of cells with cancer growth is possible in a polyp, it must also be removed.

Cancer that occurs against the background of hyperestrogenism is referred to as the so-called first pathogenetic type and it accounts for about 75% of all malignant neoplasms of the uterine body. Such tumors grow slowly and have high degree differentiation and a fairly favorable prognosis.

Sometimes a tumor develops without a previous hormonal imbalance, with a “healthy” endometrium. The reason for this phenomenon is unclear, but scientists have speculated about the possible role immune disorders. This type of cancer is classified as second pathogenetic type(about a quarter of cases of cancer of the uterine mucosa). It has a poor prognosis, grows rapidly and is represented by highly malignant, poorly differentiated forms.

Third pathogenetic type Malignant endometrial tumors have recently begun to be identified and their development is associated with hereditary predisposition. This variant is usually combined with malignant tumors of the colon.

The age range of tumor development is noteworthy. Since hormonal disorders accompanied by hyperestrogenism are most often observed during the period of extinction of the hormonal activity of the female body and the onset of menopause, it is not surprising that endometrial tumors are more common in mature and elderly women. In addition, the described underlying conditions and risk factors are also more often diagnosed in older patients. In this regard, even if 15-20 years have passed since the onset of menopause, one should not forget about the possibility of tumor development in long-nonfunctioning organs of the reproductive system.

There is an opinion that long-term use hormonal drugs can lead to the development of a malignant tumor of the uterine cavity mucosa. As a rule, this effect is achieved by medications with a high dosage of the estrogen component. Because the modern drugs for hormone therapy contain fairly low concentrations of estrogen and progesterone, the likelihood of tumor growth when used is minimal, but women taking them still need to be regularly examined.

Features of classification and staging of uterine cancer

There are several classifications of endometrial cancer, but in practical oncology the most applicable:

1. According to the TNM system developed by the International Union Against Cancer;
2. Staging proposed by the International Federation of Obstetricians and Gynecologists (FIGO).

TNM system implies comprehensive assessment not only the tumor itself (T), but also the lymph nodes (N), and also indicates the presence or absence of distant metastases (M). Simplified, it can be represented as follows:

• T0 – the tumor was completely removed during curettage and is not detectable;
• T1 – tumor within the body of the uterus;
• T2 – the tumor grows into the cervix;
• T3 – periuterine tissue and the lower third of the vagina are affected;
• T4 – cancer extends beyond the boundaries of the pelvis, grows into bladder, rectum.

The nature of the lesion of the lymph nodes is described as N0 - no lesion was detected, N1 - metastases are detected by lymphography, N2 - lymph nodes are enlarged and palpable.

The presence or absence of distant metastases is designated as M1 or M0, respectively.

In addition, a special index G has been introduced, denoting degree of cancer differentiation:

• G1 denotes well-differentiated tumors;
• G2 – cancers of moderate differentiation;
• G3 – poorly and undifferentiated tumors.

The G index is extremely important in assessing the prognosis of the disease. The higher the degree of differentiation, the better the prognosis and effectiveness of the therapy. Poorly and undifferentiated tumors, on the contrary, grow quickly, rapidly metastasize and have an unfavorable prognosis.

In addition to TNM, another classification is used that distinguishes Stages of development of uterine cancer:

• stage I (A-C) – when the tumor grows within the body of the uterus;

• stage II (A-B) – the tumor reaches the cervix, grows into its mucosa and stroma;

• Stage III (A-C) characterizes a neoplasm growing within the small pelvis; the peritoneum covering the outside of the uterus and the ovaries with fallopian tubes may be affected, but the bladder and rectum remain not involved in the pathological process;

• Stage IV (A-B), when the cancer reaches the walls of the pelvis and spreads to the wall of the bladder and rectum. During this period, it can be detected distant metastases in other organs and lymph nodes.

Of no small importance is the histological type of structure of cancer of the uterine mucosa. Since the endometrium is glandular tissue, the so-called adenocarcinoma(glandular cancer), occurring in almost 90% of cases, mainly among patients over 50 years of age. In addition to adenocarcinoma, squamous cell, glandular squamous cell carcinoma, undifferentiated and other variants are possible, which are much less common.

The stage of the disease is determined after surgical treatment and pathohistological examination of the removed tumor, lymph nodes, fiber and other tissues. This allows you to most accurately determine the extent of organ damage, as well as establish the histological structure of the tumor itself and the degree of its differentiation. Taking these data into account, a treatment regimen is drawn up and a further prognosis is determined.

Metastasis of endometrial cancer

Metastasis is the process of cancer spreading through the blood, lymph, and serous membranes. This happens because tumor cells, due to their altered structure, lose strong intercellular connections and easily separate from each other.

Lymphogenic metastasis characterized by the spread cancer cells with lymph flow from nearby and distant lymph nodes - inguinal, iliac, pelvic. This is accompanied by the appearance of new foci of tumor growth and an increase in the affected lymph nodes.

Hematogenous route is realized by spreading tumor emboli (clumps of cells circulating in the bloodstream) through vessels to other internal organs - lungs, bones, liver.

Implantation route metastasis consists in the spread of the tumor throughout the peritoneum when it grows into the wall of the uterus, periuterine tissue, and it is also possible to involve the appendages in this way.

The intensity of metastasis is determined by the size and growth pattern of the neoplasm, as well as the degree of its differentiation. The lower it is, the earlier and faster metastases will develop, not limited to regional lymph nodes.

How to suspect cancer?

The main features characterizing possible growth tumors in the uterine cavity are pain, dysfunction pelvic organs and the appearance of discharge from the genital tract, which are:

• Bloody;
• Purulent;
• Profuse leucorrhoea;
• Watery.

Uterine bleeding occurs in more than 90% of endometrial cancer cases. In women of reproductive age, these are acyclic bleeding not associated with menstruation, which can be quite long and heavy. Since this symptom is also characteristic of many other diseases and changes in the uterine mucosa, significant difficulties may arise in the timely diagnosis of cancer. This is partly due to the lack of oncological vigilance among gynecologists in relation to women who have not entered menopause. In an attempt to find other causes of bleeding, time may be lost, and the cancer will progress to an advanced stage of destruction.

In elderly patients during menopause uterine bleeding considered a classic symptom indicating growth malignant neoplasm Therefore, the diagnosis is made, as a rule, in the early stages of the disease.

Purulent discharge characteristic of large tumors, they appear during their disintegration (necrosis) or the addition of bacterial flora. This condition, when purulent discharge accumulates in the lumen of the uterus, is called pyometra. It is also not surprising that there is an increase in temperature, general weakness, chills and other signs of intoxication and inflammation.

Profuse leucorrhoea are characteristic of large neoplasms, and watery discharge is a rather specific sign of the growth of endometrial cancer.

Pain syndrome, which accompanies endometrial tumors, is characteristic of late stages of the disease, with a significant size of the tumor, growing into the walls of the pelvis, bladder or rectum. There may be persistent, quite intense, or cramping pain in the lower abdomen, sacrum and lower back, as well as disturbances in the process of emptying the bladder and intestines.

Lack of awareness among women about uterine cancer, lack of alertness among doctors regarding cancer, ignoring regular visits to the doctor or postponing them even when any symptoms appear, lead to loss of time and progression of the disease, which is detected in an advanced form. In such a situation, treatment is not always effective, and the risk of death from endometrial cancer increases.

Important to remember: self-healing in the presence of cancer is impossible, therefore only timely qualified assistance when the first symptoms of endometrial cancer appear is the key to a successful fight against it.

How to detect cancer?

If suspicious symptoms or complaints appear, a woman should first go to the antenatal clinic. The main diagnostic measures at the initial stage will be:

• Gynecological examination in mirrors;
• Aspiration biopsy or separate diagnostic curettage uterine cavity and cervical canal;
• Ultrasound of the pelvic organs;
• Chest X-ray;
• General blood test, urine test, hemostasis study (coagulogram).

These simple and accessible manipulations make it possible to exclude or confirm the growth of a tumor, determine its size, location, type, and the nature of damage to neighboring organs.

At examination in mirrors The gynecologist will make sure that there is no damage to the vagina and cervix, palpate and determine the size of the uterine body, the condition of the appendages, and the location of the pathological focus.

At aspiration biopsy or curettage, it becomes possible to take tissue fragments with subsequent cytological or histological examination of the tumor. In this case, the type of cancer and the degree of its differentiation are determined.

Ultrasound can be used as a screening for uterine tumors in all women age categories. The method is accessible for research by a wide range of people, provides a large amount of information, and is also simple and inexpensive to implement. During the study, the dimensions, contours of the uterus, and the condition of the cavity are clarified (the width of the so-called median M-echo is assessed). On ultrasound, an important criterion for cancer will be the expansion of the median M-echo, changes in the contours of the endometrium, and echogenicity.

To clarify data on tumor growth and the condition of other pelvic organs, it is possible to conduct CT and MRI. These procedures also make it possible to study the pelvic lymph nodes and identify metastases.

Rice. 1 - ultrasound examination, Fig. 2 - hysteroscopy, Fig. 3 - MRI

Hysteroscopy is a mandatory study if endometrial cancer is suspected. Its essence lies in the use of a special device - a hysteroscope, inserted into the uterine cavity and allowing one to examine its inner surface with magnification. Also, during the procedure, a targeted biopsy is necessarily taken from the affected area. The information content of the method reaches 100%. Hysteroscopy ends with separate curettage of the cervical canal and the uterine cavity, which makes it possible to evaluate the changes separately and correctly determine the location of tumor growth.

A new method for diagnosing endometrial cancer can be considered fluorescence study, which is accompanied by the introduction of special substances that accumulate in the tumor (photosensitizers) with subsequent registration of their accumulation. This method makes it possible to detect even microscopic foci of tumor growth that are inaccessible to detection using other methods.

The final and decisive stage of diagnosis for cancer of the uterine mucosa will be a histological examination of tissue fragments obtained during curettage or hysteroscopy. In this case, it becomes possible to determine the type of histological structure of the tumor, the degree of its differentiation, and in some cases, the presence of tumor ingrowth into the muscular layer of the uterus and blood vessels.

The diagnosis is made after a comprehensive and comprehensive examination of the patient using all the required laboratory and instrumental techniques. Final staging is possible only after surgical treatment with the most accurate assessment of the nature of tissue changes.

From timely diagnosis to successful treatment

The main directions of treatment for uterine tumors are surgical removal of the affected organ, radiation therapy and the use of chemotherapy.

Surgery consists of complete removal of the uterus (extirpation) with the ovaries, tubes and pelvic lymph nodes. If the operation is difficult or contraindicated, then it is permissible to use modern laparoscopic techniques, in particular hysteroresectoscopic ablation of the endometrium. The essence of the method is the destruction (removal) of the mucous membrane and several millimeters of the underlying muscle layer (myometrium). Such manipulation is possible in women with early forms of cancer in the presence of severe concomitant pathology that does not allow extirpation or long-term hormonal therapy.

During the operation, the ovaries are necessarily removed, regardless of the patient’s age, since they produce female sex hormones, and also often and early become the site of growth of metastases. After surgery, young women develop the so-called post-castration syndrome due to hormone deficiency, but its manifestations disappear after 1-2 months.

It is worth pointing out that more than 10% of patients are elderly and have severe concomitant lesions from the cardiovascular and endocrine systems ( arterial hypertension, diabetes, obesity, etc.), liver or kidneys. In some cases, these disorders also require correction, since the patient may simply not be able to tolerate surgery or chemotherapy.

If it is needed surgery, for example, cardiovascular disease with subsequent prescription of anticoagulants, there is a risk of developing massive and dangerous bleeding from the tumor. At the same time, surgery to remove the tumor can lead to the patient’s death from heart complications. In such situations, so-called simultaneous operations are performed: a team of cardiac surgeons operates on the heart simultaneously with a team of oncologists who remove a tumor of the uterine body. This approach avoids many dangerous complications, and also makes it possible to conduct adequate and complete surgical treatment.

Radiation therapy

For uterine cancer irradiation may be one of the components of combination treatment. As a rule, external beam radiation therapy is performed on the pelvic organs or a combined effect. Indications for this method of treatment are determined individually depending on the woman’s age, concomitant diseases, growth pattern and degree of cancer differentiation. For poorly differentiated tumors that grow deep into the endometrium and cervix, combined radiation exposure (external and intracavitary) is indicated.

Since the use of modern equipment makes it possible to reduce the possibility of side effects to some extent, radiation reactions are still inevitable. More often than others, the bladder, rectum, and vagina are affected, which is manifested by diarrhea, frequent and painful urination, and discomfort in the pelvis. If such symptoms appear, you must inform your oncologist.

Chemotherapy not used as independent method for the treatment of endometrial cancer, but is acceptable as part of combination therapy. The range of drugs effective against such tumors is very limited, and the most commonly used regimen is CAP (cyclophosphamide, doxorubicin and cisplatin). The drugs used in chemotherapy are toxic and have a cytostatic effect (suppress cell reproduction), which is not limited to tumor tissue, so side effects such as nausea, vomiting, and hair loss are possible. These manifestations disappear some time after discontinuation of cytostatics.

An important approach in the treatment of uterine cancer is hormone therapy, which can be an independent stage in young patients in the initial stages of the disease. It is possible to prescribe antiestrogens, gestagens or their combinations. Treatment with hormonal drugs is well tolerated by patients and does not produce significant adverse reactions.

After the first stage, which lasts about a year, the doctor must make sure that there is no tumor growth (morphological examination of the endometrium and hysteroscopy). If all is well, then you can begin to restore ovarian function and a normal ovulatory menstrual cycle. For this purpose, combined estrogen-gestagen drugs are prescribed.

Prognosis and prevention

The main indicators influencing the prognosis of endometrial cancer are the degree of differentiation (from the result of histological postoperative examination) and the extent of the tumor in surrounding tissues and organs. Usually, in the initial forms of the disease, the tumor is completely cured. Successful treatment promotes early detection of neoplasms.

Severe concomitant diseases and advanced age of patients not only greatly worsen the prognosis, but also limit the choice of methods for comprehensive comprehensive treatment.

With the third stage of endometrial cancer, about a third of patients survive, with the fourth - only about 5%, so it is very important to diagnose the tumor in time and not waste time.

All women treated for endometrial cancer are subject to constant dynamic monitoring by gynecological oncologists. In the first year, to prevent the possibility of relapse, it is necessary to examine the patient every four months, in the second year - once every 6 months, then - once every year. It must be carried out not only gynecological examination, ultrasound, but also x-ray of the lungs to exclude the appearance of tumor metastases.

Prevention of uterine cancer is extremely important and should be aimed at maintaining normal hormonal levels and the ovulatory menstrual cycle, normalization of body weight, timely detection and treatment of background and precancerous changes in the uterine mucosa. An annual visit to the antenatal clinic, examination and ultrasound of the pelvic organs is mandatory. If any symptoms appear, you should consult a doctor as soon as possible. Any disease, including uterine cancer, is easier to prevent than to treat.

Video: uterine cancer in the “Live Healthy” program

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Unfortunately, face-to-face consultations and assistance in organizing treatment are not provided at the moment.