Women's health is constantly dependent on hormonal levels. Any changes it can cause abnormalities in the body. One of the most serious hormonal changes occur in the period of menopause women. For the most part, this concerns changes in the production of estrogen and progesterone. This affects the atrophy of the mucous surfaces of the uterus, which ultimately leads to the complete cessation of menstruation and the extinction of the reproductive function of women. But in addition to the above, hormonal disruptions can cause the development of pathological processes. For example, there is a norm of endometrial thickness in menopause. Deviation from it can talk about the development of serious diseases. What should be the endometrium in menopause and what are the methods of treatment for deviations, consider in the article.
Endometrium is the mucous membrane of the uterus, which plays an important role in the process of carrying a child and prevents adhesion of the walls of the organ. Endometrium is very susceptible to any changes in hormonal levels, since it contains a large number of receptors that provide a high sensitivity of the mucous to hormones. So, in the middle of the menstrual cycle, there is an overwhelming number of receptors that respond to estrogen, and in the second half of the cycle - to progesterone.
The growth of the endometrium continues throughout the cycle, preparing for the possible conception and implantation of the embryo. By the end of the cycle, its thickness may be 10 times the original. If the pregnancy has not occurred, then the uterus rejects the functional layer of the mucous membrane, which is manifested by the onset of menstruation.
The rate of endometrial uterus with menopause
In women of reproductive age, the thickness of the uterine mucosa is constantly changing under the influence of its cyclical nature. During menopause, the amount of hormones that are produced by the ovaries gradually decreases. In this regard, there is a gradual thinning of the endometrium, it becomes more friable. The final result of these changes should be fixing the thickness of the uterine mucosa at 5 mm. If the test results revealed an increase in this value, we can speak about the development of the pathological process. In most cases, there is an excess of the normal values, which is a sign of endometrial hyperplasia. The normal thickness of the endometrium during menopause may vary, but not more than 1-2 mm. To confirm the diagnosis, it is necessary to undergo a series of diagnostic measures and, if confirmed, begin the necessary treatment. If the results of the examinations indicated an increase in the thickness of the mucous membrane to 6-7 mm, the patient is put on medical supervision, systematically undergoing an ultrasound procedure. Excessive growth of the endometrium can lead to serious consequences.
Types of endometrial hyperplasia
Currently, endometrial hyperplasia during menopause can be divided into the following types:
- Ferruginous. At the same time, the connective tissue of the uterus remains unchanged, and it is the glandular cells that grow. It is the most common form of pathology, which, if detected early, is quite successfully treatable. Growing into a malignant nature is rare.
- Cystic. When this form of the disease occurs, the formation of cysts, and epithelial tissue undergoes changes. This form of hyperplasia is dangerous, as it can develop into oncological formations.
- Cystic glandular. A mixed form of pathology in which overgrown glandular cells form cysts.
- Focal. It occurs quite rarely, but is considered quite dangerous, as it is characterized by the occurrence of polyps that are prone to malignancy. Bleeding may occur. With this form of hyperplasia, strict medical control is maintained.
- Atypical. The most dangerous form of the disease. Observed active reproduction, as well as the degeneration of mucosal cells. The endometrium deep layers are also subject to changes. This type of pathology requires surgical intervention, since in 60% of cases it stops in oncology. As a rule, during surgery, the uterus is removed.
The reasons for the increase in the size of the endometrium during menopause are quite extensive. Consider them in more detail:
- Hormonal disorders. The most common factor in the development of hyperplasia. Disruptions in the endocrine system can cause an increase in estrogen levels, leading to imbalances.
- Metabolic disorders and obesity. Fat cells are able to synthesize estrogens, exacerbating the imbalance of hormones during menopause.
- Ovarian dysfunction.
- Uterus neoplasms.
- Surgical interventions, including abortion and curettage.
- Genetic predisposition.
- Hepatic dysfunction.
- Diseases of the kidneys, adrenal glands and pancreas.
- Endocrine diseases.
- Autoimmune pathological conditions.
- Smoking and excessive drinking.
- Improper nutrition.
- Long-term use of hormonal drugs or their illiterate appointment.
As a rule, abnormalities of the endometrium of the uterus during menopause do not have symptoms specific to this pathology. With more severe growth, bleeding can occur, which is often confused with menstrual bleeding, which can still occur during the initial stage of menopause. In most cases, abundant, painful bleeding is observed, but spotting may also be of concern. Sometimes they appear white or gray.
Decreased performance, headaches, and general weakness may also be of concern.
Identification of deviations of values from the norm of the endometrium during menopause is not difficult. First of all, if any symptoms appear, you should contact your gynecologist, who will conduct an examination and prescribe diagnostic measures, which will result in effective therapy. To make the most accurate diagnosis, a comprehensive diagnosis is performed, which includes a number of laboratory and instrumental examinations. Consider them in more detail.
- The main diagnostic measure is ultrasound, which is carried out by intravaginal method.
- If the ultrasound results indicate that the endometrium grows to 8–9 mm, in most cases diagnostic curettage of the functional layer of the uterus is performed under general anesthesia. Next, the cleaned material is sent for histological examination in order to detect atypical cells.
- Biopsy, which allows to determine not only abnormalities in the thickness of the endometrium during menopause, but also the presence of pathological processes in it and malignant cells.
- Sometimes a survey with radioactive phosphorus is required. This substance has the ability to accumulate in pathologically altered cells, so that with the help of a certain sensor, you can detect foci of cell proliferation.
Laboratory diagnostic methods include:
- General analysis of urine and blood.
- Taking smears.
- Blood test for hormones.
Currently, there are several ways to treat endometrium with menopause in case of its growth, the main of which are conservative and surgical.
Conservative treatment primarily involves the use of hormonal drugs, since any gynecological disorders during menopause are caused by hormonal disruptions.
With an increased size of the endometrium during menopause, the following drugs are prescribed:
Hormonal treatment with these drugs has virtually no side effects. They also normalize the condition of mucosal cells and prevent their degeneration into a malignant form. Reception of this category of medications should be carried out from 3 months to a year under the supervision of a physician.
During hormone therapy, concurrently prescribed drugs that have a protective and regenerating effect on the liver. These include the Essentiale Forte. It may also be recommended drugs that thin the blood - "Hepatrombin" and others.
It happens that the doctor decides on the appointment of gonadotropin-releasing hormone agonists, a side effect of which is an increase in menopausal symptoms.
Surgical treatment method
Surgical treatment of endometrial hyperplasia is used quite often. Surgical intervention is used in cases of recurrence of the disease, in the form of polypoid pathology, and in cases when mucosal cells are suspected of becoming malignant.
The operation can be carried out in several ways, from which we describe below.
- Scraping. This procedure can be used as a diagnostic measure for identifying atypical mucosal cells. The operation allows you to slow down the development of the pathological process and stop the bleeding.
- Laser cautery. A very effective method of treatment, which causes minimal damage to the female body. This method is used to remove individual foci of hyperplasia.
- Cryodestruction It is used for focal hyperplasia. Cauterization is carried out using exposure to a pathological focus of low temperatures.
- Hysterectomy. This term means complete removal of the uterus. It is used in the most extreme case when atypical hyperplasia develops, in which the likelihood of oncology development is high.
Sometimes when the values of the endometrial norm are rejected during menopause, the use of traditional medicine is used as an auxiliary therapy. This treatment helps to normalize hormones and reduces the risk of inflammatory processes. It is important to remember that before taking herbs you should consult with your doctor.
The most popular recipes for the growth of the endometrium are:
- Linseed oil.
- Borovaya uterus.
- Infusion celandine.
- Burdock roots
- Nettle tincture.
- Infusion cuff.
- Plantain leaves infusion.
- Beet and carrot juices.
The important points in the treatment of hyperplasia is dieting, in which it is necessary to minimize the consumption of fatty, floury, sweet, smoked products. You need to eat more cereals, nuts, fruits and vegetables, as well as food rich in vitamin C.
Climax - a very difficult period for women, both psychologically and emotionally. There is a global hormonal alteration, during which pathological conditions can develop. Therefore, it is extremely important not to neglect the planned visits to the doctor. At detection of abnormalities in the endometrium during menopause, it is necessary to pass the necessary tests and begin treatment. With timely initiated therapy, the probability of a successful outcome is large enough.
Inside the uterine cavity is covered with a layer of epithelial cells or, as they say in a different way, is covered with a mucous membrane. This shell is called the endometrium. He is very susceptible to the influence of hormonal changes in the body and plays an important role during the carrying of the child. It also protects the uterus by preventing its walls from sticking together.
The mucosa is permeated with many blood vessels, and it also contains a large number of receptors that ensure the high sensitivity of this layer to the action of hormones produced by the appendages. When the middle of the menstrual cycle is approaching, in the endometrium there is just a peak number of receptors that perceive estrogens, and in the 2nd half of the cycle there are more receptors that respond to progesterone.
Endometrium increases its thickness over the whole cycle, and by its completion the layer thickness can be 10 times higher than the initial one, which was in the 1st phase. The mucosa increases in 2 stages, the first is called the phase of proliferation of the endometrium, and the second - the stage of secretion.
If before the end of the cycle, the egg cell was not fertilized, and conception did not occur, the uterus rejects the functional layer of the endometrium, which is manifested by the onset of menstruation. With the advent of the new cycle, the functional layer begins to recover and grow again.
For the onset of menopause is characterized by the absence of menstruation over a long period of time, not less than a year. The endometrium has no cyclic changes, it rapidly decreases, and eventually the mucous layer atrophies, and its thickness stops changing and takes a fixed value. Let us consider in more detail how the structure of the reproductive system of a woman changes with age, and what are the norms of endometrial thickness during menopause.
What changes happen with age
In women of childbearing age, the thickness of the uterine mucosa is constantly changing due to the cyclical nature of its development. Normally, by the 23rd day of the cycle, it can reach 18 mm, this is the time when the mucous membrane is gaining its maximum thickness. Endometrium with menopause is gradually thinning, and this is considered normal, since the atrophic process does not occur abruptly. Gradual atrophy of the endometrium during menopause should lead to the fact that its thickness is fixed at 5 mm.
What is the size of the endometrium normal during menopause
The thickness of the endometrium in menopause can be determined by ultrasound. With the onset of the menopausal period, this important parameter for the mucous membrane of the uterus gradually decreases, and this corresponds to the normal state of the female body. Since in the premenopausal women have monthly periods, the thickness of the endometrium does not differ in the days of the cycle, but is static. Endometrial norm should be no more than 5 mm. If the thickness of the mucous according to the results of ultrasound has exceeded this figure by 1-2 mm, additional examination is required to find any problems of the female reproductive system.
It should be noted that there are no women with a completely identical hormonal background, therefore a gradual increase by 1 mm of the thickness of the inner layer of the uterus does not in each case mean the presence of pathology. But when the thickening of the endometrium occurs abruptly and for no apparent reason, additional examination is mandatory, it will help establish the diagnosis in time and prescribe the appropriate treatment.
Causes and signs of changes in endometrial thickness
As we mentioned earlier, the thickness of the endometrium during menopause decreases with time and is fixed at one value. If this does not happen and the mucous membrane cells continue to grow, which leads to an excessive increase in the endometrium, this indicates the presence of a certain pathology caused by the hormonal changes in the body during menopause. This disease is called endometrial hyperplasia, it requires mandatory treatment. It is possible to reveal this condition only on ultrasound, since for a long time hyperplasia during menopause may not manifest itself at all, and even with serious growth it can result in heavy bleeding with severe pains in the lower abdomen.
Not only hormonal changes, but also other non-hormonal causes can cause endometrial hyperplasia during menopause:
- obesity, because fatty tissue can be a spontaneous source of estrogen,
- endocrine and hepatic dysfunction,
- neoplasm in the uterus,
- arterial hypertension,
- genetic predisposition
- gynecological diseases that the woman suffered during puberty,
- multiple abortions and uncontrolled estrogen hormone drugs
Excessive growth of the endometrium is very dangerous because it is a precancerous condition for the uterine lining. The main problem of early diagnosis is that the process starts during the onset of menopause, and the bright symptoms appear already with her arrival or even in postmenopause. Very often, women do not pay attention to pain during menstruation or even to bleeding in the middle of the cycle, because these are natural processes for the start of menopause. Suspicious woman can be suspicious when this symptom manifests after complete cessation of menstruation.
There are several types of endometrial hyperplasia:
- glandular. In this case, the glandular cells expand, and the connective tissue remains unchanged. This kind of growth of the endometrium is less susceptible to malignancy. With rapid detection is treatable,
- cystic Externally, the glands that have increased in volume, resemble blisters. Epithelial tissue is also modified. This species has a high risk of transformation into oncology,
- cystic glandular. The overgrown glandular cells form cysts filled with the secret of the glands in which the outflow is disturbed,
- focal.Mucosa does not grow evenly, but in certain areas that are sensitive to hormonal effects. As a result, polyps are prone to malignancy,
- atypical. In addition to the functional layer, a deep layer of mucous membrane is also subject to proliferation. This kind of endometrial hyperplasia most often turns into a malignant tumor. It is a rare, but difficult to treat variety, most often requiring the complete removal of the uterus.
During the period of menopause, a glandular-cystic form of endometrial hyperplasia is usually detected.
What diagnostic measures are used to determine thickness
If a woman who is in menopause suffers from bleeding and pain, then a number of interventions are required to make an accurate diagnosis. To determine the excessive growth of the endometrium in the postmenopausal, an integrated approach is required, including not only a gynecological examination and ultrasound, but also blood tests, smears and a number of invasive procedures.
The following measures will help determine the type of hyperplasia and make an accurate diagnosis:
- ultrasound is essential. It is performed transvaginally and allows you to estimate the thickness of the mucous. If it is not much more than 5 mm during menopause, the ultrasound scan should be repeated several more times over the course of 6 months. If it is already 8-10 mm, treatment or curettage is prescribed,
- diagnostic or therapeutic curettage. It is made under general anesthesia. At the same time, the uterus cavity is completely cleaned and after a certain time the bleeding stops. The cleaned material is sent for histological examination for the presence of atypical cells in it,
- biopsy provides useful information only with the full proliferation of the mucous layer of the uterus, with focal endometrial hyperplasia, this type of diagnosis is not used. Biopsy helps to determine the thickness of the mucous membrane, the presence of pathological processes and malignant cells in it. The procedure is carried out with a pipe (more here) in the form of a flexible thin tube with a piston, a suction microparticle of the mucous inside the uterus,
- x-ray of the genital organs. With the help of this study, it is possible to identify oncological formations and adhesions of the fallopian tubes. This is an invasive manipulation, which implies the introduction of contrast into the uterine cavity. During its holding a woman will feel some discomfort, but in no case pain.
Since almost all gynecological diseases during menopause are caused by hormonal changes in the body, treatment is carried out mainly with the help of hormonal medicines, in severe cases with the help of surgery.
In case of pathological growth of the endometrium, the following drugs may be prescribed:
- progestin drugs (Duphaston, Gestrinon). The treatment takes from 3 months to six months, then an ultrasound scan is done to control it. This group of drugs has no contraindications and can be administered to all women with expanding endometrium,
- the IUD only affects the mucous membrane and does not affect other organs, but the likelihood of bleeding during the first half of the year increases. The installation period of the spiral is 5 years,
- Gonadotropin-releasing hormone agonists are prescribed to women after 50 years. It is necessary to treat the patient with this method for no more than six months, since it enhances the manifestation of menopausal symptoms.
Surgical treatment of endometrial hyperplasia involves its complete curettage under general anesthesia, followed by sending the biomaterial for histological examination. After surgery, hormone maintenance therapy is prescribed using the medications listed above.
It is important not to let any changes in the endometrium take place, especially during menopause, since these pathologies have a very high risk of transformation into malignant tumors. To prevent this, you should periodically visit the gynecologist, eat right, treat infections in time and use the intrauterine device correctly.
What does endometrial thickness mean?
The endometrium of the uterus is a special inner lining that provides favorable conditions for the life of the fetus during childbearing years, and in menopause, if it grows excessively, it may pose a danger to the life of the woman.
Before the ultrasound examination appeared, such a term as “endometrial rate” had no practical and diagnostic value. And today there is hardly such a gynecologist, who will prescribe treatment or give any recommendations for the treatment of menopausal manifestations, without knowing what the thickness of the endometrium during menopause. Why is it so important to know?
The fact is that the lack of estrogen and progesterone in menopause, leads not only to atrophic changes in the mucous membranes of the urogenital area, but also to other adverse symptoms of menopause. Emotional instability, osteoporosis, development of atherosclerosis and other negative manifestations of menopause, in the opinion of practitioners, should be stopped with the help of hormone replacement therapy (HRT).
But the use of HRT is the risk of developing hypertrophy or endometrial cancer in menopause. Therefore, it is very important to know what thickness the endometrium should normally have during menopause. In this regard, ultrasound diagnostics is used for dynamic monitoring of HRT.
Signs of proliferation or thickening of the endometrium in menopause are considered pathology.
Changes in the endometrium depending on the phase of the menstrual cycle in the reproductive period
The rate of endometrium changes during the menstrual cycle:
- during menstruation and in the early proliferative phase this is a thin, bright hyperechoic strip,
- in the proliferative phase and on the eve of ovulation has a three-layer appearance,
- in the secretory phase, the inner layer becomes thick, swollen and has a uniform echogenicity.
The endometrial rate is significantly different in women of childbearing age, from that in patients in menopause. The normal range of endometrial values in menopause depends on its stage.
During this period, the menstrual cycle becomes irregular. The amount of estrogen is not enough to cause the growth of the endometrium during menopause (proliferation) at the same level. Consequently, the growth of the endometrium, as in childbearing age does not occur, but there is a tendency to reduce its thickness.
Endometrial rate in premenopause:
- during menstruation - 2-4 mm
- early proliferative phase (6-14 days) - 5-7 mm,
- before ovulation - up to 11mm,
- secretory phase of the endometrium is the thickest and reaches 7-16 mm.
Since the hormonal levels of all women are different, then the rate of the endometrium during menopause may differ. Therefore, to identify the pathological conditions of the endometrium, the assessment of its condition should be carried out over a period of 3 months.
Endometrium ceases to undergo cyclic hormonal changes at the onset of menopause and undergoes atrophy.
Normal endometrial thickness in menopause on ultrasound looks like a thin hyperechoic (bright white) strip 5 mm thick.
In the period of menopause, there are certain boundaries of the thickness of the endometrium, the excess of which is the pathology of the endometrium in menopause:
- an endometrium of more than 5 mm indicates a pathological process, the cause of which is probably endometrial hyperplasia,
- moreover, with a thickness of the endometrium of 6-7 mm, dynamic observation is allowed,
- and with an increase in the endometrium with menopause more than 8 mm, diagnostic curettage of the uterus cavity is required.
In patients taking HRT, the endometrium values will depend on the type of drugs prescribed. If estrogen monotherapy is used, the endometrial layer may be somewhat thicker than when using combined estrogen-progestin drugs.
If the width of the endometrium exceeds 8mm, then bleeding occurs from the genital tract, indicating a serious pathology. In the absence of due attention and timely treatment, this condition may acquire a malignant course.
The thickness of the endometrium in postmenopausal should be less than 5 mm.
Randomized clinical studies have shown that if the endometrium is more than 5 mm, the risk of developing carcinoma (malignant disease of the endometrium) is 7%, and if the inner layer of the uterus is less than 5 mm, then the carcinoma develops only in 0.07% of cases.
When using hormone replacement therapy, the rate of the upper limit is 5 mm!
With prolonged menopause, linear inclusions of increased echo density are allowed in the structure of the median M-echo. This is how synechia (fusion between the anterior and posterior wall of the uterus cavity) are visualized.
Anechoic formations (black), indicating the accumulation of fluid in the uterine cavity, are allowed. Signs of pathology are not. Occur due to fusion of the cervical canal and the occurrence of obstacles to the outflow of the contents of the uterus.
A normal endometrium with an ultrasound examination, regardless of the stage of menopause, is visualized as a uniform smooth hyperechoic strip, with a well-defined area of myometrium of low echo density.
There are two more states of the endometrium in postmenopausal disease: its atrophy and an abnormally thickened inner layer.
Endometrial atrophy or thinning (less than 4 mm with ultrasound scanning) is the answer to the hypoestrogenic condition. 60-75% of postmenopausal bleeding cases are caused by this condition. Other causes of thin endometrium:
- long-term use of hormonal contraceptives,
- ovarian dysfunction,
- taking tamoxifen.
With an excessively thickened inner layer of the uterus, it is important to consider at what stage of the menopause the patient is (premenopausal or postmenopausal), as well as whether she can be potentially pregnant.
A “thick” endometrioid layer can occur in premenopausal women and be associated with pregnancy:
- early term, when there is still no visualization of the ovum in the uterus,
- with an ectopic pregnancy,
- with missed abortion
- recent pregnancy, a condition after a miscarriage.
An abnormally thickened endometrium may occur in postmenopausal women and may not be associated with pregnancy, but may be due to the following conditions:
- carcinomas (has a heterogeneous appearance),
- when using hormone replacement therapy.
As can be seen from the above, the measurement of the endometrium in menopause is a simple, cheap, non-invasive method of dynamic observation of women taking hormone replacement therapy. There is no doubt that the conduct of this measurement contributes to the identification of pathological states of the endometrium and identifies the risk group for the development of cancer of the uterus. Therefore, the rate of endometrial values has an undeniable diagnostic value.
Signs of the norm
The norm of the endometrium in the state of menopause is up to 10 mm in the cycle stage, when it is maximum. In this case, a sign that the layer is in a normal state, are only the results of several ultrasound examinations performed during half a year. If during this period 3-4 studies were conducted, and the results of all are satisfactory, then the layer sizes are normal, and there is no pathological process.
Also, there are no normal acyclic bleeding. And in postmenopause - and any other. Pains may be present, as they are sometimes characteristic of menopause. But they should not be too intense. Also, in the normal state of the tissues of the uterus, usually there are not too heavy periods.
The size of the endometrium is established by ultrasound examination of the pelvic organs using a transvaginal method. You can define it very accurately, because every millimeter matters. Deviation from the norm even by 1 mm may indicate hyperplasia.
This is a condition that precedes the last menstrual period and can last even several years. During this period, the thickness of the endometrium decreases. A condition known as physiological hypoplasia develops. It is the norm for women after the age of 45.
The thickness of the endometrium is quite variable. It periodically increases and decreases. But in general, there is a tendency to decrease. Usually, the indicator is in the range from 10 to 17 mm. During this period, it is recommended to do an ultrasound, as the endometrium in the menopause can grow, and this is already a pathological process.
In the menopause
The thickness of the endometrium in menopause normally does not exceed 5 mm. In this case, ultrasound is recommended to do several times to eliminate the likelihood of hyperplasia.
Interestingly, changes in the endometrium of the uterus during this period are so characteristic that doctors even give it the name "endometrial pathology in menopause."
This is a condition that lasts 10-15 years. It begins a year after the last menstruation. In the first five years, early postmenopause is diagnosed, then 10 years later. This period ends at the age of 65-69 years. After this age is reached, it is not customary for the patient to talk about postmenopause.
The ovaries at this stage no longer function. They do not produce hormones, respectively, the endometrial renewal stops completely. It becomes more or less constant thickness. Normally, if it does not exceed 4-5 mm.
What to do if you deviate from the norm?
If the dimensions of the endometrial layer are increased, its thickness does not correspond to the norm, then it is necessary to begin treatment. It is believed that hyperplasia, which began in the reproductive period, can pass by itself when menopause occurs. But if the condition was formed in menopause, then it most likely will not go away on its own.
The treatment is carried out in two ways - conservative and radical. With the conservative method, hormonal preparations are used, which lead to the fact that the process degrades, the overgrown tissues are destroyed, and the layer returns to normal.
When the radical method is surgical intervention. Usually, it consists in removing the uterus. Doctors rarely resort to it, and prescribe it only when other methods of treatment have not helped. Despite the fact that the woman in the climax does not need to save reproductive organs, the operation is very traumatic.
The development of endometrial hyperplasia
Many women, who have entered the threshold of climacteric changes, stop paying attention to their health. They betray special significance to all the ailments that manifest themselves during this period of time, writing off everything to changes in the hormonal background. But so treat yourself, of course, impossible. After all, with the onset of menopause in the female body, the level of the immune system of protection weakens. And it is at the greatest risk of developing serious pathologies: from neoplasms with a benign nature of the course, to a cancer. Therefore, regular examination in the gynecological office is so necessary: at least 2 times a year, during which the initial stages of the development of disorders can be detected.
The development of endometrial hyperplasia in menopause is the most common pathological change in the functional layer of the uterine lining.
Endometrial hyperplasia is characterized as a pathological proliferation of the functional layer of the mucous surfaces of the uterine cavity, contributing to the formation of uterine bleeding.
This endometrial pathology in menopause develops under the influence of the body's hormonal adjustment. Also contributing to the development of pathology are the following factors:
- the presence of excess weight
- pathological changes in the functionality of the liver,
- development of diabetes
- progressive stage of hypertensive disease,
- hereditary factor.
This pathology of the endometrium in postmenopausal disease is quite dangerous, as it can go into the stage of malignancy and transformation into a cancerous tumor. The development of atypical hyperplasia can result in the formation of cancer in 25% of cases. To prevent such complications, it is necessary to know the norms of the state of the reproductive system of the body in the fertile and menopausal period.
You also need to pay attention to the symptoms, to undergo tests and not to avoid modern developments of therapeutic treatment of menopause and its pathologies.
Norms of endometrium during menopause
All processes of changes in the endometrium during menopause and in the postmenopausal period must be carefully monitored to prevent serious complications and the development of oncology.
Ultrasound diagnostic methods are the most effective and reliable methods for determining the state of the uterine organ and the norm in the endometrium during menopause.
Normal M-ECHO uterus should not be more than 5 millimeters. With the value of this indicator in the range of 6 mm, a maximum of 7 mm - it becomes necessary to dynamically control the thickness of the endometrium in menopause with repeated ultrasound studies after 3 and 6 months. Although these figures are still allowed and 7 mm - this is in some cases the normal thickness.
Если толщина эндометрия в менопаузе превышает показатель 8 мм, то это говорит о развитии патологического процесса. In this situation, in order to make an accurate diagnosis, a specialist conducts diagnostic curettage of the uterine cavity.
In the case when the endometrium in menopause, that is, directly its thickness, greatly exceeds the rate of 12-13 mm, the mucous membrane is scraped separately and sent for histological examination of the obtained biological material from the uterine cavity.
It is important to remember that curettage techniques are necessary in case of violations of the endometrial thickness norms in order to study the structure of the material obtained, to make an accurate diagnosis and to initiate an appropriate treatment.
Varieties of pathology
Hyperplastic processes in the endometrium can have 4 different forms of flow, namely:
- Glandular cystic.
One of the most common forms of the hyperplastic process is ferrous pathology. It is accompanied by the proliferation of glandular tissues, but has a less dangerous form of flow, as it develops over a very long period of time. But do not forget that the development of glandular hyperplasia in the absence of appropriate treatment can develop into oncology.
A less common variant of hyperplastic processes are glandular cystic pathology. This is a rather dangerous form of hyperplasia, characterized by the formation of cystic lesions of the mucous membranes of the uterine cavity. In 5-6% of cases, they can also develop into a cancer of the endometrial layer.
Focal forms of hyperplastic processes are quite rare, but are among the most dangerous pathological disorders of the endometrium. With the development of this form, no therapeutic treatment is applied. In this case, there is a strict control over the development of polyps with a high propensity for malignancy.
Appearance atypical forms of hyperplasia are the most dangerous pathology that, when detected, is carried out biopsy research, which in more than 60% of cases confirms the presence of carcinomas.
This form of the disease requires immediate surgical treatment.
In cases where a woman, taking care of her health, undergoes regular routine examinations, there will be no problems with the timely detection of a pathological change in the uterine cavity. Since during the examination, special gynecological mirrors are used, allowing to clearly see the fibrous and glandular-cystic type of hyperplasia.
As mentioned above, in the endometrium there is a certain rate of its thickness, the excess of which speaks of pathology. The thickness of the endometrium is detected by the ultrasound diagnostic method.
But in addition to ultrasound in case of serious violations, methods of diagnosing the uterine cavity using radioactive phosphorus can be prescribed.
Based on the results obtained and after all diagnostic procedures, the specialist develops the most effective scheme for further treatment.
Basic concepts, functionality and thickness of the endometrium
One of the components of the uterus is the endometrium. This is a layer of mucous tissue located inside the body. Its structure contains many small blood vessels. It is also divided into two layers:
The first layer is constant, but the second is systematically subjected to changes that are caused by an imbalance of hormonal levels. Throughout the cycle, mucosal thickness varies on a smaller or larger side.
With a sufficient thickness in the woman's body, fertilization of the egg and implantation of the embryo occur. If this does not happen, menstruation occurs. When it rejects the functional layer, which at its end resumes and grows.
During the period of menopause due to hormonal adjustment of the body, the thickness of the endometrium is significantly reduced. The rapid thinning of the mucous leads to menopause. It is characterized by the absence of menstruation and the end of the reproductive function of the female body.
The functional purpose of the endometrium is to create favorable conditions for the implantation of the embryo. This explains the development of infertility, one of the main reasons for which are endometrial pathology.
Another important purpose is the barrier and protective functions. It prevents accretion and does not allow the walls to stick together among themselves.
In a uterus woman, the size of the uterus is much smaller, so the walls of the cavity are close to each other and in some areas are in contact. And only thanks to the mucous they do not stick together.
If during this period such changes of this uterine lining do not occur, endometrial hyperplasia develops. This pathology often becomes a provoking factor for various pathologies.
Endometrium is an integral part of the uterus. Female health and reproductive function depends on her healthy state. Any transformations of its thickness contribute to the development of physiological changes that lead to the appearance of menopause.
Endometrial thickness: normal with menopause, abnormalities
Endometrium has certain indicators regarding thickness in any stages of its physiological state. The climacteric period also determines a certain thickness of the mucous. But, in the event that these data are higher than the standard indicators, then the probability of developing certain pathologies is high.
During the cycle, the endometrium changes its thickness. Its maximum reading in the absence of pathology is 18 mm. This thickness is formed near the end of the menstrual cycle. As a rule, this occurs by the end of 23 days. On the eve of menstruation, the layer becomes thinner.
During menopause, thin endometrium, up to 6 mm thick, is considered the norm. If its size is less than 5 millimeters, this leads to the development of a climatic period.
Such indicators are the relative norm of the healthy state of the uterine lining. They may deviate by a few millimeters. It depends on the individual physiological characteristics of the organism. The size of the hormonal and reproductive systems also affects the size of the endometrium.
Pathological changes in the uterine mucosa during the climatic period occur most often as a result of a critical change in hormonal levels. But, the following factors can also affect the growth of a layer:
- Excess weight
- Endocrine diseases
- Metabolic dysfunction
- Diabetes mellitus of any type
- Somatic diseases
- Uterine myoma
- Changes in the mucous membrane of the uterus with age
- Multiple uterine injuries
- Genetic predisposition
- Immune system disorders
With an excessive growth of the endometrium of the uterus, the growth of its cells begins to rapidly increase. Depending on the type of tissue that grows and the main site of localization of the disease in medical practice, adenomatosis of the endometrium is determined during menopause of a diverse nature.
With this pathology, breakthrough bleeding, severe pain in the abdominal cavity can often occur. There is also a high likelihood of this disease being asymptomatic.
Against the background of the development of hyperplasia, the development of oncological pathologies is often observed. This is due to the fact that in this state there is a high probability of the transformation of healthy cells of the uterine mucous membrane into malignant ones.
During the climatic period, frequent and abrupt changes in hormone levels occur in the female body. They, in turn, strongly affect women's health.
Therefore, it is necessary at the climatic age to undergo systematic medical examination with hardware inspection. It allows you to accurately diagnose the slightest deviations in the thickness of the endometrium and promptly start therapy.
Ways to diagnose endometrial thickness deviations
In the presence of the slightest deviations in the state of health in the period of menopause, women should immediately visit doctors. Especially it is worth paying attention to the presence of bleeding in menopause.
Doctors, in turn, before diagnosing uterine hyperplasia must send her patient for a comprehensive examination. Mandatory types of diagnostics are:
- Gynecological examination on the chair.
- Delivery of laboratory blood tests and smear.
- Ultrasound examination of the pelvic organs.
- Some invasive procedures prescribed by a doctor.
Ultrasound of the uterus during menopause is one of the most effective methods for examining the state of the uterine mucosa. To determine the thickness of the endometrium assigned transvaginal ultrasound. It is carried out using a special nozzle, which is inserted into the vagina.
If there is evidence above 5 millimeters during menopause, such a study is recommended to be repeated a couple of times in 6 months. If its thickness is diagnosed to more than 8 millimeters, the doctor immediately prescribes a therapeutic complex or curettage.
Gynecological cleaning of the uterus. It has therapeutic and diagnostic purpose. It is carried out exclusively under general anesthesia. At this time, an extra epithelium is scraped out of the uterine cavity, which leads to the suspension of bleeding. A prerequisite for this manipulation is the dispatch of the material after curettage to histology to determine the presence of cancer cells.
Aspiration biopsy. The information content of this manipulation is observed only with the growth of the endometrium over the entire surface of the organ. With the help of a biopsy, the thickness of the endometrium, the pathological processes in it and cancer are determined.
Manipulation is carried out using a pipe that visually resembles a special flexible pipe at the end of which is a piston. Through it, endometrial microparticles are absorbed from the uterus.
Examination of the uterus and fallopian tubes on the x-ray machine. This manipulation is effective for detecting tumors, polyps not only in the uterus, but also in the commissure of the fallopian tubes.
Before this manipulation, a contrast agent is injected into the uterus. This procedure causes discomfort, but should in no case be painful.
Timely and accurate diagnosis is the key to successful therapy. Therefore, doctors recommend not only for the manifestation of characteristic symptoms to be examined by a doctor. The best type of prevention is to conduct a systematic study of the pelvic organs.
The main methods of treatment of adenomyosis in menopause
The definition of therapy for endometrial hyperplasia formed during menopause is based on its type and the extent and duration of the disease. In medical practice, there are two main methods of treating this pathology:
Sometimes, as an adjuvant therapy in the initial stages of the development of the disease, traditional medicine can be used. Their choice should be agreed with the doctor and in no case should they be the primary means.
Drug treatment of adenomyosis during menopause is possible only in the absence of tumors in the uterus of any etiology. First of all, its main functional purpose is the effect of hormonal agents on reducing the effect of estrogen on the endometrium.
For this are assigned:
- Hydroxyprogesterone Caproate
Mandatory components of the therapeutic course of hyperplasia in menopause are the following medications:
- To restore the functionality of the liver: Ursosan or Phosphogliv.
- To prevent blood clotting: Heparin, Hepatrombin.
- The duration of the course is from three to six months, depending on the stage of the disease. But it should be systematically monitor the condition of the endometrium, conducting ultrasound.
There are cases when medication is carried out on the eve of surgery. Its main functional purpose is to reduce the foci of pathology.
The operative resolution of endometrial hyperplasia during menopause is prescribed for frequent recurrences of the pathology or a high probability of developing oncology. If atypical cells were detected during the diagnosis, then surgical treatment is indispensable.
Surgical manipulations used in the treatment of hyperplasia of the uterine mucosa:
- Curettage This manipulation is based on curettage of the uterus mucosa.
- Laser ablation Held with focal spread. Despite its sparing effect on the body, this manipulation is quite effective. Under the influence of a laser, areas of adenomyosis are destroyed and, over time, are independently eliminated from the body.
- Cryodestruction This manipulation is similar to cauterization, only for its use low temperature is used. Under its influence, pathological areas die and also come out over time.
- Hysterectomy. A cardinal method that is used in extreme cases in the acute form of atypical hyperplasia, when the organ is already affected by cancer cells. In menopause, oncology can affect not only the uterus, but all its appendages. Therefore, partial, but in most cases, complete removal of the uterus is often carried out.
Prescribe a therapeutic course should only endocrinologist-gynecologist according to the results of laboratory and hardware research. It is worth remembering that self-medication contributes to the development of a neglected form of hyperplasia. And this, in turn, contributes to the formation of oncological pathologies, the frequent outcome of which is the death of the patient.
While watching the video you will learn about the climax in women.
Every woman should be attentive to their health. It is especially important to monitor the condition of the endometrium of the uterus during menopause. During this period, serious hormonal changes occur in the body, which significantly affect the thickness of the uterine mucosa.
Endometrium - what is it?
The inner walls of the uterus are covered with a membrane consisting of epithelial cells. This shell is called endometrium. This epithelial layer is extremely dependent on hormonal changes in the body. Its main functions are to maintain the embryo developing in the womb, protect the uterus from the effects of negative factors, prevent adhesion of the uterine walls.
The endometrial layer is thickly strewn with capillaries and receptors that induce mucosal tissues to cyclically change under the influence of hormones produced in the ovaries. In the middle part of the menstrual cycle, the concentration of estrogen-sensitive receptors increases to a maximum value, and in part 2 of the cycle, the concentration of receptors responding to the action of progesterones increases.
Endometrial thickening occurs throughout the entire cycle. At the end of the cycle, the mucous layer may become 10 times thicker than at the beginning of the cycle.
If during ovulation fertilization of the egg does not happen, the uterus, shrinking, gets rid of the functional layer of the mucous membrane. The result of the rejection of the endometrium are monthly. With the beginning of the new menstrual cycle, the functional shell begins to grow again.
On the stage of menopause, you can talk when menstrual periods are absent for more than a year. During this period, the endometrium is not subjected to cyclic transformations, as a result, it is rapidly compressed, thinned and atrophied. The thickness of the endometrium during menopause ceases to fluctuate, acquires a constant value, which should not exceed 5 mm. If the functional membrane during menopause is thicker than 6 mm, this means the development of endometrial hyperplasia.
How does the endometrium change during menopause?
Endometrium is a constantly renewed tissue. In different parts of the cycle, the thickness of the endometrium changes under the influence of certain hormonal transformations.
But during the period of menopause, due to significant hormonal disruptions, the cyclical nature of the renewal and growth of the functional membrane is disturbed. This leads first to a violation of cyclicity, and then to the complete disappearance of the menstrual flow.
Endometrium in menopause goes through several stages of change, linked to the stages of inhibition of reproductive ability.
- Premenopause. During this period, an anovulatory cycle is established, which is characterized by the absence of ovulation and the phase of formation of the yellow body. A transitional form of the endometrium is formed in premenopause, characterized by a slight proliferation of mucous tissue. If the tissue grows slowly and not very quickly, then you do not need to worry. Sometimes cysts appear during this period.
- Menopause. This is the stage of life, at which the last periods go. Before the menstrual flow, the endometrium becomes slightly thicker, but after the last menstrual period the layer becomes thinner. Next comes the development of functional hypoplasia.
- Postmenopause. At this stage, the first 3 - 5 years, the transitional form of the endometrium, formed in the premenopause. Over the years, non-pathological atrophy of the layer is formed, at which mucous tissues cease to function.
All of the above changes of the endometrium are natural, not associated with pathologies.But visiting a doctor for menopause is still needed to prevent the development of serious pathologies of the uterus and appendages.
Forms of endometrial hyperplasia
Endometrial hyperplasia is divided into several forms, due to exactly which cells of the layer pathologically grow.
- Glandular hyperplasia. Benign pathology in which glandular cells grow and abnormally located. In this form of the disease, the basal and functional layers are not demarcated, but the secretory ability of the glands is normal. The glandular pathology is able to turn into a glandular cystic - a severe form, characterized by the formation of cysts in the glandular layer. Glandular cystic form is precancerous.
- Basal hyperplasia. Rarely diagnosed pathology option. With this form of development of hyperplasia, the growth of basal tissue (located on the myometrium) layer is noted.
- Polypous hyperplasia. Also called focal. With this form of pathology, endometrial tissue grows unevenly, which causes the formation of polyps - benign growths on a thin stalk. These tumors are of different sizes. One large polyp can form, and several small tumors can grow. It should be borne in mind that polypoid pathology is also precancerous.
- Atypical hyperplasia. This form of the disease is characterized by intense and non-uniform pathological changes in the functional layer, often accompanied by tissue degeneration. 10% of patients with this form of hyperplasia develop oncology.
By the method of localization secrete diffuse and focal hyperplasia.
- Diffuse. In this form, a uniform growth of the mucous membrane occurs. Endometrium of the uterus undergoes diffuse transformations.
- Focal. The growth of tissue in different parts of the mucous uneven. The heterogeneity of the endometrium in the diffuse and focal form is clearly visible on the monitor of the ultrasound machine.
An increase in endometrial tissue is a dangerous phenomenon that threatens to turn into oncology. The difficulty of diagnosing abnormalities in the thickness of the endometrium lies in the fact that the symptoms of the pathology at the stage of menopause are weak, the expressed symptoms can be observed only during the postmenopausal period. Many women ignore bleeding and pain at different stages of the menstrual cycle, suggesting that these are just manifestations of the onset of the menopausal period. Women begin to sound the alarm only when the suspicious symptoms do not go away with the disappearance of menstruation and the onset of postmenopausal women.
Treatment of endometrial hyperplasia
Since gynecological diseases during menopause are mainly due to hormonal changes, the treatment of hyperplasia and other uterine pathologies is carried out by means of hormonal drugs. In advanced situations, surgery is prescribed.
Pathological process that occurs with the mucous membranes of the uterus at the stage of menopause, is eliminated with the help of the following medicines.
- Progestin. Drugs based on female steroid sex hormones (Duphaston, Didrogesteron, Gestrinon). The course of therapy lasts from 3 to 6 months, after which the control ultrasound monitoring is done. These medicines are shown to all patients in whom the endometrium grows in menopause.
- Gonadotropin-releasing hormone agonists (Zoladex, Sinarel, Diferelin, Buserelin). Appointed to patients over 50 years. Used to treat hyperplasia, endometriosis, fibroids, infertility. To be treated with these drugs should be no longer than six months, since their active components cause a deterioration in women's health, increase menopausal symptoms.
- Intrauterine devices. They affect only the uterine mucosa, do not touch other tissues and organs of the reproductive system. In the first 6 months of wearing a spiral, the risk of uterine bleeding is high. Wearing the device should be 5 years.
Surgical intervention involves scraping the entire overgrown layer, sending biological material to study in the histological laboratory. After surgery, the patient is prescribed hormone maintenance drugs.
Traditional medicine for endometrial hyperplasia
For the purpose of optimal therapy, the doctor looks at the values obtained during diagnostic procedures and laboratory tests of indicators, the rate of endometrial thickness in each patient is individual, as are the signs of pathology. Therefore, to set yourself the diagnosis and do not self-medicate. Only a medical specialist knows everything in common about menopause, what natural and pathological changes occur in the uterus, when menstruation is completed, how hot flashes and other signs of menopause occur, therefore, it can prescribe effective and safe therapy.
Use of folk remedies as a primary therapeutic measure is useless. Recipes of traditional medicine can be used only as an additional tool in the framework of the main treatment recommended by the doctor. To be treated with infusions and decoctions of medicinal plants should be only after the permission of a medical specialist.
It is important to regularly find out how the thickness of the endometrium changes in menopause, the rate of the mucous membrane of the uterus should not be significantly exceeded. High probability of rebirth of a thickened layer into a malignant neoplasm. To avoid such a problem, one should eat well, promptly cure infectious gynecological diseases, wear a spiral correctly, and not ignore routine examinations by a gynecologist.
Changes occur with age
Endometrium with menopause can be different, it all depends on the individual characteristics of the woman. Every woman has menopause at different times. Normally, menopause begins at the age of 47 to 53 years. With the onset of this period, the production of hormones is reduced, which affects the reproductive female organs. Changes in the mucous layer can be atrophic - it all depends on the intensity of changes in the hormonal background.
Atrophy of the endometrium occurs due to changes in its structure, reducing the number of glands. During ultrasound, the endometrium does not exceed 5 mm, if an increase in thickness is observed - a sign of the development of pathologies.
During menopause, a woman may experience dishormonal bleeding, which is characterized by intensity. With a high degree of intensity, it is necessary to cure with further therapy.
What is the size of the endometrium is normal during menopause
The thickness of the endometrium in menopause is determined by ultrasound. In premenopausal mucosal changes occur on all days of the cycle. The normal state is the thickness of five millimeters - 5 mm. If during the menopausal period the ultrasound showed a thickening of the endometrium, the woman will need regular supervision by a specialist to timely diagnose possible pathologies.
However, it should be borne in mind that an increase in the thickness of the endometrium by 2 mm is not always critical. Changes in the hormonal background of each woman are individual, so the thickness of the endometrium may be different. In case of serious changes in thickness, additional research methods are conducted that help to establish an accurate diagnosis and prescribe adequate timely therapy.
Thickness determination - diagnostic methods
If a woman is faced with bleeding, pain during menopause, she needs to immediately contact a gynecologist for a complete diagnosis. Determination of endometrial thickness in postmenopause and premenopause is carried out in the following ways:
- Ultrasound examination is the main procedure for the diagnosis of hyperplasia. For transvaginal ultrasound requires the use of a special nozzle. The procedure helps to determine the exact thickness of the endometrium.
- Diagnostic curettage - is both therapeutic and diagnostic method. The procedure is performed under general anesthesia, since it is necessary to cure the entire uterus, which helps to stop the bleeding. The tissues obtained during the procedure are sent to histology to identify cancer cells.
- Biopsy. An effective diagnostic method, especially when the lesions are local, not focal.
- X-ray of the uterus, fallopian tubes. One of the best procedures to help identify tumors, polyps, adhesions. Before the procedure, the uterus cavity is filled with a contrasting substance. During the procedure, the woman may feel mild discomfort.
How to treat
Depending on the climacteric periods, various symptoms of pathologies can occur. Experts do not recommend to self-treat the manifestation of pathological conditions using popular recipes, as they may contribute to the worsening of the problem. Hormone therapy is the first stage of treating a disease; if it does not help, surgical intervention is necessary.
To determine the method of treatment the doctor must conduct a thorough examination of the patient. Because the cause of menopause are hormonal changes - hormone therapy can show quite good results.
In the case of elevated estrogen and low progesterone, endometrial thickening is observed. Most often, this pathology is diagnosed in women suffering from diabetes, overweight. Effective treatment takes place with the help of hormonal contraceptives (such as Logest, Regulon, Duphaston, Utrogestan). They need to take a course of at least six months.
Such drugs are similar to progesterone, with a shortage of which there is an increase in the endometrium. These drugs are considered safe and are prescribed even during pregnancy. It is important to remember - only a doctor can prescribe hormones, given the individual characteristics of the woman.
Surgical treatment is an extreme method. To begin with, curettage is performed, if the procedure is not effective, laparoscopy is carried out (the foci of endometrial spread are burned with the help of a laser). If the therapy does not produce results, and the risk of developing malignant cells is quite high, then uterus removal is required. Depending on the severity of the disease, there are several types of operations - removal of the uterus, or its cervix with the nearest lymph nodes.
For the appointment of adequate therapy, timely diagnosis and prevention of pathology, a woman must adhere to the following rules:
- undergo regular check-ups of a gynecologist,
- observe proper nutrition,
- to live an active lifestyle,
- promptly seek help with STDs,
- refuse abortions
- do not use for a long time intrauterine devices.
Serious changes in the thickness of endometriosis during menopause may indicate the development of pathological conditions. Experts do not recommend to ignore the symptoms and self-medicate, as this can significantly aggravate the problem. When the first signs of pathological conditions appear, it is necessary to consult a specialist for timely diagnosis and prescribing adequate therapy methods.