GYNECOLOGY Article · 26 March 2022

Endometrium – very important millimeters in womans life

The name endometrium raises the worst fears among some women. Especially in those who associate the word with endometriosis – a serious disease, causing infertility.  The association is correct, but stay calm – the endometrium is not endometriosis and having it is completely normal.


The name endometrium raises the worst fears among some women. Especially in those who associate the word with endometriosis – a serious disease, causing infertility.  The association is correct, but stay calm- the endometrium is not endometriosis and having it is completely normal.


Endometrium, what is it?


The endometrium is a mucous membrane that occurs in the uterus. Every woman has it – from a little girl to a postmenopausal lady. However, its thickness varies. In girls who have not yet entered puberty, the endometrium is 0.3 to 0.5 mm thick. Postmenopausal women should have an endometrium with a thickness of about 5 mm, while those who use hormone replacement therapy – no more than 8 mm.


It looks different in women during the childbearing period. In their case, the thickness of the endometrium varies – in the first phase of the cycle it reaches 8-9 mm, and after ovulation it is thicker. This is because the endometrium consists of two layers – basal and functional. The functional layer is preparing to accept the fertilized egg, which is why in the second part of the cycle, under the influence of estrogens and gestagens, the thickness of the functional layer increases. When fertilization does not occur, it exfoliates during menstruation, and then is reborn again.


Although it is normal for the endometrium to grow in the second phase of the cycle, its thickness should not exceed 15 mm, and for postmenopausal women – 12 mm. If this happens, consult a doctor and extend diagnostics to rule out endometrial cancer. Although the endometrium in the phase of greatest growth is no more than a dozen millimeters thick, it can be associated with many diseases.




It consists in the fact that the endometrium extends beyond the uterine cavity and can be found within the ovaries, fallopian tubes or on the surface of the peritoneal cavity – these are the most common places for endometriosis. It also happens that endometrial cells can be found in completely unexpected places, e.g. in the intestines or in the lungs. The symptom of the first may be the appearance of blood in the feces during menstruation, the symptom of the second is blood spitting. The occurrence of endometriosis in the scar after Caesarean section is increasing. In most cases, it is a painful disease, significantly reducing the comfort of life for many women. But it also has much more serious consequences – endometrial cysts and adhesions are formed at an advanced stage, leading, among others, to to obstruction of the fallopian tubes, which is one of the common causes of infertility. Treatment is difficult because all pharmacological drugs act on an ad hoc basis and only eliminate the symptoms. The most effective treatment here is a plasma knife.


Women with endometriosis most often visit the doctors because of heavy and painful periods, diarrhea, nausea, vomiting and painful intercourses. These ailments usually appear with the onset of menstruation, but can also occur throughout the entire cycle.




How does modern medicine cope with endometriosis?


Treatment of endometriosis is not easy. Pharmaceuticals available on the market have a short-term effect and only mask the symptoms that accompany the disease. Sooner or later, when endometriosis is already advanced, you need to resort to surgery. Laparoscopy becomes the basic tool. Minimizing the risk of damage to surrounding tissues and lowering the ovarian reserve is possible when laparoscopy uses such an innovative tool as a plasma knife.


This is a new, innovative surgical tool, and a plasma knife is very effective for endometriosis surgery. Plasma is ionized matter, similar to gas, but with the ability to conduct electricity. It generates an electromagnetic field and reacts with other similar fields. By using the phenomenon of good high-frequency current conduction through ionized argon, it reduces the risk of damage to surrounding tissues, allowing surgeons more aggressive interference and the retractable blade, reinforced with plasma, allows for much more precise cutting. Plasma surgery gives the opportunity to precisely remove the focus of endometriosis, without damaging the ovarian reserve. Treatments using plasma are much shorter than others, because precise application significantly reduces the time spent on the procedure. More importantly – they also give much better results. Recently, they can also be used at the Center for the Treatment of Endometriosis and Uterine Myomas Gyncentrum.


Endometriosis reduces the quality of oocytes


In the oocytes of patients with advanced endometriosis, i.e. in stage III or IV, some morphological changes are observed. They have, among others thinner casing and are equipped with a smaller number of mitochondria. These are the structures responsible for providing energy to the cell. Endometriosis also disrupts the hormonal balance in the woman’s body. A lower concentration of such hormones as AMH, FSH, LH or estradiol can be observed. However, the question arises whether these types of abnormalities may prevent fertilization and later implantation of the embryo in the uterus? For now, there is no clear evidence. However, many specialists think so.


Do you have endometriosis? Do not postpone the IVF treatment


Endometriosis is a disease that not only reduces the quality of life of woman’s life, but also negatively affects her fertility. This does not mean, however, that ladies affected by this disease have no chance to make their dream of having a child come true. The IVF helps them!


Endometriosis is a disease that is progressing. From year to year, the quality of woman’s oocytes struggling with this disease decreases. For this reason, the decision to undergo the treatment should not be put off indefinitely. Even before the entire procedure begins, the embryologist inspects the oocyte collected during puncture, carefully assessing their structure. The best quality cells are always selected for the IVF procedure.


With advanced endometriosis, the entire treatment process should be selected individually for the patient. The doctor may decide to change the treatment method (modification of the stimulation protocol), enable the woman to take additional medications or order specific tests.


To sum up, the oocytes of women with advanced endometriosis are often of lower quality, which may have an adverse effect on the course of the IVF treatment. Nevertheless, women with advanced endometriosis become pregnant and fulfill their dream of motherhood.


Endometrial hyperplasia


As a result of the imbalance between estrogens and progesterone, the endometrium may be too stimulated and the glandular cells may grow and multiply excessively. Especially in obese women who use estrogen-containing drugs. Endometrial thickening is not in itself a disease but it can lead to cancer. Therefore, diagnostics are necessary. A biopsy should be performed and the mucosal fragment obtained should be examined in laboratory conditions. If it turns out that despite thickening, there is no atypia of the endometrium and the cells have a normal structure, the risk of cancer is small. In this case, hormonal treatment is sufficient, and sometimes the changes may disappear even spontaneously.


Atypical hypertrophy is a much more serious condition, because it is associated with the risk of transformation into endometrial cancer. Usually diagnosing this type of hyperplasia is an indication for preventive removal of the uterus. Sometimes, however, the disease affects women who are about to give birth. Then hormonal treatment is used but the woman should be under constant medical supervision.


Endometrial cancer


It is, after cervical cancer, the second most common malignant tumor affecting the female reproductive system. Women between 50 and 70 years of age are particularly vulnerable, especially if they are obese, have diabetes and have never given birth. The cause of endometrial cancer is increased estrogen activity and their level is increased by excessive fat. In a woman with menstrual periods, the endometrium is controlled by two hormones – estrogen, which leads to an increase in endometrium and progesterone, which stabilizes it. A woman with excess body fat also has elevated levels of estrogen, because body fat converts steroid hormones into a type of estrogen. After menopause, the proportions between hormones get even more disturbed.


The alarm signal should be abnormal uterine bleeding. As with any cancer, success in therapy depends on early diagnosis.


Endometrial atrophy


Unlike women suffering from endometrial hyperplasia, in patients with atrophy, endometrial cells disappear and the mucosa becomes too thin. And here the main role is played by estrogens, but in this case they are active enough. Atrophy is often found in postmenopausal women. But women of childbearing age also suffer from it, which causes infertility, because a fertilized egg can’t implant in the atrophic endometrium. The condition may be the result of taking drugs that inhibit estrogen, but it may also be a hormonal disorder. Therefore, it is necessary to consult a doctor who, after conducting detailed tests, will determine exactly what causes the disorder and will take further appropriate action.




Endometritis is manifested by spotting, bleeding and lower abdominal pain. Sometimes it is accompanied by elevated body temperature. In most cases, it is the result of postpartum complications, curettage of the uterus or other gynecological procedures. Most often it occurs as a result of the transfer of bacteria from the vagina to the uterus. Untreated endometritis can turn into inflammation of the ovaries and fallopian tubes. Its effect can also be adhesions that cause obstruction of the fallopian tubes, and as a result – infertility. Therefore, endometrial inflammation should be prevented. First of all, after each surgery or delivery, you should not forget about follow-up visits. You should also seek medical advice for lower abdominal pain, spotting and unusual bleeding. Acute endometritis is usually easily diagnosed by a gynecologist. It is more difficult to diagnose chronic inflammation, where it is necessary to conduct a histopathological examination of scrapings from the uterine cavity.


Endometrial polyps


These are small fragments of hypertrophied mucosa, usually having a peduncle shape, i.e. a small bump on the leg. The reason for their formation is not exactly known. They probably arise as a result of hormonal disorders. Polyps often make it difficult to get pregnant and those who succeed in it are the cause of miscarriages. They can be detected only during transvaginal ultrasound. Treatment of small endometrial polyps begins with several months of hormonal therapy. The next stage of the procedure is invasive diagnostics (uterine cavity or hysteroscopy, which allows you to additionally examine the uterus) Although polyps are benign and rarely develop into cancer, this risk exists. Therefore, all polyps after their removal are subjected to microscopic examination. If they contain cancer cells, a hysterectomy is necessary.