If you’re trying to conceive or going down the usually difficult road of the fertilisation journey, I am sure you have heard of the importance of uterine lining thickness, but what does endometrial thickness mean, and why is everyone talking about it?
Just getting started with the conception journey, or somewhere midway through several IVF cycles, this knowledge could very well tip the scales for you.
So, let’s take a look at what this silent but influential factor is all about, hidden from our view, perhaps, but admired for its energy behind pregnancy.
What is the Endometrium?
The endometrium is the uterus’ inner lining that serves as the support for every woman’s reproductive health. In a woman’s life, the ovary peaks every month in ovulation when the endometrium thickens in preparation for embryo implantation. The endometrium is shed during periods if fertilisation does not take place. Interfering with the normal development of the endometrium results in endometriosis, hyperplasia, or endometrial cancer.
Normal endometrial thickness varies between 1-18 millimeters, depending on the specific phase of the menstrual cycle. It is measured in the context of fertility and uterine health.
Normal Endometrial Thickness Throughout the Menstrual Cycle
Normal Endometrial Thickness
- Menstrual Phase (Days 1–5): The endometrial lining sheds during menstruation. Thickness ranges from 1–4 mm.
- Proliferative Phase (Days 6–14): Estrogen builds the endometrium back. The thickness increases from 5 to 7 mm, and may even reach 11 mm before ovulation.
- Ovulatory Phase (Around Day 14): The endometrium stands at its strongest for implantation during ovulation, measuring 8–13 mm. A triple-line (trilaminar) pattern is usually detected with the ultrasound at this time a sign of perfect fertility.
- Secretory Phase (Days 15–28): Under the effect of progesterone, the endometrium becomes more glandular and supports the fertilised egg. It maintains a thickness of 9–14 mm.
Normal Endometrial Thickness for Pregnancy
For implantation and early pregnancy, one is supposed to have an endometrial thickness ideally measuring from 8 to 14 mm during ovulation or early luteal phases. Less than 6 mm is generally considered inadequate for implantation, whereas over 15 mm may indicate abnormality, warts, or hyperplasia.
Factors Affecting Endometrial Thickness
Several factors can affect endometrial development:
- Hormonal imbalance: Deficient estrogen or progesterone.
- Age: In older women, the lining is thin, especially.
- PCOS: Hormonal imbalance is reflected in the thickness.
- Medications: Fertility drugs, such as Clomid, can affect lining development.
- Uterine conditions: Fibroids, scarring (Asherman’s syndrome), and infection.
- Lifestyle: Poor nutrition, low body fat, or stress adversely affect endometrial growth.
Assessing Endometrial Thickness
Endometrial thickness is best measured by transvaginal ultrasound (TVUS). This method provides a lucid and direct image of the uterus and lining.
They may be performed in different phases of the cycle depending on the goal (fertility evaluation versus abnormal bleeding assessment). Fertility clinics typically measure the thickness just before ovulation for the best results.
How to Diagnose Endometrial Thickness in Pregnancy
Early in pregnancy, the endometrium changes into decidua, supporting the growing embryo. Suspected pregnancies may be diagnosed by transvaginal sonography to look for a gestational sac, yolk sac, and fetal heartbeat. More exact measurements of endometrial thickness lose significance once pregnancy is confirmed. Hence, a thickened endometrium (usually >15 mm) is a frequent early sign.
Implications of Abnormal Endometrial Thickness
Abnormalities in the thickness of the endometrium are indicative of various reproductive or medical problems:
- Thin Endometrium (<7 mm): Poor implantation and increased rates of miscarriage are the most common associations. Problems ensue from hormonal deficiency, scarring, or over-medication with fertility drugs.
- Thick Endometrium (>15 mm): Abnormality suggesting endometrial hyperplasia, polyps, or early pregnancy. In postmenopausal women, thickening is a cause for cancer concern.
Symptoms & Causes of High Endometrial Thickness
Symptoms
- Heavy menstrual bleeding
- Irregular periods
- Pelvic pain
- Spotting between cycles
Common Causes
- Unopposed estrogen therapy
- Obesity
- Polycystic ovary syndrome (PCOS)
- Hormone-producing ovarian tumours
- Endometrial hyperplasia or polyps
- High thickness persisting will probably require biopsy for exclusion of malignancy.
Enhancing Endometrial Thickness for Improved Fertility
The process of enhancing the endometrial thickness for fertility is paramount in treatment for implantation. These methods include:
- Estrogen Therapy: Given either orally or through the skin.
- Vasodilators (such as Viagra): Increase blood flow to the uterus.
- L-arginine and Vitamin E: Help to increase blood circulation in the uterus and promote cell growth.
- Low-dose aspirin: Increases receptivity of the endometrium.
- Acupuncture: Evidence shows better blood circulation and regulatory effects on hormones.
- General lifestyle-enhancing programs: Fast track with nutritious foods, decrease stress, and maintain an appropriate BMI, which will help in endometrial favorability.
Treatment for Abnormal Endometrium
Treatments will vary depending on the causes and fertility issues:
- Hormonal treatment: Balances estrogen and progestin to get through the cycle and normal lining growth.
- Surgical techniques: Polyps or fibroids removal through hysteroscopy.
- Antibiotics: Where infections or inflammation exist (e.g., Endometritis).
- Endometrium scratch or platelet-rich plasma (PRP): New approaches applied in fertility hospital to promote better endometrial response.
Treatment will be most planned and followed by a fertility specialist or gynaecologist.
Conclusion
The endometrium is one of the factors determining pregnancy carries to term. Understanding the normal range of endometrial thickness and its changes during the menstrual cycle is imperative, especially in women attempting to conceive. Timely monitoring for any abnormality, followed by early diagnosis and treatment, can considerably boost the chances of attaining pregnancy. Hence, if you are planning a pregnancy or working through infertility treatment, taking your endometrium on board will certainly be helpful toward achieving success.
FAQs
About 8–14 mm during ovulation is considered good for implantation.
Thin lining less than 7 mm may lead to poor implantation chances, and there are risks of miscarriage.
It is measured by using a vaginal ultrasound, either mid-cycle or in early pregnancy.
