The endometrium is the lining of the uterus. Every month, this lining builds and thickens in preparation for a potential pregnancy, providing the ideal environment for the implantation of a fertilized egg. If pregnancy does not occur, the endometrium is shed during the woman's monthly period. The term proliferative endometrium refers to the state of the endometrial layer while it grows.
A proliferative endometrium is a normal part of healthy uterine function when it occurs during the first half of the menstrual cycle. The endometrium becomes thicker leading up to ovulation to provide a suitable environment for a fertilized egg to grow inside the uterus. A proliferative endometrium in itself is not worrisome. However, sometimes problems can develop during the proliferative phase of endometrial growth.
Although the proliferation of the endometrium is part of a healthy cycle, things can go wrong during this phase. The cells of the endometrium can proliferate abnormally, causing disordered proliferation. In some cases, the endometrium thickens too much, leading to excessive endometrial tissue in the uterus. In other cases, the endometrial cells do not proliferate enough, causing problems with fertility as the lining of the uterus may not be thick enough for implantation of a fertilized egg.
Disordered endometrial proliferation is associated with various conditions. The most common is endometrial hyperplasia, where too much estrogen and too little progesterone in the system causes the cells to overgrow or causes polyps to grow in the uterine cavity. After menopause, some women develop an atrophic endometrium, where the endometrial tissue becomes too thin. This type of disordered proliferation causes bleeding to continue even after the menstrual cycle has stopped. In rare cases, excess endometrial proliferation can lead to endometrial cancer.
Symptoms of a disordered proliferative endometrium depend on the type of disordered cell growth. However, problems with heavy and painful periods are very common, especially if the endometrium is growing too thick. Affected women may experience episodes of bleeding between their periods. Problems with fertility are also common. Some women with disordered endometrial growth may struggle to conceive, as the womb lining is the wrong thickness for implantation. Menstrual cycles may also become abnormally long or short.
The doctor will ask the patient for a description of her symptoms. If they suspect disordered endometrial growth, the physician may order an ultrasound to get a detailed view of the lining of the uterus. The scan helps identify if the thickness of the lining is normal for the current stage in the woman's cycle and highlight growths, such as polyps.
To make a definitive diagnosis, the doctor may recommend an endometrial biopsy, a short procedure that involves removing a small sample from the lining of the womb. They examine the cells from the biopsy to determine if they are behaving normally. Cell changes may indicate a hormonal imbalance or abnormal tissue development. The test may also detect infection within the uterus.
A disordered proliferative endometrium usually has a hormonal cause, such as excess estrogen for overproliferation or lower levels of estrogen during menopause, which can cause the endometrium to become too thin. Anovulation is another common cause of disordered endometrium, which occurs when an egg is not released in the middle of the menstrual cycle, causing the endometrium to continue growing.
Treatment options depend on the type of disordered growth and the wishes of the patient. In many cases, hormone medications can restore balance. Doctors may prescribe medication to induce ovulation if anovulation is the cause. In some cases, treatment is not necessary when the symptoms are not particularly troublesome. However, the doctor will generally want to monitor the woman carefully due to the risk of abnormal endometrial tissue growth.
When a disordered proliferative endometrium is unresponsive to other treatments and causing unpleasant symptoms, the doctor may opt for surgical intervention. The most common surgical treatment, especially for endometrial hyperplasia, is a hysterectomy. Although this solves the problem by removing the uterus altogether, this major surgery renders the woman infertile. For this reason, hysterectomies are generally a final option when there is a high risk of malignancy.
Losing weight may help improve disordered endometrial proliferation in women with obesity. Weight loss can help reduce the amount of estrogen in the system and normalize the menstrual cycle. Eating a balanced, healthy diet and getting adequate exercise is also important for maintaining a hormonal balance.
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