Endometrium: conditions and their role in pregnancy


The endometrium is one of the stars of the female reproductive system and plays a key role both during the menstrual cycle and during pregnancy. Also called the lining of the endometrium, the tissue that forms the endometrium serves as the "wallpaper" of the uterus , or uterus, the pear-shaped organ that houses the developing baby.

Endometrial abnormalities can cause problems like endometriosis, hyperplasia, and cancer .

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The endometrium is made up primarily of mucous membranes. It has two layers.

The first layer, the basal layer, attaches to a layer of smooth muscle tissue in the uterus called the myometrium. This layer serves as an anchor for the endometrium in the uterus and remains relatively unchanged .

However, the second level is dynamic. It changes in response to the monthly influx of hormones that regulate the menstrual cycle. For this reason, it is called a functional layer or functional layer. This is the part of the endometrium where a fertilized egg (or blastocyst) implants if conception occurs .

Menstruation and pregnancy

Immediately before ovulation (the release of the ovum from the fallopian tube), the functional layer of the endometrium undergoes specific changes. Structures called uterine glands lengthen and tiny blood vessels proliferate, a process called vascularization.

As a result, the lining of the endometrium thickens and becomes enriched with blood, so that it is ready to receive a fertilized egg, in addition to supporting the placenta, an organ that develops during pregnancy to provide the fetus with oxygen. blood and nutrients. .

If conception does not occur after ovulation, the accumulation of blood vessels and tissues becomes unnecessary and disappears. This is your period.

The menstrual cycle consists of cells that extend from the functional layer of the endometrial mucosa and mix with the blood from the small blood vessels that surround the uterine glands.

Keep in mind that those who are too young to have their periods and adults who have gone through menopause will not experience these changes. Your endometrial membranes will remain relatively thin and stable.

Hormonal birth control methods can have a similar effect. People who use progesterone-only contraceptives, such as the Mirena IUD or the Nexplanon contraceptive implant, which ultimately suppress the buildup of the functional layer of the endometrium, tend to have lighter periods .

Endometrial diseases.

In most cases, the ebb and flow of the endometrial mucosa follows a fairly predictable rhythm, as you will well know if you are menstruating. However, this can be affected by abnormalities of the endometrial mucosa. These are the most common problems that women can face.


Sometimes, as the endometrial lining thickens, it extends beyond the uterus and grows into the ovaries , fallopian tubes, or the lining of the pelvis.

Even outside the uterus, this tissue will continue to grow and then break down during menstruation. The problem is that it moves, there is nowhere for blood and tissues to leave the body and get stuck .

Over time, endometriosis can lead to the formation of cysts in the ovaries, called endometriomas, as well as the formation of scar tissue and adhesions that cause the structures of the pelvis to clump together.

The main symptom is severe pain, not only during menstruation, but also during sexual intercourse, defecation, or urination. Your periods may be heavy, and you may feel more tired, bloated, or nauseous.

Endometriosis can be treated with medication, hormone therapy, or surgery, but it can still affect fertility.

Approximately 40% of people with endometriosis will have some degree of infertility as a result of a number of complications, such as scar tissue and adhesions in and around the fallopian tubes, with low levels of progesterone, which can affect the formation of the uterine lining . a condition called luteal phase defect .

Endometrial hyperplasia

In this condition, the endometrial mucosa becomes too thick. In most cases, this is due to a certain hormonal imbalance.

An excess of estrogen, which causes a thickening of the endometrium, combined with a lack of progesterone, which can occur if ovulation does not occur. Under these conditions, the endometrial mucosa is not lost and the cells within it continue to grow. multiply.

Endometrial hyperplasia can occur during perimenopause, when ovulation becomes irregular, or after menopause, when the menstrual cycle stops completely. It can also occur in people who take drugs that act like estrogen (without progestin or progesterone), or who take high doses of estrogen after menopause for a long time .

Other risk factors include irregular menstrual periods, especially in people with polycystic ovary syndrome (PCOS) , infertility, or obesity – excess fat cells also produce excess estrogen. This can lead to additional build-up of endometrium and ultimately heavier menstrual cycles .

Symptoms of endometrial hyperplasia include menstrual bleeding that is heavier or longer than usual; shorter periods than usual; or any bleeding after menopause. If you experience any of these symptoms, see your gynecologist.

Endometrial hyperplasia can put you at risk for endometrial cancer, as excess cells can become abnormal. The condition is usually treated with progestin .


Endometrial cancer is caused by the growth of abnormal cells. About 90% of people diagnosed with this condition have abnormal vaginal bleeding. Other possible symptoms of endometrial cancer include vaginal discharge that does not bleed, pelvic pain, pelvic sensation, or unexplained weight loss.

If your periods change dramatically (for example, they become heavier or last longer), or you have bleeding between periods or after menopause, see your doctor. These symptoms have less serious causes, but it is best to use caution.

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