The endometrium is the lining of the womb (uterus). It is a highly vascularized tissue that lines the inner wall of the uterus.
The Endometrium is a tissue rich in blood vessels and glands that specializes in menstruation in response to hormonal changes.
The function of the endometrium is to nourish the embryo in the early stages of pregnancy, providing the necessary conditions for the application and nutrition of the fertilized ovum until the formation of the placenta to allow the transport of nutrients and oxygen between the mother and the fetus.
When there is no fertilization, the entire functional layer of the endometrium is expelled, and initiate the process of menstruation, a remarkable phenomenon for the female nature.
This tissue is under the constant influence of ovarian hormones (estrogen and progesterone), and as months go by, its thickness and vascularity change.
This only occurs when the uterus is already well developed, i.e., at puberty when the first menstruation occurs.
Since then, every month of the year, the thickened endometrium and rich in blood vessels, in preparation for a possible pregnancy.
In humans, the cycle of the construction and diffusion of endometrial tissue is approximately 28 days, but varies from one individual to another and can change depending on the reactions of stress, seasons, loss or gain of weight.
Diseases and conditions that could affect the endometrium
Adenomyosis is a disease in which the endometrial tissue that makes up the lining of the uterus starts growing inside the muscular walls of the uterus.
It may sometimes form a massive growth (adenomyoma), but such tumor is not cancerous.
More commonly, the endometrial tissue is spread out in the walls of the womb. However, this epithelial layer still bleeds during periods, causing many signs typical to this condition.
These symptoms may include painful or heavy periods (sometimes with severe cramps and contractions), a remarkable discomfort during sexual intercourse, bloating in the lower abdomen, back pain, and nausea.
Endometrial Hyperplasia is the name given to over-proliferation of the endometrial cells. The endometrium becomes thicker than it would otherwise be.
Abnormal vaginal bleeding is a common symptom. People should consider any bleeding at all after the menopause as something anomalous, for bleeding between periods in women should happen before the menopause.
The disease increases the risk of endometrial cancer, so doctors should monitor patients regularly.
Endometrial Cancer forms in the lining of the womb (endometrium). It is the most common form of cancer of the uterus.
Abnormal vaginal bleeding is the primary sign. Other symptoms include pain in the lower abdomen and pain during sexual intercourse.
Asherman’s Syndrome involves scarring of the endometrium. Sufferers have lighter periods and may become infertile.
Causes of diseases of the Endometrium
Adenomyosis is caused by endometrial tissue starting to grow within the muscular walls of the womb. It is not clear why some women get adenomyosis, and some do not.
It tends to occur in women who have previously had children and are over 35 years of age. Symptoms usually end once women reach the menopause.
Some has been suggesting that adenomyosis could be related to the hormone estrogen.
In young women, progesterone counteracts the effects of estrogen. When women are in their thirties, progesterone levels start to decline.
The cause is unknown. Sometimes, adenomyosis can cause a mass or tumor inside the uterus. This is called adenomyoma. The disease most often occurs in women aged 40 to 50 who have had at least one pregnancy.
Endometrial Hyperplasia is caused by an unusually high level of the hormone estrogen, compared to that of the hormone progesterone.
This imbalance might occur because of obesity, certain diseases of the ovary, or as a side-effect of various medications. The combined oral contraceptive pill decreases the risk.
Endometrial cancer is the most common form of cancer of the womb (uterus). Risk factors for developing tumors in the womb include the menopause, obesity, diabetes, and hormone replacement therapy.
All these factors can lead to elevated levels of the female hormone estrogen, which increases the cancer risk. The combined oral contraceptive pill decreases the risk.
Asherman’s Syndrome occurs because of scarring of the endometrium due to some medical procedures, such as dilation and curettage.
Tests and exams.
The health care provider will make the diagnosis if a woman has symptoms of adenomyosis that are not caused by other problems. The only way to confirm the diagnosis is to examine the uterine tissue after surgery to remove it.
During a pelvic exam, the provider may find a soft, slightly enlarged uterus. The test may also reveal a uterine mass or tenderness of the uterus.
Medical experts can perform an ultrasound of the uterus, although it does not often give a precise diagnosis of adenomyosis. Docter may use an MRI when suspecting about other potential uterine.
Treatments
Painkillers can be used to reduce the severity of the symptoms of adenomyosis. A person can take Ibuprofen or acetaminophen (paracetamol).
Progesterone tablets can help lessen the symptoms of adenomyosis and endometrial hyperplasia, giving lighter periods.
The Levonorgestrel Intrauterine System (LNG-IUS) is a contraceptive implant that secretes the hormone levonorgestrel. It can be useful for relieving the symptoms of adenomyosis and endometrial hyperplasia.
Gonadotropin-Releasing Hormone Analogs (GnRHas), such as goserelin and leuprolide, can shrink areas of adenomyosis.
These drugs decrease the levels of the female hormone estrogen and produce an artificial (but reversible) menopause.
They are not suitable for oral administration, so have to be given by injection. Serious side-effects, such as bone thinning, can occur if the person consumes the drugs for more than six months.
Surgery: To treat Asherman’s syndrome doctors can remove local areas of scarring (adhesions).
They can also remove localized regions of adenomyosis, but in many cases, the adenomyosis spreads throughout the muscles of the womb. Under such circumstances, the patient may need a hysterectomy.
Endometrial hyperplasia may need to be treated with a hysterectomy, mainly when the hyperplasia is considered likely to give rise to cancer.
In the case of endometrial cancer, the patient usually requires a hysterectomy; the doctors typically remove the ovaries and fallopian tubes at the same time.
Some recommend patients follow-up treatments with chemotherapy or radiotherapy. Hormone treatment with progestin hormones helps to stop the disease spreading in some cases.
