The Endometrium and Its Role in Your Fertility

1. 🩺 Anatomy and function of the endometrium
2. 🤰 Menstruation and pregnancy: what happens to the endometrium
3. ⭐ Endometrial conditions and related diseases
4. 💊 How can you improve the health of your endometrium?
5. ✔ Endometriosis
6. 📝 Endometrial hyperplasia
7. ⚡ Endometrial cancer

After the successful implantation of a fertilized egg, the endometrium will keep it alive, providing nutrients and protection. If fertilization does not occur or the egg fails to implant, the endometrial tissue is shed and becomes menstrual flow. Pathologies of the endometrial tissue (endometriosis, hyperplasia) can not only prevent the occurrence of pregnancy, but also cause oncology. Therefore, in the article we will talk not only about the effect of the endometrium on fertility, but also about measures to prevent and treat possible problems with this tissue.

Anatomy and function of the endometrium

The endometrium is for the most part a mucous tissue inside the uterus, consisting of two layers:

• Basal;
• Functional.

The first layer is attached to the smooth muscle tissue of the uterus, the myometrium. The myometrium serves, in fact, as a support for the endometrium inside the uterine cavity. His condition is relatively unchanged.

The second layer is constantly changing depending on the hormones that control the menstrual cycle. It is in this layer that the implantation of a fertilized egg occurs, if conception has occurred.

Menstruation and pregnancy: what happens to the endometrium

Shortly before the release of the egg (ovulation) from the fallopian (uterine) tube, changes occur in the functional layer of the endometrium. The uterine glands lengthen, and the small blood vessels increase. This leads to thickening and enrichment of the endometrium with blood, thus it is prepared accept the fetus and support the placenta.

If the attachment of the embryo did not occur, then the cells of the functional layer, together with the blood accumulated in small vessels, will come out at the beginning of the next menstrual cycle.

These processes do not occur in the prepubertal period and after menopause. In these age groups, the endometrial membrane remains relatively thin and does not undergo any special changes.

In the case of taking hormonal drugs for contraception, the described processes occur differently. Preparations containing only progesterone inhibit the growth of the functional layer. Menstrual flow in this case usually has a lighter shade.

Endometrial conditions and related diseases

With normal hormonal regulation, the growth and rejection of the functional layer occur regularly and predictably: a woman has a relatively stable cycle. However, in the case of endometrial anomalies, the process can be disrupted. Three types of pathologies are the most common.

Endometriosis

Sometimes, for very different reasons, the functional layer grows beyond the uterus, grows on the ovaries, fallopian tubes, or pelvic tissues. During menstruation, the layer is destroyed, but cannot be removed naturally. This causes the formation of cysts on the ovaries, scarring of the tissue, adhesions that form the adhesion of the pelvic structures.

There are several non-specific symptoms that make it possible to suspect endometriosis:

• Severe pain during the menstrual period, during sexual intercourse, urination or defecation;
• Heavy menstrual flow;
• Nausea, bloating, increased fatigue during menstruation.

The presence of these signs does not clearly indicate endometriosis. The diagnosis is established by the doctor based on the results of tests and ultrasound.

Pathology can be treated with hormonal and concomitant drugs, as well as surgically. However, the condition can still affect fertility. Approximately 40% of women diagnosed with endometriosis will also be diagnosed with some degree of infertility. This is due to typical complications of the pathology: scar tissue, adhesions in the fallopian tubes and the space around them, low progesterone levels, which negatively affect the formation of the functional layer.

Endometrial hyperplasia

This condition, caused by an imbalance of hormones, is characterized by an abnormally thick functional layer. This occurs against the background of excess estrogen in combination with low progesterone levels in the event that ovulation has not occurred. At the same time, the endometrial layer is not rejected, but continues to grow.

The condition can occur before or after menopause, when ovulation becomes irregular or periods stop completely. Sometimes this pathology is noted in women taking estrogen preparations (without progestin or progesterone), as well as against the background of long-term use of high doses of estrogen after menopause.

Women with an irregular cycle are also at risk for hyperplasia, especially those diagnosed with polycystic ovary syndrome (PCOS), with infertility, who are diagnosed with obesity. Fat cells produce estrogen, the excess of which leads to hypertrophic buildup of the endometrium and, as a result, to heavy menstrual bleeding.

You should see a gynecologist if you experience any of the following symptoms: longer heavy or shorter than normal menstrual bleeding, any bleeding after menopause.

Endometrial hyperplasia increases the risk of endometrial cancer. This may occur due to malignant transformation of excess cells. Progestins can be used to treat pathology.

Endometrial cancer

As already noted, endometrial cancer is provoked by growing abnormal cells of the functional layer. There is a rather specific symptom noted in 90% of women with this disease - abnormal vaginal bleeding.

Other symptoms that require a visit to a gynecologist are non-bloody discharge from the vagina, pain and / or sensation of formations in the pelvic area, unexplained weight loss. Also, any sudden changes in menstrual flow, intermenstrual bleeding, postmenopausal bleeding require medical supervision. All of these symptoms do not necessarily mean cancer, but they should not be ignored, you should visit a doctor.

According to studies in the case of early diagnosis at the zero stage, the prognosis of five-year survival in the treatment of endometrial cancer is 96%.    

How can you improve the health of your endometrium?

The simplest and most affordable method is a healthy lifestyle. A healthy diet, smoking cessation and exercise lead to increased blood flow, which has a beneficial effect on the reproductive system. According to the recommendation of a doctor, drugs to increase estrogen production can be used.

In the context of infertility due to endometriosis or other pathologies, Feskov Human Reproduction Group approaches each woman individually. You must know for sure: there is no condition that can prevent you from giving life to your child. Even if your reproductive system has little chance of natural conception and gestation, we have many tools: the latest treatment methods, egg donors of various phenotypes and races, surrogacy.

Order a free analysis of your medical history on our website - we will tell you about the options available to you for the birth of a child.

Authors, contributors:

Irina Smolina
International Outreach Manager

published: 26 October 2023
updated   : 27 October 2023

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