Why Does Adenomyosis Cause Thickening Endometrium?

Some women with adenomyosis experience prolonged periods and increased menstrual flow. Since women's menstruation is, in turn, closely linked to the uterine lining, they believe that a thickening of the uterine lining may cause prolonged periods and increased menstrual flow. And the latter is caused by their adenomyosis. 

So, is this logic correct or not? Does adenomyosis cause endometrial thickening?

Adenomyosis is a lesion that develops when the glands and mesenchyme of the endometrium invade the myometrium, causing diffuse or limited hyperplasia of the myometrium. Abnormal shedding of the endometrium can also cause thickening of the endometrium.

Patients with adenomyosis have endocrine abnormalities in their bodies, and the level of estrogen secreted by the body is higher than that secreted by normal women. Therefore, the ectopic endometrium and the endometrium in the uterine cavity are stimulated by estrogen and appear to proliferate and thicken.

Patients with adenomyosis may experience thickening of the endometrium, which causes increased menstrual flow and prolonged menstrual periods, leading to anemia. Anemic patients with lowered resistance are prone to infections, which can lead to endometritis. Endometritis, in turn, aggravates the irregular shedding of the endometrium and affects the thickening of the endometrium.

Therefore, to improve endometrial thickening caused by adenomyosis, it is necessary to treat adenomyosis aggressively so that the thickness of the lining is normalized. The following therapies are to be taken:

1. Conservative Drug Treatment: It is necessary to raise the level of progesterone in the body to fight against estrogen, which can be done by taking oral contraceptive pills using Dinogestrel or Mirena. The Mirena can be placed in the uterine cavity to secrete progesterone. GnH treatment can be used to bring estrogen down to the post-menopausal state in the short term.

2. Surgery Treatment: If conservative treatment is ineffective and the patient has severe dysmenorrhea and heavy menstrual flow, surgical treatment can be used, which can be divided into hysterectomy, adenomyoma excision, and removal of the lining of the uterus. Removing the lining is a more conservative surgical method, using a heat ball device placed in the uterine cavity to remove the lining through high temperature or other physical means.

Overall, for adenomyosis, conservative treatment is considered first, and if that doesn't work, then surgery is considered.

Besides adenomyosis, what other factors can cause endometrial thickening?

Physiological Causes: During a woman's normal menstrual cycle, the endometrium is affected by estrogen and progesterone, which are influenced by the hormones secreted by the hypothalamus and pituitary gland, resulting in the secretion of estrogen and progesterone by the ovaries, causing the endometrium to thicken. 

If pregnancy does not occur, estrogen and progesterone will drop rapidly, resulting in the endometrium peeling off and menstruation, which is normal endometrial thickening.

Ovulation Disorders: lack of ovulation or abnormal follicular development due to various reasons, prolonged functional disorders leading to endometrial thickening, such as central nervous system anovulation, hypothalamic anovulation, pituitary anovulation, polycystic ovary syndrome.

Endocrine Disorders: excessive estrogen or low progesterone levels due to various factors; obesity can lead to endocrine disorders; or women in a state of long-term tension, anxiety, depression, etc., which is likely to trigger ovarian estrogen secretion abnormality, and in the long run, it is easy to lead to thickening of the uterine lining.

Gynecological Diseases: In addition to adenomyosis, endometrial thickening can be caused if a woman suffers from ovarian cysts, uterine fibroids, endometritis, endometrial polyps, submucosal fibroids, endometrial hyperplasia, and endometrial cancer.

In general, whether the condition is serious needs to be analyzed according to the specific situation. If it is physiological thickening, it usually does not matter; if it is pathologic thickening, it usually matters and needs timely treatment.

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