What is Endometrium?

The uterus is where the fetus grows and develops. It has three linings- the outermost lining, the middle layer and the innermost lining. The innermost layer is called Endometrium. The endometrium is made of mucosal tissues.

How the endometrium changes and what is its function?

Before ovulation, when an egg is released, the functional layer of the endometrium undergoes a change. Vascularization takes place i.e. a buildup of blood vessels and tissues that thickens the endometrium in anticipation of implantation of a fertilized egg. If conception does not take place, the tissues and cells are shed from the endometrium lining. This is when a woman gets her period.

When conception does take place, the fertilized egg attaches itself to the endometrium. The endometrium also supports the placenta, which provides the fetus with oxygen and nutrition.

What is the ideal thickness of the endometrium?

In pre-menopausal women, the thickness of the endometrium should be-

  Between 2-4 millimetres during menstruation,
  5-7 millimetres at the onset of the early proliferative phase
  Around 11 millimetres during the late proliferative phase
  16 millimetres during the secretory phase



What is a poor/thin endometrium?

If the endometrium lining does not meet standard thickness and is not conducive to implantation, it is called a poor endometrium.

Causes behind thin endometrium

There could be many reasons that can lead to a poor endometrial layer-

  Inadequate secretion of estrogen
  Insufficient blood flow
  Prolonged use of birth control pills
  Substandard quality of endometrial tissues
  Presence of fibroids (small uterine tumours)
  Amenorrhea (unnatural periods/ excess bleeding or too little bleeding)
  Intrauterine adhesions (scar tissues form between the layers of the uterus and glue them together)
  Pelvic inflammatory disease
  Use of clomiphene

What are the symptoms of poor endometrium?

  Infertility (inability to conceive)
  miscarriage
  Irregular menstruation
  Painful periods
  Inadequate bleeding during menstruation

Treatment for poor endometrium

  Since the most common cause of poor endometrium is insufficient estrogen, doctors prescribe estrogen pills that can raise estrogen levels.
  If poor endometrium is the result of poor blood flow, an Ultrasonography Test will reveal that. Then doctors prescribe Vitamin E pills and L-arginine amino acid pills to thicken the endometrium layer.
  Regular exercising increases blood flow to the uterus
  Acupuncture is a very effective stress buster. Chronic stress could lead to a shrunk uterine wall. Acupuncture can allay the stress and promote the health of the uterus.
  Intrauterine adhesions can be extracted through surgery.
  Natural remedy (through natural therapy) includes asparagus, royal jelly, cover and they help in thickening the endometrium layer.
  Granulocyte Colony Stimulating Factor if injected into the body raises endometrial thickness and combats infertility.

Only an endometrium of normal thickness can support a pregnancy. If the lining is not thick enough medical intervention may be necessary.

Poor Endometrium - Can It Be Treated?

An often painful condition usually involving the bowel, ovaries or the tissue lining the pelvis, endometriosis is characterized by the abnormal growth of the endometrial tissue beyond the premises of your uterus or your pelvic region. The endometrium, in fact, functions perfectly normal with each menstrual cycle, but because of it being displaced, it cannot exit the body and consequently gets trapped.

Besides causing severe pain and distress, endometriosis can also adversely affect fertility. When the ovaries get involved, certain cysts known as endometriomas tend to develop which often result in the formation of scar tissues and adhesions.

Complications associated with it

Infertility: Impaired fertility is the most common kind of complication arising from endometriosis, with approximately one-third to one-half women having problems with pregnancy. During endometriosis, the fallopian tube gets obstructed, thereby restricting the union of the egg and sperm.
Ovarian cancer: Women with endometriosis are more likely to suffer from ovarian cancer. Moreover, they are also more susceptible to acquiring endometriosis related adenocarcinoma, which is another variant of cancer, but a comparatively rarer phenomenon.
How best to treat it?

Depending upon how severe your symptoms are, endometriosis can be treated via the use of medications or through the advent of surgery.

Pain medications: Certain medications, including pain relievers and anti-inflammatory drugs, are particularly useful in providing relief to painful menstrual cramps.
Hormone therapy: Undergoing hormonal therapy can help ward off or reduce the pain of endometriosis, but it should be kept in mind that it is only a temporary fix and that symptoms might reoccur. Hormonal therapies include:
Hormonal contraceptives
Medroxyprogesterone
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
Danazol
Conservative surgery: This can either be done through laparoscopy or, in more extensive cases, through traditional abdominal surgery.
Assisted reproductive techniques: These include in-vitro fertilization, and are sometimes more preferable over conservative surgery.
Hysterectomy: This is usually done in more severe cases of endometriosis whereby ovaries are also removed with uterus and cervix

Complications and Treatment of Endometriosis

Endometriosis is a painful disorder wherein, a tissue that normally belongs to the inside of a woman s uterus, starts to grow out of the uterus. It common involves a woman s ovaries, fallopian tubes and the tissue, which lines the pelvis. In case of endometriosis, the displaced endometrial tissue continues to act like normal, becomes thick, breaks down and leads to bleeding with each menstrual cycle. Endometriosis can lead to pain, which might be severe especially during a woman s period. 

Causes of Endometriosis:

Embryonic Cells Getting Transformed: Hormones like estrogen might transform the cells, which are in the early stage of development, into implantation of endometrial cells at the time of puberty. 
Surgical Scar Implantation: After undergoing a surgery like a hysterectomy or C-section, the endometrial cells might get attached to the incisions done for conducting the surgery. 
Transport of Endometrial Cells: The tissue fluid system or the blood vessels might transport the endometrial cells to different parts of the body. 
Let us take a look at some of the symptoms of endometriosis: 

Periods which become painful 
Pain suffered during or after the intercourse. 
Feeling of pain during bowel movements 
Excess bleeding 
Infertility 
Possible location of endometriosis: 

Ovaries(the most common site) 
Fallopian tubes 
Back of the uterus 
Front of the uterus 
Uterine ligaments such as the broad or round ligament of the uterus 
Pelvic walls 
Intestines 
Urinary bladder and ureters 
Investigations Required in Endometriosis 
The investigations required in endometriosis are as follows: 

Pelvic Exam   In this exam, a doctor manually tends to feel certain areas in pelvis for any kind of abnormality like cysts or the reproductive organs or scars behind the uterus. 
Ultrasound   High-frequency sound waves are used to create certain images inside the body, through capturing them via a device known as transducer and getting it pressed against a woman s abdomen.
MRI   MRI by way of magnetic field and radio waves help to get detailed images of the tissues and organs in the body. 
Laparoscopy Endometriosis through the eyes of ayurveda: The signs and symptoms mentioned in endometriosis are described in ayurveda under the heading of vataja yonivyapadh and udavartha. 
Apana Vata is considered as the main functioning agent to maintain normal menstruation. 
This is vitiated due to sedentary life style, lack of exercise, sleep, irregular sleep, stressful professional atmosphere, mental tensions and unhealthy food habits. 
The deranged apana vata causes retrograde menstruation leading to endometriosis. Along with this, the other two doshas-pitta and kapha are vitiated leading to hormonal imbalance and abnormal growth of endometrium respectively. Hence, the first and foremost step is to restore the physiology of these doshas. 
What are shodhanas? 
Shodhanas are detoxifying procedures like snehana, svedana, vamana, virechana and basti. Benefits of shodhana in female reproductive system: 

Biological systems return to normalcy. 
Revitalizes body tissues 
Potentiates pharmacological actions of internal medicines 
Removes toxins 
Improves physiological functions and gut absorption. 
Also, improper metabolism is corrected 

Mental faculties, strength and vitality are enhanced 
Fine tunes the endocrine system (hormonal balance correcting hypothalamus-pituitary-ovarian axis). 
Promotive-promotes fertility, preventive-prevents recurrence and curative- cures from the root and rehabilitative too. 
Ayurvedic Treatment for Endometriosis 
Endometriosis s treatment in Ayurveda requires an anti-Pitta diet and regimen, where there would be complete avoidance of all spices, except coriander, turmeric and saffron. One must also refrain from having 

Salt 
Alcohol 
Refined sugar 
Good herbs might get included in the form of: 

Shatavari 
Kumari Saar 
Kanchanar 
Ashoka 
Lodhra 
Pradranta Churna 
As per Ayurveda, Endometriosis happens as a result of more Kapha due to increased growth of the uterine membrane. Anti-kapha, anti-tumor and general detoxification can be helpful along with some typical herbs like Guggul, Myrrh, Turmeric and Dandelion. 

How can Diet and Yoga help to improve Endometriosis? 
Modifications in diet by switching to the intake of healthy foods and Yoga can help to a great extent in improving Endometeriosis. Some of the diet tips include: 

Avoiding foods like cakes, donuts and fries that contain trans fats. 
Cut down on consumption of red meat. 
Have lots of fruit, vegetables and whole grains 
Put a check on consumption of caffeine and alcohol 
Reduce the intake of processed foods. 
Impact of Yoga 
Yoga s positive impact in treating endometriosis includes: 

Yoga, with its structured approach towards the body help reduce the symptoms of emdometriosis, while improving the general functioning of the body & oxygenation to the organs. 
Women, who have tried out Yoga in order to decrease pain, also observed that there has been an improvement in their condition through healing. 
Control in the breathing exercises decrease anxiety and a general sense of well-being is promoted. 
Yoga helps to ease out menstrual pain, improves fertility and helps in bringing about hormonal balance.

Endometriosis - A Possible Therapy In Ayruveda!

When endometrial tissue that usually grows inside the uterus, starts growing outside uterus, it is called Endometriosis. Pain during or before periods, pain during intercourse, pain while urinating or bowel movements, heavy bleeding, infertility are some of the symptoms of endometriosis.

Treatment of endometriosis usually depends on the following factors:

Age of female
Severity of symptoms
Duration of the symptoms
Future plans for children/ fertility
Associated pathologies
Accordingly the doctor might choose any of the treatment options like:

Medication for Pain: If the symptoms are mild, then the doctor will prescribe some pain  relieving medications like Nonsteroidal anti-inflammatory drugs (e.g. Diclofenac) or anti-spasmodics(e.g.drotaverine)
Hormone Therapy: Hormone therapy is effective, but once you stop them, your symptoms may recur. Some of the hormone therapies include: 
Hormonal Contraceptive pills: Useful in controlling the hormones that are responsible for endometrial tissue growing outside the uterine cavity.
Medroxyprogesterone: This helps to counter effect estrogen hormone which is responsible for endometrial tissue growth.
Gonadotropin-releasing hormone (GnRH) agonists: Gonadotropin hormones that stimulate ovaries are blocked by these. They bring down oestrogen levels and hence symptoms. It can cause absence of menstruation in some females which is reversible.
Danazol: It is synthetic androgen, suppresses growth of endometrial tissue temporarily.  However, Danazol may not be a favourable option because of its side effects. Females should avoid pregnancy while on this drug.
Dienogest: This newer progesterone molecule, which does not have major side effects and is apporved for use in endometriosis.
Other medications like selective progesterone receptor modulators, immunomodulators, anti angiogenic factors are being evaluated.
Conservative surgery: If you are trying to conceive, then surgical excision or ablation of endometrial tissue is one treatment option.Suboptimal surgery with conservation of maximum ovarian tissue is considered suitable in such cases.
Hysterectomy: In severe endometriosis cases where female has completed her family, hysterectomy is offered wherein the uterus, cervix & if required ovaries can be removed.

Endometriosis - Ways To Manage It Well!

The woman s reproductive system is an extremely complex one. The uterus which is the main organ with its appendages helps in conception, pregnancy, and childbirth by undergoing marvellous changes. The uterus measures just about 7.5 x 4.5 in a normal woman and expands to accommodate a full-term baby within her during gestation.

The uterus is lined with smooth muscles, and due to unknown reasons, this lining material could be found in other parts of the pelvic organs. This condition is known as endometriosis and is one of the main causes of pelvic pain. Most women suffer through it, and it mostly gets diagnosed when some other issue is being investigated. 

For women with endometriosis, there are mainly two issues to deal with i.e. pain and depression.

Pain: While the pain per se is one issue, the way it affects daily normal life is another thing to be considered. For the pain to minimally affect routine life, the following are effective ways.

Exercise: Anything that you prefer like swimming, jogging, dancing, aerobics, cycling. This will help in stress management and pain relief.
Rest: Get adequate rest of 8 to 9 hours per night. On severely painful days, go ahead and sleep for a couple of hours extra.
Stress management: Whether through yoga or meditation or music, learn to manage stress better. Nobody is without stress but managing it is the key.
Eat healthy and fresh: Whole grains, fresh fruits and vegetables, increased fibres are definitely useful. Reduce whites including sugar, salt, and dairy products if possible.
Social life: Stay connected with people whose company you enjoy   be it family or friends, or even counsellor if required.
Speak up: Let your close circle of friends at work know your problem, so they can help when you need it the most.
Depression and mood swings can be managed in the following ways.

Do what makes you happy: There are some activities which will definitely make you feel better. A quiet walk to get some fresh air. Watching a dance video. Listening to your favourite soundtrack. Changing body language to one without stopped shoulders and frowning foreheads can make a big difference.
Focus on the good: Writing down or thinking about what went well for the day can cheer you up and overcome the blues that is so common in women with endometriosis.
Positive thinking: Instead of saying, I can not try saying I will try. It makes a BIG difference, and you will be amazed at the results.
Keep happy company near you: Surround yourself with happy, positive people and see your happiness quotient go up!!!
Endometriosis is definitely an enigma that is not well known, understood, or identified. However, the above are definitely useful way to cope with it.

Pain & Depression Due To Endometriosis - How To Deal With It? 

The uterine cavity has a tissue base that is known as the endometrium. When this endometrium spills over or spreads to the other parts of the reproductive organ, it begins to punch through the uterine lining. Such a condition creates complications and even infertility, and is known as endometriosis.

Read on to know more about endometriosis and how it can cause infertility.

Endometriosis

When the endometrium tissue spreads to areas like the ovaries, and the abdominal cavity, it can lead to numerous complications. Apart from pain, this may also cause infertility. 5 to 10% of the women worldwide suffer from this condition and have trouble conceiving. Additionally, about 30 to 40% of the infertility cases are due to endometriosis, not all cases. These figures are all confirmed by various medical studies.

How does it cause infertility?

Endometriosis can prevent ovulation, which is the process that occurs every month. During the ovulation process, the ovaries release eggs that may be fertilised in order for the woman to conceive. In this condition, the fimbria of the fallopian tubes also has trouble in capturing the egg, which prevents conception from taking place. This leads to infertility in the long run. Endometriosis also interferes with the proper production of the hormones that are required for normal ovulation and fertilisation of the egg.

Diagnosis: The diagnosis of the condition can be done with the help of lab tests and ultrasounds as well as imaging tests that can create the image of the womb and the endometrium lining. This will help in showing the severity and damage caused by the tissue. A surgical procedure called a laparoscopy may be carried out by the doctor to ascertain whether the patient is suffering from this condition. In this procedure, a small incision will be made and a camera will be inserted to view the insides on a screen, to learn more about the tissue s spread and the kind of treatment that will be required. The doctor will also diagnose the condition on the basis of various symptoms like irregular and heavy bleeding.

Treatment:

Treatment for endometriosis associated with infertility needs to be individualized for each woman. There are no easy answers, and treatment decisions depend on factors such as the age of the woman, the severity of the disease and its location in the pelvis, the length of infertility, and the presence of pain or other symptoms. Some general issues regarding treatment are discussed below.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.

However, several well-controlled studies have shown that neither medical or surgical treatment for mild endometriosis improve the pregnancy rates for infertile women as compared to expectant management (no treatment).

For treatment of infertility associated with mild to moderate endometriosis, controlled ovarian hyperstimulation with intrauterine insemination - IUI is often attempted and has a reasonable chance to result in pregnancy if other infertility factors are not present.

Details about IUI success rates with endometriosis

IUI and endometriosis

Success rates with IUI for endometriosis have been variable in studies, showing:

A pregnancy rate of 6.5% for women with endometriosis vs. 15.3% per cycle for unexplained infertility
A pregnancy rate of 5.6% for women with advanced endometriosis vs. 22.7% per cycle for mild endometriosis vs. 25.7% for no endometriosis
Pregnancy chances with insemination for natural cycle IUIs (no drugs) with endometriosis are about 2% per cycle vs. 11% with injectables plus IUI for endometriosis
Treatment for severe endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women.

Unfortunately, the infertility in women with severe endometriosis is usually resistant to treatment with ovarian stimulation plus intrauterine insemination. If the pelvic anatomy is very distorted, artificial insemination is unlikely to be successful. These women often require in vitro fertilization in order to conceive.

Although the studies of in vitro fertilization for women with severe endometriosis do not all show similar results, pregnancy success rates are usually good if the woman is relatively young (under 40) and if she produces enough eggs during the ovarian stimulation.

Endometriosis - How It Results in Infertility?

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