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?

Vaginal bleeding is something that most women experience between their periods when they are not due for a menstrual cycle. It is considered as an abnormal occurrence when you bleed before you are expecting your menstrual period, or after you are done with your monthly cycle. It is usually characterised by bouts of spotting where a thick brown reddish discharge may be experienced. Also, this kind of bleeding is considered abnormal if it occurs during pregnancy or menopause.

Here are a few causes of abnormal vaginal bleeding:
1.  Hormones: An imbalance in the hormones like the estrogen and progesterone can lead to abnormal vaginal bleeding. These are the hormones that help in regulation of the monthly menstrual cycles. An imbalance can occur due to side effects caused by birth control pills that may not suit the individual, a contraceptive patch, or even contraceptive implants and injections. Further, an intrauterine device may also be the cause for this kind of bleeding. The hormonal balance can also get affected due to internal ailments like a dysfunctional thyroid gland and ovaries.

2. Pregnancy and Delivery: Some amount of spotting is considered normal in the first trimester of one's pregnancy. Yet, severe bleeding and persistent spotting must be reported to the gynaecologist immediately. Women also bleed for a while after the delivery of the baby, in the postpartum period. This may also happen when an abortion takes place as the uterus may not have come back to its original size and due to remaining foetal tissues within. Complications during the pregnancy like an ectopic pregnancy or a miscarriage can also lead to such kind of bleeding. An ectopic pregnancy is one where the egg gets implanted in the fallopian tube instead of entering and implanting itself in the uterus.

3.  Fibroids: Uterine fibroids are usually considered as non-malignant and non-cancerous growths within the uterus. These are common in many women who have gone through childbirth. These fibroids can also cause some amount of bleeding and spotting.

4. Infections: When there is an infection in the reproductive organs like the ovaries and uterus of the patient, there may be some amount of bleeding. An infection in this area can also cause inflammation, which is one of the primary causes of abnormal bleeding. This can also occur due to a sexually transmitted disease or STD, as well as painful intercourse and sexual abuse which can lead to scarring as well.

5. Cancer: One of the least common causes includes cervical, ovarian and other forms of cancer. 
Stress and diabetes can also cause abnormal vaginal bleeding in rare cases. It is best to see a doctor as soon as such bleeding takes place.

Causes of Abnormal Vaginal Bleeding

Cervical Cancer is most treatable when it is diagnosed and treated early. Problems found can usually be treated, depending on their severity and on the woman's age, past medical history, and other test results. Most women who get routine cervical cancer screening and follow up as told by their provider can find problems before cancer even develops. Prevention is always better than treatment.
Other HPV cancers are also more treatable when diagnosed and treated early. Although there is no routine screening test for these cancers, you should visit your doctor regularly for checkups.
Your doctor might recommend the HPV test if:
Your Pap test was abnormal, showing atypical squamous cells of undetermined significance (ASCUS)
You're age 30 or older
The HPV test is available only for women; no HPV test yet exists to detect the virus in men. However, men can be infected with HPV and pass the virus along to their sex partners.
What is a HPV Test?
The HPV test is a screening test for cervical cancer, but the test doesn't tell you whether you have cancer. Instead, the test detects the presence of HPV, the virus that causes cervical cancer, in your system. Certain types of HPV - including types 16 and 18 - increase your cervical cancer risk.
Knowing whether you have a type of HPV that puts you at high risk of cervical cancer means that you and your doctor can better decide on the next steps in your health care. Those steps might include follow-up monitoring, further testing, or treatment of abnormal or precancerous cells.
Pap- HPV Test:
HPV spreads through sexual contact and is very common in young women, so, frequently, the test results will be positive. However, HPV infections often clear on their own within a year or two. Cervical changes that lead to cancer take several years - often 10 years or more - to develop. For these reasons, you might follow a course of watchful waiting instead of undergoing treatment for cervical changes resulting from an HPV infection.
A combination Pap-HPV test is performed in your doctor's office and takes only a few minutes. You'll lie on your back on an exam table with your knees bent, your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of the vagina apart and a flat scraping device called a spatula or a soft brush is used to take samples of your cervical cells. This doesn't hurt, and you may not even feel the sample being taken.
Results of your HPV test are given as positive or negative 
Positive HPV test:A positive test result means that you have a type of high-risk HPV that's linked to cervical cancer. It doesn't mean that you have cervical cancer now, but it's a warning sign that cervical cancer could develop in the future. Your doctor will probably recommend a follow-up test in a year to see if the infection has cleared or to check for signs of cervical cancer.
Negative HPV test: A negative test result means that you don't have any of the types of HPV that cause cervical cancer.
Depending on your test results, your doctor may recommend one of the following as a next step:
Normal monitoring:If you're over age 30, your HPV test is negative and your Pap test normal, you'll follow the generally recommended schedule for repeating both tests in five years.
Colposcopy: In this follow-up procedure, your doctor uses a special magnifying lens (colposcope) to more closely examine your cervix.
Biopsy:In this procedure, sometimes done in conjunction with colposcopy, your doctor takes a sample of cervical cells (biopsy) to be examined more closely under a microscope.
Removal of abnormal cervical cells:To prevent abnormal cells from developing into cancerous cells, your doctor may suggest a procedure to remove the areas of tissue that contain the abnormal cells.
Seeing a specialist: If your Pap test or HPV test results are abnormal, your healthcare provider will probably refer you to a gynecologist for a colposcopic exam. If test results show that you might have cancer, you may be referred to a doctor who specializes in treating cancers of the female genital tract (gynecologic oncologist) for treatment.

Cervical Treatment Diagnosis, Tests and Treatment

Miscarriage is the early loss of foetus within 20 weeks of pregnancy. It is also known as  spontaneous abortion . According to research, about 8-20% of the pregnancies end in miscarriage. Out of the total number of miscarriages, 80% of them end within 12 weeks of pregnancy.

Types of Miscarriages and their Symptoms 

Threatened Miscarriage   As the term suggests, in this condition the process of miscarriage might have begun. This is the initial stage of the process. In threatened miscarriage, there is slight bleeding accompanied by cramps and pain in the lower back, which is usually mild. The cervix (the lower part of the uterus) remains closed. 
Inevitable and Incomplete Miscarriage   In these conditions, there is bleeding along with an open cervix. When there is dilatation and thinning of the cervix, miscarriage is inevitable. In incomplete miscarriage, part of the tissue comes out and a part remains inside the uterus. In inevitable and incomplete abortions, the bleeding and cramps are more severe. 
Complete Miscarriage   Complete miscarriage is when the embryo has completely emptied from the uterus. The pain and bleeding reduce once the foetus is expelled. This can be confirmed through ultrasound. 
Missed Miscarriage   In Missed miscarriage, there is no sign of the life of the embryo and there is no expulsion of the embryo. It can be detected from the absence of heartbeat of the embryo found on ultrasound. 
Recurrent Miscarriage   It happens when there are two or three miscarriages one after the other. It affects about 1% of the pregnancies. 
Risk Factors 

Increased maternal age i.e., women above 35 years. 
Excess or insufficient chromosome in embryo. 
Placenta is the organ which links mother and the baby for blood supply. Problem in the development of placenta can cause miscarriage. 
Excessive smoking and drinking during pregnancy. 
Obese women have higher risk of miscarriage. 
Long-term health conditions like high blood sugar, high blood pressure, liver disease etc.
Infections like rubella, malaria etc. 
Weakened cervix, which is the result of previous injury or surgery, can also result in miscarriage. 
What are the symptoms of a miscarriage? 

Bleeding or spotting can be one of the symptoms of miscarriage. It should be kept in mind that not all pregnant women who suffer from spotting or bleeding, end in miscarriage. 
Lower backache starts before or right after bleeding, which can be persistent or you could have cramps which may be mild or sharp and can feel like more of pelvic pressure. 
Missed miscarriages are detected through ultrasound when the doctor finds that there is no heartbeat of the embryo or when the uterus is not growing. 
What are the treatment options in miscarriage? 

Medical   In most of the cases, there are no specific drugs to stop a miscarriage from occurring. In some cases, certain hormonal preparations help. There is no point in prescribing medicines for prevention of miscarriage if there is heavy bleeding. 
Surgery   Dilatation and evacuation (D&E) is a simple operation which is done under general/local anaesthesia. In this operation, the cervical canal is dilated and contents present in the uterus are evacuated. There is no cutting involved as it happens through the vagina. The process needs only five to ten minutes, but the patient has to stay in the hospital for about 3-4 hours. 
This process is opted when: 

There is heavy bleeding. 
The patient suffers from missed miscarriage. 
What can you do to prevent miscarriage? 

Nothing much can be done to prevent miscarriage in most of the cases. However, following supportive measures may help: 

There should not be overexertion during pregnancy. Moderate amount of physical activity is permissible. 
One should have a well-balanced diet. Studies have shown that a diet loaded with fruits and veggies helps in overall well-being during pregnancy. One should limit the consumption of caffeine. 
Avoid smoking, alcohol and certain drugs to prevent miscarriage. 
Avoid stress and anxiety. 
Report to Doctor (preferably Obstetrician) as soon as any symptom related to miscarriage appears.

Miscarriage - Symptoms, Treatment and Prevention

Take care of these 25 things before conceiving

Just a news of expecting a baby brings cheer and excitement in a couple’s life. However, being prepared for it helps you become healthy and bring in a healthy baby too. 

Here are few things that one must take care of before and while conceiving.

1. Use Ovulation calculator to decide the best time for pregnancy.
2. Stop taking contraceptives.
3. Preconception health care is necessary to avoid miscarriage, stillbirth or premature birth
4. Keep yourself mentally ready and healthy for delivery.
5. Be aware of your body i.e. how healthy and fit you are.
6. Have medical checkups before getting pregnant.
7. If your weight is on the higher side, lose weight before getting pregnant as being overweight brings complications.
8. Fathers should also avoid smoking and drinking for better sperm quality.
9. Intake of regular folic acid.
10. Regular Exercise.
11. Stay away from Infections.
12. Consult dentist as hormonal shifts can cause gum diseases which are harmful for baby.
13. Eat lot of fish for child’s development but avoid fish that has mercury.
14. Completely avoid smoking, drinking and caffeine yourself.
15. Avoid passive smoking too.
16. Avoid soda and fruit juice as they may raise sugar levels.
17. Sleep as much as you can.
18. Take adequate amount of iodine in your diet.
19. Take up-to-date vaccinations.
20. Ensure balanced diet in consultation with dietician.
21. Keep yourself away from stress.
22. Take lot of carbohydrates, milk and milk products, fats and proteins and fresh fruits and vegetables and avoid taking uncooked or undercooked food.
23. Have a healthy working environment and avoid getting exposed to chemicals like lead and mercury and radioactive substances like X-Rays.
24. Do not take any medicine for headache, pain etc. without consulting your doctor.
25. Keep a check on your blood pressure.




A Checklist of Must Do’s Before You Try to Conceive 

Menopause is the time in a woman's life when the menstruation ceases, bringing an end to a woman's childbearing years. There are a number of symptoms that mark this stage, including hot flashes, which are very commonly experienced in such cases. Hot flashes are like a feeling of a red hot flush that may wash over the body and lead to excessive sweating. It occurs in the blood vessels that are closest to the surface of the skin. Yet, menopause is not the only reason why one may experience these hot flashes.

Here are some of the reasons that may trigger these hot flashes:

1. Carcinoid syndrome: This is a disease that may cause hot flashes as a symptom. In this condition, a tumour will usually release varied chemicals into the body, which can create varied symptoms that seem like hot flashes.

2. Hyperthyroidism: Overheating of the body and the system from within is something that many patients suffering from hyperthyroidism may experience. This usually happens when the thyroid glands end up producing too much of the thyroid hormone that brings about many symptoms ranging from depression to weight loss and even hot flashes. In hyperthyroidism, the body goes into a hyper mode, which usually leads to overheating of the same. This gives rise to frequent and often severe hot flashes.

3. Hormonal changes: There are many hormonal changes that may affect various men and women from time to time. A drop in the level of the estrogen hormone is something that many women go through on a regular basis. This may happen due to pregnancy as well. Also, this condition usually brings about symptoms like hot flashes.

4. Eating disorders: The way we eat and nurture our body is the way the body reacts. When there is a case of an eating disorder like dyslexia or bulimia, it may lead to varied symptoms, including hot flashes. This is due to the fact that the body's hormonal levels as well as the nutritional level plunge to an all-time low. In many such cases, hot flashes are the body's way of demanding better nutrition. These disorders can also give rise to related conditions like the hypothalamus disorder.

5. Hypothalamus disorder: Hypothalamus disorder may also cause hot flashes. This is a condition that is caused due to poor eating habits. This disorder is characterised by a major drop in one's nutrition levels and also leads to many hormonal changes. These changes often lead to symptoms like hot flashes and other related complications.

Hot Flashes: Is it Due to Menopause or Something Else

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