What causes endometrium thickness?

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Posted on Thu, 24 Apr 2014 in Vaginal and Uterus Health
Question: I have an endometrial lining of 19, also heterogenous, and a lot of excessive vascularity. I am 10 years post menopaus. What do you think the statistics for having cancer in this case is? I have also never had a child and was also infertile.
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Answered by Dr. Madhuri N Bagde 18 minutes later
Brief Answer: The lining is a bit on the higher side Detailed Answer: Hello and welcome, I understand your problem and worry. The endometrial lining is a bit on the higher side. The history of infertility indicates a high estrogen state. However the commonest cause of a thick endometrium is not always cancer. The risk of cancer at your age is approximately 6%-7% for an endometrium more than 11 mm. So in 94% cases it is not cancer but something else. The absence of bleeding is also a good sign as the risk of cancer is lower in women that do not have a bleed. Most common cause for a thick endometrium is endometrial hyperplasia meaning overgrowth of endometrium. This is of various types ranging from simple to complex and cystic all having different meanings. Also another thing about cancer endometrium is that it tends to remain localized at one place and does not spread easily. So surgery is possible in most cases and it is curative. So there is no need to worry. As of now, I suggest that you stop worrying about cancer as it is not the commonest cause. Get a D and C or better still a hysteroscopic biopsy for establishing the diagnosis. Future treatment will then depend upon the biopsy results. Hope this satisfies your query. Thanks for using HCM. Feel free to ask any more questions that you may have. Dr Madhuri Bagde Consultant Obstetrician and Gynecologist
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Madhuri N Bagde 23 minutes later
I was under the impression that if it was homogeneous,then it would be more likely to be benign but if it was heterogeneous,that could more likely be cancerous. Also that the multiple excessive vessels made it more likely to be a cancer. Thanks a lot.
doctor
Answered by Dr. Madhuri N Bagde 58 minutes later
Brief Answer: detailed explanation given below. Detailed Answer: Hello and welcome back, It is difficult to extrapolate the findings. They have to be viewed in relation to the history and examination and also comparing the probabilities of common versus uncommon causes. You are correct that a homogenous mass is more likely to be benign compared to a heterogenous and vascularity may indicate malignancy. So we cannot draw a line that heterogenous is malignant and homogenous is not. Also many benign masses show these features, and the probability of benign is always more than malignant as they are more common. So even with these features, benign masses are more common than malignant. The risk of 6-7% that I quoted was also based upon thick endometrium and not other features as they overlap between benign and malignant. Conditions like cystic hyperplasia, glandular hyperplasia etc will show heterogeneity and may also show increased vascularity. There are many overlapping features between hyperplasia and cancer and ultrasound is not the investigation for choice to confirm the diagnosis. It only suggests that the endometrium is thick. Beyond that other features are non specific. Even Thickness is non specific as it is seen in hyperplasia conversely there are many cases of cancer endometrium that are seen with endometrial thickness less than 5mm. So ultrasound is used as a guide for us, that if there is a thickening then a biopsy is needed. I do understand that you are worried and want to know the risk. But it is not always possible for us to give numbers as every case is different and there are no tables to stratify risks for every condition. So I am extremely sorry that I am unable to be more specific in this regard. As of now, we may say that there is a slight risk [ more than the general population ] considering the age, absent pregnancies and thick endometrium. So please get a biopsy done to clarify matters. No amount of speculations will yield results and a hysteroscopic biospy will settle the matter. Please do not stress yourself. I hope I am able to help you this time. I know the matter is important for you and I share your concern. Please feel free to ask any further queries and I will be happy to help. Dr Madhuri
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Madhuri N Bagde 33 minutes later
Okay. Thanks a lot for your answers. I'll let you know how it turns out.
doctor
Answered by Dr. Madhuri N Bagde 1 hour later
Brief Answer: It was a pleasure answering your query. Detailed Answer: I will be waiting for the outcome. All my best wishes are with you. Take care. Dr Madhuri
Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Madhuri N Bagde

OBGYN

Practicing since :2001

Answered : 1390 Questions

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