Patient's question:
A year ago, my menstrual cycle was short, about twenty days, and the bleeding lasted for about seven days. Now, it's surprising that it's around thirty days, but the bleeding lasts for more than twenty days. When I had an ultrasound at the hospital, they found that the endometrium was thickened, and it seemed like there were cysts. The doctor asked me to take four days of progesterone and then take some medication when my next period comes. During the progesterone treatment, I only took 10 mg for the first two days, and then 20 mg for the next three days. I'm very frustrated. I'm only twenty years old now, and I'm afraid of getting infertility. Please give me some advice from an expert.Doctor's answer:
Hello, the endometrium is the mucous membrane that covers the uterine cavity. It is one of the most highly differentiated tissues in the human body. During childhood, the endometrium develops and grows slowly until the premenarcheal period, when estrogen begins to have a significant effect on the glandular stroma of the endometrium.Menstruation marks the beginning of sexual maturation in women. During the menstrual cycle, the endometrium also undergoes cyclical changes. Under normal conditions, an egg is released once per menstrual cycle. If fertilization does not occur, menstruation occurs, and a new cycle begins. If the egg is fertilized and pregnancy occurs, the endometrium undergoes decidualization. The menstrual cycle is primarily regulated by ovarian hormones. If ovarian hormone levels are disrupted, it will inevitably lead to menstrual disorders, and the endometrium will also undergo corresponding morphological changes. Clinically, this may manifest as amenorrhea or "dysfunctional uterine bleeding" (DUB). Among these, DUB is more common.
There are many causes of "dysfunctional uterine bleeding," and the primary causes may differ depending on the age group. Endometrial hyperplasia is one of the most common conditions.
Endometrial hyperplasia is caused by excessive estrogen stimulation of the endometrium. Clinically, it presents as irregular, excessive, and abnormal uterine bleeding. Patients may experience persistent bleeding after a prolonged period of amenorrhea, which may be mistaken for miscarriage in clinical practice. It can also manifest as a shortened cycle length, prolonged menstrual periods, with bleeding lasting up to one month.
Pathological examination shows that the degree of endometrial hyperplasia does not always correlate with the severity of bleeding. It is characterized by endometrial thickening, with thickness ranging from 3 to 12 millimeters, and in some cases, it can even reach 20 millimeters. The endometrium appears grayish-white or pale yellow, with a smooth surface or polypoid elevations, and may be accompanied by edema. The cut surface shows