Patient's question:
Detailed medical history: I am a 29-year-old married woman. My menstrual cycle has always been relatively normal, lasting about seven days, with a cycle of approximately 28 days. Two years ago, after a sexual intercourse, I experienced non-menstrual bleeding. I went to the hospital for an ultrasound examination, which showed no abnormalities. However, two months later, my endometrium began to show non-homogeneous thickening. On the seventh day of my period, the thickness of the endometrium reached 1.8 cm, accompanied by intermenstrual bleeding (ovulation period bleeding). After taking traditional Chinese medicine for regulation, the condition gradually improved. The intermenstrual bleeding stopped, and the endometrium became much thinner, but the non-homogeneous thickening still persisted. On the seventh day of my period, the thickness was 1.2 cm. However, after stopping the traditional Chinese medicine, the condition worsened again.Doctor's answer:
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, and during the menstrual cycle, the endometrium 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 hormones are disrupted, it will inevitably lead to menstrual irregularities, 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 DUB, and the main causes vary 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 may 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 may sometimes reveal dilated glands forming cystic spaces. This condition is classified as endometrial thickening, and endometrial hyperplasia may have the potential to transform into malignancy. Because DUB is divided into ovulatory and anovulatory types. For women to conceive, the key lies in the ovary releasing an egg. If you do not ovulate, you cannot conceive normally.