Thin endometrial lining: causes, symptoms, diagnosis and treatment

This article provides a detailed overview of causes, signs, diagnostic tests and treatment options for thin endometrial lining, which is a condition affecting lots of women around the world.

What is thin endometrial lining?

Uterus is the child bearing organs of females. Uterus is made of three layers: inner most, middle and outer layer.

The inner mucous membrane of uterus of female is termed as endometrium. It is the innermost layer of uterus lying next to its muscular layer which is myometrium.

Endometrium has two layers: a basalis layer that is adherent to the myometrium, and a functional layer which undergoes different phases during a menstrual cycle. The endometrial lining contains a number of glands (secretary structures) and is meant for implantation of the fertilized egg in the uterine wall.

This lining is under the control of estrogen hormone and passes through different phases during the monthly menstrual cycle of female. Endometrium becomes thickened, rich in blood vessels and glandular in nature under the influence of estrogen hormone. This comprises the proliferative phase of menstrual cycle.

When the level of estrogen falls, this proliferation is terminated and the shedding phase of endometrium occurs that leads to menstrual bleeding. This is how normal endometrium is and how hormones control the normal functions of endometrium. The average thickness of endometrium is 8 mm which increases further in pregnancy. Less than 8 mm is considered inadequate according to the doctors.

During pregnancy, at least 9 mm of thickness is required to provide a site for proper implantation of fetus. This thickness not only plays a vital role in the implantation of fetus to the walls of the uterus but also supports the growing baby in the later stages of pregnancy. If, due to any cause, this lining becomes thin, it becomes impossible for the fertilized egg to get implanted to the wall. This can lead to infertility of a female uterus and pregnancy cannot take place because a fertilized egg needs a strong support for implantation and support for growing into an embryo.

Thinning of might be the result of hormonal variations in different stages of female like. For instance, after menopause estrogen levels fall down dramatically. As a result shrinkage of the endometrium is common in females after 40 years of age.

Causes of thin endometrial lining

Thinning of endometrial lining is a serious problem from gynecological point of view. Certain causes are described below.

Low estrogen

The menstrual cycle mainly depends on the levels of estrogen which is necessary for the thickening of endometrium. In perimenopausal (women close to age of menopause) and postmenopausal (women who have crossed menopausal age) women, there are inadequate levels of estrogen. It occurs in women of 40’s and above. Hence, there is very less possibility to conceive a baby after 35 years of age. In young women with low levels of estrogen hormone also have thin lining and mostly represent with amenorrhea (absence of menstrual periods). If a female wants to conceive, it is better for her to keep her estrogen levels checked. The measurement of endometrial lining is also helpful in this regard. In case of thin endometrium, medication with estradiol is prescribed to see if uterine wall responds well and thickens. If not, then it indicates there is inadequate blood supply or some damage to the tissue has taken place.

Inadequate blood flow

There are a bunch of reasons of insufficient blood supply to the endometrial lining.

These reasons include:

• Sedentary lifestyle: Those women who sit all the day or have to do work on a desk with a very little movement may have inadequate blood flow towards endometrial lining. It leads to the shrinkage of the lining.
• Malposition of uterus: The normal position of the uterus is tilted forward. Some women have uterus bent backward or on one side. This malposition (abnormally placed) uterus usually gets less blood supply.
• Fibroids of uterus: These are the non cancerous tumors of uterus which compress the blood vessels supplying the endometrial lining. As a result, endometrium does not get enough blood to proliferate. In old tumors, calcification takes place which make them hard and further compromising the blood flow to the endometrium.
• Uterine fibroid embolization: Sometimes cutting off the blood supply of these fibroids causes them to reduce their size by lack of blood circulation. But this procedure may block the blood supply of various parts of uterine endometrium, which causes thinning of endometrium.
• Arterial constriction of uterus: High levels of stress cause stimulation of sympathetic nervous system that subsequently causes arterial constriction. Stress also changes the levels of hormones which diminish the blood supply to the uterus. As a result, shrinkage of endometrium takes place.

Poor health of endometrial tissue

Any injury, surgery, trauma or infection can cause damage to the endometrial lining.

Following are the causes due to why thinning of endometrium may occur:

• Infections and pelvic inflammatory disease: Chronic bacterial infection, sexually transmitted disease and pelvic inflammatory diseases can cause constant inflammation that leads to scarring of the endometrial lining. Hence it cannot proliferate and its functions are compromised. In other words any disease of pelvis increases the chances of thinning of uterine endometrium.
• Dilation and curettage: This is a procedure in which functional layer of endometrium is removed in cases of miscarriages. If the basalis layer of endometrium is damaged, it cannot grow again.
• Scar tissue and adhesion damage: Damage and scarring of endometrium also takes place in these conditions: pelvic inflammatory disease, genital tuberculosis, reproductive organ surgery, laparoscopy, cesarean section and induced medical abortion.

Long term use of birth control pills

In those women, who take oral contraceptives, mainly progestin, for a longer period of time, there are greater chances of thinning and non functional endometrial lining. It eventually causes shrinkage of the endometrial lining. Oral contraceptive pills are nothing but a combination of estrogen and progestrogen. The overuse of these medicines throw the normal balance of body hormones out of order and result is altered estrogen level and endometrial thinning. This particularly occurs upon withdrawal of the contraceptive pills.

Excessive use of clomid

Clomid is a medication which stimulates ovulation (the rupture of follicle to release egg). It helps those couple who are trying to conceive for a baby. These medications can cause thinning of endometrial lining because these are antiestrogen (their activity oppose that of estrogen) in nature. Repeated use of clomid can cause blockade of estrogen as a result of which endometrium fails to proliferate.

Signs and symptoms of thin endometrial lining

There are no specific signs and symptoms related to the thin endometrial lining. However females suffering from thin endometrial lining usually present with following complaints:

Infertility problems

Most of the females present with infertility problems. As mentioned before a healthy and normal sized endometrium is critical for implantation and growth of fetus. If the endometrial lining is too thin, these things can’t take place normally. Hence women with thin endometrial lining cannot become pregnant until their problem is resolved.

Abnormal menstrual cycle

Women with problem of thin endometrial lining usually complain of abnormal menstrual cycle. It involves very light menses with little bleeding than usual.

Menses accompanied by pain

Some females with thin endometrial lining complain of menses accompanied by pain.

Irregular menses timing

Usual timings are also disturbed as menses become irregular.

Shorter menstrual bleeding

Bleeding also lasts for lesser time than usual. All this is because endometrial lining which has to be shed off is very thin and has less blood vessels and it takes less time for uterus to get rid of all the lining.

Risk factors of thin endometrial lining

Following are the factors which increase the risk of thinning of endometrial lining which leads to infertility in females:

• Diabetes mellitus causes the reproductive organs to get improper blood glucose. Moreover, the supply of blood to several organs gets affected in diabetes mellitus. Hence uterine wall becomes weak and endometrial lining shrinks in its size.
• Hypertension impedes the blood flow to the uterus thus increasing the risk of thin endometrial lining of uterus.
• Asthma causes low oxygen tension of the reproductive organs so they become undernourished and the endometrial lining starts shrinking in size.
• In Epilepsy, seizures alter the hormones levels and disturb the signals coming from brain. It also increases the risk of developing thin endometrial lining.
• Depression, anxiety, mental illness raise the stress levels of the body. In this condition, hormonal balance is disturbed causing low estrogen levels in the body. Moreover, high level of stress hormones and catecholamines compromised the blood supply of endometrium.
• Substance abuse of alcohol and smoking damages the uterine wall. Endometrial lining shrinks as a result and chances of infertility become very high.
• Immobilization or severe disability causing injuries, trauma or stroke etc. are also risk factors for the atrophy (shrinkage) of endometrial cells.
• Previous pelvic surgery weakens the uterine tissue and it is not able to hold the endometrial cells firmly. Hence, chances of implantation are greatly reduced.
• History of miscarriage or abortion is very important and indicates the high risk of thin endometrial lining which is unable to hold the fertilized egg.
• Long term use of contraceptives lowers the estrogen levels in the body and causes to decrease the thickness of endometrial lining. This phenomenon is especially prominent upon withdrawal of contraceptives.
• Pelvic infections cause drastic changes in the endometrium and damage the uterine cells. These are then unable to perform proper function during fertilization and pregnancy.
• Uterine tumors suppress the blood supply and nourishment of the endometrial lining and hence there are greater chances of decreased thickness of endometrium.

How doctors diagnose thin endometrial lining?

In the diagnosis of thin endometrial lining, main goal is to measure the thickness and then to find the cause of the decreased thickness of the endometrium. There are several new technologies introduced by the scientists that help in determining the cause. The most important techniques used for the diagnosis of thin endometrial lining include:

Pelvic exam

In this procedure, a doctor palpates the outer parts of the genital organs to see any abnormality. Then he puts two fingers of a hand into the vagina and presses the abdomen with the other hand. In this way, he is able to palpate the cervix and the vagina. A device called speculum is also inserted into the vagina, which makes the cervix and vagina dilated. As a result, the doctor can clearly see the inside of dilated uterus.

Transvaginal ultrasound

It is the major procedure used these days to measure the thickness and to check the texture of the uterus. A thin device is placed in the vagina and it produces sound waves that are caught on the surface of the uterus where they create an image. Doctor can see all the abnormalities. Thickness and texture of endometrium can also be seen. A similar procedure is known as hysterosonography in which normal saline is injected into the vagina and cervix through a small tube. It reaches the uterus and expands the uterine cavity. It gives very clear image of the inside of uterus to the doctor.

Hysteroscopy

It is a procedure used to diagnose if the doctor suspect of any polyps or tumors are present in the uterine cavity that might be suppressing the blood supply of endometrium. A thin, flexible, lighted telescope is inserted into the vagina and cervix and into the uterine cavity. Doctor examines the inside of the uterus and removes if he finds any polyps. This is a latest technique being used in various hospitals for diagnostic purposes and treating infertility.

Curettage

In this procedure, a long instrument made of metal is inserted into the vagina having a loop at the end. By this loop doctor scratches the uterine wall taking the sample of the texture of the endometrial cells. Any polyp, atypical cells or inflammatory cells are found if present. This procedure can also be done with the help of a hysteroscope. It is done mostly when biopsy results are not clear. Sample cells obtained then are examined under the microscope.

Biopsy

This is the procedure which includes removing the tissue from the uterine lining and sending it for laboratory analysis. Endometrial biopsy is a routine procedure and it does not require anesthesia. It is usually done for cancer cells in the uterus which makes the endometrial lining through by suppressing the vascular supply.

Treatment options for thin endometrial lining

To increase the thickness of endometrial lining, a number of methods can be used ranging from lifestyle changes to use of herbs and medicines. In some cases surgery is needed. The most important methods that are used to increase the thickness of endometrial lining include:

Estrogen therapy

As mentioned before, decrease of estrogen is the most important cause of thin endometrial lining. So increase the level of estrogen resolves the issue is majority cases. Estrogen can be given orally or for topical application on vagina. It stimulates the division of the cells of endometrial lining. The most common method is to give estradiol so that fertilized egg can be implanted easily. This is an effective treatment option often combined with other indirect estrogen therapies for better results.

Indirect estrogen therapy

In this therapy human menopausal gonadotropins (hMG) is given which stimulates the pituitary gland to release gonadotropin hormones. This stimulates the reproductive organs to release estrogen. This is a popular method to increase the thickness of endometrial lining and is helpful for those women who are trying to conceive a baby.

Electric stimulation

The method is to apply electrical stimulation on lower abdomen or on legs which increases the blood flow towards uterus and other reproductive organs. As a result, cells of endometrium proliferate in a better way to increase the thickness of endometrial mining. This method is very effective in those women who have thin endometrial lining due to excessive use of clomid and birth control pills. Their infertility problem can be solved in a better way.

Acupuncture

Acupuncture is the Chinese traditional way of treatment. It involves any insertion of needles at certain pressure points of the body, lower abdomen in the case of thin endometrial lining. Clinical studies have shown that acupuncture therapy can improve the supply of blood to the uterus and can thus increase the thickness of endometrial lining.

Clinical trials

These trials include medications other than the estrogen. G colony stimulating factor (CSF) is another growth hormone which is helpful in increasing the thickness of endometrial lining. Other approach is Tamoxifen vs Clomiphene citrate, which indirectly raise the levels of estrogen hormone. Thus, it also helps in the thickening of endometrial lining. Most recent clinical trials on uterine infussion with stem cells are also very promising.

Exercises for thin endometrial lining

Adequate movement of the abdomen, legs, hips and joints is necessary to improve the circulation of genital organs. Exercise helps in two ways.

First, regular exercise improves the supply of blood to the reproductive organs.

Second, regular exercise also reduces the amount of stress hormones- the harbingers of decreased supply of blood to the endometrium and thin endometrial lining. It is essential to keep the uterine artery open, which is major blood supply for endometrial lining.

On the other hand, sitting all the day can compress the reproductive organs. Fertility yoga is very helpful for those women who struggle to thicken their endometrial lining. No matter what is the cause behind thin lining, fertility yoga not only enhances the blood circulation but also makes the muscular layer strong and supportive for implantation.

Natural cures for thin endometrial lining

Supplements and herbs are useful in protecting the uterus and its endometrium from damaging effects and supply nourishment that leads to increase the in thickness of endometrial lining.

These herbs and supplements include the following:

Herbs and supplements that support healthy estrogen levels

These help the reproductive organs to release estrogen and maintain its levels in the body in order to nourish the endometrial lining.

• Red clover is an important source of phytoestrogen (plant derived estrogen). Red clover helps to increase the body circulation. It provides vitamins and minerals essential to keep the uterus healthy. It also helps in detoxification of pollutants from the body and hence is very helpful for improved function of the kidney and liver. It results in healthy and thick endometrial lining and improves fertility of a woman.
• Asparagus racemosus is also known as Shatavari. It is a herb that is famous for maintaining the estrogen levels in the body. It contains steroidal saponins which improves the immune system and significantly decrease the amount of stress hormones. It also protects the body from hormonal imbalances because it is also a phytoestrogen (estrogen derived from plant sources). As a result, thickness of endometrium is increased and uterus is protected from tissue damage or scarring.
• Royal jelly is famous because it has estrogen like effects on the body. That is why those women who are suffering from inadequate estrogen levels can take this jelly. Studies have shown that it also increases the size of uterine cells hence its helps in increasing the thickness of endometrial lining.
• Maca root controls the proper levels of estrogen in the body and thus it helps in improving the conditions of uterus and endometrium for better chances of ovulation and conception.
• Ground Flax seed contains lignans. Lignans are strong phytoestrogens (see above) and their basic role is to remove the excess of estrogen from the body because it is also harmful for the endometrium. Flax is also high in fiber. It helps in maintaining the hormone balance of the body.
• Wild Yam root helps in performing the proper function of the uterus by maintaining the estrogen levels in the body.

Blood building herbs and supplements

Women need adequate amount of iron in the body for better circulation. Those supplements which increase the absorption of iron in the body are also essential for proper thickness of endometrial lining. Hence, food, herbs and supplements rich in iron are helpful in keeping the uterus healthy.

Following are included in this category:

• Dong Quai root is recommended for those women who suffers from iron deficiency anemia (low blood circulating hemoglobin levels in red blood cells).
• Nettles leaf is high in iron and vitamin C which nourishes the blood. An increase in blood flow keeps the endometrium healthy and fertile.
• Raspberry leaf supports overall health of the uterus because it is rich in carotenoids (anti-oxidant compound), vitamins, citric acid, iron, calcium, phosphorus etc. That is why it is a natural tonic of the uterus.
• Hibiscus flower is very helpful in nourishing the endometrial lining because it is high in vitamin c which helps in absorption of iron. As a result blood is formed and blood pressure becomes normal.
• Rose hips protect the nervous system and hormonal balance in the body. It contains essential nutrients and vitamin C which helps in absorbing the iron.

Herbs and supplements that increase the blood circulation in endometrium

• Vitamin E and L-Arginine have been proved to be very useful in increasing the thickness of endometrium in the women with thickness less than 8 mm. When experiments were performed to see the effects of Vitamin E, it was proved that it increases the glandular epithelial growth and develops the vascular supply to the tissue. These supplements basically increase the uterine radial artery blood flow. After results of the research it was shown if Vitamin E is given 600 mg daily, it improves the endometrial thickness in 50% of the patients and it increases the uterine artery blood flow in 65% of patients. If L-Arginine is given 6 grams daily, it causes improvement in the thickness of endometrium in 90% of patients and enhances the uterine radial blood flow in 68% of the women.
• Dong Quai root is rich in iron so it is helpful in blood formation and increased blood flow towards uterus.
• Fertility enzyme therapy is very useful these days to stimulate the circulatory system in the body. Specific enzymes in the body enhance the metabolism. Proteolytic enzymes increase the flexibility of the red cells, inhibit the aggregation of the platelets and prevent the abnormal clotting of the blood. This therapy is also a cleanser for the tissues and stimulates formation of new healthy tissue by improved circulation. It helps removing the stagnant blood in the tissues and removes the toxins as a result. By bringing oxygenated blood to the uterus, endometrial cells and eggs increases the fertility and chances to conceive.

Herbs that strengthen the uterus

A thin endometrial lining is the indication of improper functioning of uterus. The use of following mentioned herbs can be useful in strengthening the uterine muscles and increasing the thickness of endometrium.

• Evening primrose oil has a direct effect on uterine cells because it is rich in L Arginine. It acts as a natural toner and increases the relaxation and contraction of smooth muscles of the uterus. It helps in increased cell division capability in the endometrial cells.
• Motherwort especially its aerial parts help the uterus to work properly. It stimulates the uterus mildly and hence increased thickness of endometrium can be obtained.
• Red clover is blood purifying herb. It is rich in vitamins and minerals. Calcium and magnesium helps in contraction and relaxation of the uterine muscles. Improved blood flow makes the proper functioning of uterine muscles.
• Raspberry leaf is one of the best herbs for uterine and endometrial health. It increases the tone of the uterus and helps keeping it healthy and well nourished.
• Dong Quai root helps regulating the hormonal control. It’s important function is to maintain the timing of monthly menstrual cycle.

Physical therapies for thin endometrial lining

Following physical therapies are very helpful in stimulation of endometrial cells, which then proliferates rapidly. Uterine muscles become strong and healthy and hormonal balance is improved. Increased circulation makes the reproductive organs well nourished and healthy. Infertility problems can be reduced at least by these natural methods.

Self fertility massage

It is necessary for the proper health of uterus. The uterine muscles become weak if the endometrial lining is thin. External massage hence stimulates the uterus once again. As a result enhanced circulation makes the uterine muscles strong, increase the thickness of endometrium, help in detoxification of reproductive organs and improve the proper function of hormonal feedback. By the help of self fertility massage, scar tissue damage can be removed and healing of the endometrium occurs.

Castor oil packs

This therapy is very helpful in stimulation of circulatory system, lymphatic supply and liver function. When the castor oil is applied on the body, the tissues beneath it become strong and the damaged tissue is healed rapidly. That is why it is often used in breakdown and removal of scar tissue, detoxification of reproductive organs, promoting direct blood flow towards uterus and supports the hormonal balance. Increased thickness of endometrium can be obtained by this therapy.

Acupuncture and moxibustion

Acupuncture is Chinese traditional method of treatment in which stress is released by interrupting the negative stimulation of nervous system. It is done by increasing the release of beta endorphins, which are chemicals causing relief from pain and stress. Stress causes the uterine vessels to shrink whereas beta endorphins make more blood to flow towards uterus. Endometrial cells hence proliferate rapidly. Moxibustion is the burning of a herb Mugwort. This burnt mugwort is then used on the tip of the needles of acupuncture. The method is to apply heat through it which heals the damaged tissue and remove the scar. Mugwort stimulates the blood flow towards the pelvic area. It has positive effects on uterus and endometrium.

Radiant womb therapeutic massage oil

This oil massage therapy is very useful in supporting the reproductive health. It is therapeutic oil massage done by infused herbs to maintain the hormonal balance, proliferate the endometrial cells, strengthens the uterine tissue and increased circulation to the uterus.

Fertility enzyme therapy

In cases of scar tissue and adhesions in the uterus, which makes the endometrial lining thin and weak, doctors may suggest you the fertility enzyme therapy. In this method, systemic enzymes are used to break the adhesions, reduce inflammation, lessen the pain and promote the health of the uterus. Systemic enzyme blends have shown to enhance the circulation and thus damaged and scarred tissue is broken down from the uterus and new endometrial cells proliferate to increase the thickness. This takes at least 6 weeks prior to trying to conceive because healing takes this much time. Castor oil packs massage and self fertility massage is often combined with this therapy for better results.

References

1) Uterine infusion with stem cells - clinical trial
2) Endometrial morphological changes due to contraceptive medication