Uterus lining shed happens to women during menopause. If your mom prepared you before you got your period, you should also prepare for menopause. You might have friends who can share similar experiences. However, it is best to read and educate yourself about the inevitable hormonal change your body will go through.
Table of Contents
What is uterus lining shed
The uterus comprises of two layers. The thin inner layer of the uterus is the endometrium. While the outer thick muscular layer is the myometrium.
A regular menstrual cycle happens after every 28 days. In each cycle, the woman’s body prepares the uterus lining to create an ideal environment to go through a healthy pregnancy.
The endometrium thickens and prepares the body for a normal pregnancy. However, when the person chooses not to become pregnant, the endometrial lining starts shedding during menstruation.
During menopause, the ovarian hormone stops producing, which creates uterus lining shed.
What you should know about menopause
Uterine lining shedding after period happens after your last menstrual cycle ever. Towards the end of your menstrual journey, you will face a lot of irregularities.
According to gynecologists, if you do not have periods for 12 months straight, you can confirm you have menopause. Otherwise, it can be irregular for a long time before it actually stops.
Spotting or bleeding that happens after this period is postmenopausal bleeding (PMB).
Normal endometrial thickness
Did you know that postmenopausal bleeding is one of the common complaints associated with a 1–10% risk for endometrial cancer? It depends on the person’s age and the risk factors in each scenario.
Since cancer risk is very high, you need a standard diagnostic evaluation to exclude any malignancy.
As per a study, doctors use a threshold to measure the average endometrial thickness.
Chances of cancer is high in women who have thick endometrium lining. For postmenopausal women who go through vaginal bleeding, the average endometrial thickness should be below 5 mm. More than 5 mm lining is concerning.
The cancer risk for a postmenopausal woman with vaginal bleeding is approximately 0.07%, with a thin endometrium lining (≤ 5 mm).
Whereas, for women with thick endometrium lining (> 5 mm), the risk stands at 7.3%
Uterine lining shedding no blood
Under normal conditions, the uterus lining shed a limited amount of blood in each menstrual cycle (80 ml or so). Excessive bleeding during menstrual cycles is abnormal, which makes the uterus lining shed.
Also, for women who enter menopause, uterine lining shedding might lead to bleeding or spotting. But it is not normal.
Abnormal uterus lining shed can occur due to various conditions.
Causes of uterus lining shed
Most of the condition that causes uterus lining shed happens at a specific time in a woman’s life. However, some women facing abnormalities can face it any time:
Among young girls
Bleeding before the menarche (first period) is not normal. The bleeding may originate from trauma, any foreign body (for example, toys, toilet tissue, or coin), skin irritation (due to soaps, infection, or lotion), or even any urinary problems. Bleeding can also happen due to unfortunate situations like sexual abuse.
After the first period, most girls undergo irregular bleeding, which usually indicates irregular ovulation. This irregular bleeding resolves without treatment once the ovulation and hormonal cycle regularize. However, you need further evaluation if irregular bleeding continues.
In teens, abnormal bleeding can happen due to infection, bleeding disorders, other medical issues, or pregnancy.
Many conditions cause uterus lining shed in women between adolescence and menopause.
Abrupt hormonal changes during ovulation can also cause vaginal bleeding or spotting. Erratic bleeding occurs in premenopausal ladies who are on birth control pills.
Women who do not have regular ovulation experience erratic or unpredictable vaginal bleeding. Also, irregular ovulation is most common when periods first begin, and during perimenopause, it occurs any time between the reproductive period.
Birth control and hormonal pills
Women and girls on birth control or hormonal medication (e.g., patch, pills, ring) may also face “breakthrough” bleeding between periods. This happens during the first months due to changes in the uterus lining. But if it continues for long, you must consult a doctor for thorough diagnosis.
Women who use injectable contraception can face irregular bleeding, but it stops over time. Progestin-releasing intrauterine devices (IUDs) can also cause such bleeding.
With time, the bleeding becoming lighter. In the long term, women often start experiencing spotting, scanty bleeding, or no bleeding.
Menopausal transition period
Even before the menstrual cycle ends, a woman faces a period known as perimenopause or menopausal transition. During this transition, the duration of periods starts change alongside irregular ovulation.
The ovaries in this period start to decrease the production of progesterone and estrogen. These changes make the endometrium produce excess tissue.
Endometrial hyperplasia increases the possibility that polyps eventually develop abnormal bleeding causing uterus lining shed.
You can presume a menopausal transition happen when experiencing abnormal uterine bleeding.
Women in this menopausal transition also have the risk for many other chronic diseases, including infection, cancer, and systemic illnesses. Even further evaluation may be required with irregular menstrual cycles.
Women still ovulate in this menopausal transition and can conceive. However, pregnancy may cause bleeding leading to miscarriage.
The most common reason to have perimenopause period is birth control and hormonal medications. It causes breakthrough bleeding.
Under this scenario, bleeding may occur at any time during the menopause period. You should consult a doctor to find out if you have:
- atrophy or thin uterine lining is caused by the fewer hormone levels
- endometrium Cancer
There are some scenarios where women regularly ovulate and experience excessive and erratic blood loss in their menstrual cycles. Such conditions may also cause uterine lining shedding.
The most common causes of this bleeding are uterine adenomyosis, endometrial polyps, or uterine fibroids.
Fibroids are masses present in the uterus muscle layer (myometrium), and adenomyosis is where the uterus lining (endometrium) grows into the myometrium.
These conditions can cause uterine lining shedding. For example, adenomyosis and Polyps Fibroids also occur among anovulatory women.
Some other root causes of thin uterine lining include:
- endometrium infection
- anticoagulant medications or platelet abnormalities
- chronic urinary disease
Evaluation of uterine lining shedding
A doctor will determine your medical history to investigate the amount of blood loss and the duration. They will assess reasons for bleeding and symptoms associated with bleeding, such as fever, pain, or even vaginal odor.
Other factors that can cause the bleeding include sexual intercourse or a hereditary disorder. The doctor will review your cases to find out such conditions.
Gynecologists also review medications and medical history. Some other factors may include recent change in weight, stress, or a new fitness regime.
The diagnosis requires you to go through a physical examination to evaluate overall medical condition. Note that you might need to take a pelvic examination to confirm uterus bleeding.
The clinician examination will look for lesions (sores, cuts, tumors, and polyps). They will examine the shape and size of the uterus to see if there are any signs of cervical bleeding. It is common to have a pap smear test that helps look for signs of cervical cancer.
Here are some tests you should be aware of:
1. Laboratory tests
Premenopausal women might need to take a pregnancy test.
An anemia (low blood count) test can help identify blood clots if any.
2. Ovulatory status
Hormonal irregularities contribute to many abnormal uterine issues. There are also tests to determine a woman’s ovulation cycle.
3. Endometrial assessment
To eliminate endometrial cancer, you may have to go through tests to assess the endometrium lining.
4. Endometrial biopsy
Women who are 45 or older, might need to do an endometrial biopsy. A thin instrument goes into the cervix and vagina to extract a sample for the examination of endometrial tissue.
5. Transvaginal ultrasound
A transvaginal ultrasound, also known as TVS, helps check an organ’s structure and shape. In TVS, an ultrasound device is inserted to examine the uterus, which can show a clear picture of the lining. The process helps measure and evaluate the lining. Postmenopausal women usually have a thin uterine lining with uterine bleeding.
You should carry the endometrial lining thickness chart with you before doing this test.
6. Saline infusion test (sonohysterography)
In the saline infusion test, a TVS is performed by inserting sterile saline into the patient’s uterus with the help of a thin tube. This process can expose any abnormality in the uterus.
In hysteroscopy, a scope goes through the cervix to analyze uterus health. Fluid or air passes through the uterus to expand for a better view of the patient. To eliminate any discomfort, you can agree to get an anesthes before the examination.
8. Dilation and curettage (D&C)
Under this test, the opening of the cervix of the patient’s uterus is usually dilated to allow the physician to remove any uterine tissue or endometrial. This procedure mandatorily requires anesthesia before examination.
Treatment for uterine lining shedding
The treatment depends on the below underlying causes:
Birth control or hormone pills
These pills resolve uterine bleeding due to hormonal irregularities or changes. Birth control medicines are generally used by women who have irregular periods.
They cannot predict their ovulation. To prevent the extra growth of the uterine lining or endometrium, they might need to take such medicines.
However, women who ovulate regularly, might be recommended to take these pills for heavy menstrual cycles and unbearable cramps.
For menopausal women, the medication is given to prevent the abnormal growth of the endometrium.
Progesterone is produced by the ovaries, which helps treat excessive bleeding in women who do not ovulate regularly.
A synthetic type of progesterone is known as progestin. These pills may be prescribed to treat abnormal bleeding. These are taken each month for 10-12 days.
Women who go through this therapy may face vaginal bleeding cyclically. This progestin procedure does not guarantee consistent contraception. Hence when cyclical bleeding does not happen, one can explore the possibilities of pregnancy.
Progestins can be given in many ways, such as an implant, an injection, or even an intrauterine device (IUD).
IUD secretes progestin, recommended for patients with abnormal uterine thinning or bleeding. IUD is a T-shaped instrument inserted via the vagina and cervix to examine the uterus.
Progestin-releasing IUD decreases blood loss and works as a pain relief associated with the menstrual cycle. Also, as per a study, with the use of an IUD, menstrual bleeding completely stops for the women, and the same is reversible as and when the device is removed.
To avoid surgeries IUDs may be prescribed and are always a better option.
Surgery is sometimes necessary to remove abnormal uterine skin, like polyps or fibroids. This can be an option for women who are done with childbearing and can now consider a surgery known as endometrial ablation.
This uses cold, heat, laser, or electrical energy to destroy the unwanted lining present in the uterus. Women with fibroids can undergo surgery by removing them or controlling their blood supply.
A hysterectomy or removing the uterus is the most effective surgical way to treat the abnormal uterus. In a hysterectomy, the physician may leave the ovaries in place or get them removed. It all depends on the patient’s condition. This procedure is performed by robotic or conventional laparoscopy.
How to maintain endometrial thickness
Maintaining a balanced diet
A balanced diet accelerates the body’s job to produce the right amount of estrogen, keep balanced hormones, and regularize blood flow. Food rich in fiber helps maintain a low glucose level by controlling insulin.
Sleeping is one of the most critical factors that help in improving endometrial thickness.
Exercising is often recommended to improve overall health; however, it can also help maintain a healthy endometrial thickness since it improves blood supply and blood in the woman’s womb.
Now you have a detailed idea on uterus lining shed. If you have irregularities, feel pain, cramps, or face other menstrual disorders, speak to a gynae today.