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Help Enlarged uterine wall
An_248179 posted:
My mom is 44 years old a mother of three recently she went to her primary Doctor where they told her she had a uti. She was on antibiotics and that didn't help. So she went to her obgyn. She does have a uterine fibroid on the outside of her uterus And also a uterine cyst and a cyst on her kidney. She has a history of uti ' s as a child. Her symptoms are pressure down there and sometimes a need to urinate a lot. The doctor had her get a ultrasound , which they told her her uterine wall was very thick at 27. ( mm i am assuming ) not sure how they measure that , But she hasn't had her period yet should get it any day now. But has no abnormal bleeding and periods are very regular. Her doctor said wait two weeks and come back for another ultrasound. Please help any info would be helpful I am so worried for her and scared its something bad. Thank you
Jane Harrison Hohner, RN, RNP responded:
Dear An: Your description of her salient health history was great; thank you. The uterus is comprised of a muscular wall ("myometrium") lined with tissue ("endometrium"). One can have a thickening in either (or both) areas.

Thickening in the muscular wall---The most common case is multiple very small fibroids. Individual large fibroids in the wall can do this as well, although they are easily seen on ultrasound. If a woman has endometriosis, the endometriosis can grow into the wall ("adenomyosis") creating an enlarged, boggy, tender uterus. Cancers of the wall of the uterus are a MUCH less common cause of a thickened wall.

Thickening of the lining---Another term for this is endometrial hyperplasia. Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods.

Endometrial hypertrophy is a common cause of heavy and prolonged bleeding. The diagnosis can be made by ultrasound or endometrial biopsy. The ultrasound image measures the thickness of the lining ("endometrial stripe"); with hyperplasia it is usually more than 12-15 mm. I had a patient once with a stripe of 30mm! The endometrial biopsy takes a sample of lining tissue and the pathologist can then make a very accurate diagnosis base upon the cells seen under the microscope. The treatment for simple hyperplasia which does not contain abnormal cells is synthetic progesterone pills or shots. This shrinks down the too thick lining.

Lastly, a too thick lining by ultrasound can also be multiple polyps of the lining which can create an uneven thickened appearance on ultrasound.

In your mom's case, she has a history of known fibroids. In fact a large fibroid on the front side of the uterus can press against the bladder creating the need to void more frequently (kind of like what happens to pregnant women as the uterus expands and restricts bladder capacity).

Yet my best GUESS is that the concern is a too thick lining since they want to recheck after her next period (lining being shed). IF this is correct they may decide to do do an endometrial biopsy or D&C. They could also use a saline infused ultrasound to check for polyps or a fiber optic light scope to actually look inside the uterus and look for polyps/fibroids/too thick lining.

If she gets a diagnosis after her next period and/or any further testing, would you be so kind as to let us know. Your very clear subject line may lead other women with the same concern to find your mom's information.


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