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How thick is too thick for a uterine lining?
rosie07 posted:

Take the Poll

How thick is to thick for Uterine Lining. I recently had a vaginal ultrasound that showed no abnormalities but my uterine lining was 19.8 mm, 10 days prior to getting my period. I'm 38 years old. Doctor thinks it is a hormonal imbalance. What do you think?
  • Yes to thick, get a second opinion
  • Within normal range for the luteal phase
  • Push for biopsy
View Poll Results
georgiagail responded:
A bit of a technically complicated article but it does discuss the various stages of uterine lining:

Anon_6061 replied to georgiagail's response:
You may want to have it rechecked a day or two after your period ends. That's when it would be thinnest since you would have shed the buildup.
Jane Harrison Hohner, RN, RNP responded:
Dear rosie: A uterine lining that is almost 20 mm would usually be considered "too thick" even for cycle day 18. The most common reason for this would be "hormonal", that is inadequate progesterone exposure. Inadequate progesterone can be a result of missed ovulations or low progesterone production when an ovulation occurs.

I would urge you to follow up with your GYN. They are in the best position to decide whether to follow you with a repeat ultrasound (as suggested by Anon 6061), a biopsy, a saline ultrasound if polyps are suspected, or even empiric treatment with hormones.


PS to other readers: Be sure to check the valuable link provided by georgiagail if you have additional questions about endometrial ultrasound results.
rosie07 replied to Jane Harrison Hohner, RN, RNP's response:
Thank you so much for all your response. I have contacted a GYN for a second opinion, just wanting for them to receive my ultrasound results to schedule. However, in the mean time I have looked into the possibility of low progesterone. I believe I still ovulate (I am very regular, every 28 days) can you ovulate but still get a period? Or, what I think may be happening is I'm ovulating, but like Mrs. Harrison said, I may have low progesterone during ovulation. I am spotting/light bleeding also during that time (which is what prompted the ultrasound to begin with). It doesn't last long, but could this also be a sign of low progesterone?
Since then (about a week now) I have been on 100 mg's of b complex daily. I don't know if this has anything to do with controlling my hormones, but I seem to have less pms symptoms ie, breast tenderness (which is usually really bad for me). I was talking with a lady I work with and she has been using a natural progesterone cream around ovulation and has helped her ton. She urged me to try after this cycle, however, I really don't want to start messing with my hormones (outside of b complex) until I get a second opinion. What do you think?

Just one more question....(sorry). Can you have an trans vaginal, and abdominal ultrasound and miss polys or fibroids? My doctor said that everything looked uniform, that is why she jumped to a hormonal cause.

Again, thank you for your responses. It has helped me to look at other possibilities other then cancer (because that is what my mind jumped to). Praying that the second opinion comes soon.
Jane Harrison Hohner, RN, RNP replied to rosie07's response:
Dear Rose: I concur with your plan to not do any natural progesterone cream until you have a definitive diagnosis. Your GYN can even prescribe a natural progesterone pill ("Prometrium") which is an FDA approved, standardized form of natural progesterone--if indicated.

Yes, a woman can have apparently regular flows and yet still not be having regular ovulations. How can this happen? In a cycle without an ovulation, estrogen stimulation (assisted by the hormone FSH ) will continue to make the lining of the uterus grow thicker and thicker. In the absence of a LH surge, no ovulation will occur. The progesterone level will not rise. When the follicle that contains the un-ovulated egg involutes the woman's blood estrogen level will drop. This triggers much of the lining to be shed. Thus if it takes two to three weeks for the follicle and un-ovulated egg to regress, the woman may have somewhat regular bleeds.

How often does this happen? In a study of 20-35 year old women who were had regular cycles but were infertile, an average of 30% of women were not ovulating. Among these 123 women with regular cycles the highest incidence of not ovulating was 41%. This highest incidence occurred among women who had never had a conception. Women who had at least one documented pregnancy had a lower incidence of non-ovulation despite regular periods.

In terms of the ultrasound, usually fibroids are visible by ultrasound. Polyps may show up as a non-uniform thickening. It sounds like your GYN had already looked for these culprits before deciding on a hormonal etiology.

Please do let us all know what the second opinion states.

Jane & Other Readers
rosie07 replied to Jane Harrison Hohner, RN, RNP's response:
Thank you again for your quick response, and I will be sure to let you know what the second opinion states.

Regards to having a regular cycle but not ovulating. I have two children 11 and 9 and had no troubles with conception. Can you start NOT ovulating and any given point? Could this be the start of perimenopause? Also, can you have low progesterone levels and still ovulate? One more thing, if it were something more serious (cancer) would there be more obvious signs? Sorry for all the questions, there is just so much to learn on this topic!!

Thank you again for all the very helpful information. It has been very much appreciated!
rosie07 replied to rosie07's response:
I just wanted to report back that I did get a second opinion and my OB/GYN found that the first ultrasound had two different measurements in the report that my first Dr. didn't catch. One measurement was 19.8 mm and the other was 10.8mm. After completing a second transvaginal ultra sound 7 days after my period my lining was only at 7.7mm and everything looked unformed. After reviewing the results of the first ultra sound the 10.8 mm was the correct number. So, why the bleeding? Well, the second GYN that I saw stated that I was having a surge of hormones right around ovulation. Since it was happening at the same time every month. To treat I can A). Live with it or . Go on brith control. Right now I'm choosing to just live with it, vs going on a pill. Since I'm shedding my lining each month, I'm not in danger of it building up. If it gets worse over time I may choose to go on the pill then. Also, she feels that this just may be the start of the "Change"....which she stated can happen 10 years before you actually go through menopause. Fun!
Thank you for all your advice!
Jane Harrison Hohner, RN, RNP replied to rosie07's response:
Dear rosie: What a great lesson in the value of a second opinion! We're so glad that the number was not 19.8 mm, and that the lining looked uniform. And yes that GYN was correct. One can have "estrogen withdrawal bleeding" triggered by the brief spike of estrogen which comes at ovulation then drops back down. So women will have spotting/bleeding every month; others never.

Thanks so much for sharing your story. There's a lot of valuable information in your posts--and it really reinforces the wisdom in asking questions/getting other opinions if needed.

In Gratitude,
zhangs replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,

I just being diagnosed having thick uterus lining by my GC doctor. It was diagnosed through lab test, not ultrasound. So when I asked how thick it is, there was no specific number. Anyway my doctor prescribed the generic pregestrone pill (100mg) for me to take for 3 months.
So far I took it at 11 pm, and feel sleepy about 20 minutes later. The pill seemed to help me sleep well almost like sleeping pill. I got heavy dreams and hangovers in the morning. Just 4 days after taking the pill, I feel light dizzyness in the morning. I also got light period.
I have had relatively heavy period for the last two years every 24 days. I am just being diognosed with iron-deficiency anemea.
I just turned 50 last month and had first abnormal period (very light and much delayed). I was actually pleased with the light period. But now since I started the progestrone, the period starts again, although light.
Should I continue the pill with 100mg dosage everyday? I am a bit worried if it will affect my daily work and my brain function. I feel my brain is not as clear and sharp as before when I took the pill.
Thank you in advance for your adivce.


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