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Thickened Uterine Lining

I’ve been told I have a Thickened Uterine Lining. What is it?

This is called Endometrial Hyperplasia which means the lining of the uterus has become abnormally thick. It most often is caused by excess estrogen without enough progesterone to balance it.

It usually presents as abnormal vaginal bleeding.

Here is the mechanism of how the uterine lining “works”. During menses, the hormone estrogen causes the lining to grow & thicken in preparation for pregnancy. Progesterone is made during the second half of the cycle and when progesterone levels drop, the lining is shed.

If ovulation does not occur, progesterone is not made and the lining is not shed properly. The endometrium may continue to grow in response to estrogen. This is not an optimal condition. It has the potential to lead to cancer in some women as the lining is allowed to keep building and building. This is because the cells that make up the lining may crowd together and become abnormal. TESTING:Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes the thickening of the lining), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why progesterone therapy can bring about a thin lining and shorter, lighter periods. It is also why women who miss ovulation (no progesterone produced) are at a greater risk for endometrial hypertrophy/hyperplasia and endometrial cancer. The most common reasons for a woman to not be ovulating (no lawn mower activity so thicker lawn) are having PCOS or being early perimenopausal. The diagnosis can be made by ultrasound or endometrial biopsy. The ultrasound image measures the thickness of the lining ("endometrial stripe"); with hypertrophy (over thickened) it is usually more than 12-15 mm.

The endometrial biopsy (or D&C) takes a sample of lining tissue and the pathologist can then make a very accurate diagnosis based upon the cells seen under the microscope. The treatment for simple hyperplasia/hypertrophy which does not contain abnormal cells is progesterone. This shrinks down the too thick lining. Try to avoid synthetic progesterone pills or shots, please.

Endometrial hyperplasia usually occurs after menopause when ovulation ceases and sufficient progesterone is no longer made. It can also occur in perimenopause when ovulation is often irregular. Also in cases of PCOS which is associated with irregular menstrual cycles.

Another cause: Taking estrogen after menopause without balancing it with progesterone.

Endometrial Hyperplasia is classified as simple or complex. Simple is a thickened lining without cellular changes. Complex is a little thicker than simple, with more crowding of the cells.

If abnormal cell changes are present, it is called atypical.


  • The most common is abnormal uterine bleeding such as heavy or longer bleeding, continuous, often with clots.

  • Short menstrual cycles (less than 21 days)

  • Bleeding after menopause

Hyperplasia is diagnosed by endometrial biopsy, transvaginal ultrasound, D & C, and hysteroscopy

Conventional treatment: Progestin (synthetic progesterone). Natural progesterone can help without the negative side effects.


Do not take estrogen alone…you need progesterone.

“They got together like two peas in a pod!”

Many of you are experiencing heavy bleeding in perimenopause and you are concerned because you always had “normal” periods

During perimenopause when estrogen and progesterone are fluctuating wildly, but you are still getting a monthly period, progesterone levels drop much lower than they would during a normal cycle. This allows for estrogen levels to remain considerably higher in ratio to Progesterone so it leads to a heavy build up of the endometrial lining this accounts for why the periods are unusually heavy, and often contain large blood clots.

Bioidentical progesterone helps with heavy, flooding periods

Many women say that within the first month of using Progesterone they noticed an immediate change in their periods. They became much lighter and no longer contained blood clots.

What about bleeding after Menopause?

Bleeding can occur in postmenopausal women for several reasons. For example, women who take hormone replacement therapy may have vaginal bleeding for a few months after starting the hormones. It is also possible a woman who was believed to be in menopause may ovulate. If this occurs, bleeding may also occur.

Although bleeding after menopause is often harmless, postmenopausal bleeding can sometimes be a sign of cancer. So, if it persists monthly, you would wisely make a doctor’s appointment. If it is determined that your bleeding is due to cancer, treatment depends on the type and stage. Common treatment for endometrial cancer includes surgery followed by chemotherapy and radiation.

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