The term “endometrial echo inequality,” which seems simple, actually contains a wealth of information. It is not a standalone disease diagnosis but an ultrasound imaging manifestation, indicating that there may be some abnormalities in the endometrium.
Today, let’s delve into this phenomenon together to help women better understand this ultrasound manifestation, so they can face potential health challenges more calmly and reduce unnecessary anxiety and worry.
What is endometrial echo inequality?
In ultrasound examinations, under normal circumstances, the echo of the endometrium is uniform, and the endometrium usually appears as a strip or linear echo within the uterine cavity in ultrasound images.
However, when there are abnormalities or lesions in the endometrium, the echo becomes uneven, showing thickening, mottling, irregularity, etc. This is an ultrasound descriptive language, not a disease diagnosis. This uneven echo may suggest potential issues with the endometrium, requiring further examination and assessment.
Common causes of endometrial echo inequality
Physiological changes
The vascular dilation and increased blood flow in the endometrium during menstruation support the shedding and expulsion of the endometrium. These blood flow changes also appear as enhanced or uneven local echoes in ultrasound examinations.
After menstruation, the endometrium is at its thinnest, which is why we choose to observe the endometrium within one week after menstruation, as it allows for a clearer detection of possible lesions; during the ovulatory and luteal phases, the endometrium gradually thickens, and the echo correspondingly strengthens. These physiological changes are normal and should not be overly worried about. However, if the echo inequality exceeds the normal physiological range, other possible causes should be vigilant.
Endometrial polyps
Endometrial polyps are more common in women around menopause and postmenopause. The 2024 guidelines of the Society of Obstetricians and Gynecologists of Canada indicate that the risk of malignancy of endometrial polyps in the general population is about 0.5%-5.4%, but the risk of malignancy increases in the following groups.
Obesity, combined with metabolic diseases such as hypertension and diabetes；
● Postmenopausal women over the age of 60;
● Patients with abnormal uterine bleeding;
● Patients using tamoxifen.
The formation of endometrial polyps is complex, involving various factors such as hormonal imbalance, chronic inflammatory stimulation, abnormal angiogenesis, genetic and hereditary factors, drug effects, and lifestyle.
In high-risk groups, we should strengthen monitoring and management.
Intrauterine adhesions
Common causes include:
(abortions, hysteroscopic surgeries, etc.);
● Endometritis;
● Endometrial tuberculosis;
● After pelvic radiotherapy, etc.
Clinically, it is often manifested as
progressive reduction in menstrual volume, even amenorrhea, cyclical lower abdominal pain, lower abdominal distension, infertility, or recurrent miscarriage, etc.
Hysteroscopy is the gold standard for diagnosing intrauterine adhesions. Although ultrasound examination cannot confirm intrauterine adhesions, it is also an important means of preliminary assessment of intrauterine adhesions.
Endometrial hyperplasia
There are also high-risk factors, such as:
● Diabetes;
● Hypertension;
● Polycystic ovary syndrome;
● Infertility;
● Oral tamoxifen, etc.
Endometrial hyperplasia is divided into simple hyperplasia and complex hyperplasia, among which complex hyperplasia with atypia has a significantly increased risk of cancer, about 8%.
In ultrasound examinations, hyperplastic endometrium may appear as uneven echoes or local thickening. The high-incidence age group for endometrial hyperplasia is mainly women around menopause and postmenopause. Women in this age group and those with high-risk factors, especially when combined with abnormal vaginal bleeding, should be vigilant about the possibility of this disease.
Endometrial cancer
Postmenopausal vaginal bleeding is the most common symptom of endometrial cancer, with over 90% of postmenopausal women experiencing this as their first symptom.
When the endometrium of postmenopausal women is thicker than 4mm, it is especially necessary to be vigilant about the possibility of endometrial cancer, especially in patients with high-risk factors such as obesity, unopposed estrogen use, polycystic ovary syndrome, type 2 diabetes, etc. In ultrasound examinations, endometrial cancer may appear as uneven echoes, irregular shape, or local significant thickening.
Management and response at different ages
Reproductive-age women
If endometrial echo inequality is found for the first time, and there are no other clinical manifestations such as abnormal vaginal bleeding, and no high-risk factors are present, we generally suggest follow-up re-examination of ultrasound to observe changes in the endometrium or after oral hormone treatment to completely shed the endometrium and then follow up with a re-examination.
If there are symptoms such as abnormal uterine bleeding, menstrual changes, infertility, or high-risk factors are present, the doctor may suggest further examinations, such as hysteroscopy, endometrial biopsy, etc., to clarify the diagnosis.
Perimenopausal women
At this time, in addition to physiological changes, the risks of endometrial polyps, hyperplasia, and even cancer are also gradually increasing, and clinical management is relatively more active. Especially when high-risk factors are present, it should be highly valued, and we tend to actively obtain a pathological specimen of the endometrium.
For endometrial polyps, it is recommended to promptly undergo hysteroscopic resection to avoid the risk of malignancy.
If it is endometrial hyperplasia, according to the pathological type, it can also be treated with progesterone therapy or surgical treatment. If drug treatment is chosen, regular re-examination of ultrasound and endometrial pathological examination is needed to monitor changes in the condition.
Postmenopausal women
If diagnosed with endometrial cancer, comprehensive treatment such as surgery, radiotherapy, chemotherapy, etc. should be carried out according to the condition.
For endometrial polyps, even if asymptomatic, it is recommended to undergo hysteroscopic resection to avoid potential risks of malignancy.
If it is endometrial hyperplasia, the appropriate treatment plan should be chosen according to the pathological type and the patient’s specific situation, such as progesterone therapy or surgical removal of the uterus.
How to prevent in daily life?
Maintain a healthy lifestyle
In terms of diet, eat more fresh vegetables and fruits rich in vitamins and minerals, and reduce the intake of high-fat and high-sugar foods.
Moderate exercise, such as walking, yoga, swimming, etc., helps to enhance physical fitness and regulate endocrine functions.
Through a healthy lifestyle, we can try to improve the risk of metabolic diseases and also improve overall health and quality of life.
Regular physical examination
Especially asymptomatic lesions are basically discovered through examinations.
Perimenopausal and postmenopausal women should pay more attention to overall physical examinations.
Pay attention to physical changes
Once abnormalities are found, seek medical attention promptly and do not delay. At the same time, maintain a good attitude, avoid excessive anxiety and tension, as emotional fluctuations may also affect the endocrine system, thereby affecting the health of the endometrium.
Although endometrial echo inequality sounds a bit worrying, in fact, as we have learned from the previous text, physiological factors and many benign lesions of the endometrium can also cause this phenomenon, so there is no need to be overly tense and worried. We can solve most problems through timely examinations and seeking specialized opinions.
I hope this article can help women better understand this phenomenon and pay attention to their uterine health. Remember, caring for yourself starts with paying attention to every small detail of your body.
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