As the saying goes: the more you do, the more you go wrong. The endometrium “plows” once a month, preparing the embryo to settle repeatedly, which is a joy to see. But sometimes the lining of the uterus makes mistakes that are cause for concern. Sometimes it’s a small mistake – endometrial hyperplasia, sometimes it’s a medium mistake – endometriosis, and sometimes it’s a big mistake – endometrial cancer. The endometrium is a layer of tissue on the surface of the uterine cavity and is the soil in which the embryo is nurtured. The fertilized egg, the fruit of the union of a man and a woman, migrates from the fallopian tube to the endometrium to settle. The endometrium is divided into two layers. If the uterine cavity is regarded as the “golden house” of the human embryo, the superficial endometrium is equivalent to the “lime” or “paint” layer of the wall, i.e. the functional layer; The deep lining is equivalent to the “putty layer” of the wall, i.e. the base layer. The functional layer, which is shed once a month to bring menstruation to women, is important, but the basal layer is equally important because the cells of the functional layer are changed from the cells of the basal layer. The structure of the human body is unrivaled in its precision. From the first day of menstruation, under the action of estrogen, the cells of the basal layer begin to differentiate and develop, forming the cells of the functional layer and growing progressively, which is called the proliferative endometrium. After ovulation, the endometrium, which has grown to a thickness of 1 cm or more in consideration of the possibility of an embryo coming to settle, becomes fluffy under the action of progesterone, and is called the endometrium in the secretory phase. When an early embryo reaches such an endometrium, it is as comfortable as sleeping on a down comforter and naturally stops. If no fertilized egg comes, these prepared endometrium lining will be shed and expelled from the vagina, which is a new menstrual period. The lining of the uterus provides the soil for the development of the embryo, which is a thousand years of work for human reproduction, as well as a very important physiological phenomenon that occurs once a month for women. This is the joyous part of the uterine lining, but the lining of the uterus also has its moments of concern. If you don’t work, you don’t make mistakes; the more you work, the more you make mistakes. The same saying applies to the endometrium. The lining of the uterus prepares for pregnancy without complaint, growing, shedding, growing again …… month after month, and inevitably problems arise in the constant repetition. It is worthwhile to categorize the problems of the endometrium into “small, medium and big mistakes”. 1, menstrual abnormalities can be seen as the endometrium of the “small error” Normally, the menstrual cycle is generally 28 days, the period of 3 to 7 days, the amount of menstruation is generally 50 ml. If the menstrual cycle is often a few days earlier or later, and is so every month, if you can get pregnant and have a baby, it can also be considered normal. If the menstrual cycle is shortened by more than 7 days (frequent menstruation) or delayed by more than 7 days (scanty menstruation), and the patient experiences symptoms such as anemia and infertility, it is considered abnormal. In addition, the amount of menstruation varies from person to person. If the amount of menstruation is significantly heavier than usual (heavy menstruation) or less than usual (scanty menstruation), and this is the case for 3 consecutive cycles, this is also considered an abnormality. Other abnormalities manifest as irregular vaginal bleeding, or coexist with irregular cycles, increased menstrual flow, or prolonged periods. Let’s start with a light menstrual flow. If the endometrium is infected by microorganisms, such as Mycobacterium tuberculosis, the growth of the endometrium is impaired and it does not grow to a sufficient thickness, and the menstrual flow is reduced. If the basal layer of the endometrium is mechanically damaged, such as during an abortion or childbirth operation, the endometrium will become thinner and the menstrual flow will naturally decrease. Sometimes the lining of the uterus itself is normal, but problems with its superior organ (ovaries), or its superior superior (pituitary gland), or a higher organ (hypothalamus), can also cause low or scanty menstruation or even the absence of menstruation (amenorrhea). I will not go into these issues for the time being, but will talk about them next time. More on excessive menstruation. A common cause of heavy periods is various types of endometrial hyperplasia, of which there are 3 general types. One is a thickening of the endometrium from the outside, where a microscope reveals a proportional increase in the two components of the endometrium (the functioning glandular cells and the supportive mesenchymal cells). By way of analogy, the population appears to be denser on the surface, but the physical appearance is normal and well organized. This condition is called simple hyperplasia. Another situation is not only the appearance of the endometrium has thickened, but also under the microscope can be seen that the two components of the increase is disproportionate, more glandular cells and fewer mesenchymal cells, the formation of the glandular cells of the back-to-back arrangement. In other words, on the surface, the “population” is densely populated, and the order of arrangement is problematic, but the physical appearance is normal. This is called complex hyperplasia. In the last case, the endometrium is not only thickened in appearance, but also has an abnormal cell morphology under the microscope. Normally, the nucleus of the cell is proportional to the volume of the whole cell, and if the nucleus is too large, it looks like a “big-headed doll”, which is one of the characteristics of malignant cellular changes. This is one of the characteristics of malignant cellular changes. In other words, in addition to a dense “population”, what is even worse is the appearance of a “peculiar person”. This condition is called atypical hyperplasia, which, if not intervened, can lead to a big mistake – endometrial cancer. Heavy periods can also be caused by the environment surrounding the endometrium. Sometimes there is no problem with the endometrium itself, but there is a problem with the myometrium, which is the equivalent of the “walls” (such as fibroids), resulting in an abnormal enlargement of the room, and the endometrium increases in size, which leads to excessive menstrual flow. 2, endometriosis can be regarded as the endometrium of the endometrium “in the wrong” endometriosis is the endometrium to move to areas outside the uterine cavity, in the “foreign” roots, growth, disease, resulting in dysmenorrhea, infertility, and pelvic mass, seriously affecting women’s health and quality of life. This leads to menstrual cramps, infertility and pelvic masses, seriously affecting women’s health and quality of life. The so-called “fault” lies in the fact that the endometrium doesn’t stay where it belongs, but goes where it shouldn’t be. The most common site of endometriosis is the pelvic organs, called pelvic endometriosis. In addition, the lining of the uterus can sometimes even reach the lungs, brain, skin, nails and other unimaginable parts of the body, and after treatment, it is easy to recur, so it is also known as the “immortal elf”! (For details, please refer to the ninety-seventh to the one hundredth time.) The “big mistake” of the endometrium is of course endometrial cancer. If the endometrium is cancerous, the uterus will have to be removed in most cases, is it not a “crime of breaking up the family”? If liver or lung metastasis occurs, removal of the uterus will not be helpful and will jeopardize the life of the patient, which is a “sin against the country”, is it not? In fact, some minor faults of the endometrium, such as abnormal menstruation, are often the result of problems in the higher organs, and the endometrium is merely a scapegoat.