Thickening of the lining of the uterus, it cleared up with medication, and then after two months it was not normal again, and the bleeding was not heavy, is this normal?

Normally, the thickness of the endometrium is not static and is controlled by the ovarian cycle, with corresponding cyclic changes in the histology and biology of the endometrium. According to its histologic changes, the menstrual cycle is divided into: proliferative phase, secretory phase, and menstrual phase. In the proliferative phase, the endometrium shows proliferative changes under the action of estrogen, and the endometrium is about 4-8 mm thick in this phase. In the secretory phase, the endometrium is affected by the combined action of estrogen and progesterone, and continues to thicken up to 8-14 mm, after which estrogen and progesterone withdraw, and the endometrium is shed, i.e., the menstrual phase. In menopausal women, the ovarian function declines, the thickness of the endometrium does not change cyclically, and it is atrophic, usually less than 5mm in thickness. Thickening of the endometrium may suggest the presence of pathology in the endometrium. Common causes of endometrial thickening on imaging include endometrial polyps, endometrial hyperplasia, prolonged unopposed estrogenic action of the endometrium, microscopic submucosal leiomyomas, endometrial carcinoma, inflammation of the endometrium, and individual variations in the endometrial basal layer. There is no consensus on what the threshold for endometrial thickening is in premenopausal women, and this diagnosis is rarely given clinically. However, endometrial thickening may indicate the presence of endometrial pathology. If the endometrium is simply thickened without other clinical symptoms, it can be observed or treated according to the patient’s needs, such as the need for fertility. If the endometrial lining is thickened and uneven, or accompanied by other clinical symptoms, such as irregular vaginal bleeding, increased menstrual flow, anemia, etc., or repeated medication is ineffective, it is recommended to undergo further investigations, such as diagnostic curettage and/or hysteroscopy, to determine whether the endometrial lining is diseased, and the type of lesion, and then to manage accordingly. In postmenopausal women, imaging suggestive of endometrial thickening, with or without postmenopausal bleeding, diagnostic curettage and/or hysteroscopy are recommended to exclude endometrial malignancy.