Courtesy by Prof. Dr.

Amir Gilani

Topic:The Endometrium
Syeda Khadija
PhD*, MSDU(Ultrasound)
Assistant Professor Department (UIRSMIT) FAHS
University of Lahore www.uol.edu.pk
E-mail:syyedakhadija55@gmail.com
Courtesy by Prof. Dr. Amir Gilani
Courtesy by Prof. Dr. Amir Gilani

Stages of the Menstrual Cycle

• Menstrual phase
o Endometrium degenerates due to falling estrogen and
progesterone.
• Proliferative phase
o Endometrium thickens due to increased estrogen.
• Secretory phase
o Endometrium continues to grow and secrete substances
needed for implantation, supported by estrogen and
progesterone secretion by corpus luteum.
Courtesy by Prof. Dr. Amir Gilani

Endometrium (Histological
Structure)
• Basal layer
o Constant
• Functional layer (changes during cycle)
o Basalis (Constant)
o Inner compactum or functionalis
o Spongiosum
Courtesy by Prof. Dr. Amir Gilani

Endometrium (Ultrasound
Structure)
• Outer hypoechoic layer
o Basalis
o Inner compactum
• Inner echogenic layer
o Spongiosum
• Echogenic cavity line (sometimes with fluid)
Courtesy by Prof. Dr. Amir Gilani
Courtesy by Prof. Dr. Amir Gilani

Endometrial Stripe

Basal layer (hypoechoic)

Functional Layer

Endometrial canal
Courtesy by Prof. Dr. Amir Gilani

Endometrial Stripe
Measure the thickest
echogenic stripe in AP
Courtesy by Prof. Dr. Amir Gilani
Courtesy by Prof. Dr. Amir Gilani

Endometrium
Phases of endometrium thickness appearance
Days 0-5 2-3 mm Hyperechoic
(Menstrual)
Days 7-9 4-6 mm Hypoechoic
(Early Proliferative)
Days 12-14 8-12 mm Isoechoic
(Late Proliferative)
Days 15-20 8-15mm Hyperechoic
(Secretory)
Courtesy by Prof. Dr. Amir Gilani

Endometrium phases
• Three phases of endometrium are
• Menstrual
• Proliferative
• Secretory
Courtesy by Prof. Dr. Amir Gilani

Endometrium

• Menstrual
o Hypoechoic basalis
o Thin hyperechoic band
• Endometrial cavity and residual functionalis
• Proliferative
• Secretory
 Courtesy by Prof. Dr. Amir Gilani

Endometrium
• Menstrual
o Hypoechoic basalis
o Thin hyperechoic band
• Endometrial cavity and residual functionalis
• Proliferative
• Secretory
Endometrium
• Menstrual
• Proliferative, progressively thickens to 8-12mm by
day 14
o Outer hypoechoic line (Basalis)
o Hyperechoic line (Boundary of the functionalis with
basalis)
o Slightly hypoechoic band (Proliferating funcionalis)
o Central hyperechoic line (Canal)
• Secretory
Endometrium
• Menstrual
• Proliferative, progressively thickens to 8-12mm by
day 14
o Outer hypoechoic line (Basalis)
o Hyperechoic line (Boundary of the functionalis with
basalis)
o Slightly hypoechoic band (Proliferating funcionalis)
o Central hyperechoic line (Canal)
• Secretory
Endometrium
• Menstrual
• Proliferative
• Secretory no further thickening, but echogenicity
increases to give single band appearance
o Thin hypoechoic line (basalis)
o Thick hyperechoic band (functionalis)
o Thin hyperechoc line (cavity)
 Endometrium
• Menstrual
• Proliferative
• Secretory no further thickening, but echogenicity
increases to give single band appearance
o Thin hypoechoic line (basalis)
o Thick hyperechoic band (functionalis)
o Thin hyperechoc line (cavity)
Endometrial Changes in an Ideal
Cycle

Day 2
Endometrial Changes in an Ideal
Cycle

Day 4
Endometrial Changes in an Ideal
Cycle

Day 6
Endometrial Changes in an Ideal
Cycle

Day 7
Endometrial Changes in an Ideal
Cycle

Day 12
Endometrial Changes in an Ideal
Cycle

Day 13
Endometrial Changes in an Ideal
Cycle

Day 21
Endometrial changes in an ideal cycle

Secretory Endometrium Day 24

© Anatoly Garkusha.Kiev. Ukraine
The uterus in special situations
 Post 1 st Trimester Abortion
• Thick irregular endometrial echoes might be
due to:
o Blood or retained products of conception
o Very early pregnancy
o Ectopic pregnancy
 Post 1st Trimester Abortion
(Doppler)
• “Warm” uterus with IUP or recent abortion
• “Cold” uterus with low systolic flow in
ectopic (<6cm/sec)
• High systolic flow (>15 cm/sec)
Warm Uterus
Warm Uterus
Post 1 st Trimester Abortion/D&C
 Post D&C
• Air echoes will confuse and obscure
inadequate clearance
• Might take up to 10 days to clear
 Puerperal Uterus
• Returns to normal in 6-8 weeks
• RPOC have a highly variable appearance
from solid looking to fluid, gas might be a
normal finding, might appear as thickening
of endometrial echo
• Empty cavity should look normal
Puerperal Uterus
Puerperal Uterus

One week post partum

 Focal Myometrial Contractions
• Very common
• Might persist up to 40 minutes
• Isoechoic with the normal myometrium
• Will not deform the serosal surface
Focal Myometrial Contractions