What is cervical echogenicity?

In addition to the more frequent examinations during pregnancy, some people rarely go for examinations, so when they occasionally find that the examination results show uneven cervical echoes, they will worry whether there is something in the uterine cavity. In fact, when this symptom occurs in the uterine cavity, there are several factors to consider. We just need to find the cause and slowly adjust it.

The endometrium is divided into the basal layer and the functional layer. The functional layer of the endometrium is regulated by changes in ovarian hormones and has periodic changes in proliferation, secretion, and shedding; the basal layer regenerates and repairs endometrial wounds after menstruation. According to the histological changes of the endometrium, the menstrual cycle is divided into three phases: proliferative phase, secretory phase, and menstrual phase.

1. Proliferation stage

The 5th to 14th day of the menstrual cycle corresponds to the follicular phase in the ovarian cycle. Under the action of estrogen, the surface epithelium, glands, stroma, and blood vessels of the endometrium all show proliferative changes, which is called the proliferative phase. During this period, the endometrium gradually thickens. In the early stage of proliferation, the endometrium is 3 to 6 mm thick. When the follicles reach maturity, the endometrium thickness can generally reach 10 to 14 mm.

2. Secretory phase

The 15th to 28th day of the menstrual cycle corresponds to the luteal phase in the ovarian cycle. The estrogen and progesterone secreted by the corpus luteum cause the proliferative endometrium to continue to thicken. It contains rich nutrients and is conducive to the implantation of the fertilized egg. This is called the secretory phase. In the late secretory phase, the endometrium can reach a thickness of 10 mm.

3. Menstrual period

Days 1 to 4 of the menstrual cycle are the period when the spongy functional layer of the endometrium disintegrates and falls off from the basal layer. 24 hours before menstruation, the intimal spiral arteries contract and relax rhythmically, causing ischemia, necrosis and exfoliation of the distal vascular wall and tissue. The detached intimal fragments and blood flow out of the vagina, which is the onset of menstruation. 2 to 3 days after the menstruation ends, the thickness of the endometrium is generally 5 to 6 mm.

1. Endometrial hyperplasia

It includes simple hyperplasia, complex hyperplasia, and atypical hyperplasia, which may be caused by incomplete shedding of the endometrium during menstruation. Before normal menstruation, various parts of the endometrium are shed synchronously, completely and rapidly. However, when there is no ovulation, the endometrium sheds irregularly and incompletely due to the fluctuation of estrogen. The lack of sufficient loss of functional layer tissue makes it difficult to effectively stimulate the regeneration and repair of the endometrium, which can be manifested as uneven endometrial echo on ultrasound images.

2. Very small endometrial polyps

Endometrial polyps are formed due to factors such as inflammation. They are masses composed of endometrial glands and stroma, often with pedicles protruding into the uterine cavity. Patients with endometrial polyps may experience menstrual changes, including increased menstrual volume, prolonged menstrual period, irregular vaginal bleeding, etc. Ultrasound images show enhanced echoes and clear boundaries with the endometrium. However, if the polyp is small, the patient may not have any clinical symptoms, and the presence of endometrial polyps is only discovered during pathological examination.

Endometrial adenocarcinoma is a group of epithelial malignant tumors that occur in the endometrium, with endometrial adenocarcinoma being the most common. Ultrasound images show that there are substantial heterogeneous echoes and uneven endometrium in the uterine cavity. Endometrial cancer patients have no obvious symptoms in the very early stages. As the disease progresses, symptoms such as vaginal bleeding, vaginal discharge, and pain will appear.

Ultrasound is the main auxiliary examination method for gynecological diseases, but ultrasound examination is only an imaging examination and cannot replace pathological examination. In the early stages of certain diseases, when ultrasound manifestations are atypical, ultrasound diagnosis is somewhat subjective and different doctors may have different diagnoses. A diagnostic curettage or hysteroscopy can be performed to further confirm the diagnosis.