1, The normal postmenopausal endometrium should appear thin, homogeneous and echogenic.

Double-layer endometrial thickness less than 5 mm without

focal thickening is consistent with atrophy. [8] Endometrial thickness greater than 5 mm (measured on TVUS) is highly sensitive for detecting endometrial
cancer in postmenopausal women with AUB. It is more sensitive than other invasive diagnostic methods such as endometrial biopsy or sonohysterography for
diagnosing endometrial cancer in this population [Table - 2]. [7],[9],[10],[11],[12],[13]

The endometrium in a woman undergoing hormone replacement therapy (HRT) may vary up to 3 mm if cyclic estrogen and progesterone therapy is being
used. In asymptomatic patients, a thickness of up to 8 mm is considered normal. If a patient receiving HRT presents with AUB, endometrial thickness ≥5 mm
warrants further workup. [14] However, more recent findings suggest that a thickness of 8 mm, and not 5 mm, on TVUS may be a more appropriate cutoff point
for endometrial biopsy in symptomatic patients. [15]

Tamoxifen is a selective estrogen receptor modulator used in the treatment of breast cancer and has a weak estrogen-agonist effect in the uterus. In
asymptomatic postmenopausal women treated with tamoxifen, endometrial thickness greater than 6 mm on TVUS suggests an abnormality. [16] In
symptomatic patients, however, a cutoff of 5 mm warrants further investigation. The thickness of the endometrium increases with duration of tamoxifen
therapy. [17]

http://www.bioline.org.br/request?jp10034

2. Premenopausal

In premenopausal patients, there is significant variation at different stages of the menstrual cycle.

 during menstruation: 2-4 mm 1,4

 early proliferative phase (day 6-14): 5-7 mm
 late proliferative / preovulatory phase: up to 11 mm
 secretory phase: 7-16 mm
 following dilatation and curettage or spontaneous abortion: <5 mm, if it is thicker consider retained products of conception
Please note that these measurements are a guide only, as endometrial thickness may be variable from individual to individual.

Postmenopausal

The postmenopausal endometrial thickness is typically less than 5 mm in a postmenopausal woman, but different thickness cut-offs for further evaluation have been
suggested.
 vaginal bleeding (and not on tamoxifen):
o suggested upper limit of normal is <5 mm 5
o the risk of carcinoma is ~7% if the endometrium is >5 mm and 0.07% if the endometrium is <5 mm 8

o on hormonal replacement therapy: upper limit is 5 mm

 no history of vaginal bleeding:
o the acceptable range of endometrial thickness is less well established in this group, cut-off values of 8-11 mm have been suggested
o the risk of carcinoma is ~7% if the endometrium is >11 mm, and 0.002% if the endometrium is <11 mm 8

 if on tamoxifen 3: <5 mm (although ~50% of those receiving tamoxifen have been reported to have a thickness of >8 mm 7)
If a woman is not experiencing bleeding, and the endometrium is thickened, the guidelines are less clear. Either a repeat transvaginal ultrasound or a referral to a
gynaecologist is reasonable.

https://radiopaedia.org/articles/endometrial-thickness

3. In a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her endometrium is thick (> 5 mm) and < 0.07% if her
endometrium is thin (< or = 5 mm). An 11-mm threshold yields a similar separation between those who are at high risk and those who are at low risk for
endometrial cancer. In postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6.7% if the endometrium is thick (> 11 mm) and
0.002% if the endometrium is thin (< or = 11 mm).
In a postmenopausal woman without vaginal bleeding, if the endometrium measures > 11 mm a biopsy should be considered as the risk of cancer is 6.7%,
whereas if the endometrium measures < or = 11 mm a biopsy is not needed as the risk of cancer is extremely low.

https://www.ncbi.nlm.nih.gov/pubmed/15386607

4. Pre-menopausal lady -Maximum endometrial thickness i.e. by TVS is 7-16 mm

Post menopausal, no tamoxifen

If H/o vaginal bleeding, then maximum --5 mm

No H/o vaginal bleeding then maximum safe limit--11mm

https://www.quora.com/What-is-the-normal-thickness-of-endometrium
5. W H A T D O E S ' T H I N L I N I N G ' M E A N ?

A typical cycle is about 28 days. During this time your endometrial lining should increase, starting at 3mm at the end of your period and, once your oestrogen levels are in
full swing, it should thicken by around 1mm a day till it’s at optimum levels. Ideally, the optimal lining thickness is between 10 - 13mm at around day 21 of your cycle, the
day implantation is most likely to happen.

Typically, ‘thick’ is considered anything more than 8mm. When the endometrium is thiner than this, the embryo will have problems implanting. If the embryo does implant, a
thin endometrium may not be able to supply the necessary nutrients to maintain the pregnancy.

http://www.hopeandhopscotch.com/blog/2016/what-to-do-about-thin-endometrial-uterine-lining

https://www.ncbi.nlm.nih.gov/pubmed/21880272

6. When the level of estrogen falls, this proliferation is terminated and the shedding phase of endometrium occurs that leads to menstrual bleeding.
This is how normal endometrium is and how hormones control the normal functions of endometrium. The average thickness of endometrium is 8 mm
which increases further in pregnancy. Less than 8 mm is considered inadequate according to the doctors.

During pregnancy, at least 9 mm of thickness is required to provide a site for proper implantation of fetus. This thickness not only plays a vital role in
the implantation of fetus to the walls of the uterus but also supports the growing baby in the later stages of pregnancy. If, due to any cause, this lining
becomes thin, it becomes impossible for the fertilized egg to get implanted to the wall. This can lead to infertility of a female uterus and pregnancy
cannot take place because a fertilized egg needs a strong support for implantation and support for growing into an embryo.

https://medlicker.com/523-thin-endometrial-lining-causes-symptoms-diagnosis-and-treatmen

7. Estrogenis the hormone responsible for building up a healthy and rich endometrium, which is at least 8 mm thick. 8-13 mm is
generally considered normal (1). When the endometrium is thinner than this, it is considered to be a thin uterine lining. This means
that an embryo will have trouble implanting in the endometrium, which would make it more difficult to get pregnant (if there is no
implantation, the endometrium will be shed as part of the menstrual cycle). If the embryo does implant and pregnancy occurs, the thin
endometrium may not be able to supply an adequate amount of nutrients to maintain pregnancy. This could increase the chances of
miscarriage.

http://natural-fertility-info.com/thin-lining-of-the-uterus-build-the-uterine-lining-naturally.html

http://www.ncbi.nlm.nih.gov/pubmed/8426860

8. Endometrial thickness (Eth) is measured by transvaginal ultrasound as the maximal distance between the echogenic interfaces of the
myometrium and endometrium in the plane through the central longitudinal axis of the uterine body. An endometrial thickness of <7 mm at the
time of embryo implantation is considered suboptimal in ART.
A thin endometrium is mostly defined as an endometrial thickness of <7 mm on ultrasound[5,6,7,8,9,10] although a cut-off value of 6
mm[11,12,13] and 8 mm has also been used.[14]
Though controversial endometrial thickness has been used to predict the possibility of pregnancy in ART cycles; a thin endometrium being
associated with poor success rates after IVF irrespective of the causative factor. However, pregnancies have also been reported at an endometrial
thickness of 4 mm and 5 mm[15,16,17] suggesting that receptivity may not necessarily be related to Eth. A thin endometrium is seen more often
in older women probably because of decreased vascularity. An incidence of 5% has been reported in women <40 years and 25% beyond age
forty in natural cycles.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817285/
http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=1147&Type=PAID&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=99&isPDF=NO

ENDOMETRIAL HYPERPLASIA PROGRESSION TO CANCER

1.

From Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer 1985;56(2):403–12. (https://clinicalgate.com/uterine-cancer-2/)
2.

3.
http://zygoscient.org/obstetrics-and-gynaecology-insights-ogi/archive/volume-1-issue-1/ogi17004/