Q from U: Causes of thin uterine lining and treatments to improve receptivity

October 3, 2013Carole 32 Comments »

Why is a thin uterine lining a problem? The inside of the uterus has several layers of  cells which make up the lining (or endometrium) that grows and is shed every month during menses. After about two weeks of increasing hormone (primarily estrogen) stimulation in the early part of the menstrual cycle , the cells increase in number to create a lush surface for an embryo to implant, dig in and create a pregnancy. Extreme thinness or extreme thickness can cause a problem with uterine receptivity to the embryo trying to implant.

What is the ideal thickness and appearance of the uterine lining prior to implantation? Based on data from thousands of IVF cycles in which the endometrium is visualized at the time of transfer using ultrasound, studies have shown that there is an optimal thickness. If the endometrial lining is less than 9 mm, pregnancy is possible but less likely. Based on this research article looking at over 500 IVF cycles,  embryo implantation, clinical and ongoing pregnancy rates are higher when endometrial thickness is greater than 9 mm (24.4, 48.6 and 42.2% respectively) compared to cases where the endometrial thickness was less than 9 mm (14.3, 16.0 and 11.7% respectively; P < 0.005). Another study of over 1000 IVF cycles shows a similar positive effect of having an endometrial lining of greater than 9 mm.

What are the causes of a too-thin uterine lining at the time of implantation? Repeated use of Clomid may, over time, result in a thinning of the uterine lining. Previous scarring from surgeries such as curettage (the “C” in D&C) or infections can also result in “bare” or thin patches in the uterus.

What therapies are used medically to try to improve the thickness and quality of the lining? There are some additional references in the links below but I have to mention a blog post containing a nice summary of various approaches used to increase the uterine lining. This post from the blog Dandle Dreams was written by a patient suffering from infertility due to a thin uterine lining. I’d encourage you to read her summary.

  • Estrogen Support:  Estrogen can be given vaginally to stimulate the cells of the uterine lining to grow and thicken the lining. Estrogen is commonly given in frozen embryo transfer cycles (FETs) to prepare the lining to receive the thawed embryo. One common protocol is shown here.  Likewise, women in fresh IVF cycles who have thin linings are sometimes also prescribed estrogen to increase the thickness of the lining to make it more hospitable to the embryo.  Estrace (prescribed estrogen compound), hMG (FSH-like analog to stimulate ovarian production of estrogen), and DHEA (a precursor to estrogen) are all drugs that are used to cause the endometrial cells to grow more rapidly in response to increased estrogen levels.
  • A variety of medications have been used to attempt to increase blood flow to uterus (also believed to help with cell growth) by including vasodilators such as Atenolol, aspirin,  and Viagra, sometimes in combination with the muscle relaxant, Terbutaline.
  • Traditional Chinese Medicine (particularly Acupuncture (possibly with low level electrical stimulation) may be useful to improve blood flow (and endometrial receptivity) as suggested by some studies.  Some Chinese herbal medications are also recommended by Traditional Chinese Medicine doctors, but rigorous  research studies supporting these approaches are few and far between.
  • Clinical trials– new approaches are being studied.

This is not an exhaustive list of treatment options. Please consult with your physician about these treatments or others that might be appropriate for you.


© 2013, Carole. All rights reserved.

32 Responses to this entry

  • Julie Says:

    Hi Carole, thanks for posting this. I suffer from thin uterine lining and I’m afraid that I will never overcome it. We’ve been trying for over two years and unexplained until recently. I’ve only had a measurement of over 7 mm probably once while I’ve seen an RE. I’m not sure why I suffer from this, I’ve only used chlomid for 2 IUI cycles and have had one hysteroscopy d&c to see what was going on. My lining was only a 6.3 for my first FET and my second was cancelled due to thin lining. So, for 3 months we’ve been trying to build it by taking 12mg/ day of estrogen for CD1-25 and prometrium CD15-25. In my 3rd cycle, my lining was a 5.8mm on CD6 but then a 4mm on CD23 after adding the progesterone. I’ve also been doing acupuncture for a year now and just struggling to get it thick. Are there any other clinical trials or suggestions? My RE said he was going to reach out to colleagues for suggestions, but he is so scatter brained, I’m not sure that will actually happen. Thank you again!!

  • Carole Says:

    HI Julie,
    This link takes you to all the trials that come up with the search terms “endometrial lining and IVF” http://clinicaltrials.gov/ct2/results?term=endometrial+lining+AND+ivf
    Most are not applicable to you and some are no longer recruiting but these are currently listed on clinicaltrials.gov. The highlighted words in the blog post above are links to more information on two clinical trials that may be more suitable. It may be that one of the other more established methods will be useful to you. Please discuss these possibilities with your doctor. Good Luck, Carole

  • Sdfc Says:

    I am not a doctor, but i would like to think im an expert on thin lining everything ! and want to share my story.
    I was able to get pregnant 3 times naturally within first 12 months of trying. All 3 were failed pregnancies and had to get curettes. (12 weeks, 7 weeks and 6 weeks) Began ivf treatments. Did 4 Ivf cycles. With 2 failed pregnancies, and again 2 curettes.
    We decided to mix things up and go donor egg in the usa.
    The usa doctor wanted to make sure my lining could reach a good thickness Before we went ahead. So I began trial cycles.
    They prescribed me estrogen tablets, which I increased the dosage every few days. After a month i Got to 6 mm and then went backwards to 5.5mm. The usa doctors were not happy with this. So they induced my period and began trial cycle 2. This time putting me on estrogen tablets, eastrogen patches, and porgynova pesaries. After a month i reached 5.2mm.
    The usa doctors were not happy with this so again induced my period and we began trial cycle 3: with tablets, patches, pesssaries, baby aspirin . After a month my lining got to 5mm.
    So again they decided to induce period but they then said we would start the real cycle and they would send over eastrogen injections to add to my cocktail mix.
    So I began the real cycle. I was on all of the above plus eastrogen injections, coq10, vitamin e, baby aspirin, after a few weeks i reached 4.8mm, the usa doctors still told us to go to the usa and we would go ahead.
    So we hopped on the plane and arrived in the usa. The Donor was all ready with her awesome eggs. My hubby all ready with his sample. And there was me and my lining.
    The usa doctors tried everything to get my lining up. Even tried a new drug called nuepagen, that they injected into my uterus…. Twice, But nothing. My lining would not budge and stuck at 4.8mm
    They told me my estrogen levels were completely saturated and there was nothing more they could do.
    The doctor said ”I was not in the game’ sent us home and suggested surrogacy.
    I have been through a tough few years but this took the cake. I have never felt like such a failure.
    The doctors in the country where I am from had never suggested I had lining issues and always transferred at any thickness.
    But when I started to think about it, I had always had really light periods, and they were getting lighter and lighter. ( started trying at age 31 and now I’m 35)
    The doctors in the usa didn’t know what more to do. But my doctor in my country decided to put me on a new drug called trental. It’s like a blood thinner for people with leg circulation pain but it’s started being used for uterus lining in the last couple of years and had some success.
    You take it with high dose of vitamin e. And I responded well. Not right away but after a few months i noticed my periods were getting much thicker, lasting longer, more reddy type blood. And my cycles went back to 28 days. Which i hadn’t had since I was like 26.
    So we were about to begin another cycle and go over to the usa for a transfer. But I got a flu and my thyroid got affected. I got thyroiditis( hyperactive thyroid) so I had to wait 4 months for my thyroid to return back to normal, in the mean time i continued taking the trental and my periods got even thicker.
    Once my thyroid was back to normal, I got a scan and my lining was at 7-8mm. It was awesome.
    I was ready, I was in the game.
    The usa doctors gave me instructions for my cycle which included estrogen tablets. So I did as they said, i also continued the trental. But this time my lining again only got to 4.8. I dont respond to estrogen! My dr at home said that some woman just dont and that the usa should have known that by now.
    But they obviously forgot and we were back to square one again.
    The doctors in the usa again refused to do a transfer, but this time I insisted, i was furious, it had taken me over a year to get my lining up to 8mm. And I was not prepared go through it all again.
    I put my foot down and told them they would transfer. I got on the plane and I insisted.
    So they did the transfer very reluctantly. When they did my lining was at 5mm.
    And here I am today, 18 weeks pregnant with a healthy baby growing inside me. It implanted, yes and it grew normal and healthy and perfect.

    So ladies, firstly if your lining doesn’t respond to eastrogen, then you dont! No matter what form, tablets, pesssaries, injections, patches. Please dont waste months (and money) like i did. Give trental a go. Please…Ask your doctor about trental

    But secondly and more importantly, lining isn’t important, doctors like it for their own numbers and success rate weirdness, I was able to have implantation and get pregnant and not miscarry from a lining of 5mm!
    Please feel free to ask any questions.
    Thanks for reading
    And good luck out there. I know what its like. Stay positive.

  • liz shun Says:

    I have been menstruating so heavy,thick blood clots for over a year but stopped in between some months.been on treatment,doc says maybe thinning of uterus.how do I overcome this problem,my tumy aches n legs are so sore during this time.everytime it happens I go to see doc but I am @ a dead end now.What advice can you give me plse

  • Carole Says:

    Dear Liz,
    Your questions need to be answered by a medical doctor. If you are not getting the answers you need from your current doctor, please seek a second opinion. Good Luck!! Carole

  • Bridget Says:

    Interesting, however it says not to take Trental if you are trying to get pregnant?? Will have to ask my FS about this one for sure (tried everything else.

  • Carole Says:

    Dear Bridget,
    Yes, please check with your physician before trying any supplements, new drug, or anything that claims to aid fertility. Good Luck! Carole

  • Btp Says:

    Sdfc your story was very inspirational I’m only 21 years old and I have just been told my lining is close to nothing because certain contriceptions I have been on have eaten away at it I have constant periods and am not on my second dose of estrofem after a month of taking them I’m really hoping this works because being with my partner for 4 years now we are looking into having children and it devistates me to think it may not happen but I’m trying to stay positive as I’m still young and understand there is so many ways out there I can have a baby

  • Btp Says:

    I am now **

  • pushpa Says:

    hii…sdfc,your story is the same as mine.i also struglling with thin lining since 2 years. i have spent so much money,still i am suffering from this.i have done 2 cycles of ivf but no result at all.now i am mentaly and finatially very upset.

  • mary Says:

    Hello Carol,

    I had a successful IVF 1.5 years ago and now am going back for my second. I have 2 Frozen Embryos. I did not respond to the Estriadol patches (4 patches for 6 days) and estrogen pills, 2 twice a day taken at the same time.
    My lining only reached 5.9 / 6 mm and my doc wants me to wait until my lining reaches 8mm.

    What can I do differently?

  • Carole Says:

    HI Mary,
    I am sorry that you are having such difficulty. Your doctor is correct that you really need a thicker lining. I found a clinical study looking at the results of the two main stim protocols for endometrium lining preparation prior to transfer. https://clinicaltrials.gov/ct2/show/NCT01780610 Print this out and take to your next doctor’s appointment. You might use this as a basis for discussion with your doctor about other methods your doctor might try to improve your lining. If you truly don’t respond to any methods to increase lining thickness, you might have to consider working with a gestational surrogate. Whatever you decide, I wish you all the best going forward! Carole

  • Rebecca Says:

    Hi there. I just had a miscarriage on Jan 5th. I have a 7 and a half month old that is only breast feeding still. We were surprised to find out we were pregnant over Christmas due to still full time breast feeding. Is there a chance that my uterine lining was thinned out because of breast feeding? Should I ween my baby so that my uterine lining will thicken? Or is there something I should supplement with? I have 2 healthy kids and have never had a miscarriage before. I stopped breast feeding my son and that was when we got pregnant with our second just fine. Also, I only bled about half the amount of my normal period (which is also normally pretty light) when I miscarried…) Thoughts or things to ask my doctor to check would be great. I am concerned about getting pregnant again before knowing what to help it not miscarry. Thanks for the help!

  • Carole Says:

    Dear Rebecca,
    I am very sorry to hear about your pregnancy loss. You pose some interesting questions. I did a quick PubMed search on prolonged “breast feeding and pregnancy loss” and didn’t find any relevant studies. Likewise, I found no useful results with “lactation and uterine lining”. In a well nourished person, I didn’t think breast feeding was a very effective birth control method so becoming pregnant is not that unlikely. These are all very good questions to ask your doctor. I wish I could be more help! Good Luck!!Carole

  • meilleur aspirateur Says:

    Good post. I learn something new and challenging on websites I stumbleupon every day.

    It’s always useful to read articles from other authors and practice something from other sites.

  • Laura Says:

    I suffered from thin lining for over a year with multiple cancelled FET cycles. My RE tried it all – suppository Viagra, adding estrogen orally and vaginally, taking Turbutaline, Vitamin E. None of it work and we met with a surrogacy agency. But I did ask my RE if we could try one last out of the box idea as I had read from other thin lining girls that a low dose stim of Gonal F worked for lining achievements. He said, “Why not” and while I’m not advocating that this is a fix all, it happened to also improve my lining to an 8 where all other protocols, at best I had a 5 and shrunk during the FET cycle. The goal was a low dose FSH to increase lining but not to ovulate. I’m currently pregnant with #2 using the same protocol and since then, my RE has named the protocol after me and has had success with other women as well. It might be worth a conversation with your RE to discuss this idea as I decided to be my own advocate and ask about this option.

  • amyelaine Says:

    I recently had to have 2 d&c’s within a week of each other. I pPROM at 18+6 and had to have an emergency d&c due to infection at 20+1. That was 12 weeks ago, I keep having menstrual pains but no period. My OB is sending me to have an ultrasound to check the thickness of my uterus lining. I am so scared that I have too much scarring and my uterus may be too thin. I am 39 and praying for my rainbow baby. Is there anything I should make I ask when they send me for my appointment?

  • Carole Says:

    Dear Laura,
    Thanks for sharing your story!! and congratulations on your pregnancy!! Carole

  • Carole Says:

    I am so sorry you are having such a difficult time. Unfortunately, I really do not know the answer to your medical question. I hope your doctor can provide you with some answers and a plan for moving forward. Wishing you much good luck!! Carole

  • amyelaine Says:

    Update: I was given an ultrasound to check the thickness of my uterus lining. Just received the call. I’m not having a period because my uterus lining is too thin. The doctor is starting me on hormone treatment. 3 weeks of estrogen and 1 week of progesterone. They are hoping to force a menstrual cycle.

  • Anastasia Says:

    Laura, would you be willing to email me with your exact protocol that I can take to my dr please my email is uk_nastja at yahoo dot co dot uk. Am so happy for your success. I did well at first but now don’t seem to be responding to normal estrogen progesterone protocol. Thanks

  • yasmin Says:

    Hi. I m 25 years old. I recently had to have 2 d&c. Now, my uterus line is very thin. So, please tell me what i do?

  • Racheal Says:

    Hi SDFC,
    Your story is very inspirational, I have the same condition like yours. I am trying for the last 10 years had already conceived trice …two times naturally & once with IVF…but all resulted in D & Cs the doctors say that its because the linning is two thin…ive also had a nine month AKT course to improve the lining as they had detected me with endometrial TB….but the thought never occured that my body might not respond to estrogen…I just had a failed IVF transfer & was considering adoption…will speak to my doctor about trental…it would of helped if you had specified in which country did they prescribe you trental.

  • Amy Says:

    Hello Laura,I am also suffering from thin lining with multiple FET cancelled. My body is not respond to estradiol and progesterone well. Is it possible you can email me with your exact protocol to clutch126 at hotmail dot com? Very much appreciated!!

  • Racha Says:

    Am suffering with thin uterus lining can you please suggest any duet I medication.

  • Carole Says:

    Hi Racha,
    I am not aware of any diet to help with uterine lining. There are certain hormonal regimens that your reproductive endocrinologist might prescribe in preparation for a frozen embryo transfer–but both these questions are something you need to ask your doctor about- they can give you a better answer than me. Good Luck!! Carole

  • Beth Jenkins Says:

    Hi Laura,
    Battling problems with my thin lining and have just read your post. Could you please send me details of the protocol that your doctor put you on (to bethjenkins204@yahoo.co.uk)? I would really appreciate it. Your story gives us all hope. Thanks. Beth

  • Beth Jenkins Says:

    Hi Amy and Anastasia,

    Battling problems with my thin lining and have just read your posts. Could you please send me details of the protocol that Laura’s doctor put her on (to bethjenkins204@yahoo.co.uk)? I would really appreciate it. Thanks. Beth
    P.S. I have left a message for Laura in this thread, but she might not be checking it as it is quite old.

  • Gio123 Says:

    Maybe this will help My wife went to the doctor to check or uterus lining It was 2.4 She was very discourage But I stay by her and told that is going to be all right the doctor prescribe estradiol patches 0.1 once a week For 14 days Here we go again to the doctor to have it checked Again went up to 8.0 My wife and myself are very happy We have another doctors appointment this week I will keep you guys updated

  • Neha Says:

    Hi I am also facing the same problem. I have had 2 failed IUI’s. I did IVF in october 2015, 3 blastocysts were formed but could not be transferred because of thin uterine lining. Since then my lining is not growing, sometime it got upto 7 but then I develop cyst in uterus due to injectables.
    Anyone pls tell me what can be done as i am really depressed. my doc is telling us to go for surrogacy but i dont want it….I want to give birth to my baby…
    pls guide SDFC, laura anyone…..

  • Jamuna Says:

    I think thin utrine lining is coz of our sedentry lyfstyle..less movment of our hips thigh…so i m facing the same problm.i did my iui…bt fail..coz of my lining..m so upset…i dnt know wat to do

  • Cynthia choo Says:

    Hi i am facing same thin lining issue for the last 1.5years since my d&c.can anyone share what you have done and has improved? I am very upset despite trying for 7 years. Please do pm me at mui_yoh@yahoo.com. cynthia

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