I am 37 and have no children. I have been diagnosed as having a thin endometrium (3-5mm). Since July 1997 I have had two miscarriages (one blighted ovum and one lost between 8-12 weeks after a heartbeat was detected at eight weeks). I had spotting and bleeding in both cases and D&Cs with both. I am now on a second round of a hormone treatment with Progynova & Provera after an ultrasound checkup showed a first round produced no visible improvement. This time an estrogen patch will be used & Sildenafil(Penegra) will be advocated for use vaginally. Are there any additional ways to improve the endometrium thickness — say, diet, homeopathic remedies, acupuncture, etc.? Can you suggest any other sources of information on this topic?

Thin endometrium at the time of ovulation can be a concern and may be a factor in poor placental development and miscarriage. Normally, in response to estrogen, the uterine lining or endometrium grows about 1-2mm every other day. By the time of ovulation, I like to see the endometrium at least 8mm thick. The endometrium also has a very specific ultrasound appearance marked by three bright lines. This is often called a grade-C or triple layer pattern, and it is a good sign. Failure to develop a normal uterine lining may reflect any of several factors such as infection, scarring from D&Cs, low estrogen levels, poor uterine blood supply or maybe endometrial antibodies. Clomiphene (Siphene, Ovofar) is an antiestrogen and as such can block the stimulatory effect that estrogen has on the endometrium and cause thin endometrium. If clomiphene is the problem, other ovulation induction medications may be chosen. Uterine leiomyomas or a condition called adenomyosis may also predispose to thin endometrium. While adenomysosis may be successfully addressed with a GnRH-agonist such as Lupride or Zoladex, success has been limited. The use of antibiotics or antioxidants such as vitamin C has been proposed, but these too are rarely successful and little supportive data exist. “Thin endometrium” is a finding — not a condition or disease or syndrome. As such there are few, if any, research papers addressing this problem specifically. I suggest that your physician try to determine the cause in your case; then you can seek information about that particular condition. Unfortunately, for most women with this finding, no discernible cause is identified and treatment is rarely successful.