What’s going on when my endometrium is 13mm thick but I still haven’t had my period?

The absence of menstruation when the endometrium is 13mm thick may be related to endocrine disorders, polycystic ovary syndrome, pregnancy, drug effects, endometrial lesions and other factors. It is recommended to seek medical examination promptly and follow the doctor's instructions for treatment after the cause is determined.

1. Endocrine disorders

Long-term mental stress or excessive dieting may lead to hypothalamic-pituitary-ovarian axis dysfunction, resulting in insufficient secretion of progesterone and failure of the endometrium to shed on schedule. The typical manifestation is prolonged menstrual cycle accompanied by breast tenderness, which can be diagnosed through six sex hormone tests. Treatment requires the use of progesterone capsules, dydrogesterone tablets and other drugs to regulate the cycle as directed by the doctor, as well as psychological counseling and regular work and rest.

2. Polycystic ovary syndrome

Excessive androgens caused by insulin resistance inhibit ovulation, resulting in continued thickening of the endometrium without menstruation. It is often accompanied by symptoms such as acne and hirsutism, and polycystic ovarian changes can be seen on ultrasound. It is necessary to take ethinyl estradiol and cyproterone tablets under the guidance of a doctor to regulate hormones, and cooperate with metformin tablets to improve metabolism and control body mass index within the normal range.

3. Pregnancy

After the fertilized egg implants, the endometrium will decidualize and thicken to maintain pregnancy. At this time, the blood HCG test will be positive. Early pregnancy reactions such as nausea and breast tenderness may occur, and ultrasound can confirm intrauterine pregnancy. If it is a planned pregnancy, a standardized prenatal check-up is required, and for an unintended pregnancy, medical abortion or artificial termination of pregnancy must be selected under the guidance of a doctor.

4. Effects of drugs

Long-term use of emergency contraceptive pills or estrogen drugs can interfere with the normal cyclic changes of the endometrium and lead to simple hyperplasia. It is common in people who do not take medication in a standardized way. They need to gradually stop taking the medication or switch to short-acting contraceptives such as drospirenone and ethinylestradiol tablets under the guidance of a doctor, and regularly review the thickness of the endometrium.

5. Endometrial lesions

Endometrial polyps or atypical hyperplasia may cause abnormal thickening of local tissues, which may manifest clinically as irregular bleeding or amenorrhea. Hysteroscopy can confirm the diagnosis, mild lesions can be treated with levonorgestrel sustained-release intrauterine system, and endometrial resection should be considered for severe atypical hyperplasia.

It is recommended to maintain 30 minutes of aerobic exercise every day to improve pelvic blood circulation, and to consume phytoestrogen foods such as flax seeds and soy products in moderation. Avoid staying up late and having mood swings, and record your basal body temperature to monitor ovulation. If there is no menstruation for 2 months or abnormal bleeding occurs, vaginal ultrasound and tumor marker examination need to be reviewed immediately.