What is a thin endometrium, and how is it treated?
Medically reviewed by our consultant obstetrician & gynaecologist (MBBS, MS OBG). Last reviewed: 10 November 2026.
A thin endometrium means the lining of the womb does not grow as thick as it should before ovulation or an embryo transfer, which can make it more difficult for a pregnancy to take hold. Common causes are scar tissue after a D&C (Asherman's syndrome), genital tuberculosis and low hormone levels. A hysteroscopy often finds the cause, and treatment follows it.
What is the endometrium, and when is it called thin?
The endometrium is the soft inner layer of the womb. After every period it rebuilds itself under the effect of oestrogen, and after ovulation progesterone makes it ready to hold an embryo. If no pregnancy starts, it is shed as the next period.
The doctor measures it on a vaginal ultrasound, at the point in the cycle when it should be at its fullest: around ovulation, or before an embryo transfer in IVF. If it stays thin at that point, more than once, the reason is looked for. A thin reading early in the cycle, just after a period, is normal and is not a problem.
Why does a thin lining matter for pregnancy?
An embryo needs a healthy, well-supplied lining to attach to. When the lining is thin, the blood supply under it is often poor too, and the embryo may fail to settle even when it is of good quality. So when a couple has not conceived, or when embryo transfers have not worked, the doctor checks the lining; read more in recurrent miscarriage and implantation failure.
What causes a thin endometrium?
- Scar tissue inside the womb (Asherman's syndrome). A scraping of the womb, most often after a miscarriage, a retained placenta or heavy bleeding after a delivery, can injure the base layer of the lining. Bands of scar then form and the lining cannot regrow over them.
- Genital tuberculosis. TB is still common in India, and it can reach the womb and tubes while the chest stays clear and the woman feels well. It slowly replaces healthy lining with scar.
- Low oestrogen. When the ovaries make little oestrogen, for example near the menopause or with a very low body weight, the lining has little to grow on.
- Some medicines. A few ovulation tablets can thin the lining in some women while they help the ovaries.
- Previous surgery or infection in the womb, and a poor blood flow to it.
Sometimes no cause is found. Even then, a clear plan can be made.
What are the signs of Asherman's syndrome?
The most common sign is a change in the periods after a D&C: they become much lighter, last a day or less, or stop altogether, while the hormone tests are normal. Some women have cramps at the time a period is due with little or no bleeding, because blood is trapped behind the scars. Others notice nothing and learn of it only when they do not conceive or have a miscarriage.
Which tests find the cause?
- A vaginal ultrasound at the right time of the cycle, sometimes repeated over more than one cycle, to measure the lining and its pattern; see follicle scans.
- A hysteroscopy, a look inside the womb with a thin telescope passed in through the cervix, so the abdomen is not cut. It shows scar tissue directly and can often treat it in the same sitting. Read about hysteroscopy in Goa.
- A sample of the lining, taken during the hysteroscopy or in the clinic, tested for tuberculosis and infection.
- Hormone tests such as FSH and oestradiol, to see whether the ovaries are making enough oestrogen.
When the tubes also need checking, the hysteroscopy can be combined with a laparoscopy under one anaesthetic; see diagnostic hystero-laparoscopy.
How is a thin endometrium treated?
The treatment is chosen for the cause, not for the number on the scan.
- Scar tissue is divided through the hysteroscope, freeing the cavity so the lining can regrow. Hormone tablets are usually given for some time afterwards, and a second look may be advised, because scars can re-form.
- Tuberculosis is treated with a full course of TB medicines lasting several months. The course must be completed even when you feel well. Fertility treatment is planned once it is over.
- Low oestrogen is supported with oestrogen tablets or patches, given in a planned way through the first half of the cycle.
- Medicine effects are handled by changing the ovulation tablet or the plan.
Many other treatments are offered for a thin lining. The doctor will explain which of them have good evidence behind them and which are still unproven, so that you do not spend months on something that may not help.
What if I am having IVF?
When the lining is not ready, the embryos do not have to be transferred in the same cycle. They can be frozen and placed later, in a cycle where the lining has been built up with hormones and checked on scan first. Read frozen embryo transfer explained and the IVF process.
Where is a thin endometrium treated?
At Pai Hospital, Vaddem, Vasco-da-Gama, by appointment. The scans and the hysteroscopy are done at the hospital, a diagnostic hysteroscopy usually as day-care, and fertility treatment, including IVF, is available in Goa. See fertility care in Goa or call to book. Written and reviewed by the Pai Hospital Team.
Your questions
What is a thin endometrium?
The endometrium is the inner lining of the womb. Each month it grows thicker so that an embryo can settle into it. When the lining stays thinner than expected on a scan at the time it should be at its fullest, doctors call it a thin endometrium.
Is pregnancy possible when the womb lining is thin?
It can be. A thin lining can lower the chance that an embryo implants, but some women with a thin lining do conceive after the cause is found and treated; the chance depends on the cause. The doctor looks for the reason before choosing a plan.
What is Asherman's syndrome?
It is scar tissue inside the womb, usually after a scraping (D&C) following a miscarriage or a delivery, or after an infection. The scars can make periods scanty or stop them, and can keep the lining thin. A hysteroscopy shows the scars and can divide them in the same sitting.
Can tuberculosis cause a thin endometrium?
Yes. Tuberculosis can reach the womb and the tubes without any cough or fever, and quietly damage the lining. A sample of the lining can be tested for it. If it is found, a full course of TB medicines is taken over several months.
How is a thin endometrium treated?
Treatment depends on the cause: removing scar tissue through a hysteroscope, treating an infection such as TB, or supporting the lining with hormones. In IVF, embryos can be stored frozen and placed in the womb in a later, prepared cycle.
Where is a thin endometrium checked and treated?
At Pai Hospital, Vaddem, Vasco-da-Gama, by appointment. The scans, the hysteroscopy and the follow-up are done at the hospital, and IVF is available in Goa when it is needed.
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This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.