07/22/2025
🐾 From Ultrasound to Spay: A Closer Look at Cystic Endometrial Hyperplasia (CEH)
This uterus pictured shows a very focal, exaggerated lesion representing an extreme version of something we see more often than we’d like: Cystic Endometrial Hyperplasia (CEH). I did include a picture of a normal happy uterus courtesy but of reddit.
Cystic endometrial hyperplasia, or CEH, occurs when the glands in the uterus overreact and cause hyperplasia, or thickening of the uterus. While this disease process is generally thought of as a progesterone influenced disease after a heat cycle, estrogen plays a vital role in the disease.
But here’s the twist: while progesterone gets the spotlight, estrogen sets the stage. Estrogen "primes" the uterus for pregnancy, making it ultra-sensitive to progesterone. Unlike in humans, a bitch’s uterus doesn’t slough or reset — meaning cumulative trauma can build over each cycle.
Progesterone’s Role:
After every heat cycle (whether bred or not), progesterone:
1. Suppresses the immune system → Less defense = higher risk of pyometra
2. Stimulates gland secretion → Ideal for embryos… or bacteria
3. Closes the cervix → Traps any harmful content inside
4. Reduces uterine contractility → No flushing, just… storage
So yes, progesterone is a big deal. But it's not working alone.
❓ Why does the uterus overreact in the first place?
We don’t have a simple answer — research is ongoing, and has been for years, and while treatments are being explored, no standardized treatment exists yet.
What we can say is this:
If your bitch consistently misses or has small litters despite good breeding management (proper timing, insemination, etc.), there may be more going on.
And unfortunately…
💔 A traumatized uterus isn’t one a placenta can easily attach to — even a mildly affected one.
In this case, ultrasound made diagnosis easy — but that’s not always true. Sometimes, only biopsy shows the real story.
Even though this is a exaggerated version of this disease process can you imagine a fetus trying to attach to this uterus, or even a less affected version. That's not happening.
🐶✨ Moral of the story?
Sometimes it’s not about the breeding plan — it's about what’s happening inside the uterus. And while we do our best, even great vets aren't miracle workers. We’re human, too.