If you have a problem that affects your uterus or another part of your reproductive system, this information is for you. It explains most of the problems that can affect a woman's reproductive system and ways the problems can be treated, including medication, surgery, and other kinds of treatments.
On each side of the uterus at the top are the fallopian tubes and ovaries. Together, the uterus, vagina, ovaries, and fallopian tubes make up the reproductive system. Select for illustration of The Uterus (26 KB).
In women who have not gone through menopause ("the change" or "change of life"), the ovaries produce the hormone estrogen at the beginning of the menstrual cycle. Estrogen helps to prepare the lining of the uterus (called the endometrium) for possible pregnancy. When the uterus is ready, one of the ovaries releases an egg. The egg travels down the fallopian tube where it waits for possible fertilization.
If the woman becomes pregnant, the fertilized egg travels to the uterus where it attaches to the endometrium. If she does not, the endometrium and the unfertilized egg are discharged through the vagina during the woman's next period (menstruation).
Some of the problems that can affect your uterus are:
The following information can help you think about your condition, learn about your treatment choices, and decide on some questions to ask your doctor.
Keep in mind that every woman is different and every situation is different. A good treatment choice for one woman may not be the best choice for another. That is why you should:
The first step in getting relief is to find out what the problem is.
The first step in diagnosing your problem is a medical history. The doctor—or sometimes the
nurse—will ask you questions about your medical history. This will include questions about
your
symptoms and any serious illnesses you have had, as well as whether you have ever had surgery,
been pregnant, or had children. You also may be asked about the medical history of close family
members.
If you have been using herbs, acupuncture, or other "natural remedies," be sure to tell your doctor
about them.
The doctor may ask about your sex life. You may be uncomfortable talking about such personal
matters, but it is important for your doctor to know if something that is happening in your sex life
might be related to your condition.
Finding Out About the Problem
There are several ways your doctor can find out (diagnose) what is causing your symptoms. The
most common include:A medical history.
A vaginal exam.
The doctor will use instruments to look inside your cervix and uterus. The doctor will use
a speculum to keep the walls of the vagina apart during the exam.
Sometimes this exam is
uncomfortable. You may feel a slight cramp, but it usually is not painful. If you are able to relax,
you will be more comfortable. The doctor may look inside the vagina and cervix with a
lighted
tube.
A Pap test (or Pap smear).
During the vaginal exam, the doctor usually takes a sample of cells from the cervix with a wooden
scraper, cotton swab, or small brush. The test is quick and painless. The cells are placed on a glass
slide, which is sent to a lab. A Pap test is one way that doctors can find cancer of the cervix or
dysplasia, which is a condition that sometimes can
turn
into cancer.
All women over 18 years of age—and younger women who are sexually active—should have a Pap test done every 1 to 3 years.
Depending on your symptoms, the doctor may suggest an endometrial biopsy, dilation and curettage (D&C), or other tests to help diagnose your problem.
Surgery, medicine (including hormones), a combination of the two, or "watchful
waiting" are the
most common choices for dealing with most noncancerous uterine conditions. Watchful waiting
means having no treatment but seeing the doctor regularly to keep track of your condition and
discuss symptoms. After a period of watchful waiting, if you are still having problems, you may
decide with your doctor to consider one or more treatment options.
There are always new treatments in development. Be sure to ask your doctor if there are any new
treatments for your condition that are not described in this booklet.
Your doctor may recommend that you have a hysterectomy. If so, you will want to see the section
on hysterectomy.
Remember, all treatments—including medicine, surgery, other types of treatments, and even a
decision to wait or not be treated—have risks and benefits. Be sure to ask your doctor about the
risks and benefits of each treatment option you are offered. Then you can work with your doctor
to weigh your options and make an informed choice.
Fibroids are growths in the walls of the uterus. Sometimes, a fibroid is attached to the outside of
the uterus by a stalk. Fibroids can be as small as a seed or a pea or as large as an orange or small
melon. Although fibroids are called "tumors," they are not cancer. They are smooth muscle
growths.
About 2 of every 10 women who have not gone through menopause have fibroids. The technical
term for a fibroid tumor is leiomyoma.
Fibroids may cause no symptoms at all, or they may cause pain or bleeding. Fibroids may make it
hard to pass urine if they grow large enough to press on the bladder.
Fibroids also can make it hard for you to get pregnant. Sometimes fibroids can cause problems
with pregnancy, labor, or delivery, including miscarriage and premature birth.
Select for illustration of Uterine Fibroids (29 KB).
How are fibroids treated?
You may have several treatments to choose from if you have fibroids. It depends on how big the
fibroids are, where they are, and whether you are pregnant or want to become pregnant.
Watchful waiting may be all the treatment you need if your fibroid is small and you do not have
any symptoms. You will need regular visits to your doctor for a pelvic exam to monitor the
growth of the fibroid.
Nonsurgical treatments for fibroids include hormones and pain relief medicines.
Noncancerous Uterine Conditions
After your medical history, examination, and tests are done, your doctor will explain your
condition to you and talk about your options for treatment. Later in this booklet you will find a
list of questions you may want to ask your doctor.Fibroids
What are fibroids?
Surgical treatments for fibroids include hysterectomy and myomectomy.
Recovery time after a myomectomy is about 3 to 4 weeks. About 20 percent of women who
undergo myomectomy need a blood transfusion, about 30 percent have a fever after surgery, and
many patients develop adhesions (scar tissue) in their
pelvis
in the
months following
surgery.
These complications are more likely to occur when there is more than one fibroid and when the
fibroids are large.
The growths may come back after a myomectomy, and repeat surgery may be necessary. If you are considering a myomectomy, be sure to ask the doctor how likely it is that new fibroids might grow after the surgery.
You also should ask your doctor how much experience he or she has in doing this procedure. Not all gynecologists have been trained to perform myomectomies.
Endometrial tissue lines the uterus. Each month, in tune with the menstrual cycle, the endometrial
tissue thickens and is shed during menstruation.
If you have endometriosis, it means that the same kind of tissue that lines your uterus is also
growing in other parts of your body, usually in the abdomen. This can cause scar tissue to build
up around your organs.
Endometriosis may cause severe pain and abnormal bleeding, usually around the time of your
period. Pain during intercourse is another common symptom. However, it is possible to have
endometriosis and not have any symptoms. Endometriosis is a leading cause of infertility (inability
to get pregnant). Often it is not diagnosed until a woman has trouble getting pregnant.
Endometriosis will lessen after menopause and during pregnancy, since the growth of
endometrial
tissue depends on estrogen. If you have endometriosis and take estrogen-replacement
therapy
after menopause, the tissue may grow back.
The only way to be sure that you have endometriosis is through a surgical procedure,
laparoscopy. Endometriosis can be a chronic
condition
and may
return even after
treatment with
medicine or surgery.
How can endometriosis be treated?
There are several options for treating endometriosis. The best treatment for you may depend on
whether you want to relieve pain, increase your chances of getting pregnant, or both. It is
important to work with your doctor to weigh the benefits and risks of each treatment.
Nonsurgical treatments include:
Hyperplasia is a condition in which the lining of the
uterus
becomes
too thick, which
results in
abnormal bleeding. Hyperplasia is thought to be caused by too much estrogen.
Depending on your age and how long you have had hyperplasia, your doctor may want to do a
biopsy before beginning treatment to rule out
cancer.
How is hyperplasia treated?
If you have uterine prolapse, it means that your
uterus has
tilted or
slipped. Sometimes it
slips so
far down that it reaches into the vagina. This happens when the ligaments that hold the
uterus to
the wall of the pelvis become too weak to hold the uterus in its place.
Uterine prolapse can cause feelings of pressure and discomfort. Urine may leak.
Select for illustration of Uterine Prolapse (33 KB).
How is uterine prolapse treated?
Treatment choices depend on how weak the ligaments have become, your age, health, and
whether you want to become pregnant.
Options that do not involve an operation include:
Ovarian cysts are small, fluid-filled sacs that usually are not malignant. They may not cause any
symptoms, or they may be quite painful. Sometimes, ovarian cysts appear in connection with the
menstrual cycle, and they may go away on their own in a few months. When these cysts grow
large, they may cause feelings of pressure or fullness.
Although most ovarian cysts are benign (not cancer),
they
must be
taken very seriously. A
sonogram will show whether a cyst is fluid-filled or has solid matter in it. If it is solid, it may be
related to endometriosis, or it may be cancerous.
What are the treatments for ovarian cysts?
If you have not yet gone through menopause, you may not need any treatment, unless the cyst is
very big or causing pain. Sometimes, taking birth control pills will make the cyst smaller. Surgery
may be needed if the cyst is causing symptoms or is more than 2 inches across.
If surgery is needed, often the cyst can be removed without removing the ovary. Even if one
ovary has to be removed, it is still possible to become pregnant as long as one ovary remains.
After menopause, the risk of ovarian cancer increases. Surgery to remove an ovarian cyst is
usually recommended in this case. Your doctor will probably want to do a biopsy to see if cancer
is present.
If you have gone through menopause and you have an ovarian cyst, talk with your doctor about
what will be done during surgery. Make sure you understand whether he or she plans to remove
just the cyst, the cyst and the ovary, or to do a hysterectomy. Talk over the options with your
doctor and make your own wishes known.
Treatment options include:
Women who use intrauterine devices (IUDs) are at
increased risk for
PID. Rarely, the
bacteria
that cause PID enter the body during childbirth or abortion.
PID can cause pelvic pain and fevers. It also may cause infertility (inability to get pregnant)
because of damage to the fallopian tubes. Sacs of pus, called
abscesses, may form in the pelvis. Sometimes the vagina will discharge a pus-like
substance.
If PID is not treated, pain may be so intense that it is hard to walk. The infection may spread into
the bloodstream and throughout the body, causing fever, chills, joint infections, and sometimes
death.
How is PID treated?
Some women have extreme cramping just before and during their period. The technical term for
this is dysmenorrhea. If you have this kind of pain, you should seek treatment. Severe menstrual
pain may be a symptom of endometriosis.
What can be done about severe menstrual pain?
Several types of medicine are used to treat painful cramps. These include:
As you get closer to menopause, it may be hard to tell when your period is going to start. The
time between your periods may be longer or shorter than usual. When it does start, bleeding may
be very heavy and last for several weeks.
You may have dysfunctional uterine bleeding or
DUB.
DUB most
often affects women
over 45.
Usually it is caused by an imbalance in the chemicals in the body (hormones) that control the
menstrual cycle.
Younger women also may have heavy bleeding. Usually it is because of an irregular menstrual
cycle. A woman may go for several months without a period, but the lining of her uterus
continues to build up. When finally her body sheds the uterine lining, she may have very heavy
bleeding.
The symptoms can be very upsetting and may make you feel limited in the things you can do.
Sometimes, the symptoms are a sign of a more serious problem.
Your doctor will probably do a blood test. Depending on the results, your medical history, and
your age, the doctor may recommend that you have a biopsy to rule out endometrial
hyperplasia.
What treatments are used for very heavy menstrual bleeding?
Do you have a bleeding disorder?
If you have very heavy periods (lasting more than 7 days or soaking more than one pad or tampon
every 2 to 3 hours), frequent or long-lasting nosebleeds, easy bruising, or prolonged oozing of
blood after dental work, you may have a bleeding disorder such as von
Willebrand Disease. This
is not the same as very heavy menstrual bleeding, but it can be an underlying cause. It can be
diagnosed at the Hemophilia Treatment Center, and it can be treated. Call the National Hemophilia
Foundation at 800-424-2634, extension 3051, to find the Hemophilia Treatment Center nearest
you.Endometriosis
What is endometriosis?
Several types of surgery are used to treat endometriosis, including:
Endometrial Hyperplasia
What is hyperplasia?
Uterine Prolapse
What is uterine prolapse?
Surgical treatments include:
Ovarian Cysts
What are ovarian cysts?
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is caused by an
infection that
starts in the vagina. Most
often,
it is caused by a sexually transmitted disease (STD).
The
infection
spreads upward into the uterus,
fallopian tubes, and pelvis.
Severe Menstrual Pain
What is severe menstrual pain?
Very Heavy Menstrual Bleeding
What is very heavy menstrual bleeding?