Uterine Diseases

Uterus is the primary reproductive organ in females that bears, nourishes and protects the growing fetus during pregnancy. Any disease process or abnormality in the uterine tissues can directly compromise the female’s capacity to become pregnant or give birth to a healthy baby.

The first sign of an ongoing disease process in the uterine tissues is irregular bleeding from the vagina (with or without periods); but depending upon the cause and site of issue, the patient may also present with:

• Abdominal pain
• Flank or lower back pain
• Infertility or early miscarriage
• Abdominal swelling or lump

Common Uterine Diseases

Some common uterine diseases include:

1. Adenomyosis:

Growth of myometrial tissues outside of myometrium and into other uterine layers is referred to as adenomyosis. Certain risk factors that may aggravate the risk of developing adenomyosis are; middle age, prior history of cesarean section and history of multiple childbirths. The classic symptoms are:

• Severe cramping and abdominal pain during menstrual cycles
• Moderate to severe vaginal bleeding
• Irregular vaginal bleeding and prolong menstrual cycles
• Painful intercourse
• Passage of blood clots during menstrual cycles

Presence of uterine tissue outside of uterus is referred to as endometriosis. Most frequently employed treatment modalities include; anti-inflammatory drugs, hormonal analogies (especially combined birth control pills) and hysterectomy in severe

cases.

2. Uterine fibroids:

Fibroids are benign growths of uterine tissues in response to female reproductive hormones. The endometrial tissue growth may be small and solitary or large and multiple. Smaller and solitary growth are usually asymptomatic and does not affect the fertility or menstrual cycles; but larger growths may obliterate the shape of uterus and may compromise fertility.

Classic sign and symptoms include:

• Heavy menstrual bleeding
• Intermenstrual bleeding
• Infertility
• Irregular vaginal bleeding
• Bleeding after menopause
• Painful intercourse if the fibroid is large and obstructing the opening of uterus

Management options include; watchful waiting (if the polyps/ fibroids are small and asymptomatic), pharmacological agents (hormonal analogues) and surgical removal (excision of polyps or surgical removal of uterus).

3. Uterine cancer:

The malignant growth of uterine tissues is usually reported in middle-aged to elderly females. Uterine cancer (also referred to as endometrial malignancy) is usually reported in women with following risk factors:

• History of cigarette smoking
• Nulliparous (women who never become pregnant)
• Older age at menopause
• Family history of uterine, colon or ovarian malignancies
• obesity

The classic sign and symptoms include:

• Abnormal and severe vaginal bleeding
• Very long menstrual cycles (lasting up to 20 or more days)
• Onset of vaginal bleeding after menopause

According to latest statistics reported by Cancer.org; investigators suggested that 54,870 new cases of uterine cancer will be diagnosed in 2015 and 10,170 are expected to die of cancer. Currently more than 600,000 uterine cancer survivors are living in United States due to early detection and quality treatment options (4). Treatment modalities are generally decided after carefully analyzing patient factors (age, general health status, parity or reproductive status and patient preferences) as well as size and location of tumor. Most popular options include; removal of tumor (myomectomy) or hysterectomy.

4. Double Uterus:

This is a congenital anomaly of uterus that is characterized by either a bifid uterus or two separate uterine cavities due to incomplete union of uterine tubes in the fetal life. This condition is often complicated by formation of two separate vaginal and cervical cavities. In some cases, the women may not realize it until pregnancy or childbirth.

Some signs and symptoms suggestive of double uterus are:

• More than normal menstrual bleeding
• Abdominal cramping and lower abdominal pain during periods

The risk of complications during pregnancy increases if you have a double uterus; especially because the size of uterine cavity is smaller than may impede the fetal development. Usually no treatment is needed if the patient is asymptomatic. In complicated cases, surgical resection or restorative procedures may be needed to improve the functionality.

Management of Uterine Diseases

The management of uterine diseases is largely dependent on the inciting cause. For example, if the cause of uterine tissue growth is hormonal imbalance due to birth control pills or intake of hormonal analogues; you should consult a healthcare professional to look for alternative solutions. Most popular diagnostic modalities that may help to identify the core issue are:

• Patient history and clinical examination
• A pelvic exam that may tell more about the size and texture of uterus as well as adnexa (tissue surrounding the uterus)
• Ultrasound examination of the uterus and surrounding tissues
• Magnetic resonance imaging (MRI)
• Transvaginal ultrasound
• Hysteroscopy
• Endometrial biopsy (especially if there is a growth or your doctor is suspecting malignancy).

References

1. Exacoustos, C., Manganaro, L., & Zupi, E. (2014). Imaging for the evaluation of endometriosis and adenomyosis. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(5), 655-681.

2. Vigano, P., Corti, L., & Berlanda, N. (2015). Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis. Fertility and sterility, 104(4), 802-812.

3. Walker, J. L., Piedmonte, M. R., Spirtos, N. M., Eisenkop, S. M., Schlaerth, J. B., Mannel, R. S., ... & Sharma, S. K. (2012). Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. Journal of Clinical Oncology, 30(7), 695-700.