Expanding to 1,000 times its normal size during pregnancy, a woman's uterus is designed to withstand dramatic changes.
But not all changes are as positive as those brought on by pregnancy. There are many uterine conditions that can cause pain and complications and need to be treated by a doctor, according to the Agency for Healthcare Research and Quality.
Problems that can occur include:
Fibroids. A fibroid is a growth in the wall of the uterus. It can also be attached to the outside of the uterus by a stalk. Fibroids are noncancerous tumors that are actually made of smooth muscles. They can be as small as an apple seed to as large as a grapefruit. Fibroids are common, affecting up to 80% of women by the time they reach age 50, according to the Office on Women's Health (OWH).
These growths can occur without symptoms, but they sometimes cause pain, bleeding or difficulty urinating. Fibroids can make it difficult for a woman to become pregnant or can cause difficulties during pregnancy and delivery.
Treatment options depend on the size and location of the fibroid and whether the woman is pregnant or hopes to become pregnant. Treatments that do not require surgery include hormone therapy and pain medications. Larger fibroids that cause symptoms or grow quickly may require surgery to remove the tumor or the uterus.
Endometriosis. Endometrial tissue lines the uterus and is shed during menstruation. When a woman has endometriosis, the tissue grows outside the uterus. This tissue can cause abnormal bleeding and severe pain, or there may be no symptoms at all.
Endometriosis affects about half of women with infertility, according to OWH.
Hormone therapy, pain relievers or changes in diet and exercise may take care of the problem for some women. There are also several surgical options. The best treatment option depends on the stage of the endometriosis, the site of the pain and whether the woman hopes to become pregnant.
Endometrial hyperplasia occurs when the uterine lining becomes too thick due to excess estrogen. Women who are on hormone therapy, who do not ovulate or who have gone through menopause are at highest risk for this condition.
Hormone treatment with birth control pills can sometimes help, but sometimes a hysterectomy is recommended because hyperplasia increases the risk of uterine cancer.
Uterine prolapse happens when your uterus slips or tilts because the ligaments holding it in place weaken. You may feel pressure or discomfort or have trouble controlling your bladder.
Your doctor may suggest Kegel exercises, which strengthen the pelvic muscles, to correct the prolapse. To do Kegel exercises, tighten the muscles you would use to stop urine flow and hold for a count of 10. Relax for a count of 10. Do this 20 to 25 times, three or four times a day. Your doctor can help instruct you in doing this exercise.
Propping up the uterus with a rubber device called a pessary is another nonsurgical option for prolapse.
Surgery may be necessary if the symptoms are bothersome or if the uterus has slipped so far that it is coming through the vagina.
Finding the cause
If your doctor thinks you may have one of these uterine conditions, he or she may:
- Ask for your medical history. You will be asked about your symptoms, any serious illnesses you've had, any surgeries you've undergone and whether you've ever been pregnant. You should tell your doctor about any over-the-counter medications, herbs, acupuncture or other remedies you have been trying. Answer all questions about your sexual history frankly.
- Perform an exam. Your doctor will examine your cervix and uterus.
- Perform a Pap test. This test is done during the vaginal exam. The doctor takes a sample of cells from the cervix to be examined for abnormalities.
- Order laboratory or imaging tests. Your doctor might ask for a urine sample and may draw blood to be analyzed in a lab. In some cases, x-rays or other imaging tests may also be needed.
Once the underlying cause is found, work can begin on making treatment decisions.