Are you familiar with the term pelvic organ prolapse or uterine prolapse? It is a condition when the uterus droops into the vagina due to various bodily stresses. There are various uterine diseases that are often less talked about though they affect a significant number of women worldwide. This article talks about the causes, symptoms, and treatment options for the most common uterine conditions.

Uterine Fibroid

Uterine fibroids are growths of uterine tissues and muscles that typically develop in women during their reproductive age. These fibroids can vary in size, ranging from minute growths to heavy, bulky masses. Women may also develop multiple uterine fibroids.

Cause

The exact cause of uterine fibroid is not yet known. However, clinical research suggests genetics play a role in fibroid growth. Fibroids can also develop due to factors like:

• Hormones: Estrogen and progesterone might cause the growth of fibroids by stimulating the growth of the uterine lining during each menstrual cycle. The fibroids shrink in size after menopause as the level of these hormones drops.
• Insulin-like growth factors can also affect fibrous growth.

Symptoms

Uterine fibroids are often asymptomatic. If they are symptomatic, these are common signs and symptoms you will notice:

• Heavy menstrual bleeding
• Menstrual periods lasting longer than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pains

Treatment

There are multiple treatment approaches for uterine fibroids.

• Medications like Gonadotropin-releasing hormone (GnRH) agonists, Tranexamic acid, Progestin-releasing intrauterine devices, etc. help treat symptoms like heavy menstrual bleeding and pelvic pressure and shrink the fibroids.
• Doctors often use minimally-invasive surgical procedures like Uterine artery embolization, Radiofrequency ablation, Laparoscopic myomectomy, Hysteroscopic myomectomy, and Endometrial ablation.
• A non-invasive, MRI-guided focused ultrasound surgery can also be performed to remove the fibroids.
• For larger uterine fibroids, morcellation is used to break down the tissues into smaller pieces before performing a myomectomy.

Endometriosis

Endometriosis is a painful uterine disorder that is characterized by the growth of the endometrium (the lining of the uterus) outside the uterus. The condition typically involves the ovaries, fallopian tubes, and the tissue lining the pelvis.

Cause

Medical science has not yet been able to find out the exact cause of endometriosis. Possible explanations are:

• Retrograde menstruation
• Cell transformation
• Surgical scar implantation
• Immune system disorder

Symptoms

The common signs and symptoms of Endometriosis are:

• Painful periods
• Pain during intercourse
• Painful urination and bowel movement
• Excessive menstrual bleeding
• Infertility

People may also experience fatigue, diarrhea, constipation, bloating, or nausea.

Treatment

• Pain medications like NSAIDs can help relieve painful menstrual clamps. Endometriosis can also be managed using hormone therapy like:
  • Hormonal contraceptives
  • Gonadotropin-releasing hormone agonist and antagonist
  • Progestin therapy
  • Aromatase inhibitor
• Endometriosis can impede your chances of conceiving. Your doctor might surgically remove the endometrial implant while protecting the uterus and ovaries or advise fertility therapy.

Adenomyosis of the Uterus

Adenomyosis is a condition that occurs when the endometrial tissues (tissues lining the uterus) grow into the muscular wall of the uterus. Though displaced, these tissues thicken, break down, and bleed during each menstrual cycle as they usually do.

Cause

The exact cause of uterine adenomyosis is not yet known. However, possible theories includes invasive tissue growth, uterine inflammation due to childbirth, and invasion of bone marrow stem cells can cause adenomyosis.

Symptoms

Adenomyosis often shows no signs or symptoms. However, some cases of adenomyosis can show symptoms like:

• Heavy and prolonged menstruation
• Cramps and pain during menstruation
• Chronic pelvic pain
• Painful intercourse

Treatment

Adenomyosis can be treated with anti-inflammatory drugs and hormone therapy in mild-to-moderate cases. In advanced cases of adenomyosis, your doctor might suggest a hysterectomy.

Cervicitis

Inflammation or irritation of the cervix (the end of the uterus that opens into the vagina) is called cervicitis.

Cause

Cervicitis can occur due to various reasons, such as:

• Sexually Transmitted Diseases (STI) such as gonorrhea, chlamydia, trichomoniasis, and genital herpes.
• Allergic reactions to contraceptive spermicides, feminine deodorants, latex, etc
• Bacterial Vaginosis: the overgrowth of certain bacteria in the vagina.

Symptoms

Usually, cervicitis is asymptomatic. Women with symptomatic cervicitis can experience:

• Unusual vaginal discharge
• Frequent or painful urination
• Painful sexual intercourse
• Vaginal bleeding

Treatment

• If cervicitis is caused due to hypersensitive reaction to spermicide or feminine hygiene products, you simply need to discontinue the use of the products. The symptoms will disappear within a few hours or days.

• If the conditions occur due to STI, you and your partner would need antibiotic treatment.

Cervical Ectropion

Cervical Ectropion happened when glandular cells (cells inside the cervix) that are red and sensitive grows on the outside of the cervix. This condition is common during adolescents, pregnancy, and ovulation.

Cause

Cervical ectropion is a non-cancerous condition. Research suggests women can be born with this condition or develop it later on in their lives when higher levels of estrogen is present. Adolescents and pregnant women have more estrogen, thus these groups are more likely to develop this condition.

Symptoms

Cervical ectropion does not typically manifest any signs and symptoms. Usually, people come to know about the condition when their healthcare providers perform routine pelvic exams or Pap smears. Rarely, cervical ectropion might show signs and symptoms like:

• Vaginal discharge containing blood or mucus.
• Pain and bleeding during sexual intercourse
• Pain and bleeding during pelvic exam
• Spotting between menstrual periods
• Pain in the pelvic region

Treatment

Most people do not require any treatment for cervical ectropion. In case of severe symptoms, your healthcare providers might prescribe you boric acid supplements. Some people may need more intensive procedures like Diathermy and Cryotherapy.

Cervical Polyp

Cervical polyps are finger or bulb-like growth on the cervical canal.

Cause

Doctors suspects that cervical polyps can occur due to:

• Cervical infections
• Chronic inflammation
• Abnormal response to estrogen
• Clogged blood vessels in the cervix

Symptoms

Typically, cervical polyps do not show any symptoms. However, in cases of symptomatic cervical polyps, you can experience:

• Heavy menstrual periods
• Bleeding after sexual intercourse
• Bleeding after menopause
• Bleeding between periods
• Vaginal discharge

Treatment

Take pain relive medications like Tylenol or Advil to relieve symptoms like menstrual cramps. It The safest option is to remove the polyp and sending it to a lab or testing to make sure it is not cancerous.

Cervical Cancer

Malignant tumor growth of cervical tissues is called cervical cancer. They can be of two types: Squamous cell carcinoma and adenocarcinoma. 

Cause

Most cervical cancer is caused due to exposure to various strains of the Human Papilloma Virus (HPV). Other factors like genetics, environmental, and lifestyle factors also play roles in the development of cervical cancer.

Symptoms

Cervical cancer does not show any symptoms at its initial stages. In more advanced stages, cervical cancer might show signs and symptoms like:

• Vaginal bleeding after intercourse, between periods, or after menopause.
• Watery, bloody vaginal discharge with a foul odor.
• Pelvic pain
• Pain during intercourse.

Treatment

Radiation therapy and chemotherapy help treat cervical cancer. Immunotherapy helps strengthen the immune system of the body to fight cancer. In addition, palliative therapy helps provide relief from pain and discomfort. In more advanced cases, surgical procedures like trachelectomy (removal of the cervix) and hysterectomy (removal of the uterus) are performed.

Conclusion

There are many uterine diseases, and it can be pretty overwhelming especially when people find it difficult to talk about them. This article has been created to help you become aware of the causes, symptoms, and treatment options available for different uterine diseases.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.

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