Uterine Health- 01

1- Adenomyosis: Symptoms, Causes, and Treatments

2- Enlarged Uterus
3- Prolapsed Uterus
4- D and C (Dilation and Curettage)
5- Types of Hysterectomy
6- Hysterectomy Recovery: What to Expect
7- Alternatives to Hysterectomy
<<<<<<<<<<<<<<   >>>>>>>>>>>>>

1- Adenomyosis: Symptoms, Causes, and Treatments

What Is Adenomyosis?

Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. The condition can be located throughout the entire uterus or localized in one spot.

Though adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman's quality of life.

What Are the Symptoms of Adenomyosis?

While some women diagnosed with adenomyosis have no symptoms, the disease can cause:

• Heavy, prolonged menstrual bleeding
• Severe menstrual cramps
• Abdominal pressure and bloating

Who Gets Adenomyosis?

Adenomyosis is a common condition. It is most often diagnosed in middle-aged women and women who have had children. Some studies also suggest that women who have had prior uterine surgery may be at risk for adenomyosis.

Though the cause of adenomyosis isn't known, studies have suggested that various hormones -- including estrogen, progesterone, prolactin, and follicle stimulating hormone -- may trigger the condition.

Diagnosing Adenomyosis

Until recently, the only definitive way to diagnose adenomyosis was to perform a hysterectomy and examine the uterine tissue under a microscope. However, imaging technology has made it possible for doctors to recognize adenomyosis without surgery. Using MRI or transvaginal ultrasound, doctors can see characteristics of the disease in the uterus.

If a doctor suspects adenomyosis, the first step is a physical exam. A pelvic exam may reveal an enlarged and tender uterus. An ultrasound can allow a doctor to see the uterus, its lining, and its muscular wall. Though ultrasound cannot definitively diagnose adenomyosis, it can help to rule out other conditions with similar symptoms.

Another technique sometimes used to help evaluate the symptoms associated with adenomyosis is sonohysterography. In sonohysterography, saline solution is injected through a tiny tube into the uterus as an ultrasound is given.

MRI -- magnetic resonance imaging -- can be used to confirm a diagnosis of adenomyosis in women with abnormal uterine bleeding.

Because the symptoms are so similar, adenomyosis is often misdiagnosed as uterine fibroids. However, the two conditions are not the same. While fibroids are benign tumors growing in or on the uterine wall, adenomyosis is less of a defined mass of cells within the uterine wall. An accurate diagnosis is key in choosing the right treatment.

How Is Adenomyosis Treated?

Treatment for adenomyosis depends in part on your symptoms, their severity, and whether you have completed childbearing. Mild symptoms may be treated with over-the-counter pain medications and the use of a heating pad to ease cramps.

Anti-inflammatory medications. Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve mild pain associated with adenomyosis. NSAIDs are usually started one to two days before the beginning of your period and continued through the first few of days of your period.

Hormone therapy. Symptoms such as heavy or painful periods can be controlled with hormonal therapies such as a levonorgestrel-releasing IUD (which is inserted into the uterus), aromatase inhibitors, and GnRH analogs.

Uterine artery embolization. In this minimally invasive procedure, which is commonly used to help shrink fibroids, tiny particles are used to block the blood vessels that provide blood flow to the adenomyosis. The particles are guided through a tiny tube inserted into the vagina through the cervix. With blood supply cut off, the adenomyosis shrinks. 

Endometrial ablation. This minimally invasive procedure destroys the lining of the uterus. Endometrial ablation has been found to be effective in relieving symptoms in some patients when adenomyosis hasn't penetrated deeply into the muscle wall of the uterus.

Does Adenomyosis Cause Infertility?

Because many women who have adenomyosis also have endometriosis, it is difficult to tell precisely what role adenomyosis may play in fertilityproblems. However, some studies have shown that adenomyosis may contribute to infertility.

Can Adenomyosis Be Cured?

The only definitive cure for adenomyosis is a hysterectomy, or the removal of the uterus. This is often the treatment of choice for women with significant symptoms.

2- Enlarged Uterus

Enlarged Uterus

From conception to delivery, a woman's uterus can grow from the size of a pear to the size of a watermelon. But pregnancy isn't the only potential reason for an enlarged uterus. An enlarged uterus is common and can be a symptom of a variety of medical conditions, some of which require treatment.

Two of the most common causes of an enlarged uterus are uterine fibroidsand adenomyosis.

Uterine fibroids. Uterine fibroids are common noncancerous tumors of the muscular wall of the uterus, affecting as many as eight in 10 women by the age of 50. Fibroids more commonly affect women over age 30. They are also more common in African-Americans than Caucasians. Overweight and obese women also have a greater risk of developing fibroids. Hormonal and genetic factors contribute to their growth.

While some fibroids are very small, others grow to weigh several pounds. A woman may have a single fibroid or multiple fibroids. In addition to an enlarged uterus, symptoms of uterine fibroids may include:

• Feeling of fullness or pressure in the lower abdomen
• Heavy, painful, and/or long-lasting periods, sometimes with the passage of blood clots
• Bleeding between periods
• Constipation
• Frequent urination
• Pain during intercourse
• Pregnancy or delivery complications

If symptoms are severe, treatment may involve a procedure called uterine artery embolization to cut off the blood supply to the fibroids so that they shrink and eventually die, or surgery to remove the fibroids (myomectomy) or the entire uterus (hysterectomy). Other treatments include endometrial ablation. This procedure is performed for small submucusal fibroids (when the inside lining of the uterus is removed, burned or frozen) and laparoscopic myolysis (when freezing or an electric current is used to destroy the fibroids). Medications to help control painful periods or for pain may also be used. Other treatment options include focused ultrasound surgery and an intrauterine device (IUD) to decrease bleeding.

The cause of fibroids is not known, but the tumors seem to rely on estrogen to grow. After menopause, they often shrink naturally and cause no symptoms.

Adenomyosis. Adenomyosis is a diffuse thickening of the uterus that occurs when the tissue that normally lines the uterus (endometrium) moves into its muscular outer wall and behaves like the endometrium. When this happens in a small area, or is localized, it is called an adenomyoma.

While the cause of adenomyosis is unknown, the condition usually occurs in women older than age 30 who have had children. It is more common in women who have had uterine surgery, including a cesarean section.

In addition to uterine enlargement, symptoms may include:

• Long periods or heavy bleeding
• Painful periods, which get continually worse
• Pain during intercourse

Most women have some adenomyosis at the end of their childbearing years. Most don't require treatment, but some need medication to relieve pain. Birth control pills and an intrauterine device (IUD) containing progesterone may help decrease heavy bleeding. Women with severe symptoms may need a hysterectomy to relieve symptoms.

Other Causes of an Enlarged Uterus

In some cases, an enlarged uterus can be a symptom of uterine cancers, including endometrial cancer (affecting the lining of the uterus) and cervical cancer (affecting the lower portion of the uterus where it joins the vagina). Treatment depends on the location, the extent of the cancer, and other factors.

Symptoms of an Enlarged Uterus

If you have an enlarged uterus, you won't necessarily notice it yourself. Your doctor may discover it during a physical exam or on imaging tests. Many conditions that cause an enlarged uterus are benign and don't require treatment unless symptoms are severe.

If you experience problems such as irregular bleeding; painful, heavy periods; pain during intercourse; or feelings of fullness or pressure in the lower abdomen, see your doctor, who can help determine the cause and best treatment.

3- Prolapsed Uterus

Prolapsed Uterus

Prolapsed Uterus Overview-

Your uterus (or womb) is normally held in place inside your pelvis with various muscles, tissue, and ligaments. Because of pregnancy, childbirth or difficult labor and delivery, in some women, these muscles weaken. Also, as a woman ages and with a natural loss of the hormone estrogen, her uterus can drop into the vaginal canal, causing the condition known as a prolapsed uterus.

• Muscle weakness or relaxation may allow your uterus to sag or come completely out of your body in various stages:
  
  • First degree: The cervixdrops into the vagina.
  • Second degree: The cervix drops to the level just inside the opening of the vagina.
  • Third degree: The cervix is outside the vagina.
  • Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness in all of the supporting muscles.

• Other conditions are usually associated with prolapsed uterus. They weaken the muscles that hold the uterus in place:
• Cystocele: A herniation (or bulging) of the upper front vaginal wall where a part of the bladder bulges into the vagina. This may lead to urinary frequency, urgency, retention, and incontinence(loss of urine).
• Enterocele: The herniation of the upper rear vaginal wall where a small bowel portion bulges into the vagina. Standing leads to a pulling sensation and backache that is relieved when you lie down.
• Rectocele: The herniation of the lower rear vaginal wall where the rectum bulges into the vagina. This makes bowel movementsdifficult, to the point that you may need to push on the inside of your vagina to empty your bowel.

Prolapsed Uterus Causes

The following conditions can cause a prolapsed uterus:

• Pregnancy/childbirths with normal or complicated delivery through the vagina
• Weakness in the pelvic muscles with advancing age
• Weakening and loss of tissue tone after menopause and loss of natural estrogen
• Conditions leading to increased pressure in the abdomen such as chronic cough (with bronchitis and asthma), straining (with constipation), pelvic tumors (rare), or an accumulation of fluid in the abdomen
  Being overweight or obese with its additional strain on pelvic muscles
• Major surgery in the pelvic area leading to loss of external support
• Smoking

Other risk factors include:

• Excess weight lifting
• Being Caucasian

Prolapsed Uterus Symptoms

Symptoms of a prolapsed uterus include:

• A feeling of fullness or pressure in your pelvis (you may describe it as a feeling of sitting on a small ball)
• Low back pain
• Feeling that something is coming out of your vagina
• Painful sexual intercourse
• Difficulty with urination or moving your bowels
• Discomfort walking

When to Seek Medical Care

Notify your health care provider if you experience any of the following symptoms:

• You feel the cervix near the opening of the vaginal canal or you feel pressure in your vaginal canal and the feeling of something coming out of your vagina.
• You suffer persistent discomfort from urinary dribbling or the urge to have a bowel movement (rectal urgency).
• You have continuing low back pain with difficulty in walking, urinating, and moving your bowels.

Seek medical care immediately if you experience any of the following:

• Obstruction or difficulty in urination and/or bowel movement
• Complete uterine prolapse (your uterus comes out of your vagina)

Exams and Tests

Your health care provider can diagnose uterine prolapse with a medical history and physical examination of the pelvis.

• The doctor may need to examine you in standing position and while you are lying down and ask you to cough or strain to increase the pressure in your abdomen.
• Specific conditions, such as ureteral obstruction due to complete prolapse, may need an intravenous pyelogram (IVP) or renal sonography. Dye is injected into your vein, and a series of X-rays are taken to view its progress through your bladder.
• Ultrasound may be used to rule out other pelvic problems. In this test, a wand is passed over your abdomen or inserted into your vagina to create images with sound waves.

Prolapsed Uterus Treatment

Treatment depends on how weak the supporting structures around your uterus have become.

Self-Care at Home

You can strengthen your pelvic muscles by performing Kegel exercises. You do these by tightening your pelvic muscles as if trying to stop the flow of urine. This exercise strengthens the pelvic diaphragm and provides some support. Have your health care provider instruct you on the proper ways to isolate and exercise the muscles.

Medications

Estrogen (a hormone) cream or suppository ovules or rings inserted into the vagina help in restoring the strength and vitality of tissues in the vagina. But estrogen is only for use in select postmenopausal women.

Surgery

Depending on your age and whether you wish to become pregnant, surgery can repair the uterus or remove it. When indicated, and in severe cases, your uterus can be removed with a hysterectomy. During the surgery, the surgeon can also correct the sagging of the vaginal walls, urethra, bladder, or rectum. The surgery may be performed by an open abdominal procedure, through the vagina, or through small incisions in the abdomen or vagina with specialized instruments.

Other Therapy

If you do not want surgery or are a poor candidate for surgery, you may decide to wear a supportive device, called a pessary, in your vaginal canal to support the falling uterus. You can use this temporarily or permanently. They come in various shapes and sizes and must be fitted to you. If your prolapse is severe, a pessary may not work. Also, pessaries can be irritating inside your vagina and may cause a foul-smelling discharge.

Follow-up

Follow-up depends on how your condition was treated.

• If you had surgery, you need to follow up according to your surgeon's advice.
• If you have a pessary inserted in your vagina, it needs to be cleaned and checked by your health care provider for the correct position and fit at regular intervals unless you are instructed on how to remove it and clean it yourself at home.
• If you have been told to do Kegel exercises, you should have a regular follow-up visit so that your health care provider can check the progress of your muscle strength.

Prevention

• Reduce your weight.
• Avoid constipation by eating a high-fibre diet.
• Do Kegel exercises to strengthen your pelvic muscles.
• Avoid heavy lifting or straining.

Outlook

Pessaries can be effective temporarily or permanently if they are checked and cleaned as often as necessary. Surgery can support a prolapsed uterus or remove it.