adenomyosis

The uterus, or womb, is the place where a fetus grows during pregnancy. The uterus is lined with tissue (endometrium). Endometriosis is a disease in which tissue like the lining of the uterus grows in other places in your body. These patches of tissue are called "implants," "nodules," or "lesions." They are most often found:

• On or under the ovaries
• On the fallopian tubes, which carry eggs from the ovaries to the uterus
• Behind the uterus
• On the tissues that hold the uterus in place
• On the bowels or bladder

In rare cases, the tissue may grow on your lungs or in other parts of your body.

Researchers don't know what causes endometriosis.

Endometriosis can affect anyone who menstruates. Certain factors can raise or lower your risk of getting it.

You are at higher risk if:

• You have a mother, sister, or daughter with endometriosis
• Your period started before age 11
• Your monthly cycles are short (less than 27 days)
• Your menstrual cycles are heavy and last more than 7 days

You have a lower risk if:

• You have been pregnant before
• Your periods started late in adolescence
• You breastfeed your babies

The main symptoms of endometriosis are:

• Pelvic pain, which often happens during your period
• Infertility

Other possible symptoms include:

• Painful menstrual cramps, which may get worse over time
• Pain during or after sex
• Pain in the intestine or lower abdomen
• Pain with bowel movements (pooping) or urination (peeing), usually during your period
• Heavy periods
• Spotting or bleeding between periods
• Digestive or gastrointestinal symptoms
• Fatigue or lack of energy

Surgery is the only way to know for sure that you have endometriosis. First, however, your health care provider will ask about your symptoms and medical history. You will have a pelvic exam and may have some imaging tests.

The most common surgery to diagnose endometriosis is a laparoscopy. This is a type of surgery that uses a laparoscope, a thin tube with a camera and light. The surgeon inserts the laparoscope through a small cut in the skin near your belly button. Your provider can make a diagnosis based on how the patches of endometriosis look. They may also do a biopsy to get a tissue sample.

There is no cure for endometriosis, but there are treatments for the symptoms. Your provider will work with you to decide which treatments would be best for you.

Treatments for endometriosis pain include:

• Pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and a prescription medicine specifically for endometriosis. Providers may sometimes prescribe opioids for severe pain.
• Hormone therapy, which stops the ovaries from making hormones. This may slow the growth of the endometrial tissue and may stop new areas from growing. Types of hormone therapy include:
  • Birth control pills.
  • Progestin therapy.
  • Gonadotropin-releasing hormone (GnRH) medicines (GnRH agonists and antagonists). These medicines cause a temporary menopause. After your stop taking the medicines, your menstrual periods will start again, and pregnancy is possible.
• Surgical treatments for severe pain, including procedures to remove the endometriosis patches or cut some nerves in the pelvis. The surgery may be a laparoscopy or major surgery.

Treatments for infertility caused by endometriosis include:

• Laparoscopy to remove the endometriosis patches
• In vitro fertilization

NIH: National Institute of Child Health and Human Development

The uterus, or womb, is the place where a fetus grows during pregnancy. Uterine diseases are conditions that affect the uterus. These diseases can be benign (not cancer) or malignant (cancerous). They may affect your menstrual periods, your ability to get pregnant, or the health of your reproductive organs.

Some types of uterine diseases include:

• Adenomyosis. Tissue that usually lines the uterus grows on the outside walls.
• Cervicitis. Swelling or inflamed tissue of the cervix. The cervix is the lower part of the uterus.
• Endometrial hyperplasia. An overgrowth of normal cells inside the uterus.
• Endometriosis. Tissue like the lining of the uterus grows in other places in your body.
• Uterine prolapse. The uterus drops in to the vagina due to weakened pelvic muscles. This can happen after a few vaginal births, menopause, or because of obesity.

Various factors can cause uterine diseases. These can include hormonal imbalances, thyroid problems, fibroids, polyps, cancer, infection, or pregnancy.

Your symptoms will depend on the type of uterine condition you have. The first sign of a problem with the uterus may be abnormal bleeding. Bleeding could occur between periods, be very heavy, or last much longer than usual. Other symptoms may include bleeding after sex or pelvic pain.

To find out the cause of your symptoms, your health care provider may:

• Ask about your symptoms and medical history
• Do a pelvic exam
• Order blood tests or imaging tests
• Do a biopsy

Treatment depends on the cause. It may include pain medicine, hormone therapy, or surgery. Your provider will work with you to choose the best treatment.

A hysterectomy is surgery to remove the uterus (womb). The uterus is the place where a fetus grows during pregnancy. A hysterectomy treats problems like heavy bleeding, pain, or cancer in the uterus.

After a hysterectomy, you no longer have menstrual periods and can't become pregnant. Sometimes the surgery also removes the ovaries and fallopian tubes. If you have both ovaries taken out,menopause symptoms will usually begin.

Hysterectomy is a major surgery. Your health care provider may suggest other treatment options first. These might include medicine, hormone therapy, or procedures to remove fibroids or stop heavy bleeding. Sometimes these won't help, or surgery might be the only option, depending on the condition that needs to be treated.

Your provider might recommend a hysterectomy if you have:

• Fibroids, if you are near or past menopause, have large fibroids or very heavy bleeding.
• Endometriosis, that hasn't been cured by medicine or surgery.
• Uterine prolapse, which can happen after several vaginal births, menopause, or because of obesity. It is when the uterus drops into the vagina.
• Cancer, of the uterus, cervix, ovaries, or endometrium (the lining of the uterus).
• Vaginal bleeding, that is heavy or unusual and persists despite treatment.
• Chronic pelvic pain, which starts in the uterus. A hysterectomy is a last resort since it doesn't fix some pelvic pain.
• Adenomyosis, is a thickening of the walls of the uterus. A hysterectomy is only considered if pain is severe and no other treatments have worked.

Your provider will discuss the type of hysterectomy you need, depending on your condition.

The different types of surgeries include:

• A total hysterectomy is the most common type and involves the removal of all the uterus, including the cervix. The ovaries and fallopian tubes may or may not be removed.
• A partial (subtotal or supracervical) hysterectomy removes just the upper part of the uterus. The cervix is left in place, and your ovaries may or may not be removed
• A radical hysterectomy removes all the uterus, cervix, and tissue on both sides of the cervix and the upper part of the vagina. This is most often used to treat certain types of cancer, such as cervical cancer. The fallopian tubes and ovaries may or may not be removed.

A hysterectomy may be done several different ways. Your provider will determine the best method for the surgery based on your general health, the reason for the surgery, and other factors.

Methods to perform a hysterectomy include:

• Abdominal hysterectomy. A cut is made in your lower abdomen (belly). Your provider may recommend this method if you have a large uterus or to check other pelvic organs for signs of disease. This surgery has a longer recovery time than the others.
• Vaginal hysterectomy. A small cut is made in your vagina. This may not be an option if you have very large fibroids.
• Laparoscopic hysterectomy. Uses an instrument with a thin, lighted tube and an attached camera. This helps your provider see your pelvic organs. Small cuts are made in either your abdomen (belly) or vagina. This is not an option for all types of uterine fibroids.
• Robotic surgery. Your provider guides a robotic arm to do the surgery through small cuts in your lower abdomen (belly).

After a hysterectomy, it can take four to six weeks to recover, depending on the type of surgery you have.

Like all surgeries, a hysterectomy has risks, even though the results are usually good. Talk to your provider about the benefits and risks of having a hysterectomy.

More serious risks can include:

• Too much bleeding during surgery
• Infection
• Blood clots

Dept. of Health and Human Services Office on Women's Health

Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman's monthly cycle. Every month, your body prepares for pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina.

Periods usually start between age 11 and 14 and continue until menopause at about age 51. They usually last from three to five days. Besides bleeding from the vagina, you may have:

• Abdominal or pelvic cramping pain
• Lower back pain
• Bloating and sore breasts
• Food cravings
• Mood swings and irritability
• Headache and fatigue

Premenstrual syndrome, or PMS, is a group of symptoms that start before the period. It can include emotional and physical symptoms.

Consult your health care provider if you have big changes in your cycle. They may be signs of other problems that should be treated.

NIH: National Institute of Child Health and Human Development

Adhesions are bands of scar-like tissue. Normally, internal tissues and organs have slippery surfaces so they can shift easily as the body moves. Adhesions cause tissues and organs to stick together. They might connect the loops of the intestines to each other, to nearby organs, or to the wall of the abdomen. They can pull sections of the intestines out of place. This may block food from passing through the intestine.

Adhesions can occur anywhere in the body. But they often form after surgery on the abdomen. Almost everyone who has surgery on the abdomen gets adhesions. Some adhesions don't cause any problems. But when they partly or completely block the intestines, they cause symptoms such as:

• Severe abdominal pain or cramping
• Vomiting
• Bloating
• An inability to pass gas
• Constipation

Adhesions can sometimes cause infertility in women by preventing fertilized eggs from reaching the uterus.

No tests are available to detect adhesions. Doctors usually find them during surgery to diagnose other problems.

Some adhesions go away by themselves. If they partly block your intestines, a diet low in fiber can allow food to move easily through the affected area. If you have a complete intestinal obstruction, it is life-threatening. You should get immediate medical attention and may need surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The uterus, or womb, is the place where a fetus grows during pregnancy. In an ectopic pregnancy, the fertilized egg grows in the wrong place outside the uterus. It usually occurs in the fallopian tubes. These tubes carry eggs from the ovaries to the uterus. Sometimes, an ectopic pregnancy can occur in the ovaries, abdominal cavity, or the lower part of the uterus (cervix).

Ectopic pregnancies can't end in a healthy pregnancy because the egg cannot grow. If the pregnancy continues, the fallopian tube can burst. This can cause internal bleeding, which can be a life-threatening emergency that needs immediate surgery.

An ectopic pregnancy often happens because there is a problem with your fallopian tubes. But sometimes it's not clear why an ectopic pregnancy happens.

Factors that may increase your risk for an ectopic pregnancy can include:

• Previous ectopic pregnancy
• Prior pelvic, abdominal, or fallopian tube surgery
• Certain sexually transmitted infections (STIs)
• Pelvic inflammatory disease
• Endometriosis
• Becoming pregnant while using an intrauterine device (IUD) for birth control
• Becoming pregnant after a tubal ligation

Other factors that may increase your risk can include:

• Smoking
• Being older than age 35
• Infertility treatments

You may not notice any symptoms at first. Or you may have some of the usual signs of pregnancy such as a missed period, breast tenderness, or nausea.

Early signs of an ectopic pregnancy may be light vaginal bleeding and pelvic pain. Ectopic pregnancy can be a medical emergency. Get medical care right away if you have these signs:

• Abdominal (belly) pain
• Shoulder pain
• Vaginal bleeding
• Feeling dizzy or faint

An ectopic pregnancy can't be diagnosed without blood tests and an ultrasound. Your health care provider will do a pregnancy test to confirm that you're pregnant. They may do a pelvic exam to check for areas of pain, tenderness, or a mass.

An ectopic pregnancy needs treatment to stop any damage to your organs. Your provider will use medicine or surgery to take out the ectopic tissue.

Losing a pregnancy can be devastating. An ectopic pregnancy is like a miscarriage, but it must be treated to prevent problems. People cope with grief in different ways. It may be helpful to discuss your feelings with your provider or a counselor. Many women who have had ectopic pregnancies go on to have healthy pregnancies later.

Dept. of Health and Human Services Office on Women's Health

Infertility means not being able to get pregnant after at least one year of trying (or 6 months if the woman is over age 35). If a woman keeps having miscarriages, it is also called infertility. Female infertility can result from age, physical problems, hormone problems, and lifestyle or environmental factors.

Most cases of infertility in women result from problems with producing eggs. In primary ovarian insufficiency, the ovaries stop functioning before natural menopause. In polycystic ovary syndrome (PCOS), the ovaries may not release an egg regularly or they may not release a healthy egg.

About a third of the time, infertility is because of a problem with the woman. One third of the time, it is a problem with the man. Sometimes no cause can be found.

If you think you might be infertile, see your doctor. There are tests that may tell if you have fertility problems. When it is possible to find the cause, treatments may include medicines, surgery, or assisted reproductive technologies. Happily, many couples treated for infertility are able to have babies.

Dept. of Health and Human Services Office on Women's Health

Heart disease is a general term that includes many types of heart problems. It's also called cardiovascular disease, which means heart and blood vessel disease.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease in both men and women. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to:

• Angina - chest pain from lack of blood flow
• Heart attacks - when part of the heart muscle dies from loss of blood flow
• Heart failure - when your heart can't pump enough blood to meet your body's needs
• Arrhythmia - a problem with the rate or rhythm of your heartbeat

In the United States, heart disease is the number one cause of death in women. But women are often not diagnosed with heart disease as quickly as men are. That's because:

• Women are more likely than men to have "silent" heart disease, meaning that they don't have symptoms.
• Health care providers may not recognize heart disease in women because women's symptoms may be different from men's symptoms.
• Women are more likely than men to have certain types of heart disease that can be harder to diagnose.

A delay in diagnosis may mean a delay in medical care that could help prevent serious problems, such as a heart attack. That's why it's important to learn about your risk for heart disease, the symptoms in women, and how to keep your heart healthy.

Women can get any type of heart disease. Like men, the most common type of heart disease among women is coronary artery disease. But there are certain types of heart disease which are less common, but affect women more often than men:

• Coronary microvascular disease - Chest pain from spasms (sudden tightening) in the smallest arteries of the heart that pinch off blood flow. It typically happens during rest or routine activities. This serious condition increases your risk of having a heart attack or other heart diseases. This type may be harder to diagnose since blockages in smaller arteries can be harder to see on imaging tests.
• Broken heart syndrome - Strong chest pain or other signs that look like a heart attack. It's caused by the stress of powerful emotions, such as deep grief, anger, or surprise. It can happen even if you're healthy. It mostly affects women after menopause and usually doesn't cause any lasting damage.
• Variant angina - A rare type of strong chest pain from spasms in the heart arteries. The pain usually happens in a pattern during sleep. Variant angina rarely causes a heart attack.

Your risk for developing heart disease increases with:

• Menopause. Women can develop heart disease at any age, but your risk increases after your periods stop, usually by age 55. Before menopause, your body makes more estrogen (a female hormone) which helps protect against heart disease. That's why women generally develop coronary artery disease 10 years later than men. During and after menopause, estrogen levels drop and your risk for heart diseases goes up. If your periods stop before age 40, your risk will be higher than other women your age.
• Family history of heart disease. Your risk for heart disease may be higher if your:
  • Mother or sister had heart disease before age 65.
  • Father or brother had heart disease before age 55.
• Problems during pregnancy, such as high blood pressure, gestational diabetes, anemia, and high blood pressure.
• Use of hormonal birth control (pills, patches, or vaginal rings with estrogen and progesterone).
• Endometriosis.
• Polycystic ovary syndrome.
• Inflammatory and autoimmune diseases.
• Metabolic syndrome.
• Mental health issues, such as stress, anxiety, or depression.
• Health risks from a lack physical activity.
• Obesity or being overweight.
• Diabetes.
• Low HDL cholesterol levels.
• Mild to moderate high blood pressure.
• Smoking.

If you have one or more risks for heart disease, ask your health care provider for help understanding your risk level. Ask if you need any heart tests to help catch heart disease early.

When women have symptoms of heart disease, they may include:

• Pain or discomfort in the chest that may be dull and heavy or sharp
• Pain in the neck, jaw, throat, upper belly, or back
• Nausea or vomiting
• Unusual fatigue
• Shortness of breath (feeling like you can't get enough air) during physical activity

Women who have coronary artery disease are more likely than men to have chest pain when resting or doing daily activities, rather than during exercise. They're also more likely than men to feel chest pain from mental stress.

Symptoms of a heart attack in women may also be different than in men. Chest pain is the most common symptom for both sexes. It may feel like crushing or squeezing. But women are somewhat less likely than men to have chest pain.

During a heart attack, women may feel:

• Pressure or tightness in the chest
• Pain in the upper back, arms, neck, jaw or throat
• Dizziness
• Unusual fatigue
• Indigestion, heartburn, nausea, or vomiting
• Stomach pain
• Shortness of breath

Heart attacks usually don't look like the sudden, dramatic events we see in the movies. The symptoms may be mild or strong. They may start slowly. They can stop and then come back.

You can help lower your risk by:

• Learning how to prevent heart disease and making heart-healthy habits part of your daily life.
• Asking your provider about your personal risk for heart disease and the best way to manage your heart health.

Remember, women can have heart disease without symptoms. But if you pay attention to your risk for heart disease, you can take action to prevent problems or keep them from getting worse.

NIH: National Heart, Lung, and Blood Institute

Cancer is a disease in which abnormal cells in the body grow out of control and form a tumor. Ovarian cancer is a cancerous tumor that forms in the tissues of an ovary. The ovaries are a pair of female reproductive glands that make eggs and female hormones.

There are a few different types of ovarian cancer. The most common type is epithelial cancer. It begins in the cells that cover the ovary.

There are also two related types of epithelial cancer that can spread to the ovaries:

• Fallopian tube cancer forms in the tissue lining a fallopian tube. The fallopian tubes are a pair of long, slender tubes on each side of the uterus. The uterus is the female reproductive organ where a fetus grows during pregnancy.
• Primary peritoneal cancer forms in the tissue lining the peritoneum. Your peritoneum is a tissue lining that covers the organs in the abdomen (belly).

These two cancers are like ovarian cancer, and they have the same treatments. So some medical experts also consider those two types as ovarian cancer.

Some other rarer types of ovarian cancer are malignant germ cell tumors and stromal tumors.

Ovarian cancer happens when there are changes (mutations) in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown.

Most ovarian cancers are caused by genetic changes that happen during your lifetime. But sometimes these genetic changes are inherited, meaning that you are born with them. Ovarian cancer that is caused by inherited genetic changes is called hereditary ovarian cancer.

There are also certain genetic changes that can raise your risk of ovarian cancer, including changes called BRCA1 and BRCA2. These two changes also raise your risk of breast and other cancers.

Besides genetics, your lifestyle and the environment can affect your risk of ovarian cancer.

Certain people are more likely to develop ovarian cancer. They include those who:

• Have a family history of ovarian cancer in a mother, aunt, grandmother, or sister
• Have inherited changes in the BRCA1 or BRCA2 genes
• Have certain other genetic conditions, such as Lynch syndrome
• Have endometriosis
• Took hormone replacement therapy
• Are overweight or have obesity
• Are tall
• Are older, especially those who have gone through menopause
• Have never been pregnant

Ovarian cancer may not cause early signs or symptoms. By the time you do have signs or symptoms, the cancer is often advanced.

The signs and symptoms may include:

• Pain, swelling, or a feeling of pressure in the abdomen (belly) or pelvis
• Sudden or frequent urge to urinate (pee)
• Trouble eating or feeling full
• A lump in the pelvic area
• Gastrointestinal problems, such as gas, bloating, or constipation

To find out if you have ovarian cancer, your health care provider:

• Will ask about your medical history, including your symptoms
• Will ask about your family health history, including relatives who have had ovarian cancer
• Will do a physical exam, including a pelvic exam
• Will likely do imaging tests
• May do blood tests such as a CA-125 blood test

Often the only way to know for sure that you have ovarian cancer is by having a biopsy of the tissue. A biopsy is done during surgery to remove the tumor.

Treatments for ovarian cancer may include:

• Surgery to remove as much of the cancer as possible
• Chemotherapy
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells

Your provider may suggest that you have genetic testing to look for the gene changes that raise the risk for ovarian cancer. Knowing whether you have the gene change may help your provider decide on your treatment plan.

NIH: National Cancer Institute

The ovaries are a pair of female reproductive glands that make eggs and female hormones. Women have one ovary on each side of the uterus (where a fetus grows during pregnancy). Each ovary is about the size and shape of an almond.

Ovaries play a role in menstruation, pregnancy, and menopause. Your ovaries:

• Produce and store eggs that are released during ovulation (when an egg leaves the ovary and travels into the fallopian tube). If a sperm fertilizes the egg, you can become pregnant.
• Make the female hormones estrogen and progesterone.
• Stop making those hormones and releasing eggs during menopause.

Some medical problems can affect the ovaries. These can cause various symptoms, and some ovarian disorders may need prompt treatment.

Some problems that can happen with the ovaries can include:

• Ovarian cancer is when a cancerous tumor forms in the tissues of an ovary.
• Ovarian cysts are fluid-filled sacs in or on an ovary.
• Polycystic ovary syndrome (PCOS) is a set of symptoms related to an imbalance of hormones.
• Primary ovarian insufficiency is when your ovaries stop working before age 40.
• Ovarian torsion is a twisting of the ovary.
• Endometriosis is when tissue like the lining in your uterus grows in other places in your body. It may affect the ovaries, fallopian tubes, and tissue lining the pelvis.
• Pelvic inflammatory disease is an infection and inflammation of the uterus, ovaries, and other female reproductive organs.
• Ovarian tumors.

Ovarian disorders can happen for different reasons depending on the condition. Sometimes the cause is unknown.

Your symptoms may be different, depending on the problem with your ovaries. Some ovarian disorders, such as ovarian cysts, may cause few or even no symptoms. Other disorders may cause more severe symptoms. Symptoms can include:

• Pelvic pain, which often happens during your period
• Nausea or diarrhea
• Vaginal bleeding that is between periods, very heavy, or longer than usual
• Vaginal discharge
• Painful menstrual cramps

To find out if you have a problem with your ovaries, your health care provider:

• Will ask about your medical history, including your symptoms
• Will ask about your family health history
• Will do a physical exam, including a pelvic exam
• May order imaging tests, or blood tests

Treatment depends on the ovarian disorder, your symptoms, overall health, and plans for pregnancy. Treatment can include medicines, such as pain relievers or hormonal birth control, lifestyle changes to reduce symptoms, or sometimes surgery. Ovarian cancer may require surgery, chemotherapy, or other targeted therapy.