endometrium

What is endometriosis?

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.

What causes endometriosis?

Researchers don't know what causes endometriosis.

Who is at risk for 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

What are the symptoms of endometriosis?

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

How is endometriosis diagnosed?

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.

What are the treatments for endometriosis?

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

What is a hysterectomy?

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.

What conditions does a hysterectomy treat?

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.

What are the different types of hysterectomies?

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.

What methods are used for a hysterectomy?

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.

What are the risks of a hysterectomy?

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

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is the name for set of symptoms that are related to an imbalance of hormones. PCOS affects the ovaries, as well as many other parts of the body.

People with PCOS usually have at least two of these problems:

• Not ovulating. Normally, your ovaries make the egg that is released each month as part of a healthy menstrual cycle. This is called ovulation. But with PCOS, the egg may not develop as it should, or it may not be released during ovulation. Your periods may be irregular, or you may not have them at all.
• High levels of androgens. Androgens are hormones that are important for normal male sexual development. Women normally make smaller amounts of androgens. Having higher levels of androgens can cause you to have extra body or facial hair (called hirsutism).
• Cysts in one or both ovaries. Cysts are growths that are small, fluid-filled sacs.

What causes polycystic ovary syndrome (PCOS)?

The exact cause of PCOS in unknown. Research has shown that different factors may play a role, including:

• Genetics. PCOS tends to run in families.
• Imbalances in androgen levels.
• Insulin resistance. This is a condition in which your body can't use insulin properly. Insulin is a hormone that helps move blood glucose (sugar) into your cells to give them energy. Insulin resistance can lead to high blood glucose levels.

What are the symptoms of polycystic ovary syndrome (PCOS)?

PCOS often develops as young as age 11 or 12, around the time of your first period. But you can develop it later.

The symptoms can vary from person to person. Some people have few or even no symptoms. They may not realize they have PCOS until they have trouble getting pregnant. Other people may have more severe symptoms.

The symptoms of PCOS may include:

• Irregular or missed menstrual periods.
• Too much hair on the face, chest, stomach, or thighs.
• Obesity, weight gain, or trouble losing weight.
• Severe acne which may be hard to treat.
• Oily skin.
• Patches of thickened dark skin (called acanthosis nigricans).
• Infertility. PCOS is one of the most common causes of infertility. But many women with PCOS can still get pregnant.

What other health problems are linked to polycystic ovary syndrome (PCOS)?

PCOS is linked to many other health problems, including:

• Insulin resistance, which can lead to prediabetes and type 2 diabetes.
• Heart disease. Having PCOS increases your risk, and this risk goes up as you age.
• High blood pressure.
• High LDL ("bad") cholesterol and low HDL ("good") cholesterol. This increases your risk of heart disease.
• Sleep apnea, a disorder that causes you to repeatedly stop breathing during sleep.
• Depression and anxiety.

Although there are links between PCOS and these conditions, researchers do not know whether:

• PCOS causes some of these problems
• Some of these problems cause PCOS, or
• There are other conditions that cause both PCOS and these other health problems

Not everyone who has PCOS will have all these problems. However, you and your health care provider may want to monitor your health for signs of them, so they can be treated early.

How is polycystic ovary syndrome (PCOS) diagnosed?

There is no specific test for PCOS. To find out if you have PCOS, your provider:

• Will do a physical exam, which will include looking for the physical signs of PCOS.
• Will ask about your medical history and family health history.
• May do a pelvic exam to check for signs of extra male hormones and to see if your ovaries are enlarged or swollen.
• May order a pelvic ultrasound to look for cysts on your ovaries and check the thickness of your endometrium (the lining of your uterus, or womb).
• May order blood tests, including tests to check your hormone levels.

What are the treatments for polycystic ovary syndrome (PCOS)?

There is no cure for PCOS, but treatments can help you manage your symptoms. The treatments may include:

• Lifestyle changes, which can help reduce many symptoms. They can also lower your risk for or help manage related health problems. These changes include:
  • Maintaining a healthy weight
  • Getting regular physical activity
  • Eating healthy foods
• Medicines:
  • Hormonal birth control, such as pills, shots, and IUDs, can make your period more regular. They may also help remove acne and extra facial and body hair. But you would only use them if you don't want to get pregnant.
  • Anti-androgen medicines, which block the effect of androgens. This can help reduce hair loss on your head, the growth of facial and body hair, and acne. Providers do use them to help with these symptoms, but anti-androgen medicines are not approved by the U.S. Food and Drug Administration (FDA) to treat PCOS. These medicines can cause problems during pregnancy. Your provider may have you take them with birth control (to prevent pregnancy).
  • Insulin-sensitizing medicines, which are medicines that are used to treat type 2 diabetes. They improve insulin resistance and keep your blood glucose levels steady. They may also lower your androgen levels. They are not approved by the FDA to treat PCOS. But they may help with your symptoms.
  • Medicines for acne. These medicines come in pills, creams, or gels.
• Treatments for hair removal, such as facial hair removal creams, laser hair removal, and electrolysis.
• Fertility treatments if you are having trouble getting pregnant. They include medicines and procedures such as in vitro fertilization (IVF).

What is uterine cancer?

Uterine cancer is a cancer that forms in tissues of the uterus, which is sometimes called the womb. The uterus is the place where a fetus grows during pregnancy.

There are two types of uterine cancer:

• Endometrial cancer is the most common type. This type of cancer begins in the cells lining the uterus, known as the endometrium.
• Uterine sarcoma is a rare, more aggressive cancer that is harder to treat. This type of cancer begins in muscle or other tissues in the uterus.

Who is more likely to develop uterine cancer?

Uterine cancer usually happens after menopause. The cause is unknown. However, some factors and conditions that change the balance of hormones in your body may increase your risk. These can include obesity or metabolic syndrome (a group of risk factors for certain health problems).

Other factors and conditions that may increase your risk for:

Endometrial cancer

• Taking estrogen-only hormone replacement therapy (HRT) after menopause.
• Having type 2 diabetes.
• Starting menstruation at an early age or menopause at a later age.
• Having never been pregnant.
• Taking tamoxifen, a medicine used to prevent or treat breast cancer.
• Having polycystic ovary syndrome.
• Having a mother, sister, or daughter who has had endometrial cancer.
• Having certain genetic conditions, such as Lynch syndrome.
• Having endometrial hyperplasia (thickening of the uterine lining).

Uterine sarcoma

• Having had past treatment with radiation therapy to the pelvis.
• Taking tamoxifen, a medicine used to prevent or treat breast cancer.

What are the symptoms of uterine cancer?

The most common symptom of both endometrial cancer and uterine sarcoma is abnormal vaginal bleeding. Both types of uterine cancer may also cause pelvic pain or pressure, unusual vaginal discharge, or an enlarged uterus or pelvic mass.

Less common symptoms may include urinating (peeing) often, having trouble urinating, or pain during sexual intercourse.

How is uterine cancer diagnosed?

If you have symptoms of uterine cancer, your health care provider may:

• Ask about your medical history and family health history.
• Do a pelvic exam.
• Order imaging tests.
• Suggest a biopsy or a minor procedure called dilation and curettage (D & C) to check the lining of your uterus.

What are the treatments for uterine cancer?

Treatment may depend on your health, how much cancer you have, and whether it has spread. The most common treatment is having a hysterectomy, which is surgery to remove the uterus. Sometimes the surgery also removes the ovaries and fallopian tubes.

You may have more than one type of treatment. Other treatments may include:

• Hormone therapy
• Radiation therapy
• Chemotherapy

Can uterine cancer be prevented?

There is no sure way to prevent uterine cancer. But you can do things that may help lower your risk such as aiming for a healthy weight, getting regular physical activity, and talking to your provider about the benefits and risks of hormone therapy.

NIH: National Cancer Institute