laparoscopy

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

Endoscopy is a procedure that lets your doctor look inside your body. It uses an instrument called an endoscope, or scope for short. Scopes have a tiny camera attached to a long, thin tube. The doctor moves it through a body passageway or opening to see inside an organ. Sometimes scopes are used for surgery, such as for removing polyps from the colon.

There are many different kinds of endoscopy. Here are the names of some of them and where they look.:

• Arthroscopy: joints
• Bronchoscopy: lungs
• Colonoscopy and sigmoidoscopy: large intestine
• Cystoscopy and ureteroscopy: urinary system
• Laparoscopy: abdomen or pelvis
• Upper gastrointestinal endoscopy: esophagus and stomach

Pelvic inflammatory disease (PID) is an infection of the uterus, ovaries, and other female reproductive organs. PID causes scarring in these organs. This can lead to infertility, ectopic pregnancy, pelvic pain, abscesses (a collection of pus), and other serious problems. PID is the most common preventable cause of infertility in the United States.

Many types of bacteria can cause PID, but it's often caused by sexually transmitted infections (STIs). Gonorrhea and chlamydia are the most common causes of PID.

You are at greater risk for PID if you:

• Are sexually active and younger than age 25.
• Have more than one sex partner.
• Douche. Douching can push bacteria into your reproductive organs. It may also hide the signs of PID.
• Have an STI and do not get treated.
• Have had PID or an STI before.

It's not as common, but sometimes using an intrauterine device (IUD) for birth control can increase your risk for PID. However, your risk is usually only during the first three weeks after the IUD is placed inside your uterus.

If you have PID, you may have mild or no symptoms. If you do have symptoms, the most common symptom is pain in the lower abdomen (belly). Other symptoms can include:

• Fever
• Foul-smelling vaginal discharge
• Bleeding between periods
• Pain or bleeding during sex
• Painful urination (peeing)

See your health care provider if you have any symptoms of PID or if you think you or your partner were exposed to an STI. Early treatment is important. Waiting too long for treatment increases the risk of infertility.

There is no one test for PID. To check for PID, your provider may:

• Ask about your medical and sexual history
• Review your symptoms
• Do a pelvic exam
• Order blood, urine, and imaging tests

Antibiotics are used to treat PID. You must take all the medicine, even if your symptoms go away to make sure the infection is cured. You will likely need to follow up with your provider to make sure the treatment is working.

Tell your recent sex partner(s) so they can get tested and treated. Don't have sex until you finish treatment, otherwise you can reinfect each other.

If you're pregnant, have an abscess, or your symptoms don't go away, you may need to have surgery or be hospitalized for treatment.

Treatment cannot fix any permanent damage already done to your internal organs.

If you don't get treated, complications can occur, such as:

• Scar tissue may develop in your fallopian tubes.
• Infertility.
• An abscess may develop in your reproductive organs. If untreated, this could become a life-threatening infection.
• Long-term pelvic or abdominal (belly) pain.

The best way to protect yourself against STIs is not to have sex.

If you do decide to have sex, a few ways you can lower your risk include to:

• Practice safe sex by using a condom every time you have sex, limit your number of sex partners, and ask your partners about their sexual history.
• Get tested for chlamydia and gonorrhea every year and ask your partner to get tested.
• Don't douche since this can upset the balance of bacteria in your vagina.

Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. It can be a sharp and stabbing pain in a specific spot, or a dull pain that is spread out. If the pain is severe, it might get in the way of your daily activities.

If you're a woman, you might feel pain during your period. It could also happen when you have sex. Pelvic pain can be a sign that there is a problem with one of the organs in your pelvic area, such as the uterus, ovaries, fallopian tubes, cervix, or vagina. If you're a man, the cause could be problem with the prostate. In men and women, it could be a symptom of infection, or a problem with the urinary tract, lower intestines, rectum, muscle, or bone. Some women have more than one cause of pelvic pain at the same time.

You might have to have lab, imaging, or other medical tests to find the cause of the pain. The treatment will depend on the cause, how bad the pain is, and how often it occurs.

NIH: National Institute of Child Health and Human Development

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

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

The ovaries are part of the female reproductive system. They produce a woman's eggs and make female hormones. Ovarian cysts are fluid-filled sacs in or on an ovary. They usually form during ovulation, when the ovary releases an egg. They are usually harmless and go away by themselves. Most women have them sometime during their lives.

Most ovarian cysts are small and don't cause symptoms. Women may not find out that they have them until they have a pelvic exam. If there are symptoms, they may include:

• Pressure
• Bloating
• Swelling
• Pain in the lower abdomen, on the side where the cyst is

If your health care provider finds a cyst, you may be able to wait to see if it gets bigger. You may need surgery if you have pain, are past menopause, or if the cyst does not go away. If a cyst bursts or causes bleeding, you should get medical help right away. Birth control pills can help prevent new cysts.

Rarely, ovarian cysts can become cancerous. This risk increases as you get older.

A health problem that involves ovarian cysts is polycystic ovary syndrome (PCOS). Women with PCOS can have high levels of male hormones, irregular or no periods, and small ovarian cysts.

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

Uterine fibroids are the most common noncancerous (benign) tumors in women of childbearing age. You may have uterine fibroids and not even know it since they often don't cause any symptoms. Fibroids are made of muscle cells and other tissues that grow in and around the wall of the uterus, or womb. They can vary in number and size and grow as one tumor or in clusters.

Many women with fibroids can get pregnant with no problems. However, some uterine fibroids could cause infertility (not being able to get pregnant), pregnancy loss, or problems with fetal development or delivery.

If you're a female and the age when you're usually able to get pregnant and give birth, you could develop fibroids. Some factors may increase your risk of having uterine fibroids. These can include:

• Age. Women who are older have a higher risk.
• Race/ethnicity. Black/African American women often have fibroids at a younger age. They're also more likely to have larger fibroids with worse symptoms.
• Family history. If your mother or sister had uterine fibroids.
• Other factors. If you started your period before age 10 or have never been pregnant.
• Certain medical conditions. These include obesity or vitamin D deficiency.

Your risk of getting uterine fibroids lowers with each pregnancy and with long-term use of birth control pills or shots.

No one knows what causes uterine fibroids. A few things that might play a part in getting uterine fibroids include genetics and growth hormones. Also, other hormones like estrogen and progesterone seem to help fibroids grow. These hormones cause the tissue lining inside the uterus to thicken during each menstrual cycle to prepare for pregnancy.

Many women with fibroids have no symptoms. If you do, the type of symptoms may be due to location, size, and number of fibroids. Symptoms may include:

• Heavy or painful periods or bleeding between periods
• Feeling "full" in the lower abdomen (belly)
• Urinating (peeing) often
• Pain during sex
• Lower back pain
• Problems getting pregnant, multiple miscarriages, or early labor while pregnant

You may not know that you have uterine fibroids unless you have symptoms. Or your health care provider may find the fibroids during a pelvic exam, or with imaging tests.

Uterine fibroids might be very small, or in extreme cases, they may grow large enough to make it appear like a pregnancy.

If you have no symptoms, you may not even need treatment. If you have symptoms, the treatment for uterine fibroids depends on many factors. These can include:

• Your symptoms.
• Your age. Sometimes fibroids shrink during and after menopause due to a drop in hormone levels.
• The location, type, and size of fibroids.
• If you are pregnant or want to get pregnant in the future.

Treatment may include medicines that can slow or stop fibroid growth. Surgery, such as a hysterectomy (removal of the uterus), may be considered if you are near or past menopause, your fibroids are very large or cause heavy bleeding.

If you are having trouble getting pregnant, your provider may discuss infertility treatments. They may also recommend an emotional support group if you have chronic symptoms or difficulties getting pregnant or maintaining a pregnancy.

NIH: National Institute of Child Health and Human Development

When you eat, your body breaks food down to a form it can use to build and nourish cells and provide energy. This process is called digestion.

Your digestive system is a series of hollow organs joined in a long, twisting tube. It runs from your mouth to your anus and includes your esophagus, stomach, and small and large intestines. Your liver, gallbladder and pancreas are also involved. They produce juices to help digestion.

There are many types of digestive disorders. The symptoms vary widely depending on the problem. In general, you should see your doctor if you have:

• Blood in your stool
• Changes in bowel habits
• Severe abdominal pain
• Unintentional weight loss
• Heartburn not relieved by antacids

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your gallbladder is a pear-shaped organ under your liver. It stores bile, a fluid made by your liver to digest fat. As your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. The duct connects your gallbladder and liver to your small intestine.

Your gallbladder is most likely to give you trouble if something blocks the flow of bile through the bile ducts. That is usually a gallstone. Gallstones form when substances in bile harden. Rarely, you can also get cancer in your gallbladder.

Many gallbladder problems get better with removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways of reaching your small intestine.