Common Conditions That Can Affect the Uterus

Several health conditions can affect the uterus or womb. Some are serious, while others need minimal treatment. Many involve similar symptoms such as pelvic pain or irregular bleeding. It's important to see a healthcare provider so you can get the right diagnosis and treatment.

This article explores some of the most common uterine health conditions. It also takes a look at how they are diagnosed and treated.

Uterus Structure

The uterus is a pear-shaped structure in the pelvis. It sits behind the bladder and in front of the rectum. The uterus grows during pregnancy. Afterward, it shrinks back almost to its original size within weeks.

On each side of the uterus are the fallopian tubes and ovaries. The uterus, vagina, ovaries, and fallopian tubes make up the female reproductive system. Because these organs are so close to each other, pain in the pelvis could be related to the uterus or something else entirely.

Uterine Conditions

Some of these health conditions begin in the uterus. Others are caused by factors outside the uterus, such as hormones.

Dysmenorrhea

Dysmenorrhea is menstrual pain. It can occur before and/or during your period. Period pain is not necessarily a sign of a medical condition on its own. It often improves with pain medication or hormone therapy.

Heavy Menstrual Bleeding

Heavy menstrual bleeding (previously called menorrhagia) is excessive menstrual bleeding and can also refer to bleeding that lasts too long. It can occur without any known cause, or it can be a symptom of:

• Hormone imbalances
• Fibroids
• Polyps
• Some types of birth control
• Cancer
• Other health conditions

Heavy bleeding can cause iron deficiency anemia, a low red blood cell count. If your red blood cell count is low, you may need treatment to control the bleeding as well as the anemia.

Uterine Prolapse

Uterine prolapse means the muscles and ligaments that hold the uterus in place have weakened. The uterus drops. Many people have mild to moderate uterine prolapse when they get older.

The most common symptoms are:

• An urgent feeling that you need to urinate
• Urine leaks
• Pain during or after sex in severe cases

Congenital Uterine Malformation

Sometimes the uterus has an atypical shape. This can make it harder to get pregnant and can raise the risk of miscarriage. Your healthcare provider may spot the condition on an ultrasound. It is most often diagnosed by an MRI or a hysterosalpingogram.

These differences can include:

• Septate uterus: A septate uterus is a normal uterine cavity with a wall of fibrous tissue (called the septum) going down the middle of the uterus. Some septums are completed, which mean they go all the way down to the cervix, ultimately separating the two sides of the one uterus. Others are shorter. With a septum, the patient still has one cervix and one vagina.
• Bicornuate uterus: A bicornuate uterus is heart shaped because there are two separate uterine cavities that are completely walled off. However, there is only one cervix and one vagina.
• Didelphys uterus: The uterus has two separate uterine cavities and cervixes.
• Unicornate uterus: The uterus is smaller, and there is only one fallopian tube. Sometimes there's a second section that doesn't fully develop.

Pelvic Inflammatory Disease

Sometimes, bacteria or microbes enter the cervix and spread upward. The infection can affect one or more of the pelvic organs, including the uterus, cervix, and fallopian tubes. This is called pelvic inflammatory disease (PID).

Symptoms can include:

• Discharge
• Foul smell
• An urgent need to urinate
• Pain

Polyps

Uterine polyps are common. These small, soft growths in the uterus may cause heavy menstrual bleeding, spotting between periods, and bleeding after sex.

Fibroids

Fibroids are growths in the walls or lining of the uterus. Sometimes, they attach to the outside of the uterus by a stalk. They can be as small as a seed or larger than an orange.

Symptoms include:

• Heavy or prolonged bleeding during your period or between periods
• Pelvic pain or pressure
• Back pain
• Pain during sex
• Difficulty getting pregnant 

Endometrial Hyperplasia

Endometrial hyperplasia occurs when too many cells grow in the lining of the uterus. The uterus becomes very thick as a result. The condition can cause abnormal bleeding.

It is not cancer, but in some cases, it can lead to cancer of the uterus. Symptoms include:

• Abnormal vaginal bleeding
• Discharge
• Abnormal Pap test

Endometriosis

With endometriosis, the same kind of tissue that lines your uterus grows in other parts of the body. Most of the time, it grows in the abdomen or ovaries. This can cause scar tissue to build up around the affected organs. People who have endometriosis often have endometrial hyperplasia, but not always.

Symptoms include:

• Painful or heavy periods
• Irregular bleeding or spotting
• Pain during or after sex
• Pain in the abdomen or intestines
• Pain during urination or bowel movements 

The cause of endometriosis is unclear, but there are various theories.

Uterine Scars (Asherman's Syndrome)

Sometimes, scars form after uterine surgery, radiation, or injury. These scars are also called adhesions or Asherman's syndrome. It may lead to not having periods or light bleeding during your periods. Severe cases can cause pain or infections.

Cancer

Uterine cancer causes abnormal vaginal bleeding. The most common type is endometrial cancer. It requires aggressive treatment if it has spread beyond the uterus.

Chronic Pelvic Pain

If your healthcare provider can't identify the cause of your pain, you may be diagnosed with chronic pelvic pain. This can be caused by pelvic floor dysfunction, which is also seen in conjunction with uterine problems. You may need treatment when your pain becomes worse. You may also be more sensitive to other painful conditions, such as gastrointestinal or bladder infection.

Symptoms

Symptoms of diseases of the uterus include:

• Irregular periods
• Discharge
• Pelvic pain or discomfort
• Low back pain
• Trouble urinating
• Difficulty getting pregnant

In each phase of your menstrual cycle, the uterus changes. Symptoms may get better or worse throughout the month.

Diagnosis

Your medical history and symptoms can help your healthcare provider decide which tests you need. Some of the most common tests are:

• Pelvic exam: This can identify problems such as a prolapsed or retrograde uterus. A pelvic exam can't fully assess what's happening inside the uterus. You may need other tests to confirm your diagnosis.
• Pap smear: This test can identify changes in the cells of the cervix. That's the opening of the uterus. If you have not had a recent Pap smear, this test may be a good starting point if you have symptoms of a uterine condition.
• Urinalysis: This test checks for signs of infection and, sometimes, cancer cells in your urine.
• Blood samples: Sometimes these tests identify hormonal changes that could affect the uterus.
• Imaging tests: Ultrasound or computed tomography (CT) scans produce an image of the uterus. They can reveal differences in shape, size, or location. For some CT scans, doctors may inject dye into a blood vessel to create a clearer picture.
• Interventional procedures: These tests use tiny cameras to explore the inside of the uterus without surgery. In a hysteroscopy, doctors place a tube into the cervix to look at the inside of the uterus. In a hysterosalpingography or a sonohysterogram, doctors inject fluid or dye into the cervix to see the inside of the uterus.

Treatment

The right treatment depends on what's causing your symptoms. Some of the most common treatments include:

• Antibiotics: An infection such as PID requires antibiotics.
• Hormonal treatment: Endometriosis is often treated with medications, such as birth control pills. Endometrial hyperplasia, dysmenorrhea, and heavy menstrual bleeding may be treated with hormone therapy if symptoms are severe.
• Embolization: Uterine fibroids can be treated with embolization. This procedure isn't as invasive as surgery. A healthcare provider uses a slender tube to insert a medication or material that cuts off blood supply to the fibroid. The fibroid then shrinks. The same treatment can be used to treat polyps if necessary.
• Surgery: Uterine prolapse can be treated surgically. In severe cases, the uterus may be removed. Fibroids, polyps, adenomyosis, endometriosis, and cancer can also be treated with surgery.
• Observation: Sometimes the best approach is to watch and wait. For example, healthcare providers may keep a close eye on your pregnancy if you have a uterine malformation. If you have a retrograde uterus, you can pay attention to bladder symptoms. At some point, you may need strategies to deal with urine leaks.

In some cases, treatments are combined. That's especially true in severe cases or those where a single treatment didn't work well.

Summary

The uterus can be affected by many different conditions, some of which have similar symptoms. The conditions may be caused by the way the uterus is formed, by infection, by hormonal changes, or by scars and growths.

Most of the time, symptoms include pain, unusual bleeding, and urinary leaks. Physical exams, lab tests, and imaging scans can shed light on the problem. Medication, hormones, embolization, and surgery are all options for treating different conditions. You and your healthcare provider can work together to create a treatment plan.