A number of medical conditions can affect the uterus, such as polyps, endometriosis, fibroids, adenomyosis, and cancer. Symptoms of different uterine conditions are similar and may include pain or discomfort in the pelvic and lower abdominal region that may spread to the mid-abdomen or lower back. Irregular menstrual bleeding and difficulty getting pregnant can occur due to conditions that affect the uterus.
Many uterine conditions are not dangerous, and can be treated with minimal intervention—but several uterine conditions are serious and pose a threat to your health. It’s important to see a doctor so you can get a diagnosis and appropriate treatment.
The uterus is a pear-shaped structure in the pelvis that sits behind the bladder and in front of the rectum. The uterus becomes enlarged during pregnancy and shrinks back almost to its original size within weeks after delivery.
On each side of the uterus are the Fallopian tubes and the ovaries. Together, the uterus, vagina, ovaries, and Fallopian tubes comprise the female reproductive system.
Given the close proximity of all of these organs, pain in the pelvic region could be due to a uterine condition or something else entirely.
Conditions of the uterus can begin in the uterus itself or may be caused by factors outside the uterus, such as hormones. Most of these conditions can be managed with medication, but some may necessitate surgical treatment, which might involve a hysterectomy, which is surgical removal of the uterus.
Dysmenorrhea is menstrual pain that can occur before and/or during the menstrual period. It is not a sign of uterine disease or any other medical condition, and it often improves with pain medication or hormonal therapy.
Menorrhagia is prolonged or very heavy menstrual bleeding. It can occur without any known cause, but it can also result from hormonal imbalances, uterine fibroids, polyps, certain types of birth control, cancer, and other conditions.
Often, menorrhagia causes iron deficiency anemia (low red blood cell count), so you may need treatment to control the bleeding, as well as treatment for anemia.
Uterine prolapse occurs when the muscles and ligaments that hold the uterus in place become weakened, allowing the uterus to descend near the bladder. Many people develop mild to moderate uterine prolapse as they get older.
The most common symptoms are urinary urgency and leaking of urine, but severe cases can cause pain, especially during or after sexual intercourse.
A retroverted uterus is tilted excessively towards the back of the spine. Most of the time, it doesn’t cause symptoms, and it rarely causes complications during pregnancy. Your doctor may notice if you have a retrograde uterus during your routine pelvic examination.
Congenital Uterine Malformation
Sometimes, the uterus itself is abnormally shaped. This can interfere with pregnancy and may raise the risk of miscarriage. Your doctor may identify a uterine malformation on your pregnancy ultrasound if you are pregnant, and it can be seen on an abdominal computed tomography (CT) scan or ultrasound even when you are not pregnant.
Pelvic Inflammatory Disease
When bacteria or organisms 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. Symptoms can include discomfort, discharge, a foul smell, and urinary urgency or pain.10
Many people have uterine polyps, which are small, soft growths inside the uterus that may cause heavy menstrual bleeding, spotting between periods, and bleeding after intercourse.
Fibroids are growths in the walls of the uterus or the lining of the uterus. Sometimes, a fibroid attaches to the outside of the uterus by a stalk. They can be as small as a seed or a pea or even larger than an orange.
Symptoms include heavy or prolonged bleeding between or during menstruation, pelvic pain and/or pressure, back pain, pain during intercourse, and difficulty getting pregnant.
With endometriosis, the same kind of tissue that lines your uterus also grows in other parts of the body, usually in the abdomen or ovaries. This can cause scar tissue to build up around the affected organs. Often, people who have endometriosis also have endometrial hyperplasia, but not always.
Symptoms include painful of heavy menstruation, irregular bleeding or spotting, pain during or after intercourse, pain in the abdomen or intestines, and pain during urination or while having a bowel movement.
Uterine Scars (Asherman’s Syndrome)
The presence of adhesions (scarring) after uterine surgery, radiation, or injury is called Asherman’s syndrome. It may lead to not having periods or light bleeding during your periods. Severe cases can cause pain or infections.
Uterine cancer, most commonly due to endometrial cancer, causes abnormal vaginal bleeding. It requires aggressive treatment if it has spread beyond the uterus.
Chronic Pelvic Pain
If there is no identifiable cause of your pain, you may be diagnosed with chronic pelvic pain. You may need treatment when your pain becomes exacerbated, and you may be more sensitive to conditions that cause pain, such as a gastrointestinal infection or a bladder infection.
Your medical history and symptoms can help guide your doctors to decide whether you need certain tests to identify illnesses that could be affecting your uterus.
There are several diagnostic tests your doctor may consider:
- Pelvic exam: This can identify problems such as a prolapsed uterus or a retrograde uterus. A pelvic exam cannot adequately assess the inside uterus, and you are likely to require additional testing if your doctor thinks that there is another cause of your symptoms.21
- Pap smear: This is an important test that can identify changes in the cells of the cervix, which is immediately adjacent to the uterus. If you have not had a recent Pap smear, your doctor will probably suggest that you have one if you have symptoms of a uterine condition.22
- Urinalysis: This test can identify infections and, sometimes, cancer cells, which could explain your symptoms.23
- Blood samples; Sometimes these tests can help diagnose hormonal changes that could be caused by or result in uterine conditions.24
- Imaging tests: Ultrasound or computed tomography (CT) scan, are useful in visualizing the uterus and can identify anatomical abnormalities, such as a prolapsed uterus, uterine malformation, or a retrograde uterus. A CT scan may involve an injection of dye into a blood vessel to help visualize the structures.25
- Interventional procedures: Hysteroscopy involves the insertion of a tube into the cervix to visualize the inside of the uterus, while a hysterosalpingography or a sonohysterogram involve the injection of fluid or dye into the cervix to visualize the inside of the uterus.26
The right treatment for your uterine condition depends on the cause. Medication, hormonal therapies, surgery, or other procedures may be necessary:
- Antibiotics: An infection such as pelvic inflammatory disease requires antibiotic treatment.10
- Hormonal treatment: Endometriosis is often treated with medications, such as hormonal contraceptives, to reduce symptoms.27 Similarly, endometrial hyperplasia, dysmenorrhea, and menorrhagia may be treated with hormone therapy if symptoms are severe.
- Embolization: Uterine fibroids can be treated with embolization, which is a minimally invasive procedure that reduces blood supply to the uterine tissue to shrink the fibroid. Polyps can also be managed with embolization, but usually do not require treatment.28
- Surgery: Uterine prolapse can be treated surgically, and severe cases may need to be treated with a hysterectomy.29 Many of the other uterine conditions such as fibroids, polyps, adenomyosis, endometriosis, and cancer may be treated with surgery as well.
- Observation: People who have congenital uterine malformation rarely need surgery, but often require close observation and care during pregnancy to reduce the chances of a miscarriage.30 A retrograde uterus rarely requires treatment but may require lifestyle strategies to manage urinary leaking if it occurs.
Sometimes, a combination of treatment approaches may be needed, depending on the severity of the condition and whether it improves after the first treatment approach.
A Word From Us
If you have symptoms of a uterine condition, it can be difficult to know if something serious is going on. Treatment can alleviate many effects of your condition, and can completely resolve some conditions.