Common Conditions That Can Affect the Uterus

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Woman with uterine cramps
Getty Images/Peter Dazeley

A number of medical conditions can affect a woman's uterus (womb) and cause pain, such as polyps, endometriosis, fibroids, and cancer. Uterine pain or discomfort is usually felt in the pelvic and lower abdominal region, and it often spreads to the mid-abdomen or lower back. Accompanying symptoms of different uterine conditions are similar and may include irregular menstrual bleeding and difficulty getting pregnant, so it's important to see a doctor to find out exactly what is affecting you. Some concerns are serious, but others are not.

The Uterus

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 generally shrinks almost back 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 make up a woman's 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.

Uterine Conditions

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 a hysterectomy, which is surgical removal of the uterus.

Dysmenorrhea

Dysmenorrhea is severe menstrual pain that can occur before and/or during the menstrual period. It is not usually a sign of uterine disease or any other medical condition, and it often improves with pain medication or hormonal therapy.

Menorrhagia

Menorrhagia is prolonged or very heavy menstrual bleeding. It can occur in the absence of any medical condition, but it can also result from pituitary hormone problems. Often, menorrhagia causes anemia (low red blood cell count), so you may need treatment to control the bleeding as well as treatment for anemia.

Uterine Prolapse

A 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 women have 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 as well, especially during or after sexual intercourse.

Retrograde Uterus

The uterus can be tilted toward the back of the spine, which is described as a retrograde uterus. Most of the time, there are no symptoms, and it rarely causes complications during pregnancy. Your doctor would 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 would 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.

There are several typical malformations:

  • Septate uterus: The uterus is composed of two separate sides with uterine tissue completely or almost completely partitioning the sides from each other.
  • Bicornate uterus: The uterus is shaped like a heart, resulting in an appearance of two almost equal-sized halves that are not as definitively separated as those of a septate uterus.
  • Didelphic uterus: The uterus is divided, particularly near the lower opening, with two sections that each have a separate cervical opening.
  • Unicornate uterus: The uterus appears smaller, as a section may be compressed or undeveloped, resulting in only one "real" cavity, which is especially small in size.

Pelvic Inflammatory Disease

When bacteria or organisms enter the cervix and spread upward, an infection can affect one or more of the pelvic organs, including the uterus, cervix, and fallopian tubes. This is called pelvic inflammatory disease. Symptoms include discomfort, discharge, a foul smell, and urinary urgency or pain.

Polyps

Many women have uterine polyps, which are small, soft growths inside the uterus that can cause pain, heavy menstrual bleeding, spotting between periods, and bleeding after intercourse.

Fibroids

Fibroids are growths in the walls 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 as large as an orange or small melon. Although uterine fibroids are sometimes called tumors, they are not cancer and do not invade tissue or travel to other parts of the body the way cancer does.

Endometrial Hyperplasia

Endometrial hyperplasia is a condition in which excessive proliferation of the cells of the endometrium (the inner lining of the uterus) causes it to become too thick, resulting in abnormal bleeding. It is not cancer, but in some cases, it can lead to cancer of the uterus, particularly when it occurs along with adenomyosis (growth of the endometrial tissue in the muscular uterine wall).

Endometriosis

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, women who have endometriosis also have endometrial hyperplasia, but not always.

Uterine Scars (Asherman's Syndrome)

The presence of adhesions (scarring) after uterine surgery, radiation, or injury is called Asherman's syndrome. Usually, it doesn't cause symptoms, but it may lead to light bleeding during your periods, and it can increase the risk of infertility and miscarriage. Severe cases can cause pain or infections.

Cancer

Uterine cancer, typically referred to as endometrial cancer, causes abnormal vaginal bleeding and 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.

Symptoms

Symptoms of disease of the uterus include:

  • Irregular menstrual periods
  • Vaginal discharge
  • Pelvic pain or discomfort
  • Low back pain
  • Trouble urinating
  • Difficulty becoming pregnant
  • An enlarged abdomen

Throughout the menstrual cycle, the uterus undergoes substantial changes, and this makes some uterine conditions act up at times or cause varying symptoms throughout the month.

Diagnosis

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.

  • A pelvic exam can identify problems such as a prolapsed uterus or a retrograde uterus. A pelvic exam cannot adequately asses the inside uterus, and you are likely to require additional testing if your doctor thinks that there is another cause of your symptoms.
  • A Pap smear is an important test that can identify changes in the cells of the cervix. Because the cervix is connected 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.
  • Urinalysis can identify infections and, sometimes, cancer cells, which could explain your symptoms.
  • Blood samples can diagnose hormonal changes that could be caused by or result in uterine conditions.
  • Imaging tests, such as a computed tomography (CT) scan or ultrasound, are useful in visualizing the uterus and can identify anatomical abnormalities, such as a prolapsed uterus, uterine malformation, or a retrograde uterus. These tests often use a dye that can be injected into a blood vessel to visualize the structures.
  • Interventional procedures take imaging to the next level. For example, hysteroscopy involves insertion of a tube into the cervix to visualize the inside of the uterus, while hysterosalpingography or sonohysterogram involve the injection of fluid or dye into the cervix to visualize the inside of the uterus.

Treatment

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.
  • Hormonal treatment: Endometriosis is often treated with medications, such as hormonal contraceptives, to reduce symptoms. 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.
  • Surgery: Uterine prolapse can be treated surgically, and severe cases may need to be treated with a hysterectomy.
  • Observation: Women who have Asherman's syndrome or congenital uterine malformation rarely need surgery, but often require close observation and care during pregnancy to reduce the chances of a miscarriage. 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 Verywell

    If you have symptoms of a uterine condition, it can be difficult to know if something serious is going on. The most common conditions that affect the uterus are manageable, but some conditions may not completely go away, even with treatment. Uterine cancer is not a common type of cancer, and it is far less common than the more manageable conditions that affect the uterus.

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