adenomyosis

The uterus, or womb, is the place where a baby grows when a person is pregnant. The uterus is lined with tissue (endometrium). Endometriosis is a disease in which tissue that is similar to 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 egg cells 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.

The cause of endometriosis is unknown.

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 or urination, 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 prevent 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

The uterus, or womb, is the place where a baby grows when a woman is pregnant. The first sign of a problem with the uterus may be bleeding between periods or after sex. Causes can include hormones, thyroid problems, fibroids, polyps, cancer, infection, or pregnancy.

Treatment depends on the cause. Sometimes birth control pills treat hormonal imbalances. If a thyroid problem is the cause, treating it may also stop the bleeding. If you have cancer or hyperplasia, an overgrowth of normal cells in the uterus, you may need surgery.

With two other uterine problems, tissue that normally lines the uterus grows where it is not supposed to. In endometriosis, it grows outside the uterus. In adenomyosis, it grows in the uterus's outside walls. Pain medicine may help. Other treatments include hormones and surgery.

Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman's monthly cycle. Every month, your body prepares for pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina.

Periods usually start between age 11 and 14 and continue until menopause at about age 51. They usually last from three to five days. Besides bleeding from the vagina, you may have:

• Abdominal or pelvic cramping pain
• Lower back pain
• Bloating and sore breasts
• Food cravings
• Mood swings and irritability
• Headache and fatigue

Premenstrual syndrome, or PMS, is a group of symptoms that start before the period. It can include emotional and physical symptoms.

Consult your health care provider if you have big changes in your cycle. They may be signs of other problems that should be treated.

NIH: National Institute of Child Health and Human Development

Adhesions are bands of scar-like tissue. Normally, internal tissues and organs have slippery surfaces so they can shift easily as the body moves. Adhesions cause tissues and organs to stick together. They might connect the loops of the intestines to each other, to nearby organs, or to the wall of the abdomen. They can pull sections of the intestines out of place. This may block food from passing through the intestine.

Adhesions can occur anywhere in the body. But they often form after surgery on the abdomen. Almost everyone who has surgery on the abdomen gets adhesions. Some adhesions don't cause any problems. But when they partly or completely block the intestines, they cause symptoms such as:

• Severe abdominal pain or cramping
• Vomiting
• Bloating
• An inability to pass gas
• Constipation

Adhesions can sometimes cause infertility in women by preventing fertilized eggs from reaching the uterus.

No tests are available to detect adhesions. Doctors usually find them during surgery to diagnose other problems.

Some adhesions go away by themselves. If they partly block your intestines, a diet low in fiber can allow food to move easily through the affected area. If you have a complete intestinal obstruction, it is life-threatening. You should get immediate medical attention and may need surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

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

Heart disease is a general term that includes many types of heart problems. It's also called cardiovascular disease, which means heart and blood vessel disease.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease in both men and women. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to:

• Angina - chest pain from lack of blood flow
• Heart attacks - when part of the heart muscle dies from loss of blood flow
• Heart failure - when your heart can't pump enough blood to meet your body's needs
• Arrhythmia - a problem with the rate or rhythm of your heartbeat

In the United States, heart disease is the number one cause of death in women. But women are often not diagnosed with heart disease as quickly as men are. That's because:

• Women are more likely than men to have "silent" heart disease, meaning that they don't have symptoms.
• Health care providers may not recognize heart disease in women because women's symptoms may be different from men's symptoms.
• Women are more likely than men to have certain types of heart disease that can be harder to diagnose.

A delay in diagnosis may mean a delay in medical care that could help prevent serious problems, such as a heart attack. That's why it's important to learn about your risk for heart disease, the symptoms in women, and how to keep your heart healthy.

Women can get any type of heart disease. Like men, the most common type of heart disease among women is coronary artery disease. But there are certain types of heart disease which are less common, but affect women more often than men:

• Coronary microvascular disease - Chest pain from spasms (sudden tightening) in the smallest arteries of the heart that pinch off blood flow. It typically happens during rest or routine activities. This serious condition increases your risk of having a heart attack or other heart diseases. This type may be harder to diagnose since blockages in smaller arteries can be harder to see on imaging tests.
• Broken heart syndrome - Strong chest pain or other signs that look like a heart attack. It's caused by the stress of powerful emotions, such as deep grief, anger, or surprise. It can happen even if you're healthy. It mostly affects women after menopause and usually doesn't cause any lasting damage.
• Variant angina - A rare type of strong chest pain from spasms in the heart arteries. The pain usually happens in a pattern during sleep. Variant angina rarely causes a heart attack.

Your risk for developing heart disease increases with:

• Menopause. Women can develop heart disease at any age, but your risk increases after your periods stop, usually by age 55. Before menopause, your body makes more estrogen (a female hormone) which helps protect against heart disease. That's why women generally develop coronary artery disease 10 years later than men. During and after menopause, estrogen levels drop and your risk for heart diseases goes up. If your periods stop before age 40, your risk will be higher than other women your age.
• Family history of heart disease. Your risk for heart disease may be higher if your:
  • Mother or sister had heart disease before age 65.
  • Father or brother had heart disease before age 55.
• Problems during pregnancy, such as high blood pressure, gestational diabetes, anemia, and high blood pressure.
• Use of hormonal birth control (pills, patches, or vaginal rings with estrogen and progesterone).
• Endometriosis.
• Polycystic ovary syndrome.
• Inflammatory and autoimmune diseases.
• Metabolic syndrome.
• Mental health issues, such as stress, anxiety, or depression.
• Health risks from a lack physical activity.
• Obesity or being overweight.
• Diabetes.
• Low HDL cholesterol levels.
• Mild to moderate high blood pressure.
• Smoking.

If you have one or more risks for heart disease, ask your health care provider for help understanding your risk level. Ask if you need any heart tests to help catch heart disease early.

When women have symptoms of heart disease, they may include:

• Pain or discomfort in the chest that may be dull and heavy or sharp
• Pain in the neck, jaw, throat, upper belly, or back
• Nausea or vomiting
• Unusual fatigue
• Shortness of breath (feeling like you can't get enough air) during physical activity

Women who have coronary artery disease are more likely than men to have chest pain when resting or doing daily activities, rather than during exercise. They're also more likely than men to feel chest pain from mental stress.

Symptoms of a heart attack in women may also be different than in men. Chest pain is the most common symptom for both sexes. It may feel like crushing or squeezing. But women are somewhat less likely than men to have chest pain.

During a heart attack, women may feel:

• Pressure or tightness in the chest
• Pain in the upper back, arms, neck, jaw or throat
• Dizziness
• Unusual fatigue
• Indigestion, heartburn, nausea, or vomiting
• Stomach pain
• Shortness of breath

Heart attacks usually don't look like the sudden, dramatic events we see in the movies. The symptoms may be mild or strong. They may start slowly. They can stop and then come back.

You can help lower your risk by:

• Learning how to prevent heart disease and making heart-healthy habits part of your daily life.
• Asking your provider about your personal risk for heart disease and the best way to manage your heart health.

Remember, women can have heart disease without symptoms. But if you pay attention to your risk for heart disease, you can take action to prevent problems or keep them from getting worse.

NIH: National Heart, Lung, and Blood Institute

A hysterectomy is surgery to remove a woman's uterus or womb. The uterus is the place where a baby grows when a woman is pregnant. 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, you will enter menopause.

Your health care provider might recommend a hysterectomy if you have:

• Fibroids
• Endometriosis that hasn't been cured by medicine or surgery
• Uterine prolapse - when the uterus drops into the vagina
• Cancer of the uterine, cervix, or ovaries
• Vaginal bleeding that persists despite treatment
• Chronic pelvic pain, as a last resort

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

Cancer is a disease in which abnormal cells in the body grow out of control and form a tumor. Ovarian cancer is a cancerous tumor that forms in the tissues of an ovary. The ovaries are a pair of female reproductive glands that make eggs and female hormones.

There are a few different types of ovarian cancer. The most common type is epithelial cancer. It begins in the cells that cover the ovary.

There are also two related types of epithelial cancer that can spread to the ovaries:

• Fallopian tube cancer forms in the tissue lining a fallopian tube. The fallopian tubes are a pair of long, slender tubes on each side of the uterus. The uterus is the female reproductive organ where a baby grows during pregnancy.
• Primary peritoneal cancer forms in the tissue lining the peritoneum. Your peritoneum is a tissue lining that covers the organs in the abdomen (belly).

These two cancers are similar to ovarian cancer, and they have the same treatments. So some medical experts also consider those two types as ovarian cancer.

Some other rarer types of ovarian cancer are malignant germ cell tumors and stromal tumors.

Ovarian cancer happens when there are changes (mutations) in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown.

Most ovarian cancers are caused by genetic changes that happen during your lifetime. But sometimes these genetic changes are inherited, meaning that you are born with them. Ovarian cancer that is caused by inherited genetic changes is called hereditary ovarian cancer.

There are also certain genetic changes that can raise your risk of ovarian cancer, including changes called BRCA1 and BRCA2. These two changes also raise your risk of breast and other cancers.

Besides genetics, your lifestyle and the environment can affect your risk of ovarian cancer.

Certain people are more likely to develop ovarian cancer. They include those who:

• Have a family history of ovarian cancer in a mother, daughter, or sister
• Have inherited changes in the BRCA1 or BRCA2 genes.
• Have certain other genetic conditions, such as Lynch syndrome
• Have endometriosis
• Took hormone replacement therapy
• Are overweight or have obesity
• Are tall
• Are older, especially those who have gone through menopause

Ovarian cancer may not cause early signs or symptoms. By the time you do have signs or symptoms, the cancer is often advanced.

The signs and symptoms may include:

• Pain, swelling, or a feeling of pressure in the abdomen or pelvis
• Sudden or frequent urge to urinate (pee)
• Trouble eating or feeling full
• A lump in the pelvic area
• Gastrointestinal problems, such as gas, bloating, or constipation

To find out if you have ovarian cancer, your health care provider:

• Will ask about your medical history, including your symptoms
• Will ask about your family health history, including relatives who have had ovarian cancer
• Will do a physical exam, including a pelvic exam
• Will likely do imaging tests
• May do blood tests such as a CA-125 blood test

Often the only way to know for sure that you have ovarian cancer is by having a biopsy of the tissue. A biopsy is done during surgery to remove the tumor.

Treatments for ovarian cancer may include:

• Surgery to remove as much of the cancer as possible
• Chemotherapy
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells

Your provider may suggest that you have genetic testing to look for the gene changes that raise the risk for ovarian cancer. Knowing whether or not you have the gene change may help your provider decide on your treatment plan.

NIH: National Cancer Institute

Menstruation, or period, is normal vaginal bleeding that happens as part of a woman's monthly cycle. Many women have painful periods, also called dysmenorrhea. The pain is most often menstrual cramps, which are a throbbing, cramping pain in your lower abdomen. You may also have other symptoms, such as lower back pain, nausea, diarrhea, and headaches. Period pain is not the same as premenstrual syndrome (PMS). PMS causes many different symptoms, including weight gain, bloating, irritability, and fatigue. PMS often starts one to two weeks before your period starts.

There are two types of dysmenorrhea: primary and secondary. Each type has different causes.

Primary dysmenorrhea is the most common kind of period pain. It is period pain that is not caused by another condition. The cause is usually having too many prostaglandins, which are chemicals that your uterus makes. These chemicals make the muscles of your uterus tighten and relax, and this causes the cramps.

The pain can start a day or two before your period. It normally lasts for a few days, though in some women it can last longer.

You usually first start having period pain when you are younger, just after you begin getting periods. Often, as you get older, you have less pain. The pain may also get better after you have given birth.

Secondary dysmenorrhea often starts later in life. It is caused by conditions that affect your uterus or other reproductive organs, such as endometriosis and uterine fibroids. This kind of pain often gets worse over time. It may begin before your period starts and continue after your period ends.

To help ease your period pain, you can try:

• Using a heating pad or hot water bottle on your lower abdomen
• Getting some exercise
• Taking a hot bath
• Doing relaxation techniques, including yoga and meditation

You might also try taking over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen and naproxen. Besides relieving pain, NSAIDs reduce the amount of prostaglandins that your uterus makes and lessen their effects. This helps to lessen the cramps. You can take NSAIDs when you first have symptoms, or when your period starts. You can keep taking them for a few days. You should not take NSAIDS if you have ulcers or other stomach problems, bleeding problems, or liver disease. You should also not take them if you are allergic to aspirin. Always check with your health care provider if you are not sure whether or not you should take NSAIDs.

It may also help to get enough rest and avoid using alcohol and tobacco.

For many women, some pain during your period is normal. However, you should contact your health care provider if:

• NSAIDs and self-care measures don't help, and the pain interferes with your life
• Your cramps suddenly get worse
• You are over 25 and you get severe cramps for the first time
• You have a fever with your period pain
• You have the pain even when you are not getting your period

To diagnose severe period pain, your health care provider will ask you about your medical history and do a pelvic exam. You may also have an ultrasound or other imaging test. If your health care provider thinks you have secondary dysmenorrhea, you might have laparoscopy. It is a surgery that that lets your health care provider look inside your body.

If your period pain is primary dysmenorrhea and you need medical treatment, your health care provider might suggest using hormonal birth control, such as the pill, patch, ring, or IUD. Another treatment option might be prescription pain relievers.

If you have secondary dysmenorrhea, your treatment depends upon the condition that is causing the problem. In some cases, you may need surgery.

Uterine fibroids are the most common benign tumors in women of childbearing age. Fibroids are made of muscle cells and other tissues that grow in and around the wall of the uterus, or womb. The cause of fibroids is unknown. Risk factors include being African American or being overweight.

Many women with fibroids have no symptoms. If you do have symptoms, they may include:

• Heavy or painful periods or bleeding between periods
• Feeling "full" in the lower abdomen
• Urinating often
• Pain during sex
• Lower back pain
• Reproductive problems, such as infertility, multiple miscarriages or early labor

Your health care provider may find fibroids during a gynecological exam or by using imaging tests. Treatment includes drugs that can slow or stop their growth, or surgery. If you have no symptoms, you may not even need treatment. Many women with fibroids can get pregnant naturally. For those who cannot, infertility treatments may help.

NIH: National Institute of Child Health and Human Development