Uterus, functions and diseases

Uterus is an inverted-pear-shaped organ of the female reproductive system. It has three main functions: to prpare a bed for the fertilized egg, to nourish the developing embryo during pregnanmcy and deliver the child at the end of pregnancy.

Bladder, bowel, pelvic bones and organs are supported by uterus. The bladder is in its right position above the pubic bone with the help of the uterus. It lies over and behind the bladder. Normally it is tilted slightly foreward. It is 6 cm bis 8 cm long and about 6 cm across the top. Here on the sides the fallopian tubes enter it. At the other end is the cervix and it extends down into the vagina.

Endometrium, the uterine lining, a moist mucous membrane, changes its thickness during menstruation. It is the thickest during ovulation and is ready to accept the fertilized egg. The uterine wall is about 2.5 cm thick and expands and becomes thinner as a foetus develops inside. The cervix can expand to about 10 cm for the delivery of the child.

The function of the uterus is govened by the female hormones estrogens and progesterone and if the fertilization doesn’t take place the concentration of the hormones decreases.

Diseases of the Uterus are

• Chronic pelvic pain
• Endometrial Polyps
• Uterine Prolapse
• Endometriosis
• Fibroid Tumours

Chronic pelvic pain – due to large number of possible causes of pelvic pain, the diagnosis begins by process of elimination. Your doctor do a series of test to diagnose and treat you.

Endometrial Polyps – About 25% of all women experience uterine polyps, an overgrowth of tissues in the endometrium. These are also called endometrial polyps. These are usually soft, small, bulb-shaped masses of endometrial tissue attached to the uterus. The symptoms are abnormal uterine bleeding and in this case a visit to the doctor is a must because it may also be a serious condition of emdometrial cancer.

Uterine Prolapse – Uterine prolapse is sliding or falling of the uterus from its normal position in the pelvic cavity into the vaginal canal. Connective tissue, muscle and special ligaments in the pelvis keep the uterus in position. When these connectie tissues and muscles weaken the uterus drops. Vaginal births, aging and lack of estrogens during menopause may be the reasons for uterine prolapse. Chronic constipation can worsen uterine prolapse.

Uterine prolapse usually happens in women who have had one or more vaginal births. Normal aging and lack of estrogen hormone after menopause may also cause uterine prolapse, as can chronic cough (such as a smoker's cough) and obesity. Uterine prolapse can also be caused by a pelvic tumor, although this is rare. The symptoms include:

• Vaginal bleeding
• Backache
• Painful or difficult sexual intercourse
• Heaviness or pulling sensation in the pelvis
• Coming out from the vaginal openning
• Mostly a feeling of sitting on a small ball

A visit to your doctor is important for the right diagnosis and treatment.

Endometriosis – Because of its location and the different symptoms to every woman it is a elusive disease. The symptoms of endometriosis include:

• Pain before and/or after menstruation
• Severe menstrual cramps
• Irregular and heavy menstrual bleeding
• Painful intercourse and orgasm
• Infertility
• Cycles of diarrhea and constipation
• Nausea, bloating, vomiting
• Fatique
• Pelvic pain
• Bladder pain
• Lower back pain

The problem is also that some women with endometriosis have no symptoms. It is a serious condition and you have to go for diagnosis and treatment to an experienced doctor.

Fibroid Tumours – 25 to 50 % women have this problem and it is confirmed in more than 80% after the tissue analysis.

Fibroid tumours are estrogens dependent. The problem could come only after a woman starts to menstruate, thus after the production of estrogens, the female sexual hormones. That is why during menopause fibroid tumours disappear automatically. Its growth during pregnancy is very fast because of the very high levels of estrogens.

The syptoms are excessive uterine bleeding, a feeling of pelvic pressure which brings urinary and bowel problems and painful intercourse. There are different kinds of fibroid tumours. But, it is extremely rare that these tumours are cancerous. It is about 0.002 t0 0.003% only.

Subserosal fibroids grow on the outer wall of the uterus and usually there are no symptoms. The symptoms will be there if they grow large and interfere with other organs.

Here also it is a must to go to the doctor for diagnosis and treatment.

Before taking a decision for hysterrectomy it is always better to get an second opinion if you have no life-threatening situation because many doctors see uterus is only an orgen to get a child. Since hysterectomy has long-term effects on woman’s health and sexuality it is vital to understand all possible consequences. It should be done when it is necessary to save your life.

Hysterectomy is a must in the following conditions

• Invasive cancer in the uterus, cervix, ovaries, fallopian tubes or vagina
• Severe and uncontolled bleeding
• Severe infection which does not respond to medicines and treatment
• Complications during childbirthe, for example a ruptured uterus

In all the other conditions such as endometriosis, fibroid tumours, severe pelvic infections, uterine prolapse and others your medical condition is the basis for the decision for a hysterectomy.

The birth control pill or oral contraceptive pill

The oral contraceptives contain different levels of estrogens and progesterone or progesterone alone. It is prescribed by the family doctor after considering the family history and medical records of the woman. These pills stop the ovaries from releasing eggs every month. They also make the lining of the uterus thinner so that the fertilized egg could not attach there.

The disadvantages are that the pill must be taken everyday without any break. Even if you have vomiting or diarrhoea the effect of the pill is gone and you can become pregnant. If you forget to take the pill for a day then also the risk of pregnancy is there. Every year you need three months interval for the regeneration of the hormone household of your body, otherwise infertility may be the result. There are many side effects from these hormone pills.

Side effects:

If you have the following symptoms, go to your doctor and talk to him. These include severe headache, severe vomiting, speech problems, dizziness, faintness, weakness or numbness of arms or legs, coughing up blood, shortness of breath, crushing chest pain or chest heaviness, double vision, partial or complete loss of vision, bulging eyes, pain, warmth or heaviness in the back of the lower leg, severe stomach pain, jaundice, loss of appetite, extreme tiredness, weakness or lack of energy, fever, dark urine, pale stool, swelling of the hands, feet, joints and lower legs, mood changes and depression, unusual bleeding, skin rash and menstrual bleeding which is unusually heavy or that lasts more than 7 days in a row.

The other side effects are nausea, vomiting, stomach cramps or bloating, diarrhoea, constipation, swelling of the gum, increased or decreased appetite, brown or black skin patches, acne, hair growth in unusual places, white vaginal discharge, swelling, redness, irritation, burning or itching of the vagina, breast tenderness, enlargement or discharge, painful or missed menstruation, changes in menstrual flow, bleeding or spotting between menstrual periods, weight gain or weight loss and difficulty in wearing contact lenses.

Oral contraceptives may increase the risk of developing liver tumours and breast or liver cancer. The risk of getting a heart attack, a stroke or a serious blood clot may also be increased. Consult with your doctor about these serious effects.

Cigarette smoking increases the risk of serious side effects from oral contraceptives, including heart attacks, blood clots and strokes. If you are older than 35 years or smoke 15 or more cigarettes per day, then the risk is higher. If you take birth control pills, you should not smoke.

Caution:

Oral contraceptives will work only as long as they are taken regularly. You may need to use a backup method of birth control if you vomit or have diarrhoea when you are taking this drug. You can consult your doctor to choose the correct backup method and for other advices.

The women who have family histories of diabetes, high blood pressure, migraines, blood clots and breast cancer should not take this. It is same with the progesterone-only pill also. Although both pills are 99% effective if taken properly these are not suitable for women who change their partners often because they give no protection from HIV virus and other sexually transmitted diseases (STDs).

The patch - it is a big plaster with hormones of the combined pill oestrogen and progesterone and is applied on the skin. The hormones reach the blood through the skin. Apart from the side effects of the birth control pill here is the possibility of red skin and rash are there.

The advantages and disadvantages are the same as the birth control pill. The same precaution should also be taken as the oral pills.

This a prescription drug, but in India…..