Uterine Diseases

Benign Diseases of the Uterus

Endometrial polyps are overgrowths of glands in the uterine endometrium. They are soft, pliable, and protrude from the inner surface of the uterus, often by stalks or pedicles, although they can be sessile, or closely apposed to the endometrial surface. Diameter varies from a few millimeters to several centimeters. The majority of women with endometrial polyps have no symptoms. However, endometrial polyps can cause abnormal bleeding, such as heavier-than-nor-mal menstruation (menorrhagia) or bleeding between menstruation. It is estimated that 25 percent of repro-ductive-aged women have endometrial polyps. There is a low risk (0.5 percent) of malignant transformation of a polyp. If a polyp is causing symptoms, it can be removed using curettage or long forceps.

Leiomyomas, commonly referred to as fibroids, are the most common benign tumor in the pelvis, and are composed of muscle cells and some fibrous tissue. Up to 25 percent of Caucasian women will have leiomyomas, and up to 50 percent of African women have leiomyomas. They may be small but can grow to large sizes, displacing organs in the pelvis and abdomen. Leiomyomas are categorized by the location within the layers of the uterus, including intramural, subserous, and submucous. Often, leiomyomas are asymptomatic, but if submucosal, they can lead to abnormal vaginal bleeding, infertility, or abortion.

Common symptoms of leiomyomas include pelvic pain. Their growth is linked to the mount of circulating estrogen, leading to increases in size, for example, during pregnancy. This hormone responsiveness also means that leiomyomas are not detected before the onset of puberty. If a female is experiencing symptoms, it is possible to treat leiomyomas medically, with compounds that reduce circulating levels of estrogen and progesterone. Additionally, a myomectomy (removal of the leiomyoma) or a hysterectomy (removal of the uterus) can be performed.

Adenomyosis is the growth of endometrial glands and stroma into the muscular layer of the uterus, the myometrium. These areas do not undergo the normal cyclical changes associated with menstruation. Usually, adenomyosis does not produce symptoms, and is more common in women between the ages of 35 and 50. [Page 1729]When adenomyosis does produce symptoms, they include painful menstruation (dysmenorrhea) and heavy menstruation (menorrhagia). Diagnosis includes biopsy of the endometrium, but finding adenomyosis does not rule out the presence of more serious causes of vaginal bleeding. There are no medical treatments available for adenomyosis. Treatment involves a hysterectomy.

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