What could go wrong with your uterus? 

what could go wrong with your uterus, uterine fibroids, uterine prolapse, uterine congenital abnormalities, uterine cancer, dysmenorrhea,
Medically reviewed by J. Stuart Wolf, Jr., MD, FACS

Uterine fibroids, uterine prolapse, uterine cancer, congenital uterine abnormalities, and painful periods caused by excess prostaglandins from, you guessed it, the uterus… Who knew so much could go wrong with your uterus? Here, I covered the normal things a healthy uterus does, both during and outside of pregnancy. In this article, I will cover the most common things that could go wrong with your uterus, though some of the “most common” ones are still relatively rare. 

Uterine fibroids

 A uterine fibroid is a benign (non-cancerous) tumor that develops in the myometrium (the middle, muscle-composed layer). According to John Hopkins, up to 77% of women develop a fibroid at some point in their life. They’re particularly common in African-American women. Often, there are no symptoms. When present, fibroid symptoms may include long or heavy periods, bleeding between periods, and abdominal, pelvic, or lower back pain. Bladder issues, bowel issues, infertility, pregnancy complications, or painful sex might also occur.

Fibroid diagnosis

Fibroids can be identified through various medical imaging techniques. These include ultrasound, magnetic resonance imaging (MRI), X-ray, and hysteroscopy. During a hysteroscopy, a scope is inserted into the uterus through the vagina.

Fibroid treatment

If symptoms are absent or manageable, no treatment may be needed. For women whose symptoms do affect their quality of life, multiple treatment options are available. A myomectomy is a surgery to remove fibroids. Embolization is a procedure to shrink fibroids by cutting off the blood flow to the fibroid(s). Severe fibroids are a common reason for hysterectomy, especially for women past childbearing age.

Uterine prolapse

John Hopkins Medicine describes uterine prolapse as when the muscles and tissue in the pelvis are too weak to support the uterus. As a result, the uterus begins to fall down into the vagina. This can happen to other pelvic organs, such as the bladder, especially if the uterus has been removed in a hysterectomy. Uterine prolapse occurs far more often than you might think, and affects approximately half of women between the ages of 50 and 79. The biggest risk factor for uterine prolapse is simply having given birth vaginally.

Reducing your risk of uterine prolapse

You can reduce your risk by not smoking, maintaining a healthy weight, and performing pelvic floor exercises. In fact, in France, where pelvic floor physical therapy is the postpartum standard of care, uterine prolapse is much less common. You can also avoid straining your pelvic floor by drinking water and eating a fiber-rich diet to avoid constipation. Because coughing strains the pelvic floor, seek treatment if you suffer from a chronic cough.

Prolapse treatment

The first-line treatment for uterine prolapse is a pessary: a device inserted into the vagina to provide support to the uterus. If problems persist, a doctor may recommend a hysterectomy.

Uterine cancer

As I explained here, there are three layers of the uterus. The perimetrium is the protective outermost layer. The myometrium is a middle layer of strong, smooth muscle, and the innermost layer is the endometrium.

Uterine cancer is most likely to develop in is the endometrium. This may be because these cells are designed to replicate (reproduce) more than other cells in the body, month after month. Mayo Clinic explains that endometrial cancer is most likely to develop after menopause, when the endometrial cells are no longer shed. This is one of the many reasons women need periods!  

The more rare form of uterine cancer is a uterine sarcoma. Sarcomas form in the myometrium like uterine fibroids do, but can grow and invade other tissues. According to the American Cancer Society, there are about 66,000 new cases of uterine cancer each year. For context, over 297,000 cases of breast cancer are diagnosed each year. The relatively-low baseline risk of a woman developing uterine cancer means that the protective effect birth control boasts against uterine cancer may not be all it’s cracked up to be. Incidentally, pregnancy also decreases your risk of developing uterine cancers.

If uterine cancer is diagnosed, however, this would be a medically necessary reason for a hysterectomy. 

Congenital abnormalities

Congenital abnormalities are abnormalities in the structure or function of an organ that are present at birth. According to Columbia Doctors, in a developing embryo, the uterus forms as two halves that then fuse together. In less than 5% of women, the uterus does not fuse together properly. It may form intact external layers with two endometrial cavities (septate), an indented exterior with two endometrial cavities (bicornuate), only one half (unicornuate), or two distinct halves (didelphys). These conditions may increase a woman’s risk of pregnancy loss and can be treated surgically. 

Painful periods, aka dysmenorrhea

Dysmenorrhea, the scientific name for painful periods or severe and painful cramps during menstruation, is perhaps the most common thing that could go wrong with your uterus. Dysmenorrhea can be primary or secondary.

Primary dysmenorrhea

John Hopkins Medicine states that primary dysmenorrhea (covered in-depth, here) can be due to excess levels of prostaglandins, which cause the uterus to contract irregularly or too strongly. Painful cramps related to primary dysmenorrhea tend to diminish after pregnancy. Personally, I used to have periods that were more intense than labor. But after carrying and birthing two kids, I hardly notice my menstrual cramps anymore.

Secondary dysmenorrhea

Secondary dysmenorrhea is caused by conditions such as endometriosis, fibroids, polycystic ovary syndrome (PCOS), and pelvic inflammatory disease. John Hopkins’ website lists a variety of treatments for period pain. These include NSAIDS (like ibuprofen), decreasing sugar and caffeine consumption, regular exercise, hot pads or hot baths or showers, and abdominal massage. At Natural Womanhood, we’ve written extensively about how fertility awareness and restorative reproductive medicine have helped countless women heal the root cause of their painful periods–no matter the cause.

The bottom line

So what could go wrong with your uterus? Plenty, as it turns out. But there’s no need to be caught unawares. Charting your cycle with a fertility awareness method (FAM) enables you to learn your body’s normal, and to “read” the tell-tale signs on your chart if problems are developing, in your uterus or elsewhere. Of course, you don’t have to figure things out alone. A healthcare provider trained in restorative reproductive medicine (RRM) can help translate what your chart is telling you about your body, and explore potential causes for your symptoms. 

Additional Reading:

FAM Basics: The Uterus

FAM Basics: Everything You need to Know about your Endometrium

The Surprising States of the Uterus Explained 

Hysterectomies, Part I: Signs you (might) need a hysterectomy

Hysterectomies, Part II: Discussing their complications, and whether too many are being performed in the US


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