There is a variety of diseases of the uterus, which often have many different causes.
The diseases of the uterus and cervix
In the following, you will find an overview of the diseases of the uterus and cervix, divided into the following sections:
- Infections and inflammations of the uterus
- Benign uterine tumors
- Malignant uterine tumors
- Surgery of the uterus
- Other diseases of the uterus
Cervicitis is the medical term for an inflammation of the cervix. The inflammation of the cervix is caused by bacteria or viruses: Chlamydia is the most common cause of cervical inflammation, other possible germs are Group A Streptococci and the Herpes simplex virus. Gonococci (“gonorrhea“) very rarely trigger cervical inflammation.
An inflammation of the cervix can be completely without symptoms and is usually not painful. However, a yellowish, sticky discharge often occurs. During the vaginal examination with the speculum a reddening and yellowish secretion can be seen.
A smear is taken to determine which pathogen it is. Depending on the pathogen, an appropriate antibiotic or antiviral therapy is then administered. You can find detailed information under: Inflammation of the cervix (cervicitis)Chlamydia infection is the most common sexually transmitted bacterial infection and affects between one and ten percent of all women, depending on age and lived risk behavior.
The problem with Chlamydia infection is that most infected persons hardly notice anything about the infection. Nevertheless, up to 40% of women can develop the infection within weeks and a few months, when it rises into the fallopian tubes, where the infection damages and sticks to the fine mucosa of the fallopian tubes. As a result, ectopic pregnancies occur more frequently, and after many years of undetected Chlamydia infection, infertility is also possible due to stuck fallopian tubes.
Since 2008, women under 25 years of age with statutory health insurance have had the opportunity to participate in a chlamydia screening, which is carried out by means of a urine sample taken by a gynaecologist. Detailed information can be found under: Clamydia infectionEndometritis describes the inflammation of the inner mucous membrane of the uterus, the endometrium. It usually develops from cervicitis (inflammation of the cervix) with gonococci or clamydia, as these pathogens are able to rise and cause infections of all internal female reproductive organs.
Inflammation of the lining of the uterus is also possible by pathogens of the normal skin or intestinal flora as well as by Group A Streptococci, but then it actually only occurs after vaginal surgery or after giving birth. Typical symptoms include bleeding disorders such as intermediate or spotting bleeding. If the infection spreads from the endometrium to the muscles of the uterus, the affected patient develops pain in the lower abdomen and high fever.
Depending on the pathogen, therapy is carried out with a suitable antibiotic. You can find detailed information under: Inflammation of the uterusMyomas are benign growths of the muscles of the uterus which occur very frequently. About 30% of women over 30 years of age have one or more myomas.
In most cases, the fibroids are located in the wall of the uterus, rarely in the cervix. In many cases, they do not cause any symptoms. However, if they are large enough, they can cause severe pain during menstruation (dysmenorrhea).
The fibroids can also grow directly below the lining of the uterus and then trigger vaginal bleeding, which either occurs independently of menstruation or increases it (hypermenorrhea). Myomas that grow on the outer wall of the uterus can cause pressure on the bladder, rectum or ureter, leading to difficulty defecating and frequent urination or urinary retention up to the kidneys. A stem rotation of such an external myoma causes very severe pain.
Depending on the size and type of myoma, various problems can occur during pregnancy (early abortion, infertility, pain, need for a Caesarean section). Myomas grow dependent on the female sex hormone estrogen. This explains why they become larger during pregnancy and smaller after menopause.The diagnosis is made by an ultrasound examination.
Therapy can be either hormone treatment, which is not possible in young patients, or surgery. Myomas that do not cause symptoms do not need to be treated. Detailed information can be found under: MyomaA uterine cyst is not uncommon.
Most uterine cysts are completely harmless and proceed without symptoms. Sometimes, however, symptoms such as bleeding disorders can occur. If cysts in the uterus are symptomatic and cannot be reduced in size even by medication, or if they are suspected to be malignant, it is usually advisable to have them removed.
Detailed information can be found here: Uterine cystA uterine polyp is a benign change in the lining of the uterus, which is normally harmless. They are stalk-shaped growths of the endometrium that protrude into the uterine cavity. Polyps can occur at any age; young women are significantly less frequently affected than women shortly before, during or after menopause.
Affected are 3-16% of all women. Many women are affected by polyps, but do not necessarily need therapy if they are free of symptoms. The typical symptom of a uterine polyp is vaginal bleeding, which occurs independently of normal menstrual bleeding, or an ever-present, brownish colored discharge from the vagina.
Very large polyps can also cause pain. The diagnosis is made by a transvaginal (through the vagina) ultrasound examination. Polyps can be completely cured by appropriate therapy.
Uterine polyps are treated by removing them during a uterine endoscopy. Degeneration is possible, but rare. You can find detailed information under: Polyps of the uterus – how dangerous are they?
Uterine cancer (endometrial carcinoma) is a malignant tumor of the uterus. Usually, the cancer develops from the cells of the uterine mucosa. After breast cancer, uterine body cancer is the most common gynecological cancer.
Every year, this disease is diagnosed in about 17 out of 100,000 women. It typically occurs in women who have already gone through the menopause (between 60 and 70 years of age). Only very rarely (about 2%) are affected patients under 40 years of age.
The main symptom of endometrial carcinoma is vaginal bleeding. Uterine body cancer is detected at an early stage in 75% of cases and therefore has a fairly good prognosis. The treatment consists of surgical removal of the uterus and, depending on the spread of the tumor, of surrounding structures.
Depending on the type of tumor, radiotherapy, chemotherapy or hormone therapy is performed after surgery. If the tumor is too advanced to undergo surgery, radiotherapy is performed. You can find detailed information under: Uterine cancerIn Germany, about 10 out of 100,000 women are diagnosed with cervical cancer every year; this type of cancer is one of the most common gynecological cancers.
Pre-cancerous stages of the cervix are 50 to 100 times more common. Due to the high incidence of cervical cancer, health insurance companies pay for regular cancer screening examinations in which a smear is taken from the cervix and examined for malignant cells and their precursors. An infection with HPV (Human Papilloma Virus) is considered a risk factor for the development of this cancer, which is why since 2007 a vaccination “against cervical cancer” for girls aged 12 to 17 years has been paid for by health insurance companies.
This vaccination is mainly directed against the high-risk types 16 and 18, which are responsible for 70% of all cervical cancers. In early stages, cervical cancer is largely asymptomatic. There may be spotting or bleeding during or after sexual intercourse.
Later, light red, watery discharge may occur. In the late stages, there may be difficulty urinating, defecation, pain, lymphedema in the legs and bleeding in the vagina, bladder or rectum. Preliminary stages of cervical cancer can be treated by conisation (removal of a cone of tissue from the cervix containing the affected tissue).
In cervical cancer, the radicality of the operation must be adapted to the stage. If the lymph nodes are affected, radiotherapy is then performed, which can be combined with chemotherapy.The 5-year survival rate is good in early stages (85-90%), but decreases significantly with increasing spread. For this very reason, it is absolutely necessary to keep an eye on the cancer screening appointments at the gynecologist.
Detailed information can be found at: Cervical cancerThe cervical abortion is a small gynecological operation that can often be performed on an outpatient basis. Indications for a cervical curettage are, for example: The procedure can be performed under local anesthesia, but is more commonly performed under general anesthesia and usually takes no longer than ten to fifteen minutes. You can find detailed information under: uterus abortion
- Irregular and very heavy menstrual bleeding
- Sudden bleeding after the menopause
- Abnormalities in transvaginal ultrasound as part of preventive medical checkups or after a miscarriage
A hysterectomy is removed based on various clinical situations that may exist.
A common reason for hysterectomy is benign growths of the uterus, so-called fibroids. However, malignant diseases such as cervical cancer or endometrial carcinoma, also a cancer of the uterus, can also be reasons for a hysterectomy. You can find detailed information under: Endometriosis refers to the occurrence of endometrium outside the uterine cavity.
It is estimated that every tenth woman is affected, especially women of childbearing age. The dislocated endometrium is hormone-dependent and often causes symptoms during menstruation. Typical symptoms are increased menstrual pain, chronic lower abdominal pain and cycle-dependent back pain as well as pain during sexual intercourse and infertility.
An ultrasound examination can provide a clue to the diagnosis, but a definitive diagnosis can only be made by means of a laparoscopy, which is also the surgical side of the treatment. On the conservative side, treatment can be carried out with progestin preparations. You can find detailed information under: Descensus uteri and uterine prolapse describe two degrees of severity of the same clinical picture.
There are no exact data on the incidence, but estimates suggest that up to 30% of women have at least a slight uterine descent, which does not necessarily cause symptoms. Normally, the uterus is located at the end of the vaginal vault, slightly tilted backwards. When the uterus is prolapsed, the holding apparatus of the uterus is so weak that it lowers towards the pelvic floor following the force of gravity.
When the uterus is prolapsed, the vaginal wall is inverted and the uterus protrudes outwards through the vaginal entrance. The cause of a prolapse of the uterus is a chronic stretching of the pelvic floor and/or defects in muscle or connective tissue of the pelvic floor. Risk factors are frequent pregnancies and births and other diseases that cause high pressure within the abdominal cavity (e.g. overweight, constipation, heavy physical work, etc.).
Symptoms of uterine prolapse are an increasing feeling of pressure in the lower abdomen and pelvic floor, problems with urination, constipation and faecal and/or urinary incontinence. Depending on the extent of the symptoms and the patient’s wishes, treatment can be conservative or surgical. Conservative therapy includes the repositioning of the lowered uterus by means of ring or cube pessaries, which are inserted by the patient herself, as well as pelvic floor training. There are various surgical methods of uterus prolapse available for operative therapy, which are used individually depending on the patient’s findings. You can find detailed information under:
- Uterine prolapse and
- Uterus prolapse
