Your In-Depth Guide to the Uterus
Nestled between your bladder and rectum lies one of the most powerful organs in the female body: your uterus. It plays a critical role in your reproductive health and yet, so few women spend much time (if any at all) thinking about it. Understandably, since the reproductive system functions on its own, with little to no intervention necessary. Still, since the female body is so complex, anyone with a uterus would be wise to understand its function, as well as any problems that may arise. Arm yourself with knowledge so you can better advocate for your reproductive health. Keep reading for an in-depth look at everything you need to know about your uterus.
What is a Uterus?
A uterus, also called a womb, is the female reproductive organ located in the pelvic cavity, between the bladder and the rectum. It is a hollow, pear-shaped organ that is connected to the fallopian tubes, the cervix, and the vagina (its connection to the vaginal opening makes up the birth canal—where a fetus passes through during childbirth). Measuring at about 2.4 to 3.1 inches long and 6 inches long at the largest part, the uterus isn’t all that big.
The parts that make up the uterus
The uterus is a complex little organ made up of three layers of tissue—the endometrium, the myometrium, and the perimetrium. Let’s take a look at each.
What is the endometrium?
The endometrium, or uterine lining, is the mucous membrane that lines the inside of the uterus. There are two layers of the endometrium. The outer layer attaches the myometrium and remains more or less the same throughout your entire menstrual cycle.
The other innermost layer changes with your hormones. During each cycle, just before ovulation, this functional layer of the endometrium thickens and matures, just in case the egg released by your ovaries is fertilized and implants itself into the uterus. It’s also preparing to develop the placenta—the organ that provides oxygen and nutrients to a developing fetus.
If no egg is fertilized, your endometrium will begin to shed. This is what your period consists of—the uterine lining. This happens every cycle unless you become pregnant.
What is the myometrium?
The myometrium layer of your uterus is a muscle that surrounds the endometrium. A testament to just how powerful the uterus is, the myometrium is one of the strongest muscles in your entire body. Its primary function is to exist in both menstruation and childbirth by contracting so that either the unused uterine lining or a baby can be pushed out of the uterus, through the birth canal, and out of the vaginal opening.
What is the perimetrium?
The perimetrium is the outermost layer of the uterus, acting as a type of coating. Considered a connective tissue, its job is to help provide structure and support to the uterus.
What Does the Uterus do?
The primary function of the uterus is to develop a fertilized egg into a baby. It does this by growing a thick endometrium that a fertilized egg can implant into, while also preparing to grow a placenta. Once the fetus begins to develop, the uterus provides a safe place for it to grow and develop. The uterus surrounds the developing fetus with amniotic fluid, which provides a protective cushion and helps it learn to breathe.
However, the uterus also serves other purposes. Namely, the uterus provides blood flow to the ovaries, supports the vagina, bladder, and rectum, and for some women, the ability to experience deep orgasms.
What Conditions Can Affect the Uterus?
Problems with the uterus can range from small and temporary to needing a hysterectomy. It’s difficult to self-diagnose conditions that affect your uterus but it’s important to be aware of the possible conditions and their side effects so you can know when to see a doctor.
A painful disease affecting about 178 million women, endometriosis is a reproductive disorder in which the tissue that normally grows inside of the uterus, grows on the surrounding organs. This can cause blockage or scarring of the fallopian tubes, which results in infertility for about 40 percent of women who have it. It can take up to 12 years to diagnose endometriosis correctly because symptoms often go unrecognized by women and their doctors. Unfortunately, the only reliable way to diagnose endometriosis is to have laparoscopic surgery. During this surgery, a doctor will make a small incision in the abdomen and insert a tiny tube with a light at the end (a laparoscope) so they can look at the organs and determine whether endometriosis is an issue.
What are the symptoms of endometriosis?
Often, symptoms of endometriosis are difficult to identify, largely because all of the symptoms can be attributed to other issues. If you have any of the following symptoms, or if you have a family history of endometriosis, it’s a good idea to talk to your doctor.
- Painful menstrual cramps
- Painful intercourse
- Heavy menstrual periods
- Infertility (you’ve been trying and unable to conceive for 12 months)
- Painful urination
- Blood in the urine
Treatment for Endometriosis
Once diagnosed, there are treatments available for endometriosis. This is usually done by using hormonal birth control or other hormonal therapy. If you have a very serious case of endometriosis, your doctor may recommend a hysterectomy.
When your body is producing too much estrogen and not enough progesterone, the lining of your uterus (endometrium) can thicken. This is a condition called endometrial hyperplasia. Hormonal imbalances aside, this can also be caused by obesity or anovulation, when your ovaries do not produce eggs during ovulation.
Your doctor can diagnose endometrial hyperplasia by doing an endometrial biopsy or a hysteroscopy. There are two types of endometrial hyperplasia:
- Hyperplasia without atypia: this means that it’s highly unlikely that it will turn into endometrial cancer
- Atypical hyperplasia: this indicates that there are precancerous cells present
What are the symptoms of endometrial hyperplasia?
The primary side effect of endometrial hyperplasia is abnormal menstrual bleeding. This means if your period is longer, shorter, or heavier than normal, you should see a doctor.
Endometrial Hyperplasia Treatment
Yes, there are ways your doctor can treat both types of endometrial hyperplasia. If you’re overweight, they may recommend a weight loss program (losing weight can help decrease excess estrogen). Otherwise, your doctor may:
- Put you on hormone therapy or, if you’re already on it, adjust your doses
- Give you the Mirena IUD, which only contains progesterone
- Perform a hysterectomy
Ovarian cysts are blister-like, fluid-filled sacs that form on the ovaries. There are several different types of cysts:
- Functional cysts: This type of cyst starts as a sac that forms during ovulation. It holds a maturing egg and disappears when the egg is released. If the egg is not released or the sac closes after the egg is released, it can swell with fluid. Functional ovarian cysts are generally harmless and don’t need to be treated.
- Polycystic ovarian syndrome cysts: These types of cysts form due to a buildup of follicles on the ovaries. They can make the ovaries become larger and create a thick outer coating, preventing ovulation from happening. PCOS cysts are linked to fertility problems.
- Endometrioma cysts: Women with endometriosis can have endometrioma cysts. They form when tissue that resembles uterine lining attaches to the ovaries. Also known as chocolate cysts, they can form on and around the ovaries.
What are the symptoms of ovarian cysts?
Most ovarian cysts don’t cause any symptoms but this varies from woman to woman. Some possible symptoms of ovarian cysts include:
- Dull ache or pressure in the lower abdomen
- Painful intercourse
- Irregular or very painful periods
Ovarian Cysts Treatment
Hormonal birth control is the most common method of treating ovarian cysts. In some cases, a doctor may advise having the cyst(s) removed and tested for cancer. If they’re cancerous, they may recommend a hysterectomy.
Pelvic inflammatory disease
When foreign bacteria enters the cervix, it can infect the uterus, cervix, and fallopian tubes. This leads to an infection called pelvic inflammatory disease (PID). Chlamydia and gonorrhea are sexually transmitted infections (STIs) that are known to cause PID. Women can also get PID from bacterial vaginosis, pelvic surgery, or any other type of gynecological procedure on the cervix or uterus. This is a very serious infection that can cause chronic pain and infertility.
What are the symptoms of pelvic inflammatory disease?
- Pain in the lower abdomen
- Painful intercourse
- Painful urination
- Lower back pain
- Excessive, foul-smelling vaginal odor
- Diarrhea and constipation
If caught early, you can treat pelvic inflammatory disease with antibiotics. If left untreated, surgery may be necessary to fix or remove some of your reproductive organs. It can cause long-term damage so it’s important to see your doctor if you have any signs of infection.
Fibroids are abnormal smooth muscle growths inside or on the outer wall of the uterus. The National Institutes of Health report that between 70 and 80 percent of women will have uterine fibroids before they turn 50, though most women will never have symptoms. Hormonal imbalances are the most common cause of fibroids. They disproportionately affect women who are pregnant, have a family history of fibroids, are African-American, over age 30, or are obese. Fibroids are typically diagnosed through a pelvic MRI or ultrasound.
What are the symptoms of uterine fibroids?
According to Healthline, some symptoms of fibroids include:
- Heavy bleeding between or during your periods that includes blood clots
- Pain in the pelvis and/or lower back
- Increased menstrual cramping
- Increased urination
- Pain during intercourse
- Menstruation that lasts longer than usual
- Pressure or fullness in your lower abdomen
- Swelling or enlargement of the abdomen
Treatment for Fibroids
Thankfully, you can treat fibroids, typically with hormonal birth control. If they are very large or if there are many of them, surgery is also an option.
Uterine or endometrial cancer happens most often after menopause but can happen in younger women. It’s not something most women need to worry about but if you’re obese, have gone through estrogen-only hormone therapy, or experienced any of the above uterine conditions, you could be higher risk.
Some of the symptoms of uterine cancer are:
- Abnormal vaginal bleeding or discharge
- Trouble urinating
- Pelvic pain
- Pain during intercourse
Uterine Cancer Treatment
As with other types of cancer, caught early enough, uterine cancer can be treated. The most common treatment is a hysterectomy. Chemotherapy and hormone therapy are also options. Many women choose to have multiple treatments.
The uterus, just like all of your reproductive organs, is complex and dynamic. It serves many functions and is a critical part of your reproductive system. When functioning at its best, it can help you get pregnant and help keep your menstrual cycle regular. When something goes wrong, it’s a big deal. That’s where understanding your uterus comes in handy. Knowing the signs of a uterine condition can help you know when to seek medical advice and what kinds of questions you need to ask. The more you know about your body, the more in control of it you are.
Featured image by Melannie AquinoA Monthly Experience Unlike Any Other. Shop Cora.
Author Bio A military veteran with over 7 years of experience, Christina is an Atlanta-based writer passionate about startups within the US healthcare system. She prides herself in working with companies that are taking innovation to the next level – specializing in content creation and strategy for companies addressing everything from consumer health information, population health management, and telemedicine to value-based care, and clinical workflows. She’s most passionate about women’s health rights and advocacy.