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WHAT IS A UTERUS?
The uterus is the medical term for the womb and it is also the Latin word for womb. A typical uterus is about the size and shape of an inverted pear. The uterus sits quite low in the abdomen and is held in position by muscles, ligaments and fibrous tissues. The uterus is joined to the vagina by the cervix, commonly referred to as the neck of the uterus. It is connected at the other end to the Fallopian tubes. It is within the uterus that the fetus develops during gestation.[/two_third]
UTERUS AND PERIODS
Each month the female body secretes hormones that causes ovulation in women of reproductive age. This process includes release of an egg from the ovary and periods (menstruation). The lining of the uterus is called the endometrium and is made of several layers that include surface epithelium, blood vessels, glands, and other tissues.
Each month the endometrium grows thicker to prepare for pregnancy and this process is synchronized with ovulation. If a woman does not become pregnant, the top layers of the endometrium with blood from the blood vessels are shed. These flow out through the vagina as the monthly period. Once a woman reaches menopause, the body stops production of hormones that cause ovulation and periods. Menopause happens around 52 years of age, although just like the start of menstruation, called menarche, this age differs from person to person.
FUNCTIONS OF THE UTERUS
Common functions of the uterus include nurturing fertilized ovum that develop into the fetus and holding it until the baby is mature enough for birth. The fertilized ovum is implanted into the endometrium to derive nourishment from blood vessels, which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus, and continues developing until childbirth.
Additionally, the uterus provides structural integrity and support to the bladder, bowel, pelvic bones and organs. Commonly, pregnant women will comment that their kicking baby will press on her bladder causing a sudden need to urinate, this is due in part because the womb expands over the bladder.
The networks of blood vessels and nerves of the uterus directs blood flow to the pelvis and to the external genitalia, including the ovaries, vagina, labia, and clitoris for sexual response. The uterus is also needed for uterine orgasm to occur.
Certain conditions, abnormalities, or defects in your uterus can cause problems, chronic pain, and challenges before/during pregnancy.
- Uterine fibroids
- Fibroids are benign (non-cancerous) growths made of muscle tissue in the uterus and are an acquired uterine condition. You not born with fibroids; instead, they develop later in life. Treatments include prescription management and surgery, a myomectomy.
- Uterine polyps are growths attached to the inner wall of the uterus. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of uterine polyps, also known as endometrial polyps. These polyps are usually benign, although some can be cancerous or can eventually turn into cancer (precancerous polyps). They are more common in women of menopause age, although younger women can get polyps.
- Chronic pelvic pain
- Chronic pelvic pain is a complex condition which may have multiple causes. Sometimes, a single disorder may be identified as the cause. In other cases, however, pain may be the result of multiple medical conditions. If you have sharp pelvic pain, we do recommend coming to see one our women’s health specialists as soon as possible.
- A miscarriage is the loss of a fetus before the 20th week of pregnancy. The medical term for a miscarriage is spontaneous abortion, but “spontaneous” is important because the condition is not an abortion performed as a medical procedure.
UTERINE PROCEDURES AT THE GYN SURGICAL INSTITUTE
Myomectomy — Fibroid Removal
Repair of Uterine/Endometrial Polyps
Laparoscopic Uterine Nerve Ablation for Chronic Pelvic Pain
Dilation and Curettage (D&C)
MYOMECTOMY — FIBROID REMOVAL
A myomectomy is an operation to remove fibroids while preserving the uterus. For women who have fibroid symptoms and want to have children in the future, myomectomy is the best treatment option.
A myomectomy can be performed several different ways. Depending on the size, number and location of your fibroids, you may be eligible for an abdominal myomectomy, a laparoscopic myomectomy, or a hysteroscopic myomectomy.
Abdominal Myomectomy — During this operation, an incision is made on the lower abdomen (a “bikini cut”). The fibroids are removed from the wall of the uterus, and the uterine muscle is sewn back together using several layers of stitches
Laparoscopic Myomectomy — In a laparascopic myomectomy, four one-centimeter incisions are made in the lower abdomen: one at the belly button, one below the bikini line near the pubic hair, and one near each hip. The abdominal cavity is filled with carbon dioxide gas. A thin, lighted telescope is placed through an incision so the doctors can see the ovaries, fallopian tubes and uterus. Long instruments, inserted through the other incisions, are used to remove the fibroids. The uterine muscle is then sewn back together, the gas is released and the skin incisions are closed.
Hysteroscopic Myomectomy — Only women with submucosal fibroids — fibroids that expand from the uterine wall into the uterine cavity — are eligible for this type of myomectomy. During the procedure, the woman, most likely asleep for this procedure, is on her back with feet in gynecology stirrups. A speculum is placed in the vagina and a long, slender telescope is placed through the cervix into the uterine cavity. The uterine cavity is filled with fluid to lift apart the walls of the uterus. Instruments passed through the hysteroscope are used to shave off the submucosal fibroids.
Hysterectomy Hysterectomy is a major surgical procedure in which the uterus is removed. Many women choose hysterectomy to definitively resolve their fibroid symptoms. After hysterectomy, menstrual bleeding stops, pelvic pressure is relieved, frequent urination improves and new fibroids cannot grow.
- For the procedure, four one-centimeter incisions are made in the lower abdomen: one at the belly button, one below the bikini line near the pubic hair, and one near each hip. The abdominal cavity is filled with carbon dioxide gas. A thin, lighted telescope is placed through an incision so the doctors can see the ovaries, fallopian tubes and uterus. Long instruments, inserted through the other incisions, are used to remove the uterus. A special instrument is used to cut the uterus into smaller segments for removal through the small incisions. At the end of the procedure, the gas is released and the skin incisions are closed.
WHAT ARE UTERINE POLYPS?
Uterine polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of uterine polyps, also known as endometrial polyps. These polyps are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer (precancerous polyps). Uterine polyps are formed by the overgrowth of endometrial tissue. These polyps can be removed by a procedure called a hysteroscopy.
SYMPTOMS AND DIAGNOSIS OF UTERINE POLYPS
Polyps often have no symptoms. When symptoms do occur, they include irregular or excessive menstrual bleeding, bleeding between menstrual periods, or bleeding after menopause. Bleeding from the blood vessels of the polyp contribute to an increase of blood loss during menstruation, spotting between menstrual periods, or after menopause. If the polyp protrudes through the cervix into the vagina, it may also cause pain.
Diagnosis can occur from multiple procedures including:
Transvaginal ultrasound — A slender, wand-like device placed in your vagina emits sound waves and creates an image of your uterus, including its interior. Your doctor may see a polyp that’s clearly present or may identify a uterine polyp as an area of thickened endometrial tissue.
Hysterosonography — Involves having salt water (saline) injected into your uterus through a small tube threaded through your vagina and cervix. The saline expands your uterine cavity, which gives the doctor a clearer view of the inside of your uterus during the ultrasound.
Hysteroscopy — The doctor inserts a thin, flexible, lighted telescope (hysteroscope) through your vagina and cervix into your uterus. A hysteroscopy allows the doctor to examine the inside of your uterus.
Endometrial biopsy — The doctor might use a suction catheter inside the uterus to collect a specimen for lab testing. Uterine polyps may be confirmed by an endometrial biopsy, but the biopsy could also miss the polyp.
During a hysteroscopy, instruments inserted through the hysteroscope — the device doctors use to see inside the uterus — make it possible to remove polyps once they’re identified. The removed polyp may be sent to a lab for microscopic examination.
LAPAROSCOPIC UTERINE NERVE ABLATION (LUNA)
Laparoscopic Uterine Nerve Ablation, or LUNA, involves the destruction of the uterine nerve fibers that exit the uterus through the uterosacral ligament (this ligament connects the uterus to the large bone at the base of the spine). During this procedure, the abdomen cavity is inflated with carbon dioxide gas and small incisions are made in the abdomen to provide access for the laparoscope and surgical instruments. The uterus is anteverted (inclined forward toward the front of the abdomen) with a uterine manipulator and the uterosacral ligaments are identified and transected close to their attachment to the cervix. One or both of the ligaments may be transected.
LUNA is often carried out during the course of other surgical treatment for endometriosis and to treat chronic pelvic pain.
THE MANY APPLICATIONS OF A HYSTEROSCOPY
A hysteroscopy is a procedure that allows your provider to look inside the uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopies are done using a hysteroscope – a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.
This procedure used to diagnose problems of the uterus. A diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). An HSG test uses an X-ray dye to check the uterus and Fallopian tubes. Often, diagnostic tests can be done in an office setting without need for full sedation.
The operative procedure is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can often be performed at the same time, avoiding the need for a second surgery. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope.
COMMON DIAGNOSES AND CONDITIONS:
Our surgeons may perform hysteroscopies to correct the following uterine conditions:
Polyps and fibroids — Operative hysteroscopies are used to remove these non-cancerous growths found in the uterus. For most people these growths are painless, but for others removal will alleviate chronic pelvic pain.
Adhesions — Also known as Asherman’s Syndrome, uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow as well as infertility. A hysteroscopy can help our doctors locate and remove the adhesions.
Septums — Hysteroscopy can help diagnose a uterine septum, a malformation of the uterus that is present from birth.
Abnormal bleeding — A diagnostic hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, bleeding between periods, or after menopause. Endometrial ablation is one procedure in which the hysteroscope, along with other instruments, is used to destroy the uterine lining in order to treat some causes of heavy bleeding.
DILATION & CURETAGE PROCEDURE
WHY ITS DONE
- To remove tissue in the uterus during or after a miscarriage or abortion or to remove small pieces of placenta after childbirth (This helps prevent infection or heavy bleeding).
- To diagnose or treat abnormal uterine bleeding.
- Hormonal imbalances
- Uterine cancer