Uterine Factors

A healthy uterus is an important component of a good reproductive system. When the uterus is not in top shape, it can prevent the implantation or the development of an embryo. In some cases, an unhealthy uterus may not be able to carry a pregnancy to term, resulting in premature labor. There are a number of problems, including fibroids and endometriosis that can arise with your uterus and may interfere with your reproductive capabilities.


Endometrial Polyps
Endometrial polyps are an excess growth of tissue on the uterine lining. Small polyps generally do not interfere with your reproductive abilities. However, if they become large or there are multiple polyps present, they can impede conception and may increase your risk of miscarriage.

While it is rare for a woman under the age of 20 to develop endometrial polyps, your risk factor increases with age until you start menopause. Irregular bleeding is the most common symptom of endometrial polyps. Women with this type of polyps can have very heavy bleeding during their period, experience spotting between periods or breakthrough bleeding during hormone therapy. In fact, it is estimated that as much as 25% of all unusual bleeding in women is due to endometrial polyps.

Polyps can be diagnosed through a special type of ultrasound, a sonohysterogram, which uses water to open up the uterine cavity, making it easier for your doctor to see inside. Some doctors may use a hysterosalpingogram to take an x-ray of the uterus and fallopian tubes. To get a better picture of any possible polyps, your doctor will first insert a special type of dye into your uterus before taking the x-ray.

A hysteroscopy is another common diagnostic procedure that many doctors use. Similar to a laparoscope, a hysteroscope is a small, telescope-like tube that is inserted into the uterus through the vagina and cervix, thereby allowing your doctor to see if there are any polyps.

Getting rid of endometrial polyps is fairly simple. Using a hysteroscope to guide your doctor, the polyps are scrapped off your uterus. Some women experience some spotting for a few days after the procedure but you should be able to return to your normal activities within a few days. Fertility should return to normal after the polyps have been removed.

Asherman’s Syndrome
Intrauterine adhesions or scar tissue, often referred to as Asherman’s syndrome, can seriously interfere with your reproductive functions. In addition to preventing conception from taking place, adhesions or scar tissue can increase your risk of miscarriage. Scarring can occur if you have had a dilation and curettage (D&C) after a miscarriage or abortion or if an infection occurred after a D&C.

Treating Asherman’s syndrome can usually occur at the same time as the diagnosis. Using a hysteroscopy, your doctor can look into your uterus to find any scar tissue that might be there. She can then insert small surgical tools into the hysteroscopy tube to cut through any adhesions. An IUD may be inserted afterwards to prevent further scar tissue and adhesions from forming.

Similar to endometriosis, adenomyosis occurs when tissue from the endometrial lining is found in the middle, muscular wall of the uterus. What differentiates adenomyosis from endometriosis is the fact that the tissue does not migrate beyond the middle uterine wall. Left untreated, the tissue will continue to grow.

Adenomyosis usually affects women between the ages of 40 and 50. Symptoms of the disorder include abnormal bleeding and pelvic pain during your period. However, adenomyosis is rarely ever diagnosed on its own. Its symptoms are usually masked, or joined, by symptoms of another uterine problem. Often, adenomyosis is discovered during treatment for another uterine disorder. In 50% of the cases, women with adenomyosis also have uterine fibroids.

Since experts are not sure what causes it, the most definitive way of treating adenomyosis is by having a hysterectomy. Gonadotropin releasing hormones (GnRH) are sometimes prescribed to help shrink the uterus and increase your chances of fertility. However, GnRH is not a viable treatment option over a long period of time. Additionally, the tissue begins to grow back within six months of stopping the hormones.

Congenital Defect
Some women are born with malformed uteruses. Often, a woman does not know there is anything wrong until she has troubles conceiving. There are various congenital defects that affect a woman’s uterus, some which can be treated and others that can’t.

Uterine didelphys is a rare congenital defect whereby those affected are born with a wall separating their uterus into two sections. Often, this divide continues down into the cervix and even the vaginal canal. Carrying a pregnancy is difficult because the uterus is not able to expand as much as it would normally.

A septate uterus is the most common congenital uterine defect. While most of the reproductive organs are normal, a partial or full wall divides the uterus. Although many women with this condition do not have any troubles conceiving and carrying a pregnancy to term, one in four women with a septate uterus will experience repeat miscarriages. However, this condition can be successfully treated through a hysteroscopy or laparoscopy. About 80% of the women who have had their septum removed have been able to carry a pregnancy to term.

An extreme defect, Mayer-Rokitansky-Kuster-Hauser syndrome occurs when the tubes that will form the uterus fail to fuse together during the 9th and 16th week of development. This results in a woman being born without a uterus and is therefore unable to carry a child.

In all cases, these defects are diagnosed when your doctor suspects something is amiss. She will use a hysterosalpingogram to take an x-ray of your uterus. While surgery can correct a uterine didelphys disorder, it is recommended that all other possible explanations for a miscarriage are first ruled out. Surgical treatment for this disorder should only occur after thorough discussion between you and your doctor.

Diethylstilbestrol (DES)
During the 1940s, 1950s and into the 1960s, many pregnant women were given DES by their physicians believing that it would help prevent a miscarriage. Unfortunately, it was eventually found that DES offered no protection against miscarriage but actually caused various birth defects in a woman’s developing child.

Women exposed to DES in the womb may have a misshapen uterus that resembles a ‘T’. Exposure to DES may also cause a woman to have an underdeveloped uterus and be more vulnerable to ectopic pregnancies, premature labor, or having a weak cervix.

While some women may have no problems carrying a pregnancy with a T-shaped uterus, the risk of miscarriage does increase, as does the risk of preterm labor. Unfortunately, there is little that can be done for women with a T-shaped uterus. Although there are surgeries available, some women have found them to be of little help. Therefore, it is usually not recommended.

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