Conditions and Diseases
Uterine fibroids are the most common pelvic tumor. As many as 1 in 5 women may have fibroids during their childbearing years (the time after starting menstruation for the first time and before menopause).
Fibroids usually affect women over age 30. They are rare in women under 20, and often shrink and cause no symptoms in women who have gone through menopause. They are more common in African Americans than Caucasians.
The cause of uterine fibroid tumors is unknown. However, fibroid growth seems to depend on the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly.
Fibroids can be so tiny that you need a microscope to see them. However, they can grow very large. They may fill the entire uterus, and may weigh several pounds. Although it is possible for just one fibroid to develop, usually there are more than one.
Fibroids are often described by their location in the uterus:
- Myometrial — in the muscle wall of the uterus
- Submucosal — just under the surface of the uterine lining
- Subserosal — just under the outside covering of the uterus
- Pendunculated — occurring on a long stalk on the outside of the uterus or inside the cavity of the uterus
The menstrual cycle is not the same for every woman. On average, menstrual flow occurs every 28 days (with most women having cycles between 24 and 34 days), and lasts about 4-7 days.
However, there is a wide variation in timing and duration that is still considered normal, especially if your periods began within the last few years.
A small percentage of women have periods more often than every 21 days or less often than every 35 days. These variations may be normal.
Some examples of abnormal bleeding include:
- Bleeding or spotting between periods
- Bleeding after sex
- Bleeding more heavily (passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 – 3 hours in a row)
- Bleeding for more days than normal or for more than 7 days
- Menstrual cycle less than 28 days (more common) or more than 35 days apart
- Bleeding after you have gone through menopause
Often, if you are bleeding from the rectum or there is blood in your urine, you may think the blood is coming from the vagina. To know for certain, insert a tampon into the vagina to confirm that it’s the source of your bleeding.
A change in hormone levels is a common cause of abnormal menstrual bleeding. This is called dysfunctional uterine bleeding.
Other causes of abnormal menstrual bleeding include:
- Endometrial hyperplasia (thickening/build-up of the lining of the uterus)
- Cancer of the uterus
- Uterine fibroids, uterine polyps (small noncancerous growths in the lining of the uterus), adenomyosis
- Medical conditions such as thyroid and pituitary disorders, diabetes, cirrhosis of the liver, and systemic lupus erythematosus
- Pregnancy complications — such as miscarriage or ectopic pregnancy (when a fertilized egg implants somewhere other than the uterus)
- Changes in birth control pills or estrogens that you take
- Use of certain drugs such as steroids or blood thinners (for example, warfarin or Coumadin)
- Use of an intrauterine device (IUD) for birth control
- Recent trauma, surgery, or other uterine procedure
- Infection in the uterus (pelvic inflammatory disease)
- Bleeding disorders such as Von Willebrand disease
- Polycystic ovary syndrome
- Stress, change in diet or exercise routine, recent weight loss or weight gain, travel, or illness
What is PMS?
Premenstrual syndrome (PMS) refers to a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when menstruation begins, or shortly thereafter.
Causes, incidence, and risk factors
The exact cause of PMS has not been identified. Changes in brain hormone levels may play a role, but this has not been proven. Women with premenstrual syndrome may also respond differently to these hormones.
PMS may be related to social, cultural, biological, and psychological factors. The condition is estimated to affect up to 75% of women during their childbearing years.
It occurs more often in women:
- Between their late 20s and early 40s
- Who have at least one child
- With a personal or family history of major depression
- With a history of postpartum depression or an affective mood disorder
The symptoms typically get worse in a woman’s late 30s and 40s as she approaches the transition to menopause. As many as 50% – 60% of women with severe PMS have a psychiatric disorder (premenstrual dysphoric disorder).
Abnormal Pap Smear
A Pap smear is an examination under the microscope of cells scraped from the tip of the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. The Pap smear is done as part of a gynecological exam.
The Pap smear can detect cancerous or precancerous conditions of the cervix. Most invasive cancers of the cervix can be detected early if women have Pap tests and pelvic examinations.
The stage of life between the ages of 40 and 60 is a period of ongoing transition often marked by increased feelings of physical and emotional well-being. For many women, midlife is a time to establish new goals, plan for the next life stage, switch careers, go back to school, become active in the community or take up new hobbies. It’s also a time of incredible physical change.
In your mid-40s, you begin a transitional phase called perimenopause, a period marked by changing hormone levels and menstrual cycles that generally lasts from age 45 to 55. During this time, the ovaries get smaller and produce less estrogen. Other changes occur, too, though they happen so slowly that you may not notice them. Menopause is defined as the absence of a menstrual period for at least one year. On average, most American women have their last menstrual period at age 51. Although all women go through the same basic changes, no two women experience perimenopause in exactly the same way. Some have mild symptoms, while others symptoms are more severe.
It is important to remember that perimenopause and menopause are natural events that are best experienced fully informed. By knowing what to expect, you can take steps to ease symptoms and prevent health problems later in life.