A wide variety of benign (non-cancerous) conditions may affect a woman’s reproductive system, which consists of the uterus, vagina, ovaries and fallopian tubes. Most of these conditions affect the uterus, which is the hollow, muscular organ that holds a baby as it grows inside of a pregnant woman. Common types of gynecologic conditions – such as fibroids (non-cancerous growths in the uterine wall), endometriosis (non-cancerous growths of the uterine lining) or prolapse (falling or slipping of the uterus) – can cause chronic pain and heavy bleeding, as well as other disabling symptoms.
When medication and other treatments are unable to relieve symptoms, hysterectomy – the surgical removal of the uterus – is often recommended to provide a more effective, definitive, long-term solution. In fact, this procedure is the second most common surgical procedure for women in the United States, and an estimated one third of all U.S. women will have a hysterectomy by age 60.1

Read more about gynecologic conditions:

Endometriosis / Adenomyosis

Endometriosis is a disease that affects your reproductive organs and monthly menstrual cycle. It can cause cramps and pain during your periods or pelvic pain throughout the month. If you have this disease and it is not treated, your health can be affected. But, with early diagnosis and treatment, endometriosis can be managed.

Understanding Endometriosis

If you have endometriosis, endometrial tissue grows outside the uterus in the pelvic cavity. During your menstrual cycle, this extra tissue swells with blood along with the normal tissue in your uterus. The tissue may also release tiny drops of blood. The swelling and blood irritate nearby tissues, causing pain and cramps. Constant irritation may cause scar tissue to form. This scar tissue can bind organs together and cause trouble getting pregnant (infertility).

Common Symptoms

If you have endometriosis, you may have one or more of these symptoms:

 

  • Cramps and menstrual pain
  • Pelvic pain
  • Pain during sexual intercourse
  • Trouble getting pregnant (infertility)
  • Cramps and menstrual pain
  • Pelvic pain
  • Pain during sexual intercourse
  • Trouble getting pregnant (infertility)

Stages of endometriosis

The stages of endometriosis are ranked as follows: Minimal (I), Mild (II), Moderate (III), or Severe (IV). Staging depends on certain factors. These include the number, size, and site of the implants. The stage also depends on the extent of the adhesions and whether other pelvic organs are involved. The severity of your disease may not match the pain you feel. Even mild endometriosis can cause a lot of pain.

Treatment Options for Endometriosis

Endometriosis can be treated with hormone therapy, surgery, or a combination of both. Talk to your health care provider to see which treatment is best for your condition

Hormone Therapy
Hormone therapy regulates or blocks the hormones that control your menstrual cycle. This means it can limit the swelling of your endometrium and extra endometrial tissue (implants). This treatment may be used before, instead of, or after surgery. Following are different types of hormone therapies:

GnRH Agonists and FSH and LH Inhibitors stop or lower the production of estrogen and progesterone hormones.
Birth control pills contain estrogen and progesterone. Birth control pills help to regulate the levels of estrogen and progesterone in your body.
Progestins are a form of progesterone. Progestins help keep estrogen levels low.
Danazol® is a hormone that stops or lowers the production of estrogen and progesterone.

Surgery
Surgery can be used to remove implants of endometrial tissue or for removal of the reproductive organs.
With laparoscopy a laparoscope (a thin, lighted tube) is inserted through a small incision in your abdomen. Your doctor uses the laparoscope and another small instrument to remove the implants.
Laparotomy is open surgery to remove large implants that can’t be reached with the laparoscope or when pelvic organs such as your bowel are involved.
Hysterectomy is the surgical removal of your uterus. Any implants or adhesions in your pelvic cavity will also be removed.
During a Total Hysterectomy with Bilateral Salpingo-Oophorectomy procedure, your uterus, ovaries, and fallopian tubes are removed. Any implants or adhesions in nearby tissue are also removed.

da Vinci® Hysterectomy
combines the advantages of conventional open and minimally invasive hysterectomies – but with potentially fewer drawbacks.
For patients, the benefits of da Vinci Hysterectomy may include:

  • Significantly less pain2
  • Minimal blood loss and need for transfusion 3,4
  • Fewer complications 3,4
  • Shorter hospital stay 3,4
  • Quicker recovery and return to normal activities 1,2
  • Small incisions for minimal scarring
  • Better outcomes and patient satisfaction, in many cases 3
  • Significantly less pain2
  • Minimal blood loss and need for transfusion 3,4
  • Fewer complications 3,4
  • Shorter hospital stay 3,4
  • Quicker recovery and return to normal activities 1,2
  • Small incisions for minimal scarring
  • Better outcomes and patient satisfaction, in many cases 3

It is performed using the da Vinci System, which enables surgeons to perform surgical procedures with unmatched precision, dexterity and control. Read about what may be the most effective, least invasive approach to a hysterectomy – da VinciHysterectomy.

3. Boggess JF. Robotic Surgery in Gynecologic Oncology: Evolution of a New Surgical Paradigm. J Robotic Surg 2007 1:31-3
4. Payne TN, et al. A Comparison of Total Laparoscopic Hysterectomy to Robotically Assisted Hysterectomy: Surgical Outcomes in a Community Practice. J Minim Invasive Gynecol. 2008 May-June;15(3):286-91

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Excessive Menstrual Bleeding

Excessive menstrual bleeding can happen for different reasons. Hormonal imbalance and uterine growths are two of the most common causes.

Hormonal Imbalances

Your menstrual cycle is controlled by hormones, including estrogen and progesterone. When they are out of balance, these same hormones can cause heavy periods or bleeding between periods. Causes of hormonal imbalances may include:

  • Hormonal changes in teens and women nearing menopause
  • Diabetes, thyroid disease or other medical problems
  • Obesity
  • Stress
  • Strenuous exercise
  • Anorexia (an eating disorder)

Types of Uterine Growths:

Fibroids are round “knots” of uterine muscle tissue.
Polyps are small growths of tissue from the uterine lining that grow inside, and often hang into the uterus.
Adenomyosis occurs when cells of the uterine lining grow into the muscle wall.
Hyperplasia is an overgrowth of the uterine lining.
Endometrial cancer is an uncontrolled growth of cells of the uterine lining in the abdomen.

Treatment Options for Excessive Menstrual Bleeding

Excessive menstrual bleeding can be treated with hormone therapy, surgery or a combination of both options. Your health care provider can diagnose your condition and provide treatment(s) to relieve your symptoms.

Hormone Therapy
Hormone therapy regulates or blocks the hormones that control your menstrual cycle. This means it can limit the swelling of your endometrium and extra endometrial tissue (implants). This treatment may be used before, instead of, or after surgery. The following are different types of hormone therapies:
GnRH agonists, as well as FSH and LH inhibitors, stop or lower the production of estrogen and progesterone hormones.
Birth control pills contain estrogen and progesterone. They can help to regulate the levels of estrogen and progesterone in your body.
Progestins, a form of progesterone, help keep estrogen levels low.
Danazol® is a hormone that stops or lowers the production of estrogen and progesterone.

Surgery
Surgery can be used to remove uterine growths or for a more definitive treatment, to remove the uterus itself. Surgical procedures include endometrial ablation, endometrial resection and hysterectomy.
Endometrial ablation is a medical procedure that uses energy to destroy the endometrial lining of a woman’s uterus. This technique is most often employed for women who suffer from excessive or prolonged bleeding during their menstrual cycle and is most commonly done on an outpatient basis. Endometrial ablation is contraindicated in patients who may want to get pregnant.1
Endometrial resection is the surgical removal of the uterine lining.
Hysterectomy is the surgical removal of your uterus. Depending upon your condition, your fallopian tubes, ovaries and other growths in your pelvic cavity may also be removed.

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Uterine Fibroids Treatment

Uterine fibroids* are benign (non-cancerous) tumors occurring in at least one quarter of all women.1 They can grow underneath the uterine lining, inside the uterine wall or outside the uterus. Many women don’t feel any symptoms with uterine tumors or fibroids. But for others, these fibroids can cause excessive menstrual bleeding (also called menorrhagia), abnormal periods, uterine bleeding, pain, discomfort, frequent urination and infertility. The following diagram depicts different types of fibroids that can occur.

Surgical treatment for uterine tumors most often involves the surgeon removing the entire uterus via hysterectomy. While hysterectomy is a proven way to resolve fibroids, it may not be the best treatment for every woman.
If you have the desire to preserve your uterus but not necessarily fertility, there are a number of prescription drug treatments that can help to stop continued fibroid growth or even shrink them. If you hope to later become pregnant, you may want to consider alternatives to hysterectomy like myomectomy. Myomectomy is a uterine-preserving procedure performed to remove uterine fibroids. Common treatment options for uterine fibroids include:

*Uterine fibroids are also called fibroids, uterine tumors, leiomyomata (singular: leiomyoma) and myomas or myomata (singular: myoma)

1. Newbold RR, DiAugustine RP, Risinger JI, Everitt JI, Walmer DK, Parrott EC, Dixon D. Advances in Uterine Leiomyoma Research: Conference Overview, Summary, and Future Research Recommendations. Environ Health Perspect. 2000 Oct;108 Suppl 5:769-73. Review.

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Uterine Prolapse

Uterine prolapse (“dropped uterus”) is a condition in which a woman’s uterus (womb) sags or slips out of its normal position. The uterus may slip enough that it drops partially into the vagina (the birth canal), creating a perceptible lump or bulge. This is called incomplete prolapse. In a more severe case—known as complete prolapse—the uterus slips to such a degree that some of the tissue drops outside of the vagina.

Prolapse Definition

Prolapse literally means “to fall out of place.” In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is generally reserved for organs protruding through the vagina, or for the misalignment of the valves of the heart.

Anatomy of the Vagina

The vaginal vault has three compartments: an anterior compartment (consisting of the anterior vaginal wall), a middle compartment (cervix), and a posterior compartment (posterior vaginal wall). Uterine prolapse involves the cervix.

Signs & Symptoms

Women with mild cases of uterine prolapse may have no obvious symptoms. However, as the slipped uterus falls further out of position, it can place pressure on other pelvic organs—such as the bladder or bowel—causing a variety of symptoms, including:

  • Pelvic pressure: a feeling of heaviness or pressure in the pelvis
  • Pelvic pain: discomfort in the pelvis, abdomen or lower back
  • Pain during intercourse
  • A protrusion of tissue from the opening of the vagina
  • Recurrent bladder infections
  • Unusual or excessive discharge from the vagina
  • Constipation
  • Difficulty with urination, including involuntary loss of urine (female incontinence), or urinary frequency or urgency 1
  • Pelvic pressure: a feeling of heaviness or pressure in the pelvis
  • Pelvic pain: discomfort in the pelvis, abdomen or lower back
  • Pain during intercourse
  • A protrusion of tissue from the opening of the vagina
  • Recurrent bladder infections
  • Unusual or excessive discharge from the vagina
  • Constipation
  • Difficulty with urination, including involuntary loss of urine (female incontinence), or urinary frequency or urgency 1

Symptoms may be worsened by prolonged standing or walking, due to added pressure placed on the pelvic muscles by gravity.

Causes of Uterine Prolapse

Trauma incurred during the birthing process, particularly with large babies or after a difficult labor and delivery, is one of the main causes of the muscle weakness that leads to uterine prolapse. Reduced muscle tone from aging, as well as lowered amounts of circulating estrogen after menopause, may also form contributing factors in pelvic organ prolapses. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.

Genetics also may play a role; women of Northern European descent experience a higher incidence of uterine prolapse than do women of Asian and African heritage. 2

Finally, increased intra-abdominal pressure, stemming from such diverse conditions as obesity, chronic lung disease and asthma, can be contributing factors in uterine prolapse. 3

Risk Factors

  • One or more pregnancies and vaginal births
  • Giving birth to a large baby
  • Increasing age
  • Frequent heavy lifting
  • Chronic coughing
  • Frequent straining during bowel movements 4

Statistics

In the U.S., pelvic support defects are relatively common and increase with age. One study of more than 16,000 patients found the rate of uterine prolapse to be 14.2%. The mean age at time of surgery for pelvic organ prolapse was 54.6 years. 5

U.S. studies have found Hispanic race to be correlated with prolapse. By contrast, African Americans had the lowest risk of uterine prolapse. These findings were independent of parity, age, and body habitus, suggesting a genetic component to prolapse.

Stages of Uterine Prolapse

Four stages of uterine prolapse are commonly defined:

Staging Definitions

Eversion: A turning outward or turning inside out
Procidentia: A prolapse or falling down

Stage I of uterine prolapse is defined as descent of the uterus to any point in the vagina above the hymen (or hymenal remnants).

Stage II of uterine prolapse is defined as descent to the hymen.

Stage III of uterine prolapse is defined as descent beyond the hymen.

Stage IV of uterine prolapse is defined as total eversion or procidentia.6

Uterine prolapse always is accompanied by some degree of vaginal vault prolapse.

Screening & Diagnosis

Diagnosing uterine prolapse requires a pelvic examination. You may be referred to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist). The doctor will ask about your medical history, including how many pregnancies and vaginal deliveries you’ve had. He or she will perform a complete pelvic examination to check for signs of uterine prolapse. You may be examined while lying down and also while standing. Sometimes imaging tests, such as ultrasound or magnetic resonance imaging (MRI), might be performed to further evaluate the uterine prolapse. 7

Treatment

Losing weight, stopping smoking and getting proper treatment for contributing medical problems, such as lung disease, may slow the progression of uterine prolapse.

If you have very mild uterine prolapse, either without symptoms or with symptoms that aren’t highly bothersome, no treatment is necessary. However, without treatment, you may continue to lose uterine support, which could require future treatment.

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Uterine Cancer

What Is Uterine Cancer?

In the United States , approximately 42,000 women each year are diagnosed with uterine cancer – the most common malignancy of the female genital tract and the fourth most common cancer in women. 1

Uterine cancer forms in tissues of the uterus, which is a pear-shaped organ in the pelvis where a fetus grows. The cervix is at the lower, narrow end of the uterus, and leads to the vagina. Uterine cancer can appear in cells lining the uterus (endometrium) and in muscle or other tissues in the uterus (uterine sarcoma). 2

Signs & Symptoms of Uterine Cancer

Possible signs of uterine cancer include unusual vaginal discharge or pain in the pelvis (uterus pain). Other conditions may cause the same symptoms. You should contact your health care provider if you experience any of the following symptoms:

  • Bleeding or discharge not related to menstruation (periods)
  • Bleeding after menopause
  • Irregular bleeding in between menstrual cycles or after sexual intercourse
  • A mass in the vagina
  • Frequent, difficult or painful urination
  • Pain during sexual intercourse
  • Increasing or different pelvic pain or cramping
  • A thin white (or pink) watery discharge from the vagina
  • Increased pelvic pressure, particularly if associated with changes in bladder or bowel patterns

Tests that examine the uterus are used to detect and diagnose uterine cancer. Some of the tests that may be performed include a physical exam and history, a pelvic exam, a Pap test (or Pap smear), colposcopy (looking at the cervix with a microscope), cervical biopsy, endometrial biopsy, ultrasound, dilation & curettage (D&C) and hysteroscopy.

Cervical Cancer

What is Cervical Cancer?

The neck of the uterus, called the cervix, is lined with cells which, under ordinary circumstances grow, divide and are replaced on an ongoing basis. This process called mitosis occurs throughout the body to ensure that the health and function of the cells, tissues and organ systems are maintained at optimal levels.

However, when cells divide, the good, the bad, and the ugly are replicated in the subsequent daughter cells. Cervical cancer results from a mutation in the cellular lining of the cervix, which spreads via mitosis to normal tissues and organs. Should this abnormal cell division go undetected and/or untreated, tumors will form and extensive spreading of the cancer (metastasis) will likely occur.

What Causes Cervical Cancer?

Most illnesses, including cancer, originate as a result of multiple factors working in concert. In the case of cervical cancer, there is no single cause. Rather, the initial cellular mutation is most likely triggered by one or a combination of conditions. Below are the primary causes of cervical cancer:

    • Smoking
      Women who smoke are twice as likely as those who don’t to get cervical cancer. 1 Smoke from tobacco products is carcinogenic and is linked to cellular mutation in the cervical lining and is a contributing cause of cervical cancer. 2
    • Age
      Although cervical cancer can occur in women of any age, it occurs predominantly in women over 40 and rarely in women under 21. Therefore, advancing age may considered a risk factor, or one of the many contributing causes of cervical cancer.
    • Human Papillomavirus (HPV)
      A very common infection, the human papillomavirus (HPV), is a frequent precursor to abnormal cell growth (dysplasia) and is considered a primary cause of cervical cancer. Many women experience at least one HPV infection in their lifetime. Of the 100+ HPV strains, many are non-cancerous (benign), but others are known to cause cervical cancer (malignancy).
    • Compromised Immune System
      A compromised immune system may compound the effects of the above and is considered to be a cause of cervical cancer, particularly in: 3
    • Patients who have undergone organ transplant surgery, immunosuppressive therapies are prescribed in order to stave off the body’s rejection of the implanted organ. Unfortunately the resultant suppression of the immune system also hampers the body’s ability to protect itself from disease.
    • Patients with HIV/AIDS 
    • Patients with rare congenital syndromes that adversely affect their immune systems
    • Birth Control Pills
      Long-term use (5+ years) of birth control pills is a contributing cause of cervical cancer. 4 You should talk to your doctor about the pros and cons of various types of birth control in your own case.

Multiple Pregnancies

    • Multiple full-term pregnancies are a contributing cause of cervical cancer No one really knows why this is, but it has been proven beyond doubt by large studies.

5

  • Diet
    Diets low in fruits and vegetables are linked to an increased risk of cervical and other cancers. Also, women who are overweight are at a higher risk. 6

Signs and Symptoms of Cervical Cancer

Cancer of the cervix rarely exhibits early symptoms. By the time advanced cervical cancer symptoms are apparent, the cancer has likely metastasized 7 – in other words, it has likely replicated and spread to other parts of the body. When they do present, symptoms of advanced cervical cancer may include:

  • Any unusual discharge from the vagina 8
  • Bleeding or spotting beyond your normal period 9
  • Pain after sex, douching or a pelvic exam

However, these symptoms of cervical cancer can also be indicative of many other conditions, most of them benign. Always consult your doctor for professional diagnosis of any medical condition.

Although most cervical cancer and early symptoms are seemingly invisible, there may be signs at the cellular level. These early signs are detectable via Pap tests administered in standard pelvic examinations. In fact, Pap tests can identify suspicious cellular activity long before it becomes a threat to a woman’s health. 10

Benign cells may become misshapen and divide abnormally and at an accelerated rate. This may sound like a symptom of cervical cancer, as described earlier, but in fact the cervical cells may be benign or precancerous. 11

Precancerous cells often behave like cancer cells. Indeed, they may turn into cancer cells if they are not treated. Typically, it takes several years for precancerous cells to mutate into cancer cells. So, rather than watching for symptoms of cervical cancer, your gynecologist will look for suspicious cell activity early during regular pelvic exams.

Scheduling regular pelvic exams is an important step women can take in order to prevent cervical cancer from ever presenting.

Ovarian Cancer

Cancer occurs when cells in the body begin changing and multiplying out of control. These cells can form lumps of tissue called tumors. Cancer that starts in the ovaries is called ovarian cancer. Ovarian cancer can spread from the ovaries to other parts of the body. This spread is called metastasis. The more cancer spreads, the harder it is to treat.

Understanding the Ovaries

The ovaries are a pair of walnut-sized organs in a woman’s pelvic area. They are located on either side of the uterus (the organ that holds the baby when a woman is pregnant). Ovaries make and release the eggs which, when combined with a man’s sperm, can grow into a baby. The ovaries also make the female hormones progesterone and estrogen.

When Ovarian Cancer Forms

There are three different types of ovarian tumors:

  • Epithelial tumors form in the cells that cover the outer surface of the ovaries. This is the most common type of ovarian cancer.
  • Germ cell tumors form in the cells inside the ovary that produce eggs. These rare tumors are most common in women in their teens and early twenties.
  • Stromal tumors grow from the cells that make female hormones. This is one of the least common forms of ovarian cancer.

Treatment Options for Ovarian Cancer

You and your healthcare provider will discuss a treatment plan that’s best for your needs. Treatment options may include:

  • Surgery to remove the ovaries and surrounding tissue and organs.
  • Chemotherapy , which uses strong medications to kill cancer cells. This treatment is often used along with surgery.
  • Radiation therapy , which uses directed rays of energy to kill cancer cells.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.