This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Options for Treatment
If you have a problem that affects your uterus or another part of your reproductive system, this
information is for you. It explains most of the problems that can affect a woman's reproductive system and ways the problems can be treated, including medication, surgery, and other kinds of
About the Uterus
The uterus is located in the lower abdomen
between the bladder and the rectum. The
also called the womb. It is pear-shaped, and the
narrow end of
the uterus is the cervix.
When a woman is pregnant, the baby grows in the uterus until he or she is born.
On each side of the uterus at the top are the fallopian
tubes and ovaries. Together, the uterus,
vagina, ovaries, and fallopian tubes make up the reproductive system. Select for illustration of The Uterus (26 KB).
In women who have not gone through menopause
"change of life"), the ovaries
produce the hormone estrogen at the
beginning of the menstrual cycle. Estrogen helps to
the lining of the uterus (called the endometrium) for
pregnancy. When the uterus is ready,
one of the ovaries releases an egg. The egg travels down the fallopian tube where it waits for
If the woman becomes pregnant, the fertilized egg travels to the uterus where it attaches to the
endometrium. If she does not, the endometrium and the unfertilized egg are discharged through
the vagina during the woman's next period (menstruation).
Some of the problems that can affect your uterus are:
- Noncancerous growths in the uterus, called
cause pain and bleeding.
- Endometriosis, a condition in which the tissue
lining of the uterus grows outside
- Heavy bleeding each time you have your period or between periods.
- Hormonal imbalances.
- Unexplained pelvic pain.
You will find words throughout this document that are in italics. These words are explained in the glossary at the end or
you may select the word to get its definition.
Your doctor may have recommended that you have a hysterectomy or
another kind of treatment.
Before you decide what to do, it is important that you understand the problem and the different
options you have for dealing with it.
The following information can help you think about your condition, learn about your treatment
choices, and decide on some questions to ask your doctor.
Keep in mind that every woman is different and every situation is different. A good treatment
choice for one woman may not be the best choice for another. That is why you should:
- Talk over your options carefully with your doctor.
- Ask questions until you understand what the doctor is telling you.
- Consider getting a second opinion.
- Work with your doctor to choose the treatment that is best for you.
You Are Not Alone
The first thing you need to know is that you are not alone. About 1 of every 10 women between
the ages of 18 and 50 has this type of problem. Usually, the problem can be treated, and the
symptoms can be relieved. Most women who have had treatment are satisfied with the results and
are glad to be free of pain or other unpleasant symptoms.
The first step in getting relief is to find out what the problem is.
Finding out about the problem
Noncancerous uterine conditions
Pelvic inflammatory disease
Severe menstrual pain
Very heavy menstrual bleeding
Chronic pelvic pain
What you should know about hysterectomy
Questions to ask you doctor
Resources for more information
Finding Out About the Problem
There are several ways your doctor can find out (diagnose) what is causing your symptoms. The
most common include:
A Medical History
The first step in diagnosing your problem is a medical history. The doctor—or sometimes the
nurse—will ask you questions about your medical history. This will include questions about
symptoms and any serious illnesses you have had, as well as whether you have ever had surgery,
been pregnant, or had children. You also may be asked about the medical history of close family
If you have been using herbs, acupuncture, or other "natural remedies," be sure to tell your doctor
The doctor may ask about your sex life. You may be uncomfortable talking about such personal
matters, but it is important for your doctor to know if something that is happening in your sex life
might be related to your condition.
A Vaginal Exam
The doctor will use instruments to look inside your cervix and uterus. The doctor will use
a speculum to keep the walls of the vagina apart during the exam.
Sometimes this exam is
uncomfortable. You may feel a slight cramp, but it usually is not painful. If you are able to relax,
you will be more comfortable. The doctor may look inside the vagina and cervix with a
A Pap Test (or Pap Smear)
During the vaginal exam, the doctor usually takes a sample of cells from the cervix with a wooden
scraper, cotton swab, or small brush. The test is quick and painless. The cells are placed on a glass
slide, which is sent to a lab. A Pap test is one way that doctors can find cancer of the cervix or
dysplasia, which is a condition that sometimes can
All women over 18 years of age—and younger women who are sexually active—should have a
Pap test done every 1 to 3 years.
The doctor will take a sample of your blood and a urine specimen and send them to a lab to be
examined. The results of these tests will tell the doctor a lot about your general health.
There are many ways to look inside the body without surgery. X-rays are the most well known.
Your doctor may also suggest a sonogram, CAT scan, or MRI.
help the doctor to
learn more about your body and what is causing your problem.
Depending on your symptoms, the doctor may suggest an
biopsy, dilation and
curettage (D&C), or other tests to help diagnose your problem.
Return to Contents
Noncancerous Uterine Conditions
After your medical history, examination, and tests are done, your doctor will explain your
condition to you and talk about your options for treatment. Later in this booklet you will find a
list of questions you may want to ask your doctor.
Surgery, medicine (including hormones), a combination of the two, or "watchful
waiting" are the
most common choices for dealing with most noncancerous uterine conditions. Watchful waiting
means having no treatment but seeing the doctor regularly to keep track of your condition and
discuss symptoms. After a period of watchful waiting, if you are still having problems, you may
decide with your doctor to consider one or more treatment options.
There are always new treatments in development. Be sure to ask your doctor if there are any new
treatments for your condition that are not described in this booklet.
Your doctor may recommend that you have a hysterectomy. If so, you will want to see the section
Remember, all treatments—including medicine, surgery, other types of treatments, and even a
decision to wait or not be treated—have risks and benefits. Be sure to ask your doctor about the
risks and benefits of each treatment option you are offered. Then you can work with your doctor
to weigh your options and make an informed choice.
What are fibroids?
Fibroids are growths in the walls of the uterus. Sometimes, a fibroid is attached to the outside of
the uterus by a stalk. Fibroids can be as small as a seed or a pea or as large as an orange or small
melon. Although fibroids are called "tumors," they are not cancer. They are smooth muscle
About 2 of every 10 women who have not gone through menopause have fibroids. The technical
term for a fibroid tumor is leiomyoma.
Fibroids may cause no symptoms at all, or they may cause pain or bleeding. Fibroids may make it
hard to pass urine if they grow large enough to press on the bladder.
Fibroids also can make it hard for you to get pregnant. Sometimes fibroids can cause problems
with pregnancy, labor, or delivery, including miscarriage and premature birth.
Select for illustration of Uterine Fibroids (29 KB).
How are fibroids treated?
You may have several treatments to choose from if you have fibroids. It depends on how big the
fibroids are, where they are, and whether you are pregnant or want to become pregnant.
Watchful waiting may be all the treatment you need if your fibroid is small and you do not have
any symptoms. You will need regular visits to your doctor for a pelvic exam to monitor the
growth of the fibroid.
Nonsurgical treatments for fibroids include hormones and pain relief medicines.
- Taking gonadotropin releasing hormone
fibroids to shrink. This may
surgery easier, or it may be used instead of an operation.
- Your doctor may prescribe ibuprofen (for example, Advil), acetaminophen (for example,
Tylenol), or another medicine to relieve pain.
Surgical treatments for fibroids include hysterectomy and myomectomy.
- Hysterectomy is usually recommended when the fibroids are causing symptoms, when they
have grown rapidly, or when the fibroids are large (as large as a grapefruit).
- Myomectomy is an operation to remove a fibroid tumor without taking out the uterus. This
means that pregnancy is still possible, although a Cesarean
may be necessary.
Recovery time after a myomectomy is about 3 to 4 weeks. About 20 percent of women who
undergo myomectomy need a blood transfusion, about 30 percent have a fever after surgery, and
many patients develop adhesions (scar tissue) in their
These complications are more likely to occur when there is more than one fibroid and when the
fibroids are large.
The growths may come back after a myomectomy, and repeat surgery may be necessary. If you
are considering a myomectomy, be sure to ask the doctor how likely it is that new fibroids might
grow after the surgery.
You also should ask your doctor how much experience he or she has in doing this procedure. Not
all gynecologists have been trained to perform myomectomies.
- Another option is laser surgery, which usually is an outpatient procedure. With laser surgery,
the doctor uses a high-intensity light to remove small fibroids.
- Depending on the location of the fibroid, it may be possible to remove it during a
Or, the doctor may put a thin tube (called a hysteroscope) with a
laser through the vagina and
into the uterus. The tube may have a small scraper to scrape away the fibroid from the wall of
What is endometriosis?
Endometrial tissue lines the uterus. Each month, in tune with the menstrual cycle, the endometrial
tissue thickens and is shed during menstruation.
If you have endometriosis, it means that the same kind of tissue that lines your uterus is also
growing in other parts of your body, usually in the abdomen. This can cause scar tissue to build
up around your organs.
Endometriosis may cause severe pain and abnormal bleeding, usually around the time of your
period. Pain during intercourse is another common symptom. However, it is possible to have
endometriosis and not have any symptoms. Endometriosis is a leading cause of infertility (inability
to get pregnant). Often it is not diagnosed until a woman has trouble getting pregnant.
Endometriosis will lessen after menopause and during pregnancy, since the growth of
tissue depends on estrogen. If you have endometriosis and take estrogen-replacement
after menopause, the tissue may grow back.
The only way to be sure that you have endometriosis is through a surgical procedure,
laparoscopy. Endometriosis can be a chronic
return even after
medicine or surgery.
How can endometriosis be treated?
There are several options for treating endometriosis. The best treatment for you may depend on
whether you want to relieve pain, increase your chances of getting pregnant, or both. It is
important to work with your doctor to weigh the benefits and risks of each treatment.
Nonsurgical treatments include:
- Medicine, including hormones. There are two types of hormone therapy: those that will
your body think it is pregnant and those that will make your body think it is in menopause.
Both are meant to stop the body from producing the messages that cause the endometrial
tissue to grow. Birth control pills may be used for a few months to try to shrink the adhesions
in women who want to become pregnant. Other hormones—GnRH and danazol—also
relieve the pain of endometriosis.
- Doctors sometimes prescribe pain relievers, such as ibuprofen (for example, Advil and
or, for severe pain, codeine.
- Other nonsurgical options include watchful waiting and changes in diet and exercise.
Several types of surgery are used to treat endometriosis, including:
- Laser laparoscopy, in which a cut is made in the abdomen and adhesions are removed, either
by laser beams or electric cauterization.
- Hysterectomy, which may not cure endometriosis. Unless the ovaries are removed also, they
will continue to produce estrogen. This may encourage endometrial tissue to grow in other
areas of the body.
- Bowel resection, which means taking out a section of the bowel, if endometriosis is affecting
- Cutting certain nerves, called the sacral nerves, in the lower back to relieve pain.
What is hyperplasia?
Hyperplasia is a condition in which the lining of the
too thick, which
abnormal bleeding. Hyperplasia is thought to be caused by too much estrogen.
Depending on your age and how long you have had hyperplasia, your doctor may want to do a
biopsy before beginning treatment to rule out
How is hyperplasia treated?
- Hormone treatment with birth control pills or progesterone
helps some women who have
- Hysterectomy is often recommended to treat hyperplasia. Because some types of hyperplasia
can lead to cancer, your doctor will watch your condition carefully if you choose not to have a
What is uterine prolapse?
If you have uterine prolapse, it means that your
slipped. Sometimes it
far down that it reaches into the vagina. This happens when the ligaments that hold the
the wall of the pelvis become too weak to hold the uterus in its place.
Uterine prolapse can cause feelings of pressure and discomfort. Urine may leak.
Select for illustration of Uterine Prolapse (33 KB).
How is uterine prolapse treated?
Treatment choices depend on how weak the ligaments have become, your age, health, and
whether you want to become pregnant.
Options that do not involve an operation include:
- Exercises (called Kegel exercises) can help to
strengthen the muscles of the pelvis. How to do
Kegel exercises: Tighten your pelvic muscles as if you are trying to hold back urine. Hold the
muscles tight for a few seconds and then release them. Repeat this exercise up to 10 times.
Repeat the Kegel exercises up to four time each day.
- Taking estrogen to limit further weakening of the muscles and tissues that support the
- Inserting a pessary—which is a rubber, diaphragm-like device—around the cervix
to help prop
up the uterus. The pessary does have drawbacks. It may dislodge or cause irritation, it may
interfere with intercourse, and it must be removed regularly for cleaning.
- Watchful waiting.
Surgical treatments include:
- Tightening the weakened muscles without taking out the uterus. This is usually done
the vagina, but it also can be done through the abdomen. Although this is a type of surgery, it
is not as extensive as a hysterectomy.
- Hysterectomy. Doctors usually recommend this operation if symptoms are bothersome or if
uterus has dropped so far that it is coming through the vagina.
What are ovarian cysts?
Ovarian cysts are small, fluid-filled sacs that usually are not malignant. They may not cause any
symptoms, or they may be quite painful. Sometimes, ovarian cysts appear in connection with the
menstrual cycle, and they may go away on their own in a few months. When these cysts grow
large, they may cause feelings of pressure or fullness.
Although most ovarian cysts are benign (not cancer),
taken very seriously. A
sonogram will show whether a cyst is fluid-filled or has solid matter in it. If it is solid, it may be
related to endometriosis, or it may be cancerous.
What are the treatments for ovarian cysts?
If you have not yet gone through menopause, you may not need any treatment, unless the cyst is
very big or causing pain. Sometimes, taking birth control pills will make the cyst smaller. Surgery
may be needed if the cyst is causing symptoms or is more than 2 inches across.
If surgery is needed, often the cyst can be removed without removing the ovary. Even if one
ovary has to be removed, it is still possible to become pregnant as long as one ovary remains.
After menopause, the risk of ovarian cancer increases. Surgery to remove an ovarian cyst is
usually recommended in this case. Your doctor will probably want to do a biopsy to see if cancer
If you have gone through menopause and you have an ovarian cyst, talk with your doctor about
what will be done during surgery. Make sure you understand whether he or she plans to remove
just the cyst, the cyst and the ovary, or to do a hysterectomy. Talk over the options with your
doctor and make your own wishes known.
Treatment options include:
- Watchful waiting.
- Hormone therapy to reduce the size of the cyst.
- Cystectomy to remove the cyst.
- Oophorectomy to remove the affected
- Hysterectomy. This usually is not necessary unless the cyst is cancerous.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is caused by an
starts in the vagina. Most
it is caused by a sexually transmitted disease (STD).
spreads upward into the uterus,
fallopian tubes, and pelvis.
Women who use intrauterine devices (IUDs) are at
increased risk for
PID. Rarely, the
that cause PID enter the body during childbirth or abortion.
PID can cause pelvic pain and fevers. It also may cause infertility (inability to get pregnant)
because of damage to the fallopian tubes. Sacs of pus, called abscesses, may form in the pelvis. Sometimes the vagina will discharge a pus-like
If PID is not treated, pain may be so intense that it is hard to walk. The infection may spread into
the bloodstream and throughout the body, causing fever, chills, joint infections, and sometimes
How is PID treated?
- If you have PID and it is the result of an STD, you and your sexual partner will be given
called antibiotics to treat the infection.
- If an abscess has formed, it may need to be drained.
- Treatment may include hospitalization.
- An operation may be done to help heal scar tissue.
- If the disease cannot be stopped in any other way, you may need surgery to remove the
Return to Contents
Severe Menstrual Pain
What is severe menstrual pain?
Some women have extreme cramping just before and during their period. The technical term for
this is dysmenorrhea. If you have this kind of pain, you should seek treatment. Severe menstrual
pain may be a symptom of endometriosis.
What can be done about severe menstrual pain?
Several types of medicine are used to treat painful cramps. These include:
- Over-the-counter pain relievers, such as aspirin, ibuprofen, naproxen (for example, Aleve),
acetaminophen may be helpful.
- If over-the-counter medicines don't work, your doctor can give you a prescription for a
stronger pain reliever, such as codeine.
- Birth control pills or other medicines may be used to reduce cramping.
- Surgery usually is not necessary if severe menstrual pain is the only problem.
Return to Contents
Very Heavy Menstrual Bleeding
What is very heavy menstrual bleeding?
As you get closer to menopause, it may be hard to tell when your period is going to start. The
time between your periods may be longer or shorter than usual. When it does start, bleeding may
be very heavy and last for several weeks.
You may have dysfunctional uterine bleeding or
often affects women
Usually it is caused by an imbalance in the chemicals in the body (hormones) that control the
Younger women also may have heavy bleeding. Usually it is because of an irregular menstrual
cycle. A woman may go for several months without a period, but the lining of her uterus
continues to build up. When finally her body sheds the uterine lining, she may have very heavy
The symptoms can be very upsetting and may make you feel limited in the things you can do.
Sometimes, the symptoms are a sign of a more serious problem.
Your doctor will probably do a blood test. Depending on the results, your medical history, and
your age, the doctor may recommend that you have a biopsy to rule out endometrial
What treatments are used for very heavy menstrual bleeding?
- Birth control pills or other medicines may be helpful.
- Another choice is watchful waiting.
- A surgical procedure called endometrial
may help to
relieve very heavy menstrual
bleeding. Endometrial ablation causes sterility (inability to become pregnant), but it does not
trigger menopause. The long-term effects of endometrial ablation are unknown.
Do you have a bleeding disorder?
If you have very heavy periods (lasting more than 7 days or soaking more than one pad or tampon
every 2 to 3 hours), frequent or long-lasting nosebleeds, easy bruising, or prolonged oozing of
blood after dental work, you may have a bleeding disorder such as von
Willebrand Disease. This
is not the same as very heavy menstrual bleeding, but it can be an underlying cause. It can be
diagnosed at the Hemophilia Treatment Center, and it can be treated. Call the National Hemophilia
Foundation at 800-424-2634, extension 3051, to find the Hemophilia Treatment Center nearest
Return to Contents
Chronic Pelvic Pain
What is chronic pelvic pain?
If you feel intense pain in your pelvis, but the doctor can find no cause, you may have chronic
How is chronic pelvic pain treated?
Options that do not involve surgery include:
- Combination therapy—including anti-inflammatory medicines that contain ibuprofen, birth
control pills, physical therapy, and nutritional and psychological counseling—may be helpful.
- Depending on the severity of the pain, watchful waiting may be another option.
Surgical options include:
- Surgery to take out scar tissue that may be causing pain. This is called adhesiolysis.
- Hysterectomy may be an option for women whose pelvic veins are persistently swollen or
when all other measures have been tried without success. However, it does not always relieve
- Cutting certain nerves in the lower back to help relieve pain.
Return to Contents
Proceed to Next Section