Enlargement of the female pelvic organs is usually detected during pelvic internal examination or an imaging such as CT scans or pelvic ultrasounds.
Pelvic masses may originate from gynecologic organs (cervix, Uterus, Uterine adnexa) or from other pelvic organs (intestine, bladder, ureters, skeletal muscle, bone).
Common reasons for a pelvic mass include fibroids and ovarian cysts. However, it can be something more serious in the form of malignancy. It can also affect your reproductive ability.
Type of mass tends to vary by age group.
In infants, in utero maternal hormones may stimulate development of adnexal cysts during the first few months of life. This effect is rare.
At puberty, menstrual fluid may accumulate and form a vaginal mass (hematocolpos) because outflow is obstructed. The cause usually an imperforate hymen; other causes include congenital malformations of the uterus, cervix, or vagina.
In women of reproductive age, the most common cause of symmetric uterine enlargement is pregnancy, which may be unsuspected. Another common cause is fibroids, which may extend outwards. Common adnexal masses included graafian follicles (usually 5 to 8 cm) that develop normally but do not release an egg (called functional ovarian cysts). These cysts often resolve spontaneously within a few months. Adnexal masses may also result from ectopic pregnancy, ovarian or fallopian tube cancers, benign tumors (eg, benign cystic teratomas), or hydrosalpinges. Endometriosis can cause single or multiple masses anywhere in the pelvis, usually on the ovaries.
In postmenopausal women, masses are more likely to be cancerous. Many benign ovarian masses (eg, endometriomas, myomas) depend on ovarian hormone secretion and thus become less common after menopause.
The evaluation of the mass can include a physical examination and investigative tests such as a transvaginal ultrasound and blood tests. Your doctor will discuss all diagnosis and treatment options with you in detail to create a specific plan suited to your individual case.
Endometriosis is a condition where endometrium, tissue from the lining of the uterus, forms and grows in places outside the uterus. These growths may lead to pain and infertility. Up to 50% of women who have endometriosis may experience infertility.
Besides infertility, some women with endometriosis deal with painful periods and painful sexual intercourse, among other symptoms. Other women experience no symptoms and discover the endometriosis only after an infertility evaluation.
Endometriosis symptoms vary from woman to woman. Some women will have many symptoms, while others will have no symptoms besides infertility. With that being said, the following are potential risk factors and symptoms of endometriosis. If you’re experiencing any of these symptoms, you should speak to your doctor.
• Painful Menstrual Cramps
• General Pelvic Pain
• Painful Sexual Intercourse
• Heavy Menstrual Periods
• Depression and Fatigue
• Bladder Problems
• Family History of Endometriosis
How Is Endometriosis Diagnosed?
The only way to confirm a diagnosis of endometriosis is with diagnostic laparoscopic surgery. This is an outpatient procedure that involves making a small incision in the abdomen, through which the surgeon inserts a tube with a special camera and, if needed, small surgical instruments.
Laparoscopic Surgery for Infertility
To diagnose endometriosis, the surgeon will look for visual evidence of endometrial growths. If found, a biopsy of the tissue may also be performed to confirm things. The doctor should also use the surgery to evaluate the severity of the endometriosis (known as staging). In mild to moderate cases, your gynaecologist may even treat the endometriosis during the diagnosis surgery.
While laparoscopic surgery is the only way to confirm endometriosis, your doctor may order other tests including ultrasound, MRI, or CT scan to investigate cysts or other reasons for pelvic pain or infertility.
How Is Endometriosis Treated?
Treatment of endometriosis will depend on the severity of the disease, if you’re experiencing pain, your age, and on whether you want to get pregnant. Some treatments for endometriosis would lead to decreased fertility, which would not be an option if you’re trying to conceive.
Some of the options for treatment if you’re trying to conceive include:
Laparoscopic surgery to remove endometrial growths, scar tissue, and adhesions caused by the endometriosis. This is not a cure, and endometriosis may return later. However, some women will have increased fertility for up to 9 months after surgery.
In mild to moderate cases, IUI treatment along with fertility drugs may be used.
The pain of endometriosis may be treated with over-the-counter pain medications, acupuncture and lifestyle changes, such as regular exercise and diet changes. Surgery to remove endometrial growths is also an option in treating the pain of endometriosis.
If you do not want to get pregnant, treatment options may also include hormonal treatments (which stop ovulation and prevent pregnancy) or, in cases of severe endometriosis, hysterectomy. Hysterectomy, which involves removing the uterus alone or sometimes along with the ovaries, is considered a treatment of last resort. You can’t get pregnant after hysterectomy. Speak to your gynaecologist before exploring this option.
A follicle houses the maturing egg during the menstrual cycle and releases the egg when you ovulate. Occasionally, a follicle doesn’t open to release the egg or recloses after releasing the egg and swells with fluid, forming an ovarian cyst. This is usually harmless and goes away on its own. But large cysts may cause pelvic pain, weight gain, and frequent urination. Ovarian cysts can be identified with a pelvic exam or ultrasound.
When to See Your Doctor
Schedule an appointment with your gynaecologist if your cyst becomes very painful or red. This could be the sign of a rupture or infection. A gynaecologist should check your cyst even if it is not causing any pain or other problems. Abnormal growths can be a sign of cancer. Therefore, your gynaecologist might want to remove a tissue sample for testing.
Common methods of medical treatment for cysts include:
Using anti-inflammatory medications: Cortisone injections can reduce inflammation in a cyst.
Surgical removal of the cyst: This may be used when draining does not work. Hard-to-reach internal cysts can be surgically removed instead of drained if treatment is needed.
Fibroids grow in the wall of the uterus and are sometimes called fibroid tumors, but they are not cancerous. Fibroids are common in women in their 30s and 40s and usually cause no problems. However, some women may experience pressure in the belly, low back pain, heavy periods, painful sex, or trouble getting pregnant. Talk with your doctor about treatments to shrink or remove problematic fibroids.
Most women have no symptoms. That is why most patients with fibroids do not know they have them. When symptoms do develop, they may include:
• Anemia (as a result of heavy periods)
• Discomfort in the lower abdomen (especially if fibroids are large)
• Frequent urination
• Heavy painful periods
• Pain in the legs
• Painful sex
• Swelling in the lower abdomen (especially if fibroids are large)
Other symptoms may include:
• Labor problems
• Pregnancy problems
• Fertility problems
• Repeated miscarriages
How are fibroids diagnosed?
In most cases, the symptoms of fibroids are rarely felt and the patient does not know she has them. They are usually discovered during a vaginal examination.
Ultrasound: If the doctor thinks fibroids may be present he/she may use an ultrasound scan to find out. Ultrasound can also eliminate other possible conditions which may have similar symptoms. Ultrasound scans are often used when the patient has heavy periods and blood tests have revealed nothing conclusive.
Trans-vaginal scan: A small scanner is inserted into the patient’s vagina so that the uterus can be viewed close up.
Hysteroscopy: This is a small telescope that examines the inside of the uterus. During this procedure, if necessary, a biopsy can be taken of the lining of the uterus (womb).
Biopsy: A small sample of the lining of the uterus is taken and then examined under a microscope.
What are the treatments for fibroids?
If the woman has no symptoms and the fibroids are not affecting her day-to-day life she may receive no treatment at all. Even women who have heavy periods and whose lives are not badly affected by this symptom may also opt for no treatment. During the menopause symptoms will usually become less apparent, or disappear altogether as the fibroids usually shrink at this stage of a woman’s life.
When treatment is necessary it may be in the form of medication or surgery.
Treating fibroids with medication:
GnRHA (gonadotropin released hormone agonist)
Other drugs may be used to treat fibroids; however, they are less effective for larger fibroids
Surgery to treat fibroids. When medications have not worked, the patient may have to undergo surgery. The following surgical procedures may be considered:
• Hysterectomy – removing the uterus. This is only ever considered if the fibroids are very large, or if the patient is bleeding too much. Hysterectomies are sometimes considered as an option to stop recurrences of fibroids (stop them coming back). Hysterectomies have two possible side-effects:
1. Reduced libido
2. Early menopause
• Myomectomy – the fibroids are surgically removed from the wall of the uterus. This option is more popular for women who want to get pregnant (as opposed to a hysterectomy). Women with large fibroids, as well as those whose fibroids are located in particular parts of the uterus may not be able to benefit from this procedure
• Endometrial ablation – this involves removing the lining of the uterus. This procedure may be used if the patient’s fibroids are near the inner surface of the uterus. This procedure is considered as an effective alternative to a hysterectomy
Women and men just aren’t the same, particularly when it comes to their health risks. The first step to staying healthy is knowing what you’re up against, and then taking the necessary precautions to reduce your risk. The good news is that many of the leading threats to women’s health, which can vary based on a woman’s age and background, are preventable. In this section we demystify the problems, and discuss options for treatment.