GynoFiles

Women think of their female hormones as just estrogen or progesterone; and as only coming from the ovary. We've long known that estrogen is produced at other sites in the body, so it's an over simplification to say that our only female hormones come from the ovary. Some women recognize that our hormones also include testosterone and other 'traditionally' thought of as male hormones, and again, mostly made by the ovaries in a female. Although the uterus doesn't produce any of these hormones, there are over 30 active molecules that produce what can be thought of as endocrine-like functions. The molecules produced by the uterus include lipids, like prostaglandins, cytokines, like tumor necrosis factors and interleukins, and many of the lesser known hormones such as prolactin, relaxin, renin, insulin-like molecules, and a wide variety of growth factors. These functions clearly affect the 'local' uterine activities such as the menstrual cycle and the function of...

A physician performing a bimanual exam. in this case with one finger in the vagina, two is also normal. The vaginal finger is feeling the cervix, the abdominal finger is feeling the top of the uterus which is shown in cross section. The position of the uterus in an cross sectional diagram of a woman. The uterus is located in the back wall of the vagina, its axis is approximately a 90 degree angle to the vagina it self.  The uterus can be tipped forward on that axis: then it is called anteveerted, if it is tipped back it is called retroverted.  Some women have the uterus both tipped back and folded back. Here the physician is reaching for the top of the uterus with the hand on the abdomen but a tipped back uterus is so far back it cannot be felt well. The vaginal hand can feel the bulge of the back of the uterus. This uterus that is bent back on it self is called retroflexed. Aetroverted uterus is often also retroflexed. An anterverted uterus is usually antef...

Many women have a "tipped" uterus, known to physicians as a retroverted uterus. It's likely normal, and not likely to produce symptoms. It is a different pelvic arrangement of ligaments and organs than having a uterus that isn't tipped and thus different positions during sex may be more or less comfortable, menstrual cramps may produce symptoms that are more likely to be rectal, and there has been a question as to whether women with a tipped uterus are in fact less fertile (probably not unless there is a new reason the uterus is tipped). In some cases the uterus is so tipped that pelvic exams or pap smears are more difficult for the gyno to perform and more uncomfortable for the patients. Rarely a pregnant uterus that is retroverted or tipped will not be able to grow out of the pelvis properly and become entrapped, but most gynos have never even seen one of these cases. To explain this medically, in more depth, uterus sits in a position at the top of the vagina ...

The lining of the uterus needs to be ready to have an embryo implant. What really makes the best uterus for pregnancy has been a topic of hot research. The uterus has the myometrium , or muscle layer, and an inner lining layer called the endometrium . Gynogab has pointed out that the hormone estrogen and the fact that it is necessary, at least, for that lining to be prepared . And we've discussed that the lining can be disrupted by polyps, endometriosis, lack of proper hormone stimulation, and fibroids, and that might not make the best environment for uterine implantation or more accurately  the best place for egg implantation to occur  . And we've discussed that in order to know if a pregnancy has gotten established it's important to watch hormone levels rise, but for most that just means watching the level of placental hormones.  But there is so much more to having a healthy lining, and a whole section of the September 2011 issue of Fertility and Sterility, the jo...

Chlamydia tracomatis (CT) is the most common bactterial STD reported to the CDC each eary. We have about 1 million cases reported each year, but probably over 2 million Americans are carriers without knowning they are infected. There are many reasons to be treated, and prevention of the diseases it causes is one of the best. Here is a list of possible disease conditions (or infected areas) that can be caused by CT: an infection of the urethra, would feel like a bladder infection (urethritis) white of the eye infection (conjunctivitis) lining infection of the uterus (endometritis) uterine tubal infection (salpingitis)  cervix infection (cervicitis) inflamation of the rectum, the last 6 inches of the lower colon, or the anus (proctitis) infection of the surface or surrounding area of the liver (perihepatitis) arthritis if it infects a joint, or if it progresses to a whole system wide disease it is called Reiter's syndrome Mou...

Examination of a Retroverted Uterus The tipped uterus is called a retroverted uteus, and often they are retroflexed as well (bent back). The Hodge Pessary was designed to push the uterus more forward in the pelvis, and thus correct the positioning. In texts fro the turn of the 20th century (1900s!) they thought they could actually sew the uterus to the abdominal wall to correct this. And eventually some even tried to suspend by shortening the round ligaments, which really doesn't work as they are pretty stretchy and can shorten back up. And the uterus that is tipped from birth rarely causes symptoms that need treatment.  The Hodge Pessary Hodge Pessary in place Correcting Retroversion In the 1900s women were treated with ventro-suspension of the uterus which sewed the uterus to the anterior abdominal wall

The baby bed may not be ready when you go to have a baby. there are many issues: have you had a prior pregnancy, miscarriage, have been told you have an abnormal uterus or just unsure? When you are tying for pregnancy the obvious question is 'do I have a fertile uterus?' This might mean a normal shaped cavity, or the absence of any tumors like fibroid tumors, but the lining itself needs to be healthy for a embryo to implant and grow and form it's placenta. Trying to figure out if the uterus is ready for implantation of the embryo, should it manage all those negotiations of fertilization and leaving the fallopian tube, to finally show up to implant in the endometrium or lining tissue  has been tricky business. Pelvic examinations, pap smears and just the normal cycles of a woman can show that a lot is working well but they do not accurately predict the health of the uterine lining. We shed our lining each month, but stem cells from the base layer of the uterus regenerate ...

http://gynogab.blogspot.com/2009/07/fix-my-uterus-metroplasty.html Uterine shape is fairly typically the same from woman to woman. It is that classic, well, uterus shape, triangular on the inside, and described as egg shaped when considered as a whole. But women's wombs come in all sorts of sizes and shapes. These are known as uterine anomolies, and the most common are called bicornuate uterus but there are various combinations of doubling of the uterus that are seen. This change in shape is nothing you grow once you have a normal uterus, but it happens when you are a developing fetus, mostly because of failures of fusions from the lower segment  to the upper uterine segment, or a failure of fusion of the left to the right during fetal life. What is left may be a uterus shaped like a heart, or a double, or a half a heart. In rare cases there is no uterus at all. About 4% of the fertile population has such a uterus, and about 12% of the infertile population has these kind of...

The other day on my radio show I had a caller that wanted me to tell her which physician's advice to follow, or at least suggest a solution for resolving the clearly divergent pieces of advice. Although I didn't take careful notes, so I am paraphrasing here (in case you are reading!) apparently one  physician recommended only a small suction biopsy to determine why the lining was abnormal, and the other physician advocated a large battery of tests combined with a visual inspection with a hysteroscope, a full D and C, as well as apparently an MRI test. It wasn't clear to me whether those tests were to be done regardless of the findings of each step along the way or not. and it is tough in medicine when your second opinion is so widely divergent, you almost feel you are forced to get that third tiebreaker opinion. So lets look at a few facts. Endometrial biopsies are accurate, D and Cs are more accurate still, but in fact, almost 1/5 women may still have cancers growing into...

Trying to figure out if the infertility treatment cycle is proceeding as planned can be arduous. We do get clues. We can look at the estrogen levels, both early and later in the cycle. If they rise quickly to over 150 pmol/l on day three there is a good chance of pregnancy. We know that those higher estrogen levels are also associated with a nice endometrial lining, as the place the newly fertiliezed egg wants in the way of a "bed" to lie (implant) in!

Double Uterus Shown on Ultrasound Unicornuate Uterus If your uterus is abnormal because you were born with something other than the naturally occurring egg shape you might need an operation called a Metroplasty.  Metroplasty is a repair of the uterus named for Johannes Peter Müllee who was actually a famed ichthyologist of the 1800s. Women with bleeding, pain, or miscarriages should have the shave and cavity of their uterus evaluated. If abnormally shaped they may be candidates for surgical repairs of their uterus . First step is diagnosis. Often the diagnosis of an odd shaped uterus is done with an ultrasound and one of a heart shaped uterus is shown above. x-ray image testing called hysterosalpingograms, with or without saline infusions, are helpful too. Hysterosalpingograpy with the use of ultrasound can be accurate enough for a diagnosis, or some physicians prefer a cat scan or MRI imagining before actually preforming surgery on the most complex uteri that exist. But v...