How Smart is the Uterus?

The uterus is very smart and signals the host patient when there is a problem. There are three ways that the uterus signals: it will bleed abnormally, hurt, or grow larger than usual.

The uterus will bleed abnormally if there is a problem.
If the patient is premenopausal the "menses" will either come too early (every two to three weeks) as opposed to every twenty-eight or so days. The menses may be very heavy, requiring the patient to change a pad or tampon every one to two hours as opposed to every four to six hours. The patient may also complain of large blood clots and/or bleeding irregularly and in between the “normal” cycles.

If the patient is menopausal or postmenopausal, any bleeding after not bleeding for 12 months (and many say 6 months especially if the patient has hot flashes) is considered abnormal and deserves an immediate evaluation.

Also be aware of the premenopausal patient, not using hormonal manipulation like birth control pills, who is not pregnant but does not have menses. These are all examples of abnormal uterine bleeding and is a major clinical signal for the host.

The uterus will hurt if there is a problem.
This hurt may be perceived by the patient as lower abdominal pain that may or may not radiate (travel) to the upper extremities. The patient may also perceive this “hurt” as lower back pain. The pain temporally be related to the menses, worse just prior to the start of the menses or when the bleeding is at its heaviest.  This historical information is at times difficult for the clinician to interpret because pain is subjective. What may be perceived as excruciating pain by one person may be considered mild or less by another patient. Furthermore, pressure may be the descriptive word for what the patient perceives as opposed to pain. The patient may say that what she feels is a heaviness in the pelvis or pressure in the pelvis as opposed to pain.

Lastly, the third major way that a uterus signals a problem is by an increase in size.
Of course, when a patient is pregnant the uterus will grow and may be felt (palpated) by the clinician on the abdominal examination when the pregnancy is in the late first trimester of the pregnancy (beyond 12 weeks gestational age). A pregnancy state that is progressing normally is not considered pathologic but a different normal state of the uterus.

If the uterus grows in a non-pregnancy state that is abnormal. The patient may get an inkling of an increase in size of the uterus by urinating too often including urinating at night (nocturia). If the primary reason for the increase in urination is a bladder infection, the patient will not only urinate too frequently but when she does it will be uncomfortable, and she will think she did not complete the emptying of the bladder. If the increased urination is secondary to the enlargement of the uterus (in the body they are next-door neighbors), the urination will be more frequent, and the volume will be less (the bladder cannot hold a large volume because of the pressure of the enlarged uterus). The patient may also experience abdominal girth increase. Her jeans may be tighter. She may be losing weight everywhere but her lower abdomen. After several months of exercise, she notes no improvement in her waistline. These are all clues that the uterus is growing abnormally and should be evaluated.

This abnormal bleeding, the pressure or pain, and the increase in the size of the uterus is not an all inclusive list but represents the three major ways the uterus signals the patient and the clinician that there is a problem.  Do not ignore the signals.

Soon to be reviewed: Fibroids