A uterine lesion is an abnormal area of tissue or an unusual growth that develops in or on the uterus. The uterus is the muscular, hollow organ where a fetus develops. The term is broad, encompassing any deviation from normal tissue, ranging from microscopic cellular changes to large, palpable masses. These growths can originate in the myometrium, the muscular wall, or the endometrium, the tissue lining the uterine cavity. The majority of uterine lesions are benign, meaning they are non-cancerous, and they are common, especially among women of reproductive age.
Common Types of Uterine Lesions
The most frequently encountered type of uterine lesion is the uterine fibroid, known as a leiomyoma, a benign tumor of smooth muscle and fibrous tissue. Fibroids are prevalent, occurring in 50% to 70% of women by the age of 50, with rates often exceeding 80% in Black women. These growths are classified based on their location, with intramural fibroids developing within the muscular wall being the most common type.
Fibroids located on the outside surface of the uterus are called subserosal, and they can sometimes grow outward on a stalk, becoming pedunculated. Submucosal fibroids arise just beneath the uterine lining and protrude into the uterine cavity, often causing significant symptoms even when small. Endometrial polyps are another common type of lesion, representing benign overgrowths of the uterine lining tissue that extend into the cavity.
Adenomyosis describes a condition where the endometrium grows aberrantly into the thick muscular wall of the uterus. This infiltration causes the uterus to become enlarged and often tender, and it is seen in women in their later reproductive years. While most lesions are benign, a small percentage may be pre-cancerous (endometrial hyperplasia) or malignant (endometrial carcinoma). Hyperplasia involves an overgrowth of normal-looking cells in the uterine lining, requiring evaluation to prevent progression to cancer.
Recognizing the Signs
The presence of a uterine lesion often manifests through abnormal uterine bleeding (AUB), which is often the first sign leading to medical care. AUB can present as menorrhagia (heavy or prolonged menstrual periods) or as metrorrhagia (irregular bleeding between expected periods). Bleeding after menopause should always be promptly investigated, as it can be associated with certain types of lesions.
Pelvic discomfort is another common complaint, ranging from chronic, dull aching to intense pain during menstruation, known as dysmenorrhea. Some individuals experience dyspareunia (pain during sexual intercourse), which relates to the size or location of the growths.
Large lesions can exert pressure on adjacent pelvic structures, leading to secondary symptoms. This pressure may cause frequent urination or difficulty fully emptying the bladder if the lesion pushes on the urinary tract. Pressure on the bowel can result in constipation or a feeling of pelvic fullness and bloating. For some, the primary concern is reproductive, as lesions distorting the uterine cavity can interfere with conception or increase the risk of miscarriage.
How Doctors Identify Uterine Lesions
The diagnostic process begins with a thorough evaluation, including a detailed medical history and a pelvic examination, during which a healthcare provider may feel for an enlarged or irregularly shaped uterus. Imaging tests are then used to visualize the uterus and characterize any detected growths. The transvaginal ultrasound is the primary tool for this purpose, utilizing sound waves to create clear images of the endometrium and myometrium.
Ultrasound is highly effective at determining the size, number, and location of fibroids or polyps. For more complex cases or when distinguishing between benign and potentially malignant masses is required, a magnetic resonance imaging (MRI) scan may be ordered. The MRI provides a detailed, high-resolution image of the soft tissues in the pelvis.
Investigation of the uterine cavity involves hysteroscopy, where a thin, lighted scope is inserted through the cervix to visualize the inner lining. This technique permits the doctor to precisely identify and sometimes immediately remove polyps or submucosal fibroids. When malignancy is a concern, an endometrial biopsy or dilation and curettage (D&C) is performed to collect tissue samples for laboratory analysis.
Treatment and Management Strategies
Treatment decisions for uterine lesions are highly individualized, depending on the type and size of the lesion, the severity of symptoms, and the person’s desire for future fertility. Small, asymptomatic lesions only require expectant management, involving periodic monitoring to track changes in growth or symptoms. When symptoms are mild, medical management is often the first approach.
Hormonal therapies, such as birth control pills or progestin-releasing intrauterine systems, can help manage heavy bleeding and pain. Gonadotropin-releasing hormone (GnRH) agonists may be used to temporarily shrink fibroids by creating a temporary, menopause-like state before a planned surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) are used to reduce pain and decrease menstrual blood flow.
Minimally invasive procedures offer options for those who wish to preserve their uterus. Hysteroscopic resection is effective for removing polyps and fibroids that protrude into the uterine cavity without abdominal incisions. Uterine Artery Embolization (UFE) is a non-surgical technique where small particles are injected to block the blood supply to fibroids, causing them to shrink.
Surgical options are considered when symptoms are severe or when medical management fails. Myomectomy is the surgical removal of fibroids while preserving the uterus, making it the preferred choice for those who desire future pregnancy. Hysterectomy, the complete removal of the uterus, is a definitive treatment for symptomatic lesions, but it is reserved for individuals who have completed childbearing or have severe, recurrent disease.