Women have very complex reproductive systems that are made up of multiple organs that, when functioning properly, work together to facilitate fertility and maintain the proper balance of hormones. Because of these complexities, these organs can be affected by various conditions, which can cause women’s health and reproductive challenges.
The uterus is the main organ within this complex system and is responsible for the bulk of the reproductive functions, including menstruation and pregnancy, but it is often also the most affected by health issues that often require medical intervention.
Today we are going to talk about the uterus and an abnormal condition called a heterogeneous uterus, the symptoms it can create, and what causes a heterogeneous uterus.
What Does A Heterogeneous Appearance Of The Uterus Mean?
If your doctor tells you that you have a heterogeneous uterus, it means that when they looked at it using an ultrasound, your uterus was not the normal shape or texture. They have seen issues within the myometrium, which is the middle muscular layer of the uterus and made of smooth muscle.
A normal uterus will look smooth and uniform on an ultrasound, and the echoes that occur during the procedure will be in a consistent pattern. When scanning a heterogeneous uterus, the echoes will not be uniform and will be an indication of variations in density or structure. These areas may look brighter or darker when viewing the ultrasound image, depending on the thickness of the tissue density. There are a few conditions that your doctor may look for when performing an imaging test to determine if your uterus appears abnormal, including:
Heterogeneous Myometrium
The myometrium is the part of the uterus that is made from thick muscles that contract during labor to help move the baby down the birth canal during delivery. When a doctor says your myometrium looks heterogeneous on an ultrasound or MRI, it means it does not look smooth like it should but has areas that are different in texture or color.
This condition often shows up in women who have fibroids or adenomyosis because both of these conditions can make the myometrium look patchy, lumpy, or uneven. A heterogeneous myometrium is not a diagnosis by itself, but it is a clue that indicates something might be going on in the layer of muscle wall of the uterus.
Heterogeneous Endometrium
The endometrium is the inner lining of the uterus and the part that thickens every month and sheds during your period. When it looks heterogeneous, it means this lining does not look smooth or even and might have areas that are thicker or thinner than normal, or there could be areas that look abnormal to your doctor when they are reviewing the scan.
A heterogeneous endometrium can be caused by things like polyps, fibroids pressing into the lining, hormonal imbalances, or, in rare cases, changes that can lead to cancer. Sometimes women with adenomyosis develop this condition because it can affect the uterine lining as well as the muscle wall. Just like with a heterogeneous myometrium, it has an underlying cause that requires more testing or follow-up to determine the proper treatment.
How Do You Know If You Have A Heterogeneous Uterus?
Usually, finding out that your uterus is not a normal shape is during or after you have an ultrasound or other type of imaging test that scans your reproductive organs. Most OB/GYN offices have their own ultrasound machines, and so this is the most frequently used diagnostic tool.
An ultrasound uses sound waves that can create a picture of your uterus so the doctor can see its size, shape, and structure. If the pictures from the ultrasound show that your uterus is not a normal shape, or size, or has an uneven texture, it is labeled as a heterogeneous uterus, and they may choose to do a more detailed scan using an MRI machine to determine the underlying cause.
What Causes A Heterogeneous Uterus?
There are several conditions that can cause your uterus to be misshapen, enlarged, or show up on an ultrasound as heterogeneous.
Adenomyosis
One of the most common conditions that women experience that alters the normal shape, thickness, or texture of a uterus is called adenomyosis and is caused by endometrial tissue cells growing in the wrong location. These cells that are growing out of bounds are the same type that make up the lining of the uterus and are built up and shed each month.
Somehow these cells make their way into the myometrium (the muscular layer of the uterus) and begin to grow, which can make this layer of the uterus much thicker than normal, causing pain, and heavy menstrual bleeding. One of the main issues with these cells growing in the wrong place is that they perform just as they would if they were lining the uterus and in their proper location. They get thicker during the month and then bleed during the menstrual cycle, but depending on where these cells are growing, there may be nowhere for this shed blood to go.
Endometriosis
Endometriosis is similar to adenomyosis except for the location of the irregular cell growth. The tissue that usually lines the inside of the uterus begins to grow in locations outside of the uterus. It can grow on the ovaries, fallopian tubes, on the outside surface of the uterus, or even affect other nearby organs. This abnormal growth can change the shape and texture of the uterus, impact fertility, and cause a host of painful symptoms.
Uterine Fibroids
Uterine fibroids are another form of unexplained and abnormal cell growth but involve cells originating from the muscular layer (myometrium) of the uterus. These cells begin to form hard, rock-like growths in and on different places on the uterus.
They are non-cancerous and can be tiny or grow to be huge (the largest one recorded was over 100 pounds) and can grow alone or in groups. A woman can have one fibroid, a few, or numerous fibroids and can experience zero symptoms or debilitating symptoms depending on their size, location, and number.
Uterine fibroids can cause a heterogeneous uterus, making it change shape, become much larger, or even make you look like you are pregnant. They can cause heavy and longer than normal periods, pelvic pain, chronic pelvic pressure, frequent urination, back and leg pain, painful sexual relations, and lead to more serious conditions like anemia.
Endometrial Hyperplasia
This condition can be difficult to diagnose and normally presents with symptoms of irregular bleeding from the uterus or bleeding after menopause. An imbalance between the hormones estrogen and progesterone can cause the lining of the uterus to continue to thicken without shedding, causing it to change size or shape and become heterogeneous. This condition can become serious and should be investigated and treated as soon as possible.
Pelvic Inflammatory Disease (PID)
PID is an infection that affects the upper reproductive organs and causes inflammation. This can cause the uterus to change shape or become larger.
Is A Heterogeneous Uterus Bad And A Reason To Be Concerned?
A misshapen uterus can be something to be concerned about because it is a symptom that is common to several different reproductive conditions. Some of these conditions can be life-threatening, while others cause painful symptoms that can reduce a woman’s quality of life.
Sometimes, a woman is not experiencing any symptoms, but during a routine appointment, the OB/GYN discovers that her uterus is abnormally shaped. They may recommend additional tests, such as an MRI, to take a closer look and determine the best course of action. Their recommendation for treatment would depend on the underlying cause.
Does A Heterogeneous Endometrium Mean Cancer?
A heterogeneous endometrium does not automatically mean cancer is involved. The word “heterogeneous” just means that the lining of the uterus, which is called the endometrium, looks uneven or has an unusual mix of textures when viewed using an ultrasound machine. This can happen for many reasons, including hormonal changes, polyps, fibroids, or even the normal differences that would change the appearance of the endometrium during the menstrual cycle, but they are not typically cancerous.
After women have gone through menopause, if they experience abnormal bleeding, tests are normally run to rule out any changes that could indicate cancer or precancerous changes. The term “heterogeneous” endometrium can sometimes be caused by a serious condition, but it is not a definitive sign of cancer.
What Is The Treatment For A Heterogeneous Uterus?
The treatment for women who are diagnosed with a heterogeneous uterus will depend on what has caused it. Sometimes the OB/GYN will recommend anti-inflammatory medication to help relieve symptoms, or they may suggest hormone therapy or surgery to treat the underlying cause.
Many OB/GYNs will recommend removing the uterus through a hysterectomy in cases of adenomyosis, endometriosis, or uterine fibroids, or myomectomy surgery to remove a limited number of smaller fibroids one at a time.
If you have been diagnosed with a heterogeneous uterus and the underlying cause is adenomyosis or uterine fibroids, there is a safer and less invasive treatment option available. Most OB/GYNs will not tell you about uterine embolism treatment because they do not perform this procedure.
Can A Heterogeneous Uterus Be Treated Without Surgery?
Yes, if the underlying condition causing the uterus to be misshapen is adenomyosis or uterine fibroids, they can be treated with a procedure called uterine embolism.
Uterine artery embolization (UAE) and uterine fibroid embolization (UFE) are treatments to eliminate the symptoms of adenomyosis and uterine fibroids that do not involve surgery. They are done by an interventional radiologist like Dr. John Lipman with the Atlanta Fibroid Center on an outpatient basis and do not require a hospital stay.
The abnormal cells that grow and develop into uterine fibroids need a blood source to stay alive and continue growing, so they hijack a blood vessel that has access to the uterine artery and begin to siphon off blood. Similar to fibroids, adenomyosis cells also require an ongoing supply of blood to remain viable.
The UAE and UFE procedures block their blood supply, which causes these cells to shrink back and die, often providing complete relief from the symptoms they cause. The procedure is done by inserting a special catheter into the upper groin to gain access to these blood vessels and then injecting tiny particles into the vessels that will cut off the flow of blood to these rouge cells.
The main difference between UAE and UFE is the size of the particles that are injected during the treatment. UAE is used to treat adenomyosis and uses smaller particles than the ones used to treat fibroids during UFE.
With UFE and UAE, the uterus remains intact, and the recovery is significantly shorter than surgical treatments. The procedures are between 80% and 90% effective in eliminating the symptoms of these conditions and can restore a heterogeneous uterus to its normal shape and size.
UFE can treat all the fibroids regardless of where they are growing or how many there are. Most women find complete relief from their symptoms within three months of having their procedure at the Atlanta Fibroid Center.
Where Can I Find Help With Adenomyosis Or Fibroids?
A heterogeneous uterus is not a diagnosis in itself, but it is an indication that there might be an underlying condition affecting your uterus. If you have been diagnosed with fibroids or adenomyosis, contact the Atlanta Fibroid Center today and learn more about UAE and UFE and how a non-surgical procedure may be the answer to an improved quality of life.
These procedures are complex and require a high level of expertise, so it is important to choose your doctor carefully. The doctors at the Atlanta Fibroid Center are highly specialized interventional radiologists with extensive experience performing UAE and UFE. In fact, Dr. Lipman is one of the pioneers of these procedures and is known around the world for his level of expertise and contributions surrounding fibroid knowledge and research.
Set up a consultation today and get ready to enjoy life again!
