Pelvic Inflammatory Disease
Tiredness.
Inflammation of the female reproductive organs,
most often due to a sexually transmitted
infection
Most common between the ages of 15 and 24;
rare before pubertyLifestyle as a risk factor
depends on the cause Genetics is not a
significant factor
Pelvic inflammatory disease (PID) is a common
cause of pain in the pelvic region in women. In
this condition, some of the female reproductive
organs become inflamed, usually as a result of
an infection. Young and sexually active women
are most likely to be affected. PID may have no
obvious symptoms, and some women are
unaware that they have had the condition until,
years later, they are investigated for infertility
(see Female infertility).
PID is usually caused by a sexually transmitted
infection (STI), such as gonorrhoea or
chlamydial infection. PID may also be caused by
an infection developing after a termination of
pregnancy or after childbirth. In rare cases, PID
can occur as a result of tuberculosis developing
in the pelvis or from the spread of a severe
infection from the large intestine.
The infection spreads upwards from the vagina
to the uterus and fallopian tubes. The ovaries
may also be affected. An intra-uterine
contraceptive device (IUD) makes this spread of
infection more likely if an infection is present at
the time the IUD is inserted. If you think you may
have an infection, tests will usually be performed
so that you can be treated before PID develops.
When PID is discovered during investigations for
infertility, the original cause may remain
unknown.
What are the symptoms?
PID may have no obvious symptoms, especially
when caused by chlamydia. If there are
symptoms, they may include:Pain in the pelvic
region. Fever. An abnormal vaginal discharge.
Heavy or prolonged periods (see
Menorrhagia).Pain during sexual intercourse.
If PID develops suddenly, you may have severe
pain, nausea, and vomiting, and urgent hospital
attention is required. If the condition is not
treated, the fallopian tubes may be damaged.
The infection may also spread to other organs in
the pelvis and the abdomen.
What might be done? If your doctor suspects
that you have PID, he or she will carry out a
pelvic examination. Swabs may be taken from
both the cervix and the vagina to identify the
organisms causing the infection. Ultrasound
scanning of the pelvis may also be performed. If
you have severe symptoms, you will be admitted
to hospital, and a laparoscopy may be
performed to view the abdominal and pelvic
cavities.
Your doctor will probably prescribe antibiotics,
which may be given intravenously in some
cases. You may also be given painkillers.
You should not have sexual intercourse until
your recovery is complete. Your sexual partners
should have tests to look for sexually transmitted
infections and should be treated if necessary to
prevent a reinfection (see Preventing STIs). If
you use an IUD, you may be advised to change
to a different method of contraception. If PID is
detected and treated early, you should make a
complete recovery. If PID is not treated, damage
to the fallopian tubes can increase the risk of
having an ectopic pregnancy or may lead to
infertility.
Polycystic Ovary Syndrome
Multiple, small, fluid-filled cysts in the ovaries
associated with a sex hormone imbalance
Affects females of childbearing age. Sometimes
runs in families. Lifestyle is not a significant
factor
Many women (up to about a quarter) have
multiple fluid-filled cysts in their ovaries but most
of these women do not have polycystic ovary
syndrome (PCOS), which is the presence of
multiple ovarian cysts associated with an
imbalance of the sex hormones and certain
other characteristics, such as acne, excessive
body hair (see Virilization), and menstrual
irregularities. The sex hormone imbalance,
which may include higher than normal levels of
the male sex hormone testosterone, may
prevent ovulation (egg release), thus reducing
fertility (see Female infertility).
The underlying cause of PCOS is not fully
understood but the increased resistance of body
tissues to the hormone insulin that is a feature of
the syndrome is thought to play an important
part. To compensate for the increased insulin
resistance, the pancreas produces excessive
insulin, which, in turn, may lead to
overproduction of testosterone, high levels of
which disrupt normal functioning of the ovaries.
PCOS sometimes runs in families.
What are the symptoms?
The symptoms vary in severity, depending on
the degree of hormone imbalance. PCOS may
go unnoticed until a woman is tested for
infertility. Symptoms include:
Infrequent or absent periods (see
Amenorrhoea). Obesity.
Excessive hair growth on the face, around the
nipples, and/or on the lower abdomen. Thinning
of the hair on the head. Long-lasting acne.
Women with PCOS have an increased risk of
developing diabetes mellitus, high blood
pressure (see Hypertension), coronary heart
disease, and cancer of the uterus.
What might be done?
If your doctor suspects that you have PCOS, he
or she will take blood samples to measure your
levels of sex hormones. You will also have
ultrasound scanning to look for ovarian cysts.
Treatment depends on the severity of your
symptoms and whether you want to conceive.
Infertility can be treated with drugs, such as
clomifene (see Drugs for infertility). If drugs are
unsuccessful, the cysts may be treated with
diathermy (a type of heat treatment) carried out
during laparoscopy. If necessary, assisted
conception may then be considered. If you do
not want to have children, abnormal periods can
be treated with a combined oral contraceptive
pill.
To treat insulin resistance, if necessary, and
reduce your risk of developing diabetes, you
may be prescribed an antidiabetic drug (see
Drugs for diabetes mellitus), such as metformin.
Such drugs may also restore ovulation and
regulate your menstrual periods. If you are
overweight, losing weight may help to relieve
symptoms of PCOS. Excess hair can be
removed by electrolysis.
Ovarian Cysts
Fluid-filled swellings that grow on or in one or
both ovaries
Most common between the ages of 30 and 45
Genetics and lifestyle are not significant factors
Ovarian cysts are fluid-filled sacs that grow on or
in the ovaries. Most ovarian cysts are
noncancerous and not harmful, but a cyst may
sometimes become cancerous (see Cancer of
the ovary). Cancerous cysts are more likely to
develop in women over the age of 40.
Ovarian cyst
This view through a laparoscope shows a large
ovarian cyst next to the uterus. Most ovarian
cysts are noncancerous.
What are the types?
There are many types of ovarian cyst. The most
common type is a follicular cyst, in which one of
the follicles, where eggs develop, grows and fills
with fluid. This type of ovarian cyst may grow to
5 cm (2 in) in diameter and usually occurs
singly. Multiple small cysts that develop in the
ovaries are thought to be caused by a hormonal
disorder, and this condition is known as
polycystic ovary syndrome.
Less commonly, cysts may form in the corpus
luteum, the yellow tissue that develops from a
follicle after the release of an egg. These cysts
can fill with blood and can grow to 6 cm (1/ 2in).
A dermoid cyst is a cyst that contains cells that
are normally found elsewhere in the body, such
as skin and hair cells. A cystadenoma is a cyst
that grows from one type of cell in the ovary. In
rare cases, a single cystadenoma can fill the
entire abdominal cavity.
What are the symptoms?
Often, ovarian cysts do not cause symptoms,
but when there are symptoms, they may include:
Discomfort in the abdomen. Pain during sexual
intercourse. A change in your usual menstrual
pattern.
Large cysts can put pressure on the bladder,
leading to urinary retention or a frequent need to
pass urine.
Are there complications If an ovarian cyst
ruptures or becomes twisted, severe abdominal
pain, nausea, and fever may develop. Cysts
may grow so large that the abdomen is
distended. In rare cases, a cyst producing the
sex hormone oestrogen may develop before
puberty, which leads to early sexual
development (see Abnormal puberty in females).
Some ovarian cysts produce male sex
hormones, which can cause the development of
male characteristics, such as growth of facial
hair (see Virilization).
What might be done?
Sometimes, ovarian cysts are only discovered
when a pelvic examination is carried out during
a routine checkup. If you have symptoms of a
cyst, your doctor will perform a pelvic
examination. You may also be sent for
ultrasound scanning or for a laparoscopy to
confirm the diagnosis and determine the size
and position of the cyst. You may also have
blood tests to give an indication of whether a
cyst might be cancerous.
Ovarian cysts may disappear without treatment,
although the size of a cyst may be monitored
with regular ultrasound scans. Large or
persistent cysts may be drained or removed. If
there is a chance that the cyst is cancerous, it
will be removed, leaving the ovary and fallopian
tube if possible. Ovarian cysts may recur if the
ovary is not removed.
Cancer of the Uterus
A cancerous tumour that grows in the lining of
the uterus
Most common between the ages of 55 and 65.
Being overweight and not having had children
are risk factors. Genetics is not a significant
factor.Cancer of the uterus is one of the most
common cancers of the female reproductive
organs in the UK, with about 6,900 new cases
diagnosed in 2005. Most uterine cancers
develop in the endometrium (the lining of the
uterus). More rarely, cancer occurs in the
muscular wall of the uterus.
What are the causes?
The causes of cancer of the uterus are unclear.
The disorder is more common in women aged
55–65 and in those who have or have previously
had abnormally high levels of the female sex
hormone oestrogen. Raised oestrogen levels
may be caused by being overweight and by
certain disorders, such as polycystic ovary
syndrome. The disorder is also more likely in
women who have had a late menopause (after
the age of 52) or who have not had children.
What are the symptoms?
The symptoms of cancer of the uterus vary
depending on whether it develops before or after
the menopause. These symptoms may include:
In premenopausal women, heavier than normal
periods (see Menorrhagia) or bleeding between
periods or after sexual intercourse.In
postmenopausal women, vaginal bleeding that
may vary from spotting to heavier bleeding. Left
untreated, cancer of the uterus may spread to
the fallopian tubes and the ovaries and to other
organs, including the lungs and sometimes the
liver.
How is it diagnosed?
If your doctor suspects cancer from your
symptoms, he or she will perform a pelvic
examination. During the examination, a small
sample of tissue may be taken from the
endometrium to check for the presence of
cancerous cells (see Endometrial sampling).
Your doctor will also arrange for ultrasound
scanning to assess the thickness of the lining of
the uterus. A thicker than normal lining may
indicate cancer of the uterus.
If these tests are not conclusive, a hysteroscopy
may be needed to remove a larger amount of
tissue from the uterus. Samples of the
endometrial tissue are then microscopically
examined for cancerous cells. During the
hysteroscopy, your doctor is also able to directly
view the endometrium to check for any obvious
abnormalities.
If cancer of the uterus is diagnosed, tests will be
carried out to see if the cancer has spread. For
example, you may have a chest X-ray or MRI of
the pelvis and abdomen. You may also have
blood tests to assess the function of the liver.
What is the treatment?
The treatment for cancer of the uterus depends
on the stage at which the cancer is diagnosed
and whether or not it has spread elsewhere in
the body. In most women, the tumour can be
treated by a hysterectomy, in which the uterus,
ovaries, and fallopian tubes are removed. In
addition, samples from nearby pelvic lymph
nodes are usually taken and examined under a
microscope to see if the disease has spread and
to check whether further treatment is required.
Surgery is often followed by radiotherapy to
destroy any cancer cells that remain. If
cancerous cells are found in the lymph nodes,
you will be treated with chemotherapy and the
female hormone progesterone (see Sex
hormones and related drugs), which slows down
the growth of cancer cells. After treatment, you
will have regular follow-ups to check for signs of
cancerous changes in the pelvis.
The outlook for cancer of the uterus depends on
whether the tumour is treated at an early stage
before the condition has spread to other parts of
the body. About 4 in 5 women who are treated
when the cancer is at an early stage survive for
5 years or longer.
Cancer of the Cervix
A cancerous growth occurring in the lower end
of the cervix
Most common between the ages of 45 and 65.
Unprotected sex at an early age, unprotected
sex with multiple partners, and smoking are risk
factors. Genetics is not a significant factor
Cervical cancer is the 12th most common
cancer in women, with about 2,900 new cases
being diagnosed in the UK in 2006. It is one of
the few cancers that can be largely prevented by
regular screening before symptoms appear. The
HPV (human papillomavirus) vaccine also helps
to protect against the disease. Cancer of the
cervix usually develops slowly. In the
precancerous stage, cervical cells gradually
change from being mildly to extremely abnormal,
a condition known as cervical intraepithelial
neoplasia. These changes in the cervical cells
can be detected using a cervical smear test,
allowing treatment to be carried out before
cancer develops
What are the causes?
The cause of cervical cancer is not clear in all
cases but in some cases it is associated with
certain strains of the human papillomavirus
(HPV). This virus is transmitted through
unprotected sexual intercourse, and the risk of
cervical cancer is increased if you have
unprotected sex from an early age or with many
partners. Smoking is also a risk factor for
cervical cancer. Women who have reduced
immunity or who are taking
immunosuppressants are at increased risk of
developing cancer of the cervix.
What are the symptoms?
Cancer of the cervix does not always cause
symptoms. However, in some women, there
may be some abnormal vaginal bleeding,
especially after sexual intercourse. As the
cancer progresses, further symptoms may
include:
A watery, bloodstained, and offensive-smelling
vaginal discharge. Pelvic pain. Left untreated,
cancer of the cervix may spread to the uterus
and then to the lymph glands in the pelvis.
Eventually, cancer may spread to other parts of
the body, such as the liver and lungs.
How is it diagnosed?
If your doctor suspects that you have cancer of
the cervix from your symptoms, he or she may
perform a smear test and should arrange for you
to have a colposcopy, in which the cervix is
viewed through a magnifying instrument and
checked for abnormal areas. A sample of tissue
will probably be taken from the cervix during the
procedure and later examined under a
microscope for evidence of cancerous cells. If
cancer of the cervix is diagnosed, you may have
further tests to see if the condition has spread to
other parts of the body. These tests may include
a chest X-ray or MRI of the chest to look at the
lungs and blood tests and CT scanning of the
abdomen to assess liver function.
What is the treatment?
The treatment for cancer of the cervix depends
on the stage of the disease and your individual
circumstances.If the cancer is confined to the
cervix and you plan to have children, it may be
possible to remove only the affected area of the
cervix. If the disease has spread to the uterus
and pelvis, it may be necessary to remove the
uterus as well as the fallopian tubes, the ovaries,
the top of the vagina, and the nearby lymph
nodes. In women who are premenopausal, the
ovaries are left if possible because they produce
sex hormones and removing them causes
premature menopause. If the cancer has spread
to other organs in the body, radiotherapy, and
sometimes chemotherapy, may be needed.
What is the prognosis?
If cervical cancer is diagnosed and treated early,
most women recover completely. However, if the
disease has spread, it can be fatal; in 2007 more
than 900 women in the UK died from cervical
cancer.
Cancer of the cervix

This colour-enhanced MRI through the pelvis

shows a large cancerous tumour of the cervix
lying just behind the bladder.

Can it be prevented?

Routine cervical smear tests can help to ensure

the early diagnosis and treatment of abnormal
cervical cells and have greatly reduced the
incidence of cervical cancer. In addition to
having regular cervical smears, it is advisable to
try to reduce the risk of developing cervical
cancer by not smoking and by using barrier
methods of contraception.

A vaccine is available to protect against the two

strains of HPV that cause most cases of cervical
cancer. The vaccine is routinely offered to girls
between the ages of 12 and 18. However, this
vaccine does not protect against all strains of
the virus that are associated with the cancer and
it is therefore important for girls who have been
vaccinated to have regular cervical smear tests
later in life.