Uterus FAQs

What is the uterus?

The uterus is an organ that is part of a woman’s reproductive system. It’s made of muscle fibers, similar to a calf or bicep muscle. It is hormonally affected, and when pregnant, the uterus thins significantly, grows to house the fetus, and produces the placenta. 

Where is the uterus located?

It is located in the pelvic region just behind the bladder and leans over it. The rectum is located behind the uterus.

How big is an average uterus?

An average, non-pregnant uterus is approximately 3 inches tall by 2 inches wide by 1 inch thick (without the presence of polyps or fibroids).

Are there any negative side effects after removing the uterus (hysterectomy)?

According to a recently published study* by the Mayo Clinic, removing the uterus negatively impacts cardiovascular health. It seems there are also interactions with other systems in a woman’s body and the uterus that are not yet fully understood, and these interactions may not be related to reproduction.

*Laughlin-Tommaso SK, et al. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018 May;25(5):483-492. https://www.ncbi.nlm.nih.gov/../nihms918518.pdf

AUB FAQs

What is AUB?

Abnormal uterine bleeding (AUB) is menstrual bleeding of abnormal quantity, duration, or schedule. It’s a common gynecologic condition affecting 1 in 3 women during their life.* While sometimes referred to as heavy menstrual bleeding (HMB), AUB is more complex than excessive menstrual bleeding. AUB can severely impact a woman’s quality of life, and it can also affect fertility.

*Davis E, Sparzak PB. Abnormal Uterine Bleeding. 2021 Feb 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-Feb 10. PMID: 30422508. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532913/

What causes AUB?

Diagnosing the cause of AUB is a complex process. Causes of AUB are sorted into structural and non-structural categories:

AUB-L and AUB-P: The most common structural causes of AUB are fibroids (AUB-L) and polyps (AUB-P).

AUB-E: A thick endometrium is an example of non-structural AUB and is typically caused by hormonal fluctuations that lead to changes in the shedding and repairing of the endometrium (AUB-E).

When doctors diagnose the root cause of a patient’s AUB, they use the PALM-COIEN classification system. This method simplifies and defines the diagnosis and helps patients research their specific condition and the treatment path best suited for them.

There’s limited conclusive evidence on what exactly causes some conditions that result in AUB. For instance, there is no definitive understanding of what causes fibroids and other tissue-growth conditions of the uterus. Given the severity of the symptoms associated with AUB, and its impact on fertility and overall quality of life, Minerva has committed to support future uterine health research.

Click here for more information on the causes of AUB.

Is my period normal or heavy?

A normal period is one that rarely interferes with your daily life. You’ll need to change pads or tampons as recommended, but you’re not bleeding through them in two hours. You can maintain your typical schedule, enjoy your favorite activities and work is rarely impacted by your period.

Your bleeding is heavy if you

  • bleed through pads or tampons in two hours
  • need to use both a pad and tampon regularly
  • wake up to change pads or tampons during the night
  • collect more than 30 mLs of blood in your menstrual cup
  • bleed through your clothes
  • routinely pack a just-in-case bag when you head out 
  • cancel plans or call in sick
  • schedule your life around your period

If you are passing blood clots and soaking through your usual pads or tampons each hour for two or more hours, your bleeding is considered severe, and in some cases, this can lead to anemia. You may benefit from seeing a gynecologist who understands AUB.

Click here for more information on diagnosing AUB.

When are heavy periods a problem?

When they interfere with your life experience. That’s the signal to consult a gynecologist to see if you have AUB, and if so, what the cause may be.

Once you know what is causing your AUB symptoms, you can make informed choices about your treatment path. This is important because not all gynecologists offer minimally invasive solutions for fibroid removal and instead offer a less effective alternative, like hormonal drug therapy. Or they go to the opposite extreme and suggest a hysterectomy.

If you are experiencing heavy periods, you have options that don’t require implants (IUDs, for example), invasive surgery or hormones. Seeing the right gynecologist is the first step. There are uterine-sparing, non-hormonal treatment options that are safe and effective and may be appropriate to treat your AUB. Find a physician who understands AUB

How is AUB diagnosed?

To accurately diagnose AUB, your gynecologist will want to run blood tests and conduct an imaging assessment of your uterus. An accurate procedure for diagnosing fibroids and polyps in the uterine cavity is called a “hysteroscopy”, during which polyps can be removed. If fibroids are present, your gynecologist will discuss the options for their removal.

Click here for more information on diagnosing AUB.

Why do physicians prescribe birth control pills for heavy periods?

Because some women experience high levels of estrogen and low levels of progesterone. This can cause the endometrium, or uterine lining, to thicken. When the endometrium sheds during menstruation, women might experience heavier blood flows and larger blood clots.

Why not get a hysterectomy to treat AUB?

Hysterectomies may have long term side effects, the extent of which is not fully understood. In a recent Mayo Clinic study, women who had their uterus removed, leaving the ovaries, had a 33% increased risk of coronary artery disease. Furthermore, women under the age of 35 had a 4.6-fold increased risk of congestive heart failure.* While in some cases a hysterectomy is required, 68% of all hysterectomies are for benign reasons, for which there are other less invasive options.**

Minerva is committed to providing technologically advanced, minimally invasive treatment options that preserve the uterus, and Minerva supports continued research on uterine health.

*Laughlin-Tommaso SK, et al. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018 May;25(5):483-492. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5898981/pdf/nihms918518.pdf

**https://labblog.uofmhealth.org/rounds/plotting-downward-trend-traditional-hysterectomy

AUB Causes FAQs

What are fibroids?

Fibroids are muscular non-cancerous growths, or tumors in the walls or within the cavity of the uterus. Another medical term for fibroids is leiomyoma or "myoma". Doctors believe fibroids can interfere with implantation of the fertilized egg and the ability to carry a pregnancy to term.

Are fibroids cancerous?

Rarely (less than one in 1,000*) will a fibroid be cancerous. This is called leiomyosarcoma. Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus.*

*https://www.mayoclinic.org/diseases-conditions/ uterine-fibroids/symptoms-causes/syc-20354288#:~:text=Uterine %20fibroids%20are%20noncancerous%20growths,almost%20never%20 develop%20into%20cancer.

What causes fibroids?

No one knows, and we need more research. But existing research does point to fibroids being affected by both estrogen and progesterone (naturally occurring hormones) levels. If your female relatives have fibroids, you are likely to have them as well.

What are symptoms of fibroids?

  • Heavy menstrual bleeding
  • Menstrual periods lasting more than 7 days
  • Pelvic pressure or pain
  • Feeling full or bloated
  • Frequent urination
  • Difficulty emptying the bladder
  • Constipation
  • Backache or leg pains
  • Irregular menstrual bleeding, or having frequent, unpredictable periods of variable length and heaviness

Click here to learn more about fibroids.

What are polyps?

Polyps are composed of endometrial cells, whereas fibroids are composed of muscle cells. That means polyps are less dense than fibroids. They grow in the uterine cavity and can also be found in the cervix and vagina. As with fibroids, doctors believe polyps can interfere with implantation of the fertilized egg and the ability to carry a pregnancy to term.

What causes polyps?

There is no definitive data on what causes polyps to form.

What are the symptoms of polyps?

  • Irregular menstrual bleeding, or having frequent, unpredictable periods of variable length and heaviness
  • Bleeding between menstrual periods
  • Excessively heavy menstrual periods
  • Bleeding after sex
  • Vaginal bleeding after menopause
  • Infertility

Do fibroids grow over time?

Fibroids do grow overtime, and they can also shrink and go through growth spurts.

They stop growing after a woman goes through menopause.

Do fibroids go away on their own?

Fibroids can shrink and disappear. No one knows why they go through growth spurts or vanish, but doctors do know that fibroids are impacted by hormones, so their growth patterns may be hormone-related.

How do I know if I have fibroids and/or polyps?

Occasionally fibroids can be discovered during a routine pelvic exam. But in order to definitively diagnose fibroids or polyps, you’ll need to undergo a hysteroscopy, ultrasound or MRI. A Symphion hysteroscopy will enable your physician to clearly see inside your uterus and quickly and safely remove fibroids and polyps in one treatment.

Click here to learn more about Symphion.

Does my doctor need to look inside my uterus to determine the cause of AUB?

Yes, your doctor will want to see inside of your uterus to clearly see any pathology (fibroids, polyps) present in the uterine cavity and possibly conduct an endometrial biopsy to help determine the diagnosis before treatment. You may also receive an ultrasound or MRI, but the most consistently accurate way of identifying pathology in the uterine cavity is with a hysteroscope.

Click here for more information on diagnosing AUB.

Are fibroids and polyps genetic?

Often women in the same family experience fibroids and polyps, but there is no data that indicates fibroids and polyps are hereditary.

I don’t have fibroids or polyps, so why are my periods so heavy?

AUB may be caused by many medical conditions. The heavy periods you are experiencing may be related to Abnormal Uterine Bleeding-Endometrial Dysfunction(AUB-E), or AUB caused by a thickening of the endometrium.

You can find more information about that here.

Can any doctor remove fibroids?

All gynecologists are trained to remove fibroids. Some gynecologists specialize in minimally invasive treatments for fibroid removal.

How do polyps affect fertility?

It is largely unknown if or how polyps contribute to infertility issues. Some physicians believe polyps interfere with fertility by preventing a fertilized egg from implanting in the uterine wall correctly, but more research needs to be conducted.

Click here for more information on how AUB affects fertility.

How do fibroids affect fertility?

Fibroids can affect the number of sperm that can enter the uterus and inhibit their movement or the transport of a fertilized egg in the uterus. Fibroids can block the fallopian tubes, and they can alter the lining of the uterine cavity, affecting the fertilized egg's ability to implant in the lining. Fibroids can also affect blood flow to the uterine cavity, decreasing the ability of the fertilized egg's to implant to the uterine wall or develop properly.

Click here for more information on how AUB affects fertility.

Can fibroids or polyps cause a miscarriage?

Yes, fibroids and polyps can also affect whether an embryo can implant properly, which is necessary for a sustained pregnancy. Fibroids can also affect the growth and positioning of the baby, which can result in a preterm delivery (<37 weeks), a breech presentation and the need for a cesarean section, and low birth weight*.

*Uterine fibroids at routine second-trimester ultrasound survey and risk of sonographic short cervix.
Blitz MJ, Rochelson B, Augustine S, Greenberg M, Sison CP, Vohra N
J Matern Fetal Neonatal Med. 2016 Nov; 29(21):3454-60.

I have an appointment with a gynecologist. What questions should I be asking about my periods?

Download this AUB physician discussion guide. You’ll have everything you need in one place to have an informative conversation about AUB, and you’ll be prepared with questions to ask your healthcare team.

AUB Treatments FAQs

Do I have a choice in which device a doctor uses?

You have the final say in what device is used during a treatment for you. But not all physicians offer all available devices, so you may not be informed of all available treatment options at one medical practice.

After receiving a diagnosis, ask your physician about the available treatment options and which they offer. You may find that you need to get a second opinion from a physician who offers a variety of treatment options. Visit our physician locator to find a gynecologist near you that offers Minerva treatment options.

Do all treatments for AUB need to be approved by the FDA?

Yes, but that doesn’t mean that that all treatments perform the same way or deliver the same results. For example, if one device receives FDA clearance and then two years later a new device receives clearance that treats the same condition but is more effective, the FDA does not remove the older device from the market. So, it comes down to the patient knowing that the doctor to whom she is entrusting her care is using treatments from a company that is best-in-class, and is using the right device for her specific situation.

What is Symphion?

Symphion is a system used by physicians to perform diagnostic hysteroscopies, and to remove uterine tissue like polyps (polypectomy) and fibroids (myomectomy). The uterus is accessed via the vagina and cervix. This eliminates the need for incisions or the removal of the uterus (hysterectomy).

Why should I ask for Symphion by name?

The Symphion System enables clear visualization of your uterine cavity and does not use mechanical blades to cut fibroids into pieces for removal. It uses plasma technology and the unique design of the device tip to simultaneously cut and suction out the fibroid tissue. For the physician, the ability to see clearly and remove all fibroid tissue quickly is very important to protect your health.

What can I expect after fibroid removal (myomectomy) with Symphion?

Some women have mild cramping. Rarely do women need anything but over the counter pain medicine. Most women are back to normal activities within a few days.

Why should I have fibroids removed?

Removing symptomatic fibroids may improve your experience with your period and your overall health and quality of life. If you are experiencing difficulties getting pregnant or maintaining a pregnancy, and it’s determined that you have fibroids, your chances of getting pregnant and maintaining the pregnancy may increase after fibroid removal, but there are many factors that may influence conception.

What is Minerva ES?

Minerva ES is a device that physicians use to perform an endometrial ablation. Endometrial ablation is a method of removing the endometrial layer of tissue in the uterine cavity to treat AUB.

Why should I ask for Minerva ES by name?

Clinical studies with the Minerva ES resulted in significant safety and effectiveness results for endometrial ablation. These results are published and show improvement compared to older models and designs*, as Minerva ES was designed to improve upon pre-existing ablation devices in these key ways:

  • Minerva ES does not use a vacuum. Other devices use a vacuum which collapses the uterus onto the device, which can lead to a bonding of the uterine walls. The Minerva ES technology helps prevent any parts of the uterine walls from bonding or sticking to each other after treatment. If the walls bond, parts of the endometrium remain unablated and still thicken and shed during the menstrual cycle. With nowhere for the blood to go, doctors theorize this bonding of the uterine walls leads to post-ablation pain and cramping during the menstrual cycle.
  • The Minerva ES device “array” tip is covered in a soft silicone material and has no exposed, heated electrical element in contact with your uterus. This may be the most dramatic change in endometrial ablation devices for patient comfort – and it may also be why the FDA reviewed clinical studies results were the best compared to all other endometrial ablation treatments.* The silicone design helps reduce any sticking when the device is removed at the end of the treatment. Minerva ES endometrial ablation is gentle enough that the procedure can be performed in a physician’s office.
  • Minerva ES utilizes software that senses changes in the uterine cavity and targets the tissue that is least ablated. This results in a more complete and consistent ablation. No other endometrial ablation device adjusts the power level in response to changes in the endometrial lining of the uterine cavity, which is why Minerva ES data proves best-in-class status when compared to all other endometrial ablation devices as a group.*

 

*Laberge P, Garza-Leal J, Fortin C, Grainger D, Johns DA, Adkins RT, Presthus J, Basinski C, Swarup M, Gimpelson R, Leyland N, Thiel J, Harris M, Burnett PE, Ray GF. A Randomized Controlled Multicenter US Food and Drug Administration Trial of the Safety and Efficacy of the Minerva Endometrial Ablation System: One-Year Follow-Up Results. J Minim Invasive Gynecol. 2017 Jan 1;24(1):124-132.

What can I expect after an endometrial ablation with Minerva ES?

Every woman is different, but at 1 year post-Minerva ES, 72%* of women had their period completely eliminated.

In the first year after Minerva ES treatment, many women experience a few cycles, but they are typically light enough to be handled with liners and last only a few days.

93%* of women who had the Minerva treatment had their periods reduced to a bleeding level of normal or less at 1 year.

At 1 year post-treatment with the NovaSure procedure, periods were completely eliminated in just 36%** of women.

After Minerva ES, most women resume normal activities within a day or two. You may experience some cramping, mild pain or nausea. You may also experience some discharge for a few days to a few weeks. Your gynecologist will review this with you so that you know what to expect. Be certain to follow the guidance of your gynecologist for all post-treatment care plans.

*Laberge P, Garza-Leal J, Fortin C, Grainger D, Johns DA, Adkins RT, Presthus J, Basinski C, Swarup M, Gimpelson R, Leyland N, Thiel J, Harris M, Burnett PE, Ray GF. A Randomized Controlled Multicenter US Food and Drug Administration Trial of the Safety and Efficacy of the Minerva Endometrial Ablation System: One-Year Follow-Up Results. J Minim Invasive Gynecol. 2017 Jan 1;24(1):124-132.

**NovaSure Advanced Impedance Controlled Endometrial Ablation System. Instructions For Use and Controller Operator’s Manual. Available at: https://www.hologic.com. Accessed February 04, 2019. (Not based on a head-to-head study).

Are there long-term side effects of reducing or removing the uterine lining?

There are no long-term side effects associated with reducing or removing the uterine lining.

What are the risks associated with endometrial ablation?

With all surgical procedures, including endometrial ablation, serious injury or death can occur.

The following adverse events could occur or have been reported in association with the use of other endometrial ablation systems and may occur with the Minerva System:

  • Post-ablation tubal sterilization syndrome (PATSS)
  • Thermal injury to adjacent tissue, including bowel, bladder, cervix, vagina, vulva and/or perineum
  • Perforation of the uterine wall
  • Hemorrhage
  • Hematometra
  • Difficulty with defecation or micturition
  • Uterine necrosis
  • Air or gas embolism
  • Infection or sepsis
  • Complications leading to serious injury or death

What is Genesys HTA?

Genesys HTA is an endometrial ablation device that uses heated saline to remove the endometrial lining for the treatment of AUB. This ablation device enables the physician to see your uterine cavity throughout the treatment, and, as with Minerva ES, there is no vacuum used or exposed heating element in your uterus. Instead, this treatment involves only circulating heated saline.

This device may be right for women who wish to lighten their periods and aren’t looking to end them altogether (amenorrhea). Genesys HTA is special for another reason: it is designed for unusually shaped uterine cavities, so this endometrial ablation option may be available to more women. Typically, treatments take approximately 10 minutes.

What can I expect after Genesys HTA?

Every woman is different, but most women experience fewer and lighter cycles after Genesys HTA. Periods are often light enough for just liners and last only a few days.

After Genesys HTA, most women resume normal activities within a day or two. You may experience some cramping, mild pain, or nausea. You may also experience some discharge for a few days to a few weeks. Your gynecologist will walk you through what to expect. Be certain to follow the guidance of your gynecologist for all post-treatment care plans.

Are there long-term side effects of having no uterine lining?

Except for reducing or eliminating periods, there are no long-term side effects associated with the reducing or removal of the uterine lining.

What are the risks associated with endometrial ablation?

As with any surgical procedure, there are potential risks associated with endometrial ablation. Endometrial ablation is not a sterilization procedure. And it is not safe to become pregnant after endometrial ablation. Rare but potential risks include:

  • Post-ablation tubal sterilization syndrome (PATSS)
  • Thermal injury to adjacent tissue, including bowel, bladder, cervix, vagina, vulva and/or perineum
  • Perforation of the uterine wall
  • Hemorrhage
  • Hematometra
  • Difficulty with defecation or micturition
  • Uterine necrosis
  • Air or gas embolism
  • Infection or sepsis
  • Complications leading to serious injury or death

What is Resectr?

Resectr is a disposable device that removes polyps without needing to pull or tug them out. It replaces common tissue removal tools such as graspers and forceps.

While you may not need to know the name of this device, it is important to be informed about polyps and how they contribute to AUB. Physicians who use Resectr are able to see and remove polyps in one office visit. To know if polyps are causing your symptoms, ask your physician about having a hysteroscopy. Click here to learn more about polyps.

What can I expect after having a polyp removed with Resectr?

Your physician will send the removed polyp tissue to be examined by a pathology lab. You will go about your day as normal, but may experience some spotting. Any cramping may be treated with over-the-counter pain medicine.

Why do physicians use Resectr?

Physicians appreciate the efficient and elegant design of Resectr and feel it’s gentler for the patient. They are able to remove an entire polyp, which is beneficial for pathology analysis (because it is whole and not shredded or cut into pieces). Convenience may be the optimal benefit for both physician and patient. The ability to receive this treatment in the gynecologist's office may save time and money. And for ease and comfort, most patients prefer to be in the office rather than in a surgery center or hospital.

Are the four Minerva treatments for AUB covered by insurance?

Minerva treatments for AUB are covered by most insurance providers. Talk to your physician about specific insurance options and offerings.

Can I still get pregnant after having an endometrial ablation?

Pregnancy following an endometrial ablation is NOT SAFE and can be dangerous for the woman and fetus. Endometrial ablation is not a sterilization procedure, so speak with your physician about birth control options if needed.

While the likelihood of pregnancy is significantly decreased after endometrial ablation, you can still become pregnant. DO NOT have an endometrial ablation if you want to become pregnant.