Benign Uterine Diseases

The traditional concept of the uterus is that the endometrium is the dynamic tissue, providing an intricate set of functions throughout the menstrual cycle-a process that rarely culminates in implantation and pregnancy. The myometrium has been viewed as an inert tissue, chiefly important during pregnancy and, when abnormal, providing the surgical livelihood of clinical gynecologists. To understand both the physiology of menstruation and the pathophysiology of abnormal uterine bleeding (AUB), both the myometrial and the endometrial layers of the uterus are important. This chapter covers both myometrial disease (adenomyosis and leiomyomas) and endometrial diseases (polyps, AUB, intrauterine adhesions, and dysmenorrhea). The objective is to provide the reader with an understanding of the various clinical presentations as well as the molecular pathophysiology of the disease process and to enlist various therapeutic options for these benign uterine diseases.