The Fallopian Tubes and Ovaries

The fallopian tubes and ovaries are part of the female reproductive system. Here we provide both information about the fallopian tubes and ovaries and pertinent facts concerning disorders of the fallopian tubes and ovaries. On this page you will find information on the following:

The Fallopian Tubes Ectopic Pregnancies Polycystic Ovarian Syndrome
The Ovaries Ovarian Cysts Helpful Links
Ovarian Cancer Endometriosis  


The fallopian tubes are a pair of tubes found in every female . These two tubes, sometimes referred to as the oviducts or uterine tubes, are found in the pelvic cavity, running between the uterus and the ovaries. Approximately three to four inches long, the fallopian tubes are not directly attached to the ovaries. Instead, the tubes open up into the peritonial (abdominal) cavity, very close to the ovaries.

The ovaries are a pair of reproductive glands which are part of the female reproductive system. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a fallopian tube to the uterus. The ovaries are the main source of female hormones, which control the development of female body characteristics, such as the breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy.

Fallopian Tube & Ovarian Disorders

Ovarian Cancer
Ovarian cancer is cancer that starts in the ovaries.

Causes, incidence, and risk factors
Ovarian cancer is the fifth most common cancer among women, and it causes more deaths than any other type of female reproductive cancer. Unfortunately, the cause is unknown.

The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has and the earlier in life she gives birth, the lower her risk for ovarian cancer. Certain genes defects (BRCA1 and BRCA2) are responsible for a small number of ovarian cancer cases. Women with a personal history of breast cancer or a family history of breast or ovarian cancer have an increased risk for ovarian cancer.

Women who take estrogen replacement only (not with progesterone) for 5 years or more seem to have a higher risk of ovarian cancer. Birth control pills; however, decrease the risk of ovarian cancer.

Studies suggest that fertility drugs do not increase the risk for ovarian cancer.

Older women are at highest risk for developing ovarian cancer. Most deaths from ovarian cancer occur in women age 55 and older.

Symptoms
The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early. Many times, women with ovarian cancer have no symptoms or just mild symptoms until the disease is in an advanced stage and hard to treat. You should make an appointment with All ABout Women if you have the following symptoms on a daily basis for more than a few weeks:

  • Heavy feeling in pelvis
  • Pain in lower abdomen
  • Bleeding from the vagina
  • Weight gain or loss
  • Abnormal periods
  • Unexplained back pain that gets worse over time
  • Gas, nausea, vomiting, or loss of appetite
  • Bloating
  • Difficulty eating or feeling full quickly
  • Pelvic or abdominal pain
  • Swollen abdomen or belly
  • Vaginal bleeding
  • Vague lower abdominal discomfort

Treatment
Surgery is used to treat all stages of ovarian cancer. For earlier stage ovarian cancer, it may be the only treatment. Surgery involves:

  • Removal of the uterus (total hysterectomy)
  • Removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy)
  • Partial or complete removal of the omentum, the fatty layer that covers and pads organs in the abdomen
  • Examination, biopsy, or removal of the lymph nodes and other tissues in the pelvis and abdomen

Chemotherapy is used after surgery to treat any remaining disease. Chemotherapy can also be used if the cancer comes back. Chemotherapy may be given into the veins, or sometimes directly into the abdominal cavity (intraperitoneal).

Ovarian Cysts
Ovarian cysts are small fluid-filled sacs that develop in a woman's ovaries. Most cysts are harmless, but some may cause problems such as rupturing, bleeding, or pain; and surgery may be required to remove the cyst(s).

Ovarian cysts affect women of all ages. The vast majority of ovarian cysts are considered functional (or physiologic). This means they occur normally and are not part of a disease process. Most ovarian cysts are benign, meaning they are not cancerous, and many disappear on their own in a matter of weeks, without treatment. Ovarian cysts occur most often during a woman's childbearing years.

Each month during your menstrual cycle, a follicle (where the egg is developing) grows on your ovary. Most months, an egg is released from this follicle (called ovulation). If the follicle fails to break open and release an egg, the fluid stays in the follicle and forms a cystcyst.This is called a follicular cyst.

Another type of cyst, called a corpus luteum cyst, occurs after an egg has been released from a follicle. These often contain a small amount of blood.

Functional ovarian cysts are not the same as ovarian tumors (including ovarian cancerovarian cancer) or cysts due to hormone-related conditions such as polycystic ovary diseasepolycystic ovary disease.

Taking fertility drugs can cause a condition called ovarian hyperstimulation, in which multiple large cysts are formed on the ovaries. These usually go away after a woman's period or after a pregnancy.

Symptoms
Most ovarian cysts are small and do not cause symptoms. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.

Treatment
Birth control pills may be prescribed to treat some types of ovarian cysts. This treatment will not make cysts you already have go away. But it will prevent new cysts from forming.

If your cyst is large or causing symptoms, surgery may be recommended. The extent and type of surgery that is needed depends on several factors:

  • Size and type of cyst
  • Your age
  • Your symptoms
  • Your desire to have children

Sometimes, a cyst can be removed without having to remove the ovary. This surgery is called cystectomy. In other cases, one or both of the ovaries may have to be removed.

Ectopic Pregnancy
An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies happen in a fallopian tube. Rarely, an eggwill attach to an ovary or another organ in the abdomen. As the pregnancy grows, it can cause the tube to burst. If this occurs, it can cause major internal bleeding. This can be life threatening and needs to be treated with surgery.

Symptoms of an Ectopic Pregnancy
An ectopic pregnancy may cause the following symptoms:

  • Abnormal vaginal bleeding that is not at the time of your normal menstrual period
  • Abdominal or pelvic pain: pain can be sudden and sharp and ache without relief or seem to come and go and the pain may also occur on only one side
  • Shoulder pain: blood from the ruptured tube can build up under the diaphragm (the area between your chest and stomach) and this can cause pain that is felt in the shoulder
  • Weakness, dizziness, or fainting due to blood loss

These symptoms can occur before you even suspect you are pregnant. If you have these symptoms, please call All About Women to make an appointment.

Treatment
There are generally two methods used to treat an ectopic pregnancy: medication and surgery. Several weeks of follow-up are required no matter which type of treatment is used.

If the pregnancy is small and has not ruptured the tube, sometimes drugs can be used instead of surgery to treat ectopic pregnancy. Medication stops the growth of the pregnancy and permits the body to absorb it over time. It allows a woman to keep her fallopian tube.

If the pregnancy is small and the tube is not ruptured, in some cases the pregnancy can be removed through a small cut made in the tube using laparoscopic surgery. In this procedure, a slender, light-transmitting telescope is inserted through a small opening in your abdomen andis done in a hospital with general anesthesia. A larger incision in the abdomen may be needed if the pregnancy is large or the blood loss is thought to be a concern. Some or all of the tube may need to be removed.

Future Pregnancy
If you have had surgery and the fallopian tubes have been left in place, there is a good chance that you can have a normal pregnancy in the future. However, once you have had an ectopic pregnancy you are at higher risk of having another one. It is best to discuss your options with a OBGYN before deciding to get pregnant after a ectopic pregnancy.

Endometriosis
Endometriosis is a condition in which tissue that forms the lining of the uterus grow in other areas of the body beyond the uterus. This can lead to pain, irregular bleeding, and infertility.

The cause of endometriosis is unknown. One theory is that the endometrial cells shed when you get your period travel backwards through the fallopian tubes into the pelvis, where they implant and grow. This backwards menstrual flow occurs in many women, but researchers think the immune system may be different in women with endometriosis.

Endometriosis is most common in women in their 30s and 40s, but it can occur any time in women who menstruate. Endometriosis occurs more often in women who have never had children.

A woman who has a mother or sister with endometriosis is much more likely to develop endometriosis than other women. You are more likely to develop endometriosis if you:

  • Started your period at a young age
  • Never had children
  • Have frequent periods or periods that last 7 or more days
  • A closed hymen, which blocks the flow of menstrual blood during the period

Symptoms
Pain is the main symptom of endometriosis. A woman with endometriosis may have:

  • Painful periods
  • Pain in the lower abdomen before and during menstruation
  • Cramps for a week or two before menstruation and during menstruation — cramps may be steady and range from dull to severe
  • Pain during or following sexual intercourse
  • Pain with bowel movements
  • Pelvic or low back pain that may occur at any time during the menstrual cycle

However, some women experience no symptoms at. Some women with a large number of tissue implants in their pelvis have no pain at all, while some women with milder disease have severe pain.

Treatment
Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. It may be treated with medication, surgery, or both. Although treatments may relieve pain and infertility for a time, symptoms may come back after treatment.

Polycystic Ovarian Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age. The name of the condition comes from the appearance of the ovaries in most, but not all, women with the disorder — enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance).

Infrequent or prolonged menstrual periods, excess hair growth, acne and obesity can all occur in women with polycystic ovary syndrome. In adolescents, infrequent or absent menstruation may signal the condition. In women past adolescence, difficulty becoming pregnant or unexplained weight gain may be the first sign.

The exact cause of polycystic ovary syndrome is unknown. Early diagnosis and treatment may reduce the risk of long-term complications, such as type 2 diabetes and heart disease.

Symptoms of PCOS
Doctors don't know the cause of polycystic ovary syndrome, but these factors likely play a role:

  • Infertility because of not ovulating. In fact, PCOS is the most common cause of female infertility.
  • Infrequent, absent, and/or irregular menstrual periods
  • Hirsutism — increased hair growth on the face, chest, stomach, back, thumbs, or toes
  • Cysts on the ovaries
  • Acne, oily skin, or dandruff
  • Weight gain or obesity, usually with extra weight around the waist
  • Male-pattern baldness or thinning hair
  • Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
  • Skin tags — excess flaps of skin in the armpits or neck area
  • Pelvic pain
  • Anxiety or depression
  • Sleep apnea

Treatment
Polycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism, acne or obesity.

Medications may be prescribed to help eleviate the symptoms of PCOS. Medications can help:

Regulate your menstrual cycle. If you're not trying to become pregnant, a low-dose birth control pills that contain a combination of synthetic estrogen and progesterone may be used. They decrease androgen production and give your body a break from the effects of continuous estrogen. This decreases your risk of endometrial cancer and corrects abnormal bleeding.

Help you ovulate. If you're trying to become pregnant, you may need a medication to help you ovulate.

Reduce excessive hair growth. Birth control pills to can decrease androgen production, or another medication called spironolactone (Aldactone) that blocks the effects of androgens on the skin. Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended if you're pregnant or planning to become pregnant. Eflornithine (Vaniqa) is another medication possibility; the cream slows facial hair growth in women.

If you are trying to become pregnant and medications don't help, surgery is an option for some women with PCOS. Discuss all you options with one of our doctors and we will assist you with the proper treatment.


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