Theuterus (from Latin uterus, pl.: uteri) or womb (/wuːm/) is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more embryos until birth.[1] The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.
In the human embryo, the uterus develops from the paramesonephric ducts, which fuse into the single organ known as a simplex uterus. The uterus has different forms in many other animals and in some it exists as two separate uteri known as a duplex uterus.
In medicine and related professions, the term uterus is consistently used, while the Germanic-derived term womb is commonly used in everyday contexts. Events occurring within the uterus are described with the term in utero.
The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer; the functional layer thickens and then is shed during the menstrual cycle or estrous cycle. During pregnancy, the uterine glands and blood vessels in the endometrium further increase in size and number and form the decidua. Vascular spaces fuse and become interconnected, forming the placenta, which supplies oxygen and nutrition to the embryo and fetus.[8][9]
The uterus is primarily supported by the pelvic diaphragm, perineal body, and urogenital diaphragm. Secondarily, it is supported by ligaments, including the peritoneal ligament and the broad ligament of uterus.[16]
Normally, the human uterus lies in anteversion and anteflexion. In most women, the long axis of the uterus is bent forward on the long axis of the vagina, against the urinary bladder. This position is referred to as anteversion of the uterus. Furthermore, the long axis of the body of the uterus is bent forward at the level of the internal os with the long axis of the cervix. This position is termed anteflexion of the uterus.[17] The uterus assumes an anteverted position in 50% of women, a retroverted position in 25% of women, and a midposed position in the remaining 25% of women.[2]
The uterus is located in the middle of the pelvic cavity, in the frontal plane (due to the broad ligament of the uterus). The fundus does not extend above the linea terminalis, while the vaginal part of the cervix does not extend below the interspinal line. The uterus is mobile and moves posteriorly under the pressure of a full bladder, or anteriorly under the pressure of a full rectum. If both are full, it moves upwards. Increased intra-abdominal pressure pushes it downwards. The mobility is conferred to it by a musculo-fibrous apparatus that consists of suspensory and sustentacular parts. Under normal circumstances, the suspensory part keeps the uterus in anteflexion and anteversion (in 90% of women) and keeps it "floating" in the pelvis. The meanings of these terms are described below:
In cases where the uterus is "tipped", also known as retroverted uterus, the woman may have symptoms of pain during sexual intercourse, pelvic pain during menstruation, minor incontinence, urinary tract infections, fertility difficulties,[18] and difficulty using tampons. A pelvic examination by a doctor can determine if a uterus is tipped.[19]
Bilateral Mllerian ducts form during early human fetal life. In males, anti-Mllerian hormone (AMH) secreted from the testes leads to the ducts' regression. In females, these ducts give rise to the fallopian tubes and the uterus. In humans, the lower segments of the two ducts fuse to form a single uterus; in cases of uterine malformations this fusion may be disturbed. The different uterine morphologies among the mammals are due to varying degrees of fusion of the Mllerian ducts.
The primary reproductive function of the human uterus is to prepare for the implantation of a zygote, a fertilized ovum, and maintenance of pregnancy if implantation occurs.[21] Traveling along the fallopian tube on its way to the uterine cavity, the zygote divides mitotically to become a blastocyst, which ultimately attaches to the uterine wall and implants into the endometrium.[4] The placenta later develops to nourish the embryo, which grows through embryonic and fetal development until childbirth. During this process, the uterus grows to accommodate the growing fetus.[22] When normal labor begins, the uterus forcefully contracts as the cervix dilates, which results in delivery of the infant.[22]
In the absence of pregnancy, menstruation occurs.[21] The withdrawal of female sex hormones, estrogen and progesterone, which occurs in the absence of fertilization, triggers the shedding of the functional layer of the endometrium.[21] This layer is broken down, shed, and restored in anticipation of the next menstrual cycle.[21] The average bleeding duration during menses is 5-7 days after which the menstrual cycle begins again. [23]
A hysterectomy is the surgical removal of the uterus, which may be carried out for a number of reasons including the ridding of tumours both benign and malignant. A complete hysterectomy involves the removal of the body, fundus, and cervix of the uterus. A partial hysterectomy may just involve the removal of the uterine body while leaving the cervix intact. It is the most commonly performed gynecological surgical procedure.
The procedure remains the last resort: it is as of 2023, a relatively new and somewhat experimental procedure, performed only by certain specialist surgeons in select centres, it is expensive and unlikely to be covered by insurance, and it involves risk of infection and organ rejection. Some ethics specialists consider the risks to a live donor too great, and some find the entire procedure ethically questionable, especially since the transplant is not a life-saving procedure.[28][29][30]
Most animals that lay eggs, such as birds and reptiles, including most ovoviviparous species, have an oviduct instead of a uterus. However, recent research into the biology of the viviparous (not merely ovoviviparous) skink Trachylepis ivensi has revealed development of a very close analogue to eutherian mammalian placental development.[31]
In monotremes, mammals which lay eggs, namely the platypus and the echidnas, either the term uterus or oviduct is used to describe the same organ, but the egg does not develop a placenta within the mother and thus does not receive further nourishment after formation and fertilization.
Marsupials have two uteri, each of which connect to a lateral vagina and both use a third, middle "vagina", which functions as the birth canal.[32][33] Marsupial embryos form a choriovitelline placenta (which can be thought of as something between a monotreme egg and a "true" placenta), in which the egg's yolk sac supplies a large part of the embryo's nutrition but also attaches to the uterine wall and takes nutrients from the mother's bloodstream. However, bandicoots also have a rudimentary chorioallantoic placenta, similar to those of placental mammals.
The fetus usually develops fully in placental mammals and only partially in marsupials including kangaroos and opossums. In marsupials, the uterus forms as a duplex organ of two uteri. In monotremes such as the platypus, the uterus is duplex and rather than nurturing the embryo, secretes the shell around the egg. It is essentially identical with the shell gland of birds and reptiles, with which the uterus is homologous.[34]
Two uteri usually form initially in a female and usually male fetus, and in placental mammals, they may partially or completely fuse into a single uterus depending on the species. In many species with two uteri, only one is functional. Humans and other higher primates such as chimpanzees, usually have a single completely fused uterus, although in some individuals, the uteri may not have completely fused.
The womb is the pear shaped muscular organ that holds a baby during pregnancy. Most womb cancers start in the lining of the womb. They are also called uterine or endometrial cancer. The endometrium is the lining of the womb.
A number of things can cause this hormone imbalance, including obesity, diabetes, and hormone replacement therapy (HRT). There is also a small increase in the risk of womb cancer with long-term use of the breast cancer drug tamoxifen.
A hysterectomy can cure womb cancer in its early stages, but you will no longer be able to get pregnant. Surgery for womb cancer is also likely to include the removal of the ovaries and fallopian tubes.
Bleeding may start as light bleeding accompanied by a watery discharge, which may get heavier over time. Most women and anyone with a womb diagnosed with womb cancer have been through the menopause, so any vaginal bleeding will be unusual.
Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.
After the menopause, the body stops producing progesterone. However, there are still small amounts of oestrogen being produced. This unopposed oestrogen causes the cells of the endometrium to divide, which can increase the risk of womb cancer.
Because of the link between increased levels of unopposed oestrogen and womb cancer, oestrogen-only hormone replacement therapy (HRT) should only be given to those who have had their womb surgically removed (hysterectomy).
Women and anyone with a womb who has not had children are at a higher risk of womb cancer. This may be because the increased levels of progesterone and decreased levels of oestrogen that occur during pregnancy have a protective effect on the lining of the womb.
Women and anyone with a womb who are treated with tamoxifen (a hormone treatment for breast cancer) can be at an increased risk of developing womb cancer. However, this risk is outweighed by the benefits that tamoxifen provides in preventing breast cancer.
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