Abstract
The traditional concept of the uterus is that the endometrium is the dynamic tissue, providing an intricate set of functions throughout the menstrual cycle 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, both the myometrial and the endometrial layers of the uterus are important. This chapter covers myometrial processes (adenomyosis and leiomyomas) and endometrial processes (polyps and intrauterine adhesions), as well as conditions that may be idiopathic or due to multiple simultaneous conditions. The objective is to provide an understanding of the various clinical presentations, pathophysiology of the disease processes, and the various therapeutic options for these noncancerous uterine diseases that cause substantial morbidity for women.
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