Adenomyosis (growth of tissue that normally lines the uterus—called endometrial tissue—into the wall of the uterus)

Heavy, painful periods, vaginal bleeding between periods, pain in the lowest part of the abdomen (pelvis), and a feeling of pressure on the bladder and rectum

Sometimes pain during sexual intercourse

Ultrasonography or MRI of the pelvis

In women with abnormal vaginal bleeding, sometimes a biopsy to rule out other causes of bleeding

Birth defects of the reproductive tract (rare)

Sometimes periods that never start (primary amenorrhea)

Sometimes abnormalities found during the pelvic examination, such as a blockage in the vagina or a lump in the pelvis

A doctor's examination

Sometimes hysterosalpingography (x-rays taken after a contrast agent is injected into the uterus and fallopian tubes), sonohysterography (ultrasonography after fluid is infused into the uterus), or MRI

Cervical stenosis (narrowing of the passageway through the cervix)

Irregular or no menstrual periods, vaginal bleeding between periods, infertility, and abdominal pain that occurs in cycles

A doctor's examination

Sometimes ultrasonography of the pelvis

Cysts and tumors in the ovaries (ovarian cancer or noncancerous ovarian growths)

Often no other symptoms

Sometimes abnormal vaginal bleeding

Sometimes indigestion, bloating, changes in urination, pelvic pain, or backache

Ultrasonography

If cancer is suspected, blood tests to measure substances produced by certain tumors

Endometriosis (patches of endometrial tissue that are abnormally located outside the uterus)

Dull or crampy pain that occurs before and during the first days of menstrual periods

Infertility

Often pain during sexual intercourse, bowel movements, or urination

A doctor's examination

Ultrasonography of the pelvis

Sometimes laparoscopy (insertion of a viewing tube through a small incision just below the navel)

Fibroids

Often no other symptoms

With large fibroids, sometimes pain, pressure, or heavy vaginal bleeding

Ultrasonography

Sometimes sonohysterography or hysteroscopy (use of a thin viewing tube to see the interior of the uterus)

If results are unclear, MRI

Intrauterine devicesprogesterone)

Heavy menstrual bleeding

A doctor's examination

Sometimes ultrasonography of the pelvis to determine whether the IUD is correctly placed in the uterus

Pelvic congestion syndrome (chronic pain due to accumulation of blood in veins of the pelvis)

Pain that is

• Typically dull and aching but sometimes sharp or throbbing

• Worse at the end of the day and relieved by lying down

• Worse during or after sexual intercourse

Often low back pain, aches in the legs, and abnormal vaginal bleeding

Occasionally a clear or watery discharge from the vagina

Sometimes fatigue, mood swings, headaches, and bloating

A doctor’s examination

Ultrasonography or specialized imaging techniques

Sometimes laparoscopy