The uterus, or womb, usually measures the size of your fist, but for a number of reasons, you may develop an enlarged uterus. Symptoms are not always present or may be very minor, so you may not even realize you have this condition, and often having an enlarged uterus is not a cause for concern.
However, some women do experience heavy periods, pelvic pain, pressure in the lower abdomen, and abdominal bloating when their uterus expands. If an underlying health condition is causing the uterus to grow abnormally, other symptoms and problems could develop. Regular pelvic exams are the best way to identify any uterine issues so you can get the right treatment as early as possible.
This article discusses an enlarged uterus' symptoms and causes. It also explains how an enlarged uterus is diagnosed and treated.
Female uterus.
Symptoms of an Enlarged Uterus
You likely won't be able to feel if your uterus is swollen. Many women don't experience any symptoms of an enlarged uterus, and the issue is only uncovered by a routine gynecological exam.
When your uterus is enlarged, it can put pressure on your other organs including the bladder. This may cause symptoms such as:
- Pain in the lower abdomen or pelvis
- Pressure on the pelvis and bowels, causing constipation, bloating, and gas
- Frequent urination or incontinence (not being able to hold in urine) due to pressure on the bladder
Other, more serious symptoms may occur due to underlying medical issues that cause an enlarged uterus.
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Causes of an Enlarged Uterus
Your uterus is usually the size of an apple. Like a balloon, this organ expands as needed. When you're pregnant, your womb can stretch to the size of a watermelon. Besides pregnancy, certain medical conditions can cause your uterus to become enlarged. The most common causes are fibroids and adenomyosis, but other issues can also make the uterus expand.
Uterine Fibroids
Fibroids are noncancerous growths that may cause the uterus to become swollen. Fibroids can grow as a single mass or a cluster. They can be as tiny as an apple seed or as large as a grapefruit. In rare cases, they can become large.
It's estimated that fibroids affect up to 80% of women. Fibroids can occur at any age, but they're usually less of an issue for post-menopausal women since hormones that the body produces in relation to menstruation can trigger fibroid growth.
Symptoms of Fibroids
Fibroids are usually small, and most women don't know they have them. If symptoms are present, they can include the typical symptoms associated with an enlarged uterus as well as the following:
- Anemia from heavy menstrual periods
- Feeling of fullness in the pelvic area
- Heavy bleedingduring periods (defined as soaking through a pad or tampon every hour or two for several hours)
- Lower back pain
- Pain during sex
- Painful periods
Symptoms of Uterine Fibroids
Adenomyosis
Adenomyosis is a condition where the tissue lining the inside of the uterus grows into the wall of the organ. The condition can cause the uterus to double or triple in size.
Adenomyosis is most common in women between 40 and 50 years old and affects 20% to 65% of women. While doctors don't know what causes adenomyosis, you have a higher risk if you've had at least one pregnancy or miscarriage.
Symptoms of Adenomyosis
Many cases of adenomyosis are asymptomatic (have no symptoms), however, when symptoms do occur, they can include the following:
- Feelings of abdominal bloating, fullness, or heaviness
- Heavy menstrual bleeding
- Painful sex
- Severe menstrual cramps
If you have any of these symptoms, it is important to contact a healthcare provider as soon as possible.
Polycystic Ovarian Syndrome (PCOS)
PCOS is caused by a hormonal imbalance that may prevent the lining of the uterus from shedding during menstruation. This can cause the uterus to become larger if endometrial hyperplasia/cancer occurs due to unopposed estrogen, which is a type of hormonal imbalance.
Symptoms of PCOS
In addition to general pain and discomfort that comes from an expanded uterus putting pressure on the tissues and organs, PCOS can cause the following symptoms:
- Acne or oily skin
- Dark or thick patches of skin on the back of the neck, in the armpits, and under the breasts
- Excess body hair on the chest, stomach, and back
- Infertility
- Irregular periods
- Male pattern baldness in females
- Skin tags on the neck or armpits
- Very light periods
- Weight gain, especially around the abdomen
Endometrial Cancer
Endometrial cancer occurs in the lining of the uterus. The cause is not known, but it is very curable when detected early.
Worldwide, endometrial cancer is the sixth most common cancer among women. In fact, nearly 60,000 U.S. women are diagnosed with it every year. Endometrial cancer is more common in women after menopause.
Symptoms of Endometrial Cancer
The first sign is bleeding that's not associated with a period, like spotting between cycles or bleeding after menopause. Other symptoms include:
- Pain during sex
- Pain while urinating
- Pelvic pain
Complications
Except for cancer, an enlarged uterus typically doesn't cause serious complications. Still, the condition that caused your uterus to become swollen can cause other health issues and affect your quality of life.
These conditions can cause:
- Infertility and pregnancy problems: Fibroids, adenomyosis, and PCOS increase the risk of infertility and pregnancy complications. Studies have found that fibroids may increase the risk infertility. For those who can achieve pregnancy, some may experience early labor or need acesarean delivery.
- Pain and other symptoms:An enlarged uterus puts pressure on the bladder and intestines, leading to pain, constipation, and cramping. It can also cause pain during sex.
- Abnormal bleeding: Heavy, painful, prolonged periods can cause you to miss work and skip social events. You may worry about bleeding through your clothing. Heavy bleeding can also cause anemia and reduce your energy.
- Uterine prolapse: Large fibroids can cause your uterus to prolapse. This means it bulges into or even sticks out of the vagin*.It's not life-threatening, but you may need surgery to repair your uterus.
When to See Your Healthcare Provider
See your gynecologist or women's health provider if you experience:
- Heavy bleeding
- Pressure on your bladder or bowels
- Pain in your pelvic area
- Pain during sex
If you've gone through menopause, see a doctor if you have vagin*l bleeding.
Diagnosing an Enlarged Uterus
An enlarged uterus can be detected during a pelvic exam. If your uterus is enlarged, your gynecologist may order additional testing to determine the cause. This can include:
- Blood tests to check your hormone levels
- Hysteroscopy, which uses a thin, lighted scope inserted through the cervix to see the inside of the uterus
- Imaging tests, including an ultrasound, MRI, or CT scan
- Uterine biopsy to rule out cancer
Treatment
Treatment for an enlarged uterus depends on the cause. In some cases, treatment focuses on managing symptoms. Here is a closer look at different treatment options for the causes and symptoms of an enlarged uterus.
Fibroids
Depending on the size of the fibroids, you may only need monitoring and pain medication. Your doctor may prescribe birth control or another hormonal therapy called gonadotropin-releasing hormone (GnRH). GnRH is used for six months or less to stop the bleeding and shrink fibroids.
Large uterine fibroids may require a surgical procedure known as a myomectomy. This removes the fibroids while keeping the uterus intact.
Adenomyosis
For adenomyosis, birth control or hormonal therapies may be prescribed to reduce heavy bleeding. In severe cases, your doctor might recommend a hysterectomy or removal of your uterus.
Endometrial Cancer
Treatment for endometrial cancer will depend on how advanced the cancer is. Surgeons usually remove the uterus, fallopian tubes, and ovaries.
If the cancer has spread, surgeons may remove lymph nodes too. Your doctor may also prescribe chemotherapy and radiation. The five-year relative survival rate for uterine cancers is 81%.
Heavy Periods
Heavy menstrual bleeding is commonly treated with hormone therapy unless you are trying to get pregnant. Treatments include birth control pills, shots, and other therapies that contain progesterone.
Heavy periods that do not resolve with hormone therapy may be treated with an endometrial ablation, which destroys the lining of the uterus. However, this commonly causes infertility and is only used in women who do not intend to become pregnant.
Anemia
Anemia from heavy menstrual periods—a common symptom of issues related to an enlarged uterus—is treated with iron supplements. In severe cases, blood transfusions may be needed to relieve anemia.
Bicornuate Uterus Effects on Pregnancy
Summary
An enlarged uterus itself causes few symptoms but may result in general discomfort and constipation or the need to pee frequently. However, the underlying problems that make your uterus stretch can lead to other symptoms.
Fibroids and adenomyosisare the most common causes. Signs of these conditions are heavy bleeding, which can lead to anemia, cramping, and painful intercourse. Other conditions that cause your uterus to enlarge are PCOS and cancer. These are more serious issues that require treatment to protect fertility and overall health.
Having regular pelvic exams is the best way to identify any uterine issues early so you can get the treatment you need.
