From conception to delivery, a woman’s uterus can grow from the size of a pear to the size of a watermelon. But pregnancy isn’t the only potential reason for an enlarged uterus. An enlarged uterus is common and can be a symptom of a variety of medical conditions, some of which require treatment.
Two of the most common causes of an enlarged uterus are uterine fibroids and adenomyosis.
Uterine fibroids. Uterine fibroids are common noncancerous tumors of the muscular wall of the uterus, affecting as many as eight in 10 women by the age of 50. Fibroids more commonly affect women over age 30. They are also more common in African-Americans than Caucasians. Overweight and obese women also have a greater risk of developing fibroids. Hormonal and genetic factors contribute to their growth.
While some fibroids are very small, others grow to weigh several pounds. A woman may have a single fibroid or multiple fibroids. In addition to an enlarged uterus, symptoms of uterine fibroids may include:
- Feeling of fullness or pressure in the lower abdomen
- Heavy, painful, and/or long-lasting periods, sometimes with the passage of blood clots
- Bleeding between periods
- Frequent urination
- Pain during intercourse
- Pregnancy or delivery complications
If symptoms are severe, treatment may involve a procedure called uterine artery embolization to cut off the blood supply to the fibroids so that they shrink and eventually die, or surgery to remove the fibroids (myomectomy) or the entire uterus (hysterectomy). Other treatments include endometrial ablation. This procedure is performed for small submucusal fibroids (when the inside lining of the uterus is removed, burned or frozen) and laparoscopic myolysis (when freezing or an electric current is used to destroy the fibroids). Medications to help control painful periods or for pain may also be used. Other treatment options include focused ultrasound surgery and an intrauterine device (IUD) to decrease bleeding.
The cause of fibroids is not known, but the tumors seem to rely on estrogen to grow. After menopause, they often shrink naturally and cause no symptoms.
Adenomyosis. Adenomyosis is a diffuse thickening of the uterus that occurs when the tissue that normally lines the uterus (endometrium) moves into its muscular outer wall and behaves like the endometrium. When this happens in a small area, or is localized, it is called an adenomyoma.
- What Causes an Enlarged Uterus and How Is It Treated?
- Is an Enlarged Uterus Dangerous?
- Bulky Uterus
- Uterine Fibroids: Q&A With an Expert
- What are uterine fibroids?
- What causes fibroids?
- What are the symptoms of fibroids?
- Can other issues cause these symptoms?
- How are fibroids diagnosed?
- How are fibroids treated?
- How might fibroids might affect fertility and pregnancy?
- How is adenomyosis treated?
- When to seek help
Ultrasound findings that your doctor may use to help make a likely diagnosis of adenomyosis include:
- Thickening of the area between the lining and the muscle layers in the uterus;
- A differential thickness of the walls of the uterus;
- An area of irregularity in the uterus that is not a fibroid;
- Changes in blood flow patterns in the wall of the uterus;
- A ‘lightglobe’ shaped uterus;
- Enlargement of the uterus with dimensions that are outlined above.
There are of course limitations to ultrasound and the diagnosis of any imaging study (ultrasound scan or MRI) is only a suggestion that adenomyosis is present, since the only way to absolutely diagnose the condition is by taking a biopsy and looking at it under a microscope. This of course means an invasive test and some researchers have suggested that this process may not show adenomyosis at the time of the biopsy, but the very process of biopsy itself may cause the condition.
What are the causes?
Genetic factors certainly play a role in the causation of adenomyosis, and many factors that we do not understand. Other causes that may contribute are procedures that disrupt the layer between the muscle and the lining including a curettage and a caesarean delivery. There does appear to be an overlap with endometriosis and many researchers believe that they are two manifestations along the same disease profile.
How is it treated?
Once the diagnosis is suggested (but not always confirmed as we have discussed above), the options for treatment are as follows:
- Where there are no symptoms, then no treatment is needed at all, and monitoring of symptoms is all that is required. Repeated interval ultrasounds are not necessary.
- Oral treatments including progestogens and the combined oral contraceptive pill play an important role in the management of the heavy or irregular bleeding and the pain that may be associated with adenomyosis and other causes of abnormal uterine bleeding (AUB).
- When progestogens are used, they work to decrease the activity of the glandular tissue within the wall of the uterus and decrease pain symptoms (and abnormal bleeding symptoms) however 50% of patients experience recurrence by 6 months.
- Levonorgestrel-releasing intrauterine devices (Mirena) are inexpensive, well tolerated and achieve symptom control for more than three years. These are an excellent way of controlling symptoms – particularly in the woman who has not had any children or not completed her family and wishes to maintain this option. Studies show that this is probably the best long-term medical treatment.
- Hysterectomy is considered gold standard in the treatment of adenomyosis in women who do not desire any more children, but is a major surgical intervention. It also means that the diagnosis can be confirmed – but once the uterus is out, there is no turning back! It is also a permanent solution to the bleeding and reduction in pain is substantial-complete in many women.
- Other surgical treatment options include focal removal of the adenomyosis – this is called an adenomyomectomy and may provide about 85% reduction in period pain post-operatively with post-operative pregnancy rates of up to 60%. A substantial risk of this type of surgery prior to a pregnancy is, unlike removal of a fibroid, part of the uterine tissue is removed and there is a greater risk of scar rupture during pregnancy or delivery.
- Endometrial ablation (removal of the uterine lining) may also be an option for treatment, although where the disease invades more deeply into the muscle, the rate of failure from this treatment may be 25% or more.
- Newer techniques use ultrasound guidance and focal heat therapy to destroy the adenomyotic areas, although these techniques are largely confined to clinical studies since their efficacy has not yet been clinically demonstrated.
Adenomyosis is a common condition in women and may be troublesome to treat. One of the primary issues with this disease is that we have to rely on indirect evidence for diagnosis at times, since only uterine removal will confirm the diagnosis (and also treat the issue) but this is of no value to the women who wants to maintain her uterus and/or her fertility. Management options are limited, but may be successful in the long term. If you have any more concerns, you can ask one of the Alana doctors for more information or advice.
At Alana Healthcare for Women we are dedicated to caring for the health of women at any age. Please read more about our Gynaecology services here.
What Causes an Enlarged Uterus and How Is It Treated?
An enlarged uterus is usually found incidentally. For example, your doctor may identify an enlarged uterus during a routine pelvic exam as part of a well-woman checkup. It may also be identified if your doctor is treating you for other symptoms, like abnormal menstruation.
If your uterus in enlarged because of pregnancy, it will naturally begin to shrink after you deliver. By one week postpartum, your uterus will be reduced to half its size. By four weeks, it’s pretty much back to its original dimensions.
Other conditions causing an enlarged uterus could need medical intervention.
Fibroids that are large enough to stretch the uterus will probably need some kind of medical treatment.
Your doctor may prescribe birth control drugs, such as birth control pills that contain estrogen and progesterone or a progesterone-only device like an IUD. Birth control medication may halt the growth of the fibroids and limit menstrual bleeding.
Another treatment, known as uterine artery embolization,uses a thin tube inserted into the uterus to inject small particles into the arteries of the uterus. That cuts off the blood supply to the fibroids. Once the fibroids are deprived of blood, they will shrink and die.
In some cases, you may need surgery. Surgery to remove the fibroids is called a myomectomy. Depending on the size and location of the fibroids, this may be done with a laparoscope or through traditional surgery. A laparoscope is a thin surgical instrument with a camera on one end that’s inserted through a small incision or through traditional surgery.
Complete surgical removal of the uterus, called a hysterectomy, may also be advised. Fibroids are the No. 1 reason hysterectomies are performed. They’re generally done on women whose fibroids cause a lot of symptoms, or on women with fibroids who don’t want children or are near or past menopause.
A hysterectomy can be done laparoscopically, even on a very large uterus.
Anti-inflammatory medications, like ibuprofen (Advil, Motrin) and hormonal contraception such as the birth control pill can help relieve the pain and heavy bleeding associated with adenomyosis. These medications won’t help to decrease the size of an enlarged uterus, however. In severe cases, your doctor may recommend a hysterectomy.
Like other cancers, cancers of the uterus and endometrium are typically treated with surgery, radiation, chemotherapy, or a combination of these treatments.
Is an Enlarged Uterus Dangerous?
Q1. I recently had a CT scan and was told that my uterus was enlarged. What size is normal? Is there cause for concern?
— Lisa, Florida
A normal uterus is about the size of a clenched fist or a small apple. A uterus can become enlarged for many reasons, the most common being fibroids. These are benign, muscular tumors that grow in the wall of the uterus and can cause pain and bleeding.
An enlarged uterus is usually not a cause for concern, provided that its cause has been determined by sonogram or CT scan. If your doctor concludes that the enlargement is related to fibroids, they can be monitored over time and you need not worry. If, however, no obvious cause for the enlargement is seen on the CT scan, then further testing should be done to rule out uterine cancer.
Q2. What is an inverted uterus and what causes it? Where can I get information about this problem and what is the prognosis in the long run?
An inverted uterus is a naturally-occurring variation on how the uterus is positioned in the abdominal cavity. Instead of the uterus lying on top of the bladder, it lies to either side of it. The cervix (or the opening of the uterus) is still in the same place — at the top part, or end, of the vaginal canal — but the body (or fundus) of the uterus lies in an unusual direction.
Usually the prognosis for this condition is excellent, as it does not cause any specific diseases or problems. Occasionally, it can make childbirth more difficult, though. Your doctor will be your best source of information, since she or he can tell you about the size and configuration of your own uterus and whether it will affect your health in any way. Next time you go in for your pap smear (I hope you are getting your Paps regularly), don’t be shy about asking your OB/GYN these questions.
Q3. I have recurring uterine polyps and in the last five years I’ve had three procedures to remove them. I have been using a holistic approach that includes a natural progesterone cream and other supplements to keep them at bay, but as soon as I lower the dosage, the polyps return. It seems that hormone therapy/birth control pills or a partial hysterectomy are my only options. I don’t like the idea of either one, but the heavy bleeding, painful cramps, and other symptoms are getting to be too much. Are there any options other than an annual polyp removal or the treatments mentioned above?
Recurrent uterine polyps are particularly common for women in their forties, as hormone levels begin to diminish before menopause. While uterine polyps are rarely if ever malignant, they do cause bleeding and cramping and therefore need to be removed.
Other than yearly polyp removal or hormone therapy to completely eliminate periods that lead to polyp growth, another alternative to consider may be uterine ablation. This is a surgical procedure that removes the entire lining of the uterus using a laser technique. It is more extensive that a typical D&C , and therefore may prevent the return of uterine polyps for a longer period of time. Since uterine ablation is a newer procedure, be sure you consult a physician who is experienced in this technique before you decide to pursue it as a possible treatment option.
Q4. After years of trying to have a baby, my doctor told me that I have no lining in my uterus. It’s the reason I can’t conceive. Is there a way to fix this problem? I have also had two surgeries to remove cysts from my tubes and ovaries. Can these things be related?
— Adrianna, North Carolina
Loss of the uterine lining is usually related to low hormone levels — the lining thickens with the elevation of the hormones estrogen and progesterone during the menstrual cycle. The surgeries you underwent to have cysts removed from your tubes and ovaries should not have affected these hormone levels, as long as you are still ovulating regularly. That said, it’s important to get checked to be sure that your hormone levels are rising appropriately during your cycle. If this is occurring properly, it should help the uterine lining thicken in preparation for a pregnancy to be established.
If the physician who made the diagnosis about your lining hasn’t suggested a treatment plan, consider seeing a fertility expert in your area. He or she should be knowledgeable about hormonal treatments for the problem. If hormonal therapy does not work and you still want your own biological child, there are other options you can explore, such as surrogate motherhood.
Q5. My gynecologist told me that I have a tilted uterus. Is this normal?
— Carla, Mississippi
A tilted uterus is a standard, and quite normal, variant that shouldn’t be the cause of any concern. A tilted uterus causes no symptoms, and it is not the result of aging per se.
When we refer to a uterus as being tilted, we are talking about the position the uterus occupies in the pelvic cavity. It can lie mostly toward the front of your body (“anterior,” the more common position), or toward the back of your body (“posterior,” the tilted position).
While repeated pregnancies can change the position of a uterus, they usually result in uterine prolapse (in which the uterus drops down into the vaginal canal) rather than a tilted uterus. The tilting of the uterus does not cause pain on intercourse or during menstruation. It does not require surgery and should not affect your ability to become pregnant or have a vaginal delivery.
Learn more in the Everyday Health Women’s Health Center.
Wednesday, July 24th, 2019
What does having an enlarged uterus mean?
Most women associate an enlarged uterus with pregnancy, but that’s not the only reason your uterus can become enlarged. Large, or multiple fibroids, can cause an expansion of the uterus. Some women may notice weight gain, a bloated belly, or a feeling of fullness in the lower abdomen; while others may not notice it at all.
Many of our patients reveal they first noticed a change when their pants did not fit, or their belly felt full or looked expanded. A pelvic exam or an imaging test such as an ultrasound or MRI can be used to diagnose an enlarged uterus.
Symptoms of uterine fibroids
Every woman’s experience with fibroids is very different. For some women with fibroids, they may not experience any symptoms; however, others may struggle with chronic pain. Having an expanded uterus is just one of the possible symptoms you may experience if you have fibroids, others include:
- Heavy periods lasting more than 10 days per month
- Severe pelvic pain or cramping
- Anemia caused by heavy bleeding
- Bleeding between menstrual cycles
- Pain during intercourse
- Frequent urination or difficulty emptying the bladder
- Lower back or leg pain
Want to learn more about uterine fibroids? Take our quiz to find out if fibroids could be the cause your painful symptoms.
Take Our 1-Minute Quiz
The emotional and physical toll of fibroids
Struggling with fibroids is usually associated with physical pain or discomfort, but we often forget about the emotional toll it can take. Having an enlarged uterus can affect a woman’s self-confidence, body image, and even love life. We all know that having an expanded abdomen shouldn’t prevent you from enjoying life, but for some women it still does. Some of our patients have shared they couldn’t wear what they wanted when going out with friends, were embarrassed of wearing a bathing suit to the pool, or didn’t feel confident with their partner during intimacy.
Not only does body image and insecurities cause distress, but the constant worry and fear around bleeding through your clothes in public or not having enough feminine hygiene products while away from the house can be exhausting. Many women state that living with fibroids caused them to feel as if they had no control over their bodies and that they were preventing them from enjoying the things they used to love. This is primarily due to the difficulty of managing and predicting heavy periods.
Why fibroids sometimes cause an enlarged uterus
Fibroids can cause an enlarged uterus if they grow to a large size or become numerous. The exact cause of fibroid growth is still unknown; however, researchers know they grow and shrink when there is an increase or decrease of hormones – estrogen and progesterone.
While some fibroids are as tiny as seeds, they can also grow as large as a melon. Their location isn’t limited to inside the uterine cavity; they can grow on the outside of the uterus, within the lining of the uterus, and can even attach themselves to the wall of the uterus by a stalk. If the fibroid(s) grow larger within the uterine cavity, they may expand the uterus just like a pregnancy does. If the fibroid(s) grow larger outside into the uterine wall, they may press on surrounding organs.
How fibroids affect surrounding organs
Fibroid symptoms and pain is often associated with pelvic pain or heavy bleeding, but there are other organs that can be affected as well.
- Bladder – Many women who have large fibroids may feel the need to frequently run to the bathroom. They may also have difficulty emptying their bladder if the expanded uterus puts too much pressure on the tube leading to the urethra.
- Rectum – A large fibroid can push down on the rectum, making bowel movements difficult. This is why it is also possible that some women experience constipation or pain while defecating.
- Stomach – Some women may experience the feeling of fullness and may not be able to eat as much as they used to. This can even lead to significant weight loss.
Treatment for an enlarged uterus
If you think your expanded uterus is caused by fibroids, it’s a good idea to schedule a consultation to get checked. An interventional radiologist will use either an ultrasound or MRI to diagnose your fibroids and then will work with you to create a comprehensive treatment plan. It’s important to consider your treatment options and understand that invasive surgery is not the only solution.
Non-surgical treatments like Uterine Fibroid Embolization offer many benefits such as no hospitalization, a shorter recovery, the ability to preserve your uterus, and retain fertility.
If you’re ready to take the next steps, or just want to get more information about treatment, give us a call at 855-615-2555 or click below to schedule online today.
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Share: Categories: Fibroid Awareness, Fibroid Facts, Signs and Symptoms
Related questions on bulky uterus:
Q1) I HAVE LARGE UTERINE FIBROIDS. IS IT POSSIBLE TO HAVE A NON-OPERATIVE PROCEDURE? KINDLY LET ME KNOW.
A) You have to do certain tests like ultrasound and MRI to be sure, and then only a decision can be taken by the gynaecologist whether to go for medicine or an operation.
Q2) IS ADENOMYOSIS A TUMOUR?
A) Adenomyoma is usually benign but can often be found in a progressing condition. It is said that adenomyosis does not have a risk of developing into cancer; it is a kind of endometriosis that occurs inside the uterine muscle wall.
Q3) AS PER MY SCAN REPORTS, MY UTERUS IS BULKY. WHAT TREATMENT PLAN SHOULD I FOLLOW?
A) Scans that suggests a bulky uterus must be confirmed with clinical findings and patient’s history and the cause of the condition should be known. Then only a decision can be taken.
Q4) CAN A BULKY UTERUS CAUSE PREGNANCY COMPLICATION?
A) A bulky or enlarged uterus doesn’t usually produce any health complications, but the conditions that have resulted in bulky uterus can. For example, if bulky uterus is due to uterine tumours, then they can cause pregnancy complications and even complications during childbirth.
Uterine Fibroids: Q&A With an Expert
So you’ve just come back from your annual gynecological exam and your doctor told you that you might have uterine fibroids. What are fibroids? Are they dangerous? Can they be removed? Should they be removed?
First, take a deep breath. Fibroids are pretty common — between 20-70 percent of women will develop fibroids during their reproductive years. And they’re almost always (99 percent of the time) harmless.
But that doesn’t mean you should ignore them. Fibroids can cause complications like excessive bleeding and reproductive problems. Johns Hopkins gynecologist Mindy Christianson, M.D. , who specializes in treating uterine fibroids, explains how women can manage these common growths.
What are uterine fibroids?
Uterine fibroids are benign, or noncancerous, fibrous growths that form in the uterus. They’re very common. They can grow on the outside of the uterus (called subserosal fibroids), inside the muscle of the uterus (called intramural fibroids), or into the uterine cavity (called submucosal fibroids).
What causes fibroids?
There’s definitely a genetic component, but we haven’t found any lifestyle factors that cause uterine fibroids.
What are the symptoms of fibroids?
Some women have no symptoms at all from fibroids and don’t even know they have them. Other women have severe symptoms. Symptoms can include very heavy menstrual cycles. Some women have so much bleeding that they become anemic —that’s a hallmark symptom. Fibroids that cause severe bleeding are usually closer to the uterine cavity.
Some women can have very large fibroids that cause the uterus to be up to 10 times its normal size. This causes what we call “bulk symptoms.” For example, a woman may feel that her uterus is very enlarged, like she’s pregnant. She may have related symptoms due to its bulk size, like constipation or increased urination.
Can other issues cause these symptoms?
If a woman sees her doctor because she is having increased bleeding or a heavy menstrual cycle, the doctor will likely check for uterine fibroids, but these symptoms can also be due to things such as uterine polyps, dysfunctional uterine bleeding or bleeding caused by hormonal imbalances.
How are fibroids diagnosed?
Fibroids are typically diagnosed by ultrasound. That’s really the easiest way to see the uterus, and fibroids are usually very easily seen. The first step might be an exam by your doctor, where he or she would feel an enlarged uterus and suspect fibroids. For smaller fibroids, the only way to diagnose them is often with ultrasound. Some doctors may choose to also do an MRI of the pelvis as a way to see exactly where the fibroids are.
How are fibroids treated?
It depends on symptoms and size. For example, if a woman has fibroids inside the uterine cavity, we may do a hysteroscopic myomectomy, in which we look inside the uterus with a camera. At the same time, we can do a surgical procedure to remove the fibroids if they’re just inside the uterine cavity.
If a woman has severe symptoms, and if the fibroids are in the muscle or outside of the uterus, surgery may be the best option. In that case, robotic-assisted laparoscopic myomectomy is more common. This is a minimally invasive procedure that involves making four to five small incisions in the abdomen. We then use small instruments attached to robotic arms to remove the fibroids through these very small openings.
In severe cases, a woman would have an open myomectomy, which is also called abdominal myomectomy. This surgery requires an incision either in the bikini area or a vertical incision along the abdomen. We then remove the fibroids through this incision.
Some nonsurgical management of uterine fibroids may include medicine that can help suppress their growth, such as birth control pills. There’s also a medication called leuprolide acetate, which can help shrink them.
How might fibroids might affect fertility and pregnancy?
Their impact on fertility depends on the location and the size of the fibroids, as well as the type of symptoms a woman has. Fibroids inside the uterine cavity can stop an embryo from implanting, which prevents it from growing into a fetus. Larger fibroids—about four centimeters or more—that are in the muscle of the uterus can also impact implantation. Fibroids that are inside the muscle of the uterus might block the fallopian tubes, which can cause infertility.
Sometimes fibroids can affect the mode of delivery of a baby. For instance, if a woman has a fibroid in the lower part of her uterus, it might make it difficult for the cervix to open completely, which might make a C-section difficult.
It’s really important for each woman and her obstetrician to have a game plan for delivery.
MRI (magnetic resonance imaging) can be useful in diagnosing adenomyosis because it collects pictures of soft tissue such as organs and muscles that don’t show up on x-ray examinations.
Adenomyosis is often only diagnosed by pathology tests conducted after the uterus has been removed (hysterectomy).
How is adenomyosis treated?
Adenomyosis is difficult to treat and it will disappear after menopause so management will depend on your life stage. The following are some treatment options:
|Treatment||How it works|
|Hysterectomy||Hysterectomy is the complete removal of the uterus (and therefore the adenomyosis)|
|Progestogen releasing intrauterine device (IUD) such as Mirena||
The insertion of an IUD can cause:
|GnRH agonists (an artificial hormone used to prevent natural ovulation)||
GnRH agonists cause:
In the presence of infertility and endometriosis these may be used temporarily.
For an adenomyoma (mass of adenomyosis in one area)
An adenoyoma may be surgically removed using keyhole surgery.
Guided by an MRI, high intensity focused ultrasound waves cause a localised increase in temperature to the adenomyoma causing the cells to die.
When to seek help
Seek help when your symptoms are:
- impacting on your health
- impacting on your ability to live your life normally
- interfering in your sexual function and relationship
Last updated 04 November 2019 — Last reviewed 24 February 2014
** Currently under review **
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at February 2014.