An enlarged uterus is a condition where the uterus becomes larger than its typical size. While it can cause concern, understanding its causes and symptoms is key to addressing it.
Understanding Uterine Enlargement
The uterus, a muscular organ located in the female pelvis, normally has the shape and dimensions of an inverted pear. In a non-pregnant state, it typically measures approximately 8 cm long, 5 cm wide, and 4 cm thick, roughly the size of a clenched fist.
Uterine enlargement is not a disease itself but rather an indication of an underlying health condition. While the uterus is designed to expand significantly during pregnancy to accommodate a growing baby, an enlargement outside of pregnancy warrants medical attention to identify its cause.
Common Underlying Causes
Several medical conditions can lead to an enlarged uterus. One of the most frequent causes is uterine fibroids, also known as leiomyomas. These noncancerous growths develop from the uterus’s muscle tissue, varying in size and significantly increasing its overall size. Fibroids can grow on the outer surface, within the uterine wall, or inside the uterine cavity.
Another common cause is adenomyosis, a condition where the tissue that normally lines the uterus (endometrial tissue) grows into its muscular wall. This displaced tissue thickens, breaks down, and bleeds during each menstrual cycle, causing the uterine wall to thicken and the uterus to enlarge.
During perimenopause, fluctuating hormone levels, particularly higher estrogen, can cause the uterus to temporarily grow. This hormonal influence can lead to a general increase in uterine size, though it often returns to normal after menopause. Less commonly, an enlarged uterus can be a sign of endometrial hyperplasia, an abnormal thickening of the uterine lining, or in rare instances, uterine cancer.
Recognizing the Indicators
An enlarged uterus may not always present with noticeable symptoms, sometimes only discovered during a routine pelvic examination. When symptoms do occur, they often relate to the increased size and pressure the uterus exerts on surrounding organs.
Common indicators include heavy or prolonged menstrual bleeding, which can involve passing large blood clots. Individuals may also experience pelvic pain or pressure, described as a feeling of fullness or heaviness in the lower abdomen. This pressure can extend to nearby structures, leading to frequent urination as the enlarged uterus presses on the bladder, reducing its capacity. Constipation can also occur if the uterus puts pressure on the intestines and colon, making bowel movements difficult.
Other potential indicators include abdominal bloating or a visibly swollen abdomen, sometimes mistaken for weight gain or pregnancy. Pain during sexual intercourse can also be a symptom, particularly if the enlargement is significant.
Diagnostic Approaches
Diagnosing an enlarged uterus typically begins with a pelvic examination, where a healthcare provider may feel the uterus is larger, softer, or more tender than usual. If enlargement is suspected, further diagnostic tests are ordered to confirm the finding and determine the underlying cause.
An ultrasound is a common imaging test that uses sound waves to create images of the uterus, helping to identify fibroids or thickening of the uterine wall. A transvaginal ultrasound, where a small probe is inserted into the vagina, often provides more detailed images. Magnetic Resonance Imaging (MRI) may be used for more comprehensive imaging, especially to distinguish between different types of growths or to assess the severity of conditions like adenomyosis.
In some cases, a biopsy might be necessary, particularly if there is concern about endometrial hyperplasia or uterine cancer. This procedure involves taking a small tissue sample from the uterine lining for microscopic examination.
Management and Treatment
The management and treatment of an enlarged uterus depend heavily on the specific underlying cause, the severity of symptoms, and individual circumstances, including future fertility goals. For some individuals with mild symptoms, a “watchful waiting” approach may be adopted, where the condition is monitored without immediate intervention.
Medications can be used to manage symptoms or, in some cases, to reduce the size of the enlargement. Hormonal therapies, such as birth control pills or other hormonal treatments, can help regulate menstrual bleeding and pain associated with conditions like fibroids and adenomyosis.
Non-surgical procedures also offer options, such as uterine artery embolization (UAE), which blocks blood flow to fibroids or adenomyosis tissue, causing them to shrink. Endometrial ablation, another minimally invasive procedure, destroys the uterine lining to reduce heavy bleeding.
When symptoms are severe or other treatments are ineffective, surgical options may be considered. A myomectomy involves removing fibroids while preserving the uterus, which can be an option for those who wish to maintain fertility. In cases of significant enlargement, severe symptoms, or certain conditions like uterine cancer, a hysterectomy, the surgical removal of the uterus, may be recommended. This is a permanent solution that also eliminates the possibility of future pregnancies.