Signs and Symptoms of an Enlarged Uterus

The most common symptom is heavy bleeding during periods

An enlarged uterus can be caused by a number of different conditions. Most are not harmful. In some cases, though, an enlarged uterus can signal a serious illness, like cancer.

Read on to learn more about the symptoms and causes of an enlarged uterus and how doctors treat this condition.

Female uterus.

Symptoms of an Enlarged Uterus

Many women don't experience any symptoms of an enlarged uterus. Often, their doctor detects it during a routine pelvic exam.

When symptoms do appear, the most common is heavy bleeding during periods. This is defined as soaking through a pad or tampon every hour or two for several hours. Women can have pain, long periods, or spotting between periods. They may also pass large blood clots.

Also, your uterus lies in your pelvis, between your bladder and rectum. When it becomes swollen, it can affect how these organs function.

Researchers have identified various symptoms women with an enlarged uterus can have. They include:

  • Pain in the lower abdomen, legs, back, or pelvis, and pain during sex
  • Pressure on the pelvis and bowels, causing constipation, bloating, and gas
  • Tiredness or weakness due to heavy bleeding leading to anemia (not having enough red blood cells carrying oxygen to the body)
  • Frequent urination or incontinence (not being able to hold in urine) due to pressure on the bladder
  • Weight gain around the belly
  • Pregnancy problems, which can include difficulty getting pregnant and carrying the baby to full term

What Causes 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, there are a few conditions that can cause your uterus to become enlarged.

It's possible for a woman of any age to have an enlarged uterus. The following are the most common causes.

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 tiny or up to 8 inches or more in size. Some can even be as large as a watermelon.

Fibroids can occur at any age. It's estimated that fibroids affect up to 80% of women. They're usually small, and most women don't know they have them. If symptoms are present, women may experience bleeding, back and pelvic pain, and pressure on the rectum and other organs.

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. Doctors don't know what causes it. You have a higher risk if you've had at least one pregnancy or miscarriage.

Adenomyosis is most common when women are between 40 and 50 years old. It can cause painful periods, heavy bleeding, and abdominal pain. The condition may affect 20% to 65% of women.

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.

Perimenopause

Perimenopause is the stage just before menopause. During this time, it's common to have hormonal fluctuations. This can cause the uterus to become temporarily enlarged. After menopause, however, the uterus will typically return to its normal size. 

Endometrial Cancer

Endometrial cancer occurs in the lining of the uterus. Doctors don't know what causes it. It is very curable when detected early.

The first sign is bleeding not associated with a period, like spotting between cycles or bleeding after menopause. Other symptoms include pain while urinating, pelvic pain, and pain during sex. 

Worldwide, endometrial cancer is the sixth most common cancer among women. Nearly 50,000 U.S. women are diagnosed with it every year. Endometrial cancer is more common in women after menopause. 

Complications

Except for cancer, an enlarged uterus itself 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. One study found that up to 10% of women with fibroids are infertile. Among those who did get pregnant, up to 40% experienced early labor or needed a cesarean 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.
  • Prolapsed uterus: Large fibroids can cause your uterus to prolapse.This means it bulges into or even sticks out of the vagina. It's not life-threatening, but you may need surgery to repair your uterus.

When to See Your Doctor

See your doctor if you experience heavy bleeding, pressure on your bladder or bowels, pain in your pelvic area, or pain during sex.

If you've gone through menopause, see a doctor if you have vaginal bleeding.

Treatment

Treatment depends on the condition that caused your enlarged uterus. If you have:

Heavy bleeding: Your doctor may prescribe hormonal treatments (unless you're trying to get pregnant). Birth control pills, shots, and other methods containing progesterone can reduce bleeding. This also helps treat anemia.

Fibroids: Depending on the size, 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.If your fibroids grow too large, you may need surgery to remove them.

Adenomyosis: Your doctor may prescribe birth control or hormonal therapies to reduce heavy bleeding. In severe cases, your doctor might recommend a hysterectomy or removal of your uterus.

Endometrial cancer: Treatment depends on how advanced your cancer is. Surgeons usually remove the uterus, fallopian tubes, and ovaries. If your cancer has spread, surgeons may remove lymph nodes too. Your doctor may also prescribe chemotherapy and radiation. The five-year survival rate for uterine cancers is 81%.

Summary

Women of all ages can have an enlarged uterus. The condition usually doesn't require treatment. However, the underlying problems that caused your uterus to become swollen can lead to other health issues.

Heavy, painful periods can make you miss work. Fear of bleeding through your clothes can make you skip outings with friends and family. Pain during sex can ruin your mood and make you lose interest.

If you want to have a baby, some of these conditions can hurt your fertility or cause pregnancy complications.

That's why it's a good idea to see your doctor and get relief so you can lead a happier and fuller life.

Frequently Asked Questions

  • What causes an enlarged uterus?

    Besides pregnancy, an enlarged uterus can be caused by several medical conditions. The most common reasons include uterine fibroids, adenomyosis, and endometrial cancer.

  • Where is the womb located?

    The womb (uterus) is located in the female pelvis, in front of the rectum and behind the bladder.

  • What are the symptoms of adenomyosis?

    Symptoms of adenomyosis can include heavy or persistent menstrual bleeding, painful periods that become worse over time, and pelvic pain during intercourse.

    Many cases of adenomyosis are asymptomatic (have no symptoms), but if these symptoms are present, it is important to contact a healthcare provider as soon as possible.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Lana Barhum
Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease.