Signs and Symptoms 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.

Certain conditions can also cause your uterus to become enlarged. 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.

Symptoms

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

When women have symptoms, 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

Causes

Women of all ages can 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.

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. 

Polycystic Ovary Syndrome (PCOS)

Women with PCOS have a hormonal imbalance that can affect their periods and fertility. Healthy women shed the lining of the uterus once a month. Women with PCOS can have irregular or no periods at all. This causes the lining to thicken and the uterus to enlarge. Women with PCOS have a higher risk of endometrial cancer.

PCOS can cause other symptoms and related conditions including acne, excess body and facial hair, obesity, insulin resistance, diabetes, high cholesterol, and heart disease. Nearly 10% of women worldwide have PCOS.

Ovarian Cysts

Ovarian cysts are fluid-filled sacs found inside or on the surface of the ovaries. They are common in women who have regular periods and usually form during ovulation. That's the time of the month when one of your ovaries releases an egg.

Most cysts are small and don't cause any problems. They usually disappear by themselves, but if they don't and grow too large, they can cause an enlarged uterus. The most common cause is hormonal problems.

Ovarian cysts can cause pain in the lower abdomen and back, heavy bleeding, and difficulty urinating.

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.

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.

Ovarian cysts: Like fibroids, ovarian cysts usually don't need treatment. Your doctor may prescribe birth control pills. Ovarian cysts rarely cause cancer. In severe cases, your doctor may recommend surgery. Surgery is usually recommended if ovarian cysts develop after menopause.

PCOS: Birth control pills are the most common treatment for PCOS (if you're not trying to get pregnant). Birth control pills can help regulate your periods, treat acne, and lessen unwanted hair growth. They can also reduce your risk of endometrial cancer.

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.