Signs and Symptoms of an Enlarged Uterus

Normally, the uterus is the size of a clenched fist. The uterus grows in pregnancy and can get to be the size of a large watermelon. But pregnancy is not the only reason the size of a woman’s uterus can increase, and an enlarged uterus can affect women of all ages. Many reasons for an enlarged uterus are usually benign (harmless) and will require monitoring but no treatment. However, an enlarged uterus may also be a sign of a potentially serious condition, such as endometrial cancer, a type of uterine cancer.

Symptoms of an enlarged uterus are based on the condition causing the symptoms. The most common symptom is bleeding. This includes heavy, painful, and long periods, including the passage of blood clots. However, some women may not experience any symptoms and the enlarged uterus will only be detected during a gynecological exam.

Researchers have identified different symptoms that are sometimes experienced by women with an enlarged uterus. They include:

Pain: Pain in the lower part of the abdomen may indicate an enlarged uterus but it may also be related to another condition. A woman may also experience pain in her legs, abdomen, back, and pelvic areas. Sexual intercourse may also be painful.

Bloating: An enlarged uterus may push down on the bowels, causing bloating and excess gas.

Constipation: Pressure on the bowels from the enlarged uterus may cause some women to experience constipation.

Abnormal periods: An enlarged uterus can cause heavy bleeding and clotting during periods. It can also cause irregular periods and heavy spotting between periods. Heavy bleeding may cause anemia, a condition where blood cells become decreased, causing symptoms of fatigue, dizziness, and a fast heart rate.

Frequent urination: Pressure on the bladder from the swollen uterus can cause incontinence or frequent urination.

Weight gain: A woman with an enlarged uterus may experience weight gain in her waist. Hormonal changes may also cause weight gain.

Conception and pregnancy problems: For women trying to conceive, an enlarged uterus can make it harder to get pregnant. It can also lead to premature labor and miscarriage in women who are pregnant.

Additional symptoms include:

• Feeling of fullness or pressure in the pelvis
• Leg, abdominal, back, and/or pelvic pain
• Pain during sexual intercourse
• Bloating
• Constipation
• Frequent need to urinate
• Weight gain
• Conception and pregnancy problems

There are different causes of an enlarged uterus, including:

Uterine fibroids: Fibroids are non-noncancerous growths that may cause the uterus to become swollen or enlarged. These growths may range in size from a few centimeters to weighing several pounds. Fibroids usually occur in women who are in their reproductive years.

The latest estimates show fibroids affect 40% to 80% of women, but they are small and most women never know they have them. If symptoms are present, women may experience uterine bleeding, back and pelvic pain, urinary problems, and pressure on the rectum and organs.

Adenomyosis: Adenomyosis causes excessive growth of the endometrial lining in the wall of the uterus. The symptoms of this condition are similar to uterine fibroids, including painful periods, heavy bleeding due to bleeding from the uterine muscle wall, abdominal pain, and swelling of the uterus.

Endometrial cancer: This type of uterine cancer starts in the lining of the uterus. It results from the abnormal growth cells of cells that spread to other parts of the body, including the organs. The first sign of a problem is bleeding not associated with a menstrual period. 

Additional symptoms include pain while urinating, pelvic pain, and pain during sexual intercourse. Endometrial cancer tends to affect a woman who is post-menopausal, but it can also affect women who are still menstruating. Endometrial cancer is the sixth most common cancer in women worldwide.

Polycystic ovary syndrome (PCOS): PCOS causes large cystic masses in the ovaries due to hormonal irregularities. Symptoms of PCOS include irregular or no periods, heavy periods, excess body and facial hair, skin problems, pelvic pain, and fertility problems. This condition affects up to 10 percent of women worldwide.

Ovarian cysts: Ovarian cysts are fluid-filled sacs found inside the ovaries. Sometimes, cysts dissolve on their own, but if they grow too large, they can cause an enlarged uterus, back pain, heavy menstrual bleeding, uterine inflammation and difficulty with urination.

Complications of an enlarged uterus are usually related to the condition causing the uterus to become enlarged. Unless there are malignant tumors, or someone has uterine cancer, complications are rarely life-threatening. An enlarged uterus can also affect a woman's quality of life.

Infertility and pregnancy problems: Infertility is a complication of conditions that cause an enlarged uterus. If a woman has an enlarged uterus during pregnancy, she may miscarry or go into preterm labor.  However, it is still possible to have a healthy pregnancy and carry a child to term without any complications despite an enlarged uterus condition.

Pain and other symptoms: An enlarged uterus puts pressure on the bladder and intestines, causing pain, constipation, incontinence, frequent urination, bloating and cramping.

Abnormal bleeding: Heavy, painful, and frequent bleeding can affect a woman’s daily life by causing her to miss time from work and social events, and it may even cause embarrassment if she bleeds through clothing. Heavy bleeding can also result in anemia, which causes extreme fatigue and an overall feeling of sickness.

Prolapsed uterus: A uterus with large fibroids may prolapse. This means it falls into or out of the vagina. This condition is not life-threatening, but surgery is needed to repair the condition.

Most women overlook mild enlargement of the uterus and it is usually diagnosed during a routine gynecological exam. Symptoms of an enlarged uterus and its associated conditions will vary for each woman. 

Fibroids, depending on size, may only need monitoring and pain medication to treat pain. Adenomyosis pain can also be managed with pain medication and hormone therapies to lessen bleeding. Severe cases of uterine fibroids and adenomyosis may require surgical intervention. 

Much like fibroids, ovarian cysts usually do not need treatment. Hormone contraceptives may keep them from returning and surgery is only utilized in cases of large cysts, which are rare. Ovarian cysts rarely cause cancer, but if a cystic mass is cancerous, surgery may involve a total hysterectomy (removal of the uterus, ovaries and fallopian tubes), and, possibly, radiation and/or chemotherapy. Surgery is usually recommended if a woman who develops ovarian cysts after menopause.

Birth control pills are the most common treatment for PCOS in women who do not want to get pregnant. Birth control pills can also help regulate periods and even treat acne and unwanted hair growth.

Treatment for endometrial cancer depends on how far advanced the disease is, a woman’s overall health and her preferences. Generally, treatment can include a total hysterectomy, radiation, chemotherapy, and/or hormone therapies.

The outlook for most women with endometrial cancer can be good. According to the American Society of Clinical Oncology, the five-year survival rate for women with uterine cancers is 81 percent. It is important to note that survival rates are estimates. They come from data measured every five years, so they do not show the results of better diagnoses and treatments in more recent years. Women should talk to their doctors if they have questions about statistical information.

Most of the time, an enlarged uterus is found during a gynecological exam or imaging tests. The good news is most conditions that cause an enlarged uterus are benign and non-life-threatening and don’t require treatment unless they become severe. 

It is a good idea for any woman who experiences irregular or heavy, painful periods, pain during sex, or fullness and pressure in the pelvis to see her doctor. A doctor is in the best position to determine the cause of symptoms and to recommend appropriate treatments.