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 the uterus can increase, and an enlarged uterus can happen at any age.

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.

Female uterus.

Symptoms

Symptoms of an enlarged uterus are based on the condition causing the enlargement. One of the most common symptoms is bleeding. This includes heavy, painful, and long periods, including the passage of blood clots.

However, some people 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 people 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. The person 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 (decreased red blood cells) 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 person with an enlarged uterus may experience weight gain in their waist. Hormonal changes may also cause weight gain.
  • Conception and pregnancy problems: For people trying to conceive, an enlarged uterus can make it harder to get pregnant. It can also lead to premature labor and miscarriage in people 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

Causes

Causes of an enlarged uterus
Illustration by JR Bee, Verywell

There are different causes of an enlarged uterus, including the following conditions.

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.

Recent estimates show fibroids affect up 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% 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

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 can be a complication of conditions that cause an enlarged uterus. An enlarged uterus during pregnancy may lead to miscarriage or preterm labor. However, it is possible to have a healthy pregnancy and carry a child to term without complications despite an enlarged uterus.
  • 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 daily life by causing you to miss time from work and social events, and it may even cause embarrassment if you bleed 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.

When to See Your Doctor

If a woman starts to experience bloating, weight gain, or pain in her pelvic area, she may have an enlarged uterus. Any woman whose uterus is getting larger when she is not expecting should talk to her doctor.

The enlarged uterus may be nothing serious, but medical intervention might be necessary. A woman’s doctor will request further testing to determine the cause of the enlargement and suggest a treatment plan, which will depend on the cause of the enlarged uterus.

Treatment

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 ovarian cysts develop after menopause.

Birth control pills are the most common treatment for PCOS if pregnancy isn't desired. 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, the person's overall health, and their preferences. Generally, treatment can include a total hysterectomy, radiation, chemotherapy, and/or hormone therapies.

The outlook for most people with endometrial cancer can be good. According to the American Society of Clinical Oncology, the five-year survival rate for people with uterine cancers is 81%.

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.

A Word From Verywell

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 person who experiences irregular or heavy, painful periods, pain during sex, or fullness and pressure in the pelvis to see their doctor. A doctor is in the best position to determine the cause of symptoms and to recommend appropriate treatments.

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