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There are many reasons for an enlarged uterus, but most of them are benign. However, they often cause bothersome symptoms.

If you didn't have any symptoms and your gynecologist spotted the enlargement, consider yourself lucky. Uterus enlargement symptoms can range from bleeding during intercourse, cramping, pain, pain during intercourse and feeling bloated to pressure, fullness, or pain in the abdomen, dull ache in the lower back and thighs, and problems passing urine completely to name just a few.

If you suspect you have an enlarged uterus, the first thing to do is to have it checked by a gynecologist. An ultrasound would be the first thing ordered to sort this out, but if the question remains open, a doctor could also use an MRI.

If the ultrasound came standard and the doctor found anything abnormal, there's a possibility that your uterus is just sitting high in your pelvis, so that you can feel it. Your uterus sitting high in your pelvis is usually due to: 

  • Scarring from previous surgery 
  • Endometriosis 
  • Infection
You could also be feeling a full bladder. It may be the bladder you are feeling or the uterus, which does rise out of the pelvis a bit with a full bladder. If you are feeling a bulge in your bladder, you should try to empty it and see if it gets smaller than before. 

The uterus size is relatively small; it measures about three or four inches in length, which is the size of a clenched fist or a small apple. In pregnancy, the size of the uterus changes as the baby grows and this organ can expand up to 12 inches in length. Therefore, perform a pregnancy test and make sure you are not pregnant. 
 
Two other conditions that often cause an enlarged uterus are fibroids and adenomyosis. 

Fibroids

Fibroids are the most common benign tumor of a woman’s uterus. They grow on the outside, inside or within the smooth muscle in the wall of the uterus. Fibroids may grow as a single tumor or in clusters. Fibroids can be as small as a pea and can grow as large as a melon. [1]
 
It is estimated that 20-50% of women have or will have fibroids at some time in their lives. 
 
The most common symptoms of fibroids are excessive menstrual bleeding, pelvic pain, and pressure that can additionally cause frequent urination, pain during intercourse, constipation, abdominal bloating and abdominal pain or a backache and of course enlarged uterus. Fibroids can make a woman look pregnant although she is not. 
 
Your doctor may decide to overlook the fibroids if they are small or try to have them removed if they grow too much. Discuss the treatment options with your gynecologist. They include a myomectomy or in severe cases hysterectomy, which should be the last resort. [1]

Adenomyosis

Adenomyosis is a condition similar to endometriosis. In adenomyosis, the tissue that normally lines the uterus (endometrium) also grows within the muscular walls of the uterus. This growth usually occurs late in the childbearing years and after you've had children.
 
Adenomyosis is not life-threatening but can be extremely painful. Other symptoms include heavy or prolonged menstrual bleeding, severe cramping or sharp pain during menstruation, pain during intercourse, bleeding between periods, passing blood clots during your period, tender lower abdomen.  Adenomyosis could also be silent but make your uterus bulge. This condition resolves after menopause most of the time, so you should decide on the treatment depending on how close to menopause you are. Treatment may include anti-inflammatory drugs, hormonal therapy or in severe cases hysterectomy, which is the only permanent solution. [2]

Ovarian cysts

Sometimes ovarian cysts are the reason behind your enlarged uterus. Ovarian cysts, like any other cysts, are fluid-filled sacs. The most common type of ovarian cyst is called a functional cyst, which often forms during the normal menstrual cycle. There are also other kinds of cysts, such as [3]: 
  • Endometriomas (they develop in women who have endometriosis)
  • Cystadenomas (that can become large and cause pain)
  • Dermoid cysts (these too can become large and cause pain)
  • Polycystic ovaries
Many women don't have any symptoms, but those that do have symptoms wish them gone as soon as possible. The most common symptoms are pressure, fullness, or pain in the abdomen, dull ache in the lower back and thighs, problems with passing urine, pain during sexual intercourse, weight gain, painful menstrual periods and abnormal bleeding, nausea or vomiting and breast tenderness. 
 
Most cysts resolve on their own, but gynecologists should track their progress. Beside watchful waiting, the treatments include birth control pills or surgery to remove the cyst.

Endometrial (Uterine) Cancer Or Cervical Cancer 

Endometrial (uterine) cancer could be to blame too. Cancer of the uterus and cervix occurs mostly in women over age 50. Other risk factors include having endometrial hyperplasia, using hormone replacement therapy, being obese and suffering from obesity-related disorders, taking Tamoxifen to prevent or treat breast cancer, or suffering from inherited colorectal cancer. [4]
 
The symptoms of uterine and cervical cancer include unusual vaginal bleeding or discharge, troubles urinating, pelvic pain, pain during intercourse, and an enlarged uterus. 
 
Treatment varies depending on your overall health, how advanced the cancer is and whether hormones affect its growth. Treatment is usually a hysterectomy, which is surgery to remove the uterus. Other options include hormone therapy and radiation. 
 
As you have probably noticed, many of these symptoms overlap, so you can never tell for sure what your problem is. Regular gynecologist check-ups and timely interventions will save you from dealing with these annoying symptoms and help you take care of problems on time.