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Bulky Uterus – Symptoms, Causes and Treatment

Studies show that a bulky uterus affects 1 in 10 women of reproductive age globally. Thus, it is helpful to understand this condition and how it can impact your well-being.

This article provides a comprehensive overview to help you learn everything you need to know about a bulky uterus -  including symptoms, its causes, and consequences of treatment options available. 

What Is a Bulky Uterus? 

A bulky uterus, or enlarged uterus, is the indistinct bulging in the uterine wall. Thus, the uterus becomes more extensive than usual. The uterus, or the womb, is a muscular and hollow organ between the urinary bladder and the rectum. A non-pregnant uterus has an inverted pear-shape, measuring approximately 8 cm long 5 cm wide, and has a thickness of 4cm. This size is equivalent to a clenched fist. During pregnancy, it stretches and expands to accommodate the growing embryo. 

During labour, it contracts to push the foetus out of the birth canal. After approximately six weeks post-delivery, it returns to its pre-pregnant state and size. 

A bulky uterus is more prevalent in perimenopause and menopause but can also occur in fertile years and may cause pain and anxiety.  

What Are Some of the Symptoms of an Enlarged Uterus?

Symptoms of a bulky uterus depend on the cause and vary from person to person. The condition is sometimes asymptomatic, and you may not know if you have a bulky uterus. Often, it is detectable with a pelvic examination, such as an ultrasound. The most common symptoms include: 

• Unusual bloating or sensation of fullness and bulkiness around the belly.
  
  
• Abnormal vaginal bleeding that's heavy and sometimes involves large blood clots.
  
  
• Abnormalities of the menstrual cycle, such as prolonged menstrual periods and bleeding between periods
  
  
• Pelvic pressure and pain
  
  
• Frequent urination or incontinence due to its pressure on the bladder
  
  
• Tiredness, paleness, and generalised body weakness
  
  
• Fertility problems include difficulty conceiving, miscarriage, or premature delivery
  
  
• Pain during sexual intercourse (dyspareunia)
  
  
• Pain in the back and legs
  
  
• Mass around the lower abdomen
  
  
• Post-menopausal bleeding

If you experience these symptoms, consult your fertility healthcare provider for an examination regarding the size of the uterus. 

Causes of an Enlarged Uterus

There could be various reasons for an enlargement of the uterus besides pregnancy; they include:

Uterine Fibroids (Leiomyoma/Fibromyoma)

Fibroids are benign/non-cancerous growths or uterine smooth muscle wall tumours. Research shows that uterine fibroids affect approximately 80% of women. They appear like small lumps on the uterine wall and can grow to several pounds. 

Uterine fibroids are more prevalent between ages 30-40. Besides, women with obesity or who are overweight have a higher risk of getting uterine fibroids. 

Some uterine fibroids are asymptomatic. Others grow so big that the woman seems a few months pregnant. Symptoms of a bulky uterus with fibroids include:

• Heavy bleeding(menorrhagia)
  
  
• Bleeding between periods(metrorrhagia)
  
  
• Firm mass around the pelvic region.
  
  
• Excruciating lower back pain.
  
  
• Discomfort during sexual intercourse(dyspareunia)
  
  
• Frequent urge to urinate.
  
  

In most cases, fibroids do not require medical attention. However, if you experience extreme symptoms or discomfort, consult your gynaecologist. They will conduct a pelvic examination and recommend a suitable treatment procedure.

Adenomyosis

Adenomyosis is a condition where the uterine lining tissue, i.e., endometrium, grows directly into the muscular wall of the uterus. These growths cause widespread swelling and thickening of the uterus.

Adenomyosis primarily results from hormonal imbalance and affects women above 30 years who have never borne any children or are infertile. Adenomyosis is associated with:

• Painful periods
  
  
• Abdominal pain
  
  
• Heavy bleeding
  
  

 A routine examination can detect and manage this condition early.

Ovarian Cysts

Ovarian cysts are fluid-filled or solid sacs that grow in or around the ovaries. They are usually asymptomatic and harmless and often heal on their own. However, they sometimes enlarge and rupture, leading to inflammation, heavy bleeding, and back pains. Your fertility healthcare provider can help diagnose and treat this condition and prevent complications.

Polycystic Ovary Syndrome (PCOS)

PCOS is a condition in which an imbalance between progesterone and oestrogen hormones prevents the normal shedding of the uterine lining during menstruation. This imbalance leads to abnormal or no menstruation, causing an enlarged uterus. Signs of PCOS include:

• Infertility
  
  
• Acne or oily face
  
  
• Weight gain around the abdomen
  
  
• Excess hair on the chest and stomach
  
  
• Thick and dark skin patches on the neck, under the breasts, and armpits
  
  

The good news is that PCOS is manageable. Schedule an examination if you experience any of the above symptoms.

Endometrial Cancer

Endometrial cancer is a cancerous/malignant tumour on the inside lining of the uterus that mainly affects postmenopausal women. While its cause is unknown, it's curable when diagnosed early. 

The first sign of endometrial cancer is vaginal bleeding that's not associated with menstruation, such as bleeding after menopause and spotting between periods. Other symptoms include pelvic pain, painful sex, and urination. Luckily, this condition is treatable through chemotherapy or radiotherapy. 

Perimenopause

Perimenopause is the stage just before menopause. The time leading to menopause is a common cause of an enlarged uterus due to fluctuating hormone levels. The uterus usually resumes its original size post-menopause. However, sometimes, the bulkiness persists, and you may require medical intervention if it causes discomfort.

Consequences – Impact of Bulky Uterus

Some of the impacts of a bulky uterus include:

Excessive Bleeding

 Heavy and prolonged vaginal bleeding can lead to anaemia and generalised body weakness and hinder you from attending your favourite social events. Regular gynaecological check-ups can help detect and manage the symptoms early.

Pain and Pressure Around the Pelvic Region

 You may experience pelvic pain, frequent urination, bloating, and swelling due to increased pressure on nearby organs. Your reproductive health specialist can help you find a solution to this problem.

Infertility and Pregnancy Problems

 Studies have revealed that PCOS, fibroids, and adenomyosis increase the risk of infertility and pregnancy-related complications. You may experience premature labour or require caesarean section delivery. Fortunately, early diagnosis can help manage the underlying conditions and have a safe pregnancy.



Treatment for a Bulky Uterus

Treatment for an enlarged uterus focuses on managing symptoms and depends on underlying conditions and the severity of symptoms. The available treatment options include:

Medications

The doctor may prescribe contraceptives and hormonal therapies to reduce heavy bleeding. In addition, they may recommend Non-Steroidal Anti-Inflammatories (NSAIDs) to relieve pain and discomfort.

Surgery 

In some cases, your physician may recommend a surgical procedure for the removal of the fibroids (myomectomy), removal of the uterus (hysterectomy), ovaries, fallopian tubes, and sometimes lymph nodes.

Uterine Artery Embolization (UAE)

UAE is a surgical procedure that involves making a small incision to block blood flow to uterine fibroids, causing them to shrink. 

Lifestyle Changes

Some lifestyle changes can help you manage and reduce the risk of an enlarged uterus. They include stress management, physical exercise, and avoiding caffeine and alcohol intake.

Conclusion

A bulky uterus is a common problem many perimenopausal women experience. Although this condition is often asymptomatic, its effects can negatively impact your fertility and disrupt your daily life. The signs of an enlarged uterus include frequent urge to urinate, pelvic pains, heaviness around your pelvic region, and difficulty conceiving.

You can reduce your risk of an enlarged uterus by adopting lifestyle changes such as engaging in physical exercise and limiting alcohol and caffeine. Scheduling regular pelvic exams can help detect the symptoms earlier, treat underlying conditions, and prevent long-term complications

References 

• Harmanli, O. H., Gentzler, C. K., Byun, S., Dandolu, V., & Grody, M. H. T. (2004). A comparison of abdominal and vaginal hysterectomy for the large uterus. International Journal of Gynecology & Obstetrics, 87(1), 19-23. https://www.sciencedirect.com/science/article/abs/pii/S0020729204002486

• LevGur, M. (1996). The enlarged uterus. Relation of uterine size to symptoms and histopathologic findings. The Journal of Reproductive Medicine, 41(3), 166-170. Retrieved from https://europepmc.org/article/med/8778414

• Salvig, J. D., Petersen, K. R., & Møller, B. R. (2005). Acute abdominal pain caused by torsion of an enlarged non-pregnant uterus. Journal of obstetrics and gynaecology, 25(1), 81-82. Retrieved from https://www.tandfonline.com/doi/pdf/10.1080/01443610400025689



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