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Enlarged Uterus

From conception to delivery, a woman's uterus can grow from the size of a pear to the size of a watermelon. But pregnancy isn't the only potential reason for an enlarged uterus. An enlarged uterus is common and can be a symptom of a variety of medical conditions, some of which require treatment. 

Two of the most common causes of an enlarged uterus are uterine fibroids and adenomyosis.

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Uterine fibroids. Uterine fibroids are common noncancerous tumors of the muscular wall of the uterus, affecting as many as eight in 10 women by the age of 50. Fibroids more commonly affect women over age 30. They are also more common in African-Americans than whites. Overweight and obese women also have a greater risk of developing fibroids. Hormonal and genetic factors contribute to their growth.

While some fibroids are very small, others grow to weigh several pounds. A woman may have a single fibroid or multiple fibroids. In addition to an enlarged uterus, symptoms of uterine fibroids may include:

  • Feeling of fullness or pressure in the lower abdomen
  • Heavy, painful, and/or long-lasting periods, sometimes with the passage of blood clots
  • Bleeding between periods
  • Constipation
  • Frequent urination
  • Pain during intercourse
  • Pregnancy or delivery complications

If symptoms are severe, treatment may involve a procedure called embolism to cut off the blood supply to the fibroids so that they shrink and eventually die, or surgery to remove the fibroids or the entire uterus (hysterectomy). Other treatments include endometrial ablation (when the inside lining of the uterus is removed) and myolysis (when freezing or an electric current is used to destroy the fibroids). Medications to help control painful periods or for pain may also be used.

The cause of fibroids is not known, but the tumors seem to rely on estrogen to grow. After menopause they often shrink naturally and cause no symptoms.

Adenomyosis. Adenomyosis is thickening of the uterus that occurs when the tissue that normally lines the uterus (endometrium) moves into its muscular outer wall. This can cause a growth called an adenomyoma.

While the cause of adenomyosis is unknown, the condition usually occurs in women older than 30 who have had children. It is more common in women who have had uterine surgery, including a cesarean section.

In addition to uterine enlargement, symptoms may include:

  • Long periods or heavy bleeding
  • Painful periods, which get continually worse
  • Pain during intercourse

Most women have some adenomyosis at the end of their childbearing years. Most don't require treatment, but some need medication to relieve pain. Birth control pills and an intrauterine device (IUD) containing progesterone may help decrease heavy bleeding. Younger women with severe symptoms may need a hysterectomy to relieve symptoms.

Other Causes of an Enlarged Uterus

Other possible causes of an enlarged uterus include:

  • Pelvic congestion syndrome. Rather than a disease, this is a collection of symptoms including chronic dull pain, pressure, and heaviness in the pelvis that worsen after long periods of standing or during or just after sexual intercourse. Although the exact cause is unknown, it is believed to be associated with varicose veins in the abdomen that develop during pregnancy and continue to grow over time. Pain medications or a procedure to block off the affected veins may relieve symptoms. 
  • Contraceptive use. Use of both intrauterine devices (IUDs) and birth control pills can cause swelling or thickening of the uterine walls, resulting in an enlarged uterus.
  • Cancer. In some cases, an enlarged uterus can be a symptom of uterine cancers, including endometrial cancer (affecting the lining of the uterus) and cervical cancer (affecting the lower portion of the uterus where it joins the vagina). Treatment depends on the location, the extent of the cancer, and other factors.

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