For most women who are not pregnant, the normal size of the uterus is about the same as a clenched fist or a pear. Naturally the uterus, or womb, it is an expandable organ, capable of filling out to the size of a watermelon during pregnancy. However, there can be other reasons for a bulky uterus, aside from pregnancy. For women who experience this condition, whether a bulky uterus is good or bad news depends on the cause. Most of the time, it is not dangerous. Indeed, many women may not even know about it until a routine pelvic examination. Likewise, many women can get pregnant; again, it depends on the cause.

Our IVI article takes a closer look at some of these issues – what is a bulky uterus, what are the symptoms, what are the causes, and how is it treated?

What is a bulky uterus?

Various conditions can cause an enlargement of the uterus, known as hypertrophy or a bulky uterus. This simply means that it has expanded beyond its normal 8 x 5 x 4 cm dimensions and has grown up to more than 12 cm in length and over 6 cm thick. This is quite common in women during the years of the perimenopause and menopause, but women in their fertile years can also experience the condition.

What are the symptoms of a bulky uterus?

Many women don’t notice any symptoms at all and are unaware that they have a bulky uterus until it is diagnosed during a routine pelvic examination. Others could notice that they have an unaccustomed bulkiness or bloating around the belly, or that skirts and trousers feel too tight. When symptoms do appear, the most common include:

• Heavy bleeding or passing large blood clots during periods, spotting in between periods or painful and longer than normal periods.
• Heavy bleeding can also lead to anaemia. This in turn causes tiredness or weakness because there are not enough red blood cells to carry adequate levels of oxygen around the body.
• Because of the position of the uterus in the pelvic cavity between the bladder and rectum, symptoms can result from a disruption of how these organs function, such as constipation and bloating, or pressure on the bladder resulting in frequency of urination or even incontinence.
• Pain in the legs, pelvis, back or lower abdomen, and painful sex.
• Fertility problems, which can include difficulty conceiving or in carrying a pregnancy to full term.

A bulky uterus: what are the causes?

Several common conditions can cause a bulky uterus. These include fibroids, ovarian cysts, adenomyosis, polycystic ovary syndrome (PCOS), menopause and endometrial cancer.

• Fibroids, which are non-cancerous, are the most common cause. They are small lumps which develop along the uterus walls. This may not cause any symptoms or may cause pain and heavy periods. Fibroids can also put pressure on nearby organs, causing frequent urination or pressure on the rectum.
• Ovarian cysts are fluid-filled sacs that can grow in or around the ovaries. They are usually harmless but if they become very large, they can cause an enlarged uterus.
• Adenomyosis is a non-cancerous condition with symptoms like fibroids. In adenomyosis, the lining of the uterus becomes embedded directly into the muscle walls of the uterus. This causes painful periods together with swelling of the uterus.
• PCOS, caused by a hormonal imbalance, can also cause an enlarged uterus. This is because the presence of multiple cysts can interfere with the complete shedding of the uterine lining during menstruation. The lining is not discarded completely and causes disruption to the monthly cycle.
• The time leading up to menopause, known as the perimenopause, is a frequent cause of a bulky uterus resulting from hormonal disruption. Usually, the womb returns to its normal size after menopause.
• Endometrial cancer can also have the symptom of an enlarged uterus. It is usual in women between the ages of 55 and 64.

Treatment for a bulky uterus

Happily, most of the causes of a bulky uterus are either not in need of any treatment except for pain relief, or symptoms of heavy bleeding can be relieved with the contraceptive pill or an IUD which can help to restore hormone balance. Other treatments could include:

• Hormonal therapy for the treatment of fibroids, to shrink them and stop the bleeding. If they have become too large, surgery to remove them may be necessary.
• Hormonal treatment is also used in the case of adenomyosis, or in very severe cases a hysterectomy may be recommended.
• More extensive surgery can be required in the case of endometrial cancer, depending on how advanced it is. Surgery can include the removal of the uterus, fallopian tubes, and ovaries, and sometimes even the lymph nodes. However, the five-year survival rate is good, at 81%.

A bulky uterus and pregnancy

Some of the conditions we have described, and certainly some of the treatments, can impair your ability to become pregnant. Fibroids, PCOS and adenomyosis all carry an elevated risk of fertility problems. And if you want to have a child, clearly treatment with hormonal contraceptives or an IUD is not going to help. It is important to seek medical help for any of the symptoms associated with a bulky uterus, but if you are hoping to start or extend your family, you should be clear about this when speaking to your medical advisor.

Contacting us at IVI

Many women who experience a bulky uterus are still able to go ahead and become pregnant naturally. However there are treatments available, such as a course of hormonal medication, or, where necessary, Artificial Insemination (AI) or In Vitro Fertilisation (IVF), which can help to overcome fertility problems resulting from, for example, PCOS. If one of these conditions is affecting you and you are concerned about your fertility, do get in touch with us at IVI. There’s a very good chance that we can help.