An enlarged uterus can be caused by pregnancy, uterine fibroids, adenomyosis, or uterine cancer. Diagnosis is done through gynecological examination and ultrasound, and treatment varies depending on the cause.
Uterine enlargement can occur among women of various ages. Common causes of an enlarged uterus could be physiological, gynecological, or malignant. The most common physiological cause is pregnancy. Gynecological causes include uterine pathologies such as uterine fibroids and adenomyosis. Malignant causes of an enlarged uterus include uterine cancer and metastases.
Pregnancy is the primary consideration when a woman of childbearing potential complains of uterine enlargement associated with the cessation of menstruation. The uterus reaches the pubis at 3 months, the umbilicus or umbilicus at 4.5 months, and the xiphoid or lowest part of the sternal bone at 9 months. Associated symptoms of an enlarged uterus due to pregnancy include morning sickness and breast tenderness.
Uterine fibroids are also among the most common causes of an enlarged uterus. They are the most common pelvic cancers and affect about 70% of women by the time they reach 45 years of age. A uterine fibroid, also called a leiomyoma, forms due to the proliferation of smooth muscle cells. Fibroids are benign growths and can be located in the mucosa, within the uterine muscle or in the outer walls of the uterus or serosa. Associated symptoms include menstrual irregularities, excessive menstrual bleeding, acute or chronic pelvic pain, and infertility.
A disorder called adenomyosis, in which endometrial tissue implants itself in the uterine wall, can lead to a large, inflamed uterus. Up to 20% of women suffer from this condition. The uterus is usually uniformly enlarged. Other symptoms include irregular and excessive menstruation, dysmenorrhea, and pain during intercourse or dyspareunia.
Uterine cancer is also a common cause of uterine enlargement. Carcinomas and sarcomas can occur in the uterus, producing generalized enlargement of the organ. In addition to causing an enlarged and unhealthy uterus, uterine cancer can also cause symptoms of pelvic pressure, pelvic pain, and postmenopausal bleeding. About 10% of postmenopausal women who complain of an enlarged uterus and vaginal bleeding are eventually diagnosed with endometrial cancer.
Before treating an enlarged uterus, the cause must be determined. Gynecological examination and ultrasound are the main methods of identifying possible causes of an enlarged uterus. If pregnancy is the cause, supportive advice is provided. For patients with uterine fibroids or adenomyosis, hormone analogs may be given or surgical procedures, such as myomectomy or hysterectomy, may be recommended. If uterine cancer is the suspected cause, an endometrial biopsy is done and total hysterectomy with bilateral salpingo-oophorectomy is recommended.
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