Generality
The enlarged uterus is the condition resulting from an abnormal expansion of the female reproductive organ destined to contain the fetus, on the occasion of a possible pregnancy.
To cause the enlarged uterus may be pathological and non-pathological circumstances; among the main pathological causes, there are: adenomyosis, uterine fibroids and tumors of endometrium and cervix; the main non-pathological causes, on the other hand, include: pregnancy and perimenopause.
For the diagnosis of the enlarged uterus, the information provided by the pelvic exam and, sometimes, a pelvic ultrasound are essential.
The enlarged uterus does not always impose the use of a therapy; when the latter is used, the treatments vary depending on the cause and the symptoms (which may include pain and pelvic cramps, excessive bleeding during menstruation, increased volume of the lower abdomen, back pain, etc.).
Short reference to the uterus
Unequal and hollow, the uterus is the female genital organ, which serves to receive the fertilized egg cell (that is, the future fetus) and to guarantee its correct development during the 9 months of pregnancy.
It resides in the small pelvis, precisely between bladder (anteriorly), rectum (posteriorly), intestinal loops (superiorly) and vagina (inferiorly).
During the lifetime, the uterus changes its shape; if up to the pre-pubertal age it has an elongated appearance similar to a glove finger, in adulthood it looks a lot like an inverted (or upside-down) pear, while in the post-menopausal phase it gradually reduces its volume and is crushed.
From a macroscopic point of view, doctors divide the uterus into two distinct main regions: a larger and larger portion, called the uterus body (or uterine body ), and a narrower portion, called the cervix (or cervix ).
What is the Swollen Uterus?
Swollen uterus is the jargon that indicates an expansion of the uterus beyond its normal size.
Often discovered by chance during a routine pelvic exam (or performed for other reasons) the enlarged uterus is a clinical sign whose relevance depends on the triggering cause: if the cause is not particularly important, it must not be a reason of particular apprehension ; on the contrary, if the cause is serious pathological condition, it requires appropriate treatments .
How big is the uterus in normal conditions?
When we talk about an enlarged uterus, it is right to inform interested readers of the subject that, in normal conditions, the uterus of an adult woman measures:
- 6-7 centimeters in length;
- From 2.5 to 4 centimeters in width;
- 2.5 cm in thickness.
Using a comparison, a normal uterus (where "normal" means "in the absence of conditions that cause it to enlarge") is the size of a closed fist.
Did you know that ...
Under normal conditions, the weight of the uterus is around 50-60 grams.
Who develops an enlarged uterus more?
According to statistics, the condition of enlarged uterus is more frequent among women over 30 and women who are about to enter menopause .
Causes
The enlarged uterus recognizes various causes, both pathological and non-pathological.
The main causative factors of the enlarged uterus condition include:
- The state of pregnancy ;
- Uterine fibroids ;
- Adenomyosis ;
- Perimenopause ;
- Endometrial cancer and cervical cancer .
Pregnancy
Pregnancy is one of the main non-pathological causes of an enlarged uterus.
During a gestation, the enlargement of the uterus is an indispensable process for guaranteeing the fetus the space necessary for its growth; if absurdly, in fact, the uterus lacked the ability to swell and enlarge, the future unborn child would not have the chance to develop properly.
Did you know that ...
During a pregnancy, a woman's uterus progressively passes from being the size of a closed fist to being the size of a watermelon.
Uterine fibromas
Known as leiomyomas or uterine myomas, uterine fibroids are benign tumors of the uterus, which can develop both on the inside and on the outside of the organ.
Uterine fibroids appear as nodular masses of predominantly fibrous tissue, masses whose dimensions can vary from a few millimeters to 15-20 centimeters.
Because of the fibrous component that constitutes them, uterine fibroids can, if they are large, drastically alter the elastic properties of the uterus (NB: the fibrous tissue is similar to scar tissue, which is a less elastic, retracting tissue).
Uterine fibroids are very common; according to statistics, in fact, at least 80% of women can say, at the age of 50, they have developed at least one uterine fibroid up to that point.
A uterine fibroid can cause an enlarged uterus, when it is large or when it appears in multiple mode (in practical terms, there are so many close to medium-small fibroids).
Did you know that ...
In 2016, a medical journal published the case of a patient who, due to several uterine fibroids, had an enlarged uterus weighing almost 3 kilograms.
adenomyosis
The term "adenomyosis" refers to a benign (and therefore not cancerous) condition in which a portion of the endometrium develops abnormally in the direction of the myometrium, invading the space reserved for the latter (the endometrium is the the innermost cellular layer of the uterus as well as the mucous membrane of this organ, whereas the myometrium is the layer of muscle cells immediately preceding the endometrium).
The precise cause of adenomyosis is still unclear; however, estrogen seems to play a key role in the development of the condition in question (when the level of these hormones decreases with menopause, in fact, adenomyosis tends to resolve itself).
Adenomyosis is responsible for an enlarged uterus, because it determines the unexpected development of layers of endometrium.
Severe adenomyosis can swell the uterus 2-3 times its normal size.
Did you know that ...
Adenomyosis produces symptoms very similar to those of a large uterine fibroid . This explains why, to distinguish the two conditions in question, specific diagnostic investigations are needed.
Perimenopause
Perimenopause is the phase immediately preceding menopause, that is the physiological period (therefore natural and not pathological) of a woman's life, which marks the end of her fertility as well as the repetition of menstruation.
Perimenopause is the cause of an enlarged uterus, because it is a time of hormonal disruption, which affects the behavior and anatomy of the reproductive system.
Did you know that ...
With the onset of menopause, the condition of an enlarged uterus related to perimenopause tends to resolve spontaneously, with the organ involved returning to standard dimensions.
Endometrial Tumor and Tumor of the Uterine Cervix
Endometrial cancer is the neoplasm resulting from the out-of-control proliferation of one of the cells that participate in endometrial tissue.
Also known as cervical cancer, cervical cancer is the neoplasm resulting from the uncontrolled proliferation of one of the cells that make up the aforementioned part of the uterus.
Endometrial cancer and cervical cancer are responsible for an enlarged uterus, because they cause the formation of an abnormal mass, which increases the total volume of the organ.
Did you know that ...
According to the National Cancer Institute,
- The diagnosis of endometrial cancer is mostly in women between 55 and 64;
- Endometrial cancer is the sixth most common malignancy in the female population;
- In 2012, endometrial cancer recorded 320, 000 new cases worldwide.
Symptoms and Complications
Depending on the triggering cause and on the severity of the enlargement, the enlarged uterus condition can be asymptomatic - that is without symptoms - or associated with disorders, such as:
- Presence of a protruding mass in the lower part of the abdomen;
- Increase in waist circumference;
- Sense of pressure on the pelvis. This symptom can be connected to the uterus that pushes on the internal abdominal wall or on the neighboring organs;
- Anemia due to excessive bleeding during menstruation and related symptoms;
- Pains and cramps in the pelvis;
- Constipation;
- Swelling and leg cramps;
- Backache;
- Urgency to urinate and frequent urination;
- Vaginal discharge of watery type;
- Pain during sexual intercourse (dyspareunia).
Complications
The enlarged uterus can undergo complications, when it is the result of serious pathological conditions and / or not subjected to the right treatments .
Among the possible complications that may concern those suffering from a pathological form of a serious or inadequately cured enlarged uterus are:
- The decline or loss of fertility ;
- Problems during a pregnancy ;
- Inflammation of the uterus ( metritis ).
Diagnosis
For the diagnosis of an enlarged uterus, the information coming from the pelvic exam and, if the latter was not sufficient, from a pelvic ultrasound are fundamental.
Once the diagnosis is made, the next step is to understand the cause of the condition ; to identify the causal factor at the origin of the enlarged uterus, the doctor could benefit from the investigations indicated above or he may need to resort to further more specific tests ( MRI or CT scan of the pelvis).
The search for what causes the enlarged uterus condition is essential for the most appropriate treatment planning.
Pelvic exam
The pelvic exam is an objective examination, during which the doctor (generally a gynecologist ) examines manually, first from the outside and then also from the inside (thanks to a speculum ), the vagina, the uterus (cervix in particular ), the rectum, the ovaries and the pelvis. In other words, it is an analysis of the main pelvic organs.
Spanning a few minutes, the pelvic exam allows a general assessment of a woman's gynecological health.
In the presence of a condition such as an enlarged uterus, the pelvic exam is normally highly significant; in fact, only in rare circumstances is it insufficient for a definitive diagnosis.
Pelvic ultrasound
Pelvic ultrasound is a simple external ultrasound of the lower abdominal area.
Completely painless and without any repercussions on patients' health (NB: it uses ultrasounds and not ionizing radiations), pelvic ultrasound allows the sufficiently detailed study of all the pelvic organs, namely: bladder, end part of the intestine ( rectum and sigma), the prostate complex-vas deferens-seminal vesicles in humans, and the uterus-vagina-fallopian tube-cervix-ovary complex in women.
In a context of an enlarged uterus, pelvic ultrasound is the diagnostic confirmation test, which ascertains and enriches the details that emerged during the pelvic examination (it could provide information on the causes of the condition).
Therapy
In many situations, the enlarged uterus does not require specific therapy .
Where recourse to a cure is necessary, the latter varies, above all, in relation to the triggering cause and, secondly, based on the severity of the symptomatology .
Examples of Swollen Uterus Therapy
- If the condition of an enlarged uterus depends on a tumor of the endometrium or cervix uteri, the treatment consists of surgery to remove the uterus (hysterectomy), possibly combined with the removal of the ovaries and fallopian tubes;
- If the condition of an enlarged uterus is the result of one or more uterine fibroids, the therapy may vary from the simple use of drugs (eg, birth control pills) to the implementation of a surgical operation such as myomectomy or hysterectomy, depending on age of the patient and the severity of the condition (clearly, if the patient is young it is preferable to resort to drugs; if instead the patient has exceeded childbearing age, myomectomy and, in the most severe cases, hysterectomy, are excellent solutions) ;
- If the enlarged uterus depends on pregnancy, there is no therapeutic plan, because the condition resolves spontaneously after the birth;
- If the enlarged uterus is related to adenomyosis, the treatment involves the use of painkillers and birth control pills, in less severe cases, and hysterectomy, in the most severe cases (cases in which there is a strong invasion of the myometrium by endometrium).
Prognosis
The prognosis in the case of an enlarged uterus varies according to the triggering cause: if the cause is clinically irrelevant or not a pathological condition (eg pregnancy), the condition resolves itself benevolently; vice versa, if the cause is important from the clinical point of view (ex: endometrial tumor), the condition could have serious repercussions on the patient's life.
Because severe tumors may also depend, the enlarged uterus is a condition that always deserves medical attention.
