The uterus is an organ that resides in the woman’s pelvis that functions to support the pregnancy. It together with two ovaries and a complex hormonal interaction serves a pivotal role in the child-bearing age woman. The uterus can be removed and very few consequences a woman can experience because of that.
The uterus can develop some medical abnormalities that lead up to a bulky and large uterus. Some of the conditions are normal and benign (non-cancerous) while some may need further examination and investigation to exclude malignancy (cancer).
What are the causes of the large and bulky uterus and how to treat them?
- Pregnancy
This may seem obvious for most people but it can be quite a surprise especially if you do not have the typical symptoms of pregnancy and you are confident with your contraception. If you go to the clinic or hospital and complaining of an enlarged abdomen with an absent period, the doctor will test for pregnancy first.
Both normal and ectopic pregnancy can cause large uterus. The uterus increase in size due to more vascular supply together with the expansion of the uterine cavity to accommodate the developing fetus. A simple urinary test can identify a pregnancy while an ultrasound is needed to confirm it and to exclude ectopic pregnancy.
2. Fibroids
Fibroids is an abnormal growth of smooth muscle of the uterus. It is also called leiomyomata. It is considered as a benign tumour which will not develop into a cancerous cell. Fibroids growth is dependent on oestrogen hormone which is why it is commonly seen in non-menopause women. It can grow from the size of a golf ball to even the size of a football.
Patients with fibroid growth often complain of menstruation abnormality, increase urination and sometimes with pain as well. Fibroid can grow during pregnancy and may complicate the decision to give birth. The diagnosis is done by ultrasound and treatment can be watchful waiting, hormonal treatment or surgical resection. The management of fibroids will depend on factors such as age, fertility and patient’s wish.
3. Hydatidiform mole
Hydatidiform mole is a molar pregnancy in which the pregnancy is becoming non-viable due to an error during the fertilisation of the sperm(s) and ovum. Patients may experience the symptoms and signs of pregnancy, large uterus or irregular menstruation.
Hydatidiform mole is more common in the Asian population and those with a history of molar pregnancy. The diagnosis is with all other uterine pathology, needs an ultrasound to confirm the size and findings. A management option is limited for a hydatidiform mole which only has surgical resection or chemotherapy for high-risk mole.
4. Uterine sarcoma/cancer
Uterine sarcoma which is a type of cancer of the uterus. However, uterine sarcoma is rare cancer among uterine cancer accounting for about 3%-5%. Cancer usually affects elderly women and with symptoms such as weight loss, fatigue and large uterus. Treatment involves surgical resection with or without chemotherapy.
Uterine abnormality can be subtle and patients often found out when it is too late or when the problem has become bigger and difficult to manage. It is important to consult and find doctors in Malaysia with experience and expertise in the management of woman’s health.
