April 27, 2020
Author Name: Dr. Madhu Patil || Mentor Name: Dr. Akanksha Jangid on April 27, 2020
Uterus, also called as women’s womb, is a pear-shaped muscular organ of the female reproductive system. Uterus plays very important function of nurturing the embryo and carrying a pregnancy to term, and hence its role in conception and delivery is irreplaceable. Problems of uterus account for 3% to 5% cases of infertility.
Normal dimensions of uterus ranges from 8 cm x 5cm x 4cm. Bulky uterus is a condition in which uterus is bigger in size than it is supposed to be.
What are the common causes of bulky uterus?
The two mostcommon causes of enlarged or bulky uterus in infertile patients are uterine fibroids and adenomyosis.
Fibroids – Also known as Leiomyomas, are non cancerous tumours of uterine muscles.
Adenomyosis -Is the globular swelling of the uterus which occurs if tissue that normally lines the uterus(endometrium) starts growing inside the muscular wall of the uterus.
Symptoms will depend on the cause of bulky uterus. Fibroids generally cause menstrual problems and pressure symptoms if they are big in size. experience one or more of the following problems-
a) Heavy menstrual flow
b) Pain abdomen during menses
c) Heaviness in lower abdomen
d) Difficulty in conceiving
e) Miscarriage or premature delivery
f) Bowel and urinary problems like constipation or increased frequency of urination.
Adenomyosis usually causes painful periods(dysmenorrhea) which may or may not be associated with heavy bleeding. Few patients can experience chronic pelvic pain or heaviness in lower abdomen.
Some patients might not feel any symptom and presence of bulky uterus can be a surprise finding during a pelvic examination or an ultrasound.
Fibroids are found in around 20% of women of reproductive age group but all fibroids do not affect fertility. Few might affect fertility by following mechanisms-
a) Blocking ascend of sperms from vagina,
b) By blocking tubal opening,
c) Disturbed blood supply to uterine cavity,
d)Few fibroids can even lead to miscarriages and preterm birth.
Women with adenomyosis have lower fertility. The reason behind this lower fertility is not very clear . Few studies suggest that adenomyosis might affects sperm transport. Others suggest that it makes the uterine environment hostile for growth and implantation of embryo.
Commonly the diagnosis is suspected by pelvic examination, when doctor finds that uterus is larger than expected. It is then confirmed by a transvaginal ultrasound(TVS). A vaginal ultrasound is done to note the size of the uterus and in most cases the cause can also be detected in the same sitting.
In few cases, doctor might advice you advanced imaging like MRI to confirm the diagnosis if deem necessary.
Can I conceive if I have bulky uterus?
The answer is YES.
Not all fibroids affect fertility. Many patients with fibroids conceive naturally. But in case you are suffering from infertility, and you have been diagnosed with fibroids in uterus, discuss with your doctor whether anything needs to be done for them or not.
Decision to treat a fibroid is taken after considering number, size and location of fibroids.
– Large fibroid causing pain, pressure symptoms or abnormal bleeding needs removal irrespective of its location.
– Submucous fibroids -are the ones that are near inner lining (endometrium) of uterus. These fibroids distort the uterine cavity and can cause complications in pregnancy also, so should be removed.
– Other than these two conditions, decision to treat or not to treat fibroid depends upon individual case scenario. Small fibroids, far away from the uterine cavity can be left untreated without compromising fertility.
For adenomyosis, unfortunately there is no permanent cure. However few medicines like aromatase inhibitors(Letrozole), dienogest and most frequently used GnRH(Gonadotropin Releasing Hormone) injections can temporarily decrease the severity of adenomyosis and help a women to conceive.
1. Most of the fibroids can now-a-days be removed by endoscopic surgeries – Either laparoscopy or hysteroscopy depending upon location of fibroids.
2. Very rarely, an open surgery in the form of laparotomy might be needed for fibroid removal, specially if the fibroid is very big.
3. A pregnancy can be attempted only 4-6 months after a fibroid surgery.
4. Medical management can sometimes be tried if the treating doctor decides the same.
5. Newer modalities of fibroid treatment like Uterine artery embolisation, MRI guided focus ultrasound surgery are not preferred in infertility patients. For infertility patients, surgery remains the first choice.
6. Fibroids almost never turn into cancer.
To sum up, if you have been diagnosed with bulky uterus, do not worry and consult your fertility doctor. Most of the women with bulky uteruses will need no or very little treatment. And with treatment, many of them will conceive.
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