How bulky uterus affects fertility?

Normal dimensions of uterus ranges from 7.5cm x 3.5cm. Bulky uterus is a condition in which uterus is bigger in size than it is supposed to be.

Symptoms:

  • Heavy menstrual flow which may cause anemia.
  • Painful menses.
  • Heaviness in lower abdomen.
  • Difficulty in conceiving.
  • Miscarriage or premature delivery.
  • Bowel & urinary problems like constipation or increased frequency of urination.

Some patients might not feel any symptom & presence of bulky uterus can be find during a pelvic examination or an ultrasound.

Causes:

  • Adenomyosis: It is the diffuse thickening of the uterus when the endometrium, i.e., the tissue coating the uterus, moves into the external muscle mass of the uterus. It is noncancerous condition that has similar symptoms as that of fibroids.
  • Fibroids: One of the most commonly known reasons behind a bulky uterus is fibroids. Fibroids are non- cancerous tumors that are like little lumps or bulges. They are found along the lining of the uterus, as well as into uterine cavity and very common in women between the ages of thirty & forty.
  • Perimenopause: Perimenopause is refer as the stage before menopause. Fluctuating hormone levels during this stage may cause the uterus to enlarge.
  • PCOS: Polycystic Ovarian Syndrome or PCOS is a medical condition that can make the uterus grow. It is after effect of hormonal imbalance that leads to abnormal menstruation cycle and the shedding of the endometrial lining.
  • Ovarian Cysts: Ovarian cysts are usually asymptomatic and goes on their own. But in some cases, they cause the enlargement of the uterus.
  • Endometrial Cancer: Uterine cancers can cause the uterus to enlarge thus resulting in a bulky uterus.

How does a bulky uterus affect chances of conception?

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 mechanism:

  • Blocking ascend of sperms from vagina.
  • By blocking tubal opening.
  • Disturbed blood supply to uterine cavity.
  • Few fibroids can even lead to miscarriages and preterm birth.
  • Commonly the diagnosis is suspected by pelvic examination, when doctors find that uterus is larger than expected. It is then confirmed by a Trans- Vaginal Ultrasound (TVS).
  • Not all fibroids affect fertility. Many patients with fibroids conceive naturally
  • Decision to treat a fibroid is taken after considering number, size & location of fibroids.
  • Large fibroid causing pain, pressure symptoms or abnormal bleeding needs removal irrespective of its location.
  • Sub- mucous 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.
  • Small fibroids, far away from the uterine cavity can be left untreated.
  • Most of the fibroids can now a days be removed by endoscopic surgeries, either laparoscopy or hysteroscopy depending upon location of fibroids.
  • Very rarely, an open surgery in the form of laparotomy might be needed for fibroid removal, especially if the fibroid is very big.
  • For adenomyosis, unfortunately there is no permanent cure. However, few medicines can temporarily decrease the severity of adenomyosis & help a women to conceive.

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