Bulky Uterus(Adenomyosis) or भारी गर्भाशय: What complications it causes?

In this video SimpliHealth expert gynecologist  Dr. Heena Chawla is talking about Bulky Uterus(Adenomyosis) or भारी गर्भाशय. Also she is answering some important questions that people usually ask their gynecologist like:

• My Ultrasound has reported a bulky uterus. Do I have to remove the uterus for this, or will I conceive with this report?

What is Bulky Uterus(Adenomyosis)?

Bulky, as experts know, is bigger than the standard size. The normal size of the uterus is 6.5 *  4*3 cms, so bulky is if it is more than that, technically, if the uterus size is more than 8 cm, it is a bulky uterus. 

Often our experts have noticed in the ultrasound that it is written in bold letters that I have a bulky uterus, many times, my friends call me and ask if it’s a bulky uterus in ultrasound. Do I have to do anything ? Do I need treatment for that?

Bulky Uterus Causes

You have to understand the reason behind the bulky uterus is the previous pregnancy. If you have any last pregnancy, during pregnancy, the uterus size increases to 35-36 cm, and slowly it shrinks to its standard size. Generally a gap of 0.5-1 cm is observed during shrinkage, so in that case 7.5  is normal and there is nothing to worry about as long as there is no heavy bleeding, or backache.

Bulky Uterus with Thickened Endometrium

Apart from this, one thing more important in the bulky uterus is the layers of the uterus. One is the innermost layer called the Endometrium. The other one is the muscle layer that is the 

myometrium, if there is an increase in the thickness in the innermost layer of the uterus due to some reason that also comes in the bulky uterus. And if there is an increase in thickness in the muscle layer in the myometrium for some reason, that is also considered the bulky uterus. 

The most important reason for the thickness of the myometrium is the presence of fibroids. Fibroids are known as rasouli in the everyday language. Suppose these are present in the innermost layer of the uterus inside the endometrium. 

In that case, that will prevent pregnancy which may result in heavy bleeding or prolonged bleeding, one may have back pain, and the duration of periods may increase. So if any couple who are planning pregnancy, fibroids are present in the innermost layer, the endometrium, also known as submucosal fibroids. It is necessary to remove them. Suppose they are present in the muscle layer called intramural fibroids,their impact will  depend upon the size and the location of the fibroids. 

If they are not pressing the innermost layer of the uterus, they will not affect the natural conception process. Still, sometimes few fibroids increase in size, and they start pushing the innermost layer. So there are some changes in the internal environment of the uterus because of the large size of fibroids. It may bring problems in natural conception, and even if you have naturally conceived, it may lead to abortion. So, our experts need to remove them, which could be done by laparoscopy. Another reason is adenomyosis. 

What happens in adenomyosis? 

The menstrual blood starts accumulating in the muscle layer of the uterus, and it doesn’t find an outlet. So after every cycle, when it starts getting in the muscle layer eventually results in the large size of the uterus, called a bulky uterus. 

Apart from this, if I would say the couples planning pregnancy, the presence of bulky uterus or swelling in the uterus is one of the main reasons for being unable to conceive naturally. Among them, tuberculosis is the most crucial cause or occurrence of any other type of infection that may affect the process of natural conception. 

For those patients who have tuberculosis, it has been seen that around 40% of couples, tuberculosis is a significant factor in India in preventing conception. Most commonly, these tubes are affected, and in up to 50% of cases due to tuberculosis infection, the tubes are damaged, thereby affecting the conception process.

Apart from this, the innermost layer of the uterus, due to the tuberculosis infection, i.e., the innermost layer of the uterus, that is, the endometrium, starts sticking to each other. Due to this, there is a formation of adhesion. The pattern is that the number of days of the periods start increasing, and as the endometrium layer gets stuck to each other, in some cases, the periods start decreasing. Some patients may have amenorrhea, i.e., periods stop abruptly. In addition to tuberculosis, it gives other signs you may have weight loss, loss of appetite, and some may have a low-grade fever. 

Diagnose Tuberculosis

There are many simple tests to diagnose tuberculosis, and it can be treated very easily. Apart from this, there are more chronic pelvic infections, for example, PID, due to which the size of the uterus gets bulky. Until the bulky uterus doesn’t give symptoms, we shouldn’t fear by analyzing the ultrasound report. 

If we have heavy bleeding or have back pain, or our periods are coming early, we should consult a gynecologist and get this treatment for the bulky uterus. And yes, if you are planning pregnancy and have been diagnosed with a bulky uterus in the ultrasound, you should meet your doctor and consult with her about whether we need any treatment.

In many cases, it happens that it is an incidental find. Experts go for an ultrasound, and are diagnosed with fibroids or a bulky uterus. So in many cases, experts continue the pregnancy by prescribing mild medicines, and experts can continue with the pregnancy. So one should meet the doctor and find out whatever treatment is possible and discuss it.

Thank you