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A woman in her 40s presented with a 2-day history of progressive left lower limb swelling and dyspnoea. She had a background of heavy menstrual bleeding and previously underwent insertion of an intrauterine device 2 years earlier, at which time pelvic imaging was not performed. On presentation, imaging demonstrated bilateral deep vein thromboses and a large saddle pulmonary embolism in the absence of conventional thromboembolic risk factors. Further evaluation revealed a markedly enlarged multifibroid uterus causing compression of the inferior vena cava (IVC) and bilateral iliac veins, resulting in venous stasis and thromboembolism. She was treated with therapeutic anticoagulation and managed non-surgically with two uterine artery embolisations, achieving symptom resolution and radiological improvement in venous compression on follow-up imaging. This case highlights uterine fibroid-related IVC compression as a rare cause of extensive venous thromboembolism and underscores the importance of early pelvic examination and imaging in women with abnormal uterine bleeding.