A congenital uterine anomaly is a uterus malformation that occurs during embryonic development. In the earliest stages of the life cycle, a woman’s uterus forms in two separate halves that grow together over time. Any small missteps in this development cycle can lead to a misshapen or malformed uterus, creating uterine problems later in life.
Congenital uterine anomalies happen to less than 5 percent of women. However, about 25 percent of women who miscarried have some sort of congenital uterine anomaly. Congenital uterine anomalies mostly occur due to random variations during embryonic development, but some uterine anomalies can result from in-utero exposure to certain substances.
For example, baby girls exposed to diethylstilbestrol (synthetic estrogen) are more prone to develop congenital uterine anomalies than others. Doctors often used this medication between 1938 and 1971 to help prevent miscarriages and premature births. Today, there are no known risk factors proven to increase the potential of developing a congenital uterine anomaly.
Types of Congenital Uterine Anomalies
Ultrasound is one of the most-used methods for diagnosing the type of uterine anomaly present in a patient. Doctors will use ultrasound imaging to determine how the patient’s uterus developed and what type of complications the anomaly may present later in life. Different anomalies will produce different effects and lead to varying long-term health complications.
One of the most common types of uterine anomalies, a septate uterus, describes a uterus with a normal uterine surface, but with two endometrial cavities. This anomaly occurs when the two halves of the uterus only partially combine during fetal development.
The other most common uterine anomaly is a bicornuate uterus. Like the septate uterus, a bicornuate uterus has two endometrial cavities and one external uterine surface. However, a bicornuate uterus has an indented and abnormal uterine surface.
This uterine anomaly describes a uterus with a 1 cm or smaller indentation in the endometrial cavity.
A unicornuate uterus develops only on one side. During fetal development, a baby girl’s uterus develops in two halves that gradually combine to form a single uterus. This anomaly occurs when only one half develops.
This uterine anomaly describes when the two halves of a developing uterus never combine, resulting in two separately developed halves.
This congenital disorder affects about 4 percent of females and occurs during fetal development. This condition results from a malformation of the process of developing Müllerian ducts in the female reproductive system.
These conditions are more than just uterine anomalies, and kidneys often suffer as a result. A woman with a Müllerian anomaly may be missing a kidney, leading to additional medical complications later in life.
Symptoms of Uterine Anomalies
One common thread shared by all the different possible uterine anomalies is that most are asymptomatic. Some women may experience increased pain and discomfort during menstrual cycles, but for the most part, these anomalies do not create significant symptoms on their own.
However, the resulting symptoms often interfere with pregnancy and contribute to lost pregnancies and infertility. Many women do not discover they have a uterine anomaly until they undergo screening for infertility or miscarriage.
After one or more miscarriages, a woman may decide to have a screening to determine the cause, and this is the point when doctors diagnose most uterine anomalies. Women who do experience negative symptoms typically report inconsistent periods or no periods, but the most commonly reported symptoms relate to pregnancy.
Identifying Uterine Anomalies
Doctors use ultrasound imaging to determine which type of uterine anomaly a patient has, and treatment can include many options. Uterine anomaly surgery is a viable option for some women, as it may help restore uterine function and allow for a healthy pregnancy.
However, some anomalies are more difficult to treat, often leading to more significant medical complications. Doctors may also use hysterosalpingograms or MRI procedures to help diagnose uterine anomalies.
Treating Uterine Anomalies
Most uterine anomalies will not require treatment, but treatment generally involves surgery for uterine anomalies. After a positive diagnosis for a uterine anomaly, a women’s surgery specialist will advise the patient about her options.
Most corrective surgery is minimally invasive with little risk, but physicians will recommend surgery only if the uterine anomaly:
- Prevents pregnancy
- Results in miscarriage
- Causes significant pain
Women who have a septate or bicornuate uterus may have the septum wall between the two endometrial cavities removed to restore healthy uterine function. In the case of a unicornuate uterus, the surgeon may remove the undeveloped portion of the uterus, and the patient could possibly have a viable pregnancy using the intact portion. Women at greater risk for premature delivery may require a cervical cerclage to prevent premature cervical dilation.
Is Surgery Right for Me?
Physicians only recommend surgery for a uterine anomaly if the condition prevents pregnancy or prevents the woman from maintaining a pregnancy to full term. In some cases, uterine anomalies can prevent a placenta from attaching correctly, resulting in a miscarriage.
Here are some vital facts to know about uterine anomalies an pregnancy:
- A woman with a septate uterus has a 25 to 47 percent chance of experiencing a miscarriage.
- A woman with a bicornuate uterus will have a higher risk of going into preterm labor.
- Someone with a unicornuate uterus will have about a 37 percent chance of experiencing a miscarriage, and about a 17 percent chance of preterm labor.
Other medical issues, including cervical insufficiency and uterine fibroids, can also interfere with pregnancy and full-term delivery. It’s up to the individual to decide whether her anomaly warrants surgical intervention.
Ultimately, a uterine anomaly may result in only a slightly higher risk of miscarriage for a small malformation, but more significant uterine anomalies can make pregnancy or maintaining a pregnancy to full term impossible. Women should consult their physicians if they have trouble conceiving or experience a sudden onset of symptoms that could indicate a uterine anomaly.
Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS
Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997.
Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.
Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years.
Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.