Congenital uterine anomalies are malformations of the uterus that develop during embryonic life. Congenital uterine anomalies occur in less than 5% of all women, but have been noted in up to 25% of women who have had miscarriages and/or deliveries of premature babies. Like other organs in the body, a woman’s reproductive organs take shape when she is still a fetus inside her mother’s uterus.

When a woman is in her mother’s womb, during normal development, these ducts come together. When this happens, a single uterus with an open cavity and two fallopian tubes are formed. Sometimes the uterus and fallopian tubes may not form like they should. When a woman’s uterus develops differently from most women, it is called a uterine anomaly.

Different Types of Uterus

The uterus  develops in intrauterine life. When this development is disturbed, different shaped uterus  develops. The types of uterus (misshapen uterus) can be listed as;

• Unicornuate uterus: only one half of the uterus has developed.
• Arcuate uterus: An arcuate uterus, which means there is a “dent” on the top of the uterus. This situation does not cause any problems with pregnancy.
• T shaped uterus: A t-shaped uterus is a type of uterine malformation wherein the uterus is shaped resembling the letter T.This is typically observed in DES (diethylstilbestrol)-exposed women. DES is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy  T shaped uterus is associated with failed implantation, increased risk of ectopic pregnancy, miscarriage and preterm delivery. There is a hysteroscopic surgical procedure to correct the malformation.
• Bipartite uterus / bifid uterus / bicornuate uterus / uterus bikornis: A bicornuate uterus, in which two uteri share a single cervix and vagina. This can cause painful periods if the cervix does not allow blood to flow through and can be corrected with surgery.
• Didelphic uterus / 2 uterus / two uterus / bi uterus: the two halves of the uterus remain separate.
• Septate uterus / subseptate uterus / partial septate uterus / divided uterus: In this situation, there is a fibrous band of tissue going through the uterus. This fibrous band can be removed through a minimally invasive procedure known as a hysteroscopy.
• Hypoplastic uterus / infantile uterus / small uterus / narrow uterus.

These terminology and classification is developed by American Fertility Society classification of müllerian anomalies.

Normal shape of the uterus is a shown in the figure above. The abnormalities in the uterine shape might cause problems in getting pregnant or pregnancy complications. Among the misshapen uterus the worst outcome is among septum cases. There is a high rate of abortions in uterine septum cases and these need to be corrected by hysteroscopy. Another uterine abnormality that has to be corrected before pregnancy is T shape uterus. When T shape uterus is detected hysteroscopic correction is required to overcome infertility or early pregnancy losses. The other uterine abnormalities might be associated with pregnancy complications to some degree but preconception correction with surgery is not recommended.

The position of the uterus in the pelvis

The uterus is resting in the pelvis. In most women the uterus position is towards the anterior of the pelvis. This is called anteverted and anteflexed uterus. In some women the position of the uterus in the pelvis is towards the back. This is called  retroverted uterus /reverse uterus/retroflexed uterus.

This terminology is changed now. The new classification system, that is developed by the European society of gynecological endoscopy (ESGE), below is being used now.

Uterine prolapse

Pelvic organ prolapse is a condition that affects the “pelvic floor.” The pelvic floor is the name for the muscles that support the organs in the pelvis, including the bladder, rectum, and uterus . Pelvic organ prolapse is when these muscles relax too much. This causes the organs to drop down and press against or bulge into the vagina.

Prolapse can affect different organs. Different terms for the types of prolapse are used

• Bladder – If the bladder bulges into the vagina, it is called “cystocele.”
• Rectum – If the rectum bulges into the vagina, it is called “rectocele.”
• Uterus – If the uterus bulges into the vagina, it is called “uterine prolapse.”

Pregnancy, obesity, and older age can increase your risk of having pelvic organ prolapse.

Uterine prolapse is replacement of the uterus towards down (dropped uterus). There are different stages. When the uterus comes out of the vagina then the patient needs uterine prolapse surgery. In elderly women or in women who completed their families, removal of the uterus is the preferred treatment (vaginal hysterectomy). If the women wishes to preserve the uterus or if the women is quite young ,uterine prolapse treatment can be suspension of the uterus in the pelvis by surgery.

Many times, prolapse does not cause any symptoms The uterus coming down can also cause urinary problems. These urinary problems may be leaking urine when you laugh, cough, or sneeze or needing to urinate all of a sudden. In most cases the bladder accompanies the fallen uterus. The weak uterus and the weak pelvic connective tissue causes protruding uterus or bulging uterus and bulging bladder. Other symptoms include: fullness or pressure in the pelvis or vagina, an aching feeling in the pelvis,, a bulge in the vagina or coming out of the vagina and trouble having a bowel movement. In addition when using the toilet, you might need to press on the bulge in your vagina with a finger to get out all your urine or to finish a bowel movement.

Treatment options

People who have no symptoms or who are not bothered by their symptoms do not need treatment. If you do have symptoms that bother you, your treatment options might include:

–Pelvic floor muscle exercises: This involves working with a physical therapist or more commonly performing Kegel excercises for 8 to 12 weeks to strengthen your pelvic muscles.

–A vaginal pessary: This device fits inside your vagina to support the bladder and push it back into place. Pessaries come in different shapes and sizes. If this treatment option is suitable for you, we will talk to you about your options and make sure your pessary fits your body.

–Surgery: A surgeon can move organs back where they belong and strengthen the tissues that keep them in place. Or vaginal hysterectomy may be performed.  Vaginal hysterectomy is a procedure in which the uterus is surgically removed through the vagina You should only consider this type of surgery if you do not plan to have children or are done having children.

Frequently asked questions

Can uterine anomalies affect my chances of getting pregnant?

Yes, certain uterine anomalies can affect fertility. For example, a septate uterus can make it harder for an embryo to implant and increase the risk of miscarriage. However, the impact on fertility can vary depending on the specific anomaly and its severity.

How are uterine anomalies diagnosed?

Uterine anomalies are typically diagnosed through imaging tests, such as ultrasound or MRI. A healthcare provider will review your medical history, perform a physical examination, and order these tests to assess the structure of your uterus.

Are uterine anomalies treatable?

In some cases, uterine anomalies can be treated or corrected through surgical interventions. For example, a septate uterus can often be surgically removed to improve fertility outcomes. However, not all anomalies require treatment, and the approach will depend on your specific situation.

Can I still have a healthy pregnancy with a uterine anomaly?

Yes, many women with uterine anomalies can have successful pregnancies. However, the outcome can depend on the specific type of anomaly, its severity, and other factors such as your overall reproductive health. Working closely with your healthcare provider and a fertility specialist can increase your chances of a healthy pregnancy.

Can uterine anomalies cause painful periods?

Some uterine anomalies, such as bicornuate or unicornuate uterus, can be associated with painful periods. The abnormal shape of the uterus can lead to increased pressure and cramping during menstruation. If you experience severe or prolonged menstrual pain, it’s important to consult with your doctor for evaluation and management options.