Getting diagnosed with a uterine abnormality can feel overwhelming, confusing, and even frightening. It's natural to have questions and worries about what comes next. This is because such health issues, while common, can affect everything from menstrual health to the ability to conceive and start a family. Thankfully, uterine abnormality treatment options are available — ranging from surgical procedures to fertility treatments like IVF.
This article will briefly examine the most common options for treating and managing uterine anomalies.
The term uterine abnormalities refers to any anomalies or structural malformations of the female reproductive system that may consequently hinder fertility or create complications during pregnancy. Uterine abnormalities are usually congenital; that is, these abnormalities occur during the fetal stage. These abnormalities usually happen when the Müllerian ducts—two small tubes responsible for forming the female reproductive organs during early fetal development—fail to grow or fuse correctly.
Unfortunately, in most cases, such conditions are usually diagnosed only when conception or pregnancy issues arise. Menstrual issues, the inability to become pregnant, or being unable to carry a successful pregnancy to term are indicators of a possible uterine abnormality. Apart from this, a few other symptoms that could be a sign of uterine anomalies are abnormal vaginal discharge or bleeding and recurring pain and discomfort in the pelvic region.
Müllerian Agenesis
Müllerian Agenesis refers to the partial or incomplete development of the uterus. Women with this disorder usually do not have a uterus.
Septate Uterus
Septate uterus is the most commonly diagnosed uterine abnormality. Although the uterus may appear normal from the outside, a band of tissue divides the inner cavity, splitting the uterus into two. Women with this type of anomaly usually have difficulty conceiving a baby. There is also more chance of preterm birth or early miscarriage.
Arcuate Uterus
This is a minor uterine abnormality characterised by a slight indentation at the top of the uterus. Women with an arcuate uterus may be at risk of early delivery during the later months of their pregnancy.
Unicornuate Uterus
A unicornuate uterus often looks like a banana because only one side of the uterus is developed. Consequently, only one fallopian tube and ovary are functional. Women with this type of uterine anomaly are at risk of difficulty in conceiving a child or being unable to carry the fetus to term successfully. There is also an increased risk of ectopic pregnancy.
Bicornuate Uterus
A bicornuate uterus looks heart-shaped due to the deep dent on the exterior of the uterus. The uterus is partially divided into two parts because of this indentation. Women with a bicornuate uterus are at risk of preterm delivery and miscarriage.
Uterus Didelphys
The didelphic uterus is a rare uterine abnormality whereby two separate uteruses, or double uteruses, exist, each with its own cervix, ovary, and fallopian tube. Women with this disorder are usually able to conceive without much trouble. However, there is a chance of preterm birth.
Diagnosis
It is vital to consult a healthcare provider in case there are persistent issues with menstruation or conception or if there have been repeated miscarriages. This will help determine the exact underlying cause and provide a pathway for appropriately correcting uterine abnormalities. Uterine anomalies can be diagnosed via:
1. Magnetic Resonance Imaging (MRI)
2. Vaginal Ultrasound
3. Hysterosalpingogram
4. Sonohysterogram
Once uterine abnormalities have been confirmed, appropriate treatment measures can be adopted to resolve the issues. The mode of treatment usually depends on the type of uterine abnormality. In some cases, surgery for uterine malformations might be recommended to repair the uterus to enable successful conception and delivery. In contrast to this, the other types may require close monitoring and emergency care, such as delivery via C-section, during pregnancy.
For instance, hysteroscopic septum resection surgery or hysteroscopic metroplasty may be recommended if a septate uterus has been detected. This will effectively remove the tissue wall separating the uterine cavity, thereby increasing the chance of getting pregnant. In a unicornuate uterus, one side of the uterus is either missing or blocked. If the other side works properly, surgery might be done to remove the blocked part.
However, if the scans show a bicornuate, arcuate, or didelphic uterus, then surgical intervention is rarely recommended. In most cases, rather than treating the uterine abnormality, the focus will be on managing any related issues, such as recurrent miscarriages, or helping with fertility if needed. For instance, if the baby's position during the later stages of pregnancy seems inappropriate or life-threatening, the doctor may recommend an emergency C-section to deliver the baby safely. If there is a history of miscarriage during the later stages of pregnancy, the doctor may put in a stitch in the cervix (cervical cerclage).
When the uterus is absent due to Müllerian Agenesis or is severely malformed, natural conception isn't possible. However, In-vitro fertilization (IVF) provides a promising alternative. In this process, eggs are collected from the ovaries and fertilised in a lab. If the woman cannot carry a pregnancy herself, the resulting embryo can be implanted into a surrogate's uterus.
While a diagnosis of a uterine abnormality can be emotionally challenging, it's important to remember that many women with these conditions go on to have healthy pregnancies. Advances in medical imaging, surgical techniques and fertility treatments have made it possible to manage even complex uterine anomalies effectively. Most women opt for IVF, and uterine anomalies are no longer seen as a barrier to parenthood but rather as a condition that can be managed with optimum medical support and care.
Most women with uterine abnormalities are asymptomatic, i.e. they do not face significant health issues. Most abnormalities are only diagnosed once women face menstrual or fertility problems. Even after the diagnosis has been confirmed, it must be noted that not all uterine abnormalities require medical or surgical treatment. While a septate uterus may require surgical restructuring, the other anomalies may require only close monitoring during pregnancy.
In the case of a septate uterus, the wall of tissue that separates the uterine cavity into two may be surgically removed.
Hysteroscopic septum resection is a type of surgery that is currently available for treating a septate uterus. This surgery will result in the removal of the abnormal tissue wall that divides the uterus.
Uterine abnormalities could hinder fertility and hamper the chances of getting pregnant or carrying the baby till the due date. In cases where the uterus is absent (Müllerian Agenesis) or severely malformed, natural conception is not possible. However, in such situations, IVF offers a hopeful alternative. With IVF, eggs can be retrieved from the ovaries and fertilised in a lab. The resulting embryo can then be implanted into a surrogate's uterus if the woman's uterus cannot carry a pregnancy.
