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These abnormalities can reduce uterine space, impair embryo implantation, or increase miscarriage risk. Thankfully, advancements in diagnostic methods and treatments offer promising solutions for this condition. Knowing how uterine abnormalities can affect fertility helps you take the right steps and seek timely care. You can explore options to overcome these challenges with your doctor's guidance.
What Are Uterine Abnormalities?
Uterine anomalies, also called congenital uterine malformations, are structural differences in the uterus that develop before birth. Normally, the uterus forms as two tubes that fuse together during foetal development, creating a single, hollow organ. When this process doesn’t happen correctly, it can result in an abnormally shaped uterus.Types of Uterine Abnormalities
Uterine anomalies are structural differences in the uterus present from birth. The main types are:- Septate uterus: A wall (septum) divides the uterus partially or completely, creating two cavities. It’s the most common anomaly and may increase miscarriage risk.
- Bicornuate uterus: The uterus is heart-shaped with a deep indentation at the top. It is caused by the incomplete fusion of the uterine tubes. It can affect pregnancy positioning.
- Unicornuate uterus: Only one half of the uterus forms, often with a single fallopian tube. It may lead to preterm birth or miscarriage.
- Arcuate uterus: The uterus has a slight indentation at the top. The indentation is usually less than 1 cm deep. It is considered a mild anomaly with minimal impact on pregnancy.
- Uterus didelphys: Two separate uterine cavities form, each with its own cervix. It’s rare but can complicate pregnancy or delivery.
- Agenesis or hypoplasia: The uterus is absent or underdeveloped, leading to infertility.
Acquired Uterine Anomalies
Acquired uterine anomalies are structural changes to the uterus that develop after birth due to medical conditions or past procedures. These are different from congenital anomalies, which are present at birth.- Adenomyosis : The endometrial tissue grows into the uterine wall. It causes heavy, painful periods and discomfort during intercourse.
- Intrauterine adhesions or Asherman’s Syndrome: Scar tissue develops inside the uterus and causes the walls to stick together. Uterine surgeries like dilation and curettage or infections can cause acquired uterine anomalies. It may lead to irregular periods, infertility, or miscarriages.
Causes of Congenital Uterine Anomalies
The exact cause of congenital uterine anomalies is unknown. Over 90 per cent of women with these conditions have a normal number of chromosomes, which is 46 XX.Women exposed to diethylstilbestrol (DES) in the womb have a higher risk of having a congenital uterine anomaly. Currently, there are no well-known risk factors for these conditions and no known way to prevent them.
What is Müllerian Agenesis?
Müllerian agenesis, also known as Mayer-Rokitansky-Küster-Hauser syndrome, is a congenital disorder where the female reproductive tract does not fully develop. It affects structures like the uterus, cervix, fallopian tubes and the upper vagina.This condition occurs when the Müllerian ducts fail to form correctly during early foetal development. As a result, women with MRKH syndrome are born without a functional uterus and upper vaginal canal. However, their external genitalia and ovaries develop normally.
Common Symptoms of Uterine Abnormalities
Some of its most common symptoms are:- Irregular or painful periods
- Heavy menstrual bleeding
- Pelvic pain or pressure
- Infertility or difficulty conceiving
- Recurrent miscarriages
- Pain during intercourse
- Abnormal vaginal bleeding
- No symptoms (in some cases)
Impact of Uterine Abnormalities on Fertility
Uterine abnormalities can interfere with an individual’s ability to conceive. Take a look at how it affects fertility in women:- Impaired embryo implantation: Anomalies like a septate uterus make it harder for an embryo to implant properly. This could lower the chances of successful conception.
- Increased miscarriage risk : A bicornuate uterus or Asherman’s syndrome can create an unstable environment for a growing foetus. This leads to a higher chance of recurrent miscarriages.
- Complications in pregnancy: A septate or arcuate uterus may allow conception but increase the risks of preterm labour or abnormal foetal growth.
- Amenorrhea : A person may not begin menstruating even after reaching the age of menarche.
Do Congenital Uterine Abnormalities Affect Pregnancy?
For many people, uterine abnormalities don't affect their ability to get pregnant and have a baby. However, it may increase the risk of:- Miscarriage
- Weak cervix
- Preterm birth
- Preeclampsia
- Restricted foetal growth
- Breech baby
How Are Uterine Abnormalities Diagnosed?
Below is a list of diagnostic methods commonly used to identify uterine anomalies.- Transvaginal ultrasound: A probe device is inserted into the vagina to capture detailed images of the uterus using sound waves. It helps identify structural abnormalities like fibroids, adenomyosis, or a septate uterus.
- Hysterosalpingogram (HSG): It is an X-ray procedure where dye is injected into the uterus and fallopian tubes. It reveals the shape of the uterine cavity and checks for blockages or anomalies like Asherman syndrome or a bicornuate uterus.
- Magnetic Resonance Imaging (MRI): This is a non-invasive imaging test that uses magnetic fields to create detailed pictures of the uterus. It’s highly effective for diagnosing complex anomalies like adenomyosis.
- Sonohysterogram (Saline Infusion Sonography): A special ultrasound where saline is injected into the uterus to expand the cavity, improving visibility.
Treatment Options for Uterine Abnormalities
Treatment options for uterine abnormalities depend on the type and severity of the condition. Several approaches can help manage uterine issues:- Hysteroscopic resection: A minimally invasive procedure using a hysteroscope to remove endometrial polyps, fibroids, or intrauterine adhesions. It restores the uterine cavity’s shape, improving implantation chances.
- Metroplasty: It is a surgical procedure to correct congenital uterine anomalies, such as a septate uterus, by removing the dividing wall (septum). It expands the uterine cavity, reducing miscarriage risk and improving fertility for women with recurrent pregnancy loss.
- Myomectomy: This surgery removes uterine fibroids while preserving the uterus. It helps relieve symptoms like heavy bleeding or pain. It also improves fertility by removing fibroids that interfere with embryo implantation.
- Adhesiolysis: A procedure to cut and remove scar tissue (adhesions) inside the uterus. It restores the uterine cavity's function and addresses issues like amenorrhea. It also improves fertility by supporting normal menstrual cycles.
- Hormonal therapy: Medications such as birth control pills or progestins help regulate hormonal imbalances associated with conditions like endometrial polyps. They can manage symptoms like irregular bleeding and support the health of the endometrium.
- Gonadotropin-releasing hormone (GnRH) agonists: These drugs temporarily suppress oestrogen production, which helps shrink fibroids.
- In Vitro Fertilisation (IVF): It is a fertility treatment where eggs are fertilised outside the body and embryos are transferred to the uterus. It’s used when anomalies reduce the chances of natural conception.
- Surrogacy: In this option, another person carries and delivers your baby using either your eggs or a donor's eggs.
Although uterine abnormalities can pose challenges to fertility, many women with these conditions have successfully carried pregnancies with the right treatment. Understanding the types, symptoms, and impact of these issues is important for getting the correct diagnosis and care. Fortunately, with advancements in medical technology, options like surgery, hormonal therapy, and IVF are available to address these issues and improve the chances of a healthy pregnancy.
FAQs
- What are uterine abnormalities?
Uterine abnormalities are structural differences in the uterus that can affect fertility. They may be congenital or acquired later in life due to medical conditions or procedures. - What are the symptoms of uterine abnormalities?
Common symptoms include irregular or painful periods, pelvic pain, heavy menstrual bleeding, infertility, recurrent miscarriages, and pain during intercourse. However, some women may have no symptoms. - How are uterine abnormalities diagnosed?
Uterine abnormalities are diagnosed using techniques like transvaginal ultrasound, hysterosalpingogram, MRI, and sonohysterogram.
