Double uterus

Definition

In a female fetus, the uterus starts out as two small tubes. As the fetus develops, the tubes normally join to create one larger, hollow organ — the uterus. Sometimes, however, the tubes don't join completely. Instead, each one develops into a separate structure. This condition is called double uterus (uterus didelphys).

Double uterus is rare — and sometimes not even diagnosed. The percentage of women with a double uterus is likely higher in women with a history of miscarriage or premature birth.

Treatment is needed only if a double uterus causes symptoms or complications, such as pelvic pain or repeated miscarriages.

Symptoms

Some women have a double uterus and never realize it — even during pregnancy and childbirth. Each cavity in a double uterus often leads to its own cervix. Some women with a double uterus also have a duplicate or divided vagina.

Possible signs and symptoms may include:

• Unusual pain before or during a menstrual period
• Abnormal bleeding during a period, such as blood flow despite the use of a tampon

When to see a doctor
If you have signs and symptoms common to a double uterus, make an appointment with your doctor. Receiving an early diagnosis is especially important if you plan to become pregnant, or if you've had repeated miscarriages. Your doctor can recommend treatment options to improve your chances of getting pregnant, staying pregnant and having a safe delivery.

If you've been diagnosed with a double uterus and are considering pregnancy, talk with your doctor first. Together you can make a plan for optimal care during pregnancy and delivery.

Causes

Researchers don't know what causes double uterus. This condition may be associated with kidney abnormalities, which suggests that something may influence the development of these related structures before birth.

Complications

Many women with a double uterus have normal sex lives, pregnancies and deliveries. But sometimes a double uterus and other abnormalities of uterine development lead to infertility or miscarriage. A double uterus may also cause premature birth or unusual positions of the baby in the uterus, such as bottom down (breech presentation).

Preparing for your appointment

You're likely to start by seeing your family doctor or primary care provider. However, in some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist).

Here's some information to help you prepare for your appointment and what to expect from your doctor.

What you can do

• Ask about any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance to prepare for any possible tests.
• Write down any symptoms you've had, and for how long.
• Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
• Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

For signs and symptoms common to a double uterus, some basic questions to ask your doctor include:

• What is the most likely cause of my signs and symptoms?
• Are there any other possible causes?
• What treatment approach do you recommend, if any?
• Am I a candidate for surgical treatment? Why or why not?
• Am I at increased risk of problems during pregnancy?
• What options are available to improve my chances of a successful pregnancy, if necessary?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• What are your signs and symptoms, and when did you first notice them?
• Are your signs and symptoms continuous, or do they come and go?
• Do you menstruate regularly?
• What is a typical menstrual period like for you?
• Have you ever been pregnant?
• If you have been pregnant, what was the outcome?
• Do you hope to have biological children in the future?
• Are you currently being treated or have you recently been treated for any other medical conditions?

Tests and diagnosis

A double uterus is often diagnosed during a routine pelvic exam when the doctor observes a double cervix or feels an abnormally shaped uterus. If the doctor suspects an abnormality, he or she may recommend any of the following tests:

• Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of the inside of your body. There's usually no special preparation needed for an MRI; however, the test is conducted in a confined space, and is noisy. It's a good idea to let your doctor know if you're bothered by small spaces or loud noises. He or she may prescribe a mild sedative to make you more comfortable during the test.
• Ultrasound. This test uses high-frequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer is used. The transducer sends the images to a computer screen. During the test, the transducer is either pressed against your abdominal skin or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view. To make imaging of the uterus easier through the abdomen, you'll need to drink enough fluid before the exam to fill your bladder. Your doctor will let you know exactly how much to drink and how soon before the exam you need to drink the extra liquids.
• Hysterosalpingography. For this test, a special dye is injected into your uterus through your cervix. This part of the test may be slightly uncomfortable. If you're concerned, ask your doctor to prescribe a mild sedative for the test. As the dye moves through your reproductive organs, X-rays are taken to determine the shape and size of your uterus. These X-rays are displayed instantly on a TV-like monitor.

Treatments and drugs

If you have a double uterus but you don't have signs or symptoms, treatment is rarely needed. Surgery to unite a double uterus is rarely done — although surgery may help you sustain a pregnancy if you have a partial division within your uterus and no other medical explanation for a previous pregnancy loss.

If you're pregnant and have a double uterus, your risk of pregnancy complications may be higher due to the smaller size of your uteri. Share any concerns you may have about childbirth with your doctor, because he or she may suggest ways to help prevent preterm delivery or manage labor.