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). A double uterus may have one opening (cervix) into one vagina, or each uterine cavity may have a cervix. There may even be two vaginas.
Double uterus is rare — and sometimes never diagnosed. The percentage of women with a double uterus is likely higher in those with a history of miscarriage or premature birth.
Treatment is needed only if a double uterus causes symptoms or complications, such as pelvic pain, repeated miscarriages or preterm labor.
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 pressure or cramping 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 of a double uterus, make an appointment with your doctor. 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.
Researchers don't know what causes a double uterus. This condition may be associated with kidney abnormalities, which suggests that something may influence the development of these related structures before birth.
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).
You're likely to start by seeing your primary care provider. However, in some cases when you call to set up an appointment, you may be referred to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist) or a doctor who specializes in reproductive hormones and optimizing fertility (reproductive endocrinologist).
What you can do
To prepare for your appointment:
- Ask if there's anything you need to do in advance to prepare for any possible tests.
- Make a list of 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, herbs or supplements you're taking.
- Take a family member or friend along, if possible, to help you remember everything.
- Make a list of questions to ask your doctor to help you make the most of your visit.
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?
- Are there any brochures or other printed materials that I can have? What websites do you recommend?
Don't hesitate to ask questions 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?
A double uterus may be diagnosed during a routine pelvic exam when your doctor observes a double cervix or feels an abnormally shaped uterus. If your doctor suspects an abnormality, he or she may recommend any of the following tests:
- 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 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. A 3-D ultrasound may be used where available.
- Sonohysterogram. The sonohysterogram (son-o-HIS-ter-o-gram), an ultrasound scan, is done after fluid is injected through a tube into your uterus by way of your vagina and cervix. This allows your doctor to look for problems in the shape of your uterus.
- Magnetic resonance imaging (MRI). The MRI machine looks like a tunnel that has both ends open. You lie down on a movable table that slides into the opening of the tunnel. This painless procedure uses a magnetic field and radio waves to create cross-sectional images of the inside of your body.
- Hysterosalpingography. During a hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fe), a special dye is injected into your uterus through your cervix. As the dye moves through your reproductive organs, X-rays are taken to determine the shape and size of your uterus and whether your fallopian tubes are open.
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 uterine cavity. This factor may lead to early delivery, often by C-section. 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.