Bicornuate Uterus: Symptoms, Causes and Diagnosis

Written by Medicover Team and Medically Reviewed by Dr Vineela Medapati , Gynecologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

A bicornuate uterus is a congenital condition in which the uterus has a heart shape with a deep indentation at the top. This shape results from the incomplete fusion of the two Mullerian ducts during fetal development. The Mullerian ducts are the precursors to the uterus, fallopian tubes, and upper vagina. When the fusion is incomplete, it results in the characteristic bicornuate shape of the uterus.

This condition can sometimes be asymptomatic and may not cause any issues for some women. It can, however, be associated with certain reproductive challenges. Understanding the underlying cause of a bicornuate uterus can help healthcare providers tailor appropriate management strategies for individuals affected by this anatomical variation.

What Are the Types of Bicornuate Uterus?

There are two main types of bicornuate uterus: complete and partial. These structural variations can impact fertility, pregnancy outcomes, and may require specialized management for women seeking to conceive or experiencing reproductive issues.

Complete bicornuate uterus: In this type, the uterus is completely divided into two separate horns.
Partial bicornuate uterus: Characterized by a partial division of the uterus with a single fundus.
Septate uterus: The septum divides the uterus partially or completely, affecting fertility and pregnancy outcomes.
Arcuate uterus: A minor indentation in the uterine wall, often considered a variation of normal anatomy.
Unicornuate uterus: A rare condition where only one half of the uterus develops, potentially impacting fertility and pregnancy.
Didelphys uterus: Also known as a double uterus, this condition involves the presence of two separate uteri and cervixes.

What Are the Symptoms of a Bicornuate Uterus?

A bicornuate uterus may present with symptoms such as recurrent miscarriages, preterm labor, and infertility issues. Additionally, some individuals may experience pain during menstruation or intercourse, abnormal vaginal bleeding, and urinary problems.

These symptoms can vary in severity from person to person and may require medical evaluation for proper diagnosis and management.

Irregular menstrual cycles are a common symptom of a bicornuate uterus due to the abnormal shape of the uterus.
Recurrent pregnancy loss can occur with a bicornuate uterus, as the shape may affect the ability to carry a pregnancy to full term.
Pelvic pain may be experienced by some individuals with a bicornuate uterus, often due to the structural anomalies in the uterus.
Increased risk of preterm labor and breech presentation is associated with a bicornuate uterus, impacting pregnancy outcomes.
Infertility may be a concern for some individuals with a bicornuate uterus due to potential challenges in implantation and carrying a pregnancy.

What Are the Causes of a Bicornuate Uterus?

The main cause is believed to be a disruption in the normal fusion of the Mullerian ducts, which form the uterus during embryogenesis. Genetics may also play a role, as there is a familial tendency toward certain uterine anomalies.

Other potential factors contributing to the development of a bicornuate uterus include exposure to certain medications or environmental factors during pregnancy. While the exact cause may vary among individuals, understanding these factors can help in diagnosing and managing this condition effectively.

Genetics plays a significant role in the development of a bicornuate uterus, with inherited factors contributing to the condition.
Hormonal imbalances can disrupt normal uterine development, leading to the formation of a bicornuate uterus.
Intrauterine exposure to certain teratogenic agents during fetal development can result in the formation of a bicornuate uterus.
Abnormalities during Mullerian duct fusion in early fetal development can cause a bicornuate uterus to form.
Environmental factors such as exposure to toxins or radiation can interfere with uterine development and result in a bicornuate uterus.

When to See a Doctor for a Bicornuate Uterus?

If you experience recurrent pregnancy loss, severe pelvic pain, or unusually heavy menstrual bleeding, consult a gynecologist or reproductive endocrinologist for proper evaluation.

These specialists can diagnose a bicornuate uterus through imaging studies and recommend appropriate management strategies to improve your reproductive outcomes and overall health.

You should see a doctor if you have:

Multiple miscarriages or difficulty maintaining pregnancy despite trying to conceive
Severe menstrual cramps or abnormally heavy bleeding that disrupts daily activities
Persistent pelvic pain or unusual abdominal discomfort unrelated to menstruation

Get medical help immediately if:

Sudden severe abdominal pain accompanied by fever, which may indicate infection
Heavy vaginal bleeding that soaks through multiple pads per hour during pregnancy
Signs of ectopic pregnancy, such as sharp one-sided pain with dizziness or fainting

These could be signs of a serious complication like ectopic pregnancy, which needs urgent care.

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How is Bicornuate Uterus Diagnosed?

To diagnose a bicornuate uterus, a healthcare provider typically begins with a physical exam and medical history review. Imaging tests like ultrasound, magnetic resonance imaging (MRI), or hysterosalpingography may be used to visualize the uterus's shape and structure.

These diagnostic methods help confirm the presence of a bicornuate uterus by identifying the characteristic heart-shaped structure with a deep indentation at the top. Following a thorough assessment, the healthcare provider can discuss treatment options and management strategies tailored to the individual's specific situation.

Bicornuate uterus diagnosis typically involves imaging tests like ultrasound, MRI, or hysterosalpingography to visualize the uterus's shape.
A hysteroscopy may be performed to directly view the uterus's structure and confirm the presence of a bicornuate uterus.
Three-dimensional ultrasound imaging can provide detailed visualization of the uterus to aid in diagnosing a bicornuate uterus.
Evaluation of a patient's medical history and symptoms is crucial in the diagnostic process of identifying a bicornuate uterus.
Laparoscopy may be used to assess the uterus's shape and confirm the diagnosis of a bicornuate uterus.

What Are the Treatment Options for a Bicornuate Uterus?

A bicornuate uterus does not always require treatment, especially if it is not causing symptoms or pregnancy complications. Treatment depends on the severity of the uterine abnormality, reproductive history, and associated symptoms.

Regular monitoring: Women without symptoms or reproductive problems may only require routine gynecological follow-up.
High-risk pregnancy care: Pregnant women with a bicornuate uterus are closely monitored with frequent prenatal visits and ultrasound examinations to reduce the risk of complications.
Cervical cerclage: A stitch may be placed around the cervix during pregnancy if cervical insufficiency is present to reduce the risk of miscarriage or preterm birth.
Surgical correction (Strassman metroplasty): In women with recurrent pregnancy loss or poor pregnancy outcomes, reconstructive surgery may be recommended to unify the uterine cavity.
Management of associated conditions: Other reproductive tract abnormalities or hormonal conditions are treated as needed to improve reproductive health.
Fertility counseling: Women planning pregnancy may benefit from preconception counseling and individualized care from a gynecologist or fertility specialist.

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What Are the Risk Factors of a Bicornuate Uterus?

Risk factors for developing a bicornuate uterus include genetic factors, hormonal imbalances during fetal development, exposure to certain medications or chemicals in utero, and a family history of uterine abnormalities.

Women with a bicornuate uterus may have a higher risk of recurrent miscarriages, preterm labor, and breech presentation during pregnancy. Early detection and proper management by healthcare providers can help mitigate potential complications associated with this condition.

A family history of a bicornuate uterus increases the risk of inheriting the condition.
Hormonal imbalances can contribute to the development of a bicornuate uterus.
In utero exposure to certain teratogens may raise the likelihood of a bicornuate uterus.
Genetic predisposition plays a role in the susceptibility to a bicornuate uterus.
Maternal age over 35 years can be a risk factor for developing a bicornuate uterus.

What Are the Complications of a Bicornuate Uterus?

A bicornuate uterus may not cause symptoms in every woman, but it can increase the risk of certain pregnancy and reproductive complications due to the abnormal shape of the uterus.

Recurrent miscarriage: The abnormal uterine shape may increase the risk of pregnancy loss, especially during the second trimester.
Preterm labor and premature birth: Reduced space within the uterus can trigger early labor.
Breech or abnormal fetal position: The baby may not have enough room to move into a head-down position before delivery.
Cervical insufficiency: Weakening of the cervix may lead to early cervical opening during pregnancy.
Restricted fetal growth: In some cases, limited uterine space may affect the baby's growth.
Increased likelihood of cesarean delivery: Abnormal fetal positioning and pregnancy complications may make a C-section necessary.