What Is Uterus Didelphys

Uterus didelphys, more commonly known as double uterus, is a rare abnormality in which an individual is born with two uteri. It can cause painful periods and complications during pregnancy. Whether surgery is necessary is dependent on the person.

Overview

Uterus didelphys, also known as double uterus or double womb, is a rare disorder that is present at birth in which a foetus develops two uteri. The two cavities of the uterus are narrower compared to the typical uterus cavity. 

This unusual occurrence begins as the unborn female baby undergoes development. In a typically growing female foetus, the uterus develops from two small tubes known as Mullerian ducts.  As the unborn baby grows, these tubes join to create a larger organ, the uterus.

Sometimes, the tubes do not join completely, and each tube may develop in a separate organ, resulting in two uteri. A double uterus may have one or two cervixes (opening into the vagina) and one or two vaginal canals.

Uterus didelphys is rare and impacts 0.3% of the population. It is considered one of the rarest uterine abnormalities.^1,2

In this article, we will explore its causes, its effects on menstruation and pregnancy, and the available diagnosis and treatment options for this unique medical condition.

What is the difference between a uterus didelphys and a bicornuate uterus?

Both bicornuate and uterus didelphys are congenital abnormalities, meaning that they were present at birth. In the case of the bicornuate uterus, you have one uterus, but there’s tissue separating the two halves so that it’s shaped like a heart instead of shaped like an upside-down pear. This is more common than uterus didelphys. If you have uterus didelphys, it means that you have two uteri.¹

Are there any disorders associated with uterine didelphys?

Many women with double uterus are sexually active and have uncomplicated pregnancies. However, sometimes, women with a double uterus can have issues with the following:

• Infertility.
• Kidney abnormalities
• Imperforate anus (a defect present from birth in which the opening to the anus is absent) 
• Endometriosis (a condition in which tissue similar to the lining of the uterus grows on other parts of the body).^{1 2 3}

Symptoms and causes

What are the symptoms of uterus didelphys?

Most people with uterus didelphys have no symptoms, but some may experience discomfort during sexual intercourse or have painful periods (dysmenorrhea).⁵ 

A common way in which those with double uterus and double vagina become aware of their condition is after visiting a healthcare provider due to menstrual bleeding that continues despite the use of a tampon. This scenario can occur when a tampon is placed in one vagina but bleeding still comes from the second uterus and vagina. ²

What are the causes of uterus didelphys?

When Mullerian ducts, the embryonic structure that will ultimately form the female reproductive tract, don’t join properly, they may develop into two uteri rather than one. What causes this to happen is not well understood. It might be connected to an incident during foetal development, or there's a possibility that genetics could have an impact.

There is evidence of family inheritance suggesting that specific mutations (genetic changes) may cause these defects. Furthermore, there are defined genetic syndromes that highlight abnormalities in the female reproductive system.⁶

How does uterine didelphys affect your period?

Uterine Didelphys can impact your period in one or more of the following manners.

• Excessive or unusual bleeding during your period
• Pressure and cramping in the pelvic area before and during your   period
• Painful periods
• Issues with using tampons, like bleeding continuing after a tampon is put in. ¹

Diagnosis

How is uterine didelphys diagnosed?

Double Uterus often doesn’t manifest any symptoms. You may find out that you have a double uterus during a regular pelvic exam. However, imaging tests will confirm the diagnosis.

Your doctor may also decide to use the following tests:

• Ultrasound (either abdominal or inserting it into the vagina)
• MRI (Magnetic resonance imaging)
• Sonohysterogram or saline infusion sonogram (SIS). During this procedure, a thin catheter is used to send into each uterus a salty fluid that helps the ultrasound get sharper detail images.
• Hysterosalpingography. Hysterosalpingography is an X-ray test of the uterus and fallopian tubes. A contrast agent (a special liquid) is inserted into your uterus through the cervix. As this liquid moves, X-rays are taken to determine the size and shape of your uterus. ^{3 4}

Treatment

What Is the treatment for uterine didelphys?

It is not recommended to have surgery to merge the two uteri if you have no symptoms, as this can compromise your remaining uterus. 

In cases of a double vagina along with a double uterus, surgery can be done to remove the wall between the two uteri making childbirth easier.

Surgery might also be advised in cases where you have a partially divided uterus and have experienced a pregnancy loss without any other apparent cause. This surgical intervention can help in keeping a future pregnancy.^{1 2}

Prognosis 

Can I get pregnant with a double uterus?

Some people may experience infertility due to this condition. Generally, it is not the uterus’s shape that holds you back from conceiving. Nevertheless, having a double uterus does increase the likelihood of having a miscarriage and other pregnancy complications.¹

Is there an increased risk of miscarriage if I have a double uterus?

Your chance of miscarriage slightly increases when you have a double uterus. This is because your uterus is smaller and restricts the growth of the unborn baby. It may also affect the placenta and the uterus blood flow. In case of recurrent, late second-trimester miscarriages, your doctor might suggest surgery to improve your chances of having a pregnancy that goes to full term. ¹

How does uterus didelphys affect pregnancy?

Women who have a double uterus often achieve successful pregnancies.² However, the condition increases your risk for

• Miscarriage 
• Breech delivery (when the baby is positioned feet or bottom first instead of head during birth)
• Premature birth
• Decreased live births.⁵ 

Having a double uterus is not an indication of surgery. Many individuals can have an active sexual life and a successful pregnancy. However, if you are pregnant or planning to become pregnant, you should speak with your doctor, as you may need special attention during pregnancy. In certain situations, surgery may be advisable.

Summary

Uterus didelphys, also known as a double uterus or double womb, is a rare congenital condition where an individual is born with two uteri. This anomaly arises due to the incomplete fusion of the Mullerian ducts during fetal development, resulting in two uteri instead of the typical single uterus. It affects 0.3% of the population, making it one of the most infrequent uterine abnormalities.

While many individuals with uterus didelphys may remain asymptomatic, some may experience discomfort during sexual intercourse or suffer from painful periods.

The exact cause of uterus didelphys is not fully understood, but genetics and familial inheritance are believed to contribute to some cases. Specific genetic mutations and syndromes have been associated with abnormalities in the female reproductive system.

Uterus didelphys can impact pregnancy, increasing the risk of complications such as miscarriage, breech delivery, premature birth and others. However, many individuals with a double uterus can still have successful pregnancies. Surgery may be considered in specific cases, particularly when a pregnancy loss occurs without any other medical justification. It is recommended to consult with a healthcare provider to ensure a safe pregnancy.

FAQs

Is having a uterus didelphys genetic?

Health experts do not know why uterine abnormalities happen or if it’s something that is inherited. Because this rare condition sometimes runs in families, they believe that it may have a genetic component.²

Do women with uterus didelphys get two periods?

If you have two uterus along with two vaginas, blood flow can occur from both uterus and vaginas.  You may have very heavy or abnormal bleeding during your period.^1,2