When You're Born Unique: The Unconventional Uterus

http://gynogab.blogspot.com/2009/07/fix-my-uterus-metroplasty.htmlUterine shape is fairly typically the same from woman to woman. It is that classic, well, uterus shape, triangular on the inside, and described as egg shaped when considered as a whole. But women's wombs come in all sorts of sizes and shapes. These are known as uterine anomolies, and the most common are called bicornuate uterus but there are various combinations of doubling of the uterus that are seen. This change in shape is nothing you grow once you have a normal uterus, but it happens when you are a developing fetus, mostly because of failures of fusions from the lower segment  to the upper uterine segment, or a failure of fusion of the left to the right during fetal life. What is left may be a uterus shaped like a heart, or a double, or a half a heart. In rare cases there is no uterus at all. About 4% of the fertile population has such a uterus, and about 12% of the infertile population has these kind of birth defects to their uterus according to a 2001 article by Grimbizis.

When the uterus is left with these shapes the question is whether to correct, and in fact some of the oddest shapes just do not have the pieces and parts to correct. The first step is always to know what is there. Uterine anomalies can be diagnosed fairly accurately by ultrasound examination and definitive pre-surgical diagnosis is actually not common. For more discussion on diagnosis and treatment also read our post on metroplasty. Often what is best is an actual look-see with a hysteroscope. Then a decision can be made at that setting, or at a separate step as to whether it can be or should be corrected. In patients with history of menometarrhagia  in other words bleeding heavily or long, pelvic pain, and/or miscarriages, they may need corrections. Some experts would even still support this position and state that it is not an indicated surgery in someone with primary infertility unless the treatment of other aspects of the infertility did not result in pregnancy. It has become more common for physicians to try to fix certain uterine abnormalities, for instance if you have a septum, or dividing wall hanging in the middle of the uterus where it doesn't belong, before you, the patient, has medical troubles from this. Endometriosis, crampy periods known as dysmenorrhea are also possible from these conditions, and treatment of the uterus can help avoid these complications. Although I don't think I mention this enough in these writings: here would be a great opportunity for a second opinion or a sub-specialist opinion. But what you do want is someone who has done a lot of hysteroscopies. There are options for what type of hysteroscope your gyno can use so be sure to discuss your choices. For some pictures of a type of hysteroscopy, look on the Women's Health Practice Facebook page. Once you do get pregnant, it is considered a high risk pregnancy and you should consider getting opinions with a specialist for this as well.


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