What do I need to know about a septate uterus?

Having a septate uterus is a very common malformation in women. What are the symptoms of a septate uterus? How is it diagnosed? Find out everything you need to know in this article.

What is a septate uterus?

There are different forms of uterus in women. The partitioned uterus is characterized by a partition that divides the uterine cavity in two, depending on the height and shape of the partition.

The first form is the cervical septate uterus: in this case, the septum is located at the cervix (the neck is the lower part of the uterus). The second form is the corporal septate uterus: in this case, the septum is located at the bottom of the uterus.

The third form is called "subtotal septated uterus". In this case, the septum runs from the bottom of the uterus down to the isthmus (the part before the cervix).

Finally, the last form of partitioned uterus is the total partitioned uterus. In this case, the partition runs from the bottom of the uterus to the cervix, and sometimes even into the vagina. In this case, we also speak of a complete urethro-vaginal septum.

Is it normal to have a septate uterus?

As explained above, the septate uterus is the most common malformation today. It accounts for 55% of all mullerian malformations. Scientists have not really been able to pinpoint the cause. The most likely is genetic, as in many cases (1 in 5) it is associated with polycystic ovary syndrome (PCOS).

What causes a malformed uterus?

The causes of this uterine malformation can be traced back to embryogenesis. It is during embryo formation that the malformation occurs.

The uterus is formed by the fusion of the Müllerian ducts. The two ducts fuse between the 10th and 13th weeks. However, in the case of a partitioned uterus, a malformation and a fusion defect can be observed at this stage.

What are the effects of a closed uterus on the body and health?

Although this type of anomaly is very common, it can affect health at different levels.

About pregnancy

The uterus is where the fetus develops during pregnancy. Having a partitioned uterus can affect the progress of the pregnancy, fertility and fetal development.

There are several possible risks: 

• First of all, the risk of miscarriage is very high when you have a septate uterus, and even higher, whether it's a late or early miscarriage ;
• The risk ofpremature delivery is also higher, as the fetus can run out of room and go into premature contractions;
• A breech birth (when the baby has not been able to turn around) is also more risky;
• With a closed uterus, it is also more difficult to envisage medically assisted procreation, as implanting an embryo in this case is more delicate.

Pregnancy with twins can give rise to complications, and requires increased surveillance.

Of course, it's not impossible to carry a pregnancy to term, but it does require special monitoring and rest, and sometimes bed rest to prevent the early arrival of the baby.

On the periods

A partitioned uterus does not present any particular consequences or pain on the periods.

How is a septate uterus diagnosed?

Diagnosis begins with the detection of symptoms, such as : 

• Pain or discomfort during intercourse;
• Difficulty inserting internal sanitary tampons or menstrual cups;
• Repeated miscarriages;
• Premature delivery.

When a woman is prone to recurrent miscarriage (more than 3 miscarriages), late miscarriage (after 14 weeks), or premature delivery (before 30 weeks), a septate uterus can be assumed.

In these situations, or when these symptoms are observed, you should approach medical staff for diagnosis. Diagnosis can be made using3D ultrasound. It is also advisable to seek specialist advice to carry out a complete work-up and rule out other malformations or pathologies such as bicornuate uterus, cord uterus or hypoplasia.

In some cases, an operation can be envisaged so that the patient can embark on a new pregnancy project.

The operation is performed under hysteroscopy with ultrasound. Between the 4th and 6th week after lsurgery, check-ups are carried out to ensure that healing is going well. The patient can then become pregnant again.

Sometimes, a septate uterus presents no real symptoms and is discovered during an infertility check-up.

How is a septate uterus treated?

In cases where a septated uterus is diagnosed, the proposed treatment is surgical. Even more so for women planning a pregnancy. This surgical procedure is called metroplasty. 

This operation removes the partition that separates the uterus in two. It's a simple operation performed under hysteroscopy. The operation lasts just one day, on an outpatient basis. 

After the operation, regular checks are carried out under hysteroscopy to verify healing. A few months later, pregnancy can be envisaged.

On the other hand, if the diagnosis is made while a pregnancy is already in progress lthen surgery is impossible, and only preventive treatment can be considered, to avoid premature delivery.