All about the didelphic uterus

The didelphic uterus is a rare congenital malformation that affects 0.3% of women. When asymptomatic, this uterine anomaly often goes unnoticed. In fact, it is difficult to detect during a follow-up gynecological examination. But what is a didelphic uterus? And what risks can it present for health and pregnancy? Let's take a look at these questions.

What is a didelphic uterus?

Before focusing on the case of thedidelphic uterus, let us recall some general notions about theuterus. The uterus is a hollow muscular organ of the female genital tract. Located between the rectum and the bladder, it receives the fertilized egg, protects it during the gestation and expels it when it reaches maturity.

The womb is made up of several parts : the cervix, the body and the fundus . Its walls are lined with three distinct layers: theendometrium (uterine mucosa), the myometrium (inner muscular layer) and the perimetrium (outer serous layer).

Each woman has her own uterine morphology. Health professionals thus distinguish different shapes of uterus (straight, anteverted or retroverted), which are completely normal.

However, some patients may suffer from a matrix malformation. In 5% of cases, this is a didelphic uterus (uterus didelphys). This congenital anomaly, also called "double uterus" or "uterine didelphia", results in the presence of two independent uterine cavities in women who have it.

Frequently confused with thebicornuate uterusthedidelphic uterus is divided into two subtypes:

1. Didelphic bicervical (two vaginas, two cervixes and two uterine cavities) ;
2. Didelphic unicervical(one vagina, one cervix and two uterine cavities).

What are the causes of didelphic uterus malformation?

Theuterus is formed duringorganogenesis, from the 7th week of pregnancy. The womb of a female baby normally develops in three stages:

1. Between the 6th and 9th week, the Müller ducts migrate towards the urogenital sinus;
2. From the 9th to the 13th week, the lower part of these ducts fuse. This phase allows the creation of the two upper thirds of the vagina and the cavity of the uterus, which is divided by a partition known as inter-müllerian;
3. Between the 13th and the 17th week, this partition resorbs and the formation of the uterus is completed.

A double uterus results from an anomaly in embryonic development occurring during the second stage of differentiation of thefemale reproductive system. The Müllerian ducts do not join, resulting in two separate cavities .

What is the impact of a didelphic uterus on health?

Women with a didelphic uterus do not always have symptoms. However, some may experience severe pain during menstruation and sexual intercourse, bleeding periods and difficulty using tampons. Others may experience a variety of complications during their pregnancy.

Menstrual pain or heavy bleeding

Sometimes a double uterus can cause menstrual problems. This matrix abnormality can lead to :

• Significant pelvic pain during men struation(dysmenorrhea or painful periods);
• Very heavy bleeding(heavy periods or menorrhagia);
• Two episodes of menstruation per month.

Difficulty using internal sanitary protection

Use of sanitary protection is also difficult in case of a didelphic uterus. Indeed, if your womb is didelphic bicervical and you have two vaginas, the insertion of a tampon or a menstrual cup will be complicated and the risks of leakage will be high.

We therefore advise you to use sanitary napkins or menstrual panties. These menstrual protections are ideal for absorbing the blood flowing out of the uterine cavity during your period.

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Pain during sexual intercourse

Having a didelphic uterus sometimes causes pain of varying intensity during sexual intercourse (dyspareunia). Some women may experience localized pain at the entrance to their vagina(s ) when the penis is inserted or deeper pain throughout the pelvic area during penetration.

Complications during pregnancy

Finally, although this uterine malformation does not generally affect fertility, it can be the cause of various complications during pregnancy. A double uterus increases the risk of fetal growth retardation, miscarriage, premature birth and malpositioning of the baby at the time of delivery.

In very rare cases, a pregnancy in a didelphic uterus may be characterized by the presence of two fetuses that develop independently in each uterine cavity. The monitoring of this pregnancy will thus have to be very rigorous in order to bring it to term.

How to be diagnosed with a didelphic uterus?

As we have seen, a double uterus does not systematically cause symptoms. Its identification during a gynecological follow-up consultation is therefore not always easy. For example, a woman experiencing repeated miscarriages or severe pain during menstruation will be prescribed a medical imaging examination to detect a possible malformation.

In the first instance, a conventional or 3D pelvic ultrasound will provide an overall view of the uterus and a diagnosis of the didelphic uterus. In a second step, the gynecologist can perform a hysteroscopy toexplore the interior of the cavities with a small probe equipped with a camera.

In case of emergency, an MRI (magnetic resonance imaging) will also be able toquickly identify a didelphic uterus.

Is there a treatment for a didelphic uterus?

Today, there is a surgical procedure to reconstruct a double uterus. If this treatment is not possible, patients can resort to natural methods to relieve their symptoms.

Strassman metroplasty, a surgical treatment to reconstruct a double uterus

Strassman metroplasty is a medical procedure to repair a didelphic uterus. This surgical procedure consists of reuniting the patient's two uteruses into one. However, it is not always possible to perform it because the two matrices are not necessarily the same size. In addition, it is most often reserved for very specific cases.

Natural methods to relieve the symptoms of uterine didelphia

To alleviate some of the symptoms of uterine didelphia, you can turn to natural remedies. Here are some tips to decrease your flow and ease uterine spasms:

• Drink herbal teas made withyarrow (known for its antispasmodic properties) or coriander seeds ;
• Apply a cold compress to your lower abdomen to constrict blood vessels and reduce bleeding;
• Usenettle in soup, decoction or mixed in a drink to reduce blood flow.

To prevent iron deficiency anemia caused by bleeding periods, also consider eating iron-rich foods such as legumes, green leafy vegetables, egg yolk and red meat.

Finally, to relieve your menstrual pain, we recommend placing a hot water bottle on your stomach and lower back. You can also massage yourself with a vegetable oil in which you have diluted three drops of tropical basil essential oil.