Causes and harms of a double uterus and does it affect fertility

Have you ever heard of something called a "double uterus"? The name might sound a bit scary, but the truth is, many women discover they have it by chance without any obvious symptoms. A double uterus is a rare congenital uterine anomaly where a woman has two uteri instead of one.

And then the questions start: "Is it dangerous?", "Can I still get pregnant?", "Will it affect my delivery?"

In this article from Daleeli Medical, we'll explain exactly what a double uterus is, its causes, symptoms, and whether it can actually cause problems during pregnancy or childbirth. We’ll also tell you when you should visit a doctor and what treatment options exist if intervention is necessary.Stay with us till the end to feel reassured and understand this condition from every angle.

1. Does a double uterus prevent pregnancy?
Not necessarily! Many women with a double uterus get pregnant naturally without problems. However, in some cases, the chance of pregnancy may be a bit lower, or there may be recurrent miscarriages. This is usually due to the shape of the uterus or a septum (a dividing wall) between the two uterine cavities. That’s why regular follow-up with a specialist is very important.

2. Does a double uterus affect the menstrual cycle?
Yes, it can. Some women experience severe pain during their period or irregular bleeding, especially if there’s a septum or blood accumulation in one of the uteruses. But in other cases, the cycle remains regular with no issues.

3. Is a double uterus a serious condition?
A double uterus itself is not dangerous, but it can cause difficulties during pregnancy or childbirth, such as preterm labor or abnormal fetal position. That’s why it’s important to have close medical monitoring early if you find out you’re pregnant.

4. Do I need surgery?
Not all cases require surgery. If there are no troublesome symptoms or pregnancy problems, your doctor may just monitor your condition. Surgery is usually reserved for cases with severe pain, sexual difficulties, or infertility.

5. Can I know if I have a double uterus without imaging tests?
Usually, no. A double uterus is hard to diagnose without detailed imaging like ultrasound, MRI, or hysteroscopy. Many cases are discovered incidentally during exams for other reasons.

6. Does a double uterus affect sexual relations?
If there is a vaginal septum (which sometimes occurs with a double uterus), it can cause pain during intercourse. But if there’s no septum, sexual activity is generally normal with no noticeable effects.

7. Can a double uterus cause miscarriage?
Yes, in some cases it increases the risk of miscarriage, especially if the uterus is small or has abnormal shape. The limited space inside the uterus may affect the fetus’s ability to implant and develop securely.

8. Can pregnancy occur in only one uterus?
Yes, in some women, the pregnancy occurs in only one of the two uteri, while the other may be inactive or closed off. This doesn’t necessarily cause problems but requires close monitoring.

9. Is there a permanent treatment for a double uterus?
There is no permanent medication to fix a double uterus since it is a congenital anomaly. However, surgical intervention can be done to remove a septum or correct issues causing pain or pregnancy complications.

10. Is a double uterus hereditary?
Sometimes it is hereditary, especially if similar cases exist in the family. But it’s not guaranteed to happen to all female family members, as it’s not 100% genetic.

11. Does a regular ultrasound show a double uterus?
Not always. Sometimes a standard ultrasound doesn’t provide enough detail. Doctors may request a transvaginal ultrasound or MRI to confirm the diagnosis.

12. Does a double uterus affect fetal growth?
It can. Due to limited space inside the uterus, the fetus might not grow to a normal size. This is closely monitored by your doctor during pregnancy check-ups.

13. Are there different types of double uterus?
Yes, and this is very important to know because each type affects pregnancy differently:

Complete double uterus: Two completely separate uteri, each with its own cervix.
Bicornuate uterus: One uterine cavity but with two horns, giving a heart-like shape.
Arcuate uterus: A mild indentation at the top of the uterus, which usually has minimal effect on pregnancy.
Septate uterus: A fibrous septum dividing the uterine cavity, which can cause pregnancy problems if untreated.

14. Can pregnancy occur simultaneously in both uteri?
This is very rare but has happened in a few cases worldwide—where a woman carries a fetus in each uterus at the same time! This is a complex condition needing very careful medical monitoring from the very beginning of pregnancy.

15. Can a double uterus cause delayed periods?
Not directly, but if there is a septum or blockage in one uterus, it may affect menstrual blood flow, causing irregular or delayed periods.

16. Can I have a natural delivery if I have a double uterus?
Yes, many women deliver naturally, especially if the baby is in a good position and there are no complications. But if there is a significant uterine abnormality or the baby is in a problematic position, the doctor may recommend a cesarean section for safety.

17. Can a double uterus be associated with vaginal abnormalities?
Yes, sometimes a double uterus is accompanied by a vaginal septum or even a double vagina. This can be detected during physical exams or ultrasound and is related to the uterine shape and development of the reproductive tract.

18. Should I tell my doctor if I find out I have a double uterus?
Absolutely! It’s very important to inform your doctor, especially if you’re pregnant or planning to become pregnant, so they can monitor your condition properly and prevent possible complications.

19. Can I live a normal life with a double uterus?
Definitely. Many women with a double uterus live completely normal lives—they get pregnant, give birth, and have healthy relationships. The key is regular medical follow-up and understanding your specific condition well.

What exactly is a double uterus? Can it really cause pregnancy problems?

A double uterus is a rare condition where the uterus is divided into two separate cavities instead of one. Sometimes, each cavity even has its own cervix, and in very rare cases, there can be two vaginas as well.

This condition is called a "Müllerian duct anomaly," and its severity varies from one woman to another. It can be mild with no obvious symptoms, or complete and cause issues with pregnancy or menstruation.

Is a double uterus hereditary?

Sometimes it is linked to genetics. If there are similar cases in your family, you might have a higher chance of having this anomaly. But this doesn’t mean it will definitely happen just because of family history.

Does a double uterus prevent pregnancy?

Not necessarily. Many women with a double uterus conceive naturally, but the abnormal shape of the uterus can increase the risk of:

Difficulty maintaining pregnancy
Recurrent miscarriage
Premature birth

The issue isn’t usually getting pregnant but maintaining the pregnancy and the baby’s safety inside a narrow or uneven uterus.

Does a double uterus increase the risk of miscarriage?

Yes, the risk is somewhat higher due to two main reasons:

Small uterine size, which means less space for the fetus to grow
Possible problems with placental attachment or reduced blood flow to the fetus

Can a woman get pregnant with a double uterus?

Yes, pregnancy is possible even with a double uterus. Many women conceive naturally but require close monitoring from the start of pregnancy to reduce risks like miscarriage or premature delivery.

Does a double uterus affect my long-term health?

Generally, the outlook is very positive. Many women with a double uterus live normal lives, conceive, deliver, and become mothers like anyone else. The secret is regular medical care and appropriate intervention if problems arise.

Is a double uterus common or rare?

A double uterus is very rare, affecting about 0.3% of women—roughly 3 out of every 1,000 cases. That’s why many women only discover it when they face pregnancy or menstrual problems.

What’s the difference between a double uterus and a bicornuate uterus?

The main difference is in shape and structure:

Bicornuate uterus (heart-shaped): One uterus with a partial division creating two horns, resembling a heart shape.
Double uterus: Two completely separate uteri, sometimes with two cervices and occasionally two vaginas.

Both are congenital anomalies and can cause pregnancy problems, but the bicornuate uterus is more common than the double uterus.

Can a Double Uterus Affect Pregnancy?

Yes, a double uterus can affect pregnancy, but not always. Some women with a double uterus carry their pregnancies normally, while others have a higher risk of miscarriage or premature birth. That’s why regular follow-up with a doctor from the start of pregnancy is very important.

What Are the Causes of a Double Uterus?

Failure of Müllerian Duct Fusion
During fetal development, the female reproductive system forms from two tubes called the Müllerian ducts. Normally, these two ducts fuse to form a single uterus. If fusion doesn’t occur, each duct may develop into a separate uterus, which is called a “double uterus.”
Problems in Early Fetal Development
Any disruption or abnormality during the early months of fetal development can cause an abnormal uterus, such as a double uterus or other uterine or vaginal malformations.
Genetic Factors (Rare)
In some families, multiple members may have uterine abnormalities, suggesting a genetic component. However, this is uncommon.
Associated Kidney or Vaginal Anomalies
The reproductive tract and kidneys develop from the same embryonic tissue, so some women with a double uterus may also have kidney or vaginal abnormalities.
Exposure to Certain Drugs or Substances During Pregnancy
For example, the drug diethylstilbestrol (DES), once used to prevent miscarriage, was later found to cause uterine abnormalities in daughters exposed to it in utero.
Infections During Pregnancy
If the mother experiences severe infections (viral or bacterial) during early pregnancy, it may affect the development of the fetus’s organs, including the uterus.
Poor Blood Supply During Fetal Development
Insufficient blood flow to the fetus may impair uterine formation, leading to anomalies such as a double uterus.
Genetic Mutations
Genes controlling the formation of the uterus and reproductive organs, if mutated or abnormal, can cause uterine malformations like a double uterus.
Environmental Factors
Some studies link environmental pollution and chemical exposure to congenital anomalies like a double uterus, but this research is not yet conclusive.

Types and Variations of Double Uterus

The uterus may take different forms due to variations in fetal development. Here are the main types explained simply:

Complete Double Uterus (Uterus Didelphys)
This is the classic double uterus: two completely separate uteri, each with its own cavity and cervix. Sometimes, there is also a vaginal septum.
Pregnancy: Possible but with increased risk of miscarriage or premature birth.
Bicornuate Uterus
Occurs when the two Müllerian ducts partially fuse. The uterus has two horns sharing one cervix, and the shape resembles a heart.
Pregnancy: Possible but may have complications like fetal growth restriction or preterm birth.
Septate Uterus
The uterus looks normal on the outside but is divided inside by a fibrous septum creating two cavities.
Often confused with bicornuate uterus.
Pregnancy: Common cause of recurrent miscarriage, but it is treatable by surgery (hysteroscopic metroplasty).
Unicornuate Uterus
Only one Müllerian duct develops, so the uterus is small and on one side. The other side may be absent or partially formed, sometimes with a small non-communicating cavity that can cause pain or bleeding.
Pregnancy: Difficult with high risks.
Arcuate Uterus
The mildest form, with a slight indentation on the uterine roof, not a true double uterus.
Sometimes misdiagnosed as bicornuate.
Pregnancy: Rarely causes problems.
Aplastic or Agenesis Uterus
The uterus is absent or severely underdeveloped.
Seen in conditions like Mayer-Rokitansky-Küster-Hauser syndrome.
Affected girls do not have menstruation and discover the condition at puberty.
Unicornuate Uterus with Rudimentary Horn
A small rudimentary horn may be present beside the unicornuate uterus, sometimes non-communicating.
The horn can fill with blood and cause pain.
Pregnancy: If pregnancy occurs in the rudimentary horn, rupture is possible, which is life-threatening.
Complete or Partial Bicornuate Uterus
Complete: clear division of the uterus into two horns.
Partial: slight division that may cause no obvious problems.
Sometimes confused with double uterus or septate uterus.
Rare Triple-Horned Uterus
Extremely rare anomaly with three uterine cavities due to severe Müllerian duct maldevelopment.

Symptoms of a Double Uterus: What Might You Feel?

A double uterus can cause various symptoms and signs, though not all may appear. Here are the most common ones:

Irregular or very painful menstrual periods
You may experience severe menstrual cramps (dysmenorrhea).
This pain often results from having two uterine cavities or blood pooling in one of them.
Abnormal vaginal bleeding
Bleeding may occur between periods or be excessively heavy during menstruation.
Difficulty conceiving or infertility
A double uterus may reduce the chance of the egg implanting properly.
It can also cause repeated miscarriages.
Repeated miscarriages
Especially during the early months of pregnancy.
Preterm labor or delivery complications
Due to uterine malformations, early delivery is more likely.
Cesarean section is often necessary.
Pain during intercourse
Especially if there is a vaginal septum (a tissue wall) associated with the double uterus.
Chronic pelvic pain
Pain may occur not only during periods but also persistently or intermittently in the lower abdomen or pelvis.
Abnormal vaginal discharge
This may occur due to blood pooling or infections related to the uterine anomaly.
Urinary or bowel problems
Rarely, if the double uterus presses on the bladder or intestines, you might feel discomfort or pain when urinating or defecating.
Frequent urinary or genital infections
Due to difficulty in normal fluid drainage caused by the anomaly.
Discomfort when sitting for long periods
Especially if there are two uterine cavities or large spaces inside the pelvis.
Delivery complications
Cesarean delivery is usually the safest option.
Higher risk of bleeding during delivery.
Possibility of premature birth or difficulties with fetal descent.

Effects of a Double Uterus on Menstruation

A double uterus clearly affects menstruation in some women, showing these signs:

Irregular menstrual cycles
Periods may come at irregular intervals and vary month to month.
Sometimes blood flow is uneven because each uterus may bleed separately.
Heavy bleeding
In some cases, bleeding volume is higher than normal.
Each uterine lining sheds blood independently.
Severe menstrual cramps (dysmenorrhea)
If one uterus has a partial blockage or narrow blood exit, blood may accumulate causing strong pain.
Two menstrual bleeding episodes per month
You might feel like you have two periods in the same month, as each uterus bleeds at different times.
Bleeding between periods
Not always, but some women experience light spotting due to lining problems in one of the uterine cavities.

Main Tests to Diagnose a Double Uterus

To confirm if you have a double uterus, doctors may request the following tests:

Ultrasound (Sonography)

Abdominal ultrasound: Detects abnormal uterine shape but is not always accurate.
Transvaginal ultrasound: More precise as it provides detailed images from inside.

3D Ultrasound
Shows the uterus shape in detail and helps differentiate between a double uterus and other malformations.
Magnetic Resonance Imaging (MRI)
Used when a more detailed view of the uterus and pelvic organs is needed.
Hysterosalpingography (HSG)
An X-ray test where dye is injected into the uterus and fallopian tubes to observe the uterine cavities and detect abnormalities.
Hysteroscopy
A thin camera is inserted through the vagina to view the inner lining of the uterus directly, especially useful to check for septa (dividing walls) or lining issues.
Laparoscopy
A small camera inserted through the abdomen to inspect the outer shape of the uterus and diagnose any external abnormalities.

Treatment for Double Uterus: What Are the Available Options?

A double uterus doesn’t always require treatment, but in some cases, intervention becomes necessary. Let’s explore the appropriate treatment options depending on the situation:

1. No Treatment – Just Monitoring

If you have a double uterus but don’t experience symptoms or pregnancy problems, the doctor usually recommends regular monitoring only.
✅ Many women can conceive naturally and live a normal life without symptoms even with two uteri.

2. Surgical Treatment – When and Why?

Not all cases of double uterus require surgery, but it may be needed if there are actual problems such as:

Recurrent miscarriages or difficulty conceiving.
Severe menstrual pain caused by a closed uterus or vaginal septum where blood accumulates.
A vaginal septum interfering with sexual intercourse or making natural delivery difficult.
Abnormal bleeding or blood collection in a part of the uterus not connected to the rest.

Types of Surgeries Used:

Resection of the uterine or vaginal septum:
Using hysteroscopy (a camera inserted via the vagina), the surgery unifies the uterus and normalizes blood flow, reducing miscarriage risk and other complications.

Removal of a closed or non-communicating uterus part:
If there is a small uterus or cavity that collects blood causing pain, it may be surgically removed.

General Post-Treatment Advice:

Regular pregnancy follow-up with a gynecologist.
Psychological rest is very important; contact your doctor if you experience pain or bleeding.
Appropriate treatment increases chances of successful pregnancy and improves quality of life.

Types of Surgical Procedures for Double Uterus

Surgery is not always necessary, but when the double uterus causes significant issues affecting daily life or pregnancy, these operations might be done:

1. Vaginal Septum Resection
When:
If you have two uteri separated by a vaginal septum (common in complete uterus didelphys). This septum may cause:

Pain during intercourse
Difficulty or prevention of natural birth

Procedure:

Done under spinal or general anesthesia
Surgeon removes the septum with precise tools
Quick surgery, usually under an hour

Benefits:
Improves sexual intercourse
Facilitates natural delivery
Reduces pain and bleeding

2. Hemihysterectomy (Removal of One Uterus)
When:
If one uterus is small or blocked (a horn not connected to the vagina), accumulating blood monthly causing severe pain, or causing health problems.

Procedure:

Usually performed laparoscopically (minimally invasive through small abdominal incisions)
Surgeon removes the inactive or problematic uterus

Benefits:
Rapid pain relief
Prevents monthly blood buildup
Lowers risk of infection and complications

3. Removal of Uterine Septum (In Case of Misdiagnosis)
Sometimes, a septate uterus (a single uterus with a dividing wall inside) is mistaken for a double uterus. Treatment involves:

Procedure:

Hysteroscopic metroplasty (using a thin scope through the cervix to cut the internal septum)

Benefits:
Greatly improves chances of pregnancy
Reduces miscarriage risk
Minimally invasive without abdominal incision

Recovery Time

Most of these surgeries have a quick recovery, ranging from a few days to a few weeks.
Mild bleeding might occur post-surgery.
Patients usually return to normal life soon after.

Important Post-Surgery Tips:

Rest as advised by your doctor.
Avoid sexual intercourse until your doctor permits.
Follow-up ultrasound or MRI to monitor the uterus.
Follow up with fertility specialists if planning pregnancy.

3. Treatment of Fertility and Pregnancy Issues with Double Uterus

If you have difficulty conceiving or recurrent miscarriages due to a double uterus, the following might help:

In Vitro Fertilization (IVF):
If the problem lies in embryo implantation, IVF can increase pregnancy chances.
Close Monitoring During Pregnancy:
Because of a higher risk of preterm birth in these cases, close follow-up with a specialist is crucial.
High-Risk Pregnancy Care:
If your pregnancy is classified as high risk, specialized care is needed to ensure the health of both mother and baby.

4. Psychological Support and Follow-Up

Why is psychological support important?

Anxiety and Stress:
Learning about a double uterus can cause fear about sex life, pregnancy, or miscarriage risk.
Impact of Stress on Symptoms:
Psychological stress can worsen menstrual irregularities and overall health.
Reducing Feelings of Isolation:
Many women feel different or alone, and psychological support helps them feel understood and supported.

Psychological support tools:

Counseling or therapy:
Visiting a psychologist or family counselor helps manage anxiety and depression and teaches coping skills.
Support groups:
Joining women’s groups or online forums where experiences are shared provides great support.
Accurate education:
Knowing detailed, clear information about your condition and treatment reduces fear and builds confidence.

5. Regular Medical Follow-Up

Routine scans (ultrasound or MRI) to monitor uterine health and pregnancy.
Immediate contact with your gynecologist if new symptoms or problems appear.
Specialized monitoring for high-risk pregnancies.

6. General Advice

Take good care of your health: eat well, sleep enough, and exercise lightly.
Avoid stress and psychological pressure as much as possible.
Share information and support with your partner so they can understand and help you.

Is There a Medication to Treat Double Uterus?

A double uterus is a congenital structural anomaly, not a disease, so there is no medication to “cure” it.

Treatment is either:

Regular monitoring if asymptomatic,
Or surgical intervention if complications arise.

When Are Medications Used with Double Uterus?

Although the condition itself isn’t treated with medicine, medications may be used to relieve symptoms or manage related problems:

Treating Menstrual Symptoms:
- Pain relievers: Paracetamol or ibuprofen to ease menstrual cramps.
- NSAIDs: Reduce inflammation, pain, and sometimes bleeding.
- Hormonal contraceptives: To regulate irregular or heavy bleeding.
Managing Abnormal Bleeding:
- Hormonal medications like birth control pills to regulate and reduce bleeding.
- Special medications to stop or reduce heavy bleeding if needed.
Supporting Pregnancy:
- Folic acid supplements: Important for healthy fetal development and reducing birth defects.
- Progesterone hormone: Often prescribed to help maintain pregnancy, especially if there is miscarriage risk.
- Other medications as prescribed based on individual health, always under medical supervision.