Uterus Didelphys: Causes, Symptoms, Diagnosis & Pregnancy Challenges

Understanding Uterus Didelphys: What It Means for Your Reproductive Health

Realising that you may have a congenital difference in your reproductive system can bring up a lot of questions. Uterus didelphys is one such condition. It is rare, seen in only around 0.3 per cent of the population, which is why many people may not encounter it until they receive a diagnosis.

Because it develops before birth, uterus didelphys can go unnoticed for years. Some individuals experience no symptoms at all, while others may observe subtle changes such as an unusual menstrual pattern or discomfort that prompts a medical check-up. These early signs often become the first indication that something in the reproductive structure is different.

In the sections ahead, you’ll find a simple breakdown of how uterus didelphys forms, the signs that can point to it, and the ways doctors diagnose and manage it.

What Is Uterus Didelphys and How Does It Form?

Uterus didelphys, often referred to as a double uterus, is a rare condition that develops long before birth. During early development in the womb, every female embryo has two small tubes called Müllerian ducts, which normally join to form a single uterus, cervix and upper vagina. In uterus didelphys, these ducts do not fuse, resulting in two separate uterine cavities.

Depending on the individual, each uterus may have its own cervix, or sometimes both wombs share a single cervix. In certain cases, the vagina can be divided by a thin membrane, creating two openings. Occasionally, differences in the kidneys may also be seen, since the urinary and reproductive systems develop at the same time in the embryo. This condition is present from birth and is not caused by anything the mother does during pregnancy.

Uterus didelphys accounts for approximately 11% of all congenital uterine malformations. Many women with a double uterus have normal periods and can carry pregnancies to term. There is, however, a slightly higher risk of miscarriage or preterm labour. Understanding this anatomy helps women and their healthcare providers anticipate potential challenges and make informed decisions about care.

Does Uterus Didelphys Affect the Menstrual Cycle?

Periods usually occur, but the pattern may feel different depending on your anatomy.

Uterus didelphys does not stop menstruation. However, because there are two uterine cavities, each with its own lining, the menstrual experience may look or feel different. Some people notice:

• Two Separate Menstrual Flows: Both cavities shed their lining, so you may have bleeding from two openings if there are two cervices or a septum.
• Heavier or Prolonged Bleeding: Because two linings are shedding, your period may last longer or feel heavier.
• Bleeding that seems to occur twice in a month: If each cavity sheds at slightly different times, it may feel like you have two periods.
• Difficulty recognising spotting: Spotting from one cavity can overlap with bleeding from the other, making the cycle feel irregular.

Others may experience completely normal cycles, especially if the cervix and vaginal canal allow both flows to exit together. Your experience depends on your individual anatomy, which is why personalised medical guidance is helpful.

Can You Get Pregnant With Uterus Didelphys?

Yes, pregnancy is absolutely possible, but some people may face higher risks or require closer monitoring.

Most individuals with a uterus didelphys can conceive naturally. However, the two-cavity structure can affect implantation or space available for pregnancy, which is why some people experience:

• Difficulty conceiving
• Recurrent miscarriages
• Need for early pregnancy monitoring

What Pregnancy Complications Are Linked to Uterus Didelphys?

Pregnancy is very much possible with a uterus didelphys. The only difference is that each uterus has less room for a growing baby, which can make certain complications slightly more likely. This does not happen to everyone, and many people go on to have completely healthy pregnancies. Still, knowing what to watch for can help you and your doctor plan the right care from the start.

Here are some common uterus didelphys complications:

Preterm Birth

Studies suggest that early labour can occur in about 17.44 to 33.3 per cent of pregnancies in women with a uterus didelphys. The smaller space in the uterus may sometimes trigger labour earlier than expected.

Breech Presentation

Because the baby has limited room to move freely, it becomes harder for them to turn into the usual head-down position. This increases the chance of a breech position later in pregnancy.

Restricted Foetal Growth

Some babies may have slightly less space to grow and stretch out. This can influence their growth pattern or the way they settle inside the womb.

Cervical Insufficiency

In some individuals, one cervix may not stay closed as firmly as needed throughout pregnancy. This is why regular monitoring becomes important.

Miscarriage Risk

A few people experience early pregnancy loss because the implantation space is limited or because the blood supply varies between the two uterine cavities.

How Is Uterus Didelphys Diagnosed?

Diagnosis usually involves a pelvic exam followed by imaging scans that confirm the structure.

Common diagnostic methods include:

• Pelvic Ultrasound (2D or 3D)

  Often, the first imaging test, a 3D ultrasound, gives a clearer view of Müllerian anomalies.

• Hysterosalpingography (HSG)

  A dye-based X-ray that outlines the uterine cavities.

• MRI

  Provides highly detailed imaging of the uterus, cervix and vagina. MRI is often considered the most accurate tool for diagnosing uterus didelphys.

• Pelvic Examination

  A doctor may notice two cervices or a vaginal septum. Doctors also check the kidneys because congenital uterine conditions may coexist with renal anomalies.

What Treatment Options Are Available?

Treatment depends on your symptoms, reproductive goals and overall comfort. Most people with uterus didelphys do not require surgery. Instead, uterus didelphys treatment focuses on managing symptoms or supporting pregnancy. Options include:

• Monitoring Without Surgery

  If you have no symptoms, doctors may recommend routine check-ups.

• Surgical Correction (Metroplasty)

  In rare cases where symptoms are severe, such as repeated miscarriages or significant menstrual obstruction, surgery may be considered. This is not commonly required.

• Septum Removal

  If a vaginal septum causes pain or difficulty with intercourse or tampon use, removing it can relieve symptoms.

• Pregnancy-Focused Management

  Doctors may monitor cervical length, recommend progesterone support in selected cases or schedule additional ultrasounds.

Living With Uterus Didelphys: What Can Help?

Most people live healthy, normal lives with this condition with the right guidance and awareness.

You may find the journey easier with:

• Regular gynaecological exams.
• Tracking menstrual changes.
• Pre-pregnancy counselling if you plan to conceive.
• Being aware of unusual symptoms, such as severe pain or atypical bleeding.
• Emotional support, especially if pregnancy complications have occurred.

Conclusion

Uterus didelphys is a rare congenital variation that can influence menstruation, fertility and pregnancy in different ways. While some people experience symptoms or complications, many live completely normal reproductive lives. With early diagnosis, personalised guidance and proper monitoring, you can navigate this condition confidently and plan for your reproductive health with clarity and support.