Septate Uterus

Overview

What is a septate uterus?

A septate uterus is a congenital anomaly where a membrane runs down the middle of the uterus, splitting it into two parts. This membrane is called the septum and it can vary in thickness and length. It starts at the top of your uterus and can extend to your cervix (bottom of the uterus) and occasionally to the vagina.

A typical uterus is one hollow cavity and shaped like an upside-down pear. However, if you have a septate uterus, your uterus has two smaller cavities instead of one cavity. This is because the septum acts as a partition, or barrier, in your uterus.

This condition is also referred to as a uterine septum. It can cause symptoms in some people, but most will not be aware they have a septate uterus until they are pregnant or experience multiple miscarriages. If you have a septate uterus, it's still possible to have a healthy pregnancy and delivery.

How common is a septate uterus?

A septate uterus is rare, but it's one of the more common uterine anomalies. It accounts for approximately 35% to 90% of congenital uterine irregularities. Congenital uterine anomalies occur in 4% of all people who have a uterus.

Is having a septate uterus bad?

Having a septate uterus isn't necessarily bad and doesn't cause any long-term health complications. However, it may increase your risk of miscarriage and is a possible cause of frequent pregnancy loss. One study shows the rate of miscarriage in people with a septate uterus to be about 35%. The miscarriage rate in people with a regular-shaped uterus is about 10% to 20%. However, not all people with a septate uterus experience miscarriage.

Symptoms and Causes

What are the symptoms of a septate uterus?

Most people with a septate uterus are asymptomatic. It typically does not give you symptoms and you only become aware of your condition when your healthcare provider starts to examine the cause of repeat miscarriages. Some potential symptoms of a septate uterus are:

  • Frequent miscarriages.
  • Painful menstruation.
  • Pelvic pain.

What causes a septate uterus?

A septate uterus is congenital. When you were developing in your mother's womb, two ducts (called Mullerian ducts) in your uterus didn't fuse properly. In a typical uterus, these two ducts fuse together to form one uterine cavity. However, if you have a septate uterus, the ducts didn't fuse together. Instead, they created a tissue membrane down the middle of the uterus. This membrane is the septum and it splits the uterus into two parts.

How does a septate uterus affect periods?

A septate uterus typically does not affect periods, but can occasionally give you pain during menstruation. However, because this condition has been present since birth, you may not realize it's abnormal to have that level of pain during your period.

Diagnosis and Tests

How is a septate uterus diagnosed?

Your healthcare provider will usually start with a pelvic exam. However, unless the septum extends into the vagina, a pelvic exam will not show the depth or position of the septum. Instead, your healthcare provider will use imaging tools to get the best picture of the septum, its thickness and its exact position in your uterus. There are two different kinds of septate uterus:

  • Complete septate uterus: The septum runs the entire length of the uterus and includes the cervix. In some cases, it can also extend through the cervix and into the vagina.
  • Partial septate uterus: The septum doesn't extend to the cervix.

What tests will be done to diagnose a septate uterus?

Imaging tests are used to diagnose a septate uterus. Your healthcare provider is looking for the presence of a septum and its size. The septum can be hard to distinguish since it's a small piece of tissue. It can sometimes be confused with other uterine anomalies like a bicornuate uterus.

Your healthcare provider may examine your uterus with:

Management and Treatment

How do you fix a septate uterus?

A uterine septum does not always require surgical intervention and expectant management may be reasonable. Surgery is the only way to remove a septate uterus. The surgery involves cutting or removing the septum. Once the septum is removed, the uterus is no longer divided into two parts and is one uterine cavity (like a typical uterus).

What treatments are used for a septate uterus?

A procedure called hysteroscopic metroplasty is the most common treatment for a septate uterus. It’s an outpatient procedure that takes about an hour. First, surgical instruments are inserted through the cervix and into the uterus. Then, the septum (the tissue dividing the uterus) is cut out and removed from the uterus. After having surgery to fix a septate uterus, your chance of miscarriage decreases.

After treatment, many people will be able to become pregnant even after several pregnancy losses. One study showed the rate of pregnancy after hysteroscopic metroplasty to be around 65%. However, most healthcare providers recommend waiting two months after surgery to begin conceiving.

What are the complications of treating a septate uterus?

The risks associated with removing the septum dividing the uterus include:

  • Abnormal bleeding.
  • Infection.
  • Perforation of the uterus.
  • Damage to the cervix.

Can a septate uterus grow back?

No, a septate uterus can't grow back. A septum grows in your uterus when two ducts do not fuse together during gestation. Once it's surgically removed, your body can't regenerate a uterine septum.

Prevention

How can I prevent a septate uterus?

There is nothing you can do to prevent having a septate uterus. It's congenital, meaning you were born with it. There is no evidence that a septate uterus is genetic.

Outlook / Prognosis

Can you have a normal pregnancy with a septate uterus?

Yes, it's possible to have a normal pregnancy with a septate uterus. However, there are several risks to be aware of if you're pregnant and have a septate uterus:

Your healthcare provider will consider your pregnancy high-risk and want to monitor your baby's growth closely throughout your pregnancy.

Will I have a miscarriage if I have a septate uterus?

Your chance of miscarriage increases if you have a septate uterus or any other uterine irregularity; however, many people have healthy pregnancies with a septum in place. Having a septate uterus doesn't usually affect conception or fertility.

How will a septate uterus affect my delivery?

Babies born to people with a septate uterus have an increased risk of being in a breech position. This is because the fetus has less room to rotate with their head down due to its irregular shape. If a baby is breech (feet or buttocks first in the womb), a cesarean (c-section) delivery is usually preferred.

Can my baby have a birth defect if I have a septate uterus?

If you have a septate uterus, your baby is at increased risk for preterm delivery (delivery before 37 weeks gestation). If your baby is born too early, some of their organs and systems may not fully develop. This can cause intellectual or physical congenital disabilities. However, having a septate uterus or being preterm does not mean your baby will be born with a disability. Many people with a septate uterus have healthy, full-term pregnancies.

Can you get pregnant after your septate uterus is fixed?

Yes, you can get pregnant after the septum is removed from your uterus. Most healthcare providers will recommend at least two months to recover from this surgery before attempting conception again.

Living With

Are there health risks associated with a septate uterus?

You may be at an increased risk for endometriosis if you have a septate uterus. There are no other health risks associated with a septate uterus unless you are pregnant. The health risks associated with a septate uterus are:

  • Miscarriage (especially in the second trimester).
  • Preterm birth.
  • Low birth weight.
  • Baby being breech or transverse.
  • Increase risk of c-section delivery.

When should I see my healthcare provider?

If you are pregnant and have a septate uterus, it is important to contact your healthcare provider if you experience any of the following:

  • Pelvic cramping or contractions.
  • Membranes rupturing.
  • Vaginal bleeding.

If you're not pregnant, the likelihood of you experiencing any health complications is rare. Talk to your healthcare provider about any signs or symptoms you should watch for if you have a septate uterus.

What questions should I ask my doctor about a septate uterus?

If you have a septate uterus, it is normal to have questions. Some questions you might ask your healthcare provider are:

  • Am I still able to have a healthy pregnancy?
  • What are my chances of miscarriage?
  • Should I have surgery to correct my septate uterus?
  • What are my chances of successful pregnancy after treatment?
  • Will I be considered high-risk?

A note from Cleveland Clinic

If you have been diagnosed with a septate uterus, discuss treatment options with your healthcare provider. They can discuss the procedure and your chances for a successful pregnancy based on your health history. Most people with a septate uterus can have healthy pregnancies.

Last reviewed by a Cleveland Clinic medical professional on 04/21/2022.

References

  • Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000 Jan;73(1):1-14. 4/21/2022.
  • Kenda Šuster N, Gergolet M. Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor. Gynecol Surg. 2016;13:37-41. Accessed 4/21/2022.
  • LaMonica R, Pinto J, Luciano D, Lyapis A, Luciano A. Incidence of Septate Uterus in Reproductive-Aged Women With and Without Endometriosis. J Minim Invasive Gynecol. 2016 May-Jun;23(4):610-3. 4/21/2022.
  • Practice Committee of the American Society for Reproductive Medicine. Uterine septum: a guideline. (https://www.fertstert.org/article/S0015-0282%2816%2961281-5/pdf) 4/21/2022.
  • Rikken JFW, Kowalik CR, Emanuel MH, et al. The randomised uterine septum transsection trial (TRUST): design and protocol. BMC Womens Health. 2018;18(1):163. 4/21/2022.
  • Rikken JF, Kowalik CR, Emanuel MH, et al. Septum resection for women of reproductive age with a septate uterus. Cochrane Database Syst Rev. 2017;1(1): 4/21/2022.
  • Selvaraj P, Selvaraj K. Reproductive outcome of septate uterus following hysteroscopic septum resection. J Hum Reprod Sci. 2010;3(3):143-145. 4/21/2022.
  • Valle, R. and Ekpo, G. "Hysteroscopic Metroplasty for the Septate Uterus: Review and Meta-Analysis." Journal of Minimally Invasive Gynecology. 2013; 20(1): 22-42. 4/21/2022.

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