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Mullerian Anomalies

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Introduction

Mullerian Anomaly is a “congenital condition” which means that it is present at birth. It can affect 4% of females. Usually, the uterus looks like an upside-down pear. However, in some women, the uterus and sometimes the cervix is misshapen due to Mullerian Anomalies. This condition is uncommon but is treatable.

Mullerian ducts are a critical part of the female reproductive system. These ducts differentiate to form the uterus, uterus cervix, the fallopian tubes, and the vagina. When the ducts develop abnormally, it disrupts the development of the female reproductive system. These ducts can develop abnormally in different ways. Each way results in another kind of Mullerian anomaly.

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What are the different types of Mullerian Anomalies?

Mullerian ducts develop in three phases: Organogenesis, Fusion, and Septal Resorption. The Mullerian ducts are formed in the first phase. If development is abnormal in the first phase, it results in hyperplasia/uterine agenesis or a unicornuate uterus. The ducts fuse to become the uterus. The failure of fusion results in a didelphys uterus or a bicornuate. Once the ducts are fused, the central septum is resorbed. Failure of this phase results in an arcuate uterus or a septate.

The common types of Mullerian Anomalies are explained below:

  • Unicornuate uterus: As we discussed earlier, if there is a failure when Mullerian ducts are forming, it results in Unicornuate Uterus. In this, one duct fails to develop, resulting in a half-uterus. Usually, this anomaly is accompanied by kidney problems or even a missing kidney. However, this is a rare anomaly.
  • Bicornuate Uterus: This is defined by a womb with two horns. The womb looks like an upside-down pear in ordinary circumstances. In this condition, it is heart-shaped with an indentation in the upper region.
  • Uterus didelphys: This is commonly called ‘double uterus’. In this anomaly, there is a duplication of the cervix, uterus, and vagina. A ligament of connective tissue might divide the two halves. This anomaly usually presents the least pregnancy complications.
  • DES-related uterus: DES is a synthetic form of estrogen prescribed to women between 1945 and 1971 to prevent miscarriages. The practice was stopped when it was realised that it caused cancer and uterus malfunction. The DES-related uterus is characterised by a uterine cavity that is T-shaped, a malformed cervix, and dilated horns.
  • Septate uterus: This happens when a wall or the septum divides the inner part of the uterus.
  • Arcuate uterus: This anomaly is quite normal. The anomaly is characterised by a slight indentation in the inner and outer part of the uterus.

What are the Causes of Mullerian Anomalies?

This a congenital condition whose causes are genetic and complicated. A genetic mutation can cause the anomaly, or it may be the result of a developmental defect.

What are the Symptoms of Mullerian Anomalies?

The common symptoms are as follows:

  • ● Infertility
  • ● Recurrent miscarriage
  • ● Pelvic pain
  • ● Preterm labour
  • ● Delay in periods
  • ● Difficulty with intercourse
  • ● Difficulty in using tampons

How is Mullerian Anomalies Diagnosed?

Mullerian Anomalies are often discovered with the onset of puberty – when a young female starts menstruating, or when an adolescent misses her menstrual period. The condition also comes to light when a female has trouble maintaining a pregnancy or even conceiving.

The condition is usually diagnosed by using imaging technology. Diagnostic tests such as Pelvic ultrasound, Magnetic Resonance Imaging or MRI, 3-D Ultrasound, Laparoscopy, Hysterosalpingogram or HSG, Hysteroscopy are done. Doctors may recommend a combination of these steps for an accurate diagnosis.

How is Mullerian Anomalies Treated?

The treatment of Mullerian anomalies varies on the type of anomaly. In many cases, you can leave it untreated, and it wouldn’t cause any significant problems. Some Mullerian anomalies affect menstruation and can cause substantial amounts of pain. These anomalies are usually treated with surgery. For example, a Septate Uterus, where the uterus is divided by a wall or the septum can be surgically corrected. This increases the probability of a successful pregnancy.

Women who fail to conceive within six months of trying should see a fertility specialist skilled in the area of reproductive surgery.

Result

The outlook is usually very positive in case of surgery. Successful surgery can alleviate symptoms, repair defects, eliminate discomfort during intercourse, and improve pregnancy outcomes.

What are the Risks Associated with Mullerian Anomalies treatments?

In certain cases, there is a risk of:

  1. Heavy bleeding
  2. Infection
  3. Damage to adjacent organs
  4. Anaesthetic complications
  5. Blood clots

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FAQ's

Are Mullerian Anomalies Genetic?

Yes, Mullerian Anomalies are hereditary. They may be the result of a genetic mutation. However, DES (A synthetic form of estrogen) prescribed between 1945 and 1970 to prevent miscarriage can cause Mullerian Anomalies.

How is Septate Uterus Treated?

This type of Mullerian Anomaly can be treated with surgery. Metroplasty is a reconstructive surgery that is often used to repair anomalies in the uterus. Surgeons remove the abnormal tissues. Then, they use layers of stitches to give the anomaly the normal shape.

How Do you Know if you have an Abnormal Uterus?

You might have some symptoms that can tell you that you might have an abnormal uterus. You might experience discomfort during intercourse, having difficulty conceiving, miscarriage, to name a few.

What Does having Two Uteruses Mean?

A congenital condition like Mullerian Anomalies can result in double uteruses. There is a duplication of the cervix, uterus, and vagina in this condition.

How Rare is a Septate Uterus?

Septate Uterus is the most common form of Mullerian Anomalies. It is known to be present in 3-7% of people.

How Long Does it Take to Get Pregnant After a Metroplasty?

It usually takes 14 months to get pregnant after having a Metroplasty.

Can you Carry Two Babies When you have Two Uteruses?

Carrying a baby in each womb is extremely rare. However, there is a known case of such an incident happening.

Does a Uterine Septum Cause Infertility?

No, it doesn’t usually cause infertility. However, it does cause problems with carrying a fetus to the full term.

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