Müllerian Anomalies

What are the signs and symptoms of a Müllerian anomaly?

Oftentimes, a patient does not have any symptoms, particularly if the uterus and vagina are patent, meaning there is no obstruction to the normal flow of menstrual blood. However, if a septum (extra wall of tissue) is present and blocks menstrual flow, patients can have symptoms of abdominal pain in the absence of menstrual bleeding, at an age when we would expect a girl to be having her monthly period.

Certain uterine anomalies, including a septate uterus, can cause recurrent miscarriages, so a miscarriage may be the first indication that a problem exists with the uterus. Finally, some malformations of the uterus, including bicornuate uterus, unicornuate uterus and uterine didelphys, may not be discovered until pregnancy, when a routine ultrasound shows a malformation. These conditions can also lead to the premature delivery of a baby, in which case the early delivery may be the first sign of the uterine malformation.

What tests are used to diagnose a Müllerian anomaly?

At Children's Hospital Colorado, we use a 3-dimensional ultrasound, magnetic resonant imaging (MRI) or both to take images of the pelvis and evaluate the size and shape of the uterus. An MRI uses magnets to produce detailed images of the body's organs and structures, while a 3-dimensional ultrasound uses sound waves to produce images of internal organs. For the ultrasound, we move a probe along the outside of the abdomen or pelvis to see the internal images. For the MRI, the patient simply needs to lay still as the machine scans the body.

In cases where the Müllerian anomaly is associated with malformations of the skeletal system or the urinary tract, we use X-rays and additional imaging of the kidneys to diagnose the extent of the anomaly. An X-ray uses radiation to show images of solid structures inside the body.

Why choose us for these imaging tests?

Müllerian anomalies are uncommon conditions, and the differences between each type of malformation can be subtle. Receiving the correct diagnosis is critical for patients to choose the right medical and surgical treatment.

Given the rarity of these conditions, it is important that the radiologist is familiar with these malformations. Because Children's Colorado is a regional referral center for Müllerian anomalies, our radiology team sees more of these cases and has the proven expertise and experience required to accurately diagnose them.

How do we make a diagnosis for a uterine anomaly?

At Children's Colorado, we can usually diagnose a Müllerian anomaly by reviewing a patient's imaging tests and medical history. Occasionally, we need to perform a full exam of the pelvic structures to formulate the best treatment plan. To limit any discomfort, we recommend performing this exam while the patient is asleep under anesthesia.

How is a Müllerian anomaly treated?

Treatment for a Müllerian anomaly depends upon the specific condition.

If the Müllerian anomaly is associated with a vaginal septum that is obstructing menstrual flow, we will need to perform a surgical resection (removal) of the vaginal septum.

If the anomaly is a septate or subseptate uterus, we may recommend surgery to prevent miscarriages or premature deliveries. This treatment requires outpatient surgery with a hysteroscope and the resection of the uterine septum. During hysteroscopy, we place a small camera called a hysteroscope through the cervix and into the uterine cavity, which allows us to see the septum directly. We then use the camera to guide us while we use a small surgical instrument to remove the septum, returning the divided cavity to a normal, single cavity.

If the uterine anomaly is a bicornuate uterus, unicornuate uterus, or a didelphic uterus, the malformation cannot be surgically resected because this would permanently damage the tensile strength of the uterine muscle. Instead, we counsel these patients about future reproductive risks, including risk for premature delivery, which requires additional monitoring by an obstetrician during pregnancy.

Why choose us for the treatment of a Müllerian anomaly?

Müllerian anomalies are uncommon conditions and they require management by an experienced multidisciplinary care team, including specialists from radiology, gynecology, urology, pediatric surgery, colorectal surgery as well as psychology, who help provide emotional support for our patients. At Children's Colorado, we have the experience managing these complex conditions and the multidisciplinary team to optimize the surgical outcome and psychosocial well-being of our teens.

The American Society for Reproductive Medicine (ASRM) provides multidisciplinary information, education, advocacy and standards in the field of reproductive medicine.

The Center for Young Women's Health (CYWH) is an educational entity that is committed to providing teen girls and young women with carefully researched health information, educational programs and conferences.