Bicornuate Uterus: Causes, Symptoms, and Diagnosis

Have you recently heard the term bicornuate uterus and wondered what it means for you or someone you care about? This condition simply refers to a uterus that has a different shape from usual — it’s curved or heart-shaped instead of round. Many people with a bicornuate uterus have no symptoms and go on to live healthy lives. 

While it can sometimes affect pregnancy, understanding the causes, symptoms, and how it’s diagnosed can help you feel more prepared and supported in managing your reproductive health.

What Is A Bicornuate Uterus?

A bicornuate uterus is a type of congenital uterine condition where the uterus is shaped more like a heart rather than a typical pear shape. It happens when the uterus doesn’t fully form into one unified cavity before birth. Instead, it remains divided into two parts, or "horns". This may be partial or complete, depending on the degree of separation. 

Though the shape is different, many people with this condition experience normal reproductive health and may never know they have it until a scan reveals it.

How Common Is A Bicornuate Uterus?

This condition is considered rare, but not unheard of. It affects less than 0.5% of people assigned female at birth. Among congenital uterine abnormalities, it is one of the more commonly diagnosed forms. 

Most people only find out they have a bicornuate uterus during an ultrasound, often in early pregnancy or when looking into symptoms such as recurrent miscarriages. Many live without any issues or symptoms, and some even go through pregnancy without ever knowing their uterus is shaped differently.

Is Having A Bicornuate Uterus Bad?

Not at all. Having a bicornuate uterus doesn’t mean something is wrong with you. It simply means your uterus is shaped differently. Most people with this condition have no trouble with everyday health and may even have healthy pregnancies. 

While it might be linked to certain risks during pregnancy, these risks can often be managed with the right care. The most important step is understanding your body and working closely with your doctor to ensure you get the support you need.

What Causes A Bicornuate Uterus?

A bicornuate uterus forms during early development in the womb. It’s a result of incomplete fusion of two structures known as Müllerian ducts.

Here are the main bicornuate uterus causes:

• Congenital formation: This condition starts during foetal development, usually between the 10th and 20th week of pregnancy. It is something you are born with.
• Müllerian duct fusion failure: In a typical uterus, two ducts fuse to create one uterine cavity. When this fusion is only partial, it results in a uterus with two horns—this is what creates the heart-shaped appearance.
• Not inherited: There is no strong evidence to suggest that a bicornuate uterus is passed down genetically. It is more of a developmental variation than a hereditary condition.
• No known external cause: Factors like diet, stress, or physical activity during pregnancy have not been shown to cause this condition. It simply happens during the natural formation of organs in the developing baby.

What Are The Key Symptoms Of A Bicornuate Uterus?

Many people do not experience any signs, which is why the condition can go unnoticed for years. However, in some cases, symptoms of bicornuate uterus may be present.

Some common signs include:

• Recurrent pregnancy loss: This is often the first indicator, especially after two or more miscarriages in the early stages of pregnancy.
• Painful periods (dysmenorrhoea): Some people report more cramping or discomfort during menstruation.
• Pelvic pain: Chronic lower abdominal pain may occasionally be associated with this condition.
• Painful intercourse: Discomfort during sex (dyspareunia) can sometimes occur due to the shape of the uterus.
• Abnormal bleeding: Heavier or irregular menstrual bleeding may be a symptom, especially in more severe cases.

It’s important to note that the symptoms of bicornuate uterus vary widely. Some may experience all of the above, while others may have none at all.

What Are The Different Types Of Bicornuate Uterus?

The bicornuate uterus types are based on how the uterus is divided and whether there is one cervix or two.

Here’s a breakdown:

• Partial Bicornuate Uterus: In this type, the uterus is mildly divided. The separation doesn’t go very deep, and the uterus appears slightly heart-shaped. Many people with this type have few or no symptoms.
• Complete Bicornuate Uterus: This involves a deeper division, resulting in two distinct horns that can sometimes be mistaken for two separate uteri.
• Bicornuate Unicollis: Here, there’s a single cervix (neck of the womb) and two uterine horns. It may go unnoticed unless pregnancy complications arise.
• Bicornuate Bicollis: This form includes two cervices and a divided uterus. It’s rarer and may be detected through internal examinations or imaging.
• Associated vaginal anomalies: In some people, a vaginal septum (a wall within the vagina) may be present, adding to discomfort or complications during intercourse or delivery.

Knowing your specific type can help guide your care plan and support options, especially if you're planning a pregnancy.

How Is A Bicornuate Uterus Diagnosed?

Diagnosis usually happens through medical imaging. If you're having symptoms or issues with pregnancy, your doctor may suggest tests to check your uterus’s shape.

Here are common methods:

• Ultrasound (2D and 3D): A 2D scan may suggest an unusual shape, but 3D ultrasound offers a more detailed view and helps confirm the diagnosis.
• MRI scan: Magnetic Resonance Imaging provides a clear image of your uterus, helping differentiate between a bicornuate uterus vs normal uterus, or other conditions like a septate uterus.
• Hysterosalpingography (HSG): This is an X-ray using dye to view the uterus and fallopian tubes. It’s useful but less accurate in defining the outer shape of the uterus.
• Pelvic exam or routine pregnancy scan: Sometimes the condition is found unexpectedly during routine check-ups or fertility assessments.

Your doctor may recommend more than one test to ensure an accurate diagnosis.

How Does a Bicornuate Uterus Affect Pregnancy?

While many people with this condition go on to have healthy babies, a bicornuate uterus can influence pregnancy in some cases.

Potential effects include:

• Higher miscarriage risk: The limited space in the uterine cavity can affect implantation and early growth.
• Preterm labour: The uterus may not stretch fully, which can lead to early contractions or delivery.
• Breech or abnormal foetal position: Babies may settle into less common positions because of the irregular shape.
• Need for C-section: Because of the shape, many doctors recommend a caesarean to ensure a safer delivery.
• Increased monitoring: More frequent ultrasounds may be advised to track baby’s growth and position.

Despite these risks, bicornuate uterus normal delivery is possible, especially with good medical care and careful planning.

How Do You Fix A Bicornuate Uterus?

Not everyone needs treatment. In fact, many people live comfortably without ever requiring medical intervention. However, if complications occur, bicornuate uterus treatment may be recommended.

Treatment options include:

• Metroplasty surgery: This is a procedure that reshapes the uterus into a more typical form. It’s usually done if you’ve had multiple miscarriages or other issues. It can be done using open surgery or a minimally invasive laparoscopic method.
• Laparoscopic metroplasty: A modern technique that involves small incisions. Recovery is quicker, and there's less risk of scarring compared to open surgery.
• Cerclage: This is a stitch placed in the cervix during pregnancy if there’s a risk of premature opening. It helps support the pregnancy and prevent preterm birth.
• No surgery if no issues: If you're not having symptoms or complications, treatment may not be necessary. Your doctor may recommend simply monitoring your health and pregnancy if needed.
• Wait time after surgery: If you do have surgery, it's advised to wait at least three months before trying to conceive, giving your uterus time to heal.

Always speak with your specialist to decide what’s best for you.

Complications Associated With Bicornuate Uterus

Although many live without complications, certain risks can be associated with this condition.

Possible complications include:

• Recurrent miscarriages: Often due to limited space for the embryo to develop.
• Premature labour: The uterus might not stretch fully, leading to early contractions.
• Low birth weight: Some babies may have restricted growth due to the shape of the uterus.
• Breech presentation: Unusual baby positions can occur, making delivery more complex.
• Uterine rupture (rare): In rare cases, especially during labour, the uterus may rupture due to pressure on the divided walls.

Regular prenatal monitoring helps manage these risks effectively.

Treatment Options: Is Surgery Necessary?

The need for bicornuate uterus treatment depends on your personal experience and symptoms.

Here’s what you need to know:

• Not always needed: Many people never need any procedure if they are not facing problems.
• Surgery after multiple pregnancy losses: If you've had recurrent miscarriages or preterm deliveries, your doctor may suggest metroplasty.
• No guaranteed outcome: Surgery does not ensure a successful pregnancy, but it improves your chances if your uterus shape is causing issues.
• Laparoscopic metroplasty: This option is less invasive and comes with fewer risks. It’s now more common than traditional surgery.
• Risk of adhesions and scarring: Like all surgeries, metroplasty carries risks. Discuss these with your doctor before making a decision.
• Monitoring over treatment: If you're symptom-free, regular scans and check-ups may be all that’s needed.

Talk openly with your care provider about your choices.

Living With A Bicornuate Uterus: What You Should Know

Being diagnosed can feel overwhelming, but you’re not alone. Living with a bicornuate uterus is very manageable for most people.

Here are some helpful reminders:

• You can still have children: Many with this condition go on to have full-term, healthy pregnancies.
• Lifestyle isn't limited: It doesn’t affect your day-to-day life unless you’re facing complications.
• Regular check-ups matter: Especially if you're planning a pregnancy or currently expecting.
• Emotional support helps: Talk to your healthcare team or join support groups to share your experience.
• No lifestyle cause: Remember, this is a developmental condition. You didn’t do anything wrong.

How Can We Prevent A Bicornuate Uterus?

There’s currently no way to prevent a bicornuate uterus, as it's something that occurs during development in the womb.

Here’s what to know:

• It’s congenital: This means it forms before birth during the early weeks of pregnancy.
• Not caused by lifestyle: It isn’t linked to food, stress, or physical activity during pregnancy.
• No known genetic link: Most cases aren’t inherited, although research is ongoing.
• Early detection helps: While you can't prevent it, early diagnosis can help manage related risks.
• Routine screening not common: It’s usually only found if you’re being checked for other symptoms or fertility issues.

Are There Health Risks Associated With A Bicornuate Uterus?

Most people with a bicornuate uterus remain healthy, especially if there are no symptoms. However, some risks may exist depending on your individual situation.

These include:

• Increased miscarriage risk: Particularly in the first trimester.
• Higher risk of breech presentation: Which may lead to caesarean birth.
• Pelvic discomfort or pain: In some cases, the shape may cause pressure or cramping.
• Associated kidney anomalies: Because the kidneys and uterus form at the same time in the womb, some people may have renal differences.
• Unnoticed health issues: If endometrial cancer develops, it may go undetected if only one horn is checked.

Most risks are manageable with regular check-ups and support.

When To Consult A Doctor?

You should talk to a doctor if you notice anything unusual or if you're concerned about your reproductive health.

See a healthcare provider if:

• You've had more than one miscarriage: This is one of the most common indicators.
• You’re experiencing ongoing pelvic pain: Or discomfort during periods or intercourse.
• Periods are irregular or very heavy: These could be signs of an unusual uterine shape.
• You’re planning to conceive: Knowing about the condition early helps you and your doctor prepare.
• You’re already pregnant: And have been told you may have a bicornuate uterus—early care matters.

Getting clarity from a professional can offer peace of mind and better outcomes.

Final Thoughts: Managing a Bicornuate Uterus with Confidence

A bicornuate uterus is simply a different uterine shape that many live with without issues. Understanding the condition, its causes, and possible symptoms empowers you to take informed steps, especially if you're planning a pregnancy. 

If you need clarity or a diagnosis, choosing a trusted diagnostic partner matters. Metropolis Healthcare offers accurate, science-backed tests and convenient home sample collection, helping you take charge of your reproductive health with confidence.

FAQs About Bicornuate Uterus

Q1. Can I still have a baby if I have a bicornuate uterus?

Yes, many people with a bicornuate uterus have successful pregnancies with proper monitoring and medical support.

Q2. How will a bicornuate uterus affect my pregnancy?

It may increase the risk of miscarriage, preterm labour, or breech baby, requiring closer medical monitoring.

Q3. Is bicornuate uterus serious?

Usually not serious, but it may cause pregnancy complications in some cases that need medical attention.

Q4. Can you carry a baby with a bicornuate uterus?

Yes, many carry full-term babies; medical guidance and regular check-ups are often recommended during pregnancy.

Q5. How do you know if you have a double uterus?

It’s usually found during scans, especially after repeated miscarriages, or through MRI or 3D ultrasound.

Q6. What is the difference between a Didelphys and a bicornuate uterus?

Didelphys uterus has two separate uteri and cervices; bicornuate uterus has one uterus with two horns.

Q7. Will my baby have a birth defect if I have a bicornuate uterus?

No, it doesn't cause birth defects directly, but may increase risks like preterm birth or low weight.

Q8. Are my labor and delivery affected by a bicornuate uterus?

Yes, it may affect the baby's position and lead to a higher chance of caesarean delivery.

Q9. Can you have twins if you have a bicornuate uterus?

Yes, but it's rare and considered high-risk; close monitoring and specialised care are often needed.