Can differences in the womb be present from birth? Yes. Congenital uterine abnormalities are differences in how the uterus develops before birth. A uterus may be absent or underdeveloped, one side may develop more fully than the other, or a partition may divide the space inside it. Some people first learn about a uterine difference during a scan for another reason.
The shape of the uterine cavity and the outline of the uterus help identify the type. Knowing the exact type helps your gynaecologist decide whether you need further tests, follow-up or treatment.
How does the uterus develop?
Before birth, two structures called the Müllerian ducts come together to form the uterus. A difference in how either side develops, how the two sides join, or how the tissue between them changes can affect the final shape.
A scan report may use terms such as “unicornuate,” “septate” or “bicornuate.” Each describes a different pattern.
What are the main types of congenital uterine abnormalities?
Absent or underdeveloped uterus
In Müllerian agenesis, the uterus may be absent or present only as small remnants. Some people first seek evaluation because their periods have never started despite other signs of puberty. Since several conditions can cause absent periods, a gynaecologist uses the clinical history and appropriate tests to find the cause.
Unicornuate uterus
A unicornuate uterus forms when one side develops more fully than the other. The less developed side may be absent or may form a small structure called a rudimentary horn. Imaging helps show whether a horn is present and whether it connects to the main uterine cavity.
Septate uterus
In a septate uterus, a wall of tissue called a septum extends down from the top of the cavity. It may divide the cavity partly or completely. The outside of the uterus can still have a typical shape, so clinicians assess both the cavity and the outer outline.
Bicornuate uterus
A bicornuate uterus has two upper portions and a more pronounced indentation on its outer surface. It can resemble a septate uterus on an image that shows only the cavity. Seeing the outside of the uterus helps distinguish the two.
When might a uterine difference be discovered?
Some people have regular periods and no obvious symptoms. A difference may come to light during a pelvic scan, an evaluation for difficulty getting pregnant or a review after repeated pregnancy loss. Others may seek care because their periods never began. These situations can have several causes, so the scan finding is interpreted alongside the person’s history.
Watch the doctor explain
In this Kannada video from Nisarga Diagnostics, Prof. Dr. Srinivas Prasad RH explains what an absent or underdeveloped uterus, a uterus that develops mainly on one side, and a partition inside the womb can look like.
Watch the original video on Instagram.
How doctors assess the shape of the uterus
A pelvic ultrasound may be the first scan. When a septum is suspected, three-dimensional transvaginal ultrasound, sometimes with saline, is a recommended first-line test for evaluating uterine shape. It can show how the cavity and outer contour relate to each other.
A clinician may request a pelvic MRI when the ultrasound leaves questions about the anatomy or when a more complex difference is suspected.
What can an HSG test show?
An HSG outlines the uterine cavity and helps assess whether the fallopian tubes are open. Because it gives limited information about the outside of the uterus, an HSG alone may not distinguish a septate uterus from a bicornuate uterus. Read our guides to preparing for an HSG test and what routine ultrasound can show about fallopian tube blockage.
Can these differences affect pregnancy?
The implications depend on the type and the person’s pregnancy history. Some people with a uterine difference can conceive and carry a pregnancy. A uterine septum is associated with a higher risk of miscarriage and certain pregnancy complications. Evidence about whether a septum makes it harder to conceive is less clear.
If a septum is confirmed and there have been recurrent miscarriages, a specialist may discuss the potential benefits and risks of surgery. The decision depends on the diagnosis, previous pregnancies and the person’s goals.
What to discuss after a scan
Bring the report and any previous pelvic scan images to your gynaecologist. Ask which type is suspected, whether the scan showed both the inner cavity and outer shape, and whether any further imaging would affect your care.
If you are planning a pregnancy or have had pregnancy losses, share that history so your doctor can advise you about follow-up.
Frequently asked questions
Are these changes present from birth?
Yes. They arise while the uterus develops before birth, though they may first be recognised in adolescence or adulthood.
Can I have regular periods with a septate uterus?
Yes. A septate uterus can be present even when periods are regular. Some people first learn about it during pelvic imaging.
Is a uterine septum the same as a fibroid?
A septum is tissue that divides the cavity and is present from birth. A fibroid is a growth that arises from the muscle of the uterus.
Can a routine ultrasound identify every type?
A routine scan may raise suspicion. Your doctor may advise a targeted 3D scan or MRI to clarify the anatomy.
Does a divided cavity always mean a septate uterus?
A bicornuate uterus can also appear divided. Assessing the outer contour helps distinguish it from a septate uterus.
Does everyone with a uterine septum need surgery?
Care is individual. A specialist considers the confirmed anatomy, symptoms, pregnancy history and goals before discussing treatment.
What if I am already pregnant and a scan suggests a uterine difference?
Share the report with your obstetrician. They can review the finding alongside your pregnancy history and advise whether you need additional monitoring.
Pelvic imaging at Nisarga Diagnostics
If your gynaecologist has advised pelvic imaging, contact Nisarga Diagnostics in Sanjaynagar, Bengaluru to ask about the prescribed scan and appointment availability. Bring your prescription and previous scan reports.
Medical references
ASRM Müllerian Anomalies Classification
ASRM guideline on uterine septum diagnosis and treatment
Founder of Nisarga Diagnostics, is a renowned fetal ultrasound specialist with over 20 years of expertise. An alumnus of Government Medical Colleges in Mysore and Bangalore, he also holds a D.N.B. from the National Board of Examinations, Delhi, and certification from the Fetal Medicine Foundation, London. A former Professor and HOD, he has trained countless PG students and junior radiologists, shaping the future of fetal imaging in India.