Uterine septum

Uterine Septum: Understanding This Common Uterine Abnormality

A uterine septum is one of the most common congenital abnormalities of the uterus. It occurs when a band of tissue divides the uterine cavity, partially or completely. Congenital uterine abnormalities occur when the uterus develops differently in shape or size during fetal development. Some women may be unaware they have a septum until they face fertility challenges, recurrent miscarriage, or are undergoing gynaecological investigations for other symptoms. The condition is often asymptomatic, and many women remain unaware of their septate uterus until trying to conceive.

At Happiher, we offer expert diagnosis and minimally invasive treatment for uterine septum. If you’re looking for a private gynaecologist in London with experience in congenital uterine anomalies, we’re here to support you with clarity, sensitivity, and skill.

Introduction to Uterine Abnormalities

Uterine abnormalities, also known as congenital uterine anomalies, refer to irregularities in the shape or structure of the uterus that are present from birth. These anomalies can significantly impact a woman’s reproductive health, potentially affecting her ability to conceive or carry a pregnancy to term. Among the most common types of uterine abnormalities are the septate uterus, bicornuate uterus, and unicornuate uterus.

A septate uterus, for instance, is characterised by a thin wall of tissue that divides the uterine cavity into two separate parts. This condition can increase the risk of miscarriage, preterm birth, and other pregnancy complications. Similarly, a bicornuate uterus, often described as heart-shaped, has an external indentation and an internal division, which can also pose challenges during pregnancy. Understanding these different types of uterine anomalies and their potential effects on pregnancy is crucial for women’s health and fertility.

What Is a Uterine Septum?

A uterine septum forms during fetal development when the two halves of the uterus fail to fully fuse. During fetal development, the uterus forms from two ducts that normally fuse together; if this process is incomplete, a septum can form. Instead of a single open uterine cavity, a wall of tissue (the septum) remains, dividing the space. Congenital uterine abnormalities, including uterine septum, are seen in 5 to 10 in 100 women.

There are different types:

• Partial septum: extends from the top of the uterus (fundus) but doesn’t reach the cervix

• Complete septum: extends all the way down to the cervix, and in rare cases, into the vagina

A uterine septum is different from a bicornuate uterus, which has an external indentation as well as an internal division. A bicornuate uterus is also referred to as a heart-shaped uterus, characterised by a deep dip. Accurate diagnosis is key to selecting the right treatment.

Types of Uterine Septum

A uterine septum is a wall of tissue that divides the uterus into two separate parts, and it can be classified into two main types: complete and partial. A complete septate uterus occurs when the septum extends from the top of the uterus all the way down to the cervix, creating two distinct uterine cavities. In contrast, a partial septate uterus is characterised by a septum that only partially extends into the uterus, leaving a single cavity with a partial division.

Additionally, there is a specific type of partial septate uterus known as a subseptate uterus, where the septum only partially extends into the uterine cavity. Both complete and partial septate uterus can increase the risk of pregnancy complications, including miscarriage and preterm birth. Accurate diagnosis and appropriate treatment of a uterine septum are essential to improve fertility outcomes and reduce the risk of pregnancy-related issues.

What Are the Symptoms?

Many women with a uterine septum, a type of uterine irregularity, have no symptoms and may not know they have it. However, it can sometimes cause subtle signs such as painful menstruation and recurrent miscarriages. Painful periods can be a symptom of congenital uterine abnormalities, although many are asymptomatic.

• Difficulty conceiving

• Recurrent miscarriage

• Preterm labour or abnormal foetal positioning

• Painful periods or abnormal bleeding (less common)

Pregnancy with a septate uterus can come with an increased risk of complications such as preterm birth and fetal malpresentation.

It may also be discovered during investigations for other gynaecological or fertility concerns.

How Is a Uterine Septum Diagnosed?

Diagnosis requires careful imaging of the uterus, often using a combination of techniques including magnetic resonance imaging (MRI) and 3D pelvic ultrasounds. A pelvic ultrasound scan is crucial for a comprehensive fertility evaluation and helps in identifying underlying conditions.

• Transvaginal ultrasound with 3D capability

• Saline infusion sonography (SIS)

• MRI scan (for complex cases or differentiation from other anomalies)

• Hysteroscopy (direct visual examination of the uterine cavity)

A 3D ultrasound is better than a 2D ultrasound for diagnosing a septate uterus because it gives a detailed picture of the uterus.

At Happiher, we use high-resolution imaging and advanced diagnostic techniques to confirm the diagnosis and guide treatment planning.

Does a Uterine Septum Affect Fertility?

A uterine septum is strongly associated with:

• Recurrent early miscarriage

• Reduced implantation rates

• Increased risk of pregnancy complications

While it doesn’t always prevent pregnancy, it can interfere with the ability of an embryo to implant or grow properly. This condition can also affect early pregnancy, increasing the risks of miscarriage and preterm birth. For this reason, surgical treatment is often recommended for women trying to conceive, particularly after one or more miscarriages.

Uterine Septum and Pregnancy

A uterine septum can significantly impact pregnancy in various ways. The presence of a septum can interfere with the implantation of the embryo, leading to an increased risk of miscarriage. Additionally, women with a septate uterus may experience abnormal bleeding, pelvic pain, and preterm labor. There is also a higher likelihood of delivering a low birth weight baby.

However, with proper treatment and care, many women with a septate uterus can achieve a healthy pregnancy. Treatment options for a septate uterus typically involve surgical procedures to remove the septum, such as hysteroscopic resection or laparoscopic surgery. It is crucial to discuss treatment options with a healthcare provider to determine the best course of action based on individual circumstances. With the right approach, the chances of a successful pregnancy can be significantly improved.

Treatment Options: Hysteroscopic Septum Resection

The most effective surgical intervention for a uterine septum is a hysteroscopic septum resection, a minimally invasive procedure to remove the septum and restore a normal uterine cavity. A uterine hysteroscopy takes between 30 to 60 minutes to perform.

At Happiher, we offer a variety of treatments tailored to individual needs, ensuring the best possible outcomes for our patients.

At Happiher, Dr Kaur performs this surgery using hysteroscopic techniques — meaning:

• No incisions

• Fast recovery

• Fertility-preserving approach

• Usually performed as a day case

The procedure involves inserting a small camera through the cervix into the uterus and carefully removing the septum under direct visual guidance. Most women return to normal activity within a few days. Most patients undergoing a hysteroscopy for a septate uterus are sent home the same day after the procedure. The risks of hysteroscopic surgery for a septate uterus include fluid overload and perforation, but these risks are low.

What Happens After Surgery?

You’ll usually have follow-up scans to confirm the uterine shape and healing. In some cases, a short course of hormonal therapy may be recommended to support healing. Women are typically advised to wait at least two months after septum removal surgery before trying to conceive again.

If you’re trying to conceive, fertility may improve significantly after surgery — with a reduced risk of miscarriage and improved pregnancy outcomes. Pregnancy rates after uterine septum treatment can be as high as 65 percent. Uterine septum hysteroscopies are usually highly successful, achieving reduced miscarriage rates following treatment for a septate uterus.

Uterine Septum and Mental Health

The presence of a uterine septum can have a profound impact on a woman’s mental health, especially if she experiences recurrent miscarriages or pregnancy complications. The emotional toll of repeated pregnancy loss can be overwhelming, leading to feelings of anxiety, depression, and stress. Women with a septate uterus may also struggle with feelings of guilt, shame, or inadequacy, which can affect their self-esteem and relationships.

It is essential for women with a septate uterus to seek support from their healthcare provider, therapist, or support groups to cope with the emotional challenges associated with this condition. Private gynaecologists and gynaecology services can provide fast access to diagnosis, treatment, and follow-up care, helping women manage their condition and improve their mental health. By addressing both the physical and emotional aspects of a uterine septum, women can achieve better overall well-being and a higher quality of life.

Why Choose Happiher for Uterine Septum Treatment?

If you’re seeking uterine septum diagnosis or treatment in London, Happiher offers:

• Specialist gynaecological imaging

• Consultant-led diagnosis and second opinions

• Expertise in hysteroscopic and fertility-preserving procedures

• Clear, sensitive communication throughout your care

• A supportive, respectful space to ask any questions

Our team of experienced gynaecology consultants is dedicated to providing the highest level of care and expertise.

We understand how distressing unexplained fertility or recurrent pregnancy loss can be — and we’re here to provide answers, options, and reassurance.

Final Thoughts

A uterine septum is one of the common uterine anomalies that may be hidden, but its impact on fertility and pregnancy can be very real. With accurate diagnosis and expert treatment, most women go on to have healthy, full-term pregnancies. Many women with congenital uterine abnormalities can still get pregnant and have healthy babies.

At Happiher, we’re here to help you understand your diagnosis and take the next steps forward — with skilled, sensitive care at every stage.