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New treatments for unicornuate uterus, uterus didelphys, bicornuate uterus, and septate uterus

Uterine anomalies result from their defective migration, fusion, or absorption during embryonic life. The incidence of anomalies is difficult to estimate because many congenital anomalies do not result in clinical manifestations of double uterus, unicornuate uterus, uterus didelphys, bicornuate uterus, and septate uterus. Patients with symptomatic mullerian anomalies usually have signs of menstrual outflow obstruction or reproductive dysfunction.

Anomalies can be classified as problems with hypoplasia or agenesis (American Fertility Society [AFS] class I) or as fusion defects (AFS classes II-V). Class I anomalies, also referred to as mullerian anomalies, usually are diagnosed in women who seek treatment for primary amenorrhea or for an inability to have vaginal intercourse. These defects are thought to occur developmentally when the mullerian structures fail to join with the structures.

  1. In patients with complete mullerian agenesis, the possibility of complete androgen insensitivity (testicular feminization syndrome) should be considered.
  2. The patient with an absent vagina can have one that is adequate for intercourse.

Fusion defects include unicornuate uterus (AFS class II), uterus didelphys (AFS class III), bicornuate uterus (AFS class IV), and septate uterus (class V). A unicornuate uterus has a single hemi-uterus that is attached to its fallopian tube. It may also be associated with a rudimentary cavity from the contralateral side. A didelphys uterus has two uterine cavities.

Among patients with AFS class I to IV uterine anomalies, there is an increased incidence of renal anomalies, usually renal agenesis ipsilateral to the associated hypoplastic mullerian defect.

Endometrial polyps are hyperplastic overgrowths of glands and stroma that are localized and that form a projection above the surface. Such polyps may be sessile or pedunculated.

The prevalence of polyps has been estimated at 10% to 24% among women undergoing endometrial biopsy or hysterectomy. Endometrial polyps are rare among women younger than 20 years of age. The incidence of these polyps rises steadily with increasing age.

The most common symptom in women with endometrial polyps is metrorrhagia, or irregular bleeding; it is reported in 50% of symptomatic patients. Postmenstrual spotting is also common. Less common symptoms include menorrhagia, postmenopausal bleeding, and breakthrough bleeding during hormonal therapy. Overall, endometrial polyps account for 25%.

Endometrial polyps can sometimes be seen prolapsing through the cervix. Often they are diagnosed by microscopic examination of a specimen obtained after dilatation and curettage (D & C) or after endometrial biopsy. As is the case with submucous fibroids, polyps can escape detection if the uterus is not distended.

Endometrial polyps usually are cured by thorough curettage. However, polyps or other structural abnormalities may be missed by blind curettage, and hysteroscopic-guided curettage.