Uterine hypoplasia is an underdevelopment of the uterus, characterized by a decrease in its size compared to the age and physiological norm. Clinically, uterine hypoplasia is manifested by the late onset of menstruation (after 16 years), their irregularity and increased pain; miscarriages, labor anomalies, infertility; decreased libido and anorgasmia. It is diagnosed by vaginal examination, ultrasound, probing of the uterine cavity. Treatment of uterine hypoplasia requires hormone therapy, physiotherapy, physical therapy. The prognosis for the possibility and success of pregnancy is determined by the degree of uterine hypoplasia.
Uterine hypoplasia has synonyms infantilism or baby uterus. Insufficient production of female sex steroids leads to underdevelopment of the uterus, which remains hypoplastic – with a long conical neck, a small body and hyperanteflexia. Hypoplasia of the uterus is accompanied by the presence of long convoluted tubes, which may be accompanied by infertility. In the case of conception, ectopic pregnancy often develops, since the passage of the zygote through the altered fallopian tubes is difficult. With hypoplasia of the uterus, other organs of the reproductive system are also often underdeveloped – labia, vagina, ovaries. Often hypoplasia of the uterus is accompanied by polycystic ovaries.
Congenital uterine hypoplasia is a manifestation of genital or general infantilism due to the damaging effect on the embryo in the antenatal period or hereditary factors. More often, the causes of uterine hypoplasia lie in violations of the “hypothalamus-uterus” regulation system or ovarian insufficiency with increased gonadotropic activity of the pituitary gland. Such regulatory failures occur in girls in childhood or puberty and can develop with hypovitaminosis, intoxication (narcotic, nicotine), nervous disorders, increased educational and sports loads on the child’s body, anorexia, frequent infections (tonsillitis, ARVI, flu), etc. In this case, there is a delay in the development of the initially correctly formed uterus.
The main characteristic is a decrease in its size. Normally, in sexually mature women who have not given birth, the uterus has a cavity length of at least 7 cm, in those who have given birth – 8 cm, the neck length is 2.5 cm. Depending on the time of development arrest, gynecology distinguishes three degrees of uterine hypoplasia: embryonic, formed in utero; infantile and adolescent, formed after birth. The embryonic (fetal) uterus is characterized by a length of up to 3 cm, the cavity is practically not formed, the entire size falls on the neck. Infantile (children’s) uterus has a length from 3 cm to 5.5 cm with a ratio of the length of the cervix to its cavity 3:1. The adolescent uterus with hypoplasia has a length of 5.5 cm to 7 cm, with a less pronounced predominance of the cervix – 1:3.
Uterine hypoplasia is characterized by the onset of menstruation later (after 16 years). After the formation of menstrual function, menstruation usually proceeds painfully (in the form of dysmenorrhea), irregularly, have a short, meager or abundant character. With hypoplasia of the uterus, a girl may lag behind in general physical and sexual development: a teenager of small stature, with a uniformly narrowed pelvis, narrow chest, hypoplastic mammary glands, absent or unexpressed secondary sexual characteristics.
In the future, sexually mature women with uterine hypoplasia have a reduced sexual feeling, anorgasmia. Reproductive disorders may include infertility, ectopic pregnancy, spontaneous termination of pregnancy, severe toxicosis, weak labor activity, insufficient opening of the uterine pharynx during childbirth, atonic postpartum bleeding. Women with uterine hypoplasia often develop cervicitis, endometritis due to the weak resistance of the reproductive system to infections. These symptoms should make a woman turn to a gynecologist-endocrinologist.
Gynecological examination of patients with uterine hypoplasia reveals signs of genital infantilism: insufficient hair, underdeveloped labia, the clitoral head protruding beyond the vulva. A vaginal examination determines a short, narrow vagina with weak arches, elongation and conical shape of the cervix, reduction and flattening of the uterine body, hyperanteflexia. During pelvic ultrasound, the dimensions of the body and neck are examined, which allows us to judge the degree of uterine hypoplasia.
X-ray or ultrasound hysterosalpingoscopy confirms the reduced size of the uterus, tortuosity of the fallopian tubes, ovarian hypoplasia. If hypoplasia of the uterus is suspected, a laboratory study of the level of sex hormones (FSH, progesterone, prolactin, LH, estradiol, testosterone), as well as thyroid hormones (TSH, T4) is carried out. Additionally, if hypoplasia of the uterus is suspected, they resort to probing the uterine cavity, determining the bone age of the patient, radiography of the Turkish saddle, MRI of the brain.
The nature of treatment is determined by the degree of uterine hypoplasia and the causes of its underdevelopment. The basis of the treatment of uterine hypoplasia is hormone replacement or stimulating therapy, with the adequacy of which the gynecologist manages to achieve an increase in the size of the uterus to normal and the restoration of a normal menstrual cycle.
The use of physiotherapeutic methods for uterine hypoplasia (magnetotherapy, laser therapy, diathermy, inductothermy, UHF therapy, mud therapy, ozokeritotherapy, paraffin treatment) allows to normalize blood circulation in the organ. A good effect can be observed from endonasal galvanization, under the influence of which the work of the hypothalamic-pituitary region is stimulated, the synthesis of LH and FSH hormones increases. A patient with uterine hypoplasia is prescribed vitamin therapy, physical therapy, gynecological massage, spa therapy (sea bathing and baths).
Prognosis and prevention
With fetal type of uterine hypoplasia, pregnancy is excluded, motherhood is possible only with the help of ART. If it is impossible to have an independent pregnancy, but the ovarian function is preserved, they resort to the method of in vitro fertilization using the patient’s egg. In case of miscarriage syndrome, artificial insemination (IMSI, ICSI, PIXIE) is carried out as part of surrogacy. With a small degree of uterine hypoplasia and normal ovarian structure and function, the chances of pregnancy are favorable. The course and management of pregnancy in patients with uterine hypoplasia is associated with the risks of spontaneous abortion, complicated childbirth.
For the normal formation and development of a woman’s reproductive system, it is necessary to eliminate adverse factors of influence, especially in adolescence. To prevent uterine hypoplasia, girls need proper nutrition, rejection of debilitating diets, exclusion of stressful situations, timely prevention and treatment of infections.