Arcuate Uterus: Symptoms, Types, Causes and Treatment

The arcuate uterus is one of the most common but least understood congenital anomalies of the female reproductive system. For many women, it goes unnoticed throughout life, yet it can sometimes be linked with reproductive challenges or pregnancy complications. This comprehensive article explores the symptoms, types, causes, and treatment options for arcuate uterus, synthesizing the latest research and clinical perspectives.

Symptoms of Arcuate Uterus

Discovering an arcuate uterus can be surprising, as this condition often remains silent and undiagnosed for years. Yet, when symptoms do appear, they can range from mild to more serious reproductive issues. Understanding the nuances of these symptoms is crucial for both patients and clinicians in recognizing and managing this anomaly.

Symptom	Frequency	Impact on Life	Source
Asymptomatic	Common	None	2 3 6
Recurrent miscarriage	Occasional	Emotional distress, reproductive challenges	2 3 6
Premature birth	Rare	Neonatal health risks	2 6
Infertility	Uncommon	May affect conception	1 2 3

Table 1: Key Symptoms

Asymptomatic Nature

Most women with an arcuate uterus experience no symptoms at all. The anomaly is commonly identified incidentally during imaging for unrelated reasons or during evaluations for infertility or recurrent pregnancy loss. In fact, many women carry pregnancies to term without ever knowing they have this condition 2 3 6.

Recurrent Miscarriage and Pregnancy Complications

While the majority of women are unaffected, some may experience reproductive challenges such as recurrent miscarriages or premature births. The risk appears to be slightly elevated compared to women with a normally shaped uterus, but the association is not as strong or clear-cut as with other uterine anomalies like septate or bicornuate uterus 2 3 6. Emotional distress from pregnancy loss can significantly impact quality of life for affected women.

Infertility

Although arcuate uterus is less frequently associated with infertility than other uterine malformations, some women presenting with this anomaly may have difficulty conceiving. Studies show that the reproductive prognosis for women with arcuate uterus is generally favorable, especially when no other infertility factors are present 1 3.

Other Symptoms

Unlike more severe Müllerian anomalies, arcuate uterus rarely causes symptoms such as pelvic pain, dysmenorrhea (painful periods), or primary amenorrhea (absence of menstruation) 5. These are more typical of anomalies causing outflow tract obstruction.

Types of Arcuate Uterus

The arcuate uterus represents a spectrum of uterine cavity shapes, primarily characterized by a mild indentation at the uterine fundus. While it is classified separately from more pronounced anomalies, understanding its subtle variations is important for both diagnosis and management.

Type	Description	Diagnostic Feature	Source
Typical arcuate	Mild concave indentation at fundus	Indentation <1 cm, broad base	2 5 6
Borderline/variant	Slightly deeper indentation	Features overlap with septate uterus	4 6
Residual septal stump	Post-surgical appearance	Resembles arcuate on imaging	6

Table 2: Arcuate Uterus Types

Typical Arcuate Uterus

A typical arcuate uterus features a shallow, broad-based concavity at the top (fundus) of the uterine cavity. The indentation generally measures less than 1 cm in depth and does not significantly divide the uterine cavity 2 5 6. This subtlety is what distinguishes it from more significant uterine anomalies.

Borderline or Variant Forms

Some cases fall on the borderline between arcuate and septate uterus. These variants can present with slightly deeper fundal indentations, making it challenging to distinguish between a benign arcuate configuration and a clinically significant septate uterus. Diagnostic imaging, especially 3D ultrasound or MRI, is crucial for accurate classification 4 6.

Residual Septal Stump

Interestingly, after surgical correction of a uterine septum (septoplasty), the remaining uterine shape may resemble an arcuate uterus. This “residual septal stump” looks similar on imaging and reinforces the spectrum-like nature of these anomalies 6.

Diagnostic Criteria and Classification

Leading gynecological societies, such as the American Fertility Society (AFS) and European societies, classify arcuate uterus as a distinct entity (Class 6 in some systems) 5. The differentiation relies on precise imaging and measurement of the indentation’s depth and width.

Causes of Arcuate Uterus

The origins of arcuate uterus lie in early embryonic development. A clearer understanding of these causes helps explain the variability in presentation and impact.

Cause	Mechanism	Timing (Developmental Stage)	Source
Müllerian duct anomaly	Incomplete resorption of septum	Embryogenesis (weeks 8–12)	2 5 6
Genetic predisposition	Potential familial patterns	Not definitively established	5
Environmental factors	Rarely implicated	Prenatal development	5

Table 3: Causes of Arcuate Uterus

Müllerian Duct Malformation

The arcuate uterus results from a minor anomaly during the development of the Müllerian ducts, which give rise to the female reproductive tract. Normally, these ducts fuse and the intervening septum is resorbed to create a single, unified uterine cavity. In the arcuate uterus, resorption is almost complete, leaving only a shallow indentation at the fundus 2 5 6.

Genetic and Environmental Factors

While some congenital uterine anomalies show familial clustering, a specific genetic basis for arcuate uterus has not been conclusively identified. Environmental factors, such as in utero exposure to certain substances (e.g., diethylstilbestrol), are associated with other uterine anomalies but not specifically with arcuate uterus 5.

Spectrum of Müllerian Anomalies

The arcuate uterus represents the mildest form on the spectrum of Müllerian duct anomalies. Others, such as septate, bicornuate, or unicornuate uterus, result from more significant disruptions in fusion or resorption processes 5 6. This spectrum concept explains why symptoms and clinical significance can vary so widely.

Treatment of Arcuate Uterus

Management of arcuate uterus is a nuanced topic, as most women require no intervention. However, for those with recurrent reproductive challenges, individualized treatment may be considered.

Treatment Option	Indication	Outcome/Consideration	Source
No treatment	Asymptomatic or normal reproductive history	No impact on fertility	2 3 6
Hysteroscopic resection	Recurrent pregnancy loss or poor reproductive outcomes	May improve outcomes in select cases	2 4 6
Counseling & monitoring	Mild symptoms or anxiety	Supportive care	2 6

Table 4: Treatment Approaches

Expectant Management

For the vast majority of women—especially those without symptoms or adverse reproductive history—no treatment is necessary. Studies consistently show that arcuate uterus has little to no impact on fertility or pregnancy outcomes in most cases 2 3 6. Many women with the anomaly have healthy, full-term pregnancies without intervention 2.

Surgical Options: Hysteroscopic Resection

In rare situations where a woman experiences recurrent miscarriages or unexplained infertility and an arcuate uterus is the only identifiable abnormality, hysteroscopic resection of the fundal indentation may be considered. However, evidence for routine surgical correction is lacking, and it is not universally recommended 2 4 6. Surgical intervention should be reserved for select patients who meet strict criteria, often after other causes have been excluded.

Postoperative Outcomes

When surgery is performed (often for more pronounced anomalies, but sometimes for arcuate uterus), imaging shows the uterine cavity can remodel significantly. However, this change is more pronounced—and more clearly beneficial—in women with septate than arcuate uterus 4.

Counseling and Support

For women who are anxious about the diagnosis or who have a history of reproductive loss, counseling and close monitoring during pregnancy can provide reassurance and help manage expectations 2 6. Individualized care, taking into account the woman's reproductive history and preferences, is key.

Other Considerations

• Diagnostic Imaging: 2D/3D ultrasound, MRI, and hysteroscopy are valuable for accurate diagnosis and distinguishing arcuate uterus from other anomalies 5.
• Associated Conditions: Some women may have concurrent conditions (e.g., polycystic ovary syndrome), which should be addressed as part of a comprehensive fertility evaluation 4.
• No Preventive Measures: As a congenital anomaly, arcuate uterus cannot be prevented; early detection relies on imaging if symptoms or reproductive issues arise.

Conclusion

The arcuate uterus is a subtle congenital anomaly that typically has minimal impact on reproductive health. Understanding its characteristics, origins, and management options is essential for both patients and clinicians.

Key Takeaways:

• Most women with arcuate uterus are asymptomatic and have normal reproductive outcomes 2 3 6.
• The condition is caused by incomplete resorption of the Müllerian duct septum during embryogenesis 2 5 6.
• Accurate diagnosis relies on imaging, with 3D ultrasound and MRI being the most informative 5.
• Treatment is rarely needed; surgical correction is reserved for select cases with recurrent reproductive failure 2 4 6.
• Supportive counseling and individualized care are important for women with concerns about the diagnosis 2 6.

By staying informed and working with knowledgeable healthcare providers, women diagnosed with arcuate uterus can optimize their reproductive health and outcomes.