Bifid Uterus & Heavy Periods: Understanding the Connection

A bicornuate (bifid) uterus – a congenital fusion defect creating two uterine horns – can contribute to heavy menstrual bleeding (menorrhagia).

Mechanisms

• Increased endometrial surface area: Two cavities = more lining to shed.
• Impaired contractility: The septum disrupts coordinated uterine contractions, leading to incomplete shedding and prolonged bleeding.
• Altered vascularity: Abnormal arterial supply may cause congestion and heavier flow.
• Associated endometriosis/adenomyosis: Higher prevalence in Müllerian anomalies, further increasing bleeding.

Management

• Medical: NSAIDs, tranexamic acid, combined OCP, progestin IUD (if cavity accommodates).
• Surgical: Hysteroscopic metroplasty (septum resection) for septate uterus; laparoscopic metroplasty for bicornuate if fertility affected.
• Individualized based on severity, fertility desires, and anatomy.

Not all women with a bifid uterus have heavy periods; other causes (fibroids, coagulopathy) must be excluded.