What is a 'Double Uterus' — and How Does it Affect Pregnancy?

If you keep up with celebrity news, you may have heard that Bachelorette star Hannah Brown was recently diagnosed with a double uterus. And you may have found yourself going… huh? Can someone actually have two uteruses?

And the answer? Yes, they can. But that’s not necessarily what that means when you receive this type of diagnosis. Stay with us; we’ll get to that in a minute.

Brown spoke about the diagnosis on an episode of Heal Squad x Maria Menounos, saying that she hasn't had an exploratory surgery to really figure out what's going on within her anatomy. “It looks like they’re attached in some way, so it’s just almost split,” Brown explained on the podcast episode.

Brown clearly doesn’t have all the answers — which is not surprising. Being a woman and navigating the world of women’s health often leaves us with more questions than answers. For Brown, one of those major questions is whether or not her diagnosis will affect her ability to conceive and carry children.

We spoke with Jessica Ryenic, MD, a reproductive endocrinologist, to learn more about this diagnosis and what it means for a woman’s reproductive future.

Is this condition really just… what it sounds like?

A double uterus diagnosis can signify exactly what it sounds like: Two uteri in one body. But it doesn’t always look exactly like that.

“A double uterus can likely be one of two things, both of which are in a group of developmental variants of the female reproductive tract called congenital uterine or mullerian anomalies,” says Dr. Ryniec. “The first is a true double uterus or uterine didelphys, which is a complete duplication of the uterus and cervix.”

In the second presentation, a woman can have one uterine cavity and cervix, yet have two separate horns to the uterus. This is called a bicornuate uterus.

How common is a double uterus?

A double uterus diagnosis is rare. 

According to Dr. Ryniec, studies show that about 5 to 8 percent of people have some sort of congenital uterine abnormality, and it’s more common among those with a history of recurrent pregnancy loss. Bicornuate uterus accounts for about 30% of all uterine anomalies, while didelphys accounts for about 10%.

So yes, the condition is rare, which contributes to why it’s not more commonly spoken about — and that explains why women like Brown may be “shocked”, overwhelmed, and confused when they receive this diagnosis.

Does the condition cause symptoms?

“Incredibly, it is possible to have one of these mullerian variants and never know,” says Dr. Ryniec. “Some are asymptomatic while others may have symptoms such as abnormal uterine bleeding or dysmenorrhea, and pelvic pain.”

According to Dr. Ryniec, endometriosis is also more common among those with these variants. 

In many cases, someone won’t discover a double uterus until they are pregnant. “Some discover it sooner during evaluation for pelvic pain, abnormal uterine bleeding, or infertility,” says the expert.

Diagnosis typically happens after a combination of hysterosalpingogram, 3D ultrasound, pelvic MRI, or laparoscopy and hysteroscopy.

How does having a double uterus affect fertility?

Understandably, one of Brown’s first concerns was her condition’s ability to affect her fertility. 

Brown was told that the diagnosis could complicate things, and many questions arose for her.

“Is one bigger than the other? Can it hold a baby? Which one’s better?” Brown said. “There have been cases of people having double uteruses and having babies, and it being perfectly fine… but it was definitely a shock.”

Her concern is totally valid — and may be warranted

“In pregnancy, these variants are associated with recurrent pregnancy loss, malpresentation like breech, preterm labor and delivery, and growth restriction,” says Dr. Ryniec.

With that being said, getting pregnant is not typically complicated by this issue.

“Having a double uterus does not necessarily impact the ability to get pregnant without associated conditions like endometriosis, but does have higher pregnancy complications as above,” says Dr. Ryniec.

How is the condition managed?

Brown spoke about putting management of the condition on the back burner, but what can people do if they learn they have a uterine abnormality?

“While there are surgical management options for bicornuate uterus, this is not a common procedure and is only offered with prior poor pregnancy outcomes, and even then it is unclear how beneficial it is in improving outcomes,” says Dr. Ryniec. 

“Management of other symptoms could include hormonal menstrual suppression, correction of associated anomalies like vaginal septum, or ultimately hysterectomy.”

It can be a complex issue, so if you do receive a similar diagnosis, visiting an OB/GYN and/or a fertility specialist would be wise if you want to have children in the future.

Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, MarieClaire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.