Cervical Stenosis

What is Stenosis of the uterine cervix?

The cervix is the small organ located at the bottom of the uterus, which opens into the vaginal canal. Cervical stenosis is a condition in which the endocervical canal narrows or completely closes off, hindering or blocking the passage between the uterine cavity and the vaginal canal.

Not only does a narrow or closed-off cervix complicate pregnancy and conceiving, but it can also cause problems with menstruation that can lead to more serious infections or complications.

What causes stenosis of the uterine cervix? 

Cervical stenosis can be congenital (present at birth), or it can develop from other conditions or procedures, such as:

• Uterine, endometrial, or cervical cancer
• Cervical dysplasia
• Radiation therapy for cervical or endometrial cancers
• Surgical procedures on the cervix, such as surgery to treat dysplasia
• Surgeries that affect the uterine lining, such as an endometrial ablation
• Cervical/vaginal atrophy
• Postmenopausal vaginal dryness

What are the potential complications of cervical stenosis? 

Retrograde menstruation — when menstrual blood flows up through the fallopian tubes into the pelvic cavity — is pretty common and doesn’t often cause problems. However, severe cervical stenosis can prevent regular menstruation, meaning all your menstrual blood has to flow back into the abdomen. Retrograde menstruation can cause extremely painful periods and increase your risk of endometriosis.

Cervical stenosis also increases the risk of cervical laceration and uterine perforation during certain medical procedures. The rigidity and narrowing of the cervix make it more susceptible to injury when instruments are introduced or need to be dilated.

Cervical stenosis can also cause more complications, such as:

What are the symptoms of cervical stenosis? 

For some women, especially women who have reached menopause, cervical stenosis may have few or no symptoms.

Some patients may not discover they have cervical stenosis until they start trying to conceive. A narrow or completely closed-off cervical canal can prevent sperm from reaching and fertilizing an egg. The condition can also complicate or prevent fertility treatments, such as in vitro fertilization (IVF) and intrauterine insemination (IUI), as the necessary instruments are unable to pass through the closed-off cervix.

Noticeable symptoms of cervical stenosis may include:

• Irregular periods and abnormal bleeding
• No periods (amenorrhea)
• Pain during your period (dysmenorrhea)
• Chronic pelvic pain or bulging in the pelvic area

How is a stenotic cervix diagnosed? 

Our OB/GYN may suspect cervical stenosis if you’re experiencing some of the above symptoms, especially after cervical or uterine surgery. Sometimes, stenosis is suspected when our doctor has difficulty collecting a sample for a routine Pap or HPV test or performing an endometrial biopsy.

Hysteroscopy can diagnose cervical stenosis by allowing direct visualization of the cervical canal and the internal structures of the uterus. During the minimally invasive procedure, a hysteroscope — a thin, lighted telescope-like device — is inserted through the vagina and cervix into the uterus. This tool enables the doctor to examine the cervix and uterus closely for any signs of narrowing or obstruction in the cervical canal.

If you are diagnosed with cervical stenosis, Dr. Aliabadi may want to conduct tests to rule out cervical and endometrial cancers. To take a biopsy of your uterine lining, Dr. Aliabadi will need to open the cervix with medication or a procedure called dilation and curettage (also known as a D&C).

The cervical tissue sample is then sent off to our lab to check for cellular abnormalities that could indicate cancer.

What’s the treatment for a stenotic cervix?

Dr. Aliabadi can treat cervical stenosis by physically widening the cervix with instruments called dilators. Dilators are thin, lubricated rods that come in progressively larger sizes, which can be inserted one by one until the appropriate cervical dilation has been reached.

Sometimes, the doctor will insert a cervical stent, a tube that can prevent the cervix from reclosing. The stent may remain in the cervix for four to six weeks.

Some cases can be effectively managed with a combination of dilation and estrogen therapy. A common treatment involves using a copper intrauterine device (IUD) alongside oral contraceptives.

In some cases, surgical intervention may be recommended. Excision of cervical tissue can surgically open the cervical canal by removing tissue. This is not recommended for patients who wish to become pregnant, as the cervix is essential for keeping your growing baby in the uterus.

Have questions about your health? Talk to Dr. Aliabadi

Dr. Aliabadi has been an OB/GYN for over 20 years and is board-certified by the American Board of Obstetrics and Gynecology. She and her compassionate gynecologic team are experts in women’s health care. When treated by Dr. Aliabadi, you’re guaranteed to feel safe, heard, and well cared for.

We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.

The practice of Dr. Thais Aliabadi and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.

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Sources


Al-Fozan H, Firwana B, Al Kadri H, et al, Preoperative ripening of the cervix before operative hysteroscopy. Cochrane Database Syst Rev. 2015 Apr 23;(4):CD005998. doi: 10.1002/14651858.CD005998.pub2.
 

Houlard S, Perrotin F, Fourquet F, Marret H, Lansac J, Body G. Risk factors for cervical stenosis after laser cone biopsy. Eur J Obstet Gynecol Reprod Biol. 2002;104(2):144–7.