A hydrosalpinx is a medical condition where one or both fallopian tubes become blocked and distended with fluid. The name comes from “hydro” (water) and “salpinx” (tube). This blockage prevents the egg and sperm from meeting for fertilization, or a fertilized egg from reaching the uterus, often leading to infertility. When the tube is sealed, the fluid normally secreted by the tubal lining becomes trapped, causing the tube to swell into a characteristic sausage-like shape. This article explores the causes, symptoms, diagnosis, and management of this condition, focusing on its relationship with menstrual cycle irregularity.
Anatomy of the Condition: What is Hydrosalpinx?
The fallopian tubes function as a passageway, using fimbriae to sweep the egg from the ovary after ovulation. Inside the tube, cilia move the egg toward the uterus. In hydrosalpinx, damage causes the end of the tube to close off, sealing the passageway. The fluid naturally produced by the tubal lining becomes trapped, accumulating and causing the tube to swell, a process known as tubal distension.
The most frequent underlying cause is a past infection, particularly Pelvic Inflammatory Disease (PID). PID is often the result of untreated sexually transmitted infections (STIs) such as chlamydia and gonorrhea, which cause inflammation and scarring. Other conditions that cause scarring and blockage include endometriosis and prior abdominal or pelvic surgery. These issues lead to long-term inflammation and eventual closure of the tubal opening.
Symptoms and the Menstrual Cycle Connection
Many individuals with hydrosalpinx do not experience noticeable symptoms and only discover the condition during an evaluation for infertility. When symptoms occur, they relate to the physical presence of the fluid-filled tube or the inflammation that caused it. Common symptoms include chronic or recurrent pelvic pain, often described as a dull ache. Some also report an unusual vaginal discharge, thought to be trapped fluid leaking back into the uterus. The primary concern is the impact on fertility, as the blockage prevents successful conception.
Hydrosalpinx itself does not directly interfere with the hormonal signals that regulate the menstrual cycle. The blocked tube does not affect the ovarian hormones controlling ovulation and uterine lining shedding. However, the underlying conditions that cause hydrosalpinx often do affect the menstrual cycle. Pelvic Inflammatory Disease or severe endometriosis frequently involve inflammation and hormonal disruption that can cause irregular periods. Thus, if irregular periods occur, the change is usually an indication of the root inflammatory disorder rather than a direct result of the fluid accumulation.
How Hydrosalpinx is Identified
The initial diagnostic step is often a transvaginal ultrasound, which uses sound waves to image the pelvic organs. An enlarged, fluid-filled fallopian tube can sometimes be seen as a characteristic “sausage-shaped” structure.
The most common non-surgical test is Hysterosalpingography (HSG). This involves injecting a liquid contrast dye through the cervix into the uterus, followed by X-ray imaging. If the tubes are open, the dye spills into the pelvic cavity; if a hydrosalpinx is present, the dye stops at the blockage, outlining the fluid-filled tube.
Laparoscopy is a minimally invasive surgical procedure used for both diagnosis and treatment. A camera is inserted through tiny incisions, allowing a surgeon to directly visualize the fallopian tubes and confirm the obstruction. This method provides the most accurate view of the tube’s condition.
Treatment and Management
Treatment focuses on managing symptoms and resolving the condition to improve fertility outcomes. Antibiotics are prescribed if an active infection is the underlying cause, but they cannot reverse physical damage or clear the existing fluid blockage. Once the tube is closed and filled with fluid, surgical intervention is required.
The two main surgical approaches are salpingostomy and salpingectomy. Salpingostomy involves creating a new opening to drain the fluid, but this repair often has a high rate of re-blockage. Salpingectomy, the complete surgical removal of the affected fallopian tube, is the preferred treatment, especially for individuals pursuing in vitro fertilization (IVF). The fluid in a hydrosalpinx is toxic to embryos and can leak into the uterus, lowering IVF success rates. Removing the damaged tube eliminates this toxic fluid, improving implantation and pregnancy rates.