Cervical Stenosis in Women: Narrowing of the Cervix or the Neck?

"Cervical stenosis" is a term used for two quite different conditions, because the word cervical can refer to either the cervix (the neck of the womb) or the cervical spine (the neck). This site is mainly about the spine, but many women searching for "cervical stenosis" are looking for the gynaecological condition. Here is how to tell them apart, and what each one means.

Two conditions with the same name

Narrowing of the cervix (uterine cervical stenosis)

The cervical canal is the passage from the vagina into the womb. In cervical stenosis it becomes narrowed, or occasionally closed completely. There's no single agreed definition, but in practice it means the canal is too narrow for normal instruments to pass without special techniques.

Causes

Most cases are acquired rather than present from birth. A 2024 review in Archives of Gynecology and Obstetrics lists the main causes as:

• scarring after treatment on the cervix, such as loop excision (LEEP or LLETZ), cone biopsy (conization), cryotherapy or a colposcopic biopsy
• the thinning of tissue that follows menopause, when oestrogen levels fall
• endometrial ablation (a procedure that removes the lining of the womb)
• radiotherapy, and cancer of the cervix or womb
• infection or injury to the cervix
• cysts or fibroids pressing on the canal

Never having given birth, previous curettage and taking tamoxifen are also linked with a higher risk.

Symptoms

A partial narrowing often causes no symptoms at all, because menstrual blood can still drain. It may only be found when a doctor or nurse can't pass a brush through the cervix during a smear test, or can't pass a camera into the womb.

When symptoms do happen, they can include:

• painful periods or pelvic pain
• periods that stop (secondary amenorrhoea) in women who are still menstruating
• difficulty getting pregnant, or problems with fertility treatment such as embryo transfer

If the canal closes completely, blood (haematometra), fluid or pus (pyometra) can build up inside the womb, which can cause severe pain. Blocked menstrual flow may also flow backwards into the pelvis, and narrowing has been linked with endometriosis.

Diagnosis and treatment

Hysteroscopy, where a thin camera is passed into the womb, is the most reliable way to confirm and assess the narrowing. An ultrasound scan can show complications such as fluid collecting in the womb.

Treatment is usually only needed if the narrowing causes symptoms or complications, or if the womb needs to be examined, for example because of fluid in the womb after menopause. Options include:

• medicines to soften the cervix before a procedure
• gradually widening the canal with dilators
• opening the canal during hysteroscopy with fine instruments, which is now the preferred approach in many clinics

The narrowing can come back after treatment, and there's no proven way to prevent it.

Narrowing of the spinal canal in the neck (cervical spinal stenosis)

Cervical spinal stenosis is narrowing of the spinal canal in the neck, which can press on the spinal cord or the nerves branching from it. It affects men and women and is most common in people over 50, usually because of age-related wear and tear such as bone spurs, bulging discs and thickened ligaments.

Symptoms can include:

• neck pain
• numbness, tingling, weakness or clumsiness in an arm, hand, leg or foot
• problems with balance
• difficulty with fine hand tasks, such as writing or doing up buttons

In severe cases it can affect bladder or bowel control. See a doctor about new numbness, tingling or weakness in your limbs. Read more about cervical stenosis symptoms and diagnosis, non-surgical treatment and surgery.

Which one do I have?

If your symptoms involve periods, pelvic pain or fertility, or a nurse had trouble taking a smear, the cervix is the likelier meaning: talk to your GP or a gynaecologist. If your symptoms involve your neck, arms, hands, legs or balance, it's the spine: talk to your GP, who may refer you for a scan.