Retroverted Uterus

Despite what most standard female anatomy diagrams show us, not all uteruses are positioned the same. Having a retroverted uterus (also known as a tilted uterus) is actually very common, and the position of your uterus can even change after pregnancy.

So, what does it mean if you have a retroverted uterus? Let’s explore the various uterus positions, possible causes and symptoms and when it might be time to ask for advice.

There are four main variations of uterine placement:

  1. Anteverted: The fundus is tipped forward
  2. Anteverted and anteflexed: The body of the uterus is sharply bent forward at the junction with the cervix
  3. Retroverted: The fundus is tipped backwards
  4. Retroverted and retroflexed: The body of the uterus is sharply bent backwards

Uterus Positions

Positions of the uterus within the pelvis. (From Moore KL, Dalley AF. Clinically Oriented Anatomy. 5th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006:B3.17A-D)

Having an anteverted uterus is a much more common variation (much like a variation in eye colour) and doesn’t present any issues for most people. Therefore, we will be focusing on discussing retroverted positioning in this post.

What is a tilted or retroverted uterus?

Having a uterus which lies in a different position isn't necessarily a problem and doctors refer to it as "normal anatomical variance". It is most common for the uterus to be angled slightly forward (anteversion). However, for women who have a tilted uterus or retroverted uterus, the angle of the uterus is tipped further backwards, with the fundus facing the rectum.

Causes of a retroverted uterus

Natural causes – during maturation, the uterus may not have tipped forward and over the bladder (which happens in 75% of cases) but instead stayed tipped back toward the rectum. 

Surgery – after specific medical procedures or pelvic operations the uterus position may not have shifted forward into the right spot.

Medical conditions – medical conditions like endometriosis can cause the uterus to change position as a result of the endometriosis almost "glueing" the uterus to the rectal or colon tissue. Fibroids can also make the uterus susceptible to tipping backwards.

Pregnancy – during pregnancy, the ligaments around the uterus soften, and this can lead to overstretching of the ligaments which pull the uterus backwards. In most cases, the uterus will return to the normal position after birth, but sometimes it will remain tilted backwards.

Symptoms of a retroverted uterus

For most women with a displaced uterus, the main symptoms include painful sex and painful periods (most commonly associated with endometriosis). A retroverted uterus does not affect pregnancy or fertility in most cases, and it is often suggested if painful sex is experienced, that the positions that cause the most pain to be avoided. A retroverted uterus does have a small chance of becoming trapped under the pubic bone as it grows during pregnancy. This is known as an incarcerated uterus and will require treatment with pelvic exercises.

In some cases, a retroverted uterus may also cause urinary tract infections, urinary incontinence and trouble inserting tampons or menstrual cups. For this reason, those who have a retroverted or retroflexed uterus may not be able to use a menstrual cup successfully.

Diagnosis of a retroverted uterus

A specialist or gynaecologist can diagnose a retroverted uterus through a simple pelvic exam, which is often done routinely during a check-up.

Treatment of a retroverted uterus

If the retroverted uterus is causing discomfort that enough severe enough that treatment needs to be sought, there are a few options to explore with your doctor.

Laparoscopic surgery can be performed to position the uterus in the correct anatomical position, above the bladder. Surgery might also be suggested for the treatment and clearing of endometriosis that might be keeping it stuck to the rectal walls.

Hormone treatment may be offered where the cause is related to a medical condition, in particular, endometriosis.  

Options like exercise or the insertion of silicone or plastic pessary devices to keep the uterus in place have also been recommended in the past, but both don't show long-term efficacy regarding results.

If you are experiencing severe pain during sex, are having trouble falling pregnant or suspect that you might have a retroverted uterus or endometriosis, it is suggested to make an appointment to see your specialist or gynaecologist for a consultation.