A retroverted uterus, or tilted uterus, is a normal genetic condition where the uterus tips backward at the cervix.
A retroverted uterus does not affect your ability to get pregnant, though it may cause pain during sex and your period.
A retroverted uterus may be caused by certain medical conditions like endometriosis, fibroids, or past pelvic surgeries.
A retroverted uterus, also known as a tilted uterus, is a uterus that leans or "tips" backward at the cervix. It's the opposite of an anteverted uterus, the more common genetic variation where the uterus tips forward towards the stomach.
Although it may sound scary, a retroverted uterus is a common anatomical variation. Approximately one in five women has the condition, so generally, it rarely requires treatment. More importantly, having a retroverted uterus does not have an effect on your fertility or interfere with labor or delivery.
While some women with a retroverted uterus may experience no symptoms, others may experience pain during sex or menstruation.
Here's what causes a retroverted uterus, its symptoms, and what it means for fertility.
Medical term: A retroverted uterus may also be described as a tilted uterus, tipped uterus, backward uterus, retroflexed uterus, or uterine retroversion.
What is a retroverted uterus?
Your uterus falls under one of two categories based on its position:
Anteverted uterus: The more common variation of the two, around 80% of women have an anteverted uterus. This means a uterus that tips forward at the cervix towards the stomach.
Retroverted uterus: The other 20% of women have a retroverted uterus, or a uterus that tilts backwards at the cervix towards the spine.
The only way to know whether you have a retroverted uterus is to receive a pelvic exam or an abdominal ultrasound.
"When a woman has a pelvic exam, her provider may mention something about the way her uterus sits in her pelvis," says Lauren Demosthenes, MD, and senior medical director with Babyscripts, adding that having a retroverted uterus "doesn't mean too much - both [variations] are normal. It's just that one is more common than the other."
Does a retroverted uterus affect pregnancy?
Having a retroverted uterus does not have an effect on your ability conceive, nor does it lead to infertility.
What can affect fertility is if a retroverted uterus is a consequence of another medical condition, like endometriosis, which can make it more difficult to become pregnant.
"In most cases, if not due to another medical condition, a retroverted uterus does not cause major issues with pregnancy," says Dori Gelfman, RN and community manager at Fruitful Fertility. "However, depending on the position of your uterus, you may have more lower back issues with a retroverted uterus as the baby grows."
A retroverted uterus may also cause a stronger, more frequent need to go to the bathroom, as it can put pressure on certain organs, including the bowel and the bladder.
"The location of the uterus may also make it a little tricky to get clear ultrasound imaging especially early in pregnancy," Gelfman adds. "Your doctor may have you lay on your side or adjust your body in different positions to help visualize the baby better."
Although a retroverted uterus doesn't affect your ability to conceive, in rare cases if the uterus is retroverted due to scarring or adhesions, it may cause uterine incarceration, which causes the uterus to become "fixed" or "stuck" in the posterior pelvis. Approximately one in 3,000 pregnancies lead to uterine incarceration.
"Having a fixed uterus usually means that it is scarred into that position," says Demosthenes. "This can be from prior infection that causes scar tissue or from endometriosis."
What causes a retroverted uterus?
A retroverted uterus is usually a genetic variation that you're born with, but there are certain factors that may cause your uterus to shift its position over time. Sometimes, a uterus may be retroverted due to scar tissue or pelvic adhesions.
"The position of your uterus can be genetic or may be due to certain medical conditions like fibroids, endometriosis, or even previous pelvic surgeries," says Gelfman.
Other factors and causes
Pelvic adhesions. Adhesions or scar tissue can pull your uterus into a retroverted position. Pelvic surgery, and conditions such as endometriosis and pelvic inflammatory disease can cause scarring. According to the Texas Medical Center pelvic adhesions occur in 55 to 100% of patients who have gynecologic surgery.
Fibroids. Uterine fibroids, non-cancerous growths or tumors that appear in the uterus, can cause scarring that changes how the uterus is positioned or shaped. Twenty to 80% of women develop fibroids by the age of 50, according to The Office on Women's Health.
Pregnancy. Some women develop a retroverted uterus following pregnancy. During pregnancy, the ligaments that hold your uterus in place stretch and loosen. If these ligaments become overstretched and stay that way, your uterus may become retroverted. This is unlikely though as the uterus usually returns to its pre-pregnancy size (and position) after childbirth.
Menopause. Menopause causes the pelvic ligaments in the uterus to become weakened, which may result in uterine prolapse - when the uterus drops into the vaginal canal. If this happens, your uterus may fall backward in a tipped or tilted position. According to the International Urogynecology Journal, 69% of grade 2-4 uterine prolapse involves a tilted uterus.
What are the symptoms of a tilted uterus?
Some women with a retroverted uterus are asymptomatic, meaning that they experience no symptoms at all. Others may experience pain with intercourse.
"Sometimes a woman may feel some pressure on her uterus during intercourse because of the backward tilt," says Demosthenes. "Each woman can change her position and see if that helps - of course a lot also depends on the anatomy of the male partner during intercourse. The main point is to understand your body and make adjustments as needed. It's very individual."
Additional signs and symptoms of a retroverted uterus may include:
Difficulty inserting a tampon
Back pain or cramping during your menstrual cycle or pregnancy
Urinary incontinence or loss of bladder control
Frequent urinary tract infections
Having a retroverted uterus isn't considered abnormal or unusual. It just means that your uterus leans backward instead of forward. While many women with a tilted uterus are asymptomatic, some may experience painful intercourse or painful periods. If you suspect that you have a tilted uterus, your OB-GYN will be able to confirm a diagnosis via a pelvic exam or abdominal ultrasound.
If you're trying to conceive, having a tilted uterus isn't something you should necessarily worry about unless you have an underlying condition such as endometriosis. Either way, you should consult your doctor before deciding whether it's safe for you to get pregnant.
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