Symptoms of a Tilted (Retroverted) Uterus, Causes, Effects on Fertility, and Treatment

Key takeaways:

• A tilted uterus is an abnormally positioned uterus, usually in people born female.
• A tilted uterus is harmless when it's not linked to any underlying disease. However, it produces symptoms like painful menstruation and painful sexual intercourse. 
• People with tilted uterus can still get pregnant and have healthy babies.

A tilted uterus is also known as a tipped or retroverted uterus. It is a uterine variation where the uterus is tipped backward. The typical uterus bends forward and lies over the bladder (anteversion), but a tilted uterus tilts backward towards the rectum and faces the spine (retroversion). 

This variation in the uterus position usually doesn't cause symptoms or affect a person's lifestyle. However, in some people, a retroverted uterus can cause mild to severe symptoms.  

Tilted uterus is common, affecting 1 in 5 people. Therefore, it's nothing to worry about unless there is an underlying health condition or symptoms linked with it.  

Symptoms of a tilted uterus

A tilted uterus is a variation of the uterus that usually does not produce any symptoms, but in some people, it can be the result of medical conditions such as endometriosis. When a disease causes a tilted uterus, it is usually followed by symptoms.

Some of the symptoms of a tilted uterus include:

1. Painful sexual intercourse (dyspareunia)

In a tilted uterus, the cervix is slightly above its normal position, and the ovaries, uterine ligaments, and other accessory organs bend backward.

During intercourse, the penis might touch any of these organs, which may result in pain and make intercourse uncomfortable. Rough sex or forceful penetration can cause tears in the uterine ligaments, which support the uterus.

If you have a retroverted uterus, and find sex painful, talk to your partner and find a more comfortable position and pattern to reduce the pain experienced during sex.

2. Painful menstruation (dysmenorrhea)

Women with a retroverted uterus may experience severe pain or discomfort during menstruation, such as cramps, nausea, and leg and back pain. This is one of the symptoms that may accompany tilted uterus.

The discomfort can be due to the uterus's retroverted position, which causes it to contract strongly to expel blood.

A study found that intense period pain is associated with more extreme angles of uterine position (i.e., tilt), whether it is tilted forward or backward. Dysmenorrhea (painful periods) can also lead to heavier, longer, and sometimes abnormal menstrual flow. 

It is noteworthy that a retroverted uterus position is not the only reason for menstrual pain. Medical conditions like premenstrual dysphoric disorder (PMDD) can cause severe symptoms during periods. If your period interferes with your daily activities, it’s best to visit a gynecologist to have it checked out.  

3. Urinary tract infections (UTIs)

The cervix and vagina close to the urethra can hinder urine outflow and lead to the accumulation of urine in the bladder, causing bacterial growth. This makes people with a tilted uterus more vulnerable to urinary tract infections, especially during pregnancy.

4. Mild urinary incontinence

Urinary incontinence is the loss of control of the bladder. In individuals with a tilted uterus, it happens because of the pressure on the bladder and urethral sphincter, making it difficult to hold back urine. 

5. Increased urinary frequency

An increased rate of urination is another possible symptom of a retroverted uterus. This is because, in a retroverted uterus, the vagina and/or cervix are located more anteriorly than in a normal position.

The position of the vagina and cervix can build pressure on the bladder, making it difficult to hold the urine and causing you to feel the urge to urinate frequently.

6. Pain while using tampons

The use of tampons can be uncomfortable for some people with a tilted uterus. It is better to use sanitary pads rather than tampons, as they are not invasive, unlike tampons.

7. Bowel disorders

During a condition like a tilted uterus, the pressure on the rectum develops, leading to bowel disorders like constipation. In some cases, the closeness of the womb to the rectum can cause diarrhea, particularly during periods. 

Causes of a tilted uterus

Causes of a tilted uterus include:

1. Developmental variation

A baby is usually born with an upright or slightly forward uterus. As the baby matures, the uterus gradually becomes fully anteverted or tilts fully forward.

In people with tilted uteruses, their uterus does not move much when they are in the womb, so it remains retroverted from birth and throughout life. 

2. Endometriosis

Endometriosis is a condition in which the inner lining of the uterus, called the endometrium, grows outside the uterus. These growths can attach the uterus to the pelvis or any surrounding organ, causing a tilt or bend.

3. Fibroids

Tilted uterus can also be caused by large sizes of fibroids in the uterus, especially in the posterior part. The weight exerted on the uterine walls causes the tilted uterus.

4. Childbirth

Over time, pregnancy and childbirth can lead to extra stretching of the ligaments that support the uterus. The uterine ligaments keep the uterus in the proper place.

When the supporting ligaments become weak, they cannot hold the uterus properly, causing the uterus to fall backward.

5. Adhesions and scarring

Scars and adhesion from previous surgeries or pelvic infections can fix the uterus to the pelvis or other surrounding organs, causing the uterus in a tilted position. 

6. Menopause

When people with uterus get closer to the menopause phase, the low level of estrogen causes the loosening of the uterine ligaments that hold the uterus in place. This can make the uterus move out of position.

Can a tilted uterus affect fertility?

A tilted uterus often does not affect fertility or pregnancy, unless it is linked with an underlying medical condition that affects conception, such as endometriosis. 

Fertility depends on the quality of the sperm and the health of the female reproductive system. If they are in the proper position, pregnancy can take place even with a tilted uterus. 

A tilted uterus can be considered to be the cause of infertility if all other possible reasons are ruled out.

People with a tilted uterus can still have a normal pregnancy, leading to safe delivery because, during the second trimester, the uterus grows out of the pelvis and shifts to the anteverted position. 

In some cases, when a person with a retroverted uterus conceives, their uterus can become incarcerated (trapped in the pelvis). It may be due to reasons like lax ligaments, and adhesions, but this is rare. 

How is a tilted uterus diagnosed?

A doctor diagnoses a tilted uterus through pelvic examination and, sometimes, ultrasound.

During a pelvic examination, your doctor will observe closely to see if the cervix is situated more anteriorly (in front) than normal. 

In a normal cervix and uterus, when an instrument is used during examining hollow openings in the body called the vaginal speculum is inserted, the cervix is almost in line with the vaginal opening, but in a tilted uterus, the cervix is curved, making it difficult to see through the vagina.  

In some cases, a pelvic scan/ultrasound is done to confirm the diagnosis. You may also be asked for an abdominopelvic scan to find out possible disease conditions associated with a tilted uterus.  

Treatment

Treatment of a tilted uterus depends on the cause. In most cases, the uterus regains a normal position after the resolution of any medical condition. Certain measures can also be taken to subside uncomfortable symptoms. 

Some of the treatment options include:

Hormonal therapy

Conditions like endometriosis can be resolved with hormonal therapy. This treatment is based on the use of hormonal drugs, like oral contraceptives, to suppress the hormone causing endometriosis.

Manual maneuver

An experienced gynecologist tries to manually reposition the uterus during a pelvic examination. If this is successful, the doctor may recommend some exercises, such as kegel and knee-to-chest exercises, to keep the uterus in place. 

Surgery

Tilted uterus can be treated by surgeries. The two most commonly used surgical techniques are uterine uplift and uterine suspension. They are laparoscopic procedures, which means they are minimally invasive and have a high rate of success. 

A study found that laparoscopic uterine suspension can help women with a tilted uterus who have pelvic pain.4 In some cases, doctors may recommend surgical removal of the uterus (hysterectomy).

Wrap up

Having a tilted uterus is not a harmful condition. There are more people with tilted uteruses than you may think. Most of them are just unaware of this condition because they do not experience any symptoms.

If you have a tilted uterus and experience symptoms, talk openly to your doctor to get it diagnosed properly. Your doctor will determine the cause of your tilted uterus and advise you on the best treatment available.