Tilted Uterus

The uterus is the hollow, pear-shaped organ where a developing fetus will grow. The uterus is normally in a straight vertical position; however, some women may have a tipped/tilted uterus, also termed a retroverted uterus, in which the it is tipped backward toward the back of the pelvis. It’s typically considered a normal anatomical variation.

What causes a tipped uterus?

This may occur for several reasons including:

  • As a woman matures the uterus may not move into a forward position.
  • Childbirth can tip the uterus forward or backward. If the ligaments holding the uterus in place stretch, or lose their tension during pregnancy, the it can become tipped. In most cases, the uterus returns to a forward position after childbirth.
  • Scarring from adhesions as a result of endometriosis or fibroids can also cause the uterus to shift to a tilted or retroflexed state. Sometimes a uterine suspension is used in conjunction with treatments for endometriosis to prevent the formation of adhesions after surgery.

What are the symptoms?

Some women do not experience any symptoms.
However, the primary symptoms are:

  • Pain during sexual intercourse or dyspareunia.
  • Pain during menstruation or dysmenorrhea.

Other symptoms may include:

How is it diagnosed?

Your physician can perform a simple physical exam to determine if you have a tipped uterus. This can be done during a routine pelvic exam. If you suspect that you have a tipped uterus, discuss it with your physician.

What other terms are used to describe a tipped uterus?

There are many alternative terms you should know but they all mean that the uterus is tipped backward toward the back of the pelvis.
Common terms include:

  • Retroflexed uterus
  • Tilted uterus
  • Backward uterus
  • Retroverted uterus
  • Tilted womb

Medical professionals may use the following terms:

  • Uterine retroversion
  • Uterine retroflexion
  • Retroversion of the uterus
  • Symptomatic uterine retroversion
  • Symptomatic uterine retroflexion
  • Uterine retro displacement
  • Reflexion of the uterus

What treatment options are available?

If you have a tipped uterus and are experiencing symptoms, your physician may recommend surgery to reposition the uterus. A uterine suspension can typically reduce the pain experienced during intercourse and/or menstruation. This surgical procedure is used to reposition it from its backward facing position to a forward-facing position.
The UPLIFT procedure is a newer and improved method of performing a uterine suspension. It has been proven to have fewer postoperative complications than other uterine suspension procedures. Uterine repositioning provides lasting pain relief in most cases of painful sex and in some cases of painful menstruation.
It can also be repositioned by:

  • “Knee-chest”: An exercise that may help reposition a tipped uterus temporarily. However, this exercise will not be effective if the uterus has become tipped because of endometriosis, fibroid tumors, or pelvic infections.
  • Pessary: A plastic or silicone device that is placed in the vagina to reposition a tipped uterus. It is generally considered a temporary solution for pelvic pain because long term use can lead to vaginal infections.

Can a tipped uterus prevent pregnancy?

Typically a tipped uterus is only thought to be the cause of infertility after all other possible reasons for fertility problems have been ruled out. Your doctor might recommend a uterine suspension or UPLIFT procedure if there is no other explanation for your fertility problems. However, this is not common.

Can it affect my pregnancy?

Usually, between the 10th -12th week of pregnancy, your uterus will no longer be tipped or “backward.” This should cause no difficulty for the pregnancy or for labor and birth. If the uterus does not move into a “middle” position, miscarriage can occur, but this is very rare.

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