Symptoms of a tilted (retroverted) uterus, causes, effects on fertility, and treatment

 Key takeaways

• A tilted uterus, also called a tipped uterus or retroverted uterus, is an anatomical variation in people assigned female at birth.
• A tilted uterus doesn't cause serious health problems when it's not associated with any underlying disease. However, it can cause symptoms like painful menstruation and painful sexual intercourse. 
• Women with a tilted uterus can still get pregnant and give birth to healthy babies.

A tilted uterus is a uterine variation where the uterus is tipped backward. The typical uterus leans forward and lies over the bladder (anteversion), but a tilted uterus leans back towards the rectum, facing the spine (retroversion). 

Generally, a tilted uterus doesn't cause any symptoms and does not affect a person's lifestyle.  However, in some people, a tilted uterus can cause mild to severe symptoms.  

Having a tilted uterus is not uncommon. Approximately 1 in 5 people with a uterus have it. Therefore, it's nothing to worry about unless there is an underlying medical condition or symptoms associated with it. 

Keep reading to find out more about the symptoms of a tilted uterus, some common diseases that can cause it, the effects on fertility, and available treatment options. 

 Symptoms of a tilted uterus

A tilted uterus is a variation of the uterus that often doesn’t come with symptoms, but in some people, it can be caused by medical conditions, such as endometriosis. When a disease causes a tilted uterus, symptoms usually accompany it. Some of the symptoms of a tilted uterus include:

 1. Painful sexual intercourse (dyspareunia)

In a tilted uterus, the cervix is situated a little above its normal position. The ovaries, uterine ligaments, and other accessory organs lean backward.

During intercourse, the penis might come into contact with any of these organs, causing pain and making intercourse uncomfortable. Vigorous sex or forceful penetration might even lead to tears in the uterine ligaments. 

If you're diagnosed with a tilted uterus, and experience painful sex, discuss it with your partner and devise a more comfortable position and pattern that will help reduce the pain experienced during sex.

 2. Painful menstruation (dysmenorrhea)

People with a tilted uterus may experience severe discomfort during menstruation, including cramps, nausea, back pain, and leg aches. 

The discomfort might be related to the angle of flexion of the uterus, which helps the uterus contract more to push the blood out.

A study found that higher period pain intensity is linked to more extreme angles of uterine flexion (i.e., tilt), regardless of whether the tilt is forward or backward. Dysmenorrhea can also cause heavier, longer, and sometimes irregular menstrual flow. 

It is important to note that a tilted uterus is not the only cause of menstrual pain. Medical conditions like premenstrual dysphoric disorder (PMDD) can cause disabling symptoms during menstruation. If you’re experiencing menstrual discomfort that interferes with your daily activities, it’s best to visit a gynecologist to have it checked out.  

 3. Urinary tract infections (UTIs)

The proximity of the cervix and vagina to the urethra can obstruct urine outflow and lead to the accumulation of urine in the bladder, giving room for bacterial buildup. This makes people with a tilted uterus more susceptible to urinary tract infections, especially during pregnancy.

 4. Mild urinary incontinence

Urinary incontinence is the loss of bladder control. In people with a tilted uterus, it can occur due to the pressure on the bladder and urethral sphincter, which reduces their ability to hold back urine. 

 5. Increased urinary frequency

In a tilted uterus, the vagina and/or cervix are situated more anteriorly than normal. The position of the vagina and cervix can put pressure on the bladder, causing you to feel the urge to urinate frequently.

 6. Pain while using tampons

The use of tampons can cause pain and discomfort for some people with a tilted uterus. Sanitary pads may be the best option because they are not invasive, unlike tampons.

 7. Bowel disorders

When the uterus is tilted backwards, it tends to put pressure on the rectum, leading to bowel disorders like constipation. In some cases, the closeness of the womb to the rectum can cause diarrhea, especially during menstruation. 

 Causes of a tilted uterus

Causes of a tilted uterus include:

 1. Developmental variation

A baby is usually born with an upright or slightly anteverted uterus. As the baby matures, the uterus gradually becomes fully anteverted. In people with tilted uteruses, their uterus underwent little or no repositioning, when they were in the womb, and it may remain retroverted when they are born and throughout life. 

 2. Endometriosis

In endometriosis, the inner lining of the uterus called the endometrium, grows in places outside the uterus. These growths can attach the uterus to the pelvis or any surrounding organ, causing a tilt.

 3. Fibroids

Large sizes of fibroids in the uterus, especially in the posterior part, can cause a tilted uterus. The tilt is a result of the weight exerted on the uterine walls.

 4. Childbirth

Over time, pregnancy and childbirth can cause overstretching and laxity of the uterine ligaments. The uterine ligaments help to keep the uterus in position. When the supporting ligaments are weak, they cannot hold the uterus in place, and this can result in the uterus falling backwards.

 5. Adhesions and scarring

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

 6. Menopause

A reduction in the level of estrogen as a person gets to the menopause phase can result in laxity of the uterine ligaments holding 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 associated with an underlying condition that can hinder conception, such as endometriosis. 

Fertility is dependent on the quality of the sperm and the health of the female reproductive organs. Once these are in place, conception will take place even with a tilted uterus. 

A tilted uterus is only considered to be the cause of infertility after all other possible reasons have been ruled out.

People with a tilted uterus also have a normal pregnancy, labor, and delivery because, during pregnancy, towards the second trimester, the uterus grows out of the pelvis and assumes the anteverted position. 

In some cases, when a person with a tilted uterus gets pregnant, their uterus can become incarcerated (trapped in the pelvis) 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 your cervix to see if it is situated more anteriorly (in front) than normal. 

In a normally situated cervix and uterus, when an instrument used in 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 and may not be easily visualized through the vagina.  

In some cases, a pelvic scan/ultrasound will be carried out to confirm the finding. You may also be sent for an abdominopelvic scan to rule out possible disease conditions linked to a tilted uterus.  

 Treatment

How a tilted uterus is treated depends on the cause. In most cases, the uterus assumes a normal position after the resolution of any underlying condition. Certain measures can also be taken to relieve uncomfortable symptoms. 

Treatment options include, but are not limited to:

 Hormonal therapy

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

 Manual maneuver

This is performed by an experienced gynecologist. The doctor tries to manually reposition the uterus during a pelvic examination. If this is done successfully, some exercises, such as kegel and knee-to-chest exercises, are recommended to keep the uterus in place. 

 Surgery

Surgery can be used to treat a tilted uterus. The two surgical techniques most commonly used are uterine uplift and uterine suspension. They are laparoscopic procedures, which means they are minimally invasive. These techniques have a high success rate. 

A study found that laparoscopic uterine suspension benefits people with a retroverted uterus who experience pelvic pain. In some cases, the surgical removal of the uterus (hysterectomy) may be considered.

 Wrap up

Having a tilted uterus doesn't make one less of a person. There are more people with tilted uteruses than you may think. Most of them are just unaware of it because they do not experience any symptoms.

If you have a tilted uterus and experience symptoms, speak to your doctor so that the issue can be properly investigated. Your doctor will determine the cause of your tilted uterus and advise you on the best treatment option.