Tilted Uterus: Types, Causes and Treatments

Human anatomy is complex and varies slightly from person to person and the reproductive system is no exception.

While the majority of individuals have a uterus that is positioned pointing upward and slightly forward, some may have a more prominent backward or forward tilting uterus, which is referred to as having a retroverted or anteverted uterus. This condition is relatively common and usually does not cause significant health concerns.

In this blog, we explore the types of tilted uteruses, causes, symptoms, prevention, treatments and when to seek medical advice.

What is a Tilted Uterus?

A tilted uterus, or tipped uterus, is a condition in which the uterus is positioned in a tilt, leaning either backwards towards the spine, or forwards toward the abdomen, instead of the more typical slightly forward leaning position.

It is estimated that approximately 20% to 30% of individuals with a uterus have a tilted uterus, which means it is relatively common.

Types of Tilted Uteruses

There are a couple of main types of tilted uteruses:

1. Retroversion: In retroversion, the uterus is tilted backward. The degree of retroversion can vary, with some individuals having a slight tilt, while others may have a more pronounced backward tilt.
2. Retroflexion: Retroflexion occurs when the uterus is not only tilted backward but also bent backward at the cervix. This type is less common than retroversion.
3. Anteversion: An anteverted uterus means that your uterus tilts forward toward the front of your abdomen.
4. Anteflexion: Anteflexion occurs when the uterus tilts forward at the cervix.

The severity of a tilted uterus does not necessarily correlate with symptoms or complications. In fact, many individuals with a tilted uterus have no symptoms at all.

Causes of Tilted Uterus

Several factors can contribute to a tilted uterus:

1. Congenital: Some individuals are born with a tilted uterus due to genetic factors or abnormalities during fetal development.
2. Pregnancy: During pregnancy, the growing uterus can cause temporary changes in the position of the uterus. In most cases, the uterus returns to its original position after childbirth. However, in some individuals, the uterus may remain tilted afterward.
3. Pelvic adhesions: Pelvic adhesions, which are bands of scar tissue, can result from conditions such as endometriosis, pelvic inflammatory disease (PID) or previous pelvic surgeries. These adhesions can pull the uterus out of its normal position, leading to a tilted uterus.
4. Pelvic organ prolapse: A weak pelvic floor or pelvic organ prolapse can cause the uterus to tilt backward.

Symptoms of Tilted Uterus

A tilted uterus often does not cause any noticeable symptoms however for most people however some individuals may experience:

1. Pain during sexual intercourse (dyspareunia) - avoid the postion which causes discomfort
2. Painful menstruation (dysmenorrhea)
3. Back pain
4. Frequent urinary tract infections (UTIs)
5. Difficulty using tampons or menstrual cups (often menstrual discs are better suited to those with a tilted uterus)
6. Difficulty conceiving (though a tilted uterus does not typically affect fertility)
7. A small chance of the uterus becoming trapped under the pubic bone as a pregnancy progresses (referred to as incarcerated uterus) and will require treatment with pelvic exercises.

It is important to note that these symptoms can also be caused by other underlying conditions therefore, a thorough evaluation by a healthcare professional is necessary to determine the exact cause.

Prevention and Management

There is no proven method for preventing a tilted uterus since most cases are congenital or due to factors beyond an individual's control. However, some general guidelines can help manage the condition and alleviate associated symptoms:

1. Pelvic exercises: Regular pelvic floor exercises, such as Kegels, can help strengthen the pelvic muscles, potentially improving the position of the uterus.
2. Good posture: Maintaining good posture can help minimize discomfort associated with a tilted uterus. Avoid slouching or sitting for long periods in positions that strain the back.
3. Use a pillow for support: During sleep, using a pillow under the hips or knees can help relieve pressure on the uterus and reduce discomfort.
4. Gentle abdominal massage: Some individuals find gentle abdominal massage helpful in relieving discomfort associated with a tilted uterus. Always consult with a healthcare professional before attempting any self-massage techniques.

Medical Treatments for Tilted Uterus

Most cases of a tilted uterus do not require medical intervention. However, if symptoms are severe or significantly impact an individual's quality of life, healthcare professionals may suggest the following treatments:

1. Physical therapy: A specialized physical therapist can provide exercises and techniques to help correct the position of the uterus and alleviate associated symptoms.
2. Hormonal therapy: In cases where a tilted uterus is caused by endometriosis or adenomyosis, hormonal therapies such as birth control pills or progestin-releasing intrauterine devices (IUDs) may help reduce symptoms.

When to Seek Medical Advice

While a tilted uterus is usually harmless, there are instances where medical advice should be sought:

1. Severe or persistent pain: If you experience severe or persistent pelvic pain, it is important to consult with a healthcare professional to rule out other underlying conditions.
2. Fertility concerns: If you have been actively trying to conceive for a year without success, it may be helpful to seek a fertility evaluation to ensure there are no additional factors contributing to infertility.
3. Unusual symptoms: If you experience symptoms such as heavy or irregular bleeding, severe cramping, or abnormal vaginal discharge, it is advisable to consult a healthcare professional.

A tilted uterus, or retroverted uterus, is a common condition where the uterus is positioned in a backward tilt. While it typically does not cause significant health concerns, some individuals may experience symptoms such as pain during intercourse, painful menstruation, or back pain and medical treatments are usually unnecessary unless symptoms are severe.

If you experience persistent or severe symptoms, fertility concerns, or unusual symptoms, it is important to seek medical advice to determine the underlying cause and receive appropriate treatment. See our tips on How to Talk to a Doctor about Vaginal Concerns. 

References:

1. American Pregnancy Association. (2020). Tilted Uterus: What It Means for You and Your Pregnancy. Retrieved from https://americanpregnancy.org/pregnancy-complications/tilted-uterus/
2. Mayo Clinic. (2021). Tilted Uterus. Retrieved from https://www.mayoclinic.org/diseases-conditions/retroverted-uterus/symptoms-causes/syc-20354542
3. Obstetric Fistula and Prolapse Collaborative. (n.d.). Tilted Uterus (Retroverted or Retroflexed Uterus). Retrieved from https://www.ofp-collective.org/uterus-tilted