Tilted Uterus: Types, Causes and Treatments

13 min read
Retroverted or tilted uterus compared with an anteverted uterus

A tilted uterus, also called a tipped or retroverted uterus, is one that leans backwards towards the spine rather than forwards towards the bladder.

It's relatively common, affecting around 1 in 5 people with a uterus, and for most people it's simply a variation in anatomy rather than a medical problem.

Many people never know their uterus is retroverted until it's mentioned during a pelvic examination or ultrasound. If you do have pelvic pain, painful sex, heavy bleeding or other symptoms, it's worth looking at whether something else may be contributing rather than assuming the tilt itself is the cause.

Key takeaways

  • A retroverted uterus tilts backwards towards the rectum and spine.
  • It's usually a normal anatomical variation and often causes no symptoms.
  • Uterine position alone generally doesn't affect fertility, miscarriage risk or the ability to give birth vaginally.
  • Painful periods, painful sex and urinary symptoms can have many causes, so they shouldn't automatically be blamed on a tilted uterus.
  • Most tilted uteruses don't need treatment.
  • Menstrual cups and discs can both be used with a tilted uterus. Fit depends more on cervix position, vaginal anatomy and the dimensions of the product.

On this page

What is a tilted uterus?

The uterus is a muscular organ that sits in the pelvis between the bladder and rectum. Its exact angle and position vary between people and can also change over time.

Most uteruses lean forwards towards the bladder. This is called an anteverted uterus.

A retroverted uterus leans backwards towards the rectum and spine. You may also hear it called a tilted uterus or tipped uterus.

Retroversion describes the direction the uterus faces. It isn't a measure of severity and doesn't automatically mean there is a pelvic health problem.

Types of uterine tilt

You may come across several different terms on an ultrasound report or when talking with a healthcare professional.

Anteverted uterus

An anteverted uterus leans forwards towards the bladder. This is the most common uterine position.

Retroverted uterus

A retroverted uterus leans backwards towards the rectum and spine.

Anteflexed and retroflexed uterus

Flexion describes the bend between the main body of the uterus and the cervix rather than the direction of the whole uterus.

An anteflexed uterus bends forwards at this junction, while a retroflexed uterus bends backwards.

Version and flexion therefore describe slightly different parts of uterine position, and you may see both terms used in an ultrasound report.

Diagram comparing anteverted, retroverted, anteflexed and retroflexed uterus positions

Image source: Lecturio.

What causes a retroverted uterus?

For many people, a retroverted uterus is simply how their anatomy developed.

A large 2025 review of the published research concluded that uterine retroversion is most likely developmental, although acquired changes can also occur.

Factors that may influence uterine position include:

  • pregnancy and childbirth, which can change the muscles and supporting tissues around the uterus
  • endometriosis, where adhesions can restrict the normal movement of pelvic organs
  • pelvic inflammatory disease or previous pelvic infection that causes scar tissue
  • previous pelvic surgery and resulting adhesions
  • fibroids or other changes that affect the shape or position of the uterus
  • changes to pelvic support over time

Is a retroverted uterus the same as pelvic organ prolapse?

No.

A retroverted uterus describes the direction the uterus faces. Pelvic organ prolapse occurs when one or more pelvic organs descend from their usual position.

A 2025 review found uterine retroversion was more common in people with uterine prolapse, so there appears to be an association between the two. That doesn't mean having a tilted uterus automatically causes prolapse or that someone with a retroverted uterus has prolapse.

Can a tilted uterus cause symptoms?

Usually, it doesn't.

Many people only find out they have a retroverted uterus during a pelvic examination, cervical screening appointment, pregnancy scan or another ultrasound.

Some health resources associate a tilted uterus with symptoms such as:

  • painful periods
  • deep pain during penetrative sex
  • difficulty or discomfort with tampons
  • urinary or bowel symptoms

The research isn't straightforward, though.

A study involving 181 people with pelvic pain found that whether the uterus was anteverted or retroverted wasn't associated with how intense their pain was. A more pronounced bend, or flexion, of the uterus was associated with more intense menstrual pain.

A recent review has also documented associations between retroversion and some pelvic floor, urinary and bowel symptoms, but the available research doesn't show that uterine position is responsible for every symptom that occurs alongside it.

Pelvic pain, painful periods, heavy bleeding, urinary symptoms and painful sex can have other causes, including endometriosis, fibroids, infection, adenomyosis or pelvic floor problems.

Recurrent urinary tract infections also shouldn't automatically be put down to having a retroverted uterus.

What if sex is uncomfortable?

Some people with a retroverted uterus report deeper discomfort during penetrative sex, particularly with positions that allow deeper penetration.

If a particular position is uncomfortable, changing the depth, angle or position may help. Slowing down and using lubricant may also make sex more comfortable when friction is contributing.

Persistent or significant pain during sex deserves assessment rather than simply finding ways to tolerate it. Our guide to painful intercourse explains some of the other possible causes.

How is uterine position diagnosed?

A GP or gynaecologist may be able to identify the position of your uterus during a pelvic examination.

A transvaginal pelvic ultrasound can show the uterus more clearly and confirm whether it is anteverted, retroverted, flexed or positioned in another way.

Ultrasound can also help identify other possible explanations for symptoms, such as fibroids, ovarian changes or some forms of endometriosis.

If retroversion is found incidentally and you don't have symptoms, it generally doesn't require further investigation or treatment on its own.

Does a retroverted uterus affect fertility or pregnancy?

For most people, no.

A retroverted uterus by itself isn't considered a cause of infertility. If you're having difficulty becoming pregnant, your healthcare professional can investigate other possible factors, including conditions such as endometriosis that sometimes occur alongside a retroverted uterus.

Uterine position also doesn't appear to increase the risk of miscarriage or usually affect the ability to give birth vaginally.

What happens to a retroverted uterus during pregnancy?

A retroverted uterus is relatively common early in pregnancy.

As the uterus grows, it usually rises out of the pelvis and moves into a more upright or forward position.

A 2025 study compared 83 pregnancies with a retroverted uterus with 166 pregnancies with an anteverted uterus. In 98% of the retroverted group, the position had resolved by the second trimester.

The study didn't find an increased rate of second-trimester pregnancy loss. It did find more first-trimester vaginal bleeding among those with a retroverted uterus, but this was a single hospital-based study and more research is needed to understand the association.

What is an incarcerated uterus?

Very rarely, a growing retroverted uterus remains trapped within the pelvis rather than rising into the abdomen as pregnancy progresses. This is called an incarcerated gravid uterus.

It is estimated to occur in roughly 1 in 3,000 pregnancies.

Symptoms most often become apparent during the second trimester and can include:

  • difficulty passing urine or being unable to urinate
  • lower abdominal or pelvic pain
  • pelvic or rectal pressure
  • constipation
  • other urinary symptoms

An incarcerated uterus needs assessment and management by an obstetric healthcare team. Treatment depends on the individual situation and may involve emptying the bladder with a catheter, monitoring, positioning or clinician-assisted repositioning.

It isn't something to try to correct yourself with pelvic floor exercises or other home techniques.

If you're pregnant and develop significant pelvic or abdominal pain or difficulty passing urine, seek medical care promptly. If you can't pass urine at all or feel seriously unwell, go to an emergency department.

Does a tilted uterus need treatment?

Most retroverted uteruses don't need treatment.

If you're not experiencing symptoms, there's usually nothing that needs to be corrected.

If you are experiencing pain or another problem, treatment should focus on understanding what's causing the symptom rather than automatically trying to move the uterus into a different position.

Treating an underlying condition

If endometriosis, fibroids, adhesions or another condition is contributing to symptoms or affecting uterine position, treatment may be directed towards that condition.

Treating the underlying condition doesn't necessarily mean the uterus itself will change position.

Pelvic health physiotherapy

A pelvic health physiotherapist can assess pelvic floor muscle tension, weakness, pain and other issues that may be contributing to symptoms.

Pelvic health physiotherapy may help with associated pelvic floor symptoms, but pelvic floor exercises aren't a proven way to permanently change the position of a retroverted uterus.

In fact, Kegel exercises aren't suitable for every pelvic floor problem. If your muscles are already overactive or tight, repeatedly contracting them may make symptoms worse.

Our guides to Kegel exercises and the overactive pelvic floor explain the difference.

Pessaries

A pessary is a device inserted into the vagina to provide support to pelvic structures.

Pessaries have historically been used in some symptomatic cases of uterine retroversion and may still be considered in selected circumstances. They need to be fitted and monitored appropriately by a healthcare professional.

Surgery

Surgery to reposition or support the uterus is possible, but it's uncommon for an otherwise uncomplicated retroverted uterus.

It may occasionally be considered when symptoms are significant and other causes and treatment options have been assessed.

Research into surgery specifically for symptomatic uterine retroversion is limited, so the potential benefits and risks need to be discussed individually with a gynaecologist.

Can you use a menstrual cup or disc with a tilted uterus?

Usually, yes.

Having a tilted uterus doesn't automatically mean a menstrual cup or disc will be uncomfortable or that one product type is better than the other.

The uterus itself sits above the cervix. What matters more for an internal period product is the position of your cervix, your vaginal anatomy and how the product sits in relation to those structures.

A menstrual cup sits in the vaginal canal and generally forms a seal against the vaginal walls.

A menstrual disc sits higher in the vagina, with the rim positioned in the vaginal fornix and the front edge tucked behind the pubic bone.

Fit can be influenced by:

  • cervix height
  • the direction your cervix points
  • vaginal anatomy
  • cup length, shape and firmness
  • disc diameter and firmness
  • pressure sensitivity
  • your menstrual flow

If a cup or disc is causing pain or pressure, don't assume you can't use reusable period care because your uterus is tilted. The particular product may simply not suit your anatomy.

These guides may help:

Persistent pain, pressure or difficulty inserting or removing a product is worth getting individual advice about rather than continuing to push through discomfort.

When should you seek medical advice?

Book an appointment with a GP or another qualified healthcare professional if you experience:

  • persistent or worsening pelvic pain
  • pain during or after sex
  • very painful periods
  • unusually heavy or irregular bleeding
  • persistent changes in urination or bowel function
  • symptoms that interfere with everyday activities
  • fertility concerns

These symptoms deserve assessment whether your uterus is retroverted or not.

Seek urgent medical care if you develop sudden severe pelvic pain, heavy bleeding with dizziness or faintness, fever with significant pelvic pain or an inability to pass urine.

Call triple zero (000) in an emergency. If you're unsure how urgently you need care, healthdirect provides 24-hour advice from a registered nurse on 1800 022 222.

During pregnancy, significant pelvic pain or difficulty passing urine should be assessed promptly by your doctor, midwife or an emergency department.

Frequently asked questions

How common is a tilted uterus?

Around 1 in 5 people with a uterus are thought to have a retroverted uterus. Estimates differ between studies, with a recent review suggesting around 16–18%.

Is a tilted uterus abnormal?

No. A retroverted uterus is generally considered an anatomical variation. Most people who have one don't experience problems or need treatment.

Can a tilted uterus cause painful periods?

Some people with a retroverted or strongly flexed uterus experience painful periods, but uterine position alone doesn't reliably predict pain. Conditions such as endometriosis, adenomyosis, fibroids and pelvic floor problems can also cause period pain.

Can a tilted uterus cause painful sex?

Some people report deep discomfort during penetrative sex, particularly with certain angles or deeper penetration. Persistent pain deserves assessment because there are many other possible causes of painful sex.

Can a retroverted uterus make it harder to get pregnant?

A retroverted uterus by itself isn't generally considered a cause of infertility. If you're having difficulty conceiving, your healthcare professional can investigate other fertility factors and conditions that may occur alongside a tilted uterus.

Can a tilted uterus cause miscarriage?

A retroverted uterus on its own isn't considered a cause of miscarriage. A 2025 study also found no increase in second-trimester pregnancy loss among people with a retroverted uterus compared with those with an anteverted uterus.

Will a tilted uterus correct itself during pregnancy?

Usually. As the uterus grows, it normally rises out of the pelvis and moves into a more upright position. In one recent study, 98% of retroverted uteruses had changed position by the second trimester.

Can pelvic floor exercises fix a tilted uterus?

Pelvic floor exercises can be useful for some pelvic floor problems, but they aren't a proven way to permanently reposition a retroverted uterus. Whether strengthening or relaxing the pelvic floor is appropriate depends on your individual muscles and symptoms.

Are menstrual discs better than cups for a tilted uterus?

Not automatically. Both cups and discs can work well with a retroverted uterus. Cervix position, vaginal anatomy, cup or disc dimensions and individual comfort are more useful when choosing a product.

The main takeaway

A tilted uterus is usually just one of the many ways human anatomy varies.

Knowing the position of your uterus can help you understand an ultrasound report or make sense of where your cervix sits, but the tilt itself rarely explains significant pain, bleeding or pelvic symptoms on its own.

If something hurts or has changed, the useful question isn't necessarily “How do I fix my tilted uterus?” but “What is causing this symptom?”

If internal period products have been uncomfortable, visit our Menstrual Products Comparison Hub to compare cups, discs and other options.

Related reading

Sources and further reading

This article provides general information and isn't a substitute for individual medical advice.