Retroverted uterus: causes, symptoms, diagnosis, treatment and consequences

By Cristiano Antonino Last updated Jun 19, 2023

What is a retroverted uterus? It is a clinical condition that is much more frequent than one might assume: it affects between 20 and 30% of women

The retroverted uterus is nothing more than an abnormal position within the pelvic cavity: the organ is facing backwards – slightly resting on the intestine – instead of being tilted forward and lying on the bladder (antiverted uterus).

This condition is very often asymptomatic. In others, bladder and bowel disorders, pain during menstruation, dyspareunia (i.e. painful intercourse) may be present.

Fertility is in no way affected by the retroverted uterus

There are no relevant distinctions in gestation, delivery and risk of miscarriage compared to women with a retroverted uterus.

Diagnosis is made through anamnesis, gynaecological objective test and pelvic, trans-vaginal or recto-vaginal ultrasound.

Commonly, retroversion does not require any specific treatment and may resolve spontaneously: for example, as a result of the increase in volume that occurs during pregnancy, the uterus tends to straighten and assume a more correct position.

Therapy, where necessary, may include manual or surgical displacement of the uterus, strengthening of the pelvic floor, and pharmacological treatment to treat associated symptoms (e.g. painkillers to relieve menstrual pain).

Only in rare cases is surgery (hysteropexy) used to correct the position of the uterus.

Types of retroversion: primary and secondary

Retroversion can be divided into two different types:

primary, when it is congenital i.e. present from birth
secondary (or acquired), when it is instead associated with conditions (such as endometriosis, inflammation, infectious processes, neoplasia) that generate the formation of adhesions, scarring, or the weakening of muscles in the pelvic area and thus the displacement of the organ.

In the second hypothesis, i.e. in the case of acquired retroversion, the uterus is initially anteverted and changes its position as a result of an abnormality arising in the pelvic region.

This condition most frequently occurs due to a fibroid or an inflammatory process that generates adhesions or a weakening of the pelvic ligaments, causing the uterus to be positioned differently.

Retroversion can also occur following miscarriages or difficult deliveries.

In addition, this abnormality can also be seen in very thin women prone to ptosis, i.e. a drooping of the organs.

The condition can also occur during menopause due to a relaxation of the connective tissues or as a consequence of previous surgery.

The retroverted uterus, often asymptomatic, may sometimes be associated with a feeling of heaviness in the lower abdomen and increased pain in the lower back, which intensifies in the premenstrual period or during the cycle. Some women may also experience dyspareunia.

Retroverted uterus: symptoms

As already mentioned, in a large number of cases, women with a retroverted uterus do not experience any symptoms or at least the condition remains silent for many years.

Retroversion, in fact, is not to be considered a congenital uterine malformation, but rather a para-physiological variant of the normal anatomy.

When present, the symptoms are related to those conditions in which the uterus is stressed, either mechanically or chemically (by hormonal changes), and may include:

abdominal tension and heaviness
lumbar discomfort/pain
pelvic pain
dyspareunia, i.e., pain during sexual intercourse, especially in certain positions that favour deep penetration; moreover, in case of retroversion of the uterus, the ovaries and fallopian tubes are also tilted backwards, so all these structures can be stressed during sexual intercourse causing discomfort and pain (collision dyspareunia). Finally, during the premenstrual or periovulatory period the whole pelvic area is more sore and the cervix sensitive, so there may be positions in which penetration is more painful
dysmenorrhoea (painful menstruation); compared to individuals with anteverted uterus, those with retroverted uterus typically experience more painful menstruation, often associated with headache. Pain during menstruation may be accompanied by abdominal tension, especially when uterine retroversion is related to the presence of diffuse uterine fibromatosis
pain/disappointment when using vaginal tampons and tampons
bowel and bladder disorders, although rare and/or minor; however, when present they occur through delayed or failed bladder emptying and thus increased likelihood of urinary tract inflammation/infection and slowed stool transit resulting in constipation.

Consequences of the retroverted uterus

Does the retroverted uterus have any consequences for women with this anatomical variant? If so, what? The answer is no, unless the retroversion is linked to other pathologies that can, on the contrary, generate even serious relapses.

In the following we will review the issues that most frequently cause concern when a retroverted uterus is diagnosed:

pregnancy
childbirth
risk of abortion

Pregnancy

One of the most common fears when a retroverted uterus is diagnosed is the impossibility of becoming pregnant and carrying a successful pregnancy.

However, these concerns are unfounded: a woman with a congenitally retroverted uterus usually does not experience any particular difficulties in conception and implantation.

In the first few weeks of pregnancy there may be a feeling of weight on the rectum and bladder problems, but the more the pregnancy progresses, the more the uterus increases in volume and returns to its normal position (usually around 8-12 weeks of gestation).

Only in a small percentage of cases does normalisation of the position of the uterus not occur spontaneously.

In such situations, by 14-15 weeks of pregnancy, manipulation is attempted that restores the position, although the uterus may (sometimes) shift back into a retroverted position.

As already briefly mentioned, different is the case when the abnormal uterine position is generated by other pathologies that may compromise fertility.

For example, uterine fibromatosis or endometriosis.

It is therefore of paramount importance to investigate the underlying reasons for this different anatomical conformation of the uterus, as hidden causes may on the contrary affect fertility.

Retroverted uterus in childbirth

The retroverted uterus generally undergoes a spontaneous change in potency around the third month of gestation.

When necessary, the change is made manually through specific manoeuvres by the gynaecologist.

The birth, therefore, does not present any criticalities.

Retroverted uterus and risk of miscarriage

The likelihood of miscarriage in women with a retroverted uterus is the same as in women with an anteverted uterus, unless the retroversion is due to some other hidden condition.

The risk of miscarriage is increased, however, in cases of an incarcerated uterus, i.e. when the organ is literally embedded in the pelvis, thus preventing the change of position.

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