What Is a Retroverted Uterus, and Does It Affect Fertility?

The shape, size, and position of the uterus differs from woman to woman, and people often wonder how these factors can affect a woman's fertility or ability to conceive.

What Is a Retroverted Uterus?

The uterus is placed between the bladder anteriorly and the rectum posteriorly. The position of the uterus is often described by its relation to the long axis of the cervix. It can either rest forwards on the bladder in an anteflexion or anteversion, which is the case in most women, or it can rest backwards. 

Anatomic variation occurs frequently, and the uterus can be retroverted in about 20% of women. In this retroverted position, the uterus is tilted backwards and rests on the rectum. 

What Causes Retroversion of the Uterus?

The uterine fundus can move freely in various planes due to normal pelvic structure. The fundus of the uterus is positioned posteriorly in retroversion. In certain cases, adhesions from a previous inflammatory condition hold the uterus in this position. 

A Medscape analysis showed that there is usually no obvious cause of a retroverted uterus. However, in cases of tumors such as a leiomyoma (uterine fibroid), or inflammatory diseases like endometriosis, (where endometrial tissue grows outside the uterus), a retroverted uterus could be more likely. 

Scar tissue adhesion could also cause a retroverted uterus. This is common after a surgical procedure in the abdomen or pelvis. During healing, scar tissue may form that will band the uterus to surrounding peritoneal ligaments, tilting it backwards.

Other causes of the retroflexed uterus are childbirth and menopause. In these cases, the pelvic muscles and ligaments are weakened and may not be able to support the uterus in the upright position, causing it to tilt backwards.

What Does a Retroverted Uterus Feel Like?

Retroversion of the uterus is rarely symptomatic. Therefore, most women who have a retroverted uterus will not even know about it unless it is discovered during an ultrasound or advanced imaging with MRI. The UNC School of Medicine reports showed that menstrual pain might worsen in non-pregnant women with a retroverted uterus. There may be back pain during sexual intercourse, which can be relieved by shifting body positions.

How Does a Retroverted Uterus Affect Conception?

A retroverted uterus should not impair conception. If you can't become pregnant and have a tilted uterus, it's likely due to other uterine abnormalities that impact fertility, or an impairment that can cause both a tilted uterus and reduced fertility.

How Does a Retroverted Uterus Affect Pregnancy?

During gestation, a tipped uterus does not usually result in complications. After the first trimester, the enlarging uterus lifts out of the pelvis into the abdomen and takes the characteristic position of an anteverted uterus for the rest of the pregnancy.

Uterine retroversion is a typical positional deviation in early pregnancy. One study revealed that first-trimester retroversion is typically present 10-20% of the time.

Uterine incarceration (a condition that occurs when a growing retroverted uterus becomes wedged into the pelvis) is more likely to occur if retroversion continues until the second trimester, but the risk of this problem is minimal and the condition is rare. Only approximately 2% of retroverted uteri identified during the first trimester proceed to incarceration. 

Uterine Incarceration occurs when the gravid uterus is trapped in the pelvic cavity and is unable to grow into the abdominal cavity as expected. This is commonly associated with a retroverted uterus. However, other conditions and situations may also aggravate its possibility, such as;

• Endometriosis
• Pelvic adhesions
• Uterine prolapse
• Fibroids on the posterior wall

Symptoms and Complications of Incarcerated Uterus

If the uterus ends up trapped during pregnancy, some of the manifestations include;

• Vaginal bleeding
• Urinary retention
• Increased frequency of urination
• Painful urination
• constipation
• Fetal mispositioning
• Sacculation
• Premature delivery
• Abdominal pain

If you report any of these symptoms during an antenatal visit, your doctor will suspect an incarcerated uterus, amongst other possible things that could explain your symptoms. You may need an ultrasound or an MRI – these are both non-invasive and safe modalities for diagnosing and differentiating an incarcerated uterus.

Due to its advanced imaging capabilities, vast fields of view, and strong contrast between the uterus and its nearby organs, MRI outperforms ultrasound in the detailed scanning of the uterus and its adjacent organs.

Can a Retroverted Uterus Be Treated?

In medicine, anatomic variations are rarely treated unless they lead to a complication, cause discomfort, or are extremely likely to cause discomfort in the future. If a retroverted uterus results from a gynecologic abnormality such as endometriosis or a uterine fibroid, the best course of action is to treat the underlying cause or condition. This will greatly improve any discomfort and will prevent any possible complications.

Other treatment options are available for other symptoms or complications of the tipped uterus. For example, if you experience dyspareunia (pain during or after sex) your healthcare provider may recommend trying out other positions or changing positions when you feel discomfort.

They are also removable prosthetic devices made of silicone, such as a pessary that can support and hold the uterus in an anteverted position. They also help to alleviate distressing symptoms such as urinary incontinence. However, these devices can predispose individuals to infections and pelvic inflammatory diseases.

Surgical intervention is rarely required. It may be needed to free the band trapping the uterus in cases of scar tissue adhesion. Pelvic surgeries such as uterine suspension procedures can help to hold the uterus in an anteverted position by attaching the uterus, ovaries, and fallopian tubes to the pelvic ligaments. However, this procedure is usually only carried out when there are associating pathologies, such as endometriosis.

Hysterectomy is another surgical intervention that is considered but only in extreme cases where the woman's quality of life does not improve or cannot be improved by other, more conservative options.

In pregnancy, if the retroversion leads to incarceration, several maneuvers can be employed to alleviate the situation. For example, urinary catheters may be used to improve urination, preventing any form of urinary tract infection.

If the incarceration was detected early, your obstetrician might attempt a manual repositioning to free the growing uterus. In cases where uterine incarceration was detected late and has led to fetal mispositioning, most medical professionals would recommend a cesarean section for delivery.

In general, you have nothing to worry about if you have a retroverted uterus. It is not a disease; it is an anatomic variation and is unlikely to cause any complicated symptoms that could affect fertility or threaten your quality of life.