Retroverted Uterus (Tilted Uterus): Symptoms and More

A retroverted uterus, also called a tilted or tipped uterus, happens when your uterus (womb) tilts backward toward your spine instead of forward over your bladder. It occurs in about 20% of people with a uterus.

Most people don’t know they have a retroverted uterus unless a provider discovers it during a routine pelvic or gynecological checkup.

A retroverted uterus typically doesn’t affect overall health and doesn’t require treatment. If it causes symptoms for you, available treatments can help you be more comfortable.

Many people with a retroverted uterus don’t have any symptoms. In some cases, though, you might notice certain symptoms, especially if the tilt of your uterus affects nearby organs. Potential symptoms of a tilted uterus include: 

• Discomfort in your lower back or pelvis, especially during your period or sex
• Painful periods
• Pain in the vagina (birth canal) during sex
• Trouble inserting a tampon
• Urinary symptoms, like discomfort, leakage, infections, or needing to go urgently
• Fertility difficulties, or difficulty getting pregnant (rarely)

Some people are born with a tilted uterus. Similar to eye color or height, it’s a natural and normal variation in body structure. Others may develop it after pregnancy, as the muscles and ligaments around the uterus can loosen or weaken. Aging can also weaken these muscles, leading to a tilted position around the time of menopause.

In addition, the following health conditions can cause scarring or adhesions that fix the uterus in a tilted position: 

• Endometriosis: Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, often on the ovaries or bladder. It can lead to pain, inflammation, and scarring in the pelvic area.
• Pelvic inflammatory disease (PID): PID occurs when bacteria from vaginal infections or sexually transmitted infections (STIs) affect your reproductive organs, leading to pain, fever, and sometimes scarring.
• Pelvic surgery: Surgeries like a cesarean section (C-section, surgery to deliver the baby through your abdomen) or removing fibroids or ovarian cysts may cause scarring, leading to tilting of your uterus.
• Uterine fibroids: Uterine fibroids are noncancerous growths that form in or on the uterus. They can also cause heavy periods, pain, or pelvic pressure. 

Risk Factors

Risk factors for a retroverted uterus include aging, scarring in your pelvic cavity, pregnancy, and childbirth.

Providers often find a retroverted uterus during a regular pelvic or gynecological exam. If you have symptoms, your provider may order an ultrasound, which uses sound waves to create a picture of your uterus.

In this case, a transvaginal ultrasound is more common than an abdominal (belly) ultrasound. For a transvaginal ultrasound, a provider gently places a small probe inside your vagina. This allows the probe to be closer to the uterus, creating clearer images. A transvaginal ultrasound can also show ovarian cysts or scarring.

If providers need to see precisely how a retroverted uterus affects nearby organs, they might use a computed tomography (CT) scan or an MRI (magnetic resonance imaging). These scans may help them decide on the best treatment.

A retroverted uterus is usually a harmless condition that doesn’t need treatment unless it causes symptoms. If you experience pain or other symptoms, talk to your provider, as there are options to help.

Pelvic Floor Exercises and Physical Therapy

Kegel exercises, a type of pelvic floor exercise, can help strengthen the muscles that support the uterus, bladder, and bowels. Regularly doing Kegels may improve your pelvic support and reduce pressure or discomfort. Other exercises may also help.

Kegels and other pelvic floor exercises aren’t appropriate for everyone—in some cases, they may actually worsen your pain or other symptoms—so it’s a good idea to talk to a pelvic floor physical therapist for their personalized guidance before you try any pelvic floor exercises.

Keep in mind that these exercises may not work for everyone with a tilted uterus, especially if scarring has fixed your uterus in place.

Pessary Device

Your healthcare provider may recommend a pessary, a small, flexible device made of silicone or plastic that you place in your vagina. A pessary can support your uterus and keep it upright, reducing pressure on other organs.

If you use a pessary long-term, it’s important to continue seeing your provider for regular checkups to help avoid infections.

You can’t prevent a retroverted uterus if you were born with it, as it’s a natural difference in your body structure. In other cases, getting early treatment for conditions like uterine infections and endometriosis might help prevent scarring that could change the position of the uterus over time.

People with a retroverted uterus might also experience endometriosis, pelvic inflammatory disease (PID), and urinary tract infections (UTIs).

Most people with a retroverted uterus live healthy lives without special care. If you have endometriosis or a related condition, watch for unusual symptoms and talk to your provider if pain or discomfort continues. Treatments are available to help you manage symptoms when necessary.

During pregnancy, a retroverted uterus slightly raises the risk of bleeding or miscarriage, though these issues are rare. By around the 12th week, the uterus usually moves forward, lowering the risks of pregnancy or childbirth problems.

Some people with a retroverted uterus may need a C-section, especially if labor slows down. In very rare cases, the uterus can get stuck in the pelvis, causing complications. Regular prenatal checkups allow providers to catch and avoid these issues early.