Does a retroverted uterus - tilted uterus

Retroverted Uterus - Introduction

A retroverted uterus is a womb that is tilted backwards inside the pelvis. In the majority of women, the uterus is tilted forwards but one woman in five has a retroverted uterus. This is in contrast to the slightly "anteverted" uterus that most women have, which is tipped forward toward the bladder, with the anterior end slightly concave. A tilted uterus or tipped uterus are other names for a retroverted uterus. A retroverted uterus is a common and natural finding and only rarely does this uterine position result in symptoms. Sometimes the uterus is retroverted because of other abnormality in the pelvis such as endometriosis. The symptoms, such as pelvic pain, are invariably due to the other condition and not the uterus being retroverted. An axial uterus points upwards and neither forwards or backwards. A retroflexed uterus is curved backwards and is the typical finding in a retroverted uterus. An anteverted uterus is usually anteflexed.

Figure 23.3 A retroverted uterus

The cause of a retroverted uterus.

Many women are simply born with a uterus that is retroverted, and this is entirely normal.
Some pelvic conditions, notably pelvic inflammatory disease and endometriosis, may cause scarring that causes the uterus to become retroverted.
Following the menopause, the level of the female hormone called oestrogen drops and as result the ligaments holding the uterus forward become weakened so that the uterus falls into a retroverted position.
Finally, in early pregnancy the uterus becomes heavier and sometimes becomes retroverted for a few weeks.

The Symptoms of a retroverted uterus.

The majority of women with a retroverted uterus have no symptoms. The two more common symptoms associated with a retroverted uterus are:

Pain during sexual intercourse (dyspareunia).
Pain during periods (dysmenorrhoea).

Other problems that have been associated with the uterus being retroverted include:

Lower back pain.
Urinary incontinence.
Infertility.
Urinary tract infections.

The pain is due to the pressure and movement of the retroverted uterus.

The diagnosis of a retroverted uterus.

Usually, a retroverted uterus is noted during pelvic examination. It may also be found during abdominal or pelvic ultrasound examination.

Health risks of a retroverted uterus.

For the vast majority of women with a retroverted uterus there are absolutely no problems. When symptoms occur in women who have a retroverted uterus, they are usually due to scarring in the pelvis.

Very rarely during pregnancy, the enlarging uterus becomes impacted in the pelvis. In these circumstances, the retroverted uterus may cause pain or difficulty voiding urine. The remedy is usually simple. By lying on her abdomen for a day or two, the retroverted uterus of the woman will become anteverted.

Treatment of a retroverted uterus.

Retroverted uterus is found in 20% of women and gynaecological problems such as painful periods, pain during sex and pelvic pain are extremely common. In the 1950s and 1960s many women with these symptoms underwent a simple abdominal operation to antevert the retroverted uterus called a ventrosuspension. The development of laparoscopic surgery has made this type of surgery even more simple.

Over the years, we have come to realise that when a woman with a symptom has a retroverted uterus, we should not assume cause and effect. Indeed, the retroverted uterus is rarely the cause of such symptoms. Some gynaecologists employ a simple test to see if the retroverted uterus is the cause or just an incidental finding. A special vaginal ring pessary, called a Hodge pessary is inserted (Figure 23.4). This holds the retroverted uterus into an anteverted position. If the symptom is alleviated, then there is some evidence that the uterine retroversion is the culprit.

Figure 23.4 The Hodge test for uterine retroversion.

A retroverted uterus without other disease, is unlikely to be the cause of infertility. It follows that surgery to correct a retroverted uterus is unlikely to enhance the fertility.

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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Does a retroverted uterus - Tilted uterus -cause symptoms?