Retroversion of the uterus

Definition

Retroversion of the uterus occurs when a woman's uterus (womb) tilts backward rather than forward. It is commonly called a "tipped uterus."

Alternative Names

Uterus retroversion; Malposition of the uterus; Tipped uterus; Tilted uterus

Causes, incidence, and risk factors

Retroversion of the uterus is common. It is the normal uterine position in about 20% of all women.

Weakening pelvic ligaments associated with menopause may cause this condition in women who previously did not have a retroverted uterus.

Enlargement of the uterus, either as the result of a pregnancy or a tumor, may also lead to retroversion.

Scar tissue in the pelvis (pelvic adhesions) can also hold the uterus in a retroverted position. Such scarring may result from:

• Endometriosis
• Pelvic inflammatory disease
• Salpingitis
• Pelvic surgery

Symptoms

Retroversion of the uterus almost never causes any symptoms.

Rarely, it may cause pain or discomfort.

Signs and tests

A pelvic examination reveals the position of the uterus. However, a tipped uterus can sometimes be mistaken for a pelvic mass or an enlarging fibroid. A rectovaginal exam may be used to distinguish between a mass and a retroverted uterus.

An ultrasound examination can be used to determine the exact position of the uterus, if necessary.

Treatment

Treatment is usually not necessary. Any underlying disorders (such as endometriosis or adhesions) may be treated as needed.

Support Groups

Expectations (prognosis)

Usually this condition does not cause problems.

Complications

Atypical positioning of the uterus may be caused by endometriosis, salpingitis, or pressure from a growing tumor. These conditions should be ruled out in a patient with pain or other symptoms.

Calling your health care provider

Call your health care provider if you develop persistent pelvic pain or discomfort.

Prevention

There is no known prevention. However, early treatment of PID or endometriosis may reduce the chances of a change in the position of the uterus.

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References

Lentz GM. Differential diagnosis of major gynecologic problems by age group: vaginal bleeding, pelvic pain, pelvic mass. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 8.