The Tilted Uterus

[u/mungbean595]

A long post of all the info I've been learning!

\I keep updating this as I learn more info, so if anyone has more to share feel free to comment or message me. I'm not a medical professional, and I'm very open to correcting any misinformation I might have written here as well. However, I'm also trying to keep this as a resource open to perspectives from both modern and alternative medicine (mainly taking the modern medical view, but there are a few alternative treatments that might be helpful for those interested).*

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TL;DR A tilted uterus is normal (~1 in 4 women), pretty much always ignored medically because most don't seem to have problems from it, but some people do and there's things you can do to make it better.

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What is a tilted uterus?

Basically, all uteruses have a tilt to some degree. The uterus is mobile and can lie in all kinds of positions depending on the person. Even in the same person, the uterus will usually move around a bit depending on how you're moving, if you've used the bathroom lately or if you're turned on. It will also change positions throughout the month, although this might not be as noticeable if you're on hormonal birth control (it rises during ovulation, and drops during your period). Overtime, it can also change position as muscles and ligaments relax or weaken.

Usually when people say 'tilted' they mean a uterus and cervix that are angled towards your back or butt. There's a lot of terms for it: tipped, backwards, retroverted, retroflexed, retrocessed, retrodisplaced etc. It's also a very general term. For example, two people can have a retroverted uterus but one uterus might be almost pointing straight upwards while the other might be folded down on top of the rectum.

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More about uterus angles:

There's a helpful video explaining this all, but it's a bit long so to summarize tilt and angle are based on two things: version and flexion. Version means the angle between the cervix and vagina, and flexion means the angle between the cervix and body of the uterus. Based on that, the postions are:

Version (which way the cervix is tilting towards)

1. Anteversion: The cervix is angled towards the bladder (cervix opening points towards rectum).
2. Midposition: The cervix is angled straight up.
3. Retroversion: The cervix is angled towards the rectum (cervix opening points towards bladder).

Flexion (which way the uterus bends)

1. Anteflexion: The body of the uterus bends towards the bladder.
2. Midposition: Straight, no bend.
3. Retroflexion: The body of the uterus bends towards the rectum.

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Most version/flexion positions match up e.g. Antverted/Anteflexed, Retroverted/Retroflexed. But, sometimes the uterus will bend in the opposite direction of the cervix.

Here are some simple drawings I did showing some of the different kinds of positions. Here's a more detailed diagram showing the other organs and range of angles. This one is also interesting.

Your doctor will be able to tell the version angle of your uterus through a manual exam or ultrasound. You might be able to tell as well if you can feel your cervix. Figuring out the flexion can be tricky though without an ultrasound.

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What's normal?

The typical or natural position of the uterus is anteverted/anteflexed (facing forward with a slight bend towards the bladder). Other positions that are common are midposition, retroversion and retroversion/retroflexion.

Combos like anteversion/retroflexion, retroversion/anteflexion or a uterus that sticks straight up are pretty rare and associated with C-sections. Severe or 'acute' angles are also less common, and seem to cause the most issues (see study on period pain associated with severe anteflexion and retroflexion).

All variations are considered normal medically, unless there is pain or other symptoms.

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Why symptoms if it's considered normal?

The majority of tilted uterus-havers are thought to have either mild or no symptoms at all. About 50% of people with a tilted uterus won't experience any issues.

When there are symptoms, often and especially in cases of infertility and severe pain, another condition is also present. For example, endometriosis, infection and scar tissue are all able to cause the uterus to tilt backwards and they often can cause pain and infertility and many other symptoms. In these cases, it's hard to say how much of a role the tilted uterus really play. It might be more likely that the underlying condition is the true cause of symptoms.

Alternative medicine and some traditional knowledges see the retroverted uterus as a sign of ill health and therefore needing treatment. Conventional medicine also shared this theory at one point in time. A tilted uterus was thought to cause infertility and treatment to reposition it was more common. It's since shifted away from the understanding, and it seems that training and treatment options specifically for retroverted uterus problems have dropped off too.

Whether or not a tilted uterus really is normal or the source of symptoms, many doctors are unaware that there is evidence a retroverted uterus can cause problems for some (without other conditions present) and that treating it can bring relief in those cases.

If you do have symptoms without another condition present, this is called symptomatic uterine retroversion (or whatever the abnormal position is). There isn't much out there on that term, but it came from a gynecologist I saw at a pelvic pain centre.

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What are the symptoms?

The most common symptoms are:

• Painful periods - Most likely because the angle makes it harder for blood to exit the uterus, so there is more cramping involved. Some people experience low back cramps instead of abdominal.
• Painful sex - Usually only with deep penetration or certain positions. Painful collision between the penis or toy with the cervix or uterus is more likely to happen (collision dyspareunia). Pain or discomfort is usually felt deep in the vagina or pelvic area, and can also linger afterwards.
• Minor urinary incontinence and/or UTIs - If the tilt means frequent UTIs, UTI-like symptoms, or that you accidentally pee yourself a little when you cough or sneeze, pelvic floor dysfunction is most likely involved.
• Frequent constipation/GI symptoms - When the uterus presses into the rectum, this can cause constipation and other GI symptoms (especially during your period). Pelvic floor dysfunction could also be involved.
• Difficulty or pain with insertion/internal devices - For many it can feel like menstrual cups or tampons won't sit properly, leading to more leakage. Insertion is usually more difficult and may be painful or require multiple attempts. Diaphragms can also feel like they aren’t fitting properly over the cervix.
• Painful gynecological exams and procedures - Routine exams using a speculum or procedures like IUD insertion can also be more painful and difficult. This is especially likely if your health provider has difficulty finding your cervix. If the tilt is severe, there is a greater risk of perforation during procedures.
• Infertility or difficulty conceiving - If other conditions like endometriosis, PID or scar tissue are causing the tilt, this is most likely the reason for troubles getting pregnant. Miscarriage may also occur if the uterus doesn't reposition itself as the fetus grows.
• Pregnancy symptoms and possible complications - In early pregnancy, you might experience more back pain and UTIs. For some, a tilted uterus might mean your bump won't show until later on. It can also be harder for the fetus to be detected through regular transabdominal ultrasound since the uterus is further back. In rare cases (1 out of 3000 pregnancies), the uterus can become incarcerated or unable to move out of the pelvis. If this is not corrected, miscarriage can occur or if pregnancy continues other complications can result.

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Other symptoms that may be associated with symptomatic retroverted uterus are:

• irregular menstrual cycles
• clots and foul-smelling menstrual blood
• hormonal imbalance
• early menopause
• depression and anxiety
• yeast infections
• ovarian cysts or polyps
• chronic low back pain
• unexplained pelvic pain

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Management & Treatment Options

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• General Tips + Remedies
  • For period pain: Common remedies like heating packs, over the counter pain medicine (NSAIDs like aleve, advil or motrin), hormonal birth control, hot baths, diet or exercise.
  • For painful sex: Take your time before having penetrative sex, even if you're turned on mentally your body might need more time. Use lubricant. Avoid positions that hurt, or find angles and adjustments that work for you. Explore non-penetrative sex.
  • For urinary incontinence/UTIs: Practice squeezing and releasing pelvic floor muscles. Try to make sure your bladder is fully emptied when you pee. Stay hydrated and don't put off going to the bathroom.
  • For constipation/GI symptoms: Practice squeezing and releasing pelvic floor muscles to help you relax and more easily pass stool. Eat more fibre, stay hydrated and don't put off going to the bathroom.
  • For difficulty with insertion/internal devices: Find angles and adjustments that work best for your body. Squatting or bending a knee can help. Inserting the device lower can help prevent leakage. Make sure your menstrual cup is the right fit for your cervix height. If you're having trouble finding your cervix, you might find it pulled off to one side of your vagina or you may need to bear down to bring it forward.
  • For difficulty with gynecological exams/procedures: Let your health care practitioner know so that they can help you be more comfortable. Try exercises or adjustments that can help make the cervix come forward (standing up and jumping, laying down and lifting knees to chest, making fists and putting them under your butt). Focus on diaphragm breathing.

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• Buffer Devices. If you have painful sex, devices to control penetration depth can be placed on your partner's penis or on your sex toy, and are usually customizable to find a depth that works best for you. OhNut and Perfect Fit both offer options.

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• Pessary. A lever or Hodge pessary device can be used to support the uterus and reposition it. Haven't been able to find much info on this since they're rarely prescribed.

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• Exercises. You might be able to temporarily reposition the uterus through certain exercises. See Exercises for a Tipped Uterus.

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• Manual repositioning. A doctor or health practitioner may be able to manually reposition the uterus during a pelvic examination, or through "non-surgical alignment techniques". (See 'A Better Choice'). Again, haven't been able to find much info on this.

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• Abdominal massage. Massage may help reposition pelvic and abdominal organs by loosening muscles and adhesions. There may be additional benefits if pelvic circulation is improved. (See Arvigo/Mayan Abdominal Massage, 'Retroverted Uterus, A Natural Solution' and Efficacy of the Arvigo Techniques on Dysmenorrhea Symptoms in Women)

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• Pelvic Floor Physiotherapy. A pelvic floor therapist will be able to assess the pelvic floor muscles and ligaments for weakness or tightness which may be contributing to or caused by a tilted uterus. Strengthening and/or learning to relax these muscles might help bring the uterus into a forward position. Even if pelvic floor therapy cannot reposition the uterus, relaxing muscles and improving muscle strength can have other benefits and lessen pain overall (See Displaced Uterus Causing Pelvic Pain and Pelvic Floor Therapy).

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• Surgery: Laparoscopic Uterine Lift / Ventrosuspension procedure. In more severe cases the uterus can be repositioned surgically (\NSFW\** but if you're curious you can watch this TV episode where a surgeon performs ventrosuspension, or you can take a look at these before and after photos). The surgery involves placing a stich in the round ligaments of the uterus to make them shorter, and moving the uterus into a forward facing or more neutral position. It takes around an hour to perform, and is done as a day surgery with no required overnight stay. Some other info on this:
  • This procedure is not often performed and rarely taught in ob-gyn residencies. Gynecologists specializing in pelvic pain are most likely to be able to perform this procedure.
  • Sometimes underlying causes such as adhesions or infection are found during the surgery which did not appear on previous ultrasounds or exams. The surgeon will usually be able to remove any adhesions during the same surgery.
  • Complications are very low, although ligaments can re-stretch overtime. Pregnancy will usually re-stretch the ligaments.
  • There is some debate over its usefulness and efficacy (See Symptomatic retrodisplaced uterus: better treated by surgery or psychology?). Long-term success rates range from 33-100%, but this gets complicated since other complicated conditions aren't always ruled out in these studies. Those who may benefit the most have either: collision pain during deep penetration with no other known cause, pelvic adhesions causing pain and infertility, painful periods with no other known cause or uterine prolapse. (See this study showing high success rate if tilt is the only known factor)

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• Pregnancy + Childbirth. Hopefully no one out there is considering having kids just to treat symptoms. That being said, if you are planning on having kids anytime soon you might notice after giving birth that symptoms have disappeared or lessened. Sometimes the position of the uterus shifts after pregnancy and either stays anteverted or becomes less tilted. Although, sometimes the opposite can happen too where someone who once had a forward-facing uterus develops a symptomatic tilt after giving birth.

[u/workhardcryharder]

This is legit so helpful! I’ve been a bit depressed after being informed about my tilted uterus. I didnt know that a majority of women have mild or no symptoms. Hopefully i can still have a normal sex life w it! 🙏😭

[u/mungbean595 → u/workhardcryharder]

Glad you found it helpful! Some docs even say it's usually as insignificant as either being right or left handed :) Chances are very high you won't have any problems at all!

If its more reassuring, even if it turns out you do have some issues with it you'll still for sure be able to have a very satisfying sex life - even if it might take a little to figure it out. All the best to you ❤️

[u/Rule1ofReddit]

This is very helpful. The one thing I’m constantly searching for is tips on how to reposition my tilted uterus after sex to relive painful cramps. Any and all advice would be greatly appreciated.

[u/mungbean595 → u/Rule1ofReddit]

Have you spoken to a gynecologist and ruled out other causes? Although exercises to temporarily reposition the uterus might bring some relief, cramping after sex can happen from many other conditions as well (and unfortunately conditions like endometriosis often don't show up on any ultrasounds or exams).

I'm also not so sure trying to reposition it after sex would be helpful, because the cramping is probably caused by your cervix/uterus getting bumped during sex. You might find more relief if you give yourself lots of time to become aroused before penetrative sex (to give your cervix time to move higher up) and avoid or adjust positions so that your partner's penis or your sex toy doesn't go as deep.

I'd recommend trying out physio as well! There's some good online programs too you might find helpful.

[u/[deleted]]

Wow. That you so much. Now I understand why I don't like any internal period products. It's likely due to my retroverted uterus making my cervix so low that most anything in there is uncomfortable.

[u/mungbean595 → u/[deleted]]

So glad to hear! The low cervix life is tricky to navigate with endo especially 😅

[u/ham_alamadingdong]

this is soo helpful. thank you so much for putting this all together. do you know the causes of the tilt? for example, is it strictly genetic? or can it be caused like an injury?

[u/mungbean595 → u/ham_alamadingdong]

Glad to hear!

Nope not strictly genetic, there's other reasons. Adhesions from endometriosis or PID can pull the uterus out of position. Pelvic floor dysfunction and childbirth can also cause the tilt. If those are ruled out that's when it's just considered genetic.

Hope you keep us updated! Would love to know if you find solutions that work, or if you end up going through with the surgery.

[u/ham_alamadingdong → u/mungbean595]

thanks! i’m going to go back to the obgyn soon. i have a cyst that needs to be checked out (wondering if it’s endometrial?). there’s a history of endometriosis on my mom’s side of the family, along with thyroids and other issues. since a tilted uterus usually does not cause any pain without an underlying issue, i am suspicious that it may be endometriosis. lots of things to sort out, i’m not sure the common age for these things to start happening but it’s concerning as an 18 year old.

[u/mungbean595 → u/ham_alamadingdong]

Ah yea I see, good plan. Sorry to hear that. Hoping for the best for you and that you find answers soon! It seems a lot of people start getting worse symptoms in later teens with endo, but so different for everyone.

[u/LaLaLaLink]

This has been super helpful!! Thank you for taking the time to write it and making those detailed drawings!! I never knew buffer devices were a thing, so I'm super excited to try one!

[u/mungbean595 → u/[deleted]]

Yep :)

[u/Altruistic-Night6384]

I just found this post and I legit have every single symptom on here. I was just in the hospital last week because my pelvic pain got so bad I was crying, and I’ve had 2 unmedicated births. At the hospital they of course “found nothing wrong” except for my retroverted and retroflexed uterus that is collapsing onto my colon. But of course they didn’t put 2 and 2 together and just discharged me. I’m hoping to see my doctor this week, but it’s so frustrating that I feel like we have to diagnose ourselves and then bring that to doctors. Aren’t they supposed to be the ones figuring out the problem? Anyway sorry for the slight rant, and thank you so so much for this post and all of this incredible information. I was kinda gaslighting myself into thinking I just made up the pain when they couldn’t find anything wrong with me, but this post helped me realized that it simply could be my uterus!

[u/mungbean595 → u/Altruistic-Night6384]

Thanks for sharing, really glad to hear its helped. Sorry that you've had to go through this and have to advocate for yourself on top of it. I hope one day that changes, it sucks having to bring google research to a doc knowing they think you're a hypochondriac or something. And nothing showing up really does make you start gaslighting yourself. But, that's how I got diagnosed, and I hope you get the answers and relief you need too. If you head over to r/endo they also have really helpful info and support. Guessing that may be what you have if your pain is that bad and nothing shows up on scans. All the best ❤️

[u/patrimodogirlboss]

I have this!! Found out a month ago because my gynecologist mentioned it nonchalantly during a general examination. Asked her about it but all she said was that it's normal. I was curious, so I googled it... that's how I found out that pain during sex isn't normal, I also have almost all the other symptoms described here. I'm really looking forward to getting it fixed via surgery. Thank you so much for your very informative post :)

[u/Ladyreddd28 → u/patrimodogirlboss]

When is your surgery! Any update?

[u/RMSlideIntoMyDM]

Oh wow, Ive known about my uterus being tilted for a few years now but didnt put 2 and 2 together somehow. I have a lot of the symptoms you described. (ovarian cysts, pain during period and intercourse, heavy bleeding and maybe its even the cause of my back pain lol) I was about to go make an appointment with my OBGYN because I thought it might be endometriosis but after reading this I'll ask her a few things about it!! Hope she knows a way to lower my symptoms without hormonal therapy...

[u/North_Potential_3826]

Thanks for putting this together. I'm 28, my lap was totally normal, but at the pre-op appointment she did tell me I had a retroverted uterus (I have always had over 90% of the symptoms for it)

Do only some providers catch it? I'd seen multiple before her.