Between 20 and 30% of women have an anatomical variant called a retroverted uterus, characterized by a backward tilt of the uterus. It is important to note that this configuration is not considered a pathology and is generally painless, having no significant impact on health. However, in certain situations, this particular position of the uterus may pose risks.

To understand the retroverted uterus, it is essential to know the normal functioning of this organ as well as the different positions it can adopt.

Although this anatomical variation may not have adverse effects on overall health, there are concerns about its possible impact on fertility and pregnancy.

This article explores in detail aspects of the retroverted uterus, covering its symptoms, diagnostic methods, and its possible influence on motherhood. Discover everything you need to know about this anatomical variant to better understand its potential implications.

What is the uterus and how does it work?

The uterus, a hollow organ of the female reproductive system, acts as the "bag" that houses the embryo and supports the growth of the fetus. Located in the pelvis, between the bladder and the rectum, it takes the shape of a cone directed towards the cervix and the vagina. The uterine horns, an extension of its upper part, lead to the fallopian tubes, which in turn connect to the ovaries. Held in the pelvis by round and uterosacral ligaments, elevator muscles, and pelvic floor muscles (perineum), the uterus is surrounded by a smooth muscle called the myometrium. This muscle contracts during childbirth, facilitating the expulsion of the baby.

Inside, the uterus is lined with a membrane called the endometrium, which thickens under the influence of hormones (estrogen) during the menstrual cycle. In the absence of fertilization, this membrane is shed through the vagina during menstruation. In the event of fertilization, the uterus, which normally measures 8 cm by 4 cm, expands up to 35 cm to accommodate the size of the fetus during pregnancy, returning to its usual dimensions about two months after childbirth.

The positions of the uterus vary

In most cases (70 to 80%), it is found in anteversion and anteflexion, resting on the bladder. In 20 to 30% of cases, it is retroverted, tilted backward and resting on the rectum. This retroversion is generally not problematic for pregnancy. It can also change position depending on the filling of the rectum or bladder.

The retroversion of the uterus, which affects between 20 and 30% of women, is not considered a pathology, but rather a normal anatomical feature with no significant implications. To date, there is no evidence suggesting that this feature is hereditary.

The particularities of the retroverted uterus

The backward tilted position of the uterus toward the rectum may be congenital, present from birth, or secondary, resulting for example from a childbirth with obstetric tearing or from a stretching of the uterine ligaments. It may also be related to certain pelvic pathologies. The presence of a mass such as a fibroid or uterine polyp, especially in women over 40 years old, can explain the effect of pushing the uterus backward. Additionally, a retroverted uterus may be the result of an inflammatory disease such as endometriosis.

Risk factors

Although this configuration of the uterus is usually present from birth, it can also occur due to various factors such as a prior abortion, surgery, an inflammatory process, or gradually develop in excessively thin women.

Symptoms of a retroverted uterus.

The symptoms associated with the retroverted uterus may vary, although in most cases it does not have a significant impact on the woman's fertility, health, and pregnancy. However, it can cause sometimes debilitating symptoms, such as pelvic and sacrolumbar pain more frequently before and during menstruation (dysmenorrhea), pain during sexual intercourse (dyspareunia), constipation, pain during defecation, urinary difficulties, or repeated urges to urinate. An increased risk of genital prolapse, commonly known as organ descent, may also be associated with this condition. Surgical intervention is only considered in cases of very intense pain.

Diagnosis of the retroverted uterus

Women with a retroverted uterus generally do not present any particular signs. The discovery of the retroverted uterus often occurs incidentally during a routine gynecological examination, such as an ultrasound (a painless examination with no radiation that is most frequently prescribed), an MRI (used in the presence of certain pathologies such as endometriosis), a CT scan, an exploration, or a hysteroscopy (which allows direct examination of the uterine cavity and the endometrium through fiber optics).

Consequences of a retroverted uterus

In the case of the simple anatomical variant, the retroverted uterus does not hinder the sperm's access to the egg and does not block the progress of pregnancy in any way. Its backward position is also not a barrier to ART treatments. Only associated pathologies may cause infertility problems.

In most cases, in the absence of symptoms and consequences, women with a retroverted uterus do not require any specific treatment.

Treatment of the retroverted uterus

Treatment may be considered if the pain caused by the retroverted uterus is debilitating. A pessary test can be performed to confirm the link between the perceived pain and the retroversion of the uterus. The pessary, a flexible ring made of rubber, latex, or silicone, is inserted into the vagina to stabilize or limit the movement of the cervix and support the uterus, partially correcting the retroversion. The device is left in place for a few days or even weeks. If the test is positive (i.e., pain is relieved), the causal link between the pain and the retroverted uterus is tested, and surgical intervention may be considered. Patients with a retroverted uterus can access different assisted reproduction techniques, such as artificial insemination, IVF with or without ICSI, the ROPA method, or egg donation.

Pregnancy with a retroverted uterus

In most cases, a retroverted uterus does not usually have any impact on the course of pregnancy.

However, it is possible to experience pain during the first trimester, explained by the gradual and spontaneous straightening of the uterus between the twelfth and fourteenth week. With the increase in uterine volume, it naturally straightens and moves to an anteverted position.

If the uterus does not straighten spontaneously beyond the first trimester, a vaginal maneuver may be necessary to avoid any risk of entrapment in the small pelvis. This procedure aimed at orienting the uterus to an anteverted position is usually performed under general anesthesia.

On the other hand, a retroverted uterus generally does not pose a problem for the insertion of an IUD. However, if the tilt of the uterus is due to a uterine pathology, this contraceptive method may not be recommended. In fact, intrauterine devices (IUDs) can increase the duration of periods and the amount of bleeding, making them contraindicated in cases of endometriosis or fibroids. In all cases, to obtain an accurate diagnosis of the uterus and avoid complications, it is wise to perform an ultrasound before introducing the IUD.

If you are experiencing difficulties related to a retroverted uterus or have any questions about pregnancy, fertility, or assisted reproduction methods, please do not hesitate to contact us. At NatuVitro, our team of specialists will guide you and provide you with the information you need. We understand well the importance of each individual journey and are committed to providing personalized support. Contact us today to fully understand your situation and explore your options.