What is a Retroverted Uterus and How to recognize it?

“Let’s start by defining what the uterus is. It is an organ of the female reproductive system located in the pelvis, which is the lower part of the abdomen. It typically has a pear-like shape: the narrow part of the organ is called the ‘cervix,’ while the broader part is the uterine body. Its primary function is to receive the fertilized egg, support its development, and, at the end of pregnancy, facilitate the delivery of the fetus,” explains Dr. Andrea Sala.

A retroverted uterus occurs when the uterine body, instead of tilting forward towards the bladder, bends backward towards the spine and the lower section of the intestine.

It is estimated that about 20% of women have this anatomical variation, which is often congenital. However, in some cases, it can be acquired, as the uterus’s position may change over time due to various factors.

The main causes include:

• endometriosis;
• childbirth or weakening of pelvic muscles;
• presence of fibroids;
• inflammatory diseases;
• surgical procedures.

Despite its frequency, many women are unaware they have a retroverted uterus, as in most cases, it does not cause symptoms.

“However, in rare cases, the following may occur:

• more intense menstrual pain (dysmenorrhea);
• pain during sexual intercourse (dyspareunia);
• difficulty emptying the bladder;
• intestinal issues (difficulty with bowel movements).

Generally, these symptoms are more common when the retroverted uterus is a consequence of a specific condition, such as intestinal inflammation or endometriosis.

Regarding dyspareunia, the pain typically occurs only under certain circumstances, for example, during deep penetration that impacts the uterine cervix,” explains Dr. Sala.

“The diagnosis of a retroverted uterus is straightforward and typically performed during a bimanual gynecological examination, which may be complemented by a transvaginal or transabdominal ultrasound.

If conditions such as fibroids or endometriosis are suspected, a pelvic ultrasound becomes essential to identify any associated complications.”

"Contrary to popular belief, a retroverted uterus does not pose a barrier to fertility or conception," explains Dr. Sala. "Women with a retroverted uterus have the same chances of conceiving as those with an anteverted uterus.

Only in rare cases, where the condition is associated with issues such as endometriosis or fibroids, might there be an impact on fertility or the normal progression of pregnancy."

During pregnancy, the retroverted uterus typically returns to an anteverted position spontaneously around the third month. As the uterus enlarges, it aligns itself and adapts to the growing fetus.

In the early weeks of pregnancy, however, a retroverted uterus may cause symptoms such as a feeling of pressure on the rectum. In some cases, it can lead to difficulty emptying the bladder, resulting in acute urinary retention. However, as the uterus grows, these symptoms usually resolve, and the uterus tends to assume the correct position.

As for childbirth, "a retroverted uterus does not pose a limitation," the doctor adds, confirming that pregnancy progresses normally.

Additionally, the likelihood of miscarriage is statistically similar in women with a retroverted uterus compared to those with an anteverted uterus.

"Another question that arises is whether a retroverted uterus could be responsible for abdominal bloating. In most cases, this condition does not cause bloating.

However, in the presence of fibroids or endometriosis, it can be associated with symptoms like constipation and bloating. For this reason, a joint evaluation between a gynecologist and a gastroenterologist is recommended to rule out other conditions," explains Dr. Sala.

"In summary, a retroverted uterus, while a common variation, should not cause major concern. In most cases, it does not cause symptoms and does not affect fertility or pregnancy. For women experiencing symptoms, it is important to consult a doctor for an accurate diagnosis and to rule out any underlying conditions," concludes the specialist.