Tilted Uterus: What It Is, What Causes It, And How It Affects Women

Hearing you have a tilted uterus might come as a shock. Here’s what you should know about the condition.

April 18, 2018
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These days, women have more information than ever when it comes to their reproductive health.

Women’s health is (finally!) being taken seriously by the medical community and thanks to technological advancements that allow us to better understand our bodies, modern women have more understanding about their reproductive health systems than women of any other generation. All that knowledge is empowering, but it also means that more women are finding out that they have anatomical differences, like a tilted or reverted uterus.

When it comes to reproductive health, emotions run high, so hearing that you have a tilted uterus can be scary. Is something wrong with you? Could this affect your chances of getting pregnant and delivering a healthy baby? Although most of us probably don’t give too much thought to our uteruses in day-to-day life, it’s still important to know that your reproductive system is healthy, and that it will be ready if you decide you want to have children.

Luckily, having a tilted uterus is usually just another variable when it comes to the ways our bodies are all made a little differently. Usually it’s nothing to be alarmed about.

However, there are some instances in which having a tilted uterus can indicate an underlying health concern, or can lead to trouble getting pregnant.

HealthyWay talked to women’s health and fertility specialists to answer all of the most common questions about having a tilted uterus. Here’s what you should know about having a tilted uterus, and how this condition affects conception, pregnancy, and delivery.

What is a tilted uterus?

Most people, including medical professionals, use the term “tilted uterus” to mean a uterus that points toward a woman’s back. This is also known as a retroverted uterus.

Many women are born with a uterus that is straight up and down within the abdomen, which is considered standard positioning. However, many woman have a uterus that tilts after the cervix, the opening to the uterus. The most common type of tilt is a uterus that leans slightly to the front, known as an anteverted uterus. A retroverted uterus—usually referred to simply as a tilted uterus—is the opposite of that.

Bat-Sheva L. Maslow, MD, a reproductive endocrinologist at Extend Fertility in New York City, says that having a tilted uterus is just another variation of normal, similar to being left-handed.

“While less common, having a retroverted uterus is not abnormal,” she says. In fact, about one in five women around the world have a tilted uterus.

Why do I have a tilted uterus?

If you’ve been told that you have a tilted uterus, you’re probably wondering how a tilted uterus develops. In most cases, this is just the way you were born.

“This condition can be the way some women are built; it is perfectly natural,” says Joshua M. Hurwitz, an OB-GYN and board-certified reproductive endocrinologist and infertility specialist at Reproductive Medicine Associates of Connecticut.

However, in some cases there are physical changes within the body that cause a tilted uterus. The most common is from scar tissue caused by endometriosis or fibroids. This scar tissue can weigh the uterus down, or pull in toward the back, resulting in a retroverted uterus. These conditions can also create scar tissue in the abdomen, which can then push the uterus backward. Women who have a tilted uterus accompanied by pain should talk to their doctors about whether they have any other signs of endometriosis, a condition in which the lining of the uterus grows outside the womb.

Other women might develop a tilted uterus after pregnancy. That’s because the ligaments that hold the uterus in place stretch and loosen during pregnancy, so after delivery the uterus can settle in a new position, resulting in a retroverted uterus. Menopause can cause this as well since the ligaments holding the uterus relax as estrogen drops, allowing the uterus to slip into a tilted position.

Because these conditions are all beyond your control, there is no way for a woman to prevent developing a tilted uterus.

What are the signs I might have a tilted uterus?

A woman with a tilted uterus will most often not have any signs or symptoms according to Phil Chenette, MD, a board-certified specialist in reproductive endocrinology and infertility with Pacific Fertility Center in San Francisco.

“Most women with a tilted uterus never know until it is found on pelvic exam or a pelvic ultrasound exam,” he says. Although it’s easy for a doctor to diagnose the condition during a routine exam or ultrasound, the women who have the condition usually have no signs, so a retroverted uterus usually goes unnoticed.

However, some women who have a tilted uterus will experience symptoms. A woman with a tilted uterus might experience menstrual cramps as pain that is located more toward her back than her abdomen, Maslow says. Additionally, some women who have a tilted uterus will experience more severe pain with menstruation—although that’s usually because of another underlying health issue like endometriosis (more on that in a moment).

A woman who has a tilted uterus might also experience pain during intercourse or while using tampons if her tilt is severe, Maslow explains. That’s because in some cases the uterus can tilt so severely that it puts pressure on the vagina. However, Maslow underscores that these symptoms are rare.

“The vast majority of women with retroverted uteri will experience no symptoms and not know they even have one unless a doctor has told them,” she says.

Is is harder to get pregnant with a tilted uterus?

Many women who hear that they have a retroverted uterus worry that having a tilted uterus will affect conception. The good news is that most of the time a woman with a tilted uterus will not have have a more difficult time getting pregnant that anyone else.

“As a fertility specialist, I do not believe there is any connection at all between a tilted uterus and infertility,” says Hurwitz. “Only in those exceptional cases where scar tissue from endometriosis or surgeries has caused this uterus to be mechanically displaced is there a tie-in to fertility problems.”

Chenette says that when a uterus is severely tilted it can lead to trouble conceiving. Some women have an acute retroversion, where the cervix has a tilt that is between 90 and 180 degrees, he says. Women with a more severe tilt and a sharper curve in their uterus are more likely to have trouble conceiving.

“Some women have a sharp hockey stick kind of curve and some have a slow gradual rounded curve,” Chenette says.

Having a significant tilt can prevent sperm from reaching the egg in women with a tilted uterus, thus making it more difficult to get pregnant.

“Since traversing those angles as a sperm cell can be challenging, women with a significant tilt can experience longer times to conception,” Chenette says.

If a woman with a tilted uterus is having trouble getting pregnant and all other infertility causes have been ruled out, a doctor might recommend intrauterine insemination or in vitro fertilization. During intrauterine insemination, a doctor places sperm in the main body of the uterus using a catheter. This way, sperm do not need to navigate the bend of a tilted uterus, and more of them are likely to reach the egg, increasing the chances of conception. During in vitro fertilization, an embryo (a fertilized egg) is placed in the uterus above the tilted portion. If this embryo successfully implants, the patient will become pregnant.

Although both procedures are highly effective even when a patient has a tilted uterus, Chenette says that assisted reproduction is a bit more complicated for a woman who has a tilted uterus.

“It takes an experienced doctor to perform insemination or embryo transfer in these patients,” he says. “The same cervical curve that produces the original problem can make insemination or embryo transfer challenging.”

However, usually a woman with a tilted uterus can become pregnant, even if she requires assistance.

“Careful ultrasound guidance and an experienced hand almost always solves this problem,” Chenette says.

How does a tilted uterus affect pregnancy and birth?

Although a tilted uterus can make conception tricky in some cases, it should not affect pregnancy at all.

“Once a woman conceives, which most do, the pregnancy proceeds normally,” Chenette says.

During pregnancy, the uterus expands rapidly. It starts off at about the size of an orange, and grows to the size of a grapefruit by the 12th week according to the American Pregnancy Association. By week 20 (halfway through pregnancy) the uterus usually reaches a woman’s belly button, and by full term the uterus is the size of a watermelon, stretching to the bottom of a woman’s rib cage. All of that growth works to correct the position of a tilted uterus.

“As the uterus grows with a pregnancy, it comes out of the pelvis and ‘unfolds,’” Maslow says. “By the time the baby is large enough for the mom to feel its movements, the uterus is typically out of the pelvis and you really no longer see much of a difference between those that are folded forwards or backwards.”

Whether or not the mother-to-be had a tilted uterus before pregnancy will not affect her during delivery, Maslow says.

“By the time the baby is term, there is no distinction between the way the uterus had been folded and as far as I know there isn’t any data to support that having a retroverted uterus has any impact on delivery outcomes,” she says.

How can a tilted uterus affect your sex life?

Sometimes a woman with a tilted uterus will experience pain during penetrative sex, if her tilt is severe enough that it is putting pressure on her vagina. Pain during sex is most commonly experienced by women who have endometriosis in addition to tilted uteri, so if you experience this, be sure to mention it to your doctor so you can discuss any other signs of symptoms you have that might be associated with endometriosis, Chenette says.

Most often there is a simple solution to pain experienced during intercourse, he adds.

“Sometimes a change in position is enough to relieve the discomfort,” he says.

What are the treatments for a tilted uterus?

Because a woman with a tilted uterus usually has no symptoms, there is often no need to correct the condition.

“The condition is not worrisome or dangerous at all and there is nothing to do about it or treat,” Hurwitz says.

However, if your tilted uterus is causing you pain either during sexual activity or during your period, your doctor will likely be able to recommend some treatments. One correction that you can try at home is doing a knee-to-chest exercise, according to Hurwitz. To try to reposition your tilted uterus using this exercise, lie on your back on the floor. Raise your right knee to your chest, holding for 15 to 30 seconds. Then, return that foot to the foot and draw your left knee up toward your chest. Do ten repetitions per side, three times each day. Even when knee-to-chest exercises aren’t enough to correct a tilted uterus, they can help with back pain that women with a severely tilted uterus can experience, Hurwitz says.

For women who have lots of pain that is caused by or made worse by a tilted uterus, doctors may recommend surgery to reposition the uterus. This is very rare, and usually only done when a woman has a tilted uterus that is associated with endometriosis, Hurwitz says.

Living a healthy lifestyle can help reduce pelvic pain, including the pain associated with a tilted uterus, Chenette says.

“Stress reduction and mindfulness techniques, as well as reducing alcohol and [improving] nutrition, can reduce some of the symptoms of pelvic pain,” he says.

So should you be worried about having a tilted uterus?

Unless you are having severe associated symptoms, having a tilted uterus isn’t anything to stress over.

“It is important to remember that a uterus can point in any direction: up, down, to either side, and even be rotated,” Hurwitz says. “This does not mean there is a medical, fertility, or pregnancy problem at all.”

In fact, the toughest part about having a tilted uterus is often finding out that you have the condition.

“I think the worst part for a woman hearing that she has a ‘tilted uterus’ is the anxiety and worry that the label places on her anatomy, which really does not have any negative effect anyway,” Hurwitz says.

Today it’s totally normal to hop online and research any new medical condition, but going down that rabbit hole can be scary. The experts who spoke with HealthyWay all emphasized that for most women having a tilted uterus is nothing to worry about.

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