How does the inverted uterus affect pregnancy?

Through a routine ultrasound, a pelvic exam or a retrovaginal exam, the gynecologist can detect an inverted uterus. Uterine retrogression, inverted uterus or tilted uterus It is a variant of the anatomy of women in the pelvic area, given when the position of the uterus tilts backwards, towards the back of the pelvis, rather than forward. But how does this affect to achieve pregnancy? And once pregnant? We see it below.

According to the Spanish Gynecological Association, approximately 20% of the female population has an inverted or retroversion uterus. Normally, the uterus is usually tilted forward (in the direction of the belly) or in an upright position, resting on the bladder. But in the case of a reversed or inverted uterus, it is tilted towards the back, that is, oriented towards the spine and supported by the rectum.

The causes of this particularity are not known with certainty, but it seems that it is not hereditary. If it is a primary inverted uterus it happens when the fetus is still in development and the uterus in formation acquires that backward position. Then, the girl is already born with the uterus in this anatomical position.

But uterine retroversion It can also be secondary, if the uterus that had a normal position rotates following an abnormality that appears in the pelvis, such as a fibroid or an adhesion (scar tissue in the pelvis). If the uterus becomes reversed by pregnancy, it is common for this organ to return to normal after 10 or 12 weeks of gestation (as a result of the weight of the fetus). They will do the necessary revisions to verify that the uterus has been rearranged.

Certain gynecological conditions, such as pelvic inflammatory disease and endometriosis, can cause retroversion of the uterus.

Sometimes, retrogression of the uterus can happen during postpartum: if the ligaments that support the uterus suffer a strain or tear and the uterus is transiently retracted.

Finally, the weakening of the pelvic ligaments associated with menopause could also cause this condition in women who previously did not have it.

Symptoms of inverted or reverse uterus

As we have said, many women have this anatomic deviation, but many are not even aware of it, since it has no symptoms. Some women with upside down uterus They may suffer from pain in the lumbar or pelvic region at the time of premenstrual syndrome or during the period.

Others feel a continuous sensation of stretching down, and painful sexual relations are frequent (the penetration would press on the cervix, particularly sensitive) or interference with the bladder and / or intestine, urinary infections ...

The woman may also have fine stools or constipation just before or during the period, because in these periods the uterus can become twice as large, weighing between 120 and 300 grams, which implies that the rectum must bear a much greater weight).

Incontinence may also occur or, on the contrary, retention of urine if the cervix rests on the bladder and urethra, preventing its exit. Depending on the case of an inverted uterus, and if it is associated with other problems, the woman may feel vague and general discomfort, such as headache, nervous cough, constipation, irritability or stomach upset.

The usual thing is that a routine gynecological exam diagnose the inverted uterus, but before these symptoms it is necessary to go to the consultation if it had not yet been detected (it can be confused with other problems), so that it confirms or not the diagnosis.

Can I get pregnant with an inverted uterus?

Yes, you can get pregnant, since fertility is not affected by the inverted uterus. The ability of sperm to reach the ovum is not interfered by the uterus upside down. Once conception occurs and the fetus grows, the uterus is likely to correct the deviation and take its normal position.

However, it must be taken into account that there are other factors associated with retroversion that could cause problems when conceiving, such as endometriosis, if the tissue that lines the inside of the uterus grows outside it, as in the ovaries, intestines, rectum, bladder or the lining of the pelvic area.

Other related diseases such as some pelvic inflammatory or certain tumors may also cause problems with conception and need medical attention. But usually this pathology does not present difficulties at the time of conception and most women have a normal pregnancy and childbirth.

If the reverse uterus does not correct itself during pregnancy (as we have said, this usually happens naturally during the first trimester), the gynecologist may decide to perform a digital maneuver vaginally to turn the uterus into the anteverse position and facilitate that pregnancy can develop normally.

Inverted uterus treatment

As usual, this deviation does not usually need any type of treatment. But since it is a complex situation, since it can have different consequences, the specialist has to follow up on each case and decide the steps to follow. For example, underlying diseases such as endometriosis or adhesions will need intervention.

If the need to intervene is observed, a surgical operation can be performed in order to correct the displacement of the uterus and fix it in the natural position. After this intervention, the inversion of the uterus is not repeated, even with pregnancies.

In the case of having pain in sexual relations, it is recommended to look for a position that does not involve very deep penetration, that is less uncomfortable, with the woman on the man or in the missionary posture.

About prevention of the tilted uterusThe way to prevent it is unknown, however early treatment of pelvic inflammatory disease or endometriosis may reduce the chances of a change in the position of the womb.

According to American Pregnancy, there are exercises to help change the position of the uterus temporarily, but it is always advisable to consult the gynecologist, since not all doctors agree about the usefulness of pelvic exercises as a long-term treatment:

  • Knee-chest exercise: lying on your back, flexing your legs until you bring your knees to your chest. However, this exercise will not be effective if the uterus has become tipped due to endometriosis, fibroids or pelvic infections.

  • Use of a pessary: ​​a plastic or silicone device that is placed in the vagina to change the position of an inclined uterus. In general it is considered a temporary solution for pelvic pain, because long-term use can favor vaginal infections.

Definitely, the retroverse uterus is not a disease, but the torsion of an organ, a particular anatomical condition of women, so it does not cause infertility. If there are problems for conception, it will be due to other associated problems. Nor does it interfere with a healthy pregnancy or cause abortions.

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More information | Reproducionasistida.org, Medline Plus
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