One in 5 women has a cervix and uterus (womb) that tilt back toward the spine instead of sitting upright or leaning slightly forward in the lower abdomen. Doctors call this a “tilted uterus” or “retroverted uterus.”

Most of the time, a tilted uterus doesn’t cause any health, fertility, or pregnancy problems. In fact, it’s so common that it’s considered a normal variation.

In very rare instances, though, a tilted uterus can pose health risks, so it’s a good idea to talk to your doctor about it.

Read on to learn how a tilted uterus might affect your health, fertility, and pregnancy.

Terminology check

The term “tilted cervix” isn’t commonly used in medicine. Most doctors refer to a tilted cervix as a “tilted uterus” or “retroverted uterus.”

Healthline

The cervix is the part of the uterus that attaches to the vagina. If you think of the uterus as pear-shaped, the cervix is the narrow end of the pear. When not pregnant, the uterus is around 4 centimeters long, although the exact length varies from person to person and throughout pregnancy.

The lower end of the cervix descends into the vagina. When the uterus is tipped, it can cause the cervix to lean, too.

Some people are born with a tilted uterus. Sometimes, pregnancy stretches the ligaments that support the uterus, allowing it to shift positions in the body. Certain health conditions can also lead to the formation of scar tissue that pulls on the uterus, changing its orientation.

Endometriosis, fibroids, and pelvic inflammatory disease can all cause scarring that changes how the uterus is shaped and situated.

For many women, having a tilted or retroverted uterus doesn’t cause any symptoms at all. For others, the angle of the uterus can cause:

Your doctor can diagnose this condition with an ordinary pelvic exam. During the exam, the doctor places two fingers inside your vagina and then presses gently on your abdomen to get an idea of the position of your uterus.

It’s also possible to see a retroverted uterus using an ultrasound or MRI scan.

At one time, doctors believed that it would be harder to conceive if the angle of your cervix or uterus made it more difficult for a sperm to get to an egg. Now, doctors think a tilted uterus won’t keep you from getting pregnant.

If you’re having fertility issues, it’s possible that an underlying medical condition like fibroids, endometriosis, or pelvic inflammatory disease is making it harder to get pregnant, rather than a retroverted uterus.

Most of the time, a retroverted uterus enlarges and expands normally during pregnancy, and its initial orientation doesn’t cause any problems during pregnancy or delivery.

Very rare condition: Uterine incarceration

In very rare cases, approximately 1 in 3,000 pregnancies, a severely retroverted uterus can lead to a condition called uterine incarceration, which happens when internal scars from surgery or a medical condition bind the uterus to other parts of the pelvis. These internal scars are called adhesions.

As the uterus grows, the adhesions keep it from expanding upward, trapping it in the lower part of the pelvis. Symptoms of uterine incarceration can be hard to recognize, and they usually don’t show up until after the first trimester.

Symptoms of uterine incarceration

The symptoms of uterine incarceration usually include:

Complications of uterine incarceration

If you’re experiencing these symptoms, it’s important to talk to a doctor. An incarcerated uterus can cause restricted growth, miscarriage, uterine rupture, or early delivery. The condition can also damage your kidneys or bladder.

Diagnosing uterine incarceration

Your doctor can diagnose an incarcerated uterus with a pelvic exam, an ultrasound, or an MRI scan.

Treating uterine incarceration

Most of the time, uterine incarceration can be treated successfully. If your uterus becomes incarcerated before you’re 20 weeks pregnant, your doctor may give you knee-to-chest exercises to help release or reposition your uterus.

If the exercises don’t correct it, a doctor can often turn the uterus manually to release it. In some cases, laparoscopy or laparotomy will correct the condition.

Because a tilted uterus can change the angle of the cervix in the vagina, some women have pain during deep or energetic sex.

One of the most difficult things about painful sex is the sense of isolation many women feel if they can’t discuss it with someone they trust.

If sex is painful for you, it’s important to talk to your partner and your doctor about it. A doctor can evaluate your situation and recommend treatment options that might work for you.

Painful periods

A tilted uterus is associated with more painful periods.

A 2013 study measured the degree of flexion in 181 women who had significant pain during periods and found that the more tilted the uterus was, the more painful their periods were.

Researchers think that when the uterus is sharply angled, it can close off the pathway of blood from the uterus to the cervix. Narrowing that passage may mean your body has to contract (cramp) harder to push out the menses.

Two pieces of good news here:

  1. Your uterus may shift as you get older or after a pregnancy, which can alter its position in your body and reduce cramping.
  2. If your periods are painful, there are simple things you can do at home that have been effective at relieving pain for many women.

Difficulty inserting tampons or menstrual cups

A tilted uterus can also make it more uncomfortable to insert a tampon or a menstrual cup.

If you’re having trouble putting in a tampon, try a different body position. If you normally sit on the toilet, you could stand with one foot on the edge of the tub or bend your knees so that you’re in a squatting stance.

You might also try a menstrual disc, which you place at the back of your vagina so it covers the cervix. Some women find discs more comfortable than menstrual cups or tampons.

If you’re experiencing uncomfortable symptoms, it’s a good idea to talk to a doctor. Treatments are available to correct the angle of your uterus. A doctor may prescribe:

  • knee-to-chest exercises to reposition your uterus
  • pelvic floor exercises to strengthen the muscles that hold your uterus in place
  • a ring-shaped plastic or silicone pessary to support your uterus
  • uterine suspension surgery
  • uterine uplift surgery

Having a cervix or uterus that tilts back toward your spine is a normal variation of the uterine position in the pelvis. Most of the time, women with a tipped uterus don’t have any symptoms at all.

A tilted uterus shouldn’t have any impact on your ability to get pregnant or deliver a baby. For some women, a tipped uterus can cause more painful periods, discomfort during sex, and difficulty inserting tampons.

In a very small number of cases, a tipped uterus caused by scarring may lead to a serious pregnancy complication called an incarcerated uterus, which can usually be treated successfully if it’s diagnosed early enough.

If your uterus is tipped and it’s causing problems for you, your doctor may be able to prescribe exercises, a support device, or a surgical procedure to correct the angle of your uterus and relieve your symptoms.