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Definition:
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Retroversion of the uterus occurs when a woman's uterus (womb) tilts backward rather than forward. It is commonly called a "tipped uterus."
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Alternative Names:
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Uterus retroversion; Malposition of the uterus; Tipped uterus; Tilted uterus
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Causes, incidence, and risk factors:
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Retroversion of the uterus is common. It is the normal uterine position in about 20% of all women.
Weakening pelvic ligaments associated with menopause may cause this condition in women who previously did not have a retroverted uterus.
Enlargement of the uterus, either as the result of a pregnancy or a tumor, may also lead to retroversion.
Scar tissue in the pelvis (pelvic adhesions) can also hold the uterus in a retroverted position. Such scarring may result from:
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Symptoms:
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Retroversion of the uterus almost never causes any symptoms.
Rarely, it may cause pain or discomfort.
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Signs and tests:
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A pelvic examination reveals the position of the uterus. However, a tipped uterus can sometimes be mistaken for a pelvic mass or an enlarging fibroid. A rectovaginal exam may be used to distinguish between a mass and a retroverted uterus.
An ultrasound examination can be used to determine the exact position of the uterus, if necessary.
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Treatment:
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Treatment is usually not necessary. Any underlying disorders (such as endometriosis or adhesions) may be treated as needed.
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Expectations (prognosis):
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Usually this condition does not cause problems.
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Complications:
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Atypical positioning of the uterus may be caused by endometriosis, salpingitis, or pressure from a growing tumor. These conditions should be ruled out in a patient with pain or other symptoms.
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Calling your health care provider:
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Call your health care provider if you develop persistent pelvic pain or discomfort.
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Prevention:
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There is no known prevention. However, early treatment of PID or endometriosis may reduce the chances of a change in the position of the uterus.
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References:
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Lentz GM. Differential diagnosis of major gynecologic problems by age group: vaginal bleeding, pelvic pain, pelvic mass. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 8.
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