What are the treatment options for a retroverted uterus?

Treatment Options for Retroverted Uterus

Most cases of retroverted uterus are normal anatomical variants that do not require treatment unless they cause symptoms or complications. When symptomatic, treatment should be targeted to address specific symptoms rather than the retroversion itself.

Understanding Retroverted Uterus

• Retroverted uterus is a common anatomical variant found in approximately 15-20% of adult females, while anteverted position is the most common orientation 1
• The position of the uterus can naturally change due to bladder filling or during pregnancy 1
• Retroversion is generally considered a normal variant and not a pathological condition unless it causes symptoms

When Treatment May Be Indicated

• Treatment is primarily indicated when retroversion is associated with:
  • Chronic pelvic pain 2
  • Dyspareunia (painful intercourse) 2
  • Dysmenorrhea (painful menstruation) 2
  • Complications during pregnancy 3, 4

Treatment Options

Conservative Management

• For asymptomatic retroversion:
  • No treatment is necessary as this is considered a normal anatomical variant 1
  • Regular monitoring during pregnancy to ensure the uterus repositions naturally as it grows 3

Surgical Options for Symptomatic Cases

• Uterine suspension procedures may be considered for patients with chronic pain related to retroversion:
  • Laparoscopic uterine suspension using techniques such as UPLIFT (Uterine Positioning by Ligament Investment, Fixation and Truncation) has shown effectiveness in treating pain associated with retroversion 2
  • This procedure creates shortened, thickened, and strengthened round ligaments that maintain the uterus in a mildly anteverted position 2
  • Studies have shown significant reduction in pain scores for menstrual pain (from 8.4 to 1.7 on a 10-point scale) and intercourse-related pain (from 8.1 to 1.5) 2

Treatment for Fibroids with Associated Retroversion

• When retroversion is associated with uterine fibroids:
  • Uterine Fibroid Embolization (UAE) may not only treat fibroid symptoms but can potentially change uterine orientation from retroversion to anteversion 1
  • Myomectomy may be considered for women desiring fertility preservation 5
  • Hysterectomy is the only definitive treatment when fertility preservation is not desired and symptoms are severe 5

Management During Pregnancy

• Special attention is required during pregnancy as complications may arise:
  • Most retroverted uteri (6-19% of pregnancies) spontaneously convert to anteversion by the second trimester 3, 6
  • If spontaneous repositioning doesn't occur, incarceration of the gravid uterus may develop, potentially leading to:
    • Spontaneous abortion
    • Preterm labor
    • Uterine dystocia
    • Complications during cesarean delivery 3
  • MRI can be useful in diagnosing uterine incarceration during pregnancy 4
  • Cesarean section is typically recommended for cases of incarcerated retroverted uterus at term 4

Treatment Outcomes

• For symptomatic patients with retroversion as the only significant pathology, uterine suspension procedures have shown 90% immediate and sustained symptom relief 2
• Complications from uterine suspension procedures are generally minimal, with temporary post-operative pain at the suspension site being the most common (7% of patients) 2

Important Considerations

• Treatment should focus on addressing symptoms rather than simply correcting the retroversion
• Diagnostic imaging such as ultrasound and MRI can help differentiate retroversion from other conditions that may cause similar symptoms 5
• For pregnant women with retroverted uterus, close monitoring is essential, particularly between 14-16 weeks when fundal impaction may manifest if spontaneous displacement doesn't occur 6