Uterus tilted backwards

Normally, the anatomically correct position of the uterus in the female pelvis is a position inclined forward towards the bladder (anteversion, anteflexion). Under certain circumstances, however, the position of the uterus can deviate from the norm, so that it can be shifted slightly to the left or right, be vertical or even inclined backwards (retroversion, retroflexion). There can be various reasons for a tilted uterus, so that it is either designed this way from birth or only leaves its original, forward tilted position in the course of life.

This can be the case, for example, after pregnancy or childbirth (among other things due to tension loss in the uterine ligamentous apparatus), but also due to scarring as a result of endometriosis or fibroma. In most cases, a backward inclination of the uterus remains without symptoms, but in some cases it can be accompanied by menstrual pain, back pain, constipation, pain during sexual intercourse and difficulties in conceiving a child. Under certain circumstances, ovarian cysts and endometriosis may be associated with a backward tilt.

Possible treatment methods for a symptomatic tilted uterus are hormone therapy, pelvic floor exercises, pessary therapy and surgical corrections. The mucous membrane of the uterus is subject to cyclical fluctuations, which are regulated by the hormones. These hormones are estrogen and progesterone, which are produced in the ovaries.

A menstrual cycle lasts on average 28 days. In relation to the lining of the uterus, the cycle is divided into four phases. The first phase, the growth or proliferation phase, begins on the third or fourth day of the menstrual period and lasts approximately until the 14th day after the menstrual period.

During this phase, a high proportion of estrogens is produced in the ovaries. Due to the influence of these hormones, the mucous membrane in the uterus increases in thickness and the glands in the mucous membrane increase in size. New vessels are also formed, which are spirally aligned and are therefore also called spiral arteries.

The mucus plug in the cervix is thin at this time under the influence of estrogen. This thin fluid allows sperm to pass easily through the cervix into the uterus and then into the fallopian tube, where fertilization of the egg can take place. Normally, ovulation occurs on the 14th day after the menstrual period, and there is also a sharp drop in estrogen.

The second phase of the cycle is known as the secretion phase, because in this phase the uterine glands are full of mucus and secrete it (secrete). This phase lasts until the 25th day after the last period. The largest amount of mucus is secreted on the 21st day.

The plug of mucus in the cervix is now thickened and viscous. The hormone that dominates in this phase is progesterone.It is formed in the corpus luteum in the ovaries. From the 25th day onwards, the concentration of progesterone also decreases rapidly.

This hormone withdrawal causes the vessels in the mucous membrane to contract (third phase). As a result, the mucous membrane is no longer supplied with the nutrients that are vital for it and it dies. Approximately on the 28th day after the last bleeding, the previously contracted vessels dilate again and blood flows in.

This causes the vessel walls to tear (rupture). This leads to bleeding. Now the dead layer of the mucosa detaches itself.

This and the blood from the ruptured mucous membrane vessels is perceived by the woman as menstruation. This stage is called the desquamation phase (fourth phase). It lasts 1-3 days. After that, the estrogen concentration in the blood rises again and the cycle begins again.