This article is written by medical professional Amy Harris, whom you can read more about at the end of the article.
Experiences with wearing a menstrual cup differ from person to person.
Some people experience discomfort and leakage, which makes wearing a menstrual cup less desirable—to the extent they stop wearing their cup completely. They’ve followed the instructions but it’s not working out.
In some cases, the reason is a tilted uterus, which is very common. One in four people has a normal variation in the way their uterus tilts. Just like how our eyes vary in shape, it’s another aspect of our unique bodies. No problem there.
We’ll go into more detail about the different ways a uterus can tilt, but for now, rest assured that a menstrual cup will still work for you, no matter which way your uterus tilts.
Keep reading to learn:
- What a tilted uterus is (and how to know if you have one)
- How to use a menstrual cup with a tilted uterus
- Fool-proof folding techniques for ideal placement
- How to find the best cup for you—and the planet
We have it all covered here, reviewed by a qualified medical expert.
What is a tilted uterus?
When talking about your uterus and how it sits in your body, it can be helpful to imagine that your uterus is like an upside-down pear, suspended above the bowl of your pelvic floor. That pear can tilt in any different plane. The way it’s tipped or tilted impacts how high or low your cervix (the mouth of your uterus) is in your vaginal canal.
Our diagram below portrays the different uterus tilts.
Most commonly, the uterus tilts back from the pubic bone towards your tailbone. Doctors call this an anteverted uterus. Sometimes a forward-tilting uterus can fold over on itself and doctors call this an anteflexed uterus.
A quarter of people have a uterus that tilts back backward towards their tailbone. Doctors call this normal variation a retroverted uterus. A retroverted uterus can also be flexed over itself and in this situation is called retroflexed.
Because there are a smaller number of people with a retroverted uterus (one out of every four), when talking about a tilted uterus, generally people are referring to a retroverted or retroflexed uterus. You may hear people mention a tilted cervix but this is the incorrect terminology,
Most important for you to know about retroverted or tilted uteri is that there’s nothing abnormal about having a retroverted or retroflexed uterus. There’s no reason to feel embarrassed or worried. Many, many people live their whole lives without knowing that they are packing a tilted uterus.
Most of the time a tilted uterus has zero side effects, and it doesn’t impact the ability to have a successful pregnancy or your postpartum recovery. One way a tilted uterus can affect someone though is when trying to insert a menstrual cup, finding a comfortable position.
How do you know if you have a tilted uterus?
Your ob-gyn may have already told you that you have a tilted uterus. Sometimes it may take healthcare professionals a little bit longer to locate your cervix during a gynecological exam if you have one. If your healthcare provider hasn’t said you have a tilted uterus, and you suspect you may have one, we encourage you to ask. It’s your body, why not learn all that you can about it?
Likewise, it can be empowering to know what your vagina and cervix look like. If you’re up for it, you can ask your provider to help you see your cervix during the speculum exam with a hand-held mirror.
Other clues that you might have a tilted uterus are:
Discomfort or pain during certain sex positions. If your uterus tilts back towards your tailbone or coccyx, deep penetration or having your partner enter you from behind can sometimes feel painful. Trying other positions where you can control how deep your partner penetrates you (such as you being on top) can be more enjoyable.
- It’s tricky to locate your cervix. Knowing how high in your vaginal canal your cervix sits can help you choose the best-fitting menstrual cup. If you have a tilted uterus, your cervix may be towards the front of your vaginal canal, by your pubic bone and bladder.
Learn how to find your own cervix from Ruby Cup’s help guide for checking your cervix height. Because your cervix moves over your menstrual cycle, check your cervical height during or after your period to find the best fit for a menstrual cup.
Can you use a menstrual cup if you have a tilted uterus?
Yes, you can! Finding the right size and position for your menstrual cup may be a learning curve for those with a tilted uterus, but Ruby Cup is here to guide you through the process.
A tilted uterus usually means you have a low cervix. When your cervix is low we recommend that you use a smaller size menstrual cup with a stem that you can trim.
For more help choosing which menstrual cup is right for you, check out our beginner's guide.
What to look for in a menstrual cup if you have a tilted uterus
Smaller cup. Many menstrual cup providers, like Ruby Cup, offer different sizes. Check out our menstrual cup size guide to find the right size for you.
Softer material. A cup made out of softer material makes the cup easier to try different folding methods for more comfortable insertion. Soft medical-grade silicone, like what Ruby Cup is made from, provides the softness you need for ideal comfort and fit.
- Shorter stem. When you need to wear your cup lower in your vaginal canal the stem can often get in your way. When wearing a menstrual cup the whole cup needs to be inserted into your vaginal canal. Many cups are designed to allow the user to trim the stem themselves, like Ruby Cup.
Why choose Ruby Cup for a tilted uterus
Ruby Cup’s menstrual cup comes with a smaller-sized cup option, soft medical-grade silicone, and a trimmable stem.
Other attractive Ruby Cup features include perforated holes for easier removal, a bag for storage, and multiple colors to choose from. We offer a one-time menstrual cup exchange, or a full refund within 4 months of purchase, and a 20% discount for students with a valid ID.
We’re also actively fighting period poverty. We have a Buy One Give One program where for every Ruby Cup purchased we donate one to someone in need. Period poverty is a huge issue, with many people not having access to safe period products, and we not only donate menstrual cups but also provide educational workshops to fight stigma and teach about reproductive health.
How to use a menstrual cup with a tilted uterus
We’re going to dive into more detail here about how to use a menstrual cup with a tilted uterus. Regardless of which way your uterus tilts or your cervical height, learning how to use a menstrual cup without leakage or discomfort takes practice.
Knowing where your menstrual cup should sit is something you may need to experiment with to find the best fit. With a tilted uterus there’s more of a chance that the cup will form a suction with your cervix which can be painful.
Try using a smaller cup
- A smaller-sized cup can sit lower in your vaginal canal without it being uncomfortable.
- A heavy flow may also dictate the size of the cup that works best for you.
- Ruby Cup offers a saver pack with both a small and medium-sized cup so you can mix and match depending on which size feels better and how heavy your flow may be.
- Once you have your cup you’ll need to play around with how high or low in your vaginal canal you wear your cup. The higher your cup, the closer it is to your cervix. Sometimes if your cup is lower down in your vaginal, close to your vaginal opening, that sensitive area can be irritated, as with a tampon that is not inserted far enough into your vagina. Reach out to your healthcare provider if you need help.
- Note that people who have gone through vaginal childbirth may still need a larger cup.
Try different folds
There are several different ways to fold your menstrual cup before inserting it into your vaginal canal. Check out Ruby Cup’s how to use a menstrual cup guide to become a master of menstrual cup folding. The fold that we recommend for beginners is the punch-down fold.
Saying that, try all the different folding methods and find the technique that works best for you and your body.
Related post: The 7 Best Menstrual Cups for Beginners in 2023
Let your cup open up earlier when inserting
If your menstrual cup is too close to your cervix (high up in your vaginal canal), it can sometimes create suction with your cervix instead of your vaginal walls. This suction may cause discomfort and even pain.
You can avoid this by allowing your cup to open up earlier and lower down in your vaginal canal. Because your cervix may be lower down if you have a tilted uterus, try letting your menstrual cup unfold lower down.
The technique involves releasing the fold of your cup so it opens early in your vaginal canal. You then continue to slide the cup up to your desired height. This method is great for discovering what height is most comfortable for you.
It’s good to note that menstrual cups don’t need to be worn as high as tampons if you’re used to wearing tampons.
To make insertion easy and comfortable, you can try applying some water-based lubricant around the rim of your cup. Make sure to use a water-based lubricant that will not break down the silicone of your menstrual cup.
Trim the stem
As the whole menstrual cup, stem included, needs to be inserted into your vaginal canal, users often find the stem bothersome. Or, the user is wearing the cup higher to ensure the stem is placed neatly inside.
One workaround is to trim the stem with scissors. Once you know how high it’ll sit, go ahead and cut away the length you don’t need.
It’s ok if you trim off more than you need but remember, the shorter the stem, the harder it may be to remove your menstrual cup.
Leave space between your cervix and your menstrual cup
We know we just advised you to not wear your cup too low, but you shouldn’t wear it too high either. Inserting your cup too close to your cervix can cause suction on the cervix. This can be uncomfortable and can cause pain while wearing your menstrual cup.
Aim to wear your cup below the cervix so it suctions to your vaginal walls. Your cervix is the base of the uterus which connects to the beginning of your vaginal canal. If you have a tilted uterus then you’ll likely hit your cervix with your menstrual cup. Don’t worry. Pinch the base of the cup to break the suction, and slide it down.
Related Post: Your Menstrual Cup Keeps Sliding Down? Here’s What to Do
You can use a menstrual cup if you have a tilted uterus
It’s completely normal to have a tilted uterus. Remember, one in four people will have a tilted uterus so there’s nothing to be embarrassed about. The four types of tilted uterus are anteverted, retroverted, anteflexed, and retroflexed. You can refer to them all simply as a tilted uterus, but never a tilted cervix.
The good news is that no matter which way your uterus tilts, you can still use a menstrual cup.
Using a menstrual cup can involve a little trial and error until you find the best size, insertion technique, and positioning of your menstrual cup. Not every vaginal canal is straight, and if you have a tilted uterus, it might just take a little bit more practice to perfect your placement.
Remember that the cervix and uterine position can change after vaginal childbirth so if you're a menstrual cup user and plan to wear one postpartum, you may want to ask your provider about whether or not childbirth changed your uterus’s position in your pelvis.
Your uterus may also change from scarring due to endometriosis, fibroids, and pelvic inflammatory disease.
Your body is unique, as are your intimate parts. We at Ruby Cup encourage you to use your menstrual cup journey as a way to learn more about your body, including which way your uterus tilts. Reach out to your healthcare provider with any questions and even use Ruby Cup as your go-to resource. We cover everything about your whole menstrual journey, from beginner-cup-users to, well, titled uteri and advanced folding techniques!
How does a tilted uterus affect your period?
In general, a tilted uterus will not affect your period. Some women whose uteri tilt back towards their tailbone (retroverted uterus) may experience more menstrual cramping and lower back pain with their periods.
What are the symptoms of a tilted uterus?
Some symptoms that can be experienced are
- painful periods,
- light pain during certain sex positions, and
- problems inserting period products.
Will having a tilted uterus make it harder for me to get pregnant?
People with a normal retroverted uterus aren’t at increased risk for infertility, miscarriage, or any other health problems. Once pregnant, both the anteverted and retroverted uteri will grow and work exactly the same during pregnancy and childbirth.
Which menstrual cup is best for a tilted uterus?
A small size menstrual cup that is soft, flexible, and has a stem that can be trimmed. Ruby Cup offers all of these advantages and more.
Reviewed by Amy Harris. Amy Harris is a certified nurse-midwife with more than a decade of clinical experience in reproductive health clinics, hospitals, and private OB/GYN practices. Amy holds a Masters of Science in Maternal and Child Health from Harvard School of Public Health and completed her nursing and midwifery training at Yale School of Nursing and Boston University School of Public Health. Passionate about empowering women through health education, Amy puts her public health training to work as a dedicated women’s health writer.