Chronic non-puerperal uterine inversion due to submucosal fibroid

Chronic non-puerperal uterine inversion is a rare condition, particularly in postmenopausal women, and is most commonly associated with submucosal leiomyomas. We report a postmenopausal woman in her 50s presenting with a long-standing vaginal mass, intermittent spotting and recent constipation. Clinical examination suggested a prolapsed fibroid; however, the uterine fundus was not palpable, raising suspicion of uterine inversion. Ultrasonography demonstrated an intrauterine pedunculated lesion with poor visualisation of the uterus. Definitive diagnosis was established intraoperatively, confirming complete uterine inversion with a submucosal fibroid as the leading point. The patient underwent fibroid excision followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy, with an uneventful recovery. This case highlights the importance of considering uterine inversion in the differential diagnosis of vaginal masses in postmenopausal women and emphasises the role of intraoperative diagnosis and definitive surgical management.