Abstract
<jats:title>ABSTRACT</jats:title> <jats:p>Non‐puerperal uterine inversion is exceptionally rare and often associated with submucosal or fundal leiomyomas. Its variable presentation frequently delays diagnosis, and distorted pelvic anatomy poses significant surgical challenges. We report two cases of complete non‐puerperal uterine inversion in 44‐year‐old multiparous women presenting with abnormal uterine bleeding and pelvic pain. In both cases, MRI confirmed uterine inversion associated with large fundal fibroids (8–10 cm). Conservative reduction techniques were deemed infeasible due to the size and impact of the mass. Patient A underwent preoperative uterine artery embolization followed by total abdominal hysterectomy with bilateral salpingectomy; Patient B required laparotomy after unsuccessful reduction attempts. Intraoperative identification of distorted anatomy was aided by preoperative ureteral stent placement. Both patients recovered uneventfully. These cases illustrate the critical role of a high index of suspicion to differentiate from prolapsing fibroids and complete procidentia, distinguishing imaging features, pre‐operative evaluation for possible malignancy, individualized surgical planning, and multidisciplinary coordination in optimizing outcomes for non‐puerperal uterine inversion. When reduction is not possible, a methodical, anatomy‐based abdominal approach emphasizing ureteral protection and hemostasis remains the safest definitive treatment. Early recognition and imaging‐driven management may prevent hemodynamic compromise and improve prognosis in this rare condition.</jats:p>