Natural history of pelvic organ prolapse in postmenopausal women
Abstract
OBJECTIVE: To describe the natural history of pelvic organ prolapse and risk factors for changes in vaginal descent in older women. METHODS: This 4-year prospective observational study included 259 postmenopausal women with a uterus enrolled at one Women's Health Initiative clinical site who completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations. We calculated 1-year and 3-year incidence and resolution risks for prolapse (defined as maximal vaginal descent to or beyond the hymen) and estimated progression and regression rates (1 cm or greater and 2 cm or greater changes in maximal vaginal descent) and risk factors. RESULTS: Mean age was 68.1+/-5.5 years, and median vaginal parity was 4. Seventy-three (28%) women had four exams, 128 (49%) had three exams, and 58 (22%) had two exams. Prolapse waxed and waned yearly in individual women. Overall 1-year and 3-year prolapse incidences were 26% (95% confidence interval [CI] 20-33%) and 40% (95% CI 26-56%); 1-year and 3-year prolapse resolution risks were 21% (95% CI 11-33%) and 19% (95% CI 7-39%). Rates of any change in maximal vaginal descent over time varied depending on baseline measurements. Over 3 years, the maximal vaginal descent increased by at least 2 cm in 11.0% (95% CI 4.9-20.5%) of the women and decreased by at least 2 cm in 2.7% (95% CI 0.3-9.5%). Increasing body mass index and grand multiparity increased the risk for vaginal descent progression. CONCLUSION: Prolapse progresses and regresses in older women, although rates of vaginal descent progression are slightly greater than regression overall. Obesity is a risk factor for progression in vaginal descent. LEVEL OF EVIDENCE: III.
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- Authors
- Bradley, C. S., Zimmerman, M. B., Qi, Y., & Nygaard, I. E.
- Affiliations
- University of Iowa (US)
- University of Utah (US)
- Venue
- Obstetrics & Gynecology
- Published
- 2007-04
- Volume
- 109
- Issue
- 4
- Pages
- 848-854
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W1984902625
- Cited by
- 158
- References
- 13
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 9 · 2023: 12 · 2022: 9 · 2021: 9 · 2020: 11 · 2019: 6 · 2018: 6 · 2017: 14 · 2016: 6 · 2015: 7 · 2014: 4 · 2013: 7 · 2012: 8
- FWCI
- 7.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Iowa Research Online (The University of Iowa) (submittedVersion)
- Funders
- National Institutes of Health (7k24hd042469-05)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD047654, R01 HD41131, K24 HD42469)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- pelvic organ prolapse, postmenopausal women, natural history (disease), POP-Q, risk factors, body mass index, obesity, grand multiparity, parity, uterine prolapse
- MeSH terms
- Age Factors, Aged, Female, Humans, Middle Aged, Parity, Pregnancy, Prospective Studies, Uterine Prolapse, Body Mass Index, Odds Ratio, Postmenopause
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