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Pelvic Organ Prolapse in Older Women: Prevalence and Risk Factors

From the University of Iowa Carver College of Medicine, Department of Obstetrics and Gynecology, Iowa City, Iowa.

Address reprint requests to: Ingrid Nygaard, MD, Department of Obstetrics and Gynecology, 2 BT GH UIHC, 200 Hawkins Drive, Iowa City, IA 52242; e-mail: Ingrid-nygaard{at}uiowa.edu.

OBJECTIVE: We sought to estimate the prevalence of pelvic organ prolapse in older women using the Pelvic Organ Prolapse Quantification examination and to identify factors associated with prolapse.

METHODS: Women with a uterus enrolled at one site of the Women's Health Initiative Hormone Replacement Therapy randomized clinical trial were eligible for this ancillary cross-sectional study. Subjects underwent a Pelvic Organ Prolapse Quantification examination during a maximal Valsalva maneuver and in addition completed a questionnaire. Logistic regression was used to identify independent risk factors for each of 2 definitions of prolapse: 1) Pelvic Organ Prolapse Quantification stage II or greater and 2) the leading edge of prolapse measured at the hymen or below.

RESULTS: In 270 participants, age (mean ± SD) was 68.3 ± 5.6 years, body mass index was 30.4 ± 6.2 kg/m², and vaginal parity (median [range]) was 3 (0–12). The proportions of Pelvic Organ Prolapse Quantification stages (95% confidence intervals [CIs]) were stage 0, 2.3% (95% CI 0.8–4.8%); stage I, 33.0% (95% CI 27.4–39.0%); stage II, 62.9% (95% CI 56.8–68.7%); and stage III, 1.9% (95% CI 0.6–4.3%). In 25.2% (95% CI 20.1–30.8%), the leading edge of prolapse was at the hymen or below. Hormone therapy was not associated with prolapse (P = .9). On multivariable analysis, less education (odds ratio [OR] 2.16, 95% CI 1.10–4.24) and higher vaginal parity (OR 1.61, 95% CI 1.03–2.50) were associated with prolapse when defined as stage II or greater. For prolapse defined by the leading edge at or below the hymen, older age had a decreased risk (OR 0.50, 95% CI 0.27–0.92) and less education, and larger babies had an increased risk (OR 2.38, 95% CI 1.31–4.32 and OR 1.97, 95% CI 1.07–3.64, respectively).

CONCLUSION: Some degree of prolapse is nearly ubiquitous in older women, which should be considered in the development of clinically relevant definitions of prolapse. Risk factors for prolapse differed depending on the definition of prolapse used.

LEVEL OF EVIDENCE: II-2

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