Pelvic organ prolapse in older women: Prevalence and risk factors

TLDR: Some degree of prolapse is nearly ubiquitous in older women, which should be considered in the development of clinically relevant definitions of Prolapse.

Abstract: OBJECTIVE: We sought to estimate the prevalence of pelvic organ prolapse in ol der women using the Pelvic Organ Prolapse Quantification examination and to iden tify factors associated with prolapse. METHODS: Women with a uterus enrolled at one site of the Women's Health Initiative Hormone Replacement Therapy randomize d clinical trial were eligible for this ancillary cross-sectional study. Subjec ts underwent a Pelvic Organ Prolapse Quantification examination during a maximal Valsalva maneuver and in addition completed a questionnaire. Logistic regressio n was used to identify independent risk factors for each of 2 definitions of pro lapse: 1) Pelvic Organ Prolapse Quantification stage II or greater and 2) the le ading edge of prolapse measured at the hymen or below. RESULTS: In 270 participa nts, age (mean ±.SD) was 68.3 ±.5.6 years, body mass index was 30.4 ±6.2 kg/m 2, 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. Horm one 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 p arity (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 h ymen, older age had a decreased risk (OR 0.50, 95%CI 0.27-0.92) and less educa tion, 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 differ ed depending on the definition of prolapse used.