Transactions of the Sixty-Ninth Annual Meeting of the Central Association of Obstetricians and Gynecologists
Pelvic organ prolapse in the women's health initiative: Gravity and gravidity,☆☆

To be presented at the 2002 Annual Meeting of the Central Association of Obstetricians and Gynecologists.
https://doi.org/10.1067/mob.2002.123819Get rights and content

Abstract

Objective: The purpose of this study was to describe the prevalence of and correlates for pelvic organ prolapse. Study Design: This was a cross-sectional analysis of women who enrolled in the Women's Health Initiative Hormone Replacement Therapy Clinical Trial (n = 27,342 women). Baseline questionnaires ascertained demographics and personal habits. A baseline pelvic examination assessed uterine prolapse, cystocele, and rectocele. Descriptive statistics and logistic regression models were used to investigate factors that were associated with pelvic organ prolapse. Results: In the 16,616 women with a uterus, the rate of uterine prolapse was 14.2%; the rate of cystocele was 34.3%; and the rate of rectocele was 18.6%. For the 10,727 women who had undergone hysterectomy, the prevalence of cystocele was 32.9% and of rectocele was 18.3%. After controlling for age, body mass index, and other health/physical variables, African American women demonstrated the lowest risk for prolapse. Hispanic women had the highest risk for uterine prolapse. Parity and obesity were strongly associated with increased risk for uterine prolapse, cystocele, and rectocele. Conclusion: Pelvic organ prolapse is a common condition in older women. The risk for prolapse differs between ethnic groups, which suggests that the approaches to risk-factor modification and prevention may also differ. These data will help address the gynecologic needs of diverse populations. (Am J Obstet Gynecol 2002;186:1160-6.)

Section snippets

Study population

The study population included women who enrolled in the Women's Health Initiative (WHI) Hormone Replacement Therapy Clinical Trial (n = 27,342 women). The WHI is a prospective study of 161,861 women aged 50 to 79 years after menopause in ≥1 of 3 clinical trials or an observational study who were enrolled from 1994 through 1998 in 40 clinical centers in the United States. The ethnic distribution includes a diverse population that is 18.3% minority, which represents major ethnic and racial groups

Results

Of the women with a uterus, 41.1% had some form of prolapse, with 34.3% having cystocele, 14.2% having uterine prolapse, and 18.6% having rectocele. Approximately 1 in 5 participants had prolapse at ≥2 sites. Almost 38% of women without a uterus had some form of prolapse, with 32.9% having cystocele and 18.3% having rectocele. The prevalence of uterine prolapse, cystocele, and rectocele by hysterectomy status is shown graphically in Fig 1.

. Pelvic organ prolapse prevalence. The medium gray bar

Comment

This study establishes a very high prevalence of pelvic organ prolapse in this cohort of women after menopause. Cystocele was the most common form of prolapse and was present in more than one third of the women, regardless of uterine status. Pelvic organ prolapse was associated with multiple factors in this report, the strongest being parity. Although an increase in cystocele was seen with each subsequent birth, the strongest association was seen with first birth. Cystocele prevalence for women

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Supported by National Institutes of Health contracts No. N01-WH-2-2110, N01-WH-3-2100, N01-WH-3-2101, N01-WH-3-2102, N01-WH-3-2105, N01-WH-3-2106, N01-WH-3-2108, N01-WH-3-2109, N01-WH-3-2110, N01-WH-3-2111, N01-WH-3-2112, N01-WH-3-2113, N01-WH-3-2115, N01-WH-3-2118, N01-WH-3-2119, N01-WH-3-2120, N01-WH-3-2122, N01-WH-4-2107, N01-WH-4-2108, N01-WH-4-2109, N01-WH-4-2110, N01-WH-4-2111, N01-WH-4-2112, N01-WH-4-2113, N01-WH-4-2114, N01-WH-4-2115, N01-WH-4-2116, N01-WH-4-2117, N01-WH-4-2118, N01-WH-4-2119, N01-WH-4-2120, N01-WH-4-2121, N01-WH-4-2122, N01-WH-4-2123, N01-WH-4-2124, N01-WH-4-2125, N01-WH-4-2126, N01-WH-4-2129, N01-WH-4-2130, N01-WH-4-2131, N01-WH-4-2132.

☆☆

Reprint requests: Susan L. Hendrix, DO, Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, 4707 St Antoine, Detroit, MI 48201. E-mail: [email protected]

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