title: 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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  III.
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA. catherine-bradley@uiowa.edu
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Bradley
authors.forename: M Bridget
authors.initials: MB
authors.lastname: Zimmerman
authors.forename: Yingwei
authors.initials: Y
authors.lastname: Qi
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Nygaard
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010298:Parity; D017698:Postmenopause; D011247:Pregnancy; D011446:Prospective Studies; D014596:Uterine Prolapse