Risk factors for genital prolapse in non-hysterectomized women around menopause. Results from a large cross-sectional study in menopausal clinics in Italy

NOTA IMPORTANTE: Autore dello studio è il “Progetto Menopausa Italia Study Group”. Umberto Omodei è Coordinatore Nazionale, membro dello Steering Committee e partecipante al Progetto. La pubblicazione riporta come co-autori l’elenco dei partecipanti suddivisi per incarico specifico. La pubblicazione non viene quindi individuata automaticamente inserendo il nome dell’autore nei motori di ricerca in rete. Il Progetto Menopausa Italia, del quale Umberto Omodei è co-fondatore, è un grande studio epidemiologico che aveva come obiettivo la raccolta di informazioni sulla menopausa e le condizioni cliniche correlate, basato su un network nazionale connesso in rete di 268 Centri per la Menopausa, con circa 1.500 operatori sanitari coinvolti. Il Progetto si è svolto dal 1997 al 2004 ed ha reclutato un campione di circa 130.000 pazienti seguite per oltre 5 anni.. OBJECTIVE: To analyze determinants/risk factors for uterine prolapse in a population of women around menopause. METHODS: Between 1997 and 1999, we conducted a large cross sectional study on the characteristics of women around menopause attending a network of first level outpatients menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. Eligible for the study were women consecutively observed during the study period. All women underwent a gynecological examination. RESULTS: Considering the 21,449 non-hysterectomized women, uterine prolapse was diagnosed in 1182 cases (5.5%). Of those, 772 (65.3%) had prolapse degree I and 410 (34.7%) degree II or III. The frequency of uterine prolapse increases with age: In comparison with women aged < or = 51 years, the odds ratio OR of uterine prolapse was 1.3 and 1.7 respectively for women aged 52-55 and > or = 56 years. In comparison with women with none/primary education, the OR of uterine prolapse was 0.8 (95% confidential interval CI 0.7-0.9) and 0.8 (95% CI 0.6-0.9), respectively, for women with intermediate or high school/university degree. The risk of uterine prolapse increased with body mass index (BMI; kg/m(2)) value: In comparison with women with BMI<23.8, the OR was 1.4 (95% CI 1.2-1.7) and 1.6 (95% CI 1.3-1.9) for women with BMI 23.8-27.2 and >27.2. In comparison with nulliparae, the OR of uterine prolapse increased with number of births, being 3.0 (95% CI 2.1-4.3) in women reporting > or = 3 births. A history of caesarean section or of a delivery of a fetus weighing >4500 g were not associated with increased risk of uterine prolapse. When the analysis was conducted separately in strata of grade of uterine prolapse (I and > or = II), no marked differences emerged in the OR estimates. CONCLUSIONS: This study indicates that, in this population, the risk of uterovaginal prolapse increase with the number of vaginal births and was higher in overweight women, offering some quantitative estimates of the role of these factors on the risk of the condition.