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Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis

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Abstract

Introduction and hypothesis

Age is named as a risk factor for pelvic organ prolapse (POP), despite not being the primary outcome for many observational studies. Postmenopausal status is another associated factor but has many confounders. We aimed to systematically review the role of age and/or postmenopausal status in POP development.

Methods

Systematic review addressing age and hormones, more specifically by postmenopausal status, from inception to March 2020 in four databases (PubMed, Embase, WOS, Cochrane Library). Quality of evidence was classified by the ROBINS-I classification for non-randomized studies. Experimental studies, animal studies, studies linking age with recurrent POP and case series were excluded. Effect estimates were collected from adjusted odds ratio plus 95% confidence intervals. Significance level was 5%. A discussion exploring mechanistic factors was also included.

Results

Nineteen studies (11 cross sectional, 6 cohort and 2 case control) were included for quantitative analysis. Only two studies presented a low overall risk of bias for age; most of the domains were of moderate risk. Every additional year was responsible for a 10% increase in the risk to develop POP (OR = 1.102 [1.021–1.190]; i2 = 80%, random analysis, p = 0.012). This trend was confirmed when age was dichotomized into a cutoff of 35 (p = 0.035) and 50 (p < 0.001) years. Although an increase in the risk for POP was noted in postmenopausal women, this did not reach statistical significance (OR = 2.080 [0.927–4.668], i2 = 0%, p = 0.076).

Conclusion

Age is a risk factor for POP; postmenopausal status was not statistically associated with POP, prompting the need for further studies addressing this factor.

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Acknowledgments

We thank Dr. Rufus Cartwright, Dr. Maria Gyhagen, and Dr. Ian Milson for their contribution to revising this manuscript and giving significant input.

Funding

Grant 2019/26723-5, São Paulo Research Foundation (FAPESP).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101 – Cidade Universitária, Campinas, 13148-254, Brazil

    Luiz Gustavo Oliveira Brito & Glaucia Miranda Varella Pereira

  2. Division of Urogynecology & Pelvic Reconstructive Surgery, UPMC Magee-Womens Hospital, Pittsburgh, VA, USA

    Pamela Moalli

  3. Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada

    Oksana Shynlova

  4. Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Jittima Manonai

  5. Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Bem-Gurion University of the Negev, Beer Sheva, Israel

    Adi Yehuda Weintraub

  6. Academic Department of Development and Regeneration, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

    Jan Deprest

  7. Department of Gynecology, Federal University of Sao Paulo, São Paulo, Brazil

    Maria Augusta T. Bortolini

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  1. Luiz Gustavo Oliveira Brito
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  2. Glaucia Miranda Varella Pereira
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  3. Pamela Moalli
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  4. Oksana Shynlova
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  5. Jittima Manonai
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  6. Adi Yehuda Weintraub
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  7. Jan Deprest
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  8. Maria Augusta T. Bortolini
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Contributions

AY Weintraub, J Deprest: Project development, manuscript editing, and approval of the final manuscript.

J Manonai, P Moalli, O Shynlova: Manuscript editing and approval of the final manuscript.

LGO Brito, GMV Pereira, MA Bortolini: Project development, data management and analysis, manuscript editing, and approval of the final manuscript.

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Correspondence to Luiz Gustavo Oliveira Brito.

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Brito, L.G.O., Pereira, G.M.V., Moalli, P. et al. Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis. Int Urogynecol J 33, 15–29 (2022). https://doi.org/10.1007/s00192-021-04953-1

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