Clinical Review

Uterine prolapse

BMJ 2007; 335 doi: 10.1136/bmj.39356.604074.BE (Published 18 October 2007)
Cite this as: BMJ 2007;335:819

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  1. Anjum Doshani, research fellow1,
  2. Roderick E C Teo, subspecialty trainee in urogynaecology1,
  3. Christopher J Mayne, consultant urogynaecologist1,
  4. Douglas G Tincello, senior lecturer in urogynaecology2
  1. 1Urogynaecology Department, Women's, Perinatal and Sexual Health Directorate, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW
  2. 2Reproductive Science Section, Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Clinical Sciences Unit, Leicester Royal Infirmary, Leicester LE2 7LX
  1. Correspondence to: D G Tincello dgt4{at}le.ac.uk
  • Accepted 5 September 2007

Uterine prolapse is the herniation of the uterus into or beyond the vagina as a result of failure of the ligamentous and fascial supports. It often coexists with prolapse of the vaginal walls, involving the bladder or rectum. In the United Kingdom, the disorder accounts for 20% of women waiting for major gynaecological surgery.1

Sources and selection criteria

We searched Medline (1966-2007), using the key words “uterine prolapse”, “surgical management”, “pessary”, and “conservative management”. We also reviewed the Cochrane database, as well as the BMJ archives, including BMJClinical Evidence.

Why should I read this article?

Most women with symptoms of prolapse will present to primary care, and initial assessment and treatment occurs here.2 An understanding of the pathophysiology, assessment, and management of prolapse is essential for the primary care team to streamline appropriate referrals to hospital. This article aims to cover these topics and to provide an overview of current management of secondary care.

Summary points

  • Uterine prolapse can occur at the same time as prolapse of the anterior or posterior vaginal compartments

  • Little is known about the prevalence and natural progression of prolapse

  • Initially, patients should be assessed and managed conservatively in primary care

  • Conservative management is advised for patients who are not fit for surgery or do not want surgery

  • Surgical treatment for uterine prolapse should incorporate procedures to prevent recurrence

  • Reliable evidence for both conservative and surgical treatment options is lacking, but randomised trials are under way

How common is uterine prolapse?

The exact prevalence is unknown. Forty per cent of participants in the women's health initiative (WHI) trial in the United States had some degree of prolapse. Uterine prolapse was found in 14% of the 27 342 women enrolled in the study.3 Another US study of 149 554 women found an 11% lifetime risk of surgery for prolapse or incontinence in the United States.4

The Oxford Family Planning Association …

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