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Uterine prolapse occurs when the uterus drops into the vagina.

Uterine prolapse occurs when the pelvic muscles and ligaments that support the vagina weaken, which causes the uterus to drop (prolapse) into the vagina. In the early stages of uterine prolapse, the uterus rests within the vagina. In advanced stages, the uterus protrudes out of the vagina.

Uterine prolapse affects approximately 40% of women aged 50 to 79 years in the United States. Risk factors include childbirth (particularly vaginal delivery), smoking, menopause, constipation, obesity, and other conditions that increase pressure in the abdomen.

Patients with uterine prolapse commonly notice a bulge in the vaginal area and may experience pelvic pressure. Other symptoms of uterine prolapse may include increased urinary frequency, leaking of urine (incontinence), and constipation, all of which can negatively affect quality of life.

The diagnosis of uterine prolapse is made based on a pelvic examination. Shared decision-making between patients and physicians is important to guide appropriate treatment and meet patients’ goals.

• Observation: Patients without substantial symptoms should follow up with a clinician every 6 to 12 months to assess the progression of the prolapse.

• Vaginal pessaries: A vaginal pessary, which is a soft device that is fit specifically for each patient, keeps the uterus in place when inserted into the vagina. Periodically, a pessary must be removed, cleaned, and reinserted. Some patients perform this procedure at home, while others obtain this care in a clinic.

• Physical therapy: Pelvic floor muscle exercises can help strengthen the pelvic muscles that support the uterus and may decrease symptoms of uterine prolapse.

Surgery for uterine prolapse should be performed by surgeons with specialty training in these procedures.

• Uterosacral ligament suspension involves surgery to attach uterosacral ligaments to the top of the vagina to restore support for the uterus.

• Sacrospinous ligament suspension involves surgical attachment of the cervix or top of the vagina to one or both of the sacrospinous pelvic ligaments to keep the uterus in place.

• Colpocleisis involves surgery to shorten and narrow the vagina so that the uterus cannot drop into the vaginal canal. This procedure is the most effective treatment for uterine prolapse but does not allow for future vaginal sexual intercourse.

Published Online: January 26, 2024. doi:10.1001/jama.2023.22744

Conflict of Interest Disclosures: None reported.

Source: Brown OE, Mou TP, Ackenbom MF. Uterine prolapse. JAMA. 2023;330(15):1486-1487. doi:10.1001/jama.2023.16277