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Maturitas. 2018 Apr;110:118-123. doi: 10.1016/j.maturitas.2018.02.004. Epub 2018 Feb 6.

Current management of pelvic organ prolapse in aging women: EMAS clinical guide.

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Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy.
Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain.
Institute of Biomedicine, Research Area for Women's Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece.
Nantes, France Polyclinique de l'Atlantique Saint Herblain, F 44819 St Herblain, France; Université de Nantes, F 44093 Nantes Cedex, France.
School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia.
University Women's Hospital of Tuebingen, Calwer Street 7, 72076 Tuebingen, Germany.
Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Istanbul University Cerrahpasa School of Medicine, Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul, Turkey.
National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London SW3 6NP, UK.
Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland.
Helsinki University and Helsinki University Hospital, Eira Hospital, Helsinki, Finland.
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy. Electronic address:


Management of pelvic organ prolapse (POP) is a common and challenging task. Nowadays older women are more active than they were in the past, and the development of POP disrupts quality of life and impairs social and personal activities. The menopausal transition is a time of vulnerability, during which many women start experiencing symptoms and signs of POP. The role of hormonal changes or of hormonal therapies in influencing the development or progression of POP has been explored extensively. The management of POP requires considerable clinical skills. Correct diagnosis and characterization of the prolapse and an identification of the individual woman's most bothersome symptoms are the hallmark of appropriate initial management. Therapy is multimodal and often multidisciplinary, and requires a competence in pelvic medicine and surgery. The integration of hormonal, non-hormonal and surgical strategies is important and needs to be adjusted to changing circumstances on an individualized basis. When surgery is required, optimal management requires clinicians who are familiar with the advantages and disadvantages of all the available strategies and who are able to use these strategies in a tailored manner. Complex cases should be sent to specialist referral centers. Management of POP should be integrated into the practice of healthcare professionals dealing in menopause.


Aging; Management; Pelvic organ prolapse; Urinary incontinence

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