Relation between pelvic organ prolapse and menopausal hormone therapy: nationwide cohort study.

Objective: To analyze the relationship between pelvic organ prolapse (POP) and menopausal hormone therapy (MHT).

Methods: This retrospective cohort study used Korean National Health checkup and insurance data from 2002 to 2019. The MHT group consisted of women who were prescribed menopausal hormones for more than 6 months from 2002 to 2011. The non-MHT group comprised postmenopausal women who had never used MHT.

Results: In the non-MHT group, there were 1,001,350 women, while the MHT group had 353,206 women. Tibolone (adjusted hazard ratio [aHR], 0.87; 99% confidence interval [CI], 0.818-0.926) and combined estrogen plus progestin by the manufacturer (CEPM) (aHR, 0.821; 99% CI, 0.758-0.89) were associated with reduced POP risk. The other oral MHT groups and the transdermal estrogen group showed no significant difference in POP risk compared with the non-MHT group (other oral MHT: aHR, 1.045; 99% CI, 0.941-1.161) (transdermal estrogen: aHR, 1.252; 99% CI, 0.731-2.145). Lower body mass index (BMI) (<18.5) was associated with reduced POP risk (aHR, 0.822; 99% CI, 0.698-0.968), while a BMI between 23 and 29.9 was associated with increased risk (BMI 23-24.9: aHR, 1.143; 99% CI, 1.088-1.2) (BMI 25-29.9: aHR, 1.173; 99% CI, 1.12-1.228). All parities had a higher POP risk than parity 1 (parity 0 or no response: aHR, 1.785; 99% CI, 1.589-2.005; parity 2: aHR, 1.434; 99% CI, 1.292-1.592; parity ≥3: aHR, 1.916; 99% CI, 1.712-2.144).

Conclusion: After menopause, tibolone and CEPM were associated with a reduced POP risk compared with non-MHT. Other oral MHT and transdermal estrogen were not associated with the risk of POP.