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Postmenopausal hormone therapy is accompanied by elevated risk for uterine prolapse

Rahkola-Soisalo, Päivi, MD, PhD1; Savolainen-Peltonen, Hanna, MD, PhD1,2; Gissler, Mika, PhD3,4; Hoti, Fabian, PhD5; Vattulainen, Pia, MSc5; Ylikorkala, Olavi, MD, PhD1; Mikkola, Tomi S., MD, PhD1,2

doi: 10.1097/GME.0000000000001173
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Objective: Receptors for estrogen and progesterone are present in the pelvic floor, and therefore, postmenopausal hormone therapy may affect its function. We compared the former use of estradiol-progestogen postmenopausal hormone therapy in nonhysterectomized women with a uterine prolapse surgery (N = 12,072) and control women (N = 33,704).

Methods: The women with a history of uterine prolapse operation were identified from the Finnish National Hospital Discharge Register, and the control women from the Finnish Central Population Register. The use of hormone therapy was traced from the national drug reimbursement register, and the odd ratios with 95% CIs for prolapse were calculated by using the conditional logistic regression analysis.

Results: The women with uterine prolapse had used hormone therapy more often than control women (N = 4,127; 34.2% vs N = 9,189; 27.3%; P < 0.005). The use of hormone therapy was accompanied by significant (23%-53%) elevations in the risk for prolapse, being higher with longer exposure. The risk elevations (33%-23%) were comparable between sole norethisteroneacetate-estradiol and sole medroxyprogesteroneacetate-estradiol therapy. The use of estradiol in combination with a levonorgestrel releasing intrauterine device was accompanied by a 52% elevation.

Conclusions: The postmenopausal use of estradiol in combination with various progestogen regimens may weaken the pelvic floor, resulting in uterine prolapse. This data should be incorporated into the information given to the users of estradiol-progestogen hormone therapy.

1Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

2Folkhälsan Research Center, Biomedicum, Helsinki, Finland

3National Institute for Health and Welfare, Helsinki, Finland

4Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden

5EPID Research Oy, Espoo, Finland.

Address correspondence to: Tomi S. Mikkola, MD, PhD, Helsinki University Hospital, Department of Obstetrics and Gynecology, Haartmaninkatu 2, Box 140, FIN-00029 HUS, Helsinki, Finland. E-mail: tomi.mikkola@hus.fi

Received 2 May, 2018

Revised 7 June, 2018

Accepted 7 June, 2018

Funding/support: None reported.

Financial disclosure/conflicts of interest: PR-S has received funding for congress trips from Johnson & Johnson and Astellas Pharma. HS-P has been a speaker for Mylan and received funding for congress trips from Mylan and MSD. TM has been a speaker and/or received consulting fees from Mylan and Astellas Pharma. MG and OY have nothing to disclose. FH and PV work for EPID Research. EPID Research is a company that performs financially supported studies to several pharmaceutical companies.

© 2019 by The North American Menopause Society.