Development of symptomatic pelvic organ prolapse over 10 years of mid-life follow-up is affected by occupational lifting and/or pushing for parous women

Objective: To document the risk of new-onset symptomatic pelvic organ prolapse (POP) among perimenopausal women and examine whether occupational lifting and/or pushing is a risk factor in the development of POP over a 10-year follow-up window.

Study design: Secondary analysis of prospective, longitudinal data from the Study of Women's Health Across the Nation (SWAN) cohort study.

Main outcome measures: We analyzed women with current employment at the start of SWAN who were followed annually during mid-life. At baseline, women self-reported the frequency of occupational lifting and pushing, which was classified as Never, Infrequent (less than half the time), or Frequent (half the time or more) occupational lifting and/or pushing. Women were asked about new-onset symptomatic POP from the second to tenth annual follow-up. Modified Poisson regression was used to quantify crude and adjusted risk ratios (RRs) and 95 % confidence intervals (CIs) for POP according to load-bearing categories. Parous women were modelled separately, as initial analyses suggested effect modification by parity status.

Results: In our sample of 1590 parous women, 8.2 % reported new-onset symptomatic POP over 10 years of follow-up. Multivariable analysis revealed that Infrequent (aRR 1.51, 95 % CI 1.04-2.20) and Frequent (aRR 2.03, 95 % CI 1.29-3.17) occupational lifting and/or pushing were associated with the development of POP.

Conclusion: Frequent occupational lifting and/or pushing significantly increased parous women's risk of developing POP symptoms. This strengthens existing evidence that occupational exposures can be risk factors for POP. Gender-based education and prevention strategies in the workplace and in primary health care are necessary to reduce the burden of this condition for mid-life women.