Obesity and metabolic dysfunction in pathogenesis of pelvic organ prolapse

Pelvic organ prolapse (POP) has a considerable negative effect on the women’s quality of life. The rate of POP will grow due to population ageing (according to forecasts, by 46% by the year 2050). The global prevalence of obesity is increasing dramatically: according to the WHO forecasts, more than 50% of the Earth’s population (more than 4 billion people) will be overweight or obese by the year 2035. Obesity and dyslipidemia (elevated levels of triglycerides, low-density lipoprotein cholesterol; decreased levels of high-density lipoproteins) can trigger the development and progression of POP. However, this aspect of the POP pathogenesis is poorly understood. Aim: to expand the knowledge about the POP pathogenesis in patients with obesity and metabolic disorders. Methods. Analysis of the results of the studies published in the CochraneLibrary, PubMed, Science Direct, ELibrary digital libraries in 2010–2024 for the keywords “pelvic organ prolapse/пролапс тазовых органов”, “recurrence/рецидив”, “pathogenesis/патогенез”, “metabolic syndrome/метаболический синдром”, “abdominal obesity/абдоминальное ожирение”, “hypertriglyceridemia/гипертриглицеридемия”, “hypercholesterolemia/гиперхолестеринемия” was performed. Results. Coupled with the mechanical load caused by abdominal obesity, chronic systemic inflammation associated with metabolic syndrome, elevated levels of pro-inflammatory cytokines and activation of matrix metalloproteinases, as well as oxidative stress can result in weakening of the pelvic organ supportive structures, and microvascular dysfunction disturbes local hemodynamics, thereby contributing to the pelvic floor connective tissue remodeling processes. Conclusion. Qualitative studies involving large samples are necessary for better understanding of the pathogenetic mechanisms underlying the development of primary POP and POP recurrence, as well as for the development of the treatment approaches contributing to reducing the risk of progression. The management tactics for patients with POP associated with metabolic syndrome requires a multidisciplinary approach.