Advanced Uterine Prolapse in a Primiparous Postmenopausal Woman Successfully Treated with Total Vaginal Hysterectomy: A Case Report.

BACKGROUND: Pelvic organ prolapse (POP) results from weakness of pelvic floor support structures and may significantly impair quality of life. Multiparity and vaginal delivery are major risk factors for uterine prolapse. We report a rare case of stage IV uterine prolapse in a primiparous postmenopausal woman, highlighting the potential contribution of advanced age and postmenopausal status despite the absence of multiparity. CASE PRESENTATION: A 58-year-old primiparous (P1A0) postmenopausal woman presented with a two-year history of a vaginal bulge that had progressively worsened over the preceding two months and became irreducible. She reported incomplete bladder emptying, straining during micturition, weak urinary stream, and persistent vaginal discomfort after pessary insertion. Pelvic examination revealed stage III anterior vaginal wall prolapse, stage IV uterine prolapse, stage III posterior compartment prolapse, and cervical elongation. The patient underwent total vaginal hysterectomy (TVH) with anterior colporrhaphy. Her postoperative course was uneventful, with stable clinical condition, adequate pain control, no significant bleeding, and satisfactory recovery. DISCUSSION: Surgical management was selected because of advanced prolapse, persistent symptoms, and unsuccessful conservative treatment with a pessary. In this postmenopausal patient, uterine preservation was not a priority. The transvaginal approach enabled direct management of the prolapsed uterus while simultaneously restoring apical and anterior compartment support. CONCLUSION: Total vaginal hysterectomy with anterior colporrhaphy can effectively treat advanced uterine prolapse involving multiple compartments in postmenopausal women with persistent symptoms following unsuccessful conservative treatment.