The uterus is held in its normal pelvic position by a complex system of ligaments — the uterosacral and cardinal ligaments providing the primary apical support — alongside the levator ani muscles and fascial supports of the pelvic floor. When this support system fails, the uterus descends toward the vaginal opening, carrying with it the vaginal walls and — to varying degrees — the bladder and rectum that attach to those walls.
Uterine prolapse is staged based on the degree of descent. In stage 1, the uterus has descended but remains within the upper vagina. In stage 2, it has descended to or near the vaginal opening. In stage 3, the cervix or uterus protrudes beyond the vaginal opening. Stage 4 describes complete prolapse where the entire uterus is outside the vaginal canal. Symptoms correspond roughly to degree of descent, though individual variation is significant.
Treatment decisions for uterine prolapse are guided by the patient’s symptom burden, the degree of descent, her desire for uterine preservation, her suitability for surgery, and her preferences for non-surgical management. Women who wish to retain their uterus have established surgical options that provide effective prolapse repair without hysterectomy.
Uterine prolapse symptoms are characteristically positional, worsening with standing and activity and improving with lying down. Some women with mild uterine prolapse have no symptoms at all and are diagnosed incidentally on routine examination.
- A sensation of pelvic pressure, heaviness, or fullness — often described as feeling like something is falling out of the pelvis
- A visible or palpable protrusion from the vaginal opening — the cervix or uterus at or beyond the introitus
- Pelvic pressure that worsens throughout the day, with prolonged standing, walking, or physical activity
- Pelvic symptoms that improve when lying down
- Low back or sacral discomfort associated with standing or activity, reflecting traction on the uterosacral ligaments
- Urinary symptoms — frequency, urgency, difficulty emptying, or stress leakage from associated bladder descent
- Difficulty with bowel emptying from associated posterior wall prolapse
- Discomfort or difficulty during sexual intercourse
- Tissue ulceration or irritation when the cervix or uterus is chronically exposed outside the vaginal opening in advanced prolapse
Pelvic heaviness that worsens with activity and improves lying down, combined with a felt or visible cervical protrusion, is a characteristic presentation of uterine prolapse that warrants evaluation.
Most uterine prolapse symptoms are addressed through a scheduled appointment. Contact our office the same day if you experience:
- Complete prolapse with the uterus fully outside the vaginal opening and unable to be reduced manually
- Tissue ulceration, bleeding, or significant pain at the prolapsed cervix or uterus
- Inability to urinate associated with severe prolapse — advanced uterine prolapse can kink the ureters and impair kidney drainage
Uterine prolapse management at Lapeer Women’s Health is led by Dr. Ramona D. Andrei, MD, PhD, FACOG — with an individualized approach that respects each patient’s preference regarding uterine preservation and matches the treatment intensity to the degree of prolapse and symptom burden.
Conservative Management
Pelvic floor physical therapy, local vaginal estrogen for postmenopausal women, and pessary fitting are first-line non-surgical options. A ring or Gellhorn pessary provides mechanical support for the uterus, reducing prolapse symptoms effectively in many women. Conservative management is recommended as the starting point for patients who are not ready or not suitable for surgery, and as a long-term strategy for many women with mild to moderate prolapse. Learn about pessary fitting →
Uterine-Sparing Repair
Women who wish to retain their uterus have established surgical options. Sacrospinous hysteropexy suspends the uterus to the sacrospinous ligament through a vaginal approach. Laparoscopic or robotic sacrohysteropexy suspends the uterus to the sacrum using a mesh graft through a minimally invasive abdominal approach. Both procedures have outcomes comparable to hysterectomy-based repairs in appropriately selected candidates. Dr. Andrei discusses uterine-sparing options at the surgical consultation.
Hysterectomy-Based Repair
For women who do not wish to retain the uterus, or for whom hysterectomy is part of the most appropriate surgical plan, vaginal or laparoscopic hysterectomy combined with apical suspension provides definitive uterine prolapse repair. Apical support — restoring the support of the vaginal apex after uterine removal — is the most critical component of prolapse repair surgery for long-term durability. Learn about prolapse surgery →
One of the most common misconceptions about uterine prolapse treatment is that surgery necessarily means hysterectomy. For women who wish to retain their uterus, established uterine-sparing surgical options exist with excellent outcomes. The decision about whether to include hysterectomy in a prolapse repair is entirely individualized — and is one that Dr. Andrei discusses with each patient as part of a complete surgical consultation.
Whether your preference is conservative management, uterine-sparing repair, or hysterectomy-based repair, the evaluation starts in the same place: a clinical assessment of your anatomy, your symptoms, and your goals. Dr. Ramona D. Andrei and the team at Lapeer Women’s Health are here for that assessment — at both our Lapeer and Rochester Hills offices, without a referral required.
Uterine Prolapse
Our team at Lapeer Women’s Health offers conservative management and uterine-sparing surgical options at both our Lapeer and Rochester Hills offices. No referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
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Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.