Depressive symptoms affect outcomes of pessary use in postmenopausal women with uterine prolapse

This study aimed to investigate the impact of depressive symptoms on successful pessary treatment for postmenopausal women with symptomatic pelvic organ prolapse (POP).

We performed a prospective study involving postmenopausal women with POP who visited our clinic seeking pessary treatment. Demographic information and medical histories were collected. The participants completed the following questionnaires at baseline and after 3 months of successful pessary use: (1) the Pelvic Floor Impact Questionnaire-7 (PFIQ-7); (2) the Pelvic Floor Distress Inventory (PFDI-20); and (3) the Patient Health Questionnaire-9 (PHQ-9). The data were analyzed with the independent samples t-test, Mann-Whitney U-test, χ² test, Fisher's exact test, paired t-test or Wilcoxon signed-rank test as appropriate.

In total, 102 (92.7%) participants who completed the entire study were included in the analysis. No significant differences were found in the sociodemographic or clinical characteristics between the 'positive' and 'negative' depressive symptom groups (p > 0.05). After 3 months of successful pessary treatment, the scores of the PFIQ-7 (including the Urinary Incontinence Questionnaire-7, the Colon Rectal Anal Impact Questionnaire-7 and the Pelvic Organ Prolapse Impact Questionnaire-7 subscales) and PFDI-20 (including the Pelvic Organ Prolapse Distress Inventory-6, the Colon Rectal Anal Distress Inventory-8 and the Urinary Distress Inventory-6 (UDI-6) subscales) were significantly decreased in all participants (p < 0.05). The PHQ-9 score was also significantly decreased (p < 0.001). However, the participants with depressive symptoms reported significantly less improvement post-treatment than those without depressive symptoms in the score of the PFDI-20 subscale UDI-6, which represented the degree of distress due to the lower urinary tract symptoms (p = 0.022).

Both the quality of life and depressive symptom scores were significantly improved after 3 months of successful pessary use. We advocate making depressive symptom screening a regular indicator for assessing the effectiveness of conservative POP treatment.