Salivary Free Testosterone as a Potential Biomarker for Pelvic Organ Prolapse in Postmenopausal Women: A Prospective Case–Control Study

ABSTRACT Objective Pelvic organ prolapse (POP) is a common pelvic floor disorder in postmenopausal women, yet no biomarkers currently exist to predict its development. This study aimed to investigate the relationship between sex hormone levels, particularly androgens, and the severity of POP in postmenopausal women. Methods We conducted a prospective observational study including 109 postmenopausal women with POP and 66 age‐matched women without POP (control group) at Saga University Hospital. POP severity was classified using the Pelvic Organ Prolapse Quantification (POP‐Q) system. Salivary free testosterone and 17β‐estradiol were measured, along with serum dehydroepiandrosterone sulfate (DHEA‐S), using enzyme‐linked immunosorbent assays. Clinical characteristics and lower urinary tract symptoms were also assessed. Statistical comparisons were performed using t‐tests, Chi‐square tests, and Pearson correlation analysis. Results The POP group had significantly higher BMI and parity and reported more severe lower urinary tract symptoms than the control group. Salivary free testosterone levels were significantly decreased, and serum DHEA‐S levels were significantly increased in the POP group ( p  = 0.0157 and p  = 0.0082, respectively), while estradiol levels showed no significant difference. Advanced POP (stages III–IV) was associated with further reductions in free testosterone. DHEA‐S levels were unexpectedly higher in POP stages II and III compared to controls. Conclusion Reduced levels of circulating androgens, particularly Salivary free testosterone, may be associated with POP development and severity. Salivary free testosterone could serve as a non‐invasive biomarker for POP risk stratification. Further longitudinal and multi‐institutional studies are needed to clarify the role of androgens in POP pathophysiology.