Objective: The aim of this study was to stress the importance of performing a thorough uterine assessment before selecting an organsparing surgery in patients presenting with uterine prolapse and no other complaints. Materials and Methods: This study included a total of 111 participants who presented with pelvic organ prolapse and underwent hysterectomy for grades 3-4 uterine prolapse. The posthysterectomy histopathology results were classified as benign (atrophic endometrium, proliferative or secretory endometrium) or pathologic (endometrial hyperplasia, endometrial polyp, adenomyosis, myoma uteri, and endometrium carcinoma). Results: Of the 111 patients enrolled in this study, 23 (20.2%) had endometrial hyperplasia, eight (7.2%) had endometrial polyps, 30 (27%) had uterine fibroids, and 20 (18%) had adenomyosis. Conclusion: There may be premalignant lesions of the endometrium in both premenopausal and postmenopausal women presenting with uterine prolapse and no other symptoms. A chronic inflammatory process resulting from the extra-vaginal location of the uterus may play a role in the development of these lesions. Further studies are needed on this subject.