Objective This study aims to compare the effectiveness of conservative and surgical management of uterine prolapse in elderly women, focusing on symptom relief, quality of life, and treatment outcomes. Methodology A comparative observational study was conducted at the Department of Obstetrics and Gynaecology KhairpurMedical College Khairpur Mir's Sindh from April 2023 to April 2024. A total of 101 elderly women diagnosed with uterine prolapse were included. Patients were divided into two groups: those receiving conservative treatment (pessary use, pelvic floor exercises) and those undergoing surgical intervention (vaginal hysterectomy, sacrocolpopexy, or uterosacral ligament suspension). Data on demographic characteristics, prolapse severity, treatment outcomes, complications, and patient satisfaction were collected and analyzed using SPSS version 25. A p-value of <0.05 was considered statistically significant.