Three-dimensional ultrasound evaluation of the pelvic floor in postmenopausal women using hormone therapy

• Published in: Maturitas 2021-01, Vol.143, p.65-71
• Main Authors: Marques Gomes Delmanto, Lucia Regina, Omodei, Michelle Sako, Bueloni-Dias, Flavia, Pontes, Ana Gabriela, Delmanto, Armando, Spadoto-Dias, Daniel, Nahas, Eliana Aguiar Petri
• Format: Article
• Language: English
• Subjects: Cross-Sectional Studies; Female; Hormone Replacement Therapy; Humans; Menopausal hormone therapy; Menopause; Middle Aged; Muscle Strength; Pelvic floor; Pelvic Floor - diagnostic imaging; Pelvic Floor - physiology; Postmenopause - physiology; Three-dimensional ultrasound; Ultrasonography - methods
• ISSN: 0378-5122; 1873-4111
• DOI: 10.1016/j.maturitas.2020.08.009

•Menopause-related changes in the pelvic floor often interfere with the well-being and sexuality of postmenopausal women.•Menopausal hormone therapy (MHT) may play a role in muscle function since estrogen receptors have been identified on the pelvic floor muscles (PFM).•We evaluated the 3D ultrasound characteristics of the PFM in two groups of postmenopausal women: users and nonusers of MHT.•In early postmenopausal women, the use of MHT was associated with a smaller urogenital hiatus area and higher PFM strength•These results suggest that the use of MHT for the treatment of climacteric symptoms in the first years after menopause may help to prevent a decline in the muscle function of the PFM. To evaluate the three-dimensional (3D) ultrasound characteristics of the pelvic floor muscles (PFM) in two groups of postmenopausal women: users and nonusers of menopausal hormone therapy (MHT). Observational, cross-sectional cohort study. In this study 226 sexually active heterosexual women, aged 45–60 years with amenorrhea >12 months and without clinical pelvic floor disorders or urinary incontinence were included. Women using MHT ≥ 6 months were classified as systemic users. PFM strength was assessed by digital vaginal palpation and scored on the Modified Oxford Scale. Biometry of the PFM was performed by 3D transperineal ultrasound for evaluation of total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness. The participants were divided into users (n = 78) and nonusers (n = 148) of MHT. There were no differences in clinical or anthropometric parameters between groups. The mean age was 55 years and the time since menopause was six years in both groups. The mean duration of MHT use was 43.4 ± 33.3 months. Users of MHT had greater levator ani muscle thickness (p = 0.001) and higher PFM strength (p = 0.029) than nonusers. Risk analysis adjusted for age, time since menopause, BMI, parity, and type of delivery showed an association of MHT use with greater levator ani muscle thickness (OR = 2.69; 95% CI 1.42–5.11, p = 0.029), and higher PFM strength (OR = 1.78; 95% CI1.01–3.29, p = 0.046). There was a weak positive correlation between levator ani muscle thickness and duration of MHT use (r = 0.25, p = 0.0002) and PFM strength (r = 0.12, p = 0.043). Postmenopausal women using MHT had a greater levator ani muscle thickness associated with higher PFM strength than nonusers.