Pelvic floor dysfunction in menopause: screening, evaluation and management

INTRODUCTION: Pelvic floor dysfunctions (PFD) in women result from genetic and acquired factors such as pregnancy, aging, and menopause. Despite their high prevalence, PFD during midlife remain underdiagnosed and undertreated. PFD include urinary incontinence, prolapse, sexual dysfunction, and recurrent urinary tract infections, all of which significantly impair quality of life and require targeted evaluation and treatment. AREAS COVERED: This review examines how menopause and aging contribute to pelvic floor dysfunction through estrogen deficiency, muscle atrophy, and reduced collagen, resulting in urinary incontinence, prolapse, overactive bladder, and increased susceptibility to urinary infection. A detailed overview of clinical assessment is provided, including clinical assessment and an analysis of the various management and treatment options. A literature search was conducted in PubMed/MEDLINE and the Cochrane Library for studies published up to 1 March 2025, using keywords related to menopause, aging, pelvic floor disorders, and genitourinary symptoms. EXPERT OPINION: PFD in postmenopausal women are chronic, progressive conditions that benefit from early identification, and a multidisciplinary approach. Future management will rely increasingly on AI-driven diagnostic tools, personalized therapies using genomics and hormonal profiling, greater public awareness, and expanded access through telemedicine and digital tools, ultimately improving outcomes and reducing stigma.