Menopause-Associated Remodelling of the Female Pelvic Floor: Anatomical and Functional Implications for Pelvic Floor Dysfunction

Background The female pelvic floor undergoes significant structural and functional alterations with ageing and menopause. Hormonal decline, connective tissue remodelling, muscular degeneration, and cumulative biomechanical stress contribute to the weakening of pelvic floor support structures and increased susceptibility to pelvic floor dysfunction (PFD) in postmenopausal women. Objective This narrative review aims to evaluate menopause-associated anatomical and functional changes in the female pelvic floor and examine their relationship with pelvic floor dysfunction, particularly with urinary incontinence and pelvic organ prolapse. Methods A structured narrative literature review was conducted using the PubMed, Web of Science, Cochrane Library, and Google Scholar databases. Relevant peer-reviewed studies evaluating menopause, pelvic floor anatomy, connective tissue remodelling, urinary incontinence, and pelvic organ prolapse were reviewed and narratively synthesised. Findings Menopause-associated oestrogen deficiency contributes to the progressive degeneration of the pelvic floor musculature, connective tissue weakening, collagen remodelling, and impaired neuromuscular support. Age-related changes in the levator ani complex, urethral sphincter, and supportive fascial structures compromise pelvic organ support and the mechanisms of continence. Pregnancy, parity, and vaginal childbirth further contribute to cumulative pelvic floor injury and may synergistically interact with menopausal tissue degeneration. These combined mechanisms significantly increase the risk of urinary incontinence and pelvic organ prolapse in postmenopausal women. Conclusion Pelvic floor dysfunction in postmenopausal women arises through multifactorial interactions between hormonal ageing, reproductive history, and progressive anatomical remodelling. An improved understanding of menopause-associated pelvic floor changes may support earlier preventive interventions, targeted rehabilitation strategies, and more effective management of pelvic floor disorders in ageing women.