Menopause, Weight Loss, and Pelvic Floor Changes: Clinical and Aesthetic Considerations

BACKGROUND: Menopause is associated with hormonal, structural, and functional changes affecting the vulvovaginal tissues, pelvic floor, and urinary tract. Weight loss may further alter soft-tissue volume and body composition, although effects on pelvic floor function remain incompletely understood. OBJECTIVE: The aim of this study was to review menopause-associated vulvovaginal and pelvic floor changes and discuss implications for dermatologic evaluation, weight loss, symptom management, and procedural counseling. MATERIALS AND METHODS: A narrative review of literature addressing menopause, pelvic floor dysfunction, weight loss, glucagon-like peptide-1 receptor agonists, pelvic floor rehabilitation, and emerging vulvovaginal therapies was performed. RESULTS: Menopause-associated tissue remodeling may contribute to genitourinary syndrome of menopause, urinary symptoms, sexual dysfunction, and pelvic floor disorders. Weight loss may improve obesity-associated urinary incontinence but can also reduce lean mass and external soft-tissue volume. Evidence regarding glucagon-like peptide-1 therapies and pelvic floor function remains limited. Pelvic floor physical therapy is an established treatment, whereas high-intensity focused electromagnetic therapy shows preliminary evidence of benefit. CONCLUSION: Dermatologists should recognize functional symptoms, provide evidence-based counseling, and coordinate care with gynecology, urogynecology, urology, and pelvic floor physical therapy while approaching emerging procedural therapies cautiously.