ORIGINAL ARTICLE Does estrogen deprivation affect pelvic floor muscle contractility? Hans Peter Dietz 1 & Maciej Socha 2 & I. Kamisan Atan 1,3 & N. Subramaniam 1 Received: 6 November 2018 /Accepted: 11 February 2019 # The International Urogynecological Association 2019 Abstract Introduction and hypothesis Pelvic floor muscle (PFM) function plays a role in pelvic organ support, and estrogen deprivation is commonly seen as a risk factor for pelvic floor dysfunction. This study investigated the association between estrogen deprivation and PFM contractility. Methods This was a retrospective study on women attending a tertiary urogynecological unit. The assessment included an interview, POPQ assessment, Modified Oxford Scale (MOS) score, and 4D translabial ultrasound (US) on PFM contraction (PMFC). Hormonal status and details on hormone replacement therapy (HRT) were recorded. Corrected menopausal age was defined as the duration of systemic estrogen deprivation. Offline analysis of stored US volumes was performed to measure the reduction in anteroposterior hiatal diameter and bladder neck elevation on PFMC at a later date. Results Seven hundred thirty-nine women were seen during the study period. Fifty-three were excluded for missing data, leaving 686. Mean age was 56 (17–89, SD 13.3) years; average BMI was 29 (16–66, SD 6.6) kg/m²; 60.6% (n = 416) were menopausal at a mean duration of 16 (1–56, SD 10.2) years. Forty-nine (7.1%) were currently on systemic HRT, while 104 (15.2%) had used it previously. Mean corrected menopausal age (menopausal age - systemic HRT duration) was 7.4 (0–56, SD 10.0) years. Current local estrogen use ≥ 3 months was reported by 31 (4.5%). Mean PFM contractility measured by MOS was 2 (0–5, SD 1.1,). On multivariate analysis there was no association between menopausal age and PFM contractility. Conclusions Estrogen deprivation may not be an independent predictor of pelvic floor muscle contractility. Keywords Estrogen deprivation . Menopause . Pelvic floor function . Pelvic organ prolapse . Translabial ultrasound Introduction Pelvic floor muscle (PFM) anatomical integrity and function play a major role in pelvic organ support, and alteration of this supportive role seems to be the primary etiological factor in the development of pelvic organ prolapse [1]. This is true for both structural integrity and distensibility of the muscle as seen on axial plane imaging, i.e., the biomechanical properties of the levator ani muscle [2]. In addition, pelvic floor muscle function is thought to play a major role in urinary and anal incontinence, and pelvic floor muscle exercises are the mainstay of the con- servative management of urinary incontinence [3]. As there seems to be an association between bladder dysfunction and hormonal status [4], some bladder conditions may be mediated via declining pelvic floor function after menopause. Age- related hormonal status has been claimed to affect PFM func- tion [5]. This may be attributed to changes in the proportion of different types of collagen or muscle fibers [6]. To date, there is limited information in the literature on any link between PFM function and hormonal status. This is partly due to the strong association between calendaric age and men- opausal age: any specific effect of estrogen deprivation is bound to be exceeded by effects of age on muscle function, which is well documented [7]. This may be due to multiple factors such as hypotrophy/atrophy, deterioration of end-plate structures, or impaired fiber recruitment—that is, this effect may be both neurogenic and myogenic. The end result seems to be a reduction of about 5% in skeletal muscle function per decade from about 45 years onwards [7]. Presentation at Meetings: The abstract was presented at IUGA 2016, Cape Town * Hans Peter Dietz hpdietz@bigpond.com 1 Department of Obstetrics, Gynecology & Neonatology, Sydney Medical School Nepean, The University of Sydney, 62 Derby Street, Kingswood, NSW 2747, Australia 2 Copernicus University, Bydgoszcz, Poland 3 Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia International Urogynecology Journal https://doi.org/10.1007/s00192-019-03909-w