Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University - UNESP, Sao Paulo, Brazil.
Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University - UNESP, Sao Paulo, Brazil.
Maturitas. 2021 Jan;143:65-71. doi: 10.1016/j.maturitas.2020.08.009. Epub 2020 Aug 19.
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.
评估两组绝经后女性（激素治疗使用者和非使用者）的盆底肌（PFM）的三维（3D）超声特征。
观察性、横断面队列研究。
本研究纳入了 226 名年龄在 45-60 岁、有 12 个月以上闭经且无临床盆底功能障碍或尿失禁的有性生活的异性恋女性。使用至少 6 个月激素治疗的女性被归类为系统性使用者。通过数字阴道触诊评估 PFM 力量，并采用改良牛津量表进行评分。通过 3D 经会阴超声评估总泌尿生殖裂孔面积、横径和前后径以及肛提肌厚度来评估 PFM 的生物力学。
参与者分为激素治疗使用者（n = 78）和非使用者（n = 148）。两组之间的临床或人体测量参数无差异。平均年龄为 55 岁，两组的绝经时间均为 6 年。激素治疗的平均使用时间为 43.4 ± 33.3 个月。与非使用者相比，激素治疗使用者的肛提肌厚度更大（p = 0.001），PFM 力量更强（p = 0.029）。调整年龄、绝经时间、BMI、产次和分娩类型后进行风险分析，显示激素治疗的使用与肛提肌厚度更大（OR = 2.69；95%CI 1.42-5.11，p = 0.029）和 PFM 力量更强（OR = 1.78；95%CI 1.01-3.29，p = 0.046）相关。肛提肌厚度与激素治疗使用时间（r = 0.25，p = 0.0002）和 PFM 力量（r = 0.12，p = 0.043）之间呈弱正相关。
与非使用者相比，使用激素治疗的绝经后女性的肛提肌厚度更大，与之相关的 PFM 力量也更强。
