Pelvic Floor Symptoms Across Menopausel Stages

Menopause is characterized by estrogen deficiency, resulting in structural and functional alterations in pelvic floor tissues. Lower urinary tract symptoms, bowel dysfunction, and female sexual dysfunction are increasingly recognized as important health concerns during the menopausal transition.

Despite growing evidence regarding individual pelvic floor disorders, few studies have simultaneously evaluated urinary, colorectal, and sexual symptoms across different menopausal stages.

This study will classify women according to STRAW+10 criteria into:

Perimenopause Early postmenopause Late postmenopause

Participants will undergo a single assessment session. Demographic information together with validated questionnaires will be collected. No intervention or treatment will be provided.

• Assessment for Lower Urinary Tract Symptoms (Other): Lower urinary tract symptoms will be assessed using the validated Bristol Female Lower Urinary Tract Symptoms questionnaire. Higher scores indicate greater symptom severity and poorer urinary health-related quality of life.
• Assessment for Bowel Symptoms (Other): Bowel symptoms and colorectal-anal distress will be evaluated using the Colorectal Anal Distress Inventory-8. Higher scores indicate greater symptom severity and distress related to bowel dysfunction.
• Constipation Severity Assessment (Other): Constipation severity will be assessed using the Cleveland Clinic Constipation Score. Higher scores represent more severe constipation symptoms.
• Sexual Function Assessment (Other): Female sexual function will be assessed using the Female Sexual Function Index, a validated questionnaire evaluating desire, arousal, lubrication, orgasm, satisfaction, and pain. Higher scores indicate better sexual function.

Primary outcomes

• Bristol Female Lower Urinary Tract Symptoms (BFLUTS) Score [Baseline (single assessment)]: Lower urinary tract symptoms will be assessed using the validated Bristol Female Lower Urinary Tract Symptoms questionnaire. Higher scores indicate greater symptom severity and poorer urinary health-related quality of life

Secondary outcomes

• Colorectal Anal Distress Inventory-8 (CRADI-8) [Baseline (single assessment)]: Bowel symptoms and colorectal-anal distress will be evaluated using the Colorectal Anal Distress Inventory-8. Higher scores indicate greater symptom severity and distress related to bowel dysfunction.
• Cleveland Clinic Constipation Score [Baseline (single assessment)]: Constipation severity will be assessed using the Cleveland Clinic Constipation Score. Higher scores represent more severe constipation symptoms.
• Bristol Stool Form Scale [Baseline (single assessment)]: The Bristol Stool Form Scale is a 7-category scale ranging from Type 1 (hard stools) to Type 7 (watery stools). Values range from 1 to 7. Lower scores indicate harder stool consistency, whereas higher scores indicate looser stool consistency.
• Female Sexual Function Index [Baseline (single assessment)]: Female sexual function will be assessed using the Female Sexual Function Index, a validated questionnaire evaluating desire, arousal, lubrication, orgasm, satisfaction, and pain. Higher scores indicate better sexual function.

Sex: Female, ages: 40 Years to 65 Years

Inclusion Criteria:

* Female
* Age 40-65 years
* Intact uterus and at least one ovary
* Perimenopause or postmenopause according to STRAW+10 criteria
* Able to read and understand Turkish

Exclusion Criteria:

* Hormone replacement therapy within the previous 6 months
* Oral contraceptive use
* Antipsychotic medication use
* Previous pelvic surgery
* Neurological or systemic diseases affecting bladder or bowel function
* Active urinary tract or vaginal infection
* Pelvic radiotherapy or chemotherapy history
* Active gynecological or urological malignancy
* Alcohol or substance abuse during the previous year

• Betul Cinar, PhD, Study chair, Bezmialem Vakif University