Pelvic Floor Muscle Training in Genitourinary Syndrome of Menopause: An Analysis of Protocols and Clinical Outcomes

Abstract

Background and Objectives: Genitourinary syndrome of menopause (GSM) encompasses various genital and urinary signs and symptoms attributable to estrogen deficiency, including vaginal dryness, dyspareunia, and urinary incontinence (UI). Pelvic floor muscle training (PFMT) is recommended as a first-line conservative intervention for pelvic floor disorders. This study sought to investigate the therapeutic effects of PFMT on GSM manifestations. Materials and Methods: A systematic search was performed across multiple databases (PubMed, CENTRAL, CINAHL, LILACS, SciELO, PEDro, SCOPUS, and EMBASE). Inclusion criteria comprised randomized controlled trials published within the past decade evaluating PFMT as a standalone intervention in postmenopausal women. Two independent investigators conducted study selection and data extraction. Special attention was given to the variability in training dosage, including session frequency, contraction parameters, and program duration. Methodological rigor was appraised using the PEDro scale. Results: From 170 initially identified articles, six met the inclusion criteria. The rehabilitation models exhibited clinical heterogeneity: program durations ranged from 8 to 12 weeks, with session frequencies varying between 2 and 3 times weekly. Training parameters included 1 to 3 sets of 8 to 12 repetitions, with sustained contractions ranging from 6 to 10 seconds. Despite this variability, five studies reported significant improvements in UI cure rates and symptom severity, while two noted benefits in sexual arousal, orgasm, and satisfaction. When PFMT was combined with adjunct therapies (Pilates or biofeedback), outcomes were comparable to PFMT monotherapy. Conclusion: PFMT is an effective and cost-effective treatment for UI and sexual dysfunction in postmenopausal women. Although rehabilitation models vary in duration and intensity, supervised protocols consistently demonstrate therapeutic efficacy. Future research should aim to standardize these parameters to optimize clinical outcomes.