Impact of menopause on collagen subtypes in the arcus tendineous fasciae pelvis.
OBJECTIVE
The arcus tendineous fasciae pelvis (ATFP) provides support to the anterior vagina. The objective of this study was to determine the impact of menopause on the structural components of the ATFP.


METHODS
Biopsy specimens of the ATFP were obtained from 10 premenopausal, 5 postmenopausal, and 12 postmenopausal women on hormone therapy. Scanning confocal microscopy of fluorescent micrographs was used to define the amount of collagen subtypes, smooth muscle, and elastin. Collagen fiber orientation was determined by scanning electron microscopy.


RESULTS
The ATFP is comprised primarily of parallel bundles of type III collagen fibers (84%), an intermediate amount of elastin (13%), and very little smooth muscle. The ratio of collagen I/(III+V) was decreased in postmenopausal not on hormones relative to premenopausal women (P=.04) due to a 75% decrease in collagen I (P=.046). The decrease in collagen I and change in collagen ratios was not present in women on hormone therapy. Comparison of the amounts of elastin and smooth muscle showed no difference in the ATFP of premenopausal and postmenopausal women.


CONCLUSIONS
Menopause in the absence of hormone therapy is associated with a decrease in quantity of collagen I in the ATFP resulting in a decrease in the ratio of collagen I/(III+V). This may compromise the tensile strength and an increase susceptibility to anterior vaginal wall prolapse.
Moalli
P A
PA
Magee-Womens Research Institute and Department of Obstetrics and Gynecology at Magee Womens Hospital, Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA, USA. RSIPAM@mwri.magee.edu
Talarico
L C
LC
Sung
V W
VW
Klingensmith
W L
WL
Shand
S H
SH
Meyn
L A
LA
Watkins
S C
SC
D000328:Adult; D024042:Collagen Type I / Q000378:metabolism*; D024061:Collagen Type III / Q000378:metabolism*; D024062:Collagen Type V / Q000378:metabolism*; D015914:Estrogen Replacement Therapy; D005205:Fascia / Q000378:metabolism* / Q000648:ultrastructure; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D008593:Menopause / Q000378:metabolism*; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010388:Pelvis
D024042:Collagen Type I; D024061:Collagen Type III; D024062:Collagen Type V