Strengths and limitations
The present study had several strengths. It was conducted in a large
homogenous cohort of relatively healthy Finnish women, which permits
precise measurements without a need to control potential confounders
(e.g. ethnicity, health or income). On the contrary, our results may not
be generalizable to more heterogenous populations. Unique to our study
was the exact determination of menopause status of the participants by
FSH measurements and menstrual bleeding diaries. This enabled us to
adjust the models with menopause status, and reliably evaluate its
association with pelvic floor disorders. Furthermore, the extend of this
study is exceptional: five different pelvic floor disorders were studied
among the large observational cohort including retrospective data for
early adulthood physical activity.
The study had also some limitations. The experienced symptoms of pelvic
floor disorders were asked by postal query in an early stage of the
study. We were not able to study if this timing has influenced the
willingness of the participants to report the conditions that may be
considered sensitive. In addition, the threshold to report pelvic floor
disorders may vary, since the manner women experience symptoms most
likely differs from person to person, and the symptoms may also remain
unrecognized.23,24
Pelvic floor disorders have been associated with higher
BMI,25,26,27 however, women with BMI>35
kg/m2 were excluded from the analytical study sample,
thus the results cannot be generalized to severely obese individuals.
However, there were no obvious difference in the prevalence of any type
of pelvic floor disorder among large Phase 1 study sample in which BMI
was not exclusion criteria and among the analytical sample. Another
limitation is that previous and current physical activity were
self-reported, which may result some recalling or reporting bias by
underestimating the number of low and overestimating the number of high
physically active participants.28