Declining estrogen weakens pelvic muscles, connective tissue, bladder & urethra — reducing collagen, tone & elasticity. This raises risks of stress urinary incontinence, urgency, mixed incontinence & pelvic organ prolapse. Proper pelvic floor training improves symptoms in up to 92% of women. 2025 AUA guidelines strongly recommend local vaginal estrogen. Pelvic floor physiotherapist assessment is essential to distinguish weak vs hypertonic pelvic floor. Early action yields bes