A New Era for a New Concept: Endometrial/Menstrual Mesenchymal Stem Cells and Their Secretome for Prevention and Treatment of pelvic Floor Disorders

High-rate complications and recurrences in reconstructive surgery using in situ synthetic/polypropylene meshes have driven to a new era of mesenchymal stem cells (MSCs) and/or their exosomes/microvesicles for tissue homeostasis restoration, in pelvic floor disorders (PFD) prevention and/or therapy: pelvic organ prolapse, stress urinary incontinence, and posterior compartment pathology. Molecular pathophysiology knowledge along a woman’s life and results from endometrial/menstrual MSCs (eMSCs/MenSCs) in small/large animal models facilitate the new concept of translation in human clinical practice. New strategies are cell-based – vaginal, urethral, anal injections or systemic introduced – tissue engineering with new generation meshes/scaffolds seeded with eMSCs/MenSCs or their exosomes which are proposed in PFD prevention/therapy. Being easily collected, isolated with specific markers, and cultured for number harvesting, without ethics, immune compatibility, genetic, and oncogenic issues, and with unique biologic properties, eMSCs/MenSCs differentiate in many cellular types, preserving shape and phenotype in collagen and elastin fibers. eMSCs/MenSCs influence the microenvironment by paracrine/bioactive molecules to facilitate tissue repair. The advantages of surgery/augmentation by new generation meshes/scaffolds include quick restoring effects, mediated by angiogenesis, cell proliferation/differentiation in native/original PF cells, apoptosis inhibition, no chronic inflammation, reduced foreign body reactions, less thick collagen fibers and fibrosis, improving connective/neuromuscular tissues, less PF stiffness, and more elasticity. eMSCs/MenSCs are appropriate for PFD management, respecting good protocols for women safety.