Asymptomatic Postmenopausal Women Research Articles

Níveis séricos de vitamina B12 não se relacionam com baixa densidade mineral óssea em mulheres brasileiras na pós-menopausa

Osteoporosis and vitamin B12 deficiency are conditions with an increasing prevalence over time. It has been described an association between low serum vitamin B12, osteoporosis and increased risk of bone fractures, but the studies are heterogeneous and the results are controversial. To investigate the association between plasma levels of vitamin B12 and bone mineral density in a group of asymptomatic women after menopause. Asymptomatic postmenopausal women were consecutively invited to participate in this cross-sectional study. Bone mineral density (lumbar spine and femur) was measured by DXA Lunar Prodigy Vision, and blood levels of vitamin B12, calcium, phosphorus, bone alkaline phosphatase (BAF), and parathyroid hormone were determined. For the diagnostic of osteoporosis the World Health Organization criteria were considered. Seventy women were included, mean age 62.5 ± 7 years. Eighteen (25.7%) women had normal bone mineral density, 33 (47.1%) had osteopenia and 19 (27.1%) had osteoporosis. Six (8.6%) patients had wrist fracture; two (2.8%) reported a diagnosis of vertebral fracture and only one (1.4%) patient had suffered a hip fracture. The levels of vitamin B12 (mean ± SD, pg/mL) of women with normal bone mineral density, osteopenia and osteoporosis were 590.2 ± 364.3, 536.6 ± 452.3, and 590.2 ± 497.9, respectively (P = 0.881). Multiple regression analysis showed that body mass index and BAF were the main predictors of lumbar spine bone mineral density. The results indicate that vitamin B12 serum levels are not related to bone mineral density in this group of Brazilian postmenopausal women.

Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta‐analysis

Measurement of endometrial thickness is an important tool in the assessment of women with postmenopausal bleeding, but the role of endometrial thickness measurement by ultrasound in asymptomatic women is unclear. The aims of this study were to determine: (1) the normal endometrial thickness measured by ultrasonography, (2) the prevalence of serious endometrial pathology and (3) the sensitivity and specificity of endometrial thickness measurement by transvaginal ultrasonography (TVS) for diagnosing premalignant and malignant endometrial disease in asymptomatic postmenopausal women. A MEDLINE and EMBASE search (from inception to January 2011) was performed. Articles reporting on endometrial thickness measurement in the diagnosis of endometrial carcinoma and atypical hyperplasia in asymptomatic postmenopausal women not using hormone replacement therapy (HRT) were selected. Endometrial thickness and the prevalence of endometrial (pre)malignancies were recorded. If possible, 2 × 2 tables were extracted. Thirty-two studies reporting on 11100 women were included. The estimated mean endometrial thickness was 2.9 mm (95% CI, 2.6-3.3 mm). The pooled estimated prevalences of endometrial carcinoma and atypical endometrial hyperplasia were 0.62% (95% CI, 0.42-0.82%) and 0.59% (95% CI, 0.22-0.96%), respectively. Summary estimates for sensitivity and specificity of TVS endometrial thickness measurement in the prediction of endometrial carcinoma were 0.83 (95% CI, 0.19-1.00) and 0.72 (95% CI, 0.23-0.95) for a 5-mm cut-off and 0.33 (95% CI, 0.04-0.85) and 0.94 (95% CI, 0.92-0.96) for a 6-mm cut-off. The results from this systematic review do not justify the use of endometrial thickness as a screening test for endometrial carcinoma and atypical endometrial hyperplasia in asymptomatic postmenopausal women not using HRT.

Operative Hysteroscopy in an Office-Based Setting: A Review of Patient Safety and Satisfaction in 414 Cases

To determine the safety and satisfaction among patients undergoing operative hysteroscopy in an office-based setting. A retrospective analysis. Physician's private office. Women undergoing operative hysteroscopy in an office-setting. Three-hundred and eighty-seven women underwent a total of 414 operative hysteroscopies utilizing an operative resectoscope, sonographic-guidance and parenterally administered moderate sedation. All patients were ASA Class I – III. A total of 283 women underwent a primary endomyometrial resection (EMR) of which 27 subjects underwent a concomitant removal of one or more endometrial polyps while another 105 patients underwent one or more myomectomies. One hundred and ten patients (26.6%) were treated for a failed resectoscopic or global endometrial ablation. Seven women (1.7%) underwent a hysteroscopic myomectomy, 1 (0.2%) underwent a septoplasty while an additional patient underwent an adhesiolysis. Finally, 12 (2.9%) asymptomatic postmenopausal women underwent an EMR because of abnormal ultrasound findings. The average procedure took 37.6 ± 13.5 minutes to complete and produced a 14.1 ± 10.2 grams of tissue. Ninety-nine percent of all procedures were completed. Only one patient required transfer to a hospital for evaluation of a uterine perforation requiring a diagnostic laparoscopy. There were 8 (1.9%) postoperative infections and no complications attributable the use of conscious sedation. A total of 259 women responded to our telephone survey (62.6%). Over 96% of the respondents were either very satisfied or satisfied; 1.9% were somewhat dissatisfied while 0.4% were very dissatisfied. Two hundred and forty eight (95.7%) preferred the office-based setting to a hospital setting. Eleven (4.2%) women would have preferred a hospital setting. Major operative hysteroscopic surgery can be performed in an office-based setting with a high degree of patient satisfaction and safety.

QUANTITATIVE STUDY OF LUMBAR SPINE BONE MINERAL DENSITY AND CORONARY ARTERY CALCIFICATION IN ASYMPTOMATIC POSTMENOPAUSAL WOMEN

ObjectivesTo analyse the result of lumbar spine bone mineral density and coronary artery calcification, and to investigate the correlation between the change of bone mineral density and coronary atherosclerosis in...

Systematic vertebral fracture assessment in asymptomatic postmenopausal women

IntroductionRecognition of vertebral fractures (VFs) changes the patient's diagnostic classification, estimation of fracture risk, and threshold for pharmacological intervention. Vertebral fracture assessment (VFA) enables the detection of VFs in the same session as bone mineral density (BMD) testing. ObjectiveTo study prevalence and risk factors of VFs using VFA in asymptomatic women and measure its effect on treatment recommendations. MethodsWe enrolled 908 postmenopausal women (mean age, weight and BMI of 60.9±7.7 (50–91) years, 73.2±13.2 (35–150) kg and 29.8±5.3 (14.5–50.8) kg/m2, respectively. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative (SQ) approach and morphometry. ResultsVFs were identified in 382 patients (42.0%): 203 (22.3%) had grade 1 and 179 (19.7%) had grade 2 or 3. The prevalence of VFA-detected fractures globally increased significantly with age and as BMI and BMD declined. A fracture was identified on VFA in 63 (28.3%) women with normal BMD (8.5% had grade 2/3 VFs) and in 145 (38.5%) with osteopenia (15.7% had grade 2/3 VFs). Stepwise regression analysis showed that presence of VFs was independently related to age, BMI, number of parity, history of peripheral fracture and lumbar spine BMD. ConclusionA high proportion of women with asymptomatic VFs would not receive treatment if screening were based only on BMD evaluation. Our results support the recommendation to enlarge the indications of VFA in the presence of risk factors such as age over 60, multiparity, history of peripheral traumatic fractures and low BMI.

OC19.03: Intracavitary accidental findings among asymptomatic postmenopausal women with endometrium ≥ 5 mm

OC19.03: Intracavitary accidental findings among asymptomatic postmenopausal women with endometrium ≥ 5 mm

OC19.04: Prevalence of benign ovarian lesions in asymptomatic postmenopausal women

OC19.04: Prevalence of benign ovarian lesions in asymptomatic postmenopausal women

Risk of epithelial ovarian cancer in asymptomatic women with ultrasound‐detected ovarian masses: a prospective cohort study within the UK collaborative trial of ovarian cancer screening (UKCTOCS)

To estimate the risk of primary epithelial ovarian cancer (EOC) and slow growing borderline or Type I and aggressive Type II EOC in postmenopausal women with adnexal abnormalities on ultrasound. This was a prospective cohort study in the ultrasound group of the UK Collaborative Trial of Ovarian Cancer Screening of postmenopausal women with ultrasound-detected abnormal adnexal (unilocular, multilocular, unilocular solid and multilocular solid, solid) morphology on their first scan. Women were followed up through the national cancer registries and by postal questionnaires. Absolute risks of EOC and borderline, Type I and Type II EOC within 3 years of initial scan were calculated. Of 48 053 women who underwent ultrasound examination and had complete scan data, 4367 (9.1% (95% CI, 8.8-9.3%)) had abnormal adnexal morphology. Median follow-up was 7.09 (25(th) -75(th) centiles, 6.03-7.92) years. Forty-seven (32 borderline or Type I, 15 Type II) were diagnosed with EOC. The overall absolute risk of EOC associated with abnormal adnexal morphology was 1.08% (95% CI, 0.79-1.43%); for borderline and Type I it was 0.73% (95% CI, 0.5-1.03%); and for Type II it was 0.34% (95% CI, 0.33-0.79%). In the subgroup (n = 741) with solid elements (unilocular solid, multilocular solid and solid) overall absolute risk was 4.45% (95% CI, 3.08-6.20%), for borderline and Type I it was 3.1% (95% CI, 1.9-4.6%) and for Type II it was 1.3% (95% CI, 0.6-2.4%). 11 982 women had both ovaries visualized and normal annual scans throughout the 3-year follow-up period. In this group, no borderline or Type I and eight Type II cancers were diagnosed. Asymptomatic postmenopausal women with ultrasound-detected adnexal abnormalities with solid elements have a 1 in 22 risk for EOC. Despite the higher prevalence of Type II EOC, the risk of borderline or Type I cancer in women with ultrasound abnormalities seems to be higher than does the risk of Type II cancer. This has important immediate implications for patients with incidental adnexal findings as well as for any future ultrasound-based screening.

Physical Activity, Hormone Replacement Therapy, and the Presence of Coronary Calcium in Midlife Women

Background: Atherosclerotic calcification is a risk factor for cardiovascular events, independent of other traditional risk factors. Studies of the relation of menopausal hormone therapy to cardiovascular events have had inconsistent results, and often have been confounded by lifestyle behaviors and the “healthy user” effect. The authors evaluated the cross-sectional association of hormone therapy use with the presence and severity of atherosclerosis in postmenopausal women, independent of lifestyle factors, including diet and physical activity levels. Methods: The authors consecutively enrolled postmenopausal asymptomatic women who were referred for coronary artery calcium scanning to measure cardiovascular risk. After consent was obtained, women were interviewed prior to their cardiac scan about cardiac risk factors, hormone therapy use, menopausal status, diet, and physical activity. Coronary artery calcium prevalence was defined as any calcification present (score >0).Results: Of the 544 enrolled women aged 50–80 years, 252 (46.3%) were hormone therapy users. Hormone therapy users had a significantly lower prevalence of any coronary artery calcium (defined as coronary artery calcium score >0; 37%), than non-users (50%, p = 0.04), as well as significantly lower mean calcium scores (p = 0.02). Multiple logistic regression models demonstrated a significantly reduced odds of coronary artery calcium in hormone therapy users compared to non-users with an adjusted odds ratio of 0.58 (p = 0.04), adjusting for traditional cardiac risk factors and body mass index. Women who reported consuming a vegetarian or a high-protein diet had almost two-fold odds of coronary artery calcium compared with women who reported regular, mixed, or low-fat, low-salt diets (OR = 1.78, p = 0.02). Severity of coronary artery calcium was less with increasing levels of physical activity, and a significant association was observed between physical activity and hormone therapy use (adjusted OR = 4.05, p = 0.03), independent of coronary artery calcium severity.Conclusion: This cross-sectional study demonstrated a protective association of hormone therapy with the presence and severity of coronary artery calcium. Although a strong relationship was observed between hormone therapy and physical activity, their complex interplay may affect mechanistic biochemical and physiological processes that have yet to be clearly delineated. Thus, physical activity and diet should be taken into account in prospective studies of the relation of hormone therapy use to coronary artery calcium.

217 Endometrial thickness and pathologic findings following hysteroscopy in asymptomatic postmenopausal women

217 Endometrial thickness and pathologic findings following hysteroscopy in asymptomatic postmenopausal women

Ovarian Cancer Screening

Annual screening of asymptomatic postmenopausal women using a combination of transvaginal sonography and serum Ca-125 has been evaluated in 4 major clinical trials as a means to facilitate earlier detection of ovarian cancer. In several trials, screening has caused a decrease in stage at detection. These ovarian cancer screening trials are reviewed. The effect of screening on ovarian cancer mortality varies in different trials and is the subject of further investigation.

A randomised controlled trial comparing surgical intervention rates between two protocols for the management of asymptomatic adnexal tumours in postmenopausal women

IntroductionDetection of asymptomatic adnexal tumours in postmenopausal women has increased due to wider use of diagnostic ultrasound and imaging quality improvements. Reliable methods to differentiate between benign and malignant tumours...

Diagnostic Hysteroscopy for Assessing Endometrial Lesions among Asymptomatic Postmenopausal Women with Sonographically Abnormal Endometrium

Diagnostic Hysteroscopy for Assessing Endometrial Lesions among Asymptomatic Postmenopausal Women with Sonographically Abnormal Endometrium

Struma ovarii in breast cancer

We described a case of benign struma ovarii associated to bilateral mature cystic ovarian teratoma in an asymptomatic post-menopausal woman with breast cancer. The patient synchronously underwent surgical treatment of breast and ovarian tumors.

Value of transvaginal ultrasonography in endometrial evaluation of non-bleeding postmenopausal women

Objective To investigate the value of transvaginal ultrasonography (TVU) in the evaluation of the endometrium in postmenopausal women without vaginal bleeding.Methods This was a prospective, cohort, observational study which included 259 consecutive, asymptomatic, postmenopausal women who were referred to the outpatient clinics of Shiraz University of Medical Sciences. All the participants underwent TVU by the same gynecologist at the same time as hysteroscopy and endometrial biopsy were performed. Both 3 mm and 5 mm were considered as cut-off values. Endometrial histopathology was considered the gold-standard diagnosis and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVU were calculated on the basis of pathologic reports.Results The mean age of the patients was 54.2 ± 7.46 years (range 36–79 years). The mean endometrial thickness was found to be 3.83 ± 2.95 mm (range 1–25 mm); it was > 5 mm in 41 (15.8%%) patients. The sensitivity, specificity, PPV and NPV were 62.2%%, 93.9%%, 68.3%% and 92.2%%, respectively. The receiver-operating characteristics curve showed an area under the curve of 0.853 (95%% confidence interval 0.788–0.917), indicating a moderate accuracy.Conclusion TVU is a moderately accurate test in asymptomatic postmenopausal women. Due to its high false-positive rate, its positive results cannot be interpreted.

Myocardial Perfusion Image in Asymptomatic Postmenopausal Women with Physical Inactivity and Overweight

Objective: This study aimed to investigate whether physical inactivity and overweight deteriorate myocardial perfusion and cardiac function in asymptomatic postmenopausal women. Methods: A prospective cross-sectional study design was used. Postmenopausal women recruited in this study were categorized into groups based on activity level and BMI: physically active, normal-weight group (PANw, n = 15, 60.9 ± 6.0 years), physically inactive, normal-weight group (PIANw, n = 13, 57.2 ± 5.0 years) and physically inactive, overweight group (PIAO, n = 26, 58.5 ± 5.8 years). Each subject took cardiopulmonary function tests and ECG-gated exercise ²⁰¹Tl myocardial perfusion imaging (MPI). Perfusion abnormalities, cardiac function indices, and ²⁰¹Tl lung-to- heart ratio (LHR) were derived. Results: The PIANw women had lower exercise capacity than PANw women. More subjects in PIANw (46%) or PIAO (48%) groups had worsening in left ventricular ejection fraction (LVEF) by exercise than subjects in PANw (7%) group. The PIAO women exhibited significantly lower exercise capacity and higher rest LHR than PANw women (LHR 0.41 ± 0.05 vs. 0.36 ± 0.06; p = 0.014). Abnormal MPI tended to increase in PIANw (38%) and PIAO (46%) women when compared with the PANw (27%) group. Conclusions: Physically inactive, overweight postmenopausal women had higher rest ²⁰¹Tl lung uptake and worsening LVEF by exercise and tended to have higher prevalence of inducible ischemia, suggesting higher cardiovascular risks although asymptomatic.

Transient changes in thyroid functions tests after zoledronic acid infusion

Zoledronic acid (ZA) induces an acute phase response in association with elevation of serum cytokines, which possibly alter the 3 types of iodothyronine deiodinase activity. We therefore studied the possible alteration in thyroid function tests by ZA. We investigated the acute changes in serum thyroid hormones, TSH, cortisol, white blood cells, CRP, interleukin-6 (IL-6) and tumor necrosis factor (TNF-α), before (0) and 1, 2 and 3 days after iv infusion of 5 mg ZA in 24 asymptomatic postmenopausal women with osteoporosis (ZA group) in comparison with a placebo group. In the majority of patients the ZA infusion was associated with acute phase response and fever within 24h after infusion which became attenuated on day three. Concurrently with increase in serum cortisol, CRP, IL-6 and TNF-α, on day 1 and 2, total serum T3 (TT3), free T3 (fT3), total T4 (TT4) and fT4 decreased with a nadir on day 2 in association with an increase in the fT4/fT3 ratio and reverse T3 (rT3) levels. All thyroid function changes returned to the baseline levels on day 3, with cytokines still at higher levels, although lower than those on day 2. Serum TSH remained essentially unchanged throughout the study. The changes in thyroid hormones were at least in part explained by the increased TNF-α, but not by IL-6. ZA induces short term changes in thyroid hormones, characteristic of nonthyroidal illness syndrome (NTIS), in association with an increase in TNF-α and IL-6.

Hallazgos histeroscópicos en mujeres asintomáticas con ecografía sugestiva de patología endometrial

Objective The main objective of this study was to determine the prevalence of atypical hyperplasia and endometrial adenocarcinoma detected by hysteroscopy in asymptomatic postmenopausal women with vaginal ultrasonographic findings suggestive of endometrial disease. The second aim was to ascertain the usefulness of hysteroscopy in the diagnosis of premalignant and malignant lesions in these patients. Subjects and methods We performed a descriptive study of 1,237 hysteroscopies carried out over a 7-year period (January 2000 to December 2006) in the Gynecology Department of Hospital Donostia. All the women were asymptomatic and were referred to our clinic due to an ultrasound examination suggestive of endometrial disease. Results The most frequent hysteroscopic findings were endometrial polyps (64.3%), followed by a diagnosis of normality (15.7%). A total of 1,046 endometrial biopsies were performed. In addition, 27 patients underwent hysterectomy; 14 were diagnosed with atypical hyperplasia (1.13%) and 20 with stage I endometrial adenocarcinoma (1.61%). The specificity and negative predictive value of hysteroscopy in the diagnosis of premalignant and malignant lesions were high (specificity: 97.5%, negative predictive value 99.6%, positive likelihood ratio 31.25). Conclusions The results of our study suggest that the efficiency of transvaginal ultrasound screening in asymptomatic menopausal women in the diagnosis of premalignant and malignant endometrial disease is not high. Hysteroscopy allows a reliable diagnosis in this group of women.

The Oncogenic Potential of Endometrial Polyps

To systematically review and summarize the medical literature regarding the association of menopausal status, uterine bleeding, and polyp size and risk of malignancy among women undergoing polyp resection. We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing the risk of malignancy for patients undergoing polypectomy. Key word searches were performed using the words "endometrial polyp," "malignancy," "ultrasound," "saline sonohysterography," "hysteroscopy," and "histopathology." We evaluated abstracted data and performed quantitative analyses in observational studies assessing the effects of menopausal status, vaginal bleeding, and polyp size on the risk of malignancy in patients undergoing polyp resection (n=1,552). For each study with binary outcomes, relative risks with 95% confidence intervals (CIs) were calculated. Estimates of relative risk were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Sensitivity analyses were performed to determine the effects of individual studies on the overall effect estimates. Publication bias was assessed using Egger test. Seventeen studies met inclusion criteria for this review. Among women found to have endometrial polyps, the prevalence of premalignant or malignant polyps was 5.42% (214 of 3,946) in postmenopausal women compared with 1.7% (68 of 3,997) in reproductive-aged women (relative risk 3.86; 95% CI 2.92-5.11). The prevalence of endometrial neoplasia within polyps in women with symptomatic bleeding was 4.15% (195 of 4,697) compared with 2.16% (85 of 3,941) for those without bleeding (relative risk 1.97; 95% CI 1.24-3.14). Among symptomatic postmenopausal women with endometrial polyps, 4.47% (88 of 1,968) had a malignant polyp in comparison to 1.51% (25 of 1,654) asymptomatic postmenopausal women (relative risk 3.36; 95% CI 1.45-7.80). Based on data from observational studies, both symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps are associated with an increased risk of endometrial malignancy.

OC21.04: Endometrial thickness and the prevalence of endometrial carcinoma in asymptomatic postmenopausal patients, a systematic review of the literature

Objectives: Endometrial polyps in asymptomatic postmenopausal women are present in 15–20% of patients. The prevalence of preand malignant endometrial lesion on atrophic endometrium in this group has been recently estimated to be 1.6% and 0.2%, respectively (Ferrazzi et al., AJOG 2009). The objective of this 10 year study was to observe the natural history of endometrial polyps on atrophic endometrium (thickness ≤4 mm) in asymptomatic postmenopausal women. Methods: 396 asymptomatic postmenopausal women with sonographic diagnosis of endometrial polyp were prospectively recruited. Patients on HRT and/or TMX treatment were excluded. All patients underwent transvaginal sonography (TVS) with color power Doppler (CD) evaluation, and sonohysterography (SHG). Sonographic follow-up at 3, 6, 12 and every 12 months was proposed as an option to standard hysteroscopic polypectomy. Surgery was considered in case of a high blood flow score (color score 3–4 according to IETA definitions), or in case of bleeding and/or volume growth >50% at follow-up. Demographic, sonographic and surgical data were recorded. Results: Sonographic follow-up was chosen by 292 patients (group A). 32 patients were lost at follow-up. 40 patients underwent surgery because of drop-out, uterine bleeding or increased volume at follow up, or for other gynaecological indications. Two endometrial cancers were diagnosed after uterine bleeding at 16 and 69 months of followup, respectively. In group B, surgical removal was performed in 104 patients by hysteroscopic polipectomy. One pre-malignant lesion was found in surgically treated patients (simple hyperplasia with focal atypia confirmed at hysterectomy). Conclusions: This observational study adds evidence to the feasibility of a conservative management of asymptomatic polyps. Monitoring criteria by using TVS, CD and SHG assessment need to be established.