Management Of Postmenopausal Women Research Articles

Racial disparities in the treatment of endometrial intraepithelial neoplasia in postmenopausal women

Disparities in endometrial cancer has increased during the past decade with Black women more likely to be diagnosed at a later stage and have higher mortality. The majority of research has been focused on cultural barriers, socioeconomic status, lack of access to care, comorbidities, and tumor histology to explain these disparities. Limited studies have been conducted on the disparity in the treatment of endometrial intraepithelial neoplasia(EIN). We sought to analyze the differences in treatment used in the management of postmenopausal women with EIN to evaluate whether race/ethnicity is a contributing factor. An IRB approved retrospective study was conducted amongst women at a single institution diagnosed with EIN. Ethnicity/race was defined as non-Hispanic White, non-Hispanic Black, Hispanic, and Asian. Demographic and clinical data was extracted. Multivariable logistic regression was used to examine the association between ethnicity/race and treatment, adjusted for age, BMI, and underlying medical conditions such as cardiovascular disease and diabetes.In total, 254 patients were analyzed. A significant association between ethnicity/race and treatment with non-Hispanic Black women less likely to be treated with surgical management compared to non-Hispanic White women (OR = 0.326, 95 %CI 0.129–0.827, p = 0.026). Importantly, after adjusting for clinical risk factors(age, BMI, CVD, diabetes), non-Hispanic Black women remained at an increased risk of not undergoing surgical intervention (OR = 0.333, 95 % CI 0.125–0.882, p = 0.027). Future research is imperative to evaluate the root cause of this disparity in the healthcare system.

Guidelines for fracture risk assessment and management of osteoporosis in postmenopausal women and men above the age of 50 in Qatar

SummaryWe present comprehensive guidelines for osteoporosis management in Qatar. Formulated by the Qatar Osteoporosis Association, the guidelines recommend the age-dependent Qatar fracture risk assessment tool for screening, emphasizing risk-based treatment strategies and discouraging routine dual-energy X-ray scans. They offer a vital resource for physicians managing osteoporosis and fragility fractures nationwide.PurposeOsteoporosis and related fragility fractures are a growing public health issue with an impact on individuals and the healthcare system. We aimed to present guidelines providing unified guidance to all healthcare professionals in Qatar regarding the management of osteoporosis.MethodsThe Qatar Osteoporosis Association formulated guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men above the age of 50. A panel of six local rheumatologists who are experts in the field of osteoporosis met together and conducted an extensive review of published articles and local and international guidelines to formulate guidance for the screening and management of postmenopausal women and men older than 50 years in Qatar.ResultsThe guidelines emphasize the use of the age-dependent hybrid model of the Qatar fracture risk assessment tool for screening osteoporosis and risk categorization. The guidelines include screening, risk stratification, investigations, treatment, and monitoring of patients with osteoporosis. The use of a dual-energy X-ray absorptiometry scan without any risk factors is discouraged. Treatment options are recommended based on risk stratification.ConclusionGuidance is provided to all physicians across the country who are involved in the care of patients with osteoporosis and fragility fractures.

Influence of menopausal status on physical function and performance: A cross-sectional study.

To compare the physical function and performance in pre-, peri-, and postmenopausal women. A cross sectional study using convenience sampling method was conducted in 210 women categorized into premenopausal, perimenopausal, and postmenopausal. Flexibility, muscle strength, muscle endurance, cardiovascular endurance, static balance, dynamic balance, and gait speed. The mean age of the premenopausal, perimenopausal, and postmenopausal women was 46.55 ± 1.77, 49.54 ± 3.38 and 54.85 ± 3.77years respectively. There is significant difference observed between premenopausal, perimenopausal, and postmenopausal women in muscle strength, upper limb endurance, lower limb endurance, static balance, dynamic balance, gait speed, and cardiovascular endurance (p < .05) using Kruskal Wallis test. There is no significant difference observed between the groups for flexibility (p > .05). It was observed that physical function and performance was impaired in postmenopausal women when compared to pre- and perimenopausal women. Hence, these components should be included during assessment which will provide a holistic and multimodal approach toward the understanding, planning and management of postmenopausal women in community settings.

Persistent gap in menopause care 20 years after the WHI: a population-based study of menopause-related symptoms and their management

ObjectivesTo assess the current management of menopause in France with regard to menopause-related and genitourinary symptoms, with a focus on use of menopause hormone therapy (MHT). Design, setting, and participantsThe ELISA Study is a population-based survey of 5004 French representative women aged 50 to 65 years. From July to August 2020, the participating women answered an online computer-assisted web interview on menopause-related and genitourinary symptoms and their management, including use of MHT. Main outcomes and measuresPrevalence of menopause-related and genitourinary symptoms in postmenopausal women. Management of these symptoms, including the reasons for not doing so, management by health care providers, and use of MHT. ResultsAmong the 5004 selected women, 4041 whose postmenopausal status was confirmed were included in the final analyses. Of the untreated 3685 women, 87 % reported at least 1 menopausal symptom, with a significantly higher percentage of symptomatic women in the 50–54 age group (92 %, p < 0.05) than in the other two age groups (55–59 years: 89 % and 60–64 years: 82 %). 68 % of the surveyed women experienced on average 2.5 symptoms of the genitourinary syndrome of menopause (GSM). Using a visual analogue scale (VAS) from 0 (no impact) to 10 (high impact) to evaluate the impact of menopausal/GSM symptoms on their quality of life, mean VAS score was 5.9 (SD: 2.2), with 25 % of the women aged 55–59 years rating their quality of life between 8 and 10. 61 % of the surveyed women reported being regularly followed by a health care professional. 44 % of women reported never having discussed their menopausal/GSM symptoms with a health care provider. The main reasons were because menopause is “a normal part of women's lives”, because it was not “necessary to do so”, or their symptoms were “not serious enough”. Only 242 women (6 %) were current MHT users, of whom 49 % were using estrogen-alone therapy and 71 % were using transdermal estrogens. Fear of hormones (35 %) and MHT side-effects (25 %) were the main reasons given for not using MHT. 62 % of the women reported that the decision not to take MHT was supported by their physician. Conclusions and relevanceThis large population-based survey confirmed not only the high prevalence of menopause-related and GSM symptoms in postmenopausal women within the first 10–15 years after menopause, but also the very low percentage of MHT users in France. Twenty years after the publication of the initial Women's Health Initiative (WHI) results, management of postmenopausal women is still characterized by unmet needs in menopausal care. Therefore, there is a strong need to educate the public and health care providers about menopause-related problems and possible solutions, including MHT, through dedicated educational programs.

Role of Flexible Cystoscopy in the Management of Postmenopausal Women With Recurrent Urinary Tract Infections

To evaluate office flexible cystoscopy findings in the evaluation and management of postmenopausal women with recurrent urinary tract infections (RUTIs). An IRB-approved, prospectively maintained database of women evaluated for RUTIs at a tertiary care center was retrospectively reviewed by an independent investigator for flexible cystoscopy (FC) findings and related treatment decisions over three consecutive years. Data reviewed in the electronic medical record (EMR) included demographics, UTI history, history of diabetes, hormone replacement therapy (HRT), prior urological surgeries, sexual activity, coital antibiotic prophylaxis use, urine culture findings, antibiotic resistance/allergies, cystoscopy, and treatment plan. Between 2017 and 2019, 113 consecutive postmenopausal women, mostly Caucasian, underwent flexible office cystoscopy to complete their RUTI evaluation. Eighty-four women (74%) had abnormal cystoscopy findings. The rate of overall abnormal findings on cystoscopy increased yearly, including findings of trigonitis (p=0.022). Other abnormal cystoscopy findings, as well as post-evaluation treatment plans, did not significantly differ over time. Trigonitis was the most common (67%) finding on cystoscopy. RUTI management included exposed urethral/bladder mesh removal and/or electrofulguration of chronic cystitis areas. Flexible cystoscopy, as an office diagnostic procedure, can provide valuable information of underlying etiology of RUTIs and allow directed management.

Abstract P3-03-05: The budget impact of the DiviTum®TKa assay in postmenopausal women with hormone receptor positive metastatic breast cancer

Abstract Background. Management of postmenopausal women with HR+ mBC includes monitoring with tumor markers, CT scans, and bone scans. DiviTum®TKa is a blood-based biomarker assay developed to monitor and predict treatment response in hormone receptor positive metastatic breast cancer (HR+ mBC). Uptake of DiviTum®TKa monitoring may decrease usage of traditional monitoring technologies and potentially avoid prolongation of futile treatments. Our objective was to estimate budget impacts of the assay on monitoring utilization and cancer treatment on a postmenopausal HR+ mBC population in a 1,000,000 member U.S. health plan. Methods. We developed a budget impact model comparing inclusion of DiviTum®TKa to standard monitoring practices vs. standard monitoring practices alone. The modeled population was post-menopausal women with HR+ mBC who receive 1st-line treatment with CDK4/6 inhibitors (CDK4/6i) + an aromatase inhibitor (AI). We explored two scenarios: (1) uptake of DiviTum®TKa reduces the frequency of traditional mBC monitoring tools, and 2) in addition to scenario 1, DiviTum®TKa predicts treatment futility 1 month in advance of radiological disease progression. We assumed patients were 100% adherent to DiviTum®TKa and traditional monitoring schedules, which were based on clinical guidelines and expert opinion. DiviTum®TKa’s impact on therapy utilization was based on published literature and expert opinion. Modeled costs included DiviTum®TKa, NCCN-recommended treatments, imaging, biomarker testing, and adverse events. Unit costs were based on CMS fee schedules and wholesale acquisition costs. Annual rates of incident and recurrent post-menopausal HR+ mBC were estimated from SEER and publicly available data. We calculated total and per-member per-month (PMPM) costs with a 3-year time horizon. Results. Each year, 17 women who progressed to mBC and 4 who developed de novo mBC were treated 1st-line with CDK4/6i+AI. In scenario 1 (monitoring only), addition of 404 DiviTum®TKa assays led to 203 fewer CT scans, 93 fewer bone scans, and 60 fewer biomarker tests over 3 years. In scenario 2 (impact on therapy), mean time on treatment with CDK 4/6i + AI therapy was 28 months without DiviTum®TKa testing; with DiviTum®TKa, 27 months; this led to treatment-related cost savings due to avoidance of time on futile therapy. Spend on DiviTum®TKa testing was $161,600. Accounting only for test costs (Scenario 1) resulted in incremental cost of $38,000 and a PMPM of $0.001. Accounting for time spent on futile therapy (Scenario 2) resulted in incremental cost savings of $465,600 and a PMPM cost-savings of $0.013. In one-way sensitivity analysis, results were most sensitive to DiviTum®TKa and CT scan costs, the proportion of mBC patients treated with CDK4/6i+AI, and CDK4/6i costs. Conclusions. In this analysis, use of DiviTum®TKa reduced use of a substantial proportion of traditional monitoring. If use of DiviTum®TKa can also predict lack of benefit from costly CDK4/6i therapy and clinicians act on that information in a timely fashion, this can result in substantial cost savings to patients and health plans. In this 2nd scenario, net savings on adding a new test to care were ~3X the spend on the test itself. Following approval and commercial introduction of DiviTum®TKa, future research on practice patterns will be necessary to validate our analysis. Scenario 1WithoutDiviTum®TKaWithDiviTum®TKaDifferenceDifferencePMPMTotal Cost$14,518,998$14,556,984$37,986$0.001Monitoring$284,680$322,666$37,986$0.001Treatment$13,703,867$13,703,867$0$0.000Adverse Events$530,451$530,451$0$0.000Scenario 2WithoutDiviTum®TKaWithDiviTum®TKaDifferenceDifferencePMPMTotal Cost$14,518,998$14,053,431-$465,567-$0.013Monitoring$284,680$311,179$26,500$0.001Treatment$13,703,867$13,209,240-$494,627-$0.014Adverse Events$530,451$533,013$2,561$0.000 Citation Format: Gregory F. Guzauskas, Josh J. Carlson, Robert A. Dann, Scott D. Ramsey. The budget impact of the DiviTum®TKa assay in postmenopausal women with hormone receptor positive metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-03-05.

Analysis of clusters of menopausal disorders associated with a decrease in the quality of life in postovarectomy and climacteric syndromes

The decline in the quality of life due to various menopausal disorders in the early postmenopausal period is actually the main reason that leads a woman to seek medical help. Despite this, not enough attention is paid to this problem. Currently, the concept of the formation of individual menopausal symptoms into clusters is emerging to optimize treatment and diagnostic algorithms for managing this category of patients. The aim was a comparative analysis of the menopausal disorders most associated with a decrease in the quality of life. Included were 230 women with climacteric disorders (95 with bilateral oophorectomy; 135 with natural menopause). The assessment of the severity of climacteric disorders was carried out according to the Kuperman index modified by E.V. Uvarova. The SF-36 Health Status Survey was used to assess the quality of life. The average age of patients with surgical menopause was 47.9±2.2 years, with natural menopause - 53.6±3.5 years (p˂0.05). The duration of the estrogen deficiency state in the groups was comparable - 2.8 ± 0.6 years (p&gt;0.05). All patients had a moderate degree of menopausal syndrome (p&gt;0.05), however, the values of the modified menopausal index differed significantly: with postovarectomy syndrome - 57.8±1.1 points, with menopausal syndrome - 49.7±0.9 points (р &lt;0.05). In both groups, a decrease in the quality of life was observed: the total physical component (with postovarectomy syndrome up to 57.2 (36.6; 72.7), with menopause - up to 68.4 (49.3; 83.5)) and the total psychological component (up to 53.9 (42.9; 76.7) and 64.1 (47.3; 84.5), respectively). In contrast to our approach, the formation of clusters of menopausal symptoms, based on the generally accepted approach to the analysis of climacteric disorders (psychological, vasomotor, somatic), provided a significantly smaller sample coverage (with surgical menopause - 68.5%, with natural - 62.6% variance) With a duration of estrogen deficiency of 2.8 ± 0.6 years, the cluster of menopausal disorders, which has the maximum negative effect on the quality of life, includes symptoms: hot flashes, cognitive disorders, sleep disturbances, anxiety, and covers 80.3% of the variance in postovarectomy syndrome, in menopausal - 73.6%. Knowledge of this fact contributes to the identification of risk groups and allows formulating new algorithms for the management of postmenopausal women.

Anabolic Therapy and Optimal Treatment Sequences for Patients With Osteoporosis at High Risk for Fracture

Provide an update regarding anabolic medications for osteoporosis, which are often considered to be the last resort for patients with osteoporosis, after multiple fractures have already occurred and other medications have already been administered. Literature review and discussion. Recent pivotal trial data for anabolic agents and randomized trials comparing anabolic and antiresorptive medications suggest that three anabolic agents (teriparatide, abaloparatide, and romosozumab) reduce nonvertebral and vertebral fractures faster and to a greater extent than potent antiresorptive treatments. Furthermore, bone density accrual is maximized when patients are given anabolic agents first, followed by potent antiresorptive therapy. Since total hip bone density during or after osteoporosis treatment has emerged as an excellent surrogate for future fracture risk, attaining a greater hip bone mineral density is a treatment goal for high-risk osteoporosis patients. This review defines the highest-risk patients and summarizes the rationale for the evolving role of anabolic therapy in the management of postmenopausal women at high risk for fracture. ACTIVE = Abaloparatide Comparator Trial in Vertebral Endpoints; ARCH = Active Controlled Fracture Study in Postmenopausal Women with Osteoporosis at High Risk; BMD = bone mineral density; FRAME = Fracture Study in Postmenopausal Women with Osteoporosis; FRAX = Fracture Risk Assessment Tool; PTH = parathyroid hormone; TBS = trabecular bone score.

Long-term outcome of postmenopausal women with non-atypical endometrial hyperplasia on endometrial sampling.

To assess the long-term outcome of postmenopausal women diagnosed with non-atypical endometrial hyperplasia (NEH). This was a retrospective study of women aged 55 or older who underwent endometrial sampling in our academic medical center between 1997 and 2008. Women who had a current or recent (< 2 years) histological diagnosis of NEH were included in the study group and were compared with those diagnosed with atrophic endometrium (AE). Outcome data were obtained until February 2018. The main outcomes were risk of progression to endometrial carcinoma and risk of persistence, recurrence or new development of endometrial hyperplasia (EH) ('persistent EH'). Logistic regression analysis was used to identify covariates that were independent risk factors for progression to endometrial cancer or persistent EH. During the study period, 1808 women aged 55 or older underwent endometrial sampling. The median surveillance time was 10.0 years. Seventy-two women were found to have a current or recent diagnosis of NEH and were compared with 722 women with AE. When compared to women with AE, women with NEH had significantly higher body mass index (33.9 kg/m2 vs 30.6 kg/m2 ; P = 0.01), greater endometrial thickness (10.00 mm vs 6.00 mm; P = 0.01) and higher rates of progression to type-1 endometrial cancer (8.3% vs 0.8%; P = 0.0003) and persistent NEH (22.2% vs 0.7%; P < 0.0001). They also had a higher rate of progression to any type of uterine cancer or persistent EH (33.3% vs 3.5%; P < 0.0001). Women with NEH had a significantly higher rate of future surgical intervention (51.4% vs 15.8%; P < 0.0001), including future hysterectomy (34.7% vs 9.8%; P < 0.0001). On multivariable logistic regression analysis, only NEH remained a significant risk factor for progression to endometrial cancer or persistence of EH. Postmenopausal women with NEH are at significant risk for persistent EH and progression to endometrial cancer, at rates higher than those reported previously. Guidelines for the appropriate management of postmenopausal women with NEH are needed in order to decrease the rate of persistent disease or progression to cancer. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

The Role of Local Hormone Replacement in Overactive Bladder

Overactive bladder (OAB) is a common and distressing condition which is known to increase with age and to have a significant effect on quality of life (QoL). Whilst OAB is a symptomatic diagnosis, many patients will require basic investigations prior to initiating the appropriate management. This paper will explore the prevalence and pathophysiology of OAB as well as diagnosis and management of the condition. There is increasing evidence that local oestrogen therapy may be beneficial in the management of postmenopausal women with OAB, either when used alone or as combination therapy with an antimuscarinic drug. This paper will review the postulated mechanisms of action as well as exploring the available evidence base supporting efficacy. There is now a substantial evidence base to support the use of local vaginal oestrogen therapy in postmenopausal women with OAB either in isolation or alternatively as an adjunctive therapy when used with antimuscarinic medication. Available evidence supports an improvement in lower urinary tract symptoms as well as a significant improvement in health-related quality of life (HRQoL).

Menopause and diabetes: EMAS clinical guide

IntroductionWhether menopause increases the risk of type 2 diabetes mellitus (T2DM) independently of ageing has been a matter of debate. Controversy also exists about the benefits and risks of menopausal hormone therapy (MHT) in women with T2DM. AimsTo summarise the evidence on 1) the effect of menopause on metabolic parameters and the risk of T2DM, 2) the effect of T2DM on age at menopause, 3) the effect of MHT on the risk of T2DM, and 4) the management of postmenopausal women with T2DM. Materials and methodsLiterature review and consensus of experts’ opinions. Results and conclusionMetabolic changes during the menopausal transition include an increase in and the central redistribution of adipose tissue, as well as a decrease in energy expenditure. In addition, there is impairment of insulin secretion and insulin sensitivity and an increase in the risk of T2DM. MHT has a favourable effect on glucose metabolism, both in women with and in women without T2DM, while it may delay the onset of T2DM. MHT in women with T2DM should be administered according to their risk of cardiovascular disease (CVD). In women with T2DM and low CVD risk, oral oestrogens may be preferred, while transdermal 17β-oestradiol is preferred for women with T2DM and coexistent CVD risk factors, such as obesity. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as progesterone, dydrogesterone or transdermal norethisterone. Postmenopausal women with T2DM should be managed primarily with lifestyle intervention, including diet and exercise. Most of them will eventually require pharmacological therapy. The selection of antidiabetic medications should be based on the patient’s specific characteristics and comorbidities, as well on the metabolic, cardiovascular and bone effects of the medications.

Management of Postmenopausal Women with Simple Cyst

Objective(s): Aim of the study was to explore the outcome of conservative treatment for the postmenopausal women having small cysts.Materials Methods: This prospective cross sectional study was carried out in ZH Sikder Women Medical College &amp; Hospital, Medinova and Popular hospital between January 2011 to June 2016. Five hundred (500) postmenopausal women with simple cysts were enrolled after counseling and taking written consent. Inclusion criteria were- cysts size should not be more than 5cm, they should be unilocular, without having any solid component or any debries. Exclusion criteria were, she or her family should not have any cancer of ovary, breast, or colon. Also women with HRT were excluded from the study. Thorough history taking, clinical examination, and some investigation like CA125, and TVS with colour Doppler was carried out for all women. CT Scan. MRI, and PET Scan were reserved for cases where colour Doppler ultrasonogram was suspicious. All the patients were followed up every 3 months for 3 to 5 years. Surgery was done if the patient developed any symptoms, or if there was any increment of sizes of cysts or there was any sonographic changes were evident. MRI1 (malignancy risk index) was calculated for each patient. Data were analyzed by SPSS where all calculation rate of less than 0.05 was considered significant.Results: Among 500 cysts, 285 cysts resolved spontaneously, which is highly significant (p &lt;0.05), 165 cysts needed surgery and 50 cysts regressed very slowly and did not regress completely. Histopathology of surgical specimen revealed all were benign except 4 cysts, which became malignant or malignant potential.Conclusion: Postmenopausal women with simple cysts not more than 5cm,which are unilocular, unilateral, without having any solid component and with normal Doppler study are rarely malignant. So if MRI 1 is below 200 we may avoid unnecessary surgery and assure the postmenopausal women for the conservative treatment with regular follow up.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 3-9

Management of postmenopausal women: what the clinician can rely on?

Management of postmenopausal women: what the clinician can rely on?

EMAS position statement: The management of postmenopausal women with vertebral osteoporotic fracture

IntroductionOsteoporotic vertebral fractures are associated with significant morbidity, excess mortality as well as health and social service expenditure. Additionally, women with a prevalent osteoporotic vertebral fracture have a high risk of experiencing a further one within one year. It is therefore important for the physician to use a diagnostic and therapeutic algorithm for early detection and effective treatment of vertebral fractures. AimsThe aim of this position statement is to provide and critically appraise evidence on the management of women with a vertebral osteoporotic fracture. Materials and methodsLiterature review and consensus of expert opinion. Results and conclusionsThe management of women with osteoporotic vertebral fractures includes measures to reduce pain providing early mobility, to support the affected spine ensuring fracture healing, as well as starting treatment for osteoporosis itself. Any other underlying pathology should be sought and treated. Early detection and treatment is essential as there is an increased risk of further fractures in patients with vertebral fractures. Treatment will depend on the underlying causes of bone loss, efficacy in any particular situation, cost and patient preference.

Oestrogens and overactive bladder

Estrogens are known to have a major role in the function of the lower urinary tract although the role of exogenous estrogen replacement therapy in the management of women with lower urinary tract dysfunction remains controversial. Whilst for many years systemic and vaginal estrogen therapy was felt to be beneficial in the treatment of lower urinary and genital tract symptoms this evidence has recently been challenged by large epidemiological studies investigating the use of systemic hormone replacement therapy. Consequently the role of estrogen in the management of postmenopausal women with Overactive Bladder (OAB) remains uncertain. In addition the evidence base regarding the use of exogenous estrogen therapy has changed significantly over the last decade and has led to a major changes in current clinical practice. The aim of this article is to review the evidence for the role of estrogen therapy in the management of OAB focusing on current knowledge with regard to both systemic and local estrogen therapy as well as investigating the emerging role of combination therapy with antimuscarinic agents.

Efficacy of everolimus with exemestane versus exemestane alone in Asian patients with HER2-negative, hormone-receptor-positive breast cancer in BOLERO-2.

BackgroundThe addition of mTOR inhibitor everolimus (EVE) to exemestane (EXE) was evaluated in an international, phase 3 study (BOLERO-2) in patients with hormone-receptor-positive (HR+) breast cancer refractory to letrozole or anastrozole. The safety and efficacy of anticancer treatments may be influenced by ethnicity (Sekine et al. in Br J Cancer 99:1757–62, 2008). Safety and efficacy results from Asian versus non-Asian patients in BOLERO-2 are reported.MethodsPatients were randomized (2:1) to 10 mg/day EVE + EXE or placebo (PBO) + EXE. Primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival, response rate, clinical benefit rate, and safety.ResultsOf 143 Asian patients, 98 received EVE + EXE and 45 received PBO + EXE. Treatment with EVE + EXE significantly improved median PFS versus PBO + EXE among Asian patients by 38 % (HR = 0.62; 95 % CI, 0.41–0.94). Median PFS was also improved among non-Asian patients by 59 % (HR = 0.41; 95 % CI, 0.33–0.50). Median PFS duration among EVE-treated Asian patients was 8.48 versus 4.14 months for PBO + EXE, and 7.33 versus 2.83 months, respectively, in non-Asian patients. The most common grade 3/4 adverse events (stomatitis, anemia, elevated liver enzymes, hyperglycemia, and dyspnea) occurred at similar frequencies in Asian and non-Asian patients. Grade 1/2 interstitial lung disease occurred more frequently in Asian patients. Quality of life was similar between treatment arms in Asian patients.ConclusionAdding EVE to EXE provided substantial clinical benefit in both Asian and non-Asian patients with similar safety profiles. This combination represents an improvement in the management of postmenopausal women with HR+/HER2− advanced breast cancer progressing on nonsteroidal aromatase inhibitors, regardless of ethnicity.

Hormone therapy for postmenopausal women—An unanswered issue

Abstract Menopause is a biological and natural process that occurs as part of aging in women and is secondary to ovarian failure with resultant estrogen deficiency; therefore, menopause should not be considered as a disease. However, there is no doubt that estrogen deficiency induces general psychological and physical changes, and that postmenopausal women will experience many health-related issues and problems, including osteoporotic fractures, coronary heart disease (CHD), and most importantly for the quality of life (QOL) and vasomotor symptoms (VMS) such as hot flashes and night sweats. Hormone therapy (HT) is very effective in the management of postmenopausal women with symptoms. With the large number of patients being treated with HT, especially the combination of estrogen and progestin therapy (EPT) in the Women's Health Initiative (WHI) study, clinicians now recognize the potential adverse effects of EPT. Although this concept is much clearer now, some women might still benefit from short-term HT, especially for young postmenopausal women. In this review, some health issues of postmenopausal women, especially alternative therapies are discussed.

HRT: Some Unresolved Clinical Issues in Breast Cancer, Endometrial Cancer and Premature Ovarian Insufficiency

Many important issues regarding HRT and the management of postmenopausal women are unresolved and require ongoing consideration and some explanation. HRT is only one of many factors affecting the risk of breast cancer and the risk of breast cancer is not increased in past users of HRT. There is seemingly a paradox in the effect of body weight and HRT on breast cancer risk. It is unclear whether the benefit of giving progestin with estrogen to prevent endometrial cancer in HRT outweighs the increased risk of breast cancer. Sequential HRT may not fully prevent endometrial cancer, and continuous combined regimes are to be preferred. The prevention of the consequences of premature ovarian insuffiency, both immediate and long term, has been neglected, and a strong case can be made for estrogen replacement therapy in all women with premature ovarian insuffiency, particularly following bilateral oophorectomy.

OP24.02: A prospective evaluation of two protocols for the management of postmenopausal women with adnexal tumors: analysis of potential intervention rates

OP24.02: A prospective evaluation of two protocols for the management of postmenopausal women with adnexal tumors: analysis of potential intervention rates

Management of postmenopausal women with vaginal bleeding when the endometrium can not be visualized

To determine the risk of endometrial cancer when endometrial thickness is not visualized using ultrasonography. Cross-sectional study. Gynecological oncology center in the United Kingdom. All postmenopausal women referred with vaginal bleeding. All women were investigated using gray-scale transvaginal ultrasonography. Women were arbitrarily stratified into four groups according to the endometrial thickness measurement. Women with endometrial thickness that was not adequately visualized on ultrasonography were included in a separate group. Endometrial cancer diagnosis. Over a 50-month period, 4454 women were investigated for postmenopausal vaginal bleeding. A total of 259 (6%) of women were diagnosed with endometrial carcinoma. Endometrial thickness measured 5-9.9 mm in 1201 (27%), 10-14.9 mm in 468 (11%), 15-19.9 mm in 209 (5%), and equal to or greater than 20mm in 197 (4%) of women. In 174 (4%) of women, the endometrial thickness was not visualized on transvaginal ultrasonography. For women where the endometrial thickness was not adequately visualized, the final histology included benign endometrium (124), endometrial cancer (26), endometrial polyps (11), endometritis (7), and other pathology (7). The odds of endometrial cancer in women where the endometrial thickness was not visualized were found to be significantly higher than the odds of cancer for women with an endometrial thickness of 5-9.9 mm (OR = 5.23, 95%CI 3.10-8.85, p-value <0.0001). For women presenting with postmenopausal bleeding and where the endometrial thickness cannot be adequately visualized on ultrasonography, hysteroscopic evaluation is recommended.