Menopausal Patients Research Articles

Real world experience with exemestane and everolimus for advanced HR-positive breast cancer.

e12538 Background: BOLERO-2 demonstrated a significant progression free survival (PFS) advantage for EvEx compared to Ex alone in the treatment of metastatic hormone receptor positive breast cancer (HP-MBC) following failure with aromatase inhibitor (AI) in menopausal patients. Benefits and harms reported in clinical trials do not always mirror real life, thus we examined the frequency of dose modifications for toxicity and PFS in a real-world population. Methods: Women with HP-MBC started on EvEx between Dec. 2, 2013 and Nov. 1, 2015 in any one of five cancer centres in British Columbia, Canada were identified via the provincial pharmacy database. Clinical and prior treatment details, adverse events, and outcomes were compared to those of the BOLERO-2 study participants. Results: We identified151 patients treated with EvEx: median age was 53 (range 25 – 85), and 60 (40%) were ≤49. ECOG performance status was 0-1 in 122 (81%) and 2-3 in 29 (19%). 135 (89%) received prior treatment for MBC, which included non-steroidal AI in 117 (87%) and chemotherapy in 74 (55%). 94 (62%) received EvEx as 3rd line treatment and beyond. Median follow-up was 714 days (range 10 – 1127); 66 (44%) were alive at time of analysis. Dose reductions, interruptions and discontinuations of everolimus due to toxicity occurred in 32%, 31%, and 30%, respectively, higher than reported in BOLERO-2. Median PFS was 6.1 months (95% CI: 4.9 – 7.7) in our cohort, similar to that of the investigator assessed EvEx arm of BOLERO-2. Majority, 52%, of dose reductions/interruptions occurred within the first month of treatment initiation. Conclusions: We observed similar PFS forEvEx in a real world population compared with BOLERO-2. Dose interruptions and reductions were frequent, but may have enabled patients to tolerate therapy for longer. Discontinuation rates for toxicity were high and may limit the efficacy of the combination in the real world. Recent findings of primary prophylaxis against mucositis may help enhance continuation and dose maintenance (Beck et al. JCO 2016). Alternately, starting at a lower dose of Ev and increasing to tolerance may be worth exploring, as despite higher rates of dose modifications, our PFS rate was similar to that in BOLERO-2.

LH and adrenal tumor size correlate with insulin resistance in menopausal patients with adrenal incidentalomas and (possible) autonomous cortisol secretion

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Possibilities of using melatonin in gynecology

For the modern gynecologist, the problem of human aging acquires a special urgency – the tasks of preserving the reproductive potential of a woman, alleviating the symptoms of perimenopause come to the fore. Clinical manifestations of climacteric syndrome are very diverse and polysymptomatic and can vary from the presence of several symptoms to the development of the entire symptom complex. In the article the modern strategies of conducting women during menopausal transition and postmenopause are considered: hormone replacement therapy as the main method of correction and prevention of climacteric disorders, as well as auxiliary methods – phytoestrogens, anticonvulsants, antidepressants, agents acting on the autonomic nervous system, multivitamin complexes, plant extracts that are used more or less successfully in clinical practice.Melatonin preparations, analogues of one of the main endogenous adaptogens, are of particular interest in this series. This review describes the main effects of melatonin, its place in the complex treatment of the proliferative processes of the reproductive system, in particular, in the treatment of premenstrual syndrome, dysphoria, correction of sleep disorders in the perimenopause, its special role in the maturation of the follicle and ovulation. Melatonin is a universal natural adaptogen with a sleep effect, which is recommended by the National Consensus on the management of patients in menopause as a preparation of additional non-hormonal therapy. In the treatment of climacteric syndrome, it can be used at a dose of 1.5 mg 30 minutes before sleep for three months. It can be recommended as a monotherapy in the mild course of menopause and the prevalence of sleep disorders. If symptoms are more pronounced, melatonin should be combined with hormone replacement therapy.Synthetic analogue of melatonin is represented in Ukraine by drug Vita-Melatonin produced by PJSC “Kiev Vitamin Plant”. The drug allows to perform the task of increasing the effectiveness of therapy for various gynecological diseases. Not being selectively tropic to the reproductive system, melatonin promotes adaptation, improvement of the general condition and well-being of women in the climacteric period.

The Effect of Laser Acupuncture on Menopausal Symptoms

Objective: Acupuncture is frequently utilized to manage climacteric symptoms and other gynecological conditions. Laser acupuncture has the advantages of being noninvasive, reproducible, and convenient. This study sought to explore the effectiveness of laser acupoint stimulation in relieving symptoms associated with menopause. Methods: A randomized, double-blind, controlled study was conducted on 120 women diagnosed as menopausal patients (>1 year past last menstruation), aged 40 - 60 years with a Kupperman Menopause Index (KMI) equal or more than 15. women were randomized into Group A: Laser acupuncture (n=30), Group B: (HRT); Tibolone 2,5 mg/day (n=30) orally, Group C: Laser acupuncture and Tibolone 2,5 mg/day orally (n=30), Group D: Non interventional (self-care group) (n=30). Each patient was given a standard daily log and was required to record the frequency and severity of hot flashes and side effects of the treatment felt daily. The serum levels of follicle stimulating hormone (FSH), LH and E2 were detected before and after the treatment. Results: 120 women with postmenopausal symptoms were divided randomly into four equal groups; After the treatment and the follow-up, in (Group A) there was no significant difference regarding FSH, LH and E2 level before treatment and after treatment with LASER acupuncture, as regard (Group B); there was statistically significant difference before and after treatment concerning hot flashes of KMI and he levels of FSH, LH decreased significantly and the level of E2 increased significantly. Combined treatment using hormonal replacement therapy with Laser Acupoints (Group C) showed dramatic improvement in study subjects and the improvement was more than that in group B. There were no significant differences were found regarding self-care group on either frequency of hot flashes, FSH, LH and E2 level. Conclusions: Laser acupoints are effective and can be used as an alternative treatment to decrease the frequency and severity of postmenopausal hot flashes and postmenopausal symptoms especially if combined with Tibolone.

Is there a SERM in your menopause toolkit?

Over the past 3 decades, compounds called selective estrogen receptor modulators (SERMs) have been developed that block the estrogen receptor in some tissues (estrogen receptor antagonists) or stimulate the estrogen receptor in other tissues (estrogen receptor agonists). This Practice Pearl focuses on SERMs that clinicians can use for menopausal patients.

The Women's EMPOWER Survey: Identifying Women's Perceptions on Vulvar and Vaginal Atrophy and Its Treatment

IntroductionVulvar and vaginal atrophy (VVA) affects up to two thirds of postmenopausal women, but most symptomatic women do not receive prescription therapy. AimTo evaluate postmenopausal women's perceptions of VVA and treatment options for symptoms in the Women's EMPOWER survey. MethodsThe Rose Research firm conducted an internet survey of female consumers provided by Lightspeed Global Market Insite. Women at least 45 years of age who reported symptoms of VVA and residing in the United States were recruited. Main Outcome MeasuresSurvey results were compiled and analyzed by all women and by treatment subgroups. ResultsRespondents (N = 1,858) had a median age of 58 years (range = 45–90). Only 7% currently used prescribed VVA therapies (local estrogen therapies or oral selective estrogen receptor modulators), whereas 18% were former users of prescribed VVA therapies, 25% used over-the-counter treatments, and 50% had never used any treatment. Many women (81%) were not aware of VVA or that it is a medical condition. Most never users (72%) had never discussed their symptoms with a health care professional (HCP). The main reason for women not to discuss their symptoms with an HCP was that they believed that VVA was just a natural part of aging and something to live with. When women spoke to an HCP about their symptoms, most (85%) initiated the discussion. Preferred sources of information were written material from the HCP's office (46%) or questionnaires to fill out before seeing the HCP (41%).The most negative attributes of hormonal products were perceived risk of systemic absorption, messiness of local creams, and the need to reuse an applicator. Overall, HCPs only recommended vaginal estrogen therapy to 23% and oral hormone therapies to 18% of women. When using vaginal estrogen therapy, less than half of women adhered to and complied with posology; only 33% to 51% of women were very to extremely satisfied with their efficacy. ConclusionThe Women's EMPOWER survey showed that VVA continues to be an under-recognized and under-treated condition, despite recent educational initiatives. A disconnect in education, communication, and information between HCPs and their menopausal patients remains prevalent.Kingsberg S, Krychman M, Graham S, et al. The Women's EMPOWER Survey: Identifying Women's Perceptions on Vulvar and Vaginal Atrophy and Its Treatment. J Sex Med 2017;14:413–424.

Pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Practical messages from the EULAR guidelines.

Over the last few decades, reproductive medicine has observed an improvement in the management and outcome of pregnancy in connective tissue diseases, such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). However, pregnancy and related issues remain a challenge in these patients. In routine clinical practice, health professionals dealing with SLE and APS need to consider the numerous aspects of the reproductive life of their patients, such as pregnancy, family planning, fertility, contraception, cancer surveillance, and menopause. The new European League Against Rheumatism recommendations for women's health and family planning reflect the need for a novel approach to communication in the patient-physician relationship. Preconception counseling is essential to ensure optimal pregnancy outcomes through a careful risk stratification involving disease activity, organ involvement, autoantibody profile, use of drugs, and previous pregnancy outcomes, as well as to ensure better preventive and therapeutic strategies to limit complications. In patients with stable/inactive disease and low risk of thrombosis, adequate hormonal contraception and menopausal replacement therapy should be recommended. Assisted reproductive techniques can be safely used in these patients, but anticoagulation or low-dose aspirin (or both) should be added in those with positive antiphospholipid antibody titers. All menstruating women should be counseled on the possibility to preserve fertility with gonadotropin- ‑releasing hormone analogues if receiving alkylating agents. Strict clinical, serological, laboratory, and multidisciplinary monitoring during pregnancy is mandatory to early recognize and effectively treat disease flares or obstetric complications. Doppler ultrasonography and fetal biometry should be regularly performed, especially in the second and third trimesters. Physicians should recommend screening for cervical dysplasia related to human papillomavirus (HPV) infection, especially during immunosuppressive therapy, and HPV immunization can be used in women with stable/inactive disease.

Importance of Recognition of Osteoporosis and the Radiologic Diagnosis Using DEXA Technique

Objective: Osteoporosis is the most common bone disease in humans; It is widely recognized as an important public health problem because of the significant morbidity, mortality and costs associated with its complications. The main objective of this study is to assess the osteoporosis disease and bone mineral density (MBD) in adults and menopausal patients and to estimate that osteoporosis can be prevented, diagnosed and treated before any fracture occur. Methods: This study was conducted in order to an intense effort to better recognition and understanding of osteoporosis disease and the importance of the medical radiologic diagnosis to preventing of osteoporotic fractures, using radiologic tools Dual energy x-ray absorptiometry (DEXA). Population of the study including male and female patient’s age 18 years and older, whom underwent (DEXA) exam in period from September 2016 to March 2017. Results: The main results a proved that osteoporosis can be prevented, diagnosed and treated before any fracture occurs by using BMD test. The prevalent of osteoporosis reach 86 out of 136 scanned patients with DEXA with percentage (63.3%) with the score-2.5 or lower. Others results achieved that the big distribution an effected by osteoporosis were found in the elder age over 50 years. The results also achieved the common risk factors associate with postmen pause with percentage of 43.0% and the common patient’s risk of fracture occur in the lumber spine by percentage of 45.4% a according to their T score. Conclusion: Although for many years there was awareness of the morbidity and mortality associated with fragility fractures, real progress only came with the ability to diagnose osteoporosis before fractures occur.

Effects of Group Counseling on Self-care Behaviors in Menopausal Women with Diabetes.

ObjectivesDiabetes is a chronic disease which is common in menopause period. Performing self-care behaviors is effective method for control of diabetes. This study aimed to investigate the effect of counseling on self-care behaviors in menopause diabetes women in 2016 in Hamadan, Iran.MethodsIn this study, 80 menopausal women were randomly selected and allocated to the experimental and control groups (40 per group). Data collected by a questionnaire included of demographic information, self-care behaviors, fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c). In the experimental group, training program was run during four sessions in the form of weekly group consulting sessions. During this period, the control group only received routine cares. Three months after intervention (group consultation) self-care behaviors, FBS and HbA1c were compared between two groups. Data were analyzed using SPSS 16 software.ResultsThe self-care score in the experimental group increased from 49.6 ± 12.2 before the intervention to 66.6 ± 9.3 after the intervention (P < 0.05). Also in the control group average of self-care score changed from 57.6 ± 11.5 to 62.0 ± 11.6 (P < 0.05). Three months after the group consultation, there was a significant difference between two groups in the dimensions of diet (P = 0.013), exercise (P = 0.009) and foot care (P < 0.001). In the experimental group, FBS decreased from 148.8 ± 62.4 mg/dL to 128.9 ± 46.3 mg/dL. Also, HbA1c changed from 7.2 ± 1.8 g/dL to 6.8 ± 1.6 g/dL three months after intervention (P = 0.058). No significant changes were observed in FBS and HbA1c in the control group.ConclusionsThe results showed that group counseling promoted self-care behaviors and metabolic indices in menopausal diabetic patients.

Therapeutic strategies related to ovarectomy associated with histerectomy for benign conditions

Introduction. Patients undergoing total hysterectomy for benign uterine pathology face a controversial decision of bilateral ovariectomy. Studies show that most patients feel incompletely informed about their therapeutic options. Material and methods. We have reviewed international medical databases with randomized studies, meta-analysis of current re­com­mendations and trends regarding histerectomy for benign uterine pathology and associated ovariectomy. Results. Randomized studies that included patients in the last 15 years who underwent total hysterectomy for benign pathology showed a distinct approach re­gar­ding the annexes. A series of meta-analyzes in the United States reported a 3.6% yearly decline in bi­la­teral annexectomy, from 49.7% in 2001 to 33.4% in 2011. It was standardized that patients with total hys­te­rectomy benefit from bilateral pre-menopausal sal­pin­gectomy for ovarian neoplasm prophylaxy. Also, pa­tients with familial risk of breast or ovarian neoplasia re­quire bilateral anexectomy in premenopause. The the­ra­peutic attitude is individualized in menopausal pa­tients without genital neoplasm associated risk. Conclusions. It is recommended to conserve ovaries in premenopausal patients at low risk for ovarian or breast cancer to avoid cardiovascular and sexual dys­function. For menopausal patients aged over 65 years, bilateral ovariectomy does not have benefits on cardiovascular disease, hip fracture or sexual function, which is why it is required to be associated with total hysterectomy.

Implementing a Life Cycle Approach through Establishment of a Multipurpose Behavior Therapy Room in PGIMER, Chandigarh for Enhancing the Fitness Level of Women

ABSTRACT Introduction In India, women in their natural role as mothers, sisters, wives, and daughters have been accepted as the principal providers of good health to their families and indirectly to the community. Yet, when it comes to their own health, it receives low priority. Health and fitness of women is compromised by gynecological morbidities that they consider as ‘normal' and part of their destiny. For example, in dysmenorrhea, girls remain grounded for 3 to 4 days. Uterine prolapse and urinary leakage compromise quality of women's life. Many of these problems of women can be resolved by nonmedicinal interventions. Therefore, every woman should have the opportunity to learn about the self-care of problems they experience. However, the doctors in the outpatient departments, particularly Obstetrics and Gynecology (OPG–OPD) are usually overworked to explain this to patients. Objective To document the feasibility and impact of instituting a health promotion orientation package in OPG–OPD in an apex hospital of North India. Materials and methods A health promotion orientation package of services was instituted in OPG–OPDs in an apex hospital of north India through a multipurpose behavior therapy (MPBT) room in December 2012. After referral from main OPD, patients of pregnancy, infertility, prolapse, urinary incontinence (UI), menopause, and dysmenorrhea were advised nonmedicinal interventions, such as dietary modifications, lifestyle changes, and simple exercises/yoga. Unlike main OPG–OPD, here patients were attended along with their husbands and other family members. Here patients shared their queries without hesitation. Patients were also given booklets (available in Hindi, English, Punjabi) and other IEC material on related problems free of charge. Results Favorable results of nonmedicinal interventions were reported. Around 5000 patients were successfully managed through this approach in three years. Out of 100 menopausal patients referred to the MPBT room, 64 were successfully followed up. Among 759 UI and prolapse of pelvic organs patients visiting the room, 66% reported total relief in symptoms and 26% patients reported partial relief after following behavior therapy instructions. Around 3000 antenatal care patients counselled reported relief in symptoms and satisfaction with the quality of counselling. They were also happy that they are being listened to patiently. Patients of polycystic ovarian disease, infertility, and dysmenorrhoea were also advised simple exercises, dietary changes, and lifestyle modifications. Conclusion Establishing a counseling room/MPBT room in hospital, OPDs has a potential to help women cope better with the issues related to their health. Replication of this model in other medical colleges will also help in reducing the load on doctor while simultaneously enhancing patient satisfaction. How to cite this article Sharma R, Dhaliwal LK, Suri V, Kaushal P, Singhal N, Rana AK, Singh AJ. Implementing a Life Cycle Approach through Establishment of a Multipurpose Behavior Therapy Room in PGIMER, Chandigarh for Enhancing the Fitness Level of Women. J Postgrad Med Edu Res 2017;51(3):115-122.

Chemotherapy Induced Amenorrhea in Women Treated with Chemotherapy for Breast Carcinoma in Yalgado Ou&amp;#233;draogo Teaching Hospital in Ouagadougou, Burkina Faso

Background: We conducted this study to identify factors associated with the onset and reversibility of chemotherapy-induced amenorrhea in Yalgado Ouedraogo Teaching Hospital of Ouagadougou. Methods: A historical cohort study was performed and covered the period from 1 January 2014 to 31 July 2015. No menopausal patients managed for a histologically confirmed breast carcinoma and having benefited from chemotherapy were included in the study. Logistic regression analysis was used to determine the factors associated with the occurrence of chemotherapy-induced amenorrhea as well as its reversibility. Results: Seventy patients were included. The mean age was 38.5 years. Thirteen patients were obese and 19 (40.4%) had their menarche after age of 15 years. Adjuvant chemotherapy was administered to 31 patients while 12 had received neoadjuvant chemotherapy. Sequential chemotherapy with an anthracycline and a taxanetherapeutic protocol was the most used. Forty-seven patients had a chemotherapy-induced amenorrhea. The risk of having a chemotherapy-induced amenorrhea increases by 25% for each additional year of age at diagnosis of cancer (p = 0.0001). Obesity and menarche after age 15 were found to be protective factors. After adjusting these variables together, age, obesity, and age at menarche were factors independently associated with the occurrence of the chemotherapy-induced amenorrhea. The reversibility was effective in 11 cases (37.9%) and especially concerned patients younger than 40 years (p = 0.03). Conclusion: Age is the primary risk factor. Reliable markers of ovarian function need to be developed to better select fertility conservation protocols.

The ROS-mediated activation of STAT-3/VEGF signaling is involved in the 27-hydroxycholesterol-induced angiogenesis in human breast cancer cells

Breast cancer (BC) is the leading cause of cancer-related mortality among females worldwide, and angiogenesis plays a crucial role in BC progression. 27-Hydroxycholesterol (27HC) is an endogenous selective estrogen receptor modulator, which promotes the growth and metastasis of BC. Here, we further found that, 27HC improved the angiogenic ability of BC in a VEGF-dependent manner. For the molecular mechanisms, on one hand, as an estrogen-like factor, 27HC enhanced the expression of VEGF by the classical ERα/VEGF signaling in ER-positive BC cells; on the other hand, in both ER-positive and ER-negative BC cells, 27HC enhanced the generation of ROS, which in turn activated the STAT-3/VEGF signaling in an ER independent manner. Either blocking the generation of ROS or knockdown of STAT-3 attenuated the 27HC-induced autocrine of VEGF and angiogenesis. These findings not only suggested a mechanism whereby 27HC enhanced the angiogenesis, but also helped to recognize the 27HC as a novel potential harmful factor in BC, especially in the menopause patients.

Why do we need psychosomatic care for menopausal patients?

Why do we need psychosomatic care for menopausal patients?

The use of Hormone Therapy after Surgery for Endometriosis: An Analysis

Introduction Estrogen dependence is considered central to the development and progression of endometriosis, which is often viewed as a disease of the premenopausal years, normally regressing after menopause. However, there have been several reports of postmenopausal endometriosis occurring with and without the use of hormone therapy (HT). Objective This review aimed to answer the question of whether it is prudent to offer HT for women with a past history of surgical endometriosis. What are the risks? What type of HT should be given? Methods A review of the medical literature available in Pubmed, EMBASE, Google scholar, Lilacs, Medline and Cochrane Library databases was performed by selecting articles published in the last ten years, written in any language. The keywords used were endometriosis, menopause, and hormone therapy. In all, 36 articles were found from 2006 to 2016, and their potential relevance to this review was examined. We found 20 literature reviews, 2 retrospective studies, 2 randomized controlled trials and 12 case reports. Results There is some risk of endometriosis recurrence after the menopause in patients who receive HT; particularly with estrogen-only therapy. Conclusions The existing literature is inadequate to firmly answer our questions. However it is clear that some risk of recurrence exists. Nevertheless, it is suggested that it is reasonable to prescribe HT to women with a history of surgical endometriosis. Recurrences may occur even in the absence of using HT. It is suggested that in women with severe disease the use of estrogen plus progestogen is safer than estrogen alone. Malignant transformation may occur 1% of the time and may be of greater concern with using estrogen alone, warranting close surveillance in all women.

Microarray gene expression analysis of uterosacral ligaments in uterine prolapse

ObjectivesPelvic organ prolapse (POP) is a major health problem that impairs the quality of life with a wide clinical spectrum. Since the uterosacral ligaments provide primary support for the uterus and the upper vagina, we hypothesize that the disruption of these ligaments may lead to a loss of support and eventually contribute to POP. Design and methodsIn this study, we therefore investigated whether there are any differences in the transcription profile of uterosacral ligaments in patients with POP when compared to those of the control samples. Seventeen women with POP and 8 non-POP controls undergoing hysterectomy for benign conditions were included in the study. Affymetrix® Gene Chip microarrays (Human Hu 133 plus 2.0) were used for whole genome gene expression profiling analysis. ResultsThere was 1 significantly down-regulated gene, NKX2-3 in patients with POP compared to the controls (p=4.28464e-013). KIF11 gene was found to be significantly down-regulated in patients with ≥3 deliveries compared to patients with <3 deliveries (p=0.0156237). UGT1A1 (p=2.43388e-005), SCARB1 (p=1.19001e-006) and NKX2-3 (p=2.17966e-013) genes were found to be significantly down-regulated in the premenopausal patients compared to the premenopausal controls. UGT1A1 gene was also found to be significantly down-regulated in the post menopausal patients compared to the postmenopausal controls (p=0.0005). ConclusionThis study provides evidence for a significant down-regulation of the genes that take role in cell cycle, proliferation and embryonic development along with cell adhesion process on the development of POP for the first time.

EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome

ObjectivesDevelop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).MethodsSystematic review of evidence followed by modified Delphi method to compile questions, elicit...

Assessing Response of Perimenopausal Abnormal Uterine Bleeding after Treatment

Background: Abnormal Uterine Bleeding (AUB) is caused by either Organic lesions such as genital tract infections, tumors, adenomyosis, pregnancy and its complications, systemic disorders or Dysfunctional Uterine Bleeding (DUB). In women ≥ 40 years, and certainly in menopausal patients, it mandates evaluation to confirm benign nature of the problem, by ruling out endometrial carcinoma, so that medical treatment or conservative surgery can be offered and unnecessary radical surgery can be avoided. Objectives: Categorizing of Perimenopausal women with AUB for further management according to histo-pathological report and to study the efficacy of medical management (Mainly Progestins). Material and Methods: A total of 60 patients were selected who presented with symptoms of abnormal uterine bleeding at perimenopausal age group (40-54 years). Histopathological results were evaluated after obtaining endometrial tissue and patients are treated accordingly. Treatment response was assessed and tabulated. Statistical Analysis has done by danielsoper.com using chi-square test. Results: Abnormal uterine bleeding was mostly seen in multiparous women with parity >2 about 63.3%. Among menstural irregularities, 45% of cases presented with menorrhagia. Most of the patients were diagnosed as Anovulatory DUB about 60%. Out of 11 hyperplasia patients, 2 (18.1%) patients diagnosed as complex hyperplasia without atypia. No progression of AUB has seen after MPA treatment among all patients with endometrial hyperplasia. Conclusion: Cyclical oral progestogens are effective in regulating and reducing irregular bleeding due to Oligo/Anovulation. Majority of the cases of endometrial hyperplasia without atypia can be successfully treated with progestogen therapy.

Evaluation of postoperative sexual function in patients after trans-obturator-tape operation

Introduction: In this study, we aimed to evaluate postoperative se-xual function of patients, who had undergone colporraphy anterior and transobturator tape operation due to cystocele and stres urinary incontinence. Materials and Methods: In our study, 52 patients with cystocele and stress urinary incontinence that were admitted to Dicle University, School of Medicine, Department of Obstetrics and Gynecology between January 2009 and January 2014, were included in the study. Patients with previous hysterectomy, patients who had rectocele repair during operation, patients in menopause were excluded from the study. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 before and after under going surgery. Results: Mean age of the patients in our study was 42.04 ± 7.50, average body mass index of the patients was 30.1 ± 3.7 kg/m2. Average follow-up time was 31.5 ± 11.3 months. 22 (42.3%) patients did not completely recovery the postoperative complaints. 2 (3.8%) patients had increased postoperative complaints. The positive correlation between postoperative complaints with dyspareunia was observed (r= 0.355 **p: 0.010). 5 (9.6%) patients developed postoperative complications. These complications, urinary comfortable inability in 2 (%3.8) patients, mesh erosion in 1(%1.9) patient, developed de novo urinary incontinence in 2 (%1.9) patients. The total result according to Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 was observed significant improvement in sexual function (p= 0.000). Conclusion: Urinary incontinence negatively affects the sexual life of women. We observed improvement in sexual function of women that had went transobturator tape operation for urinary incontinence.

Hyaluronic acid injection as functional adjuvant therapy in menopausal vulvovaginal symptoms - preliminary report

Objective: Aim of the study is to evaluate the role of vulvovaginal injection of a cross-linked HA in patients surgically treated for cancer affected by vulvovaginal symptomatology. Methods: 23 post menopausal patients treated for endometrial cancer with vulvovaginal symptoms were treated. We performed multiple spots injections of 1ml HA with 30Gx1/2 in needle (T1), repeated after 3 months (T2). Self-evaluation using a visual analog scale and investigators evaluation were recorded one month after each treatment. Results: After T1, improvement in vulvovaginal dryness, vulval itching, burning and dyspareunia were reported. At T2, further reduction of symptoms. No side effects were recorded. Conclusions: HA injection is a new, effective adjuvant therapy of postmenopausal vulvovaginal symptoms (above in women after cancer, with hormonal treatment not recommended).