Menopausal Patients Research Articles

Influence of the Onset of Menopause on the Risk of Developing Alzheimer's Disease.

Menopause is a natural phase marked by the permanent cessation of menstrual cycles, occurring when the production of reproductive hormones from the ovaries stops for at least 12 consecutive months. Studies have suggested a potential connection between menopause and a heightened risk of developing Alzheimer's disease (AD), underscoring the significant role of reduced estrogen levels in the development of AD. Estrogen plays a crucial role in brain metabolism, influencing energy metabolism, synaptic plasticity, and cognitive functions. The cognitive benefits associated with hormone replacement therapy (HRT) are believed to be linked to estrogen's neuroprotective effects, either through direct action on the brain or indirectly by improving cardiovascular health. Extensive literature supports the positive impact of estrogen on brain cells. While the physiological effects of estrogen on the brain have not been consistently replicated in clinical trials, further research is crucial to provide more definitive recommendations to menopausal patients regarding the influence of HRT on AD. This review aims to comprehensively explore the interplay between menopause and AD, as well as the potential of HRT to mitigate cognitive decline in post-menopausal individuals.

Age-related characteristics of the content and activity of certain components of the blood fibrinolytic system in cases of uterine cancer

Uterine cancer (UC) is the third most common cancer in women in Russia. Knowledge of age-specific features of the fibrinolytic system in patients with UC can be useful in terms of improving its pathogenetic therapy. Aim of the study was to investigate the peculiarities of the content and activity of some components of the fibrinolytic system in the blood of UC patients of different age groups. Material and methods. 30 healthy women (donors) and 56 patients with uterine cancer T1a-2N0M0, adenocarcinoma G1–G3 were divided into subgroups according to age: reproductive, perimenopause and menopause. ELISA of urokinase (u-PA), its receptor (u-PAR) and its inhibitor (PAI-1), tissue-type plasminogen activator (t-PA) content were performed in blood collected before treatment. Results. In reproductive UC patients, inhibitor u-PA (PAI-1) activity increased 14-fold (hereinafter the difference is statistically significant, p < 0.05) and content increased 2.9-fold, while receptor u-PA (u-PAR) level decreased 1.7-fold compared to reproductive donors. Perimenopausal UC patients showed a 3.3-fold increase in PAI-1 content and a 6.3-fold increase in PAI-1 activity compared to perimenopausal donors, t-PA concentration decreased 1.3-fold relative to donors and was 1.9-fold lower than in reproductive UC patients. In menopausal patients with UC, the activity and content of PAI-1 enhanced 5.5-fold and 4.5-fold, respectively, compared to donors. Additionally, they were 2.1-fold and 1.2-fold lower than in reproductive UC patients. The activity of u-PA increased 2.6-fold, reaching the values of reproductive UC patients. The activity of t-PA was 1.3-fold higher than in donors, but did not differ from the activity in other RTM patients, while the level of t-PA occupied an intermediate position between the corresponding indices in young UC patients (it was 1.4-fold lower) and perimenopausal UC patients (it was 1.4-fold higher). Conclusions. The development of UC is accompanied by an imbalance of components of the fibrinolytic system in the blood, depending on the age of women, with a minimum spectrum of changes in the indicators in reproductive patients and maximum - in menopause patients, which indicates the pathognomonicity of these factors in PTM and requires an individual approach to the management of such patients.

Effect of Menopausal Hormone Therapy on Cellular Immunity Parameters and Cytokine Profile.

A woman's entry into the menopause period is associated with a number of changes in the body, including those related to the immune system. Immune aging is a consequence of age-related changes in the function of immune cells and the composition of their subpopulations. Menopausal hormone therapy (MHT) is thought to partially neutralize the negative effects of aging on the immune system. We aimed to evaluate the effect of oral and transdermal MHT on cellular immunity parameters and cytokine profile in menopausal women. Fifty peri- and early postmenopausal women were included. Immune parameters were assessed by flow cytometry and multiplex analysis. We showed that different routes of MHT administration led to significant changes in monocyte phenotype and a decrease in monocyte chemoattractant protein-1 (MCP-1) level in menopausal patients. In addition, oral MHT resulted in a significant increase in NK and B cells. A significant increase in the number of T-helper cells was observed with transdermal MHT. In addition, oral MHT resulted in a significant decrease in IL-1β level. We have demonstrated for the first time that oral therapy, in contrast to transdermal therapy, has a more pronounced effect on specific immune subpopulations of blood cells in menopausal women. This effect is likely to be responsible for its anti-aging properties in the context of immune aging as well as its protective effects in infectious diseases. Perhaps testing blood immune parameters or assessing immune status before prescribing MHT could become a routine step in clinical practice before choosing a patient management strategy.

The Association of Systemic and Mandibular Bone Mineral Density in Postmenopausal Females with Osteoporosis.

Background/Objectives: Osteoporosis is a common general disease that mostly affects the skeletal system, including the jawbone. There is a link between systemic and mandibular osteoporosis. This study aimed at assessing the association between systemic (lumbar spine L1-L4, femoral neck, total hip) bone mineral density (BMD) and mandible BMD sites in Romanian postmenopausal females. Methods: A total of 97 menopausal patients were studied, 62 with osteoporosis and 35 females with no osteoporosis. For each patient, dual-energy X-ray absorptiometry (DXA) assessments of BMD in the mandible, proximal femur, total hip, and lumbar spine (L1-L4) were performed. Mandibular measurements were performed using the distal forearm software, followed by manual analysis after the bone contour was defined in each case. Results: Comparing the osteoporosis and control groups, there were significant differences in BMD at each examined location. The mandibular BMD (1.125 ± 0.181506 g/cm2) in the osteoporosis group was considerably smaller than in the control group (1.35497 ± 0.244397 g/cm2). Correlations between the BMD at different sites were significant: lumbar spine and femoral neck (r = 0.738, p < 0.0001), lumbar spine and total hip (r = 0.735, p < 0.0001), lumbar spine and mandible (r = 0.506, p < 0.0001), femoral neck and total hip (r = 0.891, p < 0.0001), femoral neck and mandible (r = 0.482, p < 0.0001), and total hip and mandible (r = 0.466, p < 0.0001). Conclusions: There were correlations between mandible BMD and lumbar spine, femoral neck, and total hip BMD, suggesting that osteoporosis affects mandibular bone density. BMD assessments at common locations may help predict mandibular BMD and the probability of osteoporosis.

Injectable Biomimetic Hydrogel Constructs for Cell-Based Menopausal Hormone Therapy with Reduced Breast Cancer Potential.

Hormone replacement therapy (HRT) has been a primary method in menopausal women and patients with ablated ovaries, but safety has been a concern. Cell-based HRT has emerged as an alternative approach without side effects causing pharmaceutical HRT via 3-dimensionally engineered constructs layering ovarian hormone-producing cells. In this study, we applied micro-sized ovarian cell-laden hydrogel beads as an approach to cell-based HRT using a minimally invasive method in the menopausal rat model. Here, we constructed GC/TC-laden microbeads (GTBs; GC, granulosa cell; TC, theca cell) that allow crosstalk between endocrine cells, encapsulating multiple beads for the figuration of the original ovary. We assessed the ovarian hormone production function of GTB through invitro culture for 90 days. We applied it to a menopausal rat model and confirmed that GTB-injected rats restored their endocrine function, leading to the regeneration of the thinned endometrium and the maintenance of regular estrous cycles in some individuals. Additionally, it was observed to alleviate menopausal symptoms, including body weight gain and osteoporosis. Notably, the GTB-injected rats did not show mammary gland hyperplasia observed in the pharmaceutical HRT groups and exhibited fewer p53- and KI67-positive and an increase in phosphatase and tensin homolog-positive mammary gland epithelial cells compared to pharmaceutical hormone-treated rats. These results suggest that GTB-based HRT could present a lower risk of breast cancer compared to conventional pharmaceutical-HRT use. Our study highlights the potential of cell-based HRT using an injectable artificial ovary, offering a safer alternative for women requiring HRT.

Behavioral Therapy in Post Menopause Patients with Urine Incontinence Problems – Systematic Review

A journal search was carried out used the keywords "Postmenopausal women AND Cognitive Behavioral therapy AND urinary incontinence AND meta analysis" to collect relevant articles published in the last 10 years from five databases (ProQuest, PubMed, Science Direct, Ebsco and Google Scholar. Criteria inclusions were: nurses, patients, urinary incontinence, intervention, full text articles, studies that focused on nursing assessment, and written in English. Six journal articles were selected and analyzed using PICO. Results, Non-pharmacological therapy with a behavioral therapy approach with the application of MBSR (Mindfulness based stress reduction) and HEP (Health Enhancement program) as well as Yoga Therapy &amp; PFMT (Pelvic Floor Muscle Training) exercises combined with light physical exercise such as walking, cycling, swimming. for 30 minutes as well as diet modifications can help postmenopausal patients with urinary incontinence. Conclusion: The application of MBSR (Mindfulness based stress reduction) and HEP (Health Enhancement program) as well as Yoga Therapy &amp; PFMT (Pelvic Floor Muscle Training) exercises combined with light physical exercise such as walking, cycling, swimming for 30 minutes and diet modification can reduces the number of episodes of urine leakage and improves all types of urinary incontinence problems as well as quality of life and can be beneficial for sexual function in post menopausal women.

P-422 Modified natural cycle does not increase live birth rates compared to hormone replacement therapy: success rates and perinatal outcomes of 1.354 single euploid blastocyst cryotransfers

Abstract Study question Frozen euploid single blastocyst transfer in modified natural cycle (mNC) increases success rates, improving obstetric outcomes compared to hormone replacement therapy (HRT) protocols? Summary answer Elective euploid single-blastocyst transfer (eeSBT) in mNC did not show higher success rates nor better obstetric and perinatal outcomes compared to HRT protocols What is known already eeSBT has become the gold standard for clinical trials in assisted reproduction, increasing sample homogeneity and reducing bias; when choosing endometrial preparation protocols for thawed embryo transfers, recent clinical studies have reported the superiority of mNC over HRT in terms of delivery and miscarriage rates, obstetrical and perinatal outcomes, treatment safety and costs; however, few data are available on eeSBT ≥3BB (Gardner score) cryotransfers comparing both protocols Study design, size, duration Retrospective single-centre comparative clinical study, including 1.354 eeSBT (≥3BB, Gardner score) between Jan-2018 and Dec-2022: 1.109 (82%) in HRT and 245 (18%) in mNC. HRT and mNC groups were homogeneous for egg donor’s age (28,9±5,8 yo Vs 30,6±5,9 yo), recipient’s age (41,7±5,0 yo Vs 39,5±4,5 yo), body mass index (22,6±4,8 Vs 23,1±3,4) severe male factor (3,5% Vs 7,3%), the need for sperm donation (30,4% Vs 27,8%), and the average throphoectoderm embryo quality (A = 32,1% Vs A = 31,8%) Participants/materials, setting, methods We studied the clinical, obstetric and perinatal outcomes of the 1.354 eeSBT performed, comparing HRT and mNC cycles for: pregnancy rate, miscarriage rate, live birth rate, twin pregnancy rate, severe preeclampsia, preterm birth rate (&amp;lt;37, &amp;lt;35, &amp;lt;32 and &amp;lt;28 weeks) and neonatal weight. We used Chi-square test to compare groups (p &amp;lt; 0,05). Main results and the role of chance There were no statistically significant differences between HRT Vs mNC protocol when comparing pregnancy rates (63,8% Vs 62,0%, p = 0,61), miscarriage rates (15,3% Vs 15,8%, p = 0,87) and live birth rates (44,6% Vs 46,1%, p = 0,67). The were no twin pregnancies in the mNC group, and only 5 (1%) in the HRT group. There we no significant differences in the severe preeclampsia rate, even if it doubled in the HRT group compared to mNC (1,8% Vs 0,9%, p = 0,48). Preterm, major and extreme preterm birth rates were higher in HRT but comprable to the mNC group: &amp;lt;37 weeks (7,7% Vs 6,2%, p = 0.59) &amp;lt; 35 weeks (2,8% Vs 1,8%, p = 0,59) &amp;lt;32 weeks (1,2% Vs 0,9%, p = 0,77) &amp;lt;28 weeks (0,4% Vs 0,9%, p = 0,51). There were no significant differences in neonatal weight (3287 + 477g HRT Vs 3271 + 512g in mNC, p = 0,88). Limitations, reasons for caution The HRT group included 84 patients in menopause (confounding factor), but when excluding them in a preliminary study results didn’t change. We decided to include eeSBT both from egg donation and own patient’s egg IVF treatments, after verifying that there were no significant differences in clinical results between both groups. Wider implications of the findings In eeSBT, the use of modified natural cycle could be encouraged because of its better cost-effectivenes and patient’s comfort. This study reports a non-significant trend for higher success rates in mNC compared to HRT; further prospective trials should be promoted to give accurate advice to patients undergoing thawed embryo transfers. Trial registration number Not Applicable

O-060 Ovarian rejuvenation - fact or fiction?

Abstract Ovarian aging is a reality and a physiological process which occurs with age resulting in to premature depletion of eggs . POI occurs in approximately 1% of the women who have not reached 40 years of age. The frequency is roughly 4–8% in women experiencing secondary amenorrhea and 10–28% in cases of primary amenorrhea .The prevalence of POI was higher in countries with medium and low human development indexes . . We analysed 1000 infertile patients of less than 40 years . 110 patients had AFC less then 2 and opted for egg donor program . cycle cancellation was due to nonavailability of eggs on OPU was seen in 4% cases in our analysis . Presence of oogonial stem cells (OSCs) in the ovarian cortex , hinting at a possibility of therapeutic stimulation of post-natal folliculogenesis in subfertile women it is postulated that ovarian aging or insufficiency could be reversed if OSCs are provided a healthy environment. Ovarian rejuvenation therapy is a new and innovative approach to enhancing fertility in this group of patients . It is often carried out using platelet-rich plasma (PRP) or stem cell therapy. Ovarian Rejuvenation with Stem cells is also called Autologous Stem Cell Transplant in the Ovary (ASCOT). PRP is having lots of advantages like therapeutic effect, cost effectiveness, ease of isolation and autologous nature. However some drawbacks are also there like inconclusive efficacy and lack of understanding of mechanism of action, lack of RCT /fundamental research . regenerative processes organized by platelet cytokines in somatic cells are poorly understood . PRP infusion may only be an appropriate treatment for select ovarian disorders. perimenopausal women and women deemed to be POR benefitted the most from the treatment, more so than POI and menopausal patients . platelet cytokines are ligands that attach to cell membrane receptors—not the nucleus . no case of tumorogenic activity observed in any clinical context so far . Further reassurance comes from work in other human tissue treated with PRP, where accelerated growth of healthy cells was noted without triggering malignant transformation . 13 registered clinical trials investigating the effect of PRP on ovarian rejuvenation .few of these trials describe the inclusion of appropriate PRP controls. It is only from well-controlled trials, built on detailed mechanistic understanding that we can clarify the platelet-mediated effects of PRP therapy in ovarian rejuvenation and folliculogenesis. The PRP injections into the ovaries are safe, productive, and a natural treatment that may help women with premature ovarian insufficiency to give birth to their own child . Stem cell therapy is attracting attention in the field of regenerative medicine and is advancing rapidly. Many recent studies have applied stem cell therapy to treat reproductive system diseases; however, data are not yet available as to whether this therapy shows enhanced therapeutic effects. It is evident that stem cell therapies have potential in treating POI. Stem cells and their exosomes, including content such as miRNAs, show positive effects in enhancing and restoring various aspects of ovarian function, such as folliculogenesis, the GC apoptosis rate, vascular formation, and genetic stability. Among the 10 clinical trials in the NIH database, only 4 have been completed; the rest are ongoing, recruiting and/or active. Research subjects have been selected by strict standards. Although there are several active ongoing clinical trials for POI using stem cell-based therapeutics, there are restrictions in each country regarding ethical and clinical concerns from the health-care community .Potential of stem cell therapies in treating POI still needs further research and clinical results.

P-643 Menopause should not be considered a confounding factor in endometrial preparation protocol’s comparative clinical trials: a retrospective cohort study with 1.109 euploid single embryo transfers

Abstract Study question Does menopause have an impact on obstetric and perinatal outcomes when performing elective euploid single-blastocyst transfers (eeSBT) in a hormonal replacement treatment (HRT) protocol? Summary answer eeSBT in a non-menopause elective HRT group(eHRT) did not show higher success rates nor better obstetric and perinatal outcomes compared to a menopause HRT group(mHRT). What is known already Menopause has been suggested to be a confounding factor in clinical trials when comparing the results and success rates for endometrial preparation in modified natural cycle (mNC) Vs HRT: including menopause patients could lead to selection bias seen that they can never be included in the mNC group. Few data are available on eeSBT ≥3BB (Gardner score) cryotransfers comparing obstetric and perinatal results between eHRT and mHRT, to have the opportunity to include them all in further comparative trials, with a low bias risk. Study design, size, duration Retrospective single-centre comparative study, including 1.109 eeSBT (≥3BB, Gardner score) between Jan-2018 and Dec-2022: 1.025 (92,4%) in eHRT and 84 (7,6%) in mHRT. The eHRT and mHRT groups were homogeneous for egg donor’s age (29,1±5,9 yo Vs 25,8±4,1 yo) recipient’s age (41,4±4,9 yo Vs 44,9±4,7 yo), body mass index (22,6±4,7 Vs 22,6±5,3) severe male factor (3,5% Vs 3,6%), the need for sperm donation (30,0% Vs 35,7%), and the average throphoectoderm embryo quality (A = 32,5% Vs A = 29,8%). Participants/materials, setting, methods We studied the clinical, obstetric and perinatal outcomes of the 1.109 eeSBT, comparing eHRT and mHRT groups for: pregnancy rate, miscarriage rate, live birth rate, twin pregnancy rate, severe preeclampsia, preterm birth rate (&amp;lt;37, &amp;lt;35, &amp;lt;32 and &amp;lt;28 weeks) and neonatal weight. We used Chi-square test and T-Test to compare groups (p &amp;lt; 0,05). Main results and the role of chance There were no statistically significant differences between eHRT and mHRT groups when comparing pregnancy rates (63,7% Vs 64,3%, p = 0,92), miscarriage rates (15,6% Vs 11,1%, p = 0,053) and live birth rates (44,3% Vs 48,8%, p = 0,42); no significant differences were found in the severe preeclampsia rate(2,0 Vs 1,2, p = 0,84), nor in the twin pregnancy rate (0,9 Vs 2,4, p = 0,34) even if it almost tripled in the mHRT group. Preterm, major and extreme preterm birth rates were comprable between eHRT and mHRT groups: &amp;lt;37 weeks (9,9% Vs 4,9%, p = 0,29) &amp;lt; 35 weeks (3,3% Vs 0, p = 0,23) &amp;lt;32 weeks (1,3% Vs 0, p = 0,46) &amp;lt;28 weeks (0,2% Vs 0, p = 0,76). There were no significant differences in neonatal weight (3292 + 481g Vs 3.135 + 419g, p = 0,052). Limitations, reasons for caution In a preliminary study, we compared and additional 245 eeSBT in mNC with the HRT group, and no significant differences in obstetric or perinatal outcomes were reported when including or excluding the mHRT sub-group. Wider implications of the findings In eeSBT, the eHRT group did not report better obstetric nor perinatal results compared to the mHRT group; further prospective clinical trials comparing mNC Vs HRT should not consider menopause as a major confouding factor, when using eeSBT. Trial registration number Not Applicable

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

BackgroundThe purpose of this study was to predict the risk factors for residual lesions in patients with high-grade cervical intraepithelial neoplasia who underwent total hysterectomy.MethodsThis retrospective study included 212 patients with histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2-3) who underwent hysterectomy within 6 months after loop electrosurgical excision procedure (LEEP). Clinical data (e.g., age, menopausal status, HPV type, and Liquid-based cytology test(LCT) type), as well as pathological data affiliated with endocervical curettage (ECC), colposcopy, LEEP and hysterectomy, were retrieved from medical records. A logistic regression model was applied to estimate the relationship between the variables and risk of residual lesions after hysterectomy.ResultsOverall, 75 (35.4%) patients had residual lesions after hysterectomy. Univariate analyses revealed that positive margin (p = 0.003), glandular involvement (p = 0.017), positive ECC (p < 0.01), HPV16/18 infection (p = 0.032) and vaginal intraepithelial neoplasia (VaIN) I-III (p = 0.014) were factors related to the presence of residual lesions after hysterectomy. Conversely, postmenopausal status, age ≥ 50 years, ≤ 30 days from LEEP to hysterectomy, and LCT type were not risk factors for residual lesions. A positive margin (p = 0.025) and positive ECC (HSIL) (p < 0.001) were identified as independent risk factors for residual lesions in multivariate analysis.ConclusionsOur study revealed that positive incisal margins and ECC (≥ CIN2) were risk factors for residual lesions, while glandular involvement and VaIN were protective factors. In later clinical work, colposcopic pathology revealed that glandular involvement was associated with a reduced risk of residual uterine lesions. 60% of the patients with residual uterine lesions were menopausal patients, and all patients with carcinoma in situ in this study were menopausal patients. Therefore, total hysterectomy may be a better choice for treating CIN in menopausal patients with positive margins and positive ECC.

(070) SUCCESSFUL TREATMENT OF NEUROPROLIFERATIVE VESTIBULODYNIA IN MENOPAUSAL PATIENTS

Abstract Introduction As pain symptoms from neuroproliferative vestibulodynia (NPV) often arise at initial attempt at tampon insertion or penetrative sex, most vestibulodynia patients present in their 20’s or 30’s. Consequently, individuals who reached this age prior to 2004-when Dr. Bornstein and colleagues delineated the excess mast cell and nerve pathology-had limited opportunity for successful NPV diagnosis and treatment. Menopausal patients often experience vulvar pain with genitourinary syndrome of menopause (GSM) due to the paucity of sex steroid hormonal support of their genital tissues. While symptoms of painful penetration are similar in both of these conditions, NPV is diagnosed when severe allodynia/hyperalgesia is still present with a normal or corrected hormonal milieu. A treatment for NPV is complete vestibulectomy surgery, performed in premenopausal eugonadal patients. However, in hormonally depleted patients with GSM, the vaginal tissue is thinner and less robust making it less optimal for reconstructive surgery. Objective To examine the intersection of genitourinary syndrome of menopause and neuroproliferative vestibulodynia symptoms in a subgroup of at-risk patients and to report techniques for optimizing management of this patient population. Methods We reviewed charts of two menopausal patients with NPV and report a clinical strategy for successful management. Results Two patients, ages 58 and 63 reported histories consistent with NPV during their reproductive years-one with lifelong entrance pain with any insertion and one with pain-free penetration prior to experiencing severe burning upon use of topical miconazole for candidiasis. At presentation, both had entry pain symptoms consistent with GSM and NPV. Since NPV is a diagnosis of exclusion, each was treated for GSM with intravaginal DHEA and vestibular topical compounded testosterone/estradiol cream. After 6 months, vestibular pallor and erythema resolved, however, cotton-tip swab testing scores did not improve. A positive improvement with vestibular anesthesia testing was consistent with NPV. Each underwent a complete vestibulectomy with vaginal advancement flap with successful wound healing and no adverse events despite their age and prior GSM diagnosis. Both patients report “very much better” symptoms on post-op Patient Global Impression of Improvement. Immunohistochemical staining of excised vestibular tissue confirmed a high density of CD117 and PGP9.5 staining consistent with an NPV diagnosis. Each patient has continued their menopause treatments post-op. Conclusions We report on two menopausal patients with NPV who had classic symptoms of severe allodynia/hyperalgesia in their reproductive years but who were not managed as NPV patients due to lack of knowledge at that time. Treating the GSM first with hormone replacement may restore health to vaginal tissues, thereby allowing the excised vestibular region to be covered with a vaginal advancement flap. Managing GSM symptoms prior and then undergoing vestibulectomy allowed them to have pain-free penetration. Disclosure No.

(098) LOW INTENSITY SHOCKWAVE THERAPY FOR WOMEN WITH SEXUAL DYSFUNCTION

Abstract Introduction Low intensity shockwave therapy (LiSWT) has been used to treat sexual dysfunction by inducing genital tissue mechanotransduction. Mechanotransduction is the ability of a cell to actively convert contraction/expansion mechanical stimuli induced by exposure to the shockwave energy into biochemical signals with physiological effects including synthesis of nitic oxide, upregulation of vascular endothelial growth factors, recruitment of endothelial progenitor cells, vasodilation, and expression of tumor necrosis factor alpha mRNA with anti-inflammatory activity. The greater the shockwave energy absorbed in genital tissues, the greater the opportunity for mechanotransduction physiologic effects to occur and improve sexual function. Therefore, effectiveness of LiSWT depends, in part, on applied energy (mJ/mm2) and number of applications (total shocks). In 2019, our sexual medicine clinic began utilizing the SoftWave (Urogold 100™) LiSWT device, FDA cleared for pain amelioration, connective tissue activation, wound healing, and improved blood flow, to treat individuals with vulvas with sexual dysfunction. Objective To review the various sexual health concerns in individuals with vulvas effectively treated by LiSWT. Methods A chart review was performed of individuals with vulvas with various sexual dysfunctions, including genital pain and genito-pelvic dysesthesia (GPD), who received LiSWT between April 2019 and June 2023. In general, 2400 shocks were applied at energy flux density 0.05-0.08 mJ/mm2, Hz = 3, membrane pressure = 1. The Patient Global Impression of Improvement (PGI-I) was used to assess post-LiSWT outcome; improvement was positive if the post-LiSWT PGI-I ranged from 1-3. Results 189 women, mean age 32 (range 18–67) years, with sexual dysfunction underwent LiSWT treatments in the 38 months. 18 women with neuroproliferative vestibulodynia (NPV) who underwent vestibulectomy received 3-6 post-operative vestibular LiSWT to reduce post-operative pain and improve wound healing; 83% reported improved PGI-I. 24 patients with hormone-mediated vestibulodynia who elected not to use hormone treatment, underwent vestibular LiSWT; 54% reported improved PGI-I. 25 menopausal patients with persistent symptoms of Genito-Urinary Syndrome of Menopause (GSM) received multiple vestibular LiSWT treatments; 64% improved PGI-I, including reduction of urinary incontinence. 36 women with PGAD/GPD from lumbosacral annular tear-and/or Tarlov cyst-induced sacral radiculopathy who were not candidates for minimally invasive spine surgery or continued to have symptoms after recovering from spine surgery, underwent multiple treatments of lumbosacral spine LiSWT; 58% reported improved PGI-I. 86 patients with neuroproliferative vestibulodynia (NPV) underwent 2-3 pre-operative sessions of vestibular LiSWT immediately prior to complete subepithelial vestibulectomy surgery; they used significantly fewer opioids post-op than those without pre-operative LiSWT based on historical data prior to 2019. All patients received multiple LiSWT sessions to maximize mechanotransduction effects on genital tissues. There were no significant adverse events noted with LiSWT use. Conclusions Multiple LiSWT sessions are utilized in individuals with vulvas with sexual dysfunction to maximize mechanotransduction. LiSWT is associated with improved sexual health symptoms ranging from 54% - 75%, not associated with any side effects. More research is needed regarding the role of LiSWT for management of various sexual dysfunctions. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Softwave TRT.

Exploring factors impacting quality of life in patients with breast cancer undergoing adjuvant hormone therapy: Experience of the Medical Oncology Department-CHU Hassan II-FEZ University Hospital.

e12507 Background: Considering that the recommended duration of adjuvant hormone therapy in localized breast cancer is at least 5 years, it becomes crucial to investigate the quality of life (QOL) of these patients and the factors influencing it. Objectives: To assess the quality of life (QOL) and identify factors impacting it in patients with localized hormone-sensitive breast cancer receiving adjuvant hormone therapy. Methods: We surveyed 335 patients with localized hormone-sensitive breast cancer undergoing adjuvant hormone therapy using the Moroccan Arabic dialect version of the EORTC QLQ-C30 questionnaire. Written informed consent was obtained from all participants. Confidentiality of participant data was maintained. The study was carried-out with respect to the Moroccan regulation in effect. Results: The overall quality of life (QOL) in our patient population was moderate, with positive scores for social functioning, followed by physical, cognitive, and emotional functioning. Financial difficulties emerged as the most influential factor affecting patients' QOL, followed by fatigue, pain, and other symptoms. Age-related declines in physical functioning were observed, with symptoms more prevalent, especially diarrhea, in patients aged 70 and above (p = 0.009). Urban patients faced a greater financial impact on QOL than rural patients (p = 0.025). Higher education correlated with improved QOL, particularly in physical functioning (p = 0.025). Married individuals demonstrated better overall QOL and fewer symptoms (p = 0.027). Menopausal patients exhibited lower ability and a higher loss of appetite (p = 0.027). No significant correlation was found between UICC stage and QOL. Patey-mastectomy was associated with more pain than tumorectomy (p = 0.024). Previous chemotherapy had no overall QOL impact, but users reported less diarrhea (p = 0.016). Hormone therapy type did not significantly affect overall health status, except for tamoxifen users who demonstrated improved functional roles (p = 0.008). The duration of adjuvant hormone therapy (&lt;5 years or &gt;5 years) showed no significant difference in patient QOL. Associated castration had a significant impact on overall health and role functioning, favoring non-castration (p = 0.034 and p = 0.011). Effective treatment tolerance positively influenced overall QOL, leading to better physical, emotional, and cognitive functioning (p &lt; 0.0001), with fewer pronounced symptoms. Conclusions: Our study indicate that the overall QOL of patients with localized breast cancer under AET was moderate, and several factors were identified as major influences, each affecting the QOL in distinct ways.

Combined treatment of postmenopausal patients with pelvic organ prolapse and genitourinary syndrome

Background. Colpoptosis combined with stress urinary incontinence is one of the most common conditions in postmenopausal women. Menopause is also associated with the risk of genitourinary syndrome due to estrogen deficiency. Despite the variety of options for surgical correction of genital prolapse and urinary incontinence, there is no universal technique. The use of vaginal approach in pelvic floor surgery is associated with several controversies regarding the rates of recurrence and mesh-associated complications. Studies of the state of the endothelium in menopause have demonstrated a close relationship between age-related features and the frequency of adverse clinical outcomes, which requires an optimal intervention not only on the hormonal status but also on the microcirculatory system. Aim. To improve the principles of complex treatment of pelvic organ prolapse and genitourinary syndrome in postmenopausal patients. Materials and methods. The study included 48 postmenopausal patients with genital prolapse of stage II and above according to the POP-Q classification. All patients received continuous menopausal hormone therapy (MHT) with a combined estrogen-progestogen agent. The patients in group 1 (n=24) received MHT according to clinical guidelines for managing patients with genitourinary syndrome. The patients in group 2 (n=24), in addition to MHT, received sulodexide containing glucurono-2-amino-2-deoxyglucoglucan sulfate before the intended surgical treatment and for 30 days after surgery. Correction of colpocystocele, proctocele and stress urinary incontinence was performed using anterior and posterior colporrhaphy, perineoplasty, and urethral sling placement in case of stress urinary incontinence. Results. Six months after surgical treatment, signs of genital prolapse recurrence were detected in 3 patients (12.5%) in group 1, and 1 patient (4.2%) showed signs of mesh-associated complications (implant extrusion) after urethral sling placement. In group 2, only 4.2% of patients (n=1) showed signs of recurrence of stage II cystocele. All patients who underwent urethral sling surgery reported improved urinary incontinence (n=10). During complex therapy, 3 months after surgery, a more significant improvement of endothelial dysfunction markers was noted in group 2 patients (homocysteine level in group 1 after treatment was 12.27±0.34, in group 2 – 8.34±0.24). Conclusions. Combination therapy of genitourinary syndrome and genital prolapse using MHT, endotheliotropic drugs and vaginal surgical approach in postmenopausal patients contributes to effective and safe treatment associated with minimal risk of complications and recurrence rate. Endothelial dysfunction correction is an essential step in planning surgical intervention in menopausal patients, which contributes to improving tissue repair in the postoperative period.

Abstract PO3-19-08: A phase 2 randomized pre-operative,window of opportunity trial investigating the effect of elacestrant with/without triptorelin in premenopausal patients with HR+/HER2- breast cancer – SOLTI-2104-PremiÈRe trial

Abstract Background. Premenopausal women diagnosed with HR+/HER2- breast cancer (BC) often have a different biology and worse prognosis. The SOFT and TEXT studies demonstrated an increase diseasefree survival (DFS) with ovarian function suppression (OFS) plus tamoxifen or exemestane compared to tamoxifen alone. Of note, high-risk clinicopathologic features, adjuvant chemotherapy, or aged ≤35 years correlated with greater OFS benefit. However, adding OFS in this context has intrinsic issues as higher toxicity, which led to treatment discontinuation (20% in SOFT trial), and suboptimal OFS was found in around 25% of patients (pts) with exemestane plus monthly triptorelin (SOFT-EST sub-study). Thus, new effective ET options without OFS are needed for premenopausal patients (pts). Elacestrant is the first oral, non-steroidal, selective estrogen receptor degrader (SERD) to demonstrate improved efficacy to SOC treatments and specifically compared to fulvestrant in postmenopausal pts with HR+/HER2- metastatic BC at the phase III EMERALD trial. In menopausal patients with HR+/HER2- early BC, the window of opportunity SOLTI-1905 ELIPSE trial (NCT04797728), showed that elacestrant was associated with a 27.3% rate of Complete Cell Cycle Arrest (CCCA) and a statistically significant suppression of Ki-67. Among Luminal A tumors, the CCCA rate was 45% and the average decrease in Ki-67 was 64.6%, while no CCCA was reported and the suppression of Ki-67 was less pronounced (31.7%) in the Luminal B population. There is still a need for investigating elacestrant without OFS in the premenopausal scenario. We hypothesize that elacestrant as a single agent or in combination with triptorelin is an effective and safe treatment regimen in premenopausal pts with HR+/HER2-negative early BC capable of achieving an equivalent CCCA rate as a subrogate of effectiveness regardless the use of OFS Study design. PREMIERE is a parallel, non-comparative, two-arm, randomized 1:1, open-label, multicenter, exploratory study in premenopausal women with primary operable HR+/HER2-negative BC. The study aims to evaluate the biological effects of elacestrant with or without triptorelin. Participants must have histologically confirmed HR+ (≥ 10%) and HER2- operable early BC stage I to stage IIB &amp;gt;1 cm with a Ki-67 between 10-35%. The primary objective is to assess the ability of each treatment arm to induce CCCA determined by central assessment of Ki-67 (% Ki-67 ≤ 2.7%). No formal comparison between treatment arms is intended. Secondary objectives include evaluating the biological activity of elacestrant with or without OFS, antiproliferative activity, changes in gene expression including PAM50 subtype changes, and the effect of optimal vs suboptimal suppression on CCCA . Serum E2 and FSH levels will also be evaluated. Safety and tolerability will be assessed based on adverse events and clinical laboratory test results. Pts will undergo screening and randomization, with stratification by PAM50 subtype (Luminal A vs Non-luminal A). Treatment will be elacestrant 400 mg once daily or elacestrant 400 mg once daily plus triptorelin 3.75 mg days +1 and +29 for 30 (+7) days. Surgery or biopsy will be performed after treatment completion, and a post-surgery visit will mark the end of the active follow-up period. Patients will receive SOC treatment after surgery. 48 patients will be recruited in 9 sites within SOLTI Spanish network in 9 months period. This study is financially supported by Menarini-Stemline. Citation Format: Meritxell Bellet- Ezquerra, Cristina Hernando, Pablo Tolosa, Maria Vidal, Yolanda Fernández, Santiago González-Santiago, Pilar Sanchez, Susana De La Cruz, Vanesa Ortega, Xavier Gonzalez-Farré, Milana Bergamino, Alejandra Espinosa, Tomás Pascual. A phase 2 randomized pre-operative,window of opportunity trial investigating the effect of elacestrant with/without triptorelin in premenopausal patients with HR+/HER2- breast cancer – SOLTI-2104-PremiÈRe trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-19-08.

Virtual reality on pain and anxiety after modified radical mastectomy in menopause

Objective: To examine the influence of virtual reality (VR) on pain and anxiety among post mastectomy menopause patients. Materials and Methods: Thirty females experiencing unilateral post-mastectomy shoulder pain and anxiety were randomly assigned into two equally sized groups. Group (A) which received a combination of VRand traditional physical therapy care. Group (B) which received traditional physical therapy care. A smart phone-based version of the visual analogue scale (VAS) was employed for pain assessment, while the anxiety rating scale was utilized to evaluate anxiety levels. Each group received three treatment sessions per week for three weeks.Patients were recruited from Om Elmasreen hospital and age ranged between 45-55 years. Results: Study results showed that there were no significant differences in ages between both groups statistically. Pain severity in study group had a lower mean score than those in control group, with a significant difference between two groups after the treatment statistically. Most of patients undergoing unilateral post-mastectomy reported being contended with virtual reality treatment, and there was a significant difference in anxiety between both groups statistically. Conclusion: Virtual reality demonstrates efficacy in alleviating pain and anxiety among post mastectomy menopausal patients.

Multiparametric ultrasound Diagnosis of Endometrial Cancer in the Preoperative Preparation of Menopausal Patients

Multiparametric ultrasound Diagnosis of Endometrial Cancer in the Preoperative Preparation of Menopausal Patients

Postoperative Outcomes of Ovarian Preserving Surgery in Premenopausal Women With Adnexal Torsion

ABSTRACT Adnexal torsion, a state of twisted ovaries and adnexa in the infundibulopelvic and tuboovarian ligaments, can occur in benign masses, malignant neoplasms, and normal ovaries. Definitive diagnosis of this condition is surgical, with an incidence rate of 2%–15% in women undergoing surgery for an adnexal mass. This incidence rate is possibly low in its estimation, due to lack of diagnosis sans surgical observation of the condition. This state occurs most frequently in women of reproductive age, although it can occur at any age. A decrease in ovarian blood supply during adnexal torsion may lead to ovarian ischemia, for which a lack of immediate treatment results in reduced ovarian function and fertility damage. Patients with suspicion of this condition are treated via emergent surgery. The aim of this study was to analyze anti-Müllerian hormone (AMH) level changes in premenopausal women, along with possible postoperative complications after surgery preserving ovaries in the case of adnexal torsion. The authors’ intent was to prove the value of conservative surgery in preservation of ovarian function, even in cases with intraoperative findings or postsurgery ovarian color changes. The retrospective study was performed at Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea, and included women surgically diagnosed with adnexal torsion between January 2015 and December 2020. Excluded were data for women with no adnexal torsion diagnosis, women who had undergone bilateral ovarian cystectomy, patients lacking AMH data (either prior to or after surgery), and menopausal patients. The study included 71 patients, with 15 in the oophorectomy group and 56 in the ovarian preservation group. Data collected included age, body weight, height, abdominal pain duration, time interval between symptoms and surgery, adnexal mass laterality and size based on the preoperative ultrasounds, and laboratory values (hemoglobin, platelet, white blood cells, and AMH levels). Serum AMH levels were determined both 6 months before surgery and 6–24 months after. Also included were data for postoperative fever/complications and duration of admission. There were 23 patients who had an AMH both before the surgery and postoperatively (19 in the preservation group and 4 in the oophorectomy group). In the ovarian preservation group, 21.0% of patients experienced postoperative fever, with none of the oophorectomy group experiencing similar symptoms. However, all of the fever-stricken patients were discharged with no further complications (ie, pneumonia, surgical site infections, etc). Comparison of both the oophorectomy and ovarian preservation group data showed similar preoperative AMH levels. Postoperatively, serum AMH levels decreased in the oophorectomy group, while slightly increasing in the ovary-preservation group. Despite discoloration and suspected ovarian necrosis, preservation of the ovary preserves ovarian function in reproductive-aged women with adnexal torsion. Only 1 patient undergoing emergent surgery experienced complications. Limitations of the study include its retrospective nature and small sample size when considering patients with emergency surgeries for adnexal torsion diagnoses. In addition, the number of cases with comparable before/after AMH level data available was small. Prospective studies for this area are difficult to perform due to low incidence rates and emergency characteristics. Despite these shortcomings, value can be found in the study data, such as the numerical comparison of ovarian function preservation based on AMH levels before and after surgery. In conclusion, the study found that complications in patients with adnexal torsion were not increased via ovarian-preserving surgery, even with suspected necrosis of the ovary. If preservation of the ovary occurs, the ovarian reserve may not be affected by torsion. For women with cystic masses and adnexal torsion, conservative ovarian surgery (detorsing) can be safely performed to preserve productive potential.

Evaluation of HOMA IR in perimenopause patients with abnormal uterine bleeding

Introduction: Perimenopause as a clinical entity is characterized by a series of symptoms that occur due to estrogen deficiency in multiple organs and systems. Obesity is a risk factor that favors all these changes, especially hyperplasia. Glucose homeostasis is often impaired in these patients, insulin levels are increased, and HOMA IR is increased. Goals: to detect hyperplasia in obese perimenopausal patients with abnormal uterine bleeding to determine insulin levels, HOMA IR, to determine the association between hyperplasia and HOMA IR. Material and Methods: This was a prospective cohort study, performed at the OB/GYN Clinic, over 1 year. 100 patients with abnormal uterine bleeding during the perimenopause were involved, aged 45–50, divided into two groups based on BMI. 1-patients with a BMI above 30, 2-patients with a BMI under 30, and the control group consisted of 40 asymptomatic patients. Results: The average value of glycemia in the first group was higher and was 5.7 mmol/l, the cut-off value was 5,5. The average value of the HOMA-IR insulin resistance index in the first group was highest - 2.8 (the cut-off value was 1.8). Endometrial hyperplasia was registered in the first group at 40.9%. Discussion: The first group registered a significant association between HOMA IR and hyperplasia, the risk of endometrial hyperplasia occurring was eight times higher. The first group registered a significant association between glycemia and endometrial hyperplasia. High levels of glycemia increase the risk of endometrial hyperplasia occurring three times. Conclusion: In menopausal transition patients with abnormal uterine bleeding there is an increased incidence of endometrial hyperplasia, hyperglycemia, and increased HOMA IR. There is a strong association between these changes and the risk of cardiovascular disease increases. Menopause is a period in a woman’s life that requires a multidisciplinary approach to diagnostics and treatment. Keywords: HOMA IR, perimenopause, abnormal bleeding, hyperplasia.

Postmenopausal onset of androgen excess: a diagnostic and therapeutic algorithm based on extensive clinical experience

PurposePostmenopausal hyperandrogenism is a rare condition that requires identifying those women bearing a life-threatening tumor. We aimed to study diagnostic work-up and management of postmenopausal androgen excess, proposing an algorithm for clinical decision supporting.MethodsWe conducted an observational cross-sectional study and longitudinal follow-up including 51 consecutive menopausal patients reported for hyperandrogenism between 2003 and 2023 to our clinics. We assessed diagnostic testing accuracy and performance by receiver operating characteristic curves, their respective areas under the curve (AUCROC), and 95% confidence intervals (95%CI), for distinguishing between benign and malignant conditions, and androgen excess source.ResultsMost commonly, postmenopausal hyperandrogenism derived from benign conditions such as ovarian hyperthecosis (n = 9). However, four (8%) patients had borderline/malignant tumors arising at the ovaries (n = 3) or adrenals (n = 1). These latter were more likely to develop virilization than those with benign disorders [specificity(95%CI)]: 0.87 (0.69; 0.92)]. Circulating total testosterone [AUCROC(95%CI): 0.899 (0.795; 1.000)] and estradiol [AUCROC(95%CI): 0.912 (0.812; 1.000)] concentrations showed good performances for discriminating between both conditions. Transvaginal-ultrasonography found two out of three potentially malignant ovarian neoplasms, and another was apparent on a pelvic computed tomography scan. An adrenal computed tomography scan also located an androgen-secreting carcinoma.ConclusionsClinical or biochemical features of an aggressive androgen-secreting tumor should lead to urgently obtaining a targeted imaging. At first, an abdominal-pelvic CT scan represents the best choice to perceive adrenal malignancy, and may identify aggressive ovarian tumors. When warning signs are lacking, a calm and orderly work-up allows properly addressing the diagnostic challenge of postmenopausal hyperandrogenism.