Menopausal Patients Research Articles

ASSESSMENT OF CIRCULATING miRNA LEVELS IN BREAST CANCER PATIENTS DEPENDING ON CLINICAL CHARACTERISTICS AND CHEMOTHERAPY.

Breast cancer (BC) stands out as the most prevalent cancer in women. The levels of miRNA expression before and after chemotherapy are considered a potential indicator for the prognosis of the disease. To study blood plasma miRNA levels in BC patients and to assess their correlation with the menopausal status, disease stage, and molecular BC subtype. Blood plasma levels of 6 miRNAs (miRNA-25, miRNA-27, miRNA-155, miRNA-200, miRNA-335, and miRNA-497) were studied in 70 BC patients and 18 healthy individuals using RT-PCR. miRNA-25, miRNA-335, and miRNA-497 levels were significantly higher in BC patients, while a tendency toward a decrease in the miRNA-27 and miRNA-335 levels in premenopausal patients and high miRNA-27 levels in menopausal patients was established. After neoadjuvant chemotherapy, a decrease in the miRNA-25 and miRNA-335 levels was registered. The results indicated that miRNA-25, miRNA-27, miRNA-335, and miRNA-497 deserve attention as markers for assessing the efficacy of treatment of BC patients.

Defining the relationship between ovarian adult granulosa cell tumors and synchronous endometrial pathology: Does ovarian tumor size correlate with endometrial cancer?

The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. The primary goal of this study is to identify synchronized endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. The study cohort comprised retrospectively of 316 AGCT patients from 10 tertiary gynecological oncology centers. AGCT surgery consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy, and the excision of any suspicious lesion. The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated. Endometrial intraepithelial neoplasia, or hyperplasia with complex atypia, was detected in 7.3% of patients, and endometrial cancer in 3.1% of patients. Age, menopausal status, tumor size, International Federation of Gynecology and Obstetrics stage, ascites, and CA-125 level were not statistically significant factors to predict endometrial cancer. There was no endometrial cancer under the age of 40, and 97.8% of women diagnosed with endometrial hyperplasia were over the age of 40. During the menopausal period, the endometrial cancer risk was 4.5%. Developing endometrial cancer increased to 12.1% from 3.2% when the size of the tumor was >150 mm in menopausal patients (p = 0.036). Endometrial hyperplasia, or cancer, occurs in approximately 30% of AGCT patients. Patients diagnosed with AGCT, especially those older than 40 years, should be evaluated for endometrial pathologies. There may be a relationship between tumor size and endometrial cancer, especially in menopausal patients.

High amount of fertility reducing tumors and procedures, but no evidence for premature ovarian failure in female Lynch syndrome patients

Lynch syndrome (LS; HNPCC) patients carry heterozygous pathogenic germline variants in mismatch repair (MMR) genes, which have also been shown to play an important role in meiosis. Therefore, it was hypothesized, that LS might be associated with a higher risk for premature ovarian failure (POF) or earlier menopause. Data on medical gynaecological history, cancer diagnoses and therapy were collected from 167 female LS patients and compared to a population-based control cohort. There was no difference between the age of menopause in patients compared to controls and no evidence for a higher risk of POF in LS patients. However, around one third (35%) of the probands have already had premenopausal cancer and mostly cancer-related treatment affecting fertility before the age of 45 years. Therefore, childbearing time might still be limited in these patients, especially due to the premenopausal cancer risk. LS patients should be informed in time about the elevated premenopausal cancer risks and the possible impact on family planning. This is particularly relevant since the average childbearing age has increased during the last decades.

Different effects of CO2 laser and estrogen treatment on vaginal mucosa microbiota and function in genitourinary syndrome of menopause patients.

To characterize the effects of CO2 laser treatment and estrogen treatment on vaginal microbiota in patients with genitourinary syndrome of menopause (GSM). Sixty-four patients with genitourinary syndrome were divided into the estrogen group, the CO2 laser group, and the control group. The control group did not receive any treatment. Vaginal mucosa was collected after 3 and 12 months of treatment. The former was used for 16S rRNA sequencing, and the latter was used for pathological evaluation. Vaginal health and voiding function were assessed using the vaginal health index (VHI) scale and the UDI-6 scale at 3 and 12 months after treatment. The results showed that both treatments reduced alpha diversity in the vaginal flora. Additionally, the abundance of 65 genera differed significantly between the treatment and control groups, with an increase in potentially beneficial bacteria such as Lactobacillus, IheB3_7, Mycoplasma urealyticum, and Streptococcus. In addition, the VHI and UDI-6 scores improved in both treatment groups compared to the control group after 3 months. Whereas VHI and UDI-6 scores were close to baseline in the estrogen group, and remained significantly improved in the CO2 laser group after 12 months. Pathological results showed that both methods improved the vaginal health status of patients with GSM after 12 months of treatment. However, the CO2 group exhibited a more significant increase in type III collagen. Both CO2 laser and estrogen therapies can regulate the vaginal flora imbalance of GSM and improve the corresponding symptoms. However, the long-term efficacy of CO2 laser therapy is superior compared to estrogen therapy.

VARIATIONS OF SERUM DEHYDROEPIANDROSTERONE-SULPHATE (DHEAS) LEVEL WITH PREGNANCY, FERTILITY, ABORTION, OVARIAN RESERVE AND ENDOTHELIAL FUNCTIONS.

It was aimed to evaluate the relationship of Dehydroepiandrosterone-sulphate(DHEAS) level with pregnancy, fertility, abortion, ovarian reserve and endothelial functions. Ninety-six fertile women aged 20-35 years whose DHEAS levels were measured and 28 women aged 40-55 years with oligomenorrhea-amenorrhea were included in the study.The DHEAS values of the patients,which were measured at least 12 months apart,were recorded. The first measured mean DHEAS level was 208.34±119.7ug/dL and the last measured mean DHEAS level was 187.5±101.7ug/dL. Among 28 patients with oligomenorrhea-amenorrhea, the levels of DHEAS increased in 10 patients and decreased in 18 patients. Although the annual decrease in DHEAS levels was greater in those who had pregnancy than in those who had not given birth, the difference was not statistically significant (p=0.085). Although the initial DHEAS level in 5 patients who had an abortion was higher than in those who did not have an abortion, the difference was not statistically significant (p=0.427). The increase in systolic blood pressure was statistically significant in patients with decreased DHEAS levels (p=0.03). While the mean DHEAS level was 85.3±47.3ug/dL in menopausal patients, the DHEAS level was 82.1±49.2ug/dL in non-menopausal patients (p=0.435). The age at which the DHEAS level reaches its peak level shows individual differences. While pregnancy slows down the decrease in DHEAS levels,abortion accelerates the decrease in DHEAS levels. A decrease in serum DHEAS levels can increase systolic blood pressure.

Comparative analysis of ocular findings between surgical and natural menopause patients: A cross-sectional study

Comparative analysis of ocular findings between surgical and natural menopause patients: A cross-sectional study

Efficacy of combination therapy with unkeito and boiogito for menopausal arthralgia: A retrospective observational study.

Arthralgia affects menopausal patients. Here, we report a retrospective observational study evaluating the therapeutic efficacy of a combination of unkeito and boiogito for menopausal arthralgia. Patients treated with a combination of unkeito and boiogito for menopausal arthralgia between April 2020 and October 2022 at three Japanese Kampo outpatient clinics were retrospectively examined. Treatment effectiveness was determined based on the patient's description of pain. Adverse events associated with this treatment regimen were also recorded. The study design was approved by the Tokai University Ethics Committee (Approval number: 22R196). This study was conducted by retrospectively analysing the medical records of patients who attended the three medical facilities. All patients received Kampo medicines based on traditional medical diagnoses. Outpatients with a diagnosis of menopausal arthralgia were selected, and information on those who were treated with a combination of unkeito and boiogito was collected. The age, height, and weight of all patients are represented as the mean ± standard deviation. Statistical analyses were not performed in this study as there was no comparison group. During the study period, nine patients with menopausal arthralgia received the unkeito and boiogito combination. Four patients showed a "significant" response to the combination treatment, four showed an "effective" response, and one patient showed an "ineffective" response. One patient reported headache as an adverse event. The combination of unkeito and boiogito may be effective in the treatment of menopausal arthralgia.

The alteration of apoptosis-related genes in female pelvic supportive tissues with regard to menopausal status

PurposeWe aimed to compare the expression levels of anti-apoptotic and proapoptotic genes in the parametrium, sacrouterine and round ligaments with respect to menopausal status in women presenting without any indication of pelvic organ prolapse (POP). We hypothesized that apoptosis related gene expressions in female pelvic tissues may be altered during menopause.MethodsThe study groups consisted of pre-menopausal (n = 10) and menopausal (n = 10) females who did not have POP symptoms. Three different types of tissue samples (Parametrium, Round Ligament and Sacrouterine Ligament) were obtained and RNA was isolated from these tissues. After purifying and quantifying RNA samples, qPCR was used to determine the expression levels of anti-apoptotic and pro-apoptotic genes.ResultsBCL-2 gene expression levels were significantly lower in all the tissues of menopausal patients compared to those of premenopausal patients. In comparison to premenopausal patients, the sacrouterine ligament tissue BAD expression level was significantly high (p = 0.035), and the BCL-2/BAD ratio was significantly lower in menopausal patients (p = 0.006).ConclusionApoptosis-related protein levels change during menopause; pro-apoptotic gene expressions decrease and anti-apoptotic gene expressions increase. The significant alteration of BCL-2 and BAD expression in sacrouterine ligament with respect to menopausal status was observed and this suggested that when compared to other pelvic tissues, the sacrouterine ligament, which plays a crucial role for genital organs in restoring normal pelvic anatomy and providing support, could be affected more by menopause.

Possibilities of combination treatment of urinary incontinence in women of different age groups

The effectiveness of conservative therapy in patients with urinary incontinence depends on a variety of factors. There are no clinical guidelines for the use of pharmacological and non-pharmacological treatment concepts for women of reproductive and menopausal age. The aim of the study was evaluating the efficacy of various combinations of treatment for patients with urinary incontinence, based on electrical stimulation of the pelvic floor muscles with biofeedback, fractional photothermolysis with a CO2‑laser, and medications (antimuscarinics, selective β3‑agonist). The prospective randomized study included 105 patients, of whom 20 were of reproductive age and 85 were of menopausal age. The patients were divided into three groups: group 1 included the patients who underwent a course of electrical stimulation of the pelvic floor muscles and photothermolysis (with fractional CO2‑laser); in group 2, the patients received a combination of non-drug treatment and medications; in group 3, the patients receivedonly pharmacological treatment. In group 1, there were 7 patients of reproductive age and 28 menopausal patients, in group 2–5 and 30, and in group 3–8 and 27 patients, respectively. Results. The bladder diary scores improved significantly. Increasing the urinary flow rate was more effective with non-pharmacological treatment in young patients, and reducing the frequency of urination was more efficient with drug therapy in menopausal patients. The probability of achieving a urinary frequency of less than 8 times per day in the combination treatment group was 80 % higher than that in the non-drug treatment group and 62 % higher than that in the drug treatment group. The effectiveness of non-pharmacological therapy in increasing urinary flow rate is higher in patients of reproductive age. Pharmacological treatment is more effective for three months in menopausal women. The combination treatment is equally effective in patients aged 35 to 65 years and is superior in total effect to drug and non-drug treatment, with the effect maintaining for up to 6 months in menopausal patients.

Minding menopause in patients with cognitive impairment: a patient’s perspective and reflections on clinical practice

Many women experience impairment in cognitive function during perimenopause. These symptoms are often not attributed to perimenopause by women themselves, by family and friends, or by healthcare professionals. In this article, we present a case in which perimenopausal complaints were attributed to early dementia and discuss mechanisms contributing to the low level of awareness of perimenopausal symptoms amongst patients and clinicians. Stigma amongst women and healthcare professionals impairs the recognition of perimenopausal complaints, and consideration of treatment options by clinicians. We advocate raising awareness in patients and physicians with more education, and the incorporation of potential menopause-related symptoms in general clinical guidelines.

Genitourinary syndrome of menopause in patients with breast cancer treated by hormonotherapy: women's perception in ITAC, a French web-based survey

To describe frequency, intensity and impact of genito-urinary syndrome of menopause (GUSM) in breast cancer (BC) survivors receiving hormonotherapy (HT). Web-based survey hosted on the Seintinelles website (database of patients and caregivers). Specific questionnaire of 43 questions, including sociodemographic characteristics, history of BC, characteristics of HT, side effects other than GUSM, symptoms of GUSM (frequency, intensity, treatment, and impact) and overall expectations regarding treatment. Among 1157 participants, 96.4% had at least one GUSM symptom. Percentages with at least one urinary, gynecological, or sexual symptom were 56.0%, 85.6% and 86.1% respectively while 70.3% and 10% declared at least 5 and 10 symptoms respectively. Mean (SD) and median (range) numbers of symptoms were 5.9 (2.8) and 6 (0-14) respectively. Most frequently reported symptoms were decreased desire (77.8%), decreased arousal (71.4%), and vaginal dryness 68.4%). On a scale from 0 (no impact) to 10 (maximal impact), the most important impact was reported for sexual life (mean: 6.6±3.5) followed by psychological condition/self-image (mean 5.4±3.1), and relations with partners (mean: 5.1±3.4). Only 13.6% of participants had received information on GUSM prior to the survey. GUSM remains underdiagnosed and underestimated in BC survivors who receive HT, although it is among most frequent and disabling side effects of HT. Awareness should be increased among physicians, along with information to women. Early detection and treatment of symptoms and prophylaxis of GUSM in at-risk women should be implemented.

Serum sex hormones correlate with pathological features of papillary thyroid cancer

PurposeSex hormones are thought to be responsible for the unique gender differences in papillary thyroid cancer(PTC). Most previous studies on these have focused on the expression of estrogen receptors, or have been limited to animal studies. The aim of our study was to explore the relationship between serum sex hormones and the pathological features of PTC in the clinical setting, as further evidence of the role of sex hormones in PTC.MethodsRetrospective data analysis of patients who underwent thyroid surgery at the Department of Thyroid Surgery, Nanjing Drum Tower Hospital from January 2022 to September 2022 Correlation between serum sex hormone and pathological features was analyzed in male patients and in menopausal female patients. Serum sex hormones include luteinizing hormone(LH), follicle stimulating hormone(FSH), estradiol(E2), total testosterone(TT), progesterone(P), and prolactin(PRL). Tumor pathological characteristics include the number and size of tumor, presence of extrathyroidal extension(ETE), presence of lymph node metastasis(LNM).ResultsPreoperative serum E2 in male patients was positively correlated with tumor size in PTC, LH was negatively correlated with LNM, while TT and P were negatively correlated with ETE. Similar findings were not observed in menopausal female patients.ConclusionWe observed that serum sex hormones correlate with the pathological features of PTC in male patients, for the first time in a clinical study. High serum estrogens may be a risk factor for PTC, while androgens are the opposite. This somewhat corroborates previous research and provides new variables for future PTC prediction models.

Discussion on cervical cytology in postmenopausal women.

Considering the cervix at the climacteric period, important changes take place in the morphology of the epithelium and stroma due to hypoestrogenism. Therefore, the aim of the present study was to compare the presence of transformation zone cells in the cervix of premenopausal and postmenopausal women. In a private laboratory in São Paulo (Brazil) a retrospective analysis of cervical cytology results was performed. A total of 1,026,671 satisfactory cytology tests were evaluated between January 2010 and December 2015. A marked decline in transformation zone cells with age was evident, with a greater decrease in the ≥50 years age groups. Only 35% of women ≥50 years of age had transformation zone cells in cytology, while in those <50 years, the figure was 67.5% (P<0.001). The prevalence of negative cytological results in these two age groups was respectively 89.9% and 95.3%; however, it was observed that the most serious cytological results occurred in the group after menopause. Although cytology is the recommended screening method for cervical cancer in Brazil, the low number of transformation zone cells in cytology in menopausal patients could be less sensitive for screening of dysplasia and cancer. So, we suggest routine high-risk HPV DNA testing, when possible, given that this test is considered more sensitive for detecting cervical lesions in this group of patients. When HPV DNA testing is not possible, cytology should be collected, and for cytology sampling we suggest regular topical estrogenization and use of appropriate technique.

Alternative therapy of menopausal vegetative disorders in women taking the metabolic status into account

Research objectives: to study the clinical effectiveness of alternative complex therapy of vegetative syndrome in menopausal patients using L-arginine and xylitol drugs. Materials and methods. The clinical prospective study included 50 patients in the early postmenopausal period with natural menopause, neurovegetative and psychoemotional manifestations of the climacteric syndrome. According to the Life extension strategy, patients received intravenous L-arginine (Tivortin drug) and xylitol solution with electrolytes (Xylat drug) for endothelial protection and correction of insulin resistance in order to treat climacteric syndrome. Modified Kupperman menopausal index, serum triglyceride, cholesterol, high-density lipoprotein, low-density lipoprotein, and very-low-density lipoprotein levels were determined in all women. Examinations were performed before the start of therapy and 3 months after the end of treatment.Results. The Life extension therapeutic strategy as an alternative comprehensive therapy of the vegetative syndrome in menopausal patients contributed to a reliable reduction of the manifestations of the climacteric syndrome. The advantage of combined therapy involving L-arginine and xylitol was manifested in a significant decrease in diastolic blood pressure (p = 0.043); reduction of the Kupperman index (p = 0.002) and the average score of vasomotor symptoms (p = 0.02). There was also a significant decrease in the serum level of insulin (p = 0.00007), HOMA index (p = 0.01), low-density lipoproteins (p = 0.04), and triglycerides (p = 0.03). The selected therapy was well tolerated during the observation period.Conclusions. The combined therapy involving L-arginine and xylitol in the early postmenopausal period with neurovegetative and psychoemotional manifestations of the climacteric syndrome had a pronounced clinical effect, which consisted in a significant reduction of vegetative disorders and stabilization of carbohydrate and lipid metabolism. The given therapeutic strategy can be considered as an alternative therapy in patients with climacteric disorders when phytotherapy is ineffective and when there are contraindications or limitations to menopausal hormone therapy. The results of this study showed the safety of the Life extension strategy.

A-167 Repeatedly Positive Serum and Urine Beta-HCG Results in Non-Pregnant Patients—Application of Clinical Decision Support

Abstract Background In January of 2020, a 48-year-old woman, status post bilateral tubal ligation was postponed colonoscopy due to a positive urine and serum pregnancy point of care (POC) test. The quantitative serum HCG levels were normal at 4.9 mIU/mL (reference range 0–8 mIU/mL). Follow-up showed that over the prior year there were other 6 similar incidents when nonpregnant patients showed positive qualitative pregnancy results with quantitative HCG levels within “nonpregnancy” normal range being brought to the attention of the laboratory. Methods We assessed the possibility of a detection/measurement error including possible interfering antibodies. The likelihood of interfering substances/antibodies that would interact with 2 different types of POC detection systems (urine qualitative—Clinitest HCG Pregnancy test from Siemens Medical Solutions USA, serum qualitative—Pregnancy HCG Rapid Test from Cardinal Health) and serum quantitative—is very low, especially given that both serum and urine specimens were affected, and interfering antibodies are not normally excreted into urine. Testing of the diluted sample showed results like the neat specimen which further excludes interferences in the quantitative reaction as well as a possible hook effect. Based on this we concluded that the results were accurate.Chart review showed that 6 months prior, she had another quantitative HCG test performed using the same instrumentation obtaining a value of 6.6 mIU/mL. At this time a transvaginal ultrasound excluded the presence of any masses or abnormal findings. FSH (47.8 mIU/ml) and LH (49.8 mIU/ml) were found to be within the perimenopausal range. Qualitative serum and urine test were found to be repeatedly positive, while the quantitative tests were within nonpregnancy range, over several months. Retrospective chart review of the other 6 cases revealed similar pattern. Pregnancy, certain tumors (gestational trophoblastic neoplasia, ovarian germ cell tumor), kidney failure and menopause will manifest with increased HCG production. In (peri)menopausal women the pituitary produces HCG up to 14 mIU/mL in association with increased levels of FSH. The qualitative tests were repeatedly positive over several months while the quantitative results remained unchanged, excluding the diagnosis of pregnancy or tumors, and supporting the conclusion that these results are menopause related. Results To avoid similar future incidents we added the following comment to the POC test results: “If the result does not fit the clinical picture, please repeat testing on a new sample collected 48–72 h later or order serum HCG quantitative” We also added for the quantitative HCG result, the following comment: “Peri- and postmenopausal patients may have increased HCG of pituitary origin up to 14 mIU/mL. If the result does not fit the clinical picture, FSH measurement can be used for additional information.” During the 12 months preceding the implementation of the comments we had 6 incidents of positive qualitative HCG results in non-pregnant (peri)menopausal patients brought for investigation, and none during the 24 months after that. Conclusion The addition of the interpretative comment as clinical decision support increased the efficiency of the medical service, staff engagement and most importantly, patient satisfaction and safety.

Development and validation of the genitourinary syndrome of menopause symptoms and vaginal treatments acceptability questionnaire (GSM-SVTAQ): An electronic patient-reported outcomes measure.

To develop and validate an electronic, patient-reported outcomes measure (PROM) specific for genitourinary syndrome of menopause (GSM) patients. The PROM aimed to accurately assess the burden of GSM symptoms, their impact on health-related and sexual quality of life, and the acceptability of vaginal treatments. The study encompassed a comprehensive three-stage approach to the development and validation of the PROM. Initially, during the preliminary design stage, the necessity for a new PROM was recognized, an expert panel was formed, and semi-structured qualitative interviews were carried out with GSM patients. In the second stage, the study used the five-step pre-validation methodology established by Prior et al. to generate and refine the PROM items. The third and final stage encompassed the determination of scale and item content validity indexes to ensure validity. Additionally, the reliability of each construct was evaluated using Cronbach's α. The resulting PROM was named GSM-SVTAQ (GSM-symptoms and vaginal treatments acceptability questionnaire). It demonstrated excellent validity in assessing symptoms burden, health-related and sexual quality of life, and vaginal treatment acceptability, with high content validity indices and strong internal consistency. The scale content validity indices and Cronbach's α coefficients for the three domains were (0.926, 0.939), (0.875, 0.947), and (0.824, 0.855), respectively. The GSM-SVTAQ stands as the first GSM-specific, valid, and reliable PROM capable of comprehensively measuring the three components of GSM and the acceptability of vaginal treatments. Its implementation has the potential to significantly enhance patient care and outcomes in GSM management.

Needs assessment of menopause education in United States obstetrics and gynecology residency training programs.

This study aimed to assess the variance in menopause education, educational resources, and the needs of obstetrics and gynecology (ObGyn) residency programs by conducting a national survey of program directors (PDs). In 2022, an institutional review board-approved Web-based Qualtrics survey was designed and distributed electronically to 145 US ObGyn residency PDs. The survey consists of 15 questions. The main outcomes are reported using descriptive statistics. The survey was completed by 99 of 145 PDs (68.3%). Almost all participants (92.9%) strongly agreed that residents nationwide should have access to a standardized menopause curriculum that could be utilized in their programs. Only 31.3% reported having a menopause curriculum in their residency program. Of the programs with a menopause curriculum, 96.8% reported using lectures, 77.4% reported assigned readings, and 74.2% had either dedicated menopause clinics or other clinics with a high volume of menopausal patients. Of all programs surveyed, only 29.3% reported that trainees had dedicated time assigned to a menopause clinic. A total of 83 of 99 PDs agreed or strongly agreed that their programs needed more menopause educational resources, and most (89.7%) stated they were likely or very likely to use self-paced menopause modules that include performance feedback if available. Data from the needs assessment questionnaire revealed that menopause education and resources vary across residency programs, with the majority lacking a dedicated menopause curriculum. Most PDs expressed a desire for more educational resources and standardized training materials, and preferred to access an online national menopause curriculum.

Spontaneous Coronary Artery Dissection Postpartum and Recurrence during Menopause: Hormonal Involvement in Acute Coronary Syndromes

In this case report, we present a case of a 38-year-old woman with no cardiac history and no risk factors who was admitted to the hospital with a spontaneous coronary artery dissection (SCAD) after pregnancy. Twelve years later, she suffered a recurrent SCAD during her menopause. SCAD is a rare occurrence of acute coronary syndromes and recurrence is even more rare. SCAD seems to occur predominantly in females and seems to be related to hormone levels. At first presentation, the patient was 38 years old and 4 weeks postpartum. She presented with chest pain. Electrocardiogram (ECG) showed loss of r-amplitude but no ST-segment deviation. Troponins were elevated and showed significant rise and fall. She was treated with dual anti-platelet strategy and underwent coronary angiography (CAG) which showed a type 1 dissection of the distal circumflex artery. The lesion was treated conservatively. Second presentation was 12 years later, in which she again presented with chest pain this time during menopause. ECG showed marginal changes and the troponins were again elevated. She underwent CAG again which showed a new SCAD (Type 2 B) in the second marginal obtuse artery. The old SCAD lesion was healed. Renal angiography was preformed which showed an renal bead pattern typical for fibromuscular dysplasia. Again, she was treated conservatively. This case is the first case report of a patient suffering from a recurrent SCAD in a different coronary artery, both events probably related to hormonal changes, that is, postpartum and during menopause. This may emphasize careful examination of chest pain in menopause patients with a history of earlier SCAD.

Earlier menopause in patients with increased BMI - a paradox

Earlier menopause in patients with increased BMI - a paradox

Adjuvant therapy for HR+/HER2– early-stage breast cancer (EBC): Changes in practice patterns among community oncologists in Brazil.

e18820 Background: The management of HR+/HER2– early breast cancer (EBC) has changed significantly, with more patients are being classified as low-risk and spared adjuvant chemotherapy (CT) and de-escalating endocrine therapy (ET); on the other hand, other patient groups have experienced treatment escalation, such as high-risk premenopausal women. This study aims to assess practice patterns and real-world data for patients with HR+/HER2- EBC treated in Brazil's largest network of community oncology practices. Methods: Retrospective real-world study from the Oncoclínicas with longitudinal EHR data merged in a platform where structured variables were integrated with unstructured elements from physician notes using technology-based abstraction and expert human curators that follow mCODE standards and predefined ontology. Index data was EBC diagnosis date, and we restricted the study to patients diagnosed between Jan 2017 and Jun 2022, with comparative analysis of adjuvant CT/ET practice trends in 2017-2019 versus 2020-2022. Results: From over 30k patients with breast cancer in Oncoclínicas Database, 19k had HR+/HER2– EBC, 12k were treated in high-volume clinics, and 2,988 were selected for the study due to data accessibility in the pre-specific observation period. Stage distribution: I in 45%, II in 37%, and III in 18%. Pre-menopausal status at diagnosis: 22%. Less than 5% of the study population had access to breast cancer prognostic risk scores. The disease-free survival rate in the entire cohort was 87% (CI95% 86-89) at 2 years and 74% (CI95% 70-78) at 5 years. Overall, we observed a decrease in adjuvant CT use from 51% during 2017-2019 to 41% during 2020-2022. In pre- menopausal patients, CT use reduced from 68% in stage I during 2017-2019 to 41% during 2020-2022; for stage II or III, the reduction was less noticeable (83% in 2017-2019 to 75% in 2020-2022). In post-menopausal patients, CT use reduced from 36% in stage I during 2017-2019 to 18% during 2020-2022; while it remained stable in stage II or III (55% in 2017-2019 versus 52% in 2020-2022). Concerning ET, there were no evident changes in treatment practice. In pre-menopausal, tamoxifen alone was the first option in 90% with stage I and in 64% with stage II or III, with the stability over the years. In post-menopausal, aromatase inhibitors were the first option in 61% with stage I, 70% with stage II and 77% with stage III, with the stability over the years. Conclusions: We perceived a reduction in chemotherapy use in HR+/HER2– stage I breast cancer over time. Reasons for treatment selection must be investigated further, including other prognostic factors, but might be related to greater physician confidence in avoiding CT and access to genomic signatures. There were no significant changes in patterns of adjuvant ET, with most pre- and postmenopausal patients receiving tamoxifen alone and an aromatase inhibitor respectively.