Perimenopausal Women Research Articles

General practitioners' and women's experiences of perimenopause consultations: A qualitative evidence synthesis protocol.

Perimenopause precedes menopause and can cause a myriad of symptoms for women. General practitioners (GPs) are frequently the first contact for perimenopausal women with symptoms. However, women express feeling dissatisfied with the consultations they have with their GPs for perimenopausal symptoms. Moreover, diagnostic difficulties can make these consultations challenging for GPs. Despite these challenges, research to date has focused on menopause, not the transition to menopause. To date, no evidence synthesis has examined how women experience perimenopause consultations, nor how GPs experience providing care to these women. To systematically search, collate, and appraise the qualitative literature to understand general practitioners' and women's experiences of perimenopause consultations and examine how treatment decisions are made during consultations. A meta-ethnography will be conducted following Sattar et al. (2021) guidelines for conducting a meta-ethnography as developed by Noblit and Hare (1988). Seven databases will be systematically searched. To be included, studies must report on the experiences of either general practitioners and/or perimenopausal women and published since 2014 to capture the most up-to-date evidence. Quality assessment will be conducted using CASP (Critical Appraisal Skills Programme) tools. A GRADE-CERqual (Confidence in the Evidence from Reviews of Qualitative research) will be conducted to assess the confidence of the findings. PROSPERO registration number CRD42024520537. Findings will provide new and useful insight into how GPs and women experience consultations for perimenopause and how decisions are made during these consultations.

Clinical Evaluation of Effectiveness and Safety of Combined Use of Dietary Supplements Amberen® and SmartB® in Women with Climacteric Syndrome in Perimenopause.

Perimenopause is a time of transition in a woman's life that links her reproductive years to the cessation of ovulation, or menopause. For many women, this time is characterized by a variety of physiological and lifestyle changes, including increasing irregularity in menstrual bleeding, frequency and severity of vasomotor symptoms, etc. Therapies evaluated specifically for the perimenopausal women are very limited. This study aimed to evaluate the effectiveness and safety of Amberen® (a succinate-based non-hormonal supplement) combined with a SmartB® (vitaminB) complex in women with typical (without complications) mild to moderate climacteric syndrome during perimenopause. Women up to 50years of age, in perimenopause, with vasomotor and psychosomatic symptoms of the climacteric syndrome were enrolled for the study. The trial was randomized, double-blinded, placebo-controlled, comparative, and prospective. A total of 106 participants were enrolled in the trial and, per protocol, 105 completed the trial. We observed statistically significant improvements in most of the Greene Climacteric Scale symptoms, State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS), and Well-being, Activity, and Mood (WAM) scores. The intervention was well tolerated with few adverse effects reported to be mild and transient. The use of this dietary supplement is safe and eliminates or improves vasomotor and psychosomatic symptoms of climacteric symptoms in perimenopausal women: it improves sleep and cognitive abilities, lowers depression and anxiety, improves mood and well-being, and positively affects quality of life. NCT03897738.

Screening for Breast Cancer: A Comparative Review of Guidelines.

Breast cancer is the most common malignancy diagnosed in the female population worldwide and the leading cause of death among perimenopausal women. Screening is essential, since earlier detection in combination with improvements in breast cancer treatment can reduce the associated mortality. The aim of this study was to review and compare the recommendations from published guidelines on breast cancer screening. A total of 14 guidelines on breast cancer screening issued between 2014 and 2022 were identified. A descriptive review of relevant guidelines by the World Health Organization (WHO), the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), the American College of Obstetricians and Gynecologists (ACOG), the American Society of Breast Surgeons (ASBrS), the American College of Radiology (ACR), the Task Force on Preventive Health Care (CTFPHC), the European Commission Initiative on Breast Cancer (ECIBC), the European Society for Medical Oncology (ESMO), the Royal Australian College of General Practitioners (RACGP) and the Japanese Journal of Clinical Oncology (JJCO) for women both at average and high-risk was carried out. There is a consensus among all the reviewed guidelines that mammography is the gold standard screening modality for average-risk women. For this risk group, most of the guidelines suggest annual or biennial mammographic screening at 40-74 years, while screening should particularly focus at 50-69 years. Most of the guidelines suggest that the age limit to stop screening should be determined based on the women's health status and life expectancy. For women at high-risk, most guidelines recommend the use of annual mammography or magnetic resonance imaging, while the starting age should be earlier than the average-risk group, depending on the risk factor. There is discrepancy among the recommendations regarding the age at onset of screening in the various high-risk categories. The development of consistent international practice protocols for the most appropriate breast cancer screening programs seems of major importance to reduce mortality rates and safely guide everyday clinical practice.

Pharmacological correction of immunological disorders in perimenopausal women with recurrent epithelial cervical dysplasia associated with human papillomavirus infection

Despite the successes achieved in implementing screening programs and treating diseases caused by human papillomavirus (HPV) infection, the frequency of cervical intraepithelial neoplasia (CIN) of moderate and high grades associated with high-risk human papillomavirus (HR-HPV) remains between 9% to 21%. Vaginal dysbiosis and the development of immunodeficient states due to persistent HR-HPV infection require effective immunomodulatory and antiviral therapy before cervical surgery in perimenopausal women with recurrent CIN II.The objective: to evaluate the effectiveness of antiviral and immunomodulatory therapy by determining the state of vaginal biocenosis, immunological status and papillomavirus load of the cervical mucosa before surgical treatment in perimenopausal women with recurrent CIN II.Materials and methods. A prospective study was conducted on 98 women aged 40 to 55 years old, including 60 patients with morphologically verified recurrent CIN II associated with high-risk HPV, forming the main group. The control group comprised 38 women with negative HPV test results and without significant gynecological or somatic pathology. In the main group, a complex consisting of a blend of plant extracts of sod pike grass (Deschampsia caespitosa), ground cinquefoil grass (Calamagrostis epigeios), and echinacea purpurea grass (Echinaceae purpureae) was administered orally.Vaginal microbiota was assessed using Hey-Іson criteria, and immunological status was examined in patients using solid-phase enzyme-linked immunosorbent assay to determine IgG, IgM, IgA antibodies in serum and cervical mucus, levels of interleukin-1β (IL-1β), interferons alpha (IFN-α), gamma (IFN-γ), tumor necrosis factor alpha (TNF-α). Additionally, the DNA of high-risk HPV in cervical mucosa was quantitatively assessed using real-time PCR. The investigations were conducted before and after the applied therapy.Results. The investigation of vaginal content revealed the presence of bacterial vaginosis in 65.0% of patients in the main group, the frequency of which decreased by 2 times after treatment, with the number of women with an intermediate type of vaginal content increasing by 2.8 times (51.7%) and those with normal microbiota increasing by 2.5 times. Disruptions in cellular and humoral immunity systems were identified. After treatment, there was an increase in viral load in the significant «threshold» category (3–5 lg) by 1.25 times and in the «above threshold for progression» category (>5 lg) by 2.3 times, reflecting natural HPV clearance. No direct correlation was found between viral load activity and the degree of CIN or positive morphological changes regarding regression of cervical intraepithelial lesions.Conclusions. The use of a complex containing a blend of plant extracts of sod pike grass (Deschampsia caespitosa), ground cinquefoil grass (Calamagrostis epigeios), and echinacea purpurea grass (Echinacea purpureae) improves the state of vaginal biocenosis, indicators of cellular and humoral immunity, and promotes HPV elimination, it has adequate safety and tolerability, which determines the feasibility of its use in the complex treatment of cervical intraepithelial neoplasia at the preparatory stage before surgery and in the postoperative period to prevent complications and relapses.

(066) EXPLORING THE IMPACT OF ALCOHOL ON SEXUAL FUNCTION IN PERIMENOPAUSAL WOMEN

Abstract Introduction Sexual well-being is an important quality of life component to women throughout life, and during menopausal transition and beyond. Female sexual response cycle includes desire, arousal, orgasm, and resolution phases. Female sexual dysfunction (FSD) encompasses all phases of sexual response cycle and can lead to distress for both the woman and her partner and warrant further investigation. Research has indicated both positive and negative associations between alcohol consumption and sexual health, our review goal is to further explore the relationship between alcohol consumption and sexual function in perimenopausal women. Objective We aim to review the current literature regarding the influence of alcohol use on sexual health during the menopausal transition and beyond. Methods The examination of alcohol consumption and its effects on sexual health in menopausal women was performed through reviewing existing literature. The literature search was completed in the Ovid MEDLINE database (1946- Present) in August 2023. 16 articles were identified in the initial search. 12 articles met our inclusion criteria and were independently reviewed by the authors. Results from these articles were summarized. The search was limited to the English language and the last 20 years (2003-current). Keywords included: menopause, pre-menopause, post menopause, perimenopause, alcohol use, alcohol related disorder, and sexual function. Results Seven out of 16 articles reviewed linked a negative association between alcohol consumption and female sexual function. Seven indicated a positive association between alcohol use and sexual function and 2 articles did not reveal an association. The findings of our review indicate a complex relationship of alcohol on women's sexual function. Studies indicating a positive association between mild alcohol consumption (equal or less than 0.21 FL oz. alcohol/day) and improved sexual function. This effect was theorized due to alcohol increasing endogenous estrogen or due to behavioral changes such as disinhibition, influencing sexual activities influenced by alcohol or subjective arousal due to drinking. Additionally, a positive association was seen between increased alcohol consumption and Female Sexual Function Index (FSFI) scores. However no significant influence on Female Sexual Distress Scale scoring was identified which is a key component to FSD. Other studies showed that excessive or prolonged alcohol consumption (more than 1.00 FL oz. alcohol per day) found to be associated with worsening sexual function and can impact all 6 domains on the FSFI (which include: desire, arousal, lubrication, orgasm, satisfaction, and pain) even after abstinence. These findings were reflected in another study that showed women (however not exclusively menopausal) who were seeking treatment for alcohol dependency diagnosis experienced low sexual desire, inability to achieve orgasm and less satisfaction. Initiating alcohol consumption at a younger age, along with an extended and more intense period of dependency, was correlated with a higher likelihood of experiencing increased sexual dysfunction. A meta-Analysis of 7 studies showed increased odds of sexual dysfunction with alcohol consumption. Another study showed that moderate alcohol consumption was found to be an independent risk factor for FSD and Genitourinary syndrome of menopause (GSM) which can lead to FSD. Conclusions The impact of alcohol on sexual health in postmenopausal women is multifaceted, based on varying levels of consumption influencing various aspects of sexual function. This relationship can also be influenced by other factors such as pre-existing sexual problems and the utilization of alcohol as a coping mechanism to reduce anxiety, release stress or to increase sexual behavior through enhancing arousal. A study indicated that menopausal symptoms may trigger a craving for alcohol, leading to increased alcohol consumption. Further research is essential to elucidate the direct and indirect effects of alcohol consumption on sexual dysfunction. In addition, the impact of abstinence from alcohol on sexual dysfunction in postmenopausal women needs to be further explored. Understanding the impact of alcohol consumption on sexual function of postmenopausal women is critical for healthcare professionals, to provide appropriate guidance and interventions. These findings highlight the need for further research and increased awareness regarding the impact of alcohol use on sexual health during in pre-menopausal, peri and postmenopausal women. Disclosure No.

Uterine Tumor Resembling Ovarian Sex-Cord Tumor (UTROSCT): A Rare Polyphenotypic Neoplasm.

Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare form of uterine mesenchymal neoplasm. Although UTROSCT generally exhibits benign behavior with a favorable prognosis, this neoplasm is nevertheless classified as being of uncertain malignant potential, given its low rate of recurrence and the fact that it rarely produces metastases (e.g., in the lymph nodes, epiploic appendix, omentum, small bowel, subcutaneous tissue, lungs). Its histogenesis is also uncertain. Typically, UTROSCT occurs in peri-menopausal or menopausal women, but it can sometimes be observed in young women. Usually, this neoplasm can be found in the uterine corpus as a nodular intramural lesion, while it is less frequently submucosal, subserosal, or polypoid/intracavitary. UTROSCT can cause abnormal bleeding, pelvic pain, enlarged uterus, and mass sensation, but sometimes it is found purely by chance. This neoplasm can be considered polyphenotypic on morphological, immunohistochemical, and genetic analyses. Generally, upon microscopic examination, UTROSCT shows a predominant pattern of the cords, nests, and trabeculae typical of sex-cord tumors of the ovary, while immunohistochemically it is characterized by a coexpression of epithelial, smooth muscle, and sex-cord markers. The aim of this review is to report clinical and pathological data and genetic alterations to establish their impact on the prognosis and management of patients affected by this rare entity.

An Evaluation of DNA Methylation Levels and Sleep in Relation to Hot Flashes: A Cross-Sectional Study.

Objectives: We aimed to evaluate the DNA methylation levels in perimenopausal and postmenopausal women, measured through Long Interspersed Element-1 (LINE-1) and Alu, and the sleep parameters in relation to the presence of hot flashes (HFs). Methods: This cross-sectional study included 30 peri- or postmenopausal women aged between 45 and 55. The menopausal status was determined according to STRAW + 10 criteria and all participants had a low cardiovascular disease (CVD) risk profile determined by Framingham risk score. The sample was divided into two groups based on the presence or absence of HFs documented in their medical history during their initial visit: Group 1 (n = 15) with HFs present and Group 2 (n = 15) with HFs absent. The patients had polysomnography test and HFs were recorded both by sternal skin conductance and self-report overnight. Genomic DNA was extracted from the women's blood and methylation status was analyzed by fluorescence-based real-time quantitative PCR. The quantified value of DNA methylation of a target gene was normalized by β-actin. The primary outcome was the variation in methylation levels of LINE-1 and Alu and sleep parameters according to the presence of HFs. Results: LINE-1 and Alu methylation levels were higher in Group 1 (HFs present), although statistically non-significant. LINE-1 methylation levels were negatively correlated with age. Sleep efficiency was statistically significantly lower for women in Group 1 (HFs present) (74.66% ± 11.16% vs. 82.63% ± 7.31%; p = 0.03). The ratio of duration of awakening to total sleep time was statistically significantly higher in Group 1 (HFs present) (22.38% ± 9.99% vs. 15.07% ± 6.93, p = 0.03). Objectively recorded hot flashes were significantly higher in Group 1 (4.00 ± 3.21 vs. 1.47 ± 1.46, p = 0.03). None of the cases in Group 2 self-reported HF despite objectively recorded HFs during the polysomnography. The rate of hot flash associated with awakening was 41.4% in the whole sample. Conclusions: Women with a history of hot flashes exhibited lower sleep efficiency and higher awakening rates. Although a history of experiencing hot flashes was associated with higher LINE-1 and Alu methylation levels, no statistical significance was found. Further studies are needed to clarify this association. This study was funded by the Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa. Project number: TTU-2021-35629.

Meaningfulness and Experience of Perimenopausal Women During the Pandemic in India: A Mixed-Method Study

The perimenopausal transition marks a significant phase in women’s lives, and the unforeseen challenges posed by the COVID-19 pandemic added complexity to this already intricate period. We investigated the mediating role of satisfaction with life between meaning in life and quality of life and adaptive strategies employed by perimenopausal women during the pandemic in India. Findings showed satisfaction with life as a strong mediator between meaning in life and quality of life. Thematic analysis identified a global theme of meaning in uncertainty and organizing themes: finding solace in self and actionable insights. The study emphasizes the need for understanding the meaning-making processes and adaptive strategies employed by women navigating perimenopause in the face of unprecedented global challenges.

The impact of perceived vaginal and urinary symptoms and treatment burden in predicting sexual functioning among perimenopausal and postmenopausal women.

This study aimed to explore the relationship between urogenital symptom frequency and severity, perception of vaginal treatment burden, and female sexual desire, arousal, and satisfaction. A cross-sectional study was conducted with a sample of 326 patients from three tertiary care hospitals in the United Arab Emirates. The frequency and severity of urogenital symptoms, emotional and physical functioning, and treatment burden were assessed using the validated genitourinary syndrome of menopause symptoms and vaginal treatments acceptability questionnaire (GSM-SVATQ). To examine the mediating roles of emotional and physical functioning, as well as the perceived treatment burden on sexual functioning, a partial least squares-structural equation model was developed using the SmartPLS 4 Software. The measurement model was successfully established. All constructs had a reliability of > 0.70 and discriminant validity of < 0.90. Emotional, physical and sexual functioning showed an adjusted R2 values of 0.377, 0.282 and 0.169, respectively.The multistep multiple mediator model revealed a full mediation effect of both emotional and physical functioning between symptom, treatment burden and sexual functioning. The model showed high predictive performance with all manifest variables showing lower mean absolute errors compared to the naiive benchmark model. This study enhances our understanding of the relationships between urogenital symptoms, perceived treatment burden, emotional functioning, and sexual well-being. The findings emphasize the importance of addressing emotional well-being in managing urogenital symptoms and in addressing emotional factors associated with the use of vaginal treatments.

Case Report: The Effect of Ajwa Dates on Calcium Levels in Perimenopausal Women

Perimenopause itself is defined as the permanent cessation of menstruation due to loss of ovarian activity confirmed by the onset of amenorrhea for 12 consecutive months in the absence of other pathological or physiological causes, occurring at the age of 42 years until menopause. In perimenopausal women, besides decreasing estrogen levels, there is also a decrease in calcium absorption which causes osteoporosis. Where dates contain iron, magnesium, calcium, phosphorus and potassium, but it also contains phytochemical compounds such as phytosterols and phytoestrogens. Phytoestrogens have the same structure and function as endogenous estrogens that serve to exert a major effect on women on bone remodeling and also control the timing of osteoclast apoptosis. Objective : To determine the relationship between giving ajwa dates to calcium levels in perimenopausal women. Method : Literature review with narrative review design. Results : Based on several journals that have been reviewed, it can be concluded that giving ajwa dates can inhibit the decrease in bone density in elderly women, where the active substances that play a role in this are calcium and phytoestrogens. Conclusion : Giving ajwa dates can inhibit the decrease in bone density in elderly women. Keywords : ajwa date (Phoenix dactylifera L), perimenopause, calcium.

A phase II trial of anlotinib and fulvestrant in patients with HR-positive and HER2-negative, secondary aromatase inhibitor–resistant, metastatic breast cancer.

e13065 Background: Fulvestrant is used after aromatase inhibitor (AI) failure in metastatic breast cancer but resistance develops quickly. We hypothesized that using anlotinib, a novel multi-target tyrosine kinase inhibitor, may delay fulvestrant resistance in patients (pts) and thus improve its efficacy. This single-arm, phase II trial aims to evaluate the efficacy and safety of the combined regimen in pts with HR-positive and HER2-negative, previously AI treated, locally advanced or metastatic breast cancer. Methods: The key enrolled criteria were women aged 18 years or older of any menopausal status (premenopausal or perimenopausal women received ovarian function suppression), ECOG PS 0-1, histologically confirmed HR-positive and HER2-negative breast cancer, and disease relapse within 12 months after a more than 24 months AI adjuvant setting or disease progress after a more than 6 months AI metastatic setting. Eligible pts received 500 mg fulvestrant by intramuscular injection on days 1 and 15 of cycle one and then on day one of each subsequent cycle (28 days). Pts were also given 12 mg oral anlotinib once daily for 2 weeks, followed by a week off in a 21-day cycle. The primary endpoints is progression-free survival (PFS) and the secondary endpoints include overall response rate (ORR), clinical benefit rate (CBR), overall survival (OS), and safety. Results: 30 pts have been enrolled from Aug 2021 to Dec 2023. After a median follow-up time of 12.9 months (95% CI, 9.0-16.8), the overall median PFS was 6.4 months (95% CI 3.4-9.5) and the mOS has not reached. In the 29 pts whose efficacy could be evaluated, the ORR was 20.7% (95% CI, 8.0-39.7) and the DCR was 79.3% (95% CI, 60.3-92.0), with partial response and stable disease recorded in 6 and 17 pts. The CBR was 41.4% (95% CI, 23.5-61.1), with 6 pts reach SD for more than 6 months. Pts who have not received CDK 4/6 inhibitors previously had longer PFS (14.8 months, 95% CI 3.7-25.9) than those who have received CDK 4/6 inhibitors (4.6 months, 95% CI 3.0-6.3) in the subgroup analysis (HR=0.33, P=0.038). At the same time, we find pts who have not received systemic chemotherapy previously also had longer PFS (9.7 months, 95% CI 6.0-13.2) than those who have received systemic chemotherapy (5.5 months, 95% CI 3.6-7.4) (HR=0.47, P=0.12). TEAEs of any grade were observed in 90.0% of pts, and the frequent AEs included hypertension (43.3%), wight loss (20.0%), proteinuria (20.0%), increased TSH (20.0%), and hand-foot syndrome (20.0%). Grade 3 TEAEs occurred in 11 (36.7%) pts, the most common of which was hypertension (26.7%). Dose reductions or discontinuation of anlotinib occurred in 12 (40.0%) pts. Conclusions: Anlotinib combined with fulvestrant showed a promising efficacy with an acceptable safety profile for patients with metastatic breast cancer previously treated with AI. Further results are expected. Clinical trial information: NCT05075512 .

Short- and long-term impact by vasomotor symptoms in menopause and modern approaches to their correction

The importance of management in women in menopause and postmenopause is not diminishing, but only gaining relevance. It is estimated that by 2050, more than 1.6 billion women worldwide will reach this age, compared to 1 billion in 2020. Vasomotor symptoms (VMS) are the most common symptoms of menopause and affect more than 70% of women. They are diagnosed in 35-50% of women in perimenopause and 30-80% women in postmenopause. Most of these symptoms persist less than 7 years after the last menstrual period, but one in four women may experience them up to 10 years, and one in ten women may experience them after 10 years. They are based on complex endocrine, neuroendocrine and epigenetic mechanisms. This article is a review of scientific literature publications aimed at determining the impact of VMSs on women’s future life based on the analysis of published modern studies.VMSs not only have a negative impact on a woman’s quality of life, but also have potential importance for cardiovascular health. The increased risk of cardiovascular diseases (CVD) after menopause is attributed to a sharp decrease of endogenous estrogen levels, which indicates its potential cardioprotective effect in premenopausal women. It has been established that VMSs are a risk factor for coronary heart disease and diabetes mellitus. The presence of non-alcoholic fatty liver disease is also significantly associated with an increased risk of early and severe forms of VMSs among perimenopausal women.Taking into account that women spend a third of their lives in the postmenopausal period, it is important to analyze the experience of their management during this difficult period. It is based on focusing on a healthy lifestyle as part of primary prevention, including regular physical activity, calcium/vitamin D intake, maintaining an optimal body weight, avoiding stress, etc. Menopausal hormone therapy (MHT) is considered as a first-line treatment for VMSs in menopause and perimenopause. Its use should be individualized, and initiation and discontinuation should not be based only on a woman’s age. Assessment of baseline CVD risk, age and period since menopause are important. It is considered a priority for women with menopause before 10 years or under 60 years of age who have no contraindications to MHT. Hormone therapy is not indicated only for the prevention of CVD. However, it has the potential to improve cardiovascular risk profile due to its beneficial effects on vascular function, lipid levels, glucose metabolism, and reduction of diabetes mellitus.Non-hormonal VMS treatment has sufficient experience of use when there are medical contraindications to hormonal therapy or a woman’s personal choice. However, MHT remains the most effective for VMS treatment.

Application of Vaginal Ultrasound and Hysteroscopy in the Diagnosis of Perimenopausal Endometrial Lesions

Background: This study aimed to investigate the utility of transvaginal ultrasound and hysteroscopy in diagnosing abnormal uterine bleeding in peri-menopausal women. Methods: Between September 2021 and March 2023, 176 women presenting with abnormal uterine bleeding at the Second Affiliated Hospital of Xinjiang Medical University were subjected to both hysteroscopy and transvaginal ultrasound examinations. Results: There was a significant discrepancy between the pathological diagnoses and the findings from transvaginal ultrasound (p &lt; 0.05), with a Kappa coefficient of 0.475, indicating moderate agreement. Similarly, a significant difference was observed between the results of pathological diagnosis and those obtained via hysteroscopy (p &lt; 0.05), with a Kappa coefficient of 0.669, suggesting substantial agreement. The combined diagnostic approach yielded a Kappa value of 0.784, demonstrating a better consistency and indicating superior diagnostic efficacy. In diagnosing peri-menopausal abnormal uterine bleeding, transvaginal ultrasound exhibited a sensitivity of 89.7%, specificity of 66.7%, and a negative predictive value of 46.7%. Hysteroscopy showed higher sensitivity and specificity at 94.8% and 76.2% respectively, but a relatively low negative predictive value of 66.7%. The combined diagnostic approach further improved the sensitivity and specificity to 97.4% and 81.0% respectively, with a negative predictive value of 81.0%, surpassing those of the individual methods. For the etiological diagnosis of abnormal uterine bleeding (AUB) caused by endometrial polyps, hysteroscopy achieved a concordance rate of 93.3%, significantly outperforming transvaginal ultrasound, which had a rate of 77.3% (χ2 = 7.670), thus demonstrating higher detection efficiency. Conclusions: Transvaginal ultrasound and hysteroscopy are valuable diagnostic tools in the etiological assessment of peri-menopausal AUB. Transvaginal ultrasound, being safe and cost-effective, is preferable for initial etiological screening of AUB, though it carries the risk of underdiagnosis and misdiagnosis. Despite the higher cost and reduced convenience of hysteroscopy, its combination with pathological examination significantly enhances the detection rates of cancerous and precancerous lesions. Consequently, the integration of transvaginal ultrasound with hysteroscopy is recommended for the comprehensive diagnostic evaluation of endometrial lesions in peri-menopausal women with AUB, facilitating early diagnosis and treatment.

Knowledge, attitude, and practice toward sleep disorders and sleep hygiene among perimenopausal women

This cross-sectional study aimed to explore the knowledge, attitude and practice (KAP) toward sleep disorders and sleep hygiene among perimenopausal women, who were enrolled in Dezhou region of Shandong Province between July and September 2023. A total of 720 valid questionnaires were collected (mean age: 51.28 ± 4.32 years old), and 344 (47.78%) reported experiencing insomnia. The mean scores for knowledge, attitude, practice, and Dysfunctional Beliefs and Attitudes about Sleep (DBAS) were 15.73 ± 7.60 (possible range: 0–36), 29.35 ± 3.15 (possible range: 10–50), 28.54 ± 4.03 (possible range: 10–50), and 6.79 ± 1.90 (possible range: 0–10), respectively. Path analysis showed that knowledge had direct effects on attitude (β = 0.04, 95% CI 0.01–0.07, P = 0.001), and DBAS (β = 0.04, 95% CI 0.02–0.05, P < 0.001). Knowledge had direct effects (β = 0.11, 95% CI 0.08–0.15, P < 0.001) and indirect (β = 0.02, 95% CI 0.00–0.03, P = 0.002) effect on practice. Moreover, attitude also had a direct impact on practice (β = 0.34, 95% CI 0.25–0.43, P < 0.001). In conclusion, perimenopausal women exhibited insufficient knowledge, negative attitude, inactive practice toward sleep disorders and sleep hygiene, and unfavorable DBAS, emphasizing the need for targeted healthcare interventions.

The Effect of Ajwa Dates (Phoenix dactylifera L) Consumption to Antral Ovarium Imaging by with Ultrasonography (USG) Transvaginal of Perimenopausal Women

Objectives: Perimenopause is a transition from the reproductive period to the menopause stage with a decrease in the number and function of oocytes. Transvaginal ultrasound is a reliable alternative method for detecting ovarian reserve. Ajwa dates contain phenolic and other flavonoid components which are considered to have the potential to improve the ovarian condition of perimenopausal women which can be assessed by increasing the number of antral follicles as measured by transvaginal ultrasound. This study aims to determine the effect of consuming ajwa dates (Phoenix dactylifera L.) on the appearance of ovarian follicles using transvaginal ultrasound in perimenopausal women. Methods: This research is a quasi-experimental study with a pre-post control design carried out at RSIA Sitti Khadijah I Muhammadiyah Makassar, South Sulawesi, Indonesia, from May to September 2023. This research involved 44 perimenopausal subjects aged 42-48 years who were divided into 2 groups randomly (28 intervention groups, 16 control groups). Subjects in the intervention group consumed seven pieces of ajwa dates (60-70 grams each seven pieces) every morning before having breakfast for eight weeks. The transvaginal USG was performed twice, the first was on day three of the menstrual cycle of each subject and the second was after eight weeks of intervention. A comparison of changes in ovarian follicles was analyzed using the Mann-Whitney U test. Results: This study showed a significant decrease in the number of antral follicles in the intervention group and an increase in the number in the control group (p&lt;0.05). Meanwhile, the size of the antral follicles showed a significant increase in the intervention group and a significant decrease in the size of the antral follicles in the control group (p&lt;0.05). Conclusion: Consuming Ajwa dates as an exogenous antioxidant can affect the number and size of antral follicles, which is an indicator of improving the condition of perimenopausal women's ovaries.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S66

Sonographic and histopathological findings of endometrium among perimenopausal women with abnormal uterine bleeding- A cross sectional study in north Kerala

: AUB makes a perimenopausal woman to seek medical care. This study evaluated and correlated the endometrial thickness obtained by ultrasonography and histopathological findings of endometrium in perimenopausal women with AUB.A hospital based observational cross-sectional study was conducted in Obstetrics and Gynaecology Department, Baby Memorial Hospital, Calicut for a period of 18 months. Histo-pathologic evaluation of endometrial tissue was done and was correlated with endometrial thickness.: The average age of women enrolled was 47.88 years with standard deviation of 3.729. The average endometrial thickness was 12.40mm. Endometrial hyperplasia without atypia was the leading histopathological finding obtained after analysis of endometrium (21.5%). This study shows that there is a significant relationship between histopathology findings of endometrium and age of participant and between endometrial thickness and menorrhagia. There was no relationship between histopathology findings and endometrial thickness. Perimenopausal AUB should be evaluated in a systematic manner, so that endometrial hyperplasia, carcinoma endometrium could be diagnosed in a very early stage and prompt treatment be given at right time reducing morbidity improving the quality of life.

“Sex Cord Stromal Tumor Masquerading as Broad Ligament Fibroid in a Postmenopausal Woman: Lessons Learned from a Case Report”

Background:: Ovarian fibromas are sex cord-stromal tumors accounting for 4% of all ovarian tumors. They are benign, solid ovarian tumors commonly encountered in perimenopausal and postmenopausal women. They are usually asymptomatic or present with vague symptoms like abdominal pain. This makes their pre-operative diagnosis difficult. Case Report:: The present case report briefs the finding of ovarian fibroma in a 59-year-old postmenopausal woman presenting with dull aching lower abdominal pain, misdiagnosed as broad ligament fibroid on ultrasonography and malignant ovarian mass on MRI. She underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intraoperative findings included a right-sided smooth, solid, freely mobile ovarian mass of size 4x5 cm, uterus and left ovary were atrophic, with healthy bilateral fallopian tubes. Her histopathology report revealed ovarian fibroma with minimal nuclear atypia. Conclusion:: Ovarian fibromas are common benign solid ovarian tumors, that are difficult to diagnose pre-operatively, and often confused with uterine or broad ligament fibroids due to their similar clinical and radiological presentations. Hence, the clinician should keep ovarian fibromas as one of the differentials in the diagnosis of solid adnexal masses mimicking broad ligament fibroids.

Endometrial thickness by ultrasonography and its correlation with histopathology in abnormal uterine bleeding among peri and post menopausal women

The endometrium constitutes a dynamic organ in female reproductive years, as it is subjected to hormonal variations in every cycle. Present study was conducted with the aim to correlate the endometrial thickness with the histopathology in the peri-menopausal females presenting with abnormal uterine bleeding (AUB) and to identify cut off value of endometrial thickness in order to reach at some consensus regarding when to intervene so that not a single endometrial pathology will be missed.This was an observational study conducted on 242 peri-menopausal and post-menopausal women ≥40 years of age presenting with abnormal uterine bleeding (AUB).: Based on the ROC curve, the cutoff point that delineates the abnormal histology and normal histology for endometrial thickness was 14.20 mm. Area under the curve (AUC) was 0.783 with 95% CI as 0.686 - 0.880 having sensitivity 71% and specificity 90% (p &amp;#60; 0.001). Heavy menstrual bleeding and frequent cycle were found to be commonly associated with gynecological pathology in these age groups. In all post and peri-menopausal AUB trans vaginal sonography for endometrial thickness is the initial best modality of investigation. Endometrial thickness cutoff in the range of ≥ 14 mm is of prime importance.

The Effects of Tai Chi Rouli Ball Exercise on Bone Mineral Content and Bone Metabolism Indicators in Perimenopausal Women

Background Perimenopause is associated with a decline in estrogen levels, leading to decreased bone mineral density (BMD) and altered bone metabolism, increasing the risk of osteoporosis. Tai Chi Rouli Ball, a traditional Chinese sport, is thought to have beneficial effects on physical health, but its impact on bone health in perimenopausal women is not well understood.Methods This study involved a randomized controlled trial with 52 perimenopausal women aged 45–55 years from community senior centers. Participants were divided into two groups: the Tai Chi Rouli Ball group and the control group. Baseline assessments of bone density, bone mineral content (BMC), and bone metabolism markers, including estrogen levels, were conducted. The Tai Chi Rouli Ball group underwent regular training for a specific period, while the control group did not receive any intervention. Post-experiment assessments were then compared to the baseline.Results Post-intervention, the Tai Chi Rouli Ball group showed a significant increase in spine bone density and BMC in various body parts, including the whole body, trunk/torso, and spine, compared to the control group. Bone metabolism indicators also improved, with increased levels of estrogen and a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Calcium levels showed a significant increase, while other markers like alkaline phosphatase (ALP), phosphorus (P), and magnesium (Mg) had non-significant changes.Conclusions Tai Chi Rouli Ball exercise may positively influence bone health by improving bone density, BMC, and altering bone metabolism markers in perimenopausal women. These findings suggest that Tai Chi Rouli Ball could be a viable non-pharmacological approach to prevent osteoporosis in this demographic.

Changes in bone density and structure of proximal humerus with aging in Chinese women

AimsThis study aimed to investigate age- and menopause-related differences in bone mineral density (BMD), bone structure and estimated bone strength at surgical neck of humerus in Chinese female sample. MethodsWe conducted a cross-sectional cohort study of 171 Chinese women. Bone mass, indices of geometric properties and estimated mechanical strength of the surgical neck were evaluated by quantitative computed tomography (QCT). Comparisons were performed across menstrual status categories. Age-related changes in QCT-derived bone parameters were calculated. ResultsThe age-related difference of BMD and cortical thickness was 40.25 % and 32.86 % between the age of 20 and 86 years. Progressive periosteal and endosteal expansion was associated linearly with age. Estimated mechanical strength indexes showed significant quadratic associations with age, with their peak occurred at the age of 46–55 years. The quartile of women with the greatest medullary diameter also had the lowest valve of BMD and cortical thickness and the greatest in skeletal width. Compared to premenopausal individuals, perimenopausal women were distinguished by lower cortical thickness (18.63 %) and BMD (20.05 %). The continued decrease in cortical thickness and BMD was noted after menopause. The medullary and periosteal diameter increased by 17.98 % and 9.34 % respectively in perimenopausal period, but not after menopause. The accelerated loss of the maximum and polar section modulus was observed in late postmenopausal women. ConclusionsThe increase in bone size only occurred during the menopause transition. Obvious loss of resistance to bending was in late postmenopausal period.