Postmenopausal Status Research Articles

Is It Possible to Prevent Nontherapeutic Laparotomies in Breast Cancer Patients With Isolated Adnexal Masses?

Introduction: The risk of ovarian malignancy is increasing in patients with a history of breast cancer. Thus, well-defined predictors of ovarian malignancy should be identified to determine surgical or conservative management of adnexal masses in women with breast cancer. This study aimed to clarify the predictors of malignant ovarian tumors in patients with breast cancer with an isolated adnexal mass. Methods: Breast cancer patients diagnosed with an adnexal mass who underwent surgery between 2010 and 2021 at a tertiary cancer center were included in the study. Patients with suspected extra ovarian metastases were excluded. Results: A total of 40 breast cancer patients who underwent surgery for ovarian masses were identified. 23 (57.5%) women had benign ovarian tumors and 17 (42.5%) had malignant ovarian tumors. Among the malignant ovarian tumors, there were three (17.6%) metastatic breast cancers in the ovary and 14 (82.4%) primary ovarian cancers. In univariate analyses, the risk of malignant ovarian tumors increased in women with age >52years (P = .012), postmenopausal status (P = .023), CA 125 ≥ 35IU/ml (P = .001), CA 15-3 ≥ 32IU/ml (P = .002), and complex ovarian masses (P < .001). Ovarian malignancies were observed in 82.4% of patients who had complex ovarian masses. Conclusion: Ovarian malignancies were diagnosed in 82.4% of the breast cancers who had complex ovarian mass on USG examination. Therefore, surgery is recommended in women with complex ovarian masses. Postmenopausal status, age >52years, CA 125 ≥ 35IU/ml, and CA 15-3 ≥ 32 were other risk factors for ovarian malignancy.

The Prognostic Impact of HER2-Low and Menopausal Status in Triple-Negative Breast Cancer.

TNBC is noted for its aggressive behavior and poor prognosis. Recently developed HER2 target agents have shown potential benefit even in HER2-low expressing breast cancers. This study retrospectively analyzed 2542 non-metastatic TNBC patients from 2008 to 2020, revealing that 26.0% were HER2-low. Data on demographics, tumor characteristics, pathologic complete response (pCR) rates and disease-free survival (DFS), distant metastasis-free survival (DMFS), overall survival (OS), and breast cancer-specific survival (BCSS) were analyzed. The HER2-low group, compared to the HER2-0 group, showed significantly better DFS, DMFS, OS, BCSS (p = 0.0072, p = 0.0096, p = 0.0180, and p = 0.0001, respectively) with older age and higher rates of postmenopausal status (p < 0.0001). No significant differences in pCR rates were observed. Multivariate analyses identified HER2 status as a significant prognostic factor for DFS (p = 0.048), DMFS (p = 0.018), OS (p = 0.049), and BCSS (p = 0.008). Subgroup analysis revealed that these effects varied with menopausal status, showing more pronounced benefits in postmenopausal women. Our findings suggest that HER2-low TNBC patients exhibit a distinct clinical profile and improved survival compared to HER2-0 TNBC patients, especially in postmenopausal patients. Further research on estrogen and HER2 interaction is needed.

Predictive factors for adnexal involvement in endometrial cancer FIGO stage IIIA

ObjectiveUnderstanding ovarian involvement incidence and risk factors in women with endometrial cancer may inform the decision of ovary preservation.MethodsOur retrospective study included all consecutive fully surgically staged patients with endometrial...

Novel associations between MTDH gene polymorphisms and invasive ductal breast cancer: a case–control study

ObjectiveTo reveal the contributing effects of MTDH gene SNPs in the risk of invasive ductal breast cancer (IDC).Patients and methodsA case–control study was conducted, recruiting a total of 300 cases of IDC and 565 cancer-free controls from East China. Genotyping of three single-nucleotide polymorphisms (SNPs) in the MTDH gene was performed. Genomic DNA was extracted from peripheral blood samples of patients. The three SNPs (rs1311 T > C, rs16896059 G > A, rs2449512 A > G) in the MTDH gene were selected for detection using a TaqMan real-time polymerase chain reaction assay. The association between MTDH and the risk of IDC was analyzed employing an epidemiology case–control study and a multinomial logistic regression model.ResultsAmong the three evaluated SNPs, rs1311 T > C, rs16896059 G > A, and rs2449512 A > G demonstrated a significant association with an increased risk of IDC. Furthermore, stratified analysis revealed that individuals carrying the rs1311 CC genotype, rs16896059 GA/AA genotypes, and rs2449512 GG genotype were more susceptible to developing IDC in subgroups of patients younger than 53 years, without family history of IDC, pre-menopause status, clinical stage 2, high grade, with no distant metastasis or invasion, Her2-positive type, ER positive, PR positive, and Ki67 cells less than 10%. However, carriers of the rs16896059 GA/AA genotypes and rs2449512 GG genotype had an elevate the risk of IDC in patients with tumor size larger than 2 cm, post-menopause status, clinical stage 3, with invasion, lymph node infiltration, ER negative, PR negative, Her2 negative, and Ki67 cells exceeding 10%. Compared to the reference haplotype TGA, haplotypes TAA, TAG, and TGG were significantly associated with an increased IDC risk.ConclusionIn this study, we demonstrated a significant association between MTDH gene polymorphisms and an increased risk of IDC. Moreover, our findings suggested that MTDH gene polymorphisms could serve as a potential biomarker for IDC subtyping and therapeutic selection.

P-377 Understanding the interplay between multiple sclerosis patterns and ovarian reserve, which influences the other?

Abstract Study question Is multiple sclerosis (MS) associated with diminished ovarian reserve in women? Does ovarian reserve influence multiple sclerosis progression patterns? Summary answer AntiMüllerian Hormone (AMH) is not diminished in MS patients compared to healthy matched controls. Ovarian reserve predicts multiple sclerosis patterns independently from chronological age. What is known already Population registries indicate increased childlessness in individuals with MS, but the influence of MS on ovarian reserve and the need for fertility preservation counseling are topics of ongoing debate. Notably, MS research highlights the concept of immunosenescence: with age the disease shifts from high relapse rates to disability accumulation and fewer relapses. It is uncertain whether ovarian aging, assessed through AMH, could serve as a marker of immunosenescence, offering more precise predictions of MS patterns compared to chronological age alone. Study design, size, duration This prospective observational study enrolled all female MS patients aged 18 to 50 presenting to the neurology service between June and November 2023, matching them in a 1:2 ratio with controls of similar age and BMI. The controls were healthy females, without known causes of female infertility. Exclusion criteria were: postmenopausal state, prior neoplasm requiring gonadotoxic therapy or prior hematopoietic stem cell transplantation. Participants/materials, setting, methods The study was conducted in an academic hospital, regional referral for neurology and fertility preservation. Detailed neurological and gynecological anamnesis was collected for 73 patients and 146 controls. AMH measurements were performed by the same laboratory with the Roche Elecsys AMH system. Multiple generalized linear models were carried out to explore the correlation between AMH and neurological data. All results were adjusted for age and use of hormonal contraception. Bonferroni corrected post-hoc analyses were performed. Main results and the role of chance Cases and controls were matched for age (33.6±6.1 vs. 34.4±4.5 years) and BMI (22.3±3.4 vs. 22.2±3.5 Kg/m2). The AMH values were not significantly different between cases and controls (2.7±3.5 vs. 2.7±1.6 ng/ml, p = 0.7) and showed no correlation with MS duration (p = 0.3) and disability measured with EDSS score (p = 0.9). Interestingly, higher AMH levels correlated with both having relapsed in the prior year (yes: 4.9±5.3 vs. no: 1.7±1.6 p = 0.008) and with the number of relapses in the 2 previous years (zero: 1.9±1.8, one: 2.3±2.9, more than 2: 5.8±6.2 ng/ml, p = 0.02). Consequently, patients with “No Evidence of Disease Activity”(NEDA) in the previous year showed lower AMH levels (1.68±1.3 vs. 4.1±4.7 ng/ml, p = 0.01), since absence of relapses is one of the components to define NEDA. In summary, patients with higher ovarian reserve showed a MS pattern typical of young age (higher relapse rates) independently from the actual chronological age. Limitations, reasons for caution The results should be confirmed by larger/multicenter datasets, powered to properly assess the possible influence of the different disease modifying therapies. Further research is warranted to understand the biological link behind the observed results. Wider implications of the findings Ovarian aging, measured through AMH, may provide a better indicator of a patient’s biological age than chronological age only. This may help neurologists in predicting MS patterns and treating it accordingly, providing a unique perspective on the mechanisms that link immunosenescence to the ovarian reserve reduction. Trial registration number Not Applicable

Clinical characteristics of perimenopausal female patients with rheumatoid arthritis

Objective: To explore the menopause status of patients with rheumatoid arthritis (RA) and clinical characteristics of perimenopausal RA patients. Methods: A cross-sectional study. Female RA patients were recruited retrospectively in the Sun Yat-Sen Memorial Hospital from August 2015 to August 2023. Clinical data were collected, including onset age, disease duration, RA disease activity indicators, functional assessment, and radiographic scores. According to menopausal status, the patients were categorized as pre-menopausal, perimenopausal and post-menopausal groups to explore their menopausal and clinical characteristics. Results: A total of 1 151 female patients were enrolled, with a mean age of (50.2±13.0) years. At enrollment, there were 470 (40.8%), 140 (12.2%) and 541 (47.0%) patients in pre-menopause, perimenopause and post-menopause status, respectively. The mean age of menopause was (49.0±4.2) years. Compared with pre-menopausal group, perimenopausal RA patients had higher disease activity indicators [clinical disease activity index (CDAI) 17 (6, 26) vs 10 (3, 19) ], higher levels of inflammation [erythrocyte sedimentation rate (ESR) 35 (21, 65) vs 26 (14, 44) mm/1h, C-reactive protein (CRP) 6.2 (3.2, 16.8) vs 3.3 (3.2, 13.6) mg/L], and a higher proportion of functional limitation [25.0%(35/140) vs 10.4%(49/470)] (all P<0.016 7); while there was no significant differences in disease activity[M(Q1, Q3)] [CDAI 17 (6, 26) vs 14 (6, 25)], levels of inflammation [ESR 35(21, 65) vs 42 (23, 72) mm/1h, CRP 6.2 (3.2, 16.8) vs 6.2 (3.3, 23.9) mg/L] and functional limitation [25.0%(35/140) vs 28.8%(156/541)] when compared with those in post-menopausal group (all P>0.016 7). In RA patients during the perimenopausal period, 49 cases (35.0%) developed RA during this period. Compared with patients with RA onset during reproductive age, patients with RA onset during the perimenopausal period had higher numbers of 28-joint tender joints [7 (2, 10) vs 4 (0, 8)], higher CDAI [20 (12, 29) vs 14 (4, 24)], and higher ESR [45 (25, 72) vs 32 (18, 56) mm/1h] (all P<0.05). Conclusion: Perimenopausal patients with RA have severe disease activity and functional limitation.

Coronary Artery Calcification Progression in Patients With Systemic Lupus Erythematosus.

To evaluate the progression of coronary artery calcification (CAC) and associated risk factors in a systemic lupus erythematosus (SLE) cohort. We reassessed the presence of CAC in patients with SLE who were screened 9 years before, using multidetector computed tomography. Clinical variables (cumulated disease activity and damage accrual), antiphospholipid syndrome and SLE serology, and cardiovascular (CV) risk factors (hypertension, BMI [kg/m2], modified Framingham risk score, lipid profile, menopausal status) were assessed longitudinally. We included 104 patients from the parent study. Most of them were women (94.2%), with a mean age of 41.0 (SD 8.3) years and mean disease duration of 14.8 (SD 2.9) years. We documented CAC in 17 patients (16.3%). Seven cases were from the parent study and 10 were incident cases. The cumulative incidence of CAC was 9% and the incidence density was 1 per 100 person-years. CAC occurred more frequently in the age groups 30-39 years and 40-44 years. All patients with previous CAC had worsening of their calcium indexes, and none developed clinical CV events. When comparing prevalent CAC cases (n = 17) vs patients without calcification (n = 87), both groups were similar in traditional CV risk factors, disease duration, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) area under the curve (AUC), and Systemic Lupus International Collaborating Clinics (SLICC) score, but were more likely to be postmenopausal and have higher apolipoprotein B (apoB) levels. Patients with previous CAC had higher apoB levels, SLEDAI-2K AUC scores, and anticardiolipin IgG antibodies than incident cases. CAC in patients with SLE progressed over time but was not associated with adverse CV events during the first 9 years of follow-up. ApoB levels and postmenopausal status might be associated with this progression.

Sex Differences in the Blood Metabolome During Acute Response to Ischemic Stroke.

Introduction: Females suffer greater lifetime risk of stroke and greater morbidity and mortality from stroke compared with males. This study's objective was to identify differences in metabolomic profiling of females and males with stroke and which differences were associated with neurological outcome. Methods: Females and males with acute ischemic stroke enrolled in the Emergency Medicine Specimen Bank at a comprehensive stroke center provided whole blood samples upon arrival for mass spectrometry-based metabolomics. We used descriptive statistics to characterize the cohort. A linear regression model was fit for individual metabolites to determine differences in relative abundance between males and females while controlling for covariates (age, race/ethnicity, postmenopausal status, cardiovascular risk factors, depression, time between sample collection and last known well, and initial National Institutes of Health Stroke Scale [NIHSS] score). For each differentially expressed metabolite, a linear regression model was fit to determine the association between the metabolite and NIHSS at 24 hours after admission while controlling for the covariates and acute treatments. Results: After adjusting for covariates, eight metabolites differed in females and males with a stroke. These included amino acids or their metabolites (proline and tryptophan), nucleotides (guanosine diphosphate [GDP], and inosine-3',5'-cyclic monophosphate), citrate, dehydroascorbate, choline, and acylcarnitine-(5-OH). GDP and dehydroascorbate were significantly associated with 24-hour NIHSS (p = 0.0991). Conclusions: Few metabolites were differentially abundant in blood after a stroke when comparing females with males and controlling for confounders, but the interactions between biological sex and GDP, as well as biological sex and dehydroascorbate, were associated with 24-hour neurological function. This has important implications for future studies that evaluate the therapeutic potential of these metabolites in ischemic stroke.

Diagnostic, prognostic, and predictive importance of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and CA125 in endometrial hyperplasia and carcinoma.

Inflammation has an important role in the progression of endometrial carcinoma. The aim of this study is to find the association between neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and CA125 in endometrial hyperplasia and endometrial carcinoma. The study also focuses on the association of CA125, NLR, and PLR with histopathological parameters in endometrial carcinoma that are of prognostic importance. This is a prospective cross-sectional study on 57 biopsy-proven cases of endometrial hyperplasia and carcinoma conducted over a period of two years. The NLR, PLR, and CA125 were calculated and recorded in all the 57 cases. The 57 cases were divided into three groups: endometrial hyperplasia without atypia group which included 36 cases, endometrial atypical hyperplasia group which included 10 cases, and the endometrial carcinoma group which included 11 cases. Comparison was done between the groups, and parity, NLR, PLR, and CA125 were found to be significant, but patient age and postmenopausal status were not significant. NLR, PLR, and CA125 were found to increase with higher grade, pT-stage, and nodal stage for the endometrial carcinoma cases. NLR, PLR, and CA125 were marginally increased or normal in the case of endometrial hyperplasia without atypia and endometrial atypical hyperplasia, while they were significantly increased in endometrial carcinoma, and also correlated with an increase in grade, pT-stage, and nodal stage. Hence, these can be considered for additional screening as diagnostic, prognostic, and predictive markers in case of abnormal uterine bleeding with endometrial pathology.

Sex differences in CGRP-induced vasodilation of human middle meningeal arteries but not human coronary arteries: implications for migraine.

Migraine prevalence and levels of calcitonin gene-related peptide (CGRP), a peptide involved in migraine pathophysiology, differ between men and women, and appear to be affected by changes in sex hormones. The present study investigated the sex-specific responses to CGRP in human isolated arteries. CGRP-induced relaxation of 62 (28 men and 34 women) human isolated middle meningeal arteries (HMMA) and 139 (69 men and 70 women) human isolated coronary arteries (HCA) was compared between men and women in groups <50 years and ≥50 years of age as a proxy for pre- and postmenopausal status in women, as well as matched-age groups for men. In HCA, no differences were observed between male and female tissue, or between the different age groups. However, in HMMA, the maximum response was significantly smaller and CGRP was less potent in females <50 compared with males <50 years of age. No differences were observed between the older age groups. Sex differences were observed for CGRP-induced relaxation of HMMA, but not HCA. These differences could arise from differential receptor expression in the vascular beds combined with the effect of sex hormones on CGRP and subsequent receptor desensitization.

Associations between body mass index and hormonal receptor, HER2/neu receptor, as well as other clinical characteristics of breast cancer

Background. Obesity is a growing problem in the world. Correlations have been found between increasing body mass index (BMI) and breast cancer (BC). BC has multiple predictive and prognostic factors like hormonal receptors, human epidermal growth factor 2 receptor, stage of the disease and grade. Obesity may be differentially related to the risk of different subtypes given the various potential mechanisms underlying its association with breast cancer. The study aims to analyze the association between BMI, BC histopathologic, ER, PR and HER2/neu receptors expression, tumor size axillary nodes involvement, metastasis and nuclear grade. Methods. A cross sectional study was conducted involving 256 cases with breast cancer. Oncology teaching hospital based BC cases had been interviewed and data collected regarding weight and height, estrogen and progesterone receptors status, human epidermal growth factor 2 receptor, stage of the disease, grade of tumor at time of diagnosis, and categorize the cases to pre and postmenopausal state and then subdivided according to body mass index (normal, overweight, obese) and compared between three groups. Results. Overweight/obese people showed a significant statistical effect with estrogen and progesterone receptors, positive p value = 0.026, 0.007 respectively, larger tumor size, p value =0.035, and more lymph node involvement, p-value=0.031 in post-menopausal women, while premenopausal cases did not show significant statistical effect regarding the above-mentioned variables. Body mass index difference did not show a significant statistical effect on human epidermal growth factor 2 receptor, metastasis at diagnosis, tumor grade in both pre and postmenopausal cases. Conclusion. Body mass index difference affects postmenopausal BC cases rather than premenopausal as overweight/obese cases presented with more estrogen and progesterone receptors positive, larger tumor size and more lymph node involvement.

Linking menopause-related factors, history of depression, APOE ε4, and proxies of biological aging in the UK biobank cohort

In a subset of females, postmenopausal status has been linked to accelerated aging and neurological decline. A complex interplay between reproductive-related factors, mental disorders, and genetics may influence brain function and accelerate the rate of aging in the postmenopausal phase. Using multiple regressions corrected for age, in this preregistered study we investigated the associations between menopause-related factors (i.e., menopausal status, menopause type, age at menopause, and reproductive span) and proxies of cellular aging (leukocyte telomere length, LTL) and brain aging (white and gray matter brain age gap, BAG) in 13,780 females from the UK Biobank (age range 39–82). We then determined how these proxies of aging were associated with each other, and evaluated the effects of menopause-related factors, history of depression (= lifetime broad depression), and APOE ε4 genotype on BAG and LTL, examining both additive and interactive relationships. We found that postmenopausal status and older age at natural menopause were linked to longer LTL and lower BAG. Surgical menopause and longer natural reproductive span were also associated with longer LTL. BAG and LTL were not significantly associated with each other. The greatest variance in each proxy of biological aging was most consistently explained by models with the addition of both lifetime broad depression and APOE ε4 genotype. Overall, this study demonstrates a complex interplay between menopause-related factors, lifetime broad depression, APOE ε4 genotype, and proxies of biological aging. However, results are potentially influenced by a disproportionate number of healthier participants among postmenopausal females. Future longitudinal studies incorporating heterogeneous samples are an essential step towards advancing female health.

A Study on Stromal Expression of CD10 Marker in Breast Carcinoma and Its Role as a Prognostic Marker in a Tertiary Care Center in South Kerala

Abstract Background and Aims: Breast cancer is one of the leading causes of mortality among women. The aim of our study is to evaluate the stromal expression of CD10 in invasive breast carcinoma and to find its relationship with other prognostic markers such as age, histopathologic grade, estrogen receptor (ER), progesterone receptor (PR), and HER2Neu status. Materials and Methods: A total of 51 cases of breast cancer were included in the study. Representative sections were taken and hematoxylin and eosin staining was done. Immunohistochemistry was performed with ER, PR, Her2neu, and CD10. Stromal expression of CD10 is positive when &gt;10% of stromal cells show cytoplasmic and membranous positivity in invasive breast carcinoma. This will be noted and statistically analyzed with different known prognostic markers of breast carcinoma. Results: Stromal CD10 positivity was seen in 74.5% of cases (45% were strongly positive and 29.5% were weakly positive). 25.5% of cases were negative. Positivity for ER, PR, and HER2, was 58.8%, 35.3%, and 27.5%, respectively. Stromal expression of CD10 was found to be significantly associated with ER negativity (P = 0.001) and PR negativity (P = 0.001). Increasing intensity was noted with few parameters such as postmenopausal status and histologic grade but could not show statistical significance. No correlation was found between CD10 overexpression with respect to the age, tumor size, lymph node positivity status, tumor stage and HER2Neu status. Conclusions: CD10 expression correlated strongly with well-established negative prognostic markers, ER/PR negativity, and higher tumor grade, thus indicating that CD10 can be used as an independent marker indicating poor prognosis. This study highlights the role of stromal CD10 expression in predicting prognosis and the relationship with other prognostic markers. Keeping the role stroma plays in predicting prognosis and tumor response, CD10 can be included as a routine prechemotherapy marker in breast carcinoma. Further studies should be performed to see the role stroma plays in hormonal expression and the usefulness of CD10 to predict treatment failure in breast carcinomas receiving neoadjuvant therapy.

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.

A Retrospective Cohort Study of Patient Risk Factors and Pelvic Venous Reflux Patterns on Treatment Outcomes With Pelvic Vein Embolisation.

To identify the effects of patient risk factors and pelvic venous reflux (PVR) patterns on treatment outcomes of Pelvic Vein Embolisation (PVE) for Pelvic Venous Disorder (PeVD). We performed a retrospective cohort review assessing population, intervention, comparison, and outcomes (PICO) for women undergoing PVE for PVR January 2017-January 2021. We identified 190 patients who had completed both questionnaires and who had given consent for their information to be used for research (Median age 46, IQR 40-52). The distribution of pathological pelvic venous reflux found on transvaginal duplex ultrasound (TVDUS) was analysed for all patients. Pre- and post-procedure symptom burden scores were studied using a standardised questionnaire protocol. We used inferential univariate non-parametric statistics to describe our data. 190 cases were reviewed; 62.6% (119/190) premenopausal, 11.1% (21/190) perimenopausal, 25.3% (48/190) postmenopausal and menopausal status not documented 1% (2/190). 10.1% (19/188) were nulliparous (average age 34 years; range 20-55 years). There was a statistically significant improvement in all symptoms and in the appearance of varicosities on TVDUS post-PVE (P < 0.05) of the ovarian vein plexus, uterus plexus, arcuate veins, vaginal wall, peri-urethral, peri-anal, haemorrhoids, labial and proximal thigh. The locations of veins requiring embolisation having demonstrated reflux were analysed; 82.8% (154/186) underwent embolisation of at least one internal iliac vein tributary and ovarian vein embolisation. Age, parity, menopausal status and previous laparoscopy did not affect symptom improvement (P > 0.05). No significant complications such as coil migration were observed. PVE is an effective treatment for pelvic pain due to PeVD and its diagnosis should not be limited to multiparous women of childbearing age, as a significant proportion of patients who benefited from PVE were either nulliparous and/or postmenopausal.

Menopause status- and sex-related differences in age associations with spatial context memory and white matter microstructure at midlife

Decline in spatial context memory emerges in midlife, the time when most females transition from pre- to post-menopause. Recent evidence suggests that, among post-menopausal females, advanced age is associated with functional brain alterations and lower spatial context memory. However, it is unknown whether similar effects are evident for white matter (WM) and, moreover, whether such effects contribute to sex differences at midlife. To address this, we conducted a study on 96 cognitively unimpaired middle-aged adults (30 males, 32 pre-menopausal females, 34 post-menopausal females). Spatial context memory was assessed using a face-location memory paradigm, while WM microstructure was assessed using diffusion tensor imaging. Behaviorally, advanced age was associated with lower spatial context memory in post-menopausal females but not pre-menopausal females or males. Additionally, advanced age was associated with microstructural variability in predominantly frontal WM (e.g., anterior corona radiata, genu of corpus callosum), which was related to lower spatial context memory among post-menopausal females. Our findings suggest that post-menopausal status enhances vulnerability to age effects on the brain’s WM and episodic memory.

Long-Term High-Fat Diet Limits the Protective Effect of Spontaneous Physical Activity on Mammary Carcinogenesis.

Breast cancer is influenced by factors such as diet, a sedentary lifestyle, obesity, and postmenopausal status, which are all linked to prolonged hormonal and inflammatory exposure. Physical activity offers protection against breast cancer by modulating hormones, immune responses, and oxidative defenses. This study aimed to assess how a prolonged high-fat diet (HFD) affects the effectiveness of physical activity in preventing and managing mammary tumorigenesis. Ovariectomised C57BL/6 mice were provided with an enriched environment to induce spontaneous physical activity while being fed HFD. After 44 days (short-term, ST HFD) or 88 days (long-term, LT HFD), syngenic EO771 cells were implanted into mammary glands, and tumour growth was monitored until sacrifice. Despite similar physical activity and food intake, the LT HFD group exhibited higher visceral adipose tissue mass and reduced skeletal muscle mass. In the tumour microenvironment, the LT HFD group showed decreased NK cells and TCD8+ cells, with a trend toward increased T regulatory cells, leading to a collapse of the T8/Treg ratio. Additionally, the LT HFD group displayed decreased tumour triglyceride content and altered enzyme activities indicative of oxidative stress. Prolonged exposure to HFD was associated with tumour growth despite elevated physical activity, promoting a tolerogenic tumour microenvironment. Future studies should explore inter-organ exchanges between tumour and tissues.

Is there a role for essential fatty acids in osteoporosis?

Inflammatory markers are inversely associated with bone density, geometry, and strength in postmenopausal women, and elderly subjects suggesting that osteoporosis is a low-grade systemic inflammatory condition. But glucocorticoids that are potent anti-inflammatory compounds instead of arresting/preventing osteoporosis induce osteoporosis. These results indicate that IL-6 and TNF-α, post-menopausal state, and steroids produce osteoporosis by an unidentified mechanism. Pro-inflammatory cytokines, estrogen, and steroids bring about their actions by influencing the metabolism of essential fatty acids (EFAs). I propose that EFAs and their metabolites act as second messengers of actions of corticosteroids, cytokines, and estrogen. This implies that EFAs are of benefit in the prevention and management of osteoporosis. This argument is supported by the observation that plasma phospholipid content of unsaturated fatty acids is decreased in those with osteoporosis. The reports that long-chain metabolites of EFAs including arachidonic acid, docosahexaenoic acid and eicosapentaenoic acid, and lipoxin A4 are of benefit in the prevention and management of osteoporosis lends further support to this proposal.

A study of risk factors and clinico-pathological profile of patients with cervical cancer at BPKIHS: A descriptive cross-sectional study.

e17515 Background: Cervical cancer is the cancer with highest incidence and mortality among females in Nepal according to GLOBOCAN data 2020. The aims of this study was to evaluate the risk factors and clinico-pathological profile of patients with cervical cancer attending Department of Gynaecology, BPKIHS, Dharan, Nepal. Methods: It was a descriptive cross-sectional study conducted from April, 2019 to February, 2022 among seventy-nine patients with histological diagnosis of cervical cancer after ethical approval. Results: The mean age of these patients was 54.99±12.81 years. The commonest presenting symptom was postmenopausal bleeding (65.8%) and the commonest histological type was squamous cell carcinoma (87.3%). The commonly associated risk factors among them were illiteracy (88.6%), poor local hygiene (78.5%), postmenopausal status (72.2%) and poor socio-economic status (41.8%). The mean age at marriage and first pregnancy were 18.45 (SD=2.32) years and 19.47 (SD=2.51) years respectively. More than one-fourth (29.1%) of the patients had more than or equal to 5 children. Only three (3.8%) patients had undergone cervical cancer screening once in their lifetime.Most of them (n=66; 83.5%) had locally advanced disease at diagnosis. Altogether, sixty-seven (84.8%) patients were referred outside for radiation treatment. Among the surgically treated patients, twelve (63.2%) patients subsequently required dual treatment. Conclusions: Illiteracy, poor hygiene, low socio-economic status, patient’s delays, poor screening programmes, multiparity, early age at marriage and first child birth etc. are the factors requiring major focus to reduce the burden of cervical cancer in developing countries like Nepal.

Can vitamin D deficiency be considered a risk factor be considered a risk factor in luminal breast cancer?

e24122 Background: The relationship of vitamin D (VD) with cancer is controversial. Its antiproliferative function by inhibiting the cell cycle has been described, as well as its characteristics as an inhibitor of angiogenesis, inducer of apoptosis and its ability to reduce inflammation, invasion and metastasis. Deficiency of this vitamin is very prevalent, affecting 40% of the population under 65 years of age, and there are some studies that relate it to the increase in the incidence of breast cancer (BC), colon or prostate cancer. VD deficiency is defined as a serum level of 25-hydroxy VD &lt; 20 ng/mL. We analyzed whether VD deficiency can be considered a risk factor for BC, given that it is the most frequent tumor in the world. Methods: A single-center, retrospective, descriptive and analytical study of female patients diagnosed with localized luminal BC (stage I-II and III) in the year 2023 and a control group of healthy women. Baseline VD levels were determined in both groups. Statistical analysis (IBM SPSS Statistics 22) of demographic and clinical characteristics and multivariate analysis using a logistic regression model for the study of VD deficiency, according to the variables age, menopausal status and previous chemotherapy. Results: We analyzed 231 patients (p) with luminal BC and a control group of 324 healthy women. In the BC group the median age was 62 years (range 34 - 88 years), 72% (168 p) in postmenopausal stage. 52% (121 p) had stage I, 37% (86 p) stage II, and 11% stage III. 59.7 % (138 p) had luminal A phenotype and 40.2 % luminal B phenotype. 27.7 % (64 p) had received chemotherapy. In the control group the median age was 65 years (range 45 - 78 years), 90% (287 women) in postmenopausal state. VD deficiency was present in 50.6 % of the BC group with a mean VD value of 21 ng / ml. In the control group the deficit was 33 % with a mean VD value of 24 ng / ml. Therefore, this deficit is significantly higher in breast cancer patients than in healthy patients, with OR of 2.08 with 95% CI (1.4 - 2.7). In the overall multivariate analysis postmenopausal women have 5.1 more risk of presenting VD deficit, with p = 0.04. The variable age did not reach statistical significance. Logistic regression was performed to determine the effects of age, menopausal status, and having received previous chemotherapy, on the probability of BC patients presenting a VD deficit, without reaching statistical significance. Conclusions: VD deficiency is more prevalent in women with BC than the normal population, which is consistent with previous studies. Further well-designed studies are needed to assess the effect of VD supplementation in the female population as prevention of BC.