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DOPPLER AND THREE DIMENSIONAL (3D) DOPPLER SONOGRAPHY IN EVALUATION OF ABNORMAL UTERINE BLEEDING IN MENOPAUSE
S20
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
72 ASSESSMENT OF QUALITY OF LIFE IN THE MENOPAUSE IN ECUADOR AND LATIN AMERICA
assessing three stable personality traits (introversion, emotional instability, and insincerity) in peri- and postmenopausal women is presented. Keywords: Quality of life, personaliyt scale, spanish women
P. Leon-Leon. Facultad de Ciencias Médicas, Universidad de Guayaquil, Guayaquil, Ecuador Significant biological, psychological and social changes are associated to female age and her progressive decrease in estrogenic secretion during the climacteric, which may lead to impaired quality of life (QoL). This impairment has been assessed with various instruments specifically designed for the purpose. Assessment of QoL in relation to the menopause in Latin America has also been performed, however, to a lesser extent, in which several QoL assessment tools have been used including The Menopause Specific Quality of Life Questionnaire (MENQOL) and The Menopause Rating Scale (MRS). All studies have correlated female variables with the severity of climacteric symptoms and hence QoL. Regarding small middle-aged female populations, total and subscale MRS scores correlated in Colombia, Chile and Ecuador. In the latter a high rate of women (50.6%) presented moderate to severe symptom intensity (MRS total score 9 or more), in relation to the four most prevalent MRS symptoms: hot flushes (68.9%), sleeping problems, (68.4%), depressive mood (55.2%) and irritability (51.6%). Additionally, women presented moderate to severe scorings for the psychological subscale in 35.7%, for the somatic 42.5% and for the urogenital 46.5%. As assessed with the MENQOL, Obesity (among women with the metabolic syndrome), has been determined to be an implicated factor related to more severe menopausal symptoms. Ethnicity is another issue taken into account when comparing populations in terms of severity of menopausal symptoms: Afro-Colombian women in comparison with non-black (Hispanic/mestizo) ones were at higher risk for impaired QoL (more severe menopausal symptoms). In the largest Latin American QoL assessment series, involving many countries of the region and utilizing the same MRS specific validated menopausal QoL assessing tool, important to highlight is the high prevalence of women found to have moderate to severe total MRS scorings (impaired QoL), situation that was the highest in Uruguay (67.4%) and Chile (80.8%). Impaired QoL (severe total MRS score ≥17) was associated with the use of alternatives menopausal therapies, the use of psychiatric drugs, attending a psychiatrist, being postmenopausal, having 49 years or more, living at high altitude and having a partner with erectile dysfunction or premature ejaculation. Lower risk for impaired QoL was related to living in a country with a lower income, using HT and engaging in healthy habits. In conclusion, Latin American middle aged women have a high prevalence of QoL impairment which depends upon individual female and male characteristics and the demography of the studied population.
Serbian Menopause Society
73
75
DEVELOPMENT AND UTILITY OF A NEW QUALITY OF LIFE ASSESSING TOOL (THE CERVANTES SCALE) AMONG SAPNISH WOMEN
PREMATURE OVARIAN FAILURE AS A CARDIOVASCULAR RISK FACTOR
J. Ferrer, C. Group. Spanish Menopause Society, Madrid, Spain Background And Objective: The objective of this study was to develop and validate a specific scale, the Cervantes Scale, for menopause in Spanish women. Otherwise, it was interesting to develop and validate a simple personality scale to be used as a complementary tool for menopause-specific quality-of-life instruments. Subjects and Method: This cross-sectional study included a pilot phase, construction of the questionnaire, validation, and test-retest reliability. A population-based sample of 2,274 women ponderated by age groups and education levels was used in the validation phase. Results: The final questionnaire included 31 items (“menopause and health” with 15 items made up of vasomotor symptoms, health and aging, “sexuality” with 4 items, “couple relationship” with 3 items and “psychical domain” with 9 items). The Cronbach’s (coefficient of the scale was 0.9092. The correlation coefficient of the test-retest was r=0.847 (p<0.001). Regarding the personality scale, the final 20-item scale consisted of three domains: introversion (seven items), emotional instability (seven items), and insincerity (control subscale, six items). The Cervantes Scale is short, and easy to administer (about 7 minutes). Conclusions: The Cervantes Scale is included in the new generation of instruments of health-related quality of life specific for the menopause and is intended to be used in Spanish women aged between 45 and 64 years. Concerning the personality scale a novel self-report 20-item scale for
74 DOPPLER AND THREE DIMENSIONAL (3D) DOPPLER SONOGRAPHY IN EVALUATION OF ABNORMAL UTERINE BLEEDING IN MENOPAUSE S. Dragojevic-Dikic. Gyn&Obst Clinic ’Narodni front’, Belgrade University Medical School, Gynecological Endocrinology Dept./Obstetrics Dept., Belgrade, Serbia Objectives: The aim of this study is to evaluate the role of Doppler and 3D Doppler sonography in differentiating benign from malignant endometrial changes in menopause. Methods: Eighty one (81) patients with abnormal uterine bleeding, older than 40 years, of which fifteen (15) were in postmenopause, have been tested. Prior to explorative curettage and histopathological analysis, ultrasonographic and hemodynamic studies, at the uterine blood vessels level (uterine artery bilaterally) had been performed by transvaginal colour Doppler and three dimensional (3D) Doppler sonography. Results: Histopathological results indicated 4 types of represented changes, on the basis of how the patients were divided into the groups: I, proliferative endometrium - 22 patients; II, endometrial adenocarcinoma 25 patients; III, various forms of endometrial hyperplasia - 30 patients; IV, atrophic endometrium - 4 patients. Significant statistical difference in the endometrial thickness was established between groups I and II, and endometrial cancer was not found in less than 5 mm thick endometrium. By analysing hemodynamic parameters, significantly lower PI values were obtained in the group of patients with pathologically altered endometrium, compared to other groups. Conclusions: Transvaginal colour Doppler combined with 3D Doppler sonography has significant role in the diagnostic process for evaluation of abnormal uterine bleeding in perimenopausal and postmenopausal women. Doppler and 3D Doppler sonography can help in differentiating physiological from malignant endometrial changes and in deciding on the most efficient therapeutical regime in menopause. Keywords: Doppler sonography, abnormal uterine bleeding, menopause.
S. Vujovic 1 , M. Stojanovic 2 , M. Ivovic 2 , M. Tancic 2 , M. Ivanisevic 3 , M. Barac 2 , L. Marina 2 , M. Drezgic 2 . 1 Institut of Endocrinololgy, Department of Gynecol. Endocrinology, Beograd, Serbia; 2 Institut of Endocrinology, Beograd, Serbia; 3 Institut of Gynecology, Beograd, Serbia Premature ovarian failure (POF) is defined as a occurrence of hypergonadotropic and hypoestrogenic amenorrhoea in women under 40 years. The two-fold age specific increase of mortality rate has been reported in POF. Predominant causes of deaths are cardiovascular. Objectives: Of our study was to test lipid levels and blood pressure changes in women with POF after only 1-2 years of amenorrhoa. Subjects: I POF: 62 women, 29.2±2.1 y’s old, BMI=24.4±2.3 kg/m, 1-2 years of amenorrhoa; II CONTROLS: 36 healthy women, 27±3.5 y’s old, BMI=22.8±2.2 kg/m, with regular cycles. METHODS Blood samples for total cholesterol, HDL, LDL, triglycerides, glycaemia were taken at 8 am. after overnight fast. POF was diagnosed a year before (FSH>40 IU/L, E2<50 pmol/L). To evaluate ambulatory blood pressure parameters ABMP was performed with validated Schiller BR 102 ambulatory blood pressure monitor to obtain 24-h blood pressure (BP). STATISTICS: T test, Kruskall-Wallis, ANOVA. Results: Total cholesterol (TC) 5.3±1.2 vs. 4.3±0.9, HDL 1.34±0.3 vs 1.42±0.6, LDL 3.5±2.1 vs. 2.6±1.1, triglycerides 2.2±1.1 vs. 1.8±0.9, glycaemia 5.2±1.2 vs. 4.5±1.1 mmol/L. Significant differences were found for TC and LDL (p<0.05). Mean BP: POF 120/78 (day), 96/60 (night), controls: 119/80 (day), 99/61 mmHg (night). No significant difference was found.
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
72 ASSESSMENT OF QUALITY OF LIFE IN THE MENOPAUSE IN ECUADOR AND LATIN AMERICA
assessing three stable personality traits (introversion, emotional instability, and insincerity) in peri- and postmenopausal women is presented. Keywords: Quality of life, personaliyt scale, spanish women
P. Leon-Leon. Facultad de Ciencias Médicas, Universidad de Guayaquil, Guayaquil, Ecuador Significant biological, psychological and social changes are associated to female age and her progressive decrease in estrogenic secretion during the climacteric, which may lead to impaired quality of life (QoL). This impairment has been assessed with various instruments specifically designed for the purpose. Assessment of QoL in relation to the menopause in Latin America has also been performed, however, to a lesser extent, in which several QoL assessment tools have been used including The Menopause Specific Quality of Life Questionnaire (MENQOL) and The Menopause Rating Scale (MRS). All studies have correlated female variables with the severity of climacteric symptoms and hence QoL. Regarding small middle-aged female populations, total and subscale MRS scores correlated in Colombia, Chile and Ecuador. In the latter a high rate of women (50.6%) presented moderate to severe symptom intensity (MRS total score 9 or more), in relation to the four most prevalent MRS symptoms: hot flushes (68.9%), sleeping problems, (68.4%), depressive mood (55.2%) and irritability (51.6%). Additionally, women presented moderate to severe scorings for the psychological subscale in 35.7%, for the somatic 42.5% and for the urogenital 46.5%. As assessed with the MENQOL, Obesity (among women with the metabolic syndrome), has been determined to be an implicated factor related to more severe menopausal symptoms. Ethnicity is another issue taken into account when comparing populations in terms of severity of menopausal symptoms: Afro-Colombian women in comparison with non-black (Hispanic/mestizo) ones were at higher risk for impaired QoL (more severe menopausal symptoms). In the largest Latin American QoL assessment series, involving many countries of the region and utilizing the same MRS specific validated menopausal QoL assessing tool, important to highlight is the high prevalence of women found to have moderate to severe total MRS scorings (impaired QoL), situation that was the highest in Uruguay (67.4%) and Chile (80.8%). Impaired QoL (severe total MRS score ≥17) was associated with the use of alternatives menopausal therapies, the use of psychiatric drugs, attending a psychiatrist, being postmenopausal, having 49 years or more, living at high altitude and having a partner with erectile dysfunction or premature ejaculation. Lower risk for impaired QoL was related to living in a country with a lower income, using HT and engaging in healthy habits. In conclusion, Latin American middle aged women have a high prevalence of QoL impairment which depends upon individual female and male characteristics and the demography of the studied population.
Serbian Menopause Society
73
75
DEVELOPMENT AND UTILITY OF A NEW QUALITY OF LIFE ASSESSING TOOL (THE CERVANTES SCALE) AMONG SAPNISH WOMEN
PREMATURE OVARIAN FAILURE AS A CARDIOVASCULAR RISK FACTOR
J. Ferrer, C. Group. Spanish Menopause Society, Madrid, Spain Background And Objective: The objective of this study was to develop and validate a specific scale, the Cervantes Scale, for menopause in Spanish women. Otherwise, it was interesting to develop and validate a simple personality scale to be used as a complementary tool for menopause-specific quality-of-life instruments. Subjects and Method: This cross-sectional study included a pilot phase, construction of the questionnaire, validation, and test-retest reliability. A population-based sample of 2,274 women ponderated by age groups and education levels was used in the validation phase. Results: The final questionnaire included 31 items (“menopause and health” with 15 items made up of vasomotor symptoms, health and aging, “sexuality” with 4 items, “couple relationship” with 3 items and “psychical domain” with 9 items). The Cronbach’s (coefficient of the scale was 0.9092. The correlation coefficient of the test-retest was r=0.847 (p<0.001). Regarding the personality scale, the final 20-item scale consisted of three domains: introversion (seven items), emotional instability (seven items), and insincerity (control subscale, six items). The Cervantes Scale is short, and easy to administer (about 7 minutes). Conclusions: The Cervantes Scale is included in the new generation of instruments of health-related quality of life specific for the menopause and is intended to be used in Spanish women aged between 45 and 64 years. Concerning the personality scale a novel self-report 20-item scale for
74 DOPPLER AND THREE DIMENSIONAL (3D) DOPPLER SONOGRAPHY IN EVALUATION OF ABNORMAL UTERINE BLEEDING IN MENOPAUSE S. Dragojevic-Dikic. Gyn&Obst Clinic ’Narodni front’, Belgrade University Medical School, Gynecological Endocrinology Dept./Obstetrics Dept., Belgrade, Serbia Objectives: The aim of this study is to evaluate the role of Doppler and 3D Doppler sonography in differentiating benign from malignant endometrial changes in menopause. Methods: Eighty one (81) patients with abnormal uterine bleeding, older than 40 years, of which fifteen (15) were in postmenopause, have been tested. Prior to explorative curettage and histopathological analysis, ultrasonographic and hemodynamic studies, at the uterine blood vessels level (uterine artery bilaterally) had been performed by transvaginal colour Doppler and three dimensional (3D) Doppler sonography. Results: Histopathological results indicated 4 types of represented changes, on the basis of how the patients were divided into the groups: I, proliferative endometrium - 22 patients; II, endometrial adenocarcinoma 25 patients; III, various forms of endometrial hyperplasia - 30 patients; IV, atrophic endometrium - 4 patients. Significant statistical difference in the endometrial thickness was established between groups I and II, and endometrial cancer was not found in less than 5 mm thick endometrium. By analysing hemodynamic parameters, significantly lower PI values were obtained in the group of patients with pathologically altered endometrium, compared to other groups. Conclusions: Transvaginal colour Doppler combined with 3D Doppler sonography has significant role in the diagnostic process for evaluation of abnormal uterine bleeding in perimenopausal and postmenopausal women. Doppler and 3D Doppler sonography can help in differentiating physiological from malignant endometrial changes and in deciding on the most efficient therapeutical regime in menopause. Keywords: Doppler sonography, abnormal uterine bleeding, menopause.
S. Vujovic 1 , M. Stojanovic 2 , M. Ivovic 2 , M. Tancic 2 , M. Ivanisevic 3 , M. Barac 2 , L. Marina 2 , M. Drezgic 2 . 1 Institut of Endocrinololgy, Department of Gynecol. Endocrinology, Beograd, Serbia; 2 Institut of Endocrinology, Beograd, Serbia; 3 Institut of Gynecology, Beograd, Serbia Premature ovarian failure (POF) is defined as a occurrence of hypergonadotropic and hypoestrogenic amenorrhoea in women under 40 years. The two-fold age specific increase of mortality rate has been reported in POF. Predominant causes of deaths are cardiovascular. Objectives: Of our study was to test lipid levels and blood pressure changes in women with POF after only 1-2 years of amenorrhoa. Subjects: I POF: 62 women, 29.2±2.1 y’s old, BMI=24.4±2.3 kg/m, 1-2 years of amenorrhoa; II CONTROLS: 36 healthy women, 27±3.5 y’s old, BMI=22.8±2.2 kg/m, with regular cycles. METHODS Blood samples for total cholesterol, HDL, LDL, triglycerides, glycaemia were taken at 8 am. after overnight fast. POF was diagnosed a year before (FSH>40 IU/L, E2<50 pmol/L). To evaluate ambulatory blood pressure parameters ABMP was performed with validated Schiller BR 102 ambulatory blood pressure monitor to obtain 24-h blood pressure (BP). STATISTICS: T test, Kruskall-Wallis, ANOVA. Results: Total cholesterol (TC) 5.3±1.2 vs. 4.3±0.9, HDL 1.34±0.3 vs 1.42±0.6, LDL 3.5±2.1 vs. 2.6±1.1, triglycerides 2.2±1.1 vs. 1.8±0.9, glycaemia 5.2±1.2 vs. 4.5±1.1 mmol/L. Significant differences were found for TC and LDL (p<0.05). Mean BP: POF 120/78 (day), 96/60 (night), controls: 119/80 (day), 99/61 mmHg (night). No significant difference was found.