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Evaluation of women in the perimenopausal period with gestagen test
EMAS2017 / Maturitas 100 (2017) 93–202
P049
P050
Evaluation of women in the perimenopausal period with gestagen test
Breast surveillance in perimenopausal levonorgestrel IUD users
Sezai Sahmay 1,∗ , Mahmut Oncul 2 , Nigar Sofiyeva 3 , Serife Eskalen 2 , C. Tamer Erel 1 , Hakan Seyisoglu 1 , Levent M. Senturk 1
Corina Grigoriu 1 , Simona Albu 1 , Iuliana Ceausu 1,∗ , Irina Horhoianu 2 , Mihai Grigoriu 3
1
Istanbul University, Cerrahpasa School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and In-vitro Fertilization, Istanbul, Turkey 2 Istanbul University, Cerrahpasa School of Medicine, Obstetrics and Gynecology, Istanbul, Turkey 3 Yale University, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, New Haven, United States The perimenopausal period starts with climacteric symptoms and lasts until the end of the first postmenopausal year. Clinical, terminological and laboratory variations make this period difficult to diagnose. Most of the patients undergo unnecessary and early hormone therapy when only laboratory findings are taken into consideration. Evaluation of the perimenopausal patients mainly with gestagen response was aimed in our study regardless of the laboratory findings. Prospective, one-armed study was conducted from 2010 until 2016. Ninety-seven perimenopausal women with ages between 45 and 55 years were enrolled in the study. All women were assessed for AMH, FSH, E2, Prolactin, TSH levels parallel to ultrasonographic endometrial thickness assessment. Norethisterone acetate 5 mg b.i.d. was admitted to all patients for 7 days and response to the gestagen was assessed. In the group of patients with FSH level less than 35 mlU/mL, the gestagen test was positive in 96.8% of cases, while vasomotor symptoms were seen in 78% of them. In the group of patients with FSH level higher than 35 mlU/mL, gestagen response rate was 81.8%. In the group of patients with E2 levels less than 50 pg/mL level, gestagen response was positive in 86.7% of cases, meanwhile 80.6% of them had menopausal symptoms. Gestagen response was shown in 92.6% of patients with an endometrial thickness less than 5 mm, who had vasomotor symptoms in only 78.6% of cases. Gestagen response was observed to be positive even in patients who met clinical and laboratory criteria for menopause, most of them with reduced menopausal symptoms. In conclusion, hormone levels are insufficient to diagnose the perimenopausal period and are meaningless in these perimenopausal patients, however, they may be used for research purposes. Treatment should be planned according to symptoms and contraception should be taken into account during perimenopausal period. Cyclic gestagen treatment should be considered as the first choice.
161
1
University of Medicine and Pharmacy, Ob/Gyn, Bucharest, Romania 2 UMF ‘Carol Davila’, Bucharest, Ob/Gyn, Bucharest, Romania 3 University of Medicine and Pharmacy, Surgery, Bucharest, Romania Introduction: Levonorgestrel IUD represents a modern, well tolerated contraceptive method, with several noncontraceptive benefits. Perimenopausal women benefit from the anti-proliferative endometrial effect. Material and method: Levonorgestrel IUD users may complain of several symptoms or clinical signs (tension, mastodynia, lumps). We studied retrospectively 112 patients, aged 45–52, without any breast complaints when initiating contraception. Median time of IUD usage was 4.2 years. 83 patients suffered before from some form of chronic anovulation and the choice for levonorgestrel IUD had the purpose of protecting the endometrium from hyperplasia. Results: We performed in all our patients a clinical examination and a bilateral breast ultrasound scan before IUD insertion. In 34 cases we observed mild to moderate fibrous or cystic changes. US was performed at last every year, and mammography and MRI were performed if the US scan detected an anomaly. During surveillance, 29 patients complained of some breast symptomathology (tenderness or appearance of a mass). We diagnosed 22 cases of fibrous changes, six fibroadenomas (2.5–3 cm), four large simple cysts (3–5 cm) and one incipient breast cancer. Conclusions: New breast disease in perimenopausal levonorgestrel IUD users is rare. Breasts surveillance by US scan is important in perimenopausal levonorgestrel IUD users, because of a certain degree of patients anxiety regarding hormonal treatment and possible effects on breast tissue. The examinations allow reassurance of normality and early diagnosis of breast disease. http://dx.doi.org/10.1016/j.maturitas.2017.03.150 P052 Internet-based cognitive behavioral therapy to alleviate treatment-induced menopausal symptoms in breast cancer survivors: Results of the EVA-online pilot study Vera Atema 1,∗ , Marieke Van Leeuwen 1 , Hester Oldenburg 2 , Marc Van Beurden 3 , Myra Hunter 4 , Neil Aaronson 1 1
http://dx.doi.org/10.1016/j.maturitas.2017.03.149
Netherlands Cancer Institute, Psychosocial Oncology and Epidemiology, Amsterdam, Netherlands 2 Netherlands Cancer Institute, Surgical Oncology, Amsterdam, Netherlands 3 Netherlands Cancer Institute, Gynecology, Amsterdam, Netherlands 4 King’s College, Psychology (at Guy’s), Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom Background: Menopausal symptoms are common and may be particularly severe in younger women who undergo treatmentinduced menopause. A cognitive behavioral therapy (CBT) program
P049
P050
Evaluation of women in the perimenopausal period with gestagen test
Breast surveillance in perimenopausal levonorgestrel IUD users
Sezai Sahmay 1,∗ , Mahmut Oncul 2 , Nigar Sofiyeva 3 , Serife Eskalen 2 , C. Tamer Erel 1 , Hakan Seyisoglu 1 , Levent M. Senturk 1
Corina Grigoriu 1 , Simona Albu 1 , Iuliana Ceausu 1,∗ , Irina Horhoianu 2 , Mihai Grigoriu 3
1
Istanbul University, Cerrahpasa School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and In-vitro Fertilization, Istanbul, Turkey 2 Istanbul University, Cerrahpasa School of Medicine, Obstetrics and Gynecology, Istanbul, Turkey 3 Yale University, School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, New Haven, United States The perimenopausal period starts with climacteric symptoms and lasts until the end of the first postmenopausal year. Clinical, terminological and laboratory variations make this period difficult to diagnose. Most of the patients undergo unnecessary and early hormone therapy when only laboratory findings are taken into consideration. Evaluation of the perimenopausal patients mainly with gestagen response was aimed in our study regardless of the laboratory findings. Prospective, one-armed study was conducted from 2010 until 2016. Ninety-seven perimenopausal women with ages between 45 and 55 years were enrolled in the study. All women were assessed for AMH, FSH, E2, Prolactin, TSH levels parallel to ultrasonographic endometrial thickness assessment. Norethisterone acetate 5 mg b.i.d. was admitted to all patients for 7 days and response to the gestagen was assessed. In the group of patients with FSH level less than 35 mlU/mL, the gestagen test was positive in 96.8% of cases, while vasomotor symptoms were seen in 78% of them. In the group of patients with FSH level higher than 35 mlU/mL, gestagen response rate was 81.8%. In the group of patients with E2 levels less than 50 pg/mL level, gestagen response was positive in 86.7% of cases, meanwhile 80.6% of them had menopausal symptoms. Gestagen response was shown in 92.6% of patients with an endometrial thickness less than 5 mm, who had vasomotor symptoms in only 78.6% of cases. Gestagen response was observed to be positive even in patients who met clinical and laboratory criteria for menopause, most of them with reduced menopausal symptoms. In conclusion, hormone levels are insufficient to diagnose the perimenopausal period and are meaningless in these perimenopausal patients, however, they may be used for research purposes. Treatment should be planned according to symptoms and contraception should be taken into account during perimenopausal period. Cyclic gestagen treatment should be considered as the first choice.
161
1
University of Medicine and Pharmacy, Ob/Gyn, Bucharest, Romania 2 UMF ‘Carol Davila’, Bucharest, Ob/Gyn, Bucharest, Romania 3 University of Medicine and Pharmacy, Surgery, Bucharest, Romania Introduction: Levonorgestrel IUD represents a modern, well tolerated contraceptive method, with several noncontraceptive benefits. Perimenopausal women benefit from the anti-proliferative endometrial effect. Material and method: Levonorgestrel IUD users may complain of several symptoms or clinical signs (tension, mastodynia, lumps). We studied retrospectively 112 patients, aged 45–52, without any breast complaints when initiating contraception. Median time of IUD usage was 4.2 years. 83 patients suffered before from some form of chronic anovulation and the choice for levonorgestrel IUD had the purpose of protecting the endometrium from hyperplasia. Results: We performed in all our patients a clinical examination and a bilateral breast ultrasound scan before IUD insertion. In 34 cases we observed mild to moderate fibrous or cystic changes. US was performed at last every year, and mammography and MRI were performed if the US scan detected an anomaly. During surveillance, 29 patients complained of some breast symptomathology (tenderness or appearance of a mass). We diagnosed 22 cases of fibrous changes, six fibroadenomas (2.5–3 cm), four large simple cysts (3–5 cm) and one incipient breast cancer. Conclusions: New breast disease in perimenopausal levonorgestrel IUD users is rare. Breasts surveillance by US scan is important in perimenopausal levonorgestrel IUD users, because of a certain degree of patients anxiety regarding hormonal treatment and possible effects on breast tissue. The examinations allow reassurance of normality and early diagnosis of breast disease. http://dx.doi.org/10.1016/j.maturitas.2017.03.150 P052 Internet-based cognitive behavioral therapy to alleviate treatment-induced menopausal symptoms in breast cancer survivors: Results of the EVA-online pilot study Vera Atema 1,∗ , Marieke Van Leeuwen 1 , Hester Oldenburg 2 , Marc Van Beurden 3 , Myra Hunter 4 , Neil Aaronson 1 1
http://dx.doi.org/10.1016/j.maturitas.2017.03.149
Netherlands Cancer Institute, Psychosocial Oncology and Epidemiology, Amsterdam, Netherlands 2 Netherlands Cancer Institute, Surgical Oncology, Amsterdam, Netherlands 3 Netherlands Cancer Institute, Gynecology, Amsterdam, Netherlands 4 King’s College, Psychology (at Guy’s), Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom Background: Menopausal symptoms are common and may be particularly severe in younger women who undergo treatmentinduced menopause. A cognitive behavioral therapy (CBT) program