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LIFESTYLE AND POSTMENOPAUSAL HEALTH
S18
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
63 HORMONE REPLACEMENT THERAPY IN UROGYNECOLOGIC SURGERY K. Drusany Staric, M. Barbic. Slovenian Menopause Society, University Medical Centre Ljubljana, Department of Obstetrics and Gynecology, Ljubljana, Slovenia Background: Because the female lower urinary tract and genital tract both arise from the primitive urogenital sinus, the tissues, developed in close anatomical proximity, are similar. Estrogen receptors can be found in the areas of the urethra, trigone and pubococcygeus muscle. Just like in the genital tract, the cell cycle activity of the fore-mentioned tissues could be increased under the influence of estrogens, and detected in urinary cytology. Different studies on the influence of estrogens on urinary incontinence reveal only a subjective but not an objective improvement. There are even fewer studies considering local estrogen treatment as pre-operative adjuvant therapy in the treatment of urinary incontinence, however, evidently improved local vascularization under the estrogen influence support the thesis that local estrogen treatment might improve and accelerate post-operative wound healing. Conclusions: The role of systemic and local estrogen treatment is not precisely defined yet. However, it has been confirmed that estrogens improve local vascularization of vaginal and para-vaginal tissues, which indicate beneficial effects of pre and post operative estrogen local treatment. Keywords: Urinary incontinence, operative treatment, hormonal treatment.
pared to women from the Far East, African and Asian countries, where psychological, musculoskeletal and other atypical symptoms may be more troublesome. There is some evidence that ethnicity independently affects perception of menopausal symptoms, possibly due to genetic differences in the metabolism of sex hormones. The prevalence of symptoms also varies within an ethnic group depending on a number of other factors such as biological (e.g. parity, past experiences, health, BMI, diet, exercise, smoking), socioeconomic (e.g. marital status, level of education, change in lifestyle habits, employment status, family income, financial stability) and other less researched geographical factors such as country of residence and climate differences. Experience of menopause is significantly influenced by the attitude of society as a whole. Family traditions, cultural upbringing and social support may dictate how symptoms are perceived. Availability of health information and accessibility of treatment may also determine the helpseeking behaviour in a cultural group. Recent increase in international immigration and globalisation has seen the emergence of multicultural societies worldwide. There is an increased need for health care providers to understand the difference in menopausal perception between cultures so that appropriate advice can be given and treatment can be tailored according to the needs of the community, irrespective of their country of residence.
66 LIFESTYLE AND POSTMENOPAUSAL HEALTH
64 USE OF HORMONE REPLACEMENT THERAPY IN SLOVENIAN WOMEN BEFORE THE FIRST DIAGNOSIS OF BREAST CANCER K. Gersak, J.Z. Cerne. Slovenian Menopause Society, University Medical Centre Ljubljana, Department of Obstetrics and Gynecology, Ljubljana, Slovenia Objectives: Some known risk factors for breast cancer include early menarche, late first pregnancy, late menopause, obesity in post-menopause and hormone therapy. Their common denominator is exposure to sex hormones. The aim of this study is to collect epidemiological data on hormone replacement therapy prescription in Slovenian women before the first diagnose of breast cancer, in a certain observation period. Patients and methods: The women are being recruited from the National Cancer Registry and from continuous registration of cases at the Institute of Oncology in Ljubljana. We expect to enrol at least 500 women aged 50-69 years; they are invited to participate via a personal letter. The method of voluntary questionnaire has been chosen. In addition to general questions, it contains questions that provide reproductive data (menarche, number and course of pregnancy, labours, breast-feeding), familial cancer history and bad habits. Detailed questions are asked regarding drug intake, in particular sex hormones. The same number of randomly selected women from the outpatient clinic registry of the Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana will be included as case-control pairs. Results and conlusions: The results and conclusions of this ongoing study will be presented. Keywords: Hormone replacement therapy, breast cancer, epidemiological data.
International Menopause Society (IMS)
65 ETHNIC DIFFERENCES IN THE PERCEPTION OF MENOPAUSE P. Gupta. Birmingham Heartlands Hospital, Obstetrics & Gynaecology, Birmingham, United Kingdom Ethnic origin and cultural upbringing have considerable influence on the experience of menopause. The prevalence of symptoms and the need for treatment differs widely between communities. Consistently, more women from the Western countries are troubled with vasomotor symptoms com-
A. Pines. Ichilov Medical Center, Department of Medicine ’T’, Tel-Aviv, Israel One of the most important components of lifestyle relates to physical activity. Other features of lifestyle may include smoking, alcohol consumption and nutritional habits, but those will not be covered in my presentation. Sedentary people fare less well than those who exercise regularly. The benefits of exercise can be demonstrated in many bodily organs. The most frequently studied effect of exercise is reduction in cardiovascular morbidity and mortality, but positive effects on the musculo-skeletal system, breast cancer, mood and cognition, and quality of life were recorded as well. In many cases a dose-response was evident, and even a mild to moderate degree of activity, performed only few times weekly, may carry significant merits.
67 INTERNATIONAL DIFFERENCES IN METABOLIC SYNDROME K. Tserotas. Caja del Seguro Social de Panamá, Ob-Gyn, Panama, Panama Objectives: Present differences in incidence of Metabolic Syndrome (MS) in relation to gender, nationality, ethnic and racial groups. Methods: Internet data search, World Health Organization’s information and use of various definitions of MS. Results: MS’s incidence is growing to dangerous epidemiological levels affecting the wellbeing of world population. Just after menopause there’s a shift from primarily male to female incidence as total incidence of both groups grows. Gender differences continue as ATP III criteria were more predictive of death from cardiovascular disease (CVD) for women than men (rr 4.65 vs 1.82). Within the United States, racial differences are clearly demonstrated [higher in Hispanics (36%) and afroamericans (27%) than white women (22%)]. Also, a higher incidence of hypertension in afroamericans with MS and more diabetes in hispanics under the same conditions is seen. Greater waist circumference (ATP III criteria) indicates atherogenic risk in whites and diabetogenic risk in blacks. Increased waist circumference in Filipino American women (32.6% MS incidence) did not increase CVD risk as it did in white women. A positive screen for blacks and whites is associated with higher risk of CVD; in Hispanics and Filipino Americans it’s associated with higher risk of diabetes. Asian data show very low incidence of MS but after adjustment, (male waist circumference to ≥ 90 cm, obesity to ≥ 25 kg/m2 and overweight to 23-24.9 kg/m2 ), Asia-Pacific is the fastest growing region in MS (prevalence 12-24%). In Latin America’s REDLinc Study, (12 countries), incidence of MS is 28.1% in women aged 40-44 years and up to 42.9% in 60-64 years group. In Europe obesity, as a marker of MS, varies (males: Romania 10%, Germany 13.6%, Greece 26%, and Spain 26.4%, Russia 33.5%), with higher incidence in “Mediterranean” countries and faster growing incidence in “Eastern”
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
63 HORMONE REPLACEMENT THERAPY IN UROGYNECOLOGIC SURGERY K. Drusany Staric, M. Barbic. Slovenian Menopause Society, University Medical Centre Ljubljana, Department of Obstetrics and Gynecology, Ljubljana, Slovenia Background: Because the female lower urinary tract and genital tract both arise from the primitive urogenital sinus, the tissues, developed in close anatomical proximity, are similar. Estrogen receptors can be found in the areas of the urethra, trigone and pubococcygeus muscle. Just like in the genital tract, the cell cycle activity of the fore-mentioned tissues could be increased under the influence of estrogens, and detected in urinary cytology. Different studies on the influence of estrogens on urinary incontinence reveal only a subjective but not an objective improvement. There are even fewer studies considering local estrogen treatment as pre-operative adjuvant therapy in the treatment of urinary incontinence, however, evidently improved local vascularization under the estrogen influence support the thesis that local estrogen treatment might improve and accelerate post-operative wound healing. Conclusions: The role of systemic and local estrogen treatment is not precisely defined yet. However, it has been confirmed that estrogens improve local vascularization of vaginal and para-vaginal tissues, which indicate beneficial effects of pre and post operative estrogen local treatment. Keywords: Urinary incontinence, operative treatment, hormonal treatment.
pared to women from the Far East, African and Asian countries, where psychological, musculoskeletal and other atypical symptoms may be more troublesome. There is some evidence that ethnicity independently affects perception of menopausal symptoms, possibly due to genetic differences in the metabolism of sex hormones. The prevalence of symptoms also varies within an ethnic group depending on a number of other factors such as biological (e.g. parity, past experiences, health, BMI, diet, exercise, smoking), socioeconomic (e.g. marital status, level of education, change in lifestyle habits, employment status, family income, financial stability) and other less researched geographical factors such as country of residence and climate differences. Experience of menopause is significantly influenced by the attitude of society as a whole. Family traditions, cultural upbringing and social support may dictate how symptoms are perceived. Availability of health information and accessibility of treatment may also determine the helpseeking behaviour in a cultural group. Recent increase in international immigration and globalisation has seen the emergence of multicultural societies worldwide. There is an increased need for health care providers to understand the difference in menopausal perception between cultures so that appropriate advice can be given and treatment can be tailored according to the needs of the community, irrespective of their country of residence.
66 LIFESTYLE AND POSTMENOPAUSAL HEALTH
64 USE OF HORMONE REPLACEMENT THERAPY IN SLOVENIAN WOMEN BEFORE THE FIRST DIAGNOSIS OF BREAST CANCER K. Gersak, J.Z. Cerne. Slovenian Menopause Society, University Medical Centre Ljubljana, Department of Obstetrics and Gynecology, Ljubljana, Slovenia Objectives: Some known risk factors for breast cancer include early menarche, late first pregnancy, late menopause, obesity in post-menopause and hormone therapy. Their common denominator is exposure to sex hormones. The aim of this study is to collect epidemiological data on hormone replacement therapy prescription in Slovenian women before the first diagnose of breast cancer, in a certain observation period. Patients and methods: The women are being recruited from the National Cancer Registry and from continuous registration of cases at the Institute of Oncology in Ljubljana. We expect to enrol at least 500 women aged 50-69 years; they are invited to participate via a personal letter. The method of voluntary questionnaire has been chosen. In addition to general questions, it contains questions that provide reproductive data (menarche, number and course of pregnancy, labours, breast-feeding), familial cancer history and bad habits. Detailed questions are asked regarding drug intake, in particular sex hormones. The same number of randomly selected women from the outpatient clinic registry of the Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana will be included as case-control pairs. Results and conlusions: The results and conclusions of this ongoing study will be presented. Keywords: Hormone replacement therapy, breast cancer, epidemiological data.
International Menopause Society (IMS)
65 ETHNIC DIFFERENCES IN THE PERCEPTION OF MENOPAUSE P. Gupta. Birmingham Heartlands Hospital, Obstetrics & Gynaecology, Birmingham, United Kingdom Ethnic origin and cultural upbringing have considerable influence on the experience of menopause. The prevalence of symptoms and the need for treatment differs widely between communities. Consistently, more women from the Western countries are troubled with vasomotor symptoms com-
A. Pines. Ichilov Medical Center, Department of Medicine ’T’, Tel-Aviv, Israel One of the most important components of lifestyle relates to physical activity. Other features of lifestyle may include smoking, alcohol consumption and nutritional habits, but those will not be covered in my presentation. Sedentary people fare less well than those who exercise regularly. The benefits of exercise can be demonstrated in many bodily organs. The most frequently studied effect of exercise is reduction in cardiovascular morbidity and mortality, but positive effects on the musculo-skeletal system, breast cancer, mood and cognition, and quality of life were recorded as well. In many cases a dose-response was evident, and even a mild to moderate degree of activity, performed only few times weekly, may carry significant merits.
67 INTERNATIONAL DIFFERENCES IN METABOLIC SYNDROME K. Tserotas. Caja del Seguro Social de Panamá, Ob-Gyn, Panama, Panama Objectives: Present differences in incidence of Metabolic Syndrome (MS) in relation to gender, nationality, ethnic and racial groups. Methods: Internet data search, World Health Organization’s information and use of various definitions of MS. Results: MS’s incidence is growing to dangerous epidemiological levels affecting the wellbeing of world population. Just after menopause there’s a shift from primarily male to female incidence as total incidence of both groups grows. Gender differences continue as ATP III criteria were more predictive of death from cardiovascular disease (CVD) for women than men (rr 4.65 vs 1.82). Within the United States, racial differences are clearly demonstrated [higher in Hispanics (36%) and afroamericans (27%) than white women (22%)]. Also, a higher incidence of hypertension in afroamericans with MS and more diabetes in hispanics under the same conditions is seen. Greater waist circumference (ATP III criteria) indicates atherogenic risk in whites and diabetogenic risk in blacks. Increased waist circumference in Filipino American women (32.6% MS incidence) did not increase CVD risk as it did in white women. A positive screen for blacks and whites is associated with higher risk of CVD; in Hispanics and Filipino Americans it’s associated with higher risk of diabetes. Asian data show very low incidence of MS but after adjustment, (male waist circumference to ≥ 90 cm, obesity to ≥ 25 kg/m2 and overweight to 23-24.9 kg/m2 ), Asia-Pacific is the fastest growing region in MS (prevalence 12-24%). In Latin America’s REDLinc Study, (12 countries), incidence of MS is 28.1% in women aged 40-44 years and up to 42.9% in 60-64 years group. In Europe obesity, as a marker of MS, varies (males: Romania 10%, Germany 13.6%, Greece 26%, and Spain 26.4%, Russia 33.5%), with higher incidence in “Mediterranean” countries and faster growing incidence in “Eastern”