Abstracts of Posters

MENOPAUSE PHYSIOLOGYP1IT IS ETHNICITY OR LIVING ALTITUDE WHAT INCREMENTS CLIMACTERIC SYMPTOMS? A STUDY IN ANDEAN REGIONS

Ojeda Eliana (PE)

Blümel J. (CL)

Universidad Andina Del Cusco-Peru, PE

Background. Latin American women present a greater severity of climacteric symptoms than women from other parts of the world. Previous studies suggest that this could be due to either its Amerindian crossbreeding or the altitude in which a huge proportion of the Latin-American population lives. Objective. To answer this question climacteric symptoms between Peruvian women (“Hispanic-Mestizas” and “Quechuas”), living in similar altitude (around 3 000 MASL) were compared. Method. This is a cross sectional descriptive study of healthy women of 40 to 59 years of age living in native villages from el Cusco's District (Departamento de el Cusco, Peru). Using the MRS questionnaire climacteric symptoms were assessed in 771 Peruvian women; 395 “Hispanic-Mestizas” (Quechua-Spaniard breeding) and 376 pure “Quechuas”. Results.The “Quechuas” compared with “Hispanic-Mestizas” have comparable similar age, but less: obesity, schooling years, cigarette smoking, use of hormonal therapy, diabetes and hypertension; and a greater: proportion of postmenopausal women and number of children. “Quechuas” showed a greater prevalence than “Hispanic-Mestizas” in ten of the eleven symptoms evaluated by the MRS scale, except for insomnia. The total MRS score was 14.54 ± 7.51 vs. 9.87 12± 6.26 (p < 0.0001), respectively. As a consequence of this, 46.5% of the “Quechuas” had a deteriorated quality of life due to severe climacteric symptomatology, compared to only 14,2% of “Hispanic-Mestizas” women (p < 0.0001). After adjusting for confounding variables, being a “Quechua” was associated with a greater risk of presenting severe climacteric symptoms (OR: 2.38; IC 95%, 1.27–4.45). Conclusions. Peruvian “Quechuas” women have severer climacteric symptoms than the Peruvian. “Hispanic-Mestizas” who live in a comparable altitude. This could suggest that the ethnicity could be one of the factors that could explain the augmented symptoms in the Latin-American climacteric woman.

P2LOW-LEVEL X CHROMOSOME MOSAICISM IN WOMEN WITH SPORADIC PREMATURE OVARIAN FAILURE

Gersak Ksenija (SI)

Gersak Z. (SI)

Veble A.

Department of Obstetrics and Gynecology, University Medical Center Ljubljana, SI

Background: Premature ovarian failure (POF) is defined as menopause before age 40 and occurs in 1 to 2% of women. Causes of POF are of genetic, autoimmune, iatrogenic and environmental origin. Genetic causes of POF probably comprise about one third to one half of all cases. “Low-level” X-mosaicism and its clinical relevance are still under debate. It could be interpreted as a technical artefact, genuine mosaicism or as being age-related. We evaluated the contribution of X chromosome mosaicism in phenotypically normal women with POF. Patients and methods: In ten-year period 114 patients with POF and 64 age-matched controls were karyotyped. Women with phenotypic features suggestive of Turner syndrome, primary amenorrhoea or gonadal dysgenesis, structural abnormalities in one or more chromosomes, blood lymphocyte microchimerism, fragile X premutation, mutations in the FOXL2 or inhibin INHα were excluded. We evaluated the contribution of “true” and “low-level” X chromosome mosaicism by routine G-banding chromosome analysis of at least 50 metaphases. Results: Thirteen patients (11.4%) had “true” X chromosome mosaicism (> 10% of aneuploid cells) and twelve had (10.5%) “low-level” X-mosaicism (between 6–10% of aneuploid cells). The mean age of women with “true” and “low-level” mosaicism was 26.0 ± 5.65 years and 35.92 ± 3.87 years, respectively (P < 0.001). In the control group the incidence of cells with an abnormal number of X chromosomes was 1–3%. Conclusion: The results have practical implications for genetic counseling and fertility treatment. To search and confirm the “low-level” mosaicism, a higher number of metaphases should be analyzed or additional FISH analysis must be performed. Although peripheral blood does not reflect the situation in ovarian tissue well, we presume that there are different etiological causes for “true” and “low-level” X chromosome mosaicism.

P3KILLER IMMUNOGLOBULIN-LIKE RECEPTORS (KIR) HAPLOGROUPS: IMPLICATION OF THEIR DIVERSITY IN IMMUNOSENESCENCE AND MENOPAUSE STAGE

Figueroa-Vega Nicté

Juárez-Vega G.

Sánchez-Barajas M.

Caballero A.

Moreno-Frías C.

Malacara J.

University of Guanajuato, MX

Background: Aging in the immune system is characterized by the contraction of the natural killer (NK) cells repertoire. NK cell function is modulated by the differential expression of Killer Immunoglobulin-like Receptors (KIRs). KIR molecules have been classified into stimulatory and inhibitory, and KIR genes have been grouped in the A and B haplotypes. Although no single specific criterion distinguishes all A and B haplotypes, a current working definition is that B haplotypes have more genes encoding stimulatory KIR than A haplotypes. Therefore, we have hypothesized that A and B haplotypes are associated with certain characteristics of menopause. Design and methods: In a cross-sectional study, we included 150 women, classified as peri- (n = 50), early post- (n = 50), and late postmenopausal (n = 50), according to STRAW criteria. A PCR KIR gene identification system was employed to determine the presence of 14 KIR genes and 2 pseudogenes, included: KIR2DL1, KIR2DL2, KIR2DL3, KIR2DL4, KIR2DL5, KIR2DS1, KIR2DS2, KIR2DS3, KIR2DS4, KIR2DS5, KIR3DL1, KIR3DL2, KIR3DL3, KIR3DS1, KIR2DP1, and KIR3DP1. Results: We found that genes encoding inhibitory KIR genes 2DL1, 2DL3 and 3DL1 showed no variation between the 3 groups of women studied. In contrast, inhibitory KIR genes 2DL2, 2DL5, and 2DS4, and activating genes 2DS1, 2DS2, 2DS5, 2DS3, and 3DS1, showed variability between groups. Significantly, in the majority of patients were mostly with genotype AB, all haplotypes of the patient corresponding to the “B” type, which contains more KIR activating genes. Further analysis revealed that B haplotype is more associated with several symptoms at menopause. Conclusions: It is the first study that reveals an exhausted investigation on genetic diversity of KIRs at peri-, early post- and late postmenopausal women and its role in respect to age-related disease and longevity.

P4ASSESSMENT OF HEALTH RELATED QUALITY OF LIFE IN MID-AGED WOMEN WITH THE WOMEN’S HEALTH QUESTIONNAIRE (WHQ)

Chedraui Peter (EC)

Aguirre W. (EC)

Leimberg M. (EC)

Mendoza M. (EC)

Ruilova I. (EC)

Mendoza J. (EC)

Martínez M. (EC)

Vallarino V. (EC)

Valenzuela L. (EC)

San Miguel G. (EC)

Pérez-López F. (ES)

Institute of Biomedicine, Universidad Católica de Guayaquil, Ecuador, EC

Background: During female mid-life emotional and physical health are important measures of quality of life (QoL). Objective: To assess QoL and determinants (altitude included) in mid-aged women. Method: Peri/postmenopausal women aged 45 to 55 from Ecuador (Guayaquil [Coast] and Quito [Highlands]) completed the Women's Health Questionnaire (WHQ) and a socio-demographic survey containing personal data. Bivariate analysis was used to compare WHQ scores and various factors. Results: A total of 400 women were surveyed (200 per city). Median age of the whole sample was 50 years, 75.5% were postmenopausal, 23.8% had HT at sometime, 53.0% presented hot flushes, 69.5% had increased body mass index (BMI: 25 or more) and 67.8% were married. WHQ scores (all domains except menstrual) did not differ when peri and postmenopausal women were compared. Women living at high altitude presented significantly higher WHQ scores (worse QoL) for the depression, somatic, anxiety, menstrual and attractiveness domains. Contrarily, they displayed lower scores for the vasomotor, sleep and sexual domains. No differences in memory domain scores were found among studied women. Conclusion: In this mid-aged Ecuadorian female sample, as assessed with the WHQ, QoL was found to be impaired in relation to altitude.

MENOPAUSE EPIDEMIOLOGYP5PESTICIDE EXPOSURE IS ASSOCIATED WITH INCREASING OF EARLY MENOPAUSE IN WOMEN FARMERS AT BREBES DISTRICT OF INDONESIA

Fauzi Muh (ID)

Sophia D.

Diponegoro University, ID

Background: That Brebes as the largest user of pesticides in Indonesia have potential for the occurence of pesticide poisoning which will give effect on health. Pesticide exposure has been associated with reproductive health disturbance. Some pesticides like parathion and methyl parathion are structurally similar with estrogen and may interact with hormone receptors. It cause alteration hormonal balance, direct female gamete damage. Early menopause can be associated with atresia folicular ovarian and pesticide can cause to increase a number of atresia folicular ovarian. Objectives: To prove association between pesticide exposure with early menopause in women farmer who regularly exposed pesticide. Methods: It will use an observational research using cross sectional design. We need collect all women aged 30–45 at each subdistricts in Brebes District. We will select with using proportional stratified random sampling. Each women who selected will be measured the estrogen and progesteron level in blood serum. Results: These research methods can be proved with measuring some variables which proved from some researches before with poisoning pesticide cases. Variables in this study include duration to be a farmer, duration of working, intensity of spraying and personal protective equipment use. In other hand, need to measure of estrogen and progesterone level in blood serum to strenghten association each variables. With using statistic analysis we can prove association between pesticide exposure and early menopause in women farmer in Brebes District of Indonesia. Conclusion: Association pesticide and early menopause can be proved strong design study which is ensured with measuring reproductive hormone level. In other hand we need to make a district mapping for total patients who have early menopause because pesticide.

P6ENCUESTA SOBRE EL PERFIL DE LA MUJER VENEZOLANA MENOPAUSICA

Moreno-Isturiz Jose (VE)

Clinica el Avila, VE

Introducción: Para evaluar la calidad de vida en las mujeres menopausicas a nivel mundial se han creado diversas encuestas e instrumentos, pero todas de tipo anglosajon a ecepcion de la escala Cervantes en España. Decidimos realizar una encuesta tipica para la mujer venezolana y esta son los resultados preliminares. Material y Metodo: Se realizaron 120 encuestas, para evaluar el perfil de la mujer venezolana en la menopausia, en mujeres mayores de 50 años en Maracaibo (30) y Caracas (90), distribuidas de la siguiente forma: 77 encuestas en mujeres entre los 50–60 años: 30 encuestas en mujeres entre los 60–75 años y 13 encuestas en mayores de 75 años. Se midieron parametros de Calidad de vida, Actividad Sexual, Sintomatologia Generalizada y Menopausica, Esfera Psicológica, Esfera Social y Esfera Holistica. Resultados: Entre los resultados preliminares se encontraron una serie de coincidencias en todas las edades tales como que todas las mujeres creen en si misma, confian en su inteligencia para resolver problemas, les gusta aprender cosas nuevas, piensan que la menopausia NO es un castigo, se sienten más sabias y poco seductoras, pero su vida SI tiene sentido. A las preguntas: si hay perdida de la paciencia (65%), irritabilidad facil (68%), menopausia es un castigo (82,6%), Dios me abandonó (95%), Insomnio (68%); los porcentajes fueron de respuesta negativa en todas las edades. Mi vida tiene sentido (68%), Me soporto a mi misma (89,3%), tengo confianza en mi (68%), tengo confianza en mi inteligencia (68%), dolores musculares (68%), aprendo cosas nuevas a diario y con facilidad (68%); los porcentajes fueron de respuesta afirmativa para todas las edades. A la pregunta si Dios la habia abandonado, el 100% de las encuestadas por encima de los 75 años dijo que NO. Conclusiones: Primera encuesta realizada en Venezuela que explora varios aspectos sobre la mujer venezolana menopausica. Con estas y otras preguntas creemos que podemos darnos una idea del perfil de nuestras mujeres en esta etapa de la vida. Puede ser fuente para la creación de nuestra propia escala de vida en esta etapa de la mujer. Esperamos poder ampliar mas los datos y obtener un mayor universo de mujeres con la finalidad de con esta data equipararnos a los trabajos mundiales.

P7COMPARISON OF SYMPTOMS IN PERIMENOPAUSAL AND POSTMENOPAUSAL NURSES USING THE MENOPAUSE RATING SCALE AT HAJI ADAM MALIK GENERAL HOSPITAL AND ITS SATELLITE HOSPITALS IN MEDAN-INDONESIA

Siregar Muhammad (AF)

Nasution H. (AF)

Ardiansyah E. (AF)

Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sumatera Utara, AF

Objective: To determine the proportion and discrepancies of menopausal complaints of perimenopausal and postmenopausal nurses assesed using the Menopause rating Scale. Method: This analytical descriptive cross sectional study recruited perimenopausal and postmenopausal aged nurses at Haji Adam Malik General Hospital and satelite hospitals from which data were collected after filling several questionnaires. A total of 100 questionnaires each were disrtributed to the perimenopausal and postmenopausal group, the reults from which were assesed using the L-MMPI scale. The validity of this study is highly affected by honesty due to the subjective nature of the instruments used. Therefore, the L-MMPI scale is of great significance. Fifty subjects each were extracted from 60 perimenopausal and 58 postmenopausal eligible subjects with L-MMPI scores < 5. Results: Fourty seven perimenopausal (84%) and 50 (100%) postmenopausal subjects dominantly complained joint and muscle discomfort. Twenty two perimenopausal (22%) women had slight somatic complaints, whereas 31 postmenopausal women (62%) each reported mild somatic and severe urogenital complaints, respectively with a p-value of < 0.005. The total complaint score indicated that perimenopausal subjects dominantly had mild complaints (19 women, 38%) whereas 35 subjects with moderate complaints dominated the post menopausal group (70%), with a p-value of < 0.05. Conclusion: The proportion and severity degrees of menopausal symptoms significantly differed between perimenopausal and post menopausal nurses. Keywords: Nurses, Perimenopause, Postmenopause, L-MMPI Scale, Menopause Rating Scale

P8PERFIL RIESGO CORONARIO EN PACIENTES MENOPAUSICAS EN CONSULTA PRIVADA

Moreno-Isturiz Jose (VE)

Clinica el Avila, VE

Introducción: Como bien conocemos, existe un efecto hormonal protector sobre una serie de organos y cuando se va entrando en etapa de Menopausia este efecto disminuye y uno de los sistemas mas afectados es la esfera cardiovascular. Recordemos que es la responsable del 50–60% de las muertes en mujeres por encima de los 50% y cuya morbilidad es del 70% en esta etapa de la vida. Para evitar esto se diseñó en conjunto con el laboratorio de la Clinica El Avila un perfil denominado en un principio Perfil Menopausico y que luego se denominó Perfil Riesgo Coronario. Se miden una serie de variables como Hematologia Completa, Glicemia, Colesterol, HDL, LDL, Triglicéridos, Apo A, Apo B, Homocisteina, Proteina C reactiva ultrasensible y Fibrinógeno. Paralelamente se incluye TSH, T3,T4, Antiperoxidasa y Vitamina D. Materiales y Metodos: Se realizaron evaluacion de Riesgo Coronario a 400 pacientes en el lapso Febrero-Octubre 2013 en la consulta privada. La edad promedio de la muestra fue de 55,9 años (49–80). Resultados: Se obtuvo un valor promedio del colesterol total de 196,7 mg/dl (Vn 120–200). HDL: 60,6 mg/dl (Vn 40–60). LDL: 128,6 (Vn 0,0–130,0). Glicemia: 90 mg/dl (Vn 70–110). Proteina C reactiva: 2,08 (Vn menor de 3,0). Homocisteina: 9,85 (Vn 5–15). Fibrinógeno: 326,36 (Vn 200–400). Apolipoproteina A: 151,05 (Vn 97–150). Apolipoproteina B: 109,3 (Vn 79–123). En relación con vitamina D, solamente 17 pacientes tenían valores por encima de 17 nmol/ml y 11 pacientes tenían valores por debajo de 10 nmol/ml y el valor promedio fue de 23,1 nmol/ml Conclusiones: Se observa que en nuestra muestra hay una tendencia a tener valores de colesterol total en el límite superior al igual que sus fracciones y de la apolipopotreina A. Igualmente hay una importante avitaminosis D El resto del perfil se encuentra dentro de los parámetros establecidos por AVILAB como referenciales normales y nos permite concluir que debemos hacer campañas adecuadas de cambios en la alimentación y del estilo de vida de nuestras mujeres por encima de los 50 años. De todas formas futuros estudios con un universo mayor y en mujeres menores de 50 años (que ya estan en ejecución) nos ayudará a conocer mejor nuestro panorama de Riesgo Cardiovascular.

P9RELATIONSHIP BETWEEN REPRODUCTIVE FACTORS AND OSTEOPOROSIS IN KOREAN POSTMENOPAUSAL WOMEN

Yun Bo Hyon (KR)

Seo S.

Park J.

Cho S. (KR)

Choi Y. (KR)

Lee B.

Lee H.

Park K.

Severance Hospital, Yonsei University College of Medicine, KR

Objective: The objective of the study was to investigate the relationship between reproductive factors and osteoporosis in postmenopausal women. Since importance of peak bone mass acquisition in late adolescent period to early adulthood to osteoporosis has been on the rise, various studies have been designed and presented. However, although adolescent pregnancy history has been suggested to be a risk factor of postmenopausal osteoporosis, there were no specified studies about effects of lifelong reproductive factors on postmenopausal osteoporosis, such as first delivery age, menarche, hormonal usage. Methods: This study was designed as retrospective cross sectional study, which the data was based on Korea National Health and Nutrition Examination Survey (KNHNES) 2008. Total 950 of postmenopausal women was enrolled. The reproductive factors were searched using KNHNES 2008 data and bone mineral density was measured by using dual energy X-ray absorptiometry (DISCOVERY-W, Hologic, USA). Data was analysed by student-T test, chi-square test, univarate and multiple regression analysis, logistic regression analysis using SAS version 9.2 (SAS Inc., Cary, NC, USA) Results: In descriptive analysis, reproductive factors including age at first delivery (p < 0.0001), duration from menarche to first delivery (p < 0.0001), age of menarche (p = 0.001), postmenopausal duration (p < 0.0001), total pregnancy number (p < 0.0001), previous oral pill or hormonal replacement therapy history (both p < 0.0001) were shown significanctly different between postmenopausal osteoporosis group and non- osteoporosis group. Difference among BMD according to age at first delivery was shown significantly in femur neck, total lumbar spine, and total hip. BMD was significantly decreased in group 1 (age at first delivery < 20 years old) most in femur neck, total lumbar spine, and total hip (0.5699 ± 0.1135, p < 0.0001, 0.7676 ± 0.1363, p = 0.0006, 0.7131 ± 0.1297, p < 0.0001). Multiple regression showed significantly increased risk of osteoprosis in group of age at first delivery under 20 years old (OR7.853, p = 0.03). Conclusion: In our study, reproductive factors were significantly associated with postmenopausal osteoporosis development. Age at first delivery was important risk factor of postmenopausal osteoporosis which have same context of distruption of peak bone mass acquisition.

P11PREVALENCE OF VITAMIN D DEFICIENCY IN WOMEN OF GYEONGJU AND GYEONGBUK PROVINCE

Yang Hoe Saeng (KR)

Dongguk University, KR

The aim of study is to determine the prevalence of vitamin D deficiency in women of Gyeongju and Gyeongbuk province. We recruited a total of 309 women who visited the Dongguk University Gyeongju Hospital from January 2010 to December 2013. We excluded 43 women who took vitamin D. The fasting blood serum were checked for 25 (OH) vitamin D. The vitamin D deficiency was divided into 3 groups; Mild (10–20 ng/mL), Moderate (5–10 ng/mL), Severe (< 5 ng/mL). The mean concentration of 25 (OH) vitamin D was 21.3 ± 8.6 ng/mL. The mean concentration of 25 (OH) vitamin D per age groups were follows: 20–45 years old, 23.2 ± 12.4 ng/mL; 45–55 years old, 18.3 ± 10.2 ng/mL; menopausal women, 24.3 ± 13.3 ng/mL. Vitamin D deficiency affected 52.2% of all group, which comprised 35.2% of mild, 15.6% of moderate, 1.4% of severe. Further cohort study is needed to establish the nutritional strategy.

P12PATHOLOGICAL CORELATION IN MENOPAUSE

Chitulea Petru (RO)

Gherai R.

University of Oradea, Romania, RO

Objectives: To identify the number of personal pathological antecedents, the way in which entry age for menopause is associated with the number and type of personal pathological antecedents. Method: Manual analysis of observation sheets selected from three Romanian hospitals. A number of 1.157 observation sheets were selected, from the time interval 2011–2012, the collected data being processed by Disclosure Index (DI) and comparison method. Results: DI index values show a decreased number of personal pathological antecedents in the observation sheets of patients in perimenopause and menopause periods. Still, 5 of all of the analyzed pathologies (upper limbs fractures, lower limbs fractures, hypertension, hysterectomies and varices), contribute over 80% to the average of the DI index value. The results show that personal pathological antecedents are positively associated with the patients’ entry age for menopause, with obvious focus on the 40–49 age range, compared with the results in all age ranges, from perimenopause, whose number of personal pathological antecedents and comorbidities are significantly lower. Conclusions: In postmenopausal women there predominate the systemic, cardiovascular and bone diseases, but we can also notice pathologies related to hormonal imbalances: hypothyroidism, hyperthyroidism, diabetes or uterine fibroids. The 40–49 age range presents a significantly increased risk of associated pathology, while premenopausal women have a low risk of associated pathology in all age ranges. Substitutive hormonal therapy could delay the occurrence of comorbidities associated with confirmed menopause, reducing the number of personal pathological antecedents in the 30–39 and 40–49 age ranges. Key words: pathology associated with menopause, early entry age for menopause, preexisting associated pathology

P13EPIDEMIOLOGICAL PROFILE OF WOMEN IN THE CLIMACTERIC SPECIALTY HOSPITAL FOR CHILDREN AND WOMEN IN QUERÉTARO, MEXICO

De Los Cobos-Durán L.

Tovar-Landín M.

Vega-Malagón Genaro (MX)

Bautista-García L.

Becerril-Santos A.

Avila-Morales J.

Universidad Autonoma de Queretaro, MX

Objective: Determine the epidemiological profile of women in the climacteric Specialty Hospital for Children and Women in Queretaro, Mexico Methodology: Descriptive cross-sectional study in women attending clinic visit climacteric Specialty Hospital for Children and Women in Queretaro, Mexico in the period from August to November 2013. Results: Out of 69 women interviewed, all (100%) had at least one symptom of the climacteric syndrome, married (54%), divorced (12%), widowed (10%), 71% devoted to home, l3% were unemployed and the rest (25%) were working. The most frequent was the secondary school (43%), followed by primary (29%), 41 women (59%) reported exercising regularly, smoking as reported by 16%, obesity or overweight was presented at the 73%. The average presentation of menopause was 46.7 years for. The most common symptoms were arthralgia (83%), flushing (78%), fatigue (77%), back pain (75%), depression (68%), dry skin (67%), paresthesia (64%), changes in the mood (61%) of the patients interviewed, only 25% received hormonal therapy. Conclusions: The most common factors associated with climacteric syndrome were women dedicated to home, being overweight or obese, married, but a large number were no stable partner, the most frequent symptoms were psychological or emotional. It is therefore important to consider all factors to provide a multidisciplinary approach in the management of the climacteric syndrome. Keywords: climacteric syndrome

P14THE PREVALENCE OF MENOPAUSAL SYMPTOMS AMONG EAST SIBERIAN WOMEN

Kovalenko Inna (RU)

Suturina L. (RU)

Kravchuk L.

Litvinova M.

Scientific center of family health and human reproduction problems, RU

Objectives. This study was performed to investigate the frequency of menopausal symptoms in Siberian women. Materials and methods. A total of 198 women who sought a gynecologist in the out-patient department of the Irkutsk Scientific Centre of Family Health and Human Reproduction Problems were examined during 2006–2012. The women were 52.0 ± 4.42 years old, and the mean age of onset of menopause was 48.3 ± 4.02 years. The questionnairy method with active detection of more than 30 complaints was applied. Results. According to our results sleep disturbances are the most frequent menopausal symptoms (81.8%) followed by hot flashes (77.8%). The number of hot flashes up to 10 per day was revealed in more than a half of women with ones (64.6%), between 11–20 per day–in 21.1% and over 21 – in 14.9%. Hot flashes occur throughout entire menopause, especially in the first 4 years after the last menstruation. It is worth noting that hot flashes still persist in 6 of 8 women with menopause lasting 11–20 years. One of the frequent disturbances in menopausal women is irritability (74.2%). The other symptoms follow in this order: decline of memory (70.7%), decline of libido (65.7%), anxiety (64.1%), bad mood (60.6%), numbness of fingers (59.6%), tearfulness (54.5%), inattention (51.5%), urinary incontinence (49.5%), fears (42.4), vagina dryness (37.5%), nighttime urinations more often than twice per night (29.3%). The most frequent somatic diseases in examined women are as follows: hypertension (47.97%), varicose veins (31.30%) and pathology of thyroid gland (30.8%). Only every third women (32.8%) has normal weight, but every fifth has obesity (21.7%) or is overweight (45.5%). Conclusion. The most frequent menopausal symptoms in Siberian women are sleep disturbances and hot flashes. They can persist during the entire postmenopausal period.

P15ATTITUDE AND PERCEPTIONS OF SAUDI WOMEN TOWARDS MENOPAUSE AND RELATED MEDICAL PROBLEMS

Addar Mohammed (SA)

King Saud University, SA

Background and Objectives: Research on menopause in Saudi women is limited. The aim of our study was to assess the attitudes, perceptions and associated medical problems among Saudi women and to investigate the menopausal experience of Saudi women and to explore the relationship between the psychosomatic symptoms and various sociodemographic factors. Patients and Methods: It was a cross sectional hospital based survey conducted at the department of obstetrics and gynecology king Khalid university hospital Saudi Arabia from February 2010 to January 2013. Nine hundred fifty women of aged 45 – 65 years who presented in outpatient were interviewed. Informed consent was taken. The predesigned questionnaire was used to collect the information regarding sociodemographic data. Knowledge, attitude and perception of women towards menopause and about health problem related to menopause and women's experience of menopausal symptoms. All the data was analyzed utilizing statistical program for social science (SPSS) version 11.0. Results: The mean (SD) age of the women in menopause was 47.9 (6.03) years. Menopause was natural in 930 (97.89%) women and 20 (2.11%) had surgical menopause. More than 60% (572) of women had little knowledge about menopause, while 378 (40%) women knew about menopausal physical, psychological and medical effects. All the patients considered menopause as a natural process. 85% of menopausal women were satisfied cessation of menses especially for the religious believes as they can perform Islamic prayer and fasting without interruption with menstruation. Only 45% of women sleeked medical advises for associated symptoms mainly hot flushes, mood changes and insomnia. Sexual changes were not a concern for the majority of menopausal women.

P16IS THERE A RURAL-URBAN DIVIDE IN MID-LIFE HEALTH IN INDIA?

Unni Jyothi (IN)

Chiplunkar V.

Mansukhani N.

Jain S.

Jehangir Hospital, Pune, India, IN

Introduction: India is a land of great diversity, in geography, culture and language, all of which lead to differences in health issues in the Rural and Urban women. Aim: To assess the differences in age at menopause, symptoms,weight,waist: hip ratio and attitude to menopause in rural and urban women. Methods: Women from the Rural community in Purandar district, Maharashtra, India who accompanied patients to the health Centre and women from the Urban community in Pune, India who accompanied patients to hospital were invited to participate in the study. A questionnaire was filled for those who gave consent. Their BMI and waist: hip ratio was calculated. Results: Majority of the women in both groups attained menopause between the ages of 40 and 50. However, there was a significantly greater number of women in the Rural community who had Premature menopause as compared to the Urban women. Backache and joint pains were the predominant symptoms in Rural women, whereas Vasomotor symptoms and sleep disturbance were the main complaints in the urban group. More urban women were overweight as compared to rural women (31.3% Vs 11.2%). The Waist: Hip ratio was > 0.8 in 39.6% of urban women as against 18.1% of rural women. Conclusion: There is certainly a big divide between the Rural and Urban women at midlife in terms of their symptoms, weight and waist: hip ratio. This may represent a difference in their lifestyles.

P17HOT FLASH SEVERITY ACROSS THE MENOPAUSAL TRANSITION: OBSERVATIONS FROM THE SEATTLE MIDLIFE WOMEN’S HEALTH STUDY

Woods Nancy (US)

Mitchell E.

University of Washington, US

Purpose: To describe changes in hot flash severity across the menopausal transition (MT) and early postmenopause (PM) including the effects of age, MT factors (MT stages, age of onset of late stage and FMP, estrogen, FSH); stress-related factors (cortisol, catecholamines, perceived stress); health-related factors (BMI, smoking, alcohol use, exercise, sleep, number of live births); and psychosocial factors (education, depressed mood, anxiety). Methods: A subset of Seattle Midlife Women's Health Study participants (n = 291) with up to 6973 observations) provided data during the late reproductive, early, and late MT stages and early PM. Measures included menstrual calendars, annual health questionnaires and symptom diaries between 1990 and 2013 and urine specimens from 1997 through 2005. Multilevel modeling using the R program was used to test a model accounting for hot flash severity. Results: Each variable in the model was first tested individually. Hot flash severity increased for older women, for those in late stage and early PM (all p <.001), those with a younger onset of late stage (p.03), higher anxiety (p.03), lower estrone levels and higher FSH levels (both p<.001) and with lower cortisol levels (p = .01). Marginally significant were effects of higher BMI (p.08) and less education (p.06). In a model including all variables significant at p≤.01, women in late stage or PM with lower estrone and higher FSH levels had significantly higher hot flash severity. No other non-hormonal variables were significant. When hormonal variables were excluded, hot flash severity was shown again to increase with late stage or PM and also higher anxiety levels. Conclusion: Hot flash severity was significantly driven by endocrine factors (FSH. estrone, and late MT stage and early PM). Anxiety was the only other variable that affected hot flash severity.

P18SYMPTOM CLUSTERS AND HEALTH-RELATED QUALITY OF LIFE OF INDIAN MENOPAUSAL WOMEN

Khandelwal Sunila (IN)

Sharma S.

Fortis Escorts Hospital Jaipur, IN

Objective: To assess the prevalence of menopausal symptoms and clustering in a mixed population of women and the relationship with their health-related quality of life. Material & Methods: This cross-sectional study was conducted on 1500 women, 40–65 years, living in urban/rural areas. A cluster sampling method was used for recruitment of the sample. Information was collected on demographic, socioeconomic, menstrual, personal and medical history using structured interviews. The Menopause Rating Scale was used to assess menopausal symptoms and the Short Form 36 health survey was used to assess the health-related quality of life. Results: Of the sample, 60% were postmenopausal and 20% were perimenopausal; 90% of the sample had Cluster of problems. The most prevalent menopausal symptoms were hot flushes (56%), joint and muscular discomfort (58%), physical and mental exhaustion (54%) commonest cluster (44%) was of hot flushes, sleep problems and depression. Increase in prevalence from the perimenopausal to the postmenopausal category was observed. Prevalence of chronic medical illness was significantly associated with the presence of menopausal symptoms (P < 1.01).Women with cluster of symptoms had significantly lower (P < 0.05) quality-of-life scores in most of the domains of the Short Form 36 compared with women without symptoms. Younger urban women did try to take actions to alleviate their symptoms. Conclusions: The majority of women reported cluster of symptoms. The presence of menopausal symptoms was significantly associated with a decreased health-related quality of life. To help these women in coping with menopausal symptoms, clinicians should educate and manage them with individualized multidisciplinary approach.

P19PREVALENCE OF SARCOPENIA AMONG HEALTHY AMBULATORY POSTMENOPAUSAL WOMEN IN KOREA

Lee Eun Sil (KR)

Park H. (KR)

Soonchunhyang University Hospital, KR

Introduction: Advancing age is associated with a decline in bone & muscle mass and quality of life (QOL). Sarcopenia, one of many geriatric syndromes, is defined as the age-associated loss of skeletal muscle mass and function resulting in disability, poor QOL and death. Objective: To evaluate prevalence of sarcopenia and its association with osteopenia/osteoporosis in Korean PMW. Materials & Methods: Subjects: A total of 560 Korean PMW over 50 yrs of age were enrolled at a single menopause clinic. The mean age was 60.3 yrs. The mean BMI was 23.6 Kg/m² and the mean BMD T-scores were −1.0, −0.72 and −0.5 at the lumbar spine, femur neck and femur total, respectively. Methods: Muscle mass was assessed by using the skeletal muscle mass index (SMI, appendicular muscle mass/height²) from a whole body DXA scan. Muscle strength was assessed by hand grip strength by a dynamometer. Finally, physical performance was measured by a 4-meter gait speed. Respective cut-off points for each variable were 5.5 Kg/m2, 20 Kg and 0.8 m/sec. Stage and diagnosis of sarcopenia was made according to EWGSOP recommendations. Results: Abnormal values of SMI, handgrip strength & gait speed were measured as 27.1%. 30% & 6.3%, respectively 97 (17.3%) women had presarcopenia, 48 (8.6%) had sarcopenia and 7 (1.3%) had severe sarcopenia. Severe sarcopenia was higher in women over 70 yrs than those less than 70 (6.7% vs 0.2%). Abnormal muscle function tended to increase with advancing age. 63.8% of PMW with various stages of sarcopenia displayed abnormal bone status. Of these, 47.4% had osteopenia and 16.4% had osteoporosis. Conclusion: Nearly 1 of 4 PMW over 50 yrs displayed various sarcopenic statuses. Prevalence and severity of sarcopenic status tend to increased with age. Nearly 2 of 3 PMW with abnormal muscle mass showed abnormal bone status.

P21CLIMACTERIC SYNDROME IN A NORTHEASTERN BRAZILIAN MUNICIPALITY: A HOUSEHOLD SURVEY

Brito Luciane (BR)

Chein M.

Brito L. (BR)

Silva D.

Mascarenhas T.

Malheiros E.

Federal University of Maranhão, BR

Purpose: To assess the prevalence of climacteric symptoms through a household survey of perimenopausal women in a northeastern city with poor health care and low human development indicators. Methods: Cross-sectional household cluster study of 1210 climacteric women (aged 45–60 years) in the São Luís municipality (Maranhão state, Brazil) was conducted using a standardized questionnaire that was previously tested in a pilot study and administered by interviewers to obtain socioeconomic and cultural information, aspects and life habits related to climacteric syndrome. Data analysis was performed using the chi-square and Kruskal-Wallis variance. The intensity of climacteric symptoms was analyzed by circulatory and psychological indices. The principal components analysis was used to determine the interrelationship of climacteric symptoms. Results: The mean age of natural menopause was 48 years (SD ± 4.61). Most menopausal women in the sample was in the age group 55–60 years old, dun-colored, with 9–11 years of schooling, married, gainfully employed, catholic and social class C. The prevalence of associated symptoms of the climacteric syndrome was 77.8%, especially hot flushes (56.4%) and sweating (50.4%) as the most prevalent vasomotor symptoms. The most common psychological symptoms were nervousness (45%) and irritability (44.8%). The intensity of vasomotor and psychological symptoms was significantly higher in the peri-and postmenopause. It was predominated vaginal dryness as the most prevalent urogenital complaints. Conclusions: The prevalence of menopausal symptoms in the studied population was high. Public policies for the health of this population are essential in order to minimize symptoms in view of improving their quality of life.

P22CANCER SCREENING AND MORTALITY IN ADULT WOMEN IN LATIN AMERICA AND THE CARIBBEAN

Villaseca Paulina (CL)

Liliana J.

Pizzi R.

Benitez Z.

Mostajo D.

Espinoza M.

Calle M.

Doren A.

Lagos I.

Lagos A.

Witis S.

Pontificia Universidad Católica de Chile, CL

There are important differences in the global mortality rate between countries in Latin America and the Caribbean (LAC). Regarding cancer most countries do not have data on incidence. Globocan, a WHO project, calculated national estimates of the incidence of mortality and prevalence from major types of cancers for 184 countries of the world in 2008. Globally, the 5 most frequent cancers in adult women in LAC are breast, cervix uteri, colorectum, stomach and lung. Breast cancer was the most prevalent and leading cause of death from malignancies among LAC women, followed by cervical cancer. Survival rates from breast cancer in LAC are much lower on average than the reported in first world countries, even in those with established preventive programs, as Chile and Mexico. The wide variations throughout LAC can be due to inherent differences in the socio-economic development of the countries. There are differences in indexes of poverty and of human development, as well as striking differences in health risks between the richest and the poorest within each country. Also, the diversity of health access in LAC offers different prevalence of morbidity and different indexes of management and mortality. It is noteworthy that life expectancy is high–around 80 years-, except for the countries with lower Human Development Index, as Haiti. Healthy life expectancy is very similar in the countries: 60–68 years, except for Haiti where it is 37 years. Otherwise, the quality of registries is continuously changing in quality and extent: in some countries data are not systematic, they do not cover all the population and are thus less reliable. We describe and analyze the epidemiology of cancer in midlife and elderly women, and compare health care to this respect in Bolivia, Chile, Paraguay, Perú and Venezuela, with the objective to build a proposal for better access to health screening.

P23BODY MASS INDEX (BMI) ASSESSMENT BETWEEN 45 YEARS OR OLDER WOMEN TREATED AT CLÍNICA DÁVILA

Iglesias Luis (CL)

Osorio E. (CL)

Clínica Dávila, CL

It is well known that overweight and obesity represents a risk factor for health. Both factors affect onset age of menarche and length of the menstrual cycle during woman's reproductive life. We can see that weight gain depends on the age of patients as fertility decreases and they reaches menopause. The main objective of the study was to analyze women's BMI and the second aim was to create a database which allows us to match information in future. Authors evaluated the change of BMI among 45 years or older women who were treated in Clínica Dávila. Materials and methods: We carried out a retrospective review of medical histories, which has been obtained from Clínica Dávila e-Register managed by MISAL. From 01/01/2012 to 06/06/2013, 2908 records were analyzed and 1118 were excluded because lack of comprehensive data. Remaining 1790 cases containing usable information by outcome were used to perform the analysis. Patients were classified into 6 groups: underweight (BMI < 18.5); normal weight (BMI 18.5–24.9); overweight (BMI 25–29.9); Class I obesity (BMI 30–34.9); Class II obesity (BMI 35–39.9); Class III obesity (BMI> or = 40). Age range was 45–89 years and average age was 53.4 years. Results: Of the total figure, 790 patients (44%) are overweight, 469 (26%) patients suffer Class I obesity, and 526 patients were normal weight (only a third of the total). BMI slightly increased in relation to the raising women age. Conclusion: The study concluded that 70% of the patients are overweight or obese range. Nearly 75% of obese women are Class I obesity. Age itself seems to be an important factor in explaining weight increase in patients involved in this analysis.

P24DURATION OF THE MENOPAUSAL TRANSITION IS LONGER IN WOMEN WITH YOUNG AGE AT ONSET, FINDINGS FROM THE MULTI-ETHNIC STUDY OF WOMEN'S HEALTH ACROSS THE NATION

Harlow Sioban (US)

Paramsothy P. (US)

Nan B. (US)

Greendale G. (US)

Santoro N. (US)

Crawford S. (US)

Gold E. (US)

Tepper P. (US)

Randolph J. (US)

University of Michigan School of Public Health, US

This analysis assessed factors associated with age at onset of the early menopausal transition (MT) and the duration of the early and late transition stages using data from 4 study sites of the Study of Women's Health Across the Nation Menstrual Calendar Substudy (Boston, Southeastern Michigan, Northern California, and Los Angeles). Women completed daily menstrual calendars from 1996–2006. Covariates included education, economic strain, and menstrual cycle characteristics, body mass index and smoking status. A total of 1145 of 1950 women enrolled in the main cohort study at these 4 sites participated in the menstrual calendar substudy, had the start of the menopausal transition identified, and had no missing covariate information. Participants were from 4 racial/ethnic groups: African-American, White, Chinese, and Japanese. The duration of the MT was largely influenced by the age when the transition began: earlier onset predicted a longer transition. The youngest age quartile for onset of the early MT had a longer MT (Hazard ratio = 0.30, 95% confidence interval: 0.22, 0.40) while the oldest age quartile had a shorter MT (Hazard Ratio = 1.80, 95% confidence interval: 1.40, 2.31) as compared to women in the third age-at-onset quartile. High BMI was associated with earlier age at onset of the MT, but not with duration of the MT. African-American women had earlier age at the start of the MT and a longer duration of the MT as compared to White women. Cigarette smoking was associated with shorter duration of the menopausal transition. As age at onset of the early MT was the strongest predictor of duration of the MT, this study provides a strong rationale for developing improved markers of the onset of the early transition. Supported by NIH/DHHS (U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495).

P25AGE-AT-ONSET OF THE EARLY MENOPAUSAL TRANSITION IS THE STRONGEST PREDICTOR OF DURATION OF THE MENOPAUSAL TRANSITION: THE STUDY OF WOMEN'S HEALTH ACROSS THE NATION (SWAN)

Harlow Sioban (US)

Paramsothy P. (US)

Nan B. (US)

Greendale G. (US)

Santoro N. (US)

Crawford S. (US)

Gold E. (US)

Tepper P. (US)

Randolph J. (US)

University of Michigan, US

This study assessed factors associated with age at onset of the early menopausal transition (MT) and the duration of the early and late transition stages using data from 4 study sites of the Study of Women's Health Across the Nation Menstrual Calendar Substudy (Boston, Southeastern Michigan, Northern California, and Los Angeles). Women completed daily menstrual calendars from 1996–2006. Covariates included education, economic strain, and menstrual cycle characteristics, body mass index and smoking status. A total of 1145 of 1950 women enrolled in the main cohort study at these 4 sites participated in the menstrual calendar substudy, had the start of the menopausal transition identified, and had no missing covariate information. Participants were from 4 racial/ethnic groups: African- American, White, Chinese, and Japanese. The duration of the MT was largely influenced by the age when the transition began: earlier onset predicted a longer transition. The youngest age quartile for onset of the early MT had a longer MT (Hazard ratio = 0.30, 95% confidence interval: 0.22, 0.40) while the oldest age quartile had a shorter MT (Hazard Ratio = 1.80, 95% confidence interval: 1.40, 2.31) as compared to women in the third age-at-onset quartile. High BMI was associated with earlier age at onset of the MT, but not with duration of the MT. African-American women had earlier age at the start of the MT and a longer duration of the MT as compared to White women. Cigarette smoking was associated with shorter duration of the menopausal transition. As age at onset of the early MT was the strongest predictor of duration of the MT, this study provides a strong rationale for developing improved markers of the onset of the early transition. Supported by NIH/DHHS (U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495).

SEX STEROID DEFICIENCY SYMPTOMSP26VASOMOTOR SYMPTOMS AND CARDIOVASCULAR RISK IN POSTMENOPAUSAL WOMEN

Carpintero Pablo (AR)

Litterio G.

Campostrini B.

Fusaro D.

Franchina M.

Caro R.

Rey C.

Simonet C.

IGBA, AR

Objectives: To determine the number of Postmenopausal Women (PMW) with and without Vasomotor Symptoms (VS), estimate their lipid profile and glycemia in each group and compare both results. DESIGN and METHODS: Prospective, comparative study. Population: PMW assisted in IGBA and HIGA La Plata from 2/1/12 to 31/7/13. Exclusion criteria: Patients (P) that did not complete the requested controls and survey. Variables: Age, menopause, Cholesterol (> 200 mg/dl), Triglycerides (> 140 mg/dl), Insulin Resistance (IR) (HOMA index > 3), BMI (> 25), and Hypertension (N: 120/80) all measured in intervalar scale. VS (more than 5 days in two weeks). measured in nominal scale. Sample: From 658 patients assisted, 2 samples were selected: Group A (GA): Asymptomatic (n: 182). GROUP B (GB): Symptomatic (n: 352). Statistics: Percentage, chi2, Alfa error: 0,05 Beta: 0,10.

Results: AGE: M.58, 6 range: 45–59. GA: 182P (44%) GB: 352 (66%). Cholesterol: GA: 68 (37,3%) GB: 186 (52,8%) Chi2: 10,9 p:0, 001 OR:0, 53 IC:0, 36-0,76. Triglycerides: GA: 35 (19,2%) GB 131 (37,2%) Chi²: 6,62 p: 0, 000 OR 0,21 IC: 14-0,34. IR: GA 21 (11,5%) GB: 71 (20,3%) Chi2: 1,81 p: 0,20 OR: 1,07 IC: 0, 6-1,89. BMI: GA 55 (30,5%) GB 123 (34,9%) Chi2 1,001 p: 0, 31O R: 0, 80 IC: 0,54-1,18. Hypertension: GA: 21 (11,5%) GB111 (31,5%) Chi2 24,7 p: 0. 000 OR: 0, 28 IC: 0, 17-0, 47. CONCLUSIONS: 352 Women suffered hot flashes (66%). It was significative the deleterious effect on Cholesterol, Triglycerides’ rates and Hypertension in Symptomatic PMW. There were no significative differences with BMI and Insulin Resistance.

PRIMARY OVARIAN INSUFFICIENCYP27DHEA THERAPY IN WOMEN WITH PRIMARY OVARIAN INSUFFICIENCY – PATHOPHYSIOLOGIC AND THERAPEUTIC IMPACT ON HASHIMOTO'S THYROIDITIS?

Ott Johannes (AT)

Pils S.

Promberger R. (AT)

Hermann M.

Frigo P.

Medical University of Vienna, AT

Background: Premature ovarian insufficiency (POI) is associated with a variety of autoimmune diseases including Hashimoto's thyroiditis (HT) as the most frequent one. Dehydroepiandrosterone (DHEA), a promising treatment option in patients with autoimmune diseases, is frequently used to improve ovarian response in women with diminished ovarian reserve. We aimed to evaluate the influence of DHEA supplementation on the level of antithyroid autoantibodies in women with POI. Methods: In a retrospective case series, we included 67 women who suffered from POI and received estrogen/gestagen replacement therapy with or without DHEA. Results: Women with elevated autoantibodies against thyroperoxidase and/or thyroglobulin revealed lower pretherapeutic DHEA-S serum levels than those without serological signs of HT (1. 2 mg/ml; range, 0.4–2.9; vs. 1.9 μg/ml; range, 0.2–3.9; p < 0.001). DHEA-S levels correlated inversely with both thyroperoxidase- (r = −0.362, p = 0.002) and thyroglobulin-autoantibodies (r = −0.426, p < 0.001). In women who received additional DHEA supplementation a mild but significant decrease of thyroperoxidase-autoantibodies was found (median 85.0 IU/ml, range 41–600 vs. median 51.0 IU/ml, range 20–589; p = 0.005). Conclusions: DHEA supplementation leads to a decrease of thyroperoxidase-autoantibodies in women with POI and serological signs of HT. These results should be discussed in the context of the hypothesis of an autoimmune etiology of POI, since DHEA is known to be an immune-modulatory substance.

P28COMPARISON OF SERUM CONCENTRATIONS OF ANTI-MüLLERIAN HORMONE (AMH) AND FOLLICLE STIMULATING HORMONE (FSH) WITH TELOMERE LENGTH IN PREMATURE OVARIAN INSUFFICIENCY (POI)

Košir-Pogačnik Renata (SI)

Meden-Vrtovec H.

Novaković S.

Rebolj Kodre A.

University Medical Centre Ljubljana, SI

Aim: The purpose was to determine whether the length of telomeres being indirect indicator of biologic age in women with POI differs from the length in healthy women. We intend to determine whether there is a link between altered telomere length and the variation of AMH and FSH. Based on the results we aim to identify which of the markers of ovarian reserve has the highest predictive value. Methods: The study group included 27 women with POI aged between 20 and 39 years. The control group represented 32 randomly selected healthy women. Targeted reproductive history, gynecological and vaginal ultrasound examination and measurements of AMH, FSH, LH, E2 were performed. The length of telomeres were determined and calculated by two formulas (Cawthon, Hanna). Results: LH and FSH were significantly higher in POI group than in control (average 41.46 E/L, 96.46 E/L, p < 0.001). E2 and AMH were lower in POI group (0.17 nmol/L, p = 0.01, 0.1 ug/L, p < 0.001). Antral follicle count (AFC) was higher in controls (23.25, p < 0.001). Telomere lenght did not show any significant difference between the two groups (p = 0.20). There were no correlations between telomere length and FSH (p = 0.16) and AMH (p = 0.63). Conclusion: We have not found correlation between telomere length and POI, and between telomere length and markers of ovarian reserve. The assessment of telomere length can not determine whether POI is an isolated biological process as a consequence of reduced initial stock of ovarian follicles or is a generalized process of premature aging of the organism.

P29POSSIBLE ROLE OF AUTOIMMUNITY IN PATIENTS WITH PREMATURE OVARIAN INSUFFICIENCY

Košir Pogačnik Renata (SI)

Slabe N.

Ihan A.

Vizjak A.

Levičnik A.

Meden-Vrtovec H.

University Medical Centre Ljubljana, SI

Background: To evaluate the involvement of immune abnormality in patients with idiopathic premature ovarian insufficiency (POI). In addition to the known etiology, autoimmune disorders may be a pathologic mechanism for POI. Materials and Methods: Our study was a prospective controlled trial. Twenty women with POI, reasons other than autoimmune excluded, were enrolled in this study. The control group consisted of 17 healthy women. In both groups, family and personal history were taken and the levels of follicle stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, prolactin, anti- Müllerian hormone, inhibin B, antithyroglobulin and antithyroid peroxidase antibodies were determined. Anti-ovarian antibodies and subpopulations of peripheral blood T-lymphocytes were also determined. Results: Participants in the study group exhibited hypergonadotropic hypogonadism, while high levels of follicle stimulating hormone and low levels of inhibin B and anti-Müllerian hormone were observed. In 16 (80%) patients, POI was associated in their personal and familial history with another autoimmune disease. Fifty percent of patients presented highly elevated antithyroid antibodies. The lymphocyte subset, especially B cells, was significantly higher (p = 0.014), and peripheral regulatory lymphocytes CD25 + high were significantly lower (p = 0.015) in the study group than in the control group. Anti-ovarian anti- bodies were detected in 20% of patients with POI. Conclusion: We presume that the presence of anti-ovarian antibodies together with abnormalities of cellular immunity may in some cases potentially represent the involvement of an autoimmune mechanism in idiopathic POI.

P30THE PREVALENCE OF PREMATURE OVARIAN INSUFFICIENCY IN INFERTILE WOMEN IN EASTERN SIBERIA REGION

Suturina Larisa (RU)

Labygina A.

Leshchenko O.

Lazareva L.

Darzhaev Z.

Shipchineeva T.

Scientific center of family health and human reproduction problems, RU

Objectives. The study was performed to investigate the frequency of premature ovarian failure in infertile women. Materials and methods. 1138 women, aged 30,8 ± 4,42 years, from infertile couples were examined at the out-patient department of the Scientific Center of Family Health and Human Reproduction Problems (Irkutsk, Russia), in 2006–2013 years. 83% of women were from urban areas, 17% - from villages. All infertile couples were underwent generally accepted procedures, such as: sperm analysis, ultrasound, tubal assessment, laparoscopy. Hormone levels (prolactine, LH, FSH, TSH, estradiol, testosterone) were detected by immunoassay method. Results. In accordance with our results the most frequent cause of infertility in examined couples was tubal factor (62%), ovulation disturbances were on the 2nd place (56%) and endometriosis was on the 3d (37%). Male factor was occurred in 36% of couples. The majority of infertile women (80%) had more than 2 causes of infertility. The premature ovarian failure (with increase of FSH level more than 20 IU/l) was determined in 1,7% of the examined infertile women and its frequency was significantly higher in infertile women from Buryat ethnic group (5,8%) in comparison with Russian women (1,26%) (p = 0,0003). Conclusion. The premature ovarian insufficiency is rare in infertile Siberian women and its frequency depends on the patients ethnicity.

P33THE RATIONALE FOR DIAGNOSIS OF OSTEOPENIA AND UROVAGINAL DISORDERS IN WOMEN OF REPRODUCTIVE AGE WITH LOW OVARIAN RESERVE

Novikova Vladislava (RU)

Kuban State Medical University, RU

Reduced ovarian reserve is the result of premature ovarian failure, oophorectomy, pharmacologi-cal menopause (G Suhih, A Abubakirov, T Nazarenko, 2010). Until now, finally reducing the etiology of ovarian reserve in the reproductive age is not clear (OA Kolesnikova, NM Pasman, 2009). Estrogen deficiency is an proven reason for the formation of women urovaginal disorders (VE Balan et al, 2010; VP Smetnik, 2010) and lead to increased bone resorption (SV Yureneva., 2012). Objective - to improve the diagnosis of pathological reduction in bone mineral density and urovaginal disorders in women of reproductive age in low and very low ovarian reserve. Materials and methods. The study involved 75 women: 25 women with very low ovarian re-serve (OR), 25 women - with lower OR. The control group consisted of 25 women with normal OR. The average age 28,8 ± 0,27 years. Quantitative analysis of blood hormones performed by enzyme immunoassay: follicle stimulating hormone (FSH IU/L), Anti-Müllerian hormone (AMH, ng/ml). Ultrasound performed using apparatus expert class Volusson-730 on 3–5 day of menstrual cycle. Performed: physical examination, identification of risk factors to reduce ovarian reserve, the development of urinary incontinence and abnormal reduction in bone mineral den-sity, ultrasound densitometry, the definition of a concentration of 25 (OH)-vitamin D in the blood, determination of biochemical markers of bone formation (osteocalcin), bone resorption (C-telopeptide of type I collagen); assessment of the degree of urinary incontinence, the cough trial, the definition of ph vaginal environment. Results. The main risk factors reduce the ovarian reserve in women of reproductive age are repeated ovulation induction (100%), habitual pregnancy loss (76%), secondary infertility is more than 3 years (60%), ovarian surgery (resection, cystectomy with coagulation of ovarian tis-sue, inflammation diseases of the pelvic organs (52%), hypomenstrual syndrome (44%). Among women of reproductive age with a low ovarian reserve: 1) significantly increased the frequency of urinary incontinence: an extremely low ovarian reserve to 52% of cases, with low ovarian re-serve - in 48% of cases; a characteristic of ultrasound markers of stress urinary incontinence with a very low ovarian reserve in the reproductive age are the level of posterior urethrovesical angle (98,55 ± 1,6°, the ratio of cross- sectional area and the width of the urethral sphincter - 0,869 ± 0,01); 2) significantly more higher risk of developing osteoporosis; at extremely low ovarian re-serve bone mineral density in 28% of cases corresponded to osteopenia, in 4% of cases - osteo-porosis, bone mineral density - 0,94 ± 0,01 g/cm2; Z-test -1,6 ± 0,2; 3) the US- density glandular breast tissue can meet the age criteria at age 45–54 years (the thickness of the glandular tissue 8,9 ± 0,31 mm) and US- density - 34,3 ± 0,28 standard units. There was an inverse proportional relationship between the level of the Anti-Müllerian hormone, the level of C-telopeptide of type I collagen and vitamin D in the blood, a direct proportional relationship with bone mineral density, the level of osteocalcin. Conclusions. In women of reproductive age should be excluded ovarian tissue coagulation dur-ing surgery on the ovaries, use sutures to haemostasis; recommended for women aged 28 years and older with risk factors of low ovarian reserve prevent osteopenia and urovaginal disorders, use of reserves of cell therapy in reproductive medicine, methods of conservation of genetic ma-terial for the delayed implementation of reproductive function.

POSTMENOPAUSAL HORMONE THERAPYP35THE SURVEY ON KOREAN MENOPAUSAL WOMEN'S BEHAVIOR AND PERCEPTION OF HORMONE THERAPY

Namkung Jeong (KR)

Chung Y. (KR)

Kim J. (KR)

Kim M. (KR)

The Catholic University, KR

Objective: After WHI study had been published, the use of hormone therapy have been decreasing even though it is the most effective therapy for menopausal symptom. The survey was conducted to investigate Korean menopausal women's perception of hormone therapy and behavior when they are treated by hormone therapy. Method: During 4 weeks from September 2009 to October 2009, total 600 women aged 45–64 participated in the survey by face to face interview. Out of answering women, women who have visited clinic/hospital at least 1 time to treat their menopausal symptom during last 1 year were included. 150 women for each age group, 45–49, 50–54, 55–59 and 60–64, were recruited in consecutive order. Result: Eighty percent women who have visited clinic/hospital to treat menopausal symptom, visited OBGY. Only 16% of these women were current user, and other 84% of these women had no experience of hormone therapy (53%) or stopped therapy (31%). Among current user, only 9% of women have used hormone therapy more than 5 years. 80% of current user had used hormone therapy less than 2years. Most distressing menopausal symptom is ‘hot flush’ regardless HT experience. When doctor recommend HT, 72% of patients accept HT in overall. Among women who had no experience of hormone therapy, the most common reason of not to take hormone therapy was concern of side effects (51%). And 67% of women who had concern of side effects worried about cancer incidence. Conclusion: Many women with menopausal symptom do not take hormone therapy even though it is the most effective therapy. Most of women who take hormone therapy stop treatment within 1 years. Most common reason of not to take hormone therapy is concern about side effect, increasing incidence of cancer related to hormone therapy. Therefore, HT should be restricted to short-term relief of menopausal symptoms and at the minimal dose, if possible.

P36AGE OF HRT USERS IN BELGRADE (SERBIA)

Vukotic-Pavlovic Vesna (RS)

Kostić A.

Pavlovic M.

Plavsic-Mitrovic S.

Milovic O.

Ratkovic S.

Medical Centar, RS

Summary: In the period from 05 January 2013- 01 November 2013 at the Department of Gynaecology in the Community Health Centre «Stari grad» in Belgrade a survey was conducted with patients aged 40–57 who use HRT. Introduction: HRT improves the quality of life of women in menopause by influencing a decrease of risk from occurrence of heart diseases, cerebro-vascular accidents, osteoporosis, dementia but also loss of symptoms of hot flashes, skin dryness, insomnia, anxiety, depression... Aim: Was to point out the average age of users of HRT in Belgrade. Materials and Methods: The survey was conducted during a period of six months with patients from the Department of Gynaecology aged 40–57 who use HRT and a statistic processing of the gathered data was done. Results: There were 144 patients who use HRT; those aged 40–45 amounted to 22 patients (15%); aged 45–50 amounted to 52 patients (36%); aged 50–55 amounted to 46 patients (32%), and those over 55 years of age amounted to 24 users (17%). The largest number of users is aged 45–50, immediately followed by those aged 50–55-in total 68%. The duration of HRT intake was also analysed- from 1–3 years of use 33%, less than 1 year 28%, from 3–5 years 21%, and over 5 years even 18%. Discussion and Conclusion: Age range of 45–50 years has the biggest share of users which leads to a conclusion that menopause commences earlier in Serbia. Women are not yet prepared for changes brought by menopause. The surveyed users regularly visit their gynaecologist; they are timely informed about the period of life ahead of them which is seriously understood from their side so they decide starting HRT in time. We conclude that there is a will in our users to improve their quality of life and reduce to the least possible extent the risk of getting heart diseases, osteoporosis, dementia and other symptoms of menopause. As it is familiar, the maximum benefit is achieved when therapy is started as early as possible (in the first year of menopause), and when it is used for an extended period of time (up to 10 years).

P37THE MOST COMMON REASONS FOR STARTING HRT IN BELGRADE (SERBIA)

Vukotic-Pavlovic Vesna (RS)

Kostić A.

Pavlovic M.

Zivaljevic B.

Adamov A.

Zupanc U.

Medical Centar, RS

Summary: In the period from 05 January 2013- 01 November 2013 at the Department of Gynaecology in the Community Health Centre «Stari grad» in Belgrade a survey was conducted with patients who use HRT. Introduction: Menopause represents a new stage of life of women which significantly and sometimes crucially influences the psychological, physical and social aspect of lives of women. Taking this into account we realize how important it is to recognize the symptoms and discomforts when a user should be advised to start HRT so that worsening of the quality of life would not occur. Aim: Was to determine the most common reasons for women to decide starting HRT but also whether this entirely resolved their discomforts and improved the previous quality of life. Materials and Methods: The survey was conducted with patients who use HRT at the Department of Gynaecology in the Community Health Centre «Stari grad» in Belgrade during a six month period of this year, and a statistic processing of data was done. Discussion and Conclusion: Users were offered a possibility of choice of symptoms according to which they decided starting HRT. They all chose at least two and the largest share of them 3– 4 symptoms. The main symptom for starting therapy was occurrence of hot flashes, even 83%, followed by insomnia, anxiety and uneasiness with 35%, loss of femininity 24%, depression and skin dryness with an equal of 19%, bad general condition with 17%, bone and joint pains 10%, and other 5%. We took into account if the users were satisfied: 93% were satisfied, 7% partly satisfied and there were no dissatisfied. 91% of users would recommend therapy to others, 9% maybe, and there were no users who would not recommend therapy. We conclude that vasomotor symptoms are the strongest reason for starting therapy, and the importance of feeling of femininity also should not be disregarded (even one fourth of users). Subjective impressions are decisive in starting HRT in Belgrade, even though we tried to explain the long-term benefits for the cardiovascular and skeletal system.

P38A COMPARISON OF THE EFFECT OF HORMONE REPLACEMENT THERAPY ON BONE MINERAL DENSITY, LIPID PROFILE AND BIOCHEMICAL MARKERS OF BONE METABOLISM

Namkung Jeong (KR)

Kim J. (KR)

Kim M. (KR)

The Catholic University, KR

Objective: To assess the effect of hormone replacement therapy on bone mineral density (BMD), biochemical marker of bone metabolism and lipid profile in postmenopausal women receiving hormone replacement therapy. Method: From 1995 to 2009, we retrospectively reviewed 199 postmenopausal women in Seoul St. Mary's hospital, who did not take any drugs affecting lipid or bone metabolism. Thyroid disease or metabolic disease patients were excluded. We compared the change of bone marker, lipid profile and BMD during therapy in three groups based on the kind of hormone replacement therapy; Group 1 received combined therapy, estrogen and progestin; Group 2 received estrogen only; Group 3 received tibolone. Result: Spine BMD increased in Group 1, Group 3 by 2.0%, 1.2% and femur toal BMD increased in Group 1, Group 2 by 2.3%, 0.5% from the initial values after 3 years. However, femur neck and femur toal BMD decreased in Group 3 by 4.8%, 1.9% after 3 years. (p < 0.05) Deoxypyridinoline decreased in all groups after 3years. In Group 1 and 3, total cholesterol decreased and triglyceride increased. There are no definite change of total cholesterol and triglyceride in Group 2. HDL increased in Group 1 and 2, but decreased in Group 3. Conclusion: Our results suggest that combined therapy and tibolone have benificial effect on increased spine BMD and decreased total cholesterol. There are no beneficial effect on femur BMD after tibolone therapy. Combined therapy is the most effective therapy in terms of BMD and lipid profile.

P40POSTMENOPAUSAL OVERTREATMENT WITH “BIOIDENTICAL” HORMONES IN CUSTOM-COMPOUNDED PREPARATIONS – A CASE REPORT

Gersak K. (SI)

Gersak B. (SI)

Vrabic Dezman Lucija

Department of Obstetrics and Gynecology, Health Center Kranj, SI

Since the results of the Women's Health Initiative hormone therapy (HT) trials were published, patient and clinician interest in potential alternatives to conventional HT has grown immensely. The “bioidentical” products can be prepared in individualized dosages and forms such as creams, gels, lotions and suppositories. We present a case of postmenopausal woman with an excessive plasma concentration of estradiol using “bioidentical” hormones in custom-compounded HT preparations. A 63-years old non-obese woman took oral estradiol 1 mg and norethindrone acetate 0.5 mg daily 6 years, until April 2010. At her last yearly medical check-up in February 2010 the vaginal ultrasonic scan was normal, the serum LDL and total cholesterol levels were slightly elevated, and the serum estradiol level was 0.12 nmol/L. For the next 28 mounts she used a 6% compounded topical progesterone gel at a daily dase of »push the pump once«, and 2% compounded topical estradiol gel at the »same« daily dose. In June 2011, she visited outpatient clinic complaining about unspecific abdominal pain. An ultrasonic scan showed the endometrial thickness of 4 mm and two newly grown intramural fibroids with 1.5 and 2 cm in diameter. During the examination she denied taking any hormonal medications. One year and a half later, in December 2012 she presented with severe skin rash allergic reaction on both arms. Her daughter pointed out that she had “too much energy”, and “everyone observed the changes in her behavior” (restlessness and over-reacting). An ultrasonic scan revealed a thickened endometrial lining 14 mm and three fibroids with 3 to 4 cm in diameter. The serum estradiol level was 2.87 nmol/L, in a level of controlled ovarian hyperstimulation. She was investigated by diagnostic hysteroscopy and curettage. The tissue diagnosis was atypical endometrial hyperplasia.

P41CURRENT STATUS OF MENOPAUSE HORMONE THERAPY AWARENESS AND CLINICAL PRACTICE IN CHINA: A MULTICENTER, CROSS-SECTIONAL SURVEY

Yu Qi (CN)

Chen R.

Peking Union Medical College Hospital, CN

Background: In China, MHT awareness and acceptance is much lower. Chinese Menopause Society proposed the Menopause Clinics model, developed Standard Procedure and promoted Menopause Activation Project. Objective: To investigate MHT awareness and clinical practice among Chinese menopausal clinics physicians. Methods: Menopause clinics physicians were interviewed with semi-structured questionnaire about MHT awareness, patients communication and clinical practice. Results: 194 physicians from 100 MAP hospitals in 42 cities were interviewed from 2013.6 to 2013.10. 77.8% were senior and other were junior physicians. Although 90% interviewees agree MHT is effective treatment for symptoms including hot flush (40%) and QoL (28%) with long-term benefit (osteoporosis 60%, CVD 35%), only 74% would recommend MHT to patients. Endometrial and breast cancer is top 1 concern (97%) to prescribe. The second is lack of detailed MHT communication with patients (5–10 minutes one patient, for there are mean 850 patients/month/physician). Age, menopause period, menstrual expectation, symptoms and uterus diseases history were referrence to select MHT regimens, while sexual health, CHD and liver diseases usually ignored. Cyclic sequential E+ P (39%) is most commonly used then continuous combined (21%) and continuous sequential E+ P (19%). Mean treatment duration is 16 months, longer than other gynecologic clinics. Symptoms relief is top 1 reasons for patients to discontinue MHT, then unexpected vaginal bleeding and breast tenderness for endometrial or breast cancer concern. Conclusion: Menopause clinics physicians’ MHT awareness and patient management is much better than other gynecologists. But MHT safety confidence and patients communication still need be improved. Patient MHT education is also important especially to eliminate cancer scare and pursue long-term benefit with good compliance.

P42ULTRA-LOW-DOSE ESTRADIOL AND NORETHISTERONE ACETATE: BLEEDING PATTERNS OVER 52 WEEKS OF THERAPY

Mattsson Lars-Åke

Ipsen H.

Granqvist C.

Hansbakk Olsen A.

Kokot-Kierepa M.

University of Göteborg, SE

Introduction: Hormone replacement therapy (HRT) is indicated for managing menopausal symptoms and preventing bone loss [1,2]. Lowering HRT dose to reduce the incidence of side effects while retaining positive therapeutic benefits is a key developmental aim, facilitating therapeutic initiation and continuation [3]. Uterine bleeding, an inconvenient side effect, is a major reason for stopping HRT [4]. Objectives: Eviana^® (Novo Nordisk A/S) is an ultra-low-dose continuous combined HRT (ccHRT) containing 0.5 mg 17ß-estradiol and 0. 1 mg norethisterone acetate. Marketing authorization in the US, Canada, Israel and EU has been based on the CHOICE trial, which provided efficacy and safety data for 24 weeks of treatment [5,6]. The Guideline on Clinical Investigation of Medicinal Products for Hormone Replacement Therapy of Oestrogen Deficiency Symptoms in Postmenopausal Women (Committee for Medicinal Products for Human Use) suggests 52-week data be obtained for new ccHRT preparations. Our study was designed to collect such data in a “real-life” setting. Design: A 52-week, non-interventional, multicenter, prospective study evaluated the bleeding pattern and efficacy (vasomotor symptoms, quality of life) of Eviana^® in 169 postmenopausal women in Sweden and Norway. Treatment was administered at physicians’ discretion, in line with clinical evaluations and the Summary of Product Characteristics. Data were collected using an electronic patient-reported outcomes tool. Results: Bleeding profile data over 52 weeks (bleeding and bleeding/spotting rates per lunar month) will be shown. Conclusion: Our data will support the safety and efficacy profile of Eviana^®.

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P43CUTANEOUS MICROVASCULAR PERFUSION IS ENHANCED IN FLUSHING POSTMENOPAUSAL WOMEN AFTER 8 WEEKS OF HRT

Sassarini Jenifer (GB)

Fox H.

Ferrell W.

Lumsden M.

University of Glasgow, GB

Background: Cutaneous vasodilation is one of the hallmarks of flushing. Heat loss responses are triggered in the hypothalamus and effected by cutaneous vasculature. Central thermoregulatory dysfunction has been proposed as the mechanism responsible for flushing; and our group have demonstrated increased skin blood flow in postmenopausal flushing women. It is thought that decreased oestrogen results in an imbalance of central neurotransmitters and that this may trigger hot flushes, but there is also considerable evidence that oestrogen directly influences the endothelium via oestrogen receptors ERά and ERβ. What, then, is the effect of treatment with oestrogen (HRT) on increased cutaneous vasodilatation in postmenopausal flushing women? Aim: To determine if the altered endothelial function of women who flush is reversed by successful treatment of the flushes by HRT. Methods: Skin blood flow was measured using laser Doppler imaging and endothelial function assessed by iontophoresis (administration of vasoactive agents through the skin by electric current) of acetylcholine (ACh–endothelium dependent) and sodium nitroprusside (SNP–endothelium independent). 11 postmenopausal women, with severe flushing, who were commencing hormone replacement therapy were recruited, and cutaneous microvascular perfusion assessed at baseline (before treatment) and after 8 weeks of treatment with HRT. Results: Following treatment, enhanced vascular responses are seen; ACh (p < 0.001) and SNP (p = 0.01)). Greene Climacteric Scale (GCS) scores are also significantly reduced (P = 0.003). Conclusion: GCS scores are reduced, but cutaneous microvascular perfusion appears to be increased in flushing postmenopausal women after 8 weeks of HRT. This suggests that an improvement in vasomotor symptoms by hormone therapy is not peripherally mediated or that the heat loss response is improved by the medication.

P45THE INFLUENCE ON CARDIAC DEATH OF THE METABOLIC SYNDROME IN KOREAN POSTMENOPAUSAL WOMEN

Chung Youn-Jee (KR)

Yoon J. (KR)

Shin H. (KR)

Kim M. (KR)

The Catholic University of Korea, KR

(a) Objective: Metabolic syndrome components, insulin resistance and central obesity cause type 2 diabetes and hypertension. This will increase the risk of cardiovascular disease. In women after menopause are at increased risk of metabolic syndrome. Several researchers studied that in menopause, metabolic syndrome increased cardiac death. We studied the impact on cardiac death of postmenopausal women with metabolic syndrome in the Republic of Korea. (b) Methods: 1994–2004 National University Hospital and hospitals in 18 regions visited health promotion center, there was no history of heart disease, 24,040 postmenopausal women aged 40 years or older were enrolled. Age, weights, height, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), cholesterol. triglyceride (TG), high-density lipoprotein, alcohol, smoking, exercise and whether was examined. In addition, from January 1995 to December 2009 among subjects who died of cardiac disease were analyzed. (c) Results: Metabolic syndrome was higher in postmenopausal women with age, BMI, BP, FBG, cholesterol, TG. 30 cardiac deaths were occurred during observation period. Factors affecting cardiac death were age, smoking, FBG and when age and smoking controlled, FBG was a important factor affecting cardiovascular mortality in our study. When controlling age, smoking, alcohol consumption, whenever an increase in the risk of metabolic syndrome, relative risk of cardiac death was increased. Cardiac disease survival rate was lower in postmenopausal women with metabolic syndrome than without metabolic syndrome. (d) Conclusion: Metabolic syndrome in Korean postmenopausal women increase cardiac death.

P46CHANGING KOREAN MENOPAUSAL WOMEN’S AWARENESS ON HORMONE THERAPY: 7 YEARS AFTER WOMEN’S HEALTH INITIATIVE STUDY

Kim Jang-Heub (KR)

Chung Y. (KR)

Yoon J. (KR)

Kim M. (KR)

The Catholic University of Korea, KR

Objectives: The purpose of this survey was to compare Korean menopausal women's perceptions of hormone replacement therapy before and after publication of the Women's health initiative (WHI) study. Design: This study was conducted through a survey in 713 postmenopausal women who attended lectures on health to commemorate Korean Menopause Awareness Month during 2009 in Seoul and the provinces (Incheon, Daejeon, Daegu, Gwangju and Busan). Awareness on menopause before WHI study was compared to the epidemiologic study by Korea Gallup with 1201 women in 2002. Results: Respondents knew about the cause of menopause were increased with 86.7% in 2009, compared to 56.6% in 2002. They responded that the menopause was the natural aging process (69.3%), or resulted from estrogen deficiency (26.6%). Attitudes toward menopause was negative, no significant difference in 2002. Women who required hormone therapy were increased with 57.6% in 2009, compared to 56.7%. Women who does not required hormone therapy were also increased with 4.0% in 2009, compared to 2.8%. As a source of information about hormone therapy, media was about 34.0% in 2009, different from previous study that doctor's advice was 60.7%. Among the women who stopped hormone therapy, the most common reason was fear of cancer (31.8%), increased compared to 9.3% in 2002. Women who received regular screening for breast cancer were increased with 82.3% in 2009, compared to 35.0% in 2002. Women who ever checked BMD were increased with 71.8% in 2009, compared to 40.2% in 2002. Conclusion: Menopausal women in Korea have increased awareness on menopause. They responded that hormone therapy was helpful to manage menopausal symptom, even after WHI study. They obtained menopause-related information through various sources, and the role of mass media has been greatly increased. After the actual hormone therapy, they experienced minimal side effects. But they were concerned about increased risk for cancer, especially breast cancer.

P47THE ROLE OF HORMONES AND AROMATASE INHIBITORS ON BREAST TUMOR GROWTH AND GENERAL HEALTH IN A POSTMENOPAUSAL MOUSE MODEL

Arumugam A.

Lissner E.

Lakshmanaswamy Rajkumar (US)

Texas Tech University Health Science Center at El Paso, US

Breast cancer is the most frequently diagnosed cancer in women in the United States. Approximately 70% of breast cancers are diagnosed in postmenopausal women. Major clinical trials and experimental studies showed that aromatase inhibitors are effective against postmenopausal breast cancer. Despite their effectiveness in reducing tumor recurrence, aromatase inhibitors have adverse effects on the cardiovascular system and increase osteoporosis and bone fractures. Our study is aimed at investigating the role of natural steroid hormones on serum cardiovascular and bone resorption markers in an established mouse model mimicking postmenopausal breast cancer. Ovariectomized nude mice were transplanted with MCF-7 breast cancer cells constitutively expressing aromatase. The mice were treated with different combinations and doses of steroids, [estrogen (25pg, 40pg, 100pg), progesterone (6ng) and testosterone (50ng)] along with dehydro- epiandrostenedione (100ug). Serum levels of HDL, LDL/VLDL, free and total cholesterol, total and bone specific alkaline phosphotase and triglycerides were analyzed after 5, 10 and 15 months. Free cholesterol and LDL/VLDL levels in serum were reduced in groups mimicking estrous cycle and menstrual cycle hormones treatment. HDL cholesterol was increased in all the hormone treated groups except the estrous cycle-mimicking group. Bone specific alkaline phosphatase was decreased in menstrual cycle levels of estrogen and progesterone treatment. All together our results show that use of natural hormones in appropriate combinations have beneficial effects on cardiac and bone toxicity, along with better tumor reduction than current treatments.

P48THE INFLUENCE OF HORMONE REPLACEMENT THERAPY ON THE SALIVARY FLOW OF POSTMENOPAUSAL WOMEN

Oliveira A. (BR)

Lago M.

Lopes F.

Ferreira E.

Brito Luciane Maria (BR)

UNASUS/UFMA, BR

Recognized as one of the most sensitive life stages of women, menopause is a physiological phenomenon that causes various symptoms. Among the possibilities available to reduce these unpleasant symptoms, it is currently recommended the use of hormone replacement therapy (HRT) which may be used in pre and postmenopausal women. In this case-control study, we aim to compare salivary flow between postmenopausal women submitted or not to hormone replacement therapy (HRT). The sample consisted in 86 women, divided in two groups: 47 individuals undergoing HRT, and a control group of 39 individuals who did not receive any HRT. All patients were submitted to anamnesis using a standard questionnaire, followed by total stimulated sialometry and determination of body mass index (BMI). Salivary flow was classified as follows: normal (1.0 to 3.0 mL/min), low (0.7 to 1.0 mL/min), and hyposalivation (< 0.7 mL/min). The results were analyzed statistically by the chi-square test, logistic regression model, and linear regression (p < 0.05). The HRT group presented an association of protection, even after the analysis adjusted, for low salivary flow (Adjusted OR = 0.22; 95% CI = 0.05–0.88; P = 0.034), and hyposalivation (Adjusted OR = 0.30; 95% CI = 0.10–0.92; P = 0.036). Thus, the results suggest that estroprogestative therapy (β = + 0.53; P = 0.022) has greater influence on the increase in salivary flow that estroprogen therapy (β = + 0.35; P = 0.137). Salivary flow was influenced by HRT on the sample of postmenopausal women studied.

P49ADHERENCE TO THE MENOPAUSE HORMONAL THERAPY (MHT): PROFILE OF THE BRAZILIAN WOMAN

Menezes Ana (BR)

Alves Z.

Pardini D.

UNIFESP, BR

Introduction: The MHT improves symptoms, bone mass, fracture risk, quality of life and must be continued for attainment and maintenance of these results. In Brazil financial problems are the main reason of bad adherence to MHT among women in a public health service. Objectives: Evaluate the adherence to MHT among women from public and private health services of some regions of Brazil as well as the causes of treatment interruption, and if is influenced by the previous habitual use of oral contraceptive. Method: Retrospective analysis of adherence to MHT and the reasons of treatment interruption among 596 patients of four Brazilian cities. Statistical analysis was performed by the Kaplan Meier Survival Function method, using the software SPSS17. Results: Adherence time data for all sample: mean = 4,890 y (I.C. 95% = 4,481–5,298 y); median = 3,200 y (I.C. 95% = 2,825–3,575 y). Among women from private health services (mean = 9,451 y [I.C. 95% = 7,386–11,515 y]; median = 5,000 y [I.C. 95% = 2,467–7,533 y]) and women from public health services (mean = 4,285 y [I.C. 95% = 3,947–4,623 y]; median = 3,000 y [I.C. 95% = 2, 454–3,546 y]) it is different (p < 0,001). Among women who had used anovulatory (mean = 6,044 y (I.C. 95% = 4,838–7,249 y); median = 4,000y (I.C. 95% = 3,262–4,738 y) and the ones who never used it (mean = 5,325 y (I.C. 95% = 4,307–6,342 y); median = 4,000 y (I.C. 95% = 3,241–4,759 y) adherence is also different (p < 0,004). Causes of the treatment interruption (doctor order:33%; cost of medication: 28,6%; fear of complications 12,1%; negligence: 12,1%. Conclusion: Women who were in private health services, or who used oral contraceptive showed better adherence to MHT. The cost of medication, fear of complications and neglect attitudes had negative impact on the adherence to MHT. Maybe this situation can change with free treatment and public education measures.

P50AN ANALYSIS OF BLOGS ON HORMONE THERAPY

Yuksel Nese (CA)

Bayot A. (CA)

Nguyen L. (CA)

Kwan A. (CA)

University of Alberta, CA

Introduction: With the recent controversy surrounding the term “bioidentical hormone therapy (BHT)”, women may turn to internet blogs as an information source. The objectives of this study were to analyze the information presented in BHT blogs and to describe the perspectives on BHT depicted in these blogs. Methods: Blogs were identified using the search engine Google Blog Search^®. Inclusion criteria included: English, developed between September, 2011 to August, 2012, and no more than three clicks from the top 200 search results. A quantitative content analysis was performed on 105 blogs meeting study criteria. Emerging themes were also identified through thematic analysis. Blogs were analyzed separately by two coders and a third coder resolved discrepancies. Results: The author was indicated in 75% of blogs. Only 26% were from health care professionals. Promoting a product or service was the predominant purpose (65%). Evidence to support information presented was mentioned in 21% of the blogs, with 12% providing references. Majority defined BHT as compounded (57%), while only 21% indicated that BHT is commercially available. Bioidentical hormones were categorized as estradiol (28%), estriol (23%), estrone (12%) and progesterone (50%). Testosterone (33%) and dehydroepiandrosterone (DHEA) (15%) were mentioned. 82% of blogs portrayed BHT positively, while 63% relayed negative perspectives on conventional hormone therapy (CHT). Blogs that mentioned safety claimed that BHT was safer than CHT in regards to breast cancer (30%) and cardiovascular risk (22%). General themes used to promote BHT included “hormone balance”, “natural”, “anti-ageing”, and “individualization”. Conclusion: Claims made on BHT blogs presented perspectives that were commercially based and not consistent with evidence-based recommendations supported by professional organizations.

P51CAN TIBOLONE BE MENOPAUSAL HORMONE THERAPY IN A POSTMENOPAUSAL WOMAN WITH SLE TO IMPROVE QUALITY OF LIFE?

Marakani Lakshmi (IN)

Nice Hospital for Women, Newborn and Children, IN

Introduction: SLE is an Anti inflammatory and connective tissue disorder. Normal immunosenescence may be modulated by changing levels and forms of endogenous estrogens. Estrogen promotes SLE through ER–a by receptors inducing IFN-g. So administration of ER blockers should produces clinical improvement. Case report: A 48 yr old postmenopausal, P5 L5 with h/o fatigue, hot flushes, mass PV, depression, joint pains, fever, dyspareunia, dysuria & myalgias. Menopause 3 yrs ago, BMI 35. Has malar rash. Ext genitalia atrophic. P/S dry vagina, cervical descent upto introitus, lax levator ani. V/E:retroverted, small uterus. RA factor neg., ASO titers neg., CRP raised, SLE profile ANA abs present, BMD Hip & Spine osteopenia, USG:small uterus. Given analgesics, B-complex, anti oxidants, local vaginal cream & ring pessary, on steroids for SLE. Vasomotor flushes continued, so started T. Tibolone 2.5 mg/day, which reduced symptoms. Discussion: SLE has a female preponderance of 9:1. Though there are X chromosome abnormalities associated with SLE, estrogen is strongly implicated. sex hormone imbalance with reduced androgens & increased estrogen metabolite, 16 OH estrone, elevated Aromatase enzyme activity. Pregnancy worsens & menopause diminishes its incidence. So, estrogen blocker must produce improvement. Testosterone is protective via TH–1 immune pathway. Tibolone is a STEAR with progestogenic, some androgenic & estrogenic effects, reduces vasomotor symptoms & prevents Osteoporosis. In the LIFT trial, it reduced fractures in Osteoporotic women & in the LIBERATE trial, increased BMD, reduced fracture risk. Summary: As estrogens accentuate S.L.E in postmenopausal women with vasomotor symptoms. Tibolone and lifestyle modification with adjuvant therap may improve quality of life, fatigue and Steroids induced Bone loss.

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P52TRANSDERMAL ESTRADIOL AND ORAL PROGESTERONE: 20 YEARS OF REAL-WORLD EXPERIENCE IN A MENOPAUSE AND OSTEOPOROSIS CLINIC

Boschitsch Ewald (AT)

KLIMAX, AT

In 1993 we started to switch users of menopausal hormone therapy (MHT) from oral to transdermal estrogen (tdE2) and from (synthetic) progestins to (natural) micronized progesterone (micP4) in order to minimize the risks of venous thromboembolism, breast cancer and cardiovascular disease. Nowadays these regimens have become our first-line MHT constituents because they offer a multitude of advantages over other therapeutic options, supported by a growing body of evidence in the literature since the 1990ies up to very recent publications. In our large database of 120,000 patients with informations on gyne-endocrinological, menopausal and osteoporosis associated risk factors we found more than 1,700 peri- and postmenopausal women, who have been or are currently receiving tdE2 as gel, alone or in combination with micP4, to be eligible for further evaluation. They had to have at least two visits, far enough apart from each other to measure least significant changes of bone mineral density, estradiol (E2)-serum levels, various clinical outcomes, particularly improvement of vasomotor, psychological, urogenital and other climacteric symptoms. In addition we searched for serious adverse events as breast cancer and other cancers, myocardial infarction, fragility fractures and others. These women have been invited by mail for updating their findings regarding the symptoms, risk factors and diseases listed above. Such provided data, also considering dose and duration of tdE2 and micP4, as well as previous MHT-use, will be matched with data of women, who have been or are currently receiving other types of MHT. These real-world facts will be presented in their most updated version and may be useful to complement our knowledge on MHT accessible from randomized controlled trials and observational studies.

P53THE REPLENISH TRIAL: EVALUATING TX-12-001-HR A NEW ALTERNATIVE OPTION FOR THE TREATMENT OF MENOPAUSAL SYMPTOMS

Mirkin Sebastian (US)

Amadio J. (US)

Pickar J. (US)

Bernick B. (US)

TherapeuticsMD, US

Recent epidemiological studies suggest that the type of estrogen (Smith et al., 2013) and progestogen (synthetic versus natural) (Fournier et al 2008 and Corvina-Duverger et al 2013) affect the risk/benefit profile of HRT. Observational studies suggest that HRT containing micronized progesterone have shown a more favorable breast safety profile than those containing either progesterone or testosterone derivatives. Additionally, recent evidence also suggests that HRT containing 17β-estradiol has a lower risk of cardiovascular events than those products containing other types of estrogens. It is hypothesized that the combination of 17β-estradiol and micronized progesterone could be a safer option for postmenopausal women with uterus. A new combination of 17β-estradiol/progesterone capsule is being evaluated in phase 3 and represents a novel development in HRT, as no approved compound has been able to combine natural progesterone with 17β-estradiol as an oral formulation, and provide progesterone without peanut oil. The efficacy and safety of this new capsule is being evaluated in the phase 3 REPLENISH trial. The REPLENISH trial is an ongoing phase 3 Double-Blind, Placebo-Controlled, Randomized, Multi-Center Study that evaluates the safety and efficacy of an oral capsule that contains 17β-estradiol in combination with micronized progesterone (TX-12-001-HR) in postmenopausal women with intact uterus. The REPLENISH trial is planning to enroll approximately 1550 postmenopausal women in 60 sites in the US. Four different doses ranging from estradiol 1 mg/micronized progesterone 100 mg to estradiol 0.25 mg/micronized progesterone 50 mg are being evaluated. The REPLENISH trial includes a vasomotor symptoms (VMS) sub-study where the efficacy of TX-12-001-HR in the number and severity of hot flushes is being evaluated as well as an endometrial safety study.

P55HORMONE THERAPY OF MENOPAUSE WITH TRANSDERMAL ESTRADIOL MORE QUARTERLY PROGESTERONE, TOLERANCE AND ENDOMETRIAL SAFETY

Aguirre Wellington (EC)

Mendoza J. (EC)

AXXIS Hospital, EC

Aim: The purpose was to determine tolerance and endometrial safety of the hormone therapy of menopause (HTM) with low dose of trans dermal (TD)estradiol (E2)and orally micronized progesterone (MP)in symptomatic women. Methods: We included 66 post menopausal women who had vasomotor symptoms and no have contraindications to the HTM. Three groups were studied:(A)16 hysterectomized women received E2 TD 25 mcg/d, (B) 23 who kept her uterus received E2 TD 25 mcg/d, more MP by mouth 100 mg/d for 10/d each month, (C) 27 who kept her uterus received E2 TD 25 mcg/d more MP 200 mg/d by mouth for 10/d every 3 months. In which kept her uterus is study ecosonographic by vaginal via to the start of therapy and every 3 months. Endometrial biopsy was performed at the 6 and 12 month of therapy. Results: 59 (89%) completed the 12 month follow, 1 women group A and another group C left by cutaneous intolerance. 3 group B left by technical difficulties for the therapy and 1 by intolerance to oral progesterone, while in group C one non-continuous voluntarily. Group B no present significant increase in endometrial thickness, 16 (69%) maintained regular menstrual bleeding, and the remaining 7% (30%) presented periods of amenorrhea. Endometrial biopsies performed in this group were negative to hyperplasia or other endometrial pathology. In Group C uterine bleedings were regular every 3 months and in one case the endometrium was > 5 mm. Endometrial biopsy at 12 months reported simple hyperplasia without atypia. Comment: We found that a low dose of 25 mcg/E2 TD have a limited capacity to stimulate the endometrium, which is excised properly with 100 mg/d.When endometrial protection is carried out every 3 months the dose of 200 mg/d for 10/d of MP shows a high margin of endometrial safety with the advantage of limiting the number of periods of uterine bleeding, this mode becomes attractive by users.

NON-HORMONAL THERAPIES FOR MENOPAUSAL SYMPTOMSP56THE IMPACT OF OMEGA-3 FATTY ACIDS ON DEPRESSION OF MENOPAUSAL WOMEN: A RANDOMIZED DOUBLE-BLIND CLINICAL TRIAL

Abedi Parvin (IR)

Ahvaz Jundishapur University of Medical Sciences, Nursing & Midwifery School, IR

Background: Depression is one of the most common observed problems in postmenopausal women. This study was conducted to determine the effect of omega-3 fatty acids on menopausal depression in women in Ahvaz, Iran, 2010. Materials and Methods: This randomized double-blind clinical trial was done on 70 menopausal women experiencing various levels of depression. After administering the Hamilton Depression Rating Scale (HAM-D-21), the participants who met the inclusion criteria were randomly divided into intervention group (n = 35) receiving a 2gr omega-3 capsules and control group (n = 35) receiving 2 gr placebo capsules. After 8 weeks of intervention, data were collected and analyzed by Chi-square, independent t-test, and one-way ANOVA with Repeated Measures using SPSS software version 17. Results: Mean depression scores decreased significantly in the intervention group (13.36 ± 2.23 to 8.72 ± 3.71, p < 0.001). Also mean depression scores decreased in the control group (13.25 ± 2.04 to 11.78 ± 2.93); however, it was not significant. The comparison of depression scores did not indicate a significant difference regarding the reduction of depression after intervention between the two groups (p = 0.08). Conclusion: According to the findings of this study, administration of omega-3 capsules (2gr/daily) for 8 weeks decreased menopausal depression. For a more precise observation of the effects, further studies with longer periods of intervention are needed.

Keywords: Depression, Fatty acids, Menopause, Omega-3

P58SAFETY OF ORAL OSPEMIFENE IN PHASE 2/3 PLACEBO-CONTROLLED CLINICAL TRIALS

Goldstein Steven (US)

Archer D.

Graham S.

New York University School of Medicine, New York University Medical Center, US

Objective: To report the overall safety from the clinical development program of ospemifene, a tissue selective estrogen agonist/antagonist approved by the Food and Drug Administration (FDA) for the treatment of dyspareunia in postmenopausal women. Design: Seven Phase 2/3 double-blind, placebo-controlled trials, ranging in duration from 6 to 52 weeks, assessed the safety of ospemifene in subjects receiving at least 1 dose of study drug ranging from ≤ 15 to 90 mg/day, compared to placebo. Subjects were postmenopausal with a mean age of 59 years. Most subjects had an intact uterus. Endometrial biopsies were performed at Baseline, 12 weeks and 12 months for incidence of endometrial hyperplasia and carcinoma. Results: No endometrial hyperplasia or carcinoma was reported in the ospemifene or placebo groups at 12 months. The safety population included 1696 women in the ospemifene group and 958 in placebo, and treatment emergent adverse events (TEAEs) were reported in 1118 (65.9%) vs 518 (54.1%) subjects, respectively. The majority of TEAEs were classified as mild or moderate in severity. No clear dose-related increase in adverse events (AEs) was seen with ospemifene. For ospemifene, the most commonly reported TEAE was hot flush (8.5% vs 3.3% for placebo) and incidence of venous thrombotic events was low (0.1%). Discontinuation due to TEAEs was ≤ 7% in both groups. Overall discontinuation due to hot flush was 0.9% for ospemifene vs 0.3% for placebo. Serious adverse events (SAEs) were experienced by 2.3% ospemifene vs 1.8% placebo subjects. No deaths were reported in any of the trials. Conclusion: Ospemifene was well tolerated in 7 double-blind, Phase 2/3, placebo-controlled trials that evaluated safety up to 52 weeks in postmenopausal women with VVA. These results support the use of ospemifene as the first oral alternative to estrogen prescription therapies for the treatment of dyspareunia in postmenopausal women. Funding was provided by QuatRx Pharmaceuticals Company

P60ENDOMETRIAL SAFETY OF OSPEMIFENE: RESULTS OF THE PHASE 2/3 CLINICAL DEVELOPMENT PROGRAM

Constantine Ginger

Goldstein S. (US)

Graham S.

EndoRheum Consultants, US

Objective: To assess the endometrial safety of ospemifene 60 mg/day in postmenopausal women with up to 52 weeks of exposure. Design: The endometrial safety of ospemifene 60 mg was evaluated in six Phase 2/3 randomized, double-blind, placebo-controlled, parallel-group studies of postmenopausal women aged 40 to 80 with vulvar and vaginal atrophy (VVA). Subjects were randomized 1:1 to ospemifene 60 mg/day or placebo in four clinical trials of either 6 weeks (n = 1) or 12 weeks duration (n = 3), an additional 40 weeks in an extension study of one of the 12 week pivotal trials, and in a separate 52 week trial in which subjects were randomized 6:1 to ospemifene 60 mg/day or placebo. Endometrial safety of ospemifene was assessed by endometrial histology (biopsy), thickness (TVU), and gynecological examinations. Results: There were 1,242 women exposed to ospemifene 60 mg/day in the randomized, double blind, placebo-controlled Phase 2/3 clinical trials who were evaluable for safety assessment. There were 851 (68.6%) ospemifene and 543 (58.7%) placebo participants randomized and who had an intact uterus. Endometrial biopsies were obtained at Baseline in 770 ospemifene and 466 placebo subjects; at 12 months 342 ospemifene and 83 placebo subjects had endometrial biopsies. Endometrial hyperplasia occurred in < 1% of ospemifene treated subjects and no endometrial cancer was reported. At 52 weeks, active endometrial proliferation was observed in < 1% of ospemifene treated subjects. There was no significant difference in the incidence rate of vaginal bleeding or endometrial thickness ≥ 5 mm between groups. Conclusion: Up to 52 weeks of treatment with oral ospemifene 60 mg daily for VVA was safe on the endometrium with no increase in endometrial cancer or hyperplasia in postmenopausal women and active proliferation incidence similar to that reported with raloxifene.

P63THE EFFECT OF POMEGRANATE ON POSTMENOPAUSAL SYNDROME: A RANDOMIZED DOUBLE-BLINDED PLACEBO-CONTROLLED TRIAL

Park Hyoung (KR)

Lee B.

Chung-ang University Hospital, KR

Objective: To investigate the effect of pomegranate extract on postmenopausal syndrome and its safety. Methods: A total of 112 women participated in a randomized, double-blind, placebo-controlled trial conducted in a tertiary university hospital in Korea. Women were treated with pomegranate extract or placebo for 12 weeks. The primary end point was menopausal symptoms which were evaluated as Kupperman Index. The secondary end point was serum estradiol (E2, pg/mL) level. Statistical analysis was performed. Results: Menopausal symptoms as Kupperman Index were significantly improved in pomegranate group compared to placebo on the 12 weeks of intervention (P < 0.0001). Melancholia did not differ between two groups. There was also no difference in serum E2. There were no differences between two groups in age, body weight, height, systolic and diastolic blood pressures, serum white and red blood cells count, fasting blood sugar, hemoglobin, aspartic transaminase, alanine transaminase, total cholesterol, triglyceride, high and low density lipoprotein cholesterols, creatinine, E2. Side effect of pomegranate extract was neglectible. Conclusion: Pemogranate extract improved effectively and safely menopausal symptoms. However, it is difficult to conclude that the effect was due to estrogen component of pomegranate extract.

P65OSPEMIFENE IMPROVES OBJECTIVE MEASURES OF VULVAR AND VAGINAL ATROPHY (VVA)

Constantine Ginger (US)

Graham S.

EndoRheum Consultants, US

Objective: To assess the effects of ospemifene 60 mg/day on objective measures of VVA including the correlation between cellular changes, pH and physical findings on vaginal examination. Design: Change from Baseline in percent of superficial and parabasal cells of the vaginal smear, vaginal pH and visual examination of the vagina were assessed at Baseline, Weeks 4, 12, and 52. Vaginal visual inspection for petechiae, pallor, friability, vaginal dryness and erythema was performed on gynecologic examination. Results: In the Phase 3 studies, mean changes from Baseline to Week 12/LOCF for objective measures of superficial cells, parabasal cells, and vaginal pH showed consistently statistically significant improvement of ospemifene 60 mg vs placebo (p < 0.05). At Week 52, the statistically significant improvement of ospemifene vs placebo was sustained for all measurements. Improvement in the visual evaluation of the vagina was observed in all 5 parameters at Weeks 4, 12 and 52 for the 60 mg group vs placebo (p < 0.0001). The percentage of participants assessed with complete resolution of physical findings of VVA was statistically significant at 12 weeks and sustained through 52 weeks (p ≤ 0.0001). There was a statistically significant correlation (p < 0.05) between the objective measures of cells, pH and visual examination in the ospemifene 60 mg group. Conclusion: Significant changes from Baseline in objective measures of VVA indicate improvement in the underlying physiologic findings of postmenopausal VVA in women treated with ospemifene 60 mg/day. There was a statistically significant correlation between cellular changes, pH and physical findings which was sustained through 52 weeks. Ospemifene not only provided dyspareunia symptom relief but also improved underlying atrophy with improvement of physiologic changes consistent with premenopausal vaginal epithelium.

P66THE ROLE OF ISOFLAVONES IN THE ENDOMETRIUM OF POST-MENOPAUSAL RATS

Plotzky Fernanda (BR)

Carbonell A.

Soares Jr J. (BR)

Baracat E. (BR)

Departamento de Ginecologia do Hospital das Clinicas da Universidade de São Paulo, BR

Introduction: Many post-menopausal women cannot or do not wish to receive hormonal replacement therapy. However, menopausal symptoms may impact negatively in the quality of life. Non hormonal alternatives may present potential benefit to these women. Objective: Evaluate the effect of different concentrations of genistein in castrated rats’ uterus. Methods: 40 ovariectomized virgin rats were treated in 4 different groups: control (GCtrI) and different concentrations of genistein 42 (GES42), 125 (GES125) and 250 (GES250) μg/g body weight per day. The soybean extract or vehicle (propyleneglycol) were administered by gavage for 30 consecutive days. At the end of the experiment, we measured the animal and uterine weight. The middle third of uterine horns were removed and fixed in 10% formaldehyde and processed for paraffin inclusion and histological study. Histological sections of 5 μm were stained by HE and analyzed under light microscopy. We assessed the morphology of endometrium, as well as the endometrial area, number and area of glands and number of eosinophils in propria laminae. The data was evaluated through the ANOVA and Turkey-Kramer test (p < 0.05). Results: The uterine weight, endometrial glandular area, number of glands and eosinophils in GES250 and G125 were significantly greater (GES250 > GES125 > GES42 = GCtrl - p < 0.05). The morphological data showed signs of endometrial proliferation with genistein treatment, especially in animals that received isoflavones at high dose (GES125 and GES250). All animals in the GES250 group presented squamous metaplasia. Conclusion: The administration of high-dose isoflavones has a significant effect in the uterus of ovariectomized rats and may even promote squamous metaplasia in the endometrium.

ANDROGEN THERAPYP67THE ROLE OF SUBCUTANEOUS PELLET TESTOSTERONE REPLACEMENT THERAPY IN SPINAL CORD INJURY: TAKING THE “FIRST STEPS” IN THE TREATMENT OF MEN WITH SPINAL CORD INJURIES

Derosa Angela (US)

Gray K.

DeRosa Medical, PC, US

In men with spinal cord injuries, secondary medical conditions that result can have a significant impact on the healing process. Studies examining testosterone levels in men with spinal cord injuries have demonstrated anywhere from a 47–60% prevalence of low serum testosterone based on lab reference ranges. These statistics do not take into account the spectrum of testosterone deficiency syndromes which can have a wide interindividual variability in hormonal serum levels accompanied by the recognized signs and symptoms of testosterone deficiency. Furthermore, serum levels tend to be reduced further in men using narcotic medications for pain management. The effects of testosterone extend beyond improvement of libido and have been proven to play a positive role in muscle growth and response, sugar metabolism, core strength, energy, mood and motivation. Hypogonadism can present clinically as fatigue, decreased libido, depressed mood, decreased muscle mass and body hair, hot flashes, testicular atrophy, gynecomastia, and infertility. Retrospective analysis has demonstrated increased strength gains in men after spinal cord injury when treated with testosterone replacement therapy in the form of testosterone cypionate. This case describes a 36 year old white male who became a paraplegic after a rock climbing accident who presented for treatment with classic symptoms of hypogonadism. After evaluation and treatment with subcutaneous pellet testosterone replacement therapy, he experienced complete resolution of symptoms and has made significant physical, mental, and emotional recovery. Within six months, the patient has displayed significant improvements in muscle function such that he is able to take several steps with the assistance of crutches or walker. This case highlights the improvement in quality of life and overall prognosis when the subcutaneous pellet form of testosterone is used as part of the overall plan of care in men with spinal cord injury. Due to the overwhelming preponderance of hypogonadism in men with spinal cord injuries and the significant improvement in mental and physical wellbeing with testosterone replacement, the standard of care for treatment of such patients should include screening, laboratory hormone evaluation and prompt treatment for testosterone deficiency.

OTHER TOPICS RELATED TO MENOPAUSEP70THE QUALITY OF LIFE IN MIDDLE-AGED FINNISH WOMEN

Katainen Riina (FI)

Siirtola T.

Engblom J.

Erkkola R.

Polo-Kantola P. (FI)

Turku University Hospital, FI

Objective: The aim was to measure the QoL in middle-aged Finnish women and evaluate the association with age, socio-economic factors, use of HRT and lifestyle. Material and methods: 6408 women, who were called for a municipal screening mammography, received a postal survey concerning their health-related issues. 3421 women (53.4%) returned the questionnaire. The age groups were: 41–42, 45–46, 49–50, 51–52 and 53–54 years. The QoL was studied with the Women's Health Questionnaire (WHQ). The questionnaire consisted of 36 questions rated on a four-step scale (‘yes, definitely’, ‘yes, sometimes’, ‘no, not much’, ‘no, not at all’). Questions were grouped for nine symptom domains: somatic symptoms, depressive symptoms, cognitive difficulties, anxiety and fears, sexual functioning, vasomotor symptoms, sleeping problems, menstrual symptoms and one's experienced attractiveness. The effect of age, socio-economic factors, HRT and lifestyle on QoL was analyzed with a multivariate analysis. Results: In the entire study population, a lack of one's experienced attractiveness was the most severe symptom (mean 2.62, SD 0.83, the smaller number referred to more symptoms). The next frequent symptoms were vasomotor symptoms (mean 2.89, SD 1.03), impaired sexual functioning (mean 2.90, SD 0.83), cognitive difficulties (mean 3.00, SD 0.77), somatic symptoms (mean 3.06, SD 0.65), menstrual symptoms (mean 3.16, SD 0.62), depressive symptoms (mean 3.21, SD 0.70) and sleeping problems (mean 3.22, SD 0.69). Anxiety and fears (mean 3.38, SD 0.64) were the most seldom symptoms. Our results show that increasing age reduced the QoL of the middle-aged women. Older women had more somatic, cognitive, sexual and vasomotor symptoms and sleeping problems than younger women. Only menstrual symptoms decreased with age. Divorced and widowed women had better sexual functioning than married women; there were no other associations between marital status and the QoL. Women with lower educational level had more anxiety and fears, depressive, sexual and vasomotor symptoms and sleeping problems than those with higher educational level, and they also felt themselves less attractive. Employed women had better QoL than retired women in all other symptom domains except in sexual functioning, and fewer somatic and depressive symptoms, cognitive difficulties, anxiety and fears and sleeping problems than unemployed women. Increasing BMI was associated with increase in somatic, depressive, cognitive and sexual symptoms and with lower experienced attractiveness. Non-users of HRT had better QoL than other women in almost all symptom domains; in addition, current HRT users had fewer somatic, depressive and vasomotor symptoms and sleeping problems than former HRT users. Women who used alcohol occasionally had fewer somatic, depressive, cognitive and sexual symptoms and they felt themselves more attractive than abstainers. Women who smoked daily had more symptoms than non-smokers; menstrual symptoms were the only domain where there were no differences according to smoking behaviors. Conclusions: Socio-economic circumstances and lifestyle factors are important regarding the well-being of middle-aged women. Symptoms increase also with aging. The use of HRT is not necessarily associated with better QoL. Non-users of HRT probably have fewer climacteric symptoms and thus they never start using HRT. Climacteric symptoms are often associated with other symptoms affecting the QoL, and this most likely explains why non-users have fewer symptoms than current or former users of HRT.

P71A STUDY ON CLINICAL PRESENTATION OF MENOPAUSE AND HRT

Nahar Kamrun (BD)

Green Life Medical College, BD

It is prospective study done in a private chamber, Mymensingh, Bangladesh to evaluate the clinical presentation, requirement of HRT and amongst the menopausal women so that attention can be given to address this problem. A total 100 cases were analyzed during the period from January, 2001 to December, 2001. Out of 100, 28 had artificial menopause following hysterectomy with bilateral sulpingoophorectomy and 72 had natural menopause. Treatment regimen were counseling, symptomatic treatment and HRT. Pap smear was done in all our cases. Out of 100 cases required HRT. Common clinical presentation was urogenital problem in our study. After 3 months follow up 56% were in HRT. Key Word: Menopause, clinical presentation, HRT.

P72OVARIAN ESTRADIOL PRODUCTION AND LIPID METABOLISM IN POSTMENOPAUSAL FEMALES

Tanabe Akiko (JP)

Maruoka R. (JP)

Watanabe A. (JP)

Nakamura K. (JP)

Ashihara K. (JP)

Tanaka T. (JP)

Terai Y. (JP)

Ohmichi M. (JP)

Osaka Medical College, JP

Objectives: Menopause is defined as the permanent cessation of menses. Although several previous studies demonstrated that there was slight production of androgens and estrogens by the postmenopausal ovaries, the impact of this hormone production on lipid metabolism is still uncertain. The aim of this study was to evaluate whether the postmenopausal ovary is hormonally active, and whether the hormonal status contributes to the lipid metabolism and vascular maintenance. Methods: This was a prospective study of 87 females who were treated for gynecological diseases between January 2010 and April 2013 at Osaka Medical College Hospital. They were categorized as early postmenopausal (n = 43, 56.6 ± 3.9 yr) or late postmenopausal (n = 49, 66.8 ± 5.9 yr). Serum specimens were collected from the ovarian veins of patients undergoing bilateral oophorectomy. Serum was also analyzed from peripheral blood collected intra-operatively. The sex steroid hormone levels, as well as the fasting lipid profiles, were measured. The flow-mediated dilatation (FMD) of the brachial artery was measured before and one week after surgery to evaluate the vascular endothelial damage. Results: Statistically significant gradients were seen between the ovarian venous and peripheral samples for estradiol (E2) and testosterone (Ts) in all groups. The E2 and estrone (E1) obtained from ovarian venous gradually decreased with age in postmenopausal females. There was a significant correlation between the ovarian E2 and high density lipoprotein (HDL) cholesterol level, and the low density lipoprotein (LDL)/HDL ratio. However, there was no correlation between the peripheral E2 level and any of the lipid parameters examined. The%FMD was likely to decrease after BSO in early-postmenopausal females, however, none of sex steroids obtained from ovarian venous were not correlated with%FMD. Conclusion: The postmenopausal ovary is hormonally active, and the E2 produced by postmenopausal ovaries may therefore contribute to the maintenance of the lipid metabolism.

P73PREVALENCE OF MENOPAUSAL SYMPTOMS IN AUSTRALIAN WOMEN AT MIDLIFE: A SYSTEMATIC REVIEW

Gartoulla Pragya (AU)

Women’s Health Research Program, AU

Aim: In order to determine the knowledge of the prevalence of menopausal symptoms in Australian women and to identify areas requiring further research, we have systematically reviewed the published Australian studies that have reported on menopausal symptoms. Method: A comprehensive and systematic literature search was done using 6 databases in June 2013 to retrieve all English language studies that contained information on the prevalence of menopausal symptoms among women living in Australia. Risk-of-bias of included studies was assessed using a risk-of-bias tool, specifically designed for systematic review of prevalence studies. Results: Of 6462 studies identified from the initial search, 10 studies met our inclusion criteria. Of these, 3 studies reported on the Australian Longitudinal Study on Women's Health (ALSWH), leaving 8 independent studies. A high level of bias was observed related to both external and internal validity for the included studies. The reported prevalence of hot flushes for postmenopausal women was 35% to 80% and night sweats was 26% to 39%. Five studies reported on the prevalence of vaginal dryness, and each of these differed in the way the data was reported. None of the 5 independent studies reporting on psychological symptoms employed a validated depression instrument. The reported prevalence of depression in postmenopausal women ranged from 10% to 53%, anxiety from 4% to 57% and nervousness from 47% to 58%. Five independent studies reported physical symptoms with substantial inconsistencies in the findings. Conclusion: Few studies documenting the prevalence of menopausal symptoms in Australian women have been published. Sampling issues and the use of non-validated questionnaires limited the interpretation of the published findings. A large appropriately sampled study, using validated questionnaires, is needed to establish the current prevalence and severity of menopausal symptoms in Australian women.

P75ADAPTATION OF THE UTIAN QUALITY OF LIFE SCALE TO PORTUGUESE, USING A COMMUNITY SAMPLE OF PORTUGUESE WOMEN IN PRE-, PERI- AND POST-MENOPAUSE

Pimenta Filipa (PT)

Leal I.

Maroco J.

Rosa B.

Utian W. (US)

ISPA - Instituto Universitário, PT

Objective: The present study aims at validating a climacteric-specific measure of global quality of life, namely, the Utian Quality of Life Scale (UQoLS), in a community sample of women with different menopausal status. Methods: A community sample of 1,003 Portuguese women in pre-, peri- and post-menopause filled in the UQoLS (Utian, Janata, Kingsberg, Schluchter, & Hamilton, 2002), the Menopause Symptoms’ Severity Inventory (MSSI-38) (Pimenta, Leal, Maroco, & Ramos, 2012), the Subjective Well-Being Scale (Albuquerque & Tróccoli, 2004). Menopausal status was determined according to STRAW criteria (Harlow et al., 2012). Socio-demographic, health and menopause-related information was also collected. PASW Statistics (v.19) and AMOS (v.18) software were used to perform the analysis. Results: The final structure with 22-items, organized in four factors, showed overall good psychometric properties (in terms of factor analysis, discriminant, external and criterion validity, as well as regarding reliability and sensitivity). In this Portuguese version, item 20 was excluded since it manifested associations with several other items and different factors; moreover, it presented modification indices well above the admissible value. Conclusion: This research emphasizes that UQoLS has good psychometric properties in its Portuguese version and it can be a sound instrument to assert quality of life during climacteric.

P77MEASURING WOMAN's QUALITY OF LIFE IN VENEZUELA: THE CERVANTES SCALE

Martin David (VE)

Clinica el Avila, VE

Introduction: In order to evaluate the acceptation of questionnaire Cervantes Scale^®, we applied to a pilot sample of 70 women between 45 y 64 years in Caracas, Venezuela. Methodology: The Cervantes Scale^® consists of four domains: menopause and health, psyche, sexuality and couple's relationship with 31 items. 70 surveys (63 valid) were made in a private medical consultation (Drs. Martin-Moreno) of a middle class population of Chacao municipality, The women accepted participate and were capable to answer the questionnaire by herself. We apply Cronbach's α coefficient test for internal consistency using statistical processor Epidat 3.1. Results: Demographic characteristics: women's age 45–49 31.74%, 50–59 55.55%. 66.66% had university grade. 71.42% works outside the house. It not became apparent comprehension difficulties, which require clarification by the interviewer, 96% of these women understood properly the instrument. The percentage of 1–2 unanswered questions was 4.76% (3/63). The Cronbach α index oscillated between 0,8546 and 0,8748, with a global Cronbach α index of 0,8645. The highest average score (3.9387) was on item 20 (I have good health as anyone at my age) and the lowest (0.7346) on item 17 (I think that others would be better off without me). The total mean score for Domain menopause and health was 30.03, psyche domain 23.56, sexuality 3.06 and couple's relationship 6.42, vasomotor symptoms 6.86, health 10.19, aging 14.89. Conclusions: This quality of life scale (Cervantes Scale^®) is simple, easy to apply, comprehensive, short (about 7 minutes) and consists of 31 items. An instrument in spanish capable of assessing the effect of other areas apart from the clinical evidence of hormonal changes. First report that we found using this quality of life scale in Venezuelan climateric women. It's necessary a large study across the country to validate it.

P79PROSPECTIVE COMPARATIVE ANALYSIS OF CLIMACTERIC SYNDROME’S COURSE IN WOMEN WITH ACROMEGALY AND HEALTHY POSTMENOPAUSAL WOMEN

Zaydieva Jansiyat (RU)

Logutova L.

Rifatova A.

Dreval` A.

Chechneva M.

Ilovaiskaya I.

Perfilyev A.

Moscow Regional Research Institute of Obstetrics and Gynecology, RU

Objective. To compare climacteric syndrome's course in women with acromegaly and in healthy postmenopausal women. Patients and methods. Complex clinical research of 47 female patients (pts) of Moscow region acromegaly registry and 50 healthy postmenopausal women. Results. Of 47 acromegalic women 21 underwent pituitary surgery and received somatostatin analogs, 22 – were given only medical treatment. Among extragenital diseases of pts with acromegaly were occurred hypothyroidism and nodular goiter (n = 30), hypertension (n = 30), gastrointestinal diseases (n = 35), obesity (n = 24), diabetes mellitus (n = 16), kidney diseases (n = 13). Of 41 postmenopausal women with acromegaly 16 (median 45 years) had surgical menopause. Menopausal symptoms were measured using the Greene Climacteric Scale. Mean score was 23 (severe climacteric disturbances (CD)) in acromegalic pts; it was higher than in healthy postmenopausal women. Severe CD were found in 32 women with acromegaly (24 of them had active acromegaly or incomplete remission), moderate – in 12 and mild – in 3 pts, while healthy postmenopausal women generally had mild or moderate CD. Acromegalic pts reported a significantly higher severity score for headaches (70,3%), feeling tired or lacking in energy (70,3%), muscle or joint pains (70,6%), sweating at night (40,7%). Healthy postmenopausal women reported experiencing hot flushes, difficulty sleeping in a more severe way than women with acromegaly. Conclusions. More severe CD and somatic symptoms were common for acromegalic women (mainly because of active acromegaly and severe extragenital diseases) than for healthy postmenopausal women. The last more often complained of vasomotor symptoms and had mild or moderate CD. Many of menopausal symptoms were similar with clinical signs of acromegaly (headache, muscle or joint pains, sweating at night), so it is difficult to distinguish them.

P80FACTORS ASSOCIATED WITH DISABILITY IN WOMEN OVER 50 YEARS OF AGE: A POPULATION-BASED HOUSEHOLD SURVEY

Costa-Paiva Luiz (BR)

Baccaro L. (BR)

Aguiar L.

Machado V. (BR)

Pinto-Neto A. (BR)

State University of Campinas, BR

Purpose: To evaluate the prevalence of disability and its associated factors in Brazilian women over 50 years of age. Methods: cross-sectional study with 622 women over 50 years of age residing in Campinas/Brazil was conducted in the form of a population survey. Activities of daily living and instrumental activities of daily living were assessed through a questionnaire with seven items, applied by trained interviewers. The dependent variable was defined as being completely unable to perform any of the seven items. The main independent variables were self-perception of health, sociodemographic data, health-related habits and morbidities. Statistical analysis was carried out by chi-square test and Poisson regression. Results: The mean age of the women was 64.1 years. The prevalence of disability was 43.4%. Age (PR 1.02; 95%CI 1.01–1.03; p = 0.01), fear of falling (PR 1.59; 95%CI 1.17–2.16; p < 0.01), having a higher BMI (PR 1.03; 95%CI 1.01– 1.05; p < 0.01), personal history of heart attack (PR 1.36; 95%CI 1.06–1.76; p = 0.01), smoking more than fifteen cigarettes a day (PR 1.34; 95%CI 1.04–1.72; p = 0.02), having been admitted to a hospital in the last 12 months (PR 1.29; 95%CI 1.03–1.62; p = 0.02), multimorbidity (PR 1.43; 95%CI 1.02–2.02; p = 0.03) and use of any medication prescribed by a doctor (PR 1.57; 95%CI 1.02–2.41; p = 0.04) were associated with a higher prevalence of disability. Self-perception of health as good/very good (PR 0.67; 95%CI 0.52–0.86; p < 0.01); use of alternative medications (PR 0.54; 95%CI 0.33–0.90; p = 0.01) and having more years of schooling (PR 0.65; 95%CI 0.45–0.93; p = 0.02) were associated with a lower prevalence of disability. Conclusions: the results have improved understanding of the factors associated with disability in Brazilian women and may help identify those who need multidisciplinary support to reduce the effects on quality of life.

P81AWARENESS OF HEALTH ISSUES RELATED TO MENOPAUSE AMONG PATIENTS ATTENDING OUT-PATIENT DEPARTMENT OF NATIONAL HOSPITAL OF SRI LANKA

Atapattu Piyusha (LK)

Bandara H.

Bandara S.

Yapa M.

Faculty of Medicine, University of Colombo, Sri Lanka, LK

Aims and Objectives: To assess the awareness of health issues related to menopause among patients attending the Out-Patient Department (OPD), National Hospital Of Sri Lanka (NHSL). Methods and Materials: Observational cross sectional descriptive study among male and female patients attending NHSL OPD using a self-administered questionnaire. Data were analysed using SpSSv20.0. Results: Sample comprised 42 females and 9 males of age 52.2 ± 8.1 (mean± SD) years. 84.3% were educated up to Ordinary Level. Following were identified as menopausal symptoms; hot flushes (23.5%), sleep disturbances (29.4%), dyspareunia (17.6%), urinary symptoms (23.5%), mental blues (17.6%), weight gain (35.3%), loss of libido (25.5%), arthralgia (47.1%), shortness of breath (11.8%) and chronic cough (9.8%). 30% were aware that ischaemic heart diseases, osteoporosis and dementia are associated with menopause. 11.8% considered post-menopausal bleeding (PMB) as a natural occurrence and only 21.6% stated that even a single episode of PMB needed investigation. Only 19.6% knew that contraception is necessary during peri-menopausal period. 47.1% knew about well-woman clinic (WWC) in MOH office, but only 15.7% attended them.43.1% had health education on menopause mainly via mass media (29.4%) and medical personnel (19.6%). Knowledge regarding common menopausal symptoms, long term effects of menopause and the correct measure to be taken in PMB was not significantly different with education level or presence/absence of previous health education. Conclusion: Though a considerable number had health education on menopause, knowledge regarding health issues in menopause is inadequate in this group. Effective public dissemination of information regarding menopause and improving attendance at WWC are necessary to improve health of post-reproductive women.

P82STRUCTURAL VALIDITY OF A 16-ITEM ABRIDGED VERSION OF THE MENOPAUSE CERVANTES HEALTH-RELATED-QUALITY-OF-LIFE SCALE: THE CERVANTES-SHORT FORM SCALE

Coronado P. (ES)

Sánchez Borrego Rafael (SP)

Palacios S. (ES)

Ruiz M.

Rejas J.

Clínica DIATROS, Barcelona, Spain, SP

Objective: The Cervantes scale is a specific health-related-quality-of-life questionnaire developed in Spanish through and beyond menopause. The scale contains 31-items and it is time-consuming. The aim of this work was to produce an abridged version with the same dimensional structure and similar psychometric properties. Methods: A representative sample of 626 women [mean age 57 years old (SD = 4.31, Min = 38, Max = 64)] was extracted from an epidemiological, cross-sectional study carried out in 4,157 Spanish post-menopausal women attending out-patient clinics of Gynecology throughout Spain in year 2011. Item analysis, internal consistency reliability, item-total and item-domain correlations and item correlation with the generic Spanish version of the MOS-SF12v2 questionnaire dimensions were initially studied. Dimensional and full-model Confirmatory Factor Analysis were used to check structure stability. A 3-fold cross-validation method was used to obtain stable estimates, by means of multi-group analysis. Results: The scale was reduced to a 16-items version: The Cervantes-SF. It contains four main dimensions: Menopause and health, Psychological, Sexuality, and Couple Relations, being the first dimension composed by 3 sub-dimensions: vasomotor symptoms, health, and Aging. Goodness-of-fit statistics were better than those of the extended version (chi-square/df = 2.493, AGFI = 0.802, PCFI = 0.749, RMSEA = 0.054). Internal consistency was good (Cronbach's alpha = 0.880) but slightly lower than that of the original scale. Correlations between extended and reduced subscales was high and significant in all cases (p < 0.001), ranging from r = 0.90 for Sexuality to r = 0.969 for Vasomotor symptoms. Conclusion: A faster and suitable for routine medical practice abridged version of 16-item (Cervantes-SF), which maintains the original structure and psychometric properties, was produced.

P83DIETARY LIFE OF JAPANESE FEMALE AT MIDLIFE: CURRENT STATE OF FOOD SERVICE USAGE

Maruyama Satomi (JP)

Hosoi N.

Kinjo Gakuin University, JP

Background; Most Japanese women have experience with domestic chores such as cooking. Japanese women, who began to join the work force during the 1980's, have less time to spare for domestic chores. The food service industry started to provide a large number of food items to make the preparation of meals easy. Objective; To investigate the current state of food service usage of Japanese females at midlife. Methods; This was a cross-sectional study involving 84 Japanese females at midlife and whose children go to the same university in Aichi prefecture. Since 9 subjects were caregivers whose dietary intake disagreed with that of non-caregivers, they were excluded and the final sample size was 75. Subjects were given a self-administered questionnaire. Questions included the frequency and the reason for using food service industries in the one-month period preceding the survey. In this study, the food service industry was defined as a restaurant, fast-food shop, institutional food service or coffee shop, as defined by the statistics of the Japanese Ministry of Internal Affairs and Communications. We analyzed three meals: breakfast, lunch and dinner. This study was approved by the ethics committee of Kinjo Gakuin university (No. 11001). Results: The subjects aged 48 ± 3 years. The subjects used food service industries (in one month) 0.7 times for breakfast, 14.8 times for lunch and 6.2 times for dinner. Reasons included: saving time (25.0% for breakfast), communicating with friends (34.8% for lunch) and communicating with family (46.2% for dinner). Conclusion: Traditionally, Japanese have consumed breakfast and dinner cooked by the housewife at home. In this study, over 25% of subjects used food services for meals. The dietary life of Japanese females at midlife may change more in the future.

P84EFFICACY OF PORCINE PLACENTAL EXTRACT ON SHOULDER STIFFNESS IN CLIMACTERIC AND POSTMENOPAUSAL WOMEN WITH HORMONE THERAPY

Koike Tiger (JP)

Koike K. (JP)

Suzuki N.

Morishige K.

Gifu University Graduate School of Medicine, School of Medicine, JP

One of the most common climacteric symptoms is somatic symptoms, such as muscle and joint pain, which causes limitations in performing daily tasks. This study aimed to assess whether oral porcine placental extract (PPE) affects patients with shoulder stiffness, one of the most common types of muscle-tendon stiffness in climacteric women and postmenopausal women with hormone therapy (HT). Sixty-six climacteric women with shoulder stiffness and 54 postmenopausal women with HT-resistant shoulder stiffness were enrolled into this open- label, randomized, controlled study. The control subjects received Toki-shakuyaku-san (TJ23). Experimental subjects received PPE for 24 weeks in climacteric women and for 12 weeks in postmenopausal women with HT. Changes in the degree of shoulder stiffness were evaluated by the Visual Analog Scale (VAS). Treatment with PPE was significantly effective in reducing the VAS score for shoulder stiffness during the study period compared with the control group in both climacteric and postmenopausal women with HT. The VAS score at the end of treatment was reduced by 76.4% (for climacteric women) and 64.8% (for postmenopausal women with HT) compared with baseline. PEE is a good option as an oral supplement for shoulder stiffness in climacteric women with or without HT.

P85METABOLIC SYNDROME AMONG URBAN WOMEN OF BANGLADESH

Nahar K. (BD)

Rahman D.

Bangladesh, BD

Prevalence of non-communicable diseases are a challenging problems among menopausal women specially in a least developing country like Bangladesh, where majority of women suffer from at least one chronic diseases after menopausal age. So the main objective of this study was to determine the prevalence of metabolic syndrome and related risk factors in Bangladeshi menopausal women living in the urban settings. Methods: This is a urban based cross sectional survey among 50 women aged more then 45 yrs. Metabolic syndrome was defined according to criteria of NCEP-ATP III (National cholesterol program adult treatment panel). Results: Metabolic syndrome was presented in 32% respondents. Out of 16 respondents 11 (22%) had high blood pressure, 12 (24%) had elevated blood glucose, 14 (28%) had hyperlipidemia. All the 16 women have waist circumference more then 88 cm. Conclusion: Metabolic syndrome seems to be a major health problem many postmenopausal women in many developing countries like Bangladesh. We should take necessary steps for the prevention and control of the grievous complications for menopausal women.

P8625-HYDROXYVITAMIN D LEVELS AND BODY MASS INDEX IN HEALTHY POSTMENOPAUSAL WOMEN

Kim Heung (KR)

College of Medicine, Kosin University, KR

Purpose: Obesity is associated with alterations in vitamin D (VtD) system. We evaluated the correlation between vitamin D level and BMI, as the standard for obesity in menopausal women. Materials and Methods: To study the relationship between VtD levels and obesity, We recruited 310 healthy menopausal women between January 2005 and March 2011 and analyzed the correlation between BMI and serum 25-hydroxyvitamin D (25-OH-VtD) level. We also analyzed the relationship between serum VtD level and bone health status such as Bone mirenal density measured by DXA, bone turnover marker, and PTH. Results: With a standard for VtD deficiency at 30 ng/ml, 98.9% patients showed a VtD deficiency, while 87.8% patients showed a vitamin D deficiency with a 20-ng/ml standard. VtD levels had no significant correlation with age, height, weight, BMI, or bone turnover markers. Parathyroid hormone (PTH) level and serum 25-OH-VtD level showed a negative correlation. VtD level showed negative correlation with BMI, but statistically not significant. Conclusion: In this study, most of menopausal women (more than 87.8%) had a VtD deficiency, and VtD level showed negative correlation with BMI, but was not statistically significant.

P87STUDY OF THE CLINICAL EFFECT AND SAFETY OF MEDICAL COMPLEX “CHI-KLIM” USED FOR THE CORRECTION OF AGE-RELATED CHANGES OF THE SKIN

Utskovskaya Yana (RU)

Kvach I.V.

Naumchik G.A.

Shipkih S.A.

Pacific State Medical University, RU

Nowadays the esthetic health is an extremely important indicator of the quality of life. The present demographic situation changes towards increase in life expectancy, thus development of new methods and techniques that contribute to maintaining good appearance and prolongation of active lifestyle is one of the most actual problems of modern medicine and cosmetology. The modern approaches for correction of age-related skin changes include not only injections and apparatus methods for rejuvenating but also prescribing systematic and local medications. Loss of visual appearance impairs the psycho-emotional state and significantly reduces the quality of woman's life, especially in women who are particularly concerned about their appearance. It is known that in order to maintain structural integrity, functionality and quality characteristics of the woman's skin adequate levels of sex hormones are needed while estrogen deficiency accelerates aging. Due to this, we found it useful to share experience of the multidisciplinary approach to the treatment of patients with age-related skin changes.

P88ACCEPTATION OF SPANISH MENOPAUSE SOCIETY’S MENOGUIAS BY THE MEDICAL PROFESSIONALS

Coronado Pluvio (ES)

Sanchez-Borrego R.

Mendoza N.

Llaneza P. (ES)

Manubens M.

Bayo A.

Navarro C.

Spanish Menopause Society, ES

Objective: The menoguias are guidelines created by the Spanish Menopause Society (SMS) to offer to the medical professional who manage the climacteric women the necessary tools to attend them properly. The aim of this study is to know the opinion of these medical professional when the four menoguias published until now have been presented to them. Material and Methods: The menoguias have been showed in 8 Spanish cities in different times. An overall of 306 participant have accepted and consented to fill the questionnaire about menoguias. The questionnaire is a self-filled form, which is integrated by 5 questions and 4 answers. At the end of the menoguias’ exposition, the questionnaires were given. The menoguias exposed were Perimenoapause, Osteoporosis, Symptomatic women with breast cancer and Tibolone. Results: The most of participant agreed that the menoguias were well understood (93.8% Perimenopausia, 92.5% osteoporosis, 92.8% Symptom in breast cancer, and 89.9% Tibolone. Respect to the extension of the content, the participant considered that the menoguias were suitable in length and contents (83.3%, 83.7%, 83.7% and 81.7% respectively). In relation with the information offered by the menoguias, most of participant agreed in consider these guidelines as tools that provides important information about the management of the climacteric women (85.6%, 82.7%, 85.0%, and 83.0%, respectively) and in their clinical practice (85.6%, 82.7%, 85.0% and 84.3% respectively). At last, the menoguias, in a high rate of respondents (67.3%, 69.6%, 70.6% and, 70.3% respectively), were very practical and they think will help them to find the right management to their patients. Conclusions: The SMS's menoguias have been well accepted by the medical professionals and have been considered as simple to understand, suitable in content useful in their clinical practice.

P89KNOWLEDGE AND PERSONAL USE OF MENOPAUSAL HORMONE THERAPY BY CHINESE OBSTETRICIAN-GYNECOLOGISTS: RESULTS OF A SURVEY

Yang Xin (CN)

Peking University People's Hospital, CN

Objective: Since the HERS and WHI publications, ob-gyns’ knowledge of benefits and risks and attitude of Hormone therapy have been evolving. The survey was to study Chinese ob-gyns’ perception, attitude and personal use of HT. Method: 2000 self-administered questionnaires were sent to female obstetrics-gynecologists attending the gynecological endocrinology workshops held from February, 2013 to May, 2013 in 15 provinces and cities in China. Results: 904 eligible questionnaires were collected (response rate, 45.2%). The majority of the respondents knew HT can relieve menopausal symptoms (97.7%) and osteoporosis prevention (93.5%). 69.4% of the respondents thought HT would increase the risk of breast cancer and 52.9% thought would increase the risk of endometrial cancer. The most common concern of HT side effects was risk of breast cancer, followed by risks of endometrial cancer, venous thrombosis and weight gain. 123 (38.0%) out of the 324 symptomatic respondents reported to have used hormone therapy and a further 28 (8.6%) had tried the transdermal and vaginal estrogen cream. Conclusions: These findings showed a better knowledge of HT among Chinese ob-gyns compared to the general Chinese population. However the usage of HT was relatively low and ob-gyns seemed to be over concerned about HT's risks. Education about HT in Chinese ob-gyns needs promotion so as to enhance proper use in the general population.

P90BUILDING INTERNATIONAL MENOPAUSE TRANSLATION CAPACITY

Garad R. (AU)

Deeks A.

Farrell Elizabeth (AU)

Michelmore J.

Jean Hailes for Women’s Health, AU

Background: There is little doubt that menopause has received a significant level of research focus, with study findings effectively translated to the scientific community. However, broadening the outcomes to a wider stakeholder audience such as policy makers, health professionals and consumers is not always achieved. This means there are often lost opportunities to influence policy and health related behaviours. Aims: To increase awareness of menopause for consumers, drive evidence-based practice in health professionals and advance international menopause translation capacity. Method: Jean Hailes has developed, through a twenty year iterative process, a tested and successful translation strategy. This strategy encompasses key elements such as; identifying and targeting gaps in women's health research addressing physical and emotional health, utilising an evidence based approach, responding to consumer need for health information and education, acting as a trusted health resource, providing a compendium of modalities to fit the needs of a range of end users such as a comprehensive website, fact sheets, magazine articles, health professional journal articles, video conferencing, accredited learning, professional development and social media. Conclusion: A comprehensive approach to research translation is critical to broadening the outcomes to a wider audience. A highly developed strategy maximises opportunities to reach a wide stakeholder base and build menopause translation capacity.

P95ATTITUDE REGARDING MENOPAUSE AND HORMONE REPLACEMENT THERAPY AMONG FEMALE SECONDARY SCHOOL TEACHERS IN SRI LANKA

Atapattu Piyusha (LK)

Bandara S.

Yapa M.

Bandara H.

Faculty of Medicine, University of Colombo, Sri Lanka, LK

Objectives: To assess the attitudes regarding menopause and hormone replacement therapy (HRT) among female secondary school teachers. Methods: A descriptive cross-sectional study using a self-administered questionnaire in 84 female schoolteachers > 40 years in selected national schools in Kurunegala district. Data were analysed with SpSSv19. Results: Mean age = 50.1 ± 5.9 (mean± SD)years. > 60% had university education. 25 (29.8%) had reached natural menopause. 43 (51.2%) had health education on menopause. Mean perceived age for menopause was 46.9 ± 5.9 years. They stated that menopause; is a normal aging transition (97.6%), gives freedom from menstruation/conception/childbirth (74%), causes loss of drive in performing daily activities (10.8%), a barrier for good relationship with husband (17.3%), and children (4.2%), end of sexual life (2.6%), needs no treatment (76.3%) and a positive experience (45.5%). They stated that HRT stops aging (23.9%), has more risks than benefits (74.3%), relieves every symptom of menopause (18.1%), must be avoided in any case (40.8%), is a waste of money (38%), should be supplied by government (36%), and be available over-the-counter (13.9%). There was no significant difference in attitude regarding menopause and HRT among teachers who had reached natural menopause and those who had not reached menopause, except that non-menopause group stated HRT should relieve every symptom of menopause (X2 = 4.38, p = 0.036) and be supplied by government (X2 = 0.88, p = 0.002). Conclusions: In this well-educated group, majority accepted menopause as a natural process not requiring treatment, or affecting activities of daily living and family relationships. Many considered it a positive experience. Though majority considered HRT use as risky, many had a positive attitude towards it. Non-menopausal group expected HRT to relieve every menopausal symptom and free government supply.

P96QUANTIFICATION OF DAIDZEIN AND GENISTEIN IN DIFFERENT TYPES OF SOYBEAN EXTRACT BIOTRANSFORMED BY FUNGUS

Stocco Bianca (BR)

Figueiredo S.

Bianchini F.

Fonseca M. (BR)

Torqueti M.

University of São Paulo, BR

Introduction. Hypoestrogenism, which occurs in the menopause, accelerates skin aging.The literature points that the estroprogestive Hormone Replacement Therapy (HRT) promotes an increase in collagen content and skin thickness. However, the classical HRT is contraindicated for some patients; for these cases the literature indicates the phytoestrogens as alternative therapy. Among the phytoestrogens, the isoflavones aglycone Daidzein (D) and Genistein (G), have shown to increase the thickness of the dermis and epidermis and collagen content in previous studies. However, the isoflavones aglycones are present in low amounts in soybean grains. Objective. Quantify the isoflavones daidzein and genistein present in different soybean extracts biotransformed by the fungus Aspergillus awamori (SEBF), which has the β-glucosidase enzyme, able of converting glycosylated forms, genistin and daidzin, in aglycone forms, D and G, which are the forms most absorbed by the skin. Materials and methods. Were produced 5 different types of biotransformed soybean extracts, hereby called SEBF 1, SEBF 2, SEBF 3, SEBF 4 and SEBF 5. The NBSE (not biotransformed soybean extract) was used as control. Quantification of D and G was conducted by HPLC (LC-10AT, Shimadzu). To assess the linearity of the chromatographic method, were prepared various solutions (0.5 to 7.5 mg/ml) of the standards D and G in triplicate (Sigma^®, St. Louis, MO, USA). Results. The SEBF 5 showed the highest amount of D and G (7.31 and 8.39 mg, respectively). The NBSE presented 1.55 mg of D and 0.77 mg of G, demonstrating that the increase in the concentration of isoflavones is related to the presence of β-glucosidase enzyme. Conclusion. The SEBF 5, by having the higher concentration of D and G, will be the extract chosen for the further development of custom cosmetic formulations for menopause women.

P97USE OF THE MENOPAUSE-SPECIFIC QUALITY OF LIFE (MENQOL) QUESTIONNAIRE IN RESEARCH AND CLINIC: A COMPREHENSIVE SYSTEMATIC REVIEW

Sydora Beate (CA)

Fast H.

Campbell S.

Yuksel N. (CA)

Lewis J.

Ross S.

University of Alberta, CA

The menopause-specific quality of life (MENQOL) questionnaire was developed as a validated research tool to measure condition-specific QOL in early postmenopausal women. The extent and details of MENQOL's use in medical research is not known. Our goal is to examine the use of MENQOL since its 1996 publication in order to assess its value in providing patient assessment information to clinicians and healthcare workers. We conducted a systematic review of articles from 1996 to 2012 using 13 biomedical and clinical databases with “menqol” as the search term. All studies using MENQOL as an investigative tool were included. Review articles, meeting abstracts and proceedings, dissertations, and incomplete trials were excluded. Data extracted contained study design, intervention, MENQOL version and modifications, sample age and menopause stage. Data analysis included quantitative and qualitative assessment of MENQOL's use in the selected studies. Out of 1251 items retrieved, 166 manuscripts were identified that fit our inclusion criteria. Studies described in these manuscripts were performed in 36 countries using MENQOL translated into 27 different languages and included surveys (71), RCTs (65), experimental studies (27), pilot studies (10), psychometric evaluations (6), and case reports (3). The majority of articles (125) reported using either MENQOL or MENQOL-Intervention; however, not all studies adhered to the proper items, menopause stage, and analytical methodology. The use of a modified form with reduced or added questionnaire items was explicitly reported in 15 papers. Our data indicate that the MENQOL questionnaire has found extensive use over the past 16 years in research and clinical studies of various designs. Although we recorded a variety of modifications, MENQOL emerges as a valuable tool for the assessment of menopausal women.

P98A COMPARATIVE STUDY OF LASER FACIAL RESURFACING IN MENOPAUSAL WOMEN WITH AND WITHOUT HRT

Huq Mohammad (BD)

Nasreen Z. (BD)

Square Hospital Ltd, BD

Introduction: The skin undergoes degenerative processes during menopausal. Many women notice a sudden onset of signs and symptoms of skin aging during menopause, such as a rise in skin dryness, loss of firmness, decrease in elasticity, and increase in skin looseness. The psychological distress caused by the deterioration in appearance. Numerous publications on the effects of sex hormones on the aging process are available today. Regarding HRT facial use still there are controversies. HRT must be rejected when it is solely considered for the prevention of skin aging. With the development of sophisticated, safe, and user friendly laser systems that provide effective treatment for a variety of aesthetic skin conditions. Objective: To access the effectiveness of laser facial rejuvenation in menopausal women with or with HRT. Method & Materials: Prospective study was done in Square Hospital dermatological department. Twenty menopausal women included in each group with or without HRT. All chronic dermatological diseases were excluded from the study. Procedure includes Long pulsed 1064 wave Nd Yag laser, monthly interval for five months. Nine point visual analog method was design to evaluate different skin parameters like crow feet wrinkle, global wrinkle, sagging, mottle pigmentation, and skin tightness. A short questionnaire was design which include age of menopause, when HRT started and psychological feeling. All data were tabulated and statistical analysis were done using SPSS. Result: Overall clinical improvement was noted among both groups. No significant results were with HRT, except skin tightness which improve and persist longer (8 vs 15). Women psychological feeling were better among HRT user (6 vs 18). Conclusion: As there are lot of controversies about HRT use on facial skin, Laser therapy could be an adjunct therapy for facial rejuvenation in HRT user.

P99PREMATURE OVARIAN FAILURE IN TWO MEDICAL UNITS OF TARGU-MURES: DIAGNOSTICAL DIFFICULTIES

Szabó Béla (RO)

Szanto Z. (RO)

Nagy B. (RO)

Turos J. (RO)

Kelemen G. (RO)

Kun I. (RO)

University of Medicine and Pharmacy Tirgu Mures, RO

Introduction. Premature ovarian failure (POF) is considered a secondary amenorheea due to loss of ovarian function before age 40. It may be divided into primary and secondary forms caused by ovarian and central mechanisms, respectively. Its aethiological diagnosis is often difficult or remains unclear. Our study was realized in two medical centers of the city Targu-Mures: in the Endocrinology Department of the University of Medicine and Pharmacy and in the Clinic for Human Reproduction. Thirty women with ovarian failure were included in the study. Gonadotropins, sexual hormones, ovarian US (antral follicular count), anti-müllerian hormone (AMH), antibodies against endocrine glands were determined, as well as other investigations to clarify other possible aethiological factors. Results. Among the 30 women 26 (87%) had primary, 3 (10%) secondary premature ovarian failure, and one presented mixed (secondary with primary) form. The aethiology of POF was elucidated in 63% of the cases. In the primary ovarian failure group four women underwent bilateral adnexectomy, eleven were diagnosed with autoimmune endocrinopaties and one with lactose intolerance, in the remaining 10 cases (33% of all patients and 38% of the primary forms) the aethiology could not been clarified. The three subjects with secondary ovarian failure had pituitary insufficiency, in two cases due to operated pituitary adenomas (acromegaly and non-functioning adenoma), and in one case induced by thalassemia minor. The single case of mixed ovarian failure had Sheehan syndrome with empty sella, associated with Hashimoto's thyroiditis. AMH determined in ten cases with primary ovarian failure was low in all (mean value: 0.169 ng/mL). Conclusions. Most (87%) of our cases were determined by primary ovarian failure. The aethiology of these forms could not been clarified in a considerable proportion (38%).

P101ART IN OLDER WOMEN

Bansal Vandana (IN)

Singh M. (IN)

Ibrahim R. (IN)

Bansal A. (IN)

Bansal A. (IN)

Bose S. (IN)

Jeevan Jyoti Hospital, IN

Late family planning can be seen as a consequence of increased life expectancy, extended education, job opportunities and late marriage. The inability to create a desired pregnancy that culminates in the birth of a child is likely to create a life crisis for women and their partners. Since fertility declines with age, it is not surprising that larger numbers of women over 40 are seeking IVF. Out of all 361 women undergoing IVF treatment cycles, quarter number of women were aged 40 years or over. In this group overall clinical pregnancy rate (66.26%) and implantation rate (55.67%) per embryo transfer were all significantly higher in patients cotreated with low dose aspirin and low molecular weight heparin in comparison to all other treatment groups in this study. A significant increase in the live birth rate was observed in the aspirin + heparin cotreated group compared with placebo control. The abortion rate was significantly higher in the placebo-treated group (21%) compared to the aspirin + heparin (7.5%) cotreated group (p < 0.05). The intrauterine foetal deaths (IUFD) encountered were significantly less in comparison to that observed in the placebo control group. To date, no serious complications have been associated with pregnancies in older women if appropriately screened and they experience similar pregnancy rates, multiple gestation rates, spontaneous abortion rates, neonatal outcomes similar to those of younger women. Although the incidence of gestational diabetes and preeclampsia appears to be increased in older women, but there is no definitive medical reason for excluding older women from attempting pregnancy on the basis of age alone. Assisted reproduction is, therefore, challenged to create and adapt treatment regimens for women of advanced reproductive age to bridge between this wish for late parenthood and the age-related decline in fecundity.

P102ULTRA-LOW DOSE ESTRIOL AND LACTOBACILLI IN THE LOCAL TREATMENT OF POSTMENOPAUSAL VAGINAL ATROPHY: A DOUBLE-BLIND RANDOMISED TRIAL FOLLOWED BY OPEN-LABEL MAINTENANCE THERAPY

Jaisamrarn Unnop (TH)

Chulalongkorn University, Faculty of Medicine, TH

Objective The aim of this study was to demonstrate the efficacy of a vaginal tablet containing ultra-low-dose estriol 0.03 mg in combination with viable Lactobacillus acidophilus KS400 in the short-term therapy and to investigate the long-term maintenance dose in the treatment of vaginal atrophy. Methods This was a double-blind, randomized, placebo-controlled study (Controlled phase – initial therapy) followed by an open-label follow-up (Open phase – test medication initial and maintenance therapy). Included were postmenopausal women with vaginal atrophy symptoms and Vaginal Maturation Index (VMI) of ≤ 40%. The method of treatment was initial therapy with test medication (or placebo in first phase), one vaginal tablet daily for 12 days, followed by maintenance therapy, one tablet on two consecutive days weekly for 12 weeks. Results A total of 87 women completed the study. The Controlled phase results for a change in VMI demonstrated superiority of the 0.03 mg estriol–lactobacilli combination to placebo (p < 0.001). In the test group, the positive change in VMI was 35.2%, compared to 9.9% in the placebo group. In the Open phase after the initial therapy, the VMI was increased to 55.4% and, during maintenance therapy, it stayed at a comparable level (52.8–49.4%). The maturation of epithelium was followed by improvement of clinical symptoms and normalization of the vaginal ecosystem. Conclusions The ultra-low-dose, vaginal 0.03 mg estriol–lactobacilli combination was superior to placebo with respect to changes in VMI after the 12-day initial therapy, and the maintenance therapy of two tablets weekly was sufficient to prevent the relapse of vaginal atrophy.

P103THE MENOPAUSE AND THE TWITTER: BRIDGING THE GAP BETWEEN SCIENTIFIC KNOWLEDGE AND PATIENTS

Pérez-Roncero Gonzalo (ES)

López-Baena M. (ES)

Perez-Lopez F. (ES)

Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto Aragones de Ciencias de la Salud, Zaragoza, ES

There is a wide range of information to communicate on menopause which is not fulfilled by conventional internet platforms. Social media can be considered to be a kind of street communication or speaker’s corner. Twitter allows us to share thoughts and scientific conclusions in small messages, reaching a vast audience with minimal effort. The basic idea is to provide a short cut between the primary source of information and recipients. Older people may have difficulty in following twitter and other social media. One problem is the ability to discriminate quality information from unscientific opinion and business-related promotions. On the other hand educational and health organizations and their employees use social media as a rapid source of information. Producing unbiased information in 140 characters is an art which peer reviewed journals and learned societies should develop to be able to communicate more effectively with older people. The ultimate aim is to aid engagement of older people in their health care.

P105SYMPTOM CLUSTERS RELATED TO MENOPAUSE: WOMEN'S DEFINITIONS AND HEURISTICS

Woods Nancy (US)

Ismail R. (US)

Linder L. (US)

Macpherson F. (US)

University of Washington, US

Background: To date investigators studying symptom clusters women experience during the menopausal transition and postmenopause have relied on statistical methods to cluster symptoms. Little is known about how women envision their symptoms in clusters and the heurisitics about causes and treatment. Purpose: The purpose of this study was to examine women's ability to identify clusters of symptoms and their heuristics. Methods: Women experiencing symptoms they attributed to the menopausal transition were recruited through flyers posted on campus and in clinics. Participants completed the Computerized Symptom Capture Tool (C-SCAT) using an iPad. Data from the C-SCAT application were downloaded to a secure network, Amazon Web Services account, and saved as screen images in order to preserve the graphical images and text elicited from the application. Results: Thirty women completed the application and all but one judged the final image to be an accurate representation of their symptom experience. The median number of symptoms reported was 12 (range: 3 to 22 symptoms) and the median number of symptom clusters was 2 (range: 1 to 4). Hot flashes/sudden warmth was the most important symptom, while fatigue/tiredness was the most frequent symptom in the most bothersome cluster. Psychological/physical changes and effect of hormonal changes were among the causes women identified for their symptom clusters. Women were able to identify relationships among symptoms in the clusters, named the clusters based on the symptoms in each cluster, such as “night problem,” and propose causal factors. Conclusion: Using the C-SCAT, women were able to impose a clustering structure on their symptoms, identifying relationships among them and articulating their heuristics.

P106QUALITY OF LIFE, OVERWEIGHT AND OBESITY IN THE TRANSITION TO MENOPAUSE AND POST-MENOPAUSE: HOW TO BEST EVALUATE? SYSTEMATIC REVIEW

Munhoz Lívia (BR)

Sorpreso I. (BR)

Soares J. (BR)

Baracat E. (BR)

São Paulo University – USP, BR

Overweight, obesity and transition to menopause and post-menopause greatly influence the quality of life of women. The relation between these variables and quality of life can be evaluated by generic and specific questionnaires. The objective of the systematic review is to identify the instruments applied to measure quality of life in women with overweight and obesity during the transition to menopause and post-menopause. A search was performed in Embase, Pubmed and Cochrane database using the terms: menopause/climacteric, quality of life, overweight/obesity; in each database were found 122, 102 and 27 articles respectively. Articles using at least one questionnaire of quality of life in a sample of women in the transition of menopause and post-menopause with overweight or obesity were included. Nineteen studies met the criteria for inclusion. Eighteen generic, six menopause specific and one obesity specific questionnaires were identified. The majority of studies, eleven, used generic questionnaires, while eight used menopause specific instruments. The generic and specific questionnaires most used were SF-36 and Cervantes Scale, respectively in six and three articles; however two articles which used Cervantes Scale were from the same author. In conclusion no consensus was found in the literature about the use of quality of life questionnaires in overweight and obese women in the transition to menopause and post-menopause, which is an obstacle to the comparison and reproducibility of the results. The current study is a warrant to the gynecological community that there is a need for a standard instrument to better evaluate such a growing and specific population.

P107ANTHROPOMETRIC MEASUREMENTS OF PRE AND POSTMENOPAUSAL WOMEN

Cárdenas Tania (MX)

Morfin J. (MX)

Lozano D. (MX)

Clínica de Climaterio Santa Teresa, MX

Introduction: In the years of the transition to menopause there are changes in body composition that increase cardiovascular risk and bone loss. Socioeconomic status is a confusing factor. Mexican women have reached the top spot in worldwide obesity rankings further increasing the health risks to the changes of the climacteric and postmenopause. Objective: Describe the anthropometric parameters in women from 40 to 80 years old who attended a private clinic. Design: Anthropometric measurements were performed in 495 women. We calculated waist-hip ratio, arm muscle circumference with Heymsfield's equation, BMI (body mass index),% fat with Durnin and Siri's equation. We divided the women by decades of life in five age groups. Group 1, 40–49; group 2, 50–59; group 3, 60–69, group 4, 70–79 and group 5, 81–87 years of age. Descriptive statistics data were obtained with Excel package. Results: The mean age, weight, height, BMI and waist groups are: Age (45, 54.8, 64.1, 73.6, 83.1), weight (63, 64.8, 65, 62.9, 64 kg), height (159.5, 159.2, 158.8, 158.7, 160), BMI (24.7, 25.7, 25.7, 24.9, 25.2 kg/m²), and waist circumference (77.3, 79.1, 80.1, 79.1, 80.9 cm). Conclusions: The mean of the BMI indicates no obesity on either group. This may be due to socio-economic status of these women. The trend to increase the weight and decrease the height around menopause and years later is visible. An increase of fat in the abdominal area as they reach menopause is observed.

P108HEALTH EDUCATION INTERVENTION IN EARLY AND LATE POSTMENOPAUSAL BRAZILIAN WOMEN

Sorpreso Isabel Cristina Esposito (BR)

Munhoz L. (BR)

Soares Júnior J. (BR)

Baracat E. (BR)

University of São Paulo – USP, BR

The aim of this study was to identify aspects of health in postmenopausal Brazilian women insert health-related educational program provided by a multidisciplinary team as part of the primary care approach for early and late post-menopausal symptoms. Design: Prospective cohort was performed with sixty-nine post menopause women and were divided into groups corresponding to early n = 32) and late post-menopause (n = 37) through gynecological and clinical evaluations, administered the Kuppermann-Blatt Menopausal Index and the Women's Health Questionnaire before and after health education instructions. Results: The average age for the onset of menopause was 47.9 years (n = 69). A total of 72.5% (n = 50) of the women in this study had completed their primary education, 78.3% (n = 54) performed manual labor, and 60.9% (n = 42) showed concomitant chronic illnesses. After attending a series of health-related topics, the weight reduced 3,54% in early post menopause women (p < 0.001) and 2,06% in late post menopause group (p < 0,001). The abdominal circumference was reduced 1,75% (p < 0,001) in early post menopause group. In addition, the total score Kuppermann-Blatt Menopausal Index decreased 34,38% in early and 33,33% in late post menopause group. According to the Women's Health Questionnaire, had decrease in domain depressive mood by 0,839 to 0.700 (p < 0.001) in early and 0,814 to 0.648 (p < 0.001) in late group. Conclusion: There's no differences between the early and late groups regarding the effects of primary health care actions. Menopausal symptoms, primarily vasomotor and depression improved. We observed improvement in the anthropometric parameters without changes in the lipid and glycemic profile. Key words: post menopause, primary care, patient education, women’s health and multidisciplinary approach

P109MULTIDISCIPLINARY APPROACH DURING MENOPAUSAL TRANSITION AND POSTMENOPAUSE IN BRAZILIAN WOMEN

Sorpreso Isabel Cristina Esposito (BR)

Munhoz L. (BR)

Soares Júnior J. (BR)

Baracat E. (BR)

University of São Paulo – USP, BR

Objective: To identify clinical, physical, life quality and nutritional aspects of Brazilian women during menopausal transition and post-menopausal. Methods: 184 women agreed to participate of the study. They were divided into two groups: GI– menopausal transition (n = 48) and GII- postmenopause n = 136). Kupperman-Blatt Menopausal Index (IMK) and Women's Health Questionnaire (WHQ), Food Frequency questionnaire and functional capacity were used. All patients were examined and underwent clinical and gynecological examination. Results: There was no significant difference in IMK, WHQ and functional capacity in both groups. There was a higher caloric intake, especially in sugars, in postmenopause women than in menopausal transition women. Both groups presented reduced parameters in life quality and functional capacity. Conclusion: Our data suggests that there is no significant difference between women in menopausal transition and post menopause, except in relation to the nutritional parameter. In both groups, the women presented low life quality and reduced functional capacity. Key words: premenopause, postmenopause, diet, comprehensive health care

P110PHYSICAL AND EMOTIONAL ASPECTS AND CARDIOVASCULAR RISK FACTORS IN WHITE AND NON-WHITE POSTMENOPAUSAL WOMEN

Sorpreso I. (BR)

Munhoz Lívia Oliveira (BR)

Costa C. (BR)

Bustamante T. (BR)

Soares Júnior J. (BR)

Baracat E. (BR)

University of São Paulo – USP, BR

Objective: To compare climacteric symptoms, women's general health and cardiovascular risk factors in white and non-white postmenopausal women. Method: This retrospective study enrolled 129 postmenopausal women who sought attention at Climacteric Ambulatory of Clinics Hospital São Paulo University, São Paulo, Brazil, from July to December 2010. They were subjected to general and specific physical examination and climacteric symptoms evaluation using Blatt-Kupperman Index and Women`s Wealth Questionnaire (WHQ). The participants were divided by ethnicity/race in two groups, white and non-white. In both groups, cholesterol and glucose blood levels, arterial blood pressure (BP), body mass index (BMI), Kupperman Idex and WHQ were assessed and compared. Results: The mean age, age at menopause and time after menopause were respectively 56.5, 48 and 8.5 years. Fifty two percent of the participants were white and the non-white group was composed by 34.2% black, 8.5% mulatto, 3.1% asian and 1.5% other ethnicity/race women. There was no statistical significant difference between the groups in relation to classification of IMC (p = 0.15), BP (p = 0.20), total cholesterol (p = 0.56), HDL (p = 0,49), LDL (p = 0.86), triglycerides (p = 0.70) and glucose (p = 0,15). Non-white group had fewer women with moderate menopause symptoms (8.2%) compared to the white group (23.6%) (p = 0.03). No patients with intense symptoms were found. The analyses of the WHQ domains were similar between groups. Conclusion: Postmenopausal cardiovascular risk factors were similar in non-white and white women. Non-white patients had less climacteric symptoms than white women, but somatic and emotional health evaluated by WHQ questionnaire were similar.

P111LEARNING HOW TO TALK TO PATIENTS

Schwartz Erika (US)

BHIOnline, US

The medical profession is at a major impasse in the United States. Physicians and patients are not partners and women feel intimidated and bullied in their interaction with their physician. Decisions are made from a position of fear rather than empowerment and joint care. In our practice of more than 3000 women and men over that past 11 years we have learned to improve outcome by improving communication between the doctors and the patients. This lecture will address methods we have sued successfully to remove the ego driven fear based interaction to a supportive, caring and mutually respectful interaction. The results are individualized and impressive. We would like to share with the highly esteemed congress how we learned to become better physicians and how our patients stay with us indefinitely for their general care. We learned integrative medicine, as well as nutrition and lifestyle changes to provide support and care for our population. The face of healthcare in the US is changing and more patients are joining concierge medicine practices because they are looking for caring doctors who are interested in the person and are not interested in treating statistics. We have accomplished this goal and would like to share with you our amazing journey.

P280APPLYING ALGORITHMS FOR EVALUATION AND TREATMENT IN PERI AND POSTMENOPAUSAL WOMEN IN PUBLIC HEALTH SYSTEMS

Brantes S. (CL)

Lavín Pablo

Porcile A. (CL)

Barriga P. (CL)

Parra M.

Villaseca P. (CL)

SOCHEG, CL

Access to the program first starts evaluating a self-administered MRS scale, identifying the degree of commitment to the quality of life, collecting anamnestic data, clinical examinations and screening tests to obtain as accurate a picture as possible of the individual needs of each woman. The MRS scale provides the opportunity to analyze concordance of symptoms or the eventual dominance in some domain: somatic, psychological and urogenital. A companion to the MRS scale form identifies characteristics of menstrual bleeding and data on overall health. It is supplemented by a summary of enforcement actions for preventive medicine metabolic risk and cardiovascular risk behaviors, which compiles existing prevention programs. Data have been added to detect major depression and risk factors of osteoporosis. Preventive controls are aimed at establishing cardiovascular risk and diabetes, metabolic variables exploring the ATP-III, also apply screening methods for detection of hypothyroidism and cancer constitute important problems prevalent throughout the life course. Professional actions according to the abnormalities found are planned, prioritizing individual needs, identifying those requiring HRT and possible contraindications. Predefined eligibility criteria are stated for HRT manageable at the level of primary care or to refer to levels of greater complexity at the health network, with very precise instructions for the safe intervention with HRT. Models of intervention in typical clinical situations in the peri-and postmenopause are detailed in available clinical guidelines, such as the handling of abnormal bleeding, endometrial protection, urinary incontinence and various gynecological problems as well as the proper procedures when abnormalities appear in tests screening. Heuristic models will be presented in oral conference.

ABNORMAL UTERINE BLEEDINGP114IRREGULAR BLEEDING IN PERIMENOPAUSAL WOMEN

Dotlic Jelena (RS)

Tulic L.

Boskovic V.

Raslic Z.

Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, RS

Introduction: Irregular bleeding in perimenopause together with endometrial thickness measured by ultrasound greater than 5 mm usually imply on presence of endometrial carcinoma. Still, it can also be caused by numerous benignant pathologies. Objective: The aim of this study was to assess different causes and treatments of irregular bleeding in perimenopausal women. Methods: Study involved all perimenopausal women who had explorative curettage in Clinics for Obstetrics and Gynecology Clinical Center of Serbia during three months period. Detailed anamnesis was taken from every patient and gynecological and ultrasonographic examinations were performed prior to the intervention. Results: Study included 162 patients whose average age was 48.6 years. There were no significant differences (p = 0.078) between perimenopausal women who had curettage due to (44.44%) irregular bleeding and those who had curettage due to asymptomatic endometrial pathologies (55.56%). Significantly less women with meno/metrorrhagia had endometrial hyperplasia (36.42%; p = 0.031) as well as endometrial polyposis (28.39%; p = 0.027). Only 8 patients with hyperplasia were taking medications for breast cancer (p = 0.000). During the evaluated period only 3 recurettages had to be performed due to recurrent heavy bleeding. Furthermore, recurrence of symptoms was successfully treated by hormonal therapy in 8 patients: 2 had IUD inserted and oral medications were administered to 6 women. Endometrial carcinoma was detected in 37 (22.84%) patients who underwent surgery (p = 0.017). Conclusions: Single explorative curettage is usually adequate for both diagnostics and treatment of irregular perimenopausal bleeding. However, if the symptoms reappear hormonal therapy is a treatment of choice for women with benignant hystopathological findings.

P116ENDOMETRIAL PATHOLOGIES IN PERIMENOPAUSAL WOMEN: ARE HYSTEROSCOPIC EVALUATION AND PATHOLOGIC CONFIRMATION MANDATORY?

Lee S. (KR)

Kim Y. (KR)

Kim J. (KR)

Joo K. (KR)

Choi K. (KR)

Kim Joo-Myung (KR)

Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea, KR

Objective: This study is aimed to evaluate necessity of hysteroscopic evaluation of abnormal vaginal bleeding and sonographic abnormality of perimenopausal women. Methods: This retrospective research used a surgical database of one institution from January 2010 to December 2012. The data included total 408 women aged 45 to 55 years old at the time of operation. The medical records of all patients were reviewed, and clinical parameters and histologic results of hysteroscopic operations were assessed. Results: The mean age of women was 49.2 (± 3.2) years old, and 21 women were menopaused. Abnormal vaginal bleeding was reported in 63.2% of all cases, and 26.2% of women underwent hysteroscopy because of incidentally detected endometrial abnormality such as polyp or submucosal myoma. 258 cases were diagnosed endometrial polyp after operation, and in 70 cases, submucosal myoma were detected. Endometrial hyperplasia was diagnosed in 32 cases (7.8%), and 12 patients (2.9%) were diagnosed endometrial cancer. This research included total 9 women with breast cancer, they were all diagnosed benign endometrial lesions. Other clinical variables such as age, BMI, hypertension and diabetes mellitus were assessed in this study. Conclusion: Diagnosis of abnormal uterine bleeding or sonographic abnormalities in middle-aged women might be delayed because these changes are common in perimenopause. The risk of endometrial cancer of 45–55 years old women with uterine bleeding or radiologic abnormalities were 2.9%. In our study, most of benign cases with abnormal uterine bleeding, additional medical treatment or operation such as hysterectomy were not needed after hysteroscopic resection of endometrial lesion.

ENDOMETRIAL HYPERPLASIA AND CANCERP117BODY WEIGHT AND GENE POLYMORPHISM OF ESTROGEN METABOLISM IN WOMEN WITH ENDOMETRIAL CANCER

Artymuk Natalia (RU)

Kemerovo state Medical Academy, RU

It is proved that the most important cause of hyperestrogenemia is the genetic polymorphism of cytochrome P450 genes. But the role of genetic polymorphisms of cytochrome P450 genes: CYP1A1, CYP1A2, CYP19, SULT1A1 in women with endometrial cancer (EC) and different body weight has not been studied. The objective of this research was to study of the polymorphism of estrogen metabolizing enzymes cytochrome P450 (CYP1A1, CYP1A2, CYP19 and SULT1A1) in women with EC and different body weight. It was prospective, open, monocentral, cohort study. Genetic polymorphism of estrogen metabolizing enzymes was estimated in 138 women with EC (group I) and 218 women without proliferate endometrial diseases (group II). Genotype analysis has been conducted by RFLP analysis. Genome DNA from buccal epithelium was expected by Salting-out Protein Method. The results of this study showed that women with mutant allele C and genotype C/C of the gene CYP1A2 have a higher risk of EC. Moreover, genetic polymorphism in women with EC depends on the BMI. Besides, allele Т and genotype Т/Т of the gene CYP1A1 in women with endometrial cancer and obesity and also mutant allele А and genotype G/A и А/A in women with normal weight are risk factors for the EC. Conclusion. These results allow to suggest that CYP1A1, CYP1A2 and SULT1A1 enzymes may be involved in endometrial cancer pathogenesis. Obese women with EC significantly more often had a wild allele T of the gene CYP1A1 relatively women with EC without obesity. Women with normal body weight and EC more often had the mutant allele A of the SULT1A1 gene.

P118ENDOMETRIAL CARCINOMA RISK FACTORS EVALUATION IN POSTMENOPAUSAL WOMEN

Dotlic Jelena (RS)

Terzic M.

Likic I.

Atanackovic J.

Milenkovic S.

Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, RS

Objective: The aim of this study was to assess which clinical and sonographic parameters might predict the presence of endometrial carcinoma. Material and Methods: Study included all 73 postmenopausal patients treated for endometrial carcinoma in Clinic for Ob/Gyn Clinical Centre of Serbia throughout a period of 12 months. Detailed anamnesis was taken from every patient and gynecological and sonographic examinations were performed. Postoperative hystopathlogical findings were classified according to FIGO stages. Obtained data were statistically analyzed. Results: Average age of patients was 62.5 years. Endometrial thickness varied from 5 to 25mm. Significantly more patients had hypertension (p = 0.007) and were obese (p = 0.001), but did not have diabetes (p = 0.001) and did not receive hormonal substitution (p = 0.149). The most frequent finding (90%) was adenocarcinoma (p = 0.001). FIGO stage 1B was the most and 3A the least frequent. Endometrial thickness was positively correlated with hystopathological type (p = 0.044), FIGO stage (p = 0.001) and ascites (p = 0.057), and negatively with uterine echogenity (p = 0.035). Postmenopausal bleeding was positively correlated with age (p = 0.001) and FIGO stage (p = 0.000), negatively with hormone replacement therapy (HRT) (p = 0.010). Hystopathological grade was positively correlated with ascites (p = 0.008), negatively with uterine homogeneity (p = 0.048). FIGO stage was positively correlated with HRT (p = 0.034), endometrial thickness (p = 0.001), uterine echogenity (p = 0.029), postmenopausal bleeding (p = 0.000) and adnexal masses (p = 0.043). Conclusions: The most important risk factors for endometrial carcinoma are found to be obesity and hypertension. Ultrasound parameters, such as thicker endometrium and uterine echogenity, can imply on presence of more advanced endometrial carcinoma in postmenopausal women.

VULVAR AND VAGINAL CONDITIONSP121FEMALE GENITAL TRACT GRAFT-VS.-HOST DISEASE: A CURRENT RETROSPECTIVE PATIENT REVIEW

Li Adrienne (CA)

Wolfman W.

Department of Obstetrics and Gynaecology, University of Toronto, CA

Objective: Graft-vs.-host disease (GVHD) is a complex, T cell-mediated complication following hematopoietic stem cell transplantation. We provide an up-to-date review of the literature regarding female genital tract GVHD and describe our experience in a tertiary healthcare centre. Methods: A current literature review and retrospective chart analysis of patients referred to a specialized Menopause clinic in a tertiary healthcare centre. Results: A total of 44 articles was identified, comprised of 8 reviews and guidelines, 3 observational studies, 4 retrospective studies, 20 case series and reports, and 9 posters. Incidence ranged from 7% to 49%, with most developing this complication more than 100 days after transplant. Risk factors were stem cells from peripheral blood progenitor cells and chronic GVHD of other organs. Common symptoms were vulvar pain and inability to have penetrative sex. Examination findings were similar to lichen planus, such as: vulvar erythema and ulcers; labial fusion; and vaginal adhesions and stenosis. Medical treatments were topical and/or systemic immunosuppressants and estrogen, topical corticosteroids, vaginal dilators, and regular intercourse. Surgery was reserved for severe cases. In our tertiary centre, 23 patients have been followed for female genital GVHD. Twenty had GVHD of other organs (90%). The most common complaints included vaginal dryness (87%) and dyspareunia (83%). The most common findings were vulvar adhesions (52%), vaginal adhesions (48%) and vulvar ulcers (44%). One patient with hematocolpos required surgery. Conclusions: Female genital GVHD remains under-recognized and poorly understood. Education of patients and clinicians and early, regular gynaecologic examinations are crucial to the identification, treatment, and prevention of progression of female genital GVHD. All patients should be followed in a dedicated centre.

P122ORAL LOW-MOLECULAR WEIGHT HYALURONIC ACID IN THE TREATMENT OF ATROPHIC VAGINITIS

La Galia T.

Cancellieri F. (IT)

Micali A.

Scarpino Francesco (IT)

Puzzolo D. (IT)

University of Rome Tor Vergata, IT

The aim of this work was to evaluate the effect of an oral supplement based on low-moleculare weight hyaluronic acid (HA) for the treatment of menopausal women affected by atrophic vaginitis. Twelve women, aged 45–65 years, with symptoms of atrophic vaginitis were recruited for this double blind, placebo-controlled clinical study. Patients were randomized to receive either low-molecular weight HA tablets per os (Ialos^®, Lo.Li. Pharma srl, Rome, Italy), or placebo for three months. Vaginal biopsies were taken at baseline and after three months of treatment, and vaginal epithelium was analysed at the microscope before and after treatment. The evaluation of the main subjective symptoms related to vaginal atrophy (hitching, burning, dyspareunia) was self-assessed by the patients.

Vaginal biopsies obtained from the HA group showed an epithelium thicker than the placebo group. The epithelium was formed by a single layer of columnar basal cells, parallel to the basement membrane, by many layers of parabasal cells, and by many layers of large intermediate cells. The lamina propria from the HA group also showed a denser appearance compared to the placebo group. The morphometric analysis of the epithelium showed statistically significant differences between HA - and baseline in the number of epithelial layers and in the overall epithelial thickness. The evaluation of subjective symptoms also showed an effective improvement in the clinical conditions of patients treated with HA, compared to baseline and to patients treated with placebo. To conclude, oral administration of low molecular weight HA improved the structure of the vaginal epithelium, thus decreasing vaginal atrophy. Oral hyaluronic acid tablets can be an ideal option for patients with atrophic vaginitis who do not want to or cannot take local estrogens and show low compliance toward the vaginal route of administration.

P123COST EFFECTIVE DIAGNOSIS OF VAGINAL ATROPHY IN POSTMENOPAUSAL WOMEN

Pradeep Yashodhara (IN)

Hussain N.

Gupta A.

Srivastava D.

King George Medical University, IN

Aims: 1. To establish cut off value of vaginal pH for the diagnosis of vaginal atrophy in post menopausal women 2. correlation of clinical symptoms and signs, vaginal pH and vaginal maturation value with Serum Estrogen. Material and Method: A double blind case control study done from December2010–2013November. Total 250 menopausal women were enrolled with duration of menopause equal or more than three years to 15 years, fulfilling inclusion criteria after informed consented. At the time of enrollment the detail proforma was filled. The detail clinical examination general, systemic, perinial, perspeculum, and pervaginal examination was done, pH of vagina was noted, Vaginal cells from middle third of vagina was collected with wooden spatula dried and fixed. 3ml of blood for Serum estrogen was collected. Vaginal maturation index was calculated by assigning point value of one to superficial cells, 0.5 value to intermediate cells and zero to parabasal cells. The maturation index was calculated by taking mean of three values. A value of 0–49 indicates low estrogen effect, value of 50–64 will show moderate estrogen effect and value of 65–100 will show excellent estrogen effect. Results and Conclusion: The statistical analysis is under process. The statistical analysis will be done by Chi square test by P value, sensitivity and specificity; positive predictive and negative predictive value to test the strength of clinical symptoms and signs VMI and pH and Serum estrogen against clinical symptoms and signs pH and VMI. The cytologist is blinded with clinical features and pH, the person testing for serum estrogen is blinded for the clincal features, pH, and VMI.

P124COMPARISON OF NEW MINIMALLY INVASIVE ER:YAG LASER TREATMENT AND HORMONAL REPLACEMENT THERAPY IN THE TREATMENT OF VAGINAL ATROPHY

Gaspar Adrian (AR)

University of Mendoza, AR

Objective: The objective of this study was to compare the efficacy and safety of two minimally invasive procedures for treatment of vaginal atrophy; a new Er:YAG laser procedure and hormonal replacement therapy with estriol. Method: 50 vaginal atrophy patients were randomly divided in two equal groups. Group A patients were submitted to long term estriol therapy: 0.5 mgr/day 3 times a week during 2 weeks, followed with the same estriol dosage twice a week for 4 weeks. B group patients firstly got the same short term estriol therapy for 2 weeks, followed with 3 sessions of ErYAG laser treatment, with 3 weeks interval between the sessions. Therapy efficacy was measured using maturation value, pH value, VAS scores for atrophy symptoms: Dyspareunia, Dryness, Irritation and Leukorrhea. On 6 patients from each group biopsies were taken (before and 3 months post-op). Follow-ups were at 1 month, 3 months and 6 months after the therapy. Results: Both groups showed improvement in atrophy, but laser therapy showed better and longer lasting effects. Maturation value in A group improved from 22,5 points to 24,7 points at 6 months follow-up. In comparison to that B group improvements was from 20,8 points to 47,9 points. pH value improved at 3 months for 7,2% in A group, and for 17,6% in B group. Dyspareunia in A group improved for 48%, and in B group for 72%; Dryness in A group for 68%, in B group for 76%; Irritation in A group for 48%, in B group for 60% and Leukorrhea in A group for 81%, while in B group for 94%. Both groups tolerated the therapy well and adverse effects were mild and transient. Conclusions: Hormonal replacement therapy is considered to be the first choice for vaginal atrophy, but this new minimally invasive Er:YAG laser procedure seems to be safe and efficacious alternative with potential to offer to vaginal atrophy patients longer period of symptom free life.

DIAGNOSTIC GYNECOLOGYP128THE ROLE OF OFFICE HYSTEROSCOPY IN MENOPAUSE

Koliba Peter (CZ)

Kovář P., Koliba

Jun. P. (CZ)

Gynartis, S.R.O. Ostrava, CZ

A retrospective analysis of approximately 2,100 patients, where underwent diagnostic hysteroscopy in the 4-year period ranging from 06/2009 to 05/2013 and the group of 1,208 women in menopause, consigned from 90 other medical facilities. Objective: We evaluated the efficacy of office hysteroscopy in diagnostics of intrauterine pathologies in menopause. In some cases we used routinely vaginoscopic access, without the necessity of the gynecological mirror and snap the cervix by forceps. Most women feel they can return to normal activities, such as work, the day after the procedure. Results: Subjects were 1,208 women in menopause, where underwent the procedure of hysteroscopy without analgesia or anesthesia. In 681 cases was found physiological outcome, which is 56.4%, of all cases. Abnormal findings were found in 527 cases, which is 43.6%. Endometrial polyps were uncovered in 312 cases (25.8%), endometrial hyperplasia in 128 cases (10.6%) of fibroids in 69 cases (5.7%) and endometrial carcinoma in 26 cases (2.2%). Other abnormalities and synechia were found in 45 cases (3.7%). Conclusion: Recently hysteroscopy with endometrial biopsy has begun to replace dilation and curettage (D&C) as the method of choice for the diagnosis of endometrial pathology. Many operative procedures may be performed in the office setting with simple instruments, provided that correct indications are observed. Keywords: Hysteroscopy; menopause; endometrium; endometrial biopsy; endometrial cancer

UROGYNECOLOGYP130MANEJO QUIRÚRGICO DEL PROLAPSO DE LA CÚPULA VAGINAL UTILIZANDO MALLAS DE POLIPROPILENO Y EL ABORDAJE POR VÍA VAGINAL CON LA FIJACIÓN BILATERAL AL LIGAMENTO SACROESPINOSO

Espitia De La Hoz Franklin (CO)

Clínica La Sagrada Familia, CO

Antecedentes: Las evidencias que comparan la eficacia, a largo plazo, de evaluar los resultados de la cirugía del prolapso de la cúpula vaginal, utilizando malla de polipropileno y el abordaje por vía vaginal, como la fijación al ligamento sacroespinoso bilateralmente, son escasas o nulas. Objetivos: Comparar los resultados de la colpopexia con malla de polipropileno con la colpopexia vía vaginal con fijación al ligamento sacroespinoso bilateralmente, como tratamiento del prolapso de la cúpula vaginal. Diseño: Ensayo clínico, aleatorizado, abierto, de seguimiento, entre enero del 2009 y junio del 2012. Materiales y métodos: Se incluyó a 88 mujeres consecutivas de 51 y 87 años con prolapso de la cúpula vaginal, demostrada en la consulta externa de uroginecología; que se dividieron en dos grupos: grupo A (colpopexia vía vaginal utilizando malla de polipropileno) y grupo B (colpopexia vía vaginal con fijación al ligamento sacroespinoso bilateralmente). Variables de respuesta: edad, sexualidad, días de estancia hospitalaria, diagnóstico pre y postoperatorio, tiempo quirúrgico, transfusiones, calidad de vida, complicaciones y dolor posoperatorio y analizar los costos de las técnicas de reparación protésicas y la técnica convencional. Ambito del estudio: Servicio de Uroginecología de la Clínica La Sagrada Familia, Armenia, Quindío, Colombia. Intervención: Se aleatorizó a 88 mujeres a tratamiento del prolapso de la cúpula vaginal, utilizando malla de polipropileno y abordaje por vía vaginal con fijación al ligamento sacroespinoso bilateralmente. Resultados: El tiempo quirúrgico, el consumo de analgésicos postoperatorios y la estancia postoperatoria fueron inferiores en el grupo del abordaje con fijación al ligamento sacroespinoso bilateralmente: (117,9+18,6 minutos, 6 [2,4–10,5] dosis y 1 [1–2] días frente a 147,3 +24,6 minutos, 9 [4.2–15.6] dosis y 3 [2–4] días [p < 0,0001]). Las puntuaciones de los cuestionarios sobre calidad de vida PFIQ-7, antes de la cirugía, se encontró un puntaje medio de 7.8 (rango de 2 a 16) describiendo un impacto negativo en varias dimensiones de su calidad de vida y en el PFDI-20 se encontró un puntaje un medio de 10 (rango 3 a 18); sin embargo, dichas puntuaciones se redujeron significativamente en ambos grupos después de la cirugía a 6, 12, 18 y 24 meses, lo que demuestra que la intervención mejora la calidad de vida, significativamente, en comparación con los resultados de la línea de base (p < 0.001); no hubo diferencias significativas en las complicaciones intraoperatorias; y las proporciones de curación en ningún momento del seguimiento (curación/mejoría del 96,6, el 90,9 y el 87,3% a los 6 meses, 1 y 3 años con malla de polipropileno, y del 93,3, el 87,9 y el 81,3% con abordaje por vía vaginal con fijación al ligamento sacroespinoso bilateralmente; p = 0,36, p = 0,42 y p = 0,18). Limitaciones: El estudio es abierto, lo que puede generar sesgos. Un número mayor de pacientes o un mayor tiempo de seguimiento podrían demostrar diferencias entre los procedimientos que no se han observado en el estudio, pero las limitaciones presupuestarias y en el tiempo no lo han permitido. Discusión: Tanto a corto como a largo plazo, la técnica con malla de polipropileno es tan eficaz como el abordaje por vía vaginal con fijación al ligamento sacroespinoso bilateralmente, para el tratamiento del prolapso de la cúpula vaginal, con una proporción similar de curaciones subjetivas; y aunque el tiempo quirúrgico es superior, el consumo de analgésicos y la estancia postoperatoria son inferiores así como menores las complicaciones, con la fijación al ligamento sacroespinoso bilateralmente. En nuestro medio, con 2 días de estancia postoperatoria con malla de polipropileno, los dos procedimientos tienen costos totales no similares. Palabras claves: Cistocele, histerocele, rectocele, prolapso de cúpula vaginal, colposacropexia.

P131AN ALTERNATIVE GRAFT COLPOPEXY

Missanelli John (US)

Barton Memorial Hospital, US

With robotic assisted laparoscopic multi-port or single-site surgery,and the use of an acellular biolgical matrix from porcine bladder basement membrane for stem cell regenerative medicine, a unique suspension technique is used to restore pelvic supportive tissue in women with significant pelvic floor prolapse. In a series of 123 women, POP-Q (Pelvic Organ Prolapse Quotient) was restored from 3 to 0 for as long as 3 years, with no recurrence of apical prolapse, great patient satisfaction, and 3 de novo cystoceles. The procedure provides an alternative to sacrocolpopexy, uses regenerative medicine, eliminates the use of synthetic mesh and its inherent complications, and is as successful in the short term with data collection on-going.

P132VAGINAL CUBE PESSARIES FOR GENITAL PROLAPSE

Ott Johannes (AT)

Promberger R. (AT)

Nemeth Z.

Medical University of Vienna, AT

Objectives: We aim to present a case series of women suffering from pelvic organ prolapse undergoing treatment with vaginal cube pessaries. Background: In clinical routine, most women suffering from high-grade pelvic organ prolapse are counseled to undergo some kind of surgical procedure. Data on outcome of treatment with vaginal cube pessaries is scarce. Methods: In a retrospective case series, we included 84 women (aged 42–84 years) suffering from pelvic organ prolapse stage 2–4. All patients chose to use a vaginal perforated cube pessary (ArabinTM GmbH & Co, Witten, Germany) on the long-term. Patients were informed in detail on how to use the vaginal device. This included an analogy to the use of eyeglasses: Both the pessaries and the eyeglasses basically are medical devices to be used autonomously in order to lead to a relief from illness-related symptoms only if the situation warrants. Results: Seventy-eight patients (92.9%) underwent follow-up for at least one year. Within this observation period, the vaginal cube pessary had to be switched to a smaller model in 12 women (15.4%). At the 1-year follow-up examination, 62 women (79.5%) chose the vaginal cube pessary as an ongoing long-term treatment. For these, high levels of patient satisfaction were found. Sixteen women (20.5%) requested surgery. Conclusions: Our data suggest that vaginal cube pessaries might be a feasible alternative for surgical procedures in women suffering from pelvic organ prolapse. We consider detailed counseling the major precondition of therapeutic success with vaginal pessaries.

P133URINARY INCONTINENCE IN WOMEN 50 YEARS OR OLDER: A POPULATION-BASED STUDY

Reigota Renata (BR)

Pedro A.

Machado V. (BR)

Costa-Paiva L. (BR)

Souza M.

Pinto-Neto A. (BR)

University of Campinas (UNICAMP), BR

Objective: This study aims to evaluate the prevalence of urinary incontinence and its associated factors in Brazilian women aged 50 years or older. Methods: This is a cross-sectional, population-based study using self-reports. A total of 622 women aged 50 years or older were included. Sociodemographic, clinical and behavioral factors were evaluated. Data were analyzed using W2 test and Fisher's exact test. Prevalence ratios and their 95% CIs were calculated. Results: The prevalence of UI was 52.3%. UI was classified as Stress UI, Urgency UI, Mixed UI. The prevalence of these 3 types of UI was, respectively, 12.4%, 13.2% and 26.6%. There was not association between UI and age, menopausal status and other reproductive and sociodemographic variables. There was association between BMI and UI, with a higher prevalence when BMI ≥ 25 kg/m² (57.4% - p < 0.01). The prevalence of UI among women who related multimorbidity was 59.5% (p < 0.01). Chronic use of medications was also associated to higher prevalence of UI: 54.6% (p = 0.01). In contrast, treatment of climacteric symptoms was associated to reduction of UI rates (p = 0.04). Finally, self-perception of health was worse among women with UI: 64.1% of women with UI classified their health as regular/bad/very bad (p < 0.01). Moreover, 57.1% related that UI limits their daily activities and, thus, contributes to a worse quality of life. Conclusions: According to international studies in UI and its risk factors, the association between BMI and UI prevalence is already well known and was confirmed in this study. Considering that postmenopausal status also contributes to worsening of symptoms, it is possible to explain why climateric treatment was associated with a reduction in UI rates. The relationship between multimorbidity and chronic use of medications and the prevalence of UI suggest areas for future investigation.

P134URINARY INCONTINENCE SECONDARY TO COMPLETE LABIAL FUSION IN POST MENOPAUSAL WOMEN. A CASE REPORT

Pradeep Yashodhara (IN)

Mishra B.

Singh R.

Srivastava A.

King George Medical University, IN

Objective: The case presentation describes an unusual case of complete labial fusion in post menopausal women. Method: A postmenopausal with Complaints of severe urinary voiding difficulties to the extent that she restricted her fluid intake to minimum. Results: Recently we have come across a case of A 65 year old multiparous woman, born with normal urogenital system and had three vaginal births including one twin delivery. She presented with history of recurrent urinary tract infection for past few years. She was not initially examined and investigated for recurrent urinary tract infection, and treated with repeated courses of antibiotics according to urine culture and sensitivity. Subsequently overtime her associated symptoms of urinary voiding difficulties, passing small amount of urine, poor urinary stream, and dribbling worsened to such an extent that she has almost stopped drinking tea and restricted water intake to large extent. She presented to hospital in an emergency with acute pelvic pain and gradually increasing urinary voiding difficulty to the extent of dribbling. On examination, Per abdomen she had palpable tender bladder and perinial examination revealed complete labial fusion without urethral opening only drop of urine was visible at the upper portion of vulva. Management: The management was simple After compllete investigations She was operated under spinal anesthesia labial adhesions were separated a large dermoid like cyst was excised near clitoris. Discussion: Labial fusion more often presents in children as labial synechia or adhesion. This is the first case i have come across in postmenopausal women in my more than thirty years of clinical practice. Conclusion: Complete labial fusion is a rare complication of severe urogenital atrophy. The photographs of pre surgery and steps of surgery and follow up picture will be shown in poster.

OTHER GYNECOLOGICAL TOPICSP136PSYCHOSOMATIC FINDINGS IN SURGICALLY INDUCED MENOPAUSE

Chitulea Petru (RO)

Paina G.

University of Oradea, Romania, RO

Objectives: We applied psychosomatic pre and postoperative query for histerectomyzated patients. Methods: All patients undergoing histerectomy at our hospital are entered into a database containing all general informations regarding age, diagnose, clinical and lab findings, surgical techniques used, postoperative outcome. Our study contained a number of 96 patients retrieved from the previos lot aged 20–60 undergoing histerectomy between 1 may-30 november 2012. Results: None of our pacients perceived the hysterectomy as severe mutilation; 11% of the group as moderate mutilation; 16% as mild mutilation; 73% did not perceive it as any kind of mutilation. Regarding preoperative sexual life in our patients:it was absent in 27% of patients, in 15% unsatisfactory, 21% satisfactory and only 37% as good. We reapplied this query only one week after the moment of surgery, on their postoperative expectation. Thus patients consider that their sexual life will experience no change in 67% of patients, only 31% consider it will worse and none of them expect an improval. Although advised by their gynecologist to restart their sex-life in 2 months postoperative,in case of lack of any complcations, 30% of them expect this in 3 months postoperative and 70% in a longer timespan. Opposite to that their attitude is positive towards restarting work at their jobs, 25% expect it during the first month, 25% in two months, 37, 5% in three months and only 12,5% in more than three months. Conclusions: It is important to associate a team of gynecologists, psychologists and kinetotherapists in the pre and postoperative management of histerectomized womens. Keywords: psychosomatic impact of menopause, psychosomatic impact of gynecologic surgery, holistic approach of medical team.

P139THE COMPARATIVE ANALYSIS OF A PATHOLOGY OF A CERVIX OF A UTERUS AT ENDOCRINE DISEASES OF PERIMENOPAUSAL PERIOD

Anreeva Elena (RU)

Grigoryan O.

Uzhegova Z.

Reseach Center for Endocrinology, RU

Objective: Comparative analysis of frequency and character of a pathology of a cervix of uterus at patients of perimenopausal period with endocrine diseases. Materials and methods: 43 women of perimenopausal period (middle age - 48,8 ± 4,5 years) with various endocrine disorders. Are surveyed: diabetes type 1–16 patients; thyroid gland hypofunction - 14; functional hyperprolactinemia - 13. Results: Pathology of a cervix of a uterus came to light at 73% of women with diabetes type 1; at 70,8% with thyroid gland hypofunction; and at 44% of women with functional hyperprolactinemia. Among patients with endocrine disorders at cytologic and histologic research in 88% of cases the chronic cervicite against which in 38,4% of women were found out atypical colposcopic pictures were defined. The analysis of the hormonal status has revealed in 86% of cases hyperestrogenemia. For 48,7% of women with atypical colposcopy a pictures it was diagnosed leukoplakia cervix of uterus; at 6,15% - CIN various degree of expressiveness. At 43% of women with and functional hyperprolactinemia the combination CIN, HPV infections and genital condylomatosis came to light at comparison with patients with others endocrine disorders. Conclusions: Patients with endocrine disorders, and also hyperestrogenemia of perimenopauzal period are included into risk group on occurrence of background and precancer diseases of a cervix of a uterus.

P143ANTIRECURRENT TREATMENT EFFICACY OF UTERINE FIBROIDS IN WOMEN OF REPRODUCTIVE AGE

Novikova Vladislava (RU)

Khorolsky V.

Penzhoyan G.

Kuban State Medical University, Department of Obstetrics, Gynecology and Perinatology Faculty of Postgraduate Education, RU

Uterine fibroids are the most common nonmalignant hyperplastic diseases in women during the reproductive period. Before fibroids was the most common indication for hysterectomy. Modern surgical techniques provides reservation of reproductive organ, save fertility. Fibroids can complicate by menorrhagia, different menstrual disorders, but at least 50% remain asymptomatic. Despite of symptoms fibroids may impair fertility or cause miscarriage. Conservative myomectomy is the unique treatment for women of reproductive period. Therefore it's very important to prevent recurrence of fibroids by individual antirecurrent treatment. To evaluate efficiency of antirecurrent pharmacotherapy of fibroids in women of reproductive period after conservative myomectomy the comparative investigation were performed. Objective of the study: compare the effectiveness of different pharmacological antirecurrent treatment of uterine fibroids after conservative myomectomy in women of reproductive age. Materials: Were examined 75 women, average age 32,4 ± 3,1 years, duration disease (fibroids) 4,29 ± 1,5 years (from 2-to 7 years). Initial diameter of fibroids 45,82 ± 20,76 mm, after conservative myomectomy 16,55 ± 2,56 mm. Number of fibroids /per woman 5,18 ± 2,5. Pharmacotherapy were provided with agonists of GnRH agonists, intrauterine levonorgestrel containing the depot - the system, antigestagens. The results. GnRH agonists provide decrease of volume of uterus on 30% (from 325,4 ± 16,2 sm³ to 227,8 ± 10,1 sm³), number of fibroids nodes (from 5,45 ± 2,53 to 2,54 ± 1,36), diameter of dominant node (from 18,14 ± 0,45 cm to 12,29 ± 0,28 sm). Intrauterine levonorgestrel containing the depot - the system provide decrease of volume of uterus on 20% (from 312,4 ± 15,0 to 252,5 ± 8,8 sm³), number of fibroids nodes (from 4,87 ± 2,7 to 2,27 ± 1,9), diameter of dominant node (from15,57 ± 0,4 cm to 11,57 ± 0,22 cm. Antigestagens provide decrease of volume of uterus on 20% (from 315,0 ± 9,0 to 250,6 ± 10,0 sm³), number of fibroids nodes (from 4,87 ± 2,7 to 2,27 ± 1,9), diameter of dominant node (from16,22 ± 0,55 cm to 12,87 ± 0,5 cm. No significant deferens of efficiency depended from type of pharmacotherapy was found. Conclusions. Control efficiency of аntirecurrent treatment of uterine fibroids: rectovaginal examination; transabdominal and transvaginal pelvic ultrasound; blood flow study of the myometrium and fibroid (IR, MAC, V1, F1, VF1, uterine volume, the amount of nodes) every month for the first 3 months, then every 3 months. When the negative dynamics or lack of positive dynamics in the first month (in terms of IR, MAC, V1, F1, VF1, the volume of e uterus, the amount of nodes) decision on a change of pharmacotherapy.

HORMONES AND GYNECOLOGICAL CANCERP144ELEVATED SERUM ESTRADIOL LEVEL OF OVARIAN VEIN IN POSTMENOPAUSAL PATIENT WITH ENDOMETRIAL CANCER OF TYPE 1

Tanabe Akiko (JP)

Osaka Medical College, JP

Objective: Endometrial cancer of type 1, including endometrioid adenocarcinoma of grade 1 or 2, are typically hormone sensitive. However, the majority of women diagnosed with endometrial cancer have several years beyond the menopause. Therefore, the aim of this study is to examine the involvement of estradiol level obtained from ovarian vein in endometrial cancer. Methods:Serum specimens were collected from theF ovarian and peripheral veins of 43 postmenopausal females with endometrial cancer, undergoing total hysterectomy and bilateral oophorectomy. We investigated the relation between the estradiol level of each samples and histological type of cancer, maturation score from cervical cytology, or ovarian stromal hyperplasia. Results: 25 patients had endometrial cancer of type 1, whereas 18 patients were of type 2. Although the estradiol level of peripheral vein did not show any significant differences (9.6 plusminus 4.6 vs 10.2 plusminus 5.7 pg/ml, p = 0.7), however, higher estradiol level was observed in ovarian vein obtained from the patients with type 1 endometrial cancer than those with type 2 (31.4 plusminus 18.4 vs 19.9 plusminus 8.5 pg/ml, p = 0.02). The maturation score had strong correlation with serum estradiol level from ovarian vein, but did not have significant differences between the groups. No correlation was found between the degree of ovarian stromal hyperplasia and estradiol level or histological type. Conclusion: The postmenopausal ovary is hormonally active, and higher level of serum estradiol in ovarian vein may contribute to progress into endometrial cancer.

TREATMENT SIDE-EFFECTS, SHORT- AND LONG-TERMP146REASONS FOR ABANDONMENT OF HORMONE REPLACEMENT THERAPY WITH TIBOLONE IN MENOPAUSAL WOMEN

Jaime Francisco Javier (MX)

Aguirre J. (MX)

Napoles D. (MX)

Meras E. (MX)

Instituto Mexicano del Seguro Social, MX

Background: Hormone replacement therapy (HRT) with tibolone used in the management of menopause, has low rates of acceptance and compliance in the first year. Few studies analyze the reasons for abandoning the use of tibolone. Objective: To analyze the reasons of abandoning use of tibolone in women with menopausal symptoms during the first year of use. Material and methods: In a cross-sectional study, were included 261 menopausal women between 40 and 60 year old who attended their disease control at the Gynaecological Endocrinology serving in the National Medical Center Northwest in Obregon City, Sonora, Mexico during 2010–2011. The variables studied included: age, type of menopause, time of use of HRT with tibolone, abandonment reason, development of hypertension, dyslipidemia, hypothyroidism and diabetes mellitus. Results: A total of 21 women discontinued treatment (8.60%, 95% CI -3 to 19), p = 0.0001. The reasons for abandonment included, 42.9% gynecological reasons (23.8% breast disease, 14.3% and 4.8% cervical condition ovarian pathology, p = 0.0001). Liver disease and vascular occurred in 28.6%, p = 0.050. Conclusion: The women studied have adequate adherence to treatment with tibolone (> 90%). We don't show an increased risk of cardiovascular or metabolic disease in women studied. Further studies are needed to explore the long-term clinical course, therapeutic response and complications in menopausal patients who use HRT with tibolone.

OTHER TOPICS RELATED TO ONCOLOGY (EXCEPT BREAST CANCER)P149ADENOID CYSTIC CARCINOMA OF BARTHOLIN'S GLAND IN MENOPAUSE WOMEN

Paik Won-Young (KR)

Shin J. (KR)

Park J. (KR)

Choi W. (KR)

Lee S. (KR)

Lee J. (KR)

Gyeongsang National University, KR

Adenoid cystic carcinoma (ACC) of the Bartholi's gland is a rare histological type malignancy of the external genital tract. Only less than eighty cases have been reported in the literature. A 58-year-old women presented to our clinic with chronic external genital pain. In gynecologic examination, slightly hard and swelled mass was palpated around Bartholin's gland. Under general anesthesia, we performed left hemivulvectomy, inguinal lymphadnectomy, external iliac lymph node sampling by laparoscopy. Pathologic examination conformed ACC showing positive resection margin without lymph node invasion. Postoperative radiotherapy was performed. We planned long-term follow up to evaluate optimal primary treatment and role of radiotherapy.

P152FACTORS ASSOCIATED WITH CANCER IN BRAZILIAN WOMEN OVER 50 YEARS OF AGE: A POPULATION-BASED HOUSEHOLD SURVEY

Baccaro Luiz (BR)

Manente D.

Machado V. (BR)

Costa-Paiva L. (BR)

Gabiatti J.

Pinto-Neto A. (BR)

State University of Campinas, BR

Purpose: Brazil has an aging population and there is an increasing trend in cancer, especially in postmenopausal women. This study aims to raise awareness of the prevalence and factors associated with the occurrence of malignant tumors among Brazilian women over 50 years of age. Methods: A cross-sectional study with 622 women over 50 years of age residing in Campinas/Brazil was conducted in the form of a population survey. A questionnaire was applied by trained interviewers. The dependent variable was the occurrence of a malignant tumor in any location. The independent variables were health-related habits and problems, sociodemographic data and self-perception of health. Statistical analysis was carried out by frequency distribution and the chi-square test. Results: The mean age of the women was 64.1 years. The prevalence of cancer was 6.8%. The main sites of occurrence of malignant tumors were the breast (31.9%), colon (12.7%) and skin (12.7%). Smoking more than fifteen cigarettes per day (p = 0.033); having been admitted to a hospital in the last 12 months (p < 0.001), having a shorter time since the last medical consultation (p = 0.008), use of antacid drugs (p = 0.036) and having health insurance (p = 0.043) were associated with a higher prevalence of cancer. Conclusions: the results of this study have improved understanding of the prevalence and factors associated with cancer in Brazilian women aged 50 years or more. They should be encouraged to maintain a healthy lifestyle and pay particular attention to modifiable risk factors such as smoking.

P154IMBALANCE OF GLI PROTEIN EXPRESSION AS POTENTIAL PROMPTER OF MYOMETRIAL NEOPLASMS MALIGNANT

Garcia Natalia (BR)

Bozzini N. (BR)

Cunha I. (BR)

Baiocchi G. (BR)

Soares F. (BR)

Baracat E. (BR)

Carvalho K. (BR)

Department of Obstetrics and Gynecology/LIM 58 – Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil, BR

Background: Uterine leiomyosarcoma (ULMS) and leiomyoma (ULM) are smooth muscle tumors with distinct clinical behavior that can cause infertility and even lead to death. The factors that influence these tumors biology are still unknown. Differential diagnosis between low grade sarcomas and non-typical ULM is a challenge. Thus, identification of new markers can help in this differential diagnosis. Recently, Sonic Hedgehog (SHH) signaling pathway activation was associated to several tumors development. This pathway is involved in several tumors development and the GLIs (Glioma associated oncogene) transcription factors have aroused great scientific interest. Aim: To evaluate the protein expression profile of GLI 1, 2 and 3 by immunohistochemistry in myometrium neoplasms. Methods: We selected 20 myometrium samples, 100 ULM, 10 non-typical ULM and 57 ULMS. All tissues were used in TMA blocks constructions. Immunohistochemistry reactions were performed using monoclonal antibodies against GLI1 (1:200), GLI2 (1:200) and GLI3 (1:400) using sodium citrate pH6,0 in pressure cooker. Results were evaluated by Aperio^® automated method and statistical analyses were performed using GraphPad Prism 5.0. Results: Our preliminary data showed similar protein profile (GLI2 and GLI3) between ULMS and non-typical ULM. GLI1, GLI2 and GLI3 showed higher expression in ULMS and non-typical ULM compared to ULM and health myometrium (p < 0,005). Conclusion: The preliminary results showed that expression of GLIs might play an important role in uterine smooth tumors malignances, since ULMS and non-typical ULM showed higher levels of these proteins. However, the role of these proteins must be further investigated.

BIOLOGICAL ACTIONS OF PROGESTINSP158EFFECTS OF DIENOGEST ON UTERINE ADENOMYOSIS, LIPOPROFILES AND INFLAMMATORY MARKERS

Higuchi Tsuyoshi (JP)

Iino K.

Abe K.

Taniguchi R.

Mizunuma H.

Hirosaki University Graduate School of Health Science, JP

Objectives: To evaluate effects of dienogest (DNG), one kind of progestogens, on uterine adenomyosis and action to lipoprofiles and inflammatory markers for 12 months. Materials and methods: Fifteen women (mean age 42.8 years old) who have uterine adenomyosis and with symptom of dysmenorrhea and/or hypermenorrhea due to them were enrolled to this study. Under informed consent, they were treated with DNG 2mg/day for 12 months. Pain like dysmenorrhea, pelvic pain, bleeding volume and bleeding frequency were assessed with use of self-check sheet by month. Lipoprofile (total cholesterol, LDL-cholesterol, HDL-cholesterol and Triglceride), inflammatory markers (hsCRP, SAA, TNF-alfa and IL-1beta), CA125, estradiol and FSH were also assessed using blood samples at baseline, 1,3,6,9 and 12 months later respectively as like as uterine size assessed by ultrasonography. Data obtained from each observation period were compared with the baseline data. Results: Bleeding volume and strength of pelvic pain decreased from 2 months later significantly. CA125 decreased from 3 months later significantly. Although estradiol decreased from one month later, FSH did not change at any point. Any of lipoprofiles did not change significantly but hsCRP, SAA and TNF-alfa significantly decreased from 1, 3 and 6 months later respectively. Conclusion: DNG has positive effects on suppression of inflammatory markers as same as on uterine adenomyosis.

HORMONAL CONTRACEPTIONP160INFLUENCE OF INTRAUTERINE CONTRACEPTIVE DEVICES ON GLYCAEMIC CONTROL AND LIPOPROTEIN METABOLISM IN PERIMENOPAUSAL WOMEN WITH TYPE 1 DIABETES

Anreeva Elena (RU)

Grigoryan O.

Reseach Center for Endocrinology, RU

Objective: To evaluate the effects of modern IUDs (copper- and levonorgestrel – releasing) on glycaemic control and lipoprotein metabolism in perimenopausal women with Type 1 diabetes during 12 months. Study Design: A total of 44 women with Type 1 diabetes (mean age 46,3 + 2,7 years) were assigned to equally large groups, each composed of 22 women, in whom the copper- or levonorgestrel – releasing IUD was inserted. 20 women with Type 1 diabetes of comparable age not using some form of contraception constituted the control group. Evaluation was performed befor and at 3, 6, 9 and 12 months after insertion using nonparametric statistical methods. RESULTS: HbA1c levels, body mass index, 24-hour insulin requirements did not change significantly. Lipid profile was not impared in women with HbA1 levels ≤ 7% and was impared in women with HbA1 levels > 7% (increased levels of total cholesterol, low-density lipoprotein cholesterol and decreased levels of high-density lipoprotein cholesterol were observed). Conclusion: IUD use (copper- and levonorgestrel-releasing) does not influence negatively glycaemic control and lipoprotein metabolism in perimenopausal women with Type 1 diabetes. Diabetes control have greater influence on lipid profile than composition of intrauterine contraceptive.

SELECTIVE RECEPTOR MODULATORS (SERMS, SARMS, AND OTHERS)P162EVALUATION OF EFFICACY AND SAFETY OF BAZEDOXIFENE IN A MEXICAN POPULATION OF WOMEN WITH OSTEOPOROSIS

Palacios Santiago (ES)

Williams R.

Komm B.

Pan K.

Arias L.

Mirkin S. (US)

Palacios Institute of Women's Health, ES

Introduction: Postmenopausal osteoporosis is associated with changes in bone turnover rate and decreased bone mineral density (BMD). Bazedoxifene (BZA) is a selective estrogen receptor modulator that reduces vertebral and nonvertebral fractures in postmenopausal women with osteoporosis without adverse stimulation of endometrial or breast tissue and lowers bone turnover rate. This analysis evaluated the effect of BZA on BMD and bone turnover markers (BTM) in a Mexican subpopulation of women with osteoporosis from the global pivotal trial. Methods: In this 3-year, phase 3, randomized, double-blind trial, healthy postmenopausal women with osteoporosis (N = 7,492) received BZA 20 mg/d or 40 mg/d, raloxifene 60 mg/d, or placebo (PBO). The subanalyses of Mexican patients assessed serum concentrations of BTMs osteocalcin and collagen type 1 C-telopeptide (cTX) and BMD with BZA 20 mg/d (BZA20) vs PBO. Safety was also evaluated. Results: In the ITT Mexican subpopulation (BZA20, n = 39; PBO, n = 37) at month 12, the BZA20 group vs PBO had clinically meaningful median% decreases from baseline in osteocalcin (–40.5 vs –18.5) and cTX (–45.7 vs –29.4). At month 36,% change from baseline BMD in the BZA20 group vs PBO was 3.3 vs 0.64 for lumbar spine, –0.18 vs –1.8 for total hip, 0.21 vs –2.6 for femoral neck, and –0.55 vs –1.4 for femoral trochanter, respectively. BTM and BMD results were comparable to the overall population. In Mexican patients receiving BZA20, common adverse events (AEs) (≥ 20%) included arthralgia, back pain, gastritis, headache, influenza, and pain. No AE led to withdrawal among Mexican patients receiving BZA20. There were no new safety trends relative to the global phase 3 population. Conclusion: BZA demonstrated efficacy and safety in Mexican patients, comparable with the global phase 3 population. BZA is effective for treating osteoporosis in Mexican patients.

P163TSECS: A NOVEL MECHANISM OF ACTION FOR THE TREATMENT OF MENOPAUSAL SYMPTOMS

Komm Barry

Jenkins S.

Mirkin S. (US)

Pfizer Inc, US

Estrogens bind with and activate estrogen receptors (ERs) to modulate gene transcription and signaling, impacting cellular processes in various tissues, including bone, breast, and endometrium. ER-mediated activity has shown benefits for menopause-related conditions in women; however, estrogens are associated with proliferation in uterine tissue compartments. Consequently, traditional estrogen therapy for postmenopausal women with a uterus requires use of progestins, which via the progesterone receptor, inhibit cellular proliferation in the endometrium, counteracting estrogenic effects. Progestins, however, are associated with tolerability issues including breast pain and uterine bleeding. A newer approach to menopausal therapy, the tissue selective estrogen complex (TSEC), pairs a selective estrogen receptor modulator (SERM) with 1 or more estrogens. Because SERMs exhibit distinct profiles of gene and target-tissue activity, TSECs maintain the benefits of estrogens on menopausal symptoms without the stimulatory effects on breast and uterus. The components of a TSEC can form a heteroligand-estrogen receptor (ER) complex with distinct effects on gene expression and target tissues, compared with their individual SERM or estrogen components. Preclinically, the TSEC conjugated estrogens/bazedoxifene (CE/BZA) is associated with ER agonist effects on bone turnover and vasomotor function as well as concurrent antagonist effects in breast and endometrium resulting from the presence of the bazedoxifene SERM component. CE/BZA also promotes ER degradation somewhat tissue-selectively, further minimizing endometrial and breast estrogenic responses. Thus, via receptor binding competition, variable gene transcriptional activity associated with heteroliganded receptor dimers, and ER degradation, CE/BZA is mechanistically and pharmacologically distinct from its individual components.

OTHER TOPICS RELATED TO HORMONES AND HORMONE ACTIONP165A SENSITIVE AND ROBUST LC-MS/MS METHOD FOR THE SIMULTANEOUS QUANTIFICATION OF DEHYDROEPIANDROSTERONE (DHEA), ESTRONE (E1), ESTRADIOL (E2), TESTOSTERONE (TESTO), DIHYDROTESTOSTERONE (DHT), ANDROSTENEDIONE (4-DIONE) AND ANDROST-5-ENE-3β,17β-DIOL (5-DIOL) IN POSTMENOPAUSAL SERUM USING A SINGLE SAMPLE PREPARATION METHOD

Ke Y.

Dadgar Dari

Bertin J. (CA)

Labrie F.

EndoCeutics, CA

Steroid hormones are neutral and do not ionize at a high level using the electrospray ionization technique: such steroids were usually analysed using GC-MS/MS with derivatization techniques. We are reporting a LC-MS/MS method for the simultaneous quantification of seven steroidal compounds, i.e. E1, E2, DHT, 5-diol, 4-dione, DHEA and Testo. Their quantification limits are 4 pg/mL, 1 pg/mL, 10 pg/mL, 100 pg/mL, 100 pg/mL, 500 pg/mL and 50 pg/mL, respectively. The system used to achieve this simultaneous quantitation is a UPLC-MS/MS (Qtrap 6500). With this method, the sample preparation is the combination of liquid-liquid extraction and a simple derivatization. It is simple and practically eliminates potential contamination. A full validation has been performed for the seven compounds in compliance with GLP and FDA Guidelines for bioanalytical method development and validation. The linearity and accuracy are within the bias range of 15% for all seven compounds. All testing results of other parameters also meet the acceptance criteria of EndoCeutics SOPs and FDA guidelines.

P167WHAT IS BEST TREATMENT FOR YOUNG AGED MENOPAUSED WOMEN?

Hyun Hee Cho (KR)

Catholic University Medical Colleage, KR

Aims: Puberty is important for getting secondary sexual characteristics and peak bone mass. Young aged menopaused girls during puberty need special treatment for their development. The aim of this study is to assess the suitability of previously used hormone treatment for young aged menopausal women. Materials and Method: Retrospective chart review were used for 75 young aged menopausal women who visited Seoul St. Mary's hospital during 2009. May ˜ 2013. May. Breast development and pubic hair changes, height, BMD were checked. The girls were grouped into two, one is menopaused before menarche (group I) and the other is menopaused within 5 years after menarche (group II). Results: Group I shows decreased breast development and low tanner stage. Their Tanner stage was remained in prepubertal stage regardless of HRT. No growth spurts in group I after HRT. Conclusions: Menopaused women before menarche needs special HRT program for their 2ndary sexual characteristics and final height.

OBESITYP169AN 8-WEEK INDIVIDUAL COGNITIVE-BEHAVIOURAL INTERVENTION FOR WEIGHT LOSS: OUTCOMES OF A CONTROLLED STUDY WITH PORTUGUESE MIDDLE-AGED WOMEN

Pimenta Filipa (PT)

Maroco J.

Leal I.

ISPA - Instituto Universitário, PT

Objective: Cognitive-behavioural therapy (CBT) has been proven to be effective in weight reduction. This research explores if a brief individual 8-sessions CBT can promote weight loss in midlife women as compared with a control group. Methods: Twenty-one women with body mass index (BMI) above 25 kg/m2 were randomly assigned to CBT (n = 11) or control condition (n = 10; waiting list). Anthropometric (e.g. weight), psychological (e.g. depression) and behavioural variables (e.g. presence of binge eating disorder) were assessed at baseline (T1) and post-treatment (T2) and 4-month follow-up (T3). Results: Statistically significant effects, that were dependent on the intervention, were observed on weight (F = 4.402; p = .035; hp2 = .404; π = .652) and BMI (F = 3.804; p = .050; hp2 = .369; π = .585); furthermore, marginally significant effects were also observed on external eating (F = 2.844; p = .095; hp2 = .304; π = .461). At follow-up, women in the CBT group presented with lower weight, abdominal perimeter, BMI and external eating; higher health-related quality-of-life and restrained eating were also observed in this group. Most differences identified were at a marginally significant level. Moreover, at follow-up, none of the participants of the CBT group met the criteria for binge eating disorder, whereas the number of women with binge eating disorder in the control group remained the same through all three assessments. Conclusion: An effective, though small, weight loss was achieved. Changes in quality of life were also observed. Moreover, changes in external eating behaviour were successful. Further research is needed to increase the efficacy of this intervention in the promotion of short-term weight reduction.

METABOLIC SYNDROMEP171DO METABOLIC SYNDROME & CARDIOVASCULAR RISK FACTORS DIFFER IN NATURALLY AND SURGICALLY MENOPAUSE WOMEN?

Farahmand Maryam (IR)

Research Institute for Endocrine Sciences, IR

Objective This study aimed to compare metabolic syndrome (MetS and its components in natural menopause women (NMW) with surgical menopause women (SMW). Design A longitudinal study with incident case and control Setting Tehran Lipid and Glucose Study (TLGS) Samples Three hundred fifty nine menopausal women who have undergone surgical or natural menopause during the study Methods: questionnaire including the demographic, reproductive and metabolic characteristics. Physical examinations and the biochemical profiles were assessed. In both groups the data collection were initiated before the occurrence of menopause and were recollected with an average 3 years interval. Main outcome measures Metabolic syndrome and its components Results During the follow up MetS was observed in 27.9% and 29.1% the NMW and SMW groups respectively. Mean fasting blood sugar (FBS) was significantly higher in the SMW compared to the NMW group (P < 0.05). Conclusions despite no differences on prevalence of MetS in NMW with SMW, the components of MetS are more prevalent among those with surgical menopause.

P173ASSOCIATION BETWEEN OSTEOCALCIN AND METABOLIC SYNDROME IN KOREAN POSTMENOPAUSAL WOMEN

You Youngoak (KR)

Kim M. (KR)

Lee S. (KR)

Kim J. (KR)

Catholic University of Korea, KR

Objective: Menopausal status can increase the incidence of metabolic syndrome, including increased body fat and abdominal obesity, dyslipidemia, and insulin resistance, and it increases the risk of cardiovascular disease. Osteocalcin is a marker for bone turnover and undercarboxylated osteocalcin regulates glucose and fat mass via the proliferation of pancreatic β cells, increased insulin secretion, decreased peripheral fat mass, and increased adiponectin secretion, which enhanced insulin sensitivity in an animal model. Recently, interest in the association between osteocalcin and metabolic syndrome in postmenopausal women has increased. Therefore, this study examined the association between osteocalcin and metabolic syndrome in Korean postmenopausal women. Methods: We selected 135 postmenopausal women who visited St. Vincent Hospital between September 2009 and August 2010. We measured blood pressure and body size and composition, including body mass index (BMI), waist-hip ratio (WHR), visceral fat area (VFA), percent body fat (PBF), body fat mass (BFM), and skeletal muscle mass (SMM) using bioelectrical impedance analysis and measured the lipid profile, plasma glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), homeostasis model assessment of insulin resistance (HOMA-IR), serum leptin and adiponectin, and serum total and undercarboxylated osteocalcin using blood collected after an overnight fast at the first visit. We divided the participants into metabolic syndrome and non-metabolic syndrome groups and compared the anthropometric variables, lipid profile, insulin resistance, and adipokine and osteocalcin levels. Results: There were 52 postmenopausal women were in the metabolic syndrome group and 83 in the non-metabolic syndrome group. Both serum total and undercarboxylated osteocalcin were higher in the non-metabolic syndrome group and the differences between the two groups were significant after adjusting for age and years since menopause (P = 0.015 and P = 0.025). After making this adjustment, total osteocalcin was negatively correlated with WHR, fasting insulin, HOMA-IR, and hs-CRP. Undercarboxylated osteocalcin was negatively correlated with WHR, VFA, PBF, BFM, SMM, triglyceride, fasting insulin, HOMA-IR, serum leptin, and the leptin/adiponectin ratio, and was positively correlated with serum adiponectin. A significant decrease in undercarboxylated osteocalcin was associated with a greater number of metabolic syndrome components (P = 0.042). When participants were categorized into one of four groups by the serum undercarboxylated osteocalcin level quartiles, the odd-ratio for metabolic syndrome was significantly lower in Quartile 4 than in the lowest quartile after adjusting for age, years since menopause, and BMI in binary logistic regression analyses (Quartile 4; Odd ratio = 0.30, 95% Confidence Interval = 0.08–0.94, P = 0.46). In multiple regression analysis, serum leptin and HOMA-IR were the most important predictors of the independent variables that affect serum undercarboxylated osteocalcin (P = 0.008 and P = 0.046). Conclusions: Undercarboxylated osteocalcin, rather than the total osteocalcin showed an inverse correlation with markers of insulin resistance, central obesity, glucose and fat metabolism, and the presence of metabolic syndrome in postmenopausal women, and appears to protect against metabolic syndrome. Further large-scale clinical and experimental studies are needed to clarify the potential of undercarboxylated osteocalcin as a predictor of metabolic syndrome in postmenopausal women.

P174EFFECT OF DIET AND OMEGA 3 SUPPLEMENTATION ON THE METABOLIC AND INFLAMMATORY MARKERS IN POSTMENOPAUSAL WOMEN WITH METABOLIC SYNDROME: A RANDOMIZED CONTROLLED TRIAL

Nahas Eliana (BR)

Tardivo A.

Dias F.

Orsatti C.

Rodrigues M.

Nahas-Neto J.

Botucatu Medical School - UNESP - Univ. Estadual Paulista, Sao Paulo, Brazil, BR

Objective: to evaluate the effect of diet alone or combined with Omega-3 supplementation on metabolic and inflammatory markers in postmenopausal women with MetS. Methods: In this randomized controlled trial, 87 women (age ≥ 45 years and amenorrhea ≥ 12 months) with MetS were included. According to the US National Cholesterol Education Program Adult Treatment Panel III, women showing 3 or more diagnostic criteria were diagnosed with MetS: waist circumference (WC) > 88cm, blood pressure > 130/85mmHg, triglycerides > 150 mg/dl, HDL < 50 mg/dl and glucose > 100 mg/dl. Exclusion criteria: cardiovascular disease, insulin-dependent diabetes, cancer, autoimmune diseases and use of statins or hormone therapy. Participants were randomized to diet alone (n = 43, control) or associated with Omega-3 supplementation, 900mg/dia orally (n = 44). Clinic, anthropometric (body mass index, BMI and WC), biochemical variables were measured. Inflammatory profile included C-reactive protein, tumor necrosis factor alpha (TNF-α) and interleukins (IL-1β and IL-6). The intervention time was 6 months, with assessments at initial and final moments. Results: Of the 87 women, 30 with diet alone and 33 with diet + Omega-3 completed the study. At the end, there were significant reduction in BMI and WC in two groups (p < 0.05) without significant changes in body fat or muscle mass. Intervention with diet + Omega-3 was associated with significant reduction in systolic pressure (−12.2%) and diastolic (−8.2%), triglycerides (−21.4%), and insulin resistance (−13.1%) (p < 0.05), as well as a reduction in IL-6 (−28.5%) (p = 0.034). Conclusion: In postmenopausal women with MetS, diet associated with supplementation of Omega-3 had beneficial effects on metabolic risk factors (blood pressure, triglycerides, and insulin resistance), important components of MetS, and on inflammatory markers. *FAPESP: Process 2009/14884-2.

P175CLINICAL EPIDEMIOLOGY OF METABOLIC SYNDROME IN THE FEMALE ELDERLY OCCUPATIONAL POPULATION IN TAIPEI, TAIWAN

Tung Tao-Hsin (TW)

Shen H.

Hu Y.

Chen Y.

Cheng Hsin General Hospital, TW

Purpose. To explore prevalence of metabolic syndrome and factors associated with its components in the elderly female occupational population in Taipei, Taiwan. Methods. A total of 1589 healthy subjects voluntarily and 65 years or above admitted to a teaching hospital for a physical check-up in 2010. Demographic and blood samples results were collected. Results. The mean age of study participants is 74.8 ± 6.7 years. The prevalence of metabolic syndrome is 40.50% (95%CI: 38.1%-42.9%). After adjustment for confounding factors, the older age, higher BMI, and higher serum uric acid are most significant risk factors related to metabolic syndrome. Conclusion. The prevalence of metabolic syndrome is related to obesity and elevated serum uric acid. Promoting this population with controlled obesity and health improvement for renal function are important.

P176URIC ACID, METABOLIC RISK FACTORS, AND CHRONIC KIDNEY DISEASE IN A FEMALE ELDERLY OCCUPATIONAL POPULATION IN TAIPEI, TAIWAN

Shih Hui-Chuan (TW)

Chen Y.

Shen H.

Hu Y.

Tung T. (TW)

Kaohsiung Armed Forces General Hospital, TW

Purpose. To explore the prevalence of and associated factors for chronic kidney disease (CKD) among female elderly fishing and agricultural population in Taipei, Taiwan. Methods. Females (n = 1,606) aged 65 years and over voluntarily admitted to a teaching hospital for a physical check-up were collected in 2010. Associations between age, metabolic factors, hyperuricemia, and kidney damage were examined. Results. The overall prevalence of CKD was 8.2% (95%CI: 6.9–9.5%). The age specific prevalence of CKD in 65–74 years, 75–84 years, and ≥ 85 years were 3.9%, 11.3%, and 25.0% (p < 0.0001), respectively. From the multiple logistic regression, age (OR = 1.12, 95%CI: 1.09–1.15), hyperuricemia (OR = 7.94, 95%CI: 5.07–12.42), and hyperglycemia (OR = 1.67, 95%CI: 1.08–2.56) were statistical significantly related to CKD. The sensitivity and specificity of serum uric acid and fasting blood glucose concentration as a marker of CKD were estimated 76.5%, 70.9% and 51.5%, 53.5%, respectively. Conclusion. Hyperuricemia and hyperglycemia independently affect the prevalent CKD in the female elderly fishing and agricultural population.

P178FACTORS ASSOCIATED WITH THE OCCURRENCE OF DIABETES IN WOMEN OF 50 YEARS OF AGE OR MORE: A POPULATION-BASED STUDY

Machado Vanessa (BR)

Valadares A.

Pinto-Neto A. (BR)

Souza M.

Costa-Paiva L. (BR)

University of Campinas (UNICAMP), Campinas, São Paulo, Brazil, BR

Objective: To investigate the factors most strongly associated with the onset of diabetes in women over fifty years of age. Methods: A cross-sectional, population-based study using self-reports. A total of 622 women of 50 years of age or more were included. The dependent variable was the cumulative continuation rate (survival) without diabetes. Sociodemographic, clinical and behavioral factors were evaluated. Cumulative continuation rates (survival) without diabetes were obtained using the life-table method at annual intervals. Next, Cox multiple regression models were adjusted to analyze the occurrence rates of diabetes according to predictor variables. Results: Of the 622 women interviewed, 22.7% reported having diabetes. The mean age at onset was 56 years. Menopausal status was not associated with the onset of the disease. The factors associated with the presence of diabetes were self-rated health (very good, good) (coefficient = −0.792; standard error of the coefficient = 0.215; p = 0.0001), more than two individuals living in the household (coefficient = 0.656, standard error of the coefficient = 0.223; p = 0.003), and body mass index (BMI) (kg/m²) at 20–30 years of age (coefficient = 0.056, standard error of the coefficient = 0.023; p = 0.014). Conclusions: Self-rated health considered good or very good was associated with a higher rate of survival without diabetes. Sharing a home with two or more other people and a weight increase at 20–30 years of age was associated with the presence of diabetes.

P179YEARS SINCE MENOPAUSE IS A SIGNIFICANT RISK FACTOR OF METABOLIC SYNDROME IN POSTMENOPAUSAL WOMEN

Moon Kyoung Yong (KR)

Kim H. (KR)

Ku S. (KR)

Suh C. (KR)

Kim S. (KR)

Choi Y. (KR)

Seoul National University College of Medicine, Seoul, Korea, KR

Objective: This study aimed at determining the relationship between menstrual history and metabolic syndrome. Methods: 556 postmenopausal women were recruited from Korean community healthcare screening test. To minimize confounding factors, patients taking medications for any cardiovascular disease, dyslipidemia, thyroid disease, diabetes, neuropsychiatric disease were excluded. Other exclusion criteria included heavy alcohol consumption (≥ 8 drinks per week), history of smoking, hormone replacement therapy or oral contraceptive medication, and hysterectomy. Finally, 249 women aged between 47 to 83 years were accepted for the study. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Age at menarche, age at menopause were obtained through interviews. Reproductive years were calculated by subtracting age at menarche from age at menopause, and years since menopause by subtracting from age at menopause from present age. Independent t-tests and logistic regression analysis were used. Results: The prevalence of metabolic syndrome was 26.1% (n = 65). The mean years since menopause was longer in metabolic syndrome group compared to control group (16.98 ± 10.08 vs 13.90 ± 9.52, p = 0.028), whereas the mean age was not significantly different (66.54 ± 7.74 vs 64.39 ± 7.75, p = 0.056). The age at menarche, age at menopause, and reproductive years also did not differ. Logistic regression analysis showed that one additional year since menopause significantly increased the prevalence of metabolic syndrome (OR = 1.033; 95%CI, 1.003–1.063, p = 0.029), but the effect of increasing age was not significant (OR = 1.037; 95%CI, 0.999–1.076, p = 0.057). Conclusion: Years since menopause is a more significant risk factor of metabolic syndrome compared to age in postmenopausal women.

P180MENOPAUSAL STATUS AND METABOLIC SYNDROME IN MEXICAN WOMEN

Morfín Martín Julio (MX)

Cárdenas Becerril T. (MX)

Clínica de Climaterio Santa Teresa, MX

With aging and postmenopause, the prevalence of metabolic syndrome components increases, which is associated with increased risk of developing diabetes and cardiovascular disease. Metabolic syndrome is strongly influenced by obesity, particularly in the postmenopause. According to “Joint Interim Statement” (Circulation 2009) for the diagnose of Metabolic Syndrome, a woman must have three of the following factors: abdominal circumference > 80 cm (varies by location and country), Triglycerides ≥ 150 mg/dL or drug treatment, HDL-cholesterol < 50 mg/dL or drug treatment, high blood pressure ≥ 130 systolic and/or > 85 diastolic or antihypertensive medical treatment or fasting glucose ≥ 100 mg/dL or treatment. We analyzed the characteristics and laboratory findings of 511 women between 30 and 87 years who attended a private climacteric clinic in Mexico City. Of the 511 women 149 (29.1%) had metabolic syndrome with a mean age of 62.3 years, 133 (89.2%) of whom were postmenopausal, 10 (6.7%) were in the menopausal transition and 6 (4.0%) were premenopausal. 46.9% of women met 3 criteria, 38.2% met 4 criteria and 14.7% met all 5 criteria. The prevalence of the criteria was 87.2% for waist circumference, 79.1% for triglycerides, 75.8% for HDL, 62.4% for blood pressure and 52.3% for glucose. In the 149 women with MS the mean values were 85.6 cm waist, systolic BP and diastolic 130.4/80.2 mm/Hg, glucose 102.4 g/dL, HDL 45.6 mg/dL and triglycerides 176 mg/dL. Among the patients with SM only 43 (28.8%) had a Framingham rate higher than normal for their age. The prevalence of MS in postmenopausal women was 31.6%, in the menopausal transition 27.0% and in premenopausal 11.3%. The prevalence of metabolic syndrome increases with age and postmenopausal status and in these Mexican women the main factor was abdominal obesity.

MENOPAUSE AND LIPID DISORDERSP181OVARIECTOMY IN RATS AND HIGH DIETARY CHOLESTEROL INTAKE COMBINE TO DECREASE GENE EXPRESSION OF MOLECULAR MARKER OF VLDL SYNTHESIS

Farahnak Zahra (CA)

Côté I. (CA)

T. Ngo Sock E. (CA)

Lavoie J. (CA)

University of Montreal, CA

The purpose of the study was to evaluate the effects of high dietary cholesterol intake in ovariectomized (Ovx) rats on several markers of hepatic cholesterol and lipid metabolism. Ovx and sham operated (Sham) rats were submitted to either a standard (SD), a SD + 0.25% chol, or a high fat + 0.25% chol diets for 5 weeks. Ovx was associated with higher (P < 0.05) liver total cholesterol (TC) under the SD and the SD + 0,25% chol diets but not under the HF + 0.25% chol diet, while liver triglycerides (TG) content was higher in Ovx than in Sham rats in all 3 diet conditions. On the other hand, plasma TC and TG levels were lower (P < 0.001) in Ovx than in Sham rats only under the SD + 0.25% chol diet, suggesting a decrease in VLDL secretion. Transcripts of molecular markers of VLDL synthesis including microsomal TG transfer protein (MTP), diacylglycerol acyltransferase 2 (DGAT 2), apoB, Sar1a GTPase, and CideB were all decreased (P < 0.05) in Ovx compared to Sham rats and even more so for MTP, DGAT2, apoB, and acyl-Coa: cholesterol acyl transferase (ACAT2) if rats were fed the SD + 0.25% chol diet. Interestingly, the dietary cholesterol effect in Ovx rats tended to be attenuated when the 0.25% chol was added to the HF diet. These results indicate that a high cholesterol dietary intake exacerbates the deleterious molecular effects of the ovariectomy on hepatic cholesterol and triglyceride metabolism possibly through a reduction in VLDL synthesis and assembly. On a clinical point of view, the data suggest that postmenopausal women are particularly vulnerable to the deleterious effects of high dietary cholesterol intake. Supported by grants from CRSNG and CIHR.

OTHER TOPICS RELATED TO HORMONES AND METABOLISMP182INVESTIGATION OF CHANGES TO BODY COMPOSITION (LBM,%FAT, BMI) WITH AGING

Lee Sangun (JP)

Kitamiya C.

Satoh A.

Hashimoto J. (JP)

Fujita C. (JP)

Suzuki T.

Aomori University of Health and Welfare, JP

Introduction: In the present study, we aimed to assess the changes in body composition accompanying aging, according to gender and age, in the Japanese population. Methods: The subjects included 51,735 (male; 18,246, female; 33,489) male and female aged > 20 years residing in Aomori Prefecture, Japan. We measured the height, body weight, body mass index (BMI), and body fat percentage (%fat), whereas lean body mass (LBM) was calculated using the following formula: body weight × (100 -%fat) ÷ 100. The subjects were classified into different age groups with 10 year ranges, and comparisons between the groups were performed using Tukey's test. The statistical significance was defined as a p value of < 0.05. Results: We noted that LBM reached a peak value in male and female in their 30s. Compared to male in their 30s, those in their 40s exhibited a significant reduction in LBM, whereas for female, the reduction in LBM occurred in their 50s (p < 0.001, in each). However, the curve for%fat and BMI indicated a decreasing trend for male aged >30 years, whereas female continued to show an increase until 60 years of age. Discussion: LBM is related to muscle power and stamina, and%fat and BMI are highly correlated with disease. LBM in male decreased at an earlier age as compared to female, and female experienced an increasing trend for fat-related measurements until 60 years of age. Thus, such changes in body composition with aging suggest the possibility that it is related to fat-related diseases in female and changes to levels of activity associated with LBM in male.

P183A FAST AND SENSITIVE UHPLC-MS/MS METHOD FOR THE SIMULTANEOUS QUANTIFICATION OF SERUM ANDROSTERONE GLUCURONIDE (ADT-G), ETIOCHOLANOLONE GLUCURONIDE (ETIO-ADTG), ANDROSTAN-3α, 17β DIOL 3-GLUCURONIDE (3α-DIOL-3G) AND ANDROSTAN-3α, 17β DIOL 17-GLUCURONIDE (3α-DIOL-17G) IN POSTMENOPAUSAL WOMEN

Ke Y.

Dadgar Dari (CA)

Bertin J. (CA)

Labrie F.

EndoCeutics, CA

Conjugation with glucuronic acid is the most important inactivation step of androgenic steroids. Direct detection and quantification of these compounds by the conventional hydrolysis method may underestimate some conjugates while three of them have been found to provide a good estimate of the total androgenic pool (ADT-G, 3α- diol-3G and 3α-diol-17G). In this work, a sensitive and fast liquid chromatography-tandem mass spectrometry (LC-MS/MS) method has been developed for the simultaneous quantification of ADT-G, Allo-ADT-G, 3α-diol-3G and 3α-diol-17G in postmenopausal women serum samples. The quantification limits are 0.1 ng/mL for 3α-diol-3G and 3α-diol-17G and 4 ng/mL for ADT-G and Etio-ADT-G while the total run time is 5.5 minutes for all 4 glucuronides. In this method, solid phase extraction is used for the sample preparation. The assay has been validated as a GLP method in compliance with EndoCeutics SOPs and FDA guidelines for bioanalytical method development and validation. Over 2000 clinical samples have been assayed using this method.

P185PREVALENCE OF THYROID DISORDERS IN CLIMACTERIC WOMEN ATTENDING TO A PRIVATE CLINIC IN VENEZUELA

Gonzalez Natalia (VE)

Caceres M. (VE)

Centro Profesional las Mercedes Caracas, VE

Hypothyroidism is the term for deficient thyroid hormone secretion by the thyroid gland. The prevalence of hypothyroidism increases with age and reaches 10% in older women. However, prevalence in older women is not known in Venezuela. The aim of the present study was to establish the prevalence of different types of thyroid disorders at different stages of the climacteric period. Subjects were recruited among women attended in a private clinic at Caracas, Venezuela; between July 2011 and November 2013. Baseline laboratory tests and thyroid profiles were obtained by chemoluminescent immunoassay for a total of 235 women aged 45–85 years. Thyroid disorders were categorized by measuring free thyroxine (FT4), thyrotropin (TSH) levels, antiperoxidase antibodies (AntiTPO). Most results were normal (82,9%). Secondary or tertiary hypothyroidism was the most common thyroid disorder in the climacteric women (14,8%). Subclinical hypothyroidism with no clear symptoms was found to be low (1,2%). Hyperthyroidism subclinical and hyperthyroidism (0,85%). In the present study, we were able to demonstrate a low prevalence of overt and subclinical hypothyroidism and hypothyroidism in the climacteric women which is consistent with the prevalence reported in northamerican studies. Clinical findings alone should not lead to the prompt diagnosis of hypothyroidism in elderly women. It is crucial to base diagnosis and monitoring on symptoms and signs as well as T4 concentrations. Nevertheless, routine thyroid function tests may be warranted in menopausal women.

P186ASSESSING MENOPAUSAL SYMPTOMS IN POSTMENOPAUSAL ECUADORIAN WOMEN SCREENED FOR THE METABOLIC SYNDROME

Chedraui Peter (EC)

Villacreses D. (EC)

Vintimilla-Sigüenza I. (EC)

Romero-Huete L. (EC)

Domínguez A. (EC)

Jaramillo W. (EC)

Pérez-López F. (ES)

Simoncini T. (IT)

Institute of Biomedicine, Universidad Católica de Guayaquil, Ecuador, EC

Objective: To assess menopausal related symptoms in postmenopausal Ecuadorian women. Methods: Menopausal symptoms were assessed with the Menopause Rating Scale (MRS) in natural postmenopausal women (40–65 years) participating in a metabolic syndrome (METS) screening program. Modified Adult Treatment Panel III (ATP-III) criteria were used to define the METS and women also filled out a general socio-demographic questionnaire containing personal and partner data. Results: A total of 204 women were surveyed with a median age of 56 years. A 52.9% presented the METS, with 37.3% presenting hyperglycemia, 51.5% hypertension, 58.3% abdominal obesity, 45.6% high triglyceride and 56.4% low HDL-C levels. For the whole sample median MRS scores were: 11 (total), 4 (somatic), 4 (psychological) and 2 (urogenital). Total and subscale MRS scores did no differ in accordance to the presence or not of the METS. Nevertheless, MRS scores inversely correlated with female age (psychological) and personal and partner educational level (total, somatic and psychological). Somatic scores positively correlated with abdominal circumference and urogenital and total MRS scores with glycaemia values. Conclusion: In this postmenopausal Ecuadorian sample, menopausal symptoms correlated to metabolic status and to personal and partner aspects.

FEMALE SEXUAL DYSFUNCTION EPIDEMIOLOGYP187VAGINAL SYMPTOMS IN POSTMENOPAUSAL JAPANESE WOMEN: AN ANALYSIS OF INTERNET QUESTIONNAIRE RESPONSES

Takamatsu Kiyoshi (JP)

Ito K.

Ogawa M. (JP)

Horiguchi F.

Tokyo Dental College Ichikawa General Hospital, JP

In order to study the current prevalence of vaginal symptoms in postmenopausal Japanese women, we analyzed responses from outpatients of menopause clinic as well as those from general postmenopausal women who participated in an internet questionnaire survey. Subjects included 121 post-natural-menopausal outpatients who visited the menopause clinic in our hospital. We also analyzed the responses of 132 premenopausal women and 152 post-natural-menopausal women to a Macromill, Inc. internet research system. Subjects selected one of four levels to assess the severity of the following four symptoms: vaginal dryness, vaginal discharge, vaginal itching, and dyspareunia. Some vaginal symptoms showed a prevalence rate of 28.9% in general postmenopausal women, which was significantly lower than the 50.4% shown in outpatients of menopause clinic. Levels of all symptoms except for vaginal irritation were also significantly lower in general postmenopausal women. Relative to premenopausal women, general postmenopausal women had somewhat lower prevalence rates for coital pain, and significantly lower prevalence rates for vaginal discharge and vaginal itching. Analysis of the association between vaginal symptoms and other climacteric symptoms revealed that 72.7% of the women with vaginal symptoms had complications with depression, significantly higher than the 50.0% noted for hot flashes. This indicates a need for research regarding psychogenesis associated with vaginal symptoms. Vaginal symptom prevalence rates noted for postmenopausal women in the present study were lower than that in reports from Western countries. However, it should be emphasized that our results still show that approximately 30% of these women have complaints. Efforts to pick up vaginal symptoms and proper treatments are needed for even Japanese women.

P188SEXUAL DYSFUNCTION AND ASSOCIATED FACTORS IN A FEMALE POPULATION

Vega Genaro (MX)

Universidad Autónoma de Querétaro, MX

Objective: To determine the bio psycho social factors associated with sexual dysfunction in a female population. Methods: Comparative study in women who were attended to patients at a Family Medicine Unit of IMSS Querétaro in the period from March to June 2008, were divided into two groups, group A women with a sexual disorder, group B women without alterations sex, the results were analyzed with Chi square and odds ratio, with an alpha value of 0.05. Results: 50 women interviewed, 44 (88%) reported having sexual activity. The factors associated with the presence of sexual dysfunction with a statistically significant difference (p < 0.05) were: age over 40 years (OR: 26.8), work outside the home (OR: 12.46), presence of obesity and/or overweight (OR: 7.875), hypertension (OR: 6.857), diabetes mellitus (OR: 9), prior hysterectomy (OR: 6.263), maternity (OR: 6), marital dysfunction (OR: 7.5), high self-esteem (OR: 4.2), mild to severe depression (OR: 4.615), dysfunctional family (OR: 8), low socioeconomic status (OR: 5.250). The most common sexual dysfunction were: decrease in sexual desire (34.09%), erectile dysfunction (22.72%), dyspareunia and lack of arousal (20.45%), referred to as unpleasant sex and inability to reach orgasm (13.63%), anxiety for sexual performance (6.81%) and premature ejaculation (4.54%). Conclusions: dysfunctional family background, work activities outside the home and marital dysfunction and the presence of chronic degenerative diseases such as obesity, hypertension and diabetes mellitus affect the incidence of sexual dysfunction in women. Keywords: Sexual disturbances

P189CURRENT STATUS OF FEMALE SEXUAL DYSFUNCTION IN KOREA

Kim Tak (KR)

Seo K.

Korea University Anam Hospital, KR

Objectives: In Korea, studies on female sexual dysfunction were relatively rare compared with male sexual problems. We investigated the literatures on the prevalence and features of sexual dysfunction in Korean women. Materials and Methods: Online search was performed through Pubmed. There were some published English literatures about the prevalence of female sexual dysfunction in Korea. Results & Conclusions: In the literature on 600 women aged 40–80 years, the sexual problems most frequently reported by women in Korea were lack of sexual pleasure (37%) and inability to reach orgasm (31%). Only 2% had talked to a medical doctor about their sexual problems. Middle-aged and older adults in Korea regard sex as an important part of life and report continued sexual activity. Several sexual problems are highly prevalent in this population, but very few individuals seek medical help for these disorders. This is largely due to believing that the problem is not serious, not being bothered by the problem, difficulties regarding access to or affordability of medical care, and/or a lack awareness of available treatments.

P191EFFICACY OF VAGINALLY APPLIED ESTROGEN, TESTOSTERONE OR POLYACRYLIC ACID ON SEXUAL FUNCTION IN POSTMENOPAUSAL WOMEN: A RANDOMIZED CONTROLLED TRIAL

Fernandes Tatiane (BR)

Pinto-Neto A. (BR)

Paiva L.

UNICAMP, BR

Introduction. Female libido is multifactorial and complex. Declining estrogen levels in postmenopausal women affects vaginal function. Aim. To evaluate female sexual function after using topical estrogen, testosterone or polyacrylic acid as vaginal lubricants with K-Y jelly as a placebo lubricant. Methods. This was a randomized controlled clinical trial on 80 postmenopausal women between 40 and 70 years of age with follow-up at the Menopause Clinic of the CAISM/ Unicamp. The women were randomized to treatment with topical vaginal estrogen, testosterone, polyacrylic acid or oil lubricant alone, three times a week for a period of 12 weeks from November 2011 to January 2013. Main Outcome Measures. We used the Female Sexual Function Index (FSFI) to assess changes in sexual response at baseline, and after 6 and 12 weeks. Results. After 12 weeks of treatment, polyacrylic acid and topical testosterone produced improvements in the FSFI domains of sexual desire, lubrication, satisfaction, reduced pain during intercourse and total score compared with lubricant alone. Treatment with topical estrogen in comparison with lubricant alone showed an improvement in the FSFI field of desire. The intragroup analysis over the time of the treatment showed improvements in the fields of desire, lubrication, and reduced pain for polyacrylic acid, testosterone and estrogen. Furthermore, women who used testosterone showed improvements over time in the fields of arousal, orgasm and satisfaction. Conclusions. Treatment of postmenopausal women with symptoms of vaginal atrophy with polyacrylic acid, testosterone and estrogen for 12 weeks produced improvements in self-reported female sexual function when compared with a lubricant.

OTHER TOPICS RELATED TO SEXUALITY AND SEXUAL FUNCTIONP192EFFECT OF LEPIDIUM MEYENII ON SEMEN QUALITY AND REPRODUCTIVE HORMONES LEVEL IN HEALTHY ADULT MEN

Melnikovova I.

Fait Tomas (CZ)

Huml L.

Kolarova M.

Lapcik O.

Cusimamani E.

1st Faculty of Medicine, Charles University, Prague, CZ

Products of Lepidium meyenii (maca) are consumed worldwide as an alimentary supplement to enhance fertility and restore hormonal balance, despite a lack of rigorous scientific evidence for their efficacy. The aim of this study was to evaluate its effect on semen quality and reproductive hormones level in healthy adult men. Enhancing properties of maca on semen quality in animals was previously reported by various authors, but we represent to the best of our knowledge the first double-blind, randomized, placebo-controlled trial in men. A group of 20 volunteers aged from 20 to 40 years were supplied by milled hypocotyl of maca or placebo with a daily dose of 1,75 g for three months. Negative controls of semen were compared to the samples after 6 and 12 weeks of maca administration and negative blood controls were compared to the samples after 12 weeks of treatment. Levels of reproductive hormones and sperm volume did not change significantly after 3 months of maca administration, but sperm count and motility showed rising trends compared to placebo. Quality of semen was enhanced independently on reproductive hormones level. The design of a further study considering the effect of maca on Assisted Reproduction Center's clients is currently being developed.

P193THE INFLUENCE OF LOCAL NON-HORMONAL THERAPY CONTAINING HYALURONIC ACID ON SEXUAL LIFE IN POSTMENOPAUSAL WOMEN

Skrzypulec-Plinta Violetta (PL)

Drosdzol-Cop A. (PL)

Dębski R.

Paszkowski T.

Medical University of Silesia, Katowice, Poland, PL

Aim of the study. The aim of the study was to evaluate the influence of local non-hormonal therapy on sexual life and vulvovaginal atrophy in postmenopausal women. Material and methods. The prospective study involved a population of 50 postmenopausal women aged 55–65 years. Local therapy containing hyaluronic acid, glycogen and lactic acid was used according to the recommended scheme. Two follow-up visits were planned in 7 days and 2 months after the therapy. During every visit a complete gynecological examination was performed and the patients completed the study questionnaire consisting of a general part (socio-demographic data, medical and gynecological history), 5-point analogue self-evaluation scale of vulvovaginal atrophy symptoms and Female Sexual Function Index to asses sexual life. Results. The mean age of the study population was 57.88 ± 2.42 years. Statistically significant improvement of vaginal pH and the reduction of urogenital atrophy were found both in short-term (pH and atrophy: p = 0.000006 and p = 0.00002 retrospectively) and long-term follow-up (pH and atrophy: p = 0.0000001 and p = 0.000001 retrospectively). The study group of women gained a mean FSFI score - 25.41 ± 6.75 after the therapy and 19,59 ± 8,59 before the therapy (p = 0,000006). Clinically significant sexual disorders were diagnosed in 80% of women at the baseline and in 47.5% after the study protocol (p = 0,003). Moreover, statistically significant improvement of sexual functioning in all six FSFI domains was obtained at the end of local therapy. Conclusions. The use of local non-hormonal therapy containing hyaluronic acid, glycogen and lactic acid reduces vulvovaginal atrophy and improves quality of sexual life in postmenopausal women.

P194THE PREVALENCE OF FEMALE SEXUAL DYSFUNCTION AND METABOLIC SYNDROME IN PERIMENOPAUSAL AND MENOPAUSAL WOMEN AGED 50 TO 60 YEARS IN COLOMBIA

Sierra B.

Raigosa German (CO)

Echeverri M.

Genero y Sexualidad, CO

Introduction: The menopausal transition seems to increase the risk of having sexual problems and developing Metabolic Syndrome. Furthermore, there seems to be a link between Metabolic Syndrome, high triglyceride levels and sexual dysfunction. Our objective was to evaluate the prevalence of female sexual dysfunction and metabolic syndrome in colombian women aged between 50 and 60 years of age who were menopausal or in their menopausal transition. Methods: Women aged between 50 and 60 years, were asked to participate. They were given a written questionnaire that included the Female Sexual Function Index, Menopausal Rating Scale, and several questions on demographic data and sexual relations. At that time their abdominal circunference and blood pressure were recorded. They were also given a prescription to have laboratory tests to measure their fasting levels of glucose, triglycerides, HDL, DHEAS, estradiol and FSH. Results: A large proportion (48%) of women in this age group had not had sexual relations in the previous 4 weeks. The most common cause were the absence of a sexual partner and lack of desire. The prevalence of low FSFI scores, indicative of sexual dysfunction, in women that were sexually active was 42.8%. The most common menopausal complaints were hot flushes and vaginal dryness. Forty percent (40% ) of the women met the criteria for metabolic syndrome (NCEP-ATP III criteria). We found no correlation between metabolic syndrome and sexual complaints. Conclusion: Menopausal women aged 50 to 60 years in Colombia are frecuently sexually inactive and in high percentage exhibit symptoms of the metabolic syndrome. Urogenital and somatic symptoms and sexual dysfunction are also common.

P195SEXUAL FUNCTION IN PERI AND POSTMENOPAUSAL WOMEN WITH AND WITHOUT DYSPAREUNIA

Schvartzman Luiza (BR)

Schvartzman R.

Wender M. (BR)

HNSC, BR

Introduction. Alterations in the pelvic floor during menopausal years, which are the result of hormonal and physical changes and of tissue aging itself, can lead to urinary and several forms of sexual dysfunction. Dyspareunia – pain during sexual intercourse – is among the most frequent. Aim. To assess the myoelectric action potential of pelvic floor muscles (resting muscle activity), sexual function (using the Female Sexual Function Index, FSFI) and quality of life (using the Cervantes Scale) in peri and postmenopausal women with and without dyspareunia. Methods. Cross-sectional study carried out at the outpatient Menopause clinic of the Department of Gynecology, Hospital de Clínicas de Porto Alegre (HCPA), Brazil, in a sample of climacteric women aged 45 to 60 years. Participants were interviewed, completed two questionnaires (Cervantes Scale and FSFI), and underwent assessment of the pelvic floor muscles by the electromyographic biofeedback method. Results. The sample comprised 51 women with a mean age of 52.1 ± 4.9 years. Women with dyspareunia scored worse on the FSFI (P < 0.001) and the Cervantes Scale (P = 0.009) as compared to women without dyspareunia. Furthermore, there was a significant inverse association between FSFI pain scores and mean resting muscle activity (rs = −0.300; P = 0.033). Conclusions. There were between-group differences in FSFI and Cervantes Scale scores. Further studies are required to investigate factors that could render some peri and postmenopausal women more vulnerable to the pain associated with pelvic floor muscle dysfunction.

P196DELAYED CHILDBEARING ASSESSMENT AND PERINATAL OUTCOME RISK FACTORS

Cortez Opazo J.¹ (CL)

Iglesias Venegas Luis¹ (CL)

Osorio Fuenzalida E.¹ (CL)

Ureta Bravo C.¹ (CL)

Navarrete Arriagada I.¹ (CL)

Montenegro Pacheco L.² (CL)

^aGynaecology and Obstetrics Unit, Clínica Dávila, Santiago

^bSchool of Medicine, Universidad de los Andes Clinica Davila, CL

Introduction: Delayed childbearing has increased in recent years. Several studies have shown an increased risk of adverse perinatal outcome due advanced maternal age, being this of unknown etiology, which are related with increase of maternal, late fetal, neonatal mortality and morbidity and low birth weight, among others. The purpose of this study was three: first, to determinate the behavior of these women in Clínica Dávila; second, to discern potential risk factors associated with this condition; third, to raise the need for differential obstetric care to reduce the risks. Moreover, strategy to provide contraception for this group is required. Method: Retrospective observational study to review all deliveries and abortions in Clínica Dávila from 1 January 2002 to 30 April 2013. Results: During this period, the total number of deliveries was 63835, which 3.6% (2323) were to 40–49 years mothers. There was 3081 abortions (4.82%), which 327 (0.51%) were to 40 years or older. However, if we only take the total number of deliveries between women 40 years or older, then the percentage increased to 14%. Conclusion: Births in 40 years or older women represent 3.6%. Abortions are well distributed between all births, but, in absolute terms, abortions percentage in study group was 14%, which represents a fourfold higher risk than women under age of 40. Study group must be advised for abortion risk and they also need to consider a safe contraceptive option.

P197SEXUAL FUNCTION IN CLIMACTERIC WOMEN LIVING WITH A PARTNER

Salazar Alide (CL)

Paravic T. (CL)

Universidad de Concepción, CL

Objective: The present research was to determine factors which affect sexual functioning in women living with a partner during the climacteric period. Methods: Descriptive, correlational study. The sample for the study consisted of 101 women aged 40–60 years, receiving benefits from the public health care and their couples men between 40–65 years. Data collection instruments: Menopause-Specific Quality of Life Questionnaire (MENQOL), AMS- Aging Male Symptoms Scale, Female Sexual Function Index (FSFI), Brief Male Sexual Function Inventory, Relationship questionnaire and Sex practices questionnaire. Women and their couples were interviewed at their homes after providing informed consent. Descriptive statistics and multiple regression were used to process data. p < 0.05 were considered to indicate statistical significance. Results: Women participants average age 49,1 ± 5,8 and 51,5 ± 6,8 their couples. Women presented 21,5 ± 9,5 score in Female Sexual Function Index. Domain scores: Desire (2,4 ± 1,0), Arousal (2,6 ± 1,4), Lubrication (2,97 ± 1,7), Orgasm (3,06 ± 1,8), Satisfaction (3,47 ± 1,3), Pain (3,1 ± 1,8). 67,7% of women were classified with sexual dysfunction. Significant inverse correlations were found between age and total FSFI score and all FSFI scores except sexual satisfaction. Significant inverse correlations were found between total FSFI and psychosocial, physical and sexual domain MENQOL scores. Predictors of sexual function in women that explained the 54% of the variance were: sexual domain, frequency of sexual intercourse, feelings for partner, sexual satisfaction with life partner, number partner's medical conditions and number partner's of medications. Conclusion: Female and partner's factors affected sexual function in climacteric women living with a partner.

CARDIOVASCULAR DISEASE EPIDEMIOLOGYP198DROSPIRENONE-ESTRADIOL ADMINISTRATION VERSUS PLACEBO: CLINICAL EFFECTS IN POSTMENOPAUSAL WOMEN

Russo Novella (IT)

Demetra Centro Medico, IT

Objectives: To evaluate the effect of low dose HRT on blood pressure, BMI, joint pain, vaginal lubrication and quality of life. Methods: Postmenopausal symptomatic women untreated with HRT in the previous 12 months were randomized to Calcium Carbonate (1200 mg/day) + Colecalciferol (800 U.I./ day) supplementation or to 17-Beta Estradiol (1mg/day) plus Drospirenone (2mg/day). Blood Pressure and BMI measurements, Quality of Life, joint pain and vaginal lubrication were evaluated before and after 12 weeks of treatment. Results: Quality of Life evaluated by the Women’s Health Questionnaire (WHQ) showed a significant improvement in the group of women treated with low dose HRT when compared to the calcium treated group. Joint pain as referred by patients was improved but did not reach the statistic significance. BMI was unchanged. Vaginal lubrication increased as referred by patients and confirmed by evaluating the vaginal cell maturation index. Women with high-normal systolic blood pressure (130–139 mmHg) showed a significant decrease while diastolic blood pressure values were unmodified. The calcium - vitamin D treated group showed no statistically significant improvement in all the parameters analized. Conclusion: Postmenopausal symptomatic women are responsive to treatment with E2-DRSP as confirmed by the positive effect on their Quality of Life but in particular, this treatment is to be considered the gold standard in situations of increased systolic blood pressure values from normal to high normal or in presence of a family history of hypertension.

P199VITAMIN D DEFICIENCY IS ASSOCIATED WITH HIGHER CARDIOVASCULAR RISK AS MEASURED BY FRAMINGHAM SCORE IN EARLY POST-MENOPAUSAL WOMEN: RESULTS FROM THE WOMEN'S HEALTHY AGEING PROJECT

Thawley David (AU)

Szoeke C.

Ames D.

Dennerstein L.

University of Melbourne, AU

Objective: Low levels of vitamin D are common amongst the Australian population. Ageing, post-menopausal women have increased susceptibility to vitamin D deficiency. Recently, vitamin D has been reported to be associated with increased cardiovascular risk. Cardiovascular disease is a leading cause of death the first world and is the primary cause of death in the elderly. This study report the profiles of vitamin D in a population of apparently healthy ageing Australian women aged 56–67 and examined vitamin D and cardiovascular risk as measured by Framingham score. Method: We performed a cross-sectional analysis of 263 women aged 56–67 from the Women's Healthy Ageing Project. Vitamin D levels were quantified by chemiluminescent assay using a Liaison automated system. Framingham score was calculated using measures obtained through a series of tests, interviews and questionnaires from this follow-up year. Multivariate regression analysis of vitamin D and 10 year Framingham risk score (the risk of experiencing an adverse cardiovascular event in the next 10 years) while adjusting for body mass index, physical activity, smoking status and age was conducted using SPSS statistical analysis software. Results: Low vitamin D status was associated with an increased Framingham risk score in a population of early post-menopausal women in univariate analysis. The association was maintained in multivariate regression analysis after adjustment for potential confounders (p = 0.023). Conclusions: In early post-menopausal women, low vitamin D was associated with higher cardiovascular risk as measured by Framingham score. This represents an increased chance for women that have low vitamin D status to experience an adverse cardiovascular event in the next 10 years.

P200FACTORS ASSOCIATED WITH THE ONSET OF HYPERTENSION IN WOMEN OF 50 YEARS OF AGE OR MORE IN A CITY IN SOUTHEASTERN BRAZIL

Machado Vanessa (BR)

Pinto-Neto A. (BR)

Valadares A.

Costa-Paiva L. (BR)

Souza M.

University of Campinas (UNICAMP), Campinas, São Paulo, Brazil, BR

Objective: To evaluate factors associated with the occurrence rate of systemic arterial hypertension in women of 50 years of age or more in a city in southeastern Brazil. Methods: A cross-sectional, population-based, self-report study involving 622 women. The association between sociodemographic, clinical and behavioral factors and the woman's age at the onset of hypertension was evaluated. Data were analyzed according to cumulative continuation rates (survival) without hypertension using the life-table method, considering annual intervals. Next, a Cox multiple regression analysis model was adjusted to analyze the occurrence rates of hypertension according to various predictor variables, with a 95% confidence level (p < 0.05), taking the sampling plan (primary sampling unit) into consideration. Results: In this sample, 55.9% of the women reported hypertension. Median age at onset of hypertension was 64.3 years. Cumulative continuation rate without hypertension at 90 years was 20%. Higher body mass index (BMI) at 20–30 years of age was associated with a higher cumulative occurrence rate of hypertension over time (coefficient = 0.078; p < 0.001). Being white was associated with a lower cumulative occurrence rate of hypertension over time (coefficient = -0.439; p = 0.003), while smoking > 15 cigarettes/day was associated with a higher rate over time (coefficient = 0.485; p = 0.004). Conclusion: Higher BMI at 20–30 years of age, not being white and smoking > 15 cigarettes/day were factors associated with a higher cumulative occurrence rate of hypertension in women aged ≥ 50 years.

P201ASYMPTOMATIC CORONARY EVENTS IN RELATION TO MENOPAUSE

Hosokawa Kumiko (JP)

Takata Y. (JP)

Kasamatsu Y. (JP)

Kato A. (JP)

Mitsuya K. (JP)

Kawano K. (JP)

Satomi H. (JP)

Fukuno N. (JP)

Kaneshima M. (JP)

Kamitani N. (JP)

Fukui-ken Saiseikai Hospital, JP

Objective: This retrospective study was aimed to estimate the onset age of coronary artery disease after menopause among Japanese women. Design and Methods: During 5 years starting from October 2008, 65 women with no history of coronary artery disease were enrolled and underwent both 64-slice coronary computed tomographic angiography (CCTA) and vascular function tests such as ankle- brachial index (ABI) and cardio-ankle vascular index (CAVI). They also underwent gynecological interviews and examinations to determine the menopause age individually. Three cases were eliminated because of the history of hysterectomy before menopause. Coronary stenosis and calcification were measured and evaluated by radiologists and an expert cardiologist. These findings were summarized according to the degree of lesion and the number of involved vessels, then categorized into 4 types, namely, “no abnormality”, “no trouble”, “observation”, and “need further examination”. Screening of peripheral atherosclerosis was defined as positive when the levels of either ABI or CAVI was over than basic standard. Results: Subjects were divided into 6 groups (A ˜ F) according to the years after their final menstrual period (FMP), that is, A: before FMP (n = 9), B: 0 ˜ + 4 years (n = 7), C: + 5 ˜ + 9 years (n = 16), D: + 10 ˜ + 14 years (n = 13), E: + 15 ˜ + 19 years (n = 9), F: + 20 or more years (n = 8). By CCTA analyses there were no women who needed observation or further examination in group A and B, while they were increasing in proportion in group C, D, E, F, as 12.5%, 7.7%, 33.3%, 62.5%, respectively. Atherosclerotic indicators revealed that there were no positive women in group A. The positive ratio was 14.3%, 25.0%, 23.1%, 11.1%, 62.5% in group B, C, D, E, F, respectively. Conclusion: Asymptomatic coronary events seem to arise 5 or more years after menopause.

P202ACUTE MYOCARDIAL INFARCTION ASSESSMENT AND ITS RISK FACTORS ASSOCIATED FOR 45 OVER AGE WOMEN AT CLÍNICA DÁVILA

Spichiger O.¹ (CL)

Cortez J.¹ (CL)

Osorio E.¹ (CL)

Montenegro L.¹ (CL)

Iglesias Luis¹ (CL)

Barrera V¹

Navarrete I¹

Ureta C¹

Ruiz M²

^cGynecology and Obstetrics Unit, Clínica Dávila, Santiago

^dSchool of Medicine, Universidad de los Andes, CL

Introduction: Coronary disease is the second leading cause of death among Chilean women, behind only strokes. Most of these deaths are due acute myocardial infarction (AMI). Mortality rates has reduced in the last decade, partly explained by a decrease in the incidence, the risk factor are being better controlled and/or better therapeutic use. The purpose of this study was to assess 45 over aged women with AMI and to determinate fatality and risk factors associated: hormone replacement therapy (HRT) use and lack of gynecological exam mainly. Method: Retrospective observational study to review all 45 years or older patients with AMI seen at Clínica Dávila Emergency Department from January 2010 to December 2012 Results: Average age was 71 years. Mortality rate is 8.8%. The most common risk factor was high blood pressure (HBP) (78.8%), smoking (35%), diabetes mellitus (29%), dyslipidemia (29%) and alcoholism (5%). Only 10 (12.5%) of the total number of patients were been regularly controlled and 2 of them (3.5%) used HRT. Conclusions: The AMI is an important pathology due its mortality. AMI is related with several risks factors, which must be controlled in order to prevent it. Only 3.5% of study group used HRT and it is therefore impossible to reach important conclusion concerning the relation between HRT and AMI.

P204EFFECTS OF A AGLYCONE-RICH FORMS BIOCONVERTED SOYBEAN EXTRACT ON ADHESION MOLECULES EXPRESSION, OXIDATIVE STRESS AND ENDOTHELIUM DERIVED FACTORS: NO, PROSTAGLANDIN AND ENDOTHELIN-1 ON HUMAN ENDOTHELIAL CELLS (HUVEC)

de Andrade C. (BR)

Bianchini F.

Rey F.

Fonseca M. (BR)

Toloi Maria Regina (BR)

Ribeirao Preto School of Pharmaceutical Sciences, BR

Oestrogen replacement therapy is no thought to be a safe treatment for prevention of cardiovascular disease in menopausal women; isoflavones exert anti-atherogenic effects and can be a possible alternative. The early stage of atherosclerosis is characterized by increased oxidative stress, and the expression of adhesion molecules (CAMs) on endothelium, that also produces nitric oxide (NO), a vasoprotective and anti-atherogenic agent. Therefore, compounds that suppress CAMs, reduce oxidative stress or increase NO production may be usable as therapeutic agents against the development of atherosclerosis in menopausal women. Isoflavones are present in soy foods mainly as glucosides. Soy isoflavone aglycones, the biological active estrogenlike compounds, are absorbed faster, in higher amounts and have a higher biological activity than their glucoside derivatives, implying that isoflavone aglycone-rich products may be more effective than the ones rich in glycosides in preventing atherosclerosis. Objective: To evaluate the effects of a soybean extract fermented by Aspergillus awamori (a β-glucosidases-producing fungi) on which glucosides were bioconverted to aglycone forms on CAMs expression (VCAM-1, ICAM-1 and E-selectin), H2O2 induced oxidative stress and NO, prostaglandin E2 (PGE2) and endothelin-1 (ET-1) in vitro on human endothelial cells (HUVEC) and compare it with a non-fermented extract. Results: Bioconverted and non-fermented soybean extracts supressed CAMs expression, reduced oxidative stress and increased ET-1, but the unfermented extract wasn’t able to increase NO and PGE2 production. Conclusion: Only the aglycone-rich soybean extract was able to reduce CAMs expression and oxidative stress, and to increase NO and PGE2 production, demonstrating that in HUVECs, in vitro, may be usable as therapeutic agents against the development of atherosclerosis.

CARDIOVASCULAR DISEASE CLINICAL RESEARCHP207EARLY MENARCHE IS ASSOCIATED WITH MYOCARDIAL INFARCTION AT YOUNGER AGE

Otten Amber M (NL)

Ottervanger J.

Drost J. (NL)

Kloosterman A.

van der Schouw Y.

Maas A.

Isala Klinieken, NL

Objective: There is increasing evidence that hormonal status is important in ischemic heart disease in women. It is yet unclear whether age of menarche is associated with early manifestation of ischemic heart disease. We assessed the association between age at menarche and age of ST Elevation Myocardial Infarction (STEMI). Methods: From 1998 until 2010 data from all consecutive women with STEMI were collected. Reproductive information was obtained in 770 women with age at STEMI < 75 years. Younger age of STEMI was defined as STEMI below 60 years. Age at menarche was categorized as ≤ 12 years, 13 years, 14 years and ≥ 15 years. Results: Mean age of the study population was 59 years. Compared to women with a later menarche, women with an earlier menarche smoked more often (p = 0.02). All other classical risk factors for cardiovascular disease were comparable. After both unadjusted and multivariable analysis, women with a lower age at menarche had a higher probability of STEMI at younger age, with the adjusted OR 2.4 (95% CI 1.3–4.5) for menarcheal age < 12 years as compared to menarcheal age ≥ 15 years. Conclusions: Women with early menarche have an independently increased risk of STEMI at younger age. More insights into the underlying mechanisms is warranted.

P208WHAT IF THE WOMEN'S HEALTH INITIATIVE (WHI) HAD JUST USED TRANSDERMAL ESTRADIOL AND ORAL PROGESTERONE INSTEAD?

Simon James (US)

George Washington University, US

Objective: To reanalyze and ascertain the primary outcomes from the hormone therapy arm of the WHI by imputing data from the scientific literature on the risk of these primary outcomes had non-oral estradiol (i.e. transdermal), and oral micronized progesterone been utilized in the clinical trial. Design: Utilizing validated statistical approaches, hypothetical comparisons between oral conjugated equine estrogens and transdermal estradiol, and between oral medroxyprogesterone acetate and oral micronized progesterone for their effects on four primary outcomes of the WHI: cardiovascular disease (CVD) risk, cerebrovascular disease risk (stroke), venous thromboembolism (VTE) risk, and breast cancer (BrCA) risk were derived to ascertain the relative risk (RR) and population attributable risk (PAR). Results and Conclusion: This reanalysis of the WHI data suggests that women treated with transdermal estradiol (instead of CEE) and with oral MP (instead of MPA) would have fared better with regard to CVD risk, stroke risk, VTE risk, and BrCA risk. Although low to begin with, CVD and stroke risks particularly in women in their 50s would have been mitigated or eliminated by switching from CEE to transdermal estradiol. BrCA risk would have been reduced to untreated levels if women had used MP instead of MPA. Among the risk factors analyzed, VTE risk (the greatest risk for early postmenopausal women) illustrated the most significant benefits in both relative risk (RR) and population attributable risk (PAR). A prospective RCT would be the best method for confirming the outcomes calculated here.

P209HOW MENOPAUSAL STATUS INFLUENCES HEMODYNAMIC AND BIOCHEMICAL PARAMETERS IN DIABETIC WOMEN AND NORMAL CONTROLS

Shargorodsky Marina (IL)

Wolfson Medical Center, IL

Introduction: Advancing age and estrogen withdrawal mediate arterial stiffening leading to the development of vascular disease, especially in diabetic women. The present study was designed to evaluate the effect of aging, estrogen withdrawal and presence of type 2 diabetes on arterial stiffness, as well as on metabolic and inflammatory parameters. Methods: In the present study 186 women were divided into 3 groups: Group 1 included premenopausal women without type 2 diabetes, Group 2 included postmenopausal women without diabetes and Group 3 included postmenopausal diabetic women. Blood glucose, HbA1C, insulin, lipids, CRP, HOMA-IR, aldosterone and renin were measured. Pulse wave velocity (PWV) and augmentation index (AI) were performed using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia). Results: PWV and AI values increased from Group 1 to Group 3 in a continuous fashion. Postmenopausal women with and without diabetes exhibited significantly increased AI compared to premenopausal women without diabetes, (p < 0.0001 and p < 0.0001, respectively). Postmenopausal women without diabetes had significantly higher AI compared to premenopausal non diabetic women (p < 0.0001). PWV was significantly higher in postmenopausal women with DM (Group 1), than in Group 2 and 3 (p = 0.007 and p = 0.002, respectively). Conclusions: Postmenopausal women had significantly higher AI compared to premenopausal at the same age. Combination of diabetes and postmenopausal status was associated with further deterioration in terms of AI and PWV independently of age and presence of other cardiovascular risk factors.

P210IDENTIFICATION OF ACE I/D POLYMORPHISM IN MEXICAN WOMEN

Lugo-Martínez Gabriela (MX)

Hernández-Caballero M.

Calzada-Frías J.

Navarro-Pineda D.

Ocharán-Hernández M.

Jiménez-Zamarripa C.

Linares-Pérez M.

Calzada-Mendoza C.

Instituto Politécnico Nacional-ESM, MX

Angiotensin –Converting Enzyme is in charge of producing angiotensin II and regulates blood pressure. The gene responsible for enzyme expression has three different genotypes: D/D, I/D and I/I, based in the presence or absence of 287 base pair. ACE I/D polymorphism has been associated with cardiovascular diseases, which become more important after menopause. Objective: Identify the genotype of ACE I/D polymorphism in Mexican women. Methods: Sixty Mexican women were included and divided into two groups: premenopausal and postmenopausal. We evaluated clinical data, hormonal profile, arterial tension, anthropometric parameters, glucose and polymorphisms were identified by real-time PCR. Results: In premenopausal women we found 45.15%, 41.93% and 12.9% for genotypes I/D, D/D and I/I, respectively. In post-menopausal women the distribution was as follow; 45.7% (I/D), 40% (D/D), 14.28% (I/I). The body Mass Index (BMI) average in premenopausal women was the following: 29.24, 28.84 and 24.75 kg/m² for D/D, I/D and I/I, respectively. Waist/hip (W/H) ratio average was, D/D (0.86), I/D (0.92), I/I (0.83). In postmenopausal women the BMI average was 29.33 Kg/m² in D/D genotype, 26.89 I/D, 26.78 I/I. (W/H) average 0.845 in D/D, 0.849 I/D and 1.04 I/I, On the other hand, in premenopausal the glycemic average was 92.6, 114.5 and 72.5 mg/dL (D/D, I/D and I/I). In post-menopausal women, the means glycemic were 111 in D/D, 113.45 in I/D, and 81.6 in I/I mg /dL. Finally, Mean Arterial Pressure (MAP) in premenopausal was 90.8 for D/D, 91.25 for I/D, and 81.5 mmHg for I/I genotype; but, in post-menopausal was 90.30 in D/D, 91.2 in I/D, and 84 in I/I mmHg. Conclusions: In both groups genotypes I/D and D/D are present in hypertensive women and were in relationship to higher BMI and W/H index.

P211ANTIOXIDANTS EFFECTS OF TIBOLONE

Lugo-Martínez Gabriela (MX)

Del Moral-Laguna E.

Fernández-Hernández S.

Olivares-Corichi I.

Jiménez-Zamarripa C.

Linares-Pérez M.

Calzada-Mendoza C.

ESM-Instituto Politécnico Nacional, MX

During menopause many metabolic and biochemical chances occurs, for example there is an elevation of oxidative stress; on the other hand the replacement hormone therapy reduces the symptoms and signals of menopause, but with respect to Tibolone there is no evidence about its antioxidant effects. Objective: To associate the antioxidants effects of tibolone with the reduction of in vitro-formation of polymers of insulin and decrease of mild cognitive impairment in postmenopause women Methods: In the present work were carried out two studies with tibolone by 3 months, first: insulin was incubated in whole blood, under nondenaturing electrophoresis and was visualized polymers of the hormone, second: the cognitive function was evaluated through Neuropsy test. In both cases, the damage to lipids and total sulfhydryls, were measured. The adherence to the treatment was applied the Green Scale. Results: At the first study, we found that tibolona reduced the formation of polymers, and the MDA concentration (from 12.1 ± 0.96 nM/ml to 9.8 ± 0.57nM/mL), increased SH from 0.87 ± 0.18 nM/mg to 1.8 ± 0.36 nM/mgL; with respect second work, tibolona reduced MDA/4HNE from14.034 ± 1.66 nM to 8.78 ± 1.360, and increased the score in Neuropsy test. In both cases, after three months of treatment Conclusion: Oxidative stress is increased in postmenopausal women. Tibolone reduced the formation of insulin polymers and mild cognitive impairment.

HORMONES AND THROMBOSISP212ETHINYLESTRADIOL AND ESTRADIOL PROTECT VEIN ENDOTHELIAL CELL DAMAGE GENERATED BY OXIDATIVE STRESS

Rey Fernand (BR)

FMRP, BR

The regulation of homeostasis is performed by an appropriate combination of the vascular endothelial and the bood flow. Combined oral contraceptives (COCs) demonstrate a positive association with endothelial injury increasing the risk of pro-thrombotic events.Endothelial injury is directed associated with oxidative stress, increasing the production of free radicals and reactive oxygen species (ROS) such as hydrogen peroxide (H₂O₂). However, is necessary to induce an imbalance between ROS production and the decrease of antioxidant defenseThe intent of this work is to study the protect effect of EE and E2 against the oxidative stress using HUVEC model.The HUVEC cells were culture in EBM2 medium until complete confluence than were pretreated for 24 hours with 20 and 40, 125 and 150 pg/mL of EE; and 100, 300 and 600 pg/mL of E2. Cell viability was measured using the MTT assay. At the end of incubation the supernatant was discarded and insoluble formazan crystals were dissolved in 100 μl DMSO. The optical density at each well was measured in spectrophotometer at 570nm. For the oxidative stress test the cells were exposed to 2,5 mmol H₂O₂/L for one hour. Further, washed with PBS, added 180 μl EBM-2 medium and 20μl of MTT solution than the cell were incubated for 4 hours at 37°C in 5% CO₂. Cells not exposed in H₂O₂ were incubated in the same conditions as treated. At the end of incubation the experiment was conducted as mentioned previously. Statistical data were obtained by ANOVA with Tukey post test.Completion of Experiments: Isolated drugs (EE, E2, CMA) and DMSO does not induce cell death. All tested drugs were able to protect against cell damage by oxidative stress generated compared to the control death. As drugs E2 (300 and 600 pg/ml) and chlormadinone acetate (2000 pg/ml) were able to efficiently protect against oxidative stress, similar to the control of life.

OTHER CARDIOVASCULAR TOPICSP213COST-EFFECTIVENESS ANALYSIS OF A YEARLY HYPERTENSION SCREENING IN WOMEN WITH A HISTORY OF PRE-ECLAMPSIA

Drost J. (NL)

Maas Angela (NC)

Grutters J.

Schouw Y.

UMC Radboud Nijmegen, NL

Purpose: Women with a history of preeclampsia (PE) are at increased risk for future cardiovascular disease (CVD). Until now it is not clear when and how prevention is needed in these high risk women. In the present study we evaluated the cost-effectiveness of a simple screening strategy in women post PE. Methods: A decision-analytic Markov model was constructed to evaluate costs and effects of screening for hypertension in women post PE. Screening consisted of a postpartum yearly blood pressure measurement during a timeframe of 20 years. Cardiovascular events and CVD mortality were defined as health states. Outcomes were measured in absolute costs, life-years and quality- adjusted life-years (QALYs). Results: Screening for hypertension provides an expected saving of €1,199 per person and an increment of 0.03 QALY over 20 years. Threshold analysis demonstrates a maximum cost of the screening strategy of €167 per year. Conclusion: Yearly blood pressure screening in women with a history of PE is less expensive and more effective in preventing future CVD than current standard care.

P215HORMONE THERAPY IS NOT ASSOCIATED WITH CORONARY ARTERY CALCIFICATION IN PRE-, MENOPAUSE TRANSITION AND POST-MENOPAUSAL WOMEN

Oppermann Karen (BR)

Colpani V.

Ambrós G. (BR)

Spritzer P.

Medicine School of Universidade de Passo Fundo and São Vicente de Paulo Hospital, Passo Fundo, RS, Brazil., BR

Introduction: Coronary artery calcification (CAC) is a marker of coronary plaque burden and is associated with risk of adverse cardiovascular outcomes. Objectives: The aim of this study was to assess whether clinical variables are associated with CAC in pre-, menopause transition and post-menopausal women. Design and methods: this study is part of a longitudinal population-based study of menopausal status, including 295 women in the city of Passo Fundo, Southern Brazil. The first examination was completed in 1996 and the present study was performed between 2010 and 2011. Demographic and clinical variables were obtained by questionnaires and anthropometric and metabolic profile was evaluated. Habitual physical activity was assessed by pedometer. CAC was measured by computed tomography and we used the average Agatston Score. Calcification was considered present if participant had CAC > 0 and absent if CAC = 0. Results: Women presenting CAC > 0 (34.7%) were older (58.7 ± 5.4 versus 56.3 ± 5.2, p < 0.001), had higher prevalence of central adiposity (71 versus 59%, p = 0.04), hypertension (71 versus 52%, p = 0.002) compared to CAC = 0. Smoking, physical activity, educational level, menopausal status, BMI, diabetes and alcohol intake did not differ between the groups. Hormone therapy (HT) was more prevalent in the group of CAC = 0 (19.7 versus 9.8%, p = 0.029). Prevalence ratios for presence of CAC, obtained by general linear models and adjusted for age, educational levels, smoker, alcohol intake, physical activity were: HT: 0.545 (CI:0.309–0.962, p = 0.036); hypertension: 1.752 (CI:1.207–2.541, p = 0.003); waist-to-hip ratio 1.364 (CI:0.951–1.955, p = 0.092). Conclusion: in this population-based sample of pre-, menopause transition and post-menopause women, HT was associated with protection for CAC and hypertension with risk for CAC, independently of age.

P216EFFECT OF ESTRADIOL/PROGESTIN THERAPY COMBINED WITH STATIN THERAPY ON CARDIOVASCULAR RISK FACTORS IN POSTMENOPAUSAL WOMEN WITH KNOWN CORONARY HEART DISEASE

Ruan Xiangyan (CN)

Mueck A. (DE)

Müller S.

Seeger H. (DE)

Hanke H.

Department of Gynecological Endocrinology, Beijing Ob/Gyn Hospital; Capital Medical University, Beijing, CN

Objectives: Statins play an important role in the secondary prevention of coronary heart diseases. Combined hormone therapy in the postmenopause may not reduce the risk of coronary heart disease although favourite effects on lipid parameters have been shown. In the present study the combination of estrogen/progestin plus statin therapy was investigated in comparison to a statin monotherapy. Patients and methods: Twenty postmenopausal women with known coronary heart disease were included in this study. The patients received either Locol^® combined with Merigest^® or Locol^® alone in a randomised cross-over study design. Blood flow measurement was conducted before, after 6 weeks’ and after 12 weeks of treatment. Urinay vasoactive parameters (cGMP, metabolites of prostacyclin and thromboxane) and serum parameters (lipids, P-selectin, ICAM-1, MCP-1 and homocysteine) were also measured basal and after 6 and 12 weeks of treatment. Results: Mean age of the patients was 62.3 years (SD 6.6). In the intention-to-treat analysis no significant difference was found in terms of blood flow measurements. A significant difference in total-Chol and LDL was found between both treatment groups favouring the hormone/statin group (p < 0.001), whereas no significant differences were found for LDL, HDL and Lp (a). For the vasoactive surrogate marker in serum and urine no significant differences between both treatment groups were observed. Conclusions: Combined hormone/statin therapy may have beneficial effects on cardiovascular risk factors beyond the effect of a statin monotherapy. However it is very difficult to assess as to whether the observed benefits of a hormone/statin therapy elicit a significant influence on the risk of coronary heart disease.

P217ASSOCIATION BETWEEN WAIST CIRCUMFERENCE AND CARDIOVASCULAR RISK IN HYPERTENSIVE, DYSLIPIDEMIC AND OVERWEIGHT POSTMENOPAUSAL WOMEN

Vílchez Barboza Vivian (CL)

Salazar A. (CL)

Paravic T. (CL)

Universidad de Concepción, CL

Objective: To assess the association of waist circumference with cardiovascular risk factors in hypertensive, dyslipidemic and overweight postmenopausal women. Methods: A cross-sectional and correlational study, enrolling 61 hypertensive, dyslipidemic and overweight postmenopausal women, receiving benefits from the public health care in Concepcion, Chile. Exclusion criteria included: diabetes, metabolic syndrome, cancer, chronic obstructive pulmonary disease, hypothyroidism, hyperthyroidism, ischemic heart disease, cerebrovascular accident, dementia and alcoholism. Anthropometric indicators: age, body mass index (BMI), and waist circumference (WC). Metabolic profiles as: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), atherogenic index of plasma (AIP) and the TC/HDL ratio. Systolic and diastolic blood pressure. Estimated coronary heart disease (CHD) was calculated. Descriptive and correlational statistics were used to process data, p < 0.05 were considered to indicate statistical significance. Ethics requirements were incorporated. Results: On average aged 58 years, 100% do not use HRT, on average BMI 28 (DS 1.5). On average, TC, LDL,TG and TC/HDL ratio levels were higher than recommended in 36.1, 55.7, 16.4 and 4.9% of the women respectively, and HDL was low in 8.2%. Values of WC > 82 cm were observed in 93.4% of women. On average, systolic and diastolic blood pressure were higher than recommended in 32.8, 60.7% of the women respectively. 100% women showed low CHD. A statistically significant correlation was found between BMI, AIP and TC/HDL ratio with WC at the 0.05 significance level. Conclusions: In the hypertensive, dyslipidemic, overweight postmenopausal women, the measure WC are associated with BMI, AIP and TC/HDL ratio. It is important to evaluate WC in postmenopausal women.

P219ARTERIAL HYPERTENSION IN CLIMACTERIC AND MENOPAUSE WOMAN. ITS ASSOCIATION WITH THE CLIMACTERIC SYNDROME AND ATHEROSCLEROSIS RISK FACTORS

Navarro D. (CU)

Botell M. (CU)

Napoles Miguel (CU)

CIMEQ, CU

Objective To identify the relationship between arterial hypertension and atherosclerosis frisk factors in middle aged women: Material and methods: Cases and controls in four doctor's offices of the Educational Policlinic “26 of July”. In each doctor's office, under the patients’ previous informed consent, the study started from the medical dispense registration with all the essential hypertension reports, ranging from the ages of 40 to 59 years, in the period of time comprising form February 1st, 2012 to April 30, 2012. For the comparative study for each hypertensive woman a normotense one was selected of same age and color of apparent skin. As exclusion criterion, the following was established: to exclude diabetic women, with renal complications or of the central nervous system, with the purpose of avoiding to incorporate hypertensive women of secondary character, as well as not to include those women with artificial menopause. We study the following variables age, values of arterial pressure, nutritional valuation according to body weight index, smoking habit, performance or not of systematic physical exercises and manifestations of the climacteric syndrome. Results: It was concluded that in hypertensive women there is higher frequency of overweight, obesity and tabaquism, with significant differences between both groups, as well as of sedentarism, and the manifestations of the climacteric syndrome were more frequent in the hypertensive ones. The figures of arterial pressure were higher in the women with menopause already established than in the rest of the population as study object. In spite of the hypertensive women being medicated and treated, many had high values of arterial tension over the controls, what constitutes a diagnose contribution to this investigation.

HEADACHEP221MENSTRUAL MIGRAINE AND PERIMENOPAUSE: REVIEW AND PROPOSITION FOR HORMONAL MANAGEMENT

Pinas Ingrid Md Phd FECSM (NL)

Franke H.

Couturier E.

ZBC FeM-poli Zwolle, NL

Menstrual migraine is a disabling disorder complicating the lives of approximately 3% of women in the Netherlands i.e. an estimated 500.000 suffering on a monthly basis. Attacks of menstrually related migraine usually have no aura, last longer and may be accompanied by more severe pain, nausea, vomiting and functional disability compared to non-menstrual migraine. They may also be more resistant to regular acute and prophylactic migraine treatments. Hormonal changes especially estrogen withdrawal in the luteal phase of the menstrual cycle, after pregnancy and during the perimenopausal period are thought to initiate these migraines. Cyclic use of combined oral contraceptives (COC) has also been related to menstrual migraine. Perimenopause with increasingly irregular and unpredictable menstrual cycles, has been associated with worsening or change in migraine patterns.Traditionally general practitioners and neurologists treat migraines whereas gynaecologists are more specialized in prescribing hormone treatments. Concerns of increased risk of stroke limit prescription of COC to migraineurs. Menopausal hormonal therapy (MHT) especially by non-oral routes of administration can result in substantial remission of headaches in perimenopausal women. At present evidence-based recommendations for hormonal management of perimenopausal migraine are lacking. Recent global consensus on MHT emphasized benefits to more likely outweigh risks for symptomatic women before the age of 60 years or within 10 years after menopause. Observational studies point to a lower risk of venous thromboembolism and ischemic stroke with transdermal therapy. Further study to improve management of perimenopausal migraine combining acute and prophylactic migraine treatments with the lowest MHT dose for effective control of menopause symptoms and based on updated international consensus on MHT is proposed.

SLEEP AND SLEEP DISORDERSP222THE RELATIONSHIP BETWEEN MOOD AND SLEEP IN DIFFERENT FEMALE REPRODUCTIVE STATES

Polo-Kantola Päivi (FI)

Toffol E. (FI)

Kalleinen N.

Partonen T.

Turku University Hospital, Turku, Finland, FI

Background: Sleep is disrupted in depressed subjects; it also deteriorates with age and the transition to menopause. The nature of the inter-relationship between mood, sleep, age and reproductive state is not well-defined. Our aim was to evaluate the relationship between mood and sleep among healthy women in different reproductive states. Methods: We analyzed data from 11 young (20–26 years), 21 perimenopausal (43–51 years) and 29 postmenopausal (58–71 years) women. Mood was assessed with the Beck Depression Inventory (BDI) and subjective sleep with the Basic Nordic Sleep Questionnaire (BNSQ). Objective sleep was measured with all-night polysomnography recordings. Results: Among young women, less arousals associated with higher BDI scores (p = 0.026), and higher SWS percentages with more dissatisfaction (p = 0.001) and depressive-somatic symptoms (p = 0.025), but less depressive-emotional symptoms (p = 0.001). Less awakenings from REM sleep or SWS, respectively, associated with more punishment (p = 0.005; p = 0.036), dissatisfaction (p < 0.001; p = 0.001) and depressive-somatic symptoms (p = 0.001; p = 0.009), but less depressive-emotional symptoms (p = 0.002; p = 0.003). In perimenopausal women, higher BNSQ insomnia scores (p = 0.005), lower sleep efficiencies (p = 0.022) and shorter total sleep times (p = 0.024) associated with higher BDI scores, and longer sleep latencies with more depressive-somatic symptoms (p = 0.032). In postmenopausal women, higher REM percentages associated with higher BDI scores (p = 0.019) and more depressive-somatic symptoms (p = 0.005), and longer SWS latencies with more depressive-somatic symptoms (p = 0.030). Conclusions: Depressive symptoms measured with the BDI scores associated with sleep impairment in perimenopausal and postmenopausal women. In young women, specific BDI factors revealed minor associations, suggesting different types of sleep impairment in relation to different depressive features. Keywords: depressive; menopause; perimenopause; polysomnography; postmenopause; reproduction; sleep stage; women.

P223SLEEP IN MIDLIFE WOMEN: THE EFFECT OF MENOPAUSE, VASOMOTOR AND DEPRESSIVE SYMPTOMS

Lampio Laura (FI)

Polo-Kantola P. (FI)

Polo O.

Kauko T.

Aittokallio J.

Saaresranta T.

University of Turku, FI

Objective: This study aims to evaluate subjective sleep quality in premenopausal and postmenopausal women, and to study its association with night sweats, hot flashes and depressive symptoms. Methods: A total of 158 healthy women were recruited, of which 107 were premenopausal (44–48 years) and 51 postmenopausal (53–58 years). Sleep quality was evaluated with the Basic Nordic Sleep Questionnaire, night sweats and hot flashes with a specific symptom questionnaire and depressive symptoms with the Beck Depression Inventory. Results: Postmenopausal women had poorer general sleep quality (P < 0.001), they slept more restlessly (P = 0.020) and had more nocturnal awakenings (P = 0.015). However, the frequency of difficulties falling asleep, snoring, witnessed apnea or use of sleep medication was similar between the groups. Further, sleep latency, morning or daytime tiredness did not differ between the groups. Postmenopausal women did not report more unintentional fallings asleep at work or at leisure time, but when not active they doze off more easily than premenopausal women (P < 0.001). Postmenopausal women had more night sweats (P < 0.001), hot flashes (P < 0.001) and depressive symptoms (P < 0.001). Even low frequency of night sweats disturbed sleep in postmenopausal women, whereas in premenopausal women only frequent night sweats were disturbing. Depressive symptoms disturbed sleep regardless of menopausal state. Conclusion: Postmenopausal women perceive that their sleep is more restless, and more disturbed due to awakenings and night sweats. Initiation of sleep and daytime performance are not in general affected by menopause.

P224SLEEP DISORDERS IN HEALTHY POSTMENOPAUSAL WOMEN ARE NOT MAINLY RELATED TO HOT FLASHES

Llaneza Placido (ES)

Mendoza N.

Manubens M.

Coronado P. (ES)

Navarro C.

Bayo A.

Sanchez-Borrego R.

AEEM, ES

Sleep disturbance is a symptom manifestation of the menopause transition and sleep problems after menopause has been often related with hot flushes, but the relative the impact of other important conditions that disrupt sleep are less known [1]. We carried out a cross-sectional study in a sample of 180 caucasian healthy postmenopausal women, aged 48–68 years, with sleep disturbances diagnosed by Oviedo Sleep Questionnaire [2]. Thirty seven per cent of women were obese and 49% has abdominal circumference (AC) higher than 88 cm. Menopausal changes was related to sleep disturbances by 75 (41.6%) women, but only 15 (8.3%) women revealed vasomotor symptoms as the main cause of sleep disturbance. Other factors that women did not related with menopausal changes as urinary frequency (33.3%), daytime distress (8.9%), snoring o noisy pollution (8.9%), muscle or joints aches (6.1%), and sleep apnoea (1.1%) were observed. Serum mean values of BMI, AC, Cholesterol, LDLc, Triglicerides, SHBG or Vitamin D were not statistically different in women with sleep disturbances associated to menopausal changes than in the rest of the sample. Sedentary lifestyle, and other modifiable lifestyle factors were common. Conclusion: Sleep-disturbances are highly prevalent among healthy postmenopausal women and other physical and mental problems different from vasomotor symptoms must be considered as sleep disruptors.

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P225OXIDATIVE STRESS IN POSTMENOPAUSAL WOMEN WITH SLEEP DISORDERS

Suturina Larisa (RU)

Kornakova N.

Kolesnikova L.

Madaeva I.

Solodova E.

Scientific Center of Family Health and Human Reproduction Problems, RU

Objectives: to study the state of lipid peroxidation and the antioxidant system in postmenopausal women with sleep disorders. Materials and methods: we examined 57 postmenopausal women: 34 patients with sleep disorders (the 1st group) and 23 women were classified as controls (without sleep disorders) (the 2nd group). All patients were of a similar age (56,8 ± 3,1 in the 1st group and 55,1 ± 3,0 years old - in the 2nd). There were no significant differences in clinical characteristics between groups. The measurements of substrates and products of lipid peroxidation (diene conjugates, TBARs) and components of the antioxidant system (α-tocoferol, retinol, reduced glutathione, oxidized glutathione) were made in plasma of the blood and red cells by spectrofluorofotometer methods. We applied the coefficient of oxidative stress that represented ratio of lipid peroxidation products to general antioxidative blood activity (normally it is 1). Statistical analysis was performed by non-parametric tests. Results. It was shown the increasing of substrates for lipid peroxidation of 45%(p < 0,05), diene conjugates of 50% (p < 0,05) and TBARs of 30% (p < 0,05) levels in postmenopausal women with sleep disorders compared to control group. There were no significant differences in α-tocopherol, retinol, reduced glutathione and oxidized glutathione levels between groups. The coefficient of oxidative stress was increased (4,1) due to disbalance between free radicals and antioxidant activity in women with sleep disorders. Conclusion. Our study demonstrated the relationship between oxidative stress and sleep disorders in postmenopausal women.

P226EVALUATING SLEEP DISTURBANCE IN MID-AGED WOMEN WITH THE JENKINS SLEEP SCALE

Pérez-Roncero G. (ES)

Ornat-Clemente L. (ES)

Chedraui P. (EC)

Pérez-López Faustino (ES)

Universidad de Zaragoza, ES

The objective of this investigation is to assess sleep disturbance and related factors among mid-aged women. A total of 288 women (40–59 years) completed the Jenkins Sleep Scale (JSS), the 12-item General Health Questionnaire (GHQ-12), the Menopause Rating Scale (MRS) and a general socio-demographic questionnaire containing female and partner data. Median [interquartile range] age of the whole sample was 47 [8] years. A 62.2% of women were rural residents, 21.2% were postmenopausal, 20.1% were receiving psychotropic drugs, 64.2% had abdominal obesity (waist > 88 cm), and 9.7% reported intimate violence. A 12.8% had an abnormal GHQ-12 score (total score ≥ 3) whereas 14.4% had severe menopause-related symptoms (total MRS score ≥ 17). The prevalence of disturbed sleep (JSS score ≥ 12) was 37.5%. JSS scores displayed significant differences in relation to menopausal status, presence of stress urinary incontinence, use of psychiatric treatment, intimate partner violence, self-perception of healthiness, and partner factors (perception of healthiness, educational level, and regular exercise). Higher JSS scores (disturbed sleep) positively correlated with GHQ-12 and MRS scores, number of co-morbid conditions, body mass index, and female and partner age. Multiple linear regression analysis found that JSS scores correlated positively with somatic MRS scores and with intimate violence, and inversely with partner educational level (r2 = 0.375, p < 0.05). It can be concluded that in this mid-aged female sample, disturbed sleep was related to somatic menopause-related symptoms, intimate violence and partner educational level.

P227ASSOCIATION BETWEEN BAD SLEEP QUALITY AND UROGENITAL DYSFUNCTION IS INDEPENDENT OF MENOPAUSAL STATUS IN PERUVIAN MIDDLE AGE WOMEN

Mezones-Holguin Edward (PE)

Huamani C. (PE)

Laribezcoa F. (PE)

Hernández A. (PE)

Perez-Lopez F. (ES)

Chedraui P. (EC)

Blumel J. (CL)

Instituto Nacional de Salud and Universidad Peruana de Ciencias Aplicadas, PE

Background: Bad sleep quality (BSQ) increases during the climacteric period; however the potential impact produced by urogenital dysfunction (UD) on BSQ has been poorly studied in Latin America. Aim: To evaluate the association between BSQ and UD in suburban middle age women. Methods: We carried out a cross sectional study in women aged 40 to 59 years in a deprived area in Piura, Northern Peru. We used the Pittsburgh Sleep Quality Questionnaire and Menopausal Rate Scale to assess the BSQ and UD, respectively. Menopausal status was categorized according Stages of Reproductive Aging Workshop. We used Generalized Lineal Poisson Models with robust variance for calculating 95% CI prevalence ratio (PR). Results: 449 women were included: 114 (25%) perimenopausal and 190 (42%) postmenopausal. 211 (47%) had BSQ and 153 (34.1%) had UD. Crude analysis showed that BSQ is associated with UD (PR: 1.85, 95% CI: 1.53–2.22), anxiety, depression, coffee consumption, smoking, body mass index, perimenopausal and postmenopausal status. Adjusted regression models showed that BSQ and UD are associated (PR:1.53, 95% CI:1.28–1.82) and there was no effect modification by menopausal status (p for interaction > 0.2). Conclusion: The association between BSQ and DU is independent of menopausal status and other clinical and demographic factors. Our findings contrast with other studies, in which somatic and psychological distress have a main role on sleep disturbances. These results suggest that sleep disorders require particular considerations for their management according to the specific population evaluated.

DEPRESSIONP228THE ASSOCIATION BETWEEN VASOMOTOR SYMPTOMS AND DEPRESSION DURING PERIMENOPAUSE: A SYSTEMATIC REVIEW

Worsley Roisin (AU)

Bell R. (AU)

Kulkarni J.

Davis S. (AU)

Monash University, AU

Aim: There is a high incidence of depression in women presenting to menopause clinics. The aim of this review was to determine if there is an association between depressive symptoms or major depressive disorder (MDD) and vasomotor symptoms (VMS). Methods: A systematic review of the literature was conducted according to PRISMA guidelines. Ovid Medline, EMBASE, CINAHL and PsychInfo were searched using combinations of the following terms: hot flashes, hot flushes, night sweats, vasomotor symptoms, depression, mood disorders, depressive disorders, climacteric, menopause, perimenopause, menopause transition, cohort studies, epidemiological studies, cross sectional studies, longitudinal studies, retrospective studies, prospective studies. After combining search terms the following limits were used: human, female, English language. RESULTS: 33 relevant publications were found, 12 from three large studies. Overall, we found a bidirectional association between VMS and depressive symptoms. This has been established in well conducted, large cross-sectional and cohort studies. There does not appear to be a relationship between VMS and MDD. However, studies examining VMS and MDD were prone to bias. Conclusion: During perimenopause there is a positive, bidirectional association between VMS and depressive symptoms. There does not appear to be an association between VMS and clinically diagnosed MDD but methodologically sound studies are needed to confirm this finding.

P229ANXIETY AND DEPRESSIVE DISORDERS IN MENOPAUSAL WOMEN

Tabolina Anna (BY)

Baikova I.

Dashkova I.

Belarusian Medical Academy of Post-Graduate Education, BY

Aim: to investigate the prevalence of anxiety and depressive disorders in menopausal women and identify factors influencing a woman's vulnerability to depression during the transition to menopause. Methods: this was a cross sectional study. The study was conducted on the basis of the advisory office of climax pathology of Minsk City Gynecology Hospital, Belarus from December 2012 to November 2013. The main group of the respondents consisted of 95 women aged 38–55 years with anxiety and depressive symptoms, residing in Minsk. The comparison group consisted of 68 women from Minsk with a normal course of climacteric without psychopathology. Compared groups are comparable in obstetric and gynecological history, extragenital pathology and other epidemiological characteristics. For each woman there was created an individual list of the survey, in which was introduced data reflecting the conditions of life, features of development of the female body. During the interview, four questionnaires were applied: Spielberg-Hanin's scale for anxiety diagnosis; Beck’s Depression Inventory for the diagnosis of depression; The Utian Quality of Life (UQOL) to assess quality of life. Results: Rates of depression, anxiety, restlessness were 6 times higher at women with climacteric syndrome manifestations than in the group of women with a normal course of menopause. It should be noted that at 61.3% of women identified disorder were marked at perimenopause. 68.4% of women in the target group had low quality of life, in the comparison group − 11.7%. It was noted that the risk of anxiety and depressive disorders was increasing at those women who had had various vegetative dysfunction (p = 0,00002) in childhood or adolescence, trauma (illness of loved ones or parents’ divorce ) in childhood (p = 0,01004), as well as those women who were born of mothers with abnormal pregnancy (early toxicosis, late gestosis,threatened abortion). Premenstrual syndrome prior to entry into the period of menopause was observed in 70% of women with climacteric syndrome, in the second group of women this index was 30%. Various sexual dysfunctions were found at (86.3%) women with climacteric syndrome manifestations. For most of them sexual dysfunction was a distressing factor. Conclusions: Taking into account the data of preliminary study, we may conclude that the high frequency of anxiety and depressive disorders in menopausal women, especially in perimenopause. That causes the need for timely specialized psychiatric and psychological assistance. More than a half of the women in the main group have a low quality of life, which may indicate a lack of adaptation to this critical period of life of women. Variety of factors influencing the development of anxiety and depressive symptoms in menopausal women makes it urgent to create a prognostic model of risk of development of the above mentioned disorders.

P230MEXICAN BELIEFS AND ATTITUDES TOWARD MENOPAUSE, SEXUAL FUNCTIONING, LIFE SATISFACTION, AND DEPRESSIVE SYMPTOMS

Marván Maria (MX)

Martínez-Garduño M. (MX)

Espinosa-Hernández M.

Jasso K.

Universidad Veracruzana, MX

The menopausal transition is a biopsychosocial process that is influenced by multiple psychological, social, and cultural factors. Some authors have postulated that attitudes towards menopause are related to the menopausal experience. We examined the attitudes toward menopause in premenopausal, perimenopausal and menopausal Mexican women, as well as their sexual functioning, life satisfaction, and depressive symptoms. Participants’ ages ranged from 45 to 50 years. All women lived with a romantic partner, and had not undergone a hysterectomy. Currently, 41participants have completed an online survey which examined the following constructs: life satisfaction, female sexual functioning depressive symptoms, and both positive and negative attitudes toward menopause. Final analysis will include around 100 participants. Preliminary findings suggest premenopausal women showed higher levels of both life satisfaction, and sexual functioning than perimenopausal and postmenopausal participants. Perimenopausal women reported fewer positive attitudes toward menopause and more depressive symptoms than premenopausal and postmenopausal women. Women who though that menopause is an unpleasant experience reported more depressive symptoms, whereas those women who associated menopause with feelings of well-being reported the best sexual functioning and being more satisfied with life. The use of hormone replacement therapy was not associated with attitudes toward menopause, or with depressive s symptoms, or with satisfaction with life. However, perimenopausal and menopausal women who previously used it reported the best sexual functioning. These findings may help inform effective support programs for middle-aged women by providing accurate and current information, including both physical and psychosocial aspects of menopause to improve positive attitudes.

P231OCCURRENCE OF DEPRESSIVE SYMPTOMS IN NATURAL MENOPAUSE. A MULTIFACTORIAL STUDY

Yankelevich Debora (AR)

Sternberg K.

Moggia M.

Hospital de Clinicas, AR

Objectives: 1) To determine a Depression Score using the CES-D© questionnaire (Center for Epidemiologic Studies-Depression), on a sample of women attending the out patient Ginecology Departament at Hospital de Clínicas José de San Martín. Universidad de Buenos Aires. 2) To evaluate the correlation between depression and a set of characterized variables. Methodology: We evaluated 464 patients, aged 18–60, average 52 years (SD = 6,7 years). Out of these patients, 317 were postmenopausal (Group 0), 128 perimenopausal with menstrual cycle disorders ( Group 1). Control group include 19 patients with regular cycles (Group 2) Depression was measured by the CES-D scale validated in Spanish. We provided 22 questions including demographic and clinical data. A score of 15 or higher was considered depression. Results: A total of 461 patients (99,35% of the cases), were scored by CES-D©. 31,9% (n = 147) presented depression related scores. In those scores > 15, we didn't find any statistically significant difference between group 0 and 1. (p = 0.068). We found higher scores of depression in the perimenopausal group compared with the postmenopausal. (p = 0,03). We found a positive correlation between depression and six nominal variables: personal depression history, family depression background, post-partum depression, psychotropic medication usage, presence of hot flushes and smoking (p ≤ 0,003) and a negative correlation between depression and recreational activities (p = 0,029). DISCUSSION: The perimenopausal period should, therefore, be considered a “window of vulnerability” for depression.

NON-HORMONAL TREATMENT OF MOODP232MEMORY STATUS ASSOCIATED WITH CLIMACTERIC SYNDROME IN WOMEN 45 TO 59 YEARS OLD. MEXICO

Martínez-Garduño María Dolores (MX)

Olivos-Rubio M.

Chablé-Gómez M.

Universidad Autónoma del Estado de México, MX

In Mexico, women between the ages of 45 and 59, represent the 13.56% of the population, a figure that will increase in the following years. The decline of estrogen levels among this group of women alters their physical, mental and social health of this group of women. During the menopausal transition concentrations of circulating estradiol and estrogen may decline in such a way that cognitive functions might be deteriorated. Objective. Examined the prevalence of memory impairment in women during menopause associated to the severity of climacteric symptoms in the state of Mexico. Material and Methods. This was a quantitative, cross-sectional and correlational study. The sample was non-probabilistic, convenience, including 120 women between 45 to 59 years old. Three instruments were used, sociodemographic data; Mini -Mental State Examination and Kupperman menopausal índex was applied in a public health institution. Statistical analyses were performed using SPSS Vs. 20. Descriptive statistics and Chi2 was used to establish association. Bioethical issues: According to the Declaration of Helsinki and the Regulations of the General Law on Health Research in Mexico, women who agreed to participate in the study voluntarily signed informed consent prior to the assurance of confidentiality and anonymity. Results. The mean age was 49.7 ± 4.8, the Kupperman Index, was found in 61.1% is moderate, 22.2% mild and 16.7% severe. The most affected cognitive dimension was orientation state with an average of 7.5. Conclusion. No statistically significant correlation was found between the menopausal index and the deficit of memory scale.

STRESS AND ANXIETYP233HEART RATE VARIABILITY AT PERI- AND POSTMENOPAUSE AND ITS RELATIONSHIP WITH SYMPTOMS AND STRESS

Sánchez-Barajas Mauricio

Figueroa-Vega N.

Moreno-Frías C.

Malacara J.

Department of Medical Sciences, University of Guanajuato, MX

Background: At menopause increase physical and emotional symptoms. Heart rate variability (HRV) is a predictor of cardiovascular events. Previous studies show HRV associated with symptoms at postmenopause. Diminished and increased LF/HF ratios are reported associated with symptoms. Aim: To determine the possible association of HRV with menopause symptoms. Design and Methods: In a cross-sectional study, 100 women, classified as peri- (n = 50) and early postmenopause (n = 50), were included. We assessed depression, anxiety, perceived stress, sleep disturbances and hot flashes. FSH, 17β-estradiol and cortisol were quantified. Time- and frequency-domain measures of HRV were assessed using 4-hour recordings with the POLAR RS800CX watch. Factors associated with symptoms were analyzed by a generalized linear model (GML) testing time and frequency domains. Results: Symptoms at peri- and postmenopausal were similar, except for decreased sexual interest. GLM showed hot flashes associated positively with anxiety and negatively with age at menarche and menopausal status, but not with HRV. Anxiety, has a strong and positive association with depression and HF, and negatively with age, creatinine, perceived stress, LF, and 17β-E2 concentrations. Depression, correlated positively with anxiety, time since menopause, and negatively with schooling and cortisol, but not with HRV. Sleep alterations were associated positively with time since menopause, anxiety, and SDNN index, and negatively with age, creatinine, glucose, FSH, RRm and LF. Perceived stress had a relation negative with SDNN, LF, and family size; and positive with schooling, HF and pNN50%. Finally, submission was negatively related with LF and pNN50%. Conclusions: HRV was associated with anxiety, sleep alterations, perceived stress, and submission scores. HRV in menopausal women may be an indicator of stress.

BONE LOSS/OSTEOPOROSISP234UP-REGULATION OF INHIBITORS OF DNA BINDING/DIFFERENTIATION GENE DURING ALENDRONATE-INDUCED OSTEOBLAST DIFFERENTIATION

Kim Heung (KR)

Jeon S.

Choi H. (KR)

College of Medicine, Kosin University, KR

Aim: Alendronate enhances bone morphogenetic proteins (BMP)- mediated osteoblast differentiation. A balanced regulation of inhibitors of DNA binding/ differentiation (Ids) plays an important role in BMP-induced osteoblast differentiation. However, there are no studies on the possible roles of Id genes in alendronate-induced osteoblast differentiation. This study investigated the effect of alendronate on the expression of Id genes in osteoblast differentiation. Methods: C2C12 cells were treated with alendronate for various concentrations and time periods. For evaluation of alendronate- induced osteoblast differentiation in C2C12 cells, alkaline phosphatase (ALP) activity was measured. The expression of osteoblast differentiation markers such as ALP, type-1 collagen (Col 1), and osteocalcin (OCN), and the expression of Id-1 and Id-2 were measured by RT-PCR. In order to understand the mechanism underlying the regulation of Id genes, the promoter region of the Id-1 gene was identified. Database analysis of the promoter region for Id-1 using known consensus sequences identified several putative response elements, including CCAAT/enhancer-binding protein beta (C/EBPβ). Results: Alendronate treatment significantly increased not only ALP activity but also expression of ALP, Col 1, and OCN, Id-1 and Id-2. C/EBPβ and alendronate cooperatively increased the promoter activity and expression of Id-1. Conclusion: These results suggest that C/EBPβ-mediated Id-1 transcriptional activation may regulate alendronate-induced osteoblast differentiation of C2C12 cells.

P235MANAGEMENT OF OSTEOPOROSIS IN POST MENOPAUSAL WOMAN: CURRENT UPDATE

Mahmud Naseem (BD)

United Hospital Limited (UHL), BD

Osteoporosisis a leading cause of hip and spine fractures in post menopausal women. 50% of woman with hip fractures have long term loss of mobility; 25% requiring long term care and 25% mortality within the first year of follow-up. Osteoporosis occurs in 4% of woman aged 50–59 years to 52% in those older than 80 years. Goal of management is to reduce the risk of fractures. Gynecologists became interested in osteoporosis because of the role of estrogen deficiency and the use of HRT in prevention and treatment of osteoporosis. HRT was also indicated for postmenopausal symptoms, prevention of coronary heart disease and favorable effect on serum cholesterol. Osteoporosis is silent and often only detected after a fracture occurs. Most non-vertebral fractures occurs during falls. Vertebral fractures often occurs spontaneously, with 2/3 of vertebral fractures occurring without pain. Combination of low BMD and increasing clinical risk factors increases the risk of fractures. All postmenopausal woman should be assesed for risk factors associated with osteoporosis and fractures.Recommendation for adding pharmacological management includes, all post menopausal women who have had an osteoporotic vertebral or hip fracture, BMD value consistent with osteoporosis and T-score −1.0 to −2.5 or 20% 10-year risk for major osteoporotic fracture or 3% risk for hip fracture. In using HRT to prevent osteoporosis, the risk of CHD, stroke, pulmonary embolism and breast cancer must be weighted against the benefit for fracture risk.Keeping in mind the availability of other agents that can prevent osteoporotic fractures. Focusing on non-vertebral fractures helps to choose therapies as many would reduce vertebral but not non-vertebral fractures.

P236ASSOCIATION BETWEEN POLYMORPHISMS IN NEUROMEDIN U, ITS RECEPTOR, COCAINE AND AMPHETAMINE REGULATED TRANSCRIPT, AND MELANOCORTIN 4 RECEPTOR GENES AND BONE RESPONSE TO HORMONE THERAPY IN POSTMENOPAUSAL KOREAN WOMEN

Kim Jung G. (KR)

Kim H. (KR)

Ku S. (KR)

Kim S. (KR)

Choi Y. (KR)

Kim J.

Dept. of OB/GYN, Seoul National University College of Medicine, KR

Objective: The purpose of this study was to investigate the association between polymorphisms in neuromedin U (NMU), its receptor (NMUR2), cocaine and amphetamine regulated transcript (CART) and melanocortin 4 receptor (MC4R) genes and bone response to hormone therapy (HT) in postmenopausal Korean women. Methods: The NMU c.53C> A, NMUR2 c.893G> C, and c.9455C> A, CART 224G> A, and MC4R.280G> A polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphsim (PCR-RFLP), Taqman assay or direct DNA sequencing in 490 postmenopausal Korean women receiving sequential HT for 1 year. BMD at the lumbar spine and femoral neck, and serum levels of bone alkaline phosphatase, and carboxy-terminal telopeptide of type I collagen were measured. Results: Among SNPs measured, the NMU c.53 C> A polymorphism only was associated with annual percent changes in BMD at the lumbar spine and femoral neck after 1 year of HT (P = 0.001), and BMD at the lumbar spine and femoral neck in the AA genotype of NMU c.53 C> A polymorphism decreased significantly compared to other genotypes. When a non-responder was defined as a woman who had lost more than 3% of BMD per year after HT, the NMU c.53 C> A polymorphism among genetic polymorphisms studied were associated with the risk of non-response of HT. The AA genotype of NMU c.53 C> A polymorphism showed a 1.81-times higher risk of non-response at the lumbar spine and/ or femoral neck (P = 0.02), as compared with non-AA genotype. However, No significant changes in bone turnover markers after 6months of HT were noted according to the NMU c.53 C> A polymorphism. Conclusion: The NMU c.53 C> A polymorphism may be associated with risk of non-response to HT in postmenopausal Korean women. Funding Support: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (20120008199).

P237OSTEOPOROSIS IN BLACK SOUTH AFRICAN WOMEN, A REALITY NOT A MYTH

Matsela Lineo (ZA)

University of Limpopo, ZA

Osteoporosis is a skeletal disorder characterised by compromised bone strength; predisposing to an increased risk fracture. A shift in ovarian hormonal concentration that occurs between the ages of 39–59 is associated with predominance of bone resorption. The present study determined the prevalence osteopenia and osteoporosis among black South African women residing in Odi, Soshanguve and Garankuwa districts. The study was carried out between January 2007 - December 2009. The participants in this study were those that took part in the psychosomatic and demographic features of menopause as well as in the hormonal evaluation of menopause. The participants were divided into three groups based on their hormonal results and age. From this, 68 participants were thus classified into 3 groups namely: premenopausal (mean age 37 years), perimenopausal (mean age 46 years) and postmenopausal (mean age 59 years) women were evaluated. From the study, the trend in osteopenia from all the three groups were postmenopausal > perimenopausal > premenopausal and the differences from these groups were significant statistically (p < 0.05). Osteoporosis was only discovered in post-menopausal women and the differences were also significant statistically (p < 0.05). Generally, the prevalence of osteoporosis from all the groups in the study was 11.76% and was from the postmenopausal women. The study concluded that osteoporosis exists among the black South African women residing in Odi, Soshanguve and Garankuwa districts. The importance of knowledge and understanding among the doctors who treat this condition and the need for establishment of multidisciplinary clinics for the management of this condition in public hospitals is essential.

P239THE ABSOLUTE FRAGILITY FRACTURE RISK BASED ON FRAX MODEL: A STUDY IN POSTMENOPAUSAL ROMANIAN WOMEN

Poiana Catalina (RO)

Carsote M. (RO)

Radoi V.

Mihai A.

Geleriu A.

Petris R.

Paun D.

Parhon Institute, Davila UMPh, RO

Introduction: The FRAX model is a new and dynamic instrument for fracture risk assessment. The relationship with clinical risk factors as age or body mass index is linear, also the total time period of time in menopause is not included in risk calculation itself in cases of menopausal women. Aim: We analyzed the FRAX risk in relationship with clinical risk factors as years since menopause. Material and Method: This is a cross-sectional study in postmenopausal women who were not previously pre-selected based on osteopenia/osteoporosis diagnosis; neither were they treated with any kind of medication for osteoporosis, except for vitamin D and calcium supplements. We calculated the fracture risk on 10 years based on FRAX version for Romania (without bone mineral density). The patients’ written consent was obtained. The statistical analyze used SPSS21 with statistic significance at p < 0.05, the descriptors as mean and the linear regression test. Results: 505 women in menopause were included with a mean age of 57.01 years. The patients were included in 4 groups based on decades since menopause. Regardless the values of the body mass index or the combination of clinical risk factors that were included in FRAX algorithm, the risk increases with years since menopause as pointed by the menopause decades analyze: 3%, 5%, 8%, respective 9% for the major osteoporotic risk fracture, and for the hip fracture: 0.5%, 1.5%, 3%, respective 4%. The correlation between years since menopause and fracture risk based on FRAX was statistically significant, and positive of r value (as a linear regression coefficient) of 0.6. Except for the first decade (immediately after menopause installation) the value of r was not statistically significant into the groups. Discussion: The years since menopause might become more relevant in bone assessment than age itself. Conclusion: The good, positive correlation between FRAX risk and years since menopause we found early after menopause might recommend the use of the model especially in this period of time.

P240INCIDENCE OF OSTEOPOROSIS FRACTURES IN CZECH REPUBLIC

Fait Tomas (CZ)

1st Faculty of Medicine, Charles University Prague, CZ

References about osteoporotic fractures of femur neck were collected in national register in Czech republic from 1986. We have done the comparation of possible influence by prevention (hormone replacement therapy) and therapy (bone modelators) on osteoporosis. Total number of cases per year and per 100 000 women was continously grown from 101,3 in 1986 to 283,3 in 2004. Next elevation of this number were expected in connection with hormone replacement therapy crisis after WHI result. Surprisingly the number of fractures are in steady stade from 2004 until 2012 when incidence is fluctuated around 270 per 100 000 and year. Possible sources of this situation could be discussed.

P241GENDER DIFFERENCES IN MORTALITY RATE AFTER HIP FRACTURE SURGERY

Yoon B. (KR)

Kim Seo-Hee (KR)

Lee D.

Lim S.

Moon Y.

Park Y. (KR)

Min Y.

Samsung Medical Center, KR

Objective: hip fracture is a major health problem which produces a significant economic and social burden. It results in high cost, disability, and mortality, showing about 25% of two-year mortality rate in Korea. Although some previous studies suggested a gender difference in mortality after hip fracture, data regarding this issue is still insufficient. Therefore, this study was conducted to compare two-year mortality after hip fracture surgery according to gender in Korea. Methods: Patients older than 50 years who were admitted to Samsung Medical Center with a low-energy trauma hip fracture and underwent surgery between August 2005 and May 2009 were eligible for this prospective cohort study. Among them, 221 patients (153 women and 68 men) who did not use medications having anti-fracture efficacy, such as estrogen or bisphosphonate, were followed. Mortality rate during two-year period were compared by gender. Results: Mean age and American Society of Anesthesiologists score at the time of surgery, and activities of daily life before surgery were different between the genders, but other characteristics such as body mass index, type of fracture or surgery, and number of comorbidities were comparable. In Kaplan-Meier analysis, cumulative one-year mortality rate was 20.1% in women and 17.6% in men, and two-year mortality rate was 30.5% in women and 29.4% in men, showing no gender differences. In Cox regression analysis, mortality rate also did not differ by gender during two-year follow-up. Conclusion: No gender difference was found in two-year mortality rate after hip fracture surgery in Korea. A further large-scale study is warranted.

P242INFLUENCE OF REPRODUCTIVE AGE LENGTH ON THE OSTEOPOROTIC RISK AND THE ABSOLUTE FRACTURE RISK IN A POPULATION OF CLIMACTERIC WOMEN

Bonaccorsi Gloria (IT)

Fila E. (IT)

Poetto V.

Ferrazzini S. (IT)

Castaldini M. (IT)

Massari L. (IT)

Menopause and Osteoporosis Centre, University of Ferrara, Ferrara, Italy, IT

Background: The gynecologists have a central role in the prevention of postmenopausal osteoporosis (PO) and fragility fractures (OF) through identification and treatment of middle-aged women at high risk. Several studies analyzed the influence of reproductive age length and other aspects of the fertile life that could hasten bone metabolism on the developing of PO, evaluating bone density, but only a few authors examined the association with the fracture risk. The aim of the present study was to evaluate, in a wide population of climacteric women, the influence of reproductive age length and of some gynecological variables on osteoporotic risk and on the absolute fracture risk. Methods: We performed a cross-sectional study on a selected population of n.466 postmenopausal women from the North-Eastern region of Italy, the mean age was 63, range 45–84 yr. We evaluated the gynecological history and bone density through DXA technique, the individual 10-year fracture risk was assessed using FRAX algorithm. Results and Conclusions: Menopause occurred at the mean age of 49,5 and, in 86% of the patients, in a spontaneous way. 34% of patients took OC during reproductive age and 33% took HRT after the menopause. Prevalence of PO was 41%. At least 1 clinical risk factor for fracture considered in FRAX tool was observed in 32% of the women, smoking was the most frequent. In our population OC intake resulted as a protective agent on PO and OF risk as well as HRT. No correlation emerged between the condition of early menopause and the history of clinical fragility fractures. Presence of densitometric osteoporosis and higher values of OF risk (FRAX total) was significantly influenced by menopausal age in the subset of women under the age of 65, namely in the age where the bone loss is mostly influenced by estrogen deprivation.

P244PREVALENCE OF VITAMIN D DEFICIENCY IN WOMEN OF PUSAN AND GYEONGNAM PROVINCE IN KOREA

Ji Eun Hong¹

Hyun Sil Yoon¹

Jung In Yeom¹

Han Na Jeon¹

Yong Jung Song¹

Hwi Gon Kim¹

Byoung Ick Lee²

Na Yong Jin¹ (KR)

Pusan National University Yangsan Hospital, KR

^eDepartment of Obstetrics & Gynecology, Pusan National University Yangsan Hospital, Korea

^fDepartment of Obstetrics & Gynecology, Inha University Hospital, Korea

Objectives: The aim of this study is to determine the prevalence of vitamin D deficiency in women of Pusan and Gyengnam province in Korea. Methods: We recruited a total of 208 women who visited the Pusan National University Yangsan Hospital from January 2011 to May 2012. We excluded 55 women who took medicine including vitamin D. The fasting blood serum were analyzed for 25-Hydroxy vitamin D. The vitamin D deficiency was divided into 3 groups: mild (10 to 20 ng/mL), moderate (5 to10 ng/mL), severe ( < 5 ng/mL). Result: The mean concentration of vitamin D was 20.9 ng/mL ± 9.6. The mean concentration of vitamin D per age groups were as follows: 20–45 years, 22.4 ± 16.6 ng/mL; 45–55 years, 19.4 ± 11.4 ng/mL; > 55 years, 24.4 ± 16.3 ng/ml. Vitamin D deficiency affected 55.5% of all studied subject, which comprised 36.6% of mild, 15.1% of moderate and 3.9% of severe deficiency. Among all 3 groups, there were osteoporosis measured by BMD as follows: mild deficiency, 45.8%; moderate deficiency, 29.6%; severe deficiency; 56.5%. The mean concentration of vitamin D according to seasons were 16.24 ± 9.1 ng/mL from December to May and 22.5 ± 11.0 ng/mL from June to November (p < 0.05). Conclusion: Most of Pusan and Gyengnam women in Korea might be vitamin D deficiency. Further large cohort study is needed to establish the nutritional strategy.

P245FRACTURE RISK ASSESSMENT IN POSTMENOPAUSAL WOMEN: A COMPLEX ANALYSIS

Fila Enrica¹ (IT)

Bonaccorsi G.¹ (IT)

Castaldini M.¹ (IT)

Ferrazzini S.¹ (IT)

Giganti M.² (IT)

Massari L.³ (IT)

Grossi E.⁴ (IT)

^gMenopause and Osteoporosis Centre, University of Ferrara, Italy, IT

The international guidelines underline the importance of a comprehensive assessment of osteoporotic fracture (OF) probability mainly in osteopenic postmenopausal women. The WHO validated FRAX,a tool that calculates the 10-year absolute fracture risk in individual patients, nevertheless, many recent studies revealed several limitations of this algorithm; among them, the fact that it does not include spine BMD values, resulting in a low capability of quantify vertebral fracture risk. Artificial Neural Networks (ANNs) could represent an alternative way compared to traditional statistic because it's a kind of mathematical model that try to better understand the link between BMD values, CRFs and fragility fractures. In literature, there is only one study in which is described ANNs higher sensitivity to linear statistic in the prediction of OF [Eller-Vainicher C et al, PLosOne 2011]. The purpose of our study was to evaluate the ANNs capability of predict vertebral fractures compared to FRAX accuracy, in a selected population of climacteric women with spine deformity assessed by Morphometric X-ray Absorbiometry (MXA).The data set was composed of N.587 patients (mean age 64, n.300 with vertebral fractures) and N.24 variables (n.15 clinical parameters and n.9 BMD values); among these, TWIST system selected a subset of 17 variables (n.10 clinical parameters and n.7 BMD values), that permitted to distinguish two groups: women with at least one morphometric OF and patients with negative MXA. We estimated the fracture risk probability with FRAX tool considering only the anamnestic fragility fractures. In our climacteric population the ANNs analysis showed a higher global accuracy (74%) compared to FRAX one in predicting spine OF. In our study FRAX also demonstrated to have a very low sensitivity in individualizing people at high risk of vertebral collapse, but a high specificity.

P246LOW BONE MINERAL DENSITY IN HIV INFECTED WOMEN: PREVALENCE AND ASSOCIATED FACTORS

Gomes D. (BR)

Valadares Ana (BR)

Pinto-Neto A. (BR)

Costa-Paiva L. (BR)

State University of Campinas (UNICAMP), BR

Objective: Evaluate factors associated with low bone mineral density (BMD) in HIV positive women. Subjects and methods: Cross-sectional study with 273 HIV positive women aged 40 to 60 years receiving out-patient care, using a questionnaire on sociodemographic, behavioral, clinical characteristics. Weight and height were measured. Blood sample for FSH, LH, TSH, Nadir of CD4 and viral load were collected. BMD by DXA was realized. Statistical analysis: Yates and Pearson's chi-square tests and Poisson multiple regression analysis. Results: The median age of the women was 47,7 years, 51.6% had BMI less than 25 kg/m2, 59.3% were pre or perimenopausal, 92% were in use of HAART, 87% used it regularly. 75% had Nadir CD4 above 200 and 77,8% had viral load below the detection limit. The average duration of infection was 9.98 years and mean therapy duration of 8.67 years. On the proximal femur the prevalence of low BMD was 44.4% and on lumbar spine was 44.7%. Low BMD at proximal femur was associated with ≥ 50 years (p < 0.001), not being drug addict (p = 0.028) and FSH > 40 (p < 0.001). Low BMD at L1-L4 was associated with ≥ 50 years (p < 0.001), parity > 2 (p < 0.026), and FSH > 40 (p < 0.001). There was no association between low BMD at proximal femur and L1-L4 and Nadir CD 4, plasma viral load of HIV, duration of HIV infection, and using/ have used Tenofovir. Poisson multiple regression analysis showed that the main factors associated with low BMD al proximal femur and lumbar spine were aging and FSH > 40. Conclusion: Low BMD was common in this group of women mostly using HAART, without advanced disease. Factors associated with having HIV infection were not associated with low BMD. The associated factors were classical risks and our data support the use of periodic BMD testing in HIV-infected patients and highlights the need for a full climacteric approach of these women to prevent bone loss.

P249FACTORS RELATED TO BONE QUALITY IN MIDDLE-AGED WOMAN. MUNICIPALITY PLACE OF THE REVOLUTION, HAVANA

Navarro D. (CU)

Cedeño Alina (CU)

Lopez L. (CU)

Endocrinologia, CU

Population aging is associated with increased frequency of osteoporotic fractures, causing disability and decreased life expectancy of persons. In Cuba the magnitude of osteoporosis is unknown, and scientific communications that relate events in Havana occurs at least one hip fracture each day. Objectives: Describe bone quality and frequency of some related factors with the same in the middle-aged woman belonging to two health areas of municipality Place of the Revolution, Havana September 2009 and May 2010 Methodology: Cross-sectional study that included middle-aged women with permanent residence in two areas of Health in the Municipality Place of the Revolution. The number of subjects evaluated (n = 101) was conducted based on the population statistics of municipality and frequency of osteoporosis in this group. For selection, the persons from selected clinics were organized in a list and random persons were identified to complete the number for the sample size and that met the following inclusion criteria: Between 40 and 59 years old, apparently healthy and acceptance to participate in the research. Exclusion criteria: Patients with intolerance to dairy and/or vitamin D deficiency with conditions and / or under treatment with drugs that affect bone quality, immobilized people. Each person is conducted interview, clinical examination, densitometry (dual X -ray absorptiometry, Lexxos equipment), Single Rx Spine those with osteoporosis criteria and blood extraction to determine LH, FSH, estradiol and testosterone. According T score (OMS criteria) from DXA, the patients were grouped as: no osteoporosis, osteopenia or low mass bone, osteoporosis and severe osteoporosis (if fractures). Factors related to bone quality were assessed: skin color, education, physical activity, consumption of vegetables, dairy, fish, coffee and alcohol, nutritional status, women (reproductive events, climacteric, breastfeeding). Descriptive statistics and tests (Chi square and t-test) were used to identify differences between groups using p value < 0.05 for statistical significance. Results: 58% of interviewees present poor bone quality, with no differences by sex. There was no difference in the average age of people according to bone quality and gender. In women there was a trend to worse bone quality in those older (group 55-59 years), late stage postmenopausal hypoestrogenism and more. In men lower levels of testosterone were found in 30% unrelated to bone quality. Conclusions: Despite not having national studies to compare our results, the type of study and the small number of men tested, the frequency of poor bone quality suggests that osteoporosis could be a health problem in the population evaluated.

P250THE LONGTERM EFFECT OF THE HORMONE REPLACEMENT THERAPY ON THE BONE MINERAL DENSITY IN WOMEN WITH HYPOESTROGENIC PRIMARY AMENORRHEA

Rhee Jeongho (KR)

Kim J. (KR)

Bae J. (KR)

Park J. (KR)

Keimyung University Dongsan Medical Center, KR

Objective: To investigate the longterm effect of the hormone replacement therapy on the Bone Mineral Density (BMD) in patients with hypoestrogenic primary amenorrhea. Methods: We conducted a retrospective study of 45 women diagnosed with primary amenorrhea such as Turner syndrome, hypogonadotropic hypogonadism, primary ovarian failure, who have undergone hormone replacement therapy (HRT) at least for 10 years. BMDs and Z scores at the time of diagnosis and 10 years after HRT were compared to confirm the bone sparing effect of the HRT. Additionally, subgroup comparison was performed to confirm whether there were any differences in the bone sparing effect according to the causes of amenorrhea. Results: The average lumbar spine and femur BMD (g/cm2, mean ± SD) at diagnosis and 10 years after HRT were 0.927 ± 0.15 and 0.711 ± 0.12, 0.977 ± 0.12 and 0.734 ± 0.10, respectively. The average lumbar spine and femur Z score (mean ± SD) at diagnosis and 10 years after HRT were −1.45 ± 1.26 and −1.09 ± 1.00, −1.03 ± 1.03 and −0.64 ± 0.94, respectively. The average increments of the BMDs and T scores in lumbar spine and femur were 0.049 ± 0.09 and 0.43 ± 0.78, 0.022 ± 0.07 and 0.43 ± 0.53, but there were no statistical differences in the BMDs and T scores of the lumbar spine and femur between the time of diagnosis and 10 years after HRT. In the subgroup analysis, there were no significant differences according to the causes of amenorrhea in the initial and post-treatment BMD and T score of the lumbar spine and femur. Also, there were no differences in the average increments of the BMDs and T scores in lumbar spine and femur among the groups. Conclusion: BMDs in the women with hypoestrogenic primary amenorrhea were not affected by causes of amenorrhea and hormone replacement therapy for the patients have adequate and sufficient bone sparing effect.

PHARMACOLOGICAL TREATMENT OF OSTEOPOROSISP252ESTRADIOL DROSPIRENONE CAN IMPROVE THE SYMPTOMS OF MENOPAUSAL SYNDROME, BLOOD LIPIDS, AND BONE TURNOVER MARKERS: A PROSPECTIVE, SELF-CONTROLLED STUDY

Wang Aiming (CN)

Hu L.

Song Z. (KR)

Navy General Hospital of PLA, CN

Background: Hormone replacement therapy with estradiol drospirenone (E2/DRSP) is used to alleviate menopausal symptoms for postmenopausal women. However, the effects of E2/DRSP on blood lipids and bone turnover in Chinese postmenopausal women are not clear. Objective: To investigate the efficacy of E2/DRSP in the treatment of menopausal symptoms and its effects on blood lipids and bone turnover. Methods: This was a prospective, self-controlled cohort study. Postmenopausal women who were treated with E2/DRSP for at least 6 months from March 2012 to June 2013 and at the age of 45–60 years were enrolled. Comparisons were made in KUPPERMAN index, blood lipids, bone mineral density, and bone turnover markers between pre- and post-treatment. Results: A total of 64 women (aged 52.5 ± 3.37 years) were identified. KUPPERMAN index were significantly improved at 1, 3, and 6 months after the treatment (20.57 ± 6.52 at baseline vs 16.37 ± 5.19,13.34 ± 4.52,12.70 ± 4.42 at 1st, 3rd, 6th month, respectively, P < 0.01). Levels of low-density lipoprotein, triglyceride, and total cholesterol were significantly decreased, and levels of high-density lipoprotein was increased, compared with that before the treatment (all P < 0.05). Bone mineral density of the lumber spine (1.02 ± 0.10 vs 1.03 ± 0.02, P < 0.001) and the hip (0.46 ± 0.09 vs 0.48 ± 0.14, P < 0.001) was significantly improved after 6 months of treatment. Levels of bone alkaline phosphatase (65.81 ± 14.75 at baseline vs 61.14 ± 12.38, 58.77 ± 11.35 at 3rd and 6th month, respectively, P < 0.05) and tartrate-resistant acid phosphatase (6.15 ± 3.02 at baseline vs 5.99 ± 2.98, 4.90 ± 2.90 at 3rd and 6th month, respectively, P < 0.05) were significantly decreased after treatment of E2/DRSP. Conclusion: E2/DRSP can alleviate symptoms of menopausal syndrome effectively, and also has benefits on blood lipids and bone metabolism.

P254INFLUENCE OF DYNAMIC FLAMINGO THERAPY (DFT) ON BONE METABOLISM AND PHYSICAL FUNCTION IN POST-MENOPAUSAL WOMEN

Lee Sangun (JP)

Hashimoto J. (JP)

Satoh A.

Fujita C. (JP)

Suzuki T.

Ohta S.

Aomori University of Health and Welfare, JP

Introduction: In the present study, we assessed the effect of Dynamic Flamingo Therapy (DFT) on bone-related factors and physical function in post-menopausal women. Methods: We examined 25 healthy, post-menopausal women without any underlying disease who underwent DFT for 3 months and were divided into 2 groups (Control, DFT). DFT was performed once each, on the left and right, for 1 minute, 3 times a day, and 5 times a week. Bone-related factors such as the levels of Bone Specific Alkaline Phosphatase (BAP), deoxypyridinoline (DPD), and calcitonin were measured. Moreover, physical function was assessed using the centroid oscillation system. Furthermore, we assessed the combined changes to the center of gravity with the eyes opened and closed. The SPSS 19 software was used to perform a t-test for statistical analysis; the significance level was defined as p < 0.05. Results: The levels of the bone metabolism-related hormone calcitonin decreased significantly by 28.7% in the DFT group when compared to pre-DFT measurements (p < 0.001), whereas the levels of the bone resorption marker DPD assessed through creatinine correction decreased significantly by 12.9% (p < 0.01). Moreover, the bone formation marker BAP increased significantly by 9.1% after DFT compared to the pre-DFT measurements (p < 0.01). However, changes to the center of gravity related to balance ability were not observed. Discussions: Our results indicate a mechanical stress effect on the bone due to DFT; however, no improvement of physical function was observed. Thus, DFT is an economical and safe type of load bearing exercise in the elderly that facilitates improvement in bone condition and prevention of falls. However, if the objective is to improve balance, intervention with additional load-bearing exercises will be necessary.

P255THE EFFECT OF POMEGRANATE ON BONE HISTOMORPHOMETRY IN OVARIECTOMIZED RAT

Kim T. (KR)

Park H. (KR)

Choi Hoon (KR)

Inje University Sanggye Paik Hospital, KR

Objective: To determine whether or not pomegranate extract can affect bone histomorphometry in ovariectomized rats and proliferation. Methods: Seventy-nine female Sprague-Dawley rats were used: A, no intervention; B, sham operation and distilled water; C, ovariectomy and distilled water; D, ovariectomy and 10% dilute pomegranate; E, ovariectomy and 20% pomegranate; and F, ovariectomy and 40% pomegranate. The study samples were obtained 4 weeks later. The following parameters were investigated for analyses: 24-hour food intake, body weight, bone histomorphometry, serum bone turnover markers, and sex hormones.Results: Bone volume was decreased after ovariectomy and the 40% pomegranate extract had a lower trabecular separation. There were lowering effect in serum phosphate. Conclusion: Pomegranate extract has an beneficial effect on bone histomorphometry in ovariectomized rat.

OTHER TOPICS RELATED TO THE SKELETAL SYSTEMP256BONE AND MUSCLE RELATIONSHIP IN KOREAN OLD PEOPLE

Choi Woong (KR)

Hanyang University Hospital, KR

Background: Recently, the prevalence of osteoporosis and sarcopenia in the elderly has dramatically increased. However the relationship bwtween theses disease is not clear. Objective: We aimed to determine the independent relations of muscle mass to osteoporosis (femur neck) in relation to body weight, fat mass, and other confounders. Design: We analyzed body composition and BMD data of 570 Male and 734 female who are older than 65 years from KNHANES V (2010). Body composition and bone mineral density (BMD) of femur neck were measured by DXA. Sarcopenia was defined as the appendicular skeletal muscle mass (ASM) divided by height squared (Ht2) (kg/m2) of < −1 SD below the sex-specific mean for 20–39 years adults. Results: ASM/(Ht)2 and BMD were positive corelated with body fat mass/(Ht)2. Protein & fat, carbohydrate, calcium, phosphate, calory intake were also positive corelated with BMD. Exercise also had positive corelation with ASM/(Ht)2 and BMD. However Vitamin D only positivly related with ASM/(Ht)2. With compounding factors adjusting, ASM/(Ht)2 had also positive relation with BMS in men (R2 = 0.171, B = 0.027, p < 0.001) and in women (R2 = 0.226, B = 0.016, p = 0.002). The adjusted odds ratios (95% CIs) of osteoprorosis in sarcopenia patients were 1.24 (95%CI;1.47–8.15) in men and not significant in women. Conclusions: Bone mineral density were independantly associated with muscle mass. And in men, sarcopenia was independant risk factor for oseoporosis in men but not women.

P257CAROTID INTIMA-MEDIA THICKNESS AND CALCIFICATION IN RELATION TO BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN – THE OSTPRE-BBA-STUDY

Tuppurainen Marjo (FI)

Värri M.

Tuomainen T.

Honkanen R.

Niskanen L.

Kröger H.

Departments of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland, FI

Introduction: Atherosclerosis (AS) and osteoporosis are common diseases in elderly people and they may be metabolically related. The aim of this cross-sectional study was to explore the association between common carotid artery intima- media thickness (cIMT), carotid artery calcification (CAC) and bone mineral density (BMD) in postmenopausal women. In addition, the association of postmenopausal hormone therapy (HT) and selected diseases with cIMT and carotid calcification were studied. Methods: The 346 women (mean age 73.6 years) for this Bone Brain and Atherosclerosis (OSTPRE-BBA) study were selected from the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort, Finland. For this cross-sectional study, cIMT was measured with B-mode ultrasound; femoral Neck and total body BMD were measured with dual energy x-ray absorptiometry (DXA). Results: Increased carotid maximum IMT was significantly associated with low femoral neck T-score. In the osteoporotic group (T-score < −2.5, n = 20) the maximum cIMT was 2.51 ± 0.88 mm (mean ± standard deviation) and in non-osteoporotic group (T-score > −1, n = 122) 1.93 ± 0.64 mm, (p = 0.001). There were no statistically significant associations between mean cIMT and femoral neck T-score (p > 0.05). The odds of having CAC were approximately four-fold in the osteoporotic group when compared with the normal T-score group of femoral neck (OR = 4.2, p = 0.038). Maximum cIMT was smaller in HT users (1.98 ± 0.56 mm, n = 190) than in non-users (2.16 ± 0.74 mm, n = 156) (p = 0.036). Conclusion: The results of our population- based study suggest that BMD is related to AS, at least in carotid arteries, and indirectly support the hypothesis of partially shared pathophysiological mechanisms between these two disorders. Keywords: intima-media thickness, bone mineral density, hormone therapy, arterial calcification, female.

P258EFFECT OF VITAMIN D SUPPLEMENTATION ON THE RATE OF FALLS AND THE POSTURAL BALANCE IN POSTMENOPAUSAL WOMEN: RANDOMIZED DOUBLE-BLIND PLACEBO CONTROLLED TRIAL

Cangussu L.

Nahas-Neto J.

Omodei M.

Orsatti C.

Nahas Eliana (BR)

Botucatu Medical School - UNESP - Univ. Estadual Paulista, Sao Paulo, Brazil, BR

Objective: to evaluate the effect of vitamin D (VitD) supplementation on the rate of falls and the postural balance in fallers postmenopausal women Methods: In this double-blind placebo controlled trial 160 women with age 50–65 years, amenorrhea ≥ 12 months and history of falls were included. Exclusion criteria: musculoskeletal disorders, vestibulopathies, osteoporosis, drug use that affect balance. Participants were randomized to 1,000UI vitamin D3 /day orally (n = 80) or placebo (n = 80). The intervention time was 9 months, with assessments at initial and final moments. Postural balance was assessed by stabilometry (computerized force platform). Muscle mass was estimated by Total-body DEXA and muscle strength by handgrip strength and chair-rising test. Serum levels of 25-hydroxyvitamin (OH) D3 were measured. Data were analyzed according to intention-to-treat. Results: After 9 months, mean 25 (OH)D3 levels increased from 15.0 ± 7.5 to 27.5 ± 10.4 ng/ml (+ 45.4%) in the VitD group whereas decreased from 16.9 ± 6.7 to 13.8 ± 6.0 ng/ml (−18.5%) in the placebo (p<.001). The rate of fall was higher in the placebo (46.3%, p<.001), that presented an adjusted risk of 1.9 (1.23 to 3.08) times higher of falls and 2.80 (1.43 to 5.50) times higher of recurrent falls than the VitD group. There was reduction in body sway by stabilometry, with lower amplitude of anteroposterior (−35.5%) and laterolateral (−37.0%) oscillation, only in the Vit D group (p<.001). In this group, there was significant increased in muscle strength of the lower limbs by chair-rising test (+ 45.5%, p = 0.036). Women in the placebo group presented significant reduction in the index of muscle mass (−5.8%) (p = 0.03). Conclusion: Fallers postmenopausal women with supplementation of vitamin D for 9 months had a lower rate of falls and improvement in postural balance and muscle strength. *FAPESP: process no. 2011/1444

P259BONE MINERAL DENSITY BY AGE IN KOREA

Jung Hyuk (KR)

Chosun University Hospital, KR

Objectives: The purpose of this study was to evaluate the prevalence of osteoporosis in Gwangju women. Methods: A total of 1476 Gwangju women who attended Chosun University between December 2007 and April 2010 were enrolled in this study. Bone mineral density (BMD) was determined for the lumbar spine, femoral neck, and total femur by dual-energy X-ray absorptiometry (DXA) using a GE-LUNA Progidy. We excluded women who had conditions that influence bone metabolism. BMD values were expressed in g/cm2 and the T-score. Osteoporosis was defined by a T-score < −2.5 SD for 20–29-year-old Koreanadults. Results: The prevalence of osteoporosis in Gwangju women was 19 (12.8%), 19 (12.1%), 95 (18.8%), 158 (42.2%). 97 (74.0%), and 115 (71.7%) at the spine, 0 (0%), 5 (3.4%), 11 (2.2%), 55 (14.7%). 65 (49.6%), and 101 (63.3%) at the femoral neck, and 0 (0%), 3 (1.7%), 3 (0.6%), 11 (2.9%), 22 (16.8%), and 53 (33.3%) for the total femur of the groups 20–29, 30–39, 40–49, 50–59, 60–69, 70–88 years of age, respectively. Conclusions: The criteria for osteoporosis are based on postmenopausal women, but premenopausal women who have low bone mineral density need to be examined for underlying diseases. Further, we must carefully establish a standard for BM for premenopausal women. Keywords: Osteoporosis, Bone mineral density, Gwangju women, Menopause.

P260CLINICAL VALUE OF VITAMIN D HYPOVITAMINOSIS IN POSTMENOPAUSAL WOMEN

Yureneva Svetlana (RU)

Bordakova E.

Yakushevaskaya O.

Alekseeva M.

Kuznetsov S.

Ivanetz T.

Smetnik V. (RU)

Federal State Research Centre of Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, Ministry of Health of the Russian Federation, Moscow, RU

Objectives: optimization of diagnosis and management of postmenopausal osteoporosis based on vitamin D3 in blood serum Materials and Methods: the study involved 73 postmenopausal women, which were divided into two groups depending on the status of bone mineral density: group 1 consisted of 53 patients with postmenopausal osteoporosis (T-score < −2.5, SD). Mean age was 58.5+/−4.4 years. Duration of menopause made up 9.26+/−6.05. Group 2 was recruited for comparison (bone mineral density > −1.0, SD, none of bone fractures in the anamnesis). Mean age was 57.8+/− 5.5 years. Menopause duration was 8.3+/−5.6 years. Screening of mineral bone density was conducted be way of dual energetic X-ray absorbtiometry of lumbar zone and femoral neck. Vitamin D3 25 (OH) level was initially measured in blood serum of all patients with immune-enzyme assay. Results: D3 vitamin hypovitaminosis (deficiency and insufficiency) was found in 82.1% of women in postmenopause no matter what the status of bone mineral density was. Prior saturation with 5000 IU/day of cholecalciferol allowed to achieve normal ranges of 25 (OH) vitamin D3 within 12 weeks in 88% of patients. The following supporting therapy with cholecalciferol in the dose of 800 IU/day during 12 months was sufficient only in 50% of women that indicated at the necessity to increase the recommended dose of cholecalciferol in a complex therapy of PMO. Conclusion: It is necessary to detect 25 (OH) D3 vitamin level in blood serum in all women in menopause no matter what the bone mineral density is. In case of D hypovitaminosis it is expedient to perform correction of vitamin D deficiency to prevent defects of bone mineralization. Supporting dose of cholecalciferol, that is 800 IU/day, is sufficient in 50% of postmenopausal women with hypovitaminosis of vitamin D.

P261THE PILOT EXPLORE THE RELATIONSHIP AMONG SERUM 25 (OH) VITAMIN D, FSH, ESTRADIOL AND FRAX IN POSTMENOPAUSAL TAIWANESE

Cheng Bi-Hua (TW)

Kang H.

Lin Y.

Huang K.

Assistant Professor, TW

Background: The serum level of vitamin D3 is general low as a global issue. Since Vit D has a lot of biologic effects for health promotion, not only the calcium and bone metabolism but also immunity and anti-inflammatory effects. Insufficiency and deficiency had been related to high-risk candidates of cardiovascular diseases, infectious diseases, muscle-skeletal diseases, and cancer in menopausal women. The relationship to 10 years fracture risk (FRAX) is not well known in postmenopausal Taiwanese. Aim: To explore the relationship among serum 25 (OH) Vitamin D, FSH, estradiol and FRAX in postmenopausal Taiwanese. Population and method: Serum vitamin D3 and FSH estradiol were examined for post-menopausal women who did not have major surgery or chronic diseases were included when they visited menopausal clinic first. The major menopausal complaints were recorded such as hot flush, sweating, sleep disturbance, headache, and … etc. All those medical history, previous fracture history, living habits with alcohol or smoking and their parents’ fractures were recorded. In addition, blood pressure, pule rate, body temperature, body weight and body heights were measured in same standard measurement tools. Results and Discussion: Six hundred and 10 Taiwanese women in postmenopausal status with mean age 54.8 and mean years from menopause 5 years were collected since Aug. 2010 to Oct. 2013. Their serum FSH were all higher than 30 unit/ml and estradiol were low as all lower than 30 pg/ml. There were 515 women’ (84%) serum level of Vitamin D were less than 30 ng/ml. 27 postmenopausal women had higher major fracture risk, which was counted by FRAX and higher than 10% and 35 postmenopausal women had higher hip fracture risk which larger than 3% counted by FRAX without BMD data. The correlation between fraction risk and serum Vit D or FSH or Estradiol were calculated separately by

P262CHANGE OF BONE MINERAL DENSITY AFTER TREATMENT OF ENDOMETRIAL CANCER IN POSTMENOPAUSAL WOMEN

Lee Jiyoung (KR)

Lee C. (KR)

Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea, KR

Purpose: To compare bone mineral density (BMD) before and after the treatment of endometrial cancer in postmenopausal women. Materials and Methods: We retrospectively analyzed BMD of spinal bone and femur in 68 patients treated for endometrial cancer and in 85 controls. All subjects had reached their menopause and patients with bone metastasis were not included. The controls were treated with benign uterine fibroid whose age and body mass index were consistent with those with endometrial cancer. BMD was performed before and one year after the surgical treatment in all subjects. BMD was measured with dual-energy X-ray absorptiometry. Results: The serum calcium, osteocalcin, and urine deoxypyridinoline showed no difference between the endometrial cancer patients and controls. BMD, serum calcium, osteocalcin, and urine deoxypyridinoline were not different among those with different stages of endometrial cancer. BMD of femur neck was significantly higher in endometrial cancer patients (T-score, −0.1 ± 0.8) than that in the controls (T-score, −0.4 ± 0.8; p = 0.026) before treatment. BMD of lumbar vertebrae was higher in endometrial cancer patients as well notwithstanding the lack of statistical significance. One year after the surgical treatment, BMD significantly decreased in all of total lumbar vertebrae (T-score, −0.7 ± 0.5 vs. 0.4 ± 0.7; p = 0.001) and femur neck (T-score, −0.9 ± 0.8 vs. 0.4 ± 0.9; p = 0.001). Conclusion: The higher BMD before treatment and the decrease of BMD after the treatment of endometrial cancer without change in bone turnover implies that hormonal milieu might affect BMD in patients with endometrial cancer, which is an estrogen-dependent tumor. A prospective randomized trial in large scale is warranted to elucidate the factors affecting BMD in endometrial cancer

P263THE RELATIONSHIP BETWEEN ENDOMETRIAL CANCER AND BONE DENSITY

Moon Hwa

Good Moon Hwa Hospital, KR

Objectives: A variety of neoplasms are related to osteoporosis in the absence of metastasis. We sought to evaluate bone mineral density (BMD) in patients with endometrial cancer. Methods: We retrospectively analyzed the BMD of the spine and femur using dual-energy X-ray absorptiometry (DEXA) in 43 patients with endometrial cancer and 80 control women. The control group was treated with surgery for benign disease. All patients with endometrial cancer and all control women had experienced menopause. There were no bone metastases in patients with endometrial cancer. We compared age, height, body weight, body mass index (BMI), and BMD of the spine and femur between the endometrial cancer and control groups, and compared BMD between stage I and stage Ⅱ, Ⅲ, and Ⅳ endometrial cancer patients. Results: There were no differences in the BMD of the spine or femur in patients with endometrial cancer and those in the control group. There were also no differences in the BMD of the spine or femur in patients with stage I versus stage Ⅱ, Ⅲ, or Ⅳ endometrial cancer. Conclusion: Endometrial cancer appeared to have no effects on BMD before treatment. However, to define is detailed effect on BMD, a prospective study with large sample size is needed.

P264THE RELATIONSHIP BETWEEN SERUM LEVEL OF VITAMIN D AND METABOLIC SYNDROME IN KOREAN POSTMENOPAUSAL WOMEN: A POPULATION–BASED STUDY

Kim Hoon (KR)

Ku S. (KR)

Suh C. (KR)

Kim S. (KR)

Choi Y. (KR)

Kim J. (KR)

Seoul National University College of Medicine, KR

Objective: Recently, vitamin D has been considered as an important regulator for bone mass and cardiovascular diseases. We aimed to investigate the association between serum vitamin D level and metabolic syndrome (MetS), which is a cluster of major risk factors for cardiovascular diseases. Materials and Methods: This study was based on nationwide representative survey data from the Korean National Health and Nutrition Examination Survey 2008. The cross-sectional analysis was performed and study participants included a total of 605 postmenopausal women. Any participants taking hormone therapy or treated for osteoporosis were excluded. Women with missing bone densitometry data or uncertain menopausal status and women who had a history of hysterectomy were also excluded from analysis. The MetS was classified according to the revised criteria from a joint scientific statement endorsed by National Heart, Lung, and Blood Institute and other major organizations and participants with three or more of the five components were diagnosed as having MetS. The level of 25-hydroxyvitamin D3 was determined using a radioimmunoassay kit. Results: Postmenopausal women with MetS were older and had higher BMI compared to women without MetS (P = 0.002 and 0.001, respectively). Overall prevalence of vitamin D deficiency was 84.2% when a normal serum level of vitamin D is defined as a 25- hydroxyvitamin D3 concentration same or greater than 30 ng/mL. The prevalence of hypovitaminosis D was not different according to the MetS status. After adjusting for confounders including age, body mass index, years since menopause and degree of physical activity or exercise, the serum level of vitamin D was significantly lower in women with MetS than that in women without MetS (20.7 ± 0.5 vs 22.4 ± 0.5 ng/mL, P = 0.01). The association between the number of MetS components and vitamin D level was not observed, however, the level in patients with three or more components tended to be lower. Additionally, partial correlation analysis adjusting for confounding variables revealed significant negative association between serum glucose and vitamin D level (P = 0.02). Conclusion: Hypovitaminosis D is prevalent in Korean postmenopausal women and low serum level of vitamin D is associated with MetS in studied population. Funding: This study was supported by the grants of Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2012R1A1A2006959 and NRF-2013R1A1A2009521).

P265VITAMIN D DEFICIT IS ASSOCIATED WITH INCREASED RISK FOR PERIODONTAL DISEASE IN POSTMENOPAUSAL WOMEN

Virtej Ioana (GR)

Poiana C. (RO)

Vartej P. (RO)

Ikonomou T. (GR)

Virtej A. (NO)

Endocrine Private Center Trikala Greece and University Carol Davila Bucharest Romania, GR

Periodontal disease is a common chronic inflammatory disease and an important risk factor for tooth loss. Systemic bone loss in postmenopausal women is associated with alveolar bone loss. Both periodontal disease and osteoporosis are highly prevalent among postmenopausal women. Vitamin D deficit is a major risk factor for osteoporosis and fragility fractures and could affect periodontal health by influencing skeletal metabolism or by an immunomodulatory effect. The aim of our study was to evaluate the prevalence of vitamin D deficit among postmenopausal women with periodontal disease. Methods: 55 caucasian women aged 52–69 years from the Balkan area. Exclusion criteria: < 10 teeth, smokers, prior therapy for osteoporosis, systemic diseases. Women with calcium and vitamin D supplements were included in the study. The diagnosis of periodontal disease was established by clinical examination measuring probing pocket depth (PPD) and clinical attachment loss (CAL) in 2 randomly selected upper and lower quadrants, and calculating mean value for the 2 parameters in each case. Severe periodontal disease was defined as PPD ≥ 5 mm and CAL ≥ 6 mm, moderate disease PPD 3–4 mm and CAL 4–5 mm, while mild cases have PPD < 3 mm and CAL < 4 mm. Vitamin D status was evaluated with serum 25 (OH)D concentration; values < 20 ng/mL were considered deficiency. Results: 90% of cases (50/55) had vitamin D deficiency. Severe periodontal disease was present in 47%, moderate in 32% and mild in 21% of cases. All cases of severe and moderate periodontal disease had vitamin D deficiency; mild periodontal disease had only 40% vitamin D deficiency. Mean CAL values had significant negative correlation with serum 25 (OH)D levels (r = −0,18, p < 0,01). Conclusion:Severe periodontal disease in postmenopausal women is frequently associated with vitamin D deficit.

BREAST CANCER BIOLOGYP268THE RATIO OF THE ESTRADIOL METABOLITES 2-HYDROXYESTRONE (2OHE1) AND 16ALPHA-HYDROXYESTRONE (16AOHE1) PREDICT BREAST CANCER RISK IN POSTMENOPAUSAL BUT NOT IN PREMENOPAUSAL WOMEN - A CASE-CONTROL STUDY

Ruan Xiangyan (CN)

Seeger H. (DE)

Mueck A. (DE)

Beijing OB/GYN Hospital, Capital Medical University, CN

Introduction: Two main estradiol metabolites have different biological behaviour with tumorigenic features of 16aOHE1 and antiproliferative characteristics of 2OHE1. We investigated the ratio of these estradiol metabolites in patients with breast cancer (BC) and with benign diseases. Patients and methods: From 2001 to 2003 in 41 premenopausal pts. with (cases) and without (controls n = 211) BC and 207 postmenopausal pts with and without BC (n = 206) urine samples were collected at the University womens clinic of Tuebingen. The control group comprised following diagnoses: fibroadenoma, mastopathy, hysteromyoma, urinary incontinence, benign ovarian cysts. Urine samples were collected prior to surgery and stored at −20°C until measurement. 2OHE1 and 16aOHE1 were measured by ELISA (Estramet, Immuna Care, Bethlehem, USA). Absolute values expressed in ug steroid hormone/mg creatinine were compared after logarithmic transformation (log ratio 2OHE1 to 16aOHE1) by t-test. The multiple linear regression test with two interactions was performed to evaluate the influence of different factors on the metabolic ratio. Results: In premenopausal pts. log ratio was 0.25 (CI 0.20;0.29) and 0.21 (CI 0.11;0.31) for controls and cases without significant difference. In postmenopausal pts log ratio was 0.22 (CI 0.17;0.26) and 0.11 (CI 0.07;0.15) in controls and cases respectively and was statistically significant lower (p = 0,0002). In multiple linear regression test log ratio was significantly influenced by BMI, but only in postmenopausal pts. In these pts an increased BMI resulted in a significantly (p < 0,042) decreased ratio of 2OHE1 to 16OHE1. Conclusions: The data of our case control study suggest that in postmenopausal women a different metabolism of estrogens may play an important role in the tumorigenesis of breast cancer. This genetically determined metabolism could be influenced by the exogenic factor BMI. In premenopausal women different hormone levels at different time points of the menstrual cycle may be an explanation that we could not find an influence of estrogen metabolism in this population.

BREAST CANCER EPIDEMIOLOGYP269OBESITY AND ITS ASSOCIATION WITH BREAST CANCER

Vega-Malagon Genaro (MX)

Avila-Morales J.

Becerril-Santos A.

Camacho-Calderón N.

Zaldivar-Lelo De Larrea G.

Universidad Autonoma de Queretaro, MX

Objective: Determine The association of obesity and anthropometric factors with breast cancer. Methodology: Case-control study in Querétaro General Hospital January 2000 to December 2005; cases: 60 women with histologically confirmed breast cancer, controls: 60 women with negative mammography cancer, anthropometric variables were analyzed odds ratio with confidence interval of 95%, Student’s t test and x squared. Results: The average age was similar in both groups, in the cases was 52.65 years (SD 11.80) and controls 52.01 (SD 11.15), with p > 0.05, anthropometric factors were statistically significant (p ≤ 0.05) were weight, body mass index ≥ 25 (OR: 6.05, 95% CI 2.53–14-47) Abdominal circumference ≥ 88 cm. (OR: 2.58, 95% CI 1.11–5.96), waist-hip index ≥ 0.86 (OR: 3.50, 95% CI 1.55–7.87). Conclusions: It is important to determine the anthropometric measurements of women and identify those at risk for breast cancer to conduct close monitoring and early detection of this disease. Keywords: Risk Factors, Breast Cancer.

HORMONE THERAPY AND BREAST CANCERP270SYSTEMATIC REVIEW ABOUT BREAST CANCER INCIDENCE IN RELATION TO HORMONE REPLACEMENT THERAPY USE

Antoine Caroline (BE)

Ameye L. (BE)

Paesmans M. (BE)

Rozenberg S. (BE)

CHU Saint-Pierre, BE

Background: Several studies report a Breast Cancer (BC) incidence decrease subsequent to the decrease in Hormone replacement therapy (HRT) use. But its magnitude and the time-lag may vary between countries. This may reflect differences in populations, previous type and prevalence of HRT use and BC screening. Aim: To review systematically studies assessing the relation between BC incidence and change of HRT use. Material and method: Descriptive analysis of the methodology of the studies including design limitations and presence of confounding factors, data sources for BC and HRT and regimens of HRT used. Results and discussion: Eighteen articles were selected. Most studies were ecological and confounding factors such as mammography screening and changes in reproductive and life style habits could not be excluded. Sources of data on BC and HRT were heterogeneous and only few data on HRT regimens used were available. Most studies concluded that the decrease in HRT use during the last decade was probably associated with a BC incidence decrease, especially for women aged 50 or more. Conclusions: Data, mostly from epidemiological studies, suggest that the BC incidence decrease can be partly attributed to the HRT use drop. Nevertheless, available studies are hampered by a number of limitations and it remains difficult to evaluate the exact impact of HRT drop on BC incidence decrease. Especially, the studies are seldom based on detailed individual data and don't provide information on used regimens, type of cancers and possible confounding factors.

BREAST CANCER SCREENING AND DIAGNOSISP271HYPOTHYROIDISM AND ITS EFFECTS ON THE BIOMARKER TRANSLATION TEST (BT TEST®) FOR BREAST CANCER SCREENING: HOW UNDIAGNOSED AND/OR UNTREATED HYPOTHYROIDISM CAN CAUSE A FALSE POSITIVE TEST

DeRosa Angela (US)

Gray K.

DeRosa Medical, PC, US

The Biomarker Translation Test^® (BT Test^®) is a blood-based screening tool that uses a specific multi-protein biomarker analysis for the early detection of breast cancer. The BT Test^® is designed to screen generally healthy women to help identify breast cancer in its early stages before it is easily identifiable by 2D mammography. The BT Test^® is also used by practitioners for patients with abnormal mammograms to help distinguish between invasive and benign breast neoplasms. In clinical studies, the BT Test^® has identified existing breast cancers with an accuracy of 97% in women age 49 and younger and 86% in women age 50 and older1. A controversial link remains between the relationship of hypothyroidism and breast cancer, although it has been well established that both conditions are associated with an increased inflammatory state. This study examines the role thyroid function plays on the positive predictive value of the BT Test^® and therefore the number of false positive test results. The protein biomarkers included in the BT Test^® may also be elevated in the presence of undiagnosed and therefore untreated hypothyroidism. This study identified a higher false positive rate of the BT Tests^® among women with untreated hypothyroidism compared to those euthyroid or with treated hypothyroidism. Seventy women without any contraindications conflicting with their eligibility for the test were screened for breast cancer using the BT Test^®. Untreated hypothyroidism was present in 90.9% of the patients with a positive BT Test^® and in 10.2% of the patients with a negative BT Test^®. Further data suggests a correlation between hypothyroidism, positive screening and cancer in the clinical setting. These findings are significant as they strongly suggest physicians should screen their patients for hypothyroidism prior to ordering BT Testing^® to decrease false positive results and subsequently decrease time, stress and patient cost.

MENOPAUSE AFTER BREAST CANCERP273VALIDATION OF A STERNAL SKIN CONDUCTANCE CRITERION FOR MEASURING HOT FLASHES IN BREAST CANCER PATIENTS

Savard Marie-Hélène (CA)

Savard J. (CA)

Ivers H.

Centre de Recherche du CHU de Québec, CA

Objective. This study aimed to establish the sternal skin conductance level (SCL) increase that would optimally detect hot flashes among breast cancer patients. Methods. Fifty-six women who had completed a similar treatment protocol for a first diagnosis of breast cancer within the previous 3 months wore an ambulatory sternal skin conductance device for one home-based daytime recording of hot flashes. Results. A total of 199 hot flashes were reported by the participants using the event marker. An SCL increase of 2 microsiemens (μmho) within a 30-second period, the criterion typically used, had a sensitivity of only 32% and a specificity of 97%. Comparatively, the alternative criterion proposed here, an SCL increase of 1.2 μmho, yielded a sensitivity of 61% and a specificity of 90%. Conclusions. This study provides evidence that a lower SCL criterion should be used to better detect objectively-recorded hot flashes among breast cancer patients. Further work is needed to validate the proposed criterion among this population.

P274CARDIOVASCULAR RISK IN POSTMENOPAUSAL WOMEN WITH AND WITHOUT BREAST CANCER

Conde D. (BR)

Costa-Paiva L. (BR)

Martinez E. (BR)

Pinto-Neto Aarao (BR)

Universidade Estadual de Campinas, BR

Objective: To compare the prevalence of cardiovascular disease (CVD) risk factors and cardiovascular risk in postmenopausal breast cancer survivors (BCS) and non-BCS. Methods: A cross- sectional study using one group for comparison was conducted, including women aged 45 to 65 years who had not received hormone therapy or tamoxifen during the last 6 months. Participants were recruited from the Menopause and Breast Cancer Outpatient Facilities. Fifty-six BCS and 81 non-BCS were included in the study. Sociodemographic and clinical features were assessed. Lipid profile and CVD risk were evaluated. CVD risk was assessed using the Framingham risk score. Comparisons between the groups of women with and without breast cancer were made by Student's t test or Fisher's exact test, depending on the type of variable. When appropriate, logistic or linear regression models were employed to compare the variables of interest between groups with adjustments for possible confounding effects of other predictor variables. Results: The mean age of BCS and non-BCS was 54.5 ± 5.7 years and 58.2 ± 4.7 years (p < 0.01), respectively. The prevalence of hypertension was 37.5% and 60.5% in BCS and non-BCS (p = 0.09), respectively. The mean lipid profile component was similar between groups (all p > 0.05). In the age-adjusted analysis, there was no difference in the prevalence of moderate (p = 0.87) and high (p = 0.23) CVD risk. Conclusions: The prevalence of CVD risk factors and cardiovascular risk were similar between postmenopausal BCS and non-BCS. These findings indicate the need to include CVD risk assessment in the follow-up of postmenopausal BCS.

P275HOW CAN HOT FLUSHES AND BREAST CANCER BE MANAGED EFFECTIVELY AND WITHOUT RISK?

Druckmann René (FR)

Espié M. (FR)

ANEMO, FR

For patients with breast cancer, the return to a normal quality of life is a key element in their well-being. The onset of hot flushes, whether natural or induced by anti-cancer therapy, can make it difficult to achieve this goal. As hormone replacement therapy is contraindicated in these women, other therapeutic methods must be considered. After a comprehensive review of the physiopathology of hot flushes and of the factors aggravating their frequency and severity in patients with breast cancer or in remission, this article takes stock of relevant scientific literature in order to evaluate the efficacy and safety of the various pharmacological and non-hormonal methods for treating flushes. It clarifies the place of a product consisting of purified pollen cytoplasm extracts Sérélys^®/Femal^® as part of the therapeutic arsenal available to postmenopausal women with breast cancer or with a history of breast cancer. The review of the literature shows that the use of antidepressants (venlafaxine, paroxetine, citalopram and fluoxetine), antihypertensives (clonidine) or anticonvulsants (gabapentin and pregabalin) significantly reduces the frequency and severity of hot flushes. The superiority of either of these methods has not, however, been demonstrated. However, the interaction of these products with anti-cancer therapy taken by the patient (usually tamoxifen) and the many side effects induced must be taken into consideration before proposing one of these therapies. The available data do not support the use of “natural” health products such as phytoestrogens, black cohosh and St. John’s wort in the treatment of hot flushes. Few studies have been conducted and none has demonstrated a significant impact on the frequency or severity of hot flushes. Moreover, the use of some of these products, including St. John's wort and black cohosh, could be harmful for patients treated with tamoxifen because they interfere with its metabolism. They are known for their oestrogenic activity, which renders their use inadvisable in women with breast cancer or in remission. All these data emphasize the need for a safe and effective alternative treatment for the management of menopause in these patients. Sérélys^®/Femal^®, which is made from pollen extracts, has demonstrated its clinical efficacy with respect to the most frequent climacteric symptoms such as hot flushes and night sweats. It substantially improves quality of life for postmenopausal women and proves to be a non-oestrogenic alternative to hormone therapy, particularly in postmenopausal women with breast cancer or in remission. The absence of significant amounts of phytoestrogens in its components, the absence of oestrogenic activity or uterotrophic effect and the excellent tolerance reported in clinical studies enable it to be offered safely to patients with menopausal symptoms. Sérélys^®/Femal^® therefore has its place in the arsenal of therapies available to gynaecologists and oncologists faced with a demand for safe, non-hormonal strategies capable of relieving hot flushes in women who have breast cancer or who have survived such a cancer.

OTHER TOPICS RELATED TO BREAST AND BREAST CANCERP276ADDITIONAL POSTOPERATIVE CHEMOTHERAPY AFTER NEOADJUVANT CHEMOTHERAPY FOR BREAST CANCER - A RETROSPECTIVE ANALYSIS

Promberger Regina (AT)

Dubsky P.

Ott J. (AT)

Bartsch R.

Medical University of Vienna, AT

Background: In breast cancer, the role of additional postoperative chemotherapy (APCT) after today's standard neoadjuvant chemotherapy (NACT) is still unclear. Our retrospective data set allowed for an appraisal of prognostic factors for event-free survival (EFS) and overall survival (OS). We focused on classic predictive factors and, in addition, we aimed to evaluate the value of an additional postoperative chemotherapy. Methods: In a retrospective cohort study, we included 175 female breast cancer patients who had received standard NACT (22 with and 153 without pathologic complete remission, pCR). Women with primary metastatic breast cancer, infiltration of the skin and/or ulcerated breast cancer as well as patients with HER2 + non-luminal tumors had been excluded. The decision whether APCT that had been administered in many patients was used or not had been made by the local interdisciplinary tumor board conference based on individual patient and tumor characteristics. Results: Forty-seven relapses (26.9%) and 19 deaths (10.9%) were observed (median follow up of 54.3 months, IQR 31.2–80.3 months). When comparing patients who had achieved pCR to those who had not, there were no differences in EFS or OS (p = 0.263 and p = 0.755 in logrank tests, respectively). We focused on patients without pCR: those with triple negative tumors and APCT achieved significantly worse OS in comparison with patients with hormone receptor positive tumors without ACT (p = 0.026). The situation was similar for EFS. Conclusions: pCR after NACT was not predictive for survival in patients with biologically unaggressive breast cancer. APCT was not capable of overcoming the negative effects of a high tumor burden on survival patients without pCR. Moreover, APCT might even be potentially harmful to patients and could exert adverse effects on survival.

P277THE AFFECTING FACTORS OF BREAST ANTHROPOMETRY IN KOREAN WOMEN

Kim M. (KR)

Kim Eun Jung (KR)

Lee M. (KR)

The Catholic University of Korea, KR

Background: Breast anthropometric morphology affects various factors with diverse physiognomy, making accurate measurements very difficult. The aim of this study was to measure the female breast using anthropometry and to use this method on normal subjects to examine breast asymmetry and consider the influence of age, height, weight, BMI, parity, delivery mode and breast feeding in premenopausal Korean women. Subjects and Methods: A total of 17 parameters of breast were measured with participants in a standing position. Breast volume was also assessed. Results: The mean values of the right and left breast volumes were calculated as 386.0 ± 342.5 ml and 393.3 ± 347.2 ml. With aging, the height of women decreased, but the weight, BMI, upper chest width, middle chest width, lower chest width, waist width, hip width, nipple-nipple length and ptosis increased with statistical significance. No asymmetric differences were observed between each breast, except for nipple-inframammary fold length in 20–30 year old women and upper arm length in 41–50 year old women. In our study, the breast volume increased with age as a result of weight gain, but the delivery mode and breast feeding did not affect anthropometric breast measurements. Conclusions: In conclusion, age, weight and BMI are important factors in determining breast anthropometry in our study. The results of the present study will help in the comparison of the anthropometric breast values of Korean women with those of women in other countries, and may also be useful in the understanding of breast physiologic change related obstetrical factors and epidemiologic factors. Keywords: anthropometric measurement, breast, breast volume.

P278DISORDERS OF MAMMARY GLANDS IN WOMEN WITH MENOPAUSAL SYNDROME

Burtushkina Natalia (RU)

Kravchuk L.

Irkutsk Medical University, RU

The study was aimed to determine alterations in the condition of mammary glands in women with menopausal syndrome against the background of hormonal therapy. Material and methods. 101 women with menopausal syndrome were observed in Irkutsk Scientific of the Siberian Branch of the Russian Academy of Science over the period of 2007–2013. Methods used included clinical method, mammography, sonography, thin-needle aspiration biopsy (TNAB). No pathology of mammary glands was discovered in 52 women. In 49 patients, structure of mammary glands condition was established as follows: fibrocystic mastopathy − 81.7%, nodal masthopathy − 4%, mammary fibroadenoma − 8.3%, adenosis − 2%. A combination of fibrocystic mastopathy and fibroadenoma was established in 4% of all cases. 2 groups were distinguished: Group I − 51 patients without hormonal treatment, Group II - 50 patients administered with hormonal therapy - (estradiol 1 mg + dihydrosteron 5 mg or estradiol 1 mg + drospirenone 2 mg) for 5 years. Duration of menopause in patients of Group I amounted to 4.03 ± 2.8 years, in Group II − 5.5 ± 3.6 years. Average patient age in Group I amounted to 50.8 ± 3.5 years, in Group II – 51.7 ± 3.8 years. Condition of mammary glands remained unchanged in all women of Group I and in 35 women of Group II. Alterations have been discovered in 15 patients of Group II: 2 patients were diagnosed with fibrocystic mastopathy, and in 13 patients with original fibrocystic mastopathy no pathology was found. Therefore, fibrocystic mastopathy dominates (75%) the structure of pathologies of mammary glands in women with menopausal syndrome. Frequency of the disease does not increase due to background hormonal therapy.

P279MAMMOGRAPHIC DENSITY AND METABOLIC SYNDROME IN MENOPAUSAL WOMEN

Somboonporn Woraluk (TH)

Kankoon N.

Soontrapa S.

Kaewrudee S.

Srinakarin J.

Dept of O&G, Faculty of Medicine, Khon Kaen University, TH

Objective: To evaluate whether metabolic syndrome is associated with an increase in percent mammographic density (MD), which is a breast cancer risk factor. Materials and Methods: A cross-sectional analytical study. A total of 713 climacteric women of ages between 40 and 70 were eligible to participate in our study. We performed general physical examination, blood test and mammogram on all participants. The participants were then classified into two groups, with and without metabolic syndrome, according to AHA/NHLBI 2005 statement. Radiologists read and categorized MD by using a traditional 4-level BI-RADS density scale. We used logistic regression and mixed model statistical analysis to examine the associations of metabolic syndrome and components of metabolic syndrome with the percent MD. Results: The prevalence of metabolic syndrome in our study was 20.48%. The most common range of MD in climacteric women with metabolic syndrome was 50% and in climacteric women without metabolic syndrome was 74%. When adjusting for body mass index (BMI), we found the inverse association between metabolic syndrome and percent MD. In addition, after controlling for BMI, the inverse associations were also demonstrated between percent MD and raised triglyceride. Conclusion: In our study, after controlling for BMI, metabolic syndrome inversely associated with an increase in percent MD. However, as the percent MD is considered as an intermediate outcome of breast cancer, it is still inconclusive whether metabolic syndrome is a risk factor of breast cancer.