br Symptoms of surgical menopause may negatively impact qual
Symptoms of surgical menopause may negatively impact quality of life and include vaginal dryness, mood changes, sleep disturbances, low libido, and most frequently vasomotor symptoms . Data show that over a third of patients may be reluctant to undergo oophorectomy due to the possibility of immediate menopausal symptoms and the complexities of hormone replacement .
Multiple factors such as tobacco use, albumin levels, and antidepres-sant use have been associated with the frequency and severity of men-opausal symptoms [8,10,11]. Although high body mass index (BMI, reported as kg/m2) has been suggested to increase vasomotor symp-toms during menopause, it is unknown whether BMI is associated with risk of surgical menopausal symptoms in patients who undergo oophorectomy as part of endometrial cancer staging . To provide in-formation to help surgeons and patients decide on an appropriate treat-ment strategy, our aim was to assess the association between BMI and menopausal symptoms after oophorectomy for early-stage endometrial cancer among women who are 50 years old or younger.
2. Materials and methods
After approval by the Washington University Human Research Pro-tection office (#201612038), a cross-sectional review of surgically staged EC patients from 1/1/2000–12/31/2014 was performed from our billing records. All patients within that time frame were included who had endometrial endometrioid adenocarcinoma, stage I disease, age b 50 years, removal of both Cell Counting at the time of staging, and no previously documented menopausal symptoms or hormone replace-ment usage.
Menopausal symptoms were documented in the medical record via a patient's self-symptom assessment intake form presented and filled out by all patients seen in clinic, as well as the encounter's documented progress note. Abstracted symptoms included vasomotor symptoms, mood changes, fatigue/sleep disturbances, or sexual dysfunction/vagi-nal dryness. These symptoms were recorded if they occurred within 12 weeks post-operatively. This time point was set arbitrarily to contain all patients postoperative visit as some were not seen until 8–11 weeks after their surgery. Symptoms were qualitatively classified as severe if they were both present and had a treatment prescribed, mild if present but had declined treatment, or none, if no symptoms were present. Nonprescription medications such as black cohosh, soy, or the like were unable to be captured.
Univariate analysis was performed with ANOVA and Chi-square when appropriate. Relative risks (RR) were generated from Poisson re-gression models. Covariates for multivariate analysis included age, BMI, beta blocker use, and preoperative antidepressant use. Only 8 patients were smokers and there was not interaction on statistically modeling. A P-value of b0.05 was considered statistically significant. SAS version 9.4 (SAS Institute Inc., Cary, NC, USA) was used for all statistical tests.
We identified 188 patients who underwent surgical management and were confirmed to have had stage I endometrial carcinoma. After exclusion of patients for loss to follow-up and/or ovarian conservation, 166 were evaluable with a median follow-up of 55.2 months. Mean age was 42.5 years, and mean BMI was 40.7. The majority of patients were white (n = 140, 84.3%). All patients underwent hysterectomy; 163 had bilateral salpingo-oophorectomy, and 3 had previous unilateral salpingo-oophorectomy and underwent completion unilateral salpingo-oophorectomy. Pelvic and para-aortic lymphadenectomy were performed in 53.0% and 46.4% of patients, respectively. Adjuvant chemotherapy and/or radiation only occurred in five patients (3.0%). Twenty-six patients were noted to have used selective serotonin
reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibi-tors (SNRIs) pre-operatively, and only eight patients reported tobacco use. Table 1 lists clinico-demographic factors of the cohort.
Consistent with the favorable prognostic factors of our cohort, recur-rent disease was infrequent, and occurred in only 4 (2.4%) patients; 2 patients had vaginal apex lesions and 2 had pelvic sidewall masses. Sal-vage occurred in 3 (75%) of the recurrences, and 1 patient died of
Recommended treatment of menopausal symptoms
BMI: body mass index (kg/m2), chemo: chemotherapy, RT: radiation therapy, yr: years.
Bold values indicates statistically significance at P b 0.05.
Fig. 1. Menopausal symptom prevalence.
disease. Time to recurrence was 3, 5, 11, and 38 months after surgery. Treatment regimens for recurrent disease included a combination of chemotherapy and radiation. Only 1/3 salvaged patients were treated with systemic estrogen therapy. Lastly, there were two patients with in-tercurrent deaths, neither of which were on hormonal therapy.