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    Contents lists available at ScienceDirect
    Gynecologic Oncology
    Association between body mass index and surgical menopausal symptoms in patients with early stage endometrial cancer
    James C. Cripe a, , Tommy R. Buchanan Jr a, Lindsay M. Kuroki a, Leping Wan a, Kathryn A. Mills a, Leslie Massad a, Andrea R. Hagemann a, Katherine C. Fuh a, David G. Mutch a, Matthew A. Powell a, Koji Matsuo b, Premal H. Thaker a
    a Washington University School of Medicine St. Louis, St Louis, MO, USA
    b Keck School of Medicine of USC, Los Angeles, CA, USA
    • We describe the relationship of BMI with menopausal symptoms in women undergoing oophorectomy for endometrial cancer.
    • Women with a BMI N40 had significantly less menopausal symptoms than women with BMI b30.
    • Menopausal symptom type did not differ in relation to BMI.
    • These data have not been previously documented and may impact preoperative counseling of patients.
    Article history:
    Menopausal symptoms
    Endometrial cancer
    Surgical menopause 
    Objectives. Premenopausal women may undergo surgical menopause after staging for their endometrial can-cer. Our aim was to determine the association between body mass index (BMI) and surgical menopausal symp-toms.
    Methods. We report a retrospective review of endometrial cancer patients whom underwent menopause sec-ondary to their surgical staging procedure. Symptoms were classified as severe if treatment was prescribed, or mild if treatment was offered, but declined. Univariate analysis was performed with ANOVA and Chi-square tests as appropriate. Relative risks (RR) were generated from Poisson regression models.
    Conclusions. Women younger than 50 with BMI N40 and stage I endometrial cancer are significantly less likely than women with BMI b30 to experience menopausal symptoms after oophorectomy. This information may assist in peri-operative counseling.
    1. Introduction
    The incidence of endometrial cancer has increased by N50% over the last ten years and will affect a projected 63,230 women in 2018 [1]. This steady upward trend is partially related to the increasing obesity
    Corresponding author at: Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO, USA.
    E-mail address: [email protected] (J.C. Cripe).
    epidemic affecting 36.5% of adults in the United States [2]. Not only is endometrial cancer more common, but also it is affecting premeno-pausal women more frequently [3]. The 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system includes surgical removal of uterus, tubes, and ovaries with lymphadenectomy indicated depending on pre-operative and intra-operative findings [4]. Ovarian conservation remains contro-versial despite several national database studies suggesting this does not adversely affect survival in women with early stage endometrial
    cancer [5–7]. Given the rising prevalence of endometrial cancer among premenopausal women, surgical menopause is becoming increasingly problematic when caring for these women.
    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 [8]. 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 [9].
    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 [12]. 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.