poor sleep quality after surgical menopause: complex associations between mood, vasomotor symptoms,...

DESIGN: Prospective cohort study.MATERIALS AND METHODS: 707 postmenopausal women agedR50

years were studied. Participant demographic characteristics, medical history,lifestyle factors, past-year history of falls, and physical activity (PA) scoreswere assessed. We recorded single and multiple falls, anthropometric param-eters, five special physical performance tests, hormone levels, and bone min-eral density measurements. Data on knee osteoarthritis (OA), lumbarspondylosis and osteopenia were collected. Knee and lower back painwere assessed by an interview and cognition was assessed by mini-mentalstate examination.

RESULTS: During�5 years of follow-up, 164 women (23.2%) reported atleast one fall, of whom 73 (10.3%) reported multiple falls. Six independentpredictors of all falls were identified: past-year history of falls; relative riskestimate [RR], 3.53; (95% CI confidence interval [CI]: 2.61-4.76); PA-score% lowest quartile, (RR¼2.46; 95% CI:1.50-4.01); age R65 years(RR¼2.16, 95% CI:1.30-3.12); presence of knee OA (RR¼1.76; 95%CI:1.32-2.39); hand grip strength % lowest quartile, (RR¼1.60; 95%CI:1.08-2.40); and serum 25(OH)D % lowest quartile, (RR¼1.48; 95%CI:1.16-1.84).

CONCLUSION: These results identified six risk factors for all fallsincluding past-year history of falls, poor physical activity score, age R65tears, presence of knee OA, poor handgrip strength, and vitamin-D deficiencyamong Saudi postmenopausal women.

Supported by: This is study was Supported by the Center of Excellence forOsteoporosis Research.

O-128 Tuesday, October 21, 2014 05:00 PM

MEDICAL SPECIALTYAFFECTSWHENANDWHYWOMENAREPRESCRIBED MENOPAUSAL HORMONE THERAPY. C. Yondorf,S. E. Pollack, J. Bauer, G. Neal-Perry. Obstetrics & Gynecology andWomen’s Health, Albert Einstein College of Medicine, Bronx, NY.

OBJECTIVE: The goal of this study is to assess attitudes, menopausalmedicine knowledge, and prescribing patterns of menopausal hormone ther-apy (MHT) by healthcare providers who render health care to women.

DESIGN: An anonymous survey designed to assess attitudes, MHT pre-scribing patterns, and general menopausal medicine knowledge was admin-istered to residents and faculty of the Departments of Family Medicine (FM)and of Obstetrics and Gynecology (OB/GYN) at MontefioreMedical Center-Albert Einstein College ofMedicine.We tested the hypothesis that training ina non-OB/GYN discipline and training after the paradigm shifting 2002WHIstudy reduces the likelihood clinicians will prescribe MHT for bothersomevasomotor symptoms.

MATERIALS AND METHODS: Chi squared analysis and Fisher’s exacttest were used to determine differences in the proportion of FM and OB/GYNclinicians who responded to survey questions. P<0.05 is considered statisti-cally significant.

RESULTS: We received 184 responses, 130 OB/GYN and 54 FM phy-sicians. Significantly more OB/GYN than FM physicians prescribe MHT(p<0.01). When data were stratified by when physicians trained relativeto the landmark WHI report in 2002, nearly twice as many OB/GYNsreported prescribing MHT if he/she trained before compared to afterWHI (p¼0.018; OR 2.6). Additionally, as much as 8-times more FMphysicians reported that they prescribed MHT if they trained prior toWHI (p<0.01; OR 45.6). OB/GYNs were more likely to prescribe

Factors Associated with Poor Sleep Quality

Univariate Associations Multivariable

Risk Factor Odds Ratio (OR) P value Adjusted OR*

Vasomotor Symptoms 2.14 (1.45-3.15) < .0001 1.68 (1.13-2.5)Obesity 1.64 (1.07-2.51) .02 1.46 (0.89-2.42Age >50 0.83 (0.59-1.17) .3 1.03 (0.69-1.55HRT Use 0.72 (0.48-1.08) .09 0.79 (0.51-1.25Depressed Mood 4.69 (3.14-7.06) < .0001 2.88 (1.8-4.61)Anxiety 3.62 (2.43-5.44) < .0001 2.04 (1.26-3.3)Taking Antidepressants 2.46 (1.64-3.73) < .0001 2.09 (1.34-3.28

*Adjusted for Age, Depressed Mood (borderline or clincal), Anxiety (borderline

e44 ASRM Abstracts

systemic MHT than FM physicians who typically used local MHT. FMand OB/GYN physicians cited vasomotor symptoms and vaginal drynessas common indications for MHT. However, OB/GYNs were twice aslikely to prescribe MHT for cardioprotection and cognitive heathcompared to FM doctors (P<0.01). Among physicians who do not pre-scribe MHT, 96% FM compared to 26% OB/GYN physicians expressedfear regarding adverse effects of MHT on patient health (P<0.01) as alimiting factor.CONCLUSION: Medical discipline (OB/GYN vs FM) and timing of

training relative to the publication of the primaryWHI study (before vs after)significantly affects prescribing patterns of MHT. Overall, our findings sug-gest a need to educate OB/GYN and FM physicians regarding the indicationsand utility of MHT. Education of the primary healthcare providers of womenabout the use of MHTwill ensure that aging women receive comprehensiveand current evidence-based care.Supported by: Department of Obstetrics and Gynecology.

O-129 Tuesday, October 21, 2014 05:15 PM

POOR SLEEP QUALITYAFTER SURGICAL MENOPAUSE: COM-PLEX ASSOCIATIONS BETWEEN MOOD, VASOMOTOR SYMP-TOMS, AND MEDICATIONS. S. Butts,a L. Johnson,a

L. Digiovanni,b C. Voong,b J. Chan,a S. Senapati,a S. Domchek.b aObste-trics and Gynecology, Perelman School of Medicine, University of Pennsyl-vania, Philadelphia, PA; bAbramson Cancer Institute, University ofPennsylvania, Philadelphia, PA.

OBJECTIVE: Few investigations have studied sleep quality in surgicallymenopausal women. We aimed to evaluate clinical factors associated withdisordered sleep quality in BRCA 1 and 2 carriers after risk-reducing BSO(RRBSO).DESIGN: A cross-sectional investigation of 594 women after

RRBSO.MATERIALS AND METHODS: The Pittsburgh Sleep Quality Index

was completed as a subjective measure of sleep quality. A score of 6or greater indicates poor sleep quality. Vasomotor symptoms were as-sessed using the Green Climacteric Scale. Depression and anxietywere assessed with the Hospital Anxiety Depression Scale. Univariatetests of association (Wilcoxon ranksum test and c2) and logistic regres-sion modeling were used to evaluate associations of selected variableswith poor sleep.RESULTS: The majority of participants reported poor sleep quality

(61.2%, n¼364). Vasomotor symptoms were significantly associated withpoor sleep even when accounting for hormone replacement therapy (HRT)and antidepressant use. Anxiety and depressed mood were also associatedwith poor sleep after adjusting for antidepressant use. Inwomenwithout nightsweats, the presence anxiety was significantly associated with poor sleep.CONCLUSION: Depressed mood, anxiety, and vasomotor symptoms are

significantly associated with poor sleep quality in surgically menopausalBRCA 1 and 2 carriers even when controlling for use of HRTand antidepres-sants. Our results suggest that these conditions are inadequately treated inthis population, contributing to the poor sleep quality observed.Supported by: Susan G. Komen, grant Sac10003 (SD), Basser Research

Center for BRCA (SD), NIH T32 HD007440 (LJ), NIEHS5P30ES013508-07 (SB).

Regression Regression Excluding Subjects with Night Sweats

P value Adjusted OR* P value

.01 1.38 (0.72-2.63) .3) .1 0.57 (0.24-1.38) .2) .9 1.13 (0.6-2.13) .7) .3 1.84 (0.9-3.75) .3

< .0001 1.68 (0.78-3.62) .2.004 3.41 (1.47-7.9) .004

) .001 1.84 (0.9-3.75) .1

or clinical), Vasomotor Symptoms, HRT Use, Antidepressant Use

Vol. 102, No. 3, Supplement, September 2014