Tamoxifen (TMX) is regarded as standard treatment for Background: breast cancer (BC) patients . In recent years, several studies have reported gynecological side effects and due to TMX's estrogenic effects. Here, we evaluate the side effects of TMX on the endometrium and ovaries of female BC patients.This was an ultrasound-based cohort study conducted in three Methods: oncology centers in Baghdad, Iraq. A total of 255 female patients were included, 140 premenopausal (PreM) and 115 postmenopausal (PostM), with estrogen receptor (ER)-positive BC using TMX adjuvant hormonal treatment for at least three months after surgery and adjuvant chemo/radiotherapy. Ultrasound (US) on the endometrium and ovaries of the women following BC surgery/chemotherapy (baseline) and at 3, 6, 12, and 24 months following was performed . Data collected included age, menopausal status, co-morbid chronic illness and medications, including duration of TMX treatment.Presence of ovarian cyst was significantly higher in the PreM Results: compared to PostM women, while there were no significant differences for other gynecological findings. At baseline, endometrial thickness (ET) was significantly higher in the PreM compared to the PostM women. In both groups, women with increased ET became more frequent from baseline to 3 months, from 3 to 6 months, from 6 to 12 months, and from 12 to 24 months. At all time periods, women with increased ET was significantly higher in the PostM compared PreM women, resulting in a risk of ET increase by 6 folds (ranging from 3 -11 folds) in PostM compared to PreM women.Longer duration of TMX is associated with increased ET. Conclusions:Duration of TMX did not appear to increase the risk of various gynecological outcomes, for example endometrial cancer rate was low. Finally, there was an increase in ET, which appeared to be six-folds higher in PostM compared to PreM women. Keywords

The objective of the current work to evaluate the role of metformin in inhibiting the tamoxifen induced ‎endometrial ‎changes in diabetic patients with ER-positive breast cancer, a case-control study, carried out between December 2018 to May 2019, forty ‎diabetic women in postmenopausal phase with ER+ breast cancer on tamoxifen (20mg/day), ‎metformin ‎‎(1700 mg/day) GROUP A, and 40 diabetic patients with ER+ breast cancer on the ‎same dose of tamoxifen, but other hypoglycemic agent GROUP B, were selected as controls. ‎Uterine thickness was assessed by ultrasonography imaging at the beginning of treatment with ‎tamoxifen and after 2 years of treatment. Hysteroscopy ‎was done, and pathological findings also ‎recorded.‎ Mean uterine thickness of diabetic patients on other hypoglycemic was ‎significantly higher than diabetic patients on metformin (14.79±3.6 vs 4.37±1.8). Uterine ‎thickness >5mm were 2 (5%) vs ‎36 (85%) reported with the diabetic patient on metformin and the ‎diabetic patient on ‎other oral hypoglycemic group. Three cases (7.5%) of the diabetic patients ‎on other hypoglycemic agent were developed uterine polyps, and one case (2.5%) of diabetic ‎patients on metformin were developed uterine polyps. One case (2.5%) of uterine carcinoma ‎was reported with diabetic patients on other hypoglycemic group.‎ In conclusions metformin significantly inhibit tamoxifen-induced endometrial changes and ‎offers favorable endometrium protection.

Numerous variables, including age, gender, physical inactivity, inadequate dose, noncompliance, and drug-drug interactions, may lead to substantial intraindividual variability in metformin (Met) response. This study aimed to determine how dosages and duration of metformin affected glycemic control and insulin levels in Iraqi patients with T2DM. A total of 153 T2DM patients with a disease duration of more than one year participated in a cross-sectional study at the Diabetes and Endocrinology Center, Baghdad from October 2021 to March 2022. As part of the study method, the patients were evaluated clinically and physically, and their body weight, waist circumference, and body mass index (BMI) were measured. Glycated hemoglobin (HbA1c), fasting glucose (FSG), insulin, creatinine, and C-reactive protein (CRP) levels were evaluated. After data correction for Met doses and length of treatment, FSG, HbA1c, insulin, creatinine, and CRP levels were not substantially different (P > 0.05) among groups taking different doses of Met for different periods. According to Pearson's correlation analysis, there was no significant relationship between Met doses and treatment duration and glycemic control or insulin levels. In conclusion, Met dose and treatment duration were not significantly correlated to glycemic control or serum insulin levels, which could be attributed to other factors.

Introduction: Numerous factors, including age, gender, physical inactivity, insufficient dose, noncompliance, and drug-drug interactions, may contribute to significant intraindividual variation in metformin (MET) response. This study aims to determine the effect of Met dose and treatment duration on adiposity markers and serum leptin levels in Iraqi patients with type 2 diabetes. Methods: Between October 2021 and March 2022, a cross-sectional study at the Diabetes and Endocrinology Center in Baghdad included 150 type 2 diabetes mellitus (T2DM) patients with a disease duration of more than 1 year. Clinical and physical examinations were conducted before enrollment. We measured anthropometric variables such as body mass index, waist-to-hip ratio, and visceral adiposity index. We evaluated glycated hemoglobin, leptin, C-reactive protein, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), and triglycerides (TGs) in the serum. Results: Only the TC/HDL-c and TG/HDL-c ratios were significantly different after the data were arranged according to glycemic control level. Arrangement for MET doses and treatment duration, none of the evaluated parameters were significantly different (p > 0.05) between groups receiving different doses of MET for different durations, except visceral adiposity index (VAI), which shows a very slight decrease (p = 0.046) after more than 10 years of treatment. Pearson’s correlation analysis revealed a weak and significant association between waist circumference (WC) and hip circumference and MET doses, and a weak and significant association between WC, VAI, and TG levels and treatment duration. The other markers lacked a significant relationship with MET doses or duration of treatment. Conclusion: MET dose and duration of treatment were not significantly correlated with adiposity and lipid profiles in Iraqi patients with T2DM.

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