Prevalência e severidade de sintomas em mulheres na menopausa: um estudo descritivo / Prevalence and severity of symptoms in women in the menopause: a cross-sectional study

Introdução: Muitas mulheres sofrem com sintomas associados à menopausa, que podem apresentar diferentes graus de intensidade e afetar sua qualidade de vida. Objetivo: Identificar a prevalência e severidade dos principais sintomas nas diferentes fases do climatério. Métodos: Foram selecionadas mulheres com idades entre 40 e 65 anos, que responderam a um questionário on-line com dados sociodemográficos, de saúde, alimentação e características menstruais e de menopausa. Para avaliar os sintomas da menopausa e sua intensidade, foi aplicado o questionário internacional validado Menopause Rating Scale (MRS). Resultados: Foram incluídas 283 mulheres (36,8% na pré-menopausa, 24% na perimenopausa e 39,2% na pós-menopausa). Excesso de peso foi mais prevalente na perimenopausa do que na pré-menopausa (P=0,012). Sintomas como diminuição da libido, secura vaginal, incontinência urinária, dores musculares e articulares, alterações lipídicas e ondas de calor, calorões, foram mais prevalentes em valores absolutos nas mulheres pós-menopausa. As mulheres no período de perimenopausa apresentaram maior prevalência, em valores absolutos, de estresse, irritabilidade, dor de cabeça, problemas na pele, falta de concentração/memória, distúrbios do sono e fadiga. De acordo com o MRS, não houve diferença no domínio psicossocial (P=0,265) e os sintomas somato-vegetativos e urogenitais são mais intensos nas mulheres na perimenopausa e pós-menopausa, quando comparadas com as mulheres na pré-menopausa (P<0,001). O escore global do questionário também demonstra essa intensidade menor no grupo pré-menopausa (P=0,001). Conclusões: Este estudo demonstrou uma prevalência e severidade maior de sintomas em mulheres na perimenopausa e pós-menopausa, o que pode prejudicar a qualidade de vida dessas mulheres nessa fase da vida

Introduction: Many women experience symptoms associated with menopause that present with different degrees of intensity and affect their quality of life. Objective: To identify the prevalence and severity of the main symptoms during different climacteric phases. Methods: Women aged 40­65 years answered an online questionnaire on sociodemographic data, health, diet, menstrual, and menopausal characteristics. The internationally validated Menopause Rating Scale (MRS) questionnaire was used to assess menopausal symptoms and their intensities. Results: 283 women were included (36.8% pre-menopausal, 24% peri-menopausal, and 39.2% post-menopausal). Excess weight was more prevalent in the peri-menopausal group than in the pre-menopausal group (P=0.012). Symptoms such as decreased libido, vaginal dryness, urinary incontinence, muscle and joint pain, lipid alterations, and hot flashes were more prevalent in the absolute values of post-menopausal women. Women in the peri-menopausal period had a higher prevalence, in absolute values, of stress, irritability, headache, skin problems, lack of concentration/memory, sleep disorders, and fatigue. According to the MRS, there was no difference in the psychosocial domain (P=0.265) but somato-vegetative and urogenital symptoms are more intense in peri-menopausal and post-menopausal women when compared to pre-menopausal women (P<0.001). The global score on the questionnaire also demonstrated a lower intensity in the pre-menopausal group's symptoms (P=0.001). Conclusions: This study demonstrated a higher prevalence and severity of symptoms in peri-menopausal and post-menopausal women, which may impair the quality of life of these women at this stage of life.

Síntomas climatéricos y calidad de vida mediante índice de Kupperman-Blatt y escala de Cervantes / Climacteric Symptoms and Quality of Life according to the Kupperman-Blatt Index and the Cervantes Scale

Introducción: Durante el climaterio o perimenopausia se reflejan una serie de síntomas asociados a la disminución progresiva de las secreciones hormonales de estrógeno y progesterona, estas deficiencias provocan diversos síntomas de orden somático, vasomotor, sexual y psicológico que perjudican la calidad de vida en general de las mujeres, además de las alteraciones en el ciclo menstrual. Objetivo: Determinar la severidad de los síntomas climatéricos en mujeres perimenopáusicas mediante el índice de Kupperman-Blatt y la Escala de Cervantes. Métodos: Se trató de un estudio de corte cuantitativo, tipo descriptivo, observacional, y correlacional, en pacientes que asistían al Centro de Salud Las Moras, en el Departamento de Huánuco, Distrito Huánuco Perú. La muestra estuvo conformada por 60 mujeres que cumplieron con los criterios de inclusión. Se aplicaron el Índice Menopáusico de Kupperman-Blatt y la Escala de calidad de vida de Cervantes. Resultados: La evaluación global del Índice Menopáusico de Kupperman-Blatt clasificó a 55 por ciento de las pacientes con intensidad de síntomas leve, seguido de 35 por ciento en pacientes que declararon no tener síntomas. Esto se correspondió en la Escala de calidad de vida de Cervantes con 45 por ciento en pacientes clasificadas con compromiso leve de su calidad de vida, seguido de 40 por ciento con mediano compromiso de calidad de vida. Conclusiones: Con un nivel de significancia de p < 0,05, se demostró que durante la etapa climatérica ambos test presentan una correlación positiva, entre la intensidad de la sintomatología medida con el Índice Menopáusico de Kupperman-Blatt y la calidad de vida valorada con la Escala de Cervantes(AU)

Introduction: During climacteric or perimenopause, a series of symptoms are reflected in association with a progressive decrease in estrogen and progesterone hormone secretion. These deficiencies cause diverse somatic, vasomotor, sexual and psychological symptoms that impair the general quality of life of women, in addition to alterations in their menstrual cycle. Objective: To determine the severity of climacteric symptoms in perimenopausal women, using the Kupperman-Blatt index and the Cervantes scale. Methods: This was a quantitative, descriptive, observational and correlational study with patients attending Las Moras health center, Huanuco Department, Huanuco District, Peru. The sample consisted of 60 women who met the inclusion criteria. The Kupperman-Blatt Menopausal Index and the Cervantes Quality of Life Scale were applied. Results: According to the global assessment using the Kupperman-Blatt Menopausal Index, 55 percent of the patients were classified as presenting mild symptom intensity, followed by 35 percent of patients who reported no symptoms. This values were consistent with the Cervantes Quality of Life scale, with 45 percent of patients classified as presenting mild compromise of their quality of life, followed by 40 percent with medium compromise of quality of life. Conclusions: With a significance level of P<0.05, it was demonstrated that, during the climacteric stage, both tests present a positive correlation, regarding the intensity of the symptoms measured with the Kupperman-Blatt Menopausal Index and the quality of life assessed with the Cervantes scale(AU)

Resultados de Covid-19 en mujeres posmenopáusicas y perimenopausicas: ¿Se atribuye a los estrógenos las diferencias? / COVID-19 outcomes in postmenopausal and perimenopausal women: are the diferences ascribed to estrogens ?

Antecedentes: A nivel mundial, la tasa de letalidad es mayor en hombres que en mujeres. Algunos estudios lo han sugerido. Se plantea la hipótesis de que la hormona estrogénica, puede disminuir la susceptibilidad al síndrome respiratorio agudo severo coronavirus 2. Objetivo: El objetivo del estudio fue evaluar las diferencias de género en los resultados del SARS CoV-2 y analizar si existen diferencias en los resultados en mujeres premenopáusicas en comparación con posmenopáusicas. Materiales y métodos: Se incluyeron en el estudio 720 pacientes que dieron positivo (+) para SARS CoV-2 a través de la reacción en cadena de la polimerasa (PCR) con transcripción inversa en tiempo real, mediante el ensayo Thermo Fischer Taqpath, aprobado por el Consejo Indio de Investigación Médica. Los datos obtenidos fueron analizados por las características epidemiológicas, clínicas y de laboratorio de sus historias clínicas. Resultados: La tasa de mortalidad en las mujeres fue del 12,6%, mientras que la mortalidad en los hombres fue del 19,4%. En el análisis entre grupos, el 8,6% (16/185) de las mujeres murieron en el grupo de edad premenopáusica frente al 12,8% (27/211) en el grupo posmenopáusico. La proporción de mujeres que fallecieron debido a COVID difiere significativamente según la edad y el estado posmenopáusico X2 (1, n = 293) = 7,2, el valor de p es 0,007. La diferencia es estadísticamente significativa a P<0,05. Las mujeres posmenopáusicas tenían más probabilidades de fallecer debido a la infección por COVID-19 en comparación con las mujeres premenopáusicas

Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause

Objective: Vasomotor symptoms affect 60-80% of women during the menopausal transition. Anxiety, depression, and anxiety sensitivity can have an important role in the distressful experience of vasomotor symptoms. Our aim was to evaluate the prevalence and association of vasomotor and negative affect symptoms. Methods: A cross-sectional study was conducted with 89 perimenopausal women aged 45-55 years. Broad psychiatric and clinical evaluations were carried out. The primary outcome was the vasomotor symptom problem rating and the main study factor was anxiety sensitivity. Linear regression analyses were conducted to examine the associations between the study factors and the primary outcome, and a multiple regression model was created to assess which variables were independently associated with vasomotor symptom problem rating. Results: The prevalence of anxiety, depression, and vasomotor symptoms were 58, 62, and 73%, respectively. Negative affect symptoms were positively associated with vasomotor symptom problem rating. The association of anxiety sensitivity and vasomotor symptom problem rating remained significant after controlling for perimenopausal stage, thyrotropin, follicle-stimulating hormone levels, and psychotropic medication use (β = 0.314, p = 0.002). Conclusion: A better understanding of the experience of vasomotor symptoms is needed, especially the role of negative affect symptoms and anxiety sensitivity. New strategies focusing on related thoughts and behaviors could improve the quality of life of perimenopausal women.

Análise do fêmur de ratas tratadas com ocitocina e submetidas ao treinamento de força durante a periestropausa / Analysis of the femur of rats treated with oxytocin and submitted to strength training during periestropause

A diminuição nas concentrações de estrógeno, como o que ocorre no período da perimenopausa e menopausa, contribui para o aumento do turnover ósseo, com taxa de reabsorção superior à de formação óssea que favorece a instalação da osteoporose, doença silenciosa que determina fragilidade óssea e maior probabilidade de fraturas. Entre as intervenções utilizadas para prevenção da osteoporose, destaca-se o treinamento de força (TF) e a ocitocina (OT), hormônio promissor com ação anabólica no osso. O objetivo deste estudo foi verificar a ação da associação da OT ao TF, em comparação às intervenções isoladas, no processo de remodelamento ósseo do colo do fêmur de ratas Wistar na periestropausa (18 a 21 meses). Quarenta ratas Wistar com ciclo estral irregular (18 meses) foram randomizadas nos grupos: 1- Veículo (Veh); 2-Ocitocina (Ot); 3-Treinamento de força (Tf); 4-Ot+Tf. Os animais do grupo 1 receberam salina (0,15 mol/L) e dos grupos 2 e 4 receberam OT (134 µg/kg), sendo duas injeções intraperitoneais com intervalo de 12 horas a cada 30 dias, totalizando 8 injeções ao final do período experimental. Os animais dos grupos 3 e 4 realizaram TF em escada 3 vezes por semana com realização mensal do teste de capacidade de carga máxima voluntária (CCMV). Após 120 dias, os animais foram eutanasiados, os fêmures foram coletados para análises de ensaio mecânico, densitometria, microtomografia óssea, espectroscopia de Raman e técnica de reação em cadeia da polimerase de transcrição reversa em tempo real (qRT-PCR), e o sangue para análises de marcadores bioquímicos do metabolismo ósseo, dano hepático e estresse oxidativo. A principal novidade deste estudo é a adição da OT ao TF, a qual apresentou, no ensaio de compressão, maior força máxima em relação ao Veh e menor elasticidade em relação ao Tf e, no ensaio de flexão de três pontos, maior rigidez em relação ao Veh e Ot, menor rigidez e menor elasticidade em relação ao Veh; maior espessura cortical (Ct.Th) em relação aos demais grupos, menor número de poros (Po.N) em relação ao Veh e Ot, e maior momento polar médio (J) em relação ao Tf. Houve também maior volume do osso trabecular (BV/TV) em relação ao Ot e maior espessura trabecular (Tb.Th) em relação aos demais grupos. A densidade mineral óssea areal (aDMO) do colo do fêmur foi maior que o Ot, e a DMO do fêmur total foi maior que os demais grupos. Quanto a expressão gênica, houve maior expressão do fator de transcrição relacionado ao Runt 2 (Runx2) em relação ao Veh, o fator de transcrição Osterix (Osx/Sp7) foi menor que o Ot e Tf. A proteína morfogenética óssea 2 (Bmp2) apresentou menor expressão em relação ao Veh, e a expressão da fosfatase alcalina óssea (Fal) foi maior que os demais grupos. A expressão do membro da família do fator de necrose tumoral 11b (Opg) e do ligante do fator de necrose tumoral (Rankl) foi maior que os outros grupos, a expressão do membro do fator de necrose tumoral 11a (Rank) e catepsina K (Ctsk) foi maior que Veh e Ot. Também foi observado menor atividade de fosfatase ácida resistente ao tartarato (TRAP) e capacidade antioxidante total (CAT) no ensaio bioquímico em relação aos demais grupos. Na intervenção com OT, houve maior elasticidade no ensaio de flexão de três pontos, e maior Ct.Th em relação ao Veh. A expressão gênica de Runx2, Osx/Sp7 foi maior e Bmp2 foi menor que o grupo Veh. No TF houve maior elasticidade que o Veh e Ot no ensaio de compressão, maior rigidez e elasticidade em relação ao Veh no ensaio de flexão de três pontos. Houve menor Ct.Th em relação ao Ot, maior DMO do fêmur total em relação ao Veh, e a taxa de mineralização foi maior que o Veh e Ot. Na expressão gênica, Runx2 e Osx/Sp7 foram maiores que o Veh. A Bmp2 e osteocalcina/proteína óssea gama-carboxiglutamato (Ocn) foram menores que o Veh, e a Fal foi menor que Ot. Em relação a Rank e Ctsk, estas foram maiores que Veh e Ot. Por fim, a atividade de aspartato aminotransferase (AST) foi menor que o Veh. Esses resultados mostraram que a associação de intervenções é estratégia anabólica promissora para a prevenção da osteoporose no período da periestropausa, destacando-se dos efeitos das intervenções isoladas, ao preservar aspectos mecânicos, estruturais e gênicos do osso, além de parecer controlar fatores relacionados ao cross-talk entre tecido ósseo e tecido adiposo a favor da homeostase oxidativa e de fatores relacionados a atividade de marcadores ósseos(AU)

The decrease in estrogen concentrations, such as that which occurs during perimenopause and menopause, contributes to an increase in bone turnover, with a rate of resorption higher than that of bone formation, which favors the installation of osteoporosis, a silent disease that determines bone fragility and greater probability of fractures. Among the interventions used to prevent osteoporosis, strength training (ST) and oxytocin (OT), a promising hormone with anabolic action on bone, stand out. The objective of this study was to verify the action of the association of OT and ST, compared to isolated interventions, in the process of bone remodeling of the femoral neck of Wistar rats in periestropause (18 to 21 months). Forty Wistar rats with irregular estrous cycle (18 months) were randomized into groups: 1-Vehicle (Veh); 2-Oxytocin (Ot); 3-Strength training (St); 4-Ot+St. The animals in group 1 received saline (0.15 mol/L) and in groups 2 and 4 received OT (134 µg/kg), with two intraperitoneal injections with an interval of 12 hours every 30 days, totaling 8 injections at the end of the period. trial period. The animals in groups 3 and 4 performed ST on a ladder 3 times a week with monthly performance of the maximum voluntary carrying capacity test (MVCC). After 120 days, the animals were euthanized, the femurs were collected for mechanical assay analysis, densitometry, bone microtomography, Raman spectroscopy and real-time reverse transcription polymerase chain reaction (qRT-PCR) technique, and blood for analysis of biochemical markers of bone metabolism, liver damage and oxidative stress. The main novelty of this study is the addition of OT to ST, which presented, in the compression test, greater maximum force in relation to Veh and less elasticity in relation to St and, in the three-point bending test, greater stiffness in relation to to Veh and Ot, less rigidity and less elasticity in relation to Veh; greater cortical thickness (Ct.Th) in relation to the other groups, smaller number of pores (Po.N) in relation to Veh and Ot, and greater mean polar moment (J) in relation to St. There was also greater trabecular bone volume (BV/TV) in relation to Ot and greater trabecular thickness (Tb.Th) in relation to the other groups. The areal bone mineral density (aBMD) of the femoral neck was higher than the Ot, and the BMD of the total femur was higher than the other groups. As for gene expression, there was greater expression of the transcription factor related to Runt 2 (Runx2) in relation to Veh, the transcription factor Osterix (Osx/Sp7) was lower than Ot and St. Bone morphogenetic protein 2 (Bmp2) showed lower expression compared to Veh, and boné alkaline phosphatase (Alp) expression was higher than the other groups. The expression of tumor necrosis factor 11b family member (Opg) and tumor necrosis factor ligand (Rankl) was higher than the other groups, tumor necrosis factor 11a member (Rank) and cathepsin K (Ctsk) was greater than Veh and Ot. It was also observed lower activity of tartrate resistant acid phosphatase (TRAP) and total antioxidant capacity (CAT) in the biochemical assay in relation to the other groups. In the intervention with OT, there was greater elasticity in the three-point bending test, and greater Ct.Th in relation to Veh. The gene expression of Runx2, Osx/Sp7 was higher and Bmp2 was lower than the Veh group. In ST intervention there was greater elasticity than Veh and Ot in the compression test, greater stiffness and elasticity in relation to Veh in the three-point bending test. There was lower Ct.Th in relation to Ot, higher BMD of the total femur in relation to Veh, and the mineralization rate was higher than Veh and Ot. In gene expression, Runx2 and Osx/Sp7 were higher than Veh. Bmp2 and osteocalcin/bone protein gammacarboxyglutamate (Ocn) were lower than Veh, and Fal was higher than Ot. In relation to Rank and Ctsk, these were higher than Veh and Ot. Finally, aspartate aminotransferase (AST) activity was lower than Veh. These results showed that the association of interventions is a promising anabolic strategy for the prevention of osteoporosis in the periestropause period, standing out from the effects of isolated interventions, by preserving mechanical, structural and genetic aspects of the bone, in addition to seeming to control factors related to the cross -talk between bone tissue and adipose tissue in favor of oxidative homeostasis and factors related to the activity of bone markers(AU)

Efeitos de três diferentes métodos de treinamento físico sobre os biomarcadores do estresse oxidativo e qualidade óssea de ratas no período da periestropausa / Effect of three different methods of physical training on oxidative stress biomarkers and bone quality of female rats during the periestropause period

O sedentarismo associado à diminuição da concentração plasmática de estrogênio aumenta o estresse oxidativo e promove alterações na homeostase óssea, culminando na osteopenia, que pode evoluir para osteoporose, aumentar a fragilidade óssea e o risco de fraturas. Assim, o presente estudo teve como objetivo avaliar a qualidade óssea de ratas Wistar naturalmente envelhecidas, no período da periestropausa submetidas a prática de três diferentes métodos de treinamento físico. Quarenta e oito ratas multíparas da linhagem Wistar com idade inicial de 18 meses foram submetidas três vezes por semana durante 120 dias a treinamento aeróbio (TA; corrida em esteira), treinamento resistido (TR; subir escadas), treinamento concorrente (TC; subir escadas + corrida em esteira) ou permanecer sedentário. Após o período experimental, aos 21 meses, foi realizado a coleta do material biológico para análises. Os diferentes métodos de treinamento propiciaram redução de estresse oxidativo, aumento no desempenho físico, densidade mineral óssea, melhor microarquitetura óssea, resistência mecânica, locomoção e deambulação de ratas envelhecidas naturalmente durante o período da periestropausa. Além de confirmar que o TR é boa estratégia de intervenção, verificamos também que a realização de TA e TC desencadeou benefícios importantes para a estrutura óssea e qualidade da marcha, sendo alternativas de baixo custo financeiro e de fácil acesso à comunidade, que pode ser adotada como estratégia de prevenção de fraturas osteoporóticas(AU)

A sedentary lifestyle associated with a decrease in the plasma concentration of estrogen increases oxidative stress and promotes changes in bone homeostasis, culminating in osteopenia, which can progress to osteoporosis, increase bone fragility and the risk of fractures. Thus, the present study aimed to evaluate the bone quality of naturally aged Wistar female rats, in the period of peristropause, submitted to the practice of three different methods of physical training. Forty-eight multiparous Wistar rats with an initial age of 18 months were submitted three times a week for 120 days to aerobic training (AT; treadmill running), resistance training (RT; stair climbing), concurrent training (CT; stair climbing + treadmill running) or remain sedentary. After the experimental period, at 21 months, the collection of biological material for analysis was performed. The different training methods provided reduced oxidative stress, increased physical performance, bone mineral density, better bone microarchitecture, mechanical strength, locomotion and walking of naturally aged rats during the period of periestropause. In addition to confirming that the RT is a good intervention strategy, we also verified that the performance of AT and CT triggered important benefits for bone structure and gait quality, being alternatives of low financial cost and easy access to the community, which can be adopted as a prevention strategy for osteoporotic fractures(AU)

Calidad de vida y su relación con la percepción de estrés y el perfil antropométrico en mujeres adultas / Quality of life and its relationship to stress perception and anthropometric profile in adult women

La perimenopausia produce cambios hormonales y emocionales, que podrían influir en la calidad de vida como en la percepción de estrés de las mujeres. El objetivo de este estudio fue evaluar la calidad de vida y su relación con la percepción de estrés y el perfil antropométrico en mujeres adultas. Se efectuó un estudio transversal en mujeres adultas (40-65 años) que concurrieron a la Fundación Hemocentro Buenos Aires (FHBA). El estado nutricional se evaluó con el índice de masa corporal (IMC) y circunferencia de cintura (CC). La calidad de vida se valoró mediante el cuestionario de calidad de vida (CV) de la Organización Mundial de la Salud (WHOQoL-Bref). La percepción de estrés (PS) se valoró por escala de estrés percibido (PSS-10). Se incluyeron 128 mujeres (52,3% premenopáusicas y 47,7 % posmenopáusicas). El 56,3% refirió tener una CV entre bastante buena y muy buena. La prevalencia de sobrepeso y obesidad fue de 60,2% (IC 95%; 51,5 - 68,2%). La percepción de CV se asoció inversamente al IMC (p= 0,0031) al igual que los dominios físico (p= 0,016) y psicológico de CV (p= 0,001). Asimismo, la PS se asoció de manera inversa a la precepción de CV (p= 0,008) y los cuatro dominios de CV.

Perimenopause produces hormonal and emotional changes, which could influence quality of life as well as stress perception in women. The objective of this study was to evaluate quality of life and its relationship with stress perception and anthropometric profile in adult women. A cross-sectional study was carried out in adult women (40-65 years old) who attended the Fundación Hemocentro Buenos Aires. Nutritional status was evaluated with body mass index (BMI) and waist circumference (WC). Quality of life was assessed using the World Health Organization quality of life questionnaire. Perception of stress was assessed by the perceived stress scale (PSS-10). We included 128 women (52.3% premenopausal and 47.7% postmenopausal). Over half (56.3%) reported having a quality of life between fairly good and very good. The prevalence of overweight and obesity was 60.2% (95% CI, 51.5 - 68.2%). The perception of quality of life was inversely associated to the BMI (p= 0.0031) as well as the physical (p= 0.016) and psychological domains of quality of life (p= 0.001). Similarly, perceived stress was associated inversely with the quality of life perception (p= 0.008) and the four quality of life domains.

Hemorragia uterina anormal en perimenopausia y posmenopausia / Abnormal uterine bleeding in peri menopause and post menopause

Introducción: La hemorragia uterina anormal, durante la perimenopausia y la posmenopausia tiene prevalencia hasta del 35 y el 11% respectivamente. Las pacientes, en estas etapas de sus vidas, consultan por hemorragia con mucha frecuencia, viéndose enfrentadas, dentro del síndrome climatérico, a anemia, dolor pélvico, abstinencia sexual, alteraciones en compromisos sociales y profesionales y temores de sufrir enfermedades ginecológicas malignas; condiciones que afectan profundamente la calidad de vida. Es por ello que los médicos debemos estar bien preparados para tratarlas, oportunamente, tanto en consulta externa como en salas de urgencias. Objetivo: Revisar las causas de la hemorragia uterina anormal perimenopáusica y posmenopáusica y agruparlas en una clasificación coherente, a fin de facilitar su enfoque y manejo, en sus formas de presentación crónica y urgente. Material y métodos: Revisión de la literatura de los últimos 10 años, desde enero de 2010 hasta junio de 2020, en idiomas inglés y español, en libros de texto, pubMed, Ovid, Guías clínicas y Cochrane library. Resultados y conclusiones: Actualmente, contamos con buenos métodos para diagnosticar las causas de la hemorragia anormal perimenopáusica y posmenopéusica e igualmente, diferentes opciones de tratamiento para cada paciente, en particular. Las causas son benignas en su mayoría; solo hay un 10% de riesgos de cáncer endometrial. Agrupadas en una clasificación coherente, dichas causas permiten un enfoque fácil y práctico para las mejores posibilidades de tratamiento medico-quirúrgico de ellas en sus dos formas de presentación: crónica y urgente.

Introduction: Abnormal uterine bleeding during perimenopause and postmenopausal bleeding, have a prevalence of up to 35% and 11% respectively. Patients, at these stages of their lives, consult for bleeding very often facing anemia, pelvic pain, sexual abstinence, social and professional fears of malignant gynecological diseases, profoundly altering the "quality of life".That is why doctors must be well prepared to treat them, in a timely manner from bleeding, in external consultation or in emergency rooms. Objective: To review the causes of perimenopausal and postmenopausal abnormal uterine bleeding and to group them into a coherent classification, in order to facilitate their approach and management, in their chronic and urgent forms of presentation. Material and methods: Literature review of the last 10 years, from January 2010 to June 2020, in English and Spanish languages, in textbooks, PubMed, Ovid, Clinical Guides and Cochrane library. Results and conclusions: Currently, we have good methods to diagnose the causes of abnormal perimenopausal and postmenopausal bleeding; and also, different treatment options for each patient, in particular. The causes are mostly benign, there is only a 10% risk of endometrial cancer. Grouped in a coherent classification they allow an easy and practical approach, to the best medical-surgical treatment possibilities, in its two forms of presentation: chronic and urgent.

Differences in Periodontal Severity Between Perimenopausal and Postmenopausal Women with Chronic Periodontitis

Abstract Objective: To analyze the differences in periodontal severity between perimenopausal and postmenopausal women with chronic periodontitis. Material and Methods: A cross-sectional study with 63 subjects, comprising 27 perimenopausal and 36 postmenopausal women, aged 45-59 years, was conducted in East Jakarta. The women were interviewed regarding their perimenopausal and postmenopausal status; they underwent a periodontal examination for periodontal pockets, attachment loss, gingival recession, plaque index, debris index, calculus index, oral hygiene index, papilla bleeding index, and tooth mobility. Independent T-test and Mann-Whitney U test were used for bivariate analysis Results: There were significant differences (p<0.05) in age between perimenopausal and postmenopausal women (p=0.01); however, no significant differences (p>0.05) in gingival recession (p=0.33) or tooth mobility (p=0.84) were observed. Independent t-test revealed no significant differences in pocket depth (p=0.95), attachment loss (p=0.71), plaque index (p=0.89), debris index (p=0.52), calculus index (p=0.46), oral hygiene index (p=0.48), or papilla bleeding index (p=0.63) between perimenopausal and postmenopausal women Conclusion: There was no difference in periodontal severity between perimenopausal and postmenopausal women; however, the current study obtained valuable information regarding periodontal severity in perimenopausal and postmenopausal women.

Profile of women with cervical cancer attended for treatment in oncology center / Perfil de mulheres com câncer de colo do útero atendidas para tratamento em centro de oncologia

Abstract Objectives: to evaluate the sociodemographic, clinical, histopathological, cytopathological and microbiological profile of women with cervical cancer treated at Oncology Center in Pernambuco, located in the city of Caruaru-PE. Methods: a retrospective study was carried out to evaluate the medical records of women with cervical cancer treated for radiotherapy and/or chemotherapy between January 2014 and December 2016. For the analysis of variables, the absolute and relative frequencies were calculated. Results: there was a predominance of cases in the age range between 40 and 59 years (45.37%), non-white race/color (91.75%) and incomplete primary education (44.32%). Squamous carcinoma was present in 85.19% of the cases, with a moderately differentiated histological grade being the most common (53.41%). Most women underwent radiotherapy and associated chemotherapy (72.72%) and had 3 or more pregnancies before diagnosis (73.44%). Cytopathology has more frequently identified high-grade squamous intraepithelial lesion (HSIL) cases (45.83%) and cocci and/or bacilli (66.67%) were the most evident microorganisms. Conclusions: the results showed that the perimenopause age, low educational level, multiparity, cytopathologic result of HSIL and histopathological examination evidencing moderately differentiated squamous cell carcinoma were among the characteristics most related to cervical cancer in the population studied.

Resumo Objetivos: avaliar o perfil sociodemográfico, clínico, histopatológico, citopatológico e microbiológico de mulheres com câncer de colo do útero atendidas em Centro de Oncologia Pernambucano. Métodos: estudo retrospectivo, que avaliou os prontuários de mulheres com câncer de colo do útero atendidas para tratamento radioterápico e/ou quimioterápico entre janeiro de 2014 e dezembro de 2016. Para a análise das variáveis foram calculadas as frequências absolutas e relativas. Resultados: houve predominância de casos na faixa etária entre 40 a 59 anos (45,37%), de raça/cor não branca (91,75%) e com até o ensino fundamental incompleto (44,32%). O carcinoma escamoso esteve presente em 85,19% dos casos, sendo o grau histológico moderadamente diferenciado o mais comum (53,41%). A maioria das mulheres realizaram radioterapia e quimioterapia associadas (72,72%) e apresentaram 3 gestações ou mais antes do diagnóstico (73,44%). A citopatologia identificou, com maior frequência, casos de high-grade squamous intraepithelial lesion(HSIL) (45,83%) e cocos e/ou bacilos (66,67%) foram os microrganismos mais evidentes. Conclusões: os resultados revelaram que a idade perimenopausa, baixo grau de escolaridade, multiparidade, resultado citopatológico de HSIL e exame histopatológico evidenciando carcinoma escamoso moderadamente diferenciado, estavam entre as características mais relacionadas ao câncer de colo do útero na população estudada.

Relación entre estado nutricional, consumo de alimentos no nutritivos y percepción de estrés en mujeres perimenopáusicas / Relationship between nutritional status, consumption of non - nutritive foods and stress perception in perimenopausal women

RESUMEN La perimenopausia puede afectar el peso corporal, la ingesta alimentaria y el estado anímico de las mujeres. El objetivo de este trabajo fue describir la relación entre estado nutricional, consumo de alimentos no nutritivos y percepción de estrés en mujeres adultas (40-65años) habitantes de Vedia, Provincia de Bs. As (Argentina). Estudio descriptivo transversal, muestra no probabilística a las mujeres, se las clasificó según etapa biológica en pre y postmenopáusicas y se controló el consumo de ansiolíticos. Se evaluó estado nutricional mediante índice de masa corporal (IMC) y riesgo cardio-metabólico (RCM) según circunferencia de cintura (CC). La percepción de estrés (PS) se valoró por escala de estrés percibido (PSS-10). Se estimó el consumo de alimentos no nutritivos, bebidas azucaradas y alimentos ricos en grasas. Se incluyeron 91 mujeres, edad media de 52,1 años (DS= 7,7) (40% premenopáusicas; 60% posmenopáusicas). El 62,6% presentó sobrepeso u obesidad y 70,3% RCM. La media de PS fue 15 puntos (DS= 6,0), siendo mayor en las postmenopáusicas (p= 0,03) y en las que consumían ansiolíticos (p< 0,001). La PS no se asoció al IMC (p= 0,83) ni a la distribución adiposa (p= 0,95). El consumo de alimentos no nutritivos fue similar en ambos grupos, sólo se registró un consumo mayor de chocolates en posmenopáusicas (p= 0,03). Así, el climaterio y la menopausia se deberían abordar por un equipo interdisciplinario, capacitados desde una perspectiva biopsicosocial y no solo desde la óptica clínica.

ABSTRACT Perimenopause is a critical period that can affect body weight, food intake and mood. Our objective was to describe the relationship between nutritional status, nonnutritive food consumption and perception of psychological stress in adult women (40-65 years old) from Vedia, Province of Buenos Aires (Argentina). A cross-sectional descriptive study was carried out using a non-probabilistic sample. Women were classified according to the biological stage in pre-and postmenopausal and anxiolytic consumption was controlled. Nutritional status was measured by body mass index (BMI) and cardiometabolic risk (CMR) by waist circumference (WC). The perception of stress (PS) was assessed using the PSS-10 scale. Consumption of non-nutritive foods, sugary drinks and high-fat foods was estimated. Ninety-one women were included with a mean age of 52,1 years (SD= 7,7) (40% premenopausal; 60% postmenopause); 62,6% were overweight or obese" and 70,3% had CMR according to WC. The mean of PS for the sample was 15 points (SD= 6,0), which was higher in postmenopausal women (p= 0,03) and in those who consumed anxiolytics (p<0,001). PS was not associated with BMI (p= 0,83) nor with adipose distribution (p= 0,95). The consumption of non-nutritive foods was similar among women in both biological stages, except the consumption of chocolate that was higher in the postmenopausal (p= 0,03). Thus, the climacteric and menopause should be addressed by an interdisciplinary team, trained from a biopsychosocial perspective and not only from a clinical perspective.

Impacto del síndrome climatérico en la función sexual / Impact of climateric syndrome on sexual function

Introducción: El síndrome climatérico se puede definir como el conjunto de signos y síntomas que se presentan en la perimenopausia y postmenopausia, incluye síntomas vasomotores, alteraciones del sueño, alteraciones psicológicas y atrofia genital. Objetivo: Conocer el impacto del síndrome climatérico sobre la función sexual y calidad de vida de las mujeres que atraviesan esta etapa de la vida. Métodos: Se trata de una revisión bibliográfica. Los artículos revisados fueron obtenidos de fuentes como Google Académico, Pubmed, LILACS; la selección de la bibliografía comprendió artículos publicados entre 2011 y 2018. Conclusiones: La sexualidad en este periodo y la vejez es un tema de vital importancia para la salud pública. La disfunción sexual como resultado del síndrome climatérico desencadena sentimientos de baja autoestima, desapego y frustración, lo que ocasiona en la mujer que lo padece desinterés por el sexo y un impacto negativo muy claro en su calidad de vida.

The climacteric syndrome can be defined as a set of signs and symptoms that appear in perimenopause and postmenopause, including vasomotor symptoms, sleep disturbances, psychological alterations and genital atrophy. Objective: To know the impact of the climacteric syndrome on the sexual function and quality of life of the women going through this stage of life. Methods: The present work is literature review. Reviewed articles were obtained from sources such as Google Scholar, Pubmed, LILACS; the selection of literature included articles published between 2011 and 2018. Conclusions: Sexuality in this period and old age is a topic of vital importance for public health. Sexual dysfuntion as a result of climateric syndrome originates feelings of low self­esteem, detachment and frustration, causing disinterest in sex, having a clear negative impact on women quality of life.

Relevancia de la menopausia y del apoyo social en las diferencias en salud entre mujeres y hombres / Relevance of the Menopause and Social Support in Gender Differences in Health

RESUMEN Se analizó la relevancia de la menopausia y el apoyo social en las diferencias en salud entre mujeres y hombres mediante un estudio transversal realizado con 710 mujeres y 606 hombres de la población general española con edades entre 20 y 65 años. Se encontró que, aunque en la juventud apenas había diferencias entre hombres y mujeres, a partir de la perimenopausia las mujeres informaban de más insomnio y síntomas vasomotores que los hombres, así como de más dolor durante la postmenopausia. El apoyo social percibido se asociaba con mejor salud, sobre todo en las mujeres en postmenopausia y premenopausia.

ABSTRACT This study examined the relevance of the menopause and social support in gender differences in health. A cross-sectional survey of a general population sample comprising 710 women and 606 men, aged between 20 and 65 was carried out. No health differences were found between younger men and women. However, perimenopausal women reported more insomnia and vasomotor symptoms, as well as they reported more pain than men through the postmenopause. Perceived social support was associated with better health, especially in premenopausal and postmenopausal women.

Declínio cognitivo e perimenopausa: revisão sistemática / Cognitive decline and perimenopause: systematic review

A perimenopausa é caracterizada por diminuição dos hormônios sexuais e redução de sua atuação no sistema nervoso central, o que resulta em sintomas neurológicos, como alterações vasomotoras, do humor, do sono e da cognição. A literatura mostra­se controversa em relação ao momento e ao tipo de alteração cognitiva relacionada à perimenopausa. Portanto, o objetivo deste estudo é revisar a literatura científica para identificar o momento e as alterações cognitivas mais comuns desse período. Foi feita uma busca nas bases de dados Pubmed, Lilacs e Scielo com os descritores menopause, perimenopause e cognition. A partir dos critérios de inclusão e exclusão, foram selecionados nove artigos. Os resultados demonstraram que existe uma relação direta entre redução dos hormônios sexuais e declínio cognitivo. As memórias episódica, visual e verbal, a fluência verbal, a atenção e a velocidade de processamento foram as funções mais afetadas. Entretanto, a maioria dos estudos demonstrou vieses de seleção e diagnóstico. Conclui­se que a perimenopausa está relacionada a alterações cognitivas. É importante ressaltar que com o envelhecimento da população e o consequente aumento do número de mulheres na perimenopausa, o desenvolvimento de mais estudos substanciais sobre o tema é imprescindível, de modo a não só investigar o declínio cognitivo, mas desenvolver abordagens clínicas e terapêuticas de sucesso.(AU)

Perimenopause is characterized by a decrease in sexual hormones and a reduction of their activities in the central nervous system, which results in neurological symptoms such as vasomotor dysregulation, mood alterations, sleep and cognition disorders. The literature is controversial about the timing and type of cognitive disorders related to perimenopause. Therefore, the aim of this study was to review the scientific literature to identify the period and the most common cognitive disorders related to the perimenopause. The databases Pubmed, Lilacs and Scielo were searched with the descriptors menopause, perimenopause and cognition. Considering the inclusion and exclusion criteria, nine articles were selected. The results showed that there is a direct relation between sexual hormones reduction and cognitive decline. Episodic, visual and verbal memories, verbal fluency, attention and processing speed were the most affected functions. However, most of the studies showed selection and diagnoses biases. In conclusion, the perimenopause is related to cognitive decline. It is important to highlight that because of the population ageing and consequent increase in the number of women in the perimenopause, the development of more robust studies is necessary in order to not only investigate the cognitive decline, but to also develop clinical and therapeutic approaches of success.(AU)

Consideraciones clínicas y endocrinológicas en mujeres con trastorno bipolar / Clinical and endocrine considerations in bipolar women

El trastorno bipolar es una de las enfermedades mentales más discapacitantes. Existen diferencias en cuanto al tipo de episodios más frecuentes, la polaridad predominante y la frecuencia de comorbilidad según el sexo. En la mujer es importante considerar la etapa de vida reproductiva en que se encuentra, pues se sabe que puede influir en el curso de la enfermedad. Se ha informado una elevada comorbilidad del trastorno bipolar con trastorno disfórico premenstrual y una exacerbación de los síntomas en el período premenstrual en el 44% al 65%, que puede conducir a un peor curso de la enfermedad. El embarazo no parece incrementar la presencia de episodios de la enfermedad; sin embargo, el tratamiento se complica de forma importante, mientras que la suspensión de la medicación puede llevar a recaídas, el mantenerlo puede llevar a resultados obstétricos negativos, malformaciones congénitas e incluso alteraciones del neurodesarrollo. De tal manera que la evaluación de riesgo-beneficio en estas pacientes tiene que ser muy cautelosa. En el posparto, claramente se relaciona con un incremento en el riesgo de presentar algún episodio afectivo. Al llegar a la transición a la menopausia parecieran incrementarse los episodios de tipo depresivo. La relación entre el ciclo reproductivo y la presencia de episodios de enfermedad, así como los estudios en otras entidades psiquiátricas, han llevado a considerar que una relación entre las hormonas gonadales y los neurotransmisores podrían subyacer a esta entidad. En el presente artículo describimos algunas de las observaciones relacionadas con estrógenos, progesterona y sus metabolitos, testosterona y deshidroepiandrosterona

Bipolar disorder is one of the most disabling psychiatric illnesses. Some characteristics of the disorder vary with sex, such as predominant polarity, frequency and type of comorbidity, and type of episodes presented. In the case of bipolar women, it is important to consider reproductive events, due to their influence in the course of the disorder. High comorbidity of bipolar disorder and premenstrual dysphoric disorder with an exacerbation of symptoms in the premenstrual period has been reported in 44% to 65% which may lead to a worse disease course. In general, women with premenstrual symptom exacerbation show more affective - particularly depressive - episodes, more frequent relapses, and more severe symptomatology. Pregnancy does not appear to increase presence of bipolar episodes, but significantly complicates treatment. On the one hand, stopping the treatment, particularly abruptly, increases the risk of relapse; while on the other, the use of mood stabilizers represents a risk for the newborn. Poor neonatal outcomes, congenital malformations and neurodevelopment alterations in children of mothers exposed to mood stabilizers during pregnancy have been reported. So, a meticulous benefit-risk assessment should be carried out in pregnant bipolar women. In the postpartum period, a clearer relation with increased risk of affective episode has been observed; while the perimenopause increases depressive episodes. The inter-relation between reproductive cycle and bipolar episodes suggests that gonadal hormones are involved in their physio-pathology. Here we discuss some of the observations related to testosterone, dehydroepiandrosterone, estrogens, and progesterone

Efeitos do chá mate (llex paraguariensis) na estrutura óssea de ratas na perimenopausa / Effects of mate tea (llex paraguariensis) in the bone structure of perimenopausal rats

Perimenopausa é um período marcado pela redução da densidade mineral óssea areal (aDMO) associada com um aumento do estresse oxidativo, e antioxidantes naturais têm sido utilizados como uma alternativa para reverter esta situação. Neste contexto, o presente estudo foi realizado com o objetivo de investigar os efeitos do chá mate (CM) (Ilex paraguariensis), uma bebida com alta capacidade antioxidante, no osso de ratas naturalmente perimenopausadas. Ratas Wistar perimenopausadas foram tratadas com CM na dose de 20 mg/kg de massa corpórea (m.c) durante quatro semanas e foram comparadas ao grupo não tratado. Grupo de ratas adultas foi investigado também, para confirmar os efeitos da perimenopausa. A atividade das enzimas fosfatase ácida resistente ao tartarato (TRAP) e fosfatase alcalina (FAL) foram investigados no plasma. Densidade mineral óssea areal (aDMO), área ocupada pelos adipócitos (AOA), número de osteócitos (N.Ot), volume ósseo trabecular (VTO) e imuno-histoquímica para superóxido dismutase (SOD2), osteoprotegerina (OPG), TRAP e ligante do receptor ativador do fator nuclear-kB (RANKL) foram avaliados no colo femoral. Peroxidação lipídica (MDA) e atividade da SOD foram determinadas em homogenato ósseo. O tratamento com CM foi capaz de atenuar a redução da aDMO, melhorar AOA, N.Ot e VTO. Estes resultados foram seguidos de redução de TRAP e de ALP no plasma e de MDA e SOD2 no osso. O CM minimiza o estresse oxidativo e a reabsorção óssea, atenuando assim a osteopenia de ratas na perimenopausa.

Perimenopause is a period marked by a reduction in areal bone mineral density (aBMD) associated with increased oxidative stress, and natural antioxidants have been used as an alternative to reverse this situation. In this context, the present study was to investigate the effects of mate tea (MT) (Ilex paraguariensis), a drink with high antioxidant capacity in the bone naturally perimenopausadas rats. Perimenopausadas Wistar rats were treated with MC at a dose of 20 mg / kg body mass (mc) for four weeks and compared with the untreated group. Group of adult rats was also investigated to confirm the effects of perimenopause. The activity of the enzyme tartrate resistant acid phosphatase (TRAP) and alkaline phosphatase (ALP) were investigated in plasma. Areal bone mineral density (aBMD) area occupied by adipocytes (AOA), number of osteocytes (N.Ot), trabecular bone volume (TBV) and immunohistochemistry for superoxide dismutase (SOD2), osteoprotegerin (OPG), TRAP and binder the receptor activator of the nuclear factor-kB (RANKL) were evaluated at the femoral neck. Lipid peroxidation (MDA) and SOD activity were determined in bone homogenates. Treatment with MT was able to attenuate the reduction of aBMD improve AOA N.Ot and TBV. These findings were followed by reduction of TRAP and ALP and plasma MDA and SOD2 in the bone. The MT minimizes oxidative stress and bone resorption, thereby attenuating the osteopenia of perimenopausal rats.

Qualidade de vida e insônia na perimenopausa: meditação como estratégia de intervenção / Quality of life and insomnia in perimenopausal Meditation as an intervention strategy

Introdução: A insônia está entre os mais frequentes transtornos que afetam a população na contemporaneidade, devido a mudanças hormonais e psicossociais importantes é muito prevalente na perimenopausa. Há uma relação ainda pouco estudada entre eficiência do sono e prática meditativa. Os tratamentos utilizados para insônia normalmente são de alto custo e paliativos. Objetivo: Avaliar o efeito da meditação na insônia (causada por sintomas característicos da perimenopausa) e qualidade de vida nesta fase da vida. Método: Ensaio clínico controlado para avaliar os efeitos da meditação em mulheres com insônia no período da perimenopausa e o impacto na qualidade de vida em 8 semanas de intervenção. O estudo foi realizado de abril a julho de 2013 com 33 mulheres na perimenopausa de idade entre 40 a 55 anos em 3 unidades de órgão público no município de São Paulo, SP. As participantes foram divididas aleatoriamente em dois grupos, um que praticou somente Higiene do Sono-HS (n=15) e outro que praticou Meditação + Higiene do Sono-M+HS (n=18). Foram realizados encontros semanais com as participantes de ambos os grupos para pratica de meditação em grupo e/ou critérios de higiene do sono. O grupo M+HS também realizou prática diária de meditação. Para avaliar a significância estatística das diferenças de médias antes e depois das intervenções em cada grupo foi utilizado o teste de Wilcoxon. Resultados: Houve melhora da insônia em ambos os grupos, no entanto comparando as diferenças de escore do Índice de Gravidade de Insônia entre os grupos estudados, o grupo M+HS teve um efeito superior em ambas as medições em relação ao grupos HS. No grupo M+HS, houve redução estatisticamente significativa nas categorias do Índice Menopausal de Kupperman: Palpitação, Parestesia e a Pontuação Total já no grupo HS não houve redução significativa em nenhum parâmetro do Índice de Kupperman...

Introduction: Insomnia is one of the most common disorders that affect the population in contemporaneity, because of important hormonal and psychosocial changes is very prevalent in perimenopause. There is a still understudied relationship between sleep efficiency and meditative practice. The treatments for insomnia are usually expensive and palliative. Objective: Evaluate the effects of meditation in insomnia (caused by typical symptoms of perimenopause) and quality of life in this phase of life. Method: controlled clinical trial to evaluate the effects of meditation in women with insomnia during perimenopause and impact on quality of life in 8-week intervention. The study was conducted from April to July 2013 with 33 perimenopausal women aged between 40-55 years in 3 units of public organization in São Paulo, SP, Brazil. The participants were randomly assigned to two groups, one who performed only Sleep Hygiene-HS (n = 15) and another who performed Meditation + Sleep Hygiene - SH + M (n = 18). Weekly meetings were held with the participants of both groups to practice meditation in a group and / or criteria for the sleep hygiene. The M + SH group also performed daily meditation practice. To assess the statistical significance of differences in means before and after the interventions in each group, the Wilcoxon test was applied. Results: Improvement of sleep quality in both groups, however comparing the differences in the scores of the Insomnia Severity Index between groups, group M + SH had a greater effect on both measures compared to the SH group. In M + SH group showed a statistically significant reduction in the categories of the Kupperman Menopausal Index: palpitations, paresthesia and Total Score, already in the SH group there was no significant reduction in any parameter of the Kupperman Index...

Instilación intrauterina de ácido tricloroacético como tratamiento de la hemorragia uterina anormal / Intrauterine trichloroacetic acid instillation as treatment of abnormal uterine bleeding

Objetivo: Demostrar la eficacia de la instilación intrauterina de ácido tricloroacético como método de ablación endometrial para el tratamiento de la hemorragia uterina. Métodos: Se realizó un estudio prospectivo, analítico, comparativo, en 60 pacientes que acudieron a la consulta del Servicio de Ginecología del Hospital Universitario de Caracas entre mayo 2008 y agosto 2009, en quienes se empleó ácido tricloroacético al 95 %, como método de ablación endometrial. Se seleccionaron dos grupos al azar, uno sujeto a la colocación previa de analógos de GnRh y otro control, sin este. Resultados: A los 3 meses del tratamiento, el grupo que recibió acetato de leuprolide presentó eumenorrea en 62,5 % e hipomenorrea en 37,5 %. Ninguna de las pacientes de este grupo presentó hipermenorrea, ni amenorrea. El grupo que no recibió análogos presentó eumenorrea en 50 % de los casos, hipomenorrea en 32,1 % e hipermenorrea en 17,9 %. La tasa de éxito y satisfacción de la paciente, fue de 100 % para el grupo con análogos y de 82,1 % para el control. Estos cambios resultaron estadísticamente significativos (P < 0,05). Conclusión: La instilación intrauterina de ácido tricloroacético es eficaz en el tratamiento de la hemorragia uterina, obteniendo mejores resultados al preparar el endometrio con acetato de leuprolide.

Objective: To demonstrate the efficiency of intrauterine instillation of trichloroacetic acid as a method of endometrial ablation for the treatment of uterine hemorrhage. Methods: This was a prospective, analytical and comparative study performed in 60 patients who came to consultation at the Servicio de Ginecologia del Hospital Universitario de Caracas between May, 2008 and August, 2009, in whom 95 % trichloroacetic acid was used as method of endometrial ablation. Two groups were selected at random, one subject to the previous administration of gonadotropin-releasing hormone analogue and another control, without this one. Results: To 3 months of treatment, the group that received leuprolide acetate presented eumenorrhea rates of 62.5 % and hypomenorrhea of 37.5 %. None of the patients of this group presented menorrhagia, not amenorrhea. The group that did not receive analogous presented eumenorrhea in 50 % of the cases, hypomenorrhea in 32.1 % and menorrhagia in 17.9 %. The rate of success and satisfaction of the patient was 100 % for the group with analogous and 82.1 % for the control group. These results turned out to be statistically significant (P <0.05). Conclusion: Intrauterine instillation of trichloroacetic acid is effective in the treatment of uterine hemorrhage, obtaining better results when leuprolide acetate is used previous the procedure.

Impacto de los factores de riesgo en osteoporosis sobre la densidad mineral ósea en mujeres perimenopáusicas de la Ciudad de Querétaro, México / Impact of risk factors for osteoporosis on bone mineral density in perimenopausal women of the City of Querétaro, México.

Es indispensable evaluar los factores de riesgo en osteoporosis, principalmente los modificables, como: los estilos de vida, para prevenirla, ya que es un grave problema de salud pública. Se estudiaron 805 mujeres (35-55 años) de la ciudad de Querétaro, México. Se obtuvieron datos personales, historia familiar, hábitos como: fumar, actividad física, consumo de alcohol y de cafeína (refresco de cola y café). Las participantes completaron el cuestionario de riesgo de osteoporosis (19 factores, con uno, existe riesgo) (International Osteoporosis Foundation). Se evaluó: Índice de Masa Corporal (IMC), riesgo cardiovascular y complexión corporal (Talla/Circunferencia de muñeca). Se realizó una densitometría ósea (DXA) en dos regiones diagnósticas: columna lumbar y cadera total y las participantes se clasificaron en: densidad mineral ósea (DMO) normal, DMO baja y osteoporosis. La prevalencia de osteoporosis fue de 7% y de DMO baja fue de 34%, predominantemente en región lumbar y en aquellas con menopausia. La edad fue mayor en mujeres osteoporóticas (51 años) y el 85% menopáusicas, con valores menores de: peso, talla, IMC, circunferencia de cintura y cadera, que las normales. Los factores de riesgo modificables que aumentaron el riesgo fueron: bajo peso, fumar y consumo de refresco de cola con 6,5, 1,2 y 1,4 (razón de momios) respectivamente (p<0,05). Factores no modificables significativos: menopausia (quirúrgica), historia de fractura y riesgo de osteoporosis. Se concluye que dentro de los factores de riesgo modificables para la prevención de osteoporosis de mayor impacto en esta muestra son: bajo peso, cigarrillo y el refresco de cola.

It is essential to evaluate osteoporosis risk factors, mainly the modifiable, like the lifestyle, in Mexican women in order to prevent it, since it is a serious public health problem.We studied 805 women (35-55 years old) in the City of Queretaro, México. We obtained: personal data, family history, habits, such as smoking, alcohol, caffeine (coffee and soft drink of cola) and physical activity. Participants complete the questionnaire on 19 risk factors for osteoporosis (International Osteoporosis Foundation) one of them with risk. We evaluated: body mass index (BMI), cardiovascular risk and corporal complexion. Bone densitometry was performed in two diagnostic regions: lumbar spine and total hip and participants were classified as normal bone mass density (BMD), low BMD and osteoporosis. The prevalence of osteoporosis was 7% and of low BMD was 34%, predominantly in the lumbar region and in those with menopause. In osteoporotic women, the age was higher (51 years) and 85% menopausal women, also lower values of weight, height, BMI, waist circumference and hip than women with normal bone mass density. The significantly modifiable risk factors were: low weight, smoking and consumption of soft drink of cola with 6,5, 1,2 and 1,4 (odds ratio), respectively (p <0,05). The significantly non-modifiable risk factors were: menopause (surgical), history of fracture and risk. It is concluded that within the modifiable risk factors for the prevention of osteoporosis, those with the greatest impact were low weight, cigarette and soft drink of cola.