Qualidade de vida em mulheres climatéricas com e sem perdas urinárias atendidas nas redes publica e privada de saúde / Quality of life in climateric women with and without urinary incontinence treated at public and private networks health

Trata-se de um estudo transversal, cujo objetivo foi avaliar a qualidadede vida de mulheres climatéricas com e sem perdas urináriasfrequentes, comparando-as mediante o efeito das diferenças sociaissobre a qualidade de vida. Os sujeitos deste estudo foram 52 mulheresentre 45 e 55 anos, período pré e pós-menopausa. Estas foramdivididas em dois grupos: Grupo I, 26 mulheres atendidas pela redepública de saúde, com renda familiar inferior a três salários mínimos;Grupo II, 26 mulheres atendidas pela rede privada de saúde, comrenda familiar superior a cinco salários mínimos. Os instrumentosdo estudo foram questionários contendo dados pessoais, o Women’sHealth Questionnaire e o “International Consultation on IncontinenceQuestionnaire - Short Form” (ICIQ-SF). Observou-se que as mulheresdo grupo II apresentaram melhor índice de qualidade de vida e menorinterferência das perdas urinárias em sua vida diária. Obteve-secorrelação negativa entre a escolaridade e os domínios e pontuaçãototal do WHQ (ρ = - 0,427) e do ICIQ-SF (ρ = - 0,287), apontandoque quanto maior a escolaridade menores os sintomas observados.Conclui-se, portanto, que fatores socioeconômicos, assim como asperdas urinárias interferem na percepção de qualidade de vida damulher durante o período do climatério...

Th is is a cross-sectional study aimed at evaluating the qualityof life of menopausal women with and without frequent urinaryleakage, comparing them among themselves via the eff ect of socialdiff erences on the quality of life. Th e subjects of this study werewomen between 45 to 55 years old, in pre-and postmenopausalperiod. Th ese were divided into two groups: Group I, womenassisted by public health with family income below three minimumwages; Group II, women served by the private health withfamily income above fi ve minimum wages. Th e study instrumentswere questionnaires containing personal data, the WHQ and theInternational Consultation on Incontinence Questionnaire - ShortForm (SF-ICIQ). It was observed that women in group II hadmore education, get best quality of life and less interference fromurinary loss in their daily lives. We obtained a negative correlationbetween education and the domains and total score of the WHQand ICIQ-SF, indicating that higher education implies in lowersymptoms. Th e authors conclude that socioeconomic factors, as wellas urinary incontinence interfere with the perception of quality oflife in women during the climacteric...

Urinary beta-FSH subunit concentrations in perimenopausal and postmenopausal women: a biomarker for ovarian reserve.

OBJECTIVE: The purpose of this study was to develop an integrative assessment of pituitary follicle-stimulating hormone (FSH) secretion and to validate these measurements in a population of perimenopausal (PERI) and postmenopausal (POST) women. DESIGN: In this cross-sectional study, 170 POST and 20 PERI women collected first-void morning urine samples and had a single blood sample drawn on the same day. For comparison, 11 midreproductive-aged women had urine samples collected for one menstrual cycle. In addition, one 48.5-year-old woman collected daily urine samples for 4 consecutive years during her menopausal transition. Urine samples were assayed for estrone glucuronide (E1G) and pregnanediol-3-glucuronide (PdG) and were normalized to creatinine. An ELISA assay was developed for measurement of the free beta-FSH subunit in urine. RESULTS: Mean age (+/- SD) of the PERI and POST women were 48.1 +/- 3.0 and 52.8 +/- 4.1 years, respectively. Mean serum FSH levels were 9.5 +/- 5.8 and 79.3 +/- 32 IU/L (P < 0.001) in the PERI and POST women. Mean urinary beta-FSH/Cr for the PERI were 1.8 +/- 1.2 ng/mg; for the POST, 9.3 +/- 4.5 ng/mg (P < 0.001). Mean estradiol, E1G/Cr, and PdG/Cr levels were also significantly different between the two groups. There was a high correlation between serum FSH and urinary beta-FSH/Cr for the PERI (r = 0.584, P = 0.007) and POST (r = 0.54, P < 0.001), with minimal overlap in the urinary beta-FSH/Cr levels between the PERI and POST groups. A significant correlation between PdG/Cr and urinary beta-FSH/Cr was observed for POST (r = 0.581, P = 0.002). No correlation was seen between urinary beta-FSH/Cr and E1G/Cr or estradiol levels. In the perimenopausal participant, who collected 4 years of daily urine samples, urinary beta-FSH/Cr levels progressively increased during the follicular phase and, by the fourth year, there were persistent, almost tonically high elevations of beta-FSH/Cr in the urine. CONCLUSIONS: Urinary beta-FSH subunit measurements are a useful marker for monitoring ovarian function during the menopausal transition. Urinary free beta-FSH subunit concentrations reflect pituitary FSH secretion and serve as a biomarker for ovarian reserve.

Hypercalciuria and urinary saturation measurements in climacteric women.

Fifteen percent (20/130) of a group of climacteric women on diets of their choice had urinary calcium (Ca) levels exceeding 4 mg/kg per day. Most of these hypercalciuric subjects had a daily Ca intake of 0.4-0.5 g. Their bone turnover rates were raised and high Ca absorption was observed in 4 cases. Serum Ca and total protein and glomerular filtration rates were normal in all the hypercalciuric patients. The calcium/creatinine (Ca/Cr) ratio (mg l-1/mg l-1, fasting, 09:00-10:00 h) was measured in 72 climacteric women, 35 of whom (49%) had ratios > 0.1. The latter defines a relative hypercalciuria as compared with premenopausal Ca excretion levels. Only 5 of the 35 subjects had calciuria levels above 4 mg/kg per day. The Ca/Cr ratio cannot replace daily urinary Ca measurements for the screening of subjects in whom calciuria may exceed net Ca absorption. Urinary saturation measurements were carried out in 70 women. Supersaturation was observed only in the case of Ca oxalate (CaOx) among several calcium salts usually found in urinary stones. CaOx supersaturation was observed in 95% of the hypercalciuric subjects and in 48% of the rest of the women investigated. The relatively high frequency of CaOx supersaturation can be attributed in part to the decreased excretion of citrate associated with ovarian failure. Oestrogen replacement therapy increased citrate excretion and lowered the level of CaOx supersaturation. Ca supplementation (1 g Ca/day) reduced the degree of supersaturation as a result of the concurrent reduction in oxalate excretion.

[Treatment of climacteric syndrome with new gengnian prescriptions].

It was found by the observations of clinical treatment that the three indexes of epinephrine(E), norepinephrine(NE) and dopamine(D) of urinary catecholamine(CA) increased (P less than 0.001, P less than 0.05 and P less than 0.001) for the climacteric patients who suffered from the deficiency of Yin leading to the hyperactivity of the internal heat of the heart, and the urinary 17-hydroxycorticosteroid (17-OHCS) increased (P less than 0.001) for the patients who suffered from the deficiency of Yin leading to the hyperactivity of the internal heat of the liver. Both the three indexes and urinary 17-OHCS increased for the two groups (P less than 0.01). However, for all the above groups who suffered from the deficiency of Yin leading to the hyperactivity of the internal heat, the NE/E ratio was larger than the normal ratio, which stands for the level of central catecholamine. After the treatment with new Gengnian prescriptions, the clinical symptoms of the patients were improved, and in the meantime urinary CA. 17-OHCS and NE/E were decreased. The total efficiency was 89.2%. The principle of treatment with this prescription may be due to the fact that the level of central catecholamine decreased so that the excessive excitation of sympathetics-adrenocortical system and sympathetics-adrenocortical system was restrained.

Urinary excretion of prostacyclin and thromboxane metabolites in climacteric women: effect of estrogen-progestin replacement therapy.

To study the role of vasodilatory prostacyclin and vasoconstrictory thromboxane A2 in climacteric vascular instabilities, overnight urine samples were collected from sixteen women suffering from hot flushes and sweating before, during and after the six months' cyclic estradiol-desogestrel therapy as well as from ten non-climacteric control women. The urine was assayed for 6-keto-PGF1a and 2,3-dinor-6-keto-PGF1a (metabolites of prostacyclin) as well as for thromboxane B2 and 2,3-dinor-thromboxane B2 (metabolites of thromboxane A2) by means of HPLC and radioimmunoassay. No difference was seen in baseline prostaroid output between the climacteric and non-climacteric study groups. Furthermore, no relation was observed between individual prostanoid excretion and severity of vasomotor symptoms before replacement therapy. The replacement therapy abolished or markedly alleviated hot flushes and sweating, but prostanoid output did not change. Our data imply that climacteric symptoms are not accompanied by changes in the production of prostacyclin and thromboxane A2.

[Changes in urinary NAG activity in patients with climacteric syndrome treated with estrogens]. / Variazioni dell'attività NAG-urinaria in pazienti con sindrome climaterica trattate con estrogeni.

The behaviour of urinary NAG activity was studied in patients during menopause, some of whom were given estrogen therapy due to severe vasomotor symptoms (hot flushes etc.). One group of these patients revealed slightly higher than normal blood pressure. A second group had slight arterial hypertension and pancreatic diabetes. The third group consisted of apparently healthy menopausal women. The significant increase in enzymuria in the first two groups suggests that blood pressure should be carefully checked before starting estrogen therapy. Furthermore this treatment should be given very cautiously and under constant surveillance in the presence of slight hypertension. In patients with diabetes or more severe hypertension, estrogens should never be given.

Excreción de dopamina en el climaterio femenino / Excretion of dopamine in the female climateric

Se han observado elevaciones de la dopamina (DA) cerebral durante dos fases del ciclo estral de la rata: en el proestro y en el diestro 1; así como en el climaterio de este animal. También se ha encontrado aumentada la excreción urinaria de DA durante el periodo premenstrual de mujeres sanas. En todas estas condiciones se presentan cifras bajas de progesterona sérica. Si estos aumentos en la DA estuvieron condicionados a los descensos en la progesterona circulante, cabría esperar que en el climaterio, donde se encuentran niveles especialmente bajos de progesterona, se observará una elevada excreción urinaria de DA, mayor aún que la correspondiente al periodo premenstrual