Relationship Between Menopausal Symptoms, Cancer Screening Behaviors, and Religion Attitudes of Women in the Climacteric Period: A Cross-Sectional Study.

BACKGROUND: Although it is known that religion is used to cope with health problems, there is a lack of information about the effect of religion on menopausal symptoms and cancer screening attitudes of climacteric women. AIM: This study was conducted to determine the relationship between the religious attitudes of women in the climacteric period and their attitudes toward menopausal symptoms and cancer screening. MATERIALS AND METHODS: This was a cross-sectional study of 381 women in the climacteric period in the Central Anatolia region of Türkiye. Data collection form, the Menopause Rating Scale (MRS), OK-Religious Attitude Scale (ORAS), and attitude for cancer screening (short form) (ASCS) were used to collect data. Correlation analysis assessed the relationship between MRS, ORAS, and ASCS. RESULTS: There was a low positive correlation between women's ORAS mean score (35.19 ± 4.80) and MRS mean score (12.68 ± 7.24) (r = 0.284, P < 0.001). There was no statistically significant relationship between the mean ORAS scores of the women and the mean ASCS scores (64.59 ± 10.47) (r = 0.089, P > 0.05). CONCLUSION: Women who experienced more severe menopausal symptoms had stronger religious attitudes. Women's religious attitudes did not affect their attitudes toward cancer screening. It is therefore recommended that health professionals organize counseling and training activities to protect and improve the health of menopausal women and increase their participation in screening and treatment programs.

Hormone replacement therapy subcutaneous implants for refractory menopause symptoms; the patient's perspective.

OBJECTIVE: For women with menopause symptoms refractory to standard hormone replacement therapy (HRT) preparations, HRT implants offer an alternative. The primary objective of this study was to evaluate women's perceptions regarding efficacy, tolerability, satisfaction and safety of implant therapy. STUDY DESIGN: A single centre service evaluation study performed at Birmingham Women's & Children's Foundation Hospital Trust. An anonymised semi-structured survey link was posted to all women (n = 397) recorded to have received HRT implant(s) at a tertiary Menopause clinic (May 1982 and Dec 2018). Women attending clinic (June 2020 to Sept 2020) were opportunistically invited to complete a written version of the survey. MAIN OUTCOME MEASURES: Data collected included demographics, medical and surgical history, therapy duration, type, indication and complications. Climacteric symptoms were assessed using the Greene Climacteric Scale. RESULTS: Data was obtained for 119 women. The written survey yielded higher response rates (n = 73, 61.3%). Most respondents were 51-60 years old (n = 51 42.9%) and 87.4% (n = 104) were 'White British'. 70 women used estradiol only implants. 30.1%% (n = 34) of patients reported a low Greene Climacteric Scale score (0-5). Subgroup analysis showed prevalence of sexual dysfunction and vasomotor symptoms across ages. There was a lower prevalence of psychological symptoms amongst ≥51 year olds. High satisfaction rates were reported. CONCLUSIONS: Data from a large cohort is presented. Good symptom control, satisfaction and long-term efficacy was demonstrated. This study supports the value of HRT implants for refractory menopause symptoms. A national database of implant users would be a useful tool to record satisfaction scores and adverse events.

Más allá de la "falla hormonal": concepciones de profesionales de atención primaria sobre el climaterio en Santiago, Chile / Beyond the "ovarian failure": primary healthcare practitioners' views on climacteric in Santiago, Chile

OBJETIVO: El presente artículo busca conocer cómo los profesionales conciben la sexualidad de mujeres en etapa de climaterio, enfatizando aspectos relativos a la salud sexual, al deseo sexual y a los problemas de la sexualidad. MÉTODOS: Enfoque cualitativo basado en la Teoría Fundamentada (Grounded Theory). Se realizaron diez entrevistas en profundidad a profesionales de dos Centros de Salud Familiar (CESFAM) del sector sur de Santiago. RESULTADOS: Los resultados muestran que, si bien existe cierta tendencia a concebir el climaterio desde un punto de vista biologicista centrada principalmente en la "falla hormonal", los/as profesionales muestran diversos grados de reflexividad respecto a cómo aspectos socioculturales, económicos y de género moldean la sexualidad de mujeres en la etapa de climaterio. CONCLUSIONES: Los/as profesionales asumen posturas críticas respecto al rol de las instituciones y programas en salud, a las limitaciones laborales en los centros de salud (por ej. materiales, tiempo, etc.) y a la formación profesional. Este artículo promueve la formulación de políticas de salud en la materia, así como la revisión de los planes de estudio de las carreras de la salud.

OBJECTIVE: This article aims to examine how professional practitioners view womens sexuality in the climacteric stage, emphasizing aspects related to sexual health, sexual desire, and sexual disorders. METHODS: Qualitative approach based on the Grounded Theory. Ten in-depth interviews were conducted with professionals from two Family Health Centers (CESFAM) in southern Santiago. RESULTS: The results show that, although there is a certain tendency to approach the climacteric from a biological viewpoint focused mainly on the “ovarian failure”, practitioners show different degrees of reflexivity regarding how sociocultural, economic and gender aspects shape womens sexuality in the climacteric stage. CONCLUSIONS: Practitioners adopt critical positions regarding the role of health institutions and programs, work limitations in health centers, and the practitioners training. This article promotes the development of health policies in the matter, as well as the revision of study plans of health careers.

Sexualidad y características biológicas, psicoafectivas y sociales en mujeres climatéricas / Sexuality and biological, psycho-affective and social characteristics in climacterics women

Introducción: Se desconocen las características sexuales, biológicas y psicosociales de mujeres con menopausia fisiológica, en la consulta de climaterio y menopausia. Esta información resulta importante para realizar acciones de promoción de salud. Objetivo: Determinar las características sexuales, biológicas y psicosociales más frecuentes en mujeres climatéricas. Métodos: Se realizó un estudio descriptivo, de corte transversal en 300 mujeres climatéricas, con menopausia fisiológica confirmada. Se recogió la edad (agrupada en 40-44, 45-49 y más de 49 años), el tiempo de menopausia (agrupada en menos de 3 años, 3-5 años, 6-10 años y más de 10 años), por cientopresencia de afecciones genitourinarias, síntomas físicos, psicosociales y sexuales. Resultados: Predominaron mujeres mayores de 49 años (56 por ciento) con 33,4 por ciento de 3 a 5 años de menopausia, 6,7 por ciento de atrofia genitourinaria, síntomas de sofocos 75 por ciento, dolores óseos, 70 por ciento, depresión-ansiedad y sequedad vaginal, 50 por ciento; 45 por ciento de insatisfacción sexual y dificultad en la toma de decisiones, 40 por ciento con dificultades en la comunicación con la pareja y desinterés, 38,6 por ciento tuvo disminución del deseo sexual, mientras que el 16 por ciento incrementó su apetencia sexual. Conclusiones: Las mujeres climatéricas estudiadas fueron mayores de 49 años, con menopausia entre 3 y 5 años, con bajo porcentaje de atrofia genitourinaria, con sofocos, dolores óseos, sequedad vaginal, depresión, ansiedad, dificultad en la comunicación de pareja y disminución del deseo sexual(AU)

Introduction: The sexual, biological and psychosocial characteristics of women with physiological menopause in the climacteric and menopause consultation are not known. This information is important to carry out health promotion actions. Objective: To determine the most frequent sexual, biological and psychosocial characteristics in climacteric women. Methods: A descriptive, cross-sectional study was carried out in 300 climacteric women with confirmed physiological menopause. Age (grouped in 40-44, 45-49 and more than 49 years), time of menopause (grouped in less than 3 years, 3-5 years, 6-10 years and more than 10 years), presence of genitourinary affections, physical, psychosocial and sexual symptoms. Results: Women older than 49 years (56 percent o) predominated with 33.4 percent of 3 to 5 years of menopause, 6.7 percent of genitourinary atrophy, symptoms of hot flashes 75 percent o, bone pain, 70 percent o, depression-anxiety and dryness vaginal, 50 percent o; 45 percent o of sexual dissatisfaction and difficulty in making decisions, 40 percent o with difficulties in communication with the partner and disinterest, 38.6% had a decrease in sexual desire, while 16 percent o increased their sexual desire. Conclusions: The climacteric women studied were older than 49 years, with menopause between 3 and 5 years, with a low percentage of genitourinary atrophy, with hot flashes, bone pain, vaginal dryness, depression, anxiety, difficulty in partner communication and decreased desire sexual(AU)

Efeitos da terapia floral sobre o estado de ansiedade em mulheres no climatério / Effects of floral therapy on the state of anxiety in climacteric women

Introdução: O climatério corresponde ao período de vida da mulher onde ocorre a transição do ciclo reprodutivo para o não reprodutivo. Ocorre habitualmente entre os 40 e 65 anos, constituindo-se por um período de inúmeras mudanças. O uso da terapia floral nesta fase de vida pode ser visto como terapêutica única ou complementar ao tratamento convencional. Objetivos específicos: analisar as queixas clínicas de mulheres no climatério sob acompanhamento e sua relação com os indicadores do Diagnóstico de Enfermagem Ansiedade; avaliar os efeitos da terapia floral no autocontrole do estado de ansiedade em mulheres vivendo o climatério. Método: Intervenção clínica individualizada, quase- experimental, comparativo, do tipo antes-depois, com abordagem quantitativa, aprovado por Comitê de Ética em Pesquisa, tendo respeitado todos os preceitos éticos de pesquisas com seres humanos. O campo da pesquisa foi o Núcleo de Atenção em Práticas Integrativas e Complementares de Saúde (NAPICS), da Rede de Atenção Básica do município de Maricá/RJ. As participantes foram mulheres na faixa etária compreendida entre 40 e 65 anos, independentemente de estarem, ou não, em uso de terapia hormonal, selecionadas por conveniência. A coleta de dados foi realizada no período de março a novembro de 2019, através de consulta de enfermagem individual, com acompanhamento por seis meses seguidos, sendo um encontro a cada mês. Adotou-se a entrevista individual, guiada por um roteiro semiestruturado, seguido da aplicação da escala tipo Likert para classificação dos resultados de enfermagem relacionados ao Autocontrole da Ansiedade, empregada em todas as consultas. Os frascos contendo os florais foram preparados pela pesquisadora e entregues às mulheres a partir da terceira consulta. Todas as consultas foram gravadas em meio magnético e transcritas na íntegra para posterior análise. O programa utilizado para análise foi o IBM SPSS Statistics version 24. Descrição apresentada na forma de frequência observada, porcentagem, valores mínimo e máximo, medidas de tendência central e de variabilidade. O teste não paramétrico de Friedman comparou os escores do autocontrole da ansiedade entre as consultas. O nível alfa de significância utilizado foi de 5%. Adotou-se conceitos da Teoria de Martha Elizabeth Rogers como sustentação da terapia implementada. Resultados e Discussão: Todas as consultas de enfermagem seguiram os preceitos de acolhimento e integralidade no cuidado em saúde, preconizados pelo SUS. Os resultados confirmam o perfil das mulheres que substancialmente procuram a rede básica de saúde: baixa renda familiar, ocupações compatíveis a pouca escolaridade e, ainda, desemprego. Não realizam atividadfísica 79,37% das participantes. Além da ansiedade, as mulheres apresentam tristeza (100,00%); fadiga/cansaço (98,41%); dor nas articulações (96,83%); fogachos/ondas de calor (95,24%), insônia (93,65%), cefaleia (88,89%) e dormência (88,89%). No âmago das tecnologias de cuidado no climatério, a terapia floral vem angariando espaço, vez que atende aos princípios de integralidade da mulher, elevando sua autoestima e bem-estar. Conclusão: Os resultados da investigação após o desenvolvimento de três consultas 'pré intervenção' e três consultas 'pós intervenção', constataram que a terapia floral proporcionou às participantes responderem ao DE Ansiedade de forma satisfatória, quando se compara as consultas pré e pós intervenção. Portanto, houve redução dos níveis de ansiedade das participantes do estudo com o uso da terapia floral, deferindo o desfecho pretendido.

Introduction: O climacteric corresponds to the life period of the woman where the transition from the reproductive cycle to the non-reproductive cycle occurs. It usually occurs between 40 and 65 years, constituting for a period of numerous changes. The use of floral therapy in this phase of life can be seen as a single therapy or complementary to conventional treatment. Specific objectives: to analyze the clinical complaints of women in the climacteric under follow-up and their relationship with the indicators of the Anxiety Nursing Diagnosis; evaluate the effects of floral therapy on self-control of anxiety status in women living in climacteric. Method: Individualized, almost experimental, comparative clinical intervention, of the type before-after, with quantitative approach, approved by the Research Ethics Committee, having respected all ethical precepts of research with human beings. The field of research was the Center for Attention in Integrative and Complementary Health Practices (NAPICS), of the Primary Care Network of the municipality of Maricá/RJ. The participants were women between 40 and 65 years old, regardless of whether or not they were using hormone therapy, selected for convenience. Data collection was performed from March to November 2019, through individual nursing consultation, with follow-up for six months in a row, being a meeting each month. The individual interview was adopted, guided by a semi- structured script, followed by the application of the Likert scale to classify nursing outcomes related to Self-Control Anxiety, used in all consultations. The vials containing the florals were prepared by the researcher and delivered to the women from the third consultation. All consultations were recorded in magnetic medium and transcribed in full for further analysis. The program used for analysis was IBM SPSS Statistics version 24. Description presented in the form of observed frequency, percentage, minimum and maximum values, measures of central tendency and variability. Friedman's nonparametric test compared anxiety self-control scores between appointments. The alpha level of significance used was 5%. Concepts of Martha Roger's Theory were adopted as support for the implemented therapy. Results and Discussion: All nursing consultations followed the precepts of reception and integrality in health care, recommended by the SUS. The results confirm the profile of women who substantially seek the basic health network: low family income, occupations compatible with low schooling and also unemployment. 79.37% of the participants did not perform physical activity. In addition to anxiety, women present sadness (100.00%); fatigue/tiredness (98.41%); joint pain (96.83%); hot flashes (95.24%), insomnia (93.65%), headache (88.89%) and numbness (88.89%). At the heart of climacteric care technologies, floral therapy has been gathering space, since it meets the principles of integrality of women, raising their self-esteem and well-being. Conclusion: The results of the research after the development of three 'pre- intervention' consultations and three 'post-intervention' consultations found that floral therapy allowed participants to respond to ED Anxiety satisfactorily when com commencing pre- and post-intervention consultations. Therefore, there was a reduction in the anxiety levels of the study participants with the use of floral therapy, deferring the intended outcome.

Influence of overcommitment on the quality of life and on climacteric symptoms in nursing professionals / Influencia del compromiso excesivo sobre la calidad de la vida y en los síntomas del climaterio de profesionales de enfermería / Influência do comprometimento excessivo na qualidade de vida e nos sintomas do climatério de profissionais da enfermagem

ABSTRACT Objective: To describe the general characteristics of nursing professionals and assess the influence of overcommitment on perceived climacteric symptoms and on the quality of life of nursing professionals. Method: A cross-sectional, analytical study of 152 nursing auxiliaries and assistants aged 40 years or older was conducted at 3 hospitals in the interior of São Paulo state. Sociodemographic data were collected and the Blatt-Kupperman Menopausal Index, Women´s Health Questionnaire, Medical Outcome Study 36-item Short Form Health Survey and Effort-Reward Imbalance were applied in 2017. A descriptive analysis was performed and network analysis was carried out. Results: Participants had a mean age of 50.23 years (SD ±7.1). Group 1 comprising 61 (40.1%) women with overcommitment had poorer quality of life as well as more severe climacteric symptoms. Conclusions: Presence of overcommitment seems to influence the negative perception of climacteric symptomatology and quality of life.

RESUMEN Objetivo: Describir las características generales de los profesionales de enfermería y evaluar cómo el compromiso excesivo puede influir en la percepción de los síntomas del climaterio y la calidad de vida de estas mujeres. Métodos: Este es un estudio analítico de corte transversal que evaluó a 152 auxiliares de enfermería y técnicas en el grupo de edad de 40 años en 3 hospitales em el interior del estado de São Paulo. En 2017, se recopilaron los datos sociodemográficos y se aplicaron el Índice de Menopausia de Blatt-Kupperman, Women´s Health Questionnaire, El Cuestionario de Salud SF-36 y El Cuestionario Effort-reward Imbalance. Análisis descriptivo y análisis de red se realizó. Resultados: La edad promedio de los participantes fue de 50,23 años (DP = ± 7,1). Grupo 1 compuesto por 61 (40.1%) mujeres con compromiso excesivo fue la peor calidad de vida y la mayor intensidad de síntomas climáticos. Conclusiones: La presencia de compromiso excesivo parece influir en una percepción negativa de la sintomatología climática y una peor calidad de vida.

RESUMO Objetivo: Descrever as características gerais das profissionais de enfermagem e avaliar como o comprometimento excessivo pode influenciar na percepção dos sintomas do climatério e na qualidade de vida dessas mulheres. Método: trata-se de estudo transversal analítico, que avaliou 152 auxiliares e técnicas da enfermagem, na faixa etária de 40 anos ou mais, em 3 hospitais do interior do estado de São Paulo. Em 2017, foram coletados dados sociodemográficos e aplicados os instrumentos Índice Menopausal de Blatt-Kupperman, Questionário Saúde da Mulher, Medical Outcome Study 36-item short form Health Survey e Effort Reward Imbalance. Foi realizada análise descritiva e análise de rede. Resultados: A idade média das participantes foi de 50,23 anos (DP = ±7,1). O grupo 1, composto por 61(40,1%) mulheres com comprometimento excessivo apresentou pior qualidade de vida e maior intensidade de sintomas climatéricos. Conclusões: Presença de comprometimento excessivo parece influenciar em uma percepção negativa da sintomatologia do climatério e em uma pior qualidade de vida.

A relação entre depressão, ansiedade, ideação suicida, estresse e sono em mulheres na pós-menopausa / The relationship between depression, anxiety, suicidal ideation, stress and sleep in postmenopausal women

Estudos vêm mostrando as implicações dos sintomas neuropsíquicos para a manutenção da saúde mental da mulher durante o climatério, destacando a pós-menopausa como uma fase menopausa-relacionada que merece atenção, visto o aumento da expectativa de vida e a permanência por mais anos nesta fase da vida. O estudo foi do campo da epidemiologia e saúde pública e teve como objetivo verificar a prevalência, correlatos e indicadores de sintomas neuropsíquicos no climatério feminino. O estudo foi dividido em 2 etapas e teve uma Cartilha como produto. A primeira etapa tratou de um estudo de revisão narrativa e discutiu climatério e depressão, ansiedade e ideação suicida. A revisão narrativa teve como objetivo discutir estudos acerca da prevalência de depressão, ansiedade e ideação suicida no climatério, analisando os métodos diagnósticos utilizados e as associações mais citadas. As bases consultadas foram Pubmed, Lilacs, Web of Science, Embase e a ferramenta de busca Google Scholar. Foi possível concluir que depressão e ansiedade são desordens muito comuns e bem discutidas no meio científico, mas ideação suicida, apesar de prevalências em torno dos 12%, não tem sido suficientemente estudada. Além disso, essas desordens estão sempre associadas entre si e com outros fatores, biológicos, psicossociais e sociodemográficos. O segundo estudo foi de corte transversal. Foram estudadas 123 mulheres na pós-menopausa com idade a partir de 45 anos. Utilizou-se um questionário para coleta de dados, escalas de sintomas menopausais e neuropsíquicos. Para caracterização da amostra foram estudadas as prevalências das variáveis sociodemográficas, clínicas e neuropsíquicas. Foram analisadas correlações bivariadas e análise de redes e fluxos. Os resultados mostraram importantes correlações entre os sintomas estudados e a insônia se mostrou uma variável influente. Além disso, a combinação entre fatores de diferentes naturezas foram indicadores de possível agravo à saúde mental da mulher. Concluiu-se ao final dos estudos que sintomas neuropsíquicos são muito prevalentes durante o climatério e que fatores clínicos, sociodemográficos e socioeconômicos se mostraram importantes na contextualização do sofrimento psíquico durante a pós-menopausa. Recomendamos escuta diferenciada e avaliações regulares, permitindo diagnósticos neuropsíquicos personalizados e preventivos, de abordagem biopsicossocial, compondo o acompanhamento de mulheres nos ambulatórios do climatério.

Studies have shown the implications of neuropsychical symptoms in maintaining women's mental health during the climacteric, highlighting postmenopause as a menopause-related phase that deserves attention, given the increase of life expectancy and the permanence for more years in this phase of life. The study was in the field of epidemiology and public health and aimed to verify the prevalence, correlation and indicators of neuropsychical symptoms in the female climacteric. The study was divided in 2 stages and had a booklet as a product. The first stage dealt with a narrative review study and discussed climacteric and depression, anxiety and suicidal ideation. The narrative review aimed to discuss studies on the prevalence of depression, anxiety and suicidal ideation in the climacteric, analyzing the diagnostic methods used and the most cited associations. The data bases consulted were Pubmed, Lilacs, Web of Science, Embase and the Google Scholar search engine. It was possible to conclude that depression and anxiety are very common disorders and well discussed in the scientific community, but suicidal ideation, despite having prevalence around 12%, has not been sufficiently studied. In addition, these disorders are always associated with each other and with other factors such as, biological, psychosocial and sociodemographic. The second study was cross-sectional. 123 postmenopausal women aged 45 and over were studied. A questionnaire was used to collect data, scales of menopausal and neuropsychical symptoms. To characterize the sample, the prevalence of sociodemographic, clinical and neuropsychic variables were studied. Bivariate correlations and analysis of networks and flows were analyzed. The results showed important correlations between the symptoms studied and insomnia proved to be an influential variable. In addition, the combination of different kinds of factors were indicators of possible damage to women's mental health. It was concluded at the end of the studies that neuropsychical symptoms are very prevalent during the climacteric and that clinical, sociodemographic and socioeconomic factors were important in the contextualization of psychological distress during the postmenopause. We recommend differentiated listening and regular evaluations, allowing personalized and preventive neuropsychical diagnoses, with a biopsychosocial approach, making up the monitoring of women in climacteric outpatient clinics.

Aspectos éticos y sociales de la sexualidad de la mujer en el climaterio y la posmenopausia / Ethical and Social Aspects of Women's Sexuality in the Climacteric and Postmenopause / Ethical and Social Aspects of Women's Sexuality in the Climacteric and Postmenopause

RESUMEN Introducción: La esfera sexual en el ser humano tiene una notable relevancia, por ser un mundo de sentimientos y sentidos dentro del universo humano que genera armonía, bienestar, autoestima, ternura, complicidad, y protección, tan beneficiosos para cualquiera, por lo que la misma comprende también aspectos éticos intrínsecos que son de gran importancia. Objetivos: Determinar los aspectos éticos y sociales de la sexualidad de la mujer en el climaterio y la menopausia. Métodos: Se realizó un estudio descriptivo transversal en las mujeres que acudieron a consulta de climaterio y menopausia del Municipio Playa, comprendidas en edades entre 40 y 64 años. El estudio se realizó entre el 1º de julio de 2017 y el 30 de septiembre de 2018. Variables estudiadas: Edad, etapa del climaterio, estado conyugal, principales síntomas referidos y factores sociales Resultados: Predominaron las mujeres más jóvenes comprendidas entre 40 y 44 años (25,3 %) y entre 45 y 49 años (22,9 %). El motivo de consulta no fue relacionado con problemas de la sexualidad, sino que la gran mayoría (79 pacientes; 95,1 %) asistió a consulta por otros motivos. Conclusiones: La mayoría de las pacientes presentan dudas, así como también síntomas relacionados con la sexualidad y no consultan por estos motivos. El aspecto ético resulta de gran importancia en estas mujeres, por lo que se recomienda brindarles asesoría sobre la sexualidad cuando acudan a la consulta, independientemente del motivo por el cual asistan.

ABSTRACT Introduction: The sexual sphere in the human being has remarkable relevance, as it is a world of feelings and senses within the human universe that generates harmony, well-being, self-esteem, tenderness, complicity, and protection, so beneficial to anyone, so that it also includes intrinsic ethical aspects that are of great importance. Objectives: To determine the ethical and social aspects of women's sexuality in the climacteric and menopause. Methods: A descriptive cross-sectional study was carried out in women who attended the climacteric and menopause consultation in Playa Municipality. Ages ranged 40 and 64 years. The study was conducted from July 1, 2017 to September 30, 2018. Variables studied were age, climacteric stage, marital status, main referred symptoms, and social factors. Results: Younger women between 40 and 44 years (25.3%) and between 45 and 49 years (22.9%) predominated. The reason for consultation was not related to sexuality problems, the vast majority (79 patients; 95.1%) attended consultation for other reasons. Conclusions: Most patients have doubts, as well as symptoms related to sexuality and do not consult for these reasons. The ethical aspect is of great importance in these women, so it is recommended to provide advice on sexuality when they attend the consultation, regardless of the reason they attend.

The uncertain effect of menopause on blood pressure.

In affluent societies blood pressure increases with age from early life to the eighth decade with sex differences. Before middle age, lower blood pressure values are observed in women than in coeval men, whereas the reverse seems to occur thereafter. Menopause is considered the major determinant of blood pressure rise in women. If this hypothesis is well-founded, menopause can be regarded as one of the main cardiovascular risk factors, involving more than half of the human population, as well as the most ineluctable. In industrialized countries, age at menopause ranges between 50 and 52 years. The popular message is that fertile women are protected from cardiovascular risk by circulating estrogens, a privilege that is lost when postmenopausal women become not different from men from the point of view of risk factors and cardiovascular events. Nevertheless, the hypothesis that menopause or the estrogen decrease are per se associated to blood pressure increase is still under debate. Indeed, the epidemiological challenge is due to the coincidence between advancing menopause and aging, and also to the evidence that both menopause and blood pressure have common determinants such as body mass index, diet, smoking, and socio-economic class. The strongest doubt is whether menopause is a dependent or independent risk factor for high BP, i.e. whether its action on blood pressure-if any-is due directly to estrogen fall or to other indirect factors.

Quality of life in the climacteric of nurses working in primary care / Calidad de vida en el climaterio de enfermeras que actúan en la atención primaria / Qualidade de vida no climatério de enfermeiras atuantes na atenção primária

ABSTRACT Objective: to evaluate the quality of life of primary care nurses in the climacteric. Method: A cross-sectional descriptive-analytic study, performed with 98 female nurses, aged 40-65 years, using the WHOQOL-Bref questionnaire. Results: the worst level of quality of life was observed for professionals aged 50-59 years, non-white, specialists, divorced or widowed, with children, a lower income, with another employment relationship, a weekly workload of more than 40 hours, who consumed alcoholic beverages weekly, with chronic disease, in continuous use of medications, sedentary, who did not menstruate and did not receive hormonal treatment, and who went through menopause between the ages of 43-47 years. Conclusion: Although the variables "physical activity" and "age" have a statistically significant association with quality of life, other variables seem to interfere in these professionals' lives, indicating the need for a more critical and deep reflection on these relations.

RESUMEN Objetivo: evaluar la calidad de vida de enfermeras en el climaterio que actúan en la atención primaria. Método: estudio descriptivo y de análisis, de cohorte transversal, realizado con 98 enfermeras, de entre 40 y 65 años de edad, en que se utilizó el cuestionario WHOQOL-Bref. Resultados: presentaron un peor nivel de calidad de vida las profesionales: de entre 50 y 59 años de edad, no blancas, con especialización, divorciadas o viudas, con hijos, con menor renta familiar, que tenían otro vínculo de empleo, con carga laboral semanal superior a 40 horas, que consumían alcohol semanalmente, portadoras de enfermedad crónica, en el uso continuo de medicamentos, sedentarias, que no menstruaban y no estaban bajo tratamiento hormonal, y cuya menopausia empezó entre 43 y 47 años de edad. Conclusión: a pesar de la variable "realización de actividad física" y de la variable "edad" haber presentado una asociación estadísticamente significativa con la calidad de vida, otras variables parecen afectar la calidad de vida de esas profesionales, lo que demanda una reflexión crítica y más profundizada sobre esas relaciones.

RESUMO Objetivo: avaliar a qualidade de vida de enfermeiras no climatério atuantes na atenção primária. Método: estudo descritivo-analítico, de corte transversal, realizado com 98 enfermeiras, com idade entre 40 e 65 anos, utilizando-se o questionário WHOQOL-Bref. Resultados: apresentaram pior nível de qualidade de vida as profissionais com idade entre 50 e 59 anos, não brancas, especialistas, divorciadas ou viúvas, com filhos, com menor renda, possuidoras de outro vínculo empregatício, carga horária de trabalho semanal acima de 40 horas, que ingeriam bebida alcoólica semanalmente, portadoras de doença crônica, em uso contínuo de medicamentos, sedentárias, que não menstruavam e não faziam tratamento hormonal, e que apresentaram a menopausa entre 43 e 47 anos. Conclusão: apesar das variáveis "realização de atividade física" e "idade" terem uma associação estatisticamente significante com a qualidade de vida, outras variáveis parecem interferir na dessas profissionais, indicando a necessidade de uma reflexão crítica e mais aprofundada sobre essas relações.

O conhecimento produzido acerca de climatério, família e envelhecimento / Knowledge produced on climacteric, family and aging / El conocimiento producido sobre climaterio, familia y envejecimiento

Objetivo: analisar o conhecimento produzido acerca de climatério, família e envelhecimento. Método:revisão integrativa da literatura, realizada na base de dados BVS, Pubmed e Portal de Periódicos Capes (2012-2017). Resultados:respeitando-se os critérios de inclusão, 22 artigos foram selecionados e analisados em duas categorias: a influência da família no processo de envelhecimento de mulheres em fase de climatério e o enfrentamento do climatério e suas desordens na natureza físico-psicológica da mulher. Conclusão: é necessário estudar o climatério para além da sintomatologia clínica da menopausa na perspectiva de se promover o envelhecimento ativo e saudável. A família é parte integrante deste processo, por isso, enfermeiros e demais profissionais da equipe multidisciplinar devem incluí-la no processo de conhecimento, entendimento, acompanhamento e cura das sintomatologias transitórias que possam acometer a mulher em fase de climatério/ menopausa.

Objective: to examine the knowledge produced on climacterium, family and aging. Method: this integrative literature review used the VHL, Pubmed and Capes Journal Portal databases (2012-2017). Results: 22 articles were selected and analyzed by two categories: the family's influence on the aging process of women in the climacteric phase, and coping with the climacterium and its physical and psychological disorders. Conclusion: study of the climacterium needs to go beyond the clinical symptomatology of menopause, with a view to promoting active, healthy aging. The family is an integral part of this process and, accordingly, nurses and other professionals in multidisciplinary teams should include it in the process of learning about, understanding, following up on and curing of transitory symptoms that can affect women in the menopause / climacteric phase.

Objetivo: analizar el conocimiento producido sobre climaterio, familia y envejecimiento. Método: revisión integrativa de la literatura, realizada en la base de datos BVS, Pubmed y Portal de Periódicos Capes (2012-2017). Resultados: respetando los criterios de inclusión, se seleccionaron 22 artículos que fueron analizados en dos categorías: la influencia de la familia en el proceso de envejecimiento de mujeres en fase de climaterio y el enfrentamiento del climaterio y sus desórdenes en la naturaleza físico-psicológica de la mujer. Conclusión: es necesario estudiar el climaterio más allá de la sintomatología clínica de la menopausia con vistas a promover el envejecimiento activo y saludable. La familia es parte integrante de este proceso, por eso, enfermeros y demás profesionales del equipo multidisciplinario deben incluirla en el proceso de conocimiento, entendimiento, acompañamiento y curación de las sintomatologías transitorias que puedan acometer a la mujer en fase de climaterio / menopausia.

Percepções de mulheres acerca do climatério / Women's insights about the climacteric period / Percepciones de mujeres acerca del climaterio

Objetivo: Conhecer as percepções de mulheres acerca do climatério. Métodos: Pesquisa qualitativa com 18 mulheres que vivenciam o período do climatério, que pertencem a uma Estratégia em Saúde da Família de um município da região Sul do Brasil. Os dados foram coletados por meio de entrevista semiestruturada em setembro de 2016. A análise dos dados foi a partir da Análise de Conteúdo Temática de Minayo. Resultados: Os elementos emergidos das compreensões das mulheres acerca do climatério demonstram percepções voltadas à negatividade, ao envelhecimento do corpo, ao desequilíbrio emocional e à sintomatologia manifestada nesse período. Conclusão: Portanto, é preciso implementar medidas que ofereçam a essas mulheres um maior conhecimento e entendimento sobre o climatério, pois refletirá de maneira positiva, de modo que a mulher vivencie esse período com tranquilidade e qualidade de vida

Objective: To know the perceptions of women about climacteric. Methods: Qualitative research with 18 women living in the climacteric period, who belong to a Family Health Strategy of a municipality in the Southern region of Brazil. Data were collected through a semistructured interview in September 2016. Data analysis was based on the Minayo Thematic Content Analysis. Results: The emergence of women's understanding of climacteric shows perceptions of negativity, body aging, emotional imbalance, and symptomatology manifested during this period. Conclusion: Therefore, it is necessary to implement measures that offer these women a greater knowledge and understanding about the climacteric, as it will reflect in a positive way, allowing women to experience this period with tranquility and quality of life

Objetivo: Conocer las percepciones de las mujeres sobre la menopausia. Métodos: La investigación cualitativa con 18 mujeres que experimentan período de la perimenopausia, que pertenecen a una estrategia de salud em un municipio del sur de Brasil. Los datos fueron recolectados a través de entrevista semiestructurada en septiembre de 2016. El análisis de los datos fue a partir del análisis cualitativo de Minayo. Resultados: Los elementos surgieron la comprensión de las mujeres sobre la menopausia demostrar percepciones centradas en la negatividad, el cuerpo de envejecimiento, desequilibrio emocional y síntomas que se manifiestan en este periodo. Conclusión: Por lo tanto, es necesario poner en práctica medidas que brinden a estas mujeres un mayor conocimiento y comprensión del climaterio, como se refleja positivamente causando la mujer para experimentar este periodo de tranquilidad y calidad de vida

Demandas de mulheres no climatério na Estratégia Saúde da Família: estudo descritivo / Demands of women in the climaterium in the Family Health Strategy: descriptive study / Demandas de mujeres durante el climaterio en la Estrategia Salud de la Familia: estudio descriptivo

OBJETIVO: conhecer as principais demandas de mulheres no climatério, atendidas na Atenção Primária à Saúde, a partir dos relatos dos profissionais de saúde. MÉTODO: pesquisa de caráter descritivo com abordagem qualitativa desenvolvida em uma unidade de Estratégia Saúde da Família do município do Rio de Janeiro. Através de um roteiro de entrevista semiestruturado foram entrevistados 17 profissionais de saúde, entre médicos e enfermeiros, finalizando a coleta com a utilização da técnica de amostragem por saturação teórica. As entrevistas foram tratadas por meio da análise de conteúdo temático-categorial. RESULTADOS: as demandas foram: problemas conjugais, perda de libido, dispareunia, ressecamento e atrofia vaginal. CONCLUSÃO: recomenda-se atualização dos profissionais quanto aos conceitos e aos aspectos relacionados ao climatério, visando que suas ações atendam essas mulheres integralmente. IMPLICAÇÕES PRÁTICAS: a atenção à saúde deve considerar questões do âmbito da sexualidade para poder contribuir para a saúde sexual das mulheres na fase do climatério.

AIM: to know the main demands of women in the climaterium, attended in the Primary Health Care, from the reports of health professionals. METHOD: a descriptive research with a qualitative approach developed in a Family Health Strategy unit in the city of Rio de Janeiro. Through a semi-structured interview script, 17 health professionals were interviewed among physicians and nurses, finishing the collection using the technique of sampling by theoretical saturation. The interviews were treated through analysis of thematic-categorial content. RESULTS: the demands were: marital problems, loss of libido, dyspareunia, dryness, and vaginal atrophy. CONCLUSION: it is recommended to update the professionals regarding the concepts and aspects related to the climacteric, aiming that their actions attend these women integrally. PRACTICAL IMPLICATIONS: health care should consider issues of sexuality in order to contribute to the sexual health of women in the climacteric phase.

OBJETIVO: conocer las principales demandas de las mujeres durante el climaterio, atendidas en la Atención Primaria de Salud, a partir de los relatos de los profesionales de salud. MÉTODO: investigación de carácter descriptivo, con abordaje cualitativo, realizada en una unidad de Estrategia Salud de la Familia del municipio de Rio de Janeiro. A través de un programa de entrevista semiestructurada se entrevistaron a 17 profesionales de salud, entre médicos y enfermeros, finalizando el muestreo utilizándose la técnica de muestreo por saturación teórica. Las entrevistas se analizaron por medio del análisis de contenido temático-categorial. RESULTADOS: las demandas fueron: problemas conyugales, pérdida de libido, dispareunia, sequedad y atrofia vaginal. CONCLUSIÓN: se recomienda que los profesionales actualicen los conceptos y los aspectos relacionados al climaterio, para que sus acciones atiendan a esas mujeres integralmente. IMPLICACIONES PRÁCTICAS: la atención a la salud debe considerar cuestiones del ámbito de la sexualidad para poder contribuir a la salud sexual de las mujeres durante el climaterio.

Abordagem sobre as alterações psicofísicas do climatério e menopausa: representações e significados na saúde da mulher / Approach on the psychophysical changes of climacteric and menopause: representations and meanings in women's health

Há muito a ser estudado e discutido com relação ao processo de amadurecimento e de envelhecimento, principalmente com relação às expectativas sociais, emocionais nos aspectos biopsicossociais, que formam o entorno desse processo; a reflexão sobre perdas e ganhos característicos das diferentes fases de vida pode ser bastante enriquecedora melhorando a qualidade de vida destas mulheres

Los riesgos de no usar terapia hormonal de la menopausia: deterioro de la calidad de vida / The risks of avoiding hormone replacement therapy during menopause

Menopause is associated with several symptoms which, if they reach certain intensity, can severely impair the quality of life. Overall, 90.9% of Latin American women will have at least one climacteric symptom and in 25%, these will be severe. Musculoskeletal pain, physical and mental fatigue and depressed mood are the most common climacteric symptoms. Dyspareunia, mood disorders and irritability can significantly alter female sexuality. Hot flashes are the symptoms most frequently related to menopause by both physicians and patients. However, it is one of the less common menopausal symptoms. This symptom reflects the neurochemical brain disorders caused by estrogen deficiency. The central nervous system (CNS) is also involved in changes of body composition leading to higher adipose tissue accumulation during climacterium, deteriorating quality of life and increasing the risk for chronic non-transmittable diseases. Menopausal discomfort also overloads health systems increasing the demand for medical services and decreasing productivity by labor absenteeism. Hormone therapy of menopause (HTM) decreases menopausal symptoms and improves quality of life. If we do not prescribe HTM to those women who need it, we could deprive them from several potential health benefits.

Síntomas climatéricos según el estilo de vida en mujeres de edad mediana / Climacteric symptoms and lifestyle among middle-aged women

Introducción: la expresión clínica del síndrome climatérico se asocia con el estilo de vida de la mujer. Factores socioculturales, ambientales y laborales influyen en la calidad de vida. Objetivo: identificar la relación entre la percepción de la sintomatología del síndrome climatérico y el estilo de vida en las mujeres de mediana edad estudiadas. Métodos: se realizó una investigación descriptiva, de corte transversal, con un diseño no experimental en el consultorio 17 del Policlínico Luis A. Turcios Lima, del municipio 10 de Octubre, desde el 1ro de junio de 2014 hasta el 31 de mayo de 2015. Se entrevistaron 91 mujeres entre 40 y 59 años. Se aplicó la encuesta para medir la intensidad del síndrome climatérico y la encuesta para el estudio del estilo de vida. Resultados: en la percepción de los síntomas climatéricos, la cuarta parte eran asintomáticas y los síntomas leves fueron percibidos en 37,4 por ciento de las pacientes. Casi la totalidad de las mujeres que tenían un estilo de vida saludable, eran asintomáticas o su percepción de los síntomas era leve; 42,8 por ciento presentó síntomas moderados o intensos. En el área de salud, predominaron las mujeres entre 55 y 59 años de piel blanca, universitarias y trabajadoras. Conclusiones: un estilo de vida no saludable se relaciona con el síndrome climatérico de intensidad moderada o intensa. Las condiciones físicas inadecuadas, la autoestima baja y no disponer de tiempo libre; se relacionaron con una mayor intensidad del síndrome climatérico(AU)

Introduction: the clinical expression of the climacteric syndrome is associated with the lifestyles of women. Sociocultural, environmental and occupational factors influence the quality of life. Objective: identify the relationship between perception of climacteric symptoms and lifestyle in the middle-aged women studied. Methods: a descriptive cross-sectional non-experimental study was conducted at Consultation Office 17 of Luis A. Turcios Lima Polyclinic, in the municipality of 10 de Octubre, from 1 June 2014 to 31 May 2015. Interviews were conducted with 91 women aged 40-59. Two surveys were applied: one to gauge the intensity of the climacteric syndrome and the other to study lifestyle. Results: with respect to perception of climacteric symptoms, one fourth of the patients were asymptomatic. Mild symptoms were perceived by 37.4 percent. Almost all the women who had a healthy lifestyle were either asymptomatic or their perception of symptoms was mild; 42.8 percent had either moderate or intense symptoms. In the health area there was a predominance of white women of the 55-59 age group who were workers and university graduates. Conclusions: an unhealthy lifestyle is associated with a climacteric syndrome of moderate to high intensity. Inadequate physical conditions, a low self-esteem and lack of free time are related to a greater intensity of the climacteric syndrome(AU)

Sexualidad y climaterio: una mirada integral / Sexuality and climacteric: a comprehensive approach

Cuando hablamos de sexualidad humana debemos saber que estamos hablando de una compleja y cambiante interacción de factores biológicos y socioemocionales altamente influenciables por la familia, la religión y los patrones culturales. Esto se ve en los hombres y en las mujeres, especialmente en las mujeres. La sexualidad es un concepto intuitivo que cuesta definir. Según la Organización Mundial de la Salud, se define salud sexual como "un estado de bienestar físico, emocional, mental y social relacionado con la sexualidad, la cual no es solamente la ausencia de enfermedad, disfunción o incapacidad". Es una definición que tiene en cuenta varios conceptos, muy importantes todos ellos. La respuesta sexual consiste en una serie de cambios neurofisiológicos, hemodinámicos y hormonales que involucran al conjunto del organismo. Si bien es similar en ambos sexos, en las mujeres no siempre el inicio y la progresión se correlacionan en forma sistemática o lineal como en los hombres. Y de ese intrigante devenir de la respuesta sexual femenina surge la dificultad del diagnóstico de la "disfunción sexual femenina". Podríamos resumirla en "un conjunto de trastornos en los que los problemas fisiológicos o psicológicos dificultan la participación o la satisfacción en las actividades sexuales; lo cual se traduce en la incapacidad de una persona para participar en una relación sexual de la forma que le gustaría hacerlo"16. La menopausia es percibida por muchas mujeres como el fin de la sexualidad, y no solo como el fin de la vida reproductiva. Si bien es cierto que en esta etapa la actividad sexual suele declinar y puede verse afectada por una serie de factores hormonales, psicológicos y socioculturales, para la mayoría de las mujeres la sexualidad sigue siendo importante. Debemos comprender que la disfunción sexual femenina, en cualquier etapa de la vida, es multicausal y multidimensional. A la hora de realizar el abordaje de una paciente, debemos tener en cuenta todos los factores involucrados y saber con qué herramientas contamos. El abordaje terapéutico clásicamente incluye la terapia psicológica y la terapia hormonal. Sin embargo, recientemente se ha incorporado una nueva droga recientemente aprobada por la FDA de los Estados Unidos para el tratamiento del deseo sexual hipoactivo en la mujer: el flibanserín, un psicofármaco que actúa a nivel de mediadores del deseo sexual en el sistema nervioso central, favoreciéndolo. (AU)

When we talk about human sexuality, we know that we are talking about a complex and changing interaction between biological and socioemotional factors, which are highly influenced by society, family, religion and cultural norms. This can be seen in men and women especially in women. Sexuality is an intuitive concept difficult to define. According to the World Health Organization, it is defined as "A state of physical, emotional, mental and social well being related to sexuality, which is not merely the absence of disease, dysfunction or disabilityˮ. It is a definition that takes into account several concepts, all very important. Sexual response is a series of neurophysiological, hemodynamic and hormonal changes involving the whole body. While similar in both sexes, women are not always the onset and progression correlate systematically or linearly as in men. And that intriguing evolution of the female sexual response, the difficulty of diagnosis of "female sexual dysfunctionˮ. We could summarize it in "a group of disorders in which the physiological or psychological problems impede participation or satisfaction in sexual activities; which results in the inability of a person to participate in a sexual relationship the way she or he would like to do itˮ16. Menopause is perceived by many women as to the end of sexuality, not only as the end of reproductive life. Sexual activity declines with age, and may be affected by a number of hormonal, psychological and sociocultural factors, but, for most women it continues to be important. We must understand that female sexual dysfunction, at any stage of life is multicausal and multidimensional. When approaching a patient, it is important to know all the factors that are involved, and which tools we have for deal with it. Classically, the therapeutic approach has consisted of psychological therapy and hormone therapy. However, we have to consider a recently approved drug by the FDA for the treatment of hypoactive sexual desire in women: Flibanserin. It is a psychotropic substance that acts on the mediators of sexual desire on the central nervous system favoring it. (AU)

High-level construal benefits, meaning making, and posttraumatic growth in cancer patients.

OBJECTIVE: The present study sought to explore the role of meaning making and high-level construal in the relationship between meaning discrepancy and posttraumatic growth among Chinese cancer patients. METHOD: The participants were 193 individuals diagnosed with cancer. Meaning discrepancy, meaning making, high-level construal in meaning making, and posttraumatic growth were measured. Bootstrapping and structural equation modeling were performed to test the mediation effects of high-level construal on the meaning-making process. RESULTS: Mediation analysis revealed that perceived discrepancies were associated with individuals' meaning-making efforts. Meaning-making efforts prompted participants to adopt a high-level construal orientation, which in turn enhanced posttraumatic growth. SIGNIFICANCE OF RESULTS: Our study empirically tested construal level theory in a population suffering from severe chronic trauma. The results demonstrate the important role of high-level construal in the meaning-making process of cancer patients, suggesting a specific effective strategy to foster posttraumatic growth. It seems encouraging to indicate that adopting such high-level construal may be included as part of psychological interventions for cancer patients.

Hot flushes and night sweats in midlife: why do some women have them and others do not? / Afrontamentos e suores noturnos na meia-idade: porque é que algumas mulheres os têm e outras não?

This study investigated what predicts the occurrence of hot flushes (HF) and night sweats (NS). A community sample of 992 women (42-60 years) answered a questionnaire to collect socio-demographic, health and menopause-related, as well as lifestyle information. Depressive mood and stress, as well as HF and NS (in terms of presence, frequency and intensity), were also assessed. Structural equation modelling was used to build a structural model to predict the occurrence of both vasomotor symptoms. Results: Stress predicted NS (ß =.154; p =.006), whereas depressive mood was linked to the occurrence of HF's (ß =.149; p =.006). Being peri-menopausal and post-menopausal, among several other characteristics, were also significant predictors of the occurrence of both HF and NS. This study supports a distinguished influence of stress and depressive mood in NS and HF respectively, probably due to the nature of psychological symptoms. Moreover, significant associations between vasomotor symptoms and socio-demographic, health and menopause-related characteristics, and alcohol were confirmed. (AU)

Este estudo investigou os preditores da ocorrência de afrontamentos (Af) e de suores noturnos (SN). Foi utilizada uma amostra comunitária de 992 mulheres (42-60 anos), que respondeu a um questionário para a recolha de informação sociodemográfica, de estado de saúde e menopausa, e sobre o estilo de vida. Os níveis de humor deprimido e estresse, tal como a ocorrência, frequência e intensidade dos Af e SN, foram avaliados. Modelos de equações estruturais foram utilizados para construir o modelo estrutural para predizer a ocorrência de ambos os sintomas vasomotores. Os resultados indicaram que estresse predisse os SN (ß =0,154; p =0,006), enquanto o humor deprimido associou-se à ocorrência de Af (ß =0,149; p =0,006). Estar na peri-menopausa ou na pós-menopausa, entre outras características, associou-se igualmente à ocorrência de Af e SN. Este estudo suporta uma influência diferenciada do estresse e do humor deprimido na ocorrência de SN e Af, respetivamente, provavelmente devido à natureza dos sintomas psicológicos. Adicionalmente confirmou-se uma associação significativa entre os sintomas vasomotores e características sociodemográficas, de saúde, de menopausa e consumo de álcool. (AU)