Age at menopause in Latin America.

OBJECTIVE: To assess the age at menopause (AM) in Latin America urban areas. DESIGN: A total of 17,150 healthy women, aged 40 to 59 years, accompanying patients to healthcare centers in 47 cities of 15 Latin American countries, were surveyed regarding their age, educational level, healthcare coverage, history of gynecological surgery, smoking habit, presence of menses, and the use of contraception or hormone therapy at menopause. The AM was calculated using logit analysis. RESULTS: The mean age of the entire sample was 49.4 +/- 5.5 years. Mean educational level was 9.9 +/- 4.5 years, and the use of hormone therapy and oral contraception was 22.1% and 7.9%, respectively. The median AM of women in all centers was 48.6 years, ranging from 43.8 years in Asuncion (Paraguay) to 53 years in Cartagena de Indias (Colombia). Logistic regression analysis determined that women aged 49 living in cities at 2,000 meters or more above sea level (OR = 2.0, 95% CI: 1.4-2.9, P < 0.001) and those with lower educational level (OR = 1.9, 95% CI: 1.3-2.8, P < 0.001) or living in countries with low gross national product (OR = 2.1, 95% CI: 1.5-2.9, P < 0.001) were more prone to an earlier onset of menopause. CONCLUSIONS: The AM varies widely in Latin America. Lower income and related poverty conditions influence the onset of menopause.

[Current status of hormone therapy during the menopausal transition and post-menopause]. / Terapia hormonal en la transición a la menopausia y en la posmenopausia: estado actual.

Starting from prospective clinical studies that have evaluated its benefits and risks, hormone replacement therapy in menopause women has been reassessed in its indications in the last four years. In October, 2004 a Latinamerican Experts Consensus was carried out, such report with some modifications is presented in this publication. The conclusions the experts reached were the following: 1) Hormone Therapy is the gold standard for the control of moderate to severe vasomotor symptoms; 2) this therapy must be indicated in an individual manner and only in symptomatic women in which the benefit is greater than the risk; 3) the least effective dose must be used; 4) it must be used neither for cardiovascular prevention, osteoporosis, colon cancer nor for mental disorder; 5) the patient must be informed about the benefits and risks.

Terapia hormonal en la transición a la menopausia y en la posmenopausia: estado actual / Current status of the hormone therapy during the menopausal transition and post-menopausa

La terapia hormonal para la mujer en menopausia ha sido revalorizada en sus indicaciones en los últimos cuatro años, a partir de estudios clínicos prospectivos que han evaluado sus beneficios y riesgos. En octubre de 2004 se efectuó un Consenso de Expertos Latinoamericanos cuyo informe, con algunas modificaciones, se presenta en esta publicación. Las conclusiones a las que arribaron los expertos indican que: 1) la terapia hormonal es el estándar de oro para el control de los síntomas vasomotores moderados a severos; 2) esta terapia se debe indicar de manera individualizada y solo en mujeres sintomáticas en las que el beneficio sea mayor que el riesgo; 3) se debe utilizar la menor dosis efectiva; 4) no se debe indicar solo para prevención cardiovascular, osteoporosis, cáncer de colon ni para el deterioro mental; 5) se debe informar a la paciente de los beneficios y los riesgos.

Starting from prospective clinical studies that have evaluated its benefits and risks, hormone replacement therapy in menopause women has been reassessed in its indications in the last four years. In October, 2004 a Latin-American Experts Consensus was carried out, such report with some modifications is presented in this publication. The conclusions the experts reached were the following: 1) Hormone Therapy is the gold standard for the control of moderate to severe vasomotor symptoms; 2) this therapy mutt be indicated in an individual manner and only in symptomatic women in which the benefit is greater than fue risk; 3) fue least effective dose must be used; 4) it must be used neither for cardiovascular prevention, osteoporosis, colon cancer nor for mental disorder; 5) the patient must be informed about the benefits and risks.

Terapia hormonal en la transición a la menopausia y en la posmenopausia: estado actual / Current status of the hormone therapy during the menopausal transition and post-menopausa

La terapia hormonal para la mujer en menopausia ha sido revalorizada en sus indicaciones en los últimos cuatro años, a partir de estudios clínicos prospectivos que han evaluado sus beneficios y riesgos. En octubre de 2004 se efectuó un Consenso de Expertos Latinoamericanos cuyo informe, con algunas modificaciones, se presenta en esta publicación. Las conclusiones a las que arribaron los expertos indican que: 1) la terapia hormonal es el estándar de oro para el control de los síntomas vasomotores moderados a severos; 2) esta terapia se debe indicar de manera individualizada y solo en mujeres sintomáticas en las que el beneficio sea mayor que el riesgo; 3) se debe utilizar la menor dosis efectiva; 4) no se debe indicar solo para prevención cardiovascular, osteoporosis, cáncer de colon ni para el deterioro mental; 5) se debe informar a la paciente de los beneficios y los riesgos.(AU)

Starting from prospective clinical studies that have evaluated its benefits and risks, hormone replacement therapy in menopause women has been reassessed in its indications in the last four years. In October, 2004 a Latin-American Experts Consensus was carried out, such report with some modifications is presented in this publication. The conclusions the experts reached were the following: 1) Hormone Therapy is the gold standard for the control of moderate to severe vasomotor symptoms; 2) this therapy mutt be indicated in an individual manner and only in symptomatic women in which the benefit is greater than fue risk; 3) fue least effective dose must be used; 4) it must be used neither for cardiovascular prevention, osteoporosis, colon cancer nor for mental disorder; 5) the patient must be informed about the benefits and risks.(AU)

A 13-month multicenter clinical experience of a low-dose monophasic oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene in Latin American women.

This prospective, multicenter study was conducted to evaluate the contraceptive reliability, cycle control and tolerability of a 21-day oral contraceptive regimen containing 20 microg ethinylestradiol and 75 microg gestodene in four Latin American countries (Mexico, Argentina, Brazil and Colombia). Participants took trial medication daily for 21 days. Contraceptive efficacy, cycle control and tolerability were evaluated over a period of 13 cycles. Efficacy data gathered from 5,109 treatment cycles were obtained from 393 participants. The trial medication proved to be an effective contraceptive and provided good cycle control. One pregnancy because of poor compliance was recorded. This resulted in a study Pearl index of 0.25. Forty-six percent of Latin American women reported one intracyclic spotting bleeding episode and 37.6% reported one intracyclic breakthrough bleeding (medium/excessive bleeding) episode during cycles 2-4 (primary target). Overall, intracyclic bleeding was reported in 41%. Overall, there was a trend towards a lower incidence of spotting in all the countries and this difference had statistical significance between Argentina and the others three countries (p < 0.05) during cycles 2-4. This trend was also apparent with respect to breakthrough bleeding, but again the difference did not achieve statistical significance. The discontinuation rate because of adverse events was low (3%); no serious adverse events were reported. More than 78% of the women in the four countries maintained constant body weight or lost weight (2 kg) during the study. The treatment effect on blood pressure was negligible. There were no appreciable changes in mean laboratory values over the course of the study.

Comparison of the effect of raloxifene and continuous-combined hormone therapy on mammographic breast density and breast tenderness in postmenopausal women.

OBJECTIVE: The objectives were to evaluate mammographic changes in breast density that are associated with raloxifene or hormone therapy and to compare the safety profiles of the two therapies. STUDY DESIGN: Postmenopausal women older than 60 years who had a bone mineral density T-score of < or =-1 were assigned randomly to receive raloxifene hydrochloride 60 mg/day or continuous-combined hormone therapy that consisted of conjugated equine estrogen 0.625 mg/day plus medroxyprogesterone acetate 2.5 mg/day in a 1-year, open-label study. Radiologists who were blinded to the treatment assignment assessed the mammograms according to the American College of Radiology Breast Image Reporting and Data System breast density categories. Breast density changes were analyzed for treatment differences. RESULTS: After 12 months of treatment, 0.9% of the women who received raloxifene had increased mammographic breast density compared with 27.4% of the women who received continuous-combined hormone therapy (P <.001). In the continuous-combined hormone therapy group, 77% of the women reported breast tenderness at any time during the study, compared to 22% of the women in the raloxifene group. CONCLUSION: In postmenopausal women with low bone mass, raloxifene therapy for 12 months does not increase mammographic breast density, whereas continuous-combined hormone therapy substantially increases breast density in a significant number of women.

Uso de estradiol transdérmico continuo y medroxiprogesterona oral trimestral / Continous transdermal estradiol use and medroxiprogesterone oral quarterly

Uno de los métodos para reducir o evitar los efectos colaterales de los progestágenos y así mejorar el cumplimiento de la hormonoterapia de reemplazo(HTR) es el agregado de dichos esteroides a los estrógenos en esquemas no diarios en esquemas no mensuales. El objetivo de este estudio fue evaluar el uso de uno de estos esquemas alternativos: estrógeno continuo y progrestágeno cada tres meses sobre los síntomas climatéricos, el sangrado uterino, la presión arterial, el peso corporal, los lípidos en sangre, la histología endometrial y su aceptabilidad. Ciento siete pacientes posmenopáusicas recibieron 50 mcg de estradiol transdérmico en forma continua durante seis meses y 10 mg de acetato de medroxiprogesterona (AMP) por vía oral durante 14 días cada tres meses.En síntesis, el uso de estradiol transdérmico continuo y AMP oral trimestral mostró ser un tratamiento eficaz los síntomas climatéricos, inducir un sangrado uterino aceptable, siendo bien tolerado por las pacientes y sin provocar lesiones de riesto en el endometrio

Uso de estradiol transdérmico continuo y medroxiprogesterona oral trimestral / Continous transdermal estradiol use and medroxiprogesterone oral quarterly

Uno de los métodos para reducir o evitar los efectos colaterales de los progestágenos y así mejorar el cumplimiento de la hormonoterapia de reemplazo(HTR) es el agregado de dichos esteroides a los estrógenos en esquemas no diarios en esquemas no mensuales. El objetivo de este estudio fue evaluar el uso de uno de estos esquemas alternativos: estrógeno continuo y progrestágeno cada tres meses sobre los síntomas climatéricos, el sangrado uterino, la presión arterial, el peso corporal, los lípidos en sangre, la histología endometrial y su aceptabilidad. Ciento siete pacientes posmenopáusicas recibieron 50 mcg de estradiol transdérmico en forma continua durante seis meses y 10 mg de acetato de medroxiprogesterona (AMP) por vía oral durante 14 días cada tres meses.En síntesis, el uso de estradiol transdérmico continuo y AMP oral trimestral mostró ser un tratamiento eficaz los síntomas climatéricos, inducir un sangrado uterino aceptable, siendo bien tolerado por las pacientes y sin provocar lesiones de riesto en el endometrio(AU)

Histerectomía vaginal: resultados y comparación con otras técnicas / Vaginal hyssterectomy: results and comparison with other techniques

Describir la evolución de lahissterectomía vaginal (HV) en la Argentina. Presentar los resultados obtenidos en 430 casos realizados o supervisados por el autor. Efectuar una revisión bibliográfica comparativa entre los resultados de la HV y los de la histerectomía abdominal (HA) la histerectomía laparoscópica (HL) y la resección endometrial (RE) Establecer el lugar que ocupa la HV con respecto a las otras técnicas. Analizar los factoress que pueden limitar su aplicación y proponer soluciones para facilitar su enseñanza y difusión

Histerectomía vaginal: resultados y comparación con otras técnicas / Vaginal hyssterectomy: results and comparison with other techniques

Describir la evolución de lahissterectomía vaginal (HV) en la Argentina. Presentar los resultados obtenidos en 430 casos realizados o supervisados por el autor. Efectuar una revisión bibliográfica comparativa entre los resultados de la HV y los de la histerectomía abdominal (HA) la histerectomía laparoscópica (HL) y la resección endometrial (RE) Establecer el lugar que ocupa la HV con respecto a las otras técnicas. Analizar los factoress que pueden limitar su aplicación y proponer soluciones para facilitar su enseñanza y difusión(AU)