Effects of high-intensity interval training in combination with detraining on mental health in women with polycystic ovary syndrome: A randomized controlled trial.

This study aimed to investigate the effects of high-intensity interval training (HIIT) and detraining on the quality of life and mental health of 23 women with polycystic ovary syndrome (PCOS). Participants were randomly assigned to the HIIT group (n = 12) [26.0 ± 3.92] and the control group (n = 11) [26.6 ± 4.68]. HIIT sessions comprised 40-60 min, 3 days a week for 12 weeks, followed by detraining for 30 days. We assessed the quality of life using the Short Form Health Survey (SF-36) and mental health by the Depression, Anxiety, and Stress Scale (DASS-21), and we compared group changes on these variables at three time points: 1) at baseline, 2) after 12 weeks of HIIT (or no training), and 3) after 30 days of detraining (or no training). The participants were classified as overweight and had a high percentage of body fat (41.5%) and irregular menstrual cycles (amenorrhea) (66.7%). Throughout training, participants in the HIIT group reported improvements in domains of the quality of life: functional capacity (M = 80.4 ± 3.4 vs. M = 87.0 ± 3.1), physical role functioning (M = 72.5 ± 9.4 vs. M = 81.8 ± 9.7), and general health perception (M = 48.6 ± 4.6 vs. M = 69.0 ± 5.8). Regarding anxiety symptoms (M = 6.4 ± 1.6 vs. M = 3.7 ± 0.7) and depression symptoms (M = 6.7 ± 1.6 vs. M = 3.8 ± 0.9), those reduced significantly after HIIT. After a 30-day detraining period, there was an increase in the significant change in the quality of life; however, domains of mental health showed instability. In summary, the HIIT program promoted improvements in the quality of life and mental health in women with PCOS. The 30 days of detraining changed the benefits in the quality of life and stability in the changes in mental health domains.

Effect of high-intensity interval training on metabolic parameters in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Our aim was to assess the effect of high-intensity interval training (HIIT) on metabolic parameters and body composition in women with polycystic ovary syndrome (PCOS). METHODS AND ANALYSIS: A systematic review and meta-analysis of randomized controlled trials was conducted using Embase, MEDLINE (via Ovid), PubMed, Sport Discus, Scopus, Web of Science, Cochrane Library and Google Scholar (advanced feature) up to September 2020. Two authors independently screened citations and determined the risk of bias and quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses were conducted using random effects model. RESULTS: Seven trials (n = 423) were included in the systematic review. The studies included HIIT interventions vs. moderate exercise or control groups. Most studies were small (average 32, range 24-110 participants) and of relatively short duration (10-16 weeks). The training intensity was performed between 90% and 95% of the maximum heart rate, three times a week, for at least 10 weeks. Insulin resistance, measured using homeostatic model assessment for insulin resistance (HOMA-IR), and body mass index (BMI) showed a significant decrease (MD -0.57; 95% CI, -0.98 to -0.16, p = 0.01), (MD -1.90, 95% CI -3.37, -0.42, p = 0.01) with moderate and high certainty of evidence, respectively. CONCLUSION: Results support that HIIT alone is effective for reducing HOMA-IR and BMI in women with PCOS. However, evidence is limited to discern the effect of HIIT on other outcomes. Future studies with a longer duration (> 16 weeks), larger sample sizes and other outcomes are needed.

The effect of exercise as an intervention for women with polycystic ovary syndrome: A systematic review and meta-analysis.

BACKGROUND: Polycystic ovary syndrome (PCOS) affects reproductive-aged women and is associated with increased prevalence of serious clinical problems including: reproductive implications, metabolic dysfunction, and cardiovascular risk. Physical activity offers several health benefits for women with PCOS. The aim of this systematic review was to synthesize evidence on the effect of different types of exercise on reproductive function and body composition for women with PCOS. METHODS: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) following recommended review methods. We searched 6 databases: Cumulative Index of Nursing and Allied Health Literature; Embase; MEDLINE (via Ovid); PubMed; Sport Discus; and Web of Science; and we developed search strategies using a combination of Medical Subject Headings terms and text words related to exercise interventions for women with PCOS. There was no restriction on language or publication year. The search was conducted on April 16, 2019 and updated on November 15, 2019. Two authors independently screened citations, determined risk of bias and quality of evidence with Grading of Recommendations Assessment, Development and Evaluation. We conducted meta-analyses following recommended guidelines, and report results using standardized mean difference (SMD). RESULTS: Ten RCTs (n = 533) were included in this review. Studies tested the following interventions: aerobic, resistance, and combined (aerobic/resistance) training programs. Most studies were small (average 32, range 15-124 participants), and of relatively short duration (8-32 weeks). There was high heterogeneity for outcomes of reproductive function (menstrual cycle, ovulation, and fertility). We noted low certainty evidence for little to no effect of exercise on reproductive hormones and moderate certainty evidence that aerobic exercise reduced body mass index (BMI) in women with PCOS: BMI SMD -0.35, 95% confidence interval -0.56 to -0.14, P = .001. CONCLUSION: For women with PCOS, evidence is limited to discern the effect of exercise on major health outcomes (e.g., reproductive function). There is moderate certainty evidence that aerobic exercise alone is beneficial for reducing BMI in women with PCOS. Future studies should be conducted with longer duration, larger sample sizes, and should provide detailed information on menstrual cycle and fertility outcomes.PROSPERO Systematic review registration: 2017 CRD42017058869.

Lifestyle interventions and quality of life for women with polycystic ovary syndrome: A systematic review and meta-analysis protocol.

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. PCOS has a significant negative impact on the health-related quality of life (HRQoL) and psychological function of women, of which there are reports of high levels of depression in women with PCOS compared to those without PCOS. However, the evidence surrounding the effects of exercise and/or dietary intervention participation on the HRQoL of women with PCOS is limited. Therefore, our objective is to examine the effects of lifestyle interventions (definition include exercise-only, diet-only, exercise + diet and behavioral or combined) on health-related quality of life or general quality of life in women with PCOS. METHODS: We will conduct an update of systematic review and we will follow the recommendations and guidelines of the Cochrane handbook for systematic reviews and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P). We will search the studies in the following databases: MEDLINE. PubMed, PsychINFO, Embase, SportDiscus, Web of Science, Cochrane Database (via Cochrane library), Cochrane Controlled Register of Trials (CENTRAL), and Google Scholar (advance). Manual search of the reference list of identified works, without language and year restrictions. The process of study selection and data extraction will be performed independently by 2 reviewers, with a third reviewer being responsible for the final decision in case of disagreement between the first two. We will use Egger funnel chart to evaluate possible publication biases, in addition, when possible we will perform a subgroup/meta-regression analysis. The strength of the evidence will be assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). PROTOCOL REGISTRY: PROSPERO number: CRD42019124176.

Recommendations for the Use of Testosterone in Male Transgender.

Gender incongruence is defined as a condition in which an individual self-identifies and desires to have physical characteristics and social roles that connote the opposite biological sex. Gender dysphoria is when an individual displays the anxiety and/or depression disorders that result from the incongruity between the gender identity and the biological sex. The gender affirmation process must be performed by a multidisciplinary team. The main goal of the hormone treatment is to start the development of male physical characteristics by means of testosterone administration that may be offered to transgender men who are 18 years old or over. The use of testosterone is usually well tolerated and improves the quality of life. However, there is still lack of evidence regarding the effects and risks of the long-term use of this hormone. Many different pharmacological formulations have been used in the transsexualization process. The most commonly used formulation is the intramuscular testosterone esters in a short-term release injection, followed by testosterone cypionate or testosterone enanthate. In the majority of testosterone therapy protocols, the male physical characteristics can be seen in almost all users after 6 months of therapy, and the maximum virilization effects are usually achieved after 3 to 5 years of regular use of the hormone. To minimize risks, plasmatic testosterone levels should be kept within male physiological ranges (300 to 1,000 ng/dl) during hormonal treatment. It is recommended that transgender men under androgen therapy be monitored every 3 months during the 1st year of treatment and then, every 6 to 12 months.

Incongruência de gênero é uma condição na qual o indivíduo se identifica, deseja viver e ser aceito como uma pessoa do gênero oposto ao designado por ocasião do nascimento. Na disforia de gênero o indivíduo manifesta ansiedade e sofrimento pelo desejo de viver e ser aceito como uma pessoa do gênero oposto ao designado ao nascimento. O processo transsexualizador requer trabalho em equipe multiprofissional. O objetivo do tratamento hormonal é induzir o aparecimento de características sexuais masculinas secundárias por meio da administração da testosterona em indivíduos com idade igual ou superior a 18 anos. O tratamento de estimulação androgênica costuma ser bem tolerado. Entretanto, ainda não existem evidências sobre os efeitos e riscos do uso da testosterona a longo prazo. Diferentes preparações farmacológicas da testosterona têm sido utilizadas. As mais utilizadas têm sido as injeções intramusculares de administração a curto prazo de ésteres, seguidas do cipionato de testosterona e do enantato de testosterona. Na maioria dos protocolos de tratamento observa-se o aparecimento de características corporais masculinas nos primeiros 6 meses, e a obtenção do máximo efeito da estimulação androgênica, após 3 a 5 anos de uso regular da testosterona. Recomenda-se a manutenção dos níveis plasmáticos de testosterona dentro dos limites fisiológicos para o sexo masculino (300 a 1.000 ng/dl), a fim de minimizar os riscos. A monitorização dos homens transgênero é recomendada a cada 3 meses durante o primeiro ano de tratamento e a seguir, a cada 6 a 12 meses.

Avaliação da reserva ovariana na predição do mau prognóstico reprodutivo: quando e como investigar / Ovarian reserve evaluation in the prediction of poor reproductive prognosis: when and how to investigate?

Muitas vezes, torna-se um grande desafio para o ginecologista a identificação daquelas com maior ou menor chance de concepção. Vários marcadores laboratoriais e ultrassonográficos, conhecidos conjuntamente como testes de avaliação da reserva ovariana, são estudados há décadas com a intenção de se buscar uma ferramenta para a predição do potencial reprodutivo. E, embora ainda se busquem os marcadores ideais para aplicação clínica, mais difícil do que os definir é definir quando eles estão indicados. Este artigo de atualização, assinado pela Comissão Nacional Especializada em Ginecologia Endócrina da Febrasgo, pretende oferecer ao leitor as ferramentas necessárias para o uso racional dos testes de avaliação da reserva ovariana no cotidiano.(AU)

Often, it becomes a great challenge for the gynecologist to identify women with a greater or lesser chance of conception. Several laboratory and ultrasound markers, known jointly as ovarian reserve evaluation tests, have been studied for decades with the intention of seeking a tool for the prediction of reproductive potential. And, while the ideal markers for clinical application are still sought, defining them is as harder as defining when they are indicated. This update article, signed by the National Specialized Committee on Gynecologic Endocrinology, Febrasgo, intends to offer the reader the necessary tools for the rational use of ovarian reserve evaluation tests in daily practice.(AU)

Exercise and reproductive function in polycystic ovary syndrome: protocol of a systematic review.

BACKGROUND: Although many post-participation outcomes in different types of physical training (e.g., aerobic and strength) have been previously investigated for the treatment of polycystic ovary syndrome, there is no recent systematic review of the relationship between various types of intervention and the reproductive function of women with PCOS. The current paper describes a systematic review protocol on the benefits of physical exercise and dietary or drug interventions on endocrinological outcomes in women with PCOS. METHODS: PubMed/MEDLINE, Science Direct, Bireme, Scopus, Web of Science, ProQuest, Cochrane Library (Cochrane Systematic Reviews Database, Cochrane Central Register of Controlled Studies (CENTRAL) databases will be searched. Studies randomized controlled trials reporting on intervening changes in exercise interventions with or without interventions compared such as diet, medication and acupuncture on the menstrual cycle, and fertility in women with PCOS will be included. Results will be on the decrease of the characteristics of hyperandrogenism, insulin resistance, and obesity. Studies published since 2010 and in the English language will be included. DISCUSSION: This systematic review will identify improvement strategies and types of interventions that are geared toward improving endocrine and consequently metabolic parameters. Thus, the use of such strategies may increase the types of low-cost non-drug therapies that aid in the treatment of PCOS. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017058869.

Assessment of lower urinary tract symptoms in different stages of menopause.

[Purpose] To assess lower urinary tract symptoms in different stages of menopause and the quality of life of females with incontinence. [Subjects and Methods] The sample consisted of 302 females, aged between 40 and 56 years, divided into three groups: PRE (n= 81), PERI (n= 108) and POST (n= 113). This was a cross-sectional, analytical, observational study. Data were collected by assessment chart and conducting the International Consultation on Incontinence Questionnaire-Short Form. [Results] Most of the women had less than 10 years of schooling and were married. In PERI and POST menopause, the most frequent lower urinary tract symptoms were urinary urgency and stress incontinence. The PRE group did not exhibit nocturia, urge incontinence or urinary urgency, and had the lowest symptoms frequency. In the three stages, stress incontinence was the most prevalent symptom. Of the three menopause stages, PERI had a greater impact on urinary incontinence according to the International Consultation on Incontinence Questionnaire. [Conclusion] The presence of lower urinary tract symptoms can vary across the different stages of menopause and the urinary incontinence was the most frequent complaint. Moreover, it was observed that quality of life was more affected in the perimenopause stage.

Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation / Achados ultrassonográficos das alterações fisiológicas e doenças mamárias mais frequentes durante a gravidez e lactação

Abstract Because of the physiological changes that occur during pregnancy and lactation, diagnostic ultrasound of the breast during these periods is a challenge for physicians. Therefore, a comprehensive understanding of imaging, anatomy, and physiology of the breast is important to effectively diagnosing diseases that can arise in women who are pregnancy or lactating. The aim of this article was to review the physiological changes that occur in the breasts during pregnancy and lactation, as well as to describe the main features of the breast diseases that occur most frequently during these periods.

Resumo O diagnóstico ultrassonográfico das mamas durante a gravidez e lactação representa um desafio para o médico, em função das alterações fisiológicas próprias destes períodos. Para tanto, é essencial uma compreensão das imagens, da anatomia e da fisiologia mamárias para diagnosticar mais eficazmente doenças concomitantes. O presente artigo teve como objetivo fazer uma revisão das alterações fisiológicas que ocorrem nas mamas durante a gravidez e lactação, bem como relatar as principais características ultrassonográficas das doenças mamárias mais frequentes nestes períodos.

Clustering of risk factors for cardiometabolic diseases in low-income, female adolescents

ABSTRACT Objective To assess the prevalence and clustering patterns of cardiometabolic risk factors among low-income, female adolescents. Materials and methods Cross-sectional study involving 196 students of public schools (11-19 years old). The following risk factors were considered in the analysis: excess weight, central obesity, dyslipidemia, high blood pressure, and high fasting glucose. The ratio between observed and expected prevalence and its confidence interval were used to identify clustering of risk factors that exceeded expected prevalence in the population. Results The most prevalent risk factors were dyslipidemia (70.9%), and central obesity (39.8%), followed by excess weight (29.6%), and high blood pressure (12.8%). A total of 42.9% of adolescents had two or more risk factors, and 24% had three or more. Excess weight, central obesity, and dyslipidemia were common risk factors in the clustering patterns that showed higher-than-expected prevalence. Conclusions Clustering of risk factors (≥ two factors) among the adolescents showed considerable prevalence, and there was a non-casual coexistence of excess weight, central obesity, and dyslipidemia (mainly low HDL-cholesterol).

Prevalência da síndrome metabólica nos estágios pubertários de escolares do sexo feminino / Prevalence of metabolic syndrome in pubertal stages of female students / Prevalencia del síndrome metabólico en etapas de la pubertad de las estudiantes do sexo femenino

Objetivo Analisar a prevalência da síndrome metabólica (SM) nos estágios pubertários de escolares do sexo feminino. Métodos Estudo transversal com 449 escolares, entre oito e 18 anos, estratificadas nos estágios pubertário, índice de massa corporal (IMC) e percentual de gordura (%G). A SM foi classificada pela International Diabetes Federation. A análise feita pela distribuição de frequências, intervalos de confiança (95 %), Qui-quadrado e razão de chance para associações. Resultados A prevalência de SM foi 3,3 % (IC:2 %-5 %), sendo 2,5 % (IC:0,1 %-5%) no púbere e 7,9 % (IC:3,2 %-12,6 %) no pós-púberes, com associação significante destes com a SM (X²=5,2 [p<0,02]). A razão de chance aponta meninas pós-púberes (3,3 [IC:1,2-5]) e obesas (2,1 [CI:2-2,2]) mais propensas à SM, indicando associação linear significante do IMC com o desfecho (X²=29,4 [p<0,001]). Púberes menos de 10 anos com SM apresentaram maiores %G. Os componentes prevalentes foram: circunferência da cintura alterada (27,2 % [IC23 %-31 %]) e colesterol HDL baixo (39,6 % [IC35 %-44 %]) e prevalência da hipertensão sistêmica nas pós-púberes. Conclusões A SM inicia-se no estágio púbere, com prevalência no pós-púbere, sendo o excesso de gordura o desencadeador nas menores de 10 anos. Estratégias de prevenção são necessárias à população de crianças e adolescentes.(AU)

Objective To analyze the prevalence of metabolic syndrome (MS) in pubertal stages of female students. Methods Cross-sectional study of 449 school children between eight and 18 years, stratified by pubertal stage, body mass index (BMI) and body fat percentage (BF %). The MS was classified according to the International Diabetes Federation. The analysis by frequency distribution, confidence intervals (95 %), Chi-square and odds ratio for associations was performed. Results The prevalence of MS was 3.3 % (CI:2 %-5 %) and 2.5 % (CI: 0.1 - 5 %) in pubertal and 7.9% (CI:3.2 % - 12.6 %) in the post-pubescent, with a significant association of this group with MS (X² = 5.2 [p <0.02]). The odds ratio shows that post-pubescent girls (3.3 [CI: 1.2 to 5]) and obese girls (2.1 [CI: 2 - 2.2]) are more likely to have MS, indicating significant linear association between BMI and the outcome (X²=29.4 [p<0.001]). Pubescent children under 10 years of age with MS had higher %G. The prevalent components were altered waist circumference (27.2 % [CI23 %-31 %]) and low HDL cholesterol (39.6 % [CI 35 % - 44 %]), as well as prevalence of systemic hypertension in post-pubertal girls. Conclusions MS begins in the pubertal stage, with prevalence in the post-pubertal stage. Excess fat is a trigger in children under 10 years of age. Prevention strategies are needed for the population of children and adolescents.(AU)

Objetivo Analizar la prevalencia del síndrome metabólico (SM) en el estadio puberal de estudiantes de sexo femenino. Métodos Estudio transversal con 449 niños en edad escolar entre ocho y 18 años, estratificado en la etapa de la pubertad, el índice de masa corporal (IMC) y el porcentaje de grasa corporal (% GC). El SM fue clasificado por la Federación Internacional de Diabetes. El análisis se adelantó por medio de la distri study bución de frecuencias, intervalos de confianza (95 %), Chi-cuadrado y Odds ratio para las asociaciones. Resultados La prevalencia de SM fue del 3,3 % (IC:2 %-5 %) y 2,5 % (IC:0,1 %-5 %) en la pubertad y el 7,9 % (IC:3,2 %-12,6 %) en el post-pubescente, con estas asociación significativa con SM (X²=5,2 [p <0,02]). El Odds ratio señala niñas post-púberes (3,3 [IC: 1.2 a 5]) y obesidad (2,1 [IC: 2-2,2]) más probabilidades de SM, lo que indica la asociación lineal significativa entre el IMC y la resultado (X²=29,4 [p<0,001]). Pubescentes menos de 10 años con EM tenía mayor %G. Los componentes predominantes fueron alterados circunferencia de la cintura (27,2 % [IC del 23 %-31 %]) y colesterol HDL bajo (39,6 % [IC del 35 %-44 %]) y la prevalencia de la hipertensión arterial sistémica en la post-puberal. Conclusiones SM comienza en la etapa puberal, con una prevalencia en el post-puberal, y el exceso de grasa es el desencadenante en niños menores de 10 años. Se necesitan estrategias de prevención para la población de niños y adolescentes.(AU)

Clustering of risk factors for cardiometabolic diseases in low-income, female adolescents.

OBJECTIVE: To assess the prevalence and clustering patterns of cardiometabolic risk factors among low-income, female adolescents. MATERIALS AND METHODS: Cross-sectional study involving 196 students of public schools (11-19 years old). The following risk factors were considered in the analysis: excess weight, central obesity, dyslipidemia, high blood pressure, and high fasting glucose. The ratio between observed and expected prevalence and its confidence interval were used to identify clustering of risk factors that exceeded expected prevalence in the population. RESULTS: The most prevalent risk factors were dyslipidemia (70.9%), and central obesity (39.8%), followed by excess weight (29.6%), and high blood pressure (12.8%). A total of 42.9% of adolescents had two or more risk factors, and 24% had three or more. Excess weight, central obesity, and dyslipidemia were common risk factors in the clustering patterns that showed higher-than-expected prevalence. CONCLUSIONS: Clustering of risk factors (≥ two factors) among the adolescents showed considerable prevalence, and there was a non-casual coexistence of excess weight, central obesity, and dyslipidemia (mainly low HDL-cholesterol).

Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation.

Because of the physiological changes that occur during pregnancy and lactation, diagnostic ultrasound of the breast during these periods is a challenge for physicians. Therefore, a comprehensive understanding of imaging, anatomy, and physiology of the breast is important to effectively diagnosing diseases that can arise in women who are pregnancy or lactating. The aim of this article was to review the physiological changes that occur in the breasts during pregnancy and lactation, as well as to describe the main features of the breast diseases that occur most frequently during these periods.

O diagnóstico ultrassonográfico das mamas durante a gravidez e lactação representa um desafio para o médico, em função das alterações fisiológicas próprias destes períodos. Para tanto, é essencial uma compreensão das imagens, da anatomia e da fisiologia mamárias para diagnosticar mais eficazmente doenças concomitantes. O presente artigo teve como objetivo fazer uma revisão das alterações fisiológicas que ocorrem nas mamas durante a gravidez e lactação, bem como relatar as principais características ultrassonográficas das doenças mamárias mais frequentes nestes períodos.