Association between waist-to-height ratio and anxiety in middle-aged women: a secondary analysis of a cross-sectional multicenter Latin American study.

OBJECTIVE: The aim of the study was to evaluate the association between waist-to-height ratio (WHtR) and anxiety in middle-aged women. METHODS: We carried out a secondary analysis of data from a multicenter study of women between 40 and 59 years old from 11 Latin America countries. Anxiety was assessed using the Goldberg Anxiety and Depression Scale. WHtR was calculated according to World Health Organization standards and categorized in tertiles: upper, middle, and lower using 0.45 and 0.6 as cutoff values. Prevalence ratios (PRs) and 95% CIs were calculated by generalized linear models of Poisson family with robust standard errors, both crude and adjusted models based on statistical and epidemiological criteria. RESULTS: Data of a total of 5,580 women were analyzed. Mean age was 49.7 ±â€Š5.5 years, and 57.9% were postmenopausal. The 61.3% of women had anxiety and mean WHtR was 0.54 ±â€Š0.1. In the crude model, compared with women in lower tertile, those in the middle (PR: 1.07; 95% CI, 1.01-1.13) and upper (PR: 1.23 95% CI, 1.07-1.29) WHtR tertile were significantly more likely to have anxiety. In the adjusted models, only women in upper tertile were, however, more likely of displaying anxiety than those in lower tertile (PR: 1.13; 95% CI, 1.08-1.18). CONCLUSIONS: In this series, WHtR was associated with anxiety in middle-aged women. It is advisable to further study this anthropometric measure in order for it to be incorporated in the routine clinical practice and evaluation of middle-aged women.

Association between anxiety and severe quality-of-life impairment in postmenopausal women: analysis of a multicenter Latin American cross-sectional study.

OBJECTIVE: To evaluate associations between anxiety and severe impairment of quality of life (QoL) in Latin American postmenopausal women. METHODS: This was a secondary analysis of a multicenter cross-sectional study among postmenopausal women aged 40 to 59 from 11 Latin American countries. We evaluated anxiety (The Goldberg Depression and Anxiety Scale), and QoL (Menopause Rating Scale [MRS]), and included sociodemographic, clinical, lifestyle, and anthropometric variables in the analysis. Poisson family generalized linear models with robust standard errors were used to estimate prevalence ratios (PRs) and 95% CIs. There were two adjusted models: a statistical model that included variables associated with the outcomes in bivariate analyses, and an epidemiologic model that included potentially confounding variables from literature review. RESULTS: Data from 3,503 women were included; 61.9% had anxiety (Goldberg). Severe QoL impairment (total MRS score ≥17) was present in 13.7% of women, as well as severe symptoms (MRS subscales): urogenital (25.5%), psychological (18.5%), and somatic (4.5%). Anxiety was independently associated with severe QoL impairment and severe symptoms in the epidemiological (MRS total score: PR 3.6, 95% CI, 2.6-5.0; somatic: 5.1, 95% CI, 2.6-10.1; psychological: 2.8, 95% CI, 2.2-3.6; and urogenital: 1.4, 95% CI, 1.2-1.6) and the statistical model (MRS total score: PR 3.5, 95% CI, 2.6-4.9; somatic: 5.0, 95% CI, 2.5-9.9; psychological: 2.9, 95% CI, 2.2-3.7; and urogenital: 1.4; 95% CI, 1.2-1.6). CONCLUSIONS: In this postmenopausal Latin American sample, anxiety was independently associated with severe QoL impairment. Hence, screening for anxiety in this population is important.

Obesity is associated with a higher prevalence of musculoskeletal pain in middle-aged women.

Musculoskeletal pain (MSP) has been recently linked with high plasma leptin levels. Our objective was to study if obese women, who have higher leptin levels, could have a higher frequency of MSP. We studied 6079 Latin-American women, 40-59 years old. Their epidemiological data were recorded and the Menopause Rating Scale (MRS), Golberg Anxiety and Depression Scale and Insomnia Scale were applied. MSP was defined as a score ≥2 on MRS11. Women with MSP were slightly older, had fewer years of schooling and were more sedentary. They also complained of more severe menopausal symptoms (29.2% versus. 4.4%, p < 0.0001). Furthermore, they had a higher abdominal perimeter (87.2 ± 12.0 cm versus 84.6 ± 11.6 cm, p < 0.0001) and a higher prevalence of obesity (23.1% versus 15.2%, p < 0.0001). Compared to normal weight women, those with low body weight (IMC <18.5) showed a lower risk of MSP (OR 0.71; 95%CI, 0.42-1.17), overweight women had a higher risk (OR 1.64; 95%CI, 1.44-1.87) and obese women the highest risk (OR 2.06; 95%CI, 1.76-2.40). Logistic regression analysis showed that obesity is independently associated to MSP (OR 1.34; 95%CI, 1.16-1.55). We conclude that obesity is one identifiable risk factor for MSP in middle-aged women.

Personal and professional use of menopausal hormone therapy among gynecologists: A multinational study (REDLINC VII).

BACKGROUND: Previously, the REDLINC VI study showed that the main reason for the low use of menopausal hormone therapy (MHT) was its low rate of prescription by doctors. OBJECTIVE: To determine the use of MHT and perceived related risks among gynecologists. METHODS: A self-administered and anonymous questionnaire was delivered to certified gynecologists in 11 Latin American countries. RESULTS: A total of 2154 gynecologists were contacted, of whom 85.3% responded to the survey (n = 1837). Mean age was 48.1 ± 11.4 years; 55.5% were male, 20.3% were faculty members and 85% had a partner. Overall, 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in the case of female gynecologists) or prescribe it to their partner (88.2% in the case of male gynecologists; p < 0.001). Perceived risk related to MHT use (on a scale from 0 to 10) was higher among female than among male gynecologists (4.06 ± 2.09 vs. 3.83 ± 2.11, p < 0.02). The top two perceived reported risks were thromboembolism (women 33.6% vs. men 41.4%, p < 0.009) and breast cancer (women 38.5% vs. men 33.9%, p < 0.03). Overall, gynecologists reported prescribing MHT to 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p < 0.03) and 86.8% currently prescribed non-hormonal remedies and 83.8% alternative therapies for the management of the menopause. Gynecologists who were older and academic professionals prescribed MHT more often. CONCLUSION: Although this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their partners), this is not necessarily reflected in their clinical practice.

Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity.

OBJECTIVE: The aim of the study was to evaluate the association between sedentary lifestyle and the severity of menopausal symptoms and obesity in middle-aged women. METHODS: The Menopause Rating Scale, the Goldberg Anxiety and Depression Scale, and the Athens Insomnia Scale were administered to 6,079 Latin American women aged 40 to 59 years. Sedentary lifestyle was defined as fewer than three weekly, 30-minute periods of physical activity. RESULTS: Sedentary women had more severe menopausal symptoms (total Menopause Rating Scale score: 9.57 ±â€Š6.71 vs 8.01 ±â€Š6.27 points, P < 0.0001) and more depressive symptoms (Goldberg), anxiety (Goldberg), and insomnia (Athens Scale) compared with non-sedentary women. They also had greater mean waist circumference (86.2 ±â€Š12.3 vs 84.3 ±â€Š1.8 cm, P < 0.0001) and a higher prevalence of obesity (20.9% vs 14.3%, P < 0.0001). Logistic regression analysis showed that both obesity (odds ratio [OR] 1.52; 95% CI, 1.32-1.76) and severe menopausal symptoms (OR 1.28; 95% CI, 1.06-1.53), including insomnia and depressive mood, were positively associated with a sedentary lifestyle. Having a stable partner (OR 0.85; 95% CI, 0.76-0.96), using hormone therapy (OR 0.75; 95% CI, 0.64-0.87) and having a higher educational level (OR 0.66; 95% CI, 0.60-0.74) were negatively related to sedentary lifestyle. CONCLUSIONS: There was a high prevalence of sedentary lifestyle in this middle-aged Latin American female sample which was associated with more severe menopausal symptoms and obesity.

Obesity and its relation to depressive symptoms and sedentary lifestyle in middle-aged women.

BACKGROUND: The prevalence of obesity increases during female mid-life and although many factors have been identified, data from Latin America is lacking. OBJECTIVE: To assess factors related to obesity among middle-aged women and determine the association with depressive symptoms, sedentary lifestyle and other factors. METHODS: A total of 6079 women aged 40-59 years of 11 Latin American countries were asked to fill out the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index and a general questionnaire containing personal socio-demographic data, anthropometric measures and lifestyle information. Obesity was defined as a body mass index (BMI) ≥30 kg/m(2). RESULTS: Obesity was observed in 18.5% and sedentary lifestyle in 63.9%. A 55.5% presented vasomotor symptoms, 12.2% had severe menopausal symptoms and 13.2% used hormone therapy for the menopause. Prevalence of depressive symptoms was 46.5% and anxiety 59.7%. Our logistic regression model found that significant factors associated to obesity included: arterial hypertension (OR: 1.87), depressive symptoms (OR: 1.57), sedentary lifestyle (OR: 1.50) diabetes mellitus (OR: 1.34), higher number of individuals living at home (OR: 1.31), sleep problems (OR:1.22), anxiety (OR: 1.21), having a stable partner (OR: 1.20), parity (OR: 1.16) and vasomotor symptoms (OR:1.14). A lower risk for obesity was found among women using hormonal contraceptives (OR: 0.69). CONCLUSION: Obesity in middle-aged women is the consequence of the interaction of multiple factors. It was associated to hypertension, depressive symptoms, sedentary lifestyle, climacteric symptoms and other factors.

Menopause could be involved in the pathogenesis of muscle and joint aches in mid-aged women.

BACKGROUND: Muscle and joint aches (MJA) are frequently observed among menopausal women. They impair quality of life and are a burden to the healthcare system. OBJECTIVE: To analyze the relation between MJA and several variables related to the menopause. METHODS: In this cross-sectional study, 8373 healthy women aged 40-59 years, accompanying patients to healthcare centers in 18 cities of 12 Latin American countries, were asked to fill out the Menopause Rating Scale (MRS) and a questionnaire containing personal data. RESULTS: Mean age of the whole sample was 49.1±5.7 years, 48.6% were postmenopausal and 14.7% used hormone therapy (HT). A 63.0% of them presented MJA, with a 15.6% being scored as severe to very severe according to the MRS (scores 3 or 4). Logistic regression model determined that vasomotor symptoms (OR: 6.16; 95% CI, 5.25-7.24), premature menopause (OR: 1.58; 95% CI, 1.02-2.45), postmenopausal status (OR: 1.43; 95% CI, 1.20-1.69), psychiatric consultation (OR: 1.93; 95% CI, 1.60-2.32) and the use of psychotropic drugs (OR: 1.35; 95% CI, 1.08-1.69) were significantly related to the presence of severe-very severe MJA. Other significant variables included: age, tobacco consumption and lower education. Self perception of healthiness (OR: 0.49; 95% CI, 0.41-0.59), private healthcare access (OR: 0.77; 95% CI, 0.67-0.88) and HT use (OR: 0.75; 95% CI, 0.62-0.91) were significantly related to a lower risk for the presence of severe-very severe MJA. CONCLUSION: In this large mid-aged sample the prevalence of MJA was high, which was significantly associated to menopausal variables, especially vasomotor symptoms. This association may suggest a potential role of mid-life female hormonal changes in the pathogenesis of MJA.

A multinational study of sleep disorders during female mid-life.

BACKGROUND: Although sleep disturbances are common during female mid-life, few studies have described in detail the prevalence of this problem and related risk factors. OBJECTIVE: To determine the prevalence of sleep disturbances in mid-aged women using validated tools. Assessment of determinants capable of influencing the prevalence of insomnia and poor sleep quality was also performed. METHODS: A total of 6079 women aged 40-59 of 11 Latin American countries were invited to fill out the Athens Insomnia Scale (AIS), the Pittsburgh Sleep Quality Index (PSQI), the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale (MRS), the Brief Scale of Abnormal Drinking and a general socio-demographic questionnaire. RESULTS: Overall, 56.6% of surveyed women suffered of either insomnia, poor sleep quality, or both. Specifically, 43.6% and 46.2% presented insomnia and poor sleep quality in accordance to the AIS and the PSQI respectively. The prevalence of insomnia increased with female age (from 39.7% in those aged 40-44 to 45.2% in those aged 55-59, p<0.0001) and menopausal stage (from 39.5% in premenopausal aged 40-44 to 46.3% in late postmenopausal ones, p<0.0001). "Awakening during the night" (AIS: Item 2) was the most highly rated of all items and contributing in a higher degree (mean 16%) to the total score of the scale in all menopausal phases. Sleep quality also worsened with age and menopausal status, impairment particularly affecting sleep efficiency and latency and the increased use of hypnotics. Vasomotor symptoms (VMS), depressive mood and anxiety were associated to sleep disturbances. Women presenting sleep disturbances displayed a 2-fold increase in the severity of menopausal symptoms (higher total MRS scores) which was translated into a 6-8 times higher risk of impaired quality of life. Logistic regression analysis determined that female age, the presence of chronic disease, troublesome drinking, anxiety, depression, VMS, drug use (hypnotics and hormone therapy) were significant risk factors related to the presence of sleep disturbances. Higher educational level related to less insomnia and better sleep quality. CONCLUSION: Insomnia and poor sleep quality were highly prevalent in this mid-aged female sample in which the influence of age and the menopause was only modest and rather linked to menopausal symptoms already occurring since the premenopause.

Optimal waist circumference cutoff value for defining the metabolic syndrome in postmenopausal Latin American women.

OBJECTIVE: The aim of this study was to determine an optimal waist circumference (WC) cutoff value for defining the metabolic syndrome (METS) in postmenopausal Latin American women. METHODS: A total of 3,965 postmenopausal women (age, 45-64 y), with self-reported good health, attending routine consultation at 12 gynecological centers in major Latin American cities were included in this cross-sectional study. Modified guidelines of the US National Cholesterol Education Program, Adult Treatment Panel III were used to assess METS risk factors. Receiver operator characteristic curve analysis was used to obtain an optimal WC cutoff value best predicting at least two other METS components. Optimal cutoff values were calculated by plotting the true-positive rate (sensitivity) against the false-positive rate (1 - specificity). In addition, total accuracy, distance to receiver operator characteristic curve, and the Youden Index were calculated. RESULTS: Of the participants, 51.6% (n = 2,047) were identified as having two or more nonadipose METS risk components (excluding a positive WC component). These women were older, had more years since menopause onset, used hormone therapy less frequently, and had higher body mass indices than women with fewer metabolic risk factors. The optimal WC cutoff value best predicting at least two other METS components was determined to be 88 cm, equal to that defined by the Adult Treatment Panel III. CONCLUSIONS: A WC cutoff value of 88 cm is optimal for defining METS in this postmenopausal Latin American series.

A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women.

OBJECTIVE: The aim of this study was to determine vasomotor symptom (VMS) prevalence, duration, and impact on quality of life in middle-aged women using a validated menopausal tool. METHODS: The Menopause Rating Scale (MRS) and an itemized questionnaire containing personal sociodemographic data were used to examine 8,373 women aged 40 to 59 years from 22 healthcare centers in 12 Latin American countries. RESULTS: Less than half (48.8%) of all women studied were postmenopausal, 14.7% used hormone therapy (HT), 54.5% presented VMS of any degree, and 9.6% presented severe/bothersome symptoms. The rate of VMS (any degree) significantly increased from one menopausal stage to the next. HT users presented more VMS (any degree) than did nonusers (58.6% vs 53.8%, P = 0.001). When surgical postmenopausal women were compared, non-HT users displayed a higher prevalence of severe VMS (16.1% vs 9.0%, P = 0.0001). The presence of VMS of any degree was related to a more impaired quality of life (higher total MRS score; odds ratio, 4.7; 95% CI, 4.1-5.3). This effect was even higher among women presenting severe VMS. Logistic regression analysis determined that the presence of severe psychological/urogenital symptoms (MRS), lower educational level, natural perimenopause-postmenopause status, nulliparity, surgical menopause, and living at high altitude were significant risk factors for severe VMS. HT use was related to a lower risk. A second regression model determined that surgical menopause, intense psychological/urogenital symptoms, and a history of psychiatric consultation were factors related to severe VMS persisting into the late postmenopausal stage (5 or more years). CONCLUSIONS: In this Latin American middle-aged series, VMS prevalence was high, persisting into the late postmenopausal phase in a high rate and severely impairing quality of life. HT use was related to a lower risk of severe VMS.

Sexual dysfunction in middle-aged women: a multicenter Latin American study using the Female Sexual Function Index.

OBJECTIVE: The purpose of this study was to assess the prevalence of sexual dysfunction (SD) and associated risk factors among middle-aged Latin American women using one validated instrument. METHODS: The Female Sexual Function Index (FSFI) was applied to 7,243 healthy women aged 40 to 59 years who were users of 19 healthcare systems from 11 Latin American countries. An itemized questionnaire containing personal and partner sociodemographic data was also filled out. RESULTS: Mean +/- SD age of surveyed women was 49.0 +/- 5.7 years, with 11.6 years of schooling on average. There were 55.1% of women who were married, 46.8% who were postmenopausal, 14.1% who used hormonal therapy (HT), and 25.6% who were sexually inactive. Among those who were active (n = 5,391), the mean +/- SD total FSFI score was 25.2 +/- 5.9 and 56.8% of them presented SD (FSFI total score 48 y), 1.84 (1.61-2.09); bladder problems, 1.47 (1.28-1.69); HT use, 1.39 (1.15-1.68); negative perception of female health status, 1.31 (1.05-1.64); and being married, 1.22 (1.07-1.40). Protective factors were higher educational level (women), partner faithfulness, and access to private healthcare. CONCLUSIONS: The prevalence of SD in this middle-aged Latin American series was found to be high, varying widely in different populations. A decrease in vaginal lubrication was the most important associated risk factor. Differences in the prevalence of risk factors among the studied groups, several of which are modifiable, could explain the variation of SD prevalence observed in this study.

Impaired quality of life among middle aged women: a multicentre Latin American study.

BACKGROUND: Several studies indicate that quality of life (QoL) is impaired in middle aged women. Assessment of QoL using a single validated tool in Latin American climacteric women has not been reported to date at large scale. OBJECTIVE: The Menopause Rating Scale (MRS) was used to assess QoL among middle aged Latin American women and determine factors associated with severe menopausal symptoms (QoL impairment). METHODS: In this cross-sectional study, 8373 healthy women aged 40-59 years, accompanying patients to healthcare centres in 18 cities of 12 Latin American countries, were asked to fill out the MRS and a questionnaire containing socio-demographic, female and partner data. RESULTS: Mean age of the entire sample was 49.1+/-5.7 years (median 49), a 62.5% had 12 or less years of schooling, 48.8% were postmenopausal and 14.7% were on hormonal therapy (HT). Mean total MRS score (n=8373) was 11.3+/-8.5 (median 10); for the somatic subscale, 4.1+/-3.4; the psychological subscale, 4.6+/-3.8 and the urogenital subscale, 2.5+/-2.7. The prevalence of women presenting moderate to severe total MRS scorings was high (>50%) in all countries, Chile and Uruguay being the ones with the highest percentages (80.8% and 67.4%, respectively). Logistic regression determined that impaired QoL (severe total MRS score > or =17) was associated with the use of alternatives therapies for menopause (OR: 1.47, 95% CI [1.22-1.76], p=0.0001), the use of psychiatric drugs (OR: 1.57, 95% CI [1.29-1.90], p=0.0001), attending a psychiatrist (OR: 1.66, 95% CI [1.41-1.96], p=0.0001), being postmenopausal (OR: 1.48, 95% CI [1.29-1.69, p=0.0001]), having 49 years or more (OR: 1.24, 95% CI [1.08-1.42], p=0.001), living at high altitude (OR: 1.43, 95% CI [1.25-1.62, p=0.0001]) and having a partner with erectile dysfunction (OR: 1.69, 95% CI [1.47-1.94, p=0.0001]) or premature ejaculation (OR: 1.34, 95% CI [1.16-1.55, p=0.0001]). Lower risk for impaired QoL was related to living in a country with a lower income (OR: 0.77, 95% CI [0.68-0.88], p=0.0002), using HT (OR: 0.65, 95% CI [0.56-0.76], p=0.0001) and engaging in healthy habits (OR: 0.59, 95% CI [0.50-0.69], p=0.0001). CONCLUSION: To the best of our knowledge this is the first and largest study assessing QoL in a Latin American climacteric series with a high prevalence of impairment related to individual female and male characteristics and the demography of the studied population.

Biorritmo de prolactina en mujeres en edad reeproductiva vs. perimenopáusicas / Prolactin biorhythm in women in reproductive age vs. perimenopaus

Se sabe que la prolactina durante la vida reproductiva mantiene un ritmo circadiano en las horas de la noche. Se desea evaluar en nuestro medio el biorritmode prolactina en mujeres perimenopáusicas.

Manifestaciones clínicas en la menopausia y sus modificaciones con la terapia hormonal de sustitución / Clinical manifestations in menopause and its modifications with hormone replacement therapy

INTRODUCCION: La mujer en el climaterio presenta múltiples síntomas y signos como consecuencia del déficit estrogénico. Existen diversos medicamentos, esquemas y dosis utilizadas en la terapia hormonal de sustitución(THS). Se evalúa en el presente estudio la eficacia de dos diferentes esquemas terapéuticos combinados con estrógeno y gestágeno en mujeres perimenopáusicas. CONCLUSIONES: En mujeres perimenopáusicas, la THS con dos diferentes preparados de estrógeno y gestágeno es bien tolerada e igualmente eficaz para el control de los principales síntomas climatéricos (truncado 2500 caracteres)

Comportamiento de la dismenorrea en tres grupos de adolescentes de diferente clase social

OBJETIVO: Se realiza un estudio descriptivo del comportamiento de la dismenorrea en tres grupos de adolescentes étnica y socialmenete diferentes. MATERIAL Y METODOS: Se lleva a cabo una encuesta sobre dolor durante la mestruación en 796 adolesecentes distribuidas en 3 grupos: uno de ellos compuesto por 481 jóvenes de una población urbana de Santafé de Bogotá, que asiste a un Colegio privado: Grupo A; el segundo por 285 adolescentes de un colegio público, de clase social media: Grupo B y el tercero por 30 adolescentes Indígenas de la Tribu Tukano del área rural de la Ciudad de Mitú, Capital de Vaupés: Grupo C. Se analizó estadísticamente con la t de Student para la diferencia de promedios y el Chi-2 para la diferencia de proporciones de respuesta variable. Resultados: El promedio de edad para los tres grupos fue de 12.2, 12.7 y 15.5 años respectivamente, con diferencias estadísticamente significativas en los tres grupos. La edad de la menarquia fue de 12.1, 12.8 y 11.8 años con diferencias significativas entre los Grupos A y B, B y C pero no entre A y C. La frecuencia y duración del ciclo mestrual fue de 28x5, 28x7 y 28x6, sin diferencias significativas en los 3 grupos. La dismenorrea fue menos frecuente en las adolescentes indígenas(grupo C) con un 36.7 por ciento mientras que en los grupos B y A, fue del 59.3 por ciento y 61.2 por ciento con diferencias significativas entre B y C, A y C, pero no entre A y B. El dolor leve Grado I, según la clasificación propuesta por la OMS fue de 43.1, 39.9 y 20 por ciento con diferencias significativas en los tres grupos. El dolor moderado Grado II se presentó en un 13.7, 12.7 y 13.3 por ciento sin diferencias significativas en los tres grupos. El dolor severo Grado III, fue del 2.8, 6.7 y 3.3 por ciento, con diferencias entre A y B pero no entre B y C, A y C. Conclusión: Esta encuesta demuestra que la dismenorrea es menos frecuente y de menor intensidad en el grupo indígena que en los de la ciudad. El dolor incapacitante es menos frecuente que en los países desarrollados. Factores étnicos culturales, nutricionales pueden explicar las diferencias en el comportamiento del dolor entre estos tres grupos

Valoración doble-ciega cruzada de la eficacia y tolerancia de etodolac vs. piroxicam en tratamiento de la dismenorrea primaria / Valorization double-blind crassway of eficacy and tolerance of etodolac versus piroxican in the treatment of dysminorrhea primary

Objetivo: Verificar la eficacia de etodolac por vía oral comparado con piroxicam en el tratamiento de la dismenorrea primaria. Material y métodos: Se seleccionaron 31 adolescentes de un colegio de clase social media, con edades entre 10-24 años, con ciclos regulares y una menarquía de un año de evolución. Antecedentes de dismenorrea moderada a severa. Se descartó embarazo o masas pélvicas o uso de anticonceptivos. Se solicitó ecografía pélvica previa, cuadro hemático, parcial de orina, glicemia, proteinas totales. El estudio se diseño en forma doble-ciega-cruzada, durante 4 meses donde la paciente tenía la oportunidad de recibir la medicación en forma alterna en dos ocasiones. En un cuestionário tanto personal como por los investigadores se evaluó la eficacia y tolerancia de los 2 productos. Para la valoración de significancia se utilizó la prueba de Kruskal-Wallis. Resultados: Edad de la menarquia: fue de 12,8 años, ciclos de 29,8 ñ 3,2 y duración de 4-5 días. La dismenorrea (leve) se presentó en 9,6 por ciento. Grado II (moderada), 58,1 por ciento y grado III (severa), 32,2 por ciento. En forma aleatoria el 48,4 por ciento recibió tratamiento con etodolac y 51,6 por ciento, piroxicam. La mejoría en la intensidad del dolor fue del 29,4 por ciento para etodolac y para el piroxicam, 32,5 por ciento, sin evidencia de diferencias estadísticamente significativas. Los exámenes paraclínicos previos estuvieron dentro de limites normales. Los efectos secundarios fueron mínimos, sin obligar a suspender la medicación durante los 4 días de tratamiento. Conclusión: Estos resultados nos permiten afirmar que tanto el etodolac como el piroxicam son eficaces en el tratamiento de la dismenorrea primaria. Los efectos secundarios fueron minimos

¿Qué tan útil es la ooforectomía profiláctica?

Se revisa brevemente el comportamiento del ovario en diferentes etapas de la mujer y las complicaciones que presenta al practicar prematuramente la "ooforectomía profiláctica". Se sugiere preservar el ovario en mujeres pre y postmenopáusicas y en caso de extirpación prematura es necesaria la terapia de reemplazo hormonal

Migración del espermatozoide y en el tracto genital de mujeres normales

OBJETIVO: estudiar el comportamiento del espermatozoide "Y" en espermograma normal, moco cervical y endometrio en mujeres en edad reproductiva. MATERIAL Y ETODOS: Se estudiaron 36 mujeres con ligadura de trompas provenientes de un centro de Salud de la ciudad de Cali. Con control de temperatura se orientó la prueba post-coito y se determinó la concentración de espermatozoide "Y" en moco cervical y endometrio por técnica de Fluorescencia con quinacrina. Como prueba de significa se utilizó el coeficiente de correlación. RESULTADOS: El promedio de espermatozoides "Y" en espermograma normal fue de 43 por ciento, en moco cervical 34.48 por ciento y en endometrio de 34.6 por ciento. No hubo diferencias significativas a lo largo del ciclo mestrual. CONCLUSION: El espermatozide "Y" en este estudio disminuye su concentración en moco y endometrio sin encontrarse diferencias significativas a lo largo del ciclo, dato que confirma los hallazgos de otros autores pero contradictorio para otros

La menopausia: un estado fisiológico complejo

En la medida que el conocimiento y el progreso tecnológico que nos permiten mejorar las condiciones de salud, ambientales, sociales y económicas, la expectactativa de vida humana también se incrementa, hasta el punto de considerarse que para el año 2080 ésta superará en la mujer los 90 años (1). Si tenemos encuenta que hacia los 50 años finaliza en la mujers la edad reproductiva, la menopausia comprenderá una gran parte de su vida, la cual se estima en la actualidad aproximadamente en 1/3 de la misma (2). La menopausia se acompaña de una serie de fenómenos hormonales secuenciales determinados básicamente por la capacidad ovárica de responder al estimulo hipofisiario. Con el tiempo,los estrógenos circulantes serán sintetizados exclusivamente en los tejidos periféricos, careciendo esta producción de la potencia ideal. La mayoría de las mujeres presentan entonces una serie de síntomas y signos dependientes de la deficiencia de estimulación estrogénica en órganos blancos. Es en este punto, donde el médico que se enfrenta a la paciente menopáusica debe enfocar su atención, puesto que así como en forma manifiesta se pueden evidenciar estas alteraciones en forma subclínica la paciente puede desarrollar patologías mucho más graves, que pueden incluso atentar contra su vida,como ocurre principalmente con las enfermedades cardiovasculares y óseas. Estas, aunque constituyen fenómenos normales que hacen parte del envejecimiento, son susceptibles de la manipulación farmacológica indirecta y que hace posible, en la actualidad, ofrecer una mejor calidad de vida a la mujer en este período de su vida.