Factors associated with knowledge about menopause and hormone therapy in middle-aged Brazilian women: a population-based household survey.

OBJECTIVES: The aim of the study was to evaluate knowledge about menopause and hormone therapy (HT) among middle-aged Brazilian women and identify the factors associated with the level of knowledge. METHODS: A cross-sectional study was conducted with 749 women aged 45 to 60 years, residing in the Metropolitan Region of Campinas, Brazil. The dependent variable was knowledge about menopause and HT evaluated using a numerical score based on the answers given to three questions that had several response options. The independent variables were sociodemographic characteristics, personal habits, and health conditions. Statistical analysis was carried out by Mann-Whitney, Kruskal-Wallis, and a generalized linear model. RESULTS: The mean age was 52.5 (±4.4) years. Most of the women were postmenopausal (68%) and 19.5% had a history of current or previous use of HT. The final score for knowledge about menopause ranged from +1 to +11, with a mean of 4.59 (±1.86) and a median of 4. Women with higher levels of schooling (coefficient = 0.64, P < 0.001); with higher socioeconomic status (coefficient = 0.47, P < 0.002); with vaginal dryness (coefficient = 0.47, P = 0.003); who consumed alcohol (coefficient = 0.61, P = 0.006); who use or had ever used any type of treatment to counteract menopausal symptoms (coefficient = 0.41, P = 0.008); with anxiety (coefficient = 0.35, P = 0.037); and with depression (coefficient = 0.31, P = 0.043) possessed greater knowledge about menopause and HT. Women with a higher number (≥3) of vaginal deliveries (coefficient = -0.61, P < 0.001) and a higher body mass index (coefficient = -0.02, P = 0.046) possessed less knowledge about menopause and HT. CONCLUSIONS: The knowledge about menopause and HT demonstrated by the interviewees was low and possibly related to the time of exposure to qualified information.

Factors associated with urinary incontinence in middle-aged women: a population-based household survey.

INTRODUCTION AND HYPOTHESIS: The objective was to determine the prevalence of urinary incontinence (UI) and factors associated in a sample of Brazilian middle-aged women. METHODS: A cross-sectional study was conducted between September 2012 and June 2013 with 749 women. UI was defined as any complaint of involuntary loss of urine. The independent variables were sociodemographic data and health-related habits and problems. Statistical analysis was carried out using Chi-squared test and Poisson regression. RESULTS: The mean age was 52.5 (±4.4) years. The prevalence of UI was 23.6 %. Of these, 48 (6.4 %) had stress urinary incontinence, 59 (7.8 %) urinary urgency, and 70 (9.5 %) had mixed urinary incontinence. In the final statistical model, self-perception of health as fair/poor/very poor (PR: 1.90; 95 % CI, 1.45-2.49; P < 0.001), ≥1 vaginal deliveries (PR: 1.84; 95 % CI, 1.35-2.50; P < 0.001), higher body mass index (PR: 1.04; 95 % CI, 1.02-1.06; P = 0.001), vaginal dryness (PR: 1.60; 95 % CI, 1.23-2.08; P = 0.001), current or previous hormone therapy (PR: 1.38; 95 % CI, 1.06-1.81; P = 0.019), pre-/perimenopause (PR: 1.42; 95 % CI, 1.06-1.91; P = 0.021), and previous hysterectomy (PR: 1.41; 95 % CI, 1.03-1.92; P = 0.031) were associated with a greater prevalence of UI. Current or previous use of soy products to treat menopausal symptoms was associated with a lower prevalence of UI (PR: 0.43; 95 % CI, 0.24-0.78; P = 0.006). CONCLUSIONS: Several factors are associated with UI in middle-aged Brazilian women. The results highlight the importance of carrying out interventions aimed at reducing modifiable factors.

Menopausal symptoms and associated factors in HIV-positive women.

OBJECTIVE: To evaluate menopausal symptoms and their associated factors in HIV-positive women. METHODS: A cross-sectional study was conducted with 537 women of 40-60 years of age, 273 of whom were HIV-positive and 264 HIV-negative. The women were interviewed to obtain data on their sociodemographic characteristics and menopausal symptoms. RESULTS: The mean age of the seropositive women was 47.7±5.8 years compared to 49.8±5.3 for the seronegative women (p<0.001). Bivariate analysis showed a lower prevalence of vasomotor symptoms in the seropositive group (p=0.009), specifically hot flashes (p<0.002) and sweating (p=0.049). Vaginal dryness was also less prevalent in this group (p<0.005). There were no statistically significant differences between the groups with respect to depression or insomnia. Multiple analysis showed that hot flashes were associated with being peri- or postmenopausal (PR=2.12; 95%CI: 1.52-2.94). Vaginal dryness was less common in women without a partner (PR=0.67; 95%CI: 0.49-0.90) and was associated with older age (PR=1.03; 95%CI: 1.01-1.06) and being in the peri- or postmenopause (PR=1.69; 95%CI: 1.10-2.60). Depression was inversely associated with being employed (PR=0.74; 95%CI: 0.58-0.96) and directly associated with the presence of chronic diseases (PR=1.30; 95%CI: 1.01-1.067). Insomnia was associated with a lower body mass index (PR=0.96; 95%CI: 0.95-0.97) and with being peri- or postmenopausal (PR=1.48; 95%CI: 1.11-1.97). No correlation was found between HIV serological status and any of the menopausal symptoms. CONCLUSIONS: In this study, after controlling for confounding variables, HIV infection was not found to be associated with vasomotor, genitourinary or psychological symptoms or with insomnia.

A three-year longitudinal evaluation of the forearm bone density of users of etonogestrel- and levonorgestrel-releasing contraceptive implants.

BACKGROUND: The aim of this study was to evaluate bone mineral density (BMD) at baseline and at 18 and 36 months of use of etonogestrel (ENG)-and levonorgestrel (LNG)-releasing contraceptive implants. This is a continuation of a previous study in which BMD was evaluated at baseline and at 18 months of use. METHODS: A total of 111 women, 19-43 years of age, were randomly allocated to use one of the two implants. At 36 months of follow-up, only 36 and 39 women were still using the ENG- and LNG-releasing implants, respectively. BMD was evaluated at the distal and at the ultra-distal radius of the non-dominant forearm using dual-energy X-ray absorptiometry. RESULTS: There was no difference in the BMD of users of either implant at 18 and at 36 months. BMD was significantly lower at 18 and at 36 months at the distal radius in both groups of users compared to pre-insertion values; however, no difference was found at the ultra-distal radius. CONCLUSION: Women 19-43 years of age using either one of these two contraceptive implants for 36 months had lower BMD values at the distal radius compared to pre-insertion values; however, no difference was found at the ultra-distal radius.

A prospective study of the forearm bone density of users of etonorgestrel- and levonorgestrel-releasing contraceptive implants.

BACKGROUND: The aim of the study was to compare bone mineral density (BMD) before insertion and at 18 months of use of etonorgestrel- and levonorgestrel-releasing contraceptive implants. METHODS: One hundred and eleven women, 19-43 years of age, were randomly allocated to two groups: 56 to etonorgestrel and 55 to levonorgestrel. BMD was evaluated at the midshaft of the ulna and at the distal radius of the non-dominant forearm using dual-energy X-ray absorptiometry before insertion and at 18 months of use. RESULTS: There was no difference in baseline demographic or anthropometric characteristics, or in BMD of users of either model of implant. BMD was significantly lower at 18 months of use at the midshaft of the ulna in both groups of users. However, no difference was found at the distal radius. Multiple linear regression analysis showed that the variables associated with BMD at 18 months of use in both implant groups were baseline BMD, body mass index (BMI) and difference in BMI (0 versus 18 months of use). CONCLUSIONS: Women of 19-43 years of age using either one of the implants showed lower BMD at 18 months of use at the midshaft of the ulna, however, without a difference at the distal radius.

TCu 380A IUD: a reversible permanent contraceptive method in women over 35 years of age.

OBJECTIVE: The objective of the study was to evaluate the performance of the TCu 380A IUD in women who had been using the device for more than 10 years and who were 35 years of age or more on completion of the 10th year of IUD use. METHODS: A total of 228 women who had an IUD inserted between 1987 and 1992 were included in the study. The cutoff date for analysis was January 31, 2004. Clinical performance was evaluated by life-table analysis. The mean age of women at 10 years of use was 38.8+/-0.4 years and mean parity was 2.2+/-0.08 (mean+/-SD). The duration of follow-up beyond 10 years ranged from 1 to 72 months. No pregnancy was observed in 366 woman-years of observation beyond 10 years of use. The main reason for discontinuation was removal of the device because the clients had previously been informed that the IUD was not approved for use beyond 10 years. This reason accounted for a gross cumulative 6 years discontinuation rate of 42.5 per 100 women beyond 10 years. The other main reasons for discontinuation beyond 10 years of use were surgical sterilization, menopause and expulsion with gross cumulative 6-year termination rates of 19.2, 11.0 and 21.2 per 100 women, respectively. The cumulative continuation rate beyond 10 years was 67.0 at the end of the first year of follow-up and 21.2 at the end of the sixth year. CONCLUSION: We found no evidence that the TCu 380A IUD loses its effectiveness after 10 years of use. RESULTS: The concept that women who have insertion of a TCu 380A IUD at the age of 25 years or older could use this IUD as a reversible but permanent method of contraception up to the menopause continues to be supported by the accumulation of evidence, although definitive evidence remains to be obtained.