Menstrual health: Inequities in a cohort of menstruating people in the Brazilian southeastern region.

OBJECTIVE: To assess menstrual hygiene management (MHM) and period poverty in a group of low- and medium-income menstruating people. METHODS: A cross-sectional study was conducted at the University of Campinas, Brazil, from January to June 2022 with 535 participants aged 18-49. For data collection, we used the abbreviated version of the WHO Quality-of-Life questionnaire (WHOQOL-BREF) and a pre-tested questionnaire with items regarding MHM and period poverty. RESULTS: We found an inverse relationship between the risk of no access to supplies to perform menstrual hygiene, which increased by 2.5% and each point less in the environmental domain of quality of life (QoL), and this risk increased by up to 3.1 times among participants who reported difficulty making ends meet. The risk of not having adequate conditions to perform menstrual hygiene at home increased by up to 2.6% for every one-point drop in the environmental domain of QoL. The risk of not having adequate conditions to perform menstrual hygiene outside the home increased by up to 1.3% for less points in the psychological domain of QoL, and 44.4% of those who indicated inadequate conditions for menstrual hygiene reported two or more childbirths. CONCLUSIONS: Menstruating people who have an increased risk of lacking menstrual supplies and have an increased risk of inadequate conditions for MHM at home and outside the home, as well as those who have two or more deliveries and those having difficulties making ends meet, scored low on the QoL, especially in the environmental and psychological dimensions.

Narratives of experiences of violence of Venezuelan migrant women sheltered at the northwestern Brazilian border.

OBJECTIVES: To know the experiences of Venezuelan migrant women living in shelters in Roraima state at the northwestern border between Venezuela and Brazil regarding situations of violence as part of the dynamics of everyday life. MATERIALS AND METHODS: Data were collected in January 2020 through 12 focus group discussions (FGDs) with 5 to 14 Venezuelan migrant women aged 18-49 years old living transitorily in five shelters established by the United Nations High Commissioner for Refugees (UNHCR) and the Brazilian government. We obtained individual and shared views on the experiences regarding violence that migrant women may experience in their everyday life. To organize the FGDs, variations in age and the time women were living at the shelters were considered. All FGDs were held in a place at the shelter that guaranteed privacy and secrecy so that women could express themselves freely. The initial question was broad and open ended and was followed by more specific questions about situations of domestic violence and other types of violence. RESULTS: The main themes identified were the following: i) women's perceptions on domestic violence, ii) women's perceptions on how humanitarian organizations were managing the episodes of domestic violence, and iii) situations considered violence in everyday life at the shelters. The FGDs showed that the reported violence inside the shelters was high, and several forms of violence emerged. Violence was identified as physical aggression and psychological threats, and violence in everyday life at the shelter included xenophobia when the migrants went outside the shelters that was perceived and described as violence. CONCLUSIONS: According to the perspective of Venezuelan migrant women violence was part of everyday life among those living in the UNHCR shelters at the northwestern border of Brazil-Venezuela. These women are not comfortable with this situation, and it is difficult for them to understand and handle the episodes of violence.

"Babies born early?" - silences about prematurity and their consequences.

BACKGROUND: The principal aim of this study was to understand how communication between parents and health professionals concerning prematurity occurs, from delivery to admission to the neonatal Intensive Care Unit. METHODS: This is an exploratory, descriptive study with a qualitative methodology. Data were collected using tape-recorded and Focal Groups technique interview with mothers of premature newborns and health professionals involved in caring for preterm infants, at southeast Brazil. RESULTS: The word "premature" was not said or heard during prenatal care. From the narratives, it was observed that there was a lack of information available to pregnant women about preterm birth, failure in medical care regarding signs and symptoms reported by pregnant women, and lack of communication between the medical teams, mothers and family during delivery and Neonatal Intensive Care Unit (NICU) admission. CONCLUSION: There is a fine line between born too soon and die too soon, that increases stress, fear and distance impacting negatively over communication between mothers and health professionals during antenatal care, childbirth and NICU admission.

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.

Aging, obesity, and multimorbidity in women 50 years or older: a population-based study.

OBJECTIVE: This study aims to evaluate multimorbidity and its associated factors in Brazilian women aged 50 years or older. METHODS: This is a cross-sectional, population-based study using self-reports. A total of 622 women aged 50 years or older were included. Multimorbidity was defined as two or more of the following morbidities: hypertension, osteoarthritis, cataracts, diabetes mellitus, osteoporosis, glaucoma, chronic bronchitis or asthma, urinary incontinence, cancer, myocardial infarction, stroke, and pulmonary emphysema. Sociodemographic, clinical, and behavioral factors were evaluated. Data were analyzed using χ test and Fisher's exact test, and Poisson multiple regression analysis was performed. Prevalence ratios and their 95% CIs were calculated. RESULTS: In this sample, 15.8% of participants reported no morbidities, whereas 26% reported having one morbid condition and 58.2% reported multimorbidity. With respect to morbidities, 55.9% of women reported having hypertension, 33.8% reported having osteoarthritis, 24.5% reported having cataracts, 22.7% reported having diabetes, 21.3% reported having osteoporosis, 9.9% reported having glaucoma, 9.2% reported having bronchitis, 8.9% reported having urinary incontinence, and 6.8% reported having cancer, whereas 4.8% reported having had a myocardial infarction, 2.7% reported having had a stroke, and 1.8% reported having pulmonary emphysema. Multiple regression analysis showed that for each additional year of life, women increased their likelihood of multimorbidity by 3% (95% CI, 1.02-1.04). Furthermore, for each point increase (kg/m) in their body mass index, women also increased their likelihood of multimorbidity by 3% (95% CI, 1.02-1.04). CONCLUSIONS: Multimorbidity is principally associated with aging and obesity.

Understanding and attitudes of Brazilian men with regard to premenstrual syndrome.

OBJECTIVE: To assess the understanding and attitudes of Brazilian men regarding premenstrual syndrome (PMS). METHODS: In a survey-based study between September 2007 and April 2008, information was collected from men aged 18-40 years who were attending public healthcare services or were university and faculty staff at 5 cities in different geographic regions of Brazil and the Federal District. RESULTS: In total, 527 men were interviewed. Of these, 86.3% had heard of PMS, and 34.3% reported that it is a natural part of the menstrual cycle. The most commonly reported characteristics of PMS were emotional symptoms (55.2%), including nervousness or anxiety; irritability, anger, or aggressiveness; and a greater tendency to start arguments and fights. A significant relationship was found between men who had heard of PMS and being aged 20-35 years, having a university degree, being white, and belonging to a higher socioeconomic stratum (P<0.001). Furthermore, men with a university degree were more likely to know that PMS symptoms occur before menses (P<0.004). CONCLUSION: Many of the men interviewed were knowledgeable about PMS symptoms; however, this awareness was more common among men of higher socioeconomic strata with more years of schooling.

Opinion and experience of Brazilian women regarding menstrual bleeding and use of combined oral contraceptives.

OBJECTIVE: To describe the opinion and experience of Brazilian women regarding menstruation and the use of combined oral contraceptives (COCs) to control monthly bleeding and induce amenorrhea. METHODS: Women attending regional public healthcare clinics for non-gynecologic conditions, and female members of staff from university schools unrelated to the field of medicine completed a questionnaire. RESULTS: Of the 1111 women interviewed, 64.3% reported disliking menstruation. The desired frequency of bleeding was never (65.3%), less than monthly (18.2%), and every month or more often (16.5%). More than 60% of the women reported that they would use COCs to control menstrual bleeding, 82.0% would use COCs to reduce the amount of bleeding experienced, and 86.1% would use COCs to induce amenorrhea. When compared with women who disliked menstruation, those who reported that they liked to experience monthly bleeding had fewer years of schooling (OR1.98; 95% CI, 1.30-2.97), low socioeconomic status (OR 1.66; 95% CI, 1.12-2.46), fewer days of menstruation each month (OR 1.62; 95% CI, 1.11-2.36), and 1 or more child (OR 1.13; 95% CI, 1.01-1.26). CONCLUSION: Many of the women surveyed disliked monthly menstruation and were interested in the use of COCs to control menstrual bleeding and induce amenorrhea.

Water exercises and quality of life during pregnancy.

BACKGROUND: In Brazil, concern with the quality of life of pregnant women is one of the points emphasized in the Program for the Humanization of Prenatal Care and Childbirth launched in 2000. However, there are few references in the literature on the role of either land or water-based physical exercise on women's quality of life during pregnancy. The purpose of this study was to evaluate the effects of a physical exercise program of water aerobics on the quality of life (QOL) of sedentary pregnant women. METHODS: A comparative observational study involving sedentary low-risk pregnant women bearing a single fetus with gestational age less than 20 weeks at the time of admission to the study, who were receiving antenatal care at a public health service. One group of 35 women was given routine antenatal care, while another group of 31 women, in addition to receiving the same routine care as the first group, also participated in three classes of water aerobics per week. QOL was evaluated by applying the WHOQOL-BREF questionnaire in both groups at the 20th, 28th and 36th weeks of pregnancy. In the same occasions, women also answered another questionnaire about their experience with pregnancy and antenatal care. RESULTS: The great majority of the participants considered that the practice of water aerobics had benefitted them in some way. QOL scores were found to be high in both groups during follow-up. There was no association between the practice of water aerobics and QOL. CONCLUSIONS: Further studies involving larger sample sizes should be conducted in different sociocultural contexts and/or using other instruments to adequately evaluate the QOL of women during pregnancy.

Premenstrual syndrome as reported by Brazilian women.

OBJECTIVE: To describe the perspectives and attitudes of Brazilian women toward premenstrual syndrome (PMS). METHODS: An exploratory study was conducted in 6 major cities: 1 in each geographic region of Brazil and 1 in the Federal District. Participants were women aged 18-40years who consulted at public healthcare services or who were members of staff/faculty at university. RESULTS: Of 1053 women, 96.1% had heard of PMS; 65.4% considered that all or almost all women experienced the condition; 87.5% stated that symptoms occurred prior to menstruation; and 60.3% thought that they had PMS at the time of the interview. The emotional and physical symptoms most frequently mentioned were nervousness/anxiety (76.4%); mood swings/crying (55.7%); pain, swelling, and tenderness of the breasts (37.3%); and cramps (45.4%). CONCLUSION: Premenstrual syndrome was reported by a large number of Brazilian women; actions need to be taken to provide more effectively the specific information required by both lay people and healthcare professionals.

An emerging "maternal near-miss syndrome": narratives of women who almost died during pregnancy and childbirth.

BACKGROUND: An improvement in maternal health conditions can only be achieved when a reduction in the number of deaths is accompanied by a reduction in the frequency of severe complications of pregnancy. The objective of this study was to investigate women's experiences related to the burden of severe maternal morbidity. METHODS: This qualitative study is based on narratives of women who survived severe complications of pregnancy and who were admitted to the intensive care unit of a public university hospital in the city of Campinas, Brazil. A sample of 30 women was recruited between April 2007 and January 2008. Before hospital discharge, eligible women who agreed to participate responded to a semidirected interview. The interviews were recorded and the transcripts received a thematic analysis. RESULTS: Two major themes were identified, one more closely related to the experience of a critical illness and the other to the experience of care. A complex set of reactions was found in the women who survived, indicating the occurrence of acute stress-related disorders. CONCLUSIONS: On the basis of narratives of women who almost died during pregnancy and childbirth, we reported on an acute stress disorder that may be associated with the occurrence of severe maternal complications, which we named, the "maternal near-miss syndrome." The implementation of integrated care that encompasses the physical, psychological, social, and spiritual aspects of women's health may help to alleviate the burden that maternal complications impose on millions of women around the world.

Prevalence of sexual dysfunction and its associated factors in women aged 40-65 years with 11 years or more of formal education: a population-based household survey.

OBJECTIVE: To evaluate the prevalence of sexual dysfunction and its associated factors in middle-aged women with 11 years or more of formal education. METHODS: A cross-sectional, population-based study was carried out using an anonymous, self-response questionnaire. A total of 315 Brazilian-born women, 40-65 years of age with 11 years or more of schooling, participated in the study. The instrument used in the evaluation was based on the Short Personal Experiences Questionnaire. Sexual dysfunction was calculated from the mean score of sexual responsiveness (pleasure in sexual activities, excitation and orgasm), frequency of sexual activities and libido. Sociodemographic and clinical factors were evaluated. Poisson multiple regression analysis was carried out and the prevalence ratios with respective 95% confidence intervals (95%CI) were calculated. RESULTS: The prevalence of sexual dysfunction was 35.9% among our study population. Multiple regression analysis showed that sexual dysfunction was positively associated with older age (prevalence ratios=1.04; 95%CI:1.01-1.07) and with the presence of hot flashes (prevalence ratios=1.37; 95%CI:1.04-1.80). Having a sexual partner (PR=0.47; 95%CI:0.34-0.65) and feeling well or excellent (prevalence ratios= 0.68; 95%CI: 0.52-0.88) were factors associated with lower sexual dysfunction scores. CONCLUSIONS: Sexual dysfunction was present in more than one-third of women that were 40-65 years of age with 11 years or more of formal education. Within that age group, older age and hot flashes were associated with higher sexual dysfunction scores, whereas feeling well and having a sexual partner were associated with better sexuality.

A population-based study of dyspareunia in a cohort of middle-aged Brazilian women.

OBJECTIVE: To investigate the prevalence of dyspareunia and its associated factors in a cohort of middle-aged women. DESIGN: A cross-sectional, population-based study was carried out using an anonymous, self-report questionnaire completed by 200 Brazilian-born women, 40 to 65 years of age, with 11 years or more of formal education. The evaluation instrument was based on the Short Personal Experiences Questionnaire. Sociodemographic, clinical, behavioral, reproductive, and partner-related factors were assessed. Poisson multiple regression analysis was performed, and prevalence ratios (PRs) with their 95% CIs were calculated. RESULTS: The prevalence of dyspareunia was 39.5%. Multiple analysis showed that dyspareunia was more common in women who reported nervousness (PR = 1.73, 95% CI: 1.14-2.63) and depression (PR = 1.69, 95% CI: 1.09-2.61). A score of more than 3 for frequency of sexual activity (PR = 0.20, 95% CI: 0.05-0.84) and having had more than two pregnancies (PR = 0.62, 95% CI: 0.48-0.81) were factors indicative of a protective effect against dyspareunia. CONCLUSIONS: Dyspareunia was common in this cohort of middle-aged women. Nervousness and depression increased the likelihood of experiencing dyspareunia. These findings suggest that psychological symptoms should be taken into consideration in the management of the middle-aged woman with dyspareunia, and measures should be adopted to minimize the repercussions of these factors on sexuality.

The sexuality of middle-aged women with a sexual partner: a population-based study.

OBJECTIVE: To evaluate the factors associated with the sexuality of middle-aged women with sexual partners. DESIGN: A cross-sectional, population-based study was carried out using an anonymous, self-response questionnaire completed by Brazilian-born women 40 to 65 years old with 11 years or more of formal education who had a sexual partner. Of the 378 women who agreed to participate in the study, 219 answered all the questions used for calculation of the sexuality score and reported having a sexual partner. The instrument was based on the Short Personal Experiences Questionnaire. Seven components were analyzed: satisfaction in sexual activities, orgasm, intensity of desire, self-classification of sexual life, and frequency of arousal, sexual activity, and sexual fantasies. Sociodemographic, clinical, behavioral, reproductive, and partner-related factors were evaluated. Poisson multiple regression analysis was performed, and prevalence ratios (PRs) with their 95% CIs were estimated. RESULTS: The median sexuality score was 9 (range, 2.45-13.77). The prevalence of below-median scores was higher in women who lived with their sexual partner (PR = 2.07; 95% CI: 1.17-3.69), who were in the menopausal transition or were postmenopausal (PR = 1.69; 95% CI: 1.08-2.65), and who were hypertensive (PR = 1.65; 95% CI: 1.19-2.30). Sexual activities involving penetration (PR = 0.48; 95% CI: 0.31-0.73) and a score of 6 for satisfaction with partner as a lover (PR = 0.34; 95% CI: 0.20-0.60) were indicative of a protective effect against poor sexuality. CONCLUSIONS: In this cohort, the sexuality of women in midlife was negatively associated with the factors of living with a sexual partner, being in the menopausal transition or postmenopausal, and being hypertensive. Therefore, greater attention should be paid to identifying these factors, and measures should be adopted to minimize their repercussions on the sexuality of middle-aged women.

Sexuality in Brazilian women aged 40 to 65 years with 11 years or more of formal education: associated factors.

OBJECTIVE: To evaluate factors associated with the sexuality of middle-aged women. DESIGN: Cross-sectional, population-based survey using an anonymous self-response questionnaire. A total of 276 Brazilian-born women, 40 to 65 years old with at least 11 years of formal education, participated in the study. The evaluation instrument was based on the Short Personal Experiences Questionnaire. Seven components were analyzed: satisfaction in sexual activities, orgasm, intensity of desire, self-classification of sexual life, frequency of arousal, sexual activity, and sexual fantasies. Sociodemographic, clinical, behavioral, and reproductive factors were evaluated. Data were analyzed using the chi and Fisher exact tests and Poisson multiple regression analysis. Prevalence ratios (PRs) and their 95% CIs were calculated. RESULTS: The median sexuality score was 9 (range, 2.45-13.77). Bivariate analysis indicated that being 50 years of age or older; in the menopausal transition or postmenopause; not having a sexual partner; reporting hot flushes, insomnia, depression, nervousness, sedentary lifestyle, arterial hypertension, or urinary incontinence; and poor self-perception of health were significantly associated with a below median sexuality score. Multiple regression analysis showed that the prevalence of below median scores was higher in older women (prevalence ratio [PR] = 1.03, 95% CI: 1.01-1.05) and in those with insomnia (PR = 1.46, 95% CI: 1.08-1.96). Having a sexual partner (PR = 0.68, 95% CI: 0.50-0.92) and feeling well (PR = 0.73, 95% CI: 0.57-0.94) was associated with a protective effect against a below median sexuality score. CONCLUSIONS: Older women and those with insomnia were more likely to have a low sexuality score, whereas those with a sexual partner and who felt well were less likely to have a low sexuality score.

Prevalence of sexual dysfunction and its associated factors in women aged 40-65 years with 11 years or more of formal education: a population-based household survey

OBJECTIVE: To evaluate the prevalence of sexual dysfunction and its associated factors in middle-aged women with 11 years or more of formal education. METHODS: A cross-sectional, population-based study was carried out using an anonymous, self-response questionnaire. A total of 315 Brazilian-born women, 40-65 years of age with 11 years or more of schooling, participated in the study. The instrument used in the evaluation was based on the Short Personal Experiences Questionnaire. Sexual dysfunction was calculated from the mean score of sexual responsiveness (pleasure in sexual activities, excitation and orgasm), frequency of sexual activities and libido. Sociodemographic and clinical factors were evaluated. Poisson multiple regression analysis was carried out and the prevalence ratios with respective 95 percent confidence intervals (95 percentCI) were calculated. RESULTS: The prevalence of sexual dysfunction was 35.9 percent among our study population. Multiple regression analysis showed that sexual dysfunction was positively associated with older age (prevalence ratios=1.04; 95 percentCI:1.01-1.07) and with the presence of hot flashes (prevalence ratios=1.37; 95 percentCI:1.04-1.80). Having a sexual partner (PR=0.47; 95 percentCI:0.34-0.65) and feeling well or excellent (prevalence ratios= 0.68; 95 percentCI: 0.52-0.88) were factors associated with lower sexual dysfunction scores. CONCLUSIONS: Sexual dysfunction was present in more than one-third of women that were 40-65 years of age with 11 years or more of formal education. Within that age group, older age and hot flashes were associated with higher sexual dysfunction scores, whereas feeling well and having a sexual partner were associated with better sexuality.

Support to woman by a companion of her choice during childbirth: a randomized controlled trial.

BACKGROUND: To evaluate the effectiveness and safety of the support given to women by a companion of their choice during labor and delivery. METHODS: A total of 212 primiparous women were enrolled in a randomized controlled clinical trial carried out between February 2004 and March 2005. One hundred and five women were allocated to the group in which support was permitted and 107 to the group in which there was no support. Variables regarding patient satisfaction and events related to obstetrical care, neonatal results and breastfeeding were evaluated. Student's t-test or Wilcoxon's test, chi-square or Fisher's exact test, risk ratios, and their respective 95% confidence intervals were used in the statistical analysis. RESULTS: Overall, the women in the support group were more satisfied with labor (median 88.0 versus 76.0, p < 0.0001) and delivery (median 91.4 versus 77.1, p < 0.0001). During labor, patient satisfaction was associated with the presence of a companion (RR 8.06; 95%CI: 4.84 - 13.43), with care received (RR 1.11; 95%CI: 1.01 - 1.22) and with medical guidance (RR 1.14 95%CI: 1.01 - 1.28). During delivery, satisfaction was associated with having a companion (RR 5.57, 95%CI: 3.70 - 8.38), with care received (RR 1.11 95%CI: 1.01 - 1.22) and with vaginal delivery (RR 1.33 95%CI:1.02 - 1.74). The only factor that was significantly lower in the support group was the occurrence of meconium-stained amniotic fluid (RR 0.51; 95%CI: 0.28 - 0.94). There was no statistically significant difference between the two groups with respect to any of the other variables. CONCLUSION: The presence of a companion of the woman's choice had a positive influence on her satisfaction with the birth process and did not interfere with other events and interventions, with neonatal outcome or breastfeeding.

Variáveis reprodutivas e risco para doenças benignas de mama. Estudo caso-controle / Reproductive variables and risk of benign breast diseases. A case-control study

Foram estudadas 257 mulheres com diagnòstico de doença benígna da mama (DBM), atestado por anamotopatològico ou citologia, e um controle para cada uma delas. Foram apresentados resultados das possíveis relaçöes entre variáveis reprodutivas e o risco para DBM. Os casos e controles foram comparados levando em conta a idade na menarca e na menopausa, o número de gravidezes, de meses em que amamentaram e de ciclos menstruais ovulatòrios, e os antecedentes familiares do câncer de mama. Mostraram influência significativa, em relaçäo às DBM, a nuliparidade, aumentando o risco enquanto a idade de 30 ou mais anos no primeiro parto o reduziu; o número de ciclos ovulatòrios, que foi significativamente maior para os casos, e a média de meses de uso da pílula, menor entre as mulheres com DBM. O uso de contraceptivos orais apresentou um efeito protetor apenas quando a duraçäo total do uso foi maior que dois anos. Os resultados näo se revelaram novos ou diferentes se comparados com outros estudos, mas confirmam a relativa concordância entre os fatores de risco para a DBM e para o câncer de mama, ainda que as relaçöes entre esses fatores e as DBM näo sejam täo claras como o säo para o câncer, e existam também algumas discrepâncias