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1.
Climacteric ; 25(5): 523-529, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35801642

RESUMO

OBJECTIVE: This study aims to understand the epidemiological characteristics of Brazilian menopausal women, and their view on menopause hormone therapy (MHT). METHODS: A national cross-sectional study with 1500 women between 45 and 65 years old was carried out through questionnaires. RESULTS: The overall median age of participants was 52 [47-56] years, and 55 [52-59] years for the postmenopausal subgroup. Menstrual irregularity started at median age 46 [44-49] years. Median menopause age was 48 [45-51] years with no differences between socioeconomic classes. The prevalence of any climacteric symptoms was 87.9% and hot flashes started at median age 47 [45-50] years. Among women in menopause/menopausal transition, 52.1% received any medical prescription, and MHT was recommended for 22.3%. Among those who started MHT, 45.4% were still using the treatment and the median duration of use was 8 months, but different among socioeconomic classes (24 months for class A against 3 months for class D/E). CONCLUSIONS: In this first Brazilian national population-based study on menopause and MHT, it was observed that, in spite of being symptomatic when entering menopause around 48 years of age, only a small part of Brazilian women started MHT and the median duration of treatment was less than 1 year, but the duration was higher for higher socioeconomic class.


Assuntos
Fogachos , Menopausa , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Terapia de Reposição Hormonal/métodos , Fogachos/epidemiologia , Humanos , Pessoa de Meia-Idade
2.
Climacteric ; 24(6): 593-599, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33899627

RESUMO

OBJECTIVE: The CLOSER (CLarifying Vaginal Atrophy's Impact On SEx and Relationships) survey investigated how postmenopausal vaginal atrophy (VA) affects relationships between Brazilian women and male partners. METHODS: Postmenopausal women (age 55-65 years) with VA, and male partners of women with the condition, completed an online survey on the impact of VA and local estrogen treatment on intimacy and relationships. RESULTS: A total of 360 women and 352 men from Brazil were included. Women (83%) and men (91%) reported that they were comfortable discussing VA with their partners. Women's key source of information on VA was health-care providers (HCPs), but 44% felt that not enough information is available. VA caused 70% of women to avoid sexual intimacy and resulted in less satisfying sex. VA had a negative impact on women's feelings and self-esteem. Women (76%) and men (70%) both reported that treatment with vaginal estrogen improved their sexual relationship, primarily by alleviating women's pain during sex. Women (56%) and men (59%) felt closer to each other after treatment. CONCLUSIONS: VA had a negative impact on sexual relationships for both women and men in Brazil, and reduced women's self-confidence. Vaginal hormone therapy improved couples' sexual relationships. A proactive attitude of HCPs is essential to educate women on VA and the potential benefits of treatment.


Assuntos
Pós-Menopausa , Comportamento Sexual , Vagina , Idoso , Atrofia , Brasil , Feminino , Humanos , Pessoa de Meia-Idade
3.
Climacteric ; 24(2): 157-163, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32869682

RESUMO

OBJECTIVE: A previous survey investigated postmenopausal vaginal atrophy in a sample of women across Latin America. To help implement a tailored approach to improve postmenopausal care and outcomes in Brazil, we consider results from the survey for this country. METHODS: A total of 2509 postmenopausal women resident in Argentina, Brazil, Chile, Colombia, or Mexico completed an online questionnaire. The Brazilian cohort comprised 504 women. RESULTS: Over half of the Brazilian cohort (56%) reported experiencing symptoms of vaginal atrophy; most described them as moderate or severe (76%), and almost half (48%) experienced symptoms for at least 1 year. Three-quarters of the Brazilian cohort (75%) were unaware of the chronic nature of the condition. Upon experiencing symptoms of vaginal atrophy, 92% had visited a health-care provider to discuss treatment options. Overall, 56% were aware of some form of local hormone therapy and 40% of those affected by vaginal atrophy had used such treatment. CONCLUSION: Postmenopausal women in Brazil are likely to benefit from increased awareness of the symptoms of vaginal atrophy. Health-care providers can potentially improve outcomes by helping women to understand the chronic nature of the condition and available treatment options. Women may be open to education pre menopause, before symptoms occur.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pós-Menopausa/psicologia , Vagina/patologia , Doenças Vaginais/psicologia , Saúde da Mulher/estatística & dados numéricos , Atrofia , Brasil/epidemiologia , Brasil/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , América Latina/epidemiologia , América Latina/etnologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pós-Menopausa/etnologia , Inquéritos e Questionários , Doenças Vaginais/epidemiologia , Doenças Vaginais/etnologia , Saúde da Mulher/etnologia
4.
Climacteric ; 17(4): 486-91, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24286614

RESUMO

BACKGROUND: In developing countries, there is a deficiency of densitometers with which to screen the population for osteoporosis. Thus, strategies with which to select patients for a bone density test are desirable. OBJECTIVE: To determine whether breast vascular calcifications (BVCs) may be employed to identify postmenopausal women with osteoporosis/osteopenia. METHODS: This was a cross-sectional study of postmenopausal women subjected to bilateral mammography and bone densitometry (DXA) of the spine and hip. A medical interview registered possible confounding factors, such as age, length of menopause, previous use of postmenopausal hormone therapy, family history of osteoporosis, smoking, alcoholism, hypertension, diabetes, cardiovascular diseases, and medication use. RESULTS: The study included 211 postmenopausal women aged 62.1 ± 9.3 years, 38 of whom (18.0%) exhibited BVC. Osteoporosis was detected in 36 (17.1%), and a T-score < 21.0 for any site was found in 164 (77.7%). No statistically significant difference was found between the groups without BVC (n = 173) and with BVC (n = 38) for the prevalence of 'osteoporosis' or 'moderate/severe osteopenia or osteoporosis' at the spine or at any other site. There was a difference between the groups in terms of age (59.0 ± 7.8 vs. 71.9 ± 8.9 years, respectively; p < 0.001), sedentary lifestyle (57.8% vs. 84.2%, respectively; p = 0.002), smoking (27.7% vs. 7.9%, respectively; p = 0.009), and high blood pressure (65.3% vs. 92.1%, respectively; p = 0.001). Logistic regression analysis confirmed the lack of statistical significance for BVC as a predictor of an osteoporosis diagnosis. Sensitivity values of BVCs to detect osteoporosis or osteopenia ranged from 17.9% to 25.0%. CONCLUSION: BVCs have been shown to be inadequate to identify postmenopausal women with osteoporosis or osteopenia.


Assuntos
Doenças Ósseas Metabólicas/diagnóstico , Doenças Mamárias , Osteoporose Pós-Menopausa/diagnóstico , Calcificação Vascular , Absorciometria de Fóton/métodos , Absorciometria de Fóton/estatística & dados numéricos , Idoso , Densidade Óssea , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/fisiopatologia , Brasil/epidemiologia , Mama/irrigação sanguínea , Mama/patologia , Doenças Mamárias/diagnóstico , Doenças Mamárias/epidemiologia , Doenças Mamárias/fisiopatologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Mamografia/métodos , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/epidemiologia , Osteoporose Pós-Menopausa/fisiopatologia , Pós-Menopausa , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Calcificação Vascular/diagnóstico , Calcificação Vascular/epidemiologia , Calcificação Vascular/fisiopatologia
5.
Climacteric ; 16(1): 147-53, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22640525

RESUMO

AIM: To study the effects of estrogen therapy on the expression of matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9) and perlecan in the vascular wall. METHODS: Twenty 180-day-old Wistar rats were castrated and treated 1 week later for a period of 4 weeks with one of the following: (1) placebo; (2) 0.5 µg/day estradiol benzoate (E(2)B); (3) 5 µg/day E(2)B; (4) 50 µg/day E(2)B. A fifth group consisted of rats that had not been castrated. Following treatment, expression of MMP-2 and MMP-9 mRNA (MMP-2([RNA]) and MMP-9([RNA]), respectively) was analyzed by real-time PCR, and expression of MMP-2 (MMP-2([IH])), MMP-9 (MMP-9([IH])) and perlecan was quantified by immunohistochemistry, in carotid walls. RESULTS: There were no differences among castrated groups for MMP-2([RNA]) (p = 0.1969) and for MMP-9([RNA]) (p = 0.1828); however, a correlation was observed between E(2)B dose and MMP-9([RNA]) levels (r = 0.471, p = 0.018). Differences among groups were observed for MMP-2([IH]), MMP-9([IH]) and perlecan (p < 0.0001), wherein higher levels were observed in animals treated with estrogen therapy, correlating with E(2)B doses in the case of MMP-9 (r = 0.441, p = 0.026) and perlecan (r = 0.574, p = 0.005). CONCLUSIONS: Estrogen therapy correlates with higher levels of MMP-2, MMP-9 and perlecan in the extracellular matrix of carotid walls in castrated rats, in a dose-dependent manner. There was a dose-response effect of E(2)B on the expression of MMP-9 mRNA and, possibly, MMP-2 mRNA.


Assuntos
Artérias Carótidas/metabolismo , Estradiol/análogos & derivados , Estrogênios/farmacologia , Proteoglicanas de Heparan Sulfato/metabolismo , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Análise de Variância , Animais , Artérias Carótidas/enzimologia , Relação Dose-Resposta a Droga , Estradiol/administração & dosagem , Estradiol/farmacologia , Estrogênios/administração & dosagem , Feminino , Expressão Gênica/efeitos dos fármacos , Proteoglicanas de Heparan Sulfato/genética , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 9 da Matriz/genética , Ovariectomia , RNA Mensageiro/metabolismo , Ratos , Ratos Wistar , Estatísticas não Paramétricas
6.
Climacteric ; 13(4): 362-7, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20151792

RESUMO

OBJECTIVE: To compare the effects of the abrupt discontinuation of postmenopausal hormone therapy (HT) and reduction of the daily dosage of the hormone on climacteric symptoms. METHODS: The study included Brazilian postmenopausal women who were using estrogen-progestogen hormone therapy in full doses previously prescribed for vasomotor symptoms. The patients were randomized to receive one of three treatments: placebo for 6 months; estradiol (E2) 1 mg/day + norethisterone acetate (NETA) 0.5 mg/day for 2 months, followed by placebo for 4 months; or E2 1 mg/day + NETA 0.5 mg/day for 4 months, followed by placebo for 2 months. The climacteric symptoms were assessed by the Blatt-Kupperman Menopausal Index at baseline and at 2, 4 and 6 months. Statistical evaluation was performed using the chi(2) or Fisher's test for categorical data, the Kruskal-Wallis test for numerical data, and ANOVA for time and group relationship with the Blatt-Kupperman Menopausal Index. RESULTS: We randomized 60 women (20 in each group), and 54 completed the study. It was observed that both the full Blatt-Kupperman Menopausal Index and the hot flush score did not change significantly in the HT group during low-dose therapy compared with baseline; however, the evaluation performed at 2 months after low-dose-HT cessation showed that the full Blatt-Kupperman Menopausal Index and the hot flush score were similar to those of the group who stopped HT abruptly and significantly higher than at baseline (hot flush scores: p < 0.001 for all three groups at months 2, 4 and 6, respectively, vs. baseline). CONCLUSION: Discontinuation of HT by reducing the daily dose of estrogen for a period of 2 or 4 months did not differ in its effect from that of abrupt cessation with regard to vasomotor symptoms.


Assuntos
Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios/métodos , Fogachos/epidemiologia , Feminino , Fogachos/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Noretindrona/administração & dosagem , Noretindrona/análogos & derivados , Acetato de Noretindrona , Placebos , Fatores de Tempo
7.
Climacteric ; 12(5): 439-44, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19639481

RESUMO

OBJECTIVE: The objectives of this study were to evaluate the association between cardiovascular disease (CVD) and breast arterial calcification (BAC), as well as the prevalence rates of these conditions in Brazilian postmenopausal women. METHODS: A cross-sectional study was performed in 307 women over 40 years of age who were receiving care at the gynecology clinic of the Center for Women's Integrated Healthcare (CAISM), ABC School of Medicine. All these women had been amenorrheic for at least 12 months and had undergone mammography in the preceding 12 months. Cardiovascular disease and its subtypes were evaluated, as well as its association with BAC. Means and standard deviations, absolute frequencies and percentages were calculated, and univariate analysis and multiple logistic regression were performed. RESULTS: The mean age of the patients was 55.2 +/- 6.8 years; age at menopause was 48.5 +/- 4 years. Time since menopause was 80.2 +/- 75.4 months; 96.1% of the patients were non-smokers and 46.3% were using hormone therapy. Of the patients, 33.6% had systemic arterial hypertension, 4.9% had diabetes mellitus and 5.2% had hypercholesterolemia. The mean body mass index was 27.3 +/- 4.3 kg/m(2). CVD was found in 6.8% and BAC in 8.5% of the women. Significantly more women with BAC had CVD compared to the women who did not have this condition (23.1% vs. 5.3%, p = 0.0006). BAC was associated with an odds ratio of 8.13 (95% confidence interval 2.68-24.64) for predicting CVD. CONCLUSIONS: In postmenopausal women, breast arterial calcification may represent a higher likelihood of cardiovascular disease.


Assuntos
Mama/irrigação sanguínea , Calcinose/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Vasculares Periféricas/epidemiologia , Índice de Massa Corporal , Brasil/epidemiologia , Calcinose/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Terapia de Reposição de Estrogênios , Feminino , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Mamografia , Pessoa de Meia-Idade , Razão de Chances , Doenças Vasculares Periféricas/diagnóstico por imagem , Pós-Menopausa
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