Age, menopause and hormone replacement therapy influences on cardiovascular risk factors in a cohort of middle-aged Chilean women.

OBJECTIVE: To determine the prevalence of obesity and other cardiovascular risk factors (RF) in middle-aged women, to correlate them with each other, and to describe the prevalence of such a RF and their changes with aging, menopause and Hormone Replacement Therapy (HRT) in a cohort of Chilean workers. MATERIAL AND METHOD: In 1991-1992 cardiovascular RFs were assessed in 467 women between 40 and 59 who were not taking HRT at that time. Five years later these women were re-evaluated. RESULTS: Sedentarism (87.2%), dyslipidemias (71.5%), high blood pressure (13.5%), obesity (13.1%), smoking (12.4%) and diabetes (2.8%) were the more prevalent RF. These RF become more prevalent with age. In the second control, 5 years later, hypertension (20.9%), obesity (27.3%), smoking (20.8%) and diabetes (5.9%) were observed increased. Dyslipidemia did not changed, although triglyceride levels rose from 125.9+/-56.4 to 136.8+/-63.5 mg/dl (P<0.01). Sedentarism dropped to 58.8%. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5-years follow-up from 3.8 to 35%, and related to its use a decrease in LDL-cholesterol and an increase in HDL-cholesterol levels were detected. CONCLUSION: Middle-aged women included in this cohort have a high prevalence of RF; these deteriorate with age, but no with menopause. HRT improves the lipid profile.

Changes in body mass index around menopause: a population study of Chilean woman.

OBJECTIVE: To evaluate the influence of menopause and hormone replacement therapy (HRT) on weight and the effect of weight gain on coronary risk factors. DESIGN: From 1991 to 1992 cardiovascular risk factors were assessed in 271 premenopausal women between the ages of 40 and 53 years. The women were not receiving HRT at that time. Five years later, these women were reevaluated. RESULTS: Weight and body mass index (BMI) increased steadily with age. During the observation period there was an average increase of 4.0 kg +/- 4.6 (p < 0.0001). Women who experienced menopause and those who did not experience menopause had a similar weight increase (3.8 +/- 4.4 kg vs. 4.3 +/- 4.8, p = 0.37). Likewise, weight gain was similar in those who did or did not use HRT (nonusers, 4.3 +/- 4.6 kg; users, 3.5 +/- 3.7 kg; ex-users, 3.4 +/- 5.8 kg). At their first checkups, overweight women and obese women already had significant differences in their risk factors, including higher systolic pressure (p < 0.02), diastolic pressure (p < 0.01), glucose (p < 0.02) and triglycerides (p < 0.0001), and lower high-density lipoprotein cholesterol (p < 0.004) as compared with women of normal weight. Unexpectedly, women of normal weight who became overweight or obese during the monitoring period did not show any deterioration in their risk factors. CONCLUSIONS: During the perimenopausal period there is a weight gain that does not seem to depend on the menopause or HRT. Being overweight or obese during the menopausal transition is not necessarily associated with deterioration in coronary risk factors. This seems to imply the existence of different metabolic populations within this group of women.

Quality of life after the menopause: a population study.

OBJECTIVE: To assess the impact of menopause and some sociodemographic variables on quality of life (QoL). MATERIALS AND METHODS: Four hundred and eighty-one women aged 40-59 years attending the Southern Metropolitan Health Service in Santiago de Chile were studied using the Specific Quality of Life Questionnaire for Menopause from Toronto University. RESULTS: Univariate analysis showed that menopausal women have worse QoL scores than women conserving cycles in the four areas of the questionnaire: They show a 10.6-fold higher risk for suffering vasomotor disorders affecting QoL, a 3.5-fold higher risk for psychosocial impairment, a 5.7-fold higher risk for physical disorders, and a 3.2-fold higher risk for sexual disorders (P < 0.0001). Regarding the influence of social markers (age, marital status, school years, work, number of children and sexual activity), housewives were found to have higher, worse, scores than working women in all test components (vasomotor, 3.11+/-1.90 versus 2.57+/-1.71, P < 0.003; psychosocial, 3.44+/-1.59 versus 2.92+/-1.45, P < 0.0007; physical, 3.45+/-1.36 versus 2.96+/-1.20, P < 0.0001; sexual, 3.63+/-2.23 versus 2.49+/-1.95, P < 0.0001). However, logistic regression demonstrated that the only variable found to cause a significant impairment in QoL was menopause. CONCLUSION: Menopause causes a decrease in quality of life, which is independent from age and other sociodemographic variables.

[Patterns of sexual behavior in Chilean women]. / Patrones de conducta sexual en mujeres chilenas.

BACKGROUND: Sexuality has an individual connotation, is influenced by biological, environmental and cultural factors and is present throughout all life. AM: To assess the sexual behavior of a group of Chilean women. SUBJECTS AND METHODS: A specially devised inquiry was applied to 301 women, aged 20 to 70 years old, that consulted in a medical service. RESULTS: Seventy seven percent of women were sexually active. These figures ranged from 80% of women aged 40-44 years old to 40% of women over 60. Sixty percent of women living together, 53.7% of single women, 65.6% of divorced women, 94.2% of married women and 100% of widows were sexually active. Women aged 25 to 29 years old had a mean of 8.4 relations per month compared with 3.3 relations among women older than 55. The frequency of sexual intercourse was higher in women living together and lower in widows. The mean age at the first intercourse was 20.6 +/- 4.5 years. Ninety three percent had experienced sexual desire and the percentage of satisfactory sexual relations does not change with age. Less educated women had a lower frequency of orgasms. CONCLUSIONS: Age and legal status of women are related to their sexual behavior and less educated women have a less satisfactory sexual life.

[Decrease of labor absenteeism associated with hormone replacement therapy in postmenopausal women]. / Disminución del ausentismo laboral asociado a la terapia de reemplazo hormonal en mujeres postmenopáusicas.

Absenteeism affects efficiency and costs of health care. Most of health workers are middle age women, whose climacteric symptoms may reduce their work capacity working at a public hospital in Santiago during 1992. Fifty-eight percent were postmenopausal and 34.8% of these were receiving hormone replacement therapy. Global absenteeism rate was 17.1 days/year. These figures were 14.8 days/year for premenopausal and 17.8 days/year for postmenopausal women (NS). Among the latter, those women receiving hormone replacement therapy had a significantly lower absenteeism rate (9.4 days/year compared to 20.4 days/year among those not receiving hormones). Osteoarticular diseases were responsible for 44.3% and psychiatric diseases for 18.1% of sick leaves. No differences in absenteeism were observed between different professional levels. We conclude that hormone replacement therapy is associated with a better working capacity in postmenopausal women.

[Double-blind method of the effect of menopause symptoms, lipid profile, and endometrial thickness of continuous therapy with estradiol valerate and medroxyprogesterone acetate]. / Estudio doble ciego del effecto sobre la sintomatología menopáusica, el perfil lipídico y el grosor endometrial de una terapia continua de valerato de estradiol más acetato de medroxiprogesterona.

Continuous combined therapy (CCT) using estrogens and progestagens has appeared as an alternative to avoid vaginal bleeding, which is characteristic of sequential hormone therapy, and the main reason for the stopping treatment. Irregular vaginal bleeding can occur at the beginning of treatment, but it has been observed that after a few months patients are in amenorrhea. Fifty postmenopausal women were studied in order to evaluate the clinical outcome. Half of them were treated with a product containing 2 mg estradiol valerate and 2.5 mg medroxiprogesterone acetate, while the other half received a placebo. Menopause symptomatology was recorded as described by Blatt-Kupperman, depression was evaluated with the use of Hamilton's test, lipid profile by enzymatic methods and endometrial thickness by transvaginal ultrasonography. Patients were evaluated at the beginning, third and sixth month of the study, following a double blind methodology. Symptomatology diminished both in patients under CCT and using placebo, although improvement was significantly greater in patient under CCT. Thus in the hormone treated group the Blatt-Kupperman score fell from 12.1 to 6.4 and 3.2 in the third and sixth month respectively, while in the group receiving placebo the score fell from 11.5 to 6.3 in the third month and raised to 7.4 in the sixth month. Hamilton's test showed a significant improvement of depression only in patients under hormone therapy. Nineteen out of twenty five women using CCT had vaginal bleeding, showing no changes in the endometrial thickness during the study. Finally, HDL-cholesterol was raised in 14.5% while LDL-cholesterol was lowered in 18.7% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Knowledge and beliefs of the effect of menopause and estrogenic therapy on health. Study in women attending the Barros Luco-Trudeau Hospital]. / Conocimientos y creencias del efecto de la menopausia y de la terapia estrogénica sobre la salud. Estudio en mujeres beneficiarias del Hospital Barros Luco-Trudeau.

The benefits of hormonal replacement therapy are widely known. In spite of this, the proportion of women under treatment is low. The study aims to evaluate the amount of knowledge that patients have, about menopause, and how it influences compliance with therapy. In our study, 494 women attending the outpatient's clinic of Hospital Barros Luco-Trudeau were interviewed; 93.5% considered that menopause has adverse effects upon health; 87.9% believes that it produces emotional disturbances; 55.1% bone-related and 40.9% cardiac problems. Sixty six point eight percent of the consulted women know that there is a treatment for menopause. Half of the women interviewed had consulted the physician specifically for this reason; however, only one third are or were under treatment. Obesity, hirsutism and cancer are considered to be the main secondary effects to treatment. Patients who have not received hormone therapy have a much lower degree of knowledge about menopause than the treated ones, and amongst the latter, those who abandon treatment have less information than the ones that remain under treatment. As a conclusion, we may say that our patients have information about menopause and also that they attend to the physician's office for this reason. The knowledge about the matter and related beliefs influence both adherence to and compliance with therapy.

[Symptomatic profile of the climacteric female. Clinical experience]. / Perfil sintomatico de la mujer climaterica. Experiencia clinica.

UNLABELLED: To describe the symptoms of the climacteric female, 287 climacteric patients had their symptoms evaluated according to the criteria of Blatt-Kupperman for menopause. The median age was 50 years (P10 = 43 and P90 = 58). The main complaint was flushing in 46%, psychiatric symptoms in 17.8% a health examination in 14.6%, osteoporosis in 11.1%, menstrual problems in 6.3%, and other symptoms in 4.5%. Asthenia was a prominent symptom in 82% of patients, followed closely by headache, irritability and depression. Flushing was present in 77% of patients. Symptoms not usually associated to menopause, such as vertigo, palpitations and bone pain were quite prevalent. Only 69% of females were sexually active. Among them, 45% complained of dyspareunia and 58% of decreased or absent libido. The median Blatt index was 27. Working capacity was affected in 87% of patients. CONCLUSION: The menopausal period is associated to many symptoms which may motivate females to consult an internist.

IUDs and PID: a comparative trial of strings versus stringless devices.

An international multicentered clinical trial was designed to determine the possible role of intrauterine device (IUD) marker strings in the etiology of pelvic inflammatory disease (PID). A total of 1265 women were admitted and randomly allocated to receive either a standard TCu200 IUD or a TCu200 IUD without marker strings. These patients were followed-up through 12 months postinsertion. No statistically significant differences were found between the two groups of IUD users with respect to the incidence of PID or other types of infection or inflammation. The 12-month life table termination rates and overall continuation rates were also similar for users of the respective devices, with the exception of removal rates for bleeding/pain, which were significantly higher in the strings group than in the stringless group. However, the number of bleeding/pain complaints ever reported during the study were not statistically different in the two study groups. The study results indicate that the IUD string does not play an important role in the etiology of PID associated with the use of IUDs.

[Menopause: a disease?]. / La menopausia: una enfermedad?

As life expectancy lengthens, the period that women must live deprived of estrogens is also lengthened. Not only does this hormonal deficit produce the known vasomotor symptoms, but it also increases the risk of cardiovascular disease and bone fractures. The fact that replacement therapy using hormones during the postmenopause attenuates these risks has lead to the thought that we might be facing a disease. Moreover, menopause meets the criteria that define disease. In spite of considering that to define menopause as a disease might be daring, we cannot rule it out.

Postabortion insertions of the pleated membrane.

The pleated or intrauterine membrane (IUM) was designed to fit a range of uterine sizes and shapes and to adjust to transient changes resulting from uterine motility. The retention and contraceptive abilities of postabortion IUM insertions are analyzed in this study of 154 IUM insertions made within 3 days of treatment for an incomplete or inevitable abortion. Results indicate low 1-year net cumulative event rates for pregnancy (1.7 per 100 users), expulsion (7.2 per 100 users), and removal for bleeding and/or pain (3.9 per 100 users). These rates were similar to those reported in a study of interval insertions of the IUM; moreover, these results also compared favorably with corresponding rates of postabortion insertions reported in studies using other devices. Thus, the postabortion period is indicated as being an effective time for IUM insertion.