Association of intrauterine synechiae with pituitary gonadotrophin pulse patterns: A pilot study.

BACKGROUND: Intrauterine synechiae (IS) is an acquired uterine condition that occurs when scar tissues (adhesions) form within the uterus and/or cervix, causing menstrual disturbance. However, approximately 50% of patients with IS are refractory to treatment. Therefore, other endocrine disturbances, such as gonadotropin disturbance, may affect treatment success. STUDY AIM: To analyze gonadotropin levels in women with and without IS. METHODS: Ten women with refractory IS experiencing amenorrhea since at least 6 months and nine with normal menstrual cycles (control group) were included in this study. Blood sample were collected every 10 minutes during a 4-h period. The serial ultrasound was performed in both groups for evaluating the cycle phase. Blood was collected when the follicles size was between 5-10 mm. Serum LH, FSH, progesterone and estradiol concentrations were measured. To detect LH and FSH pulses, the technique proposed by Santen and Bardin was adopted; therefore, one pulse was defined as a 20% increase in the concentrations as to the preceding point, followed by an important decrease. RESULTS: No differences were observed between the study groups at baseline. Estradiol levels were lower in the IS group than in the control group, but the difference was not statistically significant. During the first hour of monitoring, cumulative FSH pulsatile frequency of IS group was lower than one of control. CONCLUSION: Our data suggest that the estradiol levels of IS participants are lower than those of women with normal menstrual cycle. The role of this finding in the physiology of uterine synechiae requires further investigation.

Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study.

BACKGROUND: Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD. OBJECTIVE: To evaluate the effects of group CBT on women with HSDD. METHOD: Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. MAIN OUTCOME MEASURES: demographics, education, sexual history, FSQQ and its domains for sexual function assessment. RESULTS: Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001). CONCLUSION: Group CBT was shown to be an effective tool for treating HSDD.

Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study

Abstract Background: Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD. Objective: To evaluate the effects of group CBT on women with HSDD. Method: Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. Main Outcome Measures: demographics, education, sexual history, FSQQ and its domains for sexual function assessment. Results: Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001). Conclusion: Group CBT was shown to be an effective tool for treating HSDD.

Gynecological cancer and metabolic screening of 1001 elderly Brazilian women.

OBJECTIVE: The aim of this study was to evaluate gynecological cancer and metabolic screening of Brazilian women aged 65 years or older. METHODS: This retrospective descriptive study was conducted by including 1,001 Brazilian patients of the gynecological geriatric outpatient office of our institution to evaluate the influence of age on gynecological cancer and metabolic screening parameters at the first clinical visit. All patients were divided into three groups: a) 65 to 69 years; b) 70 to 74 years; c) ≥ 75 years. We considered clinical, laboratorial, and image data as variables of this study. The Chi-square test was used to assess the proportion of differences among the age groups, and Kruskal-Wallis was used for quantitative variables. RESULTS: The values of BMI and height in the group over 75 years was lower than that of the 65 to 69 years (p = 0.001). Regardless of the age group, high arterial blood pressure levels were found in 85.45% of participants. Also, many patients had glucose intolerance in the blood. The pelvic ultrasonography showed abnormal endometrial echo thickness (> 5 mm) in 6.14% of patients, but with no significant statistical difference between the age groups. A total of 4.04% of patients had ovaries with high volume values ( > 6.1 mL). Abnormal mammography (BI-RADS 3 or 4) was observed in 12.21%. CONCLUSIONS: our data suggest that a great reduction in BMI and stature is more frequent in the group over 75 years. Also, systemic arterial hypertension and carbohydrate disturbance are frequent morbidities in women over 65 years.

Gynecological cancer and metabolic screening of 1001 elderly Brazilian women

SUMMARY OBJECTIVE The aim of this study was to evaluate gynecological cancer and metabolic screening of Brazilian women aged 65 years or older. METHODS This retrospective descriptive study was conducted by including 1,001 Brazilian patients of the gynecological geriatric outpatient office of our institution to evaluate the influence of age on gynecological cancer and metabolic screening parameters at the first clinical visit. All patients were divided into three groups: a) 65 to 69 years; b) 70 to 74 years; c) ≥ 75 years. We considered clinical, laboratorial, and image data as variables of this study. The Chi-square test was used to assess the proportion of differences among the age groups, and Kruskal-Wallis was used for quantitative variables. RESULTS The values of BMI and height in the group over 75 years was lower than that of the 65 to 69 years (p = 0.001). Regardless of the age group, high arterial blood pressure levels were found in 85.45% of participants. Also, many patients had glucose intolerance in the blood. The pelvic ultrasonography showed abnormal endometrial echo thickness (> 5 mm) in 6.14% of patients, but with no significant statistical difference between the age groups. A total of 4.04% of patients had ovaries with high volume values ( > 6.1 mL). Abnormal mammography (BI-RADS 3 or 4) was observed in 12.21%. CONCLUSIONS our data suggest that a great reduction in BMI and stature is more frequent in the group over 75 years. Also, systemic arterial hypertension and carbohydrate disturbance are frequent morbidities in women over 65 years.

RESUMO OBJETIVO O objetivo deste trabalho foi estudar retrospectivamente alguns dados clínicos, laboratoriais e imagens de um grupo de idosas brasileiras. MÉTODOS Estudo observacional retrospectivo realizado com inclusão de 1.001 mulheres brasileiras atendidas no ambulatório de geriatria ginecológica de nossa instituição. Foram analisados: a idade dos pacientes na primeira consulta clínica e a idade na menopausa natural; alguns achados clínicos durante um exame ginecológico; resultados de análises laboratoriais. Considerou-se a relação dessas variáveis com o grupo da idade das mulheres. O teste do qui-quadrado foi utilizado para avaliar os dados e para algumas variáveis, Kruskal-Wallis ou Anova. RESULTADOS A avaliação do IMC e da estatura nas diferentes faixas etárias das mulheres mostrou que, com o aumento da idade, há diminuição do IMC e da estatura (p=0,001). Nível anormal de pressão arterial estava presente em 85,45%. De acordo com o grupo de idade, as medidas laboratoriais foram avaliadas pelo método estatístico Kruskal-Wallis, e a Anova mostrou diferença estatisticamente significante apenas no valor da creatinina, com pequeno aumento com a idade. A ultrassonografia pélvica foi alterada com espessura endometrial normal (>5 mm) em 29 (6,14%), mas sem diferença estatística significativa com os grupos de idade, e os ovários mostraram sete (4,04%) com volume anormal (>6,1). Mamografia anormal (BI-Rads 3 ou 4) foi observada em 104 pacientes (12,21%). CONCLUSÕES O estudo conclui que, com o aumento da idade, há redução do IMC e da estatura. A hipertensão é morbidade frequente. Os dados laboratoriais e a avaliação de imagens deste estudo são importantes para aumentar o conjunto de informações sobre mulheres idosas e talvez para melhorar a assistência à saúde.

Brazilian Women's Health after 65 Years of Age / Saúde de brasileiras acima dos 65 anos de idade

Abstract Purpose The aim of this study was to evaluate the health aspects of Brazilian women older than 65 years of age. Design This was a retrospective study that included 1,001 Brazilian women cared for in the gynecological geriatric outpatient office of our institution. We report a crosssectional analysis of female adults aged over 65 years, including data on demographics, clinical symptoms such as vasomotor symptoms, associated morbidities, physical examination and sexual intercourse. We used the chi-squared test to assess the data. Results The age of the patients on their first clinic visit ranged from65 to 98 years, with a mean age of 68.56 ± 4.47 years; their mean age at the time of natural menopause was 48.76 ± 5.07 years. The most frequent clinical symptoms reported during the analyzed period were hot flashes (n = 188), followed by arthropathy, asthenia, and dry vagina. The most frequent associated morbidities after 65 years of age were systemic arterial hypertension, gastrointestinal disturbance, diabetes mellitus, and depression, among others. The assessment of the bodymass index (BMI) found decreases inBMIwith increased age. At the time of the visit, 78 patients reported sexual intercourse. The majority of women reporting sexual intercourse (89.75%, n = 70) were between 65 and 69 years of age, 8.97% (n = 7) were between 70 and 74 years of age, and only 1.28% (n = 1) of those were aged older than 75 years. Conclusions Our findings suggested that vasomotor symptoms can persist after 65 years of age. There was a significant decrease in sexual intercourse with increased age. The cardiovascular disturbances in our study are health concerns in these women.

Resumo Objetivo Avaliar os aspectos de saúde das mulheres brasileiras após os 65 anos de idade. Métodos O estudo foi retrospectivo, e incluiu 1.001mulheres brasileiras atendidas no ambulatório de ginecologia geriátrica de nossa instituição. Foi feita uma análise transversal de mulheres com idade acima de 65 anos, incluindo dados demográficos, sintomas clínicos (sintomas vasomotores), morbidades associadas, bem como alterações no exame físico e queixas em relação à atividade sexual. Utilizamos o teste qui-quadrado para avaliar os dados. Resultados A idade das pacientes na primeira visita clínica variou de 65 a 98 anos, com média etária de 68,56 ± 4,47 anos. A média etária de entrada na menopausa foi de 48,76 ± 5,07 anos. Os sintomas clínicos mais frequentes relatados durante o período analisado foram os sintomas vasomotores (n = 188), seguidos de artropatia, astenia e vagina seca. Asmorbidades associadasmais frequentes após os65anos foram hipertensão arterial sistêmica, distúrbios gastrintestinais, diabete melito e depressão, entre outras. A avaliação do índice de massa corporal (IMC) mostrou redução deste parâmetro antropométrico com o progredir da idade. No momento da visita, 78 pacientes relataram ter relações sexuais. A maioria das mulheres que relatou ter relações sexuais (89,75%, n = 70) estava entre 65 e 69 anos, 8,97% (n = 7) tinham entre 70 e 74 anos, e apenas 1,28% (n = 1) eram mais velhas do que 75 anos de idade. Conclusões Nossos achados sugerem que os sintomas vasomotores podem persistir após os 65 anos. Houve uma diminuição significativa na relação sexual com o aumento da idade. Os distúrbios cardiovasculares em nosso estudo são preocupações de saúde nestas mulheres.

Brazilian Women's Health after 65 Years of Age.

Purpose The aim of this study was to evaluate the health aspects of Brazilian women older than 65 years of age. Design This was a retrospective study that included 1,001 Brazilian women cared for in the gynecological geriatric outpatient office of our institution. We report a cross-sectional analysis of female adults aged over 65 years, including data on demographics, clinical symptoms such as vasomotor symptoms, associated morbidities, physical examination and sexual intercourse. We used the chi-squared test to assess the data. Results The age of the patients on their first clinic visit ranged from 65 to 98 years, with a mean age of 68.56 ± 4.47 years; their mean age at the time of natural menopause was 48.76 ± 5.07 years. The most frequent clinical symptoms reported during the analyzed period were hot flashes (n = 188), followed by arthropathy, asthenia, and dry vagina. The most frequent associated morbidities after 65 years of age were systemic arterial hypertension, gastrointestinal disturbance, diabetes mellitus, and depression, among others. The assessment of the body mass index (BMI) found decreases in BMI with increased age. At the time of the visit, 78 patients reported sexual intercourse. The majority of women reporting sexual intercourse (89.75%, n = 70) were between 65 and 69 years of age, 8.97% (n = 7) were between 70 and 74 years of age, and only 1.28% (n = 1) of those were aged older than 75 years. Conclusions Our findings suggested that vasomotor symptoms can persist after 65 years of age. There was a significant decrease in sexual intercourse with increased age. The cardiovascular disturbances in our study are health concerns in these women.

Objetivo Avaliar os aspectos de saúde das mulheres brasileiras após os 65 anos de idade. Métodos O estudo foi retrospectivo, e incluiu 1.001 mulheres brasileiras atendidas no ambulatório de ginecologia geriátrica de nossa instituição. Foi feita uma análise transversal de mulheres com idade acima de 65 anos, incluindo dados demográficos, sintomas clínicos (sintomas vasomotores), morbidades associadas, bem como alterações no exame físico e queixas em relação à atividade sexual. Utilizamos o teste qui-quadrado para avaliar os dados. Resultados A idade das pacientes na primeira visita clínica variou de 65 a 98 anos, com média etária de 68,56 ± 4,47 anos. A média etária de entrada na menopausa foi de 48,76 ± 5,07 anos. Os sintomas clínicos mais frequentes relatados durante o período analisado foram os sintomas vasomotores (n = 188), seguidos de artropatia, astenia e vagina seca. As morbidades associadas mais frequentes após os 65 anos foram hipertensão arterial sistêmica, distúrbios gastrintestinais, diabete melito e depressão, entre outras. A avaliação do índice de massa corporal (IMC) mostrou redução deste parâmetro antropométrico com o progredir da idade. No momento da visita, 78 pacientes relataram ter relações sexuais. A maioria das mulheres que relatou ter relações sexuais (89,75%, n = 70) estava entre 65 e 69 anos, 8,97% (n = 7) tinham entre 70 e 74 anos, e apenas 1,28% (n = 1) eram mais velhas do que 75 anos de idade. Conclusões Nossos achados sugerem que os sintomas vasomotores podem persistir após os 65 anos. Houve uma diminuição significativa na relação sexual com o aumento da idade. Os distúrbios cardiovasculares em nosso estudo são preocupações de saúde nestas mulheres.

Alternativas para o tratamento não hormonal de mulheres no climatério / Alternatives to non-hormonal treatment of climacteric women

Objetivo: Analisar as opções de tratamento não hormonal da mulher climatérica. Material e método: Estudo e análise dos trabalhos e capítulos de livro que mostrem avaliação adequada das opções de tratamento não hormonal das mulheres climatéricas, considerando as indicações, benefícios e tolerabilidade com os diferentes tratamentos. Resultados e conclusões: A revisão apresentou evidências de que medidas gerais (dieta, atividade física e ocupacional) são recomendáveis para todas as mulheres climatéricas. Para alívio dos sintomas vasomotores, o tratamento com mais índices de sucesso é realizado com antidepressivos, outras opções como cinarizina ou hipotensores podem beneficiar secundariamente as mulheres que devam utilizá-los por indicações clínicas. A fitoterapia, acupuntura e homeopatia ainda não apresentam evidências conclusivas...

Metabolic disorder and obesity in 5027 Brazilian postmenopausal women.

OBJECTIVES: To evaluate the frequency of obesity in postmenopausal women and assess the potential effects of increased body mass index (BMI) on lipoprotein profile and on risk factors for arterial hypertension and diabetes. DESIGN: A cross-sectional study was conducted with 5027 postmenopausal Brazilian women. Analyses were performed of BMI and cardiovascular factors (systemic blood pressure [BP], total cholesterol, low-density lipoprotein, high-density lipoprotein [HDL-C], triglyceride, and fast glucose). The statistical analysis included the chi-square and Mann-Whitney tests. The significance level was set at 5%. RESULTS: Obesity (BMI >30) in our study characterized approximately 30% of the 5027 postmenopausal women. The comparison of patients with normal BMI and those with high BMI showed that high BMI had a significant negative effect on BP, as evidenced by the increased frequency of hypertension in overweight and obese patients (>25) (p < 0.001), that it also negatively and significantly affected triglyceride (p < 0.001) and fast glucose levels (p < 0.001), and that it was linked significantly to low levels of HDL-C. CONCLUSION: Our data showed the high frequency of obesity in our population and of the cardiovascular risks (glucose, systemic arterial hypertension, and low HDL-C) associated with high BMI.

Fitoestrogênios no tratamento da mulher no climatério / Phytoestrogens in the treatment of women in climacteric

Algumas divergências da literatura quanto a terapia hormonal motivaram a procura de tratamentos alternativos que fossem efetivos e seguros para aliviar os sintomas da mulher no climatério. Neste artigo serão abordados trabalhos de relevância sobre fitoestrogênios, indicações, efeitos colaterais e contraindicações destas substâncias que têm atividades biológicas semelhantes aos estrogênios. Os resultados observados mostram que os efeitos e segurança dos fitoestrogênios ainda são inconclusivos...

The expression of the estrogen receptor in obese patients with high breast density (HBD).

OBJECTIVE: Obesity has been associated with increased risk for breast cancer (BC) mortality. Verifying in women with high breast density (HBD) post-menopausal, the frequency of polymorphisms of estrogen receptor (ER)α-PvuII, ERα-XbaI and if they influence the body mass index (BMI). METHODS: Study with 308 women with HBD post-menopause divided into two groups according to BMI: 1st group = BMI < 25 kg/m(2), 2nd group = BMI ≥ 25 kg/m(2). It was characterized in the clinical history: menarche, menopause, parity, family history of BC, smoking and alcohol intake. RESULTS: Allele and genotype frequencies for the ERα-397-Pvull and ERα-351-XbaI: P = 43.99%, p = 56.01%, pp = 32.14%, Pp = 47.73%, PP = X = 20.13% and X = 41.56%, x = 58.44%; xx = 33.44%; Xx = 50.00%; XX = 16.56%, respectively. Both PvuII and XbaI influenced BMI. When XbaI is mutated the tendency is toward higher BMI (0.039), and women with lower BMI were more frequent in PvuII genotype (p = 0.002). More frequent risk factors for BC: menarche before the age of 12 years (35.38%), nulliparity or 1st child after 28 years old (41.66%), family history of BC (19.16%) and overweight/obesity (62.01%). CONCLUSION: Variations in the ERα gene affected the BMI in women with HBD, who already are at increased risk for BC.

Anteroposterior displacement behavior of the center of pressure, without visual reference, in postmenopausal women with and without lumbar osteoporosis.

OBJECTIVE: The aims of this study were to evaluate the anteroposterior displacement behavior of the center of pressure without any visual reference and determine its relationship with knee muscle strength and reports of falls in postmenopausal women. Among those with osteoporosis, the specific objective was to evaluate the correlation of thoracic kyphosis and vitamin D with center of pressure displacement. METHODS: This was a cross-sectional observational study without intervention. The assessments were performed on 126 postmenopausal women (aged 55-65 years) who were grouped according to their lumbar bone density into osteoporosis and control groups. Center of pressure was evaluated on a force platform (100 Hz frequency and 10 Hz filter), with the subjects standing on both feet with eyes closed for 60 seconds. Knee muscle strength was evaluated using an isokinetic dynamometer in concentric/concentric mode at a velocity of 60°/s. In the osteoporosis group, vitamin D was assayed, and the thoracic spine was radiographed. RESULTS: In the control group, there was a correlation between the center of pressure and knee strength (r = 0.37; p<0.003). Reports of falls were not associated with center of pressure displacement (p = 0.056). In the osteoporosis group, thoracic kyphosis and vitamin D levels were not correlated with the center of pressure. CONCLUSION: Anteroposterior center of pressure displacement without visual influence was not associated with falls, thoracic kyphosis or vitamin D in the osteoporosis group. Only knee muscle strength was associated with center of pressure displacement in the control group.

Anteroposterior displacement behavior of the center of pressure, without visual reference, in postmenopausal women with and without lumbar osteoporosis

OBJECTIVE: The aims of this study were to evaluate the anteroposterior displacement behavior of the center of pressure without any visual reference and determine its relationship with knee muscle strength and reports of falls in postmenopausal women. Among those with osteoporosis, the specific objective was to evaluate the correlation of thoracic kyphosis and vitamin D with center of pressure displacement. METHODS: This was a cross-sectional observational study without intervention. The assessments were performed on 126 postmenopausal women (aged 55-65 years) who were grouped according to their lumbar bone density into osteoporosis and control groups. Center of pressure was evaluated on a force platform (100 Hz frequency and 10 Hz filter), with the subjects standing on both feet with eyes closed for 60 seconds. Knee muscle strength was evaluated using an isokinetic dynamometer in concentric/concentric mode at a velocity of 60°/s. In the osteoporosis group, vitamin D was assayed, and the thoracic spine was radiographed. RESULTS: In the control group, there was a correlation between the center of pressure and knee strength (r = 0.37; p<0.003). Reports of falls were not associated with center of pressure displacement (p = 0.056). In the osteoporosis group, thoracic kyphosis and vitamin D levels were not correlated with the center of pressure. CONCLUSION: Anteroposterior center of pressure displacement without visual influence was not associated with falls, thoracic kyphosis or vitamin D in the osteoporosis group. Only knee muscle strength was associated with center of pressure displacement in the control group. .

Impact of age and body mass on the intensity of menopausal symptoms in 5968 Brazilian women.

OBJECTIVE: To assess the relationship of onset of menopause and body mass on the menopausal symptoms in post-menopausal Brazilian women. DESIGN: Observational study conducted by the selection and inclusion of 5968 Brazilian women after menopause. The following variables were analyzed in this study: time at menopause; the relationship between age at menarche and age at menopause; vasomotor symptoms compared with age at the time of menopause and the time of menopause; Kupperman menopausal index (KMI) versus total time of menopause; body mass index (BMI) compared to the time of menopause, vasomotor symptoms, and KMI total score. We used the Chi-square test, and the significance level was set at 5%. RESULTS: The age at natural menopause ranged from 41 to 62 years (mean 48.1 ± 4.07 years). A younger age at menopause was associated with a high intensity of vasomotor symptoms. These symptoms were more intense in the first 5 years of menopause and decreased with time. The KMI total also decreased with time after menopause, with the exception of arthralgia, myalgia, and insomnia, which did not tend to improve over time. In addition, the vasomotor symptoms and total KMI were more frequent with increasing BMI. CONCLUSIONS: Our results suggested that the age of menopause and BMI may influence the intensity of vasomotor symptoms.

Polimorfismo do gene do receptor estrogênico como fator de risco do câncer de mama / Gene estrogen receptor polymorphism as a risk factor in the breast cancer

Polimorfismo é uma variação genética de ocorrência habitual na população em geral, encontrado em frequência superior a 1%. Há vários polimorfismos conhecidos no gene do receptor de estrogênio alfa (REa), alguns dos quais podem modificar a função do receptor e a ação do estrogênio. Entre os polimorfismos conhecidos, Pvull, Xbal podem estar envolvidos com maior risco individual ao câncer de mama e à sobrevida em mulheres após a menopausa. O objetivo foi revisar publicações sobre a associação entre mutações em genes do REa com o risco para câncer de mama, nos últimos 20 anos. Este estudo revisou a literatura de 1990 a março de 2011 e analisou a associação entre polimorfismos do gene do REa e o risco de câncer de mama, nas principais bases de dados. Foram identificados 17 estudos caso-controle randomizados, duas revisões sistemáticas e uma metanálise que examinaram a frequência dos referidos alelos no risco de câncer de mama. As evidências mostram que fatores hormonais, em conjunto com fatores genéticos, podem aumentar a suscetibilidade individual para o câncer de mama. No entanto, é interessante observar que após estratificação para fatores já conhecidos, que levam à alta exposição ao estrógeno durante a vida, observa-se aumento de risco principalmente em mulheres após a menopausa

The polymorphism is a genetic variation that occurs in the general population, found with frequency of more than 1%. There are several known polymorphisms in the estrogen receptor alpha (ERa) gene, some of which can change the receptor function and the estrogen action. Among the known polymorphisms, Pvull and Xbal can be involved with a bigger individual risk of breast cancer and survival rate in postmenopausal women. The aim was to review the publications about the association between mutations in ERa gene with the risk for breast cancer in the last 20 years. This study reviewed the literature from 1990 to march, 2011 and analyzed the association between the polymorphism of the ERa gene and the risk of breast cancer in the main database. With identified 17 randomized case-control-studies, two systematic reviews and one meta-analysis that examined the frequency of the referred alleles in the risk of the breast cancer. The evidences showed that hormonal factors together with genetic factors could increase the individual susceptibility for the risk of breast cancer. However, it is interesting to observe that after stratification to the already known factors that lead to high exposition to the estrogen during the life, notice an increase of the risk mainly in women after the menopause

Anorexia nervosa: revisão baseada em evidências / Anorexia nervosa: evidence-based review

Este trabalho de revisão baseada em evidências foi idealizado para analisar aspectos relevantes de pacientes com anorexia nervosa, pois esta afeta grande número de mulheres, principalmente na adolescência, antes dos 25 anos, causando vários distúrbios clínicos. O objetivo foi avaliar, de acordo com a literatura, por meio de metodologia adequada, o quadro clínico mais característico, como fazer o diagnóstico e a melhor abordagem de tratamento. Os resultados desta revisão apontaram as melhores evidências de que o quadro clínico mostra distúrbios emocionais relacionados ao medo de engordar, perda de peso e suas repercussões clínicas. O diagnóstico é fundamentalmente clínico e o tratamento mais adequado consta de reabilitação alimentar, atendimento por equipe de especialistas, cuidados gerais e outras medidas, estas ainda sem evidências conclusivas de benefícios

This evidence-based review paper was organized in order to analyze relevant aspects of patients with anorexia nervosa because it affects a larger number of women, especially teenagers, before 25 years old, and causing a lot of clinical outcomes. The objective of the study was to evaluate according the literature by a proper methodology, the main clinical aspects, how to make the diagnosis and the best approach for treatment. The results of this review showed the best evidences of clinical aspects that were emotional disturbances related to gain weight, loss of weight and its clinical outcomes. The diagnostic is essentially by clinical data and the best treatment consists of assistance by a team of specialists, nutrition intervention, general cares and other treatments still without conclusive evidences of benefits

Impact of domestic and sexual violence on women's health / Violência doméstica e sexual em mulheres e suas repercussões na fase do climatério

INTRODUCTION: domestic violence and, particularly, sex can result in higher incidence of comorbidities in the climacteric. OBJECTIVE: to assess the effects of menopause on sexual and domestic violence. METHODS: sectional study in 124 postmenopausal women between 40 and 65, who suffered domestic violence and / or sexual, and a control group (124) composed (climacteric women who did not suffer violence) (N=120). Those who exposed to violence were divided into three groups 1 violence experienced in childhood and adolescence 2- adult phase 3- both phases. Subsequently a questionnaire on domestic and sexual violence was applied.Correlation was established for the intensity of climacteric symptoms measured with Menopausal Kupperman Index (MKI), type of violence experienced, stage of life exposesd to violence comorbidities during menopause, and women's perceptions about the quality of assistance received from the various professionals after the traumatic events. In the control group MKI and number of comorbidities were evaluated. RESULTS: those who have experienced violence in childhood/adolescence have average of 5.1 comorbidities; adulthood 4.6, and 4.4 in both phases, with a median of 5.0 in all phases, without violence (control) 2.8. The victims of sexual violence have more comorbidities compared those who underwent other types of violence. There were significant associations between having suffered any kind of violence in both phases and MKI serious and have suffered sexual violence at any stage of life, and MKI at least moderate. CONCLUSION: women who have experienced domestic and sexual violence have more comorbidities and MKI high compared to the control group.(AU)

INTRODUÇÃO: a violência doméstica e, particularmente, a sexual pode implicar em maior ocorrência de comorbidades no climatério. OBJETIVO: avaliar as repercussões no climatério da violência domestica e sexual. MÉTODO: estudo transversal em 124 mulheres menopausadas, entre 40 e 65 anos, que sofreram violência doméstica e/ou sexual, e um grupo controle (mulheres na menopausa que não sofreram violência n=120). As expostas à violência foram divididas em três grupos: 1-violência sofrida na infância e/ou adolescência, 2-fase adulta, 3-ambas as fases, e aplicou-se questionário sobre violência doméstica e sexual. Correlacionou-se a intensidade dos sintomas climatéricos medido pelo Índice Menopausal de Kupperman (IK), tipo de violência sofrida, fase da vida exposta à violência, comorbidades apresentadas no climatério e percepções da mulher sobre a forma com que os diversos profissionais acolheram ou não nos eventos traumáticos. No grupo controle avaliamos IK e numero de comorbidades. RESULTADOS: aquelas que sofreram violência na infância/adolescência apresentam media de 5,1 comorbidades; na fase adulta 4,6; e em ambas as fases 4,4, com mediana de 5,0 em todas as fases; sem violência (controle) 2,8. As que sofreram violência sexual apresentam mais comorbidades em relação aquelas que sofreram outros tipos de violência. Houve associações significativas entre ter sofrido qualquer tipo de violência em ambas às fases e IK grave e ter sofrido violência sexual em qualquer fase da vida, e IK no mínimo moderado. CONCLUSÃO: mulheres que sofreram violência doméstica e sexual apresentam mais comorbidades e IK elevado em relação ao grupo controle.(AU)

Violência doméstica e sexual em mulheres e suas repercussões na fase do climatério / Impact of domestic and sexual violence on women's health

INTRODUÇÃO: a violência doméstica e, particularmente, a sexual pode implicar em maior ocorrência de comorbidades no climatério. OBJETIVO: avaliar as repercussões no climatério da violência domestica e sexual. MÉTODO: estudo transversal em 124 mulheres menopausadas, entre 40 e 65 anos, que sofreram violência doméstica e/ou sexual, e um grupo controle (mulheres na menopausa que não sofreram violência n=120). As expostas à violência foram divididas em três grupos: 1-violência sofrida na infância e/ou adolescência, 2-fase adulta, 3-ambas as fases, e aplicou-se questionário sobre violência doméstica e sexual. Correlacionou-se a intensidade dos sintomas climatéricos medido pelo Índice Menopausal de Kupperman (IK), tipo de violência sofrida, fase da vida exposta à violência, comorbidades apresentadas no climatério e percepções da mulher sobre a forma com que os diversos profissionais acolheram ou não nos eventos traumáticos. No grupo controle avaliamos IK e numero de comorbidades. RESULTADOS: aquelas que sofreram violência na infância/adolescência apresentam media de 5,1 comorbidades; na fase adulta 4,6; e em ambas as fases 4,4, com mediana de 5,0 em todas as fases; sem violência (controle) 2,8. As que sofreram violência sexual apresentam mais comorbidades em relação aquelas que sofreram outros tipos de violência. Houve associações significativas entre ter sofrido qualquer tipo de violência em ambas às fases e IK grave e ter sofrido violência sexual em qualquer fase da vida, e IK no mínimo moderado. CONCLUSÃO: mulheres que sofreram violência doméstica e sexual apresentam mais comorbidades e IK elevado em relação ao grupo controle.

Tratamento hormonal no climatério / Climacteric hormonal treatment

Objetivo: Analisar os aspectos relevantes do tratamento hormonal no climatério, orientado por monitorização adequada, para aumentar benefícios e reduzir riscos.Material e métodos: Análise de trabalhos e livros relevantes pertinentes ao tema, que em conjunto favoreçam a monitorização clínica, laboratorial e a individualização das mulheres climatéricas, conduzindo assim para a melhor opção de tratamento hormonal.Resultados e conclusões: As evidências da literatura e os dados observados em publicação do Setor de Ginecologia Endócrina e Climatério da Clínica Ginecológica da FMUSP mostram que a individualização das mulheres climatéricas, de acordo com suas condições clínicas, possibilita tratamento hormonal individualizado para cada mulher, oferecendo maiores benefícios e segurança.