Progestin-Primed Ovarian Stimulation is a non-inferior alternative to the GnRH Antagonist Protocol in patients undergoing assisted reproductive techniques: a retrospective study.

OBJECTIVE: To demonstrate the non-inferiority of Clinical Pregnancy Rates from Progestin-Primed Ovarian Stimulation compared to the GnRH Antagonist Protocol when the freeze-all and blastocyst transfer strategy is applied. METHODS: A retrospective study included all IVF cycles performed at Pró-Criar Reproductive Medicine Center, Belo Horizonte, Minas Gerais, Brazil, between May 2018 and May 2019 using a GnRH antagonist analogue or oral progestins to block the LH peak in IVF/intra-cytoplasmic sperm injection (ICSI) cycles for infertility treatment. RESULTS: The primary outcome of our study was Clinical Pregnancy Rate at the first ET (Blastocyst), which were 58.4% in the progestin group and 54.9% in the antagonist group (p=0.735), a finding consistent with most studies published to date using different progestins. The mean number of retrieved oocytes was 11 in the antagonist group and 9 oocytes in the progestin group (p=0.009). The fertilization rate was 80% for both groups (p=0.935). The rate of blastocyst formation per cycle was 50% in the antagonist group and 55.6% in the progestin group (p=0.106). The stimulation lasted a mean of 10 days in the two groups (p=0.403) and did not vary with patient age in either group. The gonadotropin dose used was higher in the antagonist group (2025 IU) than in the progestin group (1950 IU) (p=0.057). In addition, the blockade was effective: there was only one case of spontaneous ovulation, which corresponded to less than 1% of the cycles. CONCLUSIONS: Progestin-Primed Ovarian Stimulation is a non-inferior alternative to the GnRH Antagonist Protocol in patients undergoing assisted reproductive techniques. An incidence compatible with the 0.34 to 8% risk described in the literature for failure to control the premature LH surge in antagonist protocol cycles.

A critical analysis of the impact of endocrine disruptors as a possible etiology of primary ovarian insufficiency.

Primary ovarian insufficiency is a cause of infertility that affects about 1% of women under 40 years old, and is considered as idiopathic in 75% of cases. This review aims to carry out a critical synthesis of the knowledge of the chemical agents likely to affect follicular stock in humans and / or animals, by direct toxicity to follicles, or by increasing their recruitments. For the majority of toxic agents, only experimental data are currently available. We propose a strategy to encourage progress in identifying occupational factors responsible for premature ovarian failure.

Research priorities in infertility and assisted reproductive technology treatments - a James Lind Alliance priority setting partnership with brazilian patients.

OBJECTIVE: To identify the main research interests of Brazilian patients in the field of infertility and assisted reproductive technology (ART) treatments. METHODS: This prospective multicenter cross-sectional study was carried out in Brazil. Patients attending five fertility centers from the Huntington Group between October and December 2018 were invited to join the study, which consisted of answering an anonymous survey online. Two hundred and twenty-seven patients signed the informed consent form and were emailed the survey link. The survey was designed based on the James Lind Alliance Priority Setting Partnership protocol. In the area of infertility, patients were probed on issues such as somatic and psychological effects of treatment, prevention, assisted reproductive technology (medications and procedures), success rates, risks, and emotional aspects. RESULTS: The response rate (RR) was 47.58% (108 patients; 88 women - RR 51.46% and 20 men - RR 35.71%). Patient mean age was 36.5 years (SD 4.6). The top ten research priorities listed were 1) short- and long-term side effects of treatment; 2) how to cope with infertility; 3) risks associated with ART; 4) success rates in ART; 5) impact of diet on ART and fertility; 6) healthy habits; 7) alternative therapies; 8) impact of exercise on fertility and ART success; 9) oocyte quality and ovarian reserve; and 10) genetic or inherited causes of infertility. CONCLUSION: To better cater to the needs of patients and develop patient-centered care in the field of infertility and ART treatment, clinicians, healthcare providers, and the scientific community must identify patient concerns and priorities and make efforts to address them.

Identification of research priorities in infertility and assisted reproduction: an international, multicentre study.

RESEARCH QUESTION: What are the main research interests among patients of assisted reproductive technologies (ART)? DESIGN: Cross-sectional study consisting of an anonymous online survey sent to 2112 patients from eight centres in four countries in 2018. Patients were asked to identify research questions relevant to them in the field of infertility and ART. Answers were categorized into topics and ranked by frequency. A long list of the top 30 research topics was extracted from the aggregate results, from which a short list of the top 10 research topics was created. Ten research questions were finally formulated. RESULTS: A total of 945 responses were analysed. Main interests were side-effects, success rates, infertility prevention and emotional support. The 10 research questions were: 1. What are the side-effects of drugs used in ART treatments? (51.6%). 2. What are the most effective methods to cope with infertility from the psychological point of view? (35.7%). 3. What effects could diet have on fertility? (25.9%). 4. What are ART success rates per clinical profile? (24.8%). 5. Are there some habits and lifestyle factors that could prevent infertility? (20.0%). 6. What are the long-term risks associated with ART in mother and child? (18.5%). 7. Are alternative therapies such as acupuncture, yoga and meditation effective to treat/prevent infertility? (18.5%). 8. What is the impact of exercise on fertility? (15.4%). 9. How does oocyte quantity and quality affect fertility? (9.5%). 10. What are the genetic patterns or hereditary conditions causing/related to infertility? (9.5%). CONCLUSIONS: Researchers and clinicians should keep in mind that, in addition to success rates and safety, patients greatly value research into causes, prevention and emotional aspects of infertility.

Oocyte cryopreservation for future fertility: comparison of ovarian response between cancer and non-cancer patients.

OBJECTIVE: This study aimed to assess whether a diagnosis of cancer interferes with ovarian function prior to the treatment of the disease. METHODS: This observational retrospective study used data from medical records of ovarian stimulation cycles performed for purposes of oocyte cryopreservation. RESULTS: The included patients had a mean age of 35.13±3.72 years and 51.6% of them were aged between 36 and 40 years. More than half of the patients (57.6%) were single and 82.1% had a normal body mass index (BMI). Most women had not become pregnant (85.5%) or had babies (95.1%) or miscarriages (89.6%) prior to cryopreservation. The mean number of oocytes obtained from non-cancer patients was 11.4±8, while for cancer patients the number was 13.8±9. The mean number of frozen mature oocytes was 9.7±7 for the non-cancer group and 11.2±7.2 for the cancer group. The majority (63.1%) of the patients had up to 10 oocytes frozen per cycle. Breast cancer had the highest incidence among the included patients. There was no significant difference in ovarian response between patients with different types of cancer. CONCLUSION: The number of harvested and frozen oocytes from cancer and non-cancer patients indicated that in the two groups response to ovarian stimulation was similar.

Evaluation of Cardiovascular Risk in Climacteric Women: A Cross-Sectional Study.

PURPOSE: To identify cardiovascular risk factors in women between 40 and 65 years old in two private clinic of gynecology in Minas Gerais. METHODS: Cross-sectional study from January/2016 to January/2017 in 137 climacteric women. A standardized questionnaire was used to evaluate socio-demographic characteristics, climacteric phases, cardiovascular risk factors, menopause (age, time and type), number of pregnancies, normal births, abortions, partners and hormonal therapy. The evaluation model was used according to the Framingham risk score. RESULTS: The median age was 47 years, and 35% were postmenopausal. The majority were married and 42.3% caucasian. Abdominal circumference greater than 80 cm was observed in 87.6%, and greater than 88 cm in 67.2%. High total cholesterol (TC) was observed in 48.2%. Low levels of high-density lipoprotein (HDL-c) were observed in 42.3%. Elevated levels were observed for low density lipoprotein (LDL-c) in 39.4%, triglycerides in 29.9%, and fasting glucose in 8.8%. Also, systolic and diastolic blood pressure were considered high in 25.5% cases. Postmenopausal women presented higher values of TC and HDL-c. Analysis of the Framingham risk score revealed a higher cardiovascular risk for postmenopausal women. Higher values of waist circumference, glycemia and triglycerides were observed for women with higher cardiovascular risk. CONCLUSIONS: Postmenopausal women had a higher risk of cardiovascular events when compared to premenopausal ones.

Follicle Viability after Vitrification of Bovine Ovarian Tissue / Viabilidade folicular após a vitrificação de tecido ovariano bovino

Abstract Purpose The present study aimed to evaluate the impact of vitrification on the viability of follicles using a three-dimensional (3D) in vitro culture. Methods Bovine ovarian tissue samples (n = 5) obtained from slaughterhouses were utilized. The cortex was cut into small fragments of 2 x 3 x 0.5 mm using a tissue slicer. From these fragments, secondary follicles were first isolated by mechanical and enzymatic methods, then encapsulated in alginate gel and individually cultured for 20 days. Additional fragments of the same ovarian tissue were vitrified in a solution containing 25% glycerol and 25% ethylene glycol. After warming, the follicles underwent the same follicular isolation process that was performed for the fresh follicles. Results A total of 61 follicles were isolated, 51 from fresh ovarian tissue, and 10 from vitrified tissue. After the culture, the vitrified and fresh follicles showed 20% and 43.1% survival rates respectively (p = 0.290),with no significant differences. At the end of the culture, therewere no significant differences in follicular diameter between the vitrified (422.93 ± 85.05 μm) and fresh (412.99 ± 102.55 μm) groups (p = 0.725). Fresh follicles showed higher mean rate of antrum formation when compared with vitrified follicles (47.1% and 20.0% respectively), but without significant difference (p = 0.167). Conclusions The follicles were able to develop, grow and form antrum in the 3D system after vitrification, despite the lower results obtained with the fresh tissue.

Resumo Objetivo O presente estudo teve como objetivo avaliar o impacto da vitrificação na viabilidade dos folículos utilizando a cultura in vitro tridimensional (3D). Métodos Foi utilizado tecido ovariano bovino (n = 5) obtido de abatedouros. O córtex foi cortado em pequenos fragmentos de 2 x 3 x 0,5 mm, utilizando o tissue slicer e a partir destes fragmentos foram isolados folículos secundários por meio de método enzimático e mecânico, encapsulados em gel de alginato e cultivados individualmente durante 20 dias. Outros fragmentos do mesmo tecido ovariano foram vitrificados em solução contendo 25% de glicerol e 25% de etilenoglicol. Após aquecimento, os folículos passaram pelo mesmo processo de isolamento folicular realizado a fresco. Resultados Foram isolados 61 folículos, sendo 51 originários de tecido ovariano a fresco, e 10 de tecido vitrificado. Após a cultura, os folículos vitrificados apresentaram taxa de sobrevida de 20%, e o grupo a fresco apresentou taxa de 43,1% (p = 0,290). O diâmetro folicular ao final da cultura também não apresentou diferença significativa entre o grupo vitrificado (422,93 ± 85,05 μm) e a fresco (412,99 ± 102,55 μm) (p = 0,725). Os folículos a fresco apresentarammaior taxa média de formação de antro do que os folículos vitrificados (47,1% e 20,0%, respectivamente), mas sem diferença significativa (p = 0,167). Conclusões Os folículos foram capazes de se desenvolver, crescer e formar antro em sistema 3D após a vitrificação.

Follicle Viability after Vitrification of Bovine Ovarian Tissue.

Purpose The present study aimed to evaluate the impact of vitrification on the viability of follicles using a three-dimensional (3D) in vitro culture. Methods Bovine ovarian tissue samples (n = 5) obtained from slaughterhouses were utilized. The cortex was cut into small fragments of 2 × 3 × 0.5 mm using a tissue slicer. From these fragments, secondary follicles were first isolated by mechanical and enzymatic methods, then encapsulated in alginate gel and individually cultured for 20 days. Additional fragments of the same ovarian tissue were vitrified in a solution containing 25% glycerol and 25% ethylene glycol. After warming, the follicles underwent the same follicular isolation process that was performed for the fresh follicles. Results A total of 61 follicles were isolated, 51 from fresh ovarian tissue, and 10 from vitrified tissue. After the culture, the vitrified and fresh follicles showed 20% and 43.1% survival rates respectively (p = 0.290), with no significant differences. At the end of the culture, there were no significant differences in follicular diameter between the vitrified (422.93 ± 85.05 µm) and fresh (412.99 ± 102.55 µm) groups (p = 0.725). Fresh follicles showed higher mean rate of antrum formation when compared with vitrified follicles (47.1% and 20.0% respectively), but without significant difference (p = 0.167). Conclusions The follicles were able to develop, grow and form antrum in the 3D system after vitrification, despite the lower results obtained with the fresh tissue.

Objetivo O presente estudo teve como objetivo avaliar o impacto da vitrificação na viabilidade dos folículos utilizando a cultura in vitro tridimensional (3D). Métodos Foi utilizado tecido ovariano bovino (n = 5) obtido de abatedouros. O córtex foi cortado em pequenos fragmentos de 2 × 3 × 0,5 mm, utilizando o tissue slicer e a partir destes fragmentos foram isolados folículos secundários por meio de método enzimático e mecânico, encapsulados em gel de alginato e cultivados individualmente durante 20 dias. Outros fragmentos do mesmo tecido ovariano foram vitrificados em solução contendo 25% de glicerol e 25% de etilenoglicol. Após aquecimento, os folículos passaram pelo mesmo processo de isolamento folicular realizado a fresco. Resultados Foram isolados 61 folículos, sendo 51 originários de tecido ovariano a fresco, e 10 de tecido vitrificado. Após a cultura, os folículos vitrificados apresentaram taxa de sobrevida de 20%, e o grupo a fresco apresentou taxa de 43,1% (p = 0,290). O diâmetro folicular ao final da cultura também não apresentou diferença significativa entre o grupo vitrificado (422,93 ± 85,05 µm) e a fresco (412,99 ± 102,55 µm) (p = 0,725). Os folículos a fresco apresentaram maior taxa média de formação de antro do que os folículos vitrificados (47,1% e 20,0%, respectivamente), mas sem diferença significativa (p = 0,167). Conclusões Os folículos foram capazes de se desenvolver, crescer e formar antro em sistema 3D após a vitrificação.

Indução de ovulação em pacientes com tumor estrogênio­dependente: diretrizes clínicas da Sociedade Brasileira de Reprodução Humana / Ovulation induction in patients with estrogen­dependent tumors: a Brazilian Society of Human Reproduction clinical practice guideline

A oncofertilidade é um campo de interesse interdisciplinar de desenvolvimento recente que busca mesclar os conhecimentos em oncologia e medicina reprodutiva, com a contribuição das técnicas de reprodução assistida, para o desenvolvimento de estratégias de preservação da função gonadal e oferecer a possibilidade da procriação biológica aos sobreviventes de câncer. As estratégias de preservação da fertilidade feminina em pacientes oncológicas atualmente aceitas para a prática rotineira são a criopreservação de embriões e a criopreservação de oócitos maduros. Ocorre que, para execução de ambos, a indução de ovulação é obrigatória e, com ela, vêm os riscos teóricos de estimulação do crescimento de tumores estrogênio­dependentes e a postergação do início do tratamento antineoplásico. Os protocolos de estimulação ovariana de início aleatório contemplam a intenção de se minimizar o atraso no início da quimioterapia ou radioterapia e o bloqueio ao crescimento tumoral e oferecem resultados satisfatórios, semelhantes aos obtidos em protocolos de início habitual. Apresentamos neste artigo as diretrizes clínicas da Sociedade Brasileira de Reprodução Humana para indução de ovulação em pacientes com tumor estrogênio­dependente.(AU)

Oncofertility is an interdisciplinary interest field of recent development, which aims to merge the knowledge in oncology and reproductive medicine, with the help of assisted reproductive technologies, to develop strategies for gonadal function preservation and to offer the possibility of biological procreation to cancer survivors. Preservation strategies of female fertility in oncological patients currently accepted for routine practice are the cryopreservation of embryos and cryopreservation of mature oocytes. It happens that ovulation induction is mandatory for executing both strategies, and with it the theoretical risk of stimulation of estrogen­dependent tumors growth and the postponement of anti­neoplastic treatment. Random­start ovarian stimulation protocols include the intention of minimizing the delay in onset of chemo­radiotherapy and to block tumor growth, providing satisfactory results, similar to those obtained in the usual beginning protocols. This article presents the clinical guidelines of the Brazilian Society of Human Reproduction for ovulation induction in patients with estrogen­dependent tumors.(AU)

Comparison between Slow Freezing and Vitrification in Terms of Ovarian Tissue Viability in a Bovine Model.

Objective To assess the viability of bovine ovarian tissue after cryopreservation through either slow freezing or vitrification, and to compare it to that of control tissue by performing morphological analyses. Methods The study included 20 bovine ovarian cortex fragments that were divided into control, vitrification, and slow freezing groups. Each group consisted of four fragments of the same ovary, two fixed without cultivation, and two fixed with cultivation. Tissues were evaluated based on follicular morphology immediately after heating and after 7 days of culture, and compared with the control group. Results A total of 240 fragments were analyzed, generating a sample of 1,344 follicles without cultivation and 552 with cultivation. When the non-cultivated samples were classified as non-atretic follicles, 572 were found in the control group, 289 in the vitrification group, and 373 in the slow freezing group, showing no significant differences. When classified as atretic, 46 follicles were found in the control group, 23 in the vitrification group, and 41 in the slow freezing group, also showing no statistical difference. In the post-culture sample, an evolution of the follicular stages could be observed. This finding was important to support that the follicles considered non-atretic in the non-cultivated group were actually viable in the morphological evaluation. Conclusion With no differences between the protocols, vitrification was shown to be an advanced and alternative method for patients who will undergo treatments that carry the risk of ovarian failure, as the method is less expensive, faster, and more adaptable to laboratory routine.

Comparison between Slow Freezing and Vitrification in Terms of Ovarian Tissue Viability in a Bovine Model / Comparação da viabilidade do tecido ovariano após congelamento lento e vitrificação em modelo bovino

Abstract Objective To assess the viability of bovine ovarian tissue after cryopreservation through either slow freezing or vitrification, and to compare it to that of control tissue by performing morphological analyses. Methods The study included 20 bovine ovarian cortex fragments that were divided into control, vitrification, and slow freezing groups. Each group consisted of four fragments of the same ovary, two fixed without cultivation, and two fixed with cultivation. Tissues were evaluated based on follicular morphology immediately after heating and after 7 days of culture, and compared with the control group. Results A total of 240 fragments were analyzed, generating a sample of 1,344 follicles without cultivation and 552 with cultivation. When the non-cultivated samples were classified as non-atretic follicles, 572 were found in the control group, 289 in the vitrification group, and 373 in the slow freezing group, showing no significant differences. When classified as atretic, 46 follicles were found in the control group, 23 in the vitrification group, and 41 in the slow freezing group, also showing no statistical difference. In the post-culture sample, an evolution of the follicular stages could be observed. This finding was important to support that the follicles considered non-atretic in the non-cultivated group were actually viable in the morphological evaluation. Conclusion With no differences between the protocols, vitrification was shown to be an advanced and alternative method for patients who will undergo treatments that.

Resumo Objetivo avaliar a viabilidade do tecido ovariano bovino após a criopreservação, utilizando congelamento lento e vitrificação, e comparando com o tecido controle por meio de análises morfológicas. Métodos o estudo incluiufragmentos de córtex de vinte ovários bovinos divididos em grupos controle, vitrificação e congelamento lento. Cada grupo foi composto por quatro fragmentos do mesmo ovário, sendo dois fragmentos fixados sem cultivo e dois fragmentos fixados pós-cultivo. Os tecidos foram avaliados pela morfologia folicular logo após o aquecimento e após sete dias de cultivo, e comparados com o grupo controle. Resultados um total de 240 fragmentos foi analisado, gerando uma amostra de 1.344 folículos sem cultivo e 552 pós-cultivo. Quando a amostra sem cultivo teve seus folículos agrupados em não atrésicos, obtivemos 572 no grupo controle, 289 no vitrificação, e 373 no congelamento lento, não apresentando diferença estatística. Quando agrupados em atrésicos, o grupo controle apresentou 46 folículos, o vitrificação, 23, e o congelamento lento, 41, não apresentando também diferença estatística. Na amostra pós-cultivo, podemos observar uma evolução dos estágios foliculares: esse achado foi importante para sustentar que os folículos considerados não atrésicos na avaliação morfológica sem cultivo estavam realmente viáveis. Conclusão não havendo diferenças entre os protocolos, a vitrificação se mostra um avanço e um método alternativo para pacientes que irão se submeter a tratamentos que podem levar a uma falência ovariana, uma vez que a metodologia é mais barata, mais rápida e mais bem adaptável a uma rotina de um laboratório.

Preservação da fertilidade em mulheres com câncer: atualização e perspectivas / Fertility preservation in women with cancer: update and perspectives

Com o aumento do diagnóstico de câncer em mulheres jovens e os avanços no seu tratamento, muitas pacientes que poderão ter sua fertilidade comprometida com a quimioterapia têm manifestado desejo de engravidar futuramente. O congelamento de embriões, após fertilização in vitro, para preservar a fertilidade está bem estabelecido. A criopreservação de oócitos por vitrificação evoluiu bastante nos últimos anos, deixando de ser experimental. Até 2009 nasceram mais de 900 crianças a partir de oócitos criopreservados, sem aumento do risco de anomalias congênitas. O uso de análogos do GnRH para a supressão ovariana durante a quimioterapia na tentativa de prevenir a falência ovariana prematura apresenta resultados incertos. Outras técnicas ainda são consideradas experimentais, como a criopreservação e posterior autotransplante de tecido ovariano. Já foram relatados 24 nascimentos com o seu uso, persistindo, entretanto, dúvidas que motivam o seu estudo. A maturação de folículos ovarianos in vitro é alternativa promissora para preservação da fertilidade nessas pacientes e tem apresentado resultados positivos em roedores, macacos e humanos. Muita cautela deve ser tomada com o uso de técnicas experimentais, especialmente quando oferecidas para pacientes diante de fragilidade emocional. Por isso, é importante transmitir corretamente informações sobre chances de gravidez com tratamentos existentes e as limitações das técnicas experimentais...

With the increased number of cancer diagnoses among young women and the advances in treatment, many patients who may have had their fertility compromised by chemotherapy express desire to become pregnant in the future. Freezing embryos for later IVF so as to preserve fertility is a well established process. Oocyte cryopreservation by vitrification has evolved greatly in recent years and is no longer considered experimental. By 2009 more than 900 children were born from cryopreserved oocytes, without increased risk of congenital anomalies. The preventive use of GnRH analogues for ovarian suppression during chemotherapy to avoid premature ovarian failure has uncertain outcomes. Other techniques such as cryopreservation of ovarian tissue for later autograft are still considered experimental. Although use has already been reported in 24 births, doubts still persist and motivate further study. In vitro maturation of ovarian follicles is a promising alternative for preserving patient fertility and has shown positive results in rodents, monkeys, andhumans. Caution should be used with experimental techniques, especially when offered to emotionally fragile patients. Therefore it is important to thoroughly convey information on the chances of pregnancy with existing treatments and the limitations of experimental techniques...

Fitoestrogênios: valor terapêutico no climatério / Phytoestrogens: therapeutic value in climacteric

Os fitoestrogênios são um grupo de componentes não-esteróides com propriedades estruturais e funcionais semelhantes às dos estrogênios. As isoflavonas (genisteina e daidzeina) são as mais conhecidas nesse grupo. Seu mecanismo de ação se dá por meio de sua interação com os receptores estrogênicos; possuem efeitos antioxidantes e propriedades de inibição enzimática. Devido à sua capacidade de interagir com os receptores estrogênicos, tem-se aventado a sua utilização como alternativa à terapia de reposição hormonal no climatério. Embora a maioria dos estudos demonstre um efeito benéfico nos sintomas do climatério, há controvérsias. Os dados disponíveis no momento são controversos com relação à prevenção de doenças cardiovasculares e osteoporose.

Phytoestrogens are non-steroid compounds that have structural and functional properties similar to estrogens. The isoflavones (genistein and daidzein) are well known among these components. Isoflayones have antioxidant effects and anti-enzyme properties. In addition, isoflavones interact with estrogen receptors, opening the possibilitv of their utilization as a possible alternative to the usual hormone replacement therapy in the climaterium.

Função cognitiva na pós-menopausa / Cognition in menopause: effects of estrogen therapy

Com o propósito de avaliar o efeito do estrogênio na função cognitiva de mulheres na pós-menopausa, compararam-se os resultados do uso da terapia estrogênica com a utilização do placebo. Também se propôs estudar a relação entre os efeitos do tratamento nos sintomas climatéricos e depressivos e os resultados dos testes de função cognitiva. A metodologia utilizada foi o estudo duplo-cego, randomizado, controlado, comparando o uso de 2 mg de 17-beta-estradiol por via oral com o placebo. As pacientes estudadas eram mulheres na pós-menopausa, com idades entre 48 e 65 anos, com 8 anos de instrução formal. Excluíram-se mulheres com depressão moderada ou grave, com demência, usuárias de medicações com ação sobre o sistema nervoso central ou com contra-indicações à reposição hormonal. As 74 mulheres incluídas foram avaliadas em relação à função cognitiva, sintomas depressivos e climatéricos antes e depois de 12 semanas de terapia hormonal, utilizando-se os seguintes testes psicométricos: Mini-mental, Evocação Imediata e Tardia de Estória, Span de Dígitos, FAS, Teste Stroop, Dígito-simbolo, Trilhas A, Trilhas B e Teste dos sinos, além das Escalas de Depressão de Hamilton e Climatérica de Greene. Os grupos placebo e estradiol foram homogêneos em relação à idade, número de gestações, tempo de pós-menopausa, índice de massa corporal e pontuação nos diferentes testes antes do inicio do tratamento. Ao final do estudo, os resultados mostraram melhora significante apenas no grupo que usou estradiol nos seguintes testes: Evocação Imediata e Tardia de Estória e Escalas de Greene e Hamilton. Houve melhora em ambos os grupos nos testes FAS, Stroop e Sinos. Entretanto, ao se comparar os grupos, o único teste que mostrou diferença significante foi a Escala Climatérica de Greene. Observou-se ainda uma relação direta entre a redução dos sintomas climatéricos e o melhor desempenho apenas no Teste Stroop

Tensão pré-menstrual / Premenstrual syndrome

A Tensão pré-menstrual é condição que inclui sintomas físicos, emocionais e cognitivos, afetando 75 porcento das mulheres no menacme, ocorrendo exclusivamente durante a fase lútea do ciclo menstrual. Cerca de 3 a 5 porcento das pacientes afetadas apresentam a sua forma grave (distúrbio disfórico pré-menstrual). O diagnóstico exige anamnese e exame físico minuciosos para excluir outras causas de sintomas físicos ou emocionais. Não há um consenso sobre a sua etiologia, sendo descritos fatores biológicos, emocionais, comportamentais, socioculturais e genéticos. O tratamento inclui medidas gerais, intervenções no estilo de vida, suplementos nutricionais e tratamento farmacológico, sendo seu objetivo uma boa qualidade de vida, pela redução dos sintomas, com melhora das funções sociais

Infertilidade e Emoçäo / Infertility and Emotion

Os aspectos psicológicos vivenciados pelos casais inférteis apresentam certas particularidades, podendo interferir na relaçäo do casal, nas relaçöes familiares e sociais e, em alguns casos, também no desempenho profissional. O conhecimento destas particularidades é de fundamental importância para que possamos ajudar esses casais durante o tratamento de infertilidade