Factors associated with knowledge about menopause and hormone therapy in middle-aged Brazilian women: a population-based household survey.

OBJECTIVES: The aim of the study was to evaluate knowledge about menopause and hormone therapy (HT) among middle-aged Brazilian women and identify the factors associated with the level of knowledge. METHODS: A cross-sectional study was conducted with 749 women aged 45 to 60 years, residing in the Metropolitan Region of Campinas, Brazil. The dependent variable was knowledge about menopause and HT evaluated using a numerical score based on the answers given to three questions that had several response options. The independent variables were sociodemographic characteristics, personal habits, and health conditions. Statistical analysis was carried out by Mann-Whitney, Kruskal-Wallis, and a generalized linear model. RESULTS: The mean age was 52.5 (±4.4) years. Most of the women were postmenopausal (68%) and 19.5% had a history of current or previous use of HT. The final score for knowledge about menopause ranged from +1 to +11, with a mean of 4.59 (±1.86) and a median of 4. Women with higher levels of schooling (coefficient = 0.64, P < 0.001); with higher socioeconomic status (coefficient = 0.47, P < 0.002); with vaginal dryness (coefficient = 0.47, P = 0.003); who consumed alcohol (coefficient = 0.61, P = 0.006); who use or had ever used any type of treatment to counteract menopausal symptoms (coefficient = 0.41, P = 0.008); with anxiety (coefficient = 0.35, P = 0.037); and with depression (coefficient = 0.31, P = 0.043) possessed greater knowledge about menopause and HT. Women with a higher number (≥3) of vaginal deliveries (coefficient = -0.61, P < 0.001) and a higher body mass index (coefficient = -0.02, P = 0.046) possessed less knowledge about menopause and HT. CONCLUSIONS: The knowledge about menopause and HT demonstrated by the interviewees was low and possibly related to the time of exposure to qualified information.

Hormonal, metabolic, and endometrial safety of testosterone vaginal cream versus estrogens for the treatment of vulvovaginal atrophy in postmenopausal women: a randomized, placebo-controlled study.

OBJECTIVE: The aim of the study was to evaluate the laboratory and endometrial safety of topical testosterone versus topical estrogen for the treatment of vaginal atrophy in postmenopausal women. METHODS: This was a randomized, placebo-controlled trial of 60 postmenopausal women aged 40 to 70 years at the Menopause Clinic of CAISM UNICAMP. Women were randomized into three vaginal treatment groups: estrogen, testosterone, or placebo. The treatment was applied 3 times a week for 12 weeks. Hormonal laboratory values of follicle-stimulating hormone, luteinizing hormone, estradiol, estrone, androstenedione, total testosterone, free testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin were assessed at baseline and at 6 and 12 weeks. Metabolic laboratory values of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase were also assessed at baseline and at 6 and 12 weeks. Endometrial safety was assessed using ultrasonography at baseline and at 12 weeks. RESULTS: After 12 weeks of treatment, there were no significant differences in hormonal or metabolic laboratory values among all three groups. Two participants in the estrogen group had increased serum estradiol after 12 weeks of treatment. No change in endometrial thickening was reported in all three groups. CONCLUSIONS: Twelve weeks of treatment with topical testosterone or estrogen in postmenopausal women with symptoms of vaginal atrophy demonstrated laboratory and endometrial safety when compared with placebo.

Prevalence of hormone therapy, factors associated with its use, and knowledge about menopause: a population-based household survey.

OBJECTIVE: The aim of the study was to assess the prevalence of hormone therapy (HT), the factors associated with its use, and the importance of knowledge about menopause and HT. METHODS: A cross-sectional population-based study with 749 Brazilian women aged 45 to 60 years living in the Campinas Metropolitan Region was carried out between September 2012 and June 2013. The dependent variable was current or previous HT use. The independent variables were sociodemographic data, health-related problems, and knowledge about menopause assessed using a score that was obtained with a questionnaire on various aspects of menopause. RESULTS: The mean age of the women was 52.5 (±4.4) years. With regard to the menopause status, 16% were premenopausal, 16% were perimenopausal, and 68% were postmenopausal. Among all the women included, 19.5% reported current or previous HT use. In multiple regression analysis, being postmenopausal (prevalence ratio [PR] 2.76; 95% CI, 1.74-4.38), receiving information about menopause from physicians and health service workers (PR 2.73; 95% CI, 1.91-3.89), having bilateral oophorectomy (PR 2.18; 95% CI, 1.49-3.17), experiencing work interruption due to hot flashes (PR 1.44; 95% CI, 1.03-2.01), and having extensive knowledge about menopause (PR 1.12; 95% CI, 1.05-1.19) were associated with a higher prevalence of HT use. CONCLUSIONS: The prevalence of HT use was 19.5%. Menopause status, information source, surgical menopause, work interruption due to hot flashes, and knowledge about menopause were associated with HT use. Education promoted by healthcare systems can increase HT use in women who have indications for treatment.

Is the age at menopause a cause of sexual dysfunction? A Brazilian population-based study.

OBJECTIVES: The aim of the study was to evaluate the association between age at menopause and sexual dysfunction and the components of sexual function in postmenopausal women. METHODS: In this cross-sectional population-based study, data of 540 women aged 45 to 60 years regarding the age they were when they achieved menopause and its association with sexual dysfunction (evaluated using the Short Personal Experiences Questionnaire) were obtained through interviews. We assessed the data for associations between age at menopause and sexual dysfunction and demographic, behavioral, and clinical characteristics. RESULTS: Age at menopause was not associated with sexual dysfunction. Arousal (dysfunction) was the only component of sexual function that was associated with premature ovarian insufficiency (POI) and early menopause (P = 0.01). It was reported by 64.2% of women with POI (women <40 y), compared with sexual dysfunction rates of 50% and 45.6% of women aged 40 to 45 and >45 years, respectively (P = 0.04). In women with POI or early menopause, Poisson regression analysis showed that having a partner with sexual problems (prevalence ratio [PR] = 6.6; 95% CI: 3.3-13,2; P < 0.001) and dyspareunia (PR = 3.9; 95% CI: 1.8-8.2; P = 0.0005) were factors associated with arousal dysfunction. Satisfaction with the partner as a lover (PR = 0.4; 95% CI: 0.2-0.7; P = 0.002) was protective against arousal dysfunction. CONCLUSIONS: Arousal dysfunction was associated with early ovarian failure and POI. The major factors affecting this association were having a partner with sexual problems, dyspareunia, and no satisfaction with the partner as a lover. These findings highlight the importance of evaluating partner problems and improving lubrication in these groups of women.

Factors associated with urinary incontinence in middle-aged women: a population-based household survey.

INTRODUCTION AND HYPOTHESIS: The objective was to determine the prevalence of urinary incontinence (UI) and factors associated in a sample of Brazilian middle-aged women. METHODS: A cross-sectional study was conducted between September 2012 and June 2013 with 749 women. UI was defined as any complaint of involuntary loss of urine. The independent variables were sociodemographic data and health-related habits and problems. Statistical analysis was carried out using Chi-squared test and Poisson regression. RESULTS: The mean age was 52.5 (±4.4) years. The prevalence of UI was 23.6 %. Of these, 48 (6.4 %) had stress urinary incontinence, 59 (7.8 %) urinary urgency, and 70 (9.5 %) had mixed urinary incontinence. In the final statistical model, self-perception of health as fair/poor/very poor (PR: 1.90; 95 % CI, 1.45-2.49; P < 0.001), ≥1 vaginal deliveries (PR: 1.84; 95 % CI, 1.35-2.50; P < 0.001), higher body mass index (PR: 1.04; 95 % CI, 1.02-1.06; P = 0.001), vaginal dryness (PR: 1.60; 95 % CI, 1.23-2.08; P = 0.001), current or previous hormone therapy (PR: 1.38; 95 % CI, 1.06-1.81; P = 0.019), pre-/perimenopause (PR: 1.42; 95 % CI, 1.06-1.91; P = 0.021), and previous hysterectomy (PR: 1.41; 95 % CI, 1.03-1.92; P = 0.031) were associated with a greater prevalence of UI. Current or previous use of soy products to treat menopausal symptoms was associated with a lower prevalence of UI (PR: 0.43; 95 % CI, 0.24-0.78; P = 0.006). CONCLUSIONS: Several factors are associated with UI in middle-aged Brazilian women. The results highlight the importance of carrying out interventions aimed at reducing modifiable factors.

Quality of life and menopausal and sexual symptoms in gynecologic cancer survivors: a cohort study.

OBJECTIVES: The aims of this study were to investigate the frequency of menopausal and sexual symptoms and the proportion of sexually active women and to assess and identify quality of life (QOL) predictors in gynecologic cancer survivors. METHODS: A prospective case series following a cohort of women under radiation therapy was conducted, including 107 women (aged 21-75 y) with gynecologic cancer (cervical or endometrial cancer) who underwent pelvic radiotherapy in the Radiotherapy Division of the Women's Integral Healthcare Center at the Universidade Estadual de Campinas. Adverse effects of radiotherapy were evaluated using the Common Terminology Criteria Adverse Event Scale. QOL was measured using the abbreviated version of the World Health Organization's Quality of Life instrument before radiotherapy (T0) and at 4 months (T1), 1 year (T2), and 3 years (T3) after radiotherapy. QOL scores were assessed over time using the Wilcoxon signed-rank test. Multiple linear regression analysis was used to identify QOL predictors. RESULTS: A decrease in the frequency of vaginal dryness (26.7% in T0 vs 8.3% in T3; P < 0.01) and an increase in the proportion of sexually active women (21.5% in T0 vs 44.2% in T3; P < 0.01) were observed. A significant increase in QOL scores was observed in the psychological domain and general health and overall QOL. Dyspareunia negatively affected the physical (P < 0.01), psychological (P < 0.01), and social relationship domains (P < 0.01); overall QOL (P = 0.01); and general health (P = 0.04). Family income was positively related to environment domain (P < 0.01), overall QOL (P = 0.04), and general health (P < 0.01). CONCLUSIONS: Data derived from this study indicated that gynecologic cancer survivors had a lower frequency of vaginal dryness and a higher proportion of these women were sexually active 3 years after completion of radiotherapy. Furthermore, QOL improved and dyspareunia negatively affected various QOL dimensions.

Ability to follow anti-reabsorptive drug treatment in postmenopausal women with reduced bone mass.

OBJECTIVE: Studies show that adherence to osteoporosis treatment and prevention is low, which could interfere with therapeutic response. The aim of this study was to evaluate the ability of women to follow a treatment for osteoporosis with different anti-reabsorptives in relation to the prescribed regimen, dose, indications, and mode of ingestion. METHODS: A cross-sectional study that included postmenopausal women all undergoing medicated treatment because of densitometric diagnosis of osteopenia or osteoporosis was carried out by means of the MedTake questionnaire. A total of 227 women at a menopause clinic were studied. The following were evaluated: sociodemographic characteristics, other illnesses, use of concomitant medication, use of medication for osteoporosis, length of use, and ability to follow the treatment in relation to the prescribed regimen, dose, indication, and mode of ingestion. RESULTS: The ability to follow the treatment as evaluated by the MedTake was below 80% for most of the women. No significant difference was found between the daily or weekly bisphosphonate users and those taking raloxifene. The factors associated with inadequate treatment were the following: being 70 years or older (odds ratio [OR], 5.62; 95% CI, 1.23-25.64), being illiterate (OR, 10.14; 95% CI, 2.14-48.12), use of other medications (OR, 0.33; 95% CI, 0.15-0.76), and shorter length of use of medication for osteoporosis (OR, 5.67; 95% CI, 2.27-14.16). CONCLUSION: The ability to follow a treatment involving different anti-reabsorptive medications for osteoporosis is high relative to mode of ingestion, coingestion, and indication and low in relation to knowledge of the correct dose. Low ability is associated with advanced age, being illiterate, not using other medications, and shorter treatment time.

Incontinência urinária entre mulheres climatéricas brasileiras: inquérito domiciliar / Urinary incontinence among climateric Brazilian women: household survey

OBJETIVO: Por inquérito populacional domiciliar, investigar a prevalência de incontinência urinária de esforço e os fatores a ela associados em mulheres climatéricas. MÉTODOS: Realizou-se análise secundária de dados de um inquérito populacional domiciliar sobre o climatério e a menopausa em mulheres do município de Campinas, SP, Brasil. Foram selecionadas, por meio de estudo descritivo e exploratório de corte transversal, por processo de amostragem, 456 mulheres, na faixa etária de 45 a 60 anos de idade. Exploraram-se a queixa de incontinência urinária e os fatores de risco possivelmente relacionados; idade, estrato socioeconômico, escolaridade, cor, paridade, tabagismo, índice de massa corpórea, cirurgias ginecológicas anteriores, estado menopausal e uso de terapia de reposiçäo hormonal. Os dados foram coletados por entrevistas domiciliares, com questionários estruturados e pré-testados, adaptados pelos autores e fornecidos pela Fundaçäo Internacional de Saúde, pela Sociedade Internacional de Menopausa e pela Sociedade Norte-Americana de Menopausa. A análise dos dados foi realizada por razäo de prevalência (IC 95por cento). RESULTADOS: Das mulheres entrevistadas, 35por cento referiram perda urinária aos esforços. Nenhum dos fatores sociodemográficos estudados se mostrou associado ao risco de incontinência urinária. Também a paridade näo alterou significativamente esse risco. Outros fatores como cirurgias ginecológicas anteriores, índice de massa corpórea e tabagismo näo se mostraram associados à prevalência de incontinência urinária. O estado menopausal e o uso de terapia de reposiçäo hormonal näo modificaram o risco de incontinência urinária de esforço. CONCLUSAO: Apesar de a prevalência de incontinência urinária em mulheres climatéricas ter sido alta, näo se mostrou associada aos fatores socioeconômicos e reprodutivos abordados

Adesäo à terapêutica de reposiçäo hormonal no climatério: experiência no ambulatório de menopausa - UNICAMP / Compliance with hormonal replacement therapy in climateric women: experience of menopause clinic - UNICAMP

A adesao à TRH é um ponto crucial no tratamento de mulheres pós-menopausadas e climatéricas, já que os efeitos benéficos dos hormônios podem ser afetados ou mesmo perdidos se as mulheres nao mantiverem o tratamento. Apesar da relevância do assunto, poucas avaliaçoes têm sido realizadas neste sentido. O objetivo deste estudo foi avaliar o esquema de reposiçao hormonal e a adesao ao tratamento, no Ambulatório de Menopausa do CAISM/UNICAMP. Foi avaliado, retrospectivamente, o comportamento de 127 pacientes desta clínica diante da TRH durante o ano de 1992. A média etária das pacientes foi de 5O,6 anos (+ 7,4). O regime de reposiçao hormonal mais utilizado foi a associaçao de estrogênios e progestogênios de forma cíclica. A adesao à TRH nao foi afetada pelo tipo de esquema utilizado e foi considerada alta (86 por cento), talvez devido à assistência multiprofissional e à seleçao das pacientes, uma vez que, de 224 pacientes admitidas no Ambulatório, somente 127 (56,7 por cento) receberam TRH.