Relationship between breast arterial calcification and coronary artery disease by invasive coronary angiography in postmenopausal women.

PURPOSE: To evaluate the relationship between the presence of BAC and coronary artery disease (CAD) by invasive coronary angiography (ICA) in postmenopausal women. METHODS: In this cross-sectional study, postmenopausal women (age ≥ 45 years) with history of CAD, who underwent both ICA and digitized mammography, within six months of each other, were enrolled. Women who underwent prior percutaneous coronary intervention, or exhibited grade D breast density (BI-RADS®) or breast cancer upon mammography were excluded. Digital mammograms were identified in the electronic medical record system and reviewed for the presence of BAC, without knowledge of the ICA results by two experienced physicians. The ICA results were obtained from the electronic medical record, and categorized as follows: 1-single-vessel disease; 2-two-vessel disease; and 3-multivessel disease (≥3vessels). For statistical analysis Student t test, Gamma distribution, Chi-square test and logistic regression (odds ratio,OR) were used. RESULTS: Of the 183 postmenopausal women evaluated, 39 (21.3 %) had BAC. Women with BAC were older and had a longer time since menopause when compared to women without BAC (68.2 ± 9.6 × 59.6 ± 10.0 years of age and 19 ± 10.1 × 13.5 ± 8.2 years, respectively) (p < 0.0.0001). Among the clinical and cardiovascular characteristics evaluated, only the incidence of smoking was higher in women with BAC (p = 0.007). There was no difference in the number of affected vessels upon ICA in women with or without BAC (p = 0.683). In multivariate analysis, after adjustment for age, time since menopause and smoking, the presence of BAC was not associated with a significant risk of observing a greater number of affected vessels upon ICA (OR1.07; 95 %CI 0.41-2.76, p = 0.609). CONCLUSIONS: The presence of BAC was not associated with the severity of CAD in postmenopausal women.

Different cutoff points to diagnose low muscle mass and prediction of osteoporosis in postmenopausal women.

OBJECTIVE: This study aimed to verify which of the different cutoff points of low muscle mass (LMM) based on appendicular lean mass (ALM) is associated with osteoporosis in postmenopausal women (PMW). METHODS: Cross-sectional study. PMW (n = 355) were classified for the presence of osteoporosis (score <-2.5 standard deviations) at the femoral neck and lumbar spine and LMM (three cutoff points: ALM < 15 kg; ALM/height2 [ALM index] <5.67 kg/m2 and ratio between ALM and body mass index [ALMBMI] <0.512). RESULTS: After adjustments for confounding factors, binary logistic regression showed that ALM and ALM index were associated with osteoporosis at the lumbar spine (odds ratio [OR] = 5.3 [95% CI: 2.3-12.5] and OR = 2.5 [95% CI: 1.0-6.2], respectively) and only ALM was associated with osteoporosis at the femoral neck (OR = 16.1 [95% CI: 4.1-62.5]). When women were classified as having osteoporosis in at least one site, only ALM was associated with osteoporosis (OR = 7.7 [95% CI: 3.3-15.6]). There was no association between ALMBMI and osteoporosis. The predictive value of ALM for osteoporosis decreased after BMI or height were included as a covariate in the model. CONCLUSION: Absolute ALM (<15 kg) seems to be the most suitable for predicting osteoporosis based on LMM in PMW.

Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.

INTRODUCTION: Although pelvic floor muscle (PFM) weakness can be associated with pelvic floor dysfunctions, knowledge about the relationship with sexual dysfunction is limited. AIM: The aim of this study was to evaluate the association between PFM strength and sexual function in postmenopausal women. METHODS: An analytical cross-sectional study was conducted on 226 sexually active heterosexual women aged 45-65 years with amenorrhea >12 months and without pelvic floor disorders. The Female Sexual Function Index (FSFI) was used for the evaluation of sexual function (total score ≤26.5 indicating sexual dysfunction). PFM strength was assessed by bidigital vaginal palpation using the modified Oxford scale (score 0-5) and was categorized into nonfunctional (scores 0-1, without contraction) and functional (scores 2-5, with contraction). Three-dimensional transperineal ultrasound was used to evaluate total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness. MAIN OUTCOME MEASURE: The main outcome measure was to determine the relationship between sexual dysfunction and PFM strength. RESULTS: The participants were classified as functional PFM (n = 143) and nonfunctional PFM (n = 83). There were no differences between groups in clinical and anthropometric parameters. A higher percentage of menopausal hormone therapy users was observed in the group with functional PFM (39.2%) compared to the nonfunctional group (24.1%; P = .043). Women classified as functional PFM exhibited greater levator ani muscle thickness than those classified as nonfunctional (P = .049). Women with nonfunctional PFM had poorer sexual function in the desire (P = .005), arousal (P = .001), and orgasm (P = 0.006) domains and in total FSFI score (P = .006) compared to the functional group. There was a weak positive correlation of PFM strength with the desire (r = 0.35; P = .0003), arousal (r = 0.21; P = .013), and orgasm (r = 0.23; P = .033) domains and with total FSFI score (r = 0.28; P = .004). Ultrasonographic levator ani muscle thickness showed a weak positive correlation with PFM strength (r = 0.21; P = .046) and with the arousal domain (r = 0.23; P = .044). Risk analysis adjusted for age, time since menopause, parity, and body mass index showed a lower risk of sexual dysfunction in menopausal hormone therapy users (odds ratio = 0.26; 95% CI 0.11-0.60; P = .002) and in women with greater levator ani muscle thickness (odds ratio = 0.85; 95% CI 0.73-0.98; P = .025). CLINICAL IMPLICATIONS: The maintenance of PFM strength in the climacteric period is an important factor in postmenopausal women's sexual function. STRENGTH & LIMITATIONS: The main strength of the study is that, to our knowledge, this is the first study that evaluated the correlation of PFM strength and 3D transperineal ultrasound with different domains of sexual function in postmenopausal women. The main limitation is the cross-sectional design does not permit to establish a cause-effect relationship. CONCLUSION: Postmenopausal women with PFM dysfunction have poorer sexual function than women with functional PFM. Omodei MS, Marques Gomes Delmanto LR, Carvalho-Pessoa E, et al. Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women. J Sex Med 2019;16:1938-1946.

Vitamin D deficiency is associated with metabolic syndrome in postmenopausal women.

OBJECTIVE: To evaluate the association between vitamin D (VD) deficiency and risk factors for metabolic syndrome (MetS) in postmenopausal women. STUDY DESIGN: Observational, cross-sectional cohort study. MAIN OUTCOME MEASURES: In this study, 463 women, aged 45-75 years, with amenorrhea >12months, without VD supplementation or established cardiovascular disease were included. Clinical and anthropometric data were collected. Biochemical parameters, including total cholesterol (TC), HDL, LDL, triglycerides, glucose, insulin and 25-hydroxyvitamin-D [25(OH)D] were measured. Women meeting three or more of the following criteria were diagnosed with MetS: waist circumference >88cm, triglycerides ≥150mg/dL, HDL <50mg/dL, blood pressure ≥130/85mmHg and glucose ≥100mg/dL. Serum 25(OH)D levels were classified as sufficient (≥30ng/mL), insufficient (20-29ng/mL) or deficient (<20ng/mL). ANOVA, chi-square test and logistic regression (odds ratio, OR) were used for statistical analysis. RESULTS: Serum 25(OH)D levels were sufficient in 148 women (32.0%), insufficient in 151 (32.6%) and deficient in 164 (35.4%). Women with low 25(OH)D levels had higher TC, triglycerides, insulin and HOMA-IR levels (p<0.05). MetS was detected in 57.8% (182/315) of women with hypovitaminosis D (insufficient and deficient) and in 39.8% (59/148) of those with sufficient VD​​ (p=0.003). In a multivariate logistic regression analysis, a low 25(OH)D level (<30ng/mL) was significantly associated with MetS (OR1.90, 95%CI=1.26-2.85), high triglyceride levels (OR1.55, 95%CI=1.13-2.35), and low HDL levels (OR1.60, 95%CI=1.19-2.40) (p<0.05) compared with women with sufficient 25(OH)D levels, after adjusting for age, time since menopause, body mass index, smoking and physical exercise. The mean concentration of 25(OH)D decreased with increasing numbers of MetS components (p=0.016). CONCLUSIONS: VD deficiency in postmenopausal women was associated with a higher prevalence of MetS. Women with VD deficiency had a higher risk of MetS, hypertriglyceridemia and low HDL than those with adequate levels.

Evaluation of Toll-Like receptor 2 and 4 RNA expression and the cytokine profile in postmenopausal women with metabolic syndrome.

OBJECTIVE: To evaluate the gene expression of Toll-Like (TLR-2 and TLR-4) receptors and cytokine profile in postmenopausal women with or without metabolic syndrome (MetS). METHODS: In this cross-sectional study, 311 Brazilian women (age≥45 years and amenorrhea≥12 months) were included. Women showing three or more of the following diagnostic criteria were diagnosed as positive for MetS: waist circumference>88 cm, triglycerides≥150 mg/dL, HDL cholesterol<50 mg/dL, blood pressure≥130/85 mmHg, and fasting glucose≥100 mg/dL. The expression of TLR-2 and TLR-4 in peripheral blood was evaluated by RNA extraction and subsequent real time PCR analysis. The cytokine profile, tumor necrosis factor alpha (TNF-α) and interleukins 1ß, 6, and 10, were measured by ELISA. RESULTS: The expression of TLR-2 RNA was demonstrated in 32.5% and TLR-4 in 20.6% of the subjects. There was no association between the expression of TLR-2 and TLR-4 and the presence or absence of MetS (P>0.05). A greater production of IL-6 was associated with TLR-2 and TLR-4 expressions and greater production of TNF-α was associated only with TLR-2 expression (P>0.05). Only the lower quartile of IL-10 was associated with the presence of the MetS (P>0.05). CONCLUSIONS: TLR-2 and TLR-4 expressions were associated with increased pro-inflammatory cytokines, IL-6 and TNF-α, with no association with biomarkers of MetS. The low concentrations of IL-10 may suggest an anti-inflammatory modulation in postmenopausal women with MetS.

Usefulness of clinical, ultrasonographic, hysteroscopic, and immunohistochemical parameters in differentiating endometrial polyps from endometrial cancer.

STUDY OBJECTIVE: To evaluate the usefulness of clinical, ultrasonographic, hysteroscopic, and immunohistochemical parameters in differentiating endometrial polyps from endometrial cancer. DESIGN: Cross-sectional study (Canadian Task Force classification II-2). SETTING: Tertiary public hospital, university teaching center. PATIENTS: Eighty-two women who underwent hysteroscopic polypectomy and 20 women who underwent surgery to treat endometrial cancer. INTERVENTIONS: Analysis of medical records and immunohistochemical assessment of estrogen receptors, progesterone receptors, and endothelial markers CD34 and CD105. MEASUREMENTS AND MAIN RESULTS: Among women with endometrial cancer and endometrial polyps, respectively, mean age was 63 and 57 years (p = .01), 89% and 67% were postmenopausal (p < .05), and 85% and 30.5% had postmenopausal bleeding (p < .01). No sonographic parameter enabled differentiation of endometrial polyp from cancer. Of patients with endometrial cancer, 72% exhibited signs suggestive of hyperplasia, and endometrial polyps were diagnosed during hysteroscopy. Estrogen receptors (≥ 2 vs ≥ 1; p < .001) and progesterone receptors (≥ 3 vs ≥ 2; p = .07) were greater in endometrial polyps. There was no significant difference in microvessel density (p > .05). CONCLUSIONS: Ultrasonographic parameters and endothelial markers did not enable differentiation of polyps from endometrial neoplasia. Postmenopausal bleeding and endometrial hypervascularization along with vascular atypia at diagnostic hysteroscopy showed a greater association with endometrial cancer.

Prevalência de síndrome metabólica em mulheres acima de 40 anos de Divinópolis-MG / Prevalence of metabolic syndrome in women aged 40-59 years using two international criteria Prevalencia del síndrome metabólico en las mujeres de 40-59 años utilizando 2 criterios internacionales

Avaliar prevalência da síndrome metabólica (SM) em mulheres comparando critérios internacionais. Métodos: Estudo descritivo transversal envolvendo 93 mulheres, com idade entre 40 a 59 anos, acompanhadas em Unidades Básicas eProgramas de Saúde da Família de Divinópolis-MG. Foram realizadas avaliações clínicas, antropométricas e bioquímicas. Para o diagnóstico de SM foram empregados critérios internacionais: Adult Treatment Panel IIIof the National Cholesterol Education Program (NCEP/ATP III) e International Diabetes Federation (IDF), que utilizam a presença de três ou mais dos seguintes parâmetros alterados: circunferência da cintura (CC), triglicerídeos (TG), HDL,pressão arterial e glicemia. Resultados: 54 mulheres entre 40 a 49 anos (58,7%) e 39 entre 50 a 59 anos (41,3%). Parâmetro individual mais alterado foi CC para ambos os critérios. De acordo com NCEP/ATP III, 40,8% das participantes foram diagnosticadas com SM e 53,7% pelo IDF. Faixa etária de 50-59 apresentou maior prevalência de SM para ambos critérios. Demonstrou-se aumento de risco para SM com tabagismo, diabetes e hipertensão em ambos os critérios. Boa concordância entre os critérios da NCEP ATP III e IDF (k=0,74). Conclusão: IDF foi o critério com maior prevalência para SM e a faixa etária de 50-59 foi a mais crítica...

To evaluate the prevalence of metabolic syndrome (MS) in women compared to international criteria. Methods: Crosssectional descriptive study involving 93 women, aged 40 to 59 years, accompanied in Basic Units and Family HealthPrograms in Divinópolis-MG. Clinical, anthropometric and biochemical assessments were performed. Two International criteria were employedfor the diagnosis of MS: Adult Treatment Panel III of the National Cholesterol Education Program(NCEP/ATP III) and International Diabetes Federation (IDF), which use the presence of three or more of the following altered parameters: waist circumference (WC), triglycerides (TG), HDL, blood pressure and blood glucose. Results: 54women aged 40-49 years (58.7%) and 39 aged 50-59 (41.3%). The most altered individual parameter was the WC for both criteria. According to NCEP/ATP III, 40.8% of participants were diagnosed with MS and 53.7% by IDF. The age group 50-59 showed a higher prevalence of MS for both criteria. Increased risk for MS was demonstrated with smoking, diabetes and hypertension in both criteria. There was agreement between the criteria of NCEP/ATP III and IDF (k = 0.74). Conclusion: IDF criteria was most prevalent for SM and the age group of 50-59 was the most critical...

Evaluar la prevalencia de síndrome metabólico (SM) en las mujeres en comparación con los criterios internacionales. Métodos: estudio descriptivo transversal que involucró a 93 mujeres, entre 40 a 59 años, acompañadas por las UnidadesBásicas y Programas de Salud de la Familia de Divinópolis-MG. Se realizaron evaluaciones clínicas, antropométricas ybioquímicas. Para el diagnóstico de SM criterios internacionales se emplearon: del Programa National de Education porCholesterol - Panel de Tratamiento de Adultos III (NCEP/ATP III) y Federación Internacional de Diabetes (IDF), que utilizan la presencia de tres o más de los siguientes parámetros cambiados: circunferencia de la cintura (CC), triglicéridos (TG), HDL, presión arterial y glucosa enla sangre. Resultados: 54 mujeres de 40-49 años (58,7%) y 39 entre los 50 a 59 años (41,3%). Parámetroindividual más alterado fue CC en ambos criterios. Según NCEP/ATP III, el 40,8% de las participantes fueron diagnosticadas con SM y el 53,7% por IDF. Grupo de edadde 50-59 mostraronmayor prevalencia de SM por ambos criterios. Se demostrómayor riesgo de SM con el tabaquismo, la diabetes y la hipertensión arterial en ambos criterios.Hubo bastante concordancia entre los criterios del NCEP/ATP III y IDF (k = 0,74). Conclusión: criterios de IDF fueron más frecuentes para SM y el grupo de edad de 50 a 59 fue el más crítico...

Evaluation of postural balance in postmenopausal women and its relationship with bone mineral density--a cross sectional study.

BACKGROUND: Low bone mineral density (BMD) and falls are common problems encountered in the postmenopausal women. The purpose was to evaluate the association between postural balance and BMD in postmenopausal women and its relation to risk for falls. METHODS: In this cross-sectional study, 225 women in amenorrhea > 12 months and age ≥ 45 years were included and divided, according to BMD, in T-score values > -2.0 SD (n = 140) and ≤ -2 SD (n = 85). Those with neurological or musculoskeletal disorders, history of vestibulopathies, uncorrected visual deficit or drug use that could affect balance were excluded. History of falls (last 24 months), clinical and anthropometric characteristics were evaluated. Postural balance was assessed by stabilometry (force platform). For statistical analysis were used Wilcoxon's Test, Chi-Square Test and logistic regression method for fall risk (Odds Ratio-OR). RESULTS: Patients with BMD > -2.0 SD were younger, with shorter time since menopause, and showed higher BMI as compared to those with low BMD (≤ -2 SD) (p < 0.05). It was observed that 57.8% of the participants reported fall episodes without significant difference distribution between the groups (p = 0.055). No differences were found from the comparison between the groups (p > 0.05) for stabilometric parameters. Risk for falls increased with age (OR 1.07; CI 95% 1.01-1.13), current smoking (OR 2.19; CI 95% 1.22-3.21) and corrected visual deficit (OR 9.06; CI 95% 1.14-4.09). In contrast, hormone therapy (HT) use was significantly associated with reduced risk for falls (OR 0.48; CI 95% 0.26-0.88). CONCLUSIONS: In postmenopausal women, BMD did not show association with postural balance or risk for falls. Age, smoking and corrected visual deficit were clinical indicators of risk for falls whereas HT use showed to be a protective factor.

Effect of total abdominal hysterectomy on ovarian blood supply in women of reproductive age.

OBJECTIVE: The purpose of this study was to evaluate the effect of total abdominal hysterectomy on ovarian blood supply using transvaginal color Doppler ultrasonography in women of reproductive age. METHODS: This prospective study included 61 women aged 40 years or younger who were divided into 2 groups: group 1, comprising 31 patients who underwent total abdominal hysterectomy (TAH); and group 2, comprising 30 women with no abnormalities. Inclusion criteria included normal ovarian function at baseline, with basal follicle-stimulating hormone levels of less than 15 mUI/mL, normal body weight, no tobacco use, and no history of laparotomy or ovarian disease. Ovarian arterial blood supply by determination of the pulsatility index (PI) on Doppler analysis and ovarian volume on transvaginal ultrasonography were assessed at baseline and at 6 and 12 postoperative months. The Student t test, profile analysis, and Friedman and Mann-Whitney tests were used in the statistical analysis of data. RESULTS: Statistical analysis of baseline data revealed that both groups were homogeneous. At months 6 and 12, greater ovarian volumes and lower PI values were observed in patients who underwent TAH (P < .05). By the end of the study, in 8 of the 31 patients who underwent TAH (25.5%), benign ovarian cysts were observed. In the control group, all the parameters studied remained unchanged. CONCLUSIONS: The reduced PI values observed on Doppler ultrasonography suggested a decrease in the resistance flow in the ovarian arteries in women of reproductive age who underwent TAH.

Benefits of soy germ isoflavones in postmenopausal women with contraindication for conventional hormone replacement therapy.

OBJECTIVE: To evaluate the effects of isoflavones on vasomotor symptoms and blood lipids in postmenopausal women with contraindication for conventional hormone replacement therapy (HRT). METHODS: This prospective, double-blind and placebo-controlled study included 50 postmenopausal women randomly divided into two groups: 25 women on soy germ isoflavones (60 mg per day, capsules) and 25 women on placebo. Inclusion criteria included: non-vegetarian, non-asian women whose last menstruation dated at least 12 months prior to the beginning of the study, with FSH > 40 mIU/ml, hot flushes and contraindication for HRT, not using tamoxifen or antibiotic and no disease of the gastrointestinal tract. For 6 months, the Kupperman menopausal index (KMI), the vaginal cytological maturation value (MV) and both hormonal and lipid profiles were assessed. The t-test and analysis of variance (ANOVA) were employed to compare the two groups. RESULTS: In both groups, a decreased KI rate was observed. However, isoflavone was significantly superior to placebo in reducing hot flushes (44% versus 10%, respectively) (P < 0.05). After 6 months, the isoflavone group showed increased estradiol levels with unchanged FSH, LH, and vaginal cytology, and a reduction of 11.8% in LDL and an increase of 27.3% in HDL (P < 0.05 ). In the placebo group, just a reduction in MV was observed after 6 months (P < 0.05 ). CONCLUSIONS: Soy germ isoflavone exerted favorable effects on vasomotor symptoms and lipid profile, showing itself to be an interesting alternative therapy for the postmenopausal women with contraindication for conventional HRT.