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2.
Maturitas ; 135: 1-5, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32252960

RESUMO

OBJECTIVES: The STOP-BANG questionnaire (snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender) was originally validated to screen for obstructive sleep apnea (OSA) in the surgical population. It has been validated in mixed populations of men and women. We aimed to evaluate its reliability for OSA screening of midlife women. STUDY DESIGN: We retrospectively evaluated midlife women seen at the Women's Health Clinic at Mayo Clinic in Rochester, Minnesota, who completed the STOP-BANG questionnaire and subsequently underwent diagnostic polysomnography (PSG) or home sleep apnea testing (HSAT). MAIN OUTCOME MEASURES: The questionnaire's predictive ability was assessed with the apnea hypopnea index (AHI) measured at PSG and HSAT. RESULTS: Because participants were female, the gender question response was consistently 0, making the mean (SD) STOP-BANG score low at 3 (1.2). The most sensitive item to detect any OSA and moderate to severe OSA through STOP-BANG was observed apneas; the most specific item to detect OSA and moderate to severe OSA was neck circumference exceeding 40 cm. A score of 3 or more had a sensitivity of 77 % and a specificity of 45 % to detect moderate to severe OSA. The area under the curve with the STOP-BANG score to predict moderate to severe OSA was 0.67 (95 % CI, 0.51-0.84). CONCLUSIONS: Interpretation of the STOP-BANG questionnaire is nuanced for midlife women. Given the nature of its questions, a lower score may be predictive of more severe OSA in women, necessitating use of a lower threshold to trigger further testing.

3.
Am J Obstet Gynecol ; 222(2): 103-113, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31473229

RESUMO

Genitourinary syndrome of menopause is a condition describing the hypoestrogenic effects on the female genitals and lower urinary tract leading to symptoms such as vaginal dryness, vulvar and vaginal burning, dyspareunia and dysuria. Genitourinary syndrome of menopause is experienced by over half of postmenopausal women, and is even more pervasive in women with cancer. Due to treatments such as surgery, chemotherapy, radiation, and hormonal therapy, women may experience early menopause resulting in earlier and more severe symptoms. Understanding the scope of this issue in female breast and gynecologic cancer survivors and identifying treatment options for this complex patient population are paramount. Tailored patient treatments include nonhormonal therapies (vaginal moisturizers, lubricants, pelvic floor physical therapy, dilator therapy, counseling), systemic and local hormonal therapies. Consensus recommendations by medical societies and associated evidence are reviewed, with emphasis on safety and efficacy of local vaginal hormonal therapies, and management variations noted depending on cancer type and characteristics. With knowledge and understanding of the unmet need associated with under-recognition and under-treatment of genitourinary syndrome of menopause, providers caring for women with cancer are in a position to improve the quality of life of their patients by providing safe and effective treatments.


Assuntos
Neoplasias da Mama , Terapia de Reposição de Estrogênios/métodos , Doenças Urogenitais Femininas/terapia , Neoplasias dos Genitais Femininos , Menopausa , Administração Intravaginal , Anestésicos Locais/uso terapêutico , Sobreviventes de Câncer , Dispareunia/terapia , Disuria/terapia , Feminino , Humanos , Terapia a Laser , Lidocaína/uso terapêutico , Lipídeos/uso terapêutico , Lubrificantes/uso terapêutico , Seleção de Pacientes , Diafragma da Pelve , Modalidades de Fisioterapia
4.
Support Care Cancer ; 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31811486

RESUMO

PURPOSE: Fractional CO2 laser therapy is an emerging treatment for genitourinary syndrome of menopause (GSM). The objective of this study was to determine the feasibility and preliminary efficacy of fractional CO2 laser therapy in breast cancer survivors. METHODS: This was a single arm feasibility study of breast cancer survivors with dyspareunia and/or vaginal dryness. Participants received three treatments of fractional CO2 laser therapy at 30-day intervals and returned for a 1-month follow-up. Feasibility was defined as treatment completion without serious adverse events (SAE) in 80% of patients. We collected data on the Vaginal Assessment Scale (VAS), the Female Sexual Function Index (FSFI), the Urinary Distress Index (UDI), and SAE. RESULTS: A total of 64 patients participated in the study. The majority of women had Estrogen receptor/Progesterone receptor (ER/PR) positive/Her2neu negative (n = 37; 63%), stage I (n = 32, 54%) or II (n = 19, 32%) breast cancer. Most were receiving endocrine therapy (n = 54, 92%), most commonly aromatase inhibitors (AI; n = 40, 68%). Fifty-nine (88.1%) of those enrolled completed all treatments according to protocol with no reported SAE. No patient withdrew due to SAE. The scores of the VAS (mean Δ - 0.99; 95% CI [- 1.19, - 0.79], p < 0.001)), FSFI (mean Δ 9.67; 95% CI [7.27, 12.1], p < 0.001), and UDI (mean Δ - 8.85; 95% CI [- 12.75, - 4.75], p < 0.001)) improved from baseline to follow-up. CONCLUSION: Fractional CO2 laser treatment for breast cancer survivors is feasible and appears to reduce GSM symptoms across treatment and follow-up.

5.
Maturitas ; 130: 1-5, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31706430

RESUMO

OBJECTIVE: To determine the association between relationship distress and menopausal symptoms. STUDY DESIGN: A retrospective analysis was conducted of questionnaires completed by women 40-65 years of age seeking menopause or sexual health consultation between May, 2015 and May, 2017. MAIN OUTCOME MEASURES: Associations between menopausal symptoms assessed using the Menopause Rating Scale (MRS) and relationship distress measured on the Kansas Marital Satisfaction Scale (KMSS) were evaluated with two-sample t-tests. Linear regression was used to assess associations after adjusting for potential confounders. RESULTS: The sample of 1884 women averaged 53 years of age (SD = 6.1); most were white (95%), employed (66%), married (90%), and well-educated (≥ college graduate, 64%). Women reporting no relationship distress (KMSS ≥ 17) had less severe menopausal symptoms overall compared with women reporting relationship distress (total MRS score 13.1 vs 16.0, P < 0.001), with similar findings in each MRS domain. In multivariable analyses, this relationship persisted for total MRS scores and for psychological symptoms among women with no relationship distress, who scored an estimated 1.15 points (95% CI 0.52-1.78) lower on the total MRS and 0.82 points (95% CI 0.53-1.10) lower in the psychological symptom. CONCLUSIONS: The absence of relationship distress was associated with less severe menopausal symptoms, particularly in the psychological domain, in women presenting to a women's health clinic. Given the cross = sectional design, the direction of the relationship is unknown.


Assuntos
Relações Interpessoais , Menopausa/psicologia , Estudos Transversais , Feminino , Humanos , Menopausa/fisiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Avaliação de Sintomas
6.
J Womens Health (Larchmt) ; 28(12): 1601-1605, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31553258

RESUMO

The Clinical Update series is intended to help busy providers stay up to date with important and potentially practice changing articles that have been published on topics pertinent to the care of women. The rates of obesity and the resultant morbidities are rising worldwide, making it a high-priority health issue for the medical community. Moreover, the pathophysiology and management of obesity and visceral fat accumulation in women has important nuances, distinct from those in men. It is important to consider the effect of unique female-specific influences such as reproductive stage and pregnancy. Therefore, we have chosen to review six high-impact recent studies relating to obesity and its management in women. These include guidelines for management of obesity in pregnancy, risk of nonmelanoma skin cancer in overweight/obese women, the association of vascular fat and decline in physical function in midlife women, the predictors for weight gain in premenopausal women with early-stage breast cancer, dietary patterns and obesity in postmenopausal women, and finally, normal weight obesity and mortality risk in postmenopausal women.

7.
Menopause ; 26(12): 1425-1435, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31513091

RESUMO

OBJECTIVE: Statins are a class of drugs that competitively bind to the active site of HMG-CoA reductase enzyme, thereby inhibiting the initial steps in cholesterol synthesis. Originally approved for use in lowering serum cholesterol, a risk factor for developing atherosclerosis and coronary heart disease, statins have subsequently been noted to have myriad extrahepatic effects, including potential effects on cognition, diabetes, breast cancer, bone, and muscle. This narrative review assesses the current state of the science regarding the risks and benefits of statin therapy in women to identify areas where additional research is needed. METHODS: Basic and clinical studies were identified by searching PubMed with particular attention to inclusion of female animals, women, randomized controlled trials, and sex-specific analyses. RESULTS: Statin therapy is generally recommended to reduce the risk of cardiovascular disease. None of the current clinical guidelines, however, offer sex-specific recommendations for women due to lack of understanding of sex differences and underlying mechanisms of disease processes. In addition, conclusions regarding efficacy of treatments do not consider lipid solubility for the drug, dosing, duration of treatment, interactions with estrogen, or comorbidities. Pleiotropic effects of statins are often derived from secondary analysis of studies with cardiovascular events as primary outcomes. CONCLUSIONS: Many of the trials that have established the efficacy and safety of statins were conducted predominantly or entirely in men, with results extrapolated to women. Additional research is needed to guide clinical recommendations specific to women. : Video Summary:http://links.lww.com/MENO/A462.

9.
Menopause ; 26(10): 1110-1116, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31188286

RESUMO

OBJECTIVE: The perceptions and attitudes of menopause shared by men are largely unknown. This analysis characterized men's awareness and their understanding of their partner's menopausal transition. METHODS: A 35-question, online survey was used to assess men's perceptions and attitudes toward menopause. Men were recruited from an online research marketplace and were eligible to participate if their female partners (45-64 years old) experienced ≥1 of the following symptoms: hot flashes, night sweats, sleepless nights, difficulty sleeping, low libido, mood swings, pain during sex, or vaginal dryness. Couples either lived together full time, or, if living separately, resided together regularly two or more times a week. RESULTS: Of the 1,356 surveys sent to eligible men, 450 (33%) were completed. Most men were between 50 and 69 years (80%), married and not separated (90%), and lived with their partner full time (97%). Men were aware of the symptoms regularly experienced by their partner, with difficulty sleeping (54%) and lack of energy (49%) being frequently identified; these symptoms were attributed to menopause (26%) and/or aging (22%). Of those who were affected by symptoms (63%), most men reported they negatively impacted them (77%), their partners (70%), and relationships (56%). Men engaged in discussions with their partners regarding menopausal symptoms (72%) and believed they were somewhat/very influential (75%) in their partner's decision to seek treatment or make lifestyle adjustments. CONCLUSIONS: Overall, men are aware of their partner's menopausal transition and may influence decisions relating to symptom management. Educational interventions would further benefit men's awareness of menopause and available treatment options.Video Summary:http://links.lww.com/MENO/A424.

10.
Mayo Clin Proc ; 94(5): 842-856, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954288

RESUMO

Sexual problems are common in women of all ages. Despite their frequency and impact, female sexual dysfunctions (FSDs) are often unrecognized and untreated in clinical settings. In response, the International Society for the Study of Women's Sexual Health convened a multidisciplinary, international expert panel to develop a process of care (POC) that outlines recommendations for identification of sexual problems in women. This POC describes core and advanced competencies in FSD for clinicians who are not sexual medicine specialists and serve as caregivers of women and, therefore, is useful for clinicians with any level of competence in sexual medicine. The POC begins with the expectation of universal screening for sexual concerns, proceeds with a 4-step model (eliciting the story, naming/reframing attention to the problem, empathic witnessing of the patient's distress and the problem's impact, and referral or assessment and treatment) that accommodates all levels of engagement, and delineates a process for referral when patients' needs exceed clinician expertise. Distressing problems related to desire, arousal, and orgasm affect 12% of women across the lifespan. Low desire is the most common sexual problem, but sexual pain and other less common disorders of arousal and orgasm are also seen in clinical practice. Screening is best initiated by a ubiquity statement that assures the patient that sexual concerns are common and can be revealed. Patient-centered communication skills facilitate and optimize the discussion. The goal of the POC is to provide guidance to clinicians regarding screening, education, management, and referral for women with sexual problems.


Assuntos
Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Saúde Sexual/normas , Saúde da Mulher/normas , Competência Clínica , Empatia , Feminino , Humanos , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/terapia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/terapia , Sociedades Médicas
11.
J Sex Med ; 16(6): 763-766, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31010782

RESUMO

BACKGROUND: Vaginal diazepam is frequently used to treat pelvic floor tension myalgia and pelvic pain despite limited knowledge of systemic absorption. AIM: To determine the pharmacokinetic and adverse event profile of diazepam vaginal suppositories. METHODS: We used a prospective pharmacokinetic design with repeated assessments of diazepam levels. Eight healthy volunteers were administered a 10-mg compounded vaginal diazepam suppository in the outpatient gynecologic clinic. Serum samples were collected at 0, 45, 90, 120, and 180 minutes; 8, 24, and 72 hours; and 1 week following administration of a 10-mg vaginal suppository. The occurrence of adverse events was assessed using the alternate step and tandem walk tests, the Brief Confusion Assessment Method, and numerical ratings. Plasma concentrations of diazepam and active long-acting metabolites were measured. Pharmacokinetic parameters were calculated by standard noncompartmental methods. RESULTS: The mean peak diazepam concentration (Cmax) of 31.0 ng/mL was detected at a mean time (Tmax) of 3.1 hours after suppository placement. The bioavailability was found to be 70.5%, and the mean terminal elimination half-life was 82 hours. The plasma levels of temazepam and nordiazepam peaked at 0.8 ng/mL at 29 hours and 6.4 ng/mL at 132 hours, respectively. Fatigue was reported by 3 of 8 participants. CLINICAL IMPLICATIONS: Serum plasma concentrations of vaginally administered diazepam are low; however the half-life is prolonged. STRENGTHS & LIMITATIONS: Strengths include use of inclusion and exclusion criteria aimed at mitigating clinical factors that could adversely impact diazepam absorption and metabolism, and the use of an ultrasensitive LC-MS/MS assay. Limitations included the lack of addressing the efficacy of vaginal diazepam in lieu of performing a pure pharmacokinetic study with healthy participants. CONCLUSION: Vaginal administration of diazepam results in lower peak serum plasma concentration, longer time to peak concentration, and lower bioavailability than standard oral use. Providers should be aware that with diazepam's long half-life, accumulating levels would occur with chronic daily doses, and steady-state levels would not be reached for up to 1 week. This profile would favor intermittent use to allow participation in physical therapy and intimacy. Larish AM, Dickson RR, Kudgus RA, et al. Vaginal Diazepam for Nonrelaxing Pelvic Floor Dysfunction: The Pharmacokinetic Profile. J Sex Med 2019;16;763-766.

12.
Mayo Clin Proc ; 94(2): 242-253, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30711122

RESUMO

OBJECTIVE: To evaluate the knowledge of and nature of training for menopause management in postgraduate residents. PARTICIPANTS AND METHODS: A cross-sectional, anonymous survey was e-mailed to trainees at all postgraduate levels in family medicine, internal medicine, and obstetrics and gynecology at US residency programs between January 11, and July 4, 2017. The survey was adapted from an existing instrument and included questions regarding knowledge of hormone therapy (HT) and other menopause management strategies, availability and type of training in menopause medicine, and demographic information. RESULTS: Of the 703 surveys sent, a total of 183 residents representing 20 US residency programs responded (26.0% response rate). Most trainees were between 26 and 30 years of age (133 of 172 [77.3%]), female (114 of 173 [65.9%]), and believed it was important or very important to be trained to manage menopause (165 of 176 [93.8%]). Although most respondents answered some of the menopause competency questions correctly, important gaps were identified. Of 183 participants, 63 (34.4%) indicated they would not offer HT to a symptomatic, newly menopausal woman without contraindications, and only 71 (38.7%) indicated they would prescribe HT until the natural age of menopause to a prematurely menopausal woman. Of 177 respondents, 36 (20.3%) reported not receiving any menopause lectures during residency, and only 12 of 177 (6.8%) reported feeling adequately prepared to manage women experiencing menopause. CONCLUSION: Family medicine, internal medicine, and obstetrics and gynecology residency trainees recognize the importance of training in menopause management, but important knowledge gaps exist. Investing in the education of future clinicians to provide evidence-based, comprehensive menopause management for the growing population of midlife women is a priority.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/normas , Ginecologia/educação , Medicina Interna/educação , Internato e Residência , Menopausa , Obstetrícia/educação , Adulto , Estudos Transversais , Gerenciamento Clínico , Avaliação Educacional , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Estudantes de Medicina , Estados Unidos , Adulto Jovem
14.
Sex Med ; 7(2): 162-168, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30674443

RESUMO

INTRODUCTION: Sexual dysfunction is a common problem in women and the nature of its association with alcohol use remains unclear. AIM: To explore the association between alcohol use and female sexual dysfunction (FSD). METHODS: Associations between self-reported drinking and sexual function were evaluated in 2,253 women presenting for consultation to a women's health specialty clinic. A short version of the Alcohol Use Disorders Identification Test (AUDIT-C) was used to evaluate alcohol use. Women with an AUDIT-C ≥3 were considered at risk for hazardous drinking. Multivariable regression, controlling for depression, anxiety, and abuse (childhood and recent), was used to assess the association between alcohol consumption and FSD (defined as a Female Sexual Function Index [FSFI] ≤26.55 and Female Sexual Distress Scale [FSDS] ≥11) in sexually active women. MAIN OUTCOME MEASURE: The main study outcome measure was the presence of FSD as defined by a score ≤26.55 on the FSFI and ≥11 on the FSDS. RESULTS: 57% of the 1,649 sexually active women were classified as having FSD; 80% reported any alcohol use and 38% reported drinking patterns with the potential to be hazardous. The women at risk for hazardous drinking had significantly higher FSFI domain scores indicating better sexual function (P ≤ .001). However, in multivariable analyses, there was no significant difference in the rates of FSD across alcohol use categories in women. CONCLUSION: In women presenting for consultation to a women's health specialty clinic, an association between alcohol use and FSFI scores was seen, in which greater risk of hazardous drinking was associated with better sexual function scores. However, when sexual distress was included to define sexual dysfunction, those with FSD were not at higher risk of hazardous drinking. Given the complex nature of FSD, additional study is needed to further clarify these relationships. Kling JM, Sidhu K, Rullo J, et al. Association Between Alcohol Use and Female Sexual Dysfunction From the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS). Sex Med 2019;7:162-168.

15.
J Womens Health (Larchmt) ; 28(3): 302-313, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30204537

RESUMO

BACKGROUND: In recently updated breast cancer screening guidelines, the American Cancer Society (ACS) and United States Preventive Services Task Force (USPSTF) recommended increasing mammography screening intervals for various age groups. In addition, ACS does not recommend clinical breast examination (CBE) for routine screening among average-risk women. Our study explores women's attitudes regarding screening mammography and CBE and evaluates the impact of the updated USPSTF and ACS guidelines on these attitudes. MATERIALS AND METHODS: Six hundred fourteen patients presenting to Mayo Clinic, Arizona and Minnesota, in July 2016 completed a self-administered survey, which included a summary of the updated guidelines. RESULTS: A majority of the 555 women who fit the inclusion criteria reported that CBE and mammogram are useful in detecting breast cancer and should be performed annually, and 51% of participants were unaware of the updated guidelines. Before reviewing the guidelines, 77% believed yearly CBE and 76% believed yearly mammogram was needed for routine screening. After reviewing the guidelines, the percentage of women who planned to continue with yearly CBE and mammogram decreased significantly to 61% and 64%, respectively (p < 0.001 and p < 0.001). Nearly half the participants (48%) believed the most influential reason for the guideline change was to decrease healthcare spending. CONCLUSION: Breast cancer screening is well received among patients, and a majority of surveyed women were unaware of recent guideline changes. After reviewing the guidelines, there was a significant downward shift in intended screening frequency, although the majority still planned to undergo annual screening. Informing women about updated evidence-based guidelines may influence their knowledge, preferences, and opinions.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/normas , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Comitês Consultivos , Fatores Etários , Idoso , American Cancer Society , Arizona , Estudos Transversais , Feminino , Humanos , Mamografia/normas , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Minnesota , Inquéritos e Questionários
18.
Maturitas ; 117: 64-77, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30314564

RESUMO

OBJECTIVES: We investigated the association of personal, reproductive, and familial characteristics with bilateral oophorectomy performed for nonmalignant indications in a US population. STUDY DESIGN: In an established cohort study, we used the records-linkage system of the Rochester Epidemiology Project (REP http://www.rochesterproject.org) to identify 1653 premenopausal women who underwent bilateral oophorectomy in Olmsted County, Minnesota between 1988 and 2007 for a nonmalignant indication. Each woman was matched by age (±1 year) to a population-based referent woman who had not undergone bilateral oophorectomy as of the index date. We used case-control analyses to investigate several characteristics associated with bilateral oophorectomy. Odds ratios and their 95% confidence intervals were adjusted for race, education, and income. RESULTS: In the overall analyses, infertility was more common in women who underwent bilateral oophorectomy than in the controls, whereas use of oral contraceptives, a history of breast feeding, and fibrocystic breast disease were less common. The women who underwent bilateral oophorectomy weighed more than controls, had a higher body mass index and were younger at menarche. The associations were more pronounced for women who underwent the bilateral oophorectomy before age 46 years, and some associations were different for women with or without a benign ovarian indication. Reported family histories of uterine and other cancers were more common in women without a benign ovarian indication. CONCLUSIONS: We identified a number of personal, reproductive, and familial characteristics that were associated with bilateral oophorectomy over a 20-year period. Our historical findings may help inform decision-making about oophorectomy in the future.


Assuntos
Ovariectomia , Pré-Menopausa , Adulto , Índice de Massa Corporal , Aleitamento Materno , Estudos de Casos e Controles , Características da Família , Feminino , Doença da Mama Fibrocística/epidemiologia , Humanos , Anamnese , Menarca , Pessoa de Meia-Idade , Minnesota/epidemiologia , Razão de Chances , Reprodução
19.
Physiology (Bethesda) ; 33(6): 374-383, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30303778

RESUMO

Bilateral oophorectomy in premenopausal women is a unique condition causing the abrupt and premature loss of ovarian hormones, primarily estrogen. Bilateral oophorectomy causes an alteration of several fundamental aging processes at the cellular, tissue, organ, and system levels, leading to multimorbidity, frailty, and reduced survival. However, many questions remain unanswered.


Assuntos
Envelhecimento/metabolismo , Hormônios Esteroides Gonadais/metabolismo , Ovário/metabolismo , Animais , Feminino , Humanos
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