Intensidad del síndrome vasomotor y su relación con la función endotelial en mujeres de edad mediana / Intensity of the vasomotor syndrome and its relation with endothelial function in middle age women

Introducción: El síndrome vasomotor constituye la manifestación clínica más frecuente de la transición menopaúsica y a menudo se asocia con cambios en la función endotelial. Objetivo: Determinar la relación entre la intensidad del síndrome vasomotor y la función endotelial en mujeres de edad mediana aparentemente sanas. Método: Estudio descriptivo transversal, en 133 mujeres de 40-59 años sin factores de riesgo cardiovascular. Se excluyeron aquellas mujeres con menopausia quirúrgica, uso previo de terapia hormonal de reemplazo seis meses antes. Se evaluó la función endotelial mediante la prueba de dilatación mediada por el flujo de la arteria braquial, y la intensidad del síndrome vasomotor mediante la escala de Pérez Piñeiro. Las mujeres fueron distribuidas en dos subgrupos: uno con disfunción endotelial y el otro con función endotelial normal. Para identificar la asociación entre variables se utilizó la prueba Kruskal-Wallis y la prueba Chi Cuadrado para evaluar la significación estadística, considerándose significativos los valores de p < 0,05. Resultados: El 63 por ciento de las mujeres presentaron síndrome vasomotor, 29 de intensidad leve, 31 moderado y muy molesto 33 mujeres. Del total de mujeres, 51 tuvieron disfunción endotelial, para un 38,3 por ciento, mostrando un promedio de dilatación dependiente del endotelio de 1,81±1,57 cm. No se encontró asociación significativa entre la intensidad del síndrome vasomotor y la función endotelial p = 0,139. Conclusiones: La intensidad del síndrome vasomotor no se relacionó con la disfunción endotelial en mujeres de edad mediana. Se necesita ampliar la muestra y realizar estudios prospectivos para identificar el daño vascular en ese grupo de mujeres(AU)

Introduction: The vasomotor syndrome is the most frequent clinical manifestation of the menopausal transition and it is often associated with changes in the endothelial function. Objective: Determine the relation among the intensity of the vasomotor syndrome and the endothelial function in apparently healthy middle age women. Methods: Descriptive cross-sectional study in 113 women of 40-59 years without cardiovascular risk factors. There were excluded women with surgical menopause, and use of replacement hormonal therapy six months before. It was assessed the endothelial function through the dilation test and the flow of the brachial artery, and the intensity of the vasomotor syndrome through the scale of Pérez. The women were organized in two groups: one group of women with endothelial dysfunction and the other of women with normal endothelial function. It was used the Kruskal-Wallis test to identify the association among variables and the chi-Square test to assess the statistical significance considering important the values of p < 0.05. Results: 63 percent of the women presented vasomotor syndrome, 29 of them of slight intensity, 31 moderate and 33 women had a very uncomfortable one. Of the total, 51 women presented endothelial dysfunction representing a 38.3 percent and showing an average of dilation dependant of endothelium of 1.81±1.57 cm. There was not found significant association among the intensity of the vasomotor syndrome and the endothelial function p = 0.139. Conclusions: The intensity of the vasomotor syndrome was not related with the endothelial dysfunction in middle age women. It is needed to expand the sample and to implement prospective studies in order to identify the vascular damage in that group of women(AU)

Experiences and Needs of Perimenopausal Women With Climacteric Symptoms in Singapore: A Qualitative Study.

Introduction: Women in the perimenopause stage may face climacteric symptoms where physical and mental challenges are experienced. The purpose of this study was to increase the understanding of the experiences and needs of perimenopausal women with climacteric symptoms in Singapore. Method: This is a descriptive qualitative study. Purposive sampling was used to recruit 20 perimenopausal women with climacteric symptoms from a tertiary public hospital in Singapore. Semistructured face-to-face interviews and thematic analysis were used for data collection and analysis, respectively. Results: Participants lacked knowledge resulting in misconceptions of the condition. Experiencing climacteric symptoms led to mixed feelings. The availability of support varied in different sources and forms. Participants seek for more information, understanding, compassion, and empathy from family members and health care professionals. Discussion: Health care professionals should provide adequate support to cater to the diverse experiences and needs of multiracial perimenopausal women with climacteric symptoms. Future research should include the perspectives of health care professionals and family members.

Qualidade de vida de mulheres climatéricas / Quality of life of climacteric stage women

OBJETIVO: Analisar a qualidade de vida de mulheres climatéricas. MÉTODOS: A pesquisa foi realizada em uma Unidade de Saúde da Família, com 75 mulheres na faixa etária de 35 a 65 anos. Trata-se de uma pesquisa epidemiológica, transversal. A coleta de dados foi realizada por meio dos formulários Questionário de Avaliação da Qualidade de Vida, Formulário Socioeconômico e Formulário Clínico. Para análise estatística, foram utilizados o programa BioEstat 5.0 e o teste estatístico qui quadrado de proporções esperadas iguais. RESULTADOS: Entre as entrevistadas, de maioria entre 35 e 45 anos, observou-se predominância de mulheres de raça parda e com companheiro marital, com menor predominância de sintomas. As mulheres que recebiam entre dois ou mais salários mínimos apresentaram menor intensidade de sintomas, ou mesmo não os apresentaram. Estes fatores podiam estar condicionados ao tipo de atividade exercida ou às condições de trabalho. Evidenciou-se significativa prevalência de falta de ar, suor, calor intenso e ansiedade, sendo o comprometimento do componente mental o mais significativo. Em pacientes com sobrepeso ou obesidade, foi observada maior intensidade de sintomas.CONCLUSÃO: Observou-se grande impacto por conta das mudanças do período do climatério na qualidade de vida das mulheres. Muitos dos sintomas apresentados são influenciados por fatores modificáveis. O controle dos sintomas por meio de mudanças de hábitos é necessário para a manutenção da qualidade de vida.(AU)

OBJECTIVE: To analyze the quality of life of climacteric stage women. METHODS: The study was conducted at a Family Health Unit, with 75 women aged 35-65 years. This is an epidemiological, cross-sectional research. Data collection was done through the forms: Questionnaire for Assessment of Quality of Life, Socioeconomic Form, and Clinical Form. For statistical analysis, the software Bioestat 5.0, and the chi-square statistical test of equal expected proportions were used. RESULTS: Among the interviewees, most of them between 35 and 45 years of age, there was a predominance of brown women with marital partners, with a lower prevalence of the symptoms. The women earning between two or more minimum wages presented less severe symptoms, or do not have them. These factors may be conditioned to the type of activity performed or to the working conditions. There was a significant prevalence of shortness of breath, sweat, intense heat and anxiety, with the most significant impairment being to the mental component. In patients with overweight or obesity, a greater severity of symptoms was observed. CONCLUSION: A great impact in the quality of life of women was observed due to the changes of the climacteric period. Many of the symptoms presented are influenced by modifiable factors. The control of symptoms through changes in habits is necessary for keeping quality of life.(AU)

[CONNECTIVE TISSUE METABOLIC FEATURES IN CLIMACTERIC SYNDROME'S PATIENTS WITH VARIOUS TYPES OF MENOPAUSE].

The purpose of the study was investigation of the connective tissue metabolic features among women with menopausal syndrome (MS) and MS, in which the arthropathic syndrome is leading and comparative analysis of the connective tissue indicators exchange during menopause caused in a surgical and natural way. We examined 70 women in total, menopause duration they accounted for 1,95±1,1 years, it came both as natural, and as a result of a surgery. The main group included 40 women with MS with leading arthropathic syndrome. The patients' modified menopausal index was calculated (MMI), the functional condition of the joints was assessed on a scale-questionnaire with the calculation of the clinical-functional index of WOMAC; the quantitative content and qualitative composition of glycosaminoglycans in the serum, the urinary excretion of hydroxyproline and uronic acids were determined. To determine the degree of deviation from the control (standard) indicators was used non-parametric Mann-Whitney criterion and factor analysis (main components method). It was revealed that all patients have an increased content of glycosaminoglycans and glycoprotein in the blood, which corresponds to the general age-related rearrangement of connective tissue metabolism, but the patients of the main group have more expressed indictors, which corresponds to more severe dystrophic changes and the severity of clinical symptoms. Redistribution of the fractional composition of glycosaminoglycans towards the increase of chondroitin-6 sulfate in patients of the main group indicates the presence of pre-emptive destruction of cartilage. The arthropathic syndrome availability also confirms the significant reduction CI-6s / CI-4s ratio and an increased content of chondroitin sulfates. Patients with a natural type of menopause showed more pronounced changes in connective tissue metabolites, in contrast to patients with surgical menopause еhat indicates a longer and more invasive pathologic course of natural menopause.

Fish oil and vitamin E change lipid profiles and anti-LDL-antibodies in two different ethnic groups of women transitioning through menopause / El aceite de pescado y la vitamina E modifican el perfil lipídico y los anticuerpos anti-ldl en dos grupos étnicos diferentes de mujeres en transición hacia la menopausia

Background: studies have investigated the relationship between the transition through menopause and cardiovascular diseases. White population, generally, have lower levels of traditional coronary heart risk factors, particularly dyslipidemia, hypertension, obesity, and diabetes, and lower rates of coronary heart disease mortality, than black population. Furthermore many studies have shown the cardioprotective and anti-inflammatory effects of omega-3 polyunsaturated fatty acids (eicosapentaenoic acid and docosahexaenoic acid) of marine origin. The aim of this study was to investigate the effect of omega-3 supplementation, combined or not with vitamin E, on oxidative biomarkers and lipid profiles in nonwhite and white women with dyslipidemia transitioning through menopause. Methods: a randomized, double-blind, placebo-controlled trial was conducted. Seventy-four eligible women were assigned to receive: fish oil, fish oil plus vitamin E and placebo for three months. At baseline, 45 and 90 days blood sample for biochemical variables and biomarkers of oxidative stress were taken. Socioeconomic and lifestyle variables were collected with standardized questionnaires. Results: after 90 days the fish oil plus vitamin E treated group had a significant decrease in total cholesterol and LDL-C. Furthermore, there was a decrease in anti-LDL- autoantibodies after 45 days. Plasma TBARS concentrations were increased after 90 days in the group receiving only fish oil when compared to the placebo and fish oil-vitamin E groups. All of the effects observed were independent of ethnic group. Conclusion: supplementation with fish oil and vitamin E reduced total cholesterol and LDL-C, but had opposite. effects on oxidative stress compared to supplementation with fish oil alone (AU)

Introducción: diversos estudios han investigado la relación entre la transición a la menopausia y las enfermedades cardiovasculares. Generalmente, la población de etnia blanca posee bajos niveles de factores de riesgo coronarios, particularmente dislipidemia, hipertensión, obesidad, diabetes y bajas tasas de mortalidad por enfermedades del corazón en comparación con la población de etnia negra. Además, varios estudios demostraron efectos cardioprotectores y antiinflamatorios provenientes de ácidos grasos poliinsaturados omega-3 (ácido eicosapentaenoico y ácido docosahexaenoico) de origen marino. El objetivo del estudio fue investigar el efecto de la suplementación de omega-3 combinado o no con vitamina E en biomarcadores oxidativos y perfiles lipídicos en mujeres blancas y no blancas con dislipidemia en transición hacia la menopausia. Métodos: fue realizado un estudio randomizado, duplo-ciego, placebo-controlado. Setenta y cuatro mujeres elegibles fueron escogidas para recibir: aceite de pescado, aceite de pescado con vitamina E y placebo durante tres meses. Fueron recogidas muestras de sangre en de referencia, 45 y 90 días para realizar exámenes bioquímicos y de biomarcadores para estrés oxidativo. Las variables socioeconómicas y de estilo de vida fueron recogidas por medio de cuestionarios estandarizados. Resultados: después de 90 días, el grupo tratado con aceite de pescado con vitamina E tuvo una disminución significativa para colesterol total y LDL-C. Además, hubo una disminución de anticuerpos anti-LDL después de 45 días. La concentración de plasma TBARS aumentó después de 90 días en el grupo que recibió solamente aceite de pescado, comparado con los grupos placebo y aceite de pescado con vitamina E. Todos los efectos observados fueron independientes del grupo étnico. Conclusión: la suplementación con aceite de pescado y vitamina E redujo el colesterol total y LDL-C, pero tuvo un efecto opuesto en el estrés oxidativo comparado con la suplementación solamente con aceite de pescado (AU)

Intervenciones de enfermería para la atención de la mujer en el proceso del climaterio y la menopausia, aplicada en el primer nivel de atención / Nursing interventions for the care of women in menopause and menopause process applied at three levels of care

Introducción: La menopausia es el resultado de la pérdida de la actividad folicular del ovario . En México el aumento de la esperanza de vida nos sitúa ante un nuevo perfil epidemiológico, se espera que para el año 2035, una de cada 3 mujeres estará en la etapa del climaterio o menopausia . El objetivo de esta Guía de Práctica Clínica (GPC) es establecer un referente nacional para generar intervenciones de enfermería en el cuidado de la mujer en el proceso de climaterio y menopausia. Metodología: La búsqueda sistemática de información se enfocó en documentos relacionados con el tema, intervenciones de enfermería en el climaterio y menopausia, para dar respuesta a las preguntas estructuradas, a partir de las climacteric, menopause, postmenopause, premenopause, diagnosis, etiology, metabolism, psychology, complications, therapy, drug effects. Se utilizaron los buscadores PUBMED, LILACS, CINAHL y TRIP DATABASE. Las recomendaciones se tomaron de GPC internacionales, meta-análisis, ensayos clínicos aleatorizados y estudios observaciones. La información se expresa en niveles de evidencia (E) y grado de recomendación (R) de acuerdo al características del diseño y tipo de estudio.Resultados: Esta GPC ofrece evidencia sobre las intervenciones del profesional de enfermería al cuidado de la mujer en el proceso de climaterio y menopausia, para la promoción de la salud, detección oportuna y limitación de daños y riesgos en el climaterio y menopausia. Conclusión: La aplicación de la GPC permite homogeneizar criterios en el cuidado del climaterio y la menopausia para otorgar una atención con calidad.

Introduction: Menopause is the result of loss of ovarian follicular activity. In Mexico the increase in life expectancy presents us with a new epidemiological profile, it is expected that by the year 2035, one out of every 3 women will be in menopause or climacteric. The objective of this Clinical Practice Guideline (CPG) is to establish a national benchmark to generate nursing interventions in the care of women in the process of menopause and menopause.Methodology: The systematic search for information focused on related subject, nursing interventions in climacteric and menopause, to respond to structured questions from keywords documents: climacteric, menopause, postmenopause, premenopause, diagnosis, etiology, metabolism, psychology, complications, therapy, drug effects. the PUBMED, LILACS, CINAHL and TRIP DATABASE searchers were used. The recommendations were taken from international GPC, meta-analyzes, randomized trials and observational studies. The information is expressed in levels of evidence (E) and grade of recommendation (R) according to the characteristics of the design and type of study.Results: This CPG provides evidence on interventions nurse to care for women in menopause and menopause process, for health promotion, early detection and damage limitation and risks in the climacteric and menopause. Conclusion: The application of the GPC allows homogenize criteria in the care of climacteric and menopause to provide quality care.

Introduction: La ménopause est le résultat de la perte de l'activité folliculaire ovarienne. Au Mexique, l'augmentation de l'espérance de vie nous présente un nouveau profil épidémiologique, il est prévu que d'ici l'an 2035, une personne sur 3 femmes seront en ménopause ou climatérique. L'objectif de ce guide de pratique clinique (CPG) est d'établir une référence nationale pour générer des interventions de soins infirmiers dans les soins des femmes dans le processus de la ménopause et de la ménopause.Méthodologie: La recherche systématique de l'information axée sur sujet connexe, les interventions infirmières en climatère et la ménopause, pour répondre à des questions structurées à partir des mots-clés: documents climatérique, la ménopause, la postménopause, la préménopause, le diagnostic, effets étiologie, le métabolisme, la psychologie, les complications, la thérapie, la drogue. PubMed, LILACS, CINAHL et TRIP chercheurs DATABASE ont été utilisés. Les recommandations ont été prises à partir de GPC, les méta-analyses internationales, des essais randomisés et des études d'observation. L'information est exprimée en niveaux de preuve (E) et la teneur de la recommandation (R) en fonction des caractéristiques de la conception et le type d'étude. Résultats: Ce CPG fournit la preuve sur les interventions infirmières aux soins pour les femmes en ménopause et le processus de la ménopause, pour la promotion de la santé, la détection précoce et la limitation des dommages et des risques dans la ménopause et la ménopause.Conclusion: L'application de la GPC permet d'homogénéiser les critères de la prise en charge de la ménopause et de la ménopause pour fournir des soins de qualité.

Função sexual e fatores associados à disfunção sexual em mulheres no climatério / Sexual function and factors associated with sexual dysfunction in climacteric women

OBJETIVO: Avaliar a função sexual e os fatores associados à disfunção sexual de mulheres no período do climatério. MÉTODOS: Foi realizado um estudo de corte transversal incluindo 173 mulheres, na faixa etária de 35 a 65 anos, com parceiro fixo nos últimos 6 meses, alfabetizadas, sem comprometimento cognitivo e com atividade sexual há pelo menos 6 meses. O instrumento utilizado para avaliar o desempenho sexual foi o Quociente Sexual, versão feminina. A associação entre disfunção sexual e dados sociodemográficos, antecedentes pessoais e obstétricos e história sexual foi realizada por meio do teste do χ2 de Pearson e da força de associação, por meio do odds ratio (OR) com intervalo de confiança de 95% (IC95%). RESULTADOS: Neste estudo, 46,2% das mulheres apresentaram disfunção sexual. Houve uma diminuição da chance de disfunção sexual para a faixa etária entre 35 e 49 anos (OR=0,3; IC95% 0,2–0,6) e para as mulheres que se sentiam à vontade para falar sobre sexo (OR=0,5; IC95% 0,2–0,8). Entretanto, presença de osteoporose (OR=3,3; IC95% 1,5–7,6), incontinência urinária (OR=2,0; IC95% 1,1–3,7) e correções cirúrgicas do assoalho pélvico (OR=2,2; IC95% 1,1–4,5) elevaram essa chance. CONCLUSÕES: A frequência de disfunção sexual em mulheres na faixa etária entre 35 e 65 anos foi 46,2% e fatores como osteoporose, incontinência urinária e correções cirúrgicas do assoalho pélvico aumentaram a chance de disfunção sexual. .

PURPOSE: To evaluate the sexual function and factors associated with sexual dysfunction in climacteric women. METHODS: A cross-sectional study was conducted on 173 women aged 35 to 65 years old, with a steady partner during the last 6 months, who are literate, without cognitive impairment, and with sexual activity for at least 6 months. The instrument used to assess sexual performance was the Sexual Quotient, female version. The association between sexual dysfunction and sociodemographic data, personal, obstetric and sexual history was determined by Pearson's χ2 test and strength of association by the odds ratio (OR) with a 95% confidence interval (95%CI). RESULTS: In this study, 46.2% of the women reported sexual dysfunction. There was a decrease in the chance of sexual dysfunction for the age group between 35 and 49 years old (OR=0.3; 95%CI 0.2–0.6) and for women who felt comfortable talking about sex (OR=0.5; 95%CI 0.2–0.8). However, the presence of osteoporosis (OR=3.3; 95%CI 1.5–7.6), urinary incontinence (OR=2.0; 95%CI 1.1–3.7), and surgical corrections of the pelvic floor (OR=2.2; 95%CI 1.1–4.5) increased this chance. CONCLUSIONS: The frequency of sexual dysfunction in women aged 35 to 65 years old was 46.2% and factors such as osteoporosis, urinary incontinence and surgical corrections of the pelvic floor increased the chance of sexual dysfunction. .

[Discriminatory analyses of climacteric syndrome patients of shen deficiency syndrome].

OBJECTIVE: To find out a set of practical,objective, and quantitative laboratory indices of climacteric syndrome (CS) patients of Shen deficiency syndrome (SDS), thus studying the essence of SDS from the perspective of laboratory medicine. METHODS: Recruited were 40 CS patients of SDS (or of SDS as main syndrome) as the SDS group, while another 40 healthy subjects were recruited as the control group. Their serum samples were collected. Serum levels of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (TESTO), estradiol (E2), prolactin (PRL), progesterone (PROG), cortisol (CORT), immunoglobulin M (IgM), immunoglobulin G (lgG), Complement 3 (C3), complement hemolysis 50% (CH50), angiotensin converting enzyme (ACE), aldosterone (ALD), serum alkaline phosphatase (ALP), and bone Gla-protein (BGP) were measured by automatic electrochemical luminescence assay analyzer, automatic chemiluminescence assay analyzer, automatic biochemistry analyzer, and automatic enzyme-linked immunosorbent assay (ELISA) analyzer. The correlation between syndrome types and laboratory indices were judged by gradual discriminant analyses. RESULTS: (1) Compared with the control group,serum levels of CORT, TESTO, E2, TT3, FT3, FT4, TSH, C3, CH50, ALP, and BGP significantly decreased in the SDS group (P < 0.01, P < 0. 05), while FSH, LH, and ACE significantly increased (P < 0.05). (2) The index with stronger capacity for diagnosing CS patients of SDS was ranked from high to low as CH50, PROG, TSH, TESTO, BGP, CORT, and C3, with their contribution rate of the discriminant function being 95.9%. (3) Discriminant analysis equation of CS patients of SDS was Y = -25.904 - 0.468CH50 + 0.002PROG + 0.182TSH + 9.690TESTO + 1.015BGP + 0.016CORT + 33.581 C3. CONCLUSIONS: (1) CS patients of SDS were closely correlated with thyroid hypothalamus-pituitary-adrenal axis, hypothalamus-pituitary-adrenal axis, renin-renin-angiotensin-aldosterone system,the immune function, and bone formation, and etc. (2) CH50 might be of a high sensibility marker for diagnosing CS patients of SDS. (3) Discriminant analysis equations of laboratory medicine index may be used in preliminary diagnosis and auxiliary certificate of CS patients of SDS.

Avaliação do risco cardiovascular em mulheres climatéricas assistidas pelo Programa Saúde da Família / Evaluation of cardiovascuar risk in climateric women aided by Family Health Program

JUSTIFICATIVA E OBJETIVO: No Brasil, ainda que os dados de morbidade sejam escassos, as informações sobre mortalidade em mulheres após a menopausa demonstram a necessidade de mais estudos. Assim, a realização do presente trabalho justifica-se pela busca de intervenções possíveis em fatores de risco cardiovascular modificáveis, considerando mudanças de estilo de vida que levem à alteração, em longo prazo, dos fenômenos cardiovasculares dessa população. O objetivo deste estudo foi comparar o risco cardiovascular em mulheres pré e pós-menopáusicas assistidas em uma unidade de saúde. MÉTODOS: Trata-se de um estudo transversal, retrospectivo, englobando 164 mulheres com média de idade de 60,73±12,60 anos, atendidas pelo Programa de Saúde da Família, no bairro Morrinhos, no Município de Montes Claros (MG). RESULTADOS: Foram apresentadas 50 mulheres na pré-menopausa e 114 mulheres na pós-menopausa. Níveis elevados de colesterol total e de LDL-colesterol foram observados nas mulheres pós-menopáusicas (59,6 e 58,8%, respectivamente), enquanto que os níveis de HDL-colesterol se mostraram inferiores ao considerado ideal em praticamente toda a população estudada (66,0% das mulheres pré-menopáusica e 61,4% das mulheres pós-menopáusicas). Quanto aos níveis de triglicerídeos, estes se apresentaram elevados efetivamente nas mulheres pós-menopáusicas (48,2%). Em relação ao perfil glicídico, apenas 28% das mulheres na pré-menopausa e 31,6% das pós-menopausadas apresentaram glicemia de jejum alterada. Os valores apontados determinam que o grupo das pacientes pós-menopáusicas (Mean Rank 92,60) possui maior risco cardiovascular quando comparado ao grupo das pré-menopáusicas (Mean Rank 59,47). CONCLUSÃO: As mulheres pós-menopáusicas apresentam maior risco de eventos cardiovasculares, conforme o escore de risco de Framingham, ao se comparar com as pré-menopáusicas...

BACKGROUND AND OBJECTIVE: In Brazil, despite scarce data, the information about morbidity and mortality in postmenopausal women demonstrate that further studies are necessary. Thus, this work is warranted by the search for possible interventions for modifiable cardiovascular risk factors, considering lifestyle changes that lead to alteration of the longterm cardiovascular phenomena of this population. The objective of this study was to compare the cardiovascular risk in pre and post-menopausal women who were attented in a health care facility. METHODS: This was a cross-sectional, retrospective study, comprising 164 women with a mean age of 60.73±12.60year, served by the Family Health Program in the District Morrinhos, in the city of Montes Claros (state of Minas Gerais). RESULTS: We presented 50 premenopausal women and 114 postmenopausal women. High levels of total cholesterol and LDL-cholesterol were observed in postmenopausal women (59.6 and 58.8%, respectively), while HDL-cholesterol was lower than that considered optimal in almost all the studied population (66.0% of premenopausal women and 61.4% of postmenopausal women). Regarding the levels of triglycerides, they were really high in postmenopausal women (48.2%). Regarding glucose profile, only 28.0% of premenopausal women and 31.6% of postmenopausal women showed impaired fasting glucose. These numbers show that the group of postmenopausal patients (Mean Rank 92.60) had higher cardiovascular risk compared to the group of premenopausal (Mean Rank 59.47) women. CONCLUSION: Postmenopausal women had increased risk of cardiovascular events, according to the Framingham risk score, when compared with premenopausal women...

Síndrome metabólica como fator de risco para disfunção sexual feminina / Metabolic syndrome as a risk factor for female sexual dysfunction

Obesidade, hipertensão, dislipidemia e diabetes tipo 2 são doenças consideradas fatores de risco para aterosclerose e disfunção endotelial e estão frequentemente presentes em indivíduos com síndrome metabólica. Inúmeros estudos comprovam a correlação entre disfunção endotelial e disfunção sexual, pelo comprometimento da oxigenação dos tecidos e subsequente dano funcional e estrutural no trato genital masculino e feminino. A prevalência da síndrome metabólica aumenta em conjunto com a epidemia de obesidade nos países ocidentais e parece ser um dos mais importantes fatores que comprometem a qualidade de vida de mulheres no climatério.Em geral, as disfunções sexuais são prevalentes em ambos os sexos, com taxas mais elevadas entre as mulheres. Por serem, obesidade e síndrome metabólica, problemas de saúde pública, modificar os fatores comportamentais de risco (sedentarismo, dieta hipercalórica) é essencial para impedir a progressão de ambas e, consequentemente, diminuira prevalência das disfunções sexuais, sobretudo na pré e pós-menopausa. A prevenção e o tratamento da síndrome metabólica inclui evitar principalmente complicações mórbidas, tratando o diabetes, a hipertensão, a dislipidemia e promovendo mudanças no estilo de vida (perda de peso, exercícios físicos, abandono do tabagismo e do sedentarismo, dieta balanceada). Atenção às disfunções sexuais também proporciona melhora na qualidade de vida em homens e mulheres. Na mulher, a terapia hormonal parece ter influência positiva nos parâmetros metabólicos. O benefício da cirurgia bariátrica sobre a função sexual feminina ainda é controverso e são necessárias novas pesquisas.

Revisiting the cutaneous impact of oral hormone replacement therapy.

Menopause is a key point moment in the specific aging process of women. It represents a universal evolution in life. Its initiation is defined by a 12-month amenorrhea following the ultimate menstrual period. It encompasses a series of different biologic and physiologic characteristics. This period of life appears to spot a decline in a series of skin functional performances initiating tissue atrophy, withering, and slackness. Any part of the skin is possibly altered, including the epidermis, dermis, hypodermis, and hair follicles. Hormone replacement therapy (oral and nonoral) and transdermal estrogen therapy represent possible specific managements for women engaged in the climacteric phase. All the current reports indicate that chronologic aging, climacteric estrogen deficiency, and adequate hormone therapy exert profound effects on various parts of the skin.

Tratamento da atrofia urogenital com a administração local de estrogênios: um estudo randomizado, controlado em mulheres no climatério e na pós-menopausa / Treatment of urogenital atrophy with the local administration of oestrogens: a randomized, controlled study in climateric and postmenopausal women

Objetivo: Avaliar a eficácia, segurança e aceitabilidade de cremes vaginais contendo promestriene (Colpotrofine®, Laboratórios Teva do Brasil) ou estriol (Ovestrion®, MSD, Brasil), em mulheres no climatério e na menopausa. Método: Estudo prospectivo, randomizado, aberto, de grupos paralelos e controlado. Locais: Instituto de Ginecologia da Universidade Federal do Rio de Janeiro e Faculdade de Medicina da Valença. Material: 80 mulheres na menopausa ou climatério, para quem o tratamento com creme vaginal de estrogênio foi indicado. Intervenção(s): As pacientes aplicaram 1g do creme vaginal, respectivo, a cada noite por 20 dias e depois uma aplicação semanal durante seis meses consecutivos. As pacientes foram distribuídas aleatoriamente sucessivamente numa proporção de 1:1, de acordo com a sua ordem de chegada: as pacientes ímpares foram designadas para receber promestriene e as com números pares foram designadas para receber estriol. Principal medida de desfecho(s): A variável de resposta primária foi a maturação do epitélio vaginal, avaliada pela citologia vaginal e medida pelo índice de Frost. Ambos os tratamentos melhoraram significativamente o trofismo do epitélio vaginal. Resultado(s): Uma melhoria acentuada (94,1%) foi indicado para pacientes do grupo promestriene por três meses, culminando na melhoria de 100% em 6 meses (p <0,0001). Houve clara melhoria dos sintomas da menopausa para ambos os grupos, sendo os tratamentos seguros e bem tolerados. Pacientes do grupo promestriene foram significativamente (p <0,038) mais satisfeitas (100%) com seu tratamento em comparação ao grupo estriol (73,33%). Conclusão(s): Ambos os tratamentos reverteram a atrofia vaginal, levando a um epitélio vaginal saudável, com destaque estatisticamente significativo para o promestriene, o que condicionou a uma melhoria da qualidade de vida.

Isolation and identification of steroidogenic peptides from calf spleen.

Since women with climacteric syndrome have significantly lower serum levels of estradiol and other related hormones, hormone replacement therapies (HRT) such as estrogen are needed to lessen symptoms. However, HRT can often cause severe adverse effects that include many cancers and stroke. Therefore, new and novel approaches to relieve climacteric syndrome still need to be developed. The aim of this study was to identify biologically active peptides from calf spleen that are responsible for stimulating biosynthesis of steroid hormone and to explore the potential of isolated peptides as therapeutic agents for menopausal syndrome. The reverse phase HPLC system was used to isolate active compounds from calf spleen extract, a cell culture system was used to screen the activity of stimulating hormone secretion, and Matrix-Assisted Laser Desorption/Ionization (MALDI) mass spectrometry was used for molecular weight determination. In the present study, two calf steroidogenic peptides, CSP-1 (MW; 4.655 kDa) and CSP-2 (MW; 8.331 kDa), were isolated and identified from calf spleen and may be putative climacteric syndrome therapeutic agents.

Osteoporose no climatério I: epidemiologia, definição, rastreio e diagnóstico / Osteoporosis in climacteric I: epidemiology, definition, screening and diagnosis

A osteoporose é um distúrbio osteometabólico caracterizado pela diminuição da densidade mineral óssea (DMO), com deterioração da microarquitetura óssea, levando a um aumento da fragilidade esquelética e do risco de fraturas, pelo comprometimento da resistência e/ou da qualidade óssea. Sua incidência pode variar de 14 a 29% em mulheres acima de 50 anos e chegar até 73% em mulheres acima de 80 anos. O objetivo do nosso artigo é estudar a osteoporose relacionada ao período pós-menopausa, mas vale ressaltar que os riscos de fraturas em algumas condições independem da quantidade de massa óssea mensurada, e sim da qualidade óssea. Atualmente dispomos de uma ferramenta muito útil, denominada FRAXtm (Fracture Risk Assessement tool), para avaliação do risco de fraturas; por meio dela, é possível calcular a probabilidadede, em dez anos, ocorrer fratura no quadril e em outros sítios, não somente pela quantidade de massa óssea, mas pela associação de outros fatores clínicos de risco. Isso poderá nos ajudar a tomar decisões clínicas quanto à prevenção e tratamento da osteoporose na mulher na pós-menopausa, na nossa prática diária, quando validada para uso no Brasil

Osteoporosis is a metabolic disorder characterized by decreased bone mineral density (BMD), with deterioration of bone microarchitecture. It leads to an increase in skeletal fragility and fracture risk, by compromising the strength and/or quality of bone. Its incidence varies from 14 to 29% in women over 50 years and reaches 73% in women over 80 years. The objective of our paper is to study osteoporosis related to post-menopause. But, it is noteworthy that the risk of fractures in some conditions depends on the bone quality. Currently, we have a very useful tool called FRAXtm (Fracture Risk Assessment tool), to evaluate the risk of fractures. The probability to occur hip fracture, or another bone fracture, in ten years is calculated, not only by the amount of bone mass, but by the association of other clinical risk factors. This may help us make clinical decisions about prevention and treatment of osteoporosis in postmenopausal women in our daily practice, when validated for use in Brazil

Reproductive depression.

Reproductive depression is the depression in women that is related to the hormonal changes of the menstrual cycle, pregnancy and the menopause and is manifested clinically as premenstrual depression, postnatal depression and climacteric depression. These three components occur in the same vulnerable women in that a woman with depression in the menopausal transition will usually have a history of premenstrual syndrome (PMS; premenstrual dysphoric disorder [PMDD]), would have been in a good mood during pregnancy and then develop postnatal depression. When the periods return the depression becomes cyclical as PMS. These three conditions are effectively treated with transdermal estrogens which should be the first-choice therapy rather than antidepressants. Estrogens can be used together with antidepressants. The critical time to prevent long-term mood problems is the correct treatment of postnatal depression. In women with low energy and libido, often a side effect of antidepressants, the addition of transdermal testosterone is useful. These women with reproductive depression are often progesterone/progestogen intolerant and a smaller dose or duration of progestogen is a necessary compromise. Alternatively a Mirena IUS or rarely a hysterectomy is required.

[Ovary: ontogenesis and aging].

The neuroendocrine mechanisms of development and aging of ovary as the main reproductive organ are considered in the review. There are the analysed data of new investigation which is connected with the role of immune cells of ovary at involutive processes in reproductive system.

Psicoterapia para a saúde sexual: resultados com um grupo de mulheres na transição menopáusica / Psicoterepia for sexual health: results with a group of women in the menopausal transition

Introdução: Estudos epidemiológicos apontam alta prevalência de dificuldades sexuais na população geral. Alterações na resposta sexual são acentuadas com a idade.Objetivo: Avaliar resultados de intervenção psicoterapêutica na saúde sexual, comparando, antes e após a intervenção, a qualidade de vida e a função sexual de mulheres na transição menopáusica.Método: Participaram 14 pacientes, que responderam aos questionários Índice de Função Sexual Feminina (Female Sexual Function Index, FSFI) e instrumento abreviado de avaliação da qualidade de vida (QV). O modelo de intervenção foi psicoterapia de grupo tematizada e de tempo limitado para disfunções sexuais, com adaptações para a transição menopáusica.Resultados: FSFI e seus domínios desejo, orgasmo e satisfação apresentaram alterações estatisticamente significantes (P < 0,05), enquanto o índice de QV não teve alterações significantes (P > 0,05). Houve tendência de aumento no índice de função sexual e correlações positivas entre escores do FSFI e QV, após a psicoterapia.Discussão: Tendência de melhora na função sexual sugere fortalecimento da saúde sexual. Componentes cognitivos e afetivos, atenção à atividade sexual e à região e responsividade genital, bem como a construção de contexto e habilidades relacionais podem ter influído na maior disponibilidade das pacientes para tal atividade. A correlação entre melhora da função sexual e qualidade de vida confirma condições emocionais como fatores de risco para as disfunções sexuais.Conclusão: Os índices de função sexual feminina, mas não o de qualidade de vida, apresentam variação estatisticamente significante após intervenção psicoterapêutica. Houve correlação positiva entre melhora da função sexual e da qualidade de vida.