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1.
Medicine (Baltimore) ; 99(38): e21917, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957311

RESUMO

BACKGROUND: Many epidemiologic studies were performed to clarify the protective effect of regular aspirin use on breast cancer risks, but the results remain inconsistent. Here, we conducted an updated meta-analysis of 38 studies to quantitatively assess the association of regular aspirin use with risk of breast cancer. METHOD: We performed a bibliographic database search in PubMed, Embase, Web of Science, Cochrane library, Scopus, and Google Scholar from January 1939 to December 2019. Relative risk (RR) estimates were extracted from eligible case-control and cohort studies and pooled using a random effects model. Subgroup analysis was conducted based on study design, aspirin exposure assessment, hormone receptor status, menopausal status, cancer stage as well as aspirin use duration or frequency. Furthermore, sensitivity and publication bias analyses were performed. RESULTS: Thirty eight studies of 1,926,742 participants involving 97,099 breast cancer cases contributed to this meta-analysis. Compared with nonusers, the aspirin users had a reduced risk of breast cancer (RR = 0.91, 95% confidence interval [CI]: 0.87-0.95, P value of significance [Psig] < .001) with heterogeneity (P value of heterogeneity [Phet] < .001, I = 82.6%). Subgroup analysis revealed a reduced risk in case-control studies (RR = 0.83, 95% CI: 0.78-0.89, Psig < .001), in hormone receptor positive tumors (RR = 0.91, 95% CI: 0.88-0.94, Psig < .001), in situ breast tumors (RR = 0.79, 95% CI: 0.71-0.88, Psig < .001), and in postmenopausal women (RR = 0.89, 95% CI: 0.83-0.96, Psig = .002). Furthermore, participants who use aspirin for >4 times/wk (RR = 0.88, 95% CI: 0.82-0.96, Psig = .003) or for >10 years (RR = 0.94, 95% CI: 0.89-0.99, Psig = .025) appeared to benefit more from the reduction in breast cancer caused by aspirin. CONCLUSIONS: Our study suggested that aspirin use might be associated with a reduced risk of breast cancer, particularly for reducing the risk of hormone receptor positive tumors or in situ breast tumors, and the risk of breast cancer in postmenopausal women.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Neoplasias da Mama/patologia , Neoplasias da Mama/prevenção & controle , Humanos , Incidência , Estadiamento de Neoplasias , Estudos Observacionais como Assunto , Pós-Menopausa , Medição de Risco
2.
Medicine (Baltimore) ; 99(36): e22048, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899065

RESUMO

Owing to hormonal changes, women experience various psychophysiological alterations over a wide age range, which may result in decreased quality of life as well as in increased risks of diseases, such as cardiovascular diseases. Although studies have been performed to research complementary methods, such as meditation, the research field still requires an adequate amount of studies for public health guidelines. This pilot cross-sectional study aims to investigate a potential association of meditation with menopausal symptoms and blood chemistry for healthy women. In this study, data of 65 healthy women (age range 25-67) including 33 meditation practitioners and 32 meditation-naïve controls were analyzed to compare the Menopausal Rating Scale scores and blood chemistry with 7 more dropouts in the blood chemistry. For blood chemistry, nine components including glucose (GLU) and high-density lipoprotein cholesterol (HDL) were measured. Two-way analysis of variance was performed by dividing the total participants into 2 groups: premenopausal and postmenopausal participants. Compared to the control group, the meditation group showed a trend of reductions in the Menopausal Rating Scale total score (P = .054) and its 2 subcomponents: depressive mood (P = .064) and irritability (P = .061). In HDL level, there was a significant interaction between group and menopausal state (P = .039) with following post hoc results: among the premenopausal participants, a significant increase in the meditation group compared to the control group (P = .005); among the control group, a significant increase in the postmenopausal compared to the premenopausal participants (P = .030). In GLU level, there was a mild interaction between group and menopausal state (P = .070) with following post hoc results: among the postmenopausal participants, a trend of increase in the control group compared to the meditation group (P = .081); among the control group, a significant increase in the postmenopausal compared to the premenopausal participants (P = .040). Our research suggests a potential association of practicing meditation with alleviations in menopausal symptoms and changes in blood chemistry, warranting further studies with a longitudinal study design and larger populations to understand the underlying causal relationships.


Assuntos
Análise Química do Sangue/métodos , Meditação/métodos , Menopausa/sangue , Menopausa/psicologia , Adulto , Glicemia , Estudos de Casos e Controles , HDL-Colesterol/sangue , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Menopausa/fisiologia , Pessoa de Meia-Idade , Pós-Menopausa/sangue , Pós-Menopausa/psicologia , Pré-Menopausa/sangue , Pré-Menopausa/psicologia , Qualidade de Vida
3.
Maturitas ; 140: 49-54, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32972635

RESUMO

OBJECTIVE: To compare the effects of a 12-week course of 5%Pueraria mirifica gel and placebo gel on the prevalence of bacterial vaginosis, vaginal fungi, vaginal pH, vaginal health index (VHI), and genitourinary symptoms in postmenopausal women. STUDY DESIGN: In a randomized, double-blinded, placebo-controlled study (TCTR20160517002), 60 postmenopausal women were randomly assigned to a 12-week course of eitherP. mirifica gel or identical placebo gel. MAIN OUTCOME MEASURE: Vaginal Nugent score, fungal culture, pH, VHI, and genitourinary symptoms were evaluated at baseline and after 12 weeks of treatment. RESULTS: After 12 weeks of treatment, the proportion of participants with an abnormal Nugent score in the P. mirifica and the placebo groups were 6.7 % (2/30) and 23.3 % (7/30), respectively (p =  0.006). The mean changes in Nugent scores and VHI were significantly higher in the P. mirifica group (p <  0.05). There were no significant decreases in the prevalence of symptoms between the two groups after treatment (p > 0.05). CONCLUSION: A 12-week course of treatment with 5 % P. mirifica vaginal gel in postmenopausal women with GSM has been proved to be effective in reducing indicators of bacterial vaginosis compared with placebo gel. Nevertheless, the effect on alleviating genital symptoms was not demonstrated.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Doenças Urogenitais Femininas/tratamento farmacológico , Micoses/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Pueraria , Método Duplo-Cego , Feminino , Humanos , Concentração de Íons de Hidrogênio , Pessoa de Meia-Idade , Fitoterapia , Pós-Menopausa , Síndrome , Vagina/química , Vagina/efeitos dos fármacos , Cremes, Espumas e Géis Vaginais/uso terapêutico
4.
Revista Digital de Postgrado ; 9(2): 227, ago. 2020. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1103383

RESUMO

Evaluar los efectos de la terapia hormonal (TH) con Drospírenona (DRSP)/17 ß -estradiol (E2), sobre los parámetros del Síndrome Metabólico (SM) en pacientes postmenopáusicas. Métodos: Investigación comparativa y aplicada, con diseño cuasi experimental, de casos y controles a simple ciego, prospectivo y de campo; realizada en la Consulta de Ginecología. Hospital "Dr. Manuel Noriega Trigo". San Francisco, Estado Zulia. Venezuela. Participaron 120 mujeres separadas al azar para recibir la combinación DRSP/E2 (Grupo A) o un placebo (Grupo B). Se evaluaron los componentes del SM antes y posterior a 6 meses de haber recibido la TH. Resultados: Se encontró una alta prevalencia de SM en ambos grupos antes de recibir el tratamiento (53,3% y 48%; grupo A y B respectivamente). Posterior al tratamiento, DRSP/E2 al compararse con un placebo, redujo significativamente tanto la prevalencia del SM como el riesgo de padecerlo (21,7% versus 48,3%, OR [IC95%]= 0,29 [0,13-0,65]; p < 0.001), con reducción significativa (p< 0.001) de la hipertensión arterial, glicemia basal alterada, hipertrigliceridemia y obesidad central; además de una reducción significativa de los síntomas vasomotores, síntomas psicológicos e incontinencia urinaria (p< 0.001). En el grupo B la prevalencia del SM se mantuvo sin cambios, salvo para la glicemia basal alterada y los síntomas vasomotores y psicológicos que mostraron una reducción significativa (p< 0.001). Conclusión: DRSP/E2 (2mg/1 mg) demostró ser eficaz luego de 6 meses de tratamiento tanto para el control de los parámetros que definen al SM; con pocos y leves efectos indeseados(AU)


To assess the effects of hormone therapy (HT) with drospirenone (DRSP)/17 ß -estradiol (E2) on the parameters of the metabolic syndrome (MS) in postmenopausal patients. Methods: We performed a comparative and applied research, with quasiexperimental, case-control, single-blind, prospective and field design. The study was realized in the Gynecology consultation. Hospital "Dr. Manuel Noriega Trigo". San Francisco, Estado Zulia. Venezuela. 120 women were included, they were separated to receive either the combination DRSP/E2 (Group A) or placebo (Group B). We assess MS components before and ather 6 months of receiving HT. Results: We found a high prevalence in both groups before receiving treatment (53.3% and 48%, group A and B respectively). A ther treatment, DRSP/E2 when compared to placebo, significantly reduced both the prevalence of MS as the risk of setting it (21.7% versus 48.3%, OR [95%] = 0.29 [0.13-0.65] p <0.001), with a significant reduction (p <0.001) of hypertension, impaired fasting glucose, hypertriglyceridemia, central obesity; and a significant reduction in vasomotor symptoms, psychological symptoms and urinary incontinence (p <0.001). In group B the prevalence of MS was unchanged, except for impaired fasting glycemia and vasomotor and psychological symptoms showed a significant reduction (p <0.001). Conclusion: DRSP/E2 (2mg /1mg), proved to be effective a ther 6 months of treatment both for the control of the parameters that define the SM, with few and mild side effects(AU)


Assuntos
Humanos , Feminino , Progestinas/uso terapêutico , Terapia de Reposição Hormonal , Síndrome Metabólica/fisiopatologia , Estradiol/uso terapêutico , Pós-Menopausa , Endocrinologia , Ginecologia
5.
Cleve Clin J Med ; 87(8): 457, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737039
6.
Mymensingh Med J ; 29(3): 509-515, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844787

RESUMO

Menopause is the permanent cessation of menstruation at the end of the reproductive life due to loss of ovarian follicular activity. The prevalence of hypertension in women increases after menopause, suggesting that an absence of female gonadal steroids may represent a major risk factor for postmenopausal hypertension. Menopause is the phase from where bone mineralization becomes critics because of various physiological and hormonal changes. Estrogen deficiency and age related processes alter the rate of calcium turnover in bone that the ageing women face. Both systolic and diastolic blood pressure is significantly higher and serum calcium level is significantly lower among post menopausal women as compared with reproductive aged women. The objective of the study was to assess the blood pressure and serum calcium level changes in healthy postmenopausal women in order to compare this parameter with healthy reproductive aged women. This comparative study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. Two hundred healthy women (100 female were postmenopausal as study group and 100 female were reproductive aged women as control group) aged between 25 to 65 years were enrolled in this study. Blood pressure was measured by indirect auscultatory method with an aneroid sphygmomanometer and serum calcium level of the individual was measured by enzymatic colorimetric method with o-cresoftaline-complexon. Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean value ±SD of blood pressure was higher and serum calcium level was lower in postmenopausal group in comparison to the reproductive women group. This study concludes, blood pressure increases and serum calcium level decreases in postmenopausal women.


Assuntos
Hipertensão , Pós-Menopausa , Adulto , Idoso , Bangladesh , Pressão Sanguínea , Cálcio , Feminino , Humanos , Pessoa de Meia-Idade
7.
Life Sci ; 258: 118030, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32739470

RESUMO

The risk of atherosclerosis (AS) ascends among post-menopausal women, while current hormone replacement therapy exerts several adverse effects. Alisol B 23-acetate (AB23A), a tetracyclic triterpenoid isolated from the rhizome of Alisma orientale, was reported to show multiple physiological activities, including regulating lipid metabolism. According to molecular docking analysis, it was predicted to bind with estrogen receptor α (ERα). In this study, we aimed to observe the effect of AB23A on preventing post-menopausal AS and explore whether the mechanism was mediated by ERα. In vitro, free fatty acid (FFA) was applied to induce the abnormal lipid metabolism of L02 cells. In vivo, the ApoE-/- mice were ovariectomized to mimic the cessation of estrogen. The high-fat diet was also given to induce post-menopausal AS. We demonstrated AB23A attenuated the accumulation of total cholesterol and triglyceride induced by free fatty acids in hepatocytes. In high-fat diet-ovariectomy-treated ApoE-/- mice, AB23A eliminated lipids in blood and liver. AB23A not only reduced the synthesis of proprotein convertase subtilisin/kexin type 9 (PCSK9) through sterol-regulatory element binding proteins (SREBPs) but also suppressed the secretion of PCSK9 through silent information regulator 1 (SIRT1). Notably, AB23A promoted the expression of ERα in vivo and in vitro. The both ERα inhibitor and ERα siRNA were also applied in confirming whether the hepatic protective effect of AB23A was mediated by ERα. We found that AB23A significantly promoted the expression of ERα. AB23A could inhibit the synthesis and secretion of PCSK9 through ERα, lower the accumulation of triglyceride and cholesterol, and prevent post-menopausal AS.


Assuntos
Aterosclerose/patologia , Colestenonas/farmacologia , Receptor alfa de Estrogênio/metabolismo , Metabolismo dos Lipídeos/efeitos dos fármacos , Pós-Menopausa/efeitos dos fármacos , Animais , Aterosclerose/genética , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Colestenonas/química , Dieta Hiperlipídica , Ácidos Graxos/metabolismo , Feminino , Lipoproteínas LDL/metabolismo , Camundongos , Ovariectomia , Regiões Promotoras Genéticas/genética , Pró-Proteína Convertase 9/genética , Pró-Proteína Convertase 9/metabolismo , Receptores de LDL/genética , Receptores de LDL/metabolismo , Sirtuína 1/metabolismo , Proteínas de Ligação a Elemento Regulador de Esterol/genética , Proteínas de Ligação a Elemento Regulador de Esterol/metabolismo , Regulação para Cima/efeitos dos fármacos
8.
PLoS One ; 15(8): e0237454, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764814

RESUMO

There is growing interest in "osteosarcopenia" as the coexistence of osteoporosis and sarcopenia exacerbates negative outcomes. However, limited information is available regarding the risk factors of osteosarcopenia development in patients with osteoporosis. Therefore, we retrospectively reviewed 276 consecutive patients with postmenopausal osteoporosis who regularly visited Showa University Hospital. Patients were eligible for the study if they were ≥65 years of age and underwent dual-energy X-ray absorptiometry, blood sampling, and physical performance assessment. Patients were divided into the osteosarcopenia and osteoporosis alone groups according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Of the 276 patients with osteoporosis, 54 patients (19.6%) had osteosarcopenia. Patients in the osteosarcopenia group had a greater risk of frailty than did those in the osteoporosis alone group (odds ratio 2.33; 95% confidence interval, 1.13-4.80, P = 0.028). Low body mass index seemed to be the strongest factor related to the development of osteosarcopenia, and none of the patients in the osteosarcopenia group were obese (BMI ≥27.5 kg/m2). Multiple logistic analyses revealed that patients aged 65-74 years who had comorbidities such as kidney dysfunction and high levels of HbA1c were at risk of developing osteosarcopenia. Thus, we strongly recommend the assessment of the key components of the diagnosis of osteosarcopenia in an osteoporosis clinic for patients with low body mass index. Furthermore, appropriate assessments, including comorbidities, will help in identifying patients at greater risk of developing osteosarcopenia.


Assuntos
Osteoporose/diagnóstico , Osteossarcoma/diagnóstico , Absorciometria de Fóton , Acidentes por Quedas/estatística & dados numéricos , Idoso , Índice de Massa Corporal , Feminino , Fragilidade/complicações , Fragilidade/diagnóstico , Humanos , Fator de Crescimento Insulin-Like I/análise , Modelos Logísticos , Força Muscular , Razão de Chances , Osteoporose/complicações , Osteossarcoma/complicações , Pós-Menopausa , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/diagnóstico
9.
JAMA ; 324(4): 369-380, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32721007

RESUMO

Importance: The influence of menopausal hormone therapy on breast cancer remains unsettled with discordant findings from observational studies and randomized clinical trials. Objective: To assess the association of prior randomized use of estrogen plus progestin or prior randomized use of estrogen alone with breast cancer incidence and mortality in the Women's Health Initiative clinical trials. Design, Setting, and Participants: Long-term follow-up of 2 placebo-controlled randomized clinical trials that involved 27 347 postmenopausal women aged 50 through 79 years with no prior breast cancer and negative baseline screening mammogram. Women were enrolled at 40 US centers from 1993 to 1998 with follow-up through December 31, 2017. Interventions: In the trial involving 16 608 women with a uterus, 8506 were randomized to receive 0.625 mg/d of conjugated equine estrogen (CEE) plus 2.5 mg/d of medroxyprogesterone acetate (MPA) and 8102, placebo. In the trial involving 10 739 women with prior hysterectomy, 5310 were randomized to receive 0.625 mg/d of CEE alone and 5429, placebo. The CEE-plus-MPA trial was stopped in 2002 after 5.6 years' median intervention duration, and the CEE-only trial was stopped in 2004 after 7.2 years' median intervention duration. Main Outcomes and Measures: The primary outcome was breast cancer incidence (protocol prespecified primary monitoring outcome for harm) and secondary outcomes were deaths from breast cancer and deaths after breast cancer. Results: Among 27 347 postmenopausal women who were randomized in both trials (baseline mean [SD] age, 63.4 years [7.2 years]), after more than 20 years of median cumulative follow-up, mortality information was available for more than 98%. CEE alone compared with placebo among 10 739 women with a prior hysterectomy was associated with statistically significantly lower breast cancer incidence with 238 cases (annualized rate, 0.30%) vs 296 cases (annualized rate, 0.37%; hazard ratio [HR], 0.78; 95% CI, 0.65-0.93; P = .005) and was associated with statistically significantly lower breast cancer mortality with 30 deaths (annualized mortality rate, 0.031%) vs 46 deaths (annualized mortality rate, 0.046%; HR, 0.60; 95% CI, 0.37-0.97; P = .04). In contrast, CEE plus MPA compared with placebo among 16 608 women with a uterus was associated with statistically significantly higher breast cancer incidence with 584 cases (annualized rate, 0.45%) vs 447 cases (annualized rate, 0.36%; HR, 1.28; 95% CI, 1.13-1.45; P < .001) and no significant difference in breast cancer mortality with 71 deaths (annualized mortality rate, 0.045%) vs 53 deaths (annualized mortality rate, 0.035%; HR, 1.35; 95% CI, 0.94-1.95; P= .11). Conclusions and Relevance: In this long-term follow-up study of 2 randomized trials, prior randomized use of CEE alone, compared with placebo, among women who had a previous hysterectomy, was significantly associated with lower breast cancer incidence and lower breast cancer mortality, whereas prior randomized use of CEE plus MPA, compared with placebo, among women who had an intact uterus, was significantly associated with a higher breast cancer incidence but no significant difference in breast cancer mortality.


Assuntos
Neoplasias da Mama/epidemiologia , Estrogênios Conjugados (USP)/efeitos adversos , Terapia de Reposição Hormonal/efeitos adversos , Histerectomia , Acetato de Medroxiprogesterona/efeitos adversos , Idoso , Neoplasias da Mama/induzido quimicamente , Neoplasias da Mama/mortalidade , Neoplasias da Mama/prevenção & controle , Estrogênios Conjugados (USP)/uso terapêutico , Feminino , Seguimentos , Humanos , Histerectomia/efeitos adversos , Incidência , Acetato de Medroxiprogesterona/uso terapêutico , Pessoa de Meia-Idade , Pós-Menopausa , Risco
10.
Medicine (Baltimore) ; 99(28): e20906, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664083

RESUMO

Osteoporosis (OP) is a metabolic bone disease that can cause structural changes in bone marrow cavity. Bone marrow is the hematopoietic organ of adults. Accumulating evidence has shown a close connection between bone marrow hematopoietic function and bone formation. Some studies have revealed that OP is associated with hematopoiesis. However, the relationship is not definite.This study aimed to evaluate the association between peripheral blood cell counts (white blood cells [WBC], red blood cells [RBC], platelets [PLT]), hemoglobin [HGB], and bone mineral density [BMD]) in a sample of Chinese postmenopausal women. This is a retrospective study involving 673 postmenopausal women cases. The BMD of lumbar spine and left hip joint were measured by dual-energy X-ray absorptiometry. The levels of blood cell counts and HGB were measured and analyzed.The study results showed the WBC, RBC, PLT, and HGB levels of postmenopausal women in the OP group were all higher than those in the non-osteoporosis group. Spearman linear trend analysis and partial correlation analysis demonstrated that BMD was negatively correlated with WBC, RBC, PLT, and HGB in postmenopausal women.Due to the differences between different countries and races, and there are few studies on the association of BMD with peripheral blood cell counts and HGB in Chinese Postmenopausal Women. Therefore, more large sample studies are needed.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Contagem de Células Sanguíneas/métodos , Densidade Óssea/fisiologia , Hemoglobinas/análise , Pós-Menopausa/sangue , Absorciometria de Fóton/métodos , Idoso , Contagem de Células Sanguíneas/tendências , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/fisiopatologia , Estudos de Casos e Controles , Feminino , Hematopoese/fisiologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Osteogênese/fisiologia , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 99(29): e20821, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702824

RESUMO

This study was to investigate the efficacy and safety of fulvestrant 500 mg for the treatment of hormone receptor positive advanced postmenopausal women, including ovarian ablation and investigated factors associated with prolonged time-to-treatment failure.Data from 60 women with metastatic breast cancer who were treated at Zhejiang Cancer Hospital. Patients received 500 mg (n = 60) between December 2011 and November 2012 were followed until November 2017. Main outcomes were clinical responses to fulvestrant, including best response, progressive disease, partial response, and stable disease lasting 12 months or more. Time to progression and time to progression-free-survival were also analyzed.Among the included 60 patients (mean age 47.18 years), 51 (85.0%) had received prior adjuvant therapy. During follow-up after fulvestrant treatment, the median PFS for the best response was derived as 7.0 months (inter-quartile = 4, 13.8 months). The observed median progression-free-survival time for best response was represented longer when fulvestrant was first-line treatment than when patients received prior endocrine and/or chemotherapy. Univariate analysis revealed that receiving either endocrine therapy only or endocrine therapy plus chemotherapy prior to fulvestrant treatment may be associated with median progression-free survival time to best response (P = .002, .026, .007, respectively).Fulvestrant treatment is safe and well-tolerated in women with hormone-sensitive advanced breast cancer, and first-line fulvestrant therapy increases progression-free-survival time, especially in patients without prior adjuvant treatment.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Antagonistas do Receptor de Estrogênio/uso terapêutico , Fulvestranto/uso terapêutico , Metástase Neoplásica/tratamento farmacológico , Pós-Menopausa/efeitos dos fármacos , Adulto , Antineoplásicos Hormonais/uso terapêutico , Grupo com Ancestrais do Continente Asiático/etnologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Quimioterapia Adjuvante/métodos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Intervalo Livre de Progressão , Estudos Retrospectivos , Segurança , Tempo para o Tratamento , Resultado do Tratamento
12.
Clinics (Sao Paulo) ; 75: e1768, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32609225

RESUMO

OBJECTIVES: Menopause marks the end of women's reproductive period and can lead to sarcopenia and osteoporosis (OP), increasing the risk of falls and fractures. The aim of this study is to evaluate the influence of normal and low bone mineral density (BMD) on muscular activity, observed through inflammatory edema when mapping using magnetic resonance imaging (MRI) on the quadriceps muscle of postmenopausal women. METHODS: This was a cross-sectional study involving 16 older women, who were divided into two groups: osteoporosis group (OG), older women with OP, and control group (CG), older women without OP. The groups were evaluated in terms of nuclear MRI exam before and after carrying out fatigue protocol exercises using an isokinetic dynamometer and squatting exercises. RESULTS: The results of the present study showed that in intragroup comparisons, for both groups, there was a significant increase (p<0.05) in the T2 signal of the nuclear MRI in the quadriceps muscle after carrying out exercises using both thighs. In the intergroup comparison, no statistically significant difference was observed between the OG and CG, pre- (p=0.343) and postexercise (p=0.874). CONCLUSION: The acute muscular activation of the quadriceps evaluated by T2 mapping on nuclear MRI equipment is equal in women with and without OP in the postmenopausal phase. BMD did not interfere with muscle response to exercise when muscle fatigue was reached.


Assuntos
Imagem por Ressonância Magnética/métodos , Pós-Menopausa , Músculo Quadríceps/diagnóstico por imagem , Absorciometria de Fóton , Idoso , Densidade Óssea , Estudos Transversais , Feminino , Humanos , Osteoporose Pós-Menopausa , Músculo Quadríceps/fisiopatologia
14.
Lancet Glob Health ; 8(8): e1027-e1037, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32710860

RESUMO

BACKGROUND: Breast cancer has distinct causes, prognoses, and outcomes and effects in patients at premenopausal and postmenopausal ages. We sought to assess the global burden and trends in breast cancer by menopausal status. METHODS: We did a population-based analysis of global breast cancer incidence and mortality among premenopausal and postmenopausal women. Menopausal status was defined using age as a proxy, whereby breast cancer cases or deaths at age 50 years or older were regarded as postmenopausal. Age-standardised breast cancer incidence and mortality in 2018 were calculated using GLOBOCAN data. Incidence trends for 1998-2012 were assessed in 44 populations from 41 countries using the Cancer in Five Continents plus database, by calculating the annual average percent change. FINDINGS: Approximately 645 000 premenopausal and 1·4 million postmenopausal breast cancer cases were diagnosed worldwide in 2018, with more than 130 000 and 490 000 deaths occurring in each menopausal group, respectively. Proportionally, countries with a low UNDP human development index (HDI) faced a greater burden of premenopausal breast cancer for both new cases and deaths compared with higher income countries. Countries with a very high HDI had the highest premenopausal and postmenopausal breast cancer incidence (30·6 and 253·6 cases per 100 000, respectively), whereas countries with low and medium HDI had the highest premenopausal and postmenopausal mortality, respectively (8·5 and 53·3 deaths per 100 000, respectively). When examining breast cancer trends, we noted significantly increasing age-standardised incidence rates (ASIRs) for premenopausal breast cancer in 20 of 44 populations and significantly increasing ASIRs for postmenopausal breast cancer in 24 of 44 populations. The growth exclusively at premenopausal ages largely occurred in high-income countries, whereas the increasing postmenopausal breast cancer burden was most notable in countries under transition. INTERPRETATION: We provide evidence of a rising burden of both premenopausal and postmenopausal breast cancer worldwide. Although early diagnosis and access to treatment remain crucial in low-income and middle-income countries, primary prevention efforts seeking to decrease exposure to known breast cancer risk factors are warranted in all world regions to curb the future breast cancer burden. FUNDING: None.


Assuntos
Neoplasias da Mama/epidemiologia , Saúde Global/estatística & dados numéricos , Pós-Menopausa , Pré-Menopausa , Feminino , Humanos , Incidência , Pessoa de Meia-Idade
16.
PLoS One ; 15(6): e0235478, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603379

RESUMO

OBJECTIVE: Most women live to experience menopause and will spend 4-8 years transitioning from fertile age to full menstrual stop. Biologically, reproductive ageing is a continuous process, but by convention, it is defined categorically as pre-, peri- and postmenopause; categories that are sometimes supported by measurements of sex hormones in blood samples. We aimed to develop and validate a new tool, a reproductive ageing score (RAS), that could give a simple and yet precise description of the status of reproductive ageing, without hormone measurements, to be used by health professionals and researchers. METHODS: Questionnaire data on age, menstrual regularity and menstrual frequency was provided by the large multicentre population-based RHINE cohort. A continuous reproductive ageing score was developed from these variables, using techniques of fuzzy mathematics, to generate a decimal number ranging from 0.00 (nonmenopausal) to 1.00 (postmenopausal). The RAS was then validated with sex hormone measurements (follicle stimulating hormone and 17ß-estradiol) and interview-data provided by the large population-based ECRHS cohort, using receiver-operating characteristics (ROC). RESULTS: The RAS, developed from questionnaire data of the RHINE cohort, defined with high precision and accuracy the menopausal status as confirmed by interview and hormone data in the ECRHS cohort. The area under the ROC curve was 0.91 (95% Confidence interval (CI): 0.90-0.93) to distinguish nonmenopausal women from peri- and postmenopausal women, and 0.85 (95% CI: 0.83-0.88) to distinguish postmenopausal women from nonmenopausal and perimenopausal women. CONCLUSIONS: The RAS provides a useful and valid tool for describing the status of reproductive ageing accurately, on a continuous scale from 0.00 to 1.00, based on simple questions and without requiring blood sampling. The score allows for a more precise differentiation than the conventional categorisation in pre-, peri- and postmenopause. This is useful for epidemiological research and clinical trials.


Assuntos
Envelhecimento/fisiologia , Menopausa/fisiologia , Adulto , Idoso , Estudos de Coortes , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Perimenopausa , Pós-Menopausa , Reprodução/fisiologia , Inquéritos e Questionários/estatística & dados numéricos
17.
Maturitas ; 138: 36-41, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32631586

RESUMO

BACKGROUND: Menopause is often associated with a central accumulation of body fat. This provokes insulin resistance. The resulting hyperinsulinemia may increase the risk of diabetes, cardiovascular disease and breast cancer. Long-term studies indicate that menopausal hormone therapy (MHT) reduces insulin resistance. To broaden knowledge of the mechanisms behind the influence of MHT on glucose homeostasis we focused on the direct short-term effects of MHT with oral combined estradiol and drospirenone on glucose and insulin metabolism in healthy postmenopausal women. METHODS: This randomized, placebo-controlled study recruited 80 healthy postmenopausal women. Women were randomized to treatment with estradiol 1 mg continuously combined with drospirenone 2 mg or placebo for 6-8 weeks. All participants underwent an oral glucose tolerance test (OGTT) before and after the treatment period. Glucose, insulin, fructosamine and C-peptide levels were measured in serum before and 30, 60, 90, 120 and 150 min after a 75-gram oral glucose challenge. RESULTS: After intervention, significantly higher glucose levels at 120 min (p < 0.024) and 150 min (p < 0.030) were observed in the MHT group compared with the placebo group. These glucose levels remained within the normal range. A significantly lower insulin peak serum level (p < 0.040) and a non-significantly smaller area under the curve (AUC) for insulin levels (p = 0.192) was observed in the MHT group at the end of the study period relative to baseline. No significant change in the insulin AUC in the placebo group was observed. There were no significant differences in fructosamine, HOMA-IR and C-peptide levels between the MHT group and the placebo group. CONCLUSION: This double-blind randomized study (EC/2008/694) indicates that treating healthy, postmenopausal women with 1 mg estradiol continuously combined with 2 mg drospirenone significantly decreases peak insulin levels and increases peak glucose levels during an OGTT compared to placebo. These glucose levels remained within the normal range.


Assuntos
Androstenos/uso terapêutico , Estradiol/uso terapêutico , Estrogênios/uso terapêutico , Glucose/metabolismo , Terapia de Reposição Hormonal , Insulina/metabolismo , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Administração Oral , Glicemia/análise , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Teste de Tolerância a Glucose , Humanos , Pessoa de Meia-Idade , Pós-Menopausa
18.
Arq Gastroenterol ; 57(2): 188-192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32609161

RESUMO

BACKGROUND: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.


Assuntos
Constipação Intestinal/epidemiologia , Pós-Menopausa , Adulto , Brasil/epidemiologia , Estudos Transversais , Defecação , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência
19.
Rev Med Chil ; 148(2): 145-150, 2020 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-32730490

RESUMO

BACKGROUND: Postmenopausal women have higher severity of coronary heart disease (CHD) than premenopausal women and type 2 diabetes mellitus (T2DM) is an independent risk factor. AIM: To assess the severity of CHD in pre and postmenopausal patients undergoing coronary angiography and the impact of T2DM in both groups. MATERIAL AND METHODS: A coronary angiography was performed to 707 women due to suspected CHD during 2013 and 2014. Of these, 579 were older than 55 years and were considered as postmenopausal. Factors such as hypertension, obesity, smoking, creatinine and T2DM were registered. The severity of CHD in coronary angiography was evaluated according to the number of vessels with more than 50% stenosis. RESULTS: Compared to their postmenopausal counterparts, premenopausal women had less frequency of T2DM (31% and 42% p < 0.033), hypertension (52 and 78%, p < 0.001) and alteration of renal function (11 vs. 39%, p < 0.001). Absence of coronary lesions was found in 44 and 32% of premenopausal and postmenopausal women, respectively (p < 0.01). Premenopausal women with T2DM had a higher frequency of multi-vessel disease than those without the disease (25 and 4.5%, p < 0.001). The frequency of multi-vessel disease was higher in postmenopausal than premenopausal women (24 and 11%, p < 0.01). Hypertension, T2DM and renal involvement were associated with a higher frequency multiple vessel disease. CONCLUSIONS: The severity of CHD is higher in postmenopausal women and T2DM is associated with the disease.


Assuntos
Doença da Artéria Coronariana , Diabetes Mellitus Tipo 2 , Angiografia Coronária , Feminino , Humanos , Pós-Menopausa , Pré-Menopausa , Fatores de Risco
20.
Eur J Endocrinol ; 183(4): 439-452, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32698159

RESUMO

Objective: Combining conjugated estrogens (CE) with the selective estrogen receptor modulator bazedoxifene (BZA) is a novel, orally administered menopausal therapy. We investigated the effect of CE/BZA on insulin sensitivity, energy metabolism, and serum metabolome in postmenopausal women with obesity. Design: Randomized, double-blind, crossover pilot trial with washout was conducted at Pennington Biomedical Research Center. Eight postmenopausal women (age 50-60 years, BMI 30-40 kg/m2) were randomized to 8 weeks CE/BZA or placebo. Primary outcome was insulin sensitivity (hyperinsulinemic-euglycemic clamp). Secondary outcomes included body composition (DXA); resting metabolic rate (RMR); substrate oxidation (indirect calorimetry); ectopic lipids (1H-MRS); fat cell size, adipose and skeletal muscle gene expression (biopsies); serum inflammatory markers; and serum metabolome (LC/MS). Results: CE/BZA treatment produced no detectable effect on insulin sensitivity, body composition, ectopic fat, fat cell size, or substrate oxidation, but resulted in a non-significant increase in RMR (basal: P = 0.06; high-dose clamp: P = 0.08) compared to placebo. CE/BZA increased serum high-density lipoprotein (HDL)-cholesterol. CE/BZA also increased serum diacylglycerol (DAG) and triacylglycerol (TAG) species containing long-chain saturated, mono- and polyunsaturated fatty acids (FAs) and decreased long-chain acylcarnitines, possibly reflecting increased hepatic de novo FA synthesis and esterification into TAGs for export into very low-density lipoproteins, as well as decreased FA oxidation, respectively (P < 0.05). CE/BZA increased serum phosphatidylcholines, phosphatidylethanolamines, ceramides, and sphingomyelins, possibly reflecting the increase in serum lipoproteins (P < 0.05). Conclusions: A short treatment of obese postmenopausal women with CE/BZA does not alter insulin action or ectopic fat but increases serum markers of hepatic de novo lipogenesis and TAG production.


Assuntos
Metabolismo dos Carboidratos/efeitos dos fármacos , Metabolismo Energético/efeitos dos fármacos , Estrogênios Conjugados (USP)/farmacologia , Glucose/metabolismo , Indóis/farmacologia , Metabolismo dos Lipídeos/efeitos dos fármacos , Obesidade/metabolismo , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Estudos Cross-Over , Método Duplo-Cego , Estrogênios Conjugados (USP)/uso terapêutico , Feminino , Humanos , Indóis/uso terapêutico , Pessoa de Meia-Idade , Obesidade/tratamento farmacológico , Projetos Piloto , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/metabolismo
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