Evaluación del Tratamiento Homeopático de Mujeres en Climaterio entre los 45 y 60 años con la Menopause Rating Scale (MRS) / Treatment Evaluation Homeopathic Women in Climacteric between 45 and 60 years old with Menopause Rating Scale (MRS)

La terapia hormonal es el tratamiento convencional para contrarrestar síntomas propios del climaterio; sin embargo, algunas mujeres tienen contraindicada esta terapia debido a los efectos adversos que provoca. El objetivo de este estudio fue evaluar la utilidad del tratamiento homeopático durante el climaterio con el uso de la Menopause Rating Scale (MRS) o Escala de Calificación Menopáusica. El estudio incluyó a 31 mujeres, sin problemas cardiacos, sin terapia de reemplazo hormonal y sin antecedentes de cáncer, a quienes se les aplicó el cuestionario de la MRS para obtener un puntuaje antes del tratamiento. Para determinar el tratamiento se utilizó el repertorio electrónico Radar 10.0 para Windows, con el objetivo de repertorizar los síntomas característicos de cada paciente y determinar el medicamento similar. El medicamento fue prescrito en dinamizaciones 30CH, indicando 5 gotas sublinguales cada 8 horas. La evaluación de los pacientes se llevó a cabo cada mes durante tres meses. Se realizó una evaluación final a los tres meses por comparación de puntajes de la escala inicial y final, a través de un análisis estadístico y utilizando la prueba de Wilcoxon. Lachesis trigonocephalus y Pulsatilla nigricans fueron los medicamentos indicados con mayor frecuencia, de acuerdo con los síntomas de cada paciente. La comparación del puntaje, antes y después del tratamiento, evidenció una reducción de síntomas con diferencia estadística, lo cual reflejó una mejoría global del 35%. Esta evidencia sugiere que el tratamiento homeopático beneficia a las mujeres en el climaterio. (AU)

Hormonal therapy is the conventional treatment for counteracting climacteric symptoms; however, this treatment is contraindicated in some women due to the adverse effects that this therapy may cause. The purpose of this study was to evaluate the usefulness of homeopathic therapy during the climacteric using the Menopause Rating Scale (MRS). The study included 31 women, without cardiac problems, history of no cancer or hormone replacement therapy; a MRS scale questionnaire was applied to these women to evaluate each symptom before to treatment. The Radar 10.0 for Windows electronic repertoire was used to repertorize the characteristic symptoms of each patient and determine the similarly. Homeopathic medication was prescribed in 30CH dynamization as 5 sublingual drops every 8 hrs. Patient evaluation took place monthly for 3 months. The evaluation of the results was performed by the comparison of scale scores through a statistical analysis using the Wilcoxon test. Lachesis trigonocephalus and Pulsatilla nigricans were the most frequent treatment indications, according to the symptoms of each patient. At the end of the homeopathic treatment, symptoms reduction was observed with statistical significance in the score, which reflects an overall improvement of 35%. This evidence suggested that homeopathic treatment benefits women in climacteric. (AU)

Depoimentos de mulheres sobre a menopausa e o tratamento de seus sintomas / The opinion of women on menopause and treatment of its symptoms

OBJETIVO: Avaliar a percepção de um grupo de mulheres de Belo Horizonte (MG) sobre a menopausa e seu tratamento. MÉTODOS: Realizou-se análise secundária de dados de estudo populacional de corte transversal com 378 mulheres brasileiras natas, de 40 a 65 anos, com 11 anos ou mais de educação formal. Avaliaram-se os relatos escritos espontaneamente ao final de um questionário sobre sexualidade, entregue por auxiliares de pesquisa e auto-respondido anonimamente. As mulheres foram alocadas em dois grupos: as que escreveram comentários ao final do questionário e as que não escreveram. Compararam-se os grupos em relação às características sociodemográficas e reprodutivas por meio do teste Qui quadrado de Pearson. Os comentários foram transcritos na íntegra para arquivo computadorizado para realizar a análise temática de seu conteúdo, identificando-se e categorizando-se as unidades de significado. RESULTADOS: Aproximadamente um terço das mulheres escreveu comentários (114/378), o que foi significativamente mais freqüente entre as mulheres com menor renda familiar. As principais categorias de análise identificadas foram: a) insegurança/confusão, com as principais idéias referentes a angústia, estresse e dúvidas sobre a menopausa; b) sintomas que provocam sentimentos negativos, como ondas de calor, secura vaginal e alterações de humor; c) terapia de reposição hormonal, medos e sentimentos da falta de convicção por parte dos médicos em prescrevê-la. CONCLUSÃO: Os comentários indicam a necessidade de dar mais atenção aos problemas percebidos no climatério, particularmente direcionada às mulheres menos favorecidas economicamente.

OBJECTIVE: To evaluate the perception of a group of women from Belo Horizonte, Minas Gerais, Brasil, with respect to menopause and its treatment. METHODS: A secondary analysis was performed on data from a population-based, cross sectional study carried out with 378 Brazilian born women between 40 and 65 years of age, with 11 years or more of formal education. Some women added spontaneous comments to the end of the questionnaire on sexuality handed out by research assistants and self-responded anonymously. There were those who provided comments at the end of the questionnaire and those who did not. The groups were compared with respect to sociodemographic and reproductive characteristics using Pearson's chi-square test. Comments were transcribed in their entirety to a computerized file for thematic content analysis, and units of meaning were identified and classified. RESULTS: Approximately one-third of the women (114/378) provided comments. Significantly more women with lower income levels provided comments as compared to those with higher income levels. The principal identified categories of analysis were: a) uncertainty and/or confusion, mainly with regard to anguish, stress and doubts about menopause; b) symptoms that lead to negative feelings, such as hot flushes, vaginal dryness and mood changes; and c) hormone replacement therapy, fears and perception of a lack of conviction in the physicians who prescribe it. CONCLUSION: The comments indicate that more attention must be given to the problems perceived in climacteric women with a special emphasis on those of the lower incomes levels.

Terapia hormonal de reemplazo en prevención cardiovascular: ¿Dónde estamos parados? / Hormone replacement therapy and cardiovascular prevention: Where are we now?

Durante su edad fértil, la mujer sufre una incidencia de enfermedad cardiovascular ateroesclerótica (particularmente infarto de miocardio) significativamente inferior a la del hombre. Este beneficio desaparece progresivamente luego de la menopausia, hasta equilibrarse luego de la sexta década de la vida. Estudios experimentales en modelos animales y humanos sugirieron la existencia de mecanismos fisiológicos por los cuales los estrógenos podrían ser los responsables de esta protección cardiovascular, y análisis retrospectivos de estudios clínicos mostraron que las mujeres climatéricas que habían consumido terapia hormonal de reemplazo (THR) sufrían menos eventos cardiovasculares. Estas observaciones estimularon la ejecución de numerosos ensayos clínicos prospectivos aleatorizados (algunos de gran envergadura) en mujeres climatéricas, destinados a probar la hipótesis de que la THR podría prevenir eventos cardiovasculares graves en esa población. La hipótesis no pudo probarse, ya que en ninguno de esos ensayos la THR fue efectiva, y en algunos casos incluso fue en ciertos aspectos perjudicial. Existen cuestionamientos de orden metodológico que tienen que ver con el diseño de dichos ensayos prospectivos, fundamentalmente la edad de las pacientes incluidas y el momento del inicio de la THR. Existen también razones biológicas que pueden explicar la mencionada contradicción. Una nueva hipótesis, basada asimismo en observaciones experimentales y clínicas, se orienta hacia la posibilidad de que el inicio de la THR en mujeres más jóvenes y más precozmente luego de la menopausia, podría mostrar diferentes resultados.

During their fertile period women suffer significantly less atherosclerotic cardiovascular disease (particularly myocardial infarction) than men. This benefit progressively disappears after menopause, to equalize after the sixth decade of life. Experimental studies in animal and human models demonstrated the existence of physiological mechanisms suggesting that estrogens could be responsible for this cardiovascular protection, and retrospective analysis of clinical studies showed that post menopausal women who had used hormonal replacement therapy (HRT) suffered less cardiovascular events. These observations stimulated the execution of several prospective, randomized clinical trials (some of them with a large number of patients and prolonged follow-up) in post menopausal women, with the aim of proving the hypothesis that HRT could prevent major cardiovascular events. Such hypothesis could not be demonstrated in any of those studies because HRT was not beneficial, and in several cases it was even deleterious in some aspects. Criticism has arisen over some of the methodological aspects of those prospective trials, basically regarding the age of the included patients and the timing of the beginning of HRT. There are also biological reasons that can explain the contradiction. A new hypothesis, also based on experimental and clinical observations, suggests the possibility that beginning HRT in younger women and earlier after menopause could yield different results.

Sexualidade no climaterio e na senilidade / Sexuality in climacteric and senility

As mudancas fisiologicas que ocorrem na mulher com a menopausa e senilidade podem prejudicar com maior ou menor intensidade sua atividade sexual. E importante que a mulher seja informada a respeito das mudancas comportamentais e fisiologicas que ocorrem com o envelhecimento, tanto nela mesma quanto em seu parceiro e que ambos sejam reeducados sexualmente. Dificuldades na identificacao e tratamento das disfuncoes sexuais desta fase se devem, principalmente, ao despreparo dos profissionais de saude e a repressao sexual da mulher, sobretudo da mulher idosa. Esta revisao mostra que na sexualidade da mulher no climaterio e na senilidade alem dos fatores psicossociais interferem...