Effects of oxytocin versus promestriene on genitourinary syndrome: a pilot, prospective, randomized, double-blind study

Abstract Objectives: In this pilot, prospective, randomized, double-blind study, the authors compared the efficacy of oxytocin with promestriene in improving vaginal atrophy of Genitourinary Syndrome of Menopause (GSM). Methods: A total of 51 postmenopausal women with symptoms of GSM were evaluated. They were randomized into two groups: oxytocin (25 patients) and promestriene (26 patients) and were evaluated before and after 90 days of treatment; the evaluation was based on the domains of the Female Sexual Function Index (FSFI) (lubrication, satisfaction, and pain during sexual intercourse), clinical visual examination, and vaginal wall thickness. Results: After the use of the medications, both groups showed significant improvement in the three evaluated FSFI domains (p < 0.05) and there was no significant difference between the groups (p > 0.05). On clinical examination, the medications improved all the evaluated parameters but without statistical significance (p > 0.05). The evaluation of the thickness of the vaginal epithelium showed that both treatments led to increase in the vaginal epithelium (p < 0.05); however, the efficacy of promestriene was higher than that of oxytocin (p < 0.05). Conclusions: Both medications were effective, however, studies with larger samples and longer follow-ups are needed to confirm the clinical applicability.

Effects of raloxifene combined with low-dose conjugated estrogen on the endometrium in menopausal women at high risk for breast cancer

OBJECTIVES: To compare the effects of low-dose conjugated estrogen (CE), raloxifene, and the combination thereof on the endometrium of postmenopausal women. METHODS: Postmenopausal women between 45 and 60 years of age, with Gail score≥1.67 and no endometrial disorders, were randomly assigned to receive low-dose CE (0.3 mg), raloxifene (60 mg), or combined therapy for 1 year. Transvaginal ultrasound was performed at baseline and every 3 months; the Kupperman Index was assessed at baseline and every 6 months. Endometrial biopsies were performed if endometrial thickness (ET) was ≥5 mm or if vaginal bleeding occurred. The primary outcome was the occurrence of ET≥5 mm over the one-year period. RESULTS: Seventy-three women were randomly assigned and analyzed on an intent-to-treat basis. Eight, three, and four women in the CE, raloxifene, and combination groups, respectively, exhibited ET≥5 mm. No genital bleeding was reported in the combination group. Endometrial biopsy revealed atrophy or polyps in all groups, with one patient in the CE group exhibiting a proliferative endometrium without atypia. At 6 months, there was a progressive increase in mean ET in the CE group, but not in the other two groups, with statistically significant differences at 6, 9, and 12 months. Mean scores for vasomotor symptoms and Kupperman Index favored the CE and combination groups over raloxifene. CONCLUSION: Combined raloxifene and low-dose CE decreased the severity of menopausal symptoms to a similar extent as CE alone and had similar effects as raloxifene alone on the endometrium.

Disparities in female breast cancer mortality rates in Brazil between 1980 and 2009

OBJECTIVE: To describe the temporal trends in female breast cancer mortality rates in Brazil in its macro-regions and states between 1980 and 2009. METHODS: This was an ecological time-series study using data on breast cancer deaths registered in the Mortality Data System (SIM/WHO) and census data on the resident population collected by the Brazilian Institute of Geography and Statistics (IBGE/WHO). Joinpoint regression analyses were used to identify the significant changes in trends and to estimate the annual percentage change (APC) in mortality rates. RESULTS: Female breast cancer mortality rates in Brazil tended to stabilize from 1994 onward (APC = 0.4%). Considering the Brazilian macro-regions, the annual mortality rates decreased in the Southeast, stabilized in the South and increased in the Northeast, North, and Midwest. Only the states of Sao Paulo (APC = -1.9%), Rio Grande do Sul (APC = -0.8%) and Rio de Janeiro (APC = -0.6%) presented a significant decline in mortality rates. The greatest increases were found in Maranhao (APC=12%), Paraiba (APC=11.9%), and Piaui (APC=10.9%). CONCLUSION: Although there has been a trend toward stabilization in female breast cancer mortality rates in Brazil, when the mortality rate of each macro-region and state is analyzed individually, considerable inequalities are found, with rate decline or stabilization in states with higher socioeconomic levels and a substantial increase in those with lower socioeconomic levels.

Dismenorreia / Dysmenorrhea

O conhecimento da abordagem diagnóstica e a terapêutica para a dismenorreia são de fundamental importância para o ginecologista, uma vez que esse quadro é muito frequente durante a vida reprodutiva da mulher. As dismenorreias podem ser classificadas em primárias e secundárias, dependendo da sua origem. A dismenorreia primária não apresenta uma causa definida, enquanto a secundária se dá em decorrência de alguma patologia pélvica preestabelecida. A abordagem dessas pacientes deve visar mudanças do estilo de vida e emprego de tratamento medicamentoso. Muitas vezes tratando a causa da dismenorreia secundária, consequentemente tratamos a dismenorreia. No entanto, algumas pacientes não solucionam definitivamente a patologia pélvica, como, por exemplo, adenomiose ou mioma, e assim são tratadas com o mesmo arsenal terapêutico da dismenorreia primária.O tratamento medicamentoso padrão para as dismenorreias são os anti-inflamatórios não esteroidais (AINEs), mas em nossa prática clínica utilizamos muito os anticoncepcionais orais (ACO). A tomada de decisão deve ser estabelecida durante a consulta ginecológica.

Efetividade do dispositivo intrauterino liberador de levonorgestrel (Mirena®) para a terapia de reposição hormonal na perimenopausa e pós-menopausa. / The effectiveness of the levonorgestrel-releasing intrauterine system (Mirena®) for hormone replacement therapy in the peri- and postmenopausal women

A utilização do dispositivo intrauterino (DIU) hormonal para a contracepção é uma constante no consultório de ginecologia da atualidade. Entretanto, outras indicações como o tratamento de algumas patologias ginecológicas benignas, e mais recentemente, o uso para terapia de reposição hormonal (TRH) no climatério têm chamado a atenção. Esta revisão tem como objetivo demonstrar os achados dos artigos publicados, desde 2001, sobre a avaliação do DIU de levonorgestrel (LNG) durante esta fase de turbulência hormonal feminina. No período do climatério, a mulher com útero intacto ganha vários benefícios com essa nova modalidade terapêutica associada ao estrogênio nas suas diversas formas de apresentação. Pode-se concluir que o DIU com LNG na mulher da perimenopausa e pós-menopausa pode ser utilizado para contracepção, alívio de sintomas vasomotores quando associado à terapia com estrogênio e alta resolutividade nos quadros de menorragia que frequentemente acometem a mulher durante esta fase da vida

There is a wide use of the levonorgestrel-releasing intrauterine system (LNG IUS) in recent years for hormonal contraception. However, other indications, as the treatment of some benign gynecological diseases and, more recently, for hormone replacement therapy in peri and postmenopausal women have happened. This review aimed to demonstrate the findings of articles published since 2001 on the use of the LNG IUS in the women's climacteric period. During this phase of life, women with intact uterus benefit of using this new modality of therapy associated with estrogen in their several forms of presentation. It can be concluded that LNG IUS in the peri and postmenopausal women can be used as a contraceptive method, to abbreviate hot flashes symptoms when associated with estrogen therapy and to solve menorrhagia that is a very common finding in this period

Efeitos biomoleculares dos moduladores seletivos dos receptores de estrogênio (SERMs) no câncer de mama e de endométrio / Biomolecular efects of seletive estrogen receptor modulators (SERMs) in breast and endometrial cancers

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