Assessing a cut-off point for the diagnosis of abnormal uterine bleeding using the Menstrual Bleeding Questionnaire (MBQ): a validation and cultural translation study with Brazilian women

ABSTRACT BACKGROUND: Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES: To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING: Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS: MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS: Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION: The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.

Cardiovascular Risk Factors in Premature Ovarian Insufficiency using Hormonal Therapy / Fatores de risco cardiovascular na insuficiência ovariana prematura em uso de terapia hormonal

Abstract Objective Premature ovarian insufficiency (POI) is characterized by early hypoestrogenism. An increased risk of cardiovascular (CV) disease is a long-term consequence of POI. A challenge of hormone therapy (HT) is to reduce the CV risk. Methods Cross-sectional study with lipid profile analysis (total cholesterol, LDL-C, HDL-C, VLDL-C and triglycerides), blood glucose levels and arterial blood pressure of women with POI using HT, compared with age and BMI-matched women with normal ovarian function (controls). Results The mean age and BMI of 102 POI patients using HT and 102 controls were 37.2 ± 6.0 and 37.3 ± 5.9 years, respectively; 27.0 ± 5.2 and 27.1 ± 5.4 kg/m2. There wasn't difference between groups in arterial systolic and diastolic blood pressure, blood glucose levels, total cholesterol, LDL-C, VLDL-C and triglycerides. HDL-C levels were significantly higher in the POI group (56.3 ± 14.6 and 52 ± 13.9mg/dL; p = 0.03). Arterial hypertension was the most prevalent chronic disease (12% in the POI group, 19% in the control group, p = ns), followed by dyslipidemia (6 and 5%, in POI and control women). Conclusion Women with POI using HT have blood pressure levels, lipid and glycemic profile and prevalence of hypertension and dyslipidemia similar to women of the same age and BMI with preserved gonadal function, in addition to better HDL levels.

Resumo Objetivo A insuficiência ovariana prematura (IOP) é caracterizada pelo hipoestrogenismo precoce. Risco aumentado de doença cardiovascular (CV) é uma consequência a longo prazo da IOP e um desafio da terapia hormonal (TH) é reduzir o risco CV. Métodos Estudo transversal com análise do perfil lipídico (colesterol total, LDL-C, HDL-C, VLDL-C e triglicerídeos), glicemia e pressão arterial de mulheres com IOP em uso de TH, em comparação a mulheres com função ovariana normal (controles) pareadas por idade e IMC. Resultados A média de idade e IMC de 102 pacientes com IOP em uso de TH e 102 controles foi de 37,2 ± 6,0 e 37,3 ± 5,9 anos, respectivamente; 27,0 ± 5,2 e 27,1 ± 5,4 kg/m2. Não houve diferença entre os grupos na pressão arterial sistólica e diastólica, glicemia, colesterol total, LDL-C, VLDL-C e triglicerídeos. Os níveis de HDL-C foram significativamente maiores no grupo IOP (56,3 ± 14,6 e 52 ± 13,9mg/dL; p = 0,03). A hipertensão arterial foi a doença crônica mais prevalente (12% no grupo POI, 19% no grupo controle, p = ns), seguida da dislipidemia (6 e 5%, no grupo POI e controle). Conclusão Mulheres com IOP em uso de TH apresentam níveis pressóricos, perfil lipídico e glicêmico e prevalência de hipertensão e dislipidemia semelhantes às mulheres da mesma idade e IMC com função gonadal preservada, além de melhores níveis de HDL.

Abnormal uterine bleeding in reproductive age: a comparative analysis between the five Brazilian geographic regions

SUMMARY OBJECTIVE: This study aimed to comparatively evaluate the presence of abnormal uterine bleeding and associated factors among women from the five official Brazilian geographic regions. METHODS: This is a cross-sectional, population-based, multicenter study of reproductive-age women from the five regions of Brazil. All participants answered questionnaires containing personal and socioeconomic data and information on uterine bleeding (self-perception and objective data). RESULTS: A total of 1,761 Brazilian women were included, 724 from the Southeast, 408 from the Northeast, 221 from the South, 213 from the North, and 195 from the Central-West. Considering women's self-perception, the prevalence of abnormal uterine bleeding was 37.56% in the North region, 39.46% in the Northeast, 21.54% in the Central-West, 29.56% in the Southeast, and 25.34% in the South (p<0.001). Abnormal uterine bleeding was more prevalent in the North and Northeast, where women had lower purchasing power, became pregnant more often, and were the only ones financially responsible for supporting the family more often (p<0.001). The menstrual cycle lasted <24 days in less than 20% of the women in all regions (p=NS). Among these, approximately 8 out of 10 women had never undergone treatment in four out of the five regions evaluated. More than half of the evaluated women reported a worsening of their quality of life during bleeding. CONCLUSION: The prevalence of abnormal uterine bleeding in Brazilian women was higher in the North and Northeast, followed by the Southeast, South, and Central-West regions. There was a worsening of quality of life during menstruation regardless of the woman's self-perception of abnormal uterine bleeding. Such results can direct the actions of health managers toward a better approach to abnormal bleeding.

Perfil do atendimento de vítimas de violência sexual em Campinas / Profile of victims of sexual violence receiving care in Campinas / Perfil de la atención a víctimas de violencia sexual en Campinas

Resumo O objetivo deste estudo foi caracterizar o perfil do atendimento a mulheres vítimas de violência sexual, com ênfase nos aspectos jurídicos. Foi realizado estudo descritivo e retrospectivo, incluindo 41 mulheres com média etária de 31 anos que sofreram violência sexual no período. A maior frequência dos crimes ocorreu entre meia-noite e seis da manhã (n=17). Para os dados de "boletim de ocorrência" foi encontrada frequência de 56%. Os crimes encontrados na amostra foram de estupro (n=37) e violação sexual mediante fraude (n=4). Do total, 12,20% (n=5) completaram o atendimento proposto. As vítimas eram na maioria solteiras, sujeitas a estupro com violência e grave ameaça no local "rua". Apesar de mais da metade da amostra relatar ter feito registro de boletim de ocorrência, não se pôde confirmar a veracidade dessa informação, pois as cópias dos boletins não foram encontradas nos prontuários médicos correspondentes.

Abstract The aim of this study was to characterize the profile of the care offered to female victims of sexual violence with an emphasis on legal aspects. A descriptive and retrospective study of 41 women with an average age of 31 years who had experienced sexual violence within the stipulated period was carried out. The highest frequency of the crimes occurred between 00h00min and 06h00min (n=17). There was a frequency of 56% for the data "police report". The crimes found were rape (n=37) and rape by deception (n=4). A total of 12.20% victims (n=5) completed the proposed treatment. The majority of victims were single, and subjected to rape with violence or serious threat in the "street" location. Although more than half of the sample described completing a police report, the veracity of this information could not be confirmed as the reports were not found in their medical records.

Resumen El objetivo de este estudio fue caracterizar el perfil de la atención a mujeres que fueron víctimas de violencia sexual, con énfasis en los aspectos jurídicos. Se realizó un estudio descriptivo y retrospectivo, en el cual se incluyeron 41 mujeres de un promedio de 31 años, quienes fueron violentadas sexualmente en el periodo. La mayor frecuencia de los crímenes ocurrió entre la media noche y las seis de la mañana (n=17). Para los datos del "informe de eventos" se encontró una frecuencia del 56%. Los delitos que se hallaron en la muestra fueron violación (n=37) y violación por medio del engaño (n=4). Del total, el 12,20% (n=5) completó la atención propuesta. La mayoría de las víctimas eran solteras, sometidas a abusos sexuales con violencia y amenaza grave en la calle. A pesar de que más de la mitad de la muestra relató que hizo el registro en el informe de eventos, no se puede comprobar la veracidad de esa información, ya que no se encontraron las copias de los informes en los registros médicos correspondientes.