ABSTRACT
The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.
Subject(s)
Female , Humans , Cardiovascular Diseases/etiology , Climacteric/physiology , Quality of Life , Cardiovascular Diseases/chemically induced , Chile , Climacteric/drug effects , Estrogen Replacement Therapy/adverse effects , Gonadal Steroid Hormones/therapeutic use , Life Style , Risk Factors , Societies, MedicalABSTRACT
La mayoría de las mujeres ve afectada su salud en el período climatérico, ya sea por sintomatología que le deteriora su calidad de vida (CV) o por la aparición de enfermedades crónicas que le afectan sus expectativas de vida. Por lo tanto, es básico evaluar estos dos aspectos, teniendo como objetivos centrales de las eventuales intervenciones terapéuticas, mejorar la CV y reducir el riesgo de enfermedades cardiovasculares y/o fracturas...
Subject(s)
Female , Climacteric/metabolism , Bone Density/physiology , Quality of LifeABSTRACT
Se evalúa la utilidad clínica de la prueba de sobrecarga a la glucosa oral (PSG), en 513 gestantes con factores de riesgo de diabetes. De las 933 PSG efectuadas el 13,7% fueron positivas (valor límite: glicemia en plasma a la hora*150 mg/dl.); en el 82,8% de los casos fueron realizadas después de las 20 semanas de gestación. De las 128 PSG positivas se obtuvieron 73 Test de tolerancia de glucosa positivos. (Criterio O'Sullivan). La prevalencia de diabetes gestacional encontradas en este grupo fue de 15,2%. De los factores de riesgo más frecuentes (antec. de familiar diabético, obesidad y macrosomía) no hubo diferencia entre la población general en estudio y el grupo de diabéticas gestacionales. Conclusión: La PSG por su fácil aplicación, bajo costo y excelente tolerancia es un examen que debería ser incluido en los exámenes prenatales habituales como screening de diabetes gestacional en nuestro medio