Atendendo mulheres com cariótipo 46, XY / Attending women with 46, XY karyotype

As diferenças ou distúrbios do desenvolvimento sexual (DDS) compreendem um grupo heterogêneo de condições congênitas que resultam na discordância entre os cromossomos sexuais, as gônadas e/ou o sexo anatômico de um indivíduo. A classificação desses distúrbios é baseada no cariótipo conforme o Consenso de Chicago de 2006 e substitui os termos pseudo-hermafroditismo, hermafroditismo e intersexo. O objetivo desta revisão é fornecer ao ginecologista conhecimentos básicos sobre a etiologia, fisiopatologia e orientações das principais anormalidades de DDS para uma avaliação diagnóstica e terapêutica no atendimento de mulheres na infância, adolescência e em idade adulta com cariótipo 46,XY. O diagnóstico deve ser realizado pela interação entre o exame clínico as dosagens hormonais, os exames de imagem e a análise genética, desde o cariótipo até o estudo de alterações dos genes por técnicas de biologia molecular. O tratamento é realizado de acordo com a etiologia e inclui intervenções cirúrgicas como a gonadectomia e plásticas sobre a genitália externa, terapia de reposição hormonal e apoio psicológico. São necessárias a individualização dos casos e uma equipe interdisciplinar, para um atendimento adequado às mulheres com cariótipo 46,XY.(AU)

Differences or disorders of sexual development (DSDs) comprise a heterogeneous group of congenital conditions that result in the disagreement between an individual's sex chromosomes, gonads and/or anatomic sex. The classification of these disorders is based on the karyotype according to the 2006 Chicago Consensus and replaces the terms pseudohermaphroditism, hermaphroditism and intersex. The aim of this review is to provide the gynecologist with basic knowledge about the etiology, pathophysiology and guidelines of the main abnormalities of DDS for a diagnostic and therapeutic evaluation in the care of women in childhood, adolescence and adulthood with a karyotype 46,XY. The diagnosis must be made by the interaction between clinical examination hormonal measurements, imaging and genetic analysis from the karyotype to the study of gene alterations by molecular biology techniques. Treatment is carried out according to the etiology and includes surgical interventions such as gonadectomy and plastic surgery on the external genitalia, hormone replacement therapy and psychological support. Individualization of cases and an interdisciplinary team are required to provide adequate care for women 46,XY karyotype.(AU)

Terapia de reposição hormonal e câncer de mama: uma revisão de literatura acerca da influência do tratamento hormonal no desenvolvimento neoplásico / Hormone Therapy and Breast Cancer: a literature review about the influence of hormonal treatment on neoplastic development

A menopausa é decorrente da queda gradativa de secreção hormonal ovariana e, nesse período, muitas mulheres apresentam sintomas que comprometem a qualidade de vida. A terapia hormonal (TH) surgiu como importante ferramenta para amenizar a sintomatologia climatérica. No entanto, foram levantadas suspeitas sobre a correlação entre o tratamento e o aumento do risco do câncer de mama (CM). O presente trabalho objetiva avaliar a relação entre CM e TH, abrangendo as implicações da terapia nos sintomas da menopausa, na incidência da neoplasia e na mortalidade. Trata-se de uma revisão narrativa de literatura, em que foram buscados artigos publicados entre julho de 2010 e julho de 2020, nas bases de dados LILACS, MEDLINE e SciELO. Os principais tipos de TH são o estrogênio isolado e o combinado com progesterona. Nos estudos analisados, a terapia combinada foi relacionada à maior incidência de CM quando comparada ao regime estrogênico. De acordo com a literatura, modificações na densidade mamográfica, induzidas pela TH, podem elevar o risco para carcinoma mamário. Os artigos relataram que fatores além da terapia hormonal, como o estilo de vida, podem interferir na incidência de CM e devem ser analisados individualmente. A mortalidade por CM influenciada pela TH não demonstrou aumento significativo. No geral, a TH foi considerada o tratamento mais eficaz para aliviar sintomas climatéricos. Entretanto, estudos a longo prazo que analisem os riscos e a confiabilidade da terapia devem ser estimulados, a fim de indicar a terapêutica mais segura e evitar intervenções indevidas.

Menopause is due to the gradual drop in ovarian hormonal secretion, and, during this period, many women have symptoms that compromise quality of life. Hormone therapy (HT) has emerged as an important tool to alleviate climacteric symptoms. However, suspicions were raised about the correlation between treatment and the increased risk of breast cancer (BC). The present study aims to evaluate the relationship between BC and HT, covering the implications of therapy for menopausal symptoms, the incidence of neoplasia and mortality. This is a narrative review of the literature, in which articles published between July 2010 and July 2020 were searched for in the LILACS, MEDLINE and SciELO databases. The main types of HT are estrogen alone and combined formula with progesterone. In the studies analyzed, combined therapy was related to a higher incidence of BC when compared to the estrogenic regimen. According to the literature, changes in mammographic density, induced by HT, can increase the risk for breast carcinoma. The articles reported that factors other than hormone therapy, such as lifestyle, can interfere with the incidence of BC and should be analyzed individually. Mortality from BC influenced by HT did not show a significant increase. Overall, HT was considered to be the most effective treatment for relieving climacteric symptoms. Although, long-term studies that analyze the risks and reliability of therapy should be encouraged in order to indicate the safest therapeutics and to avoid unnecessary interventions.

Body composition, but not insulin resistance, influences postprandial lipemia in patients with Turner's syndrome

ABSTRACT Objective: The aim of the present study was to examine the influence of body composition and insulin resistance on the magnitude of postprandial lipemia in patients with Turner's syndrome receiving oral versus transdermal estrogen replacement. Subjects and methods: Twenty-five patients with Turner's syndrome receiving oral or transdermal estrogen replacement were evaluated for body mass index, waist-to-hip and waist-to-height ratios, fasting glycemia, insulin, body composition (dual-energy X-ray absorptiometry), and postprandial lipid metabolism. For statistical analysis, we used parametric tests to compare numeric variables between the two subgroups. Results: We observed no difference in postprandial triglyceride levels between patients receiving oral versus transdermal hormone replacement therapy. The postprandial triglycerides increment correlated positively with the percentage of total fat mass (p=0.02) and android fat mass (p=0.02) in the transdermal group. In the oral estrogen group, a positive correlation was observed between the increment in postprandial triglycerides and waist-to-hip (p=0.15) and waist-to-height (p=0.009) ratios. No association was observed between the estrogen replacement route and insulin resistance evaluated by the homeostatic model assessment-insulin resistance (HOMA-IR) index (p=0.19 and p=0.65 for the oral and transdermal groups, respectively). Conclusion: We concluded that body composition and anthropometric characteristics possibly affect the extent of postprandial lipemia independently from the route of estrogen replacement.

Hormone therapy after risk-reducing surgery in patients with BRCA1/BRCA2 mutation: evaluation of potential benefits and safety

SUMMARY Women with mutations in the BRCA 1 and 2 genes are at increased risk for ovarian and breast cancer and therefore candidates for risk-reducing surgery, including salpingo-oophorectomy and mastectomy. Risk-reducing salpingo-oophorectomy (RRSO) is considered the most effective prophylactic measure for ovarian cancer prevention in this group of patients. This procedure involves loss of ovarian function and induced menopause. Estrogen therapy is the most effective treatment for controlling vasomotor symptoms and improving the quality of life of climacteric women. However, the potential hormonal stimulation of these tumors and the risk of breast cancer are a concern regarding the safety of hormone replacement therapy (HRT) in this population. This article aims to review the current evidence regarding the potential benefits and safety of HRT after RRSO.

RESUMO Mulheres portadoras de mutações nos genes BRCA 1 e 2 possuem risco aumentado para cânceres de ovário e mama e, portanto, são candidatas às cirurgias redutoras de risco, incluindo a salpingo-ooforectomia e a mastectomia. A salpingo-ooforectomia redutora de risco (SORR) é considerada a medida profilática mais efetiva para prevenção do câncer de ovário nesse grupo de pacientes. Esse procedimento implica a perda da função ovariana e menopausa induzida. A estrogenioterapia é o tratamento mais efetivo para o controle de sintomas vasomotores e melhora da qualidade de vida de mulheres no climatério. No entanto, a potencial estimulação hormonal desses tumores e o risco de câncer de mama constituem uma preocupação com a segurança da terapia hormonal (TH) nesta população. Este artigo tem como objetivo uma revisão das evidências atuais quanto aos benefícios potenciais e segurança da TH após SORR.

Changes in Cardiac Autonomic Modulation in Women with Breast Cancer Using Aromatase Inhibitors and the Relation with Biochemical Variables / Alterações na Modulação Autonômica Cardíaca em Mulheres com Câncer de Mama em Uso de Inibidores de Aromatase e sua Relação com Variáveis Bioquímicas

Abstract Background: The use of autonomic modulation as a predictor of cardiovascular risk in women with breast cancer is important. Objective: To evaluate the cardiac autonomic modulation of postmenopausal women using aromatase inhibitors for breast cancer treatment, as well as its relation with the following biochemical variables. Methods: Postmenopausal women who did not have breast cancer (n = 33) and postmenopausal women with breast cancer (n = 15). For evaluation of the autonomic modulation the heart rate was recorded beat-to-beat for 30 minutes and the series of RR intervals obtained were used to calculate the following heart rate variability indices: Mean RR ms, SDNN (standard deviation of all normal RR intervals, expressed in milliseconds) ms, Mean HR, RMSSD (square root of the mean of the squared differences between adjacent normal RR interval) ms, NN50 (number of pairs of successive NNs that differ by more than 50 ms) count, pNN50% (proportion of NN50 divided by total number of NNs), RRtri (RR triangular), TINN (triangular interpolation of NN interval) ms, SD1 ms, SD2 ms, LF ms2, HF ms2, LH/HF ms2. The values of biochemical variables (fasting glycemia, triglycerides, HDL-cholesterol, and C-reactive protein) were analyzed by blood sample. Results: Lower values of heart rate variability indices were observed in postmenopausal women with breast cancer in relation to postmenopausal women who did not have breast cancer: Mean RR (p = 0.03); SDNN (p = 0.03); RMSSD (p = 0.03); NN50 count (p = 0.03); pNN50 % (p = 0.03); RRtri (p = 0.02); SD1 (p = 0.01); SD2 (p = 0.02); LF ms2 (p = 0.01); HF ms2 (p = 0.03).There was an inversely proportional correlation between the indices SDNN, SD2, and HFms2 with triglycerides (SDNN p = 0.04; SD2 p = 0.04; HF ms2 p = 0.04). No statistically significant correlations were found between heart rate variability indices and others variables. Statistical significance was set at 5% for all analyses. Conclusion: Women with breast cancer present reduced autonomic modulation and in these women of heart rate variability indices are inversely correlated with triglyceride values.

Resumo Fundamentos: A modulação autonômica como um preditor de risco cardiovascular em mulheres com câncer de mama é importante. Objetivos: Avaliar a modulação autonômica em mulheres pós-menopausa em uso de inibidores de aromatase como tratamento de câncer de mama, e sua relação com algumas variáveis bioquímicas. Métodos: Foram avaliadas mulheres pós-menopausa sem câncer de mama (n = 33) e mulheres pós-menopausa com câncer de mama (n = 15). Para avaliação da modulação autonômica, a frequência cardíaca (FC) foi registrada batimento a batimento por 30 minutos, e as séries de intervalos RR obtidas foram usadas para o cálculo dos seguintes índices de variabilidade da frequência cardíaca: média de RR ms, SDNN (desvio padrão de todos os intervalos RR normais) ms, FC, RMSSD (raiz quadrada da média das diferenças ao quadrado entre os intervalos RR normais adjacentes) ms, contagem NN50 (número de pares de NNs sucessivos que se diferem em mais de 50 ms), pNN50% (proporção de NN50 dividida pelo número total de NNs), RRtri (RR triangular), TINN (interpolação triangular do intervalo NN) ms, DP1 ms, DP2 ms, LF (baixa frequência) ms2, HF (alta frequência) ms2, LH/HF ms2. Os valores das variáveis bioquímicas (glicemia de jejum, triglicerídeos, HDL-colesterol, e proteína C reativa) foram analisadas das amostras de sangue. O nível de significância adotado nas análises estatísticas foi de 5%. Resultados: As mulheres pós-menopausa com câncer de mama apresentaram menores índices de variabilidade da frequência cardíaca em comparação àquelas sem câncer de mama: média de RR (p = 0,03); SDNN (p = 0,03); RMSSD (p = 0,03); contagem NN50 (p = 0,03); pNN50% (p = 0,03); RRtri (p = 0,02), DP1 (p = 0,01), DP2 (p = 0,02); LF ms2 (p = 0,01); HF ms2 (p = -0,03). Observou-se uma correlação inversamente proporcional dos índices SDNN, DP2 e HF ms2 com triglicerídeos (SDNN p = 0,04, DP2 p = 0,04; HF ms2 0,04). Não houve correlação significativa entre os índices de variabilidade da frequência cardíaca e as demais variáveis. Conclusão: Mulheres com câncer de mama apresentam modulação autonômica diminuída e índices de variabilidade da FC inversamente correlacionados com valores de triglicerídeos.

Revisión narrativa de la evidencia actual acerca de las alternativas hormonales y no hormonales en el manejo de los síntomas vasomotores y urogenitales de la menopausia / Narrative Review of Current Evidence Regarding Hormonal and Non-Hormonal Therapeutic Options for Vasomotor and Genitourinary Menopause Symptoms

La menopausia es el periodo de transición en que la mujer culmina su edad reproductiva y trae consigo cambios anatómicos y fisiológicos, manifestados principalmente por síntomas vasomotores y urogenitales, con gran afectación de la calidad de vida de las pacientes. Es de gran importancia conocer las alternativas terapéuticas que existen, la evidencia que las respalda, y así ofrecer la mejor alternativa según indicaciones, eficacia, perfil de efectos adversos y contraindicaciones de cada una. Métodos: Se realizó una búsqueda y selección de la literatura en las bases de datos Cochrane, Pubmed, SciELO, JAMA, en idiomas español e inglés, sin restricción de fecha. Conclusiones: Las terapias actuales no son satisfactorias, bien sea por la baja eficacia en el control de los síntomas o por su asociación con efectos adversos de importancia. Es necesario evaluar acuciosamente el riesgo-beneficio de cada intervención.

Menopause is the transitioning phase of a woman at the end of her reproductive age and which is associated with both anatomical and physiological changes, with great compromise of quality' of Iife. It is of upmost importance to be aware of the currently available therapeutic options, the evidence that supports them, and thus, be able to provide the best alternative according to medical indications, efficacy, adverse effects and counter-indications. Methods: We conducted a search on the databases Cochrane, Pubmed, SciELO, JAMA, both in English and Spanish, without date restrictions. Conclusión: Current therapies are not satisfactory, either because of their low efficacy in symptom control or because of the associated risks. It is necessary to make a thorough evaluation of the benefit/risk relation for every individualized case.

Klotho and Postmenopausal Hormone Replacement Therapy in Women with Chronic Kidney Disease

Kidney function is highly susceptible to age-related changes, with chronic kidney disease (CKD) serving as an important cause of morbidity and mortality in older patients. The prevalence of CKD in Korea is higher among the elderly, relative to the general population, with the most significant increases seen following the onset of menopause. Under normal conditions, estrogen attenuates renal superoxide production and protects the kidney from oxidative damage. As estrogen levels are known to decrease by as much as 80% during menopause, this represents a significant risk for older women. Postmenopausal hormone replacement therapy (HRT) modulates the renin-angiotensin system, thereby reducing the progressive deterioration of renal function. Use of estrogen-based HRT has been shown to ameliorate renal function in postmenopausal women, and delay CKD progression. Renal expression of klotho, an important suppressor of aging, is markedly decreased in CKD patients, making it a promising candidate for use as a prognostic biomarker in CKD. Here, we review the key links between renal function, sex, age, and estrogen levels during menopause, and discuss the use of postmenopausal HRT in CKD attenuation.

Effect of low-dose or standard-dose conjugated equine estrogen combined with different progesterone on bone density in menopause syndrome women / 中华妇产科杂志

Objective To explore the effect of low-dose or standard-dose conjugated equine estrogen (CEE)combined with natural progesterone or dydrogesterone on bone density in menopause syndrome women.Methods Totally 123 patients with menopause syndrome were recruited and randomly assigned to 3 treatment groups: group A(low-dose CEE+progesterone), group B(standard-dose CEE+progesterone), group C(standard-dose CEE+dydrogesterone). Using continuous sequential regimen, the duration of intervention was 12 cycles.The bone mineral density of lumbar 2-4 and neck of femur,the bone metabolic markers, the level of FSH and estradiol were examined just before the drug administration and 12 months after the beginning of experiment. Results There were 107 cases completed the one year trial.(1)Bone density:after 12 cycles of treatment,there was no significant change in bone density in group A(P>0.05);lumbar vertebrae of group B and C increased significantly,at 3.0% and 2.1%respectively(all P<0.05).The bone density of left femoral neck of group C significantly increased by 2.9%(P=0.029). There was no significant difference among the treatment groups at the beginning of experiment(P>0.05).(2)Bone metabolic markers: after 12 cycles of treatment, the levels of calcium, phosphorus, alkaline phosphatase, Ca/Cr decreased significantly,the difference were statistically significant(all P<0.05).There was no significant difference among the treatment groups at the beginning of experiment(P>0.05).(3)Levels of FSH and estradiol:after 12 cycles of treatment,the levels of FSH in three groups were decreased significantly(all P<0.01). The levels of estradiol in three groups were increased significantly(all P<0.01). There was no significant difference among the treatment groups at the beginning of experiment(P>0.05). Conclusions Both low-dose and standard-dose menopause hormone therapy(MHT)could elevate the level of estradiol, reduce bone turnover, prevent bone loss of postmenopausal women effectively. The standard dose of MHT could also increase the density of vertebrae and femoral neck,and generate more clinical benefits.

The clinical study of Bushen-Qingxin decoction for the patients with premature ovarian failure with kidney deficiency / 国际中医中药杂志

Objective To observe the clinical efficacy of Bushen-Qingxin decoction for the patients with premature ovarian failure (POF) with kidney deficiency type. Methods A total of 120 POF patients were randomly divided into the observation group and the control group. The observation group were treated with Bushen-Qingxin decoction. The control group were treated with hormone replacement therapy (HRT). After continuous treatment for 3 courses, the clinical efficacy, clinical symptoms and the levels of estrogen (E2), luteotropic hormone (LH), follicle-stimulating hormone (FSH) were comparedbefore and after treatment. Results The total effective rate in the observation group was 86.7% (52/60), and the control group was 60.0% (36/60). The difference was statistically significant (x2=9.588, P=0.002) between two groups. The symptoms aversion to cold, and cold limbs, depressed mood, night sweats were improved significantly better than those in the control group(x2=16.464,16.214,11.525,9.938,P<0.001).After treatment,the serum E2(88.32 ± 9.35 pmol/L vs. 62.10 ± 7.22 pmol/L, t=17.848) in the observation group was significantly higher than this in the control group,while the serum FSH(32.33 ± 4.60 U/L vs.46.82 ± 5.47 U/L,t=15.704),LH(24.80 ± 3.37 U/L vs.32.16 ± 4.02 U/L, t=10.868) in the observation group were significantly lower than those in the control group (P<0.01). In the follow-up of 3 months, the recurrence rate in the observation group was 3.8% (2/52), but 16.7% (6/36) in the control group. The difference was statistically significant between two groups (x2=4.231, P=0.040).Conclusions The Bushen-Qingxin decocation can significantly improve the clinical symptoms and restore ovarian function.The Bushen-Qingxin decocation is an effective method for the treatment of premature ovarian failure.

Conhecimento sobre a menopausa de acordo com mulheres brasileiras de meia-idade: um estudo de base populacional / Menopausal knowledge among Brazilian middle-aged women: a population-based household survey

Introdução: a síndrome do climatério é definida pelo conjunto de sintomas decorrentes da interação entre fatores endócrinos, socioculturais e psicológicos que ocorrem na mulher que envelhece. A procura por ajuda especializada e a utilização de algum método terapêutico neste período podem estar diretamente relacionadas ao nível de conhecimento apresentado pela mulher. Objetivos: avaliar a opinião sobre o significado da palavra menopausa, o conhecimento sobre o tema, os fatores associados ao nível de conhecimento e saber quais são as fontes de informação para mulheres de meia-idade residentes na Região Metropolitana de Campinas (RMC). Métodos: estudo transversal de base populacional com 749 mulheres brasileiras com idade entre 45 e 60 anos, residentes nos municípios que compõem a RMC. As respostas fornecidas à questão aberta "o que é a menopausa?" foram digitadas e codificadas, criando-se categorias que emergiram da fala das entrevistadas. Também foram analisadas as respostas à pergunta: "Onde ou de quem a senhora obteve informações sobre a menopausa?". Os conhecimentos sobre menopausa e Terapia Hormonal (TH) foram avaliados através de um escore calculado com base nas respostas fornecidas para três perguntas sobre o tema. As variáveis independentes foram as características sociodemográficas, hábitos de saúde e antecedentes ginecológicos. A análise estatística foi realizada através dos testes de Mann-Whitney, Kruskal-Wallis e Modelo Linear Generalizado. Resultados: a média etária das entrevistadas foi de 52,5 (+4,4) anos. Dessas, 16% estavam na pré-menopausa, 16% na perimenopausa e 68% estavam na pós-menopausa. Cento e quarenta e seis mulheres (19,5%) tinham antecedente de uso atual ou prévio de TH. De acordo com 67,5% das entrevistadas, o conceito de menopausa englobava alterações no ciclo menstrual e nos hormônios. Para 48% das entrevistadas, menopausa significava a ocorrência de alterações físicas, como "calores e ressecamento vaginal", e "envelhecimento". Para 22,7%, menopausa representava alterações psicológicas. O conceito de menopausa esteve associado a alguma alteração da sexualidade para 7,6% das entrevistadas. Aproximadamente 18% não tinham ideia do que significava menopausa. Quanto às fontes de informação, amigos, parentes e conhecidos foram os mais citados (44,5%). Médicos ou serviços de saúde vieram em seguida, mencionados por 44,3% das mulheres. Televisão ou rádio foram citados por 22,0%, revistas, jornais ou livros foram citados por 14,0% e a internet foi citada como fonte de informação sobre a menopausa por 6,8% das mulheres. O escore final de conhecimento variou entre +1 e +11, com uma média de 4,59 (+1,86) e uma mediana de 4. Mulheres com maior escolaridade (ß = 0,64; p 3 partos normais (ß= -0,61; p < 0,001) e com maior Índice de Massa Corporal (IMC) (ß = -0,02; p= 0,046) apresentaram menor conhecimento. Conclusões: a maioria das mulheres de meia-idade residentes na RMC relacionava o termo "menopausa" a eventos fisiológicos, porém uma parcela significativa delas os vivenciava de maneira negativa. O conhecimento sobre menopausa e TH demonstrado pelas entrevistadas foi baixo. Fatores pessoais relacionados a uma maior exposição à informação qualificada parecem se associar a um maior conhecimento sobre menopausa e TH. Aparentemente, há uma demanda reprimida por informação sobre os diversos aspectos da transição menopausal entre mulheres brasileiras de meia-idade.(AU)

Abstract: Introduction: The climacteric syndrome is defined as a set of symptoms resulting from the interaction between endocrine, sociocultural, and psychological factors that occur in the aging woman. The search for specialized help and the use of some therapeutic method may be directly related to the level of knowledge that an individual acquires about a certain topic. Objectives: to evaluate the opinion about the meaning of the word menopause, the knowledge about the theme, the factors associated with the level of knowledge and to know the sources of information for middle-aged women living in the Metropolitan Region of Campinas (MRC). Methods: a population-based cross-sectional study was conducted with 749 women aged 45-60 years, residing in the Metropolitan Region of Campinas ¿ Brazil. The answers to the question "What is menopause?" were typed and coded, and categories that emerged from the interviewees¿ own speech were created. The answers to the question: "Where or from whom did you get information about menopause?" were also analyzed. Knowledge about menopause and hormone therapy (HT) was evaluated using a numerical score based on the answers given to 3 questions that had several response options. The independent variables were sociodemographic characteristics, personal habits, and gynecological background. Statistical analysis was carried out by Mann-Whitney, Kruskal-Wallis, and a generalized linear model. Results: the mean age was 52.5 (±4.4) years. Of them, 16% were premenopausal, 16% were perimenopausal and 68% were postmenopausal. One hundred and forty-six women (19.5%) had a history of current or previous use of HT. According to 67.5% of the interviewees, the concept of menopause encompassed changes in the menstrual cycle and hormones. For 48% of the interviewees, menopause meant physical changes such as "hot flushes and vaginal dryness" (42.5%), and "aging and getting old" (5.5%). For 22.7%, menopause represented psychological changes. The concept of menopause was associated with some change in sexuality for 7.6% of the interviewees. Approximately 18% could not explain and had no idea about what menopause meant. Regarding the sources of information, 44.5% of the women attributed this knowledge to friends and relatives. Doctors or health services were mentioned by 44.3% of women. Television or radio was cited by 22.0%; magazines, newspapers, or books was cited by 14.0%; and the internet was cited by 6.8% of women. The final score for knowledge about menopause ranged from +1 to +11, with a mean of 4.59 (±1.86) and a median of 4. Women with higher levels of schooling (?=0.64, p<0.001); with higher socioeconomic status (?=0.47, p<0.002); with vaginal dryness (?=0.47, p=0.003); who consumed alcohol (?=0.61, p=0.006); who use or had ever used any type of treatment to counteract menopausal symptoms (?=0.41, p=0.008); with anxiety (?=0.35, p=0.037); and with depression (?=0.31, p=0.043) possessed greater knowledge about menopause and HT. Women with a higher number (?3) of vaginal deliveries (?=-0.61, p<0.001) and a higher BMI (?=-0.02, p=0.046) possessed less knowledge about menopause and HT. Conclusions: most middle-aged women living in the Metropolitan Region of Campinas relate the term "menopause" to physiological events, but a significant portion of them experience them in a negative way. The knowledge about menopause and HT demonstrated by the interviewees was low. Personal factors related to a greater exposure to qualified information seem to be associated with greater knowledge about menopause and HT. There appears to be a suppressed demand for information on the various aspects of the menopausal transition among middle-aged Brazilian women(AU)

Effects of estrogen replacement therapy on the myelin sheath of cerebral white matter and hippocampus and Lingo-1 expression in middle-aged ovariectomized rats / 基础医学与临床

Objective To detect the expressions of Lingo-1 and myelin associated protein in the white matter and hippocampus of ovariectomized rats after short-term estrogen replacement therapy in order to explore the possible mechanisms for the effects of estrogen on the brain myelin sheaths and cognitive function.Methods 24 middleaged (9-12 months) female Sprague-Dawley (SD) rats were bilaterally ovariectomized (OVX) and randomly divided into vehicle replacement (OVX+Veh) group and estrogen replacement (OVX+E) group.After one month ERT,The spatial learning and memory ability of all rats were assessed with Morris water maze.Then,10 rats were randomly selected from each group.The ultrastucture of myelin sheaths in the cerebral white matter and hippocampus were observed,and the protein expression of MBP and Lingo-1 were investigated with Western blot and immunohistochemical staining.Results The escape latencies of OVX+E rats in navigation test were significantly shorter than that of OVX+Veh rats(P＜0.05).The myelin sheaths in the white matter and hippocampus of OVX+Veh rats showed obviously degeneration.In the OVX+E group,the expression of MBP in the white matter and hippocampus was significantly higher than that of OVX+Veh group(P＜0.05),however,the expression of Lingo-1 was significantly lower than that of OVX +Veh group (P＜ 0.05).Conclusions One-month ERT has significant beneficial effects on the spatial learning capacity and myelin sheaths in the white matter and hippocampus.The protective effects may be related to estrogen-induced downregulation of the Lingo-1 expression in the white matter and hippocampus of rats.

The Effect of Estrogen Replacement Therapy on Visceral Fat, Serum Glucose, Lipid Profiles and Apelin Level in Ovariectomized Rats

OBJECTIVES: Ovarian hormones have been shown to regulate body weight, intra-abdominal fat accumulation and plasma level of cytokines. The aim of this study was to investigate the effect of estrogen replacement therapy on visceral adipose tissue, plasma level of apelin, lipid profiles, and glucose in ovariectomized (OVX) rats. METHODS: Thirty female Wistar rats were divided into OVX (n = 20) and sham (n = 10) groups. OVX rats were subdivided into estrogen replacement therapy (OVX+est; n = 10) receiving 17 β-estradiol valerates (30 µg/kg, s.c., 5 day/week, for eight weeks), and vehicle control group receiving sesame oil same as experiment group (OVX+ses oil; n = 10). After the treatments, all groups were sacrificed and blood samples were collected, visceral fats were taken from the abdominal cavity and weighed immediately. Apelin were measured using enzyme-linked immunosorbent assay kits. Lipid profiles and glucose were measured using the enzymatic colorimetric method. Data were analyzed with one-way analysis of variance and (P < 0.05) determined as the statistical significance level. RESULTS: After eight weeks, body weight, body mass index (BMI), visceral fat, apelin and lipid profiles (P < 0.01) were increased significantly in OVX rats compared to sham group. Treatment with estrogen leads to significant reduction in body weight and BMI (P < 0.05), there was no significant change in serum apelin level in OVX+est rats compared to OVX+ses. CONCLUSIONS: These results suggest that estradiol replacement therapy successfully attenuated some of the metabolic syndrome components, and apelin does not probably stand as a mediator of these physiological functions.

Prevalence of temporomandibular disorders in postmenopausal women and relationship with pain and HRT

Abstract The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.

Incidência de doenças cardiovasculares e estrogênios na pós-menopausa / Incidence of cardiovascular diseases and estrogens in post-menopause

Estudos observacionais relatam que o risco de doenças cardiovasculares (DCV) se encontra diminuído em mulheres jovens quando comparado a homens de mesma idade. Acredita-se que essa proteção possa ser devido a ação ateroprotetora dos estrogênios endógenos indicando que a perda dos estrogênios na pós-menopausa induz DCV. No entanto, investigações clínicas avaliando mulheres que fizeram uso de terapia hormonal com estrogênios mostraram resultados duvidosos, não apresentando os benefícios observados em trabalhos básicos de experimentação animal. Estas discrepâncias podem ser explicada em parte devido as diferenças no desenho dos estudos: pois no campo experimental o tratamento com estrogênios é realizado imediatamente ou logo após a ovariectomia, embora alguns ensaios clínicos, refiram a ministração de estrogênios logo após o início da menopausa. Esses estudos referem que a reposição logo no início da pós-menopausa evita a apoptose e necrose das células endoteliais e cardíacas, atenuando ainda a hipertrofia cardíaca. Além disso referem que os estrogênios atuam como agente anti-inflamatório, o que é de grande utilidade no envelhecimento. No entanto pesquisas básicas sobre os mecanismos moleculares da ação dos estrogênios são ainda essenciais para fornecer uma melhor compreensão das propriedades deste hormônio.

Sistema nervoso e estrogênios na pós-menopausa / Nervous system and estrogens in menopause

Estudos observacionais relatam que o risco de doenças relacionadas com o sistema nervoso encontra-se diminuído em mulheres jovens ou quando utilizam a terapia hormonal. No entanto, investigações clínicas avaliando mulheres que fizeram uso de terapia hormonal com estrogênios mostraram resultados duvidosos, não apresentando os benefícios observados nos trabalhos básicos de experimentação animal. Estas discrepâncias podem ser explicadas, em parte, devido às diferenças no desenho dos estudos: pois no campo experimental o tratamento com estrogênios é realizado imediatamente ou logo após a ovariectomia, embora alguns ensaios clínicos refiram a ministração de estrogênios logo após o início da menopausa. Esses estudos referem que a reposição logo no início da pós-menopausa evita a apoptose das células endoteliais e dos neurônios, atenuando ainda a perda das conecções sinapses. Além disso, referem que os estrogênios atuam como agente anti-inflamatório e antioxidante, o que é de grande utilidade no envelhecimento. No entanto pesquisas básicas sobre os mecanismos moleculares da ação dos estrogênios no sistema nervoso são ainda essenciais para fornecer uma melhor compreensão das propriedades destes hormônios.

A cross-sectional study of cryptorchidism in children: testicular volume and hormonal function at 18 years of age

Purpose To evaluate the relationship between unilateral or bilateral criptorchidism, patient age, primary location of the gonad and modality of treatment with testicular volume and hormonal status at 18 years in patients diagnosed and treated for cryptorchidism during childhood. Materials and Methods Testicular volume, LH, FSH, and testosterone were evaluated in 143 young men at 18 years treated in childhood for unilateral (n=103) or bilateral (n=40) cryptorchidism. Results Unilateral cryptorchidism: Location of testis was prescrotal in 36 patients, inguinal in 52 and non-palpable in 15. The mean volume was 9.7 mL compared to 16.2 mL. for the spontaneously descended testicle in unilateral cryptorchidism. However, 22 patients who received HCG had a significantly bigger testis (11.8 mL.) than those treated with primary surgery (9.2 mL). The results showed a significant positive correlation between testicular volume and patient age at treatment. Bilateral cryptorchidism Location of testis was prescrotal in 34 cases, inguinal in 40 and 6 patients with non-palpable testicles. Mean volume at 18 years was 12.9 mL, greater than unilateral cryptorchid testis (9.7 mL) but smaller than healthy contralateral in unilateral cases (16.2 mL). There were significant differences in the testicular growth for bilateral patients with testicular descent after being treated with HCG (14.4 mL) in respect with those untreated (11.1 mL) or those who underwent primary surgery (11.4 mL). There was a significant positive correlation between the testicular volume and palpable (12.4 mL) or non-palpable testis (10.4 mL). There was a correlation between unilateral or bilateral cryptorchidism and levels of FSH. Conclusions Testicular volume and hormonal function at 18 years for patients diagnosed and treated for cryptorchidism during childhood are strongly influenced by whether the undescended testis was unilateral or bilateral. Location of the testes at diagnosis or ...

The effect of soy dietary supplement and low dose of hormone therapy on main cardiovascular health biomarkers: a randomized controlled trial / O efeito de um suplemento alimentar à base de soja e terapia hormonal em baixa dose sobre os principais marcadores de risco cardiovascular: ensaio clínico randomizado controlado

PURPOSE: To assess the effects of a soy dietary supplement on the main biomarkers of cardiovascular health in postmenopausal women compared with the effects of low-dose hormone therapy (HT) and placebo. METHODS: Double-blind, randomized and controlled intention-to-treat trial. Sixty healthy postmenopausal women, aged 40-60 years, 4.1 years mean time since menopause were recruited and randomly assigned to 3 groups: a soy dietary supplement group (isoflavone 90mg), a low-dose HT group (estradiol 1 mg plus noretisterone 0.5 mg) and a placebo group. Lipid profile, glucose level, body mass index, blood pressure and abdominal/hip ratio were evaluated in all the participants at baseline and after 16 weeks. Statistical analyses were performed using the χ2 test, Fisher's exact test, Kruskal-Wallis non-parametric test, analysis of variance (ANOVA), paired Student's t-test and Wilcoxon test. RESULTS: After a 16-week intervention period, total cholesterol decreased 11.3% and LDL-cholesterol decreased 18.6% in the HT group, but both did not change in the soy dietary supplement and placebo groups. Values for triglycerides, HDL-cholesterol, glucose level, body mass index, blood pressure and abdominal/hip ratio did not change over time in any of the three groups. CONCLUSION: The use of dietary soy supplement did not show any significant favorable effect on cardiovascular health biomarkers compared with HT. Clinical Trial Registry: The trial is registered at the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos - ReBEC), number RBR-76mm75. .

OBJETIVO: Avaliar os efeitos do uso de um suplemento alimentar à base de soja sobre os principais marcadores de risco cardiovascular e compará-los com o uso da terapia hormonal (TH) de baixa dose e grupo placebo em mulheres na pós-menopausa. MÉTODOS: Foram selecionadas 60 participantes do ambulatório de menopausa com idade entre 40 e 60 anos, com idade média de 4,1 anos na menopausa para participar de um ensaio clínico randomizado, duplo-cego e controlado com duração de 16 semanas. As pacientes foram randomizadas em 3 grupos: um grupo que recebeu suplemento dietético à base de soja (isoflavona 90 mg), um grupo que recebeu TH em baixa dose (estradiol 1 mg e noretisterona 0,5 mg) e um grupo placebo. Os seguintes parâmetros foram avaliados no início e ao término das 16 semanas de intervenção: perfil lipídico, glicemia de jejum, índice de massa corpórea, pressão sanguínea arterial e circunferência abdominal. A análise estatística foi realizada usando-se o teste do χ2, teste exato de Fisher, teste não paramétrico de Kruskal-Wallis, análise de variância (ANOVA), teste t de Student pareado e teste de Wilcoxon. RESULTADOS: Ao final do período de intervenção de 16 semanas, houve uma diminuição do colesterol total em 11,3% e do LDL-colesterol em 18,6% no grupo da TH, porém ambos não tiveram mudanças tanto no grupo do suplemento alimentar à base de soja quanto no grupo placebo. Os valores de triglicérides, HDL-colesterol, glicemia de jejum, índice de massa corpórea, pressão sanguínea arterial e circunferência abdominal não mudaram ao longo da intervenção em nenhum dos grupos estudados. CONCLUSÃO: Do ponto de vista cardiovascular, o suplemento alimentar à base de soja não mostrou efeito ...

Correlation between the estrogen replacement therapy and the prevalence of female with Alzheimer's dis-ease:a meta-analysis / 中国神经精神疾病杂志

Objective To investigate the relationship between estrogen replacement therapy and female patients with Alzheimer's risk. Methods We searched the PubMed, Springer, CBM, CNKI, VIP database for studies on the es-trogen replacement therapy and women with Alzheimer's disease, retrieval time from database to 2012 December. We evaluated the methodological quality of the included studies, used RevMan 5.0 software to analyze the extracted data. Results We found seven case-control studies which included 1392 patients and 2719 controls. The meta analysis re-sults show that the proportion of estrogen replacement therapy in AD group is significantly lower than that of the con-trol group, the difference has statistically significant [OR=0.68, 95%CI(0.50,0.90), P=0.01]. Conclusions estrogen re-placement therapy has effects on female patients with Alzheimer's disease, and is a protective factor.