ABSTRACT
O transplante de medula óssea (TMO) é um procedimento indicado para o tratamento de doenças hematológicas, que afetam muitas mulheres jovens. O aperfeiçoamento dos cuidados durante o TMO proporciona altos índices de cura e de sobrevida. No entanto, pode deixar sequelas em vários órgãos e sistemas, entre eles o sistema reprodutor e os órgãos genitais, impactando negativamente a qualidade de vida das receptoras do TMO. O objetivo desta publicação foi realizar uma revisão narrativa sobre o tema e propor um protocolo assistencial que torne acessível os cuidados relacionados à saúde sexual e reprodutiva a esse grupo especial de mulheres, baseado em dados clínicos de um ambulatório de assistência ginecológica às mulheres transplantadas no Hospital Amaral Carvalho, em Jaú, no interior de São Paulo.(AU)
Bone marrow transplantation (BMT) is indicated for the treatment of hematological diseases which affect many young women. The improvement of care during BMT procedures provides higher cure and survival rates. however, it can cause sequelae in various organs and systems, including the reproductive system and genitals, negatively impacting quality of life. The purpose of this publication is to present a narrative review related to this theme and to propose a healthcare protocol that allows sexual and reproductive care in this special group of patients, based on the clinical experience of a gynecological outpatient clinic at the Amaral Carvalho Hospital, in Jaú (SP) which specifically care for these women.(AU)
Subject(s)
Humans , Female , Postoperative Complications , Bone Marrow Transplantation/adverse effects , Clinical Protocols , Risk Factors , Immunosuppression Therapy/adverse effects , Primary Ovarian Insufficiency/physiopathology , Female Urogenital Diseases/physiopathology , Graft vs Host Disease/physiopathologyABSTRACT
The aim of the present study was to assess the prevalence of osteoporosis in a sample of 32 patients with spontaneous primary ovarian insufficiency (POI) in comparison to reference groups of 25 pre- and 55 postmenopausal women. Hip (lumbar) and spinal bone mineral density (BMD) measurements were performed by dual-energy X-ray absorptiometry in the three groups. The median age of POI patients at the time of diagnosis was 35 years (interquartile range: 27-37 years). The mean ± SD age of postmenopausal reference women (52.16 ± 3.65 years) was higher than that of POI (46.28 ± 10.38 years) and premenopausal women (43.96 ± 7.08; P = 0.001) at the time of BMD measurement. Twenty-seven (84.4 percent) POI women were receiving hormone replacement therapy (HRT) at the time of the study. In the postmenopausal reference group, 30.4 percent were current users of HRT. Lumbar BMD was significantly lower in the POI group (1.050 ± 0.17 g/cm²) compared to the age-matched premenopausal reference group (1.136 ± 0.12 g/cm²; P = 0.040). Moreover, 22 (68.7 percent) POI women had low bone density (osteopenia/osteoporosis by World Health Organization criteria) versus 47.3 percent of the postmenopausal reference group (P = 0.042). In conclusion, the present data indicate that BMD is significantly lower in patients with POI than in age-matched premenopausal women. Also, the prevalence of osteopenia/osteoporosis is higher in POI women than in women after natural menopause. Early medical interventions are necessary to ensure that women with POI will maintain their bonemass.
Subject(s)
Adult , Female , Humans , Middle Aged , Osteoporosis/etiology , Primary Ovarian Insufficiency/complications , Absorptiometry, Photon , Bone Density , Hormone Replacement Therapy , Osteoporosis, Postmenopausal/diagnosis , Osteoporosis, Postmenopausal/etiology , Osteoporosis, Postmenopausal/physiopathology , Osteoporosis/diagnosis , Osteoporosis/physiopathology , Premenopause/physiology , Primary Ovarian Insufficiency/physiopathologyABSTRACT
Se presenta el cuadro de falla ovárica prematura de etiología inmunológica, describiendo sus características fisiopatológicas y clínicas, diagnóstico, tratamiento y pronóstico. Se reporta un caso clínico atendido en el Servicio de Ginecología y Obstetricia del Hospital San Juan de Dios, discutiendo alternativas diagnósticas y terapéuticas
Subject(s)
Humans , Female , Adult , Autoimmune Diseases/complications , Primary Ovarian Insufficiency/etiology , Amenorrhea/etiology , Hormone Replacement Therapy , Primary Ovarian Insufficiency/classification , Primary Ovarian Insufficiency/physiopathology , Primary Ovarian Insufficiency/drug therapy , Oophoritis/physiopathology , Signs and SymptomsABSTRACT
El desarrollo de amenorrea hipotalámica refleja generalmente una respuesta individual al stress ambiental y al propio estilo de vida. En la mayoría de los casos, no hay una anormalidad anatómica detestable del eje hipotálamo-hipófisis-ovario-endometrio. Numerosas evidencias sugieren que el defecto de base es una reducción de la actividad del generador hipotalámico de pulsos de GNRH. Los factores neuroendocrinos que regulan la función de este centro son parcialmente conocidos. El sistema opioidérgico y dopaminérgico han sido implicados como posibles factores en la reducción de la secreción pulsátil de GNRH. Debido a la naturaleza por lo general funcional del trastorno, se espera una reactivación de la actividad pulsátil de GNRH una vez superado los factores que lo desencadenaron. La persistencia de la anovulación obliga a una terapia de reemplazo hormonal fundamentalmente por el riesgo de terapia de reemplazo hormonal fundamentalmente por el riesgo de osteoporosis. En las pacientes que desean fertilidad, la inducción de ovulación con GNRH pulsátil es la alternativa terapéutica más efectiva
Subject(s)
Humans , Female , Adolescent , Adult , Amenorrhea/etiology , Hypothalamic Diseases/complications , Amenorrhea/classification , Anovulation/drug therapy , Clomiphene/therapeutic use , Stress, Psychological/complications , Estrogens/deficiency , Exercise , Pulsatile Flow/physiology , Gonadotropin-Releasing Hormone/metabolism , Gonadotropin-Releasing Hormone/therapeutic use , Gonadotropins/deficiency , Ovulation Induction/methods , Primary Ovarian Insufficiency/physiopathology , Naltrexone/therapeutic use , Nutrition Disorders/complicationsABSTRACT
Presentamos una paciente de 33 años de edad que consulta por amenorrea secundaria causada por una Falla Ovárica Prematura(FOP) secundaria a un Síndrome Turner en mosaico. La FOP definida como amenorrea hipergonadotrópica en pacientes menores de 40 años tiene una incidencia del 2 al 10 por ciento. Es causada por diferentes entidades entre las que encontramos desórdenes autoinmunes, defectos metabólicos y enzimáticos, enfermedades infecciosas, causas iatrogénicas, defectos en las gonadotropinas y causas genéticas. Estas últimas son responsables de FOP especialmente en pacientes menores de 30 años, en las que se justifica la solicitud de cariotipo como parte del estudio. Describimos las características de la disgenesia gonadal, del Síndrome Turner y los elementos funcionales del cromosoma X cuya ausencia altera la función gonadal. También mencionamos los diferentes mosaicos descritos en relación al Síndrome Turner y sus consecuencias en el desarrollo somático y gonadal