Isoflavonas como tratamento alternativo na sintomatologia climatérica: uma revisão sistemática / Isoflavones as alternative treatment in climacteric symptomatology: a systematic review

O climatério é uma fase natural da vida da mulher que ocorre entre os 40 e 65 anos de idade e é caracterizado pela transição entre a fase reprodutiva e não reprodutiva. Neste período, devido às alterações hormonais, ocorrem alterações biológicas, endócrinas e clínicas. Sintomas vasomotores são típicos do hipoestrogenismo e podem interferir negativamente na qualidade de vida das mulheres. Este estudo teve como objetivo revisar os resultados dos estudos de intervenção que utilizaram isoflavonas na sintomatologia de mulheres climatéricas não usuárias de Terapia de Reposição Hormonal (TRH). Realizou-se uma revisão sistemática de artigos publicados entre os anos de 2008 e 2019 na base de dados PubMed. Foram encontrados 169 estudos, e considerando os critérios de inclusão, 18 artigos foram selecionados, em que houve intervenção com isoflavonas por meio de cápsulas e/ou suplementos ou alimentos para tratamento da síndrome climatérica. Foram verificados resultados positivos nos sintomas globais, com destaque para sintomas vasomotores, em mais da metade dos estudos avaliados, em que doses entre 45 mg a 160 mg diárias de isoflavonas por pelo menos 12 semanas foram administradas, especificadamente nas mulheres no período da pós-menopausa.

The climacteric is a natural phase during women’s life, which occurs between 40 and 65 years. It is characterized by the transition from their reproductive to non-reproductive phase. In this period, due to hormonal changes, biological, endocrine and clinical modifications also occur. Vasomotor symptoms are characteristic of hypoestrogenism and can negatively affect women’s quality of life. This study aimed to review the results of intervention studies which used isoflavones to treat the symptoms of climacteric women who did not undergo Hormone Replacement Therapy (HRT). A systematic review of articles published between 2008 and 2019 in the PubMed database was carried out. 169 studies were found, and considering the inclusion criteria, 18 articles were selected, in which it was described isoflavones intervention with capsules and/ or supplements or foods for the treatment of climacteric syndrome. Positive results were observed regarding to global symptoms, with emphasis on vasomotor symptoms in more than half of the studies, in which daily doses of isoflavones, between 45 mg to 160 mg, for at least 12 weeks, were administered specifically in postmenopausal women.

Evaluación del Tratamiento Homeopático de Mujeres en Climaterio entre los 45 y 60 años con la Menopause Rating Scale (MRS) / Treatment Evaluation Homeopathic Women in Climacteric between 45 and 60 years old with Menopause Rating Scale (MRS)

La terapia hormonal es el tratamiento convencional para contrarrestar síntomas propios del climaterio; sin embargo, algunas mujeres tienen contraindicada esta terapia debido a los efectos adversos que provoca. El objetivo de este estudio fue evaluar la utilidad del tratamiento homeopático durante el climaterio con el uso de la Menopause Rating Scale (MRS) o Escala de Calificación Menopáusica. El estudio incluyó a 31 mujeres, sin problemas cardiacos, sin terapia de reemplazo hormonal y sin antecedentes de cáncer, a quienes se les aplicó el cuestionario de la MRS para obtener un puntuaje antes del tratamiento. Para determinar el tratamiento se utilizó el repertorio electrónico Radar 10.0 para Windows, con el objetivo de repertorizar los síntomas característicos de cada paciente y determinar el medicamento similar. El medicamento fue prescrito en dinamizaciones 30CH, indicando 5 gotas sublinguales cada 8 horas. La evaluación de los pacientes se llevó a cabo cada mes durante tres meses. Se realizó una evaluación final a los tres meses por comparación de puntajes de la escala inicial y final, a través de un análisis estadístico y utilizando la prueba de Wilcoxon. Lachesis trigonocephalus y Pulsatilla nigricans fueron los medicamentos indicados con mayor frecuencia, de acuerdo con los síntomas de cada paciente. La comparación del puntaje, antes y después del tratamiento, evidenció una reducción de síntomas con diferencia estadística, lo cual reflejó una mejoría global del 35%. Esta evidencia sugiere que el tratamiento homeopático beneficia a las mujeres en el climaterio. (AU)

Hormonal therapy is the conventional treatment for counteracting climacteric symptoms; however, this treatment is contraindicated in some women due to the adverse effects that this therapy may cause. The purpose of this study was to evaluate the usefulness of homeopathic therapy during the climacteric using the Menopause Rating Scale (MRS). The study included 31 women, without cardiac problems, history of no cancer or hormone replacement therapy; a MRS scale questionnaire was applied to these women to evaluate each symptom before to treatment. The Radar 10.0 for Windows electronic repertoire was used to repertorize the characteristic symptoms of each patient and determine the similarly. Homeopathic medication was prescribed in 30CH dynamization as 5 sublingual drops every 8 hrs. Patient evaluation took place monthly for 3 months. The evaluation of the results was performed by the comparison of scale scores through a statistical analysis using the Wilcoxon test. Lachesis trigonocephalus and Pulsatilla nigricans were the most frequent treatment indications, according to the symptoms of each patient. At the end of the homeopathic treatment, symptoms reduction was observed with statistical significance in the score, which reflects an overall improvement of 35%. This evidence suggested that homeopathic treatment benefits women in climacteric. (AU)

Medicamentos homeopáticos en el tratamiento del climaterio y la menopausia: una revisión / Homeopathic medicinal products in the treatment of climateric and menopause: a review

RESUMEN Durante el climaterio y la menopausia debido a cambios hormonales pueden presentarse en las mujeres síntomas que afectan la calidad de vida y las relaciones interpersonales. La homeopatía puede ser utilizada como terapia alternativa o complementaria en el manejo de sus síntomas proporcionando múltiples beneficios, escasos efectos secundarios, ahorro de recursos y apertura de una nueva línea para investigar. La bibliografía sobre este tema es insuficiente y se encuentra dispersa lo que dificulta la consulta por parte de los profesionales que la necesitan. Se realizó una revisión bibliográfica con el objetivo de identificar y describir los principales medicamentos homeopáticos que pueden ser utilizados para tratar los síntomas durante el climaterio y la menopausia. Los artículos se identificaron básicamente a través de la búsqueda automatizada en las bases de datos Scielo, PubMed y EBSCO, entre los meses de enero de 2017 a mayo de 2018. Se revisaron aquellos libros y artículos que por su trascendencia fueron considerados como referentes en el tema. Se escogieron 26 referencias bibliográficas que se ajustaban a los objetivos de esta investigación. Fueron identificados y descritos 22 medicamentos homeopáticos susceptibles de ser utilizados en el tratamiento de los síntomas de climaterio y menopausia por lo que puede ser una fuente útil de consulta (AU).

ABSTRACT During the climacteric and menopause, due to hormonal changes, women may present symptoms affecting life quality and interpersonal relations. Homeopathy could be used as an alternative or complementary therapy in the management of those symptoms, providing several benefits, scarce secondary effects, saving resources and opening a new research field. There is not enough bibliography on this topic and it is dispersed, making it difficult for the professional to consult it when it is necessary. A bibliographic review was carried out with the objective of identifying and describing the main homeopathic medicinal products that could be used to treat the symptoms during the climacteric and menopause. The articles were identified mainly through an automated search in Scielo, PubMed and EBSCO databases, in the period from January 2017 and May 2018. Those books and articles considered as referents in the topic because of their transcendence were reviewed. 26 bibliographic references were chosen because they complied with the objective of this research. 20 homeopathic medicinal products capable of being used in the treatment of the climacteric and menopause symptoms were identified and described, being therefore a useful consultation source (AU).

Does Cimicifuga racemosa have the effects like estrogen on the sublingual gland in ovariectomized rats?

BACKGROUND: Cimicifuga racemosa is one of the herbs used for the treatment of climacteric syndrome, and it has been cited as an alternative therapy to estrogen. Apart from hectic fevers, dyspareunia and so on, dry mouth also increase significantly after menopause. It has not yet been reported whether C. racemosa has any impact on the sublingual gland, which may relate to dry mouth. In an attempt to determine this, we have compared the effects of estrogen and C. racemosa on the sublingual gland of ovariectomized rats. RESULTS: HE staining showed that the acinar cell area had contracted and that the intercellular spaces were broadened in the OVX (ovariectomized rats) group, while treatment with estradiol (E2) and iCR (isopropanolic extract of C. racemosa) improved these lesions. Transmission electron microscopy showed that rough endoplasmic reticulum expansion in mucous and serous acinar epithelial cells and apoptotic cells was more commonly seen in the OVX group than in the SHAM (sham-operated rats) group. Mitochondria and plasma membrane infolding lesions in the striated ducts were also observed. These lesions were alleviated by both treatments. It is of note that, in the OVX + iCR group, the volume of mitochondria in the striated duct was larger than in other groups. Immunohistochemical staining showed that the ratio of caspase-3 positive cells was significantly increased in the acinar cells of the OVX group compared with the SHAM group (p < 0.05); and the MA (mean absorbance) of caspase-3 in the striated ducts also increased (p < 0.05). Estradiol decreased the ratio of caspase-3 positive cells and the MA of caspase-3 in striated ducts significantly (p < 0.05). ICR also reduced the ratio of caspase-3 positive cells and the MA in the striated ducts (p < 0.05), but the reduction of the MA in striated ducts was inferior to that of the OVX + E2 group (p < 0.05). CONCLUSION: Both estradiol and iCR can inhibit subcellular structural damage, and down-regulate the expression of caspase-3 caused by ovariectomy, but their effects were not identical, suggesting that both drugs confer a protective effect on the sublingual gland of ovariectomized rats, but that the specific location and mechanism of action producing these effects were different.

Estudo exploratório do uso de plantas medicinais para o controle de fatores de risco cardiometabólico em mulheres pós-menopausa / Exploratory study of the medicinal plants used to control cardiometabolic risk, in postmenopausal women

Este estudo buscou identificar o uso de plantas medicinais para o controle de fatores de risco cardiometabólico, em mulheres pós-menopausa. Trata-se de um estudo transversal, analítico e exploratório e subprojeto de uma pesquisa institucional "Estudo multidimensional de mulheres pós-menopausa do município de Catuípe/RS". As informações relativas ao uso de plantas foram obtidas em entrevista estruturada e os dados relativos ao índice de massa corporal, circunferência abdominal, pressão arterial, perfil lipídico e glicêmico do banco de dados da referida pesquisa. Foram selecionadas 51 mulheres, 37,2% relataram usar plantas para problemas cardiometabólicos e apresentavam elevado risco cardiovascular. Foram citadas 18 espécies de plantas, três usadas para diabetes mellitus, sendo a Sphagneticola trilobata a mais citada, uma para hipertrigliceridemia, cinco para hipercolesterolemia, entre as quais a Myristica fragrans foi a mais mencionada, uma para hipertensão e três para redução de peso, destacandose a Camellia sinensis. Para seis das espécies estudadas foi atribuída ação diurética e uma delas tem indicação para problemas cardíacos. Dentre as citadas, seis encontramse na RDC 10/2010 e três no Formulário de Fitoterápicos da Farmacopéia Brasileira, contudo, apenas a indicação de uma planta confere com o relato das entrevistadas, por outro lado foram encontrados estudos que relacionaram estas plantas com efeitos cardioprotetores. Considerando a importância do manejo adequado destas doenças, tornase necessário averiguar se as plantas estão sendo utilizadas para a indicação correta. Sugere-se também a implantação de ações educativas visando qualificar o uso de plantas para diminuir o risco cardiometabólico, utilizando as Políticas do SUS como instrumento de trabalho.

This study objective to identify the use of medicinal plants to control cardiometabolic risk factors in postmenopausal women. This study is cross-sectional, analytical and exploratory and subproject of an institutional research "Multidimensional study of postmenopausal women in the city of Catuípe/RS". The information about the use of plants were obtained from structured interviews and the data on body mass index, waist circumference, blood pressure, lipid and glycemic profile of said search database. The sample is 51 women, 37.2% reported using plants to cardiometabolic problems and had high cardiovascular risk. There were 18 plant species mentioned, three was used for diabetes mellitus, sphagneticola trilobata being the most cited, one for hypertriglyceridemia, and five to hypercholesterolemia, among which Myristica fragrans was the most mentioned, one medicinal plant was cited for hypertension and three to reduce weight, like Camellia sinensis. For six of the species studied was attributed diuretic action and one of them is indicated for heart problems. Among the aforementioned six are in the DRC 10/2010 and three in Brazilian Herbal Pharmacopoeia, however, only the indication of a plant gives to the account of the interviewees, however studies have found that these plants with related effects cardioprotective. Considering the importance of proper management of these diseases, it is necessary to determine whether the plants are being used for the correct indication. It also suggests the implementation of educational actions to qualify the use of plants to reduce cardiometabolic risk, using Public Health Rules as a working tool.

effect of melatonin on climacteric symptoms in menopausal women; a double-blind, randomized controlled, clinical trial

Menopause is one of the most critical periods of woman's life. With reducing of ovarian estrogen; women are more prone to psychological and physical symptoms. The present study aimed to investigate the effect of melatonin on the climacteric symptoms. The present double blind, placebo randomized controlled clinical trial was conducted on 240 menopausal women [40 - 60 years old] referring to the gynecology clinics of Shiraz University of Medical Sciences [January - November 2012]. The participants were randomly divided into two groups through sortition. Demographic characteristics, Goldberg's general health questionnaire [GHQ], Greene Climacteric Scale and level of Follicle Stimulating Hormone [FSH] were determined for both groups before the intervention. The intervention group received one 3mg melatonin tablet each night for 3 months and the control group received the placebo in the same period. Changes of climacteric symptoms and drug complications were measured 1, 2 and 3 months after the intervention We analyzed the data of 99 postmenopausal women in the intervention group and 101 postmenopausal women in the control group. In the melatonin group, the climacteric symptoms score decreased from 35.73+11.6 to 17.09+10.22 during the 3-month study period and regardless of time, a significant difference was observed between the two groups [P<0.001]. In addition, a significant difference was found between the two groups regarding various dimensions of the climacteric symptoms over time [P<0.001]. No significant difference was found regarding side effects between the two groups [P= 0.135]. The study findings showed that using melatonin improved the climacteric symptoms

Posición oficial de la Sociedad Chilena de Climaterio para el manejo clínico de la mujer climatérica / Official position of the Chilean Society of Climacteric on the management of climacteric women

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.

Efeitos do Trifolium pratense nos sintomas climatéricos e sexuais na pós-menopausa / Effects of Trifolium pratense on the climacteric and sexual symptoms in postmenopause

OBJETIVO: Avaliar os efeitos do tratamento com Trifolium pratense nos sintomas climatéricos e na satisfação sexual de mulheres na pós-menopausa. MÉTODOS: Este estudo foi prospectivo, randomizado, duplo-cego e controlado com placebo. Foram selecionadas 120 mulheres na faixa etária de 45 anos a 65 anos com sintomas climatéricos, amenorreia superior a um ano e sem tratamento nos últimos seis meses. Após a seleção, foram divididas em dois grupos: GT -receberam Trifolium pratense na dose de 40 mg, 1 capsula/dia; GP -receberam placebo (controle), contendo lactose, 1 cápsula/dia. A duração do tratamento foi de 12 meses. As pacientes foram avaliadas clinica e laboratorialmente antes do tratamento e com quatro, oito e 12 meses de tratamento. Foi empregado também o Índice Menopausal de Kupperman (IMK) e o Inventário de Satisfação Sexual Golombok Rust. No final do estudo, cada grupo tinha 50 pacientes. RESULTADOS: Houve melhora significante dos sintomas menopausais após quatro meses de tratamento pelo IMK, principalmente em relação aos fogachos, comparando os dados antes do tratamento nos dois grupos, porém, não houve diferença significante entre os grupos. Não houve melhora na sexualidade antes e após o tratamento. CONCLUSÃO: O tratamento por 12 meses com Trifolium pratense, na dose de 40mg/dia, não promoveu melhora significante dos sintomas menopausais e na satisfação sexual.

OBJECTIVE: To evaluate effects of treatment with Trifolium pratense on climacteric symptoms and sexual satisfaction in postmenopausal women. METHODS: This study was prospective, randomized, double-blind and placebo-controlled. We selected 120 women, aged between 45 and 65 years with climacteric symptoms, with absence of menstruation (amenorrhea) for more then one year and without any treatment in the last six months. After selection, women were divided into two groups: GT received 40 mg of Trifolium pratense (one capsule per day); GP received placebo (control, one capsule of lactose per day). Treatment lasted 12 months and women were evaluated before and after four, eight and twelve months of treatment by clinical (Kupperman Menopausal Index -KMI and the Golombok Rust Inventory of Sexual Satisfaction) and laboratory exams. At study end, each group had 50 patients. RESULTS: There was a significant decrease of symptoms after four months of treatment according to the KMI, mainly of hot flashes in relation to baseline data for both groups, but not between both groups. Evaluation of sexual satisfaction did not disclose any difference in both groups before and after treatment. CONCLUSION: The 40mg/day Trifolium pratense treatment may not ameliorate menopausal symptoms or improve sexual satisfaction.

[ effect of tibolone on hclimacteric symptoms of healthy postmenopausal women]

Menopause is related to many symptoms that have an effect on women's life quality. HRT and its alternatives such as Tibolone are some of the routes for enhancement of different aspects of QoL in menopause. The aim of this study was the comparison of the effects of Tibolone and placebo on climacteric symptoms of healthy menopausal women. This is a randomized, prospective clinical study. A total of 96 women with no absolute contraindication for hormone replacement therapy [HRT] that reffered to selected clinics [gynecologic clinics in Fajr and Avesina Hospitals, Aboraihan and Shahid Haidari Polyclinic and an individual clinic] during 2007-2008 were divided into two groups: 41 women in the Tibolone group received Tibolone 2.5 mg/day + Ca-D [500 mg +200 IU] and 45 women in the placebo group received only Ca-D [500 mg +200 IU] for six months. At baseline and after six months, climacteric symptoms were assessed by Greene Climacteric Scale [GCS]. Data was analyzed by SPSS version 15. Paired and independent t-test, Chi-Square test and Mann-Whitney were used for analyzing the collected data. Thirty two women in the Tibolone group and 43 women in the placebo completed the study. Comparing the baseline and placebo values, the Tibolone group significantly improved on all of GCS subscales which include: depression, anxiety, somatic, vasomotor symptoms and libido [P<0.05]. In postmenopausal women, Tibolone significantly improved all aspects of climacteric symptoms and increased their quality of life

Efficacy and safety of Pueraria mirifica (Kwao Kruea Khao) for the treatment of vasomotor symptoms in perimenopausal women: Phase II Study.

OBJECTIVES: To evaluate the preliminary efficacy and safety of Pueraria mirifica in the treatment of vasomotor symptoms. DESIGN: Open-label study. SETTING: Hat Yai Regional Hospital, Thailand. SUBJECTS: Pre and postmenopausal women with vasomotor symptoms, such as hot flushes and night sweats. Other unpleasant symptoms, urogenital and psychological symptoms, were also evaluated. MATERIAL AND METHOD: Patients were enrolled voluntarily and randomly received 50 mg or 100 mg of Pueraria mirifica in capsules, once daily for six months. RESULTS: Of the 48 enrolled patients, 11 cases were excluded for failing to complete the initial work-up. Thirty-seven cases were evaluated. 20 of 37 (54.1%) randomly received a dose of 50 mg/day of Pueraria mirifica (Group A), and 17 of 37 (45.9%) received 100 mg/day of Pueraria mirifica (Group B). The mean of the modified Greene climacteric scale decreased from 35.6 to 26.6, 17.2 and 15.1 in group A, while group B, declined from 32.6 to 21.0, 14.8 and 13.6 at 1-, 3- and 6-month respectively. The mean serum estradiol, fluctuated from the baseline of 76.6 to 55.4, 56.7, 72.5, 69.2, 114.2 and 74.5 pg/ml at 1-, 2-, 3-, 4-, 5- and 6-month respectively. Whereas the mean serum follicle-stimulating hormone (FSH)/luteinizing hormone (LH) was stable in the range of; 27.1/12.6, 28.3/12.9 and 22.5/11.4 mIU/ml at baseline, 3- and 6-month respectively. CONCLUSIONS: Pueraria mirifica, containing phytoestrogens, relatively alleviated the climacteric symptoms in perimenopausal women. The transient negative profiles occurred in a small number of subjects that included anemia, and liver profiles. While there was a slight decrease in lipoproteins and an increase in hormonal profiles, Pueraria mirifica demonstrates great promise in the treatment of climacteric symptoms among perimenopausal women. However, optimal doses should be clinically assessed, to meet appropriate individual responses.

Alleviation of the climacteric symptoms with oral sequential hormone replacement therapy.

The efficacy of the oral hormone replacement therapy (HRT) preparation estradiol valerate/levonorgestrel (EV/LNG, Klimonorm) in the alleviation of the menopausal complaints of peri- and postmenopausal Thai women was studied in a prospective, open, uncontrolled phase IV clinical trial. Of the 50 peri- or postmenopausal women screened, 39 completed the study. From them 31 were postmenopausal and 8 perimenopausal. The participants received EV/LNG over a period of 6 cycles. The Menopause Rating Scale II (MRS II) was used to assess the effect of EV/LNG on the menopausal symptoms. The changes in the main parameters of the MRS II during the treatment with EV/LNG showed that the general score decreased by 34.9 per cent after 3 months and was kept at the same value after 6 months of treatment. The somato-vegetative complaints decreased by 32.5 per cent after 3 months and by 35 per cent after 6 months. The psychological complaints decreased by 34.1 per cent after 3 months and by 32.9 per cent after 6 months. The urogenital complaints decreased by 29.3 per cent after 3 months, and remained at the same level after 6 months of treatment. In conclusion, the 6-months administration of the oral HRT preparation estradiol valerate/levonorgestrel caused a considerable alleviation of the climacteric symptoms in menopausal women.

Efeito da terapia de reposicao estrogenica no humor em mulheres menopausadas / Effects of estrogen replacement therapy on mood in postmenopausal women: a review of the literature

Foram revisados estudos intervencionistas e epidemiologicos que procuraram identificar o efeito da terapia de reposicao estrogenica sobre o humor em mulheres menopausadas. A maioria desses estudos apresenta desenhos experimentais muito diferentes entre si, e importantes limitacoes metodologicas sao encontradas em muitos deles...

Efeitos da isoflavona na síndrome do climatério / The effects of isoflavone in climacteric syndrome

Estudo realizado pela equipe da Disciplina de Ginecologia, no setor de Climatério da Universidade Federal de Säo Paulo (Unifesp), revela os efeitos positivos dos fitoestrógenos - presentes nos vegetais, especialmente na soja - na prevençäo de doenças crônicas, comoo câncer de cólon, mama, próstata, distúrbios cardiovasculares, além dos efeitos benéficos nas pacientes na pós-menopausa

Sexualidade no climaterio e na senilidade / Sexuality in climacteric and senility

As mudancas fisiologicas que ocorrem na mulher com a menopausa e senilidade podem prejudicar com maior ou menor intensidade sua atividade sexual. E importante que a mulher seja informada a respeito das mudancas comportamentais e fisiologicas que ocorrem com o envelhecimento, tanto nela mesma quanto em seu parceiro e que ambos sejam reeducados sexualmente. Dificuldades na identificacao e tratamento das disfuncoes sexuais desta fase se devem, principalmente, ao despreparo dos profissionais de saude e a repressao sexual da mulher, sobretudo da mulher idosa. Esta revisao mostra que na sexualidade da mulher no climaterio e na senilidade alem dos fatores psicossociais interferem...

Avaliaçäo da adesäo ao tratamento de mulheres climatéricas em hospital universitário / Evaluation of the adherence to the treatment of climacteric women at an university hospital

A terapia de reposiçäo hormonal vem sendo aplicada de maneira universal porém pouco uniforme nos últimos 15 anos e muitas säo as dificuldades para alcançar um grau de adesäo aceitável. Destacam-se como fatores influentes os sócio-econômico-demográficos, a relaçäo médico-paciente e os efeitos colaterais. Tendo em vista os poucos dados existentes em nosso meio, este estudo objetivou avaliar a adesäo à terapia de reposiçäo hormonal e ao seguimento climatérico em um grupo de mulheres na pós menopausa. 323 pacientes na pós menopausa foram estudadas, sendo que 237 receberam algum tipo de reposiçäo hormonal (esquemas seqüenciais e contínuos: oral, transdérmicos ou vaginal) e 86 pacientes foram oferecidas medidas de suporte. Avaliaram-se os principais sintomas, a taxa de adesäo e os efeitos colaterais ao longo de 5 anos de seguimento. Comparou-se a adesäo ao tratamento entre os grupos estudados e naquele que utilizou reposiçäo hormonal comparou-se diferentes tipos de esquemas entre si. Houve queda progressiva e continuada da taxa de adesäo ao tratamento proposto, sendo observado que apenas 6 por cento das pacientes continuaram o seguimento após o período de estudo. Näo houve diferenças entre os grupos que utilizaram reposiçäo hormonal com o que näo utilizou. O seguimento a pacientes climatéricas sofre inúmeras influências que geralmente conduzem ao abandono do tratamento, sobressaindo neste estudo as dificuldades sócio-econômicas. Várias medidas e estratégias clínicas podem conduzir ao aumento da adesäo e menores índices de abandono.

Avaliaçäo dos efeitos vasculares do 17ß-estradiol sobre as artérias uterinas de mulheres na pós-menopausa através da Dopplervelocimetria transvaginal colorida / Transvaginal color Dopplerflow assessment of vascular effects of 17ß-estradiol in the uterine arteries in postmenopausal women

OBJETIVOS: Desenvolver um estudo controlado, triplo cego, randomizado para avaliar os efeitos do estradiol(E) sobre a resistência vascular sobre as artérias uterinas em mulheres na pós-menopausa. PACIENTES E METODOS: Sessenta e quatro pacientes menopausadas foram incluídas em um estudo randomizado, triplo cego e divididos em 2 grupos: Grupo estudo, 32 pacientes que receberam estradiol transdérmico (E), e Grupo controle, 32 pacientes que receberam adesivos transdérmicos com placebo. O Doppler colorido foi usado para avaliar a resistência vascular das artérias uterinas, utilizando-se o Indice de Pulsatilidade (IP) como base para a análise. A primeira avaliaçäo ao Doppler foi realizada antes do início da terapia estrogênica e a segunda avaliaçäo no 12º dia do primeiro ciclo de E2. Análise estatística foi feita através do teste de t de Student. RESULTADOS: Os valores de IP pré-tratamento foram 3,41 ñ 0,81 para o grupo estudo e 3,41 ñ 0,66 para o grupo controle; após a administraçäo de E2, os valores médios de IP encontrados foram 2,37 ñ 0,82 no grupo com reposiçäo de estradiol (p<0,0001), enquanto que no grupo controle esta diferença näo foi significativa (p=0,9439). CONCLUSÃO: Os resultados demonstram que a estrogenioterapia possui efeito vasodilatador nas artérias uterinas promovendo uma diminuiçäo na resistência vascular local. Este efeito pode ser demonstrado já em um curto período de tempo e provavelmente tem um importante papel nos mecanismos de proteçäo cardiovascular após a menopausa.