Síntomas climatéricos y calidad de vida mediante índice de Kupperman-Blatt y escala de Cervantes / Climacteric Symptoms and Quality of Life according to the Kupperman-Blatt Index and the Cervantes Scale

Introducción: Durante el climaterio o perimenopausia se reflejan una serie de síntomas asociados a la disminución progresiva de las secreciones hormonales de estrógeno y progesterona, estas deficiencias provocan diversos síntomas de orden somático, vasomotor, sexual y psicológico que perjudican la calidad de vida en general de las mujeres, además de las alteraciones en el ciclo menstrual. Objetivo: Determinar la severidad de los síntomas climatéricos en mujeres perimenopáusicas mediante el índice de Kupperman-Blatt y la Escala de Cervantes. Métodos: Se trató de un estudio de corte cuantitativo, tipo descriptivo, observacional, y correlacional, en pacientes que asistían al Centro de Salud Las Moras, en el Departamento de Huánuco, Distrito Huánuco Perú. La muestra estuvo conformada por 60 mujeres que cumplieron con los criterios de inclusión. Se aplicaron el Índice Menopáusico de Kupperman-Blatt y la Escala de calidad de vida de Cervantes. Resultados: La evaluación global del Índice Menopáusico de Kupperman-Blatt clasificó a 55 por ciento de las pacientes con intensidad de síntomas leve, seguido de 35 por ciento en pacientes que declararon no tener síntomas. Esto se correspondió en la Escala de calidad de vida de Cervantes con 45 por ciento en pacientes clasificadas con compromiso leve de su calidad de vida, seguido de 40 por ciento con mediano compromiso de calidad de vida. Conclusiones: Con un nivel de significancia de p < 0,05, se demostró que durante la etapa climatérica ambos test presentan una correlación positiva, entre la intensidad de la sintomatología medida con el Índice Menopáusico de Kupperman-Blatt y la calidad de vida valorada con la Escala de Cervantes(AU)

Introduction: During climacteric or perimenopause, a series of symptoms are reflected in association with a progressive decrease in estrogen and progesterone hormone secretion. These deficiencies cause diverse somatic, vasomotor, sexual and psychological symptoms that impair the general quality of life of women, in addition to alterations in their menstrual cycle. Objective: To determine the severity of climacteric symptoms in perimenopausal women, using the Kupperman-Blatt index and the Cervantes scale. Methods: This was a quantitative, descriptive, observational and correlational study with patients attending Las Moras health center, Huanuco Department, Huanuco District, Peru. The sample consisted of 60 women who met the inclusion criteria. The Kupperman-Blatt Menopausal Index and the Cervantes Quality of Life Scale were applied. Results: According to the global assessment using the Kupperman-Blatt Menopausal Index, 55 percent of the patients were classified as presenting mild symptom intensity, followed by 35 percent of patients who reported no symptoms. This values were consistent with the Cervantes Quality of Life scale, with 45 percent of patients classified as presenting mild compromise of their quality of life, followed by 40 percent with medium compromise of quality of life. Conclusions: With a significance level of P<0.05, it was demonstrated that, during the climacteric stage, both tests present a positive correlation, regarding the intensity of the symptoms measured with the Kupperman-Blatt Menopausal Index and the quality of life assessed with the Cervantes scale(AU)

El climaterio como etapa fisiológica crucial en la prevención de la enfermedad cardiovascular / The climacteric as a crucial physiological stage in the prevention of cardiovascular disease

El climaterio es una etapa fisiológica que permite al médico reconocer tempranamente los riesgos de patologías y la gran oportunidad de revertirlas. Este trabajo examinará la evidencia actual de la terapia hormonal en la prevención primaria de la enfermedad cardiovascular en mujeres, así como la importancia que igualmente tienen la indemnidad de los ovarios, el peso normal, el uso correcto de antibióticos, la preservación de la microbiota intestinal, las dietas antioxidantes, los estilos de vida saludables y el obligatorio abandono del hábito de fumar.

Interrelationships between obesity, blood pressure and metabolic profile in climacteric women / Inter-relações entre obesidade, pressão arterial e perfil metabólico em mulheres climatéricas

ABSTRACT Objective This study aimed to evaluate the interrelationships between obesity, blood pressure and metabolic profile in climacteric women. Methods This is a cross-sectional study with a random sample of 874 women, aged 40 to 65 years, assisted in Family Health Strategies units in Montes Claros, Minas Gerais, Brazil. A structural equation model was used to assess the interrelationships between obesity, blood pressure and metabolic profile, adjusted for age. The variables blood pressure, obesity and metabolic profile were treated as constructs, which measurement models were developed using confirmatory factor analysis. Results It was observed that age has a positive and significant effect on blood pressure (β=0.20; p<0.001) and obesity (β=0.10; p=0.004). There was a direct and positive effect of obesity on blood pressure (β=0.26; p<0.001) and on the metabolic profile (β=0.10; p=0.037), adjusted for physical activity. Conclusions The simultaneous analysis of the relationships between age, obesity, blood pressure and metabolic profile in menopausal women suggests that, ageing has an effect on the increase of obesity and blood pressure, just as obesity increases blood pressure and changes the metabolic profile.

RESUMO Objetivo Avaliar as inter-relações entre obesidade, pressão arterial e perfil metabólico em mulheres climatéricas. Métodos Trata-se de estudo transversal com amostra aleatória composta por 874 mulheres com idade entre 40 a 65 anos assistidas em unidades de Estratégias de Saúde da Família em Montes Claros, Minas Gerais, Brasil. Foi utilizado modelo de equação estrutural para avaliar as inter-relações entre obesidade, pressão arterial e perfil metabólico, ajustado pela idade. As variáveis pressão arterial, obesidade e perfil metabólico foram tratadas como construtos, cujos modelos de mensuração foram construídos utilizando-se a análise fatorial confirmatória. Resultados Observou-se que a idade exerce efeito positivo e significativo sobre a pressão arterial (β=0,20; p<0,001) e a obesidade (β=0,10; p=0,004). Houve efeito direto e positivo da obesidade na pressão arterial (β=0,26; p<0,001) e no perfil metabólico (β=0,10; p=0,037), ajustado por atividade física. Conclusão A análise simultânea das relações entre idade, obesidade, pressão arterial e perfil metabólico em mulheres no climatério sugere que o aumento da idade tem efeito sobre o aumento da obesidade e da pressão arterial, assim como a obesidade tem efeito positivo sobre o aumento da pressão arterial e sobre a alteração no perfil metabólico.

Elevated leptin levels in healthy climacteric women from Northeastern Brazil: an effect of age or adiposity?

ABSTRACT Objective Climacterium is associated with elevated leptin levels and increased risk of cardiovascular disorders. Conflicting data diverge on whether high leptin levels in climacterium reflect increasing adipose mass or, at least partially, age-related hormonal changes. This study addresses this issue in women from a Brazilian state with a low human development index. Subjects and methods A case-control study was conducted, enrolling 136 women from the state of Maranhão, 52 (38.2%) climacteric and 84 (61.8%) non-climacteric. Biometric, biochemical, hormonal and immunological parameters were analyzed. Results Climacteric women showed a moderately increased waist/hip ratio (0.894 versus 0.834, p < 0.05), sustained body mass index (27.46 versus 28.68, p > 0.05) increased leptin levels (9.59 versus 7.13, p < 0.05) and no evidence of metabolic syndrome. No other parameters were altered. The climacteric cohort didn't show significant body fat gains but displayed a typical age-related redistribution of adipose tissue. Even so, leptin levels were significantly elevated compared with non-climacteric women. Conclusions Altogether, these data support the hypothesis that leptin is elevated, at least partially, as a function of age and climacterium and is not necessarily correlated with metabolic dysfunction and systemic inflammation. Further studies are needed to evaluate the impact of higher leptin levels on postmenopausal women. Arch Endocrinol Metab. 2020;64(3):276-81

Enfoque neuropsicológico de la memoria de trabajo en el climaterio / Neuropsychological approach to working memory in menopausal status

Introducción: Estudios multidisciplinarios que involucran mecanismos hormonales, neuronales, conductuales y de cognición contribuyen en las neurociencias. Los estrógenos localizados en el hipocampo y en la corteza prefrontal, pueden afectar la memoria de trabajo. Objetivo: evaluar neuropsicológicamente y comparar el desempeño en memoria de trabajo verbal y visual, durante la premenopausia, perimenopausia y postmenopausia. Se hipotetizó el peor desempeño en memoria de trabajo verbal en etapa de perimenopausia y, la mejor competencia en memoria de trabajo visual para mujeres en etapa de postmenopausia. Método: Estudio exploratorio, no experimental, transversal, con muestreo no probabilístico. 59 mujeres saludables de la población general en edad mediana. Variables clínicas y memoria de trabajo. Resultados: En la memoria de trabajo verbal no hubo diferencia significativa. En la memoria de trabajo visual, hubo diferencia significativa e importante (Ɛ2 R = .23, p = .001 y Ɛ2 R = .12, p = .047) en subpruebas que involucran la visoconstrucción, a diferencia de la subprueba de elección múltiple que no hubo diferencia significativa con el peor desempeño en la perimenopausia. Conclusiones: La memoria de trabajo se encuentra disociada, observando en la memoria de trabajo verbal el rendimiento en función del envejecimiento reproductivo y en la memoria de trabajo visual afectación por fluctuaciones hormonales, siendo una función sensible para detectar fallas cognoscitivas en forma temprana, que pudieran asociarse con enfermedades neurodegenerativas en la vejez. Es relevante considerar al momento de valorar a las mujeres, la etapa del climaterio que estén transitando, por la posible comorbilidad en el SNC.

Introduction: Multidisciplinary studies involving hormones, neurons, behavioral and cognitive functions promote neurosciences. Estrogens located in the hippocampus and the prefrontal cortex can affect working memory. Aim: Neuropsychological evaluation and comparison the efficiency in verbal and visual working memory in premenopausal, perimenopausal and postmenopausal stages. It was hypothesized the worst performance in verbal working memory in perimenopause stage, and the best competition in visual working memory in the postmenopausal stage. Method: Exploratory, non-experimental, cross-sectional study, with non-probability sampling. 59 healthy women from the general population. Study clinical, mental health and working memory. Results: There was no significant difference in verbal working memory. In visual working memory there was significant and relevant difference (Ɛ2 R = .23, p = .001 y Ɛ2 R = .12, p = .047) in the subtest involves visual construction; unlike the multiple-choice subtest there was no significant difference, finding the worst performance in perimenopause. Conclusions: Working memory is dissociated, verbal working memory observed performance based on reproductive aging and visual working memory supports the participation of hormonal fluctuations. It is considered a sensitive measure to detect cognitive failures early, which could be associated with neurodegenerative diseases in the aging. When evaluating middle-aged women, it is important to consider the stage of menopausal status that is transiting, due to the possible comorbidity in the CNS.

Síndrome climatérico en mujeres de edad mediana / Climacteric syndrome in women of middle age

introducción: Es evidente que el síndrome climatérico puede manifestarse de formas diferentes, con un mayor o menor grado de intensidad, de acuerdo a las condiciones sociales y ambientales de cada mujer, esto puede afectar el patrón biológico y variar su estado de salud.Objetivos: Caracterizar a las mujeres de edad mediana en virtud de la intensidad del síndrome climatérico y un conjunto de características biológicas, psicológicas y sociales, así como identificar entre las variables evaluadas, aquellas que constituyen factores de riesgo para los niveles más intensos del síndrome climatérico en las mujeres de edad mediana Métodos: La investigación clasifica como observacional, que transita del nivel descriptivo al analítico, con una muestra de 532 mujeres de edad entre 40 a 59 años del municipio Plaza de la Revolución durante el primer semestre de 2017. Las variables estudiadas fueron edad en años, edad de aparición de los síntomas, apoyo familiar y cantidad de enfermedades. Resultados: La intensidad del síndrome climatérico en mujeres de edad mediana, de manera global, mostró ser menos intenso en aquellas que no han tenido la menopausia, con una tendencia decreciente con la edad en este segmento poblacional. Conclusiones: La intensidad del síndrome climatérico está asociada con la edad cronológica de la mujer de edad mediana, la edad de aparición de la menopausia, el apoyo familiar y la cantidad de enfermedades relacionadas(AU)

Introduction: The climacteric syndrome can evidently manifest itself in different ways, with a greater or lower degree of intensity. According to the social and environmental conditions of each woman, this can affect the biological pattern and vary the woman's state of health. Objectives: To characterize women of middle age based on the intensity of the climacteric syndrome and a set of biological, psychological and social characteristics, as well as to identify, among the variables evaluated, those that constitute risk factors for the most intense levels of the climacteric syndrome in women of middle age. Methods: The research was classified as observational, which moves from the descriptive to the analytical level, with a sample of 532 women aged 40-59 years of Plaza de la Revolución Municipality during the first semester of 2017. The variables studied were age in years, age of symptoms onset, family support and number of diseases. Results: The intensity of the climacteric syndrome in women of middle age showed to be globally less intense in those that have not had menopause, with a tendency that decreases with age in this population segment. Conclusions: The intensity of the climacteric syndrome is associated with the chronological age of the woman of middle age, the age of menopause onset, family support and the number of associated diseases(AU)

Demandas de mulheres no climatério na Estratégia Saúde da Família: estudo descritivo / Demands of women in the climaterium in the Family Health Strategy: descriptive study / Demandas de mujeres durante el climaterio en la Estrategia Salud de la Familia: estudio descriptivo

OBJETIVO: conhecer as principais demandas de mulheres no climatério, atendidas na Atenção Primária à Saúde, a partir dos relatos dos profissionais de saúde. MÉTODO: pesquisa de caráter descritivo com abordagem qualitativa desenvolvida em uma unidade de Estratégia Saúde da Família do município do Rio de Janeiro. Através de um roteiro de entrevista semiestruturado foram entrevistados 17 profissionais de saúde, entre médicos e enfermeiros, finalizando a coleta com a utilização da técnica de amostragem por saturação teórica. As entrevistas foram tratadas por meio da análise de conteúdo temático-categorial. RESULTADOS: as demandas foram: problemas conjugais, perda de libido, dispareunia, ressecamento e atrofia vaginal. CONCLUSÃO: recomenda-se atualização dos profissionais quanto aos conceitos e aos aspectos relacionados ao climatério, visando que suas ações atendam essas mulheres integralmente. IMPLICAÇÕES PRÁTICAS: a atenção à saúde deve considerar questões do âmbito da sexualidade para poder contribuir para a saúde sexual das mulheres na fase do climatério.

AIM: to know the main demands of women in the climaterium, attended in the Primary Health Care, from the reports of health professionals. METHOD: a descriptive research with a qualitative approach developed in a Family Health Strategy unit in the city of Rio de Janeiro. Through a semi-structured interview script, 17 health professionals were interviewed among physicians and nurses, finishing the collection using the technique of sampling by theoretical saturation. The interviews were treated through analysis of thematic-categorial content. RESULTS: the demands were: marital problems, loss of libido, dyspareunia, dryness, and vaginal atrophy. CONCLUSION: it is recommended to update the professionals regarding the concepts and aspects related to the climacteric, aiming that their actions attend these women integrally. PRACTICAL IMPLICATIONS: health care should consider issues of sexuality in order to contribute to the sexual health of women in the climacteric phase.

OBJETIVO: conocer las principales demandas de las mujeres durante el climaterio, atendidas en la Atención Primaria de Salud, a partir de los relatos de los profesionales de salud. MÉTODO: investigación de carácter descriptivo, con abordaje cualitativo, realizada en una unidad de Estrategia Salud de la Familia del municipio de Rio de Janeiro. A través de un programa de entrevista semiestructurada se entrevistaron a 17 profesionales de salud, entre médicos y enfermeros, finalizando el muestreo utilizándose la técnica de muestreo por saturación teórica. Las entrevistas se analizaron por medio del análisis de contenido temático-categorial. RESULTADOS: las demandas fueron: problemas conyugales, pérdida de libido, dispareunia, sequedad y atrofia vaginal. CONCLUSIÓN: se recomienda que los profesionales actualicen los conceptos y los aspectos relacionados al climaterio, para que sus acciones atiendan a esas mujeres integralmente. IMPLICACIONES PRÁCTICAS: la atención a la salud debe considerar cuestiones del ámbito de la sexualidad para poder contribuir a la salud sexual de las mujeres durante el climaterio.

Factores socioculturales y laborales asociados a la sintomatología del síndrome climatérico / Cultural and labor factors associated with syndrome climacteric symptoms

Introducción: la expresión clínica del síndrome climatérico se asocia con el estilo de vida de la mujer, factores socioculturales, ambientales y laborales, las relaciones familiares y de pareja, la sobrecarga en los roles que desempeña, su personalidad y autoestima. Objetivos: identificar la percepción de intensidad de la sintomatología del síndrome climatérico en un grupo de mujeres de edad mediana y relacionarla con algunos factores socioculturales. Métodos: se realizó una investigación descriptiva transversal en el Centro de Investigaciones Médico-Quirúrgicas desde el 17 de septiembre de 2012 hasta el 31 de mayo de 2013. Se entrevistaron 120 mujeres entre 40 y 59 años de diferentes departamentos asignados al azar, a las que se aplicó la encuesta para medir la intensidad del síndrome climatérico recomendada en el Consenso cubano vigente. Resultados: una tercera parte de la muestra ya había tenido la menopausia. El promedio de edad fue de 48,52 años. Hubo predominio de los síntomas moderados y muy molestos. Las condiciones de la vivienda, el hacinamiento y las disfunciones familiares no resultaron significativas para la sintomatología. Del total de mujeres, 58,1 por ciento refirieron disfunción con su pareja y presentaron sintomatología moderada o intensa. La sintomatología vasomotora fue más intensa en locales de trabajo calurosos. Conclusiones: más de la mitad de las mujeres con disfunción de pareja presentaron síntomas moderados e intensos, sobre todo, genitourinarios. Los síntomas psicológicos son más frecuentes en las mujeres con pérdida de la autoestima y la mitad de ellas los percibe con intensidad moderada o severa(AU)

Introduction: the clinical expression of climacteric syndrome is associated with the lifestyle of women, socio-cultural, environmental and occupational factors, family and marital relationships, overloading in the roles played, personality and self-esteem. Objectives: identify the perception of intensity of the climacteric syndrome symptoms in a group of middle-aged women and relate them with some sociocultural factors. Methods: adescriptive investigation was conducted at the Center for Medical and Surgical Research from 17 September 2012 to 31 May 2013. 120 women were interviewed between 40 and 59 years of different departments randomized. These subjects took a survey to measure the intensity of the climacteric syndrome. The survey used was recommended in the current Cuban Consensus. Results: one third of the sample had their menopause and the average age was 48.52. There was predominance of moderate and very troublesome symptoms. Housing conditions, overcrowding and family dysfunction were not significant for the symptoms. 58.1percent of women who reported dysfunction with her partner showed moderate to severe symptoms. Vasomotor symptoms were more intense in local hot jobs. Conclusions: more than half of women with marital dysfunction presented mostly moderate to severe symptoms, genitourinary. Psychological symptoms are more common in women with loss of self-esteem and half of them perceived moderate or severe intensity(AU)

Los riesgos de no usar terapia hormonal de la menopausia: deterioro de la calidad de vida / The risks of avoiding hormone replacement therapy during menopause

Menopause is associated with several symptoms which, if they reach certain intensity, can severely impair the quality of life. Overall, 90.9% of Latin American women will have at least one climacteric symptom and in 25%, these will be severe. Musculoskeletal pain, physical and mental fatigue and depressed mood are the most common climacteric symptoms. Dyspareunia, mood disorders and irritability can significantly alter female sexuality. Hot flashes are the symptoms most frequently related to menopause by both physicians and patients. However, it is one of the less common menopausal symptoms. This symptom reflects the neurochemical brain disorders caused by estrogen deficiency. The central nervous system (CNS) is also involved in changes of body composition leading to higher adipose tissue accumulation during climacterium, deteriorating quality of life and increasing the risk for chronic non-transmittable diseases. Menopausal discomfort also overloads health systems increasing the demand for medical services and decreasing productivity by labor absenteeism. Hormone therapy of menopause (HTM) decreases menopausal symptoms and improves quality of life. If we do not prescribe HTM to those women who need it, we could deprive them from several potential health benefits.

Intensidad y evolución del síndrome climatérico y su relación con los factores de riesgo para aterosclerosis / Intensity and Evolution of the Climacteric Syndrome and Its Relation with Atherosclerosis Risk Factors

Introducción: el estudio del climaterio y la menopausia tiene gran importancia y vigencia por su morbilidad asociada. Objetivo: determinar la presencia de factores de riesgo ateroscleróticos con la intensidad y evolución del síndrome climatérico en este grupo. Métodos: estudio prospectivo y de intervención en mujeres de 40 a 59 años con síndrome climatérico a las que se les aplicó terapia hormonal -previo consentimiento informado- y se observó la respuesta evolutiva al mismo. Resultados: las variables estudiadas: sobrepeso, obesidad, sedentarismo, hábito de fumar, circunferencia de cintura, hipertensión arterial y diabetes mellitus tipo 2; así como la sobrecarga de género que tenían dichas mujeres, tuvieron relación con la presencia y evolución desfavorable del síndrome climatérico. La obesidad y el sobrepeso son las de mayor influencia sobre la evolución de este síndrome. La otra variable de mayor importancia fue el hábito de fumar. En orden de importancia le siguió el sedentarismo. Conclusiones: los factores de riesgo para aterosclerosis estudiados se asociaron con síndrome climatérico más intenso y con una evolución desfavorable del mismo, aporte científico de esta investigación, lo que también ocurrió con la sobrecarga de género. El aumento de la circunferencia de cintura, el índice de masa corporal elevado y el tabaquismo fueron los factores de riesgo de mayor importancia en la evolución desfavorable de dicho síndrome(AU)

Introduction: The study of climacteric and menopause has great importance and validity due to its associated morbidity. Objective: Determine the presence of atherosclerotic risk factors with the intensity and evolution of the climacteric syndrome in this group. Methods: A prospective and interventional study was carried out in women aged 40 to 59 years with climacteric syndrome who received hormone therapy - previous informed consent. The evolutionary response was observed. Results: The variables studied (overweight, obesity, sedentary lifestyle, smoking habits, waist circumference, arterial hypertension and type 2 diabetes mellitus), these women gender overload were related to the presence and unfavorable evolution of the climacteric syndrome. Obesity and overweight are the most influential on this syndrome evolution. The other major variable was smoking. In order of importance, sedentary followed. Conclusions: The atherosclerosis risk factors studied were associated with a more intense climacteric syndrome and with an unfavorable evolution of them, which is the scientific contribution of this research. Increased waist circumference, high body mass index and smoking habits were the most important risk factors for the unfavorable evolution of this syndrome(AU)

Metabolic syndrome and sexual function in postmenopausal women

ABSTRACT Objective The purpose of this study was to evaluate whether female sexual dysfunction (FSD) is associated with metabolic syndrome (MS) and to identify factors that contribute to FSD in postmenopausal women. Subjects and methods This was a cross-sectional study in 111 sexually active women aged 45-65 years. We applied the Female Sexual Function Index (FSFI) to evaluate the participant’s sexual function and a structured questionnaire to collect demographic, socioeconomic, clinical, anthropometric, and laboratory data. Results The prevalences of MS and FSD were 68.5% and 70.3%, respectively. After logistic regression analysis, we identified the following variables associated with FSD: married status (prevalence ratio [PR] 1.69, 95% confidence interval [95% CI] 1.16-2.47, p < 0.01), 6-10 years elapsed since menopause (PR 1.60, 95% CI 1.22-2.09, p < 0.01), occurrence of climacteric symptoms (PR 1.01, 95% CI 1.00-1.02, p = 0.03), and history of sexual abuse (PR 1.40, 95% CI 1.12-1.73, p < 0.01). Conclusion We found a high prevalence of MS and FSD, but no association between both. Married status, time elapsed since menopause, climacteric symptoms, and history of sexual abuse emerged as factors associated with FSD on multivariate analysis.

La masa grasa en la mujer durante el periodo climatérico / Fat mass in climacteric women

Introducción: el índice de masa corporal es un método simple y ampliamente utilizado para estimar la proporción de la grasa corporal. Objetivo: determinar las características de la distribución de grasa en mujeres, durante el período climatérico. Método: se realizó un estudio descriptivo longitudinal y prospectivo en las consultas de climaterio del Hospital Ginecoobstétrico de Guanabacoa y del Policlínico Docente Andrés Ortiz del mismo municipio, en La Habana, Cuba, desde marzo de 2013 hasta marzo de 2014. La muestra quedó constituida por las féminas que desearon participar en la investigación, previo consentimiento. Se realizó una encuesta donde se emplearon las siguientes variables para luego ser procesadas: índice de masa corporal, circunferencia abdominal y pliegues cutáneos (subescapular, supra ilíaco, tricipital) según las tablas de Berdasco. Resultados: el mayor índice de masa corporal se halló en las mujeres obesas: 34,9 por ciento premenopáusica, y 42 por ciento posmenopáusica. El perímetro abdominal mayor de 88 cm fue de 81 y 65,4 por ciento para las pre y posmenopáusica, respectivamente. El pliegue supra ilíaco mayor del 90 percentil para las premenopáusica fue de 83,7 por ciento y en la posmenopáusica con 94 por ciento. Conclusiones: la mujer en el período climatérico presenta un índice de masa corporal elevado con predominio de la obesidad central y del pliegue supra ilíaco(AU)

Introduction: the body mass index is a simple, widely used method to estimate the proportion of body fat. Objective: determine the characteristics of fat distribution in climacteric women. Methods: a prospective longitudinal descriptive study was conducted at the climacteric service of the Obstetrics and Gynecology Hospital and Andres Ortiz Teaching Polyclinic in the municipality of Guanabacoa, Havana, Cuba, from March 2013 to March 2014. The study sample was composed of women who granted their informed consent to participate in the study. A survey was conducted which included the following variables: body mass index, abdominal circumference and skinfolds (subscapular, suprailiac, tricipital) based on Berdasco's tables. Results: the highest body mass index was found among obese women: 34,9 percent for premenopausal and 42 percent for posmenopausal women. Abdominal perimeter above 88 cm was 81 cm: 65,4 percent for pre-menopausal and posmenopausal women, respectively. A suprailiac fold greater than the 90th percentile was 83,7 percent for pre-menopausal women and 94 percent for post-menopausal women. Conclusions: climacteric women have a high body mass index with a predominance of central obesity and the suprailiac fold(AU)

Sexualidad y climaterio: una mirada integral / Sexuality and climacteric: a comprehensive approach

Cuando hablamos de sexualidad humana debemos saber que estamos hablando de una compleja y cambiante interacción de factores biológicos y socioemocionales altamente influenciables por la familia, la religión y los patrones culturales. Esto se ve en los hombres y en las mujeres, especialmente en las mujeres. La sexualidad es un concepto intuitivo que cuesta definir. Según la Organización Mundial de la Salud, se define salud sexual como "un estado de bienestar físico, emocional, mental y social relacionado con la sexualidad, la cual no es solamente la ausencia de enfermedad, disfunción o incapacidad". Es una definición que tiene en cuenta varios conceptos, muy importantes todos ellos. La respuesta sexual consiste en una serie de cambios neurofisiológicos, hemodinámicos y hormonales que involucran al conjunto del organismo. Si bien es similar en ambos sexos, en las mujeres no siempre el inicio y la progresión se correlacionan en forma sistemática o lineal como en los hombres. Y de ese intrigante devenir de la respuesta sexual femenina surge la dificultad del diagnóstico de la "disfunción sexual femenina". Podríamos resumirla en "un conjunto de trastornos en los que los problemas fisiológicos o psicológicos dificultan la participación o la satisfacción en las actividades sexuales; lo cual se traduce en la incapacidad de una persona para participar en una relación sexual de la forma que le gustaría hacerlo"16. La menopausia es percibida por muchas mujeres como el fin de la sexualidad, y no solo como el fin de la vida reproductiva. Si bien es cierto que en esta etapa la actividad sexual suele declinar y puede verse afectada por una serie de factores hormonales, psicológicos y socioculturales, para la mayoría de las mujeres la sexualidad sigue siendo importante. Debemos comprender que la disfunción sexual femenina, en cualquier etapa de la vida, es multicausal y multidimensional. A la hora de realizar el abordaje de una paciente, debemos tener en cuenta todos los factores involucrados y saber con qué herramientas contamos. El abordaje terapéutico clásicamente incluye la terapia psicológica y la terapia hormonal. Sin embargo, recientemente se ha incorporado una nueva droga recientemente aprobada por la FDA de los Estados Unidos para el tratamiento del deseo sexual hipoactivo en la mujer: el flibanserín, un psicofármaco que actúa a nivel de mediadores del deseo sexual en el sistema nervioso central, favoreciéndolo. (AU)

When we talk about human sexuality, we know that we are talking about a complex and changing interaction between biological and socioemotional factors, which are highly influenced by society, family, religion and cultural norms. This can be seen in men and women especially in women. Sexuality is an intuitive concept difficult to define. According to the World Health Organization, it is defined as "A state of physical, emotional, mental and social well being related to sexuality, which is not merely the absence of disease, dysfunction or disabilityˮ. It is a definition that takes into account several concepts, all very important. Sexual response is a series of neurophysiological, hemodynamic and hormonal changes involving the whole body. While similar in both sexes, women are not always the onset and progression correlate systematically or linearly as in men. And that intriguing evolution of the female sexual response, the difficulty of diagnosis of "female sexual dysfunctionˮ. We could summarize it in "a group of disorders in which the physiological or psychological problems impede participation or satisfaction in sexual activities; which results in the inability of a person to participate in a sexual relationship the way she or he would like to do itˮ16. Menopause is perceived by many women as to the end of sexuality, not only as the end of reproductive life. Sexual activity declines with age, and may be affected by a number of hormonal, psychological and sociocultural factors, but, for most women it continues to be important. We must understand that female sexual dysfunction, at any stage of life is multicausal and multidimensional. When approaching a patient, it is important to know all the factors that are involved, and which tools we have for deal with it. Classically, the therapeutic approach has consisted of psychological therapy and hormone therapy. However, we have to consider a recently approved drug by the FDA for the treatment of hypoactive sexual desire in women: Flibanserin. It is a psychotropic substance that acts on the mediators of sexual desire on the central nervous system favoring it. (AU)

Riesgo cardiovascular de la menopausia / Cardiovascular risk of menopause

La enfermedad cardiovascular es la principal causa de muerte en mujeres de más de 50 años. Los eventos cardiovasculares son inusuales en mujeres de 55 años, por lo que se ha sugerido que pudiera ser fruto del hipoestrogenismo. En las mujeres hay condiciones únicas que merecen atención especial tales como edad de la menopausia, complicaciones del embarazo (preeclampsia, diabetes y/o hipertensión gestasional,) enfermedades autoinmunes de la colágena como lupus eritematoso y artritis reumatoide. Desafortunadamente la mayoría de los cardiólogos rara vez indagan sobre éstos antecedentes cuando tratan a las mujeres con enfermedad cardiovascular. En esta revisión se abordará el papel que desempeñan las hormonas sexuales esteroideas en el sistema circulatorio así como los factores de riesgo cardiovascular relacionado con las hormonas.

Etapas del climaterio y función endotelial en mujeres de edad mediana / Climacteric stages and endothelial function in middle-aged women

Introducción: La disminución de los estrógenos durante el climaterio repercute negativamente en el endotelio vascular, y origina disfunción endotelial, cuyo significado clínico está aún por definir. Objetivo: determinar la frecuencia de disfunción endotelial en las etapas del climaterio. Métodos: estudio descriptivo transversal, en 133 mujeres de 40-59 años, sin factores de riesgo cardiovascular, seleccionadas en centros de los 3 niveles de atención del Sistema Nacional de Salud, entre mayo de 2012 y mayo de 2013. Se evaluó la función endotelial mediante la prueba de dilatación mediada por el flujo de la arteria braquial, y su relación con etapas del climaterio. Se exploró la asociación entre variables utilizando pruebas no paramétricas (Kruskal-Wallis). Resultados: en el 38 por ciento de las mujeres se encontró disfunción endotelial, más frecuente en la etapa temprana de la posmenopausia respecto a la tardía y a la perimenopausia (45,0 vs. 27,5 vs. 27,5 por ciento respectivamente [p< 0,05]). Conclusiones: la disfunción endotelial es un evento frecuente en las mujeres de edad mediana aparentemente sanas, y al parecer, el descenso inicial de los estrógenos en los primeros años de la posmenopausia, tiene mayor impacto negativo en el endotelio vascular que el tiempo de exposición al hipoestrogenismo(AU)

Introduction: Estrogen reduction during the climacteric has a negative effect on the vascular endothelium and causes endothelial dysfunction, whose clinical significance is still to be defined.Objective: determine the frequency of endothelial dysfunction in the different stages of climacteric. Methods: a descriptive cross-sectional study was conducted of 133 women aged 40-59 with no cardiovascular risk factors, selected from institutions of the three health care levels within the National Health System from May 2012 to May 2013. Endothelial function was evaluated using the brachial artery flow-mediated dilation test and its association with climacteric stages. The relationship between variables was analyzed using non-parametric tests (Kruskal-Wallis). Results: 38 percent of the women had endothelial dysfunction, which was more common in the early stage of post-menopause than in the late stage and in perimenopause (45.0 vs. 27.5 vs. 27.5 percent, respectively [p< 0.05]). Conclusions: endothelial dysfunction is a common event among seemingly healthy middle-aged women. It seems that the initial reduction in estrogens in the first years of post-menopause has a greater negative impact on the vascular endothelium than the time of exposure to hypoestrogenism(AU)

Terapia de reemplazo hormonal y riesgo cardiovascular: evidencia al 2015 / Hormone replacement therapy and cardiovascular risk: evidence 2015

La enfermedad cardiovascular es la principal causa de muerte en las mujeres. Aunque históricamente se dice que la incidencia de la enfermedad coronaria es relativamente baja en la mujer antes de los 50 años, sin embargo cuando ésta llega al período menopáusico la mujer rápidamente iguala y llega a superar la mortalidad presentada por los hombres. Aún no se conoce la razón exacta de esta "protección cardiovascular" pre-menopáusica, sin embargo son varias las teorías, dentro de las cuales se incluyen el papel de los estrógenos...

Incontinência urinária no climatério: prevalência, fatores associados e impacto na qualidade de vida / Urinary incontinence in climacteric prevalence, associated factors andthe impact on quality of life

A saúde da mulher no climatério tem sido amplamente investigada e discutida, não só pelas repercussões clínicas que afetam a vida das mulheres, mas também pelo significativo impacto para a saúde pública. A literatura brasileira é escassa em inquéritos populacionais sobre a incontinência urinária (IU) no climatério que, apesar de não expor as mulheres a risco, promove significativo impacto sobre a qualidade de vida que pode estender-se para as atividades da vida diária, prática de exercício, função sexual e relações interpessoais. Objetivo - Estimar a prevalência e identificar os possíveis fatores associados à IU e ao impacto da perda urinária em mulheres climatéricas. Método - Por meio de amostragem aleatória estratificada foram selecionadas 1200 mulheres, entre 35 a 72 anos, cadastradas na Estratégia de Saúde da Família do município de Pindamonhangaba - SP, 2014. As variáveis dependentes foram a IU e o impacto da perda urinária - pesquisadas por meio do ICIQ-SF e KHQ - e as independentes - fatores epidemiológicos e clínicos - investigadas por meio de inquérito populacional, medidas antropométricas, coleta de sangue e urina. Resultados - Participaram do estudo 998 mulheres com média de 51,9 anos (DP=8,8 anos). As mulheres com IU tinham em média 52,8 (DP=9,2 anos), estavam na menopausa (62,5 por cento ), eram casadas (87,5 por cento ), católicas (48,9 por cento ) e declararam-se negras ou pardas (47,2 por cento )...

Womens health during climacteric has been widely investigated and discussed not only due tothe clinical repercussions affecting women/'s lives, but also due to the significant impact on public health. The Brazilian literature is sparse in population surveys of urinary incontinence (UI) in climateric. While not exposing women to risks, significant impact on quality of life can extend to the activities of daily living, exercise practice, sexual function and interpersonal relationships. Objective -To estimate the prevalence and identify associated factors with UI and with the impact of urinary loss in climacteric women. Method - In stratified random sample 1200 women between 35 to 72 years of age were selected. They were enrolled in the Family Health Strategy of the municipality of Pindamonhangaba - SP, 2014. The dependent variables were the UI and the impact of urinary loss - researched through the ICIQ -SF and KHQ.The independent ones were epidemiological and clinical factors, investigated through population survey, anthropometric measurements, blood and urine sampling. Results - The study included 998 women with a mean of 51.9 years (SD=8.8 years). Women with UI averaged 52.8 years (SD=9.2 years), were in menopause (62.5 per cent ), married (87,5 per cent ) and Catholic (48,9 per cent ), 47.2 per cent declared themselves black or brown. The average age of menopauseof women with UI was 47.3 years (SD=5.8 years)...

Satisfacción personal de la mujer de edad mediana y su relación con otros factores de la vida cotidiana / Self-satisfaction of the mean age woman and its relation to other factors of daily life

Introducción: la llamada edad mediana, dentro del período climatérico, abarca desde los 40 hasta los 59 años de edad, etapa durante la cual se realiza esta investigación. La satisfacción personal en mujeres de edad mediana puede adquirir una expresión particular en el punto medio de la vida. Este es un proceso de revalorización de la propia vida, que muchos la describen como la segunda crisis de identidad. Objetivo: caracterizar la satisfacción personal de la mujer de edad mediana y analizar cómo repercute en su calidad de vida, al interactuar con otros factores de la vida cotidiana. Métodos: se realizó un estudio descriptivo transversal de 166 mujeres climatéricas pertenecientes a 3 consultorios médicos del Policlínico Universitario Ana Betancourt, del municipio Playa en La Habana, en el período comprendido entre abril del año 2010 y marzo del 2011...

Introduction: the called middle age during the climateric period covers from the 40 until the 50 years old, stage in which this research is conducted. The personal satisfaction in middle age women may becomes a particular expression in the middle point of life. This is a process of revaluation of the own life described by many people like the second crisis of identity. Objective: to characterize the personal satisfaction of the middle age woman and to analyze the repercussion in its quality of life due to its interaction with other factors of the daily life. Methods: a cross-sectional and descriptive study was conducted in 166 climateric women from three medical consulting room of the Ana Betancourt University Polyclinic of the Playa municipality in a Habana from April, 2010 to March, 2011...