Triticum vulgare para el tratamiento del síndrome genitourinario de la menopausia, Armenia, Colombia / Triticum vulgare for the treatment of genitourinary syndrome of menopause, Armenia, Colombia

OBJETIVO: Evaluar la eficacia y la seguridad de Triticum vulgare en el tratamiento del síndrome genitourinario de la menopausia (SGUM). MÉTODO: Estudio cuasiexperimental (antes-después, con grupo control) en mujeres posmenopáusicas (amenorrea ≥ 36 meses, hormona estimulante del folículo > 40 U/l y estradiol < 25 pg/ml), sexualmente activas, con un índice de maduración vaginal (IMV) < 50 y pH ≥ 5, citología cervical negativa (Papanicolaou) y diagnóstico de SGUM, atendidas en el programa de climaterio y menopausia de una clínica privada de mediana complejidad, en Armenia, Quindío (Colombia). Se seleccionaron 207 mujeres con edad promedio de 55,19 ± 7,28 años. Se realizó un muestreo consecutivo. Se asignaron dos grupos: A (n = 105), que recibió T. vulgare, y B (n = 102), que recibió placebo. Se hizo seguimiento al inicio (basal) y 4, 8 y 12 semanas después, utilizando el IMV y el Índice de Función Sexual Femenina (IFSF). Los síntomas del SGUM se evaluaron con una escala visual analógica (EVA). Se aplicó estadística descriptiva. RESULTADOS: La puntuación media del IMV fue mayor en las semanas 4, 8 y 12 en todas las mujeres del grupo A (p = 0,01). Se observó una diferencia significativa en el promedio final de la puntuación del IMV de T. vulgare frente al placebo (p < 0,05). Al final del estudio, el grupo A mostró una mejoría significativa en la puntuación promedio del IFSF, en comparación con el grupo B (p < 0,001). Las puntuaciones de la EVA presentaron una disminución progresiva a lo largo del estudio, pero fueron comparables entre los dos grupos (p = 0,813). CONCLUSIONES: T. vulgare es una efectiva, segura e innovadora alternativa, no hormonal, para el tratamiento del SGUM. No se registraron eventos adversos, por lo que se demostró su seguridad.

OBJECTIVE: To evaluate the efficacy and safety of Triticum vulgare in the treatment of genitourinary syndrome of menopause. METHOD: Quasi-experimental study (before-after, with control group) in postmenopausal women (amenorrhea ≥ 36 months, FSH > 40 U/L and estradiol < 25 pg/ml), sexually active, with a vaginal maturation index (VMI) < 50 and pH ≥ 5, negative cervical cytology (Papanicolaou) and with a diagnosis of genitourinary syndrome of menopause (SGUM); who were treated in the climacteric and menopause program of a private clinic of medium complexity, in Armenia, Quindío (Colombia). 207 participants were selected, with a mean age of 55.19 ± 7.28 years. A consecutive sampling was carried out. Two groups were assigned: A (n = 105) with T. vulgare and B (n = 102) with placebo. Follow-up was done at baseline (baseline), four, eight and twelve weeks later, using the VMI and the female sexual function index (IFSF). Symptoms of SGUM were evaluated using a visual analog scale (VAS). Descriptive statistics were applied. RESULTS: The mean score of the IMV was higher in weeks 4, 8 and 12 in all the participants of group A (p = 0.01). A significant difference was observed in the final mean MVI score of T. vulgare versus placebo (p < 0.05). At the end of the study, group A showed a significant improvement in the mean IFSF score, compared to placebo (p < 0.001). The VAS scores showed a progressive decrease throughout the study but were comparable between the two groups (p = 0.813). CONCLUSIONS: T. vulgare is an effective, safe and innovative non-hormonal alternative for the treatment of SGUM. No adverse events were recorded, guaranteeing their safety.

Vulvar tuberculosis-A rare manifestation of the disease / Tuberculose vulvar - Uma manifestação rara da doença

Abstract Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.

Resumo A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas demorte nomundo. Embora afetemais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis pormeios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.

Tratamento da atrofia vaginal da mulher na pós­menopausa / Treatment of vaginal atrophy of women in postmenopausal

Sintomas relacionados com a atrofia vulvovaginal apresentam um impacto negativo sobre a qualidade de vida de até 50% das mulheres na pós­menopausa. No entanto, algumas recusam o uso de estrogênios, que é a terapia eficaz padrão, devido à publicidade negativa nos últimos anos e à disponibilidade de outras terapias opcionais. Esta revisão avaliou a eficácia de tratamentos hormonais, fitoterápicos de uso oral ou tópico para aliviar os sintomas da atrofia vaginal em mulheres na pós­menopausa. Foram avaliados estudos do Medline, Scopus e Cochrane Central Register de Ensaios Controlados com as palavras­chaves vagina, postmenopause, isoflavones, estrogen, syndrome genitourinária, vulvovaginal atrophy, clinical applications. Estudos de revisão e ensaios clínicos randomizados foram incluídos neste estudo. Os dados mostraram que os estrogênios de uso sistêmico ou local são os mais indicados, as isoflavonas só mostraram efeitos positivos quando de uso local. Alguns tratamentos não hormonais, como hidratantes, lubrificantes e o uso de laser vaginal, também são indicados. Outra possibilidade de tratamento é o ospemifeno, um modulador de receptor hormonal seletivo (SERM) na dispareunia e na atrofia vulvovaginal. Assim, o uso de opções é benéfico para mulheres com risco de neoplasia relacionada aos estrogênios.(AU)

Symptoms related to atrophy vulvovaginal have a negative impact on quality of life up to 50% of women after menopause. However, some refuse the use of estrogens that is the standard effective therapy due to negative publicity in recent years and other available alternatives therapies. This review assessed the effectiveness of hormonal treatments, herbal oral or topical use to relieve the symptoms of vaginal atrophy in women after menopause. We evaluated studies of Medline, Scopus, Cochrane Central Register of Controlled Trials using vagina, postmenopause, isoflavones, estrogen, syndrome genitourinária, vulvovaginal atrophy, clinical applications, as keywords. Review studies and randomized controlled trials were included in this study. The data showed that the systemic or local use of estrogens are the most appropriate, and the isoflavones only showed positive effects when used locally. Some non­hormonal treatments such as moisturizing, lubricating and the use of vaginal laser are also suitable. Another possible treatment is ospemifene, a selective estrogen receptor modulator (SERM) on dyspareunia and vulvovaginal atrophy. Thus, the use of alternatives is beneficial for women with cancer risk related to estrogens.(AU)

Promestrieno no tratamento da atrofia vulvovaginal: revisão sistemática / Promestriene for treatment of vulvovaginal atrophy: a systematic review

Os sintomas decorrentes da atrofia vulvovaginal são muito comuns no climatério. Os estrogênios aplicados localmente na vagina se mostram eficazes no alívio de tais manifestações; no entanto, os estrogênios conjugados na forma de creme vaginal apresentam efeitos sistêmicos e o estriol aplicado localmente pode ser absorvido sistemicamente também. O promestrieno é um estrogênio cuja absorção sistêmica é desprezível quando empregado topicamente, porém a falta de revisão sistemática sobre o tema suscitou a realização da presente revisão. Foram incluídos 16 estudos publicados entre 1976 e 2009, que avaliaram eficácia do promestrieno no alívio dos sintomas decorrentes da atrofia vulvovaginal, ou que investigaram seus efeitos na citologia vaginal, e também aqueles que avaliaram a absorção da substância quando empregada topicamente. As evidências encontradas confirmaram a eficácia do promestrieno, utilizado localmente no tratamento das afecções atróficas genitais femininas decorrentes do hipoestrogenismo, aliada a absorção sistêmica desprezível

The symptoms resulting from vulvovaginal atrophy are very common during climacteric. Estrogens applied locally in the vagina are effective in relieving these manifestations, however, conjugated estrogens as vaginal cream have systemic effects and locally applied estriol may be systemically absorbed. Promestriene is an estrogen without systemic absorption when applied topically, but the lack of a systematic review on the substance motivated the idea to make this review. Sixteen studies published between 1976 and 2009 which evaluated the effectiveness of promestriene on the relief of symptoms resulting from vulvovaginal atrophy or which investigated its effects on vaginal cytology and those which evaluated the absorption of the substance when used locally were included. The found evidences confirmed the effectiveness of locally applied promestriene in the treatment of female genital atrophic disorders due to low estrogen levels coupled with negligible systemic absorption

Atrofia urogenital: seguridad del tratamiento con estrógenos vaginales / Safety of vaginal estrogens for urogenital atrophy

Urogenital atrophy is characterized by dryness, inflammation, and thinning of the epithelial lining of the vagina and lower urinary tract due to estrogen decline. Local estrogen therapy if effective to relieve signs and symptoms of vaginal atrophy without causing an elevation of serum estrogen levels. Although there are no big studies addressing the safety of this type of treatment, it can be maintained over long periods to avoid annoying symptoms. Special care must be taken with women with breast cancer in whom the effective dose must be titrated to avoid an increase in serum estrogens over the levels usually observed in postmenopausal women.

Challenges in the conduct of Thai herbal scientific study: efficacy and safety of phytoestrogen, pueraria mirifica (Kwao Keur Kao), phase I, in the alleviation of climacteric symptoms in perimenopausal women.

OBJECTIVE: To evaluate the preliminary efficacy and safety of Pueraria mirifica (Kwao Keur Kao), phytoestrogen, for the alleviation of climacteric symptoms. MATERIAL AND METHOD: Perimenopausal women attending with climacteric symptoms, such as hot flushes and night sweats, were invited to join the present study, conducted at the Menopausal Clinic, Hat Yai Regional Hospital. The patients were voluntarily enrolled and randomly received the raw material of Pueraria mirifica, oral 50 and 100 mg capsule, once daily for six months, as an open-label study. RESULTS: Of the 10 enrolled patients, 8 cases were completely evaluated. The modified Greene climacteric scale (MGCS) was satisfactorily decreased in both groups. The average scale declined from 44.1 at baseline, to be 26, 17, and 11.1 at 1-, 3-, and 6- month follow-up respectively. No other laboratory abnormalities, except one case had transiently increased the creatinine level, and one case of increased blood urea nitrogen. The mean serum estradiol was slightly increased, while the mean serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were nearly stable. CONCLUSION: Pueraria mirifica is relatively safe and preliminarily alleviates the climacteric symptoms in perimenopausal. women, but the data is insufficient to draw definite conclusions regarding the estrogenic effect.

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.

Effect and safety of 17 beta-estradiol vaginal tablet in postmenopausal women with urogenital symptoms.

OBJECTIVE: To evaluate the effects of a 17 beta-estradiol vaginal tablet on urogenital symptoms, vaginal pH, vaginal cytology, endometrial thickness, and plasma estradiol level in postmenopausal women with urogenital symptoms. METHOD: Twenty-seven postmenopausal women with urogenital symptoms received 25 microg of a 17 beta-estradiol tablet intravaginally daily for the first 2 weeks, followed by 10 weeks of twice a week dosage. The results of urogenital symptoms, vaginal pH, vaginal cytology, endometrial thickness, and plasma estradiol level were analysed. RESULTS: The urogenital symptoms improved significantly in all women. The mean vaginal pH was significantly decreased. The vaginal cytology showed estrogenic effect on the karyopyknotic index and the maturation value. There was no significant difference in endometrial thickness and level of plasma estradiol before and after treatment. There was one case of vaginal bleeding from endometrial proliferation. CONCLUSION: Local vaginal treatment of 17 beta-estradiol (25 microg) had a positive effect on the urogenital symptoms, vaginal pH, and vaginal cytology. No elevation of plasma estradiol level was detected after treatment.