Eficacia y seguridad de una alternativa a la terapia hormonal de la menopausia: extracto purificado de polen / Efficacy and safety of an alternative to menopausal hormone therapy: purified cytoplasm of pollen

Los síntomas vasomotores (SVM) se encuentran entre los síntomas más comunes de la transición a la menopausia. Más del 70% de las mujeres de mediana edad informan SVM en algún momento durante la transición a la menopausia, y para un tercio de las mujeres los SVM son muy frecuentes o graves. Muchas mujeres recurren a terapias naturales para tratar los SVM. Esta revisión se centra en una de esas opciones naturales: el extracto purificado de polen (Serelys®). Se realizó una búsqueda e identificación de artículos publicados hasta octubre de 2022 recopilados de sistemas de búsqueda electrónicos, como Google Scholar, MEDLINE, PubMed y Scopus. Las palabras de búsqueda fueron “Vasomotor symptoms”, “menopause” AND “pollen”. Los estudios preclínicos señalan un mecanismo de acción en su implicación sobre el sistema serotoninérgico, así como su unión a los receptores de dopamina. Los estudios clínicos demuestran la seguridad y el efecto positivo sobre los SVM.

Vasomotor symptoms (VMS) are among the most common symptoms of the menopausal transition. More than 70% of middle-aged women report VMS at some point during the menopausal transition, and for a third of women, VMS is very common or severe. Many women turn to natural therapies to treat VMS. This review focuses on one such natural option, purified pollen extract (Serelys®). The information available until October 2022 was collected via the library and electronic search systems such as Google Scholar, MEDLINE, PubMed, and Scopus. The search words were: “Vasomotor symptoms”, “menopause” AND “pollen”. Preclinical studies point to a mechanism of action in its involvement in the serotonergic system, as well as its binding to dopamine receptors. Clinical studies demonstrate the safety and positive effect on VMS.

Manejo dos sintomas climatéricos em pacientes com câncer de mama / Management of menopausal symptoms in patients with breast cancer

O câncer de mama é a neoplasia maligna mais frequente nas mulheres, inclusive na pós-menopausa. O tratamento hormonal e quimioterápico dessa doença pode induzir o aparecimento de sintomas vasomotores, atrofia urogenital, alteração da função sexual e instalação da menopausa precocemente, os quais merecem avaliação e controle. O tratamento dos sintomas climatéricos em pacientes sobreviventes do câncer de mama tem grande relevância clínica, pois, em razão do aumento da incidência e dos avanços na abordagem terapêutica, o número de mulheres que sobrevivem ao câncer de mama e experimentam sintomas climatéricos tem aumentado. Objetivou-se identificar na literatura evidências recentes acerca das opções terapêuticas na redução dos sintomas climatéricos. Dessa forma, foi realizada uma revisão na literatura por meio de consulta nas principais bases de dados, priorizando artigos mais recentes e com maior nível de evidência. Os estudos randomizados controlados sobre o uso de fitoterápicos, acupuntura e ioga no tratamento de fogachos em pacientes com câncer de mama são limitados, tanto nas opções de tratamento e tempo de seguimento quanto na comprovação científica de sua eficácia. Abordando os tratamentos farmacológicos, vários inibidores da recaptação de serotonina (paroxetina, fluoxetina e citalopram) e inibidores da recaptação de serotonina e adrenalina (venlafaxina e desvenlafaxina) têm sido mais eficazes que o placebo na redução dos sintomas vasomotores em estudos a curto prazo em mulheres com câncer de mama. A avaliação dos sintomas e seu impacto na qualidade de vida, além do desejo da paciente, são determinantes na escolha do tratamento. Independentemente do tipo de tratamento indicado, as modificações de estilo de vida devem ser recomendadas.(AU)

Breast cancer is the most commonly diagnosed malignancy in women, including after menopause. The hormonal and chemotherapeutic treatment of this disease can induce the appearance of vasomotor symptoms, urogenital atrophy, abnormal sexual function and installation of early menopause that require evaluation and control. The treatment of climacteric symptoms in breast cancer survivors is of great clinical relevance, once the number of women experiencing menopausal symptoms has increased because of the high incidence of breast cancer and advances in therapeutic approach. The purpose is to identify recent evidence in the literature on the therapeutic options in reducing these menopausal symptoms. Thus, a literature review through consultation was held in the main databases, prioritizing newer and higher level of evidence items. Randomized controlled trials on the use of herbals, acupuncture and yoga in the treatment of hot flashes in patients with breast cancer are limited, such as treatment options, follow-up time and the scientific evidence of its effectiveness. Addressing the pharmacological treatments, several serotonin reuptake inhibitors (paroxetine, fluoxetine and citalopram) and reuptake inhibitors of serotonin and adrenaline (venlafaxine and desvenlafaxine) have been more effective than placebo in reducing vasomotor symptoms in short-term studies in women with breast cancer. The evaluation of symptoms and their impact on quality of life, beyond the desire of the patient, are determinant in the choice of treatment. Regardless of the type of treatment indicated, changes in lifestyle should be recommended.(AU)

Paullinia cupana para o controle de fogachos em pacientes com câncer de mama: um estudo piloto / Paullinia cupana for control of hot flashes in breast cancer patients: a pilot study

OBJETIVO: Avaliar se a Paullinia cupana diminui o número e a gravidade dos fogachos em mulheres após diagnóstico de câncer de mama. MÉTODOS: Estudo piloto prospectivo fase II realizado com mulheres que sobreviveram ao câncer de mama, que completaram o tratamento pelo menos 3 meses antes e que apresentavam ao menos 14 episódios de fogachos por semana. Utilizando o desenho de Simon para que a primeira etapa fosse considerada positiva, ao menos 9 de 15 mulheres deveriam ter a gravidade dos fogachos diminuída em pelo menos 50%. As pacientes receberam 50mg do extrato seco de Guaraná oralmente 2 vezes por dia por 6 semanas. Foram avaliadas, a gravidade e a frequência dos fogachos. RESULTADOS: Dezoito pacientes iniciaram o tratamento com Paullinia cupana e 15 completaram o estudo. Três pacientes deixaram o estudo imediatamente após iniciarem o tratamento em razão de dificuldade na participação e não adesão. Das 15 pacientes que completaram o estudo, 10 obtiveram diminuição de mais de 50% dos índices de gravidade de fogachos. Durante as 6 semanas de tratamento, diminuições estatisticamente significativas foram observadas tanto no número de fogachos (p=0,0009), quanto nos índices de gravidade (p<0,0001). Paullinia cupana foi bem tolerada, e não houve relato de toxicidade como causa de saída do estudo. CONCLUSÕES: Paullinia cupana pareceu promissora para o controle de fogachos. Estudos mais extensivos são necessários.

OBJECTIVE: To evaluated whether Paullinia cupana decrease number and severity of hot flashes in breast cancer survivors. METHODS: This was a prospective phase II pilot study. We studied female breast cancer survivors who had completed the cancer treatment 3 months previously and who were experiencing at least 14 hot flashes per week. At least 9 of the 15 patients were required to have a decrease of at least 50% in hot flash severity score in keeping with the Simon Design. Patients received 50mg of dry extract of Paullinia cupana orally twice a day for 6 weeks. We assessed both frequency and severity of hot flashes. RESULTS: A total of 18 patients started the Paullinia cupana treatment, and 15 completed the study. Three patients left the study immediately after starting the treatment because of personal difficulties in participation or noncompliance. Of the 15 patients who completed the study 10 had a decrease of more than 50% in hot flash severity scores. During the 6 weeks of treatment, statistically significant decreases were seen in both numbers of hot flashes (p=0.0009) and severity scores (p<0.0001). Paullinia cupana was well tolerated, and there were no instances of discontinuation because of toxicity. CONCLUSIONS: Paullinia cupana appears promising for controlling hot flashes. More extensive studies seem warranted.

Extrato de soja no tratamento dos sintomas vasomotores no período menopausal / Soybean extract in the treatment of vasomotor symptoms in menopausal period

Os sintomas vasomotores, tais como fogachos e sudorese noturna, são comuns no período menopausal. A terapia hormonal permanece como a mais efetiva no alívio desses sintomas. No entanto, desperta preocupações sob o risco de aumentar a ocorrência de doenças diretamente relacionadas ao trato genital e mamas, sendo ainda contraindicada em algumas doenças crônicas. Assim, alguns tratamentos alternativos, baseados em alimentos ou suplementos enriquecidos com fitoestrogênios, produtos químicos presentes em algumas plantas, têm sido utilizados. No entanto, existem divergências quanto a sua eficácia. Assim, realizamos esta revisão a partir de artigos recuperados da base de dados Medical Literature Analysis and Retrieval System on Line (MEDLINE), com o objetivo de tentar esclarecer se o uso das isoflavonas está relacionado à redução dos sintomas vasomotores na menopausa. A partir dos artigos recuperados, pudemos observar que não existem evidências de que o uso de fitoestrogênios por mulheres na pós-menopausa reduzem os sintomas vasomotores. Por outro lado, nenhum dos trabalhos analisados mencionou efeitos prejudiciais no uso dessas substâncias. Entretanto, estudos experimentais em animais evidenciaram, quando administradas em altas doses, a ocorrência de metaplasia endometrial.

Hot flushes and night sweats are common vasomotor symptoms during menopausal period. Hormone therapy is believable to be the most effective treatment for relieving these symptoms. However, such treatment concerns us because its use may be directly related to genital tract and breast diseases. It is also contraindicated in some chronic diseases. Thus, some alternative treatments have been used such as consuming foods or supplements enriched with phytoestrogens, which are chemical compounds present in some plants. Whereas there are disagreements regarding its effectiveness, we conducted this review based on articles retrieved from the Medical Literature Analysis and Retrieval System on Line (MEDLINE) data base. Our aim was to try clarifying whether the use of isoflavones are related to reduction of vasomotor symptoms at menopause. From the articles retrieved, we observed that there is no conclusive evidence that the use of isoflavones by postmenopausal women reduces vasomotor symptoms. On the other hand, none of the consulted articles reported harmful effects on the use of such substances. However, experimental studies in animals have shown endometrial metaplasia when they are administered in high doses.

Terapia estrogênica no climatério: qual a melhor via? Uma resposta baseada nas melhores evidências / Estrogen therapy in climacteric: what is the best route? An answer based on the best evidences

Foi realizada uma pesquisa abrangente acerca de revisões sistemáticas, trabalhos randomizados e controlados, utilizando o banco de dados, Medline, Pubmed, Scielo e Biblioteca Cochrane com descritores apropriados para avaliar os efeitos das diferentes vias de administração dos estrogênios nas principais indicações da terapia estrogênica para o controle dos sintomas atribuídos à deficiência estrogênica do climatério (sintomas vasomotores e atrofia urogenital). Concluiu-se que, para os sintomas vasomotores, a administração de estrogênios pelas vias oral ou não-oral são eficientes. No caso da atrofia urogenital, a administração de estrogênios pela via vaginal parece ser mais eficaz do que a sistêmica

To evaluate the influence of different forms of estrogens delivery on the primary indication of estrogen therapy in postmenopausal women for the control of symptoms attributed to estrogen deficiency (vasomotor symptoms and urogenital atrophy) a comprehensive literature search was conducted using the database Medline, Pubmed, Scielo and Cochrane Library with appropriate key words for systematic reviews and controlled randomized trials on the subjects. It was concluded that, for vasomotor symptoms, oral or non-oral routes of estrogens administrations are safe and effective, and for urogenital atrophy, the vaginal route has showed to be better than systemic route

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.

Terapêutica não hormonal no tratamento de distúrbios do climatério / Nonhormonal therapeutics in the treatment of climacteric disorders

Ondas de calor ou fogachos representam uma das queixas mais comuns entre as mulheres no período do climatério. A sua fisiopatologia é parcialmente conhecida. A terapia com estrogênios permanece como a mais efetiva para os sintomas vasomotores. No entanto, em decorrência de contraindicações ou pelos conceitos próprios do que seja seguro, muitas mulheres relutam em utilizá-la. Alguns tratamentos farmacológicos não hormonais têm sido avaliados em estudos randomizados, clínicos e prospectivos para alívio destes sintomas. Foi realizada revisão da literatura com o objetivo de descrever as opções não hormonais na abordagem dos sintomas vasomotores baseada nas evidências científicas disponíveis. Atualmente, os inibidores de recaptação seletiva da serotonina (SSRIs) e os inibidores de recaptação da serotonina e norepinefrina (SNRIs) são os agentes mais estudados para mulheres sintomáticas com ou sem história prévia de câncer de mama. Os dados sugerem que a paroxetina e a venlafaxina são os agentes mais efetivos, embora comparações diretas entre os diferentes agentes não tenham sido conduzidas. A gabapentina e a clonidina também se revelaram opções bem toleradas e eficazes. As isoflavonas apresentaram resultados conflitantes, provavelmente justificados pela falta de padronização das doses utilizadas

Hot flashes represent one of the most common complaints in climacteric, and its pathophysiology is partly known. The estrogen therapy remains as the most effective one for vasomotor symptoms. However, because of the contraindications or their own concepts about security, many women are reluctant to use it. Some pharmacological nonhormonal options have been evaluated in randomized clinical trials and prospective trials for the relief of the symptoms. The authors performed a review of the literature aiming at describing the nonhormonal options in the approach of the vasomotor symptoms based on the scientific evidence available. Currently, the selective serotonin reuptake inhibitors (SSRIs) and the selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are the most analyzed drugs for symptomatic women with or without a history of breast cancer. Data suggest that paroxetine and venlafaxine are the most effective agents, though comparisons between different agents have not been done. Gabapentin and clonidine proved to be tolerable and effective options, too. Isoflavones presented conflicting results, probably due to the lack of standardization of the used doses

Terapia não-hormonal no manejo das ondas de calor no climatério / Non-hormonal therapy in the management of hot flushes in climateric

A menopausa, ponto máximo do climatério, é um evento acompanhado frequentemente por sintomas vasomotores, podendo ter um impacto significativo na qualidade de vida da mulher. A maioria das mulheres experimentará fogachos em algum momento de suas vidas com frequência e intensidade variáveis. Apesar das inúmeras teorias, a fisiopatologia exata dos fogachos ainda não é conhecida. Existem muitas opções de terapias farmacológicas hormonais e não-hormonais, até intervenções não-farmacológicas, e escolher a melhor opção de tratamento para cada mulher envolve o conhecimento dos possíveis riscos e benefícios de cada tratamento, necessitando de individualização na conduta. O tratamento hormonal (estrogênio e/ou progesterona) ainda é a opção mais utilizada, o qual se tem mais estudos realizados com esta modalidade de tratamento, resultando em uma redução de 80 a 90% dos fogachos, entretanto, cada vez mais são procuradas terapias alternativas. O manejo não-hormonal com melhores resultados tem sido conseguido com a classe dos antidepressivos mais recentes, a qual compreende vários inibidores seletivos da recaptação da serotonina, alguns fornecendo redução de cerca de 60% dos fogachos. Este artigo procurou avaliar as opções de terapias não-hormonais disponíveis para o controle dos sintomas climatéricos, seus efeitos colaterais e mecanismos de ação.

Menopause, the highest point of climateric, is frequently followed by vasomotor symptoms and may case a large impact in women's quality of life. The majority of women will experience episodes of hot flushes at various frequencies and intensities during their lives. Despite many theories about the physiopathology of hot flushes, the exact cause is still unknown. Different treatments for climacteric symptoms are available, such as hormonal and non-hormonal therapies, and non-pharmacological intervention also becomes an option. Choosing the best treatment requires ample knowledge of each therapy risks and benefits, and it is necessary to individualize the treatment for each woman. The hormonal therapy (estrogens and/or progestins) is still the most applied option. Accomplished studies about this kind of treatment demonstrated that it can reduce the intensity of hot flushes from 80 up to 90%; however, more and more women are searching for alternative therapies. The non-hormonal therapy with the best result involves the most recent class of antidepressant drugs, which includes many selective serotonin reuptake inhibitors, some of them reducing hot flushes up to 60%. This article aimed at evaluating non-hormonal therapy options available to control climacteric symptoms, their side effects and mechanism of action.

Efficacy comparison of Pueraria mirifica (PM) against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of climacteric symptoms in perimenopausal women: phase III study.

OBJECTIVE: To evaluate the efficacy comparison of Pueraria mirifica (PM), name in Thai is Kwao Kruea Khao, against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of perimenopuasal women with climacteric symptoms. MATERIAL AND METHOD: Perimenopausal women attending the Menopausal clinic of Hat Yai Regional Hospital were voluntarily recruited. The vasomotor symptoms such as hot flushes and night sweats, as well as other unpleasant symptoms, urogenital and psychological symptoms, were also assessed. Patients were voluntarily enrolled and randomly received daily 50 mg raw material of PM, Group A, or daily 0.625 mg of conjugated equine estrogen (CEE) with/without 2.5 mg of medroxyprogesterone acetate (MPA), Group B, depend on non-hysterectomized/hysterectomized condition. RESULTS: Seventy-one patients were enrolled. Eleven of those were excluded for failing to complete the initial work-up and follow-up. Sixty cases were evaluated, 30 cases in Group A and 30 cases in Group B. After medication, the mean of modified Greene climacteric scale (MGCS) in Group A/Group B had decreased from 29.0/32.26 to 17.86/18.1, 12.56/9.57 and 9.9/8.16 at 1-, 3-, and 6- month respectively. The clinical satisfaction using MGCS was not statistically significant between PM (Group A) and CEE with/without MPA (Group B) in the alleviation of climacteric symptoms (p-value > 0.05). There were no statistically significant changes of three serum markers: estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) between both groups. CONCLUSION: PM, containing phytoestrogens, has estrogenic effect as similar as CEE, and can alleviate the climacteric symptoms in perimenopausal women. PM demonstrates great promise in the treatment of climacteric symptoms. However, optimal doses should be clinically assessed to meet appropriate individual responses.

effect of valerian on hot flash in menopausal women

Menopause is accompanied by a number of complications, which affects the life quality and diminishes feeling of health. The most common of these complications is hot flash. Hormone therapy is commonly used for treatment of this symptom but it has a few side effects and thus is not used in some patients. Therefore, this study was aimed to determine the effect of valerian on hot flash in a group of menopausal women. This double-blinded clinical trial was performed on 48 women aged 45-65 years complaining from hot flash. The women were randomly divided into two groups of experimental [taking valerian] and control [taking placebo]. The women were interviewed and a questionnaire consisting individual characteristics and hot flash severity [using Kupperman index] was filled. Hot flash severity was measured before and 30 and 60 days after treatment. The data was analyzed by SPSS using mann-whhitney and Wilkokson tests. Based on our results, 37.9% of the experimental group was suffered from severe hot flash. One month and two months after treatment, the rate decreased to 6.9% and 3.4%, respectively [p<0.001]. In the control group, the rate was 36.8%, before and 15% one and two months after the treatment [p<0.05]. Mann-Whitney test indicated that valerian was more effective than placebo in reducing the severity of hot flash during the menopausal period [p<0.01]. This drug reduced duration of hot flash, two months after the treatment [p<0.05] and decreased its frequency one [p<0.05] and two months [p<0.01] after treatment. The results of this study showed that valerian is effective for treatment of hot flash during menopausal period and it may be used as an alternative for hormone therapy

Application of Gabapentin in Thai women with menopausal syndrome.

Application of 100 mg. three times a day of Gabapentin group, 70 women to relieve menopausal syndrome with the following symptoms:Paresthesia,sweating, hot flushes in a comparative study with the amitriptyline group, 52 women 10 mg once daily. Analysis of data was done by Chi square which assumed that the Gabapentin is superior to amitripyline as accept alternative hypothesis (Ha) and other reject null hypothesis(H0) assumed both have the same action. The result of Chi square showed that the value of calculated Chi square (39.32) is higher than Table Chi square (6.63) at p < 0.01 so the authors have to accept that Ha means that Gabapentin therapy is more significantly effective than amitripyline(p < 0.01). In addition, the present study showed that the number need to treat (NNT) of Gabapentin =2.

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.

Avaliaçäo de uma combinaçäo estro-progestativa sequencial contendo valerato de estradiol e acetato de medroxiprogesterona no controle dos sintomas climatéricos, ciclo menstrual e efeitos sobre o perfil lipídico em mulheres na peri-menopausa / Estradiol valerate abd nedrixiprogesterone acetate treatment in climacteric patients: effects on symptoms, menstrual cycle and lipidic profile

OBJETIVOS: Avaliar o efeito sobre a sintomatologia climatérica, ciclo menstrual e perfil lipídico de uma combinaçäo estro-progestativa, em esquema ciclico-sequencial, contendo 2,0 mg de valerato de estradiol de 10 mg de acetato de medroxiprogesterona (Dilena), em mulheres na peri-menopausa. TIPO DE ESTUDO: Estudo prospectivo, aberto, näo comparativo e multicêntrico. MATERIAL E METODOS: 67 mulheres na perimenopausa foram tratadas com a combinaçäo estro-progestativa mencionada, por via oral, durante um período de 6 meses. Foram avaliados antes, durante e ao término do uso da medicaçäo os seguintes parâmetros: Indice de Kupperman, número de fogachos, características do fluxo menstrual e perfil lipídico. RESULTADOS: A severidade e freqüência da sintomatologia climatérica diminui significativamente com o tratamento, bem como o número de fogachos, quando avaliado isoladamente. O sangramento menstrual esteve presente em 95 por cento das mulheres, predominantemente na forma de ciclos regulares (89,5 por cento) e com intensidade semelhante aos ciclos anteriores ao uso da medicaçäo, das pacientes. Na avaliaçäo dos níveis de colesterol total, HDL-colesterol, LDL-colesterol, VLDL-colesterol e triglicérides, näo foram diferenças estatisticamente significantes antes e após o tratamento. CONCLUSÃO: A associaçäo de valerato de estradiol e medroxiprogesterona, nas doses e esquema utilizados, é uma boa opçäo de tratamento na perimenopausa, por resultar em altos índices de remissäo dos sintomas climatéricos, promover regularidade menstrual e näo alterar o perfil lipídico

Efectos del valerato de estradiol ciproterona sobre el síndrome climaterio y parámetros bioquímicos en mujeres chilenas / Effects of estradiol valerate and ciproterone acetate on climateric syndrome and biochemical parameters in Chilean women

La menopausia se asocia a un demostrado aumento del riesgo de enfermedad cardiovascular y de osteoporosis, lo que justifica el uso de terapia hormonal de reemplazo. Como ésta se plantea por tiempo prolongado, debe ser efectiva en prevenir las complicaciones y en suprimir el síndrome climatérico. Se estudió la eficacia de la asociación de valerato de estradiol (VE) y acetato de ciproterona (CPA) en la reducción de los síntomas asociados a menopausia. Se analizaron, prospectivamente, 342 mujeres durante 6 meses, consignando la intensidad de sus síntomas y los cambios en peso, presión arterial y parámetros bioquímicos. Las oleadas de calor, así como otros síntomas y signos, disminuyeron en intensidad. No hubo diferencia significativa en la evolución del peso ni de la presión arterial, aunque sí en algunos parámetros del perfil lipídico y hepático. Se concluye que la asociación VE y CPA reduce la intensidad de los síntomas climatéricos en el grupo estudiado