Incidence and Outcomes Associated with Menopausal Status in COVID-19 Patients: A Systematic Review and Meta-analysis / Incidência e resultados associados ao estado da menopausa em pacientes com COVID-19: Uma revisão sistemática e metanálise

Abstract Objective Menopause causes several changes in the body that may affect the response to COVID-19. We aimed to investigate the possible association between menopausal status and incidence and outcomes in COVID-19 patients. Methods Combinations of keywordsCOVID-19, menopause, and estrogen were used to search the PubMed, Embase, Web-of-Science, and Scopus databases for articles reporting the incidence and outcomes of COVID-19 (discharge, length-of-admission, intensive care, or mortality) in premenopausal women, available through December 29, 2022. Data from studies comparing the incidence of COVID-19 infection with the age-matched male population were pooled and meta-analyzed using a random-effects model. Results Overall, 1,564 studies were retrieved, of which 12 were finally included in the systematic review to compare disease outcomes, and 6 were meta-analyzed for the incidence of COVID-19 in premenopausal and postmenopausal women. All studies reported better COVID-19-associated outcomes in premenopausal women compared with postmenopausal women. After adjusting for confounding factors, three studies found better outcomes in postmenopausal women, and two found no association between menopausal status and COVID-19 outcomes. Our meta-analysis found a higher incidence of COVID-19 infection among premenopausal women than postmenopausal women, when compared with age-matched men (odds ratio = 1.270; 95% confidence interval: 1.086-1.486; p= 0.003). Conclusion The incidence of COVID-19 was significantly higher in premenopausal women than in postmenopausal women when compared with age-matched men. Although premenopausal women may have more favorable COVID-19-associated outcomes, the presumed preventive effect of estrogens on the incidence and related outcomes of COVID-19 in premenopausal women cannot be proven at present. Further longitudinal studies comparing pre- and post-menopausal women are required to provide further insight into this matter.

Resumo Objetivo A menopausa causa diversas alterações no corpo que podem afetar a resposta ao COVID-19. Nosso objetivo foi investigar a possível associação entre o status da menopausa e a incidência e os resultados em pacientes com COVID-19. Métodos Combinações de palavras-chave COVID-19, menopausa e estrogênio foram usadas para pesquisar os bancos de dados PubMed, Embase, Web-of-Science e Scopus para artigos relatando a incidência e os resultados do COVID-19 (alta, tempo de internação, tratamento intensivo cuidados ou mortalidade) em mulheres na pré-menopausa, disponível até 29 de dezembro de 2022. Dados de estudos comparando a incidência de infecção por COVID-19 com a população masculina da mesma idade foram agrupados e meta-analisados usando um modelo de efeitos aleatórios. Resultados No geral, 1.564 estudos foram recuperados, dos quais 12 foram finalmente incluídos na revisão sistemática para comparar os resultados da doença e 6 foram meta-analisados para a incidência de COVID-19 em mulheres na pré e pós-menopausa. Todos os estudos relataram melhores resultados associados ao COVID-19 em mulheres na pré-menopausa em comparação com mulheres na pós-menopausa. Após o ajuste para fatores de confusão, três estudos encontraram melhores resultados em mulheres na pós-menopausa e dois não encontraram associação entre o status da menopausa e os resultados do COVID-19. Nossa meta-análise encontrou uma maior incidência de infecção por COVID-19 entre mulheres na pré-menopausa do que mulheres na pós-menopausa, quando comparadas com homens da mesma idade (odds ratio = 1,270; intervalo de confiança de 95%: 1,086-1,486; p = 0,003). Conclusão A incidência de COVID-19 foi significativamente maior em mulheres na pré-menopausa do que em mulheres na pós-menopausa quando comparadas com homens da mesma idade. Embora as mulheres na pré-menopausa possam ter resultados mais favoráveis associados ao COVID-19, o efeito preventivo presumido dos estrogênios na incidência e nos resultados relacionados ao COVID-19 em mulheres na pré-menopausa não pode ser comprovado no momento. Mas estudos longitudinais comparando mulheres pré e pós-menopausa são necessários para fornecer mais informações sobre este assunto.

Confiabilidad de cuestionarios electrónicos para evaluar calidad de vida y actitudes hacia la vejez en mujeres de 40 a 69 años / Reliability of electronic questionnaires to evaluate quality of life and attitudes towards old age in women aged 40 to 69 years

Introducción: el uso de cuestionarios electrónicos se ha convertido en algo común, sin embargo, depende de diversos factores (como la edad y las habilidades digitales), por lo que es necesario determinar la confiabilidad de estos instrumentos para su aplicación. Objetivo: determinar la concordancia y reproducibilidad de los cuestionarios Calidad de vida breve de la OMS (WHOQoL-B) y Actitudes autoevaluadas hacia la vejez (AAV) en formato electrónico para su aplicación vía remota a mujeres de edad madura y adulta mayor. Metodología: se realizó un estudio instrumental con el método test-retest con 35 mujeres (40-69 años). Se transfirieron ambos cuestionarios a un formulario de Google y se enviaron vía WhatsAppen dos ocasiones, con una diferencia mayor a 15 días entre la aplicación. Se calcularon los parámetros de confiabilidad por estabilidad temporal y concordancia estadística. Resultados: el WHOQoL-B obtuvo a y CCI = 0.880 y r = 0.785 en la calificación total; para sus dimensiones a > 0.740 y r > 0.590. La calificación total del AAV mostró a y CCI = 0.708 y r = 0.552 y sus dimensiones a > 0.710 y r de 0.295 a 0.508. Conclusiones: los cuestionarios WHOQoL-B y AAV en formato electrónico pueden ser utilizados para aplicación vía remota, aunque el AAV es menos consistente...(AU)

Abstract Introduction: The electronic tests have been used on a regular basis, although their use depends on several factors such as age and digital ability, therefore it is necessary to determine the confidence of these instruments for their application. Objective: To determine the agreement and reproducibility of the WHO Quality of Life-Bref (WHOQoL-B) and the Self-Assessed Attitudes Towards Old Age (SATO) questionnaires in electronic format for application in middle-aged and older women. Methods: An instrumental study with a test-retest method was carried out with 35 women (40-69 years). Both questionnaires were transferred to a Google form and sent to the women by WhatsApp twice with a difference of more than 15 days between applications. We calculate the confidence by temporal stability and the statistical agreement. Results: For the WHOQoL-B, an a and ICC= 0.880, and r = 0.785 were obtained in the total rating; for their dimensions the result for a was > 0.740, and r > 0.590. The total rating of SATO shows an a and ICC= 0.708, and r = 0.552; for their dimensions, the a was > 0.710, and r from 0.295 to 0.508. Conclusions: The electronic tests WHOQoL and SATO can be used for remote application, although SATO is less consistent.

Nutrição no climatério: quais os benefícios? Revisão integrativa / Nutrition in Menopause: What are the Benefits? An Integrative Review / Nutrición en el Climaterio: ¿Cuáles son los Beneficios? Una Revisión Integradora

Introdução:A menopausa é uma fase transitória entre o período reprodutivo para o período não fértil na vida da mulher, sendo dividido em três períodos: pré-menopausa, perimenopausa e pós-menopausa, podendo durar de 12 meses a 03 anos. Anutrição e a alimentação possuem um importante papel durante esse período, visando evitar ou minimizar problemas como: osteoporose, constipação, desidratação, hipertensão, ansiedade, diminuição da libido, depressão, alterações no sono, dores nas articulações e ganho de peso. Objetivo:Descrever os possíveis benefícios relacionados à nutrição durante o climatérioMetodologia:Revisão da literatura que utilizou as bases de dados Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PubMed) e Scientific Electronic Library Online (Scielo), por meio dos Descritores em Ciência da Saúde (DeCS) "Diet", "Climacteric" combinados com o operador booleano AND. Nossa pesquisa considerou estudos originais publicados nos últimos cinco anos, tanto de acesso livre quanto restrito, sem restrição de idioma. Excluímos revisões, duplicatas e artigos não relacionados ao tema. Encontramos um total de 122 artigos com os descritores utilizados e selecionamos 19 para a amostra desta revisão. Resultados:Observou-se uma perda de peso significativa entreas mulheres no climatério, assim como ondas de calor em decorrência dos sintomas da menopausa. A compulsão alimentar dos grupos randomizados mostrou-se baixa bem como a pressão arterial. Pode-se constatar, ainda, que o IMC dessas mulheres apresentou declínio e os sintomas relacionados à depressão igualmente registraram uma redução. Conclusões:A intervenção nutricional no climatério resultou em benefícios significativos, incluindo perda de peso, redução dos sintomas da menopausa, melhora da saúde cardiovascular, diminuição do IMC e alívio dos sintomas relacionados à depressão. Esses resultados destacam a importância da nutrição como uma abordagem eficaz para melhorar a qualidade de vida das mulheres nessa fase de transição (AU).

Introduction:Menopause is a transitional phase between the reproductive and the non-fertile periods of women, divided into pre-menopause, perimenopause and post-menopause, lasting from 12 months to 3 years. Nutritionand diet play a relevant role, aiming to avoid or minimize problems such as osteoporosis, constipation, dehydration, hypertension, anxiety, decreased libido, depression, changes in the sleep cycle, joint pain, and weight gain. Objective:Describing the possible benefits related to nutrition during menopause. Methodology:AThis paper presents a literature review that used the Virtual Health Library (VHL), National Library of Medicine (PubMed) and Scientific Electronic Library Online (Scielo) databases, through the Health Science Descriptors (DeCS) "Diet", "Climacteric" combined with the Boolean operator AND. The research considered original studies published in the last five years, both of open and restricted access, without restrictions for languages. Reviews, duplicates and articles unrelated to the topic were excluded. A total of 122 articles were found using these descriptors, and 19 were selected for the sample of this review. Results:Significant weight loss was observed among climacteric women, as well as hot flashes due to menopausal vasomotor symptoms. Binge eating in the randomized groups was low, as was blood pressure. It was also observed that the BMI of these women showed a decline and symptoms related to depression were also reduced. Conclusions:A nutritional intervention during menopause resulted in significant benefits, including weight loss, reduced symptoms, improved cardiovascular health, decreased BMI, and relief of symptoms related to depression. The importance of nutrition is highlighted as an effective approach to improve the quality of life of women in this transition phase (AU).

Introducción: La menopausia es una fase transitoria entre el período reproductivo y el período no fértil en la vida de la mujer, siendo dividido en tres fases: premenopausia, perimenopausia y posmenopausia, pudiendo durar de 12 meses a 03 años. La nutrición y la alimentación tienen un importante papel durante este período, buscando evitar o minimizar problemas como: osteoporosis, estreñimiento, deshidratación, hipertensión, ansiedad, disminución de la libido, depresión, cambios en el sueño, dolor en las articulaciones y aumento de peso. Objetivo: Describir los posibles beneficios relacionados con la nutrición durante el climaterioMetodología: Revisión de la literatura que utilizó las bases de datos Biblioteca Virtual en Salud (BVS), National Library of Medicine (PubMed) y Scientific Electronic Library Online (Scielo), por medio de los descriptores en Ciencia de la Salud (DeCS) "Diet", "Climacteric" combinados con el operador booleano AND. Nuestra investigación consideró estudios originales publicados en los últimos cinco años, tanto de acceso libre como restringido, sin limitación de idiomas. Excluimos revisiones, duplicados y artículos no relacionados con el tema. Encontramos un total de 122 artículos con los descriptores utilizados y seleccionamos 19 para la muestra de esta revisión. Resultados: Se observó una pérdida de peso significativa entre las mujeres en el climaterio, al igual que una reducción de loscalores súbitos como consecuencia de los síntomas de la menopausia. La compulsión alimentaria de los grupos aleatorizados demostró ser baja, así como la presión arterial. Se puede constatar, además, que el IMC de esas mujeres presentó una disminución y los síntomas relacionados a la depresión igualmente registraron una reducción. Conclusiones: La intervención nutricional en el climaterio ocasionó beneficios significativos, incluyendo pérdida de peso, reducción de los síntomas de la menopausia, mejora de la salud cardiovascular, disminución del IMC y alivio de los síntomas relacionados con la depresión. Estos resultados resaltan la importancia de la nutrición como un enfoque efectivo para mejorar la calidad de vida de las mujeres en esta fase de transición (AU).

Prevalencia y caracterización de las disfunciones sexuales en mujeres en transición a la menopausia / Prevalence and characterization of sexual dysfunctions in women in transition to menopause

Objetivo: Caracterizar las disfunciones sexuales y estimar la prevalencia en un grupo de mujeres en transición a la menopausia, así como evaluar la frecuencia de la sintomatología climatérica. Método: Estudio de corte transversal, entre 2017 y 2020, que incluyó 411 mujeres en transición a la menopausia, residentes en el Quindío, con pareja estable y actividad sexual en las últimas 6 semanas. Se utilizó como instrumento el FSFI-6 (6-Item Female Sexual Function Index). Resultados: La edad promedio fue de 46,53 ± 2,87 años. La prevalencia de disfunciones sexuales fue del 38,92%, caracterizadas por dificultades con el deseo sexual (38,92%), seguido de dolor/dispareunia (35,52%). El promedio general en la puntuación del FSFI-6, en la totalidad de la población participante, fue de 22,29 ± 0,84 puntos; en la población afectada (< 19 puntos) fue de 15,78 ± 3,94. En los dominios, la puntuación más baja estuvo en el deseo (3,14 ± 0,56). La mediana de disfunciones sexuales por mujer fue de tres (23,84%). Conclusiones: más de un tercio de las mujeres del Quindío en transición a la menopausia presentan disfunciones sexuales; el trastorno más común fue el bajo deseo. Se deben hacer esfuerzos para aumentar la conciencia en los asuntos de salud sexual.

Objective: To characterize sexual dysfunctions and estimate the prevalence in a group of women in transition to menopause, as well as to evaluate the frequency of climacteric symptoms. Method: Cross-sectional study, between 2017 and 2020, included 411 women in transition to menopause, residents of Quindío, with a stable partner and sexual activity in the last 6 weeks. The FSFI-6 (6-Item Female Sexual Function Index) was used as an instrument. Results: The mean age was 46.53 ± 2.87 years. The prevalence of sexual dysfunctions was 38.92%, characterized by difficulties with sexual desire (38.92%), followed by pain/dyspareunia (35.52%). The general average, in the FSFI-6 score, in the entire participating population, was 22.29 ± 0.84 points; while in the affected population (< 19 points), it was 15.78 ± 3.94. In the domains, the lowest score was in desire (3.14 ± 0.56). The median number of sexual dysfunctions per woman was three (present in 23.84%). Conclusions: This study showed that more than one third of the women in Quindío, in transition to menopause, had sexual dysfunctions; the most common type of disorder was low desire. Efforts should be made to increase awareness about sexual health issues.

La relación entre la transición a la menopausia y los trastornos del estado de ánimo / The relationship between menopause transition and mood disorders

Este estudio tuvo como objetivo examinar la relación entre la transición a la menopausia y los trastornos del estado de ánimo, específicamente la ansiedad y la depresión. Se llevó a cabo una revisión narrativa de la literatura relevante sobre la transición a la menopausia y los trastornos del estado de ánimo. Se revisaron estudios que se enfocaron en el impacto de los cambios hormonales durante la menopausia en el bienestar psicológico y se evaluaron diversas opciones de tratamiento para los trastornos del estado de ánimo. La disminución de los niveles hormonales de estrógenos y progesterona durante la menopausia puede llevar a diversos cambios psicológicos, como ansiedad y depresión. La terapia hormonal con estrógenos solo o en combinación con progesterona puede mejorar los síntomas depresivos en mujeres en la menopausia, pero este tratamiento no está exento de riesgos. Otros tratamientos no hormonales, como la terapia cognitivo-conductual, el ejercicio y una buena higiene del sueño, también pueden ser efectivos para manejar los trastornos del estado de ánimo. Se concluyó que existe una compleja interacción entre factores hormonales, biológicos y psicosociales para desarrollar intervenciones efectivas que mejoren el bienestar psicológico de las mujeres en la menopausia.

This study aimed to examine the relationship between menopause transition and mood disorders, specifically anxiety and depression. The authors conducted a narrative review of relevant literature on menopause transition and mood disorders. They reviewed studies that focused on the impact of hormonal changes during menopause on psychological well-being and evaluated various treatment options for mood disorders. The decline in estrogen and progesterone hormone levels during menopause can lead to various psychological changes, such as anxiety and depression. Hormonal therapy with estrogen alone or in combination with progesterone can improve depressive symptoms in menopausal women, but this treatment is not without risks. Other non-hormonal treatments, such as cognitive-behavioral therapy, exercise, and good sleep hygiene, can also be effective in managing mood disorders. The study highlights the need for recognition of the complex interplay between hormonal, biological, and psychosocial factors in developing effective interventions to improve the psychological well-being of menopausal women. Further research is needed to fully understand the potential relationship between menopause transition and mood disorders.

A incontinência urinária nas fases de climatério e menopausa: Efeitos, Consequências e Aceitação / Urinary incontinence in the climacteric and menopause phases: Effects, Consequences and Acceptance

Este trabalho traz a reflexão, através de conhecimentos multidisciplinares, sobre a incontinência urinária em decorrência da menopausa. Conceitua, a critério de informação, as diferentes fases que compõem o período de finalização da menstruação, experenciadas pelo público feminino, mais especificamente o climatério, pré-menopausa, menopausa e pós-menopausa. A discussão tem o objetivo de encontrar alternativas de comunicação e interação com a mulher em menopausa e trabalhar todos os sintomas possíveis encontrados nesta fase da vida, para que ela perceba a importância e a necessidade de procurar ajuda médica, informações inerentes ao tema, para uma melhor qualidade de vida, saúde e segurança nas suas transformações físicas e psíquicas. Reflete-se também sobre a realidade da mulher, os efeitos e impactos da menopausa na vida dela e a incontinência urinária como efeito dessa passagem. Como elas enfrentam essa condição no dia a dia e a insegurança que carregam ao viverem esse momento de transformação e 'perdas' relacionadas. Por isso, os profissionais debatem sobre a importância da comunicação e da disseminação da informação como caminhos para auxiliar na compreensão desse público a tudo relacionado à condição de incontinência urinária, em especial na menopausa. Os temas também debatem sobre a rede de apoio e o papel de cada um na percepção das mulheres ao que elas devem fazer, como fazer e por que fazer os tratamentos preventivos ou remediativos. É ciclo natural da vivência da mulher, mas os sintomas e efeitos não podem ser naturalizados, por isso a necessidade de se entender o panorama da incontinência urinária, nível Brasil, na vida das mulheres em menopausa.(AU)

This work brings reflection, through multidisciplinary knowledge, on urinary incontinence due to menopause. It conceptualizes, at the discretion of information, the different phases that make up the period of completion of menstruation, experienced by the female public, more specifically the climacteric, pre-menopause, menopause and post-menopause. The purpose of the discussion is to find alternatives for communication and interaction with women undergoing menopause and to work on all the possible symptoms found in this phase of life, so that she realizes the importance and need to seek medical help, information inherent to the subject, for a better quality of life, health and safety in their physical and mental transformations. It also reflects on the reality of women, the effects and impacts of menopause on her life and urinary incontinence as an effect of this transition. How they face this condition on a daily basis and the insecurity they carry when experiencing this moment of transformation and related 'losses'. Therefore, professionals discuss the importance of communication and dissemination of information as ways to help this public understand everything related to the condition of urinary incontinence, especially in menopause. The themes also discuss the support network and the role of each one in the women's perception of what they should do, how to do it and why to do preventive or remedial treatments. It is a natural cycle of women's experience, but the symptoms and effects cannot be naturalized, hence the need to understand the panorama of urinary incontinence, at the level of Brazil, in the lives of women undergoing menopause.(AU)

Este trabajo trae la reflexión, a través del conocimiento multidisciplinario, sobre la incontinencia urinaria por menopausia. Conceptualiza, a criterio de la información, las diferentes fases que componen el período de finalización de la menstruación, experimentado por el público femenino, más específicamente el climaterio, la premenopausia, la menopausia y la posmenopausia. El propósito de la charla es encontrar alternativas de comunicación e interacción con la mujer en la menopausia y trabajar todos los síntomas posibles encontrados en esta etapa de la vida, para que ella se dé cuenta de la importancia y necesidad de buscar ayuda médica, información inherente al tema. , para una mejor calidad de vida, salud y seguridad en sus transformaciones físicas y mentales. También reflexiona sobre la realidad de la mujer, los efectos e impactos de la menopausia en su vida y la incontinencia urinaria como efecto de esta transición. Cómo enfrentan esta condición en el día a día y la inseguridad que cargan al vivir este momento de transformación y las 'pérdidas' relacionadas. Por lo tanto, los profesionales discuten la importancia de la comunicación y la difusión de información como formas de ayudar a este público a comprender todo lo relacionado con la condición de incontinencia urinaria, especialmente en la menopausia. Los temas también discuten la red de apoyo y el papel de cada uno en la percepción de las mujeres sobre lo que deben hacer, cómo hacerlo y por qué hacer tratamientos preventivos o curativos. Es un ciclo natural de la experiencia de la mujer, pero los síntomas y los efectos no se pueden naturalizar, de ahí la necesidad de comprender el panorama de la incontinencia urinaria, a nivel de Brasil, en la vida de las mujeres en fase de menopausia.(AU)

Transtornos alimentares: vivências de mulheres acima de 30 anos / Eating disorders: experiences of women aged over 30 years / Trastornos alimentarios: experiencias de mujeres de más de 30 años

O objetivo deste estudo foi compreender como mulheres adultas (acima de 30 anos) diagnosticadas com transtornos alimentares (TAs) vivenciam o adoecer. Trata-se de um estudo qualitativo, descritivo e exploratório, desenvolvido com base no referencial teórico-metodológico da Análise Fenomenológica Interpretativa (AFI). Participaram seis mulheres, com idades entre 34 e 65 anos, atendidas em um serviço especializado. Os dados foram coletados por meio de entrevista aberta, de inspiração fenomenológica, na modalidade remota. As entrevistas foram audiogravadas, transcritas e analisadas seguindo os passos da AFI. Duas categorias temáticas foram identificadas: "Vivendo antes do adoecer" e "Encontrando-se doente." Constatou-se que os sintomas tiveram início anteriormente à vida adulta e que houve dificuldade na confirmação do diagnóstico. Na perspectiva das participantes, conviver com a sintomatologia ficou mais complicado em função de particularidades de manejo dos sintomas na vida adulta, e a idade é percebida como um fator que impacta e dificulta ainda mais a recuperação. As participantes relataram desesperança em relação ao futuro, apesar de a maioria reconhecer melhoras no quadro clínico ao longo do tempo e de valorizar a relação de confiança estabelecida com a equipe multiprofissional.(AU)

This study aimed to understand the experience of illness of adult women (over 30 years) diagnosed with eating disorders (ED). This is a qualitative, descriptive, and exploratory study, using Interpretative Phenomenological Analysis (IPA) as theoretical and methodological framework. A sample of six women aged 34-64 years, assisted in a specialized service, were recruited to complete a phenomenological in-depth open interview. The data were remotely collected. Interviews were audio-recorded, transcribed and analyzed following the IPA. Two thematic categories were identified: "Living before the illness" and "Finding about the illness." It was found that the symptoms started before adulthood and that there was difficulty establishing the diagnosis. Living with the symptoms became more complicated due to particularities of symptom management in adulthood and age is perceived as a factor that impacts recovery and makes it even more difficult. The participants reported hopelessness about the future, although most recognized improvements in the clinical condition over time and valued the trusting relationship they established with the multiprofessional team.(AU)

El objetivo de este estudio fue comprender las experiencias de las mujeres adultas (mayores de 30 años) diagnosticadas con trastornos alimentarios (TA) respecto a la enfermedad. Se trata de un estudio cualitativo, descriptivo y exploratorio, desarrollado a partir del marco teórico y metodológico del Análisis Fenomenológico Interpretativo (AFI). Participaron seis mujeres, con edades de entre 34 y 65 años, atendidas en un servicio especializado. Los datos se recogieron mediante entrevistas abiertas, de inspiración fenomenológica, en la modalidad a distancia. Las entrevistas fueron grabadas en audio, transcritas y analizadas siguiendo los pasos del AFI. Se identificaron dos categorías temáticas: "Vivir antes de enfermar" y "Encontrarse enfermo." Se constató que los síntomas comenzaron antes de la edad adulta y que hubo dificultades de establecer el diagnóstico. La convivencia con síntomas se complicó debido a las particularidades del manejo de los síntomas en la vida adulta y la edad se percibe como un factor que influye y dificulta aún más la recuperación. Los participantes manifestaron desesperanza sobre el futuro, aunque reconocieron mejoras en el cuadro clínico con el paso del tiempo y valoraron la relación de confianza establecida con el equipo multiprofesional.(AU)

Prevalência e severidade de sintomas em mulheres na menopausa: um estudo descritivo / Prevalence and severity of symptoms in women in the menopause: a cross-sectional study

Introdução: Muitas mulheres sofrem com sintomas associados à menopausa, que podem apresentar diferentes graus de intensidade e afetar sua qualidade de vida. Objetivo: Identificar a prevalência e severidade dos principais sintomas nas diferentes fases do climatério. Métodos: Foram selecionadas mulheres com idades entre 40 e 65 anos, que responderam a um questionário on-line com dados sociodemográficos, de saúde, alimentação e características menstruais e de menopausa. Para avaliar os sintomas da menopausa e sua intensidade, foi aplicado o questionário internacional validado Menopause Rating Scale (MRS). Resultados: Foram incluídas 283 mulheres (36,8% na pré-menopausa, 24% na perimenopausa e 39,2% na pós-menopausa). Excesso de peso foi mais prevalente na perimenopausa do que na pré-menopausa (P=0,012). Sintomas como diminuição da libido, secura vaginal, incontinência urinária, dores musculares e articulares, alterações lipídicas e ondas de calor, calorões, foram mais prevalentes em valores absolutos nas mulheres pós-menopausa. As mulheres no período de perimenopausa apresentaram maior prevalência, em valores absolutos, de estresse, irritabilidade, dor de cabeça, problemas na pele, falta de concentração/memória, distúrbios do sono e fadiga. De acordo com o MRS, não houve diferença no domínio psicossocial (P=0,265) e os sintomas somato-vegetativos e urogenitais são mais intensos nas mulheres na perimenopausa e pós-menopausa, quando comparadas com as mulheres na pré-menopausa (P<0,001). O escore global do questionário também demonstra essa intensidade menor no grupo pré-menopausa (P=0,001). Conclusões: Este estudo demonstrou uma prevalência e severidade maior de sintomas em mulheres na perimenopausa e pós-menopausa, o que pode prejudicar a qualidade de vida dessas mulheres nessa fase da vida

Introduction: Many women experience symptoms associated with menopause that present with different degrees of intensity and affect their quality of life. Objective: To identify the prevalence and severity of the main symptoms during different climacteric phases. Methods: Women aged 40­65 years answered an online questionnaire on sociodemographic data, health, diet, menstrual, and menopausal characteristics. The internationally validated Menopause Rating Scale (MRS) questionnaire was used to assess menopausal symptoms and their intensities. Results: 283 women were included (36.8% pre-menopausal, 24% peri-menopausal, and 39.2% post-menopausal). Excess weight was more prevalent in the peri-menopausal group than in the pre-menopausal group (P=0.012). Symptoms such as decreased libido, vaginal dryness, urinary incontinence, muscle and joint pain, lipid alterations, and hot flashes were more prevalent in the absolute values of post-menopausal women. Women in the peri-menopausal period had a higher prevalence, in absolute values, of stress, irritability, headache, skin problems, lack of concentration/memory, sleep disorders, and fatigue. According to the MRS, there was no difference in the psychosocial domain (P=0.265) but somato-vegetative and urogenital symptoms are more intense in peri-menopausal and post-menopausal women when compared to pre-menopausal women (P<0.001). The global score on the questionnaire also demonstrated a lower intensity in the pre-menopausal group's symptoms (P=0.001). Conclusions: This study demonstrated a higher prevalence and severity of symptoms in peri-menopausal and post-menopausal women, which may impair the quality of life of these women at this stage of life.

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.

Combined Aerobic and Strength Training Improves Dynamic Stability and can Prevent against Static Stability Decline in Postmenopausal Women: A Randomized Clinical Trial / O treinamento de força e aeróbio combinado melhora a estabilidade dinâmica e pode prevenir contra o declínio da estabilidade estática em mulheres na pósmenopausa: um ensaio clínico randomizado

Abstract Objective To analyze the effect of combined training (CT) in postural control and gait parameters in postmenopausal women. Methods A parallel-group, randomized, control study was conducted with 16 weeks of combined training (n = 16) versus a non-training control group (n = 12) in postmenopausal women (aged 59.3 ± 8.0). Pre and postintervention assessments included postural control (using an AMTI force platform - Advanced Mechanical Technology, Inc., Watertown, MA, USA) and gait impairments (using baropodometry). In addition, the upper limb strength and abdominal tests, as well as aerobic capacity, assessed functional indicators. Results The CT intervention in postmenopausal women resulted in improved gait (stride length (p = 0.006); speed (p = 0.013); double support time (p = 0.045); and improved postural control (displacement area of postural sway in a normal base of support with eyes open (p = 0.006). Combined training increased functional indicators (abdominal - p = 0.031; aerobic capacity - p = 0.002). Conclusion In conclusion, combined aerobic plus strength training effectively improved gait and balance control in older women. The postmenopausal women from the CT group walked faster and with bigger steps after the intervention than the control group. In addition, they presented decreased postural sway in standing and decreased the percentage of double support time while walking, which means improved static and dynamic balance control and functional indicators.

Resumo Objetivo Analisar o efeito do treinamento combinado (TC) no controle postural e nos parâmetros da marcha em mulheres na pós-menopausa. Métodos Foi realizado um estudo controlado randomizado de grupos paralelos com 16 semanas de treinamento combinado (n = 16) versus um grupo controle sem treinamento (n = 12) em mulheres na pós-menopausa (59,3 ± 8,0 anos). As avaliações pré e pós-intervenção incluíram controle postural (usando a plataforma de força AMTI) e deficiências da marcha (usando baropodometria). Além disso, os testes de força de membros superiors e abdominal, bem como a capacidade aeróbica, avaliaram indicadores funcionais. Resultados A intervenção do TC em mulheres na pós-menopausa resultou em melhora da marcha (comprimento da passada (p = 0,006), velocidade (p = 0,013), tempo de apoio duplo (p = 0,045) e controle postural aprimorado (área de deslocamento da oscilação postural em base de apoio normal com olhos abertos (p = 0,006). O TC aumentou os indicadores funcionais (abdominal - p = 0,031; capacidade aeróbia - p = 0,002). Conclusão Em conclusão, o TC de força e aeróbico melhorou efetivamente o controle da marcha e do equilíbrio em mulheres idosas. As mulheres na pós-menopausa do grupo CT caminharam mais rápido e com passos maiores após a intervenção do que o grupo controle. Além disso, elas apresentaram redução da oscilação postural em pé e do percentual de tempo de apoio duplo durante a caminhada, o que significa melhora no controle do equilíbrio estático e dinâmico e dos indicadores funcionais.

Barreras y facilitadores de los médicos de atención primaria para abordar las consultas vinculadas a la sexualidad de pacientes durante el climaterio / Barriers and facilitators of primary care physicians to address consultations related to the sexuality of patients during the climacteric

Introducción. Pese a la alta prevalencia de disfunciones sexuales femeninas durante el climaterio y a que existen intervenciones para mejorarlas, este problema no suele ser consultado por las pacientes ni explorado por los profesionales de la salud. Si bien suponemos que existen condicionamientos culturales que actuarían como barreras para su abordaje, no conocíamos las percepciones, incomodidades y experiencias de los profesionales que atienden en el ámbito de la atención primaria a pacientes que transitan su climaterio. Objetivos. Comprender desde la perspectiva de los médicos de atención primaria los factores que contribuyen a la invisibilidad de la problemática de las disfunciones sexuales femeninas durante el climaterio en mujeres de clase media atendidas en el Área Metropolitana de Buenos Aires. Diseño. Estudio exploratorio transversal con enfoque cualitativo realizado en el Hospital Italiano de Buenos Aires durante2020 y 2021. Resultados. A partir del análisis de diez entrevistas semiestructuradas a médicos de atención primaria (de familia, clínicos y ginecólogos) identificamos seis ejes temáticos: 1) un modelo institucional en el que el tiempo limitado para la consulta y forma de pago capitada incentivaría a que las las disfunciones sexuales femeninas permanezcan invisibilizadas; 2) la longitudinalidad de la relación médico-paciente contribuiría como un facilitador del abordaje de problemáticas vinculadas con la esfera sexual; 3) la discordancia de género entre los profesionales y las pacientes operaría como un obstáculo para abordar aspectos de la sexualidad durante el climaterio; 4) la biografía y la formación de los profesionales de la salud influiría sobre sus habilidades para abordar la problemática de la sexualidad de sus pacientes; 5) el examen ginecológico y/o la detección de síntomas de depresión contribuyen a abrir la puerta para indagar sobre la disfunción sexual femenina; y 6) el prejuicio de que el fin de la etapa reproductiva implicaría el fin de la actividad sexual. Conclusiones. Si bien no existen recomendaciones formales para la pesquisa sistemática de disfunciones sexuales femeninas, su elevada prevalencia, su fácil diagnóstico y la existencia de herramientas terapéuticas para aliviarlas, ameritan que estén más disponibles entre nuestras hipótesis diagnósticas. (AU)

Background. Despite the high prevalence of female sexual dysfunctions during the climacteric and the existence of interventions to improve them, this problem is not usually consulted by patients or explored by health professionals. Although weassume that there are cultural conditioning factors that would act as barriers to its approach, we were unaware of the perceptions, discomforts, and experiences of the professionals who care for patients who are going through their climactericin the field of primary care. Objectives. To understand, from the perspective of primary care physicians, the factors that contribute to the invisibility of the female sexual dysfunctions problem during the climacteric in middle-class women treated in the Buenos Aires Metropolitan Area. Design. Cross-sectional exploratory study with a qualitative approach carried out at Hospital Italiano de Buenos Aires during 2020 and 2021. Results. From the analysis of ten semi-structured interviews with primary care physicians (family, clinicians and gynecologists) we identified six thematic axes: 1) an institutional model in which the limited time for consultation and capitated form of payment would encourage female sexual dysfunctions to remain invisible; 2) the longitudinality of the doctor-patient relationship would contribute as a facilitator in addressing problems related to the sexual sphere; 3) the gender discrepancy between professionals and patients would operate as an obstacle to address aspects of sexuality during the climacteric; 4) the biography and training of health professionals would influence their abilities to address the problems of their patients'sexuality; 5) gynecological examination and/or the detection of symptoms of depression contribute to opening the door toinquire about FSD; 6) the prejudice that the end of the reproductive stage would imply the end of sexual activity. Conclusions. Although there are no formal recommendations for the systematic screening of female sexual dysfunctions, its high prevalence, its easy diagnosis and the existence of therapeutic tools to alleviate them, deserve that they be more available among our diagnostic hypotheses. (AU)

Knowledge, attitudes, and practices regarding menopause among female employees aged 45 years old and above in a tertiary government hospital

Background@#Studies show that employers and healthcare practitioners should be aware of the difficulties women experience during menopause. Cultural norms and social influences may affect each woman’s experience during menopause.@*Objective@#This study aimed to assess the knowledge, attitudes, and practices regarding menopause among female employees working in a tertiary government hospital. @*Methods@#This is a descriptive, observational, cross-sectional research design, that used a validated and reliable questionnaire.@*Results@#The mean age of respondents was 51.75±5.06 years. Majority of the respondents belong to the Nursing Department, followed by the Allied Health (30%), Medical (21%) and Administrative Department (9%). Overall, they had a High Level of Knowledge (Mean = 7.59), a Strongly Evident Attitude (Mean = 3.85), and Highly Manifested Practices (Mean=3.85) regarding menopause.@*Conclusion@#With the knowledge that the respondents have on menopause, the attitude that these women have become is strongly evident. Women who have adequate knowledge on menopause are able to tolerate its complications with a positive attitude and approach. This knowledge also highly manifested in their practices.

Secular trends of age at menarche and age at menopause in women born since 1951 from a county of Shandong Province, China / 北京大学学报(医学版)

OBJECTIVE@#To describe the secular trends of age at menarche and age at natural menopause of women from a county of Shandong Province.@*METHODS@#Based on the data of the Premarital Medical Examination and the Cervical Cancer and Breast Cancer Screening of the county, the secular trends of age at menarche in women born in 1951 to 1998 and age at menopause in women born in 1951 to 1975 were studied. Joinpoint regression was used to identify potential inflection points regarding the trend of age at menarche. Average hazard ratios (AHR) of early menopause among women born in different generations were estimated by performing multivariate weighted Cox regression.@*RESULTS@#The average age at menarche was (16.43±1.89) years for women born in 1951 and (13.99±1.22) years for women born in 1998. The average age at menarche was lower for urban women than that for rural women, and the higher the education level, the lower the average age at menarche. Joinpoint regression analysis identified three inflection points: 1959, 1973 and 1993. The average age at menarche decreased annually by 0.03 (P < 0.001), 0.08 (P < 0.001), and 0.03 (P < 0.001) years respectively for women born during 1951-1959, 1960-1973, and 1974-1993, while it remained stable for those born during 1994-1998 (P=0.968). As for age at menopause, compared with women born during 1951-1960, those born during 1961-1965, 1966-1970 and 1971-1975 showed a gradual decrease in the risk of early menopause and a tendency to delay the age at menopause. The stratified analysis presented that the risk of early menopause gradually decreased and the age of menopause showed a significant delay among those with education level of junior high school and below, but this trend was not obvious among those with education level of senior high school and above, where the risk of early menopause decreased and then increased among those with education level of college and above, and the corresponding AHRs were 0.90 (0.66-1.22), 1.07 (0.79-1.44) and 1.14 (0.79-1.66).@*CONCLUSION@#The age at menarche for women born since 1951 gradually declined until 1994 and leveled off, with a decrease of nearly 2.5 years in these years. The age at menopause for women born between 1951 and 1975 was generally delayed over time, but the trend of first increase and then decrease was observed among those with relatively higher education levels. In the context of the increasing delay in age at marriage and childbearing and the decline of fertility, this study highlights the necessity of the assessment and monitoring of women' s basic reproductive health status, especially the risk of early menopause.

Study on the relationship between the age at natural menopause and postmenopausal metabolic syndrome / 中华预防医学杂志

To explore the relationship between the early or delayed age at natural menopause and metabolic syndrome (MS) in women. A total of 4 734 natural menopausal women who completed the baseline survey from November 2017 to January 2020 in the Guangzhou Middle-aged and Elderly Chronic Disease Prospective Cohort Study were selected in this cross-sectional study. Data on general demographic characteristics, disease history and female physiological health indicators were collected. Logistic regression model and restricted cubic spline curve were used to analyze the relationship between the age at natural menopause and MS. The results showed that the mean age of the subjects was (60±6) years old. The median (Q1,Q3) age at natural menopause was 50 (49, 52) years old, and the prevalence of MS was 14.8%(699/4 734). After adjusting for confounders, the age at natural menopause was closely related to MS in an approximate"U"shape. Compared with the group of normal age at natural menopause, the early age at menopause (OR=1.52, 95%CI: 1.12-2.06) and delayed age at menopause (OR=1.77, 95%CI: 1.36-2.30) had a higher risk of MS. In the group with time since menopause ≤6 years and 7-9 years, the risk of MS in the group with delayed age at menopause was 2.40 times (95%CI: 1.54-3.75) and 2.19 times (95%CI: 1.11-4.31) higher than that in the group with normal menopausal age, respectively. In conclusion, the early and delayed age at natural menopause increased the risk of MS. The increased risk of MS in delayed age at natural menopause mainly occurred within 10 years since menopause.

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)

Does Obesity Aggravate Climacteric Symptoms in Postmenopausal Women? / A obesidade agrava os sintomas climatéricos em mulheres na pós-menopausa?

Abstract Objective To determine if there is a correlation between body mass index (BMI) and climacteric symptoms in postmenopausal women. Methods The study sample was composed of 109 postmenopausal women with a mean age of 57 ± 8 years, mean body mass index (BMI) of 30 ± 6 kg/m2, and 8 ± 8 years after menopause. For the assessment of the climacteric symptoms, the Blatt-Kupperman Index (BKI), the Menopause Rating Scale (MRS), and the Cervantes Scale (CS) were used. Data analysis was performed through the Chi-squared test, analysis of variance (ANOVA) with the Bonferroni post hoc test, and multiple linear regression. The level of significance adopted was of p < 0.05. The statistical analyses were performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 26.0. Results The multiple linear regression showed a positive association (p<0.01) between BMI values and menopause symptoms when adjusted for age and time after menopause in the 3 questionnaires used (BKI: B = 0.432; CS: B = 304; and MRS: B = 302). Regarding symptom scores, the obese women had higher mean scores (p<0.05) when compared to eutrophic women (BKI = 28 ± 10 and 20 ± 10; and MRS = 20 ± 10 and 13±7, respectively). In the Chi-squared analysis, 28% of obese women had severe symptoms and 46% had moderate symptoms, while only 1% and 46% of eutrophic women had these same symptoms. Conclusion There is an association between BMI and climacteric symptoms, and overweight or obese women have more intense and moderate symptoms than eutrophic women.

Resumo Objetivo Verificar se há correlação entre o índice de massa corporal e os sintomas do climatério em mulheres na pós-menopausa. Métodos Participaram do estudo 109 mulheres na pós-menopausa, com idade média de 57± 8 anos, índice de massa corporal (IMC) médio de 30± 6kg/m2 e 8± 8 anos após a menopausa. Para a avaliação dos sintomas climatéricos, foram utilizados os questionários específicos para essa população: Índice de Kupperman-Blatt (IKB), Menopause Rating Scale (MRS), e Escala de Cervantes (EC). A análise dos dados foi realizada por meio do teste do chi-quadrado, análise de variância (analysis of variance, ANOVA, em inglês) com o teste post hoc de Bonferroni e regressão linear múltipla. O nível de significância adotado foi p<0,05. Todas as análises estatísticas foram realizadas no programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, Estados Unidos), versão 26.0. Resultados A regressão linear múltipla mostrou associação positiva (p < 0,01) entre os valores do IMC e os sintomas do climatério quando ajustados pela idade e pelo tempo após a menopausa nos 3 questionários utilizados (IKB: B = 0,432; CE: B = 304; e MRS: B = 302). Quanto às pontuações dos sintomas, as mulheres com obesidade apresentaram médias maiores (p < 0,05) quando comparadas às mulheres eutróficas (IKB = 28 ± 10 e 20 ± 10; e MRS = 20± 10 e 13 ±7). Na análise pelo chi-quadrado 28% das mulheres obesas apresentaram sintomas graves, e 46%, moderados, ao passo que apenas 1% e 46% das eutrópicas apresentavam esses mesmos sintomas. Conclusão Há uma associação entre IMC e sintomas climatéricos, e mulheres com sobrepeso ou obesidade apresentam sintomas mais intensos e moderados do que mulheres eutróficas.

The use of homeopathy and flower therapy as an aid in the treatment of climacteric symptoms: an integrative review

Climacteric is characterized as the set of symptoms that usually start in the period of transition from the reproductive phase to female senility, and directly impacts woman's quality of life. Currently, the treatments approved by the FDA for this pathology mainly involve the use of antidepressants and hormone replacement, both having side effects. Clinical studies carried out in 2002, showed an increased risk of breast cancer, and other pathologies related to the prolonged use of these drugs. The impact ofthe studies resulted in a greater interest in complementary and alternative medicines (CAMs), such as the use of homeopathy and flower remedies for the treatment of climacteric symptoms. This abstract aims to present an integrative review on the use of homeopathy and flower remedies in the treatment of climacteric symptoms, in order to identify it main scientific evidence. For this, metodology consisted of research in the databases Web of Science, Google Scholar, HomeoIndex, LILACS and SciELO. The inclusion criteria were original human studies, totally available, and published in the last 10 years in Portuguese, English and Spanish, presenting the use of floral remedies or homeopathic treatment. The main homeopathic medicines used were Lachesis mutus, Belladona, Sepia officinalis, Sanguinaria canadensis and Sulfur. The main flower remedies were Cherry plum, Agrimony, Gentian, Walnut, Olive and Larch. The findings in this review demonstrate a positive outcome trend in favor of the effectiveness of these practices through the studies evaluated, encouraging the expansion of new designs and research that fully contemplate the principles of these practices. Thus, this work contributes to the advancement in the understanding of each one of these rationalities, making this work a source of consultation for health professionals and for future research, resulting in a strengthening of CAMs in the field of health.

Histomorphometry of Bone Microarchitecture in Rats Treated with Vitamin D and Bisphosphonate in the Management of Osteoporosis / Histomorfometria da microarquitetura óssea em ratas tratadas com vitamina D e bisfosfonato no manejo da osteoporose

Abstract Objective To verify how the combined administration of alendronate (ALN) and vitamin D3 (VD) acts on the bone microarchitecture in rats with glucocorticoid-induced osteoporosis. Methods The experiment used 32 90-day-old female Wistar rats weighing between 300 and 400g. The induction of osteoporosis consisted of intramuscular administration of dexamethasone at a dose of 7.5 mg/kg of body weight once a week for 5 weeks, except for the animals in the control group. The animals were separated into the following groups: G1 (control group without osteoporosis), G2 (control group with osteoporosis without treatment), G3 (group with osteoporosis treated with ALN 0.2 mg/kg), G4 (group with osteoporosis treated with VD 10,000UI/500μL), and G5 (group with osteoporosis treated with ALN þ VD). The right femurs of the rats were fixed in 10% buffered formaldehyde, decalcified, and processed for inclusion in paraffin. Histological sections were stained with hematoxylin-eosin for histomorphometric analysis. Cortical thickness and medullary cavity were measured in cross-sections. Results There was a statistical difference (p< 0.05) between groups G3 and G5 compared with the positive control group (G2), both related to the measurement of cortical thickness and to the total diameter of the bone. In the evaluation of the spinal area, only the G3 group has shown to be statistically different from the G2 group. Conclusion Concomitant treatment with daily ALN and weekly VD is effective in preventing glucocorticoid-induced bone loss. However, there was no difference between the therapy tested and treatment with ALN alone.

Resumo Objetivo Verificar como a administração conjunta de alendronato de sódio (ALN) e vitamina D3 (VD) atua na microarquitetura óssea em ratas com osteoporose induzida por glicocorticoide. Métodos O experimento utilizou 32 ratas da linhagem Wistar, com peso médio de 300 a 400g, com 90 dias de vida. A indução da osteoporose consistiu na administração de dexametasona na dose de 7,5 mg/kg de peso corporal, por via intramuscular, 1 vez por semana durante 5 semanas, à exceção dos animais do grupo controle. Os animais foram distribuídos nos seguintes grupos: G1 (grupo controle sem osteoporose), G2 (grupo controle com osteoporose sem tratamento), G3 (grupo com osteoporose tratado com ALN 0,2 mg/kg), G4 (grupo com osteoporose tratado com VD 10.000UI/500μL) e G5 (grupo com osteoporose tratado com ALN þ VD). Os fêmures direitos das ratas foram fixados em formol a 10% tamponado, descalcificados e processados para inclusão em parafina. Os cortes histológicos foram corados com hematoxilina-eosina para análise histomorfométrica. A espessura cortical e a cavidade medular foram medidas em cortes transversais. Resultados Houve diferença estatística (p< 0,05) entre os grupos G3 e G5 em relação ao grupo controle positivo (G2), tanto em relação à medida da espessura cortical quanto em relação ao diâmetro total do osso. Na avaliação da área medular, apenas o grupo G3 se mostrou estatisticamente diferente do grupo G2. Conclusão O tratamento concomitante com ALN diário e VD semanal é eficaz para prevenir a perda óssea induzida por glicocorticoide. No entanto, não houve diferença entre esta terapia testada e o tratamento apenas com o ALN.

Saberes e práticas de cuidado à saúde no climatério / Conocimientos y prácticas de atención de la salud en el climaterio / Knowledge and practices of health care in the climacteric

Objetivo: conhecer os saberes e as práticas de cuidado à saúde adotados no climatério por um grupo de mulheres vinculadas a uma Estratégia de Saúde da Família de um município da Serra Gaúcha. Método: pesquisa qualitativa, desenvolvida com oito mulheres, em fevereiro e março de 2015. Utilizou-se entrevista grupal e individuais, associadas à oficina de bonecas de pano. Adotou-se a proposta operativa para análise dos dados. Resultados: os saberes advêm da própria vivência e/ou das experiências de outras mulheres do seu meio social. As práticas de cuidado estão associadas aos desconfortos no climatério, envolvendo o uso de ervas e plantas medicinais, água fria e toalhas úmidas, alimentos derivados da soja, atividade física e lazer. Conclusões: os saberes e práticas de cuidado são repassados entre as gerações e estão ligados às condições de vida e de trabalho, a história e o meio social.(AU)

Objective: to know the knowledge and practices of health care adopted in the climacteric by a group of women linked to a Family Health Strategy of a municipality of serra gaúcha. Method: qualitative research, developed with eight women in February and March 2015. A group and individuals' interview were used, associated with the workshop of cloth dolls. The operative proposal for data analysis was adopted. Results: knowledge comes from your own experiences and/or experiences of other women in their social environment. Care practices are associated with discomforts in the climacteric, involving the use of herbs and medicinal plants, cold water and wet towels, foods derived from soybean, physical activity, and leisure. Conclusions: knowledge and care practices are passed on between generations and are linked to living and working conditions, history, and the social environment.(AU)

Objetivo: conocer los conocimientos y prácticas de atención de salud adoptados en el climaterio por un grupo de mujeres vinculadas a una Estrategia de Salud de la Familia de un municipio de serra gaúcha. Método: investigación cualitativa, desarrollada con ocho mujeres en febrero y marzo de 2015. Se utilizó entrevista grupal e individuáis, asociadas al taller de muñecas de tela. Se adoptó la propuesta operativa de análisis de datos. Resultados: el conocimiento proviene de sus proprias experiencias y/o experiencias de otras mujeres en su entorno social. Las prácticas de cuidado se asocian con molestias en el climaterio, que implican el uso de hierbas y plantas medicinales, agua fría y toallas húmedas, alimentos derivados de la soja, actividad física y ocio. Conclusiones: el conocimiento y las prácticas de cuidado se transmiten entre las generaciones y están vinculados a las condiciones de vida y de trabajo, la historia y el entorno social.(AU)

Physical activity as a protective factor for climacteric symptoms / Atividade física como fator de proteção para sintomas do climatério

The aim of this study was to investigate the association between the symptoms and quality of life (QOL) in climacteric with the level and intensity of physical activity (PA), body mass index (BMI), use of menopausal hormone therapy (MHT) and education level. The study was carried out with 641 climacteric women, 56 ± 6 years of age, who completed four questionnaires: Kupperman-Blatt Index (KBI) and Menopause Rating Scale (MRS) to assess climacteric symptoms, the Cervantes Scale (CS) for assess QOL, the International Physical Activity Questionnaire ­ short version (IPAQ) to assess PA and questions about weight, height, use of MHT and level of education. Spearman's correlation was performed in SPSS 26 software and binary logistic regression in Stata 14.0 software, adopting a p < 0.05. Having a university education (KBI = 44%), practicing more than 150 minutes of total PA/week (KBI = 48%) and more than 10 minutes of vigorous PA/week (KBI = 36%) were protective factors for vasomotor symptoms, weakness, headache, paresthesia, vertigo, arthralgia or myalgia, palpitations, tingling and symptoms related to moderate/high mood. Having a normal BMI (CS =4 3%), university level of education (CS = 46%) and practicing more than 150 minutes of total PA/week (CS = 61%) are protective factors for better QOL. For psychological, somatic and urogen-ital symptoms, assessed by MRS, there was no association with exposure factors. Thus, reaching the PA recommendations, having a university education level and having a normal BMI are protective factors for moderate and severe climacteric symptoms and QOL

O objetivo desta pesquisa foi investigar a associação entre os sintomas e qualidade de vida (QDV ) no cli-matério com o nível e intensidade da atividade física (AF), índice de massa corporal (IMC), utilização de terapia hormonal da menopausa (THM) e nível de escolaridade.O estudo foi realizado com 641 mulheres climatéricas, com 56 ± 6 anos de idade, que preencheram o Índice de Kupperman-Blatt (IKB) e Menopause Rating Scale (MRS) para avaliar os sintomas do climatério, a Escala de Cervantes (EC) para avaliar a QDV, o Questionário Internacional de Atividade Física ­ versão curta (IPAQ) para avaliar AF e perguntas sobre peso, estatura, uso de THM e nível de escolaridade. Foi realizado a correlação de Spearman no software SPSS 26 e a regressão logística binária no software Stata 14.0, adotando-se um p < 0,05. Ter nível de escola-ridade universitário (IKB = 44%), praticar mais de 150 minutos de AF total/semana (IKB = 48%) e mais de 10 minutos de AF vigorosa/semana (IKB = 36%), são fatores de proteção para sintomas vasomotores, fraque-za, cefaleia, parestesia, vertigem, artralgia ou mialgia, palpitações, formigamentos e sintomas relacionados ao humor moderado/acentuado. Ter IMC normal (EC = 43%), nível de escolaridade universitário (EC = 46%) e praticar mais de 150 minutos de AF total/semana (EC = 61%), são fatores protetores de proteção para melhor QDV. Para sintomas psicológicos, somáticos e urogenital, avaliados pelo MRS, não houve associação com os fatores de exposição.Assim, atingir as recomendações de AF, ter nível de escolaridade universitário e o IMC normal são fatores de proteção para sintomas climatéricos moderados e acentuados e QDV