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.

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)

El significado de la menopausia para un grupo de mujeres chilenas atendidas en el sistema público de salud / The significance of menopause for Chilean women attending primary health care centers

BACKGROUND: Menopause connects a biological event with social representations related to aging AIM: To assess the meaning of menopause in a group of Chilean women attending primary health care. MATERIALS AND METHODS: Secondary analysis of a descriptive qualitative study of in-depth interviews to explore the meaning of menopause in fifteen women aged 55 to 71 years who experienced menopause between 2 and 29 years before. Data were collected using the method proposed by the Grounded Theory. Guba's criteria of scientific rigor were used. RESULTS: Relational analysis shows that menopause divides the life cycle of women into two stages related with the possibility of having children, which is heavily influenced by the cultural significance of menopause. CONCLUSIONS: Women perceive that menopause is a natural stage and that it is the end of a period focused on tasks related to reproduction and motherhood. However, that "normality" includes a suffering process, loaded with negative cultural beliefs about menopause passed down for generations.

Temporal trend and contributing factors of depressive symptoms in Chinese menopausal women: analysis based on CHARLS panel data / 南方医科大学学报

OBJECTIVE@#To understand the temporal trend of and the factors affecting depressive symptoms in Chinese menopausal women to provide evidence for the development of prevention and treatment strategies.@*METHODS@#CHARLS data were used to select menopausal women aged 45-60 years. Complete values of the key variables were screened and missing values were removed to obtain the cross-sectional data of the years 2011 (n=4318), 2013 (n=4200), 2015 (n=3930), and 2018 (n= 4147). The panel data were matched by the cross-sectional data, and a total of 5040 cases with complete record of the follow-up data were obtained for the 4 years to constitute a balanced short panel dataset with n=1260 and T=4. The prevalence and temporal trend of depressive symptoms in the menopausal women were analyzed based on the panel data. The random-effects Logit model with a panel dichotomous choice model was used to explore the factors affecting depressive symptoms in the menopausal women.@*RESULTS@#The prevalence of depressive symptoms in the menopausal women calculated based on the panel data was 35.9%, 33.1%, 36.7% and 43.7% in the 4 years, respectively, showing no statistically significant changes in the temporal trend (APC=3.25%, P=0.183). The results of the random-effects Logit model analysis showed that living in the urban area (OR=0.570, 95%CI: 0.457-0.710), a high education level (OR=0.759, 95%CI: 0.655-0.879), and having a spouse (OR=0.363, 95% CI: 0.236-0.558) were associated with a decreased incidence of depressive symptoms, while poor self-reported health (OR= 2.704, 95% CI: 2.152-3.396), disability (OR=1.457, 95%CI: 1.087-1.954), chronic disease (OR=1.407, 95% CI: 1.179-1.680), falls in the last two years (OR=2.028, 95% CI: 1.613-2.550), abnormal sleep duration (OR=2.249, 95% CI: 1.896-2.664), and dissatisfaction with life (OR=4.803, 95% CI: 3.757-6.140) were associated with an increased incidence of depressive symptoms.@*CONCLUSION@#The prevalence of depressive symptoms is relatively high in menopausal women in China. Measures should be taken to ensure that the menopausal women living in rural areas, with low education level, without spouse, with a poor self-reported health status, disability, chronic diseases, falls in recent two years, abnormal sleep time and dissatisfaction with life have access to psychological health care services and interventions.

Perceptions and feelings about physical changes in climacteric women / Percepciones y sentimientos sobre los cambios corporales de mujeres climatéricas / Percepções e sentimentos sobre as alterações corporais de mulheres climatéricas

ABSTRACT Objective: To know the perceptions and feelings about the physical changes of climacteric women in a city of Rio Grande do Sul. Methods: Qualitative exploratory descriptive study developed with 16 women on public spaces of Porto Alegre/RS/Brazil, in September and October of 2018; data gathered through semi-structured interviews and submitted to thematic analysis. Results: Four themes were found: "Knowledge (or not) on climacteric and menopause (and their differences)", "Changes perceived", "Changes felt", and "How to deal with climacteric and menopause". Conclusions: Women have little information on climacteric; it is the nurses' responsibility to clarify about these phases, offer emotional support and indicate physical activities that may ease their signs and symptoms.

RESUMEN Objetivo: Conocer las percepciones y sentimientos acerca de las alteraciones corporales de mujeres climatéricas en una ciudad de Rio Grande do Sul. Métodos: Investigación cualitativa exploratoria-descriptiva realizada con 16 mujeres en espacios públicos de Porto Alegre/RS/Brasil, en septiembre y octubre de 2018, a través de entrevistas semiestructuradas y cuyas informaciones pasaron por análisis temático. Resultados: Se han obtenido cuatro temas: "Conocimiento (o no) sobre el climaterio y la menopausia (y sus diferencias)", "Alteraciones observadas", "Cambios sentidos" y "Cómo lidiar con el climaterio y la menopausia". Conclusiones: Las mujeres poseen poca información sobre el climaterio; es responsabilidad de la enfermera aclarar sobre los pasos, ofrecer ayuda emocional e indicar actividades físicas que pueden aligerar sus señales y síntomas.

RESUMO Objetivo: Conhecer as percepções e sentimentos sobre as alterações corporais de mulheres climatéricas em uma cidade do Rio Grande do Sul. Método: Pesquisa qualitativa exploratório-descritiva realizada com 16 mulheres, em setembro e outubro de 2018, em espaços públicos de Porto Alegre/RS, por meio de entrevistas semiestruturadas e cujas informações passaram por análise temática. Resultados: Foram obtidos quatro temas: "Conhecimento (ou não) sobre o climatério e a menopausa (e suas diferenças)", "Alterações percebidas", "Alterações sentidas" e "Como lidar com o climatério e a menopausa". Conclusão: As mulheres têm poucas informações sobre o climatério; à enfermeira cabe esclarecer sobre suas fases, oferecer suporte emocional e indicar atividades físicas que podem amenizar seus sinais e sintomas.

Riesgo para el desarrollo de trastorno depresivo mayor al existir alteraciones en la sintomatología menopaúsica en mujeres de Guadalajara, Jalisco / Risk for the development of major depressive disorder when there are alterations in menopausal symptoms in women from Guadalajara, Jalisco

RESUMEN Antecedentes: El Trastorno Depresivo Mayor (TDM) puede presentarse durante el inicio de la menopausia, variando su prevalencia de acuerdo a diferentes factores de riesgo clínicos y sociodemográficos; presentándose una mayor asociación al existir alteraciones en la sintomatología menopaúsica. Ante esto, se buscará determinar el riesgo para desarrollar TDM al presentar alteraciones en la sintomatología menopaúsica. Metodología: Es un diseño transversal analítico que incluyó a 252 mujeres iniciando su menopausia (48±1.7 años), atendidas en centros de salud de Guadalajara, Jalisco. Las variables analizadas fueron antecedentes sociodemográficos, utilizando el Inventario de Depresión de Beck para identificar el TDM y la Escala de Valoración de la Menopausia para determinar alteraciones en los principales dominios sintomatológicos de la menopausia. Se realizaron análisis descriptivos y de asociación por medio de Odds Ratio (OR), aplicando finalmente una regresión logística. Resultados: La prevalencia de TDM fue de 40.5%, teniendo asociación con el antecedente de uso de anticonceptivos y con el agravamiento en la sintomatología menopaúsica. El análisis ajustado determinó que hay más riesgo de presentar TDM cuando existen alteraciones en los dominios sintomatológicos, tales como en el somático (OR 3.96, IC95% 1.58-9.95), el urogenital (OR 4.29, IC95% 2.13-8.65) y el psicológico (OR 13.55, IC95% 3.97-46.30). Conclusión: La presencia de alteraciones en la sintomatología menopaúsica se encuentra asociado con un mayor riesgo de presentar TDM, sobre todo si el dominio psicológico está afectado, por lo cual es necesario que el personal de salud identifique estas alteraciones y brinde un manejo temprano en esta etapa de la vida.

ABSTRACT Background: Major Depressive Disorder (MDD) can occur during the onset of the menopause, varying its prevalence according to different clinical and sociodemographic risk factors; presenting a greater association with the existence of alterations in the menopausal symptomatology. Given this, we will seek to determine the risk to develop MDD by presenting alterations in the menopausal symptoms Methodology: It is an analytical cross-sectional design that included 252 women beginning their menopause (48±1.7 years old), and who were attended in health centers of Guadalajara, Jalisco. The analyzed variables were their sociodemographic background, using the Beck Depression Inventory to identify the MDD and the Menopause Rating Scale to determine alterations in the main symptomatological domains of the menopause. Descriptive and association analyzes were performed by means of Odds Ratio (OR), subsequently applying a logistic regression model. Results: The prevalence of MDD was 40.5%, with significant associations with the history of contraceptive use and the worsening of menopausal symptoms. The adjusted analysis allowed us to determine that there is more risk for developing MDD when there were alterations in the symptomatological domains, such as in the somatic (OR 3.96, 95% CI 1.58-9.95), the urogenital (OR 4.29, IC95% 2.13-8.65) and in the psychological (OR 13.55, IC95% 3.97-46.30). Conclusion: The presence of alterations in the menopausal symptomatology is associated with an increased risk of developing MDD, especially if the psychological domain is affected, which is why it is necessary for health personnel to identify these alterations and provide early management in this stage of live.

Quality of life in the climacteric of nurses working in primary care / Calidad de vida en el climaterio de enfermeras que actúan en la atención primaria / Qualidade de vida no climatério de enfermeiras atuantes na atenção primária

ABSTRACT Objective: to evaluate the quality of life of primary care nurses in the climacteric. Method: A cross-sectional descriptive-analytic study, performed with 98 female nurses, aged 40-65 years, using the WHOQOL-Bref questionnaire. Results: the worst level of quality of life was observed for professionals aged 50-59 years, non-white, specialists, divorced or widowed, with children, a lower income, with another employment relationship, a weekly workload of more than 40 hours, who consumed alcoholic beverages weekly, with chronic disease, in continuous use of medications, sedentary, who did not menstruate and did not receive hormonal treatment, and who went through menopause between the ages of 43-47 years. Conclusion: Although the variables "physical activity" and "age" have a statistically significant association with quality of life, other variables seem to interfere in these professionals' lives, indicating the need for a more critical and deep reflection on these relations.

RESUMEN Objetivo: evaluar la calidad de vida de enfermeras en el climaterio que actúan en la atención primaria. Método: estudio descriptivo y de análisis, de cohorte transversal, realizado con 98 enfermeras, de entre 40 y 65 años de edad, en que se utilizó el cuestionario WHOQOL-Bref. Resultados: presentaron un peor nivel de calidad de vida las profesionales: de entre 50 y 59 años de edad, no blancas, con especialización, divorciadas o viudas, con hijos, con menor renta familiar, que tenían otro vínculo de empleo, con carga laboral semanal superior a 40 horas, que consumían alcohol semanalmente, portadoras de enfermedad crónica, en el uso continuo de medicamentos, sedentarias, que no menstruaban y no estaban bajo tratamiento hormonal, y cuya menopausia empezó entre 43 y 47 años de edad. Conclusión: a pesar de la variable "realización de actividad física" y de la variable "edad" haber presentado una asociación estadísticamente significativa con la calidad de vida, otras variables parecen afectar la calidad de vida de esas profesionales, lo que demanda una reflexión crítica y más profundizada sobre esas relaciones.

RESUMO Objetivo: avaliar a qualidade de vida de enfermeiras no climatério atuantes na atenção primária. Método: estudo descritivo-analítico, de corte transversal, realizado com 98 enfermeiras, com idade entre 40 e 65 anos, utilizando-se o questionário WHOQOL-Bref. Resultados: apresentaram pior nível de qualidade de vida as profissionais com idade entre 50 e 59 anos, não brancas, especialistas, divorciadas ou viúvas, com filhos, com menor renda, possuidoras de outro vínculo empregatício, carga horária de trabalho semanal acima de 40 horas, que ingeriam bebida alcoólica semanalmente, portadoras de doença crônica, em uso contínuo de medicamentos, sedentárias, que não menstruavam e não faziam tratamento hormonal, e que apresentaram a menopausa entre 43 e 47 anos. Conclusão: apesar das variáveis "realização de atividade física" e "idade" terem uma associação estatisticamente significante com a qualidade de vida, outras variáveis parecem interferir na dessas profissionais, indicando a necessidade de uma reflexão crítica e mais aprofundada sobre essas relações.

Percepções de mulheres acerca do climatério / Women's insights about the climacteric period / Percepciones de mujeres acerca del climaterio

Objetivo: Conhecer as percepções de mulheres acerca do climatério. Métodos: Pesquisa qualitativa com 18 mulheres que vivenciam o período do climatério, que pertencem a uma Estratégia em Saúde da Família de um município da região Sul do Brasil. Os dados foram coletados por meio de entrevista semiestruturada em setembro de 2016. A análise dos dados foi a partir da Análise de Conteúdo Temática de Minayo. Resultados: Os elementos emergidos das compreensões das mulheres acerca do climatério demonstram percepções voltadas à negatividade, ao envelhecimento do corpo, ao desequilíbrio emocional e à sintomatologia manifestada nesse período. Conclusão: Portanto, é preciso implementar medidas que ofereçam a essas mulheres um maior conhecimento e entendimento sobre o climatério, pois refletirá de maneira positiva, de modo que a mulher vivencie esse período com tranquilidade e qualidade de vida

Objective: To know the perceptions of women about climacteric. Methods: Qualitative research with 18 women living in the climacteric period, who belong to a Family Health Strategy of a municipality in the Southern region of Brazil. Data were collected through a semistructured interview in September 2016. Data analysis was based on the Minayo Thematic Content Analysis. Results: The emergence of women's understanding of climacteric shows perceptions of negativity, body aging, emotional imbalance, and symptomatology manifested during this period. Conclusion: Therefore, it is necessary to implement measures that offer these women a greater knowledge and understanding about the climacteric, as it will reflect in a positive way, allowing women to experience this period with tranquility and quality of life

Objetivo: Conocer las percepciones de las mujeres sobre la menopausia. Métodos: La investigación cualitativa con 18 mujeres que experimentan período de la perimenopausia, que pertenecen a una estrategia de salud em un municipio del sur de Brasil. Los datos fueron recolectados a través de entrevista semiestructurada en septiembre de 2016. El análisis de los datos fue a partir del análisis cualitativo de Minayo. Resultados: Los elementos surgieron la comprensión de las mujeres sobre la menopausia demostrar percepciones centradas en la negatividad, el cuerpo de envejecimiento, desequilibrio emocional y síntomas que se manifiestan en este periodo. Conclusión: Por lo tanto, es necesario poner en práctica medidas que brinden a estas mujeres un mayor conocimiento y comprensión del climaterio, como se refleja positivamente causando la mujer para experimentar este periodo de tranquilidad y calidad de vida

Síntomas psicológicos en la transición menopáusica / Psychological symptoms in the menopausal transition

RESUMEN OBJETIVO: Conocer los síntomas en la Transición Menopáusica, mediante el autoinforme de la mujer, clasificado en tres grupos: 1er. Temprana de la Transición Menopáusica (etapa −2), 2°. Tardía de la Transición Menopáusica y Temprana de Postmenopausia (etapas −1 y +1a) y 3er. grupo Temprana de Postmenopausia con Tardía de Postmenopausia (etapas +1b, +1c y +2), analizando síntomas psicológicos. MATERIAL Y MÉTODO: Estudio no experimental transversal muestreo no probabilístico. Participantes 116 mujeres en un rango de edad entre 40 y 60 años con alto nivel de escolaridad, mediante la Escala de Clasificación en la Menopausia MRS, el Inventario de Ansiedad y Depresión de Beck. RESULTADOS: La muestra quedó conformada por un total de 100 mujeres con al menos un síntoma, con alto nivel de escolaridad y en el rango de edad de 40 a 60 años, agrupadas por etapa de Transición Menopáusica: 1er. grupo 36 mujeres, 2°. grupo 16 y 3er. grupo con 48 personas. Los síntomas psicológicos medidos con MRS son los más frecuentes en 41.60%; reportan queja subjetiva de pérdida de memoria 57% de las mujeres. Alfa Cronbach de .74 en MRS. CONCLUSIONES: Los síntomas psicológicos están presentes como un continuo a lo largo de la Transición Menopáusica, posiblemente debidos a la disminución de concentración de estrógenos, lo que conlleva en algunos casos al diagnóstico de Trastorno Neurocognitivo Leve.

ABSTRACT OBJECTIVE: To know the symptoms in the Menopausal Transition, through the self-report of the women, classified into three groups: 1st. Early Menopausal Transition (stage −2), 2nd. Late Menopausal Transition and Early Postmenopause (stages −1 and +1a) and 3rd. group Early Postmenopause with Late Postmenopause (stages +1b, +1 c and +2), analyzing psycological symptoms. MATERIAL & METHOD: Non-experimental transversal study, non-probabilistic sampling. The participants were 116 women between 40 and 60 years old with high schooling level, through The Menopause Rating Scale MRS, Beck Anxiety Inventory and Depression Inventory. RESULTS: The final sample consisted of 100 women with at least one symptom, with a high schooling level in the range of 40 to 60 years, grouped by Menopausal Transition stage: 1st. 36 women, 2nd. Group 16 and 3rd. group with 48. The psycological symptoms measured with MRS were the most frequently in 41.60%; report subjective complaint of memory loss 57% of women. Alfa Cronbach of .74 in MRS. CONCLUSION: Psychological symptoms are present as a continuum throughout the Menopausal Transition, possibly due to the decreased concentration of estrogen, which in some cases leads the diagnosis of Mild Neurocognitive Disorder.

Fatores associados à obesidade geral e ao percentual de gordura corporal em mulheres no climatério da cidade de São Paulo, Brasil / Factors associated with general obesity and the percentage of body fat of women during the menopause in the city of São Paulo, Brazil

Resumo Para verificar a associação entre obesidade e variáveis demográficas, clínicas e relacionadas ao estilo de vida em mulheres no climatério, foi realizado um estudo transversal com 469 mulheres de 40 a 65 anos em dois ambulatórios públicos da cidade de São Paulo. As variáveis dependentes foram: obesidade, segundo índice de massa corporal (IMC) e obesidade, segundo percentual de gordura corporal (%GC). A variável explanatória principal foi: fase do climatério (pré ou pós-menopausa); e as variáveis de controle foram: idade; anos de estudo; paridade; uso de terapia hormonal da menopausa; prática de atividade física e hábito de fumar. Realizou-se análise de regressão "glm" múltipla, utilizando para as análises o software Stata 9.2. Segundo o IMC, a obesidade associou-se positivamente, à paridade (RP = 1,62; IC 95% = 1,11-2,37) e, negativamente, aos anos de estudo (RP = 0,71; IC 95% = 0,55-0,91) e à prática de atividade física (RP = 0,45; IC 95% = 0,33-0,61). De acordo com o %GC, a obesidade associou-se positivamente à paridade (RP = 1,60; IC 95% = 1,03-2,49) e, negativamente, à prática de atividade física (RP = 0,43; IC 95% = 0,29-0,63). Enquanto a prática de atividade física foi um fator protetor, a multiparidade constituiu-se como fator de risco para a prevalência de obesidade no grupo de mulheres deste estudo.

Abstract To verify the association between obesity and demographic, clinical and lifestyle variables in climacteric women, a cross-sectional study was conducted in outpatient clinics, with 469 women aged 40 to 65 years in the city of São Paulo, Brazil. The dependent variables were: obesity according to body mass index (BMI) and obesity according to percentage of body fat (% BF). The main explanatory variable was: climacteric phase (pre or postmenopausal); and control variables were: age; years of formal study; parity; menopausal hormone therapy (MHT) use; physical activity practice and smoking habit. Multiple regression analysis was performed using the Stata 9.2 software. According to the BMI, obesity was positively associated with parity (RR = 1.62, 95% CI = 1.11-2.37) and, negatively, with years of formal study (RP = 0.71, CI 95% = 0.55-0.91) and with physical activity practice (PR = 0.45, 95% CI = 0.33-0.61). According to the % BF, obesity was positively associated with parity (PR = 1.60, 95% CI = 1.03-2.49) and negatively with physical activity practice (PR = 0.43; 95% CI = 0.29-0.63). While being active physically was protective, multiparity was a risk factor for developing obesity for women in this study.

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

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

Relevancia de la menopausia y del apoyo social en las diferencias en salud entre mujeres y hombres / Relevance of the Menopause and Social Support in Gender Differences in Health

RESUMEN Se analizó la relevancia de la menopausia y el apoyo social en las diferencias en salud entre mujeres y hombres mediante un estudio transversal realizado con 710 mujeres y 606 hombres de la población general española con edades entre 20 y 65 años. Se encontró que, aunque en la juventud apenas había diferencias entre hombres y mujeres, a partir de la perimenopausia las mujeres informaban de más insomnio y síntomas vasomotores que los hombres, así como de más dolor durante la postmenopausia. El apoyo social percibido se asociaba con mejor salud, sobre todo en las mujeres en postmenopausia y premenopausia.

ABSTRACT This study examined the relevance of the menopause and social support in gender differences in health. A cross-sectional survey of a general population sample comprising 710 women and 606 men, aged between 20 and 65 was carried out. No health differences were found between younger men and women. However, perimenopausal women reported more insomnia and vasomotor symptoms, as well as they reported more pain than men through the postmenopause. Perceived social support was associated with better health, especially in premenopausal and postmenopausal women.

Depresión y calidad de vida en mujeres con cáncer de cérvix del Hospital Regional de Encarnación / Depression and quality of life in women with cervical cancer at the Regional Hospital of Encarnación

Introducción: la depresión a consecuencia del cáncer de cérvix es un tema poco investigado a pesar de la relevancia que posee. Objetivo: determinar la calidad de vida y el grado de depresión en estas pacientes con cáncer de cérvix que acuden al Hospital Regional de Encarnación en periodo 2012-2015. Materiales y Métodos: estudio observacional descriptivo con componente analítico. Fueron seleccionadas 58 pacientes que cumplieron los criterios de inclusión. La calidad de vida se medió con la escala de Mezzich y Cohen y la depresión con el inventario de Beck. Resultados: 46% presentó altibajos normales del estado de ánimo, 5% depresión severa y 12% depresión moderada. En cuanto a la calidad de vida, 79% conservó un nivel de vida alto. La edad mayor a 47 años y no recibir tratamiento oncológico influyeron en un descenso de la calidad de vida de las pacientes. La edad promedio de las pacientes con depresión fue 51 años y en su mayoría agravada por la etapa del climaterio y menopausia. Conclusión: la calidad se vio afectada en 21% y la depresión severa se constató en 5%.

Introduction: depressive symptoms as a consequence of cervical cancer is a subject which has not been researched, enough despite its relevance. Objective: to determine the quality of life and degree of depression in patients with cervical cancer attended to Regional Hospital of Encarnación in the period of 2012-2015. Materials and methods: Prospective and cross-sectional observational study. A total of 58 patients were selected who met the inclusion criteria. Quality of life was measured with the Mezzich and Cohen scale, and depression with Beck's questionnaire. Results: 46% presented normal variabilities of mood, 5% severe depression and 12% moderate depression. In terms of quality of life, 79% kept a high standard of life. Age over 47 years and not receiving cancer treatment had a decrease in patients quality of life. The average age of patients with depression was 51 years and mostly worsen by climacteric and menopause stage. Conclusion: quality was affected in 21% and severe depression was found in 5%.

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

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

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

Calidad de vida en la menopausia, un reto en la práctica clínica / Quality of life in menopause, a challenge in clinical practice

Introducción: la menopausia constituye una etapa significativa en la vida de la mujer y por ende requiere de un estudio integral. La medición de la calidad de vida en estas mujeres representa un desafío y los instrumentos para su valoración complementan de forma indispensable la evaluación médica. Objetivo: explorar la información existente en la literatura que aborda la calidad de vida en la menopausia, para contextualizar al lector en los aspectos relacionados con este periodo en la vida de la mujer; finalmente se plantea una revisión de los datos actuales que enfocan la terapia hormonal como un posible tratamiento de la gran variedad de síntomas que se presentan en este periodo. Métodos: búsqueda de la literatura de artículos de investigaciones originales en MEDLINE, EMBASE, Lilacs y ScienceDirect durante julio de 2014 y marzo del 2015, con el uso de combinación de palabras clave y términos MeSH relacionados, climaterio, calidad de vida, atención integral de salud, salud de la mujer. Se restringió el idioma a inglés y español. Conclusiones: es de vital importancia que el médico tratante cuente con herramientas y opciones terapéuticas que le permitan brindar soluciones a la paciente con menopausia frente a los síntomas que afectan su calidad de vida, no obstante, en la actualidad no se cuenta con evidencia suficiente para apoyar completamente una terapia adecuada que logre dar una respuesta casi completa a las pacientes y que a la vez considere un equilibrio en riesgo-beneficio(AU)

Introduction: Menopause is an important stage in a women's life, therefore it requires a comprehensive study in daily clinical practice. Measuring the quality of life of menopausal women represents a challenge, that´s why the tools available in order to perform this comprehensive evaluation are indispensable in the medical evaluation; they allow us to correctly consider the patient´s point of view regarding their state of health. Objective: Explore the existing information in the literature about the quality of life in menopause to contextualize the reader in the most common topics related with alterations during this period in the life of women; finally a review of current data that focus on hormonal therapy as a possible treatment for a variety of symptoms that occur in this period. Methods: A search of the literature of original research articles in MEDLINE , EMBASE , Lilacs and ScienceDirect was conducted between July 2014 and March 2015, using combinations of keywords and MeSH terms related to menopause, , quality of life , comprehensive health care , women's health. For this review, we restricted the languages to Spanish and English. Conclusion: The instruments for assessing quality of life are an indispensable complement to the comprehensive clinical evaluation of these women, being that they correctly consider the patient's view of their state of health(AU)

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

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

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

Hot flushes and night sweats in midlife: why do some women have them and others do not? / Afrontamentos e suores noturnos na meia-idade: porque é que algumas mulheres os têm e outras não?

This study investigated what predicts the occurrence of hot flushes (HF) and night sweats (NS). A community sample of 992 women (42-60 years) answered a questionnaire to collect socio-demographic, health and menopause-related, as well as lifestyle information. Depressive mood and stress, as well as HF and NS (in terms of presence, frequency and intensity), were also assessed. Structural equation modelling was used to build a structural model to predict the occurrence of both vasomotor symptoms. Results: Stress predicted NS (ß =.154; p =.006), whereas depressive mood was linked to the occurrence of HF's (ß =.149; p =.006). Being peri-menopausal and post-menopausal, among several other characteristics, were also significant predictors of the occurrence of both HF and NS. This study supports a distinguished influence of stress and depressive mood in NS and HF respectively, probably due to the nature of psychological symptoms. Moreover, significant associations between vasomotor symptoms and socio-demographic, health and menopause-related characteristics, and alcohol were confirmed. (AU)

Este estudo investigou os preditores da ocorrência de afrontamentos (Af) e de suores noturnos (SN). Foi utilizada uma amostra comunitária de 992 mulheres (42-60 anos), que respondeu a um questionário para a recolha de informação sociodemográfica, de estado de saúde e menopausa, e sobre o estilo de vida. Os níveis de humor deprimido e estresse, tal como a ocorrência, frequência e intensidade dos Af e SN, foram avaliados. Modelos de equações estruturais foram utilizados para construir o modelo estrutural para predizer a ocorrência de ambos os sintomas vasomotores. Os resultados indicaram que estresse predisse os SN (ß =0,154; p =0,006), enquanto o humor deprimido associou-se à ocorrência de Af (ß =0,149; p =0,006). Estar na peri-menopausa ou na pós-menopausa, entre outras características, associou-se igualmente à ocorrência de Af e SN. Este estudo suporta uma influência diferenciada do estresse e do humor deprimido na ocorrência de SN e Af, respetivamente, provavelmente devido à natureza dos sintomas psicológicos. Adicionalmente confirmou-se uma associação significativa entre os sintomas vasomotores e características sociodemográficas, de saúde, de menopausa e consumo de álcool. (AU)

Serum interleukin-17 levels are associated with nephritis in childhood-onset systemic lupus erythematosus

OBJECTIVES: To determine the serum interleukin-17 (IL-17) levels in childhood-onset systemic lupus erythematosus patients and to evaluate the association between IL-17 and clinical manifestations, disease activity, laboratory findings and treatment. METHODS: We included 67 consecutive childhood-onset systemic lupus erythematosus patients [61 women; median age 18 years (range 11-31)], 55 first-degree relatives [50 women; median age 40 years (range 29-52)] and 47 age- and sex-matched healthy controls [42 women; median age 19 years (range 6-30)]. The childhood-onset systemic lupus erythematosus patients were assessed for clinical and laboratory systemic lupus erythematosus manifestations, disease activity [Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)], cumulative damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index] and current drug use. Serum IL-17 levels were measured by an enzyme-linked immunosorbent assay using commercial kits. RESULTS: The median serum IL-17 level was 36.3 (range 17.36-105.92) pg/mL in childhood-onset systemic lupus erythematosus patients and 29.47 (15.16-62.17) pg/mL in healthy controls (p=0.009). We observed an association between serum IL-17 levels and active nephritis (p=0.01) and migraines (p=0.03). Serum IL-17 levels were not associated with disease activity (p=0.32), cumulative damage (p=0.34), or medication use (p=0.63). CONCLUSION: IL-17 is increased in childhood-onset systemic lupus erythematosus and may play a role in the pathogenesis of neuropsychiatric and renal manifestations. Longitudinal studies are necessary to determine the role of IL-17 in childhood-onset systemic lupus erythematosus. .

Sexual satisfaction in couples in the male and female climacteric stage / Satisfacción sexual en parejas durante el climaterio femenino y masculino / Satisfação sexual nos casais durante o climatério feminino e masculino

The objective was to describe the sexual life satisfaction of couples in the climacteric stage and determine whether there are differences between the perception of satisfaction and the sex life of each partner. We studied 142 couples obtained by stratified sampling of family health centers, Concepción, Chile. 66% of women and 84% of men reported being very or somewhat satisfied with their sex lives. Slight concordance was found between the responses of the partners in relation to satisfaction with their sexual life. Moreover, a slight degree of agreement was found between the sexual life satisfaction reported by women and their partners' perceptions of the women's sexual life satisfaction. Additionally, a slight degree of agreement was reported between the sexual life satisfaction reported by men and their partners' perceptions of the men's sexual life satisfaction. This study provides new information about Chilean couples in the climacteric stage in relation to self-reported sexual satisfaction and perceived satisfaction in couples.

O objetivo foi descrever a satisfação com a vida sexual dos casais no período do climatério e determinar se existem diferenças entre as percepções da satisfação com a vida sexual de cada membro do casal. Foram seleccionados cento e quarenta e dois casais por meio de uma amostragem estratificada dos centros de saúde familiar em Concepción, Chile. Sessenta e seis porcento das mulheres e 84% dos homens relataram ser muito ou moderadamente satisfeitos com suas vidas sexuais. Verificou-se uma leve concordância entre as respostas de cada membro do casal em relação à satisfação com a vida sexual. Também identificou-se um leve grau de concordância entre a satisfação com a vida sexual referida pela mulher e a percepção da satisfação com a vida sexual que seu parceiro tem dela. Da mesma forma, verificou-se um discreto grau de acordo para a referida pelo homem e a percepção da satisfação com a vida sexual que sua companheira tem dele. É oferecida uma nova informação a respeito dos casais chilenos no período do climatério, em relação à satisfação sexual autoinformada e a satisfação percebida no parceiro, evidenciando-se a diferença da percepção entre os casais.

El estudio describe la satisfacción con la vida sexual de parejas en etapa de climaterio, además de determinar si existen diferencias entre las percepciones de satisfacción con la vida sexual de cada miembro de la pareja. Se estudiaron 142 parejas, obtenidas mediante muestreo estratificado en centros de salud familiar de Concepción, Chile. Un 66% de mujeres y un 84% de hombres informaron sentirse muy o algo satisfechos con su vida sexual de pareja. Se encontró una concordancia leve entre las respuestas de cada miembro de la pareja, en relación con la satisfacción en la vida sexual. También, se encontró un grado de acuerdo leve entre satisfacción con la vida sexual informada por la mujer y la percepción de satisfacción con la vida sexual que su pareja tiene de ella. Asimismo, se reportó un grado discreto de acuerdo para la satisfacción con vida sexual referida por el hombre y la percepción de satisfacción con la vida sexual que su pareja tiene de él. Este estudio proporciona nueva información respecto a parejas chilenas en etapa de climaterio, en relación con la satisfacción sexual autoinformada y percibida en la pareja.