Masa ósea en mujeres de edad mediana del Policlínico 19 de abril / Bone Mass in Middle-Aged Women from Policlínico 19 de Abril of Havana

Introducción: La osteoporosis es una enfermedad esquelética difusa caracterizada por una disminución generalizada de la resistencia ósea, que predispone a un mayor riesgo de fracturas por fragilidad y está reconocida como un grave problema de salud. Objetivo: Determinar la masa ósea en mujeres de edad mediana y algunos factores relacionados con ella. Métodos: Se realizó un estudio descriptivo transversal en mujeres de edad mediana del Policlínico 19 de abril. De la planilla de recolección de datos se extrajeron: edad, color de la piel, etapa climatérica, número de partos, meses de lactancia, resultados hormonales. Se realizó densitometría para determinar mujeres con hueso normal, baja masa ósea u osteopenia y osteoporosis, y se asociaron con algunos factores de riesgo. Resultados: Se estudiaron 82 mujeres. El 67,07 por ciento tuvo masa ósea normal en la columna lumbar, un 19,51 por ciento baja masa ósea u osteopenia y un 13,42 por ciento osteoporosis. En la cadera izquierda la mayoría (91,46 por ciento) presentó masa ósea normal. De las perimenopáusicas, una entre 50 y 54 años presentó baja masa ósea; en posmenopáusicas predominó la osteoporosis en el grupo de 50-54 (50 por ciento), en las de 55-59, las que tenían hueso normal y osteopenia (41,2 por ciento cada una). En las posmenopáusicas, las que tenían la piel blanca fueron las que presentaron mayor afectación de la masa ósea. A mayor tiempo de posmenopausia menor masa ósea (p= 0,031*), a niveles más elevados de hormona luteinizante (p= 0,000) y foliculoestimulante (p= 0,000), menor densidad mineral ósea en la columna lumbar y cadera izquierda; a niveles más elevados de estradiol (p= 0,000), mayor densidad mineral ósea en ambas localizaciones. Conclusiones: Se concluye que la mayoría de las mujeres de edad mediana del policlínico 19 de abril tenían hueso normal; la osteoporosis predominó en los grupos de mayor edad y el color de la piel blanca. Mayor tiempo de posmenopausia y niveles elevados de hormona luteinizante y foliculoestimulante se asociaron con mala masa ósea; niveles elevados de estradiol con mejor masa ósea(AU)

Introduction: Osteoporosis is a diffuse skeletal disease characterized by a generalized decrease in bone resistance, which predisposes patients to an increased risk of fragility fractures and is recognized as a serious health problem. Objective: To determine bone mass in middle-aged women and some factors related to it. Methods: A descriptive and cross-sectional study was carried out in middle-aged women from the Policlínico 19 de Abril. The following data were extracted from the data collection form: age, skin color, climacteric stage, number of deliveries, breastfeeding months, hormonal results. Densitometry was performed to determine women with normal bone, low bone mass or osteopenia and osteoporosis, and these were associated with some risk factors. Results: A group of 82 women were studied. Of them, 67.07percent had normal bone mass in the lumbar spine, 19.51percent had low bone mass or osteopenia, and 13.42percent ad osteoporosis. On the left hip, the majority (91.46percent) had normal bone mass. Of the perimenopausal women, one aged 50-54 years had low bone mass; among postmenopausal women, osteoporosis predominated in the 50-54 age group (50percent), as well as in those aged 55-59, those with normal bone mass and osteopenia (41.2percent for each condition). In the postmenopausal women, those with white skin were the most affected in bone mass. The longer the postmenopausal period, the lower the bone mass (p = 0.031*); the higher the levels of luteinizing hormone (p = 0.000) and the follicle stimulating hormone (p = 0.000), the lower bone mineral density on the lumbar spine and left hip; the higher the levels of estradiol (p = 0.000), the higher bone mineral density on both locations. Conclusions: Most middle-aged women from the Policlínico April 19 were concluded to have normal bone; osteoporosis predominated in older age groups and white skin color. Longer postmenopausal time and higher levels of luteinizing hormone and the follicle stimulating hormone were associated with poor bone mass; high levels of estradiol were associated with better bone mass(AU)

Asociación entre el síndrome metabólico y el cáncer de mama en mujeres posmenopáusicas: Un estudio observacional de centro único / Association between metabolic syndrome and breast cancer in postmenopausal women: A single-center observational study

Introducción: El factor de riesgo más importante para el desarrollo del síndrome metabólico (SM) es la obesidad, un estado pro inflamatorio con alteraciones sistémicas y locales vinculadas al crecimiento tumoral, siendo un determinante en el desarrollo del cáncer de mama en la posmenopausia, en su pronóstico y en la eficacia del tratamiento. El objetivo del presente estudio fue determinar la asociación entre el SM y el Cáncer de Mama en mujeres posmenopáusicas comparradas con un grupo control. Materiales y métodos: El estudio fue de diseño observacional, analítico; se llevó a cabo en el Hospital de SOLCA-Guayaquil entre enero a diciembre del 2019. El muestreo fue no probabilístico. Se incluyeron casos de mujeres de 50 ­ 70 años con patología de mama. Las variables fueron presencia de síndrome metabólico y diagnóstico de cáncer de mama en mujeres posmenopaúsicas. Se utilizó Chi cuadrado, Odds Ratio, el intervalo de confianza al 95 % y valor P < 0.05 para revisar la significancia estadística. Resultados: Ingresaron al estudio 157 casos, 107 en el grupo con cáncer de mama (G1) y 50 mujeres (31 %) sin patología maligna (G2). La edad en G1 fue de 59.9±9.9 años en G2 55.5±5.5 (P=0.001). El índice de masa corporal fue 29.05±1.2 en G1 y 26.80±1.3 en G2 (P<0.001). OR del SM para el desarrollo de Cáncer de mama fue 4.60 (IC 95% 2.23-9.51 ) P<0.0001. OR del SM para el desarrollo de cáncer de mama en mujeres menores a 54 años fue de 0.22 (0.069-0.72), P=0.0118. No hubo asociaciones por tipo histológico. Conclusión: Existe asociación entre el SM y el cáncer de mama en mujeres posmenopáusicas, por lo que se debe considerar la salud metabólica como un factor de riesgo clínicamente relevante y modificable para el desarrollo del cáncer.

Introduction: The most critical risk factor for developing metabolic syndrome (MS) is obesity, a pro-inflammatory state with systemic and local alterations linked to tumor growth. It is a determinant in developing postmenopausal breast cancer in its prognosis. and the efficacy of treatment. This study aimed to determine the association between MS and Breast Cancer in postmenopausal women compared to a control group. Materials and methods: The study had an observational, analytical design at the SOLCA-Guayaquil Hospital between January and December 2019. The sampling was non-probabilistic. Cases of women between 50 and 70 years of age with breast pathology were included. The variables were the presence of metabolic syndrome and diagnosis of breast cancer in postmenopausal women. Chi-square, Odds Ratio, 95% confidence interval, and P value < 0.05 were used to review statistical significance. Results: 157 cases entered the study, 107 in the group with breast cancer (G1) and 50 women (31%) without malignancy (G2). The age in G1 was 59.9±9.9 years in G2 55.5±5.5 (P=0.001). The body mass index was 29.05±1.2 in G1 and 26.80±1.3 in G2 (P<0.001). OR of the MS for the development of breast cancer was 4.60 (95% CI 2.23-9.51) P<0.0001. OR of the MS for the development of breast cancer in women under 54 years of age was 0.22 (0.069-0.72), P=0.0118. There were no associations by histological type. Conclusion: There is an association between MS and breast cancer in postmenopausal women, so metabolic health should be considered a clinically relevant and modifiable risk factor for cancer development.

Relationship between vitamin B12 levels and insulin resistance in postmenopausal women from Colombia Caribbean / Relação entre níveis de vitamina B12 e resistência à insulina em mulheres na pós-menopausa da Colômbia Caribe

Introduction: The high prevalence of low vitamin B12 serum levels has been recognized as a public health problem in Latin America; however, the current magnitude of this deficiency in Colombia is uncertain. Low levels of vitamin B12 can induce clinical and subclinical hematological and neurological disorders. Epidemiological studies have demonstrated a relationship between vitamin B12 deficiency and cardiovascular diseases (CVDs). However, the role of vitamin B12 in insulin resistance has been poorly studied. Objective: This study aimed to evaluate the relationship between vitamin B12 serum levels and biochemical and anthropometric markers related to CVDs and insulin resistance in postmenopausal women from Colombia Caribbean. Methods: Correlational, descriptive study. By convenience sampling, 182 postmenopausal women from the medical consultation service of a health institution were linked. Serum vitamin B12 levels, anthropometric variables (body mass index, abdominal perimeter), and biochemical variables (glycemia, insulin, lipid profile, HOMA IR) were evaluated. Results: The average value of the vitamin B12 serum level was 312.5 ± 122.5 pg/mL (230.6 ± 90.4 pmol/L); 46.7% of the women had less than adequate levels of 300 pg/mL (> 221 pmol/L), and 9. 9% were deficient, with levels of less than 200 pg/mL (148 pmol/L). The women with metabolic syndrome were 63.7%, and according to HOMA IR, 52.7 % had insulin resistance. A significant inverse relationship was shown between serum vitamin B12 levels with basal glycemic (P =0.002) and HOMA-IR (P =0.040). Conclusions: A significant inverse relationship between vitamin B12 levels and basal glycemia and HOMA-IR was observed. These findings highlight vitamin B12 deficiency in postmenopausal women and suggest nutritional supplementation.Keywords: Vitamin B12, Insulin resistance, Diet, Postmenopause, Cardiovascular diseases (AU).

Introdução: A alta prevalência de baixos níveis séricos de vitamina B12 foi reconhecida como um problema de saúde pública na América Latina, mas a magnitude atual dessa deficiência na Colômbia é incerta. Baixos níveis de vitamina B12 podem induzir distúrbios hematológicos e neurológicos clínicos e subclínicos. Na verdade, estudos epidemiológicos demonstram uma relação entre deficiência de vitamina B12 e doenças cardiovasculares (DCVs). No entanto, o papel da vitamina B12 na resistência à insulina tem sido pouco estudado. Objetivo: O objetivo deste estudo foi avaliar a relação entre os níveis séricos de vitamina B12 e marcadores bioquímicos e antropométricos relacionados com doenças cardiovasculares e resistência à insulina em mulheres pós-menopáusicas da Colômbia Caribe. Métodos: Estudo correlacional, descritivo. Por amostragem de conveniência, foram vinculadas 182 mulheres na pós-menopausa do serviço de consulta médica de uma instituição de saúde. Níveis séricos de vitamina B12, variáveis antropométricas (índice de massa corporal, perímetro abdominal) e variáveis bioquímicas (glicemia, insulina, perfil lipídico, HOMA IR) foram avaliadas. Resultados: O valor médio do nível sérico de vitamina B12 foi de 312,5 ± 122,5 pg/mL (230,6 ± 90,4 pmol/L); 46,7% das mulheres tinham níveis abaixo do adequado de 300 pg/mL (> 221 pmol/L), e 9,9% eram deficientes, com níveis abaixo de 200 pg/mL (148 pmol/L).As mulheres com síndrome metabólica foram 63,7% e, segundo o HOMA IR, 52,7% apresentavam resistência à insulina. Uma relação inversa significativa entre os níveis séricos de vitamina B12 com glicemia basal (P = 0,002) e HOMA-IR (P = 0,040) foi mostrada. Conclusões: Foi observada uma relação inversa significativa entre os níveis de vitamina B12 e glicemia basal e HOMA-IR. Esses achados destacam a deficiência de vitamina B12 em mulheres na pós-menopausa e sugerem suplementação nutricional (AU).

Relación de triglicéridos y estimación de riesgocardiovasculares en mujeres posmenopáusicas / Triglyceride ratio and cardiovascular risk estimation inpostmenopausal women

Objetivo: Determinar la relación de triglicéridos basales, con el riesgo a desarrollar enfermedades cardiovasculares en mujeres posmenopáusicas. Método: Estudio descriptivo, observacional y transversal, donde a 31 pacientes posmenopáusicas y sin antecedentes de enfermedades cardiometabólicas, se les determinó parámetros antropométricos (peso, talla, índice de masa corporal -IMC-); perfil lipídico en ayunas (colesterol total, triglicéridos o TG, lipoproteínas de baja y alta densidad -LDL, HDL-), por método enzimático colorimétrico, apolipoproteína B 100 (Apo B-100) por inmunodifusión radial, índices matemáticos LDL/Apo B-100y TG/HDL y cálculo de colesterol no-HDL. Resultados: los promedio y desviación de las variables fueron: edad:59±5 años con tiempo de posmenopausia: 8,77±3,92 años; IMC:27,6±4,4 kg/m.; colesterol total: 194±36 mg/dl; triglicéridos: 85±35 mg/dl; HDL: 33±8 mg/dl; LDL: 144±33 mg/dl; no-HDL: 159±37 mg/dl; Apo B-100: 172±246 mg/dl; LDL/Apo B-100: 1,15±0,03 y TG/HDL: 4,46±1,28. Discusión: Las pacientes se encontraron con sobrepeso, triglicéridos normales, colesterol total y LDL aumentado y las HDL bajas. El LDL-C/Apo B-100-100, que se relaciona con el tamaño y densidad de LDL, estuvo por debajo de 1,3 indicando la presencia de partículas pequeñas-densas, mientras TG/HDL, que se usa para estimar riesgo cardiovascular, estuvo por encima del corte establecido de 3,5. Conclusiones: Al relacionar los triglicéridos basales con LDL/Apo B-100 y TG/HDL, se observa que a partir del valor de triglicéridos de 100 mg/dl, se observa la presencia de partículas de lipoproteínas pequeñas-densas, y un alto riesgo cardiovascular, por lo que es necesario en mujeres posmenopáusicas el seguimiento a partir del valor de triglicéridos en 100 mg/dL ya que pudiera implicar el desarrollo de enfermedades cardiovasculares, en esta población(AU)

Objective: To determine the relationship of basal triglycerides with the risk of developing cardiovascular disease in postmenopausal women. Method: Descriptive, observational and cross-sectional study, where 31 postmenopause patients with no history of cardiometabolic disease were determined anthropometric parameters (weight, height, BMI); fasting lipid profile (total cholesterol, triglycerides or TG, LDL,HDL, by colorimetric enzymatic method), Apo B-100 (byradial immunodiffusion), LDL/Apo B-100 and TG/HDL mathematical indices and calculation of non-HDL cholesterol. Results: the mean and deviation of the variables were: age:59±5 years with postmenopause time: 8.77±3.92 years; BMI:27.6±4.4 kg/m2; total cholesterol: 194±36 mg/dl; triglycerides:85±35 mg/dl; HDL: 33±8 mg/dl; LDL: 144±33 mg/dl; non-HDL: 159±37 mg/dl; Apo B-100: 172±246 mg/dl; LDL/Apo B-100: 1.15±0.03 and TG/HDL: 4.46±1.28. Discussion: Patients were found to be overweight, normal triglycerides, total and LDL cholesterol high, and low HDL. LDL-C/ApoB-100-100, which is related to LDL size and density, was below 1.3 indicating the presence of small-dense particles, while TG/HDL, which is used to estimate cardiovascular risk, was above the established cut-off of 3.5. Conclusions: When relating the basal triglycerides with LDL/Apo B-100 and TG/HDL, it is observed that from the triglyceride value of 100mg/dl, the presence of small-dense lipoprotein particuals anda high cardiovascular risk is observed, so it is necessary in postmenopausal women to follow up from the triglycerid evalue in 100 mg/dL since it could imply the development of cardiovascular diseases, in this population(AU)

Iron accumulation and its impact on osteoporotic fractures in postmenopausal women / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Postmenopausal osteoporosis is a kind of degenerative disease, also described as "invisible killer." Estrogen is generally considered as the key hormone for women to maintain bone mineral content during their lives. Iron accumulation refers to a state of human serum ferritin that is higher than the normal value but less than 1000 μg/L. It has been found that iron accumulation and osteoporosis could occur simultaneously with the decrease in estrogen level after menopause. In recent years, many studies indicated that iron accumulation plays a vital role in postmenopausal osteoporosis, and a significant correlation has been found between iron accumulation and fragility fractures. In this review, we summarize and analyze the relevant literature including randomized controlled trials, systematic reviews, and meta-analyses between January 1996 and July 2022. We investigate the mechanism of the effect of iron accumulation on bone metabolism and discuss the relationship of iron accumulation, osteoporosis, and postmenopausal fragility fractures, as well as the main clinical treatment strategies. We conclude that it is necessary to pay attention to the phenomenon of iron accumulation in postmenopausal women with osteoporosis and explore the in-depth mechanism of abnormal bone metabolism caused by iron accumulation, in order to facilitate the discovery of effective therapeutic targets for postmenopausal osteoporosis.

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.

Vitamin D is associated with a low quality of life: a primary care study

Introduction: Some studies have described impairment in quality of life of vitamin-deficient subjects. However, little is known about this association in primary care. This study aimed to evaluate the association between vitamin D deficiency and quality of life in postmenopausal women attending primary care in the municipality of Santa Maria ­ Brazil. Methods: A cross-sectional study was carried out with postmenopausal women over 55 years of age, accompanied in primary care, from March to August 2014. These women were randomly selected among the participants of a cohort study in the municipality of Santa Maria ­ Brazil. Data were collected through a standardized questionnaire, quality of life was assessed using the Short Form-36 Health Survey (SF-36), and 25-hydroxyvitamin D were measured using the ALPCO® ELISA method. Results: Of the total of 78 studied women, 11.54% had vitamin D deficiency. Women with vitamin D deficiency had a poorer quality of life assessed by SF-36. In the regression analysis, both vitamin D deficiency and falls were independently associated with a lower physical component of the SF-36. Conclusion: Vitamin D deficiency is associated with poorer quality of life in the studied postmenopausal women.

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.

Affective response of postmenopausal women to resistance training on stable and unstable surfaces: a randomized cross-over study / Respostas afetivas de mulheres pós-menopausadas submetidas ao treinamento com pesos em superfície estável e instável: um estudo cross-over randomizado

Objective: To compare the affective response of postmenopausal women who undergo 6 weeks of resistance training on stable and unstable surfaces. Methods: This randomized counterbalanced cross-over study carried included 14 postmenopausal women (55 [SD, 3] years; height 1.55 [SD, 0.03] m; body mass 78.70 [SD, 12.00] kg; and body mass index 32.80 [SD, 4.90] kg/m²), who underwent 6 weeks of resistance training on stable and unstable surfaces. The participants were initially allocated to 1 experimental condition (stable or unstable) in a randomized counterbalanced manner. The intervention consisted of 8 exercises in 3 series of 8-10 repetitions, with intervals of 60-90 seconds, for 3 weeks. After the first 3-week protocol, they were switched to the other experimental condition for another 3 weeks. To evaluate affective response, the Hardy and Rejeski Sensation Scale was applied weekly at the end of each exercise and again at the end of the 6 weeks. Results: Affective response was similar to the general affect observed at the end of the sessions (stable surface: 5.00 [3.00]; unstable surface: 5.00 [1.00]; p = 0.114), except for the bridge exercise (stable surface: 3.00 [2.00]; unstable surface: 4.00 [2.00]; p = 0.048]). Conclusions: The affective response of these women was not affected by training on unstable surfaces, except for the bridge exercise, in which the unstable surface increased affective response

Objetivo: Comparar as respostas afetivas de mulheres pós-menopausadas submetidas a seis semanas de treinamento com pesos realizado em superfície estável e instável. Metodologia: Trata-se de um estudo cross-over, randomizado e contrabalanceado realizado com 14 mulheres pós-menopausadas (55 ± 3 anos; estatura de 1,55 ± 0,03 m; massa corporal 78,70 ± 12,00 kg; e índice de massa corporal de 32,80 ± 4,90 kg/m²) submetidas a seis semanas de treinamento com pesos em superfície estável e instável. As participantes foram alocadas, inicialmente, numa das condições experimentais de forma randomizada e contrabalanceada. A intervenção foi composta por oito exercícios em três séries de oito a dez repetições, com intervalos entre 60 e 90 segundos, durante três semanas. Para avaliação das respostas afetivas, foi aplicada a Escala de Sensação de Hardy e Rejeski ao fim da última série de cada exercício e ao final das sessões, durante as seis semanas. Resultados: As respostas afetivas foram similares para o afeto geral observado ao final das sessões [Superfície estável: 5,00 (3,00); Superfície instável: 5,00 (1,00); p = 0,114], mas não para o exercício de ponte [Superfície estável: 3,00 (2,00); Superfície instável: 4,00 (2,00); p = 0,048)]. Conclusões: Conclui-se que as respostas afetivas de mulheres pós-menopausadas, observadas ao final da sessão, não foram afetas pela instabilidade. Contudo, as sensações de prazer, no exercício de ponte, foram maiores com a inserção da instabilidade

Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review / Eficácia das abordagens hormonais e não hormonais para atrofia vaginal e disfunções sexuais em mulheres na pós-menopausa: Uma revisão sistemática

Abstract Objective To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women. Data Sources We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied. Selection of Studies We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women. Data Collection Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors. Data Synthesis A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study). Conclusion We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

Resumo Objetivo Avaliar a eficácia das abordagens hormonais e não hormonais para os sintomas de disfunção sexual e atrofia vaginal em mulheres na pós-menopausa. Fontes de Dados Pesquisamos as bases de dados PubMed, Embase, Scopus, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), e Cumulative Index to Nursing and Allied Health Literature (CINAHL), assim como bancos de dados de ensaios clínicos. Foram analisados estudos publicados entre 1996 e 30 de maio de 2020. Nenhuma restrição de idioma foi aplicada. Seleção dos Estudos Foram selecionados ensaios clínicos randomizados que avaliavam o tratamento das disfunções sexuais em mulheres na pós-menopausa. Coleta de Dados Três autores (ACAS, APFC e JL), revisaram cada artigo com base em seu título e resumo. Os dados relevantes foram posteriormente retirados do texto completo do artigo. Quaisquer discrepâncias durante a revisão foram resolvidas por consenso entre todos os autores listados. Síntese dos Dados Ao todo, 55 estudos foram incluídos na revisão sistemática. As abordagens testadas para tratar a disfunção sexual foram: lubrificantes e hidratantes (18 estudos); fitoestrogênios (14 estudos); deidroepiandrosterona (DHEA; 8 estudos); ospemifeno (5 estudos); testosterona vaginal (4 estudos); exercícios para os músculos do assoalho pélvico (2 estudos); oxitocina (2 estudos);laser de CO2 vaginal (2 estudos); lidocaína (1 estudo), e vitamina E vaginal (1 estudo). Conclusão Identificou-se falta de coerência na literatura quanto aos tratamentos propostos e medidas de resultados selecionadas. Apesar da grande diversidade de modalidades de tratamento e medidas de resultados, esta revisão sistemática pode lançar luz sobre alvos potenciais para o tratamento, que é considerado necessário para a disfunção sexual, assumindo que a maioria dos estudos randomizados foi avaliada com baixo risco de viés de acordo com a ferramenta de avaliação de risco de viés de Cochrane Collaboration. Esta revisão tem cadastro no International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

Role of caveolin-eNOS platform and mitochondrial ATP-sensitive potassium channel in abrogated cardioprotective effect of ischemic preconditioning in postmenopausal women

Abstract Caveolin, the protein of the caveolar membrane, interacts and binds with endothelial nitric oxide synthase (eNOS), forming a caveolin-eNOS complex leading to suppression of the eNOS activity. Caveolin, therefore, maintains eNOS in the inactivated state leading to reduced nitric oxide (NO) production. Ischemic preconditioning disrupts the caveolin-eNOS complex leading to activation of the eNOS and thus results in cardioprotection. During ischemic preconditioning, NO produces cardioprotection by the opening of the KATP channel, and the caveolin forms a suitable signalling platform facilitating the interaction of NO with the KATP channel. Estrogen deficiency has been reported to upregulate caveolin-1 expression. The article aims to review the various mechanisms that placed the women at the risk of coronary artery diseases after postmenopausal estrogen deficiency and their role in the cardioprotective effect of ischemic preconditioning.

Análise comparativa do reparo alveolar em camundongos fêmeas C57BL/6 em falência ovariana provocada pela senescência, induzida quimicamente ou por ovariectomia / Comparative analysis of alveolar repair in female C57BL/6 mice in ovarian failure caused by senescence, chemically induced or by ovariectomy

Diferentes modelos animais são utilizados para investigação do metabolismo e reparo ósseo pós-menopausa, resultando em diferentes impactos na produção dos hormônios ovarianos. O presente trabalho analisou e comparou o processo de reparo ósseo intramembranoso após a extração dentária de camundongos fêmeas em condição de estropausa fisiológica, induzida quimicamente e por ovariectomia, bem como os níveis séricos de marcadores ósseos e de estresse oxidativo. Foram utilizados 46 camundongos fêmeas C57BL/6J, com idades iniciais entre 4, 6 e 18 meses, pesando cerca de 25 - 28 gramas, as quais constituíram cinco grupos: CT ­ animas que não receberam nenhum tratamento (6 meses), SHAM ­ ovariectomia fictícia (4 meses), OVX ­ submetidas a ovariectomia (4 meses), VCD ­ medicadas com diepóxido 4-vinilciclohexeno (VCD) (4 meses) na dose de 160 mg/Kg/dia, via IP por 20 dias consecutivos e ID ­ em período pós-estropausa fisiológica (18 meses). Constatada a condição de diestro persistente nos animais de todos os grupos, os mesmos foram submetidos a exodontia do incisivo superior direito para posterior eutanásia nos períodos de 7 e 21 dias, quando as maxilas contendo os alvéolos foram removidas para obtenção de lâminas histológicas coradas com HE, Tricrômico de Goldner e para a técnica imuno-histoquímica para as proteínas RANKL e OPG. O sangue também foi coletado para as análises bioquímicas para dosagem dos níveis de cálcio, fosfato, fosfatase alcalina (FAL) e TRAP total, bem como para capacidade antioxidante total e TBARs. A análise histopatológica revelou que todos os alvéolos repararam aos 21 dias; porém, com diferenças nos aspectos histomorfológicos entre os grupos. Os grupos Controle e SHAM apresentaram trabeculado ósseo regular e em remodelação com moderada marcação para RANKL e OPG. Já os grupos OVX e Idosa apresentaram trabéculas ósseas irregulares e delgadas desde o dia 7, as quais mostravam-se pouco celularizadas aos 21 dias. O grupo VCD exibiu neoformação mais discreta aos 7 dias, porém, com tecido ósseo em franca remodelação aos 21 dias. Apesar destas diferenças, notou-se moderada marcação para RANKL e OPG nestes grupos, com destaque para o infiltrado inflamatório mononuclear. Os níveis séricos de TRAP e FAL estavam significativamente aumentados no grupo Idosa aos 21 dias em comparação com os demais grupos, bem como a capacidade antioxidante total. Não foram observadas diferenças estatísticas nos níveis de cálcio e fosfato, e em TBARs. A partir dos resultados obtidos pode-se concluir que os diferentes modelos de falência ovariana, fisiológica ou precoce, interferem de modo distinto no reparo ósseo alveolar pós-exodontia, bem como nos níveis séricos nos marcadores de remodelação óssea e de capacidade antioxidante, devendo ser considerados no momento da seleção do modelo e correlação com os achados clínicos em humanos(AU)

Different animal models are used to investigate postmenopausal metabolism and bone repair, resulting in different impacts on ovarian hormone production. The present work analyzed and compared the intramembranous bone repair process after tooth extraction in female mice in physiological stropause, chemically induced and by ovariectomy, as well as the serum levels of bone markers and oxidative stress. Fortysix C57BL/6J female mice were used, with initial ages between 4, 6 and 18 months, weighing about 25 - 28 grams, which constituted five groups: CT - animals that did not receive any treatment (6 months), SHAM - ovariectomy dummy (4 months), OVX ­ submitted to ovariectomy (4 months), VCD ­ medicated with 4-vinylcyclohexene diepoxide (VCD) (4 months) at a dose of 160 mg/kg/day, via IP for 20 consecutive days and ID ­ in the physiological post-estropause period (18 months). Once the condition of persistent diestrus was observed in the animals of all groups, they were submitted to extraction of the upper right incisor for later euthanasia in the periods of 7 and 21 days, when the jaws containing the alveoli were removed to obtain histological slides stained with HE, Goldner trichrome and for the immunohistochemical technique for RANKL and OPG proteins. Blood was also collected for biochemical analysis to measure calcium, phosphate, alkaline phosphatase (FAL) and total TRAP levels, as well as for total antioxidant capacity and TBARs. Histopathological analysis revealed that all alveoli repaired at 21 days; however, with differences in histomorphological aspects between the groups. The Control and SHAM groups showed regular bone trabeculation and remodeling with moderate staining for RANKL and OPG. On the other hand, the OVX and Elderly groups presented irregular and thin bone trabeculae from day 7, which showed little cellularization at day 21. The VCD group exhibited more discrete neoformation at 7 days, however, with bone tissue in clear remodeling at 21 days. Despite these differences, moderate staining for RANKL and OPG was observed in these groups, with emphasis on the mononuclear inflammatory infiltrate. The serum levels of TRAP and FAL were significantly increased in the Elderly group at 21 days compared to the other groups, as well as the total antioxidant capacity. No statistical differences were observed in calcium and phosphate levels, and in TBARs. From the results obtained, it can be concluded that the different models of ovarian failure, physiological or early, interfere differently in post-extraction alveolar bone repair, as well as in the serum levels of bone remodeling and antioxidant capacity markers, and should be considered at the time of model selection and correlation with clinical findings in humans(AU)

Anthropometric indicators as predictors of dynapenia in postmenopausal women

Abstract Aim: Anthropometry represents an alternative to the evaluation of nutritional status and screening of events related to muscle fitness. Therefore, this study aimed to compare anthropometric indicators of postmenopausal women with and without dynapenia and to identify the predictive capacity of these indicators to screen the respective outcome in this population. Methods: Cross-sectional epidemiological study, conducted with postmenopausal women. Dynapenia was diagnosed by handgrip strength < 20 kgf. Arm (AC), abdominal (AbC), hip (HC) and calf circumferences (CC), triceps, biceps, subscapular, supraspinatus and thigh skinfolds were analyzed. Body Mass Index, Conicity Index (CI), Body Adiposity Index (BAI), Waist to Hip and Waist to Height Ratio (WHtR), Corrected Arm Muscle Area (CAMA) and Arm Muscle Circumference (AMC) were calculated. Results: A total of 273 women participated in the study. The BAI, WHtR, and CI did not present significant differences between the groups. For the other indicators, the dynapenic group obtained significantly lower values compared to the non-dynapenic. AC was the indicator with the highest sensitivity to screen for postmenopausal dynapenia (79.8%). While CAMA and AMC were the indicators with the best specificity (86.2%). However, CC showed the best balance between sensitivity (67.5%) and specificity (63.0%). Conclusion: The indicators AC, CAMA, and/or the AMC can be used together, or CC alone, to predict postmenopausal women with dynapenia. Therefore, these indicators can be used as important epidemiological tools to improve women's health surveillance actions.

Alterations in haematological and clotting profile of post-menopausal women in Benin City, Nigeria

Background: The cessation of ovarian functions at menopause and the accompanying decline in the production of ovarian steroid hormones creates a unique set of health concerns for women. Reductions in sex steroid levels, particularly oestrogen, have been associated with various diseases and conditions, including bleeding disorders, coronary heart disease (CHD), osteoporosis, cognitive dysfunction, urinary incontinence, hot flushes, and mood changes, among others. Objective: To determine changes in haemorheological and clotting profile in post-menopausal women. Methods: Two hundred participants comprising one hundred and fifty post-menopausal women and fifty healthy pre-menopausal control subjects were studied. The investigations carried out include whole blood viscosity, plasma viscosity, fibrinogen concentration, Prothrombin time (PT), Activated partial thromboplastin time with kaolin (APTTK) levels and complete blood count using standard methods. Results: The mean age (p=0.01), platelet count (p= 0.013), neutrophil (p= 0.03), neutrophil to lymphocyte ratio (p= 0.045) and platelet to lymphocyte ratio (p=0.044) in postmenopausal women were significantly higher while lymphocyte count (p= 0.004) was significantly lower in postmenopausal compared to premenopausal women. Similarly, plasma oestradiol (p= 0.001), plasma viscosity (p= 0.03), relative blood viscosity (p= 0.03), whole blood viscosity (p= 0.03) and PTTK(p= 0.04) were significantly lower among postmenopausal women compared to premenopausal control subjects. Conclusion: Relative plasma viscosity correlated positively with age. There were significantly lower levels of haemorheological and clotting profile in post-menopausal women. These changes may be due to age or a decline in circulating oestrogen levels.

Prevalence of osteoporosis and related factors in postmenopausal women aged 40 and above in China / 中华流行病学杂志

Objective: To understand the prevalence of osteoporosis and related factors in postmenopausal women aged ≥40 years in China and provide scientific evidence for osteoporosis prevention and control. Methods: Data of this study were from the 2018 China Osteoporosis Epidemiological Survey, covering 44 counties (districts) in 11 provinces in China. Related variables were collected by questionnaire survey and physical measurement, and the BMD of lumbar spine and proximal femur was measured by dual-energy X-ray absorption method. The prevalence of osteoporosis and its 95%CI in postmenopausal women aged ≥40 years were estimated with complex sampling weights. Results: A total of 5 728 postmenopausal women aged ≥40 years were included in the analysis and the prevalence of osteoporosis was 32.5% (95%CI: 30.3%-34.7%). The prevalence of osteoporosis in postmenopausal women aged 40-49 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years were 16.0% (95%CI:4.5%-27.5%), 18.4% (95%CI:15.9%-20.8%), 37.5% (95%CI:34.5%-40.4%), 52.9% (95%CI: 47.5%-58.3%), and 68.0% (95%CI:55.9%-80.1%) respectively. The prevalence of osteoporosis was higher (P<0.001) in those with education level of primary school or below (47.2%, 95%CI: 43.0%-51.3%) and in those with individual annual income less than 10 000 Yuan, (40.3%, 95%CI: 36.9%-43.7%). The prevalence of osteoporosis was 35.1% in rural areas (95%CI: 32.0%-38.1%), which was higher than that in urban areas (P<0.001). The prevalence of osteoporosis in low weight, normal weight, overweight and obese groups were 69.9% (95%CI: 59.0%-80.8%), 42.2% (95%CI: 38.7%-45.7%), 24.2% (95%CI: 21.3%-27.1%) and 14.6% (95%CI: 11.1%-18.0%), respectively. The prevalence of osteoporosis in those with menstrual maintenance years ≤30 years and in those with menopause years ≥11 years were 46.1% (95%CI:40.8%-51.3%) and 48.2% (95%CI:45.0%-51.3%), respectively. Multivariate logistic analysis showed that age ≥60 years, education level of primary school or below, annual household income per capita less than 10 000 Yuan, low body weight, menstrual maintenance years ≤30 years, menopause years ≥11 years were risk factors of osteoporosis in postmenopausal women in China. Conclusions: The prevalence of osteoporosis was high in postmenopausal women aged ≥40 years in China, and there were differences in osteoporosis prevalence among different socioeconomic groups. Effective interventions should be taken for the prevention and control of osteoporosis in key groups in the future.

Evaluation of diagnostic efficacy of artery elasticity and endothelial function indexes for coronary heart disease with blood stasis syndrome in postmenopausal women by Logistic regression combined with ROC curve model / 中国中药杂志

The present study explored the correlation of coronary heart disease(CHD) with blood stasis syndrome in postmenopausal women with artery elasticity and endothelial function indexes and evaluated the diagnostic efficacy of the prediction model via logistic regression and receiver operating characteristic(ROC) curve model. A retrospective comparison was made between 366 postmenopausal CHD patients from August 1, 2020, to September 30, 2021, in the Department of Cardiology of Integrated Traditional Chinese and Western Medicine of China-Japan Friendship Hospital, who were divided into the blood stasis syndrome group(n=196) and the non-blood stasis syndrome group(n=170). General clinical characteristics of the two groups were compared. Multivariate logistic regression analysis was used to probe the correlation of CHD with blood stasis syndrome in postmenopausal women with brachial-ankle pulse wave velocity(baPWV), ankle-brachial index(ABI), and flow-mediated dilatation(FMD), and the ROC curve was drawn to evaluate the diagnostic efficiency of the prediction model. Multivariate logistic regression analysis showed that the correlation coefficients of CHD with blood stasis syndrome in postmenopausal women with baPWV, ABI, and FMD were 1.123, 0.109, and 0.719, respectively(P=0.004, P=0.005, P<0.001),and the regression equation for predicting probability P was P=1/[1+e~(-(3.131+0.116×baPWV-2.217×ABI-0.330×FMD))]. ROC curve analysis suggested that in the context of baPWV≥19.19 m·s~(-1) or ABI≤1.22 or FMD≤9.7%, it was of great significance to predict the diagnosis of CHD with blood stasis syndrome in postmenopausal women. The AUC of baPWV, ABI, FMD, and prediction probability P was 0.763, 0.607, 0.705, and 0.836, respectively. The AUC of prediction probability P was higher than that of each index alone(P<0.001), and the sensitivity and specificity were 0.888 and 0.647, respectively. The results demonstrate that baPWV, ABI, and FMD are independently correlated with CHD with blood stasis syndrome in postmenopausal women, and show certain independent predictive abilities(P<0.05). The combined evaluation of the three possesses the best diagnostic efficiency.

Autoestima, autoimagem, qualidade de vida e de saúde de mulheres na pós-menopausa / Postmenopausal women self-esteem, self-image, and quality of life and health

Este estudo avaliou a autoestima, autoimagem, qualidade de vida e de saúde de mulheres no período de pós-menopausa. Trata-se de uma pesquisa quantitativa, transversal e descritiva, com amostra de conveniência de cinquenta mulheres. Como instrumentos, foram utilizados um questionário socioeconômico, a escala de qualidade de vida (WHOQOL-Bref), questionário de saúde mental da mulher (QSM), questionário de autoestima e autoimagem e escala de avaliação da menopausa (MRS). Observou-se que as mulheres estavam insatisfeitas com sua autoimagem e autoestima, na avaliação da menopausa foram encontrados sintomas moderados, no questionário de saúde mental o escore foi considerado médio e nos domínios de qualidade de vida teve maior satisfação no físico e menor no meio ambiente. Concluiu-se que as avaliadas apresentaram sintomas considerados moderados da menopausa e não estavam muito satisfeitas com sua autoestima e autoimagem e com o domínio meio ambiente de qualidade de vida.

This study evaluated the self-esteem, self-image, quality of life and health of postmenopausal women. This is a quantitative, cross-sectional, and descriptive study, with a convenience sample of fifty women. The instruments used were a socioeconomic questionnaire, the quality of life scale (WHOQOL-Bref), a women's mental health questionnaire (WMHQ), a self-esteem and self-image questionnaire, and a menopause assessment scale (MRS). It was observed that women were dissatisfied with their self-image and self-esteem; in the menopause assessment, moderate symptoms were found, in the mental health questionnaire the score was considered medium, and in the quality of life domains they had greater satisfaction in the physical domain and lower in the environment one. It was concluded that the evaluated women presented moderate symptoms of menopause and were not very satisfied with their self-esteem and self-image and with the environment domain of quality of life.

Este estudio evaluó la autoestima, la autoimagen, la calidad de vida y la salud de mujeres posmenopáusicas. Se trata de una investigación cuantitativa, transversal y descriptiva con cincuenta mujeres. Se aplicó un cuestionario socioeconómico, escala de calidad de vida (WHOQOL-Bref), cuestionario de salud mental de la mujer (QSM), cuestionario de autoestima y autoimagen y escala de evaluación de la menopausia (MRS). Se observó que las mujeres estaban descontentas con su autoimagen y autoestima, en la evaluación de la menopausia se encontraron síntomas moderados, en el cuestionario de salud mental se consideró puntaje medio y en los dominios de calidad de vida tuvieron mayor satisfacción en la parte física y más bajo en el medio ambiente. Se concluyó que las evaluadas presentaban síntomas moderados de menopausia y no estaban muy satisfechas con su autoestima e imagen de sí mismas y con el dominio ambiental de la calidad de vida.

Efectos del tadalafilo en el deseo sexual y la excitación/lubricación en mujeres postmenopáusicas / Effects of Tadalafil on Sexual Desire and Arousal/Lubrication in Postmenopausal Women

Objetivo Determinar los efectos y la seguridad del tadalafilo en el deseo sexual y la excitación/lubricación en mujeres postmenopáusicas. Métodos Estudio cuasi experimental (con comparación antes de la intervención y después), con seguimiento de la cohorte de pacientes: 228 mujeres mayores de 40 años en postmenopausia, que consultaron por bajo deseo sexual y alteración de la excitación /lubricación, en una clínica sexológica en Armenia (Colombia), entre 2018 y 2019. Las mujeres recibieron 2,5 mg diarios de tadalafilo durante 12 semanas. Se determinaron las puntuaciones del instrumento, el Índice de Función Sexual Femenina (IFSF), cada cuatro semanas. Resultados El promedio de edad fue de 54,36 ± 4,92 años. Antes del tratamiento, la media en la puntuación del IFSF fue de 22,41 puntos (intervalo de confianza del 95% [IC95%]: 7,11­29,76); a las 4 semanas, 24,73 puntos (IC95%: 23,51­30,28); a las 8 semanas, 25,97 puntos (IC95%: 24,26­31,53); y, al final, 26,99 puntos (IC95%: 25,97­32,46), con diferencias estadísticamente significativas entre las 4 medidas pareadas (p < 0,001). La excitación fue el dominio con mayor puntuación tras el tratamiento (4,83 puntos; IC 95%: 4,36­4,91), seguida por la lubricación (4,77 puntos; IC95%: 4,28­4,87). El deseo sexual mostró un significativo incremento al final del estudio (4,29 puntos; IC95%: 4,07­4,39). Se presentaron efectos adversos leves. Se observó una satisfacción con el consumo de tadalafilo del 84,21%. Conclusiones El tratamiento diario con 2,5 mg de tadalafilo genera mejoría en la función sexual de mujeres en la postmenopausia, y el incremento en la puntuación del IFSF demuestra su efecto positivo.

Objective To determine the effects and safety of tadalafil on sexual desire and arousal/lubrication in postmenopausal women. Materials and methods Quasi-experimental study (with a comparison before and after the intervention) with follow-up of the patient cohort: 228 postmenopausal women older than 40 years of age, who consulted due to low sexual desire and altered arousal/lubrication, in a sexology clinic in Armenia (Colombia) between 2018 and 2019. The women received 2.5 mg of tadalafil daily for 12 weeks. The scores on the instrument used, the Female Sexual Function Index, (FSFI), were determined every four weeks. Results The mean age was 54.36 ± 4.92 years. Before the treatment, the mean FSFI score was of 22.41 points (95% confidence interval [95%CI]: 7.11­29.76); at 4 weeks, it was of 24.73 points (95%CI: 23.51­30, 28); at 8 weeks, 25.97 points (95%CI: 24.26­31.53); and, at the end, it was of 26.99 points (95%CI: 25.97­32.46), with statistically significant differences among the four paired measurements (p < 0.001). Arousal was the domain with the highest posttreatment score (4.83 points; 95%CI: 4.36­4.91), followed by lubrication (4.77 points; 95%CI: 4.28­4.87). Sexual desire showed a significant increase at the end of the study (4.29 points; 95%CI: 4.07­4.39). Mild adverse effects occurred. A rate of satisfaction of 84.21% with the intake of tadalafil. Conclusions The daily treatment with tadalafil 2.5 mg results in an improvement in sexual function in postmenopausal women; the increase in the score on the FSFI demonstrates its positive effect.

Métodos de estudio de pacientes con sangrado uterino posmenopáusico: recomendaciones prácticas / Study methods of patients with postmenopausal uterine bleeding: practical recommendations

Resumen El sangrado uterino posmenopáusico se define como aquel sangrado que ocurre después del cese definitivo de la menstruación en la etapa reproductiva de la mujer como consecuencia de la claudicación biológica de los ovarios, o como un sangrado no esperado en mujeres con terapia de reposición hormonal sistémica de la menopausia. Representa el 5% de las consultas ginecológicas y, si bien su origen suele ser por causas benignas, puede requerir una evaluación minuciosa para descartar patologías malignas del endometrio. El objetivo de este trabajo es establecer un flujograma diagnóstico basado en la evidencia para la evaluación de las pacientes con sangrado uterino posmenopáusico.

Abstract Postmenopausal uterine bleeding is defined as the bleeding that occurs after the last menstruation due to loss of ovarian function, or a non-scheduled bleeding in patients with hormonal therapy. It represents 5% of the gynecologic visits, and even though its origin is often benign, it requires a thorough evaluation to discard malignant diseases. The objective of these review is to propose a diagnostic algorithm based on the available evidence for the evaluation of patients with postmenopausal uterine bleeding.

Perfil clínico e alimentar de idosas na pós-menopausa / Clinical and dietary profile of postmenopausal elderly women

Objetivo:investigar os sintomas clínicos e o hábito alimentar das idosas na pós-menopausa. Método: estudo descritivo,transversal,de abordagem quantitativa,realizado com 96 idosas da Estratégia Saúde da Família(ESF). A coleta de dados ocorreu por meio de formulário semiestruturadoeentrevistas realizadas nas ESF e no domicíliodas participantes.Os dados foram distribuídos e ordenados noprograma estatístico IBM Statistical Package for the Social Sciences (SPSS)eos resultados analisados e discutidos com base na literatura específica e apresentadosem tabelas. Resultados:quando questionadas sobre quais sintomas apresentaram durante a menopausa, 30,2% relataram nenhum sintomae 15,5% disseram sentir fogachos, conhecidos como ondas de calor. Sobreaalimentação,observou-seque alimentos conhecidos na culinária brasileira são consumidos em uma frequência menor que três vezes por semana.Dentre os não consumidos, prevaleceram amêndoas, atum conservadoem óleo, iogurte naturale leite líquido desnatado com as maiores porcentagens.Conclusão: todos os sintomas investigadosdurante a menopausa e pós-menopausa foram citados, obtendo destaque osmais comuns. Considerou-se satisfatória a presença do cálcio na alimentação das participantes, uma vez que alimentos ricos no mineral estão presentes no cardápio das idosas em porções diárias

Objective: to investigate the clinical symptoms and eating habits of postmenopausal elderlywomen. Method:a descriptive, cross-sectional study with a quantitative approach, carried out with 96 elderly women from the Family Health Strategy (FHS). Data collection took place using a semi-structured form and interviews conducted at the FHS and at the participants' homes. The data were distributed and ordered in the statistical program IBM Statistical Package for the Social Sciences (SPSS) and the results were analyzed and discussed based on the specific literature and presented in tables. Results:when asked what symptoms they had during menopause, 30.2% reported no symptoms and 15.5% said they felt hot flashes, known as a sudden feeling of heat. Regarding food, it was observed that foods known in Brazilian cuisine are consumed less than three times a week. Among those not consumed, almonds, tuna preserved in oil, natural yogurt and skimmed milk prevailed with the highest percentages. Conclusion:all the symptoms investigated during menopause and postmenopause were mentioned, with the most common being highlighted. The presence of calcium in the participants' diet was considered satisfactory, since foods rich with the mineral are present in the menu of the elderly women in daily portions.