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1.
Rev. chil. endocrinol. diabetes ; 12(1): 26-28, 2019. ilus
Article in Spanish | LILACS | ID: biblio-982035

ABSTRACT

La definición de sangrado ginecológico anormal durante terapia hormonal de la menopausia es aquel sangrado no programado durante el uso de la terapia. Este artículo es un pauteo que describe: 1) cuándo diagnosticar unsangrado anormal, ya que difiere según el tipo de esquema hormonal utilizado; 2) eldiagnóstico diferencial del origen del sangrado anormal; 3) los métodos de evaluación para diagnosticar el origen del sangrado. Se destacan los aspectos principales para el diagnóstico diferencial entre patología orgánica versus disrupción endometrial debida al tratamiento hormonal. Además, se describen los ajustes posibles para resolver el sangrado cuando éste se debe a disrupción del endometrio.


Abnormal bleeding related to menopausal hormone therapy is defined as unscheduled bleeding during the use of the therapy. This article outlines when to diagnose an abnormal bleeding -as this differs according to the type of hormonal scheme used-, the differential diagnosis of the origin of abnormal bleeding, and the methods of evaluation to assess the origin of the bleeding. The main aspects are highlighted on the differentiation of organic pathology versus disruption of the endometrium due to treatment. Also, treatment adjustments to resolve bleeding when it is due to disruption of the endometrium are outlined.


Subject(s)
Humans , Female , Uterine Hemorrhage/etiology , Menopause , Estrogen Replacement Therapy/adverse effects , Estrogen Receptor Modulators/adverse effects , Norpregnenes/adverse effects , Polyps/complications , Polyps/diagnosis , Endometrial Neoplasms/complications , Endometrial Neoplasms/diagnosis , Estrogen Receptor Modulators/therapeutic use , Diagnosis, Differential , Endometrial Hyperplasia/complications , Endometrial Hyperplasia/diagnosis , Endometrium/diagnostic imaging , Metrorrhagia/etiology , Norpregnenes/therapeutic use
2.
Rev. chil. obstet. ginecol. (En línea) ; 83(5): 527-550, nov. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978127

ABSTRACT

ABSTRACT In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these Recommendations is to provide a simple and updated reference on postmenopausal MHT. The term MHT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential (Seq) when progestogen is added to ERT for 10-14 days a month, or continuous combined (CC) when progestogen is administered continuously every day along with a fixed amount of estrogen. MHT also includes Tibolone and the Tissue Selective Estrogen Complex (TSEC).


Subject(s)
Humans , Female , Societies, Medical/trends , Menopause , Estrogen Replacement Therapy , Estrogen Replacement Therapy/adverse effects , Risk Factors , Estrogens/administration & dosage
3.
Femina ; 42(6): 255-260, nov-dez. 2014. ilus
Article in Portuguese | LILACS | ID: lil-749145

ABSTRACT

O Lúpus Eritematoso Sistêmico (LES) é uma doença inflamatória crônica, de maior prevalência no sexo feminino, multissistêmica e de natureza autoimune, caracterizada pela presença de diversos autoanticorpos que evolui com manifestações clínicas polimórficas, com períodos de exacerbações e remissões Este artigo consistiu de revisão da literatura realizada pela consulta de seis bases de dados em busca de artigos nacionais e internacionais que relataram o evento tromboembólico e cardíaco nas pacientes lúpicas usuárias de terapia hormonal (TH), buscou relatos sobre o efeito da TH na prevenção da osteoporose nestas pacientes, e saber se o estrogênio pode ser fator etiológico no aparecimento da doença ou causando exacerbação de mulheres lúpicas expostas à TH. Como resultado, conclui-se que terapia hormonal pode ser usada na ausência de atividade da doença e sem agudizações por alguns anos, em mulheres com anticorpo anticardiolipina e/ou anticoagulante lúpico negativo e com doses terapêuticas de glicorticóide baixa e que se deve preferir baixa dose de estrogênio transdérmico combinado com progesterona natural, micronizada ou derivados pregnanos, por apresentar menor potencial trombogênico. E, naquelas pacientes com atividade da doença em controle e ainda com sintomas vasomotores, um agente não-estrogênico (antidepressivo ou progesterona) deve ser a primeira linha de tratamento.(AU)


Systemic Lupus Erythematosus (SLE) is a chronic multisystemic inflammatory disease, more prevalent in women. It is considered an autoimmune disease, characterized by the presence of several autoantibodies. Its clinical presentation is polymorphic, characterized by exacerbation and remissions periods. It was performed an extensive literature research in six databases searching for articles related to the thromboembolic and cardiac events in female SLE patients exposed to replacement hormone therapy (HT). Furthermore, it was searched articles on the effects of HT in the prevention of osteoporosis, as well as if estrogen therapy could be an etiologic factor in the emergence or exacerbation of LES in female patients. HT can be safely used in the absence of disease activity, in patients without exacerbation for some years, in women with no evidence of anticardiolipin or lupus anticoagulant antibodies, and using low corticoid doses. When the use of HT is necessary it is preferable to use low dose of transdermical estrogen combined with natural progesterone, micronised or pregnane derivatives that have less thrombogenic potential. In addition, in patients with LES activity controlled that maintain hot flashes a non-estrogenic therapy (antidepressant or progesterone) should be the first treatment line.(AU)


Subject(s)
Female , Estrogen Replacement Therapy/adverse effects , Hormone Replacement Therapy/adverse effects , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Osteoporosis , Thromboembolism , Risk Factors , Databases, Bibliographic , Coronary Disease
4.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 6(3): 1302-1312, jul.-set. 2014. tab
Article in English, Portuguese | LILACS, BDENF | ID: lil-719771

ABSTRACT

Objective: to analyze the scientific production involving the use of hormone replacement therapy during menopause as a risk factor for developing breast cancer. Method: an integrative literature review. The databases BDENF, LILACS and SciELO were used. There were 71 articles identified of which 24 comprised the sample. Results: it was observed that Brazil was the country with the most publications and Portuguese was the most queried language. Regarding the choice of study design, 50% of the studies had a methodological qualitative approach and the data collection method by means of documents was the most used. Conclusion: nurses as health professionals should advise women in per menopausal age about the risks and benefits of the use of hormone replacement therapy in order to assist them in adhering or not to treatment.


Objetivo: analisar a produção científica envolvendo o uso da terapia de reposição hormonal no climatério como um fator de risco para desenvolvimento de câncer de mama. Método: realizou-se uma revisão integrativa da literatura. Utilizamos as bases de dados BDENF, LILACS e SciELO. Identificamos 71 artigos, dos quais 24 compuseram nossa amostra. Resultados: observamos que o Brasil foi o país com mais publicações e o idioma mais requisitado foi o português. Em relação à escolha do delineamento do estudo, 50% dos estudos possuíam abordagem metodológica do tipo qualitativa e o método de coleta de dados por meio de documentos foi o mais utilizado. Conclusão: a enfermagem como profissional da saúde deve orientar as mulheres em idade perimenopausa sobre os riscos e benefícios do uso da terapia de reposição hormonal a fim de auxiliá-las na adesão ou não a esse tratamento.


Objetivo: analizar la producción científica involucrando el uso de la terapia de reemplazo hormonal durante la menopausia como factor de riesgo para desarrollar cáncer de mama. Método: se realizó una revisión integradora de la literatura. Utilizamos las bases de datos BDENF, LILACS y SciELO. Se identificaron 71 artículos, de los cuales 24 formaban la muestra. Resultados: observamos que Brasil fue el país con el mayor número de publicaciones y la lengua portuguesa fue la más solicitada. En cuanto a la elección del diseño del estudio, el 50% de los estudios tenía aproximación metodológica de tipo cualitativo y el método de recogida de datos por medio de los documentos fue el más utilizado. Conclusión: enfermería como profesional de la salud debe aconsejar a las mujeres en edad peri menopáusica acerca de los riesgos y beneficios del uso de la terapia de reemplazo hormonal con el fin de ayudarles en el cumplimiento o no de este tratamiento.


Subject(s)
Humans , Female , Adult , Middle Aged , Climacteric , Menopause , Hormone Replacement Therapy , Estrogen Replacement Therapy , Estrogen Replacement Therapy/adverse effects , Brazil
5.
Arq. bras. endocrinol. metab ; 58(2): 172-181, 03/2014. tab
Article in Portuguese | LILACS | ID: lil-709341

ABSTRACT

Embora o estrógeno já esteja disponível para venda há mais de seis décadas, as mulheres ainda permanecem confusas quanto ao risco e aos benefícios da terapia hormonal na menopausa (THM), terapia estrogênica isolada ou associada a progestágenos. A publicação de estudos controlados, randomizados, como o Heart and Estrogen/progestin Replacement Study (HERS) e Women’s Health Initiative (WHI), intensificou essa controvérsia risco/benefício. Milhares de mulheres são tratadas com THM para alívio dos sintomas menopausais, incluindo sintomas vasomotores e sudorese, principal indicação da estrogenoterapia. Outras podem persistir no tratamento na esperança de prevenir doenças crônicas. A manutenção da massa óssea e a prevenção de fraturas são efeitos do estrógeno já bem estabelecidos. Estudos observacionais dos efeitos metabólicos e vasculares do estrógeno sugerem um benefício em potencial na redução do risco de doenças vasculares, mas estudos randomizados e controlados não demonstraram nenhuma evidência de que a terapia hormonal pudesse beneficiar as mulheres com doença vascular previamente instalada ou em mulheres aparentemente saudáveis. O aumento do risco de câncer de mama e doença tromboembólica tem se confirmado nesses estudos. A incidência em números absolutos de efeitos adversos é baixa e o risco individual no primeiro ano de tratamento é muito baixo. Os riscos são cumulativos com o tempo de uso. A relação risco/benefício deve ser individualizada.


Although estrogen has been clinically available for more than six decades, women have been confused by different opinions regarding the risks and benefits of menopausal hormone therapy (HT), estrogen therapy (ET), and estrogen-progestin therapy (EPT). The publication of randomized controlled trials (RCTs), notably, the Heart and Estrogen/progestin Replacement Study (HERS) and Women’s Health Initiative (WHI), has intensified the risk vs. benefit controversy. Millions of women are treated with HT for relief of menopausal symptoms, including vasomotor flushes and sweats, for which estrogen is uniquely and highly effective. Others may continue longer-term treatment in the hope that HT will help to prevent chronic disease. The preservation of bone mass with continuing estrogen therapy and reduction of subsequent risk of fracture is well established. Observational studies of the metabolic and vascular effects of estrogens have suggested a potential benefit in reducing the risk of vascular disease, but recently published randomized controlled trials demonstrated no evidence of benefit in women with established vascular disease or in apparently healthy women. The increased risks of breast cancer and thromboembolic disease have been confirmed in these trials, with evidence of increased risk of stroke. The absolute incidence of an adverse event is low, and the risk of stroke in an individual woman in a single year is very small, but with long-term use, the risks are cumulative over time. The risk-benefit balance needs to be individualized for each woman.


Subject(s)
Adult , Female , Humans , Middle Aged , Clinical Trials as Topic , Estrogen Replacement Therapy , Estrogens/therapeutic use , Menopause/drug effects , Bone Density/drug effects , Bone Neoplasms/chemically induced , Estrogen Replacement Therapy/adverse effects , Progestins/therapeutic use , Risk Assessment , Stroke/drug therapy , Stroke/etiology
6.
Arq. gastroenterol ; 50(3): 180-185, July-Sept/2013. tab
Article in English | LILACS | ID: lil-687257

ABSTRACT

Context Nonalcoholic Fatty Liver Disease (NAFLD) is common in postmenopausal women. It is associated with metabolic syndrome. However, the influence of hormone replacement therapy in NAFLD development in these women needs to be investigated. This study aimed to describe the clinical characteristics of NAFLD in postmenopausal women, and the relationship between hormone replacement therapy and this disease. Methods From April 2009 to April 2011, 292 postmenopausal women from National Health System from Northeast of Brazil were selected, and 251 were included in this study. Menopause was defined as the absence of menstruation for 12 consecutive months in otherwise healthy women. Criteria to NAFLD included: presence of steatosis on abdominal ultrasound; history of alcohol consumption less than 20 g/day and exclusion of other liver diseases. All women underwent a clinical evaluation. Standard univariate and multivariate analyses were performed to evaluate the results. Results The mean age was 56.5 ± 6.7 years. Hormone replacement therapy was referred by 21.1% (53) women and 78.9% (198) was not. Prevalence of NAFLD was 37.1% (93/251) in postmenopausal women, 26,4% (14/53) in the group with hormone replacement therapy and 39,9% (79/198) without hormone replacement therapy. Gamma-glutamyl transpeptidase (P = 0.001), alanine transaminase (P<0.01), ferritin (P<0.001) and insulin resistance (homeostatic model assessment of insulin resistance ≥3) (P<0.001) were higher in the group of women with NAFLD diagnosis who did not referred the use of hormone replacement therapy. Metabolic syndrome was also more frequent in women with NAFLD, who did not refer hormone replacement therapy. Conclusion In conclusion this data suggests elevated prevalence of NAFLD in postmenopausal women; negative association of hormone replacement therapy and NAFLD. .


Contexto A doença hepática gordurosa não alcoólica (DHGNA) é comum em mulheres na pós-menopausa. Esta condição está associada à síndrome metabólica. No entanto, a influência da terapia de reposição hormonal no desenvolvimento da DHGNA nessas mulheres necessita ser investigada. Este estudo teve como objetivo descrever as características clínicas da DHGNA em mulheres na pós-menopausa e, a relação entre terapia de reposição hormonal e esta doença. Métodos De abril de 2009 a abril de 2011, 292 mulheres pós-menopausadas do Sistema Único de Saúde foram selecionados, e 251 foram incluídas neste estudo. A menopausa foi definida como a ausência de menstruação durante 12 meses consecutivos em mulheres saudáveis. Os critérios para diagnostico da DHGNA foram: presença de esteatose na ultra-som abdominal, história de consumo de álcool menor que 20 g/dia e exclusão de outras doenças hepáticas. Todas as mulheres foram submetidas a uma avaliação clínica. Para a obtenção dos resultados foram realizadas as análises uni e multivariada. Resultados A média de idade foi de 56,5 ± 6,7 anos. O uso de terapia de reposição hormonal foi referido por 21,1% (53) das mulheres e 78,9% (198) negaram seu uso. A prevalência de DHGNA foi de 37,1% (93/251) nas mulheres pós-menopausadas, sendo de 26,4% (14/53) no grupo em uso de terapia de reposição hormonal e 39,9% (79/198) no grupo sem uso desta terapia. A gama-glutamil transpeptidase (P = 0,001), alanina transaminase (P<0,01), ferritina (P<0,001) e resistência à insulina (obtida pelo modelo de avaliação homeostática de resistência à insulina ≥ 3) (P<0,001) foram ...


Subject(s)
Female , Humans , Middle Aged , Estrogen Replacement Therapy/adverse effects , Fatty Liver/etiology , Postmenopause/drug effects , Analysis of Variance , Cross-Sectional Studies , Insulin Resistance , Metabolic Syndrome/etiology , Risk Factors , Severity of Illness Index , Socioeconomic Factors
8.
Egyptian Journal of Histology [The]. 2012; 35 (1): 34-43
in English | IMEMR | ID: emr-126541

ABSTRACT

Soy bean phytoestrogens have estrogenic properties and have been reported to be safe on female reproductive tissue. The present work aimed at comparing the effects of soya and estrogen in the lung of ovariectomized rats and demonstrating whether dietary soya could substitute estrogen replacement therapy. Thirty-nine adult female albino rats were divided into four groups. Group I [control] included nine rats. Group II included 10 rats ovariectomized for 6 months. Groups III and IV: each included 10 rats ovariectomized for 6 months and received estrogen replacement [group III] or soy bean [group IV]. Lung sections were subjected to H and E, Masson's trichrome stains, and immunohistomchemical staining of alpha smooth muscle actin [alpha SMA]. The mean smooth muscle thickness, area of collagen deposition, and area percent of alpha SMA were assessed. In group II, thick interalveolar septa with condensed collagen fibers, thickened bronchiolar smooth muscles, and cellular infiltration were detected. Positive alpha SMA immunoreactivity was noted in the thickened interalveolar septa. The mean smooth muscle thickness, collagen deposition, and area percent of alpha SMA immunoreactivity showed a significant increase in group II versus other groups, and there was significant decrease in groups III and IV versus group II. In groups III and IV, cellular infiltration and extravasated red blood cells were noted. Otherwise, they were comparable to the control group. It could be concluded that both soya and estrogen led to improved changes in the lung of ovariectomized rats almost to the same extent. Thus, soya might be recommended as a safe therapeutic substitute to estrogen, which has been reported to have side effects on female reproductive tissue


Subject(s)
Female , Animals, Laboratory , Lung/pathology , Immunohistochemistry , Soybean Oil/adverse effects , Estrogen Replacement Therapy/adverse effects , Comparative Study , Rats , Female
9.
São José dos Campos; s.n; 2012. 51 p. ilus, tab, graf.
Thesis in Portuguese | LILACS, BBO | ID: biblio-870175

ABSTRACT

Os exames radiográficos panorâmicos são de grande importância na rotina de pacientes idosos. A radiografia panorâmica pode servir para avaliar o nível de densidade mineral óssea e auxiliar no encaminhamento desses pacientes para a realização de exames de maior complexidade como a densitometria óssea. Na mulher, durante o ciclo biológico normal, há perda de 35% do osso cortical e 50% do osso trabecular, enquanto os homens perdem dois terços dessa quantidade. Entre 30 e 49 anos, a mulher perde 0,18%/ano do osso esponjoso, com aumento para 1-4%/ano, nos cinco primeiros anos após a menopausa. O objetivo nesta pesquisa foi avaliar, por meio de exames radiográficos panorâmicos, 75 mulheres adultas foram divididas em 3 grupos distintos, sendo 25 mulheres com idade entre 20 e 39 anos, 25 mulheres com idade entre 40 e 60 anos que não fazem reposição hormonal e 25 mulheres com idade entre 40 e 60 anos que fazem terapia de reposição hormonal. Foi utilizada a geometria fractal para verificar a viabilidade da utilização dessa ferramenta por meio do programa de computador Image J em radiografias panorâmicas digitais para a comparação da densidade óssea e concluiu-se que mulheres pós-menopáusicas que fazem uso de reposição hormonal apresentaram maior valor dos índices de analise fractal que aquelas que não utilizavam esta medicação. Este é um indicativo de que a reposição hormonal altera a arquitetura óssea mandibular, tornando-a mais porosa e reduzindo o conteúdo mineral.


The panoramic radiographs are of great importance in the routine of elderly patients. Panoramic radiography may be used to assess the level of bone mineral density and assist in referral of patients to perform more complex tests such as bone densitometry. In women, during the normal life cycle, there is aloss of 35% of cortical bone and 50% trabecular bone, while men lose two thirdsof that amount. Between 30 and 49, the woman loses 0.18% per year of bones pongy, up to 1-4% / year in the first five years after menopause. The objective of this research will be to perform panoramic radiographs in 75 adult women separated into three distinct groups, comprising 25 women aged between 20and 30 years, 25 women aged between 40 and 60 who are not hormone replacement therapy(HRT) and 25 women aged between 40 and 60 who are using hormone replacement therapy, in order to verify the feasibility of using fractal analysis with Image J software on digital panoramic radiographs for comparison of bone density and concluded that post menopausal women whouse hormone replacement therapy had higher rates of fractal analysis to those who did not use this medication. This is an indication that HRT alters the mandibular bone architecture, making it more porous and reducing the mineral content.


Subject(s)
Bone Density , Radiography, Panoramic , Estrogen Replacement Therapy/adverse effects , Mandible
10.
São José dos Campos; s.n; 2012. 51 p. ilus, tab, graf.
Thesis in Portuguese | LILACS, BBO | ID: biblio-867528

ABSTRACT

Os exames radiográficos panorâmicos são de grande importância na rotina de pacientes idosos. A radiografia panorâmica pode servir para avaliar onível de densidade mineral óssea e auxiliar no encaminhamento desses pacientes para a realização de exames de maior complexidade como a densitometria óssea. Na mulher, durante o ciclo biológico normal, há perda de 35% do osso cortical e 50% do osso trabecular, enquanto os homens perdem dois terços dessa quantidade. Entre 30 e 49 anos, a mulher perde 0,18%/ano do osso esponjoso, com aumento para 1-4%/ano, nos cinco primeiros anos após a menopausa. O objetivo nesta pesquisa foi avaliar, pormeio de exames radiográficos panorâmicos, 75 mulheres adultas foram divididas em 3 grupos distintos, sendo 25 mulheres com idade entre 20 e 39 anos, 25 mulheres com idade entre 40 e 60 anos que não fazem reposição hormonal e 25 mulheres com idade entre 40 e 60 anos que fazem terapia dereposição hormonal. Foi utilizada a geometria fractal para verificar a viabilidade da utilização dessa ferramenta por meio do programa de computador ImageJ em radiografias panorâmicas digitais para a comparação da densidade óssea e concluiu-se que mulheres pós-menopáusicas que fazem uso de reposição hormonal apresentaram maior valor dos índices de analise fractal que aquelas que não utilizavam esta medicação. Este é um indicativo de que a reposição hormonal altera a arquitetura óssea mandibular, tornando-a mais porosa e reduzindo o conteúdo mineral


The panoramic radiographs are of great importance in the routine of elderly patients. Panoramic radiography may be used to assess the level of bone mineral density and assist in referral of patients to perform more complex tests such as bone densitometry. In women, during the normal life cycle, there is aloss of 35% of cortical bone and 50% trabecular bone, while men lose two thirdsof that amount. Between 30 and 49, the woman loses 0.18% per year of bones pongy, up to 1-4% / year in the first five years after menopause. The objective of this research will be to perform panoramic radiographs in 75 adult women separated into three distinct groups, comprising 25 women aged between 20and 30 years, 25 women aged between 40 and 60 who are not hormone replacement therapy(HRT) and 25 women aged between 40 and 60 who are using hormone replacement therapy, in order to verify the feasibility of using fractal analysis with Image J software on digital panoramic radiographs for comparison of bone density and concluded that post menopausal women whouse hormone replacement therapy had higher rates of fractal analysis to those who did not use this medication. This is an indication that HRT alters the mandibular bone architecture, making it more porous and reducing the mineral content


Subject(s)
Bone Density , Radiography, Panoramic , Estrogen Replacement Therapy/adverse effects , Mandible
11.
J. bras. patol. med. lab ; 47(5): 561-568, out. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-604380

ABSTRACT

INTRODUÇÃO: O glicogênio representa a forma de armazenamento de açúcares na célula animal, sendo estocada naturalmente no hepatócito. Em sua dinâmica metabólica ocorre participação de receptores, hormônios e enzimas que mantêm e equilibram os níveis séricos desse componente. OBJETIVO: O presente estudo investigou a influência da tibolona no metabolismo glicídico hepático por meio de avaliação da presença do glicogênio hepático e níveis séricos de glicose. MATERIAL E MÉTODOS: Utilizamos ao todo 14 ratas Wistar, em menopausa cirúrgica comprovada citologicamente, tratadas diariamente com tibolona (n = 9) ou com placebo (n = 5) durante 20 semanas. Efetuou-se avaliação dos pesos do animal e do fígado e dos níveis de glicose sérica. O estudo morfológico foi realizado em cortes histológicos de tecido hepático, corados com hematoxilina e eosina (HE) e com ácido periódico de Schiff (PAS), com e sem amilase salivar. Para avaliação do glicogênio no fígado, utilizou-se grade de estudo morfológico (GEM), que delineia as regiões metabólicas e circulatórias do lóbulo hepático. RESULTADOS: O peso dos animais foi menor no Grupo Tibolona, com glicose sérica em níveis mais baixos; já o peso relativo do fígado foi significativamente maior (p < 0,001). No Grupo Controle o glicogênio apresentou distribuição heterogênea em três diferentes padrões e o Grupo Tibolona mostrou glicogênio uniforme em toda a estrutura lobular. CONCLUSÃO: A tibolona, administrada em alta dose e por tempo prolongado, determina perda de peso por deficiência alimentar, que leva a alterações nas funções hepáticas, podendo influir na glicogenólise e na gliconeogênese, com modificações do glicogênio hepático e da glicose circulante.


INTRODUCTION: Glycogen serves as glucose storage in animals and it is naturally found in hepatocytes. Receptors, hormones and enzymes, which maintain and balance serum levels of this component, participate in its metabolic dynamics. OBJECTIVE: This study investigated the influence of tibolone on the hepatic glycemic metabolism by assessing the presence of liver glycogen and serum glucose. MATERIAL AND METHODS: Fourteen castrated Wistar rats, cytologically validated as surgical menopause models, were treated with tibolone (n = 9) or placebo (n = 5) for 20 weeks. Their body and liver weight and serum glucose levels were assessed. The morphologic study was performed in histological sections of liver tissue stained with hematoxylin and eosin (HE) and periodic acid-Schiff (PAS), with and without salivary amylase. For liver glycogen analysis, a morphological study grid (MSG), which outlines the metabolic and circulatory areas in the liver lobule, was applied. RESULTS: The animals' weight was lower in the Tibolone Group, with serum glucose at lower levels, whereas the relative liver weight was significantly higher (p < 0.001). The Control Group showed heterogeneous glycogen distribution in three different patterns. The Tibolone Group presented uniform glycogen throughout the lobular structure. CONCLUSION:Tibolone administration in high doses and for a long period determines weight loss by dietary deficiency, which leads to liver function changes. Thus, it may affect glycogenolysis and gluconeogenesis with changes in liver glycogen and circulating glucose.


Subject(s)
Animals , Female , Rats , Liver/metabolism , Blood Glucose/analysis , Glycogen/analysis , Menopause , Carbohydrate Metabolism , Estrogen Replacement Therapy/adverse effects , Rats, Wistar
13.
Säo Paulo med. j ; 128(4): 211-214, July 2010. tab
Article in English | LILACS | ID: lil-566414

ABSTRACT

CONTEXT AND OBJECTIVE: Studies on postmenopausal women have reported increased risk of breast cancer relating to the type and duration of hormone therapy (HT) used. Women with premature ovarian failure (POF) represent a challenge, since they require prolonged HT. Little is known about the impact of prolonged HT use on these women's breasts. This study aimed to evaluate the effects of one type of HT on the breast density of women with POF, compared with postmenopausal women. DESIGN AND SETTING: Cross-sectional study at the Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). METHODS: 31 women with POF and 31 postmenopausal women, all using HT consisting of conjugated equine estrogen combined with medroxyprogesterone acetate, and matched according to HT duration, were studied. Mammography was performed on all subjects and was analyzed by means of digitization or Wolfe's classification, stratified into two categories: non-dense (N1 and P1 patterns) and dense (P2 and Dy). RESULTS: No significant difference in breast density was found between the two groups through digitization or Wolfe's classification. From digitization, the mean breast density was 24.1 percent ± 14.6 and 18.1 percent ± 17.2 in the POF and postmenopausal groups, respectively (P = 0.15). Wolfe's classification identified dense breasts in 51.6 percent and 29.0 percent, respectively (P = 0.171). CONCLUSION: There was no difference in breast density between the women with POF and postmenopausal women, who had used HT for the same length of time. These results may help towards compliance with HT use among women with POF.


CONTEXTO E OBJETIVO: Estudos com mulheres na pós-menopausa relatam aumento no risco de câncer de mama relacionado ao tipo e duração da terapia hormonal (TH) utilizada. Mulheres com falência ovariana prematura (FOP) representam desafio por necessitarem de TH prolongada. Pouco se conhece sobre ação da TH nas mamas dessas mulheres. Este estudo objetivou avaliar os efeitos de um tipo de TH sobre a densidade mamária de mulheres com FOP comparativamente à de mulheres pós-menopausa. TIPO DE ESTUDO E LOCAL: Estudo de corte transversal no Departamento de Tocoginecologia, Universidade Estadual de Campinas (Unicamp). MÉTODOS: Estudaram-se 31 mulheres com FOP e 31 mulheres na pós-menopausa, todas usando TH com estrogênio conjugado equino mais acetato de medroxiprogesterona, pareadas pelo tempo de utilização da TH. Todas realizaram mamografia, analisada por digitalização e por classificação de Wolfe, estratificada em duas categorias: não densa (padrão N1 e P1) e densa (P2 e Dy). RESULTADOS: Não houve diferença significativa entre a densidade mamária dos grupos analisadas por digitalização ou classificação de Wolfe. Pela digitalização, calculou-se densidade mamária média em 24.1 por cento ± 14.6 e 18.1 por cento ± 17.2 nas com FOP e pós-menopausa, respectivamente (P = 0,15); pela classificação de Wolfe identificou-se mamas densas em 51,6 por cento e 29,0 por cento, respectivamente (P = 0,171). CONCLUSÃO: Não se observou diferença na densidade mamária de mulheres com FOP comparativamente à de mulheres na pós-menopausa utilizando TH pelo mesmo período de tempo. Estes resultados podem auxiliar na aderência à TH de pacientes com FOP.


Subject(s)
Adult , Female , Humans , Middle Aged , Breast/drug effects , Estrogen Replacement Therapy/adverse effects , Postmenopause/drug effects , Primary Ovarian Insufficiency/drug therapy , Breast Neoplasms/etiology , Cross-Sectional Studies , Mammography , Pilot Projects , Risk Factors
14.
Rev. méd. Chile ; 138(5): 645-651, mayo 2010. ilus
Article in Spanish | LILACS | ID: lil-553265

ABSTRACT

The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.


Subject(s)
Female , Humans , Cardiovascular Diseases/etiology , Climacteric/physiology , Quality of Life , Chile , Cardiovascular Diseases/chemically induced , Climacteric/drug effects , Estrogen Replacement Therapy/adverse effects , Gonadal Steroid Hormones/therapeutic use , Life Style , Risk Factors , Societies, Medical
15.
Indian J Med Sci ; 2010 Jan; 64(1) 17-25
Article in English | IMSEAR | ID: sea-145477

ABSTRACT

Background and Objective: The aim of the present study was to evaluate oxidative stress byinvesting oxidatively damaged DNA AS Formamidopyrimidine DNA glycosylase (Fpg) -sensitive sites, glutathione peroxidase (GPx), superoxide dismutase (SOD) activities reduced glutathione (GSH) level and nitrite level as satble end product of in women receiving hormone replacement therapy (HRT). Materials and Methods: 127 healthy postmenopausal women receiving HRT and 25 healthy control postmenopausal women were included in this study. Women receiving HRT, comprised surgical menopausal women who underwent surgery for benign conditionsand received conjugated equine estrogen, 0.625 mg/day for 1year (group 1), 5 years (group 2) and more than 10 years (group 3), spontaneous postmenopausal women received conjugated equine estrogen, 0.625 (Premarin) mg/day and medroxyprogesterone acetate, 2.5 mg/day (Premelle) for 1 year (group 4), 5 years (group 5) and more than 5 years (group 6).We investigated in the present study the effects of HRT on nitrite level and GSH level, activities of SOD and GPx and oxidative damage to DNA by comet assays by measuring levels of Fpg-sensitive sites. Results: Although no significant differences were found in the SOD activities, in total group receiving HRT, increased DNA oxidation (P<0.001) together with an increased GPx activity (P<0.001) and nitrite level (P<0.001) as well as a decreased GSH level (P < 0.05) as compared with controls were observed. Conclusion: Estrogen alone or oestrogen in combination with progesterone and duration of use did not significantly alter the results. We evaluated that caused oxidative stress by investigating oxidative DNA damage as Fp-sensitive sites and GSH.NO levels in women receiving HRT.


Subject(s)
Analysis of Variance , Antioxidants/metabolism , Case-Control Studies , DNA Damage/drug effects , DNA-Formamidopyrimidine Glycosylase/metabolism , Dose-Response Relationship, Drug , Drug Administration Schedule , Estrogen Replacement Therapy/adverse effects , Estrogen Replacement Therapy/methods , Estrogens, Conjugated (USP)/administration & dosage , Estrogens, Conjugated (USP)/adverse effects , Follow-Up Studies , Hormone Replacement Therapy/adverse effects , Hormone Replacement Therapy/methods , Humans , Medroxyprogesterone Acetate/administration & dosage , Medroxyprogesterone Acetate/adverse effects , Middle Aged , Oxidation-Reduction/drug effects , Oxidative Stress/drug effects , Postmenopause/blood , Postmenopause/drug effects , Reference Values , Treatment Outcome
16.
RBM rev. bras. med ; 66(8): 238-244, ago. 2009.
Article in Portuguese | LILACS | ID: lil-525025

ABSTRACT

O objetivo desta revisão é analisar as principais evidências clínicas sobre os efeitos da terapia hormonal da pós-menopausa no risco de desenvolver neoplasias mamária, endometrial, ovariana e colorretal. As principais considerações: a) as mulheres devem ser orientadas sobre a associação entre terapia hormonal e risco de câncer de mama, apesar do risco absoluto ainda permanecer relativamente baixo b) mulheres com antecedente de câncer de mama devem considerar terapias alternativas para o tratamento de sintomas de menopausa c) mulheres com útero devem receber terapia combinada com estrogênio e progesterona.


Subject(s)
Humans , Female , Middle Aged , Breast Neoplasms/chemically induced , Estrogen Replacement Therapy/adverse effects , Menopause/metabolism , Women's Health
17.
J. bras. med ; 96(4): 11-15, abr. 2009. ilus
Article in Portuguese | LILACS | ID: lil-539057

ABSTRACT

As mulheres no climatério, principalmente na pós-menopausa, apresentam redução dos níveis de androgênio - sobretudo da testosterona livre - de aproximadamente 50 por cento, quando comparadas com as de 20 anos. Isso ocorre porque há um acréscimo da testosterona ligada à SHBG, o que a inativa, com a consequente perda da libido, do bem-estar e da energia. A terapia de reposição androgênica se mostra benéfica na medida em que melhora o desejo sexual, a depressão, o aumento de massa magra e o bem-estar. Entretanto, há efeitos colaterais que são correlacionados com as doses e a via de administração. As doses baixas, através das vias periféricas, minimizam acentuadamente esses efeitos. O presente estudo faz uma revisão na literatura das indicações e contraindicações dessa terapia, além de avaliar as formas de administração desses hormônios.


Subject(s)
Female , Adult , Middle Aged , Menopause , Menopause/physiology , Menopause/metabolism , Estrogen Replacement Therapy/adverse effects , Estrogen Replacement Therapy , Postmenopause , Quality of Life , Risk Factors , Testosterone/deficiency , Testosterone/adverse effects , Testosterone/therapeutic use
19.
Article in English | IMSEAR | ID: sea-158051

ABSTRACT

To study the differential effects of estrogen and progestin on memory in postmenopausal women receiving hormone replacement therapy (HRT). Methods: Thirty women between ages 45 and 60 years who had attained natural menopause and received combined estrogen progestin therapy constituted group I. While group II included 30 surgically menopausal women who received only estrogen, PGI memory scale having a battery of ten subtests devised specially for Indian subjects was used. Results were analyzed by repetitive measure analysis. Results: Women showed an improved score on memory scale after 6 months of HRT in both the groups. The comparison of both groups post therapy revealed improvement in scores of delayed recall & visual retention in group II indicating that only estrogen users benefited more. Conclusion: This study supports the view that estrogens with or without progestin if given early after menopause i.e. below 60 yrs if age do have a beneficial role on memory.


Subject(s)
Adult , Estrogen Replacement Therapy/adverse effects , Estrogen Replacement Therapy/psychology , Female , Hormone Replacement Therapy/adverse effects , Hormone Replacement Therapy/psychology , Humans , Memory/drug effects , Memory/psychology , Postmenopause/drug effects , Postmenopause/psychology
20.
Medicina (B.Aires) ; 68(3): 251-257, mayo-jun. 2008. tab
Article in Spanish | LILACS | ID: lil-633548

ABSTRACT

Durante su edad fértil, la mujer sufre una incidencia de enfermedad cardiovascular ateroesclerótica (particularmente infarto de miocardio) significativamente inferior a la del hombre. Este beneficio desaparece progresivamente luego de la menopausia, hasta equilibrarse luego de la sexta década de la vida. Estudios experimentales en modelos animales y humanos sugirieron la existencia de mecanismos fisiológicos por los cuales los estrógenos podrían ser los responsables de esta protección cardiovascular, y análisis retrospectivos de estudios clínicos mostraron que las mujeres climatéricas que habían consumido terapia hormonal de reemplazo (THR) sufrían menos eventos cardiovasculares. Estas observaciones estimularon la ejecución de numerosos ensayos clínicos prospectivos aleatorizados (algunos de gran envergadura) en mujeres climatéricas, destinados a probar la hipótesis de que la THR podría prevenir eventos cardiovasculares graves en esa población. La hipótesis no pudo probarse, ya que en ninguno de esos ensayos la THR fue efectiva, y en algunos casos incluso fue en ciertos aspectos perjudicial. Existen cuestionamientos de orden metodológico que tienen que ver con el diseño de dichos ensayos prospectivos, fundamentalmente la edad de las pacientes incluidas y el momento del inicio de la THR. Existen también razones biológicas que pueden explicar la mencionada contradicción. Una nueva hipótesis, basada asimismo en observaciones experimentales y clínicas, se orienta hacia la posibilidad de que el inicio de la THR en mujeres más jóvenes y más precozmente luego de la menopausia, podría mostrar diferentes resultados.


During their fertile period women suffer significantly less atherosclerotic cardiovascular disease (particularly myocardial infarction) than men. This benefit progressively disappears after menopause, to equalize after the sixth decade of life. Experimental studies in animal and human models demonstrated the existence of physiological mechanisms suggesting that estrogens could be responsible for this cardiovascular protection, and retrospective analysis of clinical studies showed that post menopausal women who had used hormonal replacement therapy (HRT) suffered less cardiovascular events. These observations stimulated the execution of several prospective, randomized clinical trials (some of them with a large number of patients and prolonged follow-up) in post menopausal women, with the aim of proving the hypothesis that HRT could prevent major cardiovascular events. Such hypothesis could not be demonstrated in any of those studies because HRT was not beneficial, and in several cases it was even deleterious in some aspects. Criticism has arisen over some of the methodological aspects of those prospective trials, basically regarding the age of the included patients and the timing of the beginning of HRT. There are also biological reasons that can explain the contradiction. A new hypothesis, also based on experimental and clinical observations, suggests the possibility that beginning HRT in younger women and earlier after menopause could yield different results.


Subject(s)
Aged , Female , Humans , Middle Aged , Cardiovascular Diseases/prevention & control , Estrogen Replacement Therapy , Progestins/therapeutic use , Raloxifene Hydrochloride/therapeutic use , Selective Estrogen Receptor Modulators/therapeutic use , Clinical Trials as Topic , Estrogen Replacement Therapy/adverse effects , Menopause/drug effects , Myocardial Infarction/prevention & control , Progestins/adverse effects , Selective Estrogen Receptor Modulators/adverse effects , Women's Health
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