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

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

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

Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil

The objective of the present study was to estimate the prevalence of chronic pelvic pain in the community of São Luís, capital of the State of Maranhão, Northeastern Brazil, and to identify independent conditions associated with it. A cross-sectional study was conducted, including a sample of 1470 women older than 14 years predominantly served by the public health system. The interviews were held in the subject's home by trained interviewers not affiliated with the public health services of the municipality. The homes were visited at random according to the city map and the prevalence of the condition was estimated. To identify the associated conditions, the significant variables (P=0.10) were selected and entered in a multivariate analysis model. Data are reported as odds ratio and 95% confidence interval, with the level of significance set at 0.05. The prevalence of chronic pelvic pain was 19.0%. The independent conditions associated with this diagnosis were: dyspareunia (OR=3.94), premenopausal status (OR=2.95), depressive symptoms (OR=2.33), dysmenorrhea (OR=1.77), smoking (OR=1.72), irregular menstrual flow (OR=1.62), and irritative bladder symptoms (OR=1.90). The prevalence of chronic pelvic pain in Sao Luís is high and is associated with the conditions cited above. Guidelines based on prevention and/or early identification of risk factors may reduce the prevalence of chronic pelvic pain in São Luís, Brazil.

Manejo de la mujer en transición menopáusica, menopausia y post-menopausia / Management of women in menopausal transition, menopause and post-menopause

El concepto actual de Salud Integral de la Mujer, y en especial de la Mujer Menopáusica, requiere que los grupos científicos relacionados con este tema, elaboren programas con dicho enfoque integral y que los mismos sean puestos en práctica a nivel público y privado. En atención a lo anterior, la Asociación Costarricense de Climaterio, Menopau-sia y Osteoporosis (ACCMYO) ha elaborado estas guías de Manejo de la Mujer en transición Menopáusica, Menopausia y Post-menopausia...

Correlation between body mass index and overactive bladder symptoms in pre-menopausal women / Correlação entre índice de massa corporal e sintomas de bexiga hiperativa em mulheres no menacme

Objective: The aim of the study was to establish a correlation between Overactive Bladder (OAB) symptoms and Body Mass Index (BMI) in women aged 20-45. Methods: We interviewed 1.050 women aged 20-45 in the area of Campinas, Brazil, to investigate the prevalence of overactive bladder symptoms. In this study, we used the ICIQ-OAB questionnaire (ICS standard), in its validated portuguese version and a specific questionnaire for the demographics, which includes information about BMI. Results: Overall, women with BMI ≥30 presented a significantly higher score than women with a lower BMI (18.5 - 24.9) (p=0.0066). In the analysis of individual symptoms, no significant differences were found regarding urinary frequency (p=0.5469). Women with BMI ≥30 presented more nocturia than women with BMI ranging between 18.5 and 24.9 (p=0.0154). Women in the group of BMI 25 - 29.9 presented more urgency than women with BMI 18.5 - 24.9 (p=0.0278). Significant difference was also found regarding urge-incontinence; women with BMI 25 - 29.9 presented a higher score than women in the group 18.5 - 24.9 (p= 0.0017). Analysis was also performed on the visual analogue scale regarding how much each symptom bothers the women (quality of life). There were no significant differences regarding frequency, nocturia or urgency but urgency incontinence bother was significant. Women with BMI 25 - 29.9 were more bothered by incontinence than women with BMI 18.5 - 24.9 (p=0.002). Conclusion: In conclusion, this study reinforces the correlation between BMI and OAB symptoms. Obese women present more OAB symptoms than non-obese women. .

Objetivo: O objetivo do estudo foi estabelecer uma correlação entre os sintomas de bexiga hiperativa e índice de massa corporal (IMC) em mulheres com idades entre 20 e 45 anos. Métodos: Foram entrevistadas 1.050 mulheres com idades entre 20 e 45 anos na região de Campinas, Brasil, para investigar a prevalência de sintomas de bexiga hiperativa. Neste estudo, foi utilizado o questionário ICIQ-OAB (padrão ICS), em sua versão validada em português e um questionário específico para os dados demográficos, que inclui informações sobre o IMC. Resultados: As mulheres com IMC ≥ 30 apresentaram uma pontuação significativamente maior do que as mulheres com IMC mais baixo (18,5 a 24,9); p = 0,0066. Na análise dos sintomas individuais, não foram encontradas diferenças significativas em relação a frequência urinária (p = 0,5469). Mulheres com IMC ≥ 30 apresentaram mais noctúria do que as mulheres com IMC variando entre 18,5 e 24,9 (p = 0,0154). As mulheres no grupo de IMC 25 a 29,9 apresentaram mais urgência do que as mulheres com IMC 18,5 a 24,9 (p = 0,0278). Também foi encontrada diferença significativa em relação à incontinência de urgência. As mulheres com IMC 25 a 29,9 apresentaram pontuação maior do que as mulheres no grupo 18,5 a 24,9 (p = 0,0017). A análise também foi realizada na escala analógica visual sobre quanto cada sintoma incomoda as mulheres (qualidade de vida). Não houve diferenças significativas em relação a frequência, noctúria e urgência, mas o incômodo causado pela incontinência de urgência foi significativo. Mulheres com IMC 25 a 29,9 foram mais incomodadas com a incontinência do que as mulheres com IMC 18,5 a 24,9 (p = 0,002). Conclusão: Em conclusão, este ...

[Evaluation of the risk factors related to dysfunctional uterine bleeding in peri-menopausal women in Sanandaj]

Dysfunctional uterine bleeding [DUB] is one of the common problems in peri-menopausal women that can affect their physical, emotional and social conditions. In addition DUB is one of the main causes of hysterectomy. The aim of this study was to investigate risk factors associated with DUB in peri-menopausal women in Sanandaj. This case-control study included 62 women with DUB[case group] and 124 women without DUB[control group]. We used a questionnaire consisted of different items which was completed for every subject after clinical interview. Using SPSS software, data analysis was performed by chi-square, Fisher exact test and logistic regression. DUB showed significant relationships with type of delivery [p=0.015] and age [p=0.045]. DUB had no significant relationship with diabetes [p=0.095], hypertension [p=0.917] and type of contraceptive methods [p=0.906]. Analysis by logistic regression revealed that women over 50 years of age and women with history of Cesarean section [C/S] had a respective risk of 2.284 [p=0.021] and 2.493 [p=0.009] times greater to develop DUB than women without these factors. The age over 50 years and C/S was suggested as risk factors which can be related to DUB. Attention to the advantages of vaginal delivery and complications of C/S is necessary and reduction of C/S rate can be effective in decreasing the incidence of DUB

Climaterio y menopausia / Climateric and menopause

La experiencia de la menopausia es diferente para cada mujer y entre mujeres de diferentes culturas o procedencias. La menopausia no es el final de la vida, sino el comienzo de una etapa que ocupa casi la tercera parte de la vida femenina; por otra parte, se plantea que el climaterio no es el cese de la existencia, sino la etapa que deja abierta las puertas al disfrute de una nueva forma que debe cursar con menos tensión, con menos carga. Según los conceptos de salud, salud mental y salud sexual de la Organización Mundial de la Salud, nada puede impedir que la mujer climatérica sea capaz de ser mental y sexualmente sana; por lo que el profesional de la salud debe estar actualizado en todos aquellos elementos que redunden en un mejor desempeño y en la expresión de la plenitud de las posibilidades físicas, psíquicas y sociales de la mujer en esta etapa. En este artículo se profundiza en los aspectos históricos y conceptuales del climaterio y la menopausia, los elementos esenciales relacionados con los principales síntomas y signos del climaterio, los factores de riesgo en esta etapa, así como en la conducta terapéutica que se debe tener en cuenta para su adecuado manejo, en la atención integral, por los profesionales de la salud.

The experience of menopause for each woman is different and among women of different cultures or origin. Menopause is not the end of the life, but the onset of a stage occupying almost the third part of the female life; by other hand, it is proposed that climateric is not the final of existence, but the stage leaving open the doors for the enjoyment of a new way that must to take place with less stress and with less burden. According to the concepts of health, mental health and sexual health from the World Health Organization, nothing may to prevent that climateric woman be able to has a mentally and sexually life; thus, the health professional must to be updated on all those elements having an effect on a better performance and on the expression of completeness of physical, psychic and social possibilities of the woman during this stage. In present paper authors deepen in the historical and conceptual features of climateric and the menopause, the essential elements related to the main symptoms and signs of climateric, the risk factors present in this stage, as well as the therapeutical behavior to take into account for its appropriate management in the integral care by the health professionals.

Alveolar bone mass in pre- and postmenopausal women with serum calcium as a marker: A comparative study.

Context: In most women bone mass reaches its peak in the third decade of life and declines thereafter with the onset of menopause and might lead to osteoporosis. Osteoporosis may result in reduced jaw bone mass and alterations of the mandibular structure. Qualitative and quantitative indices have been used for panoramic radiographs to assess the alveolar bone quality. Aims: The purpose of this study was to compare the alveolar bone quality of premenopausal and postmenopausal women using the panoramic mandibular index (PMI). This study also aimed to estimate the levels of serum calcium in premenopausal and postmenopausal women. Settings and Design: Single centre case control study. Materials and Methods: A total of 30 patients were divided into three groups of ten each - the healthy group, control group, and study group. Alveolar bone mass was evaluated by the PMI. Serum calcium was also assessed for all the patients. Statistical analysis used: The results obtained were subjected to statistical analysis by one-way analysis of variance using Statistical Software SPSS version 17, Tukey test for comparision, Pearson's correlation coefficient was employed. Results: Premenopausal women had the highest values for alveolar cortical bone mass as recorded by the PMI, followed by postmenopausal women with a healthy periodontium. The lowest values were recorded in the group of postmenopausal women with chronic generalized periodontitis. Similar results were found for serum calcium values. Conclusion: Postmenopausal women exhibit a reduced alveolar bone mass and lowered levels of serum total calcium with the increasing age. These changes may be useful indicators for low skeletal bone mineral density or osteoporosis.

Women with primary ovarian insufficiency have lower bone mineral density

The aim of the present study was to assess the prevalence of osteoporosis in a sample of 32 patients with spontaneous primary ovarian insufficiency (POI) in comparison to reference groups of 25 pre- and 55 postmenopausal women. Hip (lumbar) and spinal bone mineral density (BMD) measurements were performed by dual-energy X-ray absorptiometry in the three groups. The median age of POI patients at the time of diagnosis was 35 years (interquartile range: 27-37 years). The mean ± SD age of postmenopausal reference women (52.16 ± 3.65 years) was higher than that of POI (46.28 ± 10.38 years) and premenopausal women (43.96 ± 7.08; P = 0.001) at the time of BMD measurement. Twenty-seven (84.4 percent) POI women were receiving hormone replacement therapy (HRT) at the time of the study. In the postmenopausal reference group, 30.4 percent were current users of HRT. Lumbar BMD was significantly lower in the POI group (1.050 ± 0.17 g/cm²) compared to the age-matched premenopausal reference group (1.136 ± 0.12 g/cm²; P = 0.040). Moreover, 22 (68.7 percent) POI women had low bone density (osteopenia/osteoporosis by World Health Organization criteria) versus 47.3 percent of the postmenopausal reference group (P = 0.042). In conclusion, the present data indicate that BMD is significantly lower in patients with POI than in age-matched premenopausal women. Also, the prevalence of osteopenia/osteoporosis is higher in POI women than in women after natural menopause. Early medical interventions are necessary to ensure that women with POI will maintain their bonemass.

Metabolic effects of streptozotocin-induced diabetes in ovarectomized rats

Little information is available about how the changes that occur around the time of menopause might affect management of diabetes mellitus .The present study investigates the metabolic consequences of estrogen deficiency with streptozotocin induced-diabetes. The study was performed on 130 female Wistar rats, allocated into 4 groups: control [Sham]; diabetic [STZ]; ovarectomized [OVX] and ovarectomized diabetic [OVX-STZ] .Rats were subjected to determination of body weight and body mass index [BMI]. Estimation of blood glucose, plasma levels of insulin, estradiol, leptin, malondialdehyde, lipids, atherogenic index as well as in vitro diaphragmatic glucose uptake and renal glucose output. OVX- STZ rats showed significantly lower body weight and BMI than OVX rats. Blood glucose level was significantly higher than Sham, STZ and OVX groups. Diaphragmatic glucose uptake significantly decreased, while renal glucose output significantly increased compared to OVX and Sham groups .Plasma lipid profile in OVX-STZ rats was worse than Sham, STZ and OVX groups as indicated by the significant increase in plasma triglycerides, total plasma cholesterol and LDL-c. Atherogenic index was significantly higher than Sham and OVX rats. Similarly, lipid peroxidation was significantly higher than Sham, STZ and OVX groups. Plasma insulin decreased significantly compared to Sham, STZ and OVX groups, while the decrease in plasma leptin was significant when compared to Sham group. The present study demonstrates that metabolic derangements of combined insulin and estrogen deficiency overweigh the derangement of either hormone deficiency in postmenopausal period

Síndrome metabólica e menopausa: estudo transversal em ambulatório de ginecologia / Metabolic syndrome and menopause: cross-sectional study in gynecology clinic / Síndrome metabólico y menopausia: estudio transversal en ambulatorio de ginecología

FUNDAMENTO: No Brasil, são escassos os estudos sobre síndrome metabólica na população geral, mais raros são os que a correlacionam ao climatério. OBJETIVO: Determinar a prevalência da síndrome metabólica e seus componentes em mulheres climatéricas. MÉTODOS: Estudo transversal com 323 mulheres climatéricas, divididas em dois grupos: pré e pós-menopausadas. Foram avaliadas para presença de síndrome metabólica, segundo os critérios do National Cholesterol Education Program's (NCEP) e da International Diabetes Federation (IDF). Foi verificada a associação entre as variáveis estudadas e a síndrome metabólica por meio de análise uni e multivariada. Um p-valor < 0,05 foi considerado significante estatisticamente. RESULTADOS: A prevalência de síndrome metabólica no climatério foi de 34,7 por cento (NCEP) e de 49,8 por cento (IDF). Os componentes mais frequentes da síndrome metabólica foram o HDL-colesterol baixo, hipertensão arterial, obesidade abdominal, hipertrigliceridemia e diabete em ambos os critérios. A análise multivariada mostrou que a idade foi o fator de risco mais importante para o surgimento da síndrome metabólica (p < 0,001), que esteve presente em 44,4 por cento (NCEP) e 61,5 por cento (IDF) das mulheres menopausadas em comparação a 24 por cento (NCEP) e 37 por cento (IDF) daquelas na pré-menopausa. CONCLUSÃO: A prevalência de síndrome metabólica foi maior nas mulheres menopausadas que naquelas na pré-menopausa. O principal fator de risco para o aumento dessa prevalência foi a idade. A menopausa, quando analisada isoladamente, não se constituiu um fator de risco para a síndrome metabólica.

BACKGROUND: In Brazil, there are few studies of the metabolic syndrome in the general population, and even fewer studies that establish a correlation between metabolic syndrome and climacteric. OBJECTIVE: To determine the prevalence of metabolic syndrome and its components among climacteric women. METHODS: Cross-sectional study with 323 climacteric women, divided into two groups: pre and post-menopausal. They were examined for the presence of metabolic syndrome, according to the criteria of National Cholesterol Education Program's (NCEP) and International Diabetes Federation (IDF). It was possible to notice the association between the variables under study and the metabolic syndrome by conducting a univariate analysis and a multivariate analysis. A p-value < 0.05 was considered statistically significant. RESULTS: The prevalence of metabolic syndrome during the climacteric was 34.7 percent (NCEP) and 49.8 percent (IDF). The most frequent components of the metabolic syndrome were low HDL-cholesterol, hypertension, abdominal obesity, hypertriglyceridemia and diabetes in both criteria. The multivariate analysis showed that age was the most important risk factor for the development of metabolic syndrome (p < 0.001), which was present in 44.4 percent (NCEP) and 61.5 percent (IDF) of postmenopausal women compared to 24 percent (NCEP) and 37 percent (IDF) of premenopausal women. CONCLUSION: The prevalence of metabolic syndrome was higher in postmenopausal women than in premenopausal women. The main risk factor for the increase in this prevalence was age. Menopause, when it is analyzed alone, did not constitute a risk factor for metabolic syndrome.

FUNDAMENTO: En Brasil, son raros los estudios sobre síndrome metabólico en la población general, más raros son los que la correlacionan al climaterio. OBJETIVO: Determinar la prevalencia del síndrome metabólico y sus componentes en mujeres climatéricas. MÉTODOS: Estudio transversal con 323 mujeres climatéricas, divididas en dos grupos: pre y posmenopáusicas. Se evaluaron para presencia de síndrome metabólico, según los criterios del NCEP y de la IDF. Se verificó la asociación entre las variables estudiadas y el síndrome metabólico por medio de análisis uni e multivariado. Un p-valor < 0.05 fue considerado significante estadísticamente. RESULTADOS: La prevalencia de síndrome metabólico en el climaterio fue de un 34,7 por ciento (NCEP) y de un 49,8 por ciento (IDF). Los componentes más frecuentes del síndrome metabólico fueron el HDL-colesterol bajo, hipertensión arterial, obesidad abdominal, hipertrigliceridemia y diabetes en ambos criterios. El análisis multivariado evidenció que la edad fue el factor de riesgo más importante para el surgimiento del síndrome metabólico (p<0.001), que estuvo presente en un 44,4 por ciento (NCEP) y un 61,5 por ciento (IDF) de las mujeres menopáusicas en comparación a 24 por ciento (NCEP) y el 37 por ciento (IDF) de aquellas en la premenopausia. CONCLUSIÓN: La prevalencia de síndrome metabólico fue mayor en las mujeres menopáusicas que en aquellas en la premenopausia. El principal factor de riesgo para el aumento de esta prevalencia fue la edad. La menopausia, cuando analizada aisladamente, no se constituyó un factor de riesgo para el síndrome metabólico.

Atención sostenida asociada con hormonas ováricas en mujeres en la premenopausia y posmenopausia / Sustained attention associated to ovarian hormones in premenopausal and posmenopausal women

El objetivo fue asociar la atención sostenida medida con la Prueba de Ejecución Continua con los niveles hormonales de LH, FSH, progesterona, estrona y estradiol en 10 mujeres en la posmenopausia y 10 en la premenopausia. Este último grupo fue evaluado en la fase menstrual, con bajos niveles hormonales y en la fase ovulatoria, con altos niveles hormonales. Se analizó el número de aciertos, errores, omisiones y tiempo de reacción en dos niveles de dificultad de la prueba. El número de aciertos en el segundo nivel de dificultad de la prueba de las mujeres premenopáusicas, en fase ovulatoria, fue mayor (p=0.019) y cometieron menos errores (p=0.019) comparadas con las mujeres en la posmenopausia. En la posmenopausia, el número de aciertos se asoció positivamente con la progesterona (p<0.0001), FSH (p<0.001) y estrona (p<0.0001) y negativamente con LH (p<0.03). En la premenopausia, en fase menstrual, los aciertos se asociaron negativamente con progesterona (p<0.0001), LH (p<0.0001) y estrona (p<0.0001). En la fase ovulatoria, los aciertos se asociaron positivamente con FSH (p<0.0001), progesterona (p<0.0001) y estrona (p<0.0001) y negativamente con LH (p<0.0001). Estos resultados sugieren que las hormonas sexuales pueden influir en la atención sostenida en mujeres en la transición hacia la menopausia.

The aim was to associate the sustained attention, measured by means of the Continuous Performance Test with hormonal levels of FSH, LH, progesterone, estradiol and estrone, in ten posmenopausal women and ten premenopausal women. This last group was evaluated in menstrual phase, with low hormonal levels, and during the ovulatory phase, with high hormonal levels. The number of correct responses, errors, omissions and reaction time during two levels of difficult of the test were obtained. The number of correct responses made by the premenopausal women in the ovulatory phase was high (p=0.019),and they committed less errors (p=0.019) during the second level of difficult of test compared with posmenopausal women. In the posmenopause, the number of correct responses was positively associated with progesterone (p<0.0001), FSH(p<0.001), and estrone (p<0.0001), and negatively associated with LH (p<0.03). In the premenopause, in menstrual phase, the correct responses were negatively associated with progesterone (p<0.0001), LH (p<0.0001) and estrone (p<0.0001). In the ovulatory phase, the correct responses were positively correlated with FSH (p<0.0001), progesterone (p<0.0001) and estrone (p<0.0001), and negatively with LH (p<0.0001). These findings suggest that the sex hormones may influence on sustained attention in women in transition to menopause.

Effects of Self-Foot Reflexology on Stress, Fatigue and Blood Circulation in Premenopausal Middle-Aged Women

PURPOSE: This study was to examine the effects of self-foot reflexology on stress, fatigue and blood circulation in premenopausal middle-aged women. METHODS: A quasi-experimental nonequivalent control group, pretest-posttest design was used. Participants were 59 premenopausal, middle-aged women in their 40s and 60s living in G city: 30 in the experiment group and 29 in the control group. Data were collected from May to August 2008. Self-foot reflexology was performed three times a week for 6 weeks for 40 min at each session. RESULTS: The results showed that self-foot reflexology was effective in reducing perceived stress and fatigue and helped blood circulation in premenopausal middle-aged women. CONCLUSION: Self-foot reflexology may be an effective nursing intervention in reducing perceived stress and fatigue and in improving blood circulation.

Redução da densidade mineral óssea em mulheres na menacme com prolactinoma / Decreased bone mineral density in pre-menopause women with prolactinoma

A hiperprolactinemia tumoral e conseqüente hipogonadismo têm sido associados à osteoporose. Avaliamos a densidade mineral óssea (DMO) por absortometria com dupla fonte de RX em 24 mulheres entre 18 e 49 anos, com prolactinoma (15 macro e 9 micro). Utilizamos teste t de Student não pareado ou Mann-Whitney para comparar subgrupos, e teste de Spearman para correlações. O maior acometimento foi de coluna lombar, onde 20,83 por cento das pacientes tinham Z-escore < -2 DP. Não detectamos diferenças densitométricas entre macro e microprolactinomas, nem entre pacientes com prolactina normal versus as hiperprolactinêmicas. A DMO e o Z-escore na coluna foram maiores nas pacientes com > 8 ciclos menstruais no ano anterior à densitometria versus as oligoamenorréicas (p = 0,030). O número de ciclos/ano correlacionou-se com a DMO na coluna (r = 0,515, p = 0,017), e o índice de massa corporal, com a DMO em colo femural (r = 0,563, p = 0,006) e fêmur total (r = 0,529, p = 0,011). Conclusões: Em nossa amostra de mulheres jovens com prolactinoma, 20,83 por cento têm densidade óssea abaixo do esperado para a idade. O maior acometimento de regiões ricas em osso trabecular, como as vértebras, sugere a participação do hipogonadismo na gênese da doença óssea. Independentemente dos valores séricos de prolactina, o retorno dos ciclos menstruais parece ser o melhor índice de bom controle dessas pacientes.

Tumoral hyperprolactinemia and consequent hypogonadism have been associated with osteoporosis. Bone mineral density (BMD) was measured by dual-energy RX absorptiometry in 24 patients with prolactinoma (15 macro and 9 micro adenomas; age range = 18 to 49 years). Student unpaired t or Mann-Whitney tests were used to compare groups, and Spearman test studied correlations. Lumbar spine (LS) was the most affected, as LS Z-score was < -2 SD in 20.83 percent of the patients. No difference was found in densitometric parameters for the comparison between macro and microprolactinoma, or those with normal prolactin versus hyperprolactinemia. LS BMD and LS Z-score were higher in the patients with > 8 menstrual cycles in the preceding year then in those with oligoamenorrhea (p = 0.030). The number of cycles was correlated to LS BMD (r = 0.515, p = 0.017) and body mass index to femoral neck BMD (r = 0.563, p = 0.006) and total femur BMD (r = 0.529, p = 0.011). CONCLUSIONS: Decreased bone mineral density was detected in 20.83 percent of our young patients with prolactinoma. The great involvement of trabecular bone skeletal regions, such as vertebrae, suggests the participation of hypogonadism in the pathogenesis of bone disease. Irrespective of prolactin levels, return to normal menses seems the best index of good control.

Effect of exercise on rate pressure product in premenopausal and postmenopausal women with coronary artery disease.

Incidence of coronary artery disease (CAD) increases sharply after menopause in women. Rate pressure product (RPP) is a major determinant of cardiac oxygen consumption. It is an important indicator of ventricular function. RPP varies with exercise. The peak rate pressure product (PRPP) which gives an accurate reflection of the myocardial oxygen demand and myocardial workload is the RPP at peak of exercise. The higher the PRPP, the more will be myocardial oxygen consumption (MVO2). The ability to reach higher PRPP is associated with more adequate coronary perfusion. Thus the low value of PRPP suggests significant compromise of coronary perfusion and decreased left ventricular function. In the present study effect of exercise on RPP of pre and postmenopausal women with CAD was compared. The percentage increase in RPP was significantly more in postmenopausal women with CAD (62%) as compared to premenopausal women with CAD (54%) indicating more compromised coronary perfusion in postmenopausal women.

Menopause, estrogens, and endothelial dysfunction: current concepts

Menopause is defined as the permanent cessation of menses. Cardiovascular disease is the leading cause of death among postmenopausal women in developed countries. The disparity between the incidence of cardiovascular disease among women in pre- and postmenopause has been ascribed to the actions of endogenous estrogen on the cardiovascular system and, particularly, on the vascular endothelium. The endothelium plays an important role in cardiovascular homeostasis, either through the vascular tonus and its regulation, or through coagulation and the inflammatory response. Endothelial dysfunction is implicated in the genesis of atherosclerosis and other chronic disorders, such as diabetes mellitus and hypertension. The pharmacological use of estrogen exerts influence on the circulating levels of markers of vascular tonus, and inflammation, as well as prothrombotic, and fibrinolytic markers, but the impact of these changes on the atherosclerotic disease is still uncertain.

A menopausa é definida como a cessação permanente das menstruações. A doença cardiovascular é a principal causa de mortalidade em mulheres na pós- menopausa, em países desenvolvidos. A disparidade entre a incidência de doença cardiovascular entre mulheres na pré e pós menopausa tem sido atribuída a ações do estrogênio endógeno sobre o sistema cardiovascular e, em especial, sobre a função do endotélio vascular. O endotélio tem importante papel na homestase cardiovascular, seja no controle do tônus e permeabilidade vascular, ou da coagulação e resposta inflamatória. A disfunção endotelial está implicada na gênese da aterosclerose e de outras doenças crônicas, como diabete melito e hipertensão arterial. O uso farmacológico de estrogênio exerce influência sobre concentrações circulantes de marcadores do tônus vascular, inflamatórios, pró-trombóticos e fibrinolíticos, porém o impacto destas alterações sobre a doença aterosclerótica ainda não está determinado.

Principais causas de diminuição da massa óssea em mulheres na pré-menopausa encaminhadas ao ambulatório de doenças ósteo-metabólicas de um Hospital Terciário de Curitiba / Main causes of low bone mass in premenopausal women referred to a Metabolic Bone Clinic of Curitiba / Main causes of low bone mass in premenopausal women referred to a Metabolic Bone Clinic of Curitiba

Selecionamos mulheres pré-menopausadas com redução da DMO encaminhadas ao ambulatório de Metabolismo Osseo do Hospital de Clínicas da UFPR, com o objetivo de definirmos o perfil destas pacientes em relação aos fatores de risco e prováveis causas secundárias de osteoporose. Trinta e quatro mulheres foram estudadas (19­48 anos). Em 29 pacientes (85,3 por cento) a coluna lombar estava acometida, 8 (23,5 por cento) apresentaram Z-score < -2,5 e 21 (61,8 por cento) Z-score entre -1,0 e -2,5. Vinte pacientes (58,8 por cento) apresentaram redução da DMO em fêmur, 2 (6,2 por cento) com Z-score < -2,5 e 18 (56,2 por cento) com Z-score entre -1,0 e -2,5. Causa secundária foi identificada em 26 pacientes (76,5 por cento). Este estudo demonstra que a realização de densitometria óssea é importante em mulheres na pré-menopausa com fatores de risco para redução da massa óssea, uma vez que permite o início precoce do tratamento e a prevenção das complicações relacionadas.

We conducted a chart review of premenopausal women with low bone mineral density referred to the Metabolic Bone Clinic of Federal University of Paraná, to determine the outline of these patients regarding their risk factors and secondary causes of osteoporosis. Thirty-four women (19­48 years old) were evaluated. Twenty nine (85.3 percent) patients presented a low bone mineral density (BMD) in lumbar spine, 8 (23.5 percent) had Z-score < -2.5 and 21 (61.8 percent) had Z-score between -1.0 and -2.5. Twenty patients (58.8 percent) had a low bone mass in total femur, 2 (6.2 percent) with Z-score < -2.5 and 18 (56.2 percent) with Z-score between -1.0 and -2.5. A secondary cause could be identified in 26 patients (76.5 percent). This study shows that DMO is important in premenopausal women with risk factors of low BMD because it leads to the best treatment option and follow-up.

Qualidade do sono em mulheres paulistanas no climatério / Quality of sleep of climacteric women in São Paulo: some significant aspects

OBJETIVO: O climatério é um período de grandes transformações em que a qualidade do sono usualmente se deteriora. O objetivo foi avaliar subjetivamente a qualidade do sono em mulheres no climatério (35 a 65 anos). MÉTODOS: Um questionário contendo informações pessoais, hábitos/saúde, sexualidade e sono foi aplicado a 271 mulheres. RESULTADOS: A amostra estudada constituiu-se principalmente de mulheres casadas, ativas profissionalmente, de alta condição econômica e escolaridade, não usuárias de terapêutica hormonal da menopausa (THM), com hábito freqüente de ingerir café e com pouco consumo de álcool/tabaco. A maioria das participantes tinha hábito de jantar e de praticar atividade física. A avaliação subjetiva da qualidade do sono foi considerada ruim por 29 por cento das mulheres da amostra. A menopausa e a autopercepção de saúde foram as únicas variáveis que exibiram relação estatisticamente significante com a qualidade do sono. Mulheres na perimenopausa (ou seja, entre 45 anos e até um ano após a menopausa) e após menopausa cirúrgica declararam a pior qualidade de sono, enquanto mulheres na pré-menopausa revelaram a melhor qualidade de sono. Mulheres que se consideravam saudáveis informaram melhor qualidade de sono do que as que declararam problemas de saúde. CONCLUSÃO: A qualidade do sono piora durante o climatério e nas mulheres que se percebem doentes; ademais, há um grande desconhecimento de regras básicas de higiene do sono entre as mulheres.

Four years follow-up of bone mineral density change in premenopausal women with systemic lupus erythematosus.

OBJECTIVE: To measure the change in bone mineral density (BMD) in premenopausal women with systemic lupus erythematosus (SLE) during 4 years of follow-up, and to identify the role of glucocorticoid and disease related variables. METHOD: Premenopausal women with SLE were clinically evaluated and underwent BMD measurement of the lumbar spine, femoral neck and trochanter by dual energy x-ray absorptiometry. RESULTS: 106 SLE patients were evaluated with a mean age of 31.7 +/- 7.5 years, duration of SLE 2.5 +/- 2.6 years, mean daily dose 17.1 +/- 14 mg/d, duration of prednisolone treatment 16.3 +/- 19.9 months during 4 years of follow-up. There was no significant change in BMD at the lumbar spine (1.051 +/- 0.15 vs 1.052 +/- 0.14 vs 1.056 +/- 0.17 vs 1.056 +/- 0.19; p = 0.27), femoral neck (0.861 +/- 0.12 vs 0.867 +/- 0.12 vs 0.846 +/- 0.12 vs 0.844 +/- 0.12, p = 0.28) and trochanter (0.718 +/- 0.12 vs 0.726 +/- 0.13 vs 0.717 +/- 0.13 vs 0.709 +/- 0.14; p = 0.26) at the baseline, first, second and fourth year follow-up study. Furthermore, annual percentage BMD changes were not significant in lumbar BMD (p = 0.37), femoral neck BMD (p = 0.65) and trochanteric BMD (p = 0.47) during the 4 years follow-up study. The average annual percentage change of BMD was not significantly associated with change in age, body mass index (BMI), disease activity, disease severity, disease duration and prednisolone treatment. In addition, there were no significant bone changes between subgroups treated with < or = 7.5 mg and > 7.5 mg daily dose of prednisolone as indicated by BMD at the lumbar spine, femoral neck and trochanter as well as annual percentage BMD changes over the study period. CONCLUSION: There was no significant change of lumbar spine, femoral neck or trochanteric BMD in premenopausal SLE women treated with corticosteroid. These findings suggest that low dose prednisolone may not be detrimental to bone in premenopausal women with SLE during longterm treatment.