Résumé
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.
Sujets)
Femelle , Humains , Maladies cardiovasculaires/étiologie , Climatère/physiologie , Qualité de vie , Maladies cardiovasculaires/induit chimiquement , Chili , Climatère/effets des médicaments et des substances chimiques , Oestrogénothérapie substitutive/effets indésirables , Hormones sexuelles stéroïdiennes/usage thérapeutique , Mode de vie , Facteurs de risque , Sociétés médicalesRésumé
El objetivo de este documento es entregar una guía práctica de tratamiento del climaterio, debido a la confusión producida por el estudio WHI en 2002. La TH debe ser solo utilizada cuando exista una indicación clara para su uso. La paciente sintomática es la principal beneficiada del tratamiento. No existe un tratamiento alternativo a los estrógenos o estrógeno/progestina tan eficaz en el alivio de la sintomatología y en reducción de fracturas. La indicación de un tratamiento prolongado debe ser revisada anualmente.
Sujets)
Humains , Femelle , Ménopause , Hormonothérapie substitutive/effets indésirables , Hormonothérapie substitutive/normes , Climatère , Oestrogènes/administration et posologie , Guides de bonnes pratiques cliniques comme sujet , Progestines/administration et posologie , Chlorhydrate de raloxifène/administration et posologie , Hormonothérapie substitutiveRésumé
La menopausia se asocia a un demostrado aumento del riesgo de enfermedad cardiovascular y de osteoporosis, lo que justifica el uso de terapia hormonal de reemplazo. Como ésta se plantea por tiempo prolongado, debe ser efectiva en prevenir las complicaciones y en suprimir el síndrome climatérico. Se estudió la eficacia de la asociación de valerato de estradiol (VE) y acetato de ciproterona (CPA) en la reducción de los síntomas asociados a menopausia. Se analizaron, prospectivamente, 342 mujeres durante 6 meses, consignando la intensidad de sus síntomas y los cambios en peso, presión arterial y parámetros bioquímicos. Las oleadas de calor, así como otros síntomas y signos, disminuyeron en intensidad. No hubo diferencia significativa en la evolución del peso ni de la presión arterial, aunque sí en algunos parámetros del perfil lipídico y hepático. Se concluye que la asociación VE y CPA reduce la intensidad de los síntomas climatéricos en el grupo estudiado
Sujets)
Humains , Femelle , Adulte d'âge moyen , Climatère/effets des médicaments et des substances chimiques , Cyprotérone/pharmacologie , Association de médicaments , Oestradiol/pharmacologie , Poids/effets des médicaments et des substances chimiques , Dyspareunie/traitement médicamenteux , Hormonothérapie substitutive , Bouffées de chaleur/traitement médicamenteux , Menstruation , Pression sanguine , Études prospectives , Sommeil , Résultat thérapeutique , Incontinence urinaire/traitement médicamenteuxRésumé
Background: There is no consensur about the ideal antimicrobial agent and duration of treatment for urinary tract infection in women. Aim: To assess the efficacy of a five days course of ciprofloxacion for the treatment of urinary tract infection in women. Patients and methods: Women with urinary tract infection were treated with ciprofloxacin (Baycip, Bayer) 250mg bid during 5 days. Patients were evaluated three to four days after treatment start, two to seven days and one month after treatment end. Results: Of 101 eligible women, 96 aged 18 to 65 years old, coming from three major Chilean cities, participated in the study and 80 completed the follow up period. There was a 95 percent clinical success, 2.5 percent partial improvement and 2.5 percent treatment failure. The causal microorganism was erradicated in 90 percent of cases, in 1.2 percent treatment failed and in 8.7 percent a re-infection occurred. Adverse effects attributable to the drug were observed in 12 patients (headache in 3, gastrointestinal disturbances in 8, somnolence in 1 and irritability in 1). Conclusions: Ciprofloxacin is an useful antimicrobial for the treatment of lower urinary tract infection in women