Transdermal estrogen therapy effects on fibrinogen levels in women with a past history of venous thromboembolism: a pilot study.

OBJECTIVE: To evaluate thromboelastographic parameters and fibrinogen levels in women treated with transdermal 17beta estradiol. METHODS: 29 menopausal women with a history of venous thromboembolic disease were included. Nine patients composed the treatment (HT) group and 20 the control group. Coagulation was assessed by thromboelastography in samples of whole blood and platelet-poor plasma (PPP). The following thromboelastographic variables were measured: time for initial coagulation (R), blood clotting speed (K and the alpha angle), clot tensile strength (MA and G), global index of coagulation (CI) and fibrinolysis (LY30) and fibrinogen levels. RESULTS: There were no differences in the other parameters comparing both groups. Fibrinogen levels showed a 13.77 +/- 19.94% reduction in the HT group and a 5.51 +/- 8.09% increase in the control group after 6 months. CONCLUSIONS: Our data suggested that transdermal estrogen may not increase blood coagulability, but that it reduces fibrinogen levels in HT women.

The effects of cinnarizine on menopausal symptoms in women.

OBJECTIVE: To evaluate the effectiveness and safety of cinnarizine in the treatment of menopausal symptoms. DESIGN: A total of 100 climacteric and symptomatic women participated in a double-blind, placebo-controlled study. They were divided into two groups of the same size: Gcin, intake of 25 mg of cinnarizine every 12 h for 6 months (n=50); and Gpla, placebo intake every 12 hours for 6 months (n=50). Menopausal symptoms were evaluated according to the Kupperman menopausal index on the first visit and at 6 months of treatment. A total of 62 women completed the study: 27 from the Gcin group and 35 from the Gpla group. RESULTS: Based on the Kupperman menopausal index, there were no statistically significant differences between the two groups before and after the treatment. CONCLUSION: Our data suggest cinnarizine is not effective on menopausal symptoms because it had no more efficacy than placebo.

Acupuncture-ameliorated menopausal symptoms: single-blind, placebo-controlled, randomized trial.

OBJECTIVES: To evaluate the effects of acupuncture and sham-acupuncture on women with menopausal symptoms as reflected in the intensity of their hot flushes and the Kupperman Menopausal Index (KMI). METHOD: This was a randomized, single-blind, placebo-controlled, cross-over trial with 81 patients assigned to two groups: Group 1 received 12 months of acupuncture, then 6 months of sham-acupuncture treatment (n = 56) and Group 2 received 6 months of sham-acupuncture, then 12 months of acupuncture treatment (n = 25). The needles were inserted in a harmonic craniocaudal manner at a depth of about 2 cm, and each session lasted approximately 40 min. The efficacy of acupuncture in ameliorating the climacteric symptoms of patients in postmenopause was determined through the KMI and the intensity of hot flushes. The analysis of variance method for two factors and repeated measures was applied. RESULTS: The baseline values of the women in both groups were similar for the KMI score and number of hot flushes. At the end of 6 months, the values for the KMI and hot flushes for the women in Group 1 were lower than those of the women in Group 2 (p < 0.05). After 12 months, the KMI and hot flush data were similar in both groups. After 18 months, the values of the KMI and hot flushes for the women in Group 2 for were lower than those of the women in Group 1 (p < 0.05). CONCLUSION: Acupuncture treatment for relieving menopausal symptoms may be effective for decreasing hot flushes and the KMI score in postmenopausal women.

Hormone therapy in Brazilian postmenopausal women with chronic hepatitis C: a pilot study.

OBJECTIVE: To evaluate liver function and hemostatic parameters in postmenopausal women who have chronic infection with the hepatitis C virus and climacteric symptoms and are undergoing hormone therapy (HT) (standard dose of transdermal continuous combined hormone therapy). DESIGN: Fifty out of 336 postmenopausal patients with chronic infection with the hepatitis C virus were selected. The non-inclusion criteria were other chronic or systemic liver diseases, severe vascular diseases, autoimmune diseases or malignant tumors. The patients were randomized into two groups: the HT group with 25 patients to be given transdermal hormone therapy (50 microg estradiol plus 170 microg norethisterone/day) and the control group with the other 25 patients (no medication). Hepatic tests (alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, total alkaline phosphatase, albumin, serum bilirubin) and hemostatic parameters (prothrombin time, factor V, fibrinogen) were evaluated at baseline and at 1, 4, 7 and 9 months of treatment. RESULTS: No significant changes in parameters were found in the comparison between the treated group and the controls, except for a decrease in total alkaline phosphatase (p = 0.002), presumably due to changes in bone remodelling. CONCLUSIONS: There were no changes in liver function after a 9-month treatment with transdermal estradiol plus norethisterone in symptomatic postmenopausal patients with hepatitis C.

Effects of the addition of methyltestosterone to combined hormone therapy with estrogens and progestogens on sexual energy and on orgasm in postmenopausal women.

OBJECTIVE: To evaluate the effect of the addition of methyltestosterone to estrogen and progestogen therapy on postmenopausal sexual energy and orgasm. METHODS: Sixty postmenopausal women in a stable relationship with a partner capable of intercourse, and presenting sexual complaints that appeared after menopause, were randomly divided into two groups: EP (n = 29) received one tablet of equine estrogens (CEE) 0.625 mg plus medroxyprogesterone acetate (MPA) 2.5 mg and one capsule of placebo; EP + A (n = 31) received one tablet of CEE 0.625 mg plus MPA 2.5 mg and one capsule of methyltestosterone 2.0 mg; The treatment period was 12 months. The effects of treatment on sexual energy were assessed using the Sexual Energy Change Scale. The ability to reach orgasm in sexual relations with the partner was verified through monthly calendars and by calculating the ratio between monthly frequency of orgasms in sexual relations and monthly sexual frequency. RESULTS: There was a significant relationship between improvement in level of sexual energy and the addition of methyltestosterone to CEE/MPA treatment (p = 0.021). No significant effect on orgasmic capacity was noted after the treatment period. CONCLUSION: Addition of methyltestosterone to CEE/MPA therapy may increase sexual energy, but might not affect the ability to obtain orgasm in sexual relations.

Monophasic estrogen-progestogen therapy and sexuality in postmenopausal women.

OBJECTIVE: This study aimed to evaluate the effects of monophasic estrogen-progestogen therapy on the sexuality and climacteric symptoms of postmenopausal women. PATIENTS AND METHODS: A prospective, randomised, double-blind, crossover, placebo-controlled, single-centre study was carried out over a total of 12 consecutive months in 40 postmenopausal women with an intact uterus who had no contraindications to hormone therapy. Patients received 17beta-estradiol 2mg in combination with norethisterone acetate 1mg (Cliane) daily for 6 months or one placebo tablet daily for 6 months. The tablets were identical in appearance. After 6 months, the groups were crossed over and the patients were followed up for another 6 months. The groups were homogenous with respect to age, height, bodyweight, body mass index and race. For the statistical analysis, the group receiving hormone therapy was referred to as group A and the placebo group was designated group B, irrespective of the placebo/hormone therapy sequence. RESULTS: In group A there were fewer hot flashes (F=22.85, p<0.01) and an improvement in sexual interest (F=5.55, p<0.05). The sequence in which the medication was received resulted in a statistically significant difference with respect to dyspareunia (F=9.65, p<0.01) and satisfaction with the duration of penetration (F=6.58, p<0.05). In the intrapatient analysis of variation with respect to orgasmic capability and the presence of dialogue with partner regarding the couple's sexual life, whether the placebo was taken prior to or following hormone therapy was significant (F=17.12, p<0.001 and F=7.10, p<0.05, respectively). CONCLUSIONS: Monophasic estrogen-progestogen therapy has a beneficial effect on sexuality and on hot flashes in postmenopausal women.

Sexuality in healthy postmenopausal women.

OBJECTIVE: To assess the influence of psychosocial factors, behavior and hormones on postmenopausal sexuality. METHODS: Nine hundred and ninety-nine women (age range 41-60 years) underwent physical and supplementary tests and answered questionnaires regarding sexual behavior. Sixty healthy women with 1 or more years of amenorrhea, without hormone replacement therapy and with a partner capable of intercourse were chosen from this group. Logistic regression models with dependent variables (sexual satisfaction and orgasmic capacity) and independent variables (sexual initiation, psychosocial factors, behavior, relationship, menopause and hormones) were developed. RESULTS: Important variables for sexual satisfaction were: good self-esteem (p< 0.01), first orgasm obtained by masturbation (p = 0.004), major personal income (p = 0.007), sexual initiation in adulthood (p = 0.008), value physical contact with partner (p = 0.021) and major orgasmic capacity p = 0.040). The following contributed (towards orgasmic capacity with the partner: sexual initiation in adulthood (p = 0.012), regular physical activity (p = 0.040) and higher testosterone levels (p = 0.050). CONCLUSIONS: The importance of relationship, psychological, hormonal, economic and behavioral factors confirm the complexity of sexuality, and we note that current as well as prior events seem to affect the sexual satisfaction and orgasmic capacity of healthy postmenopausal women.

Colpocitologia em ambulatório de ginecologia preventiva / Colpocytology in a preventive gynecological ambulatory

OBJETIVOS: Avaliar os resultados de colpocitologia oncótica de mulheres atendidas em ambulatório de ginecologia preventiva (Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo). MÉTODOS: Foram estudadas 6821 mulheres submetidas a exame clínico e ginecológico com realizaçäo de colpocitologia oncótica pela técnica de Papanicolaou. Estas mulheres foram consideradas conforme a faixa etária em três grupos: abaixo de 40 anos, entre 41 e 60 anos e acima de 60 anos. RESULTADOS: Amaioria das mulheres reconhecem tanto a necessidade da colpocitologia como sua periodicidade, principalmente entre as mais jovens. As mulheres acima de 60 anos eram as que mais referiam (54,1 por cento) näo conhecer a necessidade da colpocitologia oncótica, nem sua periodicidade (58,8 por cento); o grupo que melhor referia conhecimento da necessidade e periodicidade da colpocitologia oncótica foi o de mulheres entre 40 e 60 anos. O material foi considerado insuficiente para análise em 15,1 por cento ou inadequado em 1,1 por cento, sendo os resultados: classe I (21,7 por cento), II (59,9 por cento), III (2,0 por cento), IV (0,1 por cento) e V (0,1 por cento). Näo houve diferença significativa em relaçäo à distribuiçäo dos casos de neoplasia intraepitelial (NIC) entre as faixas etárias. O achado microbiológico mais freqüente foi Gardnerella sp. (8,6 por cento). Presença de papilomavírus humano (HPV) foi significativamente menor nas mulheres acima de 60 anos. CONCLUSÖES: O diagnóstico de alteraçöes colpocitológicas relacionadas a neoplasias foi de 2,2 por cento com detecçäo de Gardnerella sp. como o agente microbiológico mais prevalente por este método. A distribuiçäo de infecçäo pelo HPV mostrou declínio com o aumento da faixa etária. As mulheres mais velhas foram as que menos apresentavam conhecimento sobre a realizaçäo de colpocitologia

[Colpocytology in a preventive gynecological ambulatory service]. / Colpocitologia em ambulatório de ginecologia preventiva.

BACKGROUND: evaluate the results of Pap smear in women attended at a gynecology preventive ambulatory (University of São Paulo Medical School Clinical Hospital). METHODS: 6821 women were submitted to a medical interview, clinical and gynecologic exam. Cervical and vaginal cytology (Pap smear) were analyzed according to the Papanicolaou method and classification. All women were grouped according to their age into three categories:under 40 years old, between 41 and 60 years and over 60 years. RESULTS: most of them, and mainly the younger ones, had been submitted to a previous Pap smear in a period shorter than 1 year (44.2%). The majority of women recognized the usefulness of the exam and knew its interval; the group that best knew its importance and interval was the one with ages between 41 and 60 years, while most women over 60 years did not know both its importance and interval. Cytological material was considered insufficient for analysis in 15,1% and inadequate in 1.1%, and for those with adequate material results were classes I (21.7%), II (59.9%), III (2.0%), IV (0.1%) and V (0.1%). Distribution of cervical intraepithelial neoplasia (CIN) were similar in the three groups. The main microbiologic findings was Gardnerella sp. (8,6%) and Human papillomavirus (HPV) incidence was significantly lower among women over 60 years. CONCLUSION: Cytological diagnoses of neoplastic modifications were performed in 2,2% and Gardnerella sp. was the most prevalent microbiologic agent. Distribution of HPV showed a decrease with age. Older women had lower knowledge on the importance of regular Pap smear examination.

Endometrial prolactin in hyperprolactinemic women.

OBJECTIVE: To observe the behavior of endometrial prolactin in hyper- and normoprolactinemic women. METHOD: Forty women were selected due to alterations in menstrual cycle and/or galactorrhea and/or sterility. Patients were divided into two groups: Group A, 19 hyperprolactinemic women; and Group B, 21 normoprolactinemic women. Their mean age was 28.3 years. Laboratory assessments were carried out in the initial follicular phase (days 3-9), initial luteal phase (days 15-21), and late luteal phase (days 22-29) in menstruating women (samples 1, 2 and 3, respectively). In the non-menstruating women, samples were collected on days 1, 14 and 21 after the initial appointment (samples 1, 2 and 3, respectively). LH, FSH, prolactin and estradiol were measured in sample 1, while prolactin and progesterone were measured in samples 2 and 3. All women were submitted to two biopsies of the endometrium for observing the menstrual cycle, dating, and immunohistochemical detection of endometrial prolactin. Biopsies were obtained simultaneously to samples 2 and 3. To compare the two groups, Student's t-tests or Mann-Whitney statistics were performed. RESULT: Results showed that the mean percentage of endometrial prolactin were higher in the late luteal phase compared to the initial one in hyper- and normoprolactinemic women. CONCLUSION: The data allowed us to conclude that serum prolactin is not correlated to endometrial prolactin, and that the synthesis of the latter is directly correlated to the differentiation of stromal cells, that is induced by progesterone in a decidualized endometrium.

The effects of systemic hormonal replacement therapy on the skin of postmenopausal women.

OBJECTIVE: The aim of this study was to determine the effects of hormonal replacement therapy on the skin of postmenopausal women. METHOD: Forty-one postmenopausal women were randomly allocated to receive either hormonal replacement (valerate estradiol--2 mg/day for 21 days and cyproterone acetate--1 mg/day for 10 days) or placebo, both in a cyclic scheme for 6 months. Neither patients nor investigators were aware of the group allocation. Histologic changes were evaluated by skin biopsy of the left upper arm at baseline and after 6 months of treatment, utilizing computerized image analysis to assess the ratio area of epidermis/basement membrane length (AE/BML), ratio area of keratin/basement membrane length (AK/BML) and collagen and elastic fibers content. RESULT: Collagen content of the left upper arm increased after 6 months of treatment only in the hormonal group (+6.49%; P < 0.05). Other parameters did not present any significant alteration after treatment in both groups. CONCLUSION: Hormonal replacement for climacterics increases skin collagen content.

Vaginose bacteriana: experiência com o tiafenicol / Bacterial vaginosis: experience with thiamphenicol; \"Clue Cell\"

O objetivo deste trablho foi avaliar a eficácia do tiafenicol no tratamento da vaginose bacteriana. Foram estudadas 31 pacientes portadoras de vaginose bacteriana, cujo diagnóstico presuntivo foi confirmado através do isolamento de Gardneella vaginalis no conteúdo vaginal. Realizou-se também cultura para germes aeróbios, anaeróbios, Chlamydia trachomatis, Neisseria gonorrhoeae e Mobiluncus sp. As pacientes e seus parceiros sexuais foram tratados com tiafenicol, na dosagem de 2,5 g VO (dose única, ao dia, durante dois dias). As avaliaçÆes realizadas no 7§ e 28§ dias após o tratamento demonstraram cura clínica em 29 (93,5 por cento) casos. A cultura para Gardnerella vaginalis foi positiva em dois (6,5 por cento) casos no 7§ dia e em três (9,7 por cento) casos no 28§ dia. Os germes anaeróbios foram isolados em um (3,2 por cento) caso no 7§ dia e em dois (6,5 por cento) casos no 28§ dia. A cultura para Mobiluncus sp foi positiva em seis (19,3 por cento) casos antes do tratamento e negativa em todos após omesmo. Concluem os autores que otiafenicol mostrou-se eficaz para otratamento da vaginose bacteriana

Morphologic hysteroscopic criteria suggestive of endometrial hyperplasia.

OBJECTIVES: To evaluate the morphologic hysteroscopic criteria leading to a diagnosis of endometrial hyperplasia and compare their accuracy with that of histology. METHODS: A total of 95 hysteroscopic examinations were evaluated. Of these, 37 had a histologic diagnosis of normal endometrium and the remaining 58 of simple or complex endometrial hyperplasia. We compared the morphologic hysteroscopic criteria for the two groups using Pearson's chi-squared and Fisher's exact test. RESULTS: Only the presence of endometrial glands presenting a cystic pattern at hysteroscopy gave statistically significant results (P < 0.05), with low sensitivity (15.79%), high specificity (97.29%) and a relative risk of 6.75. With a prevalence of endometrial hyperplasia of 22.97% in a population of women with metrorrhagia, the positive predictive value was 63.53% and the negative predictive value was 79.40%. CONCLUSION: Additional, prospective studies are needed to determine the real value of the diagnostic morphologic parameters under consideration.