Three-dimensional ultrasound evaluation of the pelvic floor in postmenopausal women using hormone therapy.

OBJECTIVE: To evaluate the three-dimensional (3D) ultrasound characteristics of the pelvic floor muscles (PFM) in two groups of postmenopausal women: users and nonusers of menopausal hormone therapy (MHT). STUDY DESIGN: Observational, cross-sectional cohort study. MAIN OUTCOME MEASURES: In this study 226 sexually active heterosexual women, aged 45-60 years with amenorrhea >12 months and without clinical pelvic floor disorders or urinary incontinence were included. Women using MHT ≥ 6 months were classified as systemic users. PFM strength was assessed by digital vaginal palpation and scored on the Modified Oxford Scale. Biometry of the PFM was performed by 3D transperineal ultrasound for evaluation of total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness. RESULTS: The participants were divided into users (n = 78) and nonusers (n = 148) of MHT. There were no differences in clinical or anthropometric parameters between groups. The mean age was 55 years and the time since menopause was six years in both groups. The mean duration of MHT use was 43.4 ± 33.3 months. Users of MHT had greater levator ani muscle thickness (p = 0.001) and higher PFM strength (p = 0.029) than nonusers. Risk analysis adjusted for age, time since menopause, BMI, parity, and type of delivery showed an association of MHT use with greater levator ani muscle thickness (OR = 2.69; 95% CI 1.42-5.11, p = 0.029), and higher PFM strength (OR = 1.78; 95% CI1.01-3.29, p = 0.046). There was a weak positive correlation between levator ani muscle thickness and duration of MHT use (r = 0.25, p = 0.0002) and PFM strength (r = 0.12, p = 0.043). CONCLUSIONS: Postmenopausal women using MHT had a greater levator ani muscle thickness associated with higher PFM strength than nonusers.

Clinical management of incidental findings on pelvic adnexal masses.

Due to widespread use of pelvic and transvaginal ultrasound in routine gynecological evaluation, the incidental finding of adnexal masses has led to discussions about management in asymptomatic patients regarding the risk of ovarian cancer. Transvaginal ultrasonography remains the modality of choice in the evaluation of suspicious characteristics. The combined analysis of ultrasound morphological parameters with Doppler study, serum carcinoma antigen 125 and investigation of a symptom index may improve diagnosis. Surgical approach should be considered whenever there are suspicious images, rapid growth of cysts, changes in the appearance compared to the initial evaluation or when the patient has symptoms. Future studies on genetic and molecular mechanisms may help explain the pathophysiology of ovarian cancer, improving early diagnosis and treatment.

Clinical management of incidental findings on pelvic adnexal masses / Manejo clínico dos achados incidentais de massas pélvicas anexiais

Summary Due to widespread use of pelvic and transvaginal ultrasound in routine gynecological evaluation, the incidental finding of adnexal masses has led to discussions about management in asymptomatic patients regarding the risk of ovarian cancer. Transvaginal ultrasonography remains the modality of choice in the evaluation of suspicious characteristics. The combined analysis of ultrasound morphological parameters with Doppler study, serum carcinona antigen 125 and investigation of a symptom index may improve diagnosis. Surgical approach should be considered whenever there are suspicious images, rapid growth of cysts, changes in the appearance compared to the initial evaluation or when the patient has symptoms. Future studies on genetic and molecular mechanisms may help explain the pathophysiology of ovarian cancer, improving early diagnosis and treatment.

Resumo Em virtude da ampla utilização da ultrassonografia pélvica e transvaginal na avaliação ginecológica de rotina, o achado incidental de massas anexiais tem ocasionado discussões sobre a conduta em pacientes assintomáticas frente ao risco de desenvolvimento do câncer de ovário. A ultrassonografia transvaginal continua a ser a modalidade de primeira escolha na avaliação de características suspeitas. A análise conjunta de parâmetros morfológicos ultrassonográficos com o estudo Doppler, a pesquisa de CA-125 e a investigação de índice de sintomas pode incrementar as taxas de diagnóstico. Abordagem cirúrgica deve ser considerada sempre que houver alterações em exames de imagem, quando houver crescimento rápido do cisto, mudanças em seu aspecto em relação à avaliação inicial ou quando a paciente apresentar sintomatologia. Uma compreensão melhor de mecanismos genéticos e moleculares pode auxiliar na elucidação da fisiopatologia do câncer ovariano, aprimorando seu diagnóstico e tratamento precoces.

Effects of soy isoflavones on mammographic density and breast parenchyma in postmenopausal women: a randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE: This study aims to evaluate the effects of soy isoflavones on breast tissue in postmenopausal women. METHODS: In this randomized, double-blind, placebo-controlled study, 80 women (aged ≥ 45 y and with amenorrhea >12 mo) with vasomotor symptoms were randomized to receive either 250 mg of standardized soy extract corresponding to isoflavone 100 mg/day (n = 40) or placebo (n = 40) for 10 months. Breasts were evaluated through mammographic density and breast parenchyma using ultrasound (US) at baseline and 10-month follow-up. Independent t test, analysis of variance, Mann-Whitney U test, and χ2 trend test were used in statistical analysis. RESULTS: Baseline clinical characteristics showed no significant differences between the isoflavone group and the placebo group, with mean (SD) age of 55.1 (6.0) and 56.2 (7.7) years, mean (SD) menopause duration of 6.6 (4.8) and 7.1 (4.2) years, and mean (SD) body mass index of 29.7 (5.0) and 28.5 (4.9) kg/m2, respectively (P > 0.05). The study was completed by 32 women on isoflavone and 34 women on placebo. The groups did not differ in mammographic density or breast parenchyma by US (P > 0.05). Within each group, the baseline and final moments did not differ in mammography or US parameters significantly (P > 0.05). CONCLUSIONS: The use of soy isoflavone extract for 10 months does not affect breast density, as assessed by mammography and US, in postmenopausal women.

Avaliação do tecido mamário em mulheres na pós-menopausa usuárias de isoflavona da soja / Evalution the effect of soy isoflavone on breast tissue in post menopausal women

Avaliar o efeito da isoflavona da soja sobre o tecido mamário em mulheres na pós-menopausa. Trata-se de estudo clínico, prospectivo, randomizado, duplo-cego, placebo controlado, envolvendo 80 mulheres na pós-menopausa com sintomas vasomotores, idade entre 45 a 70 anos, acompanhadas no Ambulatório de Climatério e Menopausa da Faculdade de Medicina de Botucatu-Unesp, de janeiro de 2005 a dezembro de 2006. Na randomização, 40 pacientes receberam 100 mg isoflavona da soja/dia (duas cápsulas de 125 mg de extrato seco de glicine Max) e 40 pacientes placebo (duas cápsulas de lactose) durante 10 meses. A densidade mamária (DM) foi avaliada pela mamografia e o parênquima mamário pela ultrassonografia de mamas no início e após dez meses de seguimento. Para análise estatística foram utilizados o teste t-Student, ANOVA, teste de Mann-Whitney e teste do Qui-Quadrado. Na comparação das características clínicas iniciais entre os grupos de usuárias de isoflavona e placebo, não houve diferenças significantes, com valores médios de idade de 55,1±6,0 e 56,2±7,7 anos, tempo de menopausa de 6,6±4,8 e 7,1±4,2 anos e IMC de 29,7±5,0 e 28,5±4,9 kg/m2, respectivamente (p>0,05). Concluíram o estudo 32 pacientes sob isoflavona e 34 sob placebo. Na comparação da densidade mamográfica entre os momentos inicial e final, não houve diferença estatisticamente significativa. Na avaliação do parênquima mamário pela ultrassonografia, não houve diferença entre os grupos. Na comparação entre os momentos dentro de cada grupo, não foram constatadas diferenças significativas nos parâmetros da mamografia e ultrassonografia...

To evaluate the effect of soy isoflavone on breast tissue in postmenopausal women. This study is a prospective, randomized, double-blind, placebo-controlled trial involving 80 postmenopausal women with vasomotor symptoms, aged 45-70 years, followed in Climacteric and Menopause Clinic of the Botucatu Medical School-UNESP, from January 2005 to December 2006. At randomization, 40 patients received 100 mg of soy isoflavone/day (two capsules of 125 mg standardized soy extract, Glicine max) and 40 patients, placebo (two capsules of lactose) for 10 months. The breast density was evaluated by mammography and breast parenchyma by ultrasound, at baseline and after ten months of follow-up. The Student t-test, ANOVA, Mann-Whitney and Chi-Square were used in the statistical analysis. In comparison of baseline clinical characteristics between the isoflavone and placebo groups, there were no significant differences, with mean age of 55.1 ± 6.0 and 56.2 ± 7.7 years, duration of menopause 6.6 ± 4.8 and 7.1 ± 4.2 years and BMI 29.7 ± 5.0 and 28.5 ± 4.9 kg/m2, respectively (p> 0.05). Concluded the study, 32 patients on isoflavone and 34 in the placebo group. In comparison in mammographic density (MD) between moments, baseline and final, there was no difference statistically significant. In the evaluation of breast parenchyma by ultrasound, there was no difference between groups. In comparing the moments within each group, there were no significant differences in the parameters of mammography and ultrasound...

Effect of raloxifene on the vaginal epithelium of postmenopausal women.

OBJECTIVE: The objective was to analyze the effect of raloxifene on the vaginal epithelium of postmenopausal women. STUDY DESIGN: In this non-randomized clinical trial, 80 women (mean age = 60.6 years) were prospectively studied. Forty patients received 60 mg/day of raloxifene (RG), and 40 women constituted a non-treated control group (CG), paired by age and time since menopause. The treated group consisted of patients with osteoporosis of the lumbar spine. Those with a diagnosis of infection in the lower genital tract and using hormone therapy (HT) up to 6 months prior to the study were excluded. Vaginal smears were collected at baseline and after 6 months of intervention. The vaginal maturation value (VMV) was determined, and counts of superficial, intermediate and parabasal cells were performed. Smears were analyzed by only one cytopathologist who was blinded to patient data. The t-test, Wilcoxon test, and Chi-Squared test were used in the statistical analysis. RESULTS: The study groups were homogeneous regarding age, time since menopause, parity, HT use, smoking, and body mass index. No statistically significant differences were observed in VMV median values (RG, 39.7 and 35.7; CG, 50.0 and 50.0, respectively) or in the percentage of superficial, intermediate and parabasal cells between the groups at baseline and after 6 months (p>0.05). There was no significant correlation between VMV and age, time since menopause, previous HT use, or body mass index, in either of the groups. CONCLUSION: Treatment with raloxifene for 6 months has no effect on the maturation of the vaginal epithelium in postmenopausal women with osteoporosis.

Terapia hormonal e câncer endometrial, ovariano e cervical / Hormone therapy and endometrial cancer, ovarian and cervical

A terapia hormonal (TH) em mulheres na pós-menopausa sobreviventes de câncer endometrial, ovariano e cervical é considerada historicamente um tabu. O risco de que esta terapia aumente a probabilidade de doença recorrente tem base infundada e necessita de revisão crítica. Vários estudos retrospectivos em usuárias de hormônios, sobreviventes de câncer ginecológico, não puderam demonstrar efeitos adversos. Os benefícios da TH têm sido bem documentados. Com o avanço da medicina e com o sucesso no tratamento dos cânceres de endométrio, ovário e colo, o número de pacientes sobreviventes destes cânceres está crescendo consideravelmente. São necessários ensaios clínicos, randomizados e controlados com placebo, com amostragem adequada, para que se possa avaliar com segurança o papel da TH nestas pacientes. A história prévia de câncer de endométrio, ovário e colo, não deve ser considerada contra-indicação absoluta para terapia hormonal