Prevalence of fibromyalgia and quality of life in women with and without endometriosis.

The objectives of the study were to assessed if there is any difference in the prevalence of fibromyalgia and in quality of life (QoL) between women with and without endometriosis. A cross-sectional study was conducted in 2011-2013, involving 257 women with surgically and histopathologically confirmed endometriosis and 253 women with no history of endometriosis and no endometriosis-related symptoms. Women were recruited both at the family planning and endometriosis clinic, Department of Obstetrics and Gynecology, University of Campinas, Brazil. The Short Form 36 questionnaire (SF-36) was used to assess QoL, while the 1990 and 2010 American College of Rheumatology (ACR) criteria were used to evaluate fibromyalgia. According to the 1990 ACR criteria, there were no cases of fibromyalgia in either group. Nevertheless, according to the 2010 ACR criteria, four women, two with endometriosis and two without the disease, were diagnosed with fibromyalgia. Scores were significantly lower in all the domains of the QoL questionnaire for the women with endometriosis compared to those without the disease. This study reports no difference in the prevalence of fibromyalgia between women with and without endometriosis; however QoL was poorer among women with endometriosis when compared to women without the disease.

Reasons for Brazilian women to switch from different contraceptives to long-acting reversible contraceptives.

OBJECTIVES: Long-acting reversible contraceptives (LARCs) include the copper-releasing intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants. Despite the high contraceptive efficacy of LARCs, their prevalence of use remains low in many countries. The objective of this study was to assess the main reasons for switching from contraceptive methods requiring daily or monthly compliance to LARC methods within a Brazilian cohort. STUDY DESIGN: Women of 18-50 years of age using different contraceptives and wishing to switch to a LARC method answered a questionnaire regarding their motivations for switching from their current contraceptive. Continuation rates were evaluated 1 year after method initiation. Sample size was calculated at 1040 women. Clinical performance was evaluated by life table analysis. The cutoff date for analysis was May 23, 2013. RESULTS: Overall, 1167 women were interviewed; however, after 1 year of use, the medical records of only 1154 women were available for review. The main personal reason for switching, as reported by the women, was "fear of becoming pregnant" while the main medical reasons were nausea and vomiting and unscheduled bleeding. No pregnancies occurred during LARC use, and the main reasons for discontinuation were expulsion (in the case of the IUD and LNG-IUS) and a decision to undergo surgical sterilization (in the case of the etonogestrel-releasing implant). Continuation rate was ~95.0/100 women/year for the three methods. CONCLUSIONS: Most women chose a LARC method for its safety and for practical reasons, and after 1 year of use, most women continued with the method.

Comparison of active and passive forces of the pelvic floor muscles in women with and without stress urinary incontinence / Comparação das forças ativa e passiva dos músculos do assoalho pélvico de mulheres com e sem incontinência urinária de estresse

BACKGROUND: The reduction of the pelvic floor muscles (PFM) strength is a major cause of stress urinary incontinence (SUI). OBJECTIVES: To compare active and passive forces, and vaginal cavity aperture in continent and stress urinary incontinent women. METHODS: The study included a total of thirty-two women, sixteen continent women (group 1 - G1) and sixteen women with SUI (group 2 - G2). To evaluate PFM passive and active forces in anteroposterior (sagittal plane) and left-right directions (frontal plane) a stainless steel specular dynamometer was used. RESULTS: The anteroposterior active strength for the continent women (mean±standard deviation) (0.3±0.2 N) was greater compared to the values found in the evaluation of incontinent women (0.1±0.1 N). The left-right active strength (G1=0.43±0.1 N; G2=0.40±0.1 N), the passive force (G1=1.1±0.2 N; G2=1.1±0.3 N) and the vaginal cavity aperture (G1=21±3 mm; G2=24±4 mm) did not differ between groups 1 and 2. CONCLUSION: The function evaluation of PFM showed that women with SUI had a lower anteroposterior active strength compared to continent women.

CONTEXTUALIZAÇÃO: A redução da força dos músculos do assoalho pélvico (MAP) é a maior causa da incontinência urinária de estresse (IUE). OBJETIVO: Comparar as forças ativa e passiva e a abertura da cavidade vaginal em mulheres continentes e com IUE. MÉTODOS: O estudo incluiu um total de 32 mulheres, 16 mulheres continentes (grupo 1 - G1) e 16 mulheres com IUE (grupo 2 - G2). Um espéculo dinamométrico de aço inoxidável foi usado para avaliar as forças ativa e passiva dos MAP nas direções ântero-posterior (plano sagital) e látero-lateral (plano frontal). RESULTADOS: A força ativa ântero-posterior nas mulheres continentes (0,3±0,2 N) foi maior que nas mulheres com IUE (0,1±0,1 N). Não houve diferença entre o G1 e o G2 nos valores de força ativa látero-lateral (G1=0,43±0,1 N; G2=0,40±0,1 N), força passiva (G1=1,1±0,2 N; G2=1,1±0,3 N) e abertura da cavidade vaginal (G1=21±3 mm; G2=24±4 mm). CONCLUSÃO: A avaliação da função dos MAP mostrou que mulheres com IUE tiveram uma menor força ativa ântero-posterior quando comparadas com as mulheres continentes.

Comparison of active and passive forces of the pelvic floor muscles in women with and without stress urinary incontinence.

BACKGROUND: The reduction of the pelvic floor muscles (PFM) strength is a major cause of stress urinary incontinence (SUI). OBJECTIVES: To compare active and passive forces, and vaginal cavity aperture in continent and stress urinary incontinent women. METHOD: The study included a total of thirty-two women, sixteen continent women (group 1--G1) and sixteen women with SUI (group 2--G2). To evaluate PFM passive and active forces in anteroposterior (sagittal plane) and left-right directions (frontal plane) a stainless steel specular dynamometer was used. RESULTS: The anteroposterior active strength for the continent women (mean±standard deviation) (0.3±0.2 N) was greater compared to the values found in the evaluation of incontinent women (0.1±0.1 N). The left-right active strength (G1=0.43±0.1 N; G2=0.40±0.1 N), the passive force (G1=1.1±0.2 N; G2=1.1±0.3 N) and the vaginal cavity aperture (G1=21±3 mm; G2=24±4 mm) did not differ between groups 1 and 2. CONCLUSION: The function evaluation of PFM showed that women with SUI had a lower anteroposterior active strength compared to continent women.

Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial / Comparação de diferentes procedimentos de estimulação elétrica neuromuscular utilizados no tratamento da incontinência urinária de esforço feminina: ensaio clínico randomizado

BACKGROUND: Neuromuscular electrical stimulation (NMES) is widely treatment for stress urinary incontinence (SUI) but there is no consensus in literature regarding the most effective treatment parameters. OBJECTIVE: To compare two NMESintra-vaginal protocols for the treatment of SUI in women. METHODS: The study included 20 volunteers with an average age of 55.55±6.51 years and with the clinical diagnosis of SUI. Volunteers were randomly divided into two groups: group 1 (G1) received NMES with medium-frequency current and group 2 (G2) received NMES with low-frequency current. Functional assessments of pelvic floor muscles (PFM) were performed by perineometry. The severity of signs and symptoms were objectively evaluated using the 1 hour pad test and subjectively evaluated using a visual analog scale that measured the discomfort caused by the SUI. Shapiro-Wilk test was used to analyze data normality, and the Friedman test was used to analyze nonparametric data. For analysis of symptoms related to SUI the Fisher exact test and the Mann-Whitney test were used. Significance level of 5 percent was set for all data analysis. RESULTS: No significant differences (p>0.05) were found between groups for any of the variable assessed. The within group analysis of initial and final evaluations (after NMES) demonstrated significant differences (p<0.05) in amount of urine lost, the discomfort caused by urinary incontinence and perineal pressure for both treatment groups. CONCLUSION: The two NMES protocols applied were equally effective in the treatment of SUI.

CONTEXTUALIZAÇÃO: A estimulação elétrica neuromuscular (EENM) é amplamente utilizada no tratamento da incontinência urinária de esforço (IUE), no entanto não há consenso na literatura sobre os parâmetros de tratamento mais eficazes. OBJETIVO: Avaliar os procedimentos de EENM intravaginal no tratamento de mulheres com IUE. MÉTODOS: Participaram do estudo 20 voluntárias com idade média de 55,55±6,51 anos, com diagnóstico clínico de IUE. As voluntárias foram divididas aleatoriamente em dois grupos: grupo 1 (G1), que recebeu EENM com corrente de média frequência, e grupo 2 (G2), com corrente de baixa frequência. A avaliação funcional dos músculos do assoalho pélvico (MAP) foi realizada por meio de perineometria, e a severidade dos sinais e sintomas da IUE foi avaliada, objetivamente, pelo pad test de uma hora e, subjetivamente, pela Escala Visual Analógica (EVA), que mediu o desconforto causado pela incontinência. Para a análise de normalidade dos dados, utilizou-se o teste Shapiro-Wilk, seguido do teste de Friedman para dados não paramétricos. Para a análise dos sintomas relacionados à IUE, usaram-se os testes Exato de Fisher e Mann-Whitney. Em todas as análises, considerou-se o nível de significância de 5 por cento. RESULTADOS: Não houve diferença significativa (p>0,05) entre os grupos em nenhuma variável avaliada. Na comparação intragrupos das avaliações iniciais e finais (após EENM), houve diferença significativa (p<0,05) na quantidade de urina perdida, no desconforto causado pela incontinência urinária e na pressão perineal. CONCLUSÃO: Os procedimentos de EENM utilizados neste estudo foram igualmente eficazes no tratamento da IUE.

Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial.

BACKGROUND: Neuromuscular electrical stimulation (NMES) is widely treatment for stress urinary incontinence (SUI) but there is no consensus in literature regarding the most effective treatment parameters. OBJECTIVE: To compare two NMESintra-vaginal protocols for the treatment of SUI in women. METHODS: The study included 20 volunteers with an average age of 55.55±6.51 years and with the clinical diagnosis of SUI. Volunteers were randomly divided into two groups: group 1 (G1) received NMES with medium-frequency current and group 2 (G2) received NMES with low-frequency current. Functional assessments of pelvic floor muscles (PFM) were performed by perineometry. The severity of signs and symptoms were objectively evaluated using the 1 hour pad test and subjectively evaluated using a visual analog scale that measured the discomfort caused by the SUI. Shapiro-Wilk test was used to analyze data normality, and the Friedman test was used to analyze nonparametric data. For analysis of symptoms related to SUI the Fisher exact test and the Mann-Whitney test were used. Significance level of 5% was set for all data analysis. RESULTS: No significant differences (p>0.05) were found between groups for any of the variable assessed. The within group analysis of initial and final evaluations (after NMES) demonstrated significant differences (p<0.05) in amount of urine lost, the discomfort caused by urinary incontinence and perineal pressure for both treatment groups. CONCLUSION: The two NMES protocols applied were equally effective in the treatment of SUI.