Fitoestrogênios no tratamento da mulher no climatério / Phytoestrogens in the treatment of women in climacteric

Algumas divergências da literatura quanto a terapia hormonal motivaram a procura de tratamentos alternativos que fossem efetivos e seguros para aliviar os sintomas da mulher no climatério. Neste artigo serão abordados trabalhos de relevância sobre fitoestrogênios, indicações, efeitos colaterais e contraindicações destas substâncias que têm atividades biológicas semelhantes aos estrogênios. Os resultados observados mostram que os efeitos e segurança dos fitoestrogênios ainda são inconclusivos...

The expression of the estrogen receptor in obese patients with high breast density (HBD).

OBJECTIVE: Obesity has been associated with increased risk for breast cancer (BC) mortality. Verifying in women with high breast density (HBD) post-menopausal, the frequency of polymorphisms of estrogen receptor (ER)α-PvuII, ERα-XbaI and if they influence the body mass index (BMI). METHODS: Study with 308 women with HBD post-menopause divided into two groups according to BMI: 1st group = BMI < 25 kg/m(2), 2nd group = BMI ≥ 25 kg/m(2). It was characterized in the clinical history: menarche, menopause, parity, family history of BC, smoking and alcohol intake. RESULTS: Allele and genotype frequencies for the ERα-397-Pvull and ERα-351-XbaI: P = 43.99%, p = 56.01%, pp = 32.14%, Pp = 47.73%, PP = X = 20.13% and X = 41.56%, x = 58.44%; xx = 33.44%; Xx = 50.00%; XX = 16.56%, respectively. Both PvuII and XbaI influenced BMI. When XbaI is mutated the tendency is toward higher BMI (0.039), and women with lower BMI were more frequent in PvuII genotype (p = 0.002). More frequent risk factors for BC: menarche before the age of 12 years (35.38%), nulliparity or 1st child after 28 years old (41.66%), family history of BC (19.16%) and overweight/obesity (62.01%). CONCLUSION: Variations in the ERα gene affected the BMI in women with HBD, who already are at increased risk for BC.

Densidade mamográfica e polimorfismo do gene do receptor estrogênico em mulheres após a menopausa / Mammographic density and polymorphism of the estrogen receptor gene in women after menopause

Introdução: Receptores hormonais modulam a resposta dos tecidos ao estímulo humoral. Evidências epidemiológicas mostram que as variações dos genes que regulam a biossíntese e metabolização dos receptores estrogênicos (RE) causam alterações no efeito dos estrógenos no tecido mamário, podendo explicar as variações individuais da densidade mamográfica. A alta densidade mamográfica é um fator de risco importante para o câncer de mama.Objetivo: Avaliar a associação das características clínicas e dos polimorfismos do gene do REalfa (XBal, Pvull e (GT)n) com a densidade mamográfica em mulheres após a menopausa. Casuística e métodos: Avaliaram-se prospectivamente 463 mulheres após a menopausa, sendo que 308 mulheres com mamas densas e 155 com mamas não densas, segundo os critérios do ACR-BIRADS (2003) por avaliação objetiva computadorizada, com idade de 45 a 60 anos, não usuárias de terapia hormonal nos últimos 12 meses e sem antecedentes pessoais de câncer de mama. Amostras de sangue periférico foram obtidas para extração de DNA e análise dos polimorfismos presente no íntron 1 e região promotora (Xbal, Pvull e (GT)n) do gene do RE?. Resutados: Dos fatores considerados de risco para o câncer de mama, houve associação com a densidade mamográfica: idade (p=0,005); medida da cintura abdominal (p=0,001); número de gravidezes (p=0,007); idade ao ter o 1º filho (p=0,035); antecedentes familiares (p=0,035); tempo decorrido deste a data da última menstruação (p=0,007) e índice de massa corpórea (p=0,022). Foi verificada diferença significante entre os grupos de mama densa e não densa para distribuição do genótipo do polimorfismo Pvull (p=0,024). Xbal (p=0,362) e, para o polimorfismo de repetição (GT)n (p=0,151) a associação não foi significante. Conclusão: Apenas o polimorfismo Pvull e os fatores clínicos: idade, cintura abdominal, número de gravidezes, idade ao ter o primeiro filho, antecedentes familiares de câncer de mama, tempo decorrido desde a data da...

Introduction: The hormone receptors modulate the tissue response to hormonal stimulation. Epidemiological evidences show that the variations in genes that regulate the biosynthesis and metabolism of estrogen receptors (ER) cause changes in the effect of estrogen in breast tissue, which may explain individual variations of the mammographic density. High mammographic density is an important risk factor for the breast cancer. Objective: Evaluating the association of clinical characteristics and polymorphisms of the gene ERalfa [XbaI, PvuII and (GT)n] and mammographic density in postmenopausal women. Methods: It was prospectively evaluated 463 postmenopausal women - 308 women with high mammographic density (HMD) and 155 controls (to 50% density or less), according to the criteria of the ACR - BIRADS (2003 ) computed objective assessment , aged 45 to 60 , nonusers of hormone therapy in the past 12 months and with no personal history of breast cancer. Peripheral blood samples were obtained for DNA extraction and analysis of this polymorphism in intron 1 and promoter [XbaI, PvuII and (GT) n)] of the ERalfa gene region. Results: Among the risk factors for breast cancer there was an association with mammographic density: age (p = 0.005), waist circumference (p = 0.001), number of pregnancies (p = 0.007), age of first birth ( p = 0.035 ), family history (p = 0.035), time after menopause (p = 0.007 ) and body mass index (p = 0.022). Significant difference was observed between the groups of HMD and control only for the distribution of the polymorphism PvuII (p = 0.024 ). XbaI (p = 0.362 ) and for repeat polymorphism (GT) n (p = 0.151) the association was not significant. Conclusion: Only the PvuII polymorphism and clinical factors: age, waist circumference, number of pregnancies, age of first birth, family history of breast cancer, time after menopause and body mass index proved to be associated with high mammographic density after menopause.

Polymorphisms of estrogen receptor-α gene in Brazilian women with high breast density after menopause.

UNLABELLED: The association of genetic polymorphism in the estrogen receptor alpha (ERα) gene and risk for diseases including breast cancer (BC) has been the subject of great interest. OBJECTIVE: Checking on women with high breast density after menopause, the frequency of the Pvull and Xbal polymorphisms of the ERα gene and the correlation between them and the known risk factors for breast cancer. METHOD: Observational study with 308 women between 45 and 65 years old with high breast density, without hormonal therapy, menstruation for a year or more, breast and ovarian cancer history. It was characterized in clinical history and physical examination: menarche, menopause, parity, family history of BC, smoking, alcohol intake and body mass index. RESULTS: The allelic and genotypic frequencies for ERα-Pvull and Xbal: p = 43.99%; p = 56.01%; pp = 32.14%; Pp = 47.73% and PP = 20.13%; X = 41.56%; x = 58.44%; xx = 33.44%; Xx = 50.00% and XX = 16.56%, respectively. The most frequent risk factors for BC: menarche before 12 years old (35.38%), nulliparity or first child after 28 years old (41.66%), family history of BC (19.16%) and overweight/obesity (62.01%). CONCLUSION: Allelic and genotypic distribution similar to literature. The risk factors for BC were more prevalent in women with high breast density but without significant associations with these polymorphisms.

Impact of age and body mass on the intensity of menopausal symptoms in 5968 Brazilian women.

OBJECTIVE: To assess the relationship of onset of menopause and body mass on the menopausal symptoms in post-menopausal Brazilian women. DESIGN: Observational study conducted by the selection and inclusion of 5968 Brazilian women after menopause. The following variables were analyzed in this study: time at menopause; the relationship between age at menarche and age at menopause; vasomotor symptoms compared with age at the time of menopause and the time of menopause; Kupperman menopausal index (KMI) versus total time of menopause; body mass index (BMI) compared to the time of menopause, vasomotor symptoms, and KMI total score. We used the Chi-square test, and the significance level was set at 5%. RESULTS: The age at natural menopause ranged from 41 to 62 years (mean 48.1 ± 4.07 years). A younger age at menopause was associated with a high intensity of vasomotor symptoms. These symptoms were more intense in the first 5 years of menopause and decreased with time. The KMI total also decreased with time after menopause, with the exception of arthralgia, myalgia, and insomnia, which did not tend to improve over time. In addition, the vasomotor symptoms and total KMI were more frequent with increasing BMI. CONCLUSIONS: Our results suggested that the age of menopause and BMI may influence the intensity of vasomotor symptoms.

Polimorfismo do gene do receptor estrogênico como fator de risco do câncer de mama / Gene estrogen receptor polymorphism as a risk factor in the breast cancer

Polimorfismo é uma variação genética de ocorrência habitual na população em geral, encontrado em frequência superior a 1%. Há vários polimorfismos conhecidos no gene do receptor de estrogênio alfa (REa), alguns dos quais podem modificar a função do receptor e a ação do estrogênio. Entre os polimorfismos conhecidos, Pvull, Xbal podem estar envolvidos com maior risco individual ao câncer de mama e à sobrevida em mulheres após a menopausa. O objetivo foi revisar publicações sobre a associação entre mutações em genes do REa com o risco para câncer de mama, nos últimos 20 anos. Este estudo revisou a literatura de 1990 a março de 2011 e analisou a associação entre polimorfismos do gene do REa e o risco de câncer de mama, nas principais bases de dados. Foram identificados 17 estudos caso-controle randomizados, duas revisões sistemáticas e uma metanálise que examinaram a frequência dos referidos alelos no risco de câncer de mama. As evidências mostram que fatores hormonais, em conjunto com fatores genéticos, podem aumentar a suscetibilidade individual para o câncer de mama. No entanto, é interessante observar que após estratificação para fatores já conhecidos, que levam à alta exposição ao estrógeno durante a vida, observa-se aumento de risco principalmente em mulheres após a menopausa

The polymorphism is a genetic variation that occurs in the general population, found with frequency of more than 1%. There are several known polymorphisms in the estrogen receptor alpha (ERa) gene, some of which can change the receptor function and the estrogen action. Among the known polymorphisms, Pvull and Xbal can be involved with a bigger individual risk of breast cancer and survival rate in postmenopausal women. The aim was to review the publications about the association between mutations in ERa gene with the risk for breast cancer in the last 20 years. This study reviewed the literature from 1990 to march, 2011 and analyzed the association between the polymorphism of the ERa gene and the risk of breast cancer in the main database. With identified 17 randomized case-control-studies, two systematic reviews and one meta-analysis that examined the frequency of the referred alleles in the risk of the breast cancer. The evidences showed that hormonal factors together with genetic factors could increase the individual susceptibility for the risk of breast cancer. However, it is interesting to observe that after stratification to the already known factors that lead to high exposition to the estrogen during the life, notice an increase of the risk mainly in women after the menopause

Tratamento hormonal do hirsutismo baseado em evidências / Evidence-based hormonal treatment of hirsutism

A revisão de estudos baseados em evidências mostra o melhor tratamento hormonal para o hirsutismo. Inicialmente, resumiu-se a fisiologia do pelo, caracterizou-se o hirsutismo, suas variantes e suas causas. Revelou-se que o tratamento hormonal do hirsutismo deve ser complementado pelo tratamento cosmético e não deve ser indicado para mulheres grávidas ou que desejam engravidar. A primeira opção é o contraceptivo hormonal oral, seguro para contracepção e eficaz para tratamento do hirsutismo. Após tempo estipulado, não ocorrendo resposta satisfatória, associar acetato de ciproterona ou espironolactona. A finasterida é indicada para hirsutismo idiopático e a flutamida, devido aos efeitos colaterais, ainda não é opção segura

An evidence-based review shows the best hormonal treatment of hirsutism. This paper summarized the physiology of the hair, characterized the hirsutism, its variants and etiologies. The study revealed that hormonal treatment of hirsutism has to be complemented by esthetic treatment, and it is not recommended for pregnant women or for those who want to get pregnant. The first option is hormonal oral contraceptive, which is safe for contraception and effective for treatment of hirsutism. After a established period of treatment, if good results do not occur, the association of cyproterone or spironolactone is recomended. Finasteride is the treatment of idiopathic hirsutism, and flutamide is not a safe option due to its side effects