Puberty in girls with Prader-Willi syndrome: cohort evaluation and clinical recommendations in a Latin American tertiary center.

Introduction: Prader-Willi syndrome (PWS) is a genetic disorder characterized by hypothalamic-pituitary deficiencies including hypogonadism. In girls with PWS, hypogonadism can present early in childhood, leading to genital hypoplasia, delayed puberty, incomplete pubertal development, and infertility. In contrast, girls can present with premature activation of the adrenal axis leading to early pubarche and advanced bone age. We aim to evaluate the progression of puberty and adrenarche signals in girls with PWS. Methodology: A longitudinal retrospective cohort study included girls with PWS followed at a Pediatric Endocrinology Outpatient Clinic in a Tertiary University Hospital in Sao Paulo, Brazil from 2002 to 2022. Data collected via chart review included clinical information on birth history, breast and pubic hair Tanner stages, presence of genital hypoplasia, age at menarche, regularity of menstrual cycles, body mass index (BMI) z-score, final height, age of initiation of estrogen replacement and growth hormone replacement, as well as results for PWS genetic subtype; biochemical investigation (LH, FSH, estradiol, DHEA-S); radiographic bone age and pelvic ultrasound. Results: A total of 69 girls were included in the study and the mean age of puberty onset was 10.2 years in those who started puberty after the age of 8 years. Breast Tanner stage IV was reached by 29.1% girls at a mean age of 14.9 years. Spontaneous menarche was present in 13.8% and only one patient had regular menstrual cycles. Early adrenarche was seen in 40.4% of cases. Conclusion: Our study demonstrated in a large sample that girls with PWS often present with delayed onset of puberty despite frequent premature adrenarche. Based on our results, we suggest an estrogen replacement protocol for girls with PWS to be started at the chronological age or bone age of 12-13 years, taking into consideration the uterus size. Further prospective studies are needed.

Neuroprotective effect of hormone replacement therapy: a review of the literature.

OBJECTIVE: Menopause is a physiological period characterized by the cessation of ovarian activity. Sequential changes during this transition affect multiple systems, including the brain. Sixty percent of women experience cognitive impairment. The objective of this review is to show the neuroprotective effect of hormone replacement therapy (HRT) through the different scales and whether there is a benefit of this in women. METHOD: A search was conducted in six databases. Eligibility criteria included women within 10 years of menopause, receiving HRT controlled with placebo, studies lasting more than 6 months and women without a history of chronic underlying pathology. RESULTS: A total of nine randomized controlled trials met the inclusion criteria. Regarding memory, two studies reported better performance of HRT with a significant odds ratio (OR) of 0.67; regarding attention, one study reported potential improvement in women receiving HRT with a significant OR of 0.87; and neuroimaging assessment found an increase in ventricular volume compared to placebo over a 3-year period. CONCLUSIONS: The early initiation of menopausal HRT in healthy women appears to yield a positive effect on certain cognitive aspects, such as attention and cortical volume in the central nervous system. These findings should be confirmed through future prospective studies.

Cobertura de MRS e indicación de terapia hormonal en Pedro Aguirre Cerda, septiembre de 2019 / MRS coverage and hormone replacement therapy indication at Pedro Aguirre Cerda, September 2019

Introducción: El envejecimiento de la población en todo el mundo es un fenómeno progresivo y Chile no se queda atrás frente a esto. Actualmente existe un subprograma de climaterio mujeres entre los 45 a 64 años, que presenta diversas acciones y propósitos. Objetivo: Describir la cobertura de la aplicación de la Menopause Rating Scale (MRS) e indicación de terapia de reemplazo hormonal en mujeres inscritas en los CESFAM de la comuna de Pedro Aguirre Cerda. Método: Descriptivo transversal. Resultados: La cobertura de aplicación de MRS en mujeres entre 45-64 años fue de un 62,6%. Un 34,3% de mujeres presentaron un puntaje MRS alterado, indicándose terapia hormonal en un 37,8% de los casos, en las indicaciones un 21,8% eran usuarias candidatas acorde a criterios médicos y un 78,2% no lo eran. Conclusiones: Se debe aumentar la cobertura de MRS y recursos para exámenes de laboratorio, de imágenes y capacitaciones, esto para mejorar la entrega de las prestaciones en el subprograma climaterio.

Introduction: The aging of the population worldwide is a progressive phenomenon and Chile is not lagging behind in this. Currently, there is a climacteric subprogram for women between 45 and 64 years of age, which has various actions and purposes. Objective: To describe the coverage of the application of the Menopause Rating Scale (MRS) and indication of hormone replacement therapy in women enrolled in the CESFAM of the commune of Pedro Aguirre Cerda. Method: Cross-sectional descriptive study. Results: The coverage of the MRS application in women between 45-64 years old was 62.6%. A 34.3% of women presented an altered MRS score, indicating hormone therapy in 37.8% of the cases, 21.8% of the indications were candidates according to medical criteria and 78.2% were not. Conclusions: There is a lack of labs and images tests in the climacteric controls, resulting in a mayor number of women no candidates to the hormonal therapy according to medical criteria.

Preoperative promestriene for hysteroscopy: a randomized clinical trial

SUMMARY OBJECTIVE: Intraoperative complications of hysteroscopy, such as the creation of a false passage, cervix dilatation failure, and uterine perforation, may require suspension of the procedure. Some patients refuse a new procedure, which delays the diagnosis of a possible serious uterine pathology. For this reason, it is essential to develop strategies to increase the success rate of hysteroscopy. Some authors suggest preoperative use of topical estrogen for postmenopausal patients. This strategy is common in clinical practice, but studies demonstrating its effectiveness are scarce. The aim of this study was to evaluate the effect of cervical preparation with promestriene on the incidence of complications in postmenopausal women undergoing surgical hysteroscopy. METHODS: This is a double-blind clinical trial involving 37 postmenopausal patients undergoing surgical hysteroscopy. Participants used promestriene or placebo vaginally daily for 2 weeks and then twice a week for another 2 weeks until surgery. RESULTS: There were 2 out of 14 (14.3%) participants with complications in the promestriene group and 4 out of 23 (17.4%) participants in the placebo group (p=0.593). The complications were difficult cervical dilation, cervical laceration, and vaginal laceration. CONCLUSION: Cervical preparation with promestriene did not reduce intraoperative complications in postmenopausal patients undergoing surgical hysteroscopy.

Terapia hormonal en la menopausia vía transdérmica: un asunto de eficacia y seguridad

Los síntomas vasomotores (SVM) asociados a la menopausia suelen disminuir la calidad de vida de las mujeres, al generar un elocuente malestar. La terapia hormonal de la menopausia (THM) es el estándar en el tratamiento de los síntomas de la menopausia, siendo el único tratamiento que ha demostrado ser eficaz para los SVM. Objetivo: describir la eficacia y seguridad de la terapia hormonal de la menopausia vía transdérmica (THM TD) para aliviar los síntomas de la menopausia. Métodos: se hizo una revisión sistemática de la literatura en diferentes bases de datos electrónicas (CINAHL Plus, EMBASE, Scopus, Lilacs, Medline, Pubmed, entre otras), a través de términos de búsqueda estandarizados. Los desenlaces evaluados incluyeron los estudios donde se publicó cualquier tratamiento o intervención con la THM TD en mujeres tratadas por síntomas de la menopausia, porcentajes de alivio de los síntomas climatéricos y proporción de eventos adversos asociados. Resultados: se incluyeron 45 publicaciones, y convienen en aconsejar el tratamiento con la THM TD, en vista de un alivio de los síntomas climatéricos cerca del 90%, asimismo de ser más segura y potencialmente más eficaz que la terapia oral; con resultados normales en la evaluación mamográfica, y sin eventos adversos relacionados después de 5 años de seguimiento. Conclusiones: la terapia hormonal en la menopausia vía transdérmica es segura y eficaz para aliviar los síntomas de la menopausia. Al evitarse el metabolismo hepático, alcanza mejores beneficios clínicos, a la vez que minimiza la exposición de eventos adversos. Las publicaciones revisadas demuestran que la vía transdérmica es la mejor forma de tratar los síntomas de la menopausia.

Vasomotor symptoms (VMS) associated with menopause usually reduce the quality of life of women, generating eloquent discomfort. Menopausal hormone therapy (MHT) is the standard in the treatment of menopausal symptoms, being the only treatment that has been shown to be effective for VMS. Objective: to describe the efficacy and safety of transdermal menopausal hormone therapy (THM TD) to relieve menopausal symptoms. Methods: a systematic review of the literature was carried out in different electronic databases (CINAHL Plus, EMBASE, Scopus, Lilacs, Medline, Pubmed, among others), through standardized search terms. The outcomes evaluated included studies where any treatment or intervention with TD MHT was published in women treated for menopausal symptoms, percentages of relief of climacteric symptoms and proportion of associated adverse events. Results: 45 publications were included, and they agree in advising treatment with MHT TD, in view of a relief of climacteric symptoms close to 90%, as well as being safer and potentially more effective than oral therapy; with normal results in mammographic evaluation, and without related adverse events after 5 years of follow-up. Conclusions: transdermal hormonal therapy in menopause is safe and effective in relieving menopause symptoms. By avoiding hepatic metabolism, it achieves better clinical benefits, while minimizing the exposure to adverse events. The reviewed publications demonstrate that the transdermal route is the best way to treat menopause symptoms.

Simultaneous use of contraceptives and hormone replacement therapy in women receiving psychoactive drugs. From theory to integral health practice / Uso simultáneo de anticonceptivos y terapia hormonal de reemplazo en mujeres que reciben psicofármacos. De la teoría a la práctica de la salud integral.

Sexuality in people with mental disorders is a topic usually tinged with prejudice and stigma. Women with severe mental disorders are more exposed to suffer sexually transmitted diseases, becoming victims of gender violence and being involved with unintended pregnancies. In adults and adolescents, sexual intercourse under the influence of alcohol or other drugs, or during worsening or exacerbation of baseline symptoms or condition, are often unplanned, unprotected, with casual partners from high risk groups, without contraceptive methods and with less capacity to agree or deny safe sexual practices. Sexual and reproductive rights as well as gender perspective need to be considered an integral part of women with mental disorders health being and treatment. For this reason, discussing with patients about their desire or not to have children, their sexual life and provide them the most adequate options of contraceptive methods taking into consideration their needs so that and informed decision should be part of the psychiatric consultation. Hormonal contraceptives are widely used globally, being one of the most prescribed groups of drugs. It is estimated that more than 100 million women take oral contraceptives to prevent pregnancy, to treat menstrual pain and/or menstrual heavy bleeding or to control acne. Oral contraceptives result from the combination of estrogen and progestin derivatives, or progestins alone. This review will focus on the description of each hormonal contraceptive methods and hormone replacement therapy and the special features of their concomitant use with psychotropic drugs during treatment of women with psychiatric disorders.

La sexualidad de las personas con trastornos mentales es una temática habitualmente teñida de prejuicios y estigma. Las mujeres con trastornos mentales severos presentan mayor vulnerabilidad a padecer enfermedades de transmisión sexual, ser víctimas de violencia de género y tener embarazos no intencionales. En adultas y adolescentes, las relaciones sexuales bajo la influencia del alcohol o de otras drogas, o en momentos de descompensación de su cuadro de base son a menudo no planificadas, con parejas de riesgo, sin métodos anticonceptivos y con menor capacidad para negociar prácticas sexuales seguras. Desde una perspectiva de género y de derechos humanos, en la atención de mujeres con trastornos mentales, es necesario incluir los derechos sexuales y reproductivos como parte del tratamiento. Por tal motivo, hablar con nuestras pacientes sobre sus deseos de tener hijos, o no, sobre su vida sexual y la provisión de un método anticonceptivo acorde a su elección y necesidades, forma parte de la consulta psiquiátrica. Los anticonceptivos hormonales están ampliamente utilizados a nivel global, constituyendo uno de los grupos de fármacos más prescriptos. Se estima que más de 100 millones de mujeres los consumen para evitar el embarazo, como tratamiento de los sangrados abundantes, las menstruaciones dolorosas o el acné. Resultan de la combinación de derivados estrogénicos y progestágenos, o progestágenos solos. En esta revisión se focalizará en la descripción de los diversos métodos anticonceptivos hormonales, en la terapia hormonal de reemplazo y en las particularidades del uso simultáneo con psicofármacos en mujeres tratadas por trastornos psiquiátricos.

Clinical Approaches to Nestorone Subdermal Implant Therapy in Women's Health.

Segesterone acetate (SA) or Nestorone, a fourth-generation progestogen, is a synthetic compound with high progestational activity and no androgenic, glucocorticoid, or anabolic effects. However, due to its oral inactivity, SA must be used by other routes, such as subcutaneous. Thus, considering its peculiar properties, the SA subdermal implant is successfully used in female contraception and postmenopausal hormone replacement therapy (HRT). In recent years, its potential uses in endometriosis, polycystic ovaries syndrome (PCOS), and a new therapeutic possibility for neuroprotection have made this treatment extremely interesting. However, the absence of a standardized dose and the long-term safety of SA implant therapy in women is still controversial. Here, we present the possible indications, doses, limitations, and side effects of SA implant therapy.

Association Between Hormone Therapy and Weight Gain in the Menopause Transition and After Menopause: A Systematic Review and Meta-Analysis

Objectives: to conduct a systematic review and meta-analysis in order to assess whether hormone therapy (HT) increases weight in women in the menopausal transition and after menopause. Method: this article proposes an update to the systematic review published in 2005 by the Cochrane Library (Kongnyuy EJ et al 2005) with reference to studies assessing weight changes in women receiving HT from 1986 to 2005. Following PRISMA recommendations, we included randomized controlled trials (RCTs) ) from May 2005 onwards from Medline, Embase, and the Cochrane CENTRAL databases. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Two authors independently assessed the risk of biases in the selected studies. Results: ten RCTs were included, totaling 2,588 HT users and 764 non-users. Different regimens, dosages, and routes of administration in HT users were analyzed and compared to non-users. The results did not show statistically significant differences for most of the HT regimens evaluated. There was significant weight gain only in patients using EEC alone at dosages of 0.45 mg/day and 0.3 mg/day when compared to placebo (p 0.01); as well as in patients receiving esto-progestative combinations of 0.5 mg/day 17-beta-estradiol (E2) + 100 mg/day progesterone, with a 0.7 kg weight increase (p 0.032). On the other hand, the combinations of 1 mg/day estradiol valerate + 3 mg/day drospirenone showed a -1.0 kg reduction (p = 0.04), whereas a -0.2 kg reduction (p = 0.001) was identified in patients using 1 mg /day estradiol (E) + 0.5 mg norethisterone acetate (NETA). Tibolone therapy showed no statistically significant changes in weight. After performing a meta-analysis, the comparative results between users and non-users showed that there was a slight weight increase (+0.279 kg ; CI -1.71 to 2.27) in patients using 0.625 mg/day conjugated equine estrogen (CEE) + 2.5 mg/day medroxyprogesterone acetate (MPA). As for the patients receiving 2.5 mg/day Tibolone, weight gain (+0.670 kg; CI from -1.14 to 2.48) was also observed in them. However, these increases were not significant when compared to non-HT users. Conclusions: most regimens studied showed that patients using HT in the menopausal transition and after menopause did not show significant weight gain. The only combination that showed weight gain was 0.5 mg/day 17-beta-estradiol (E2) + 100 mg/day progesterone observed, while there was weight reduction in patients using 1 mg/day estradiol valerate + 3 mg/day drospirenone and 1 mg/day estradiol (E) + norethisterone acetate.

Objetivo: realizar uma revisão sistemática e meta-análise para avaliar se a terapia hormonal (TH) aumenta o peso em mulheres na transição menopausal e após a menopausa. Métodos: este artigo propõe uma atualização da revisão sistemática publicada em 2005 pela Cochrane Library (Kongnyuy EJ et al., 2005) com referência a estudos avaliando mudanças de peso em mulheres recebendo TH de 1986 a 2005. Seguindo as recomendações do PRISMA, incluímos ensaios clínicos randomizados (RCTs) de maio de 2005 em diante do Medline, Embase e dos bancos de dados Cochrane CENTRAL. Diferenças médias padronizadas (SMD) e intervalos de confiança de 95% (IC) foram calculados. Dois autores avaliaram independentemente o risco de vieses nos estudos selecionados. Resultados: foram incluídos dez ECRs, totalizando 2.588 usuários de HT e 764 não usuários. Diferentes esquemas, dosagens e vias de administração em usuários de HT foram analisados e comparados a não usuários. Os resultados não mostraram diferenças estatisticamente significativas para a maioria dos esquemas de TH avaliados. Houve ganho de peso significativo apenas nos pacientes que usaram apenas EEC nas doses de 0,45 mg/dia e 0,3 mg/dia quando comparados ao placebo (p 0,01); assim como em pacientes recebendo combinações estoprogestativas de 0,5 mg/dia de 17-beta-estradiol (E2) + 100 mg/dia de progesterona, com aumento de peso de 0,7 kg (p 0,032). Por outro lado, as combinações de 1 mg/dia de valerato de estradiol + 3 mg/dia de drospirenona apresentaram redução de -1,0 kg (p = 0,04), enquanto foi identificada redução de -0,2 kg (p = 0,001) nas pacientes que usaram 1 mg /dia estradiol (E) + 0,5 mg de acetato de noretisterona (NETA). A terapia com tibolona não mostrou alterações estatisticamente significativas no peso. Após realizar uma meta-análise, os resultados comparativos entre usuárias e não usuárias mostraram que houve um leve aumento de peso (+0,279 kg ; IC -1,71 a 2,27) em pacientes em uso de 0,625 mg/dia de estrogênio equino conjugado (CEE) + 2,5 mg/dia de acetato de medroxiprogesterona (MPA). Quanto aos pacientes que receberam Tibolona 2,5 mg/dia, também foi observado ganho de peso (+0,670 kg; IC de -1,14 a 2,48). No entanto, esses aumentos não foram significativos quando comparados aos não usuários de HT. Conclusões: a maioria dos esquemas estudados mostrou que as pacientes em uso de TH na transição menopausal e após a menopausa não apresentaram ganho de peso significativo. A única combinação que apresentou ganho de peso foi 0,5 mg/dia de 17-beta-estradiol (E2) + 100 mg/dia de progesterona, enquanto houve redução de peso nas pacientes que usaram 1 mg/dia de valerato de estradiol + 3 mg/dia de drospirenona e 1 mg/dia estradiol (E) + acetato de noretisterona.

Understanding Progestins: From Basics to Clinical Applicability.

Progestin is a term used to describe a synthetic progestogen. The activity and potency of synthetic progestins are mostly evaluated via parameters associated with their endometrial effects, which are related to their interactions with progesterone, estrogen, androgen, glucocorticoid, and mineralocorticoid receptors. The chemical structure of progestins is the key to understanding their interactions with these receptors and predicting the other effects associated with these drugs. Due to their endometrial effect, progestins are used for different gynecological conditions, such as endometriosis, contraception, hormonal replacement therapy, and artificial reproduction techniques. This review is focused on improving our knowledge of progestins (from their history and biochemical effects related to their chemical structures to clinical applications in gynecological conditions) in order to improve clinical practice.

Cardiovascular Safety and Benefits of Testosterone Implant Therapy in Postmenopausal Women: Where Are We?

We discuss the CV safety and efficacy data for subcutaneous testosterone therapy (STT) in postmenopausal women. We also highlight new directions and applications of correct dosages performed in a specialized center. To recommend STT, we propose innovative criteria (IDEALSTT) according to total testosterone (T) level, carotid artery intima-media thickness, and calculated SCORE for a 10-year risk of fatal cardiovascular disease (CVD). Despite all the controversies, hormone replacement therapy (HRT) with T has gained prominence in treating pre and postmenopausal women in the last decades. HRT with silastic and bioabsorbable testosterone hormone implants has gained prominence recently due to its practicality and effectiveness in treating menopausal symptoms and hypoactive sexual desire disorder. A recent publication on the complications of STT, looking at a large cohort of patients over seven years, demonstrated its long-term safety. However, the cardiovascular (CV) risk and safety of STT in women are still controversial.

Cardio-Metabolic Health and HRT in Menopause: Novel Insights in Mitochondrial Biogenesis and RAAS.

Recent evidence shows the cardiometabolic effects of estrogen administration in postmenopausal women. Women have a cardiometabolic advantage during their reproductive years, which is lost at menopause due to declining estradiol (E2). E2, also known as 17-beta-estradiol, has diverse effects in its target tissues, including the cardiovascular (CV) system, through genomic and non-genomic signaling. Metabolic changes characteristic of menopause include a worsening lipid profile, changes in body fat distribution, epicardial and pericardial fat deposition, increased susceptibility to weight gain, and increased blood pressure, resulting in an increased risk of accelerated cardiovascular disease (CVD) development. E2 mediates its cardioprotective actions by increasing mitochondrial biogenesis, angiogenesis, and vasodilation, decreasing reactive oxygen species (ROS) and oxidative stress, and modulating the renin-angiotensin-aldosterone system (RAAS). In this review, we assess whether it is prudent to develop an approach to managing postmenopausal women based on modifying the patient's CV risk that includes human-identical hormone replacement therapy (HRT), modulation of RAAS, and stimulating mitochondrial biogenesis. Further research is needed to assess the safety and benefit of HRT to reduce cardiometabolic risk.

Does the use of oral contraceptives or hormone replacement therapy offer protection against the formation or rupture of intracranial aneurysms in women?: a systematic review and meta-analysis

SUMMARY OBJECTIVE: The aim of this study was to carry out a systematic review of the literature with meta-analysis to evaluate the effect of using oral contraceptive and hormone replacement therapy as a protective factor in the formation of intracranial aneurysms and subarachnoid hemorrhage. METHODS: This is a systematic review of the literature with meta-analysis, using PubMed and Embase as databases and the PRISMA method. Case-control and cohort studies published until December 2022 were included in this review. RESULTS: Four studies were included in this review; three of which were eligible for meta-analysis. Regarding the use of oral contraceptive and the development of subarachnoid hemorrhage, there was a lower risk of aneurysm rupture with an odds ratio 0.65 (confidence interval 0.5-0.85). In the analysis of patients using hormone replacement therapy and developing subarachnoid hemorrhage, there was also a lower risk of aneurysm rupture with an OR 0.54 (CI 0.39-0.74). Only one article analyzed the formation of intracranial aneurysm and the use of hormone replacement therapy and oral contraceptive, and there was a protective effect with the use of these medications. oral contraceptive: OR 2.1 (CI 1.2-3.8) and hormone replacement therapy: OR 3.1 (CI 1.5-6.2). CONCLUSION: The use of hormone replacement therapy and oral contraceptive has a protective effect in intracranial aneurysm rupture and formation.

Progestinas y cáncer de mama en terapia de reemplazo hormonal: cómo actúan y qué alternativas son más seguras / Progestins and breast cancer in hormone replacement therapy: how do they work, and what alternatives are safer

En algunos estudios se ha asociado a la terapia de reemplazo hormonal (TRH) con estrógenos y progestinas a un mayor riesgo de cáncer de mama que la terapia con estrógenos solos. Sin embargo, dependiendo de su naturaleza algunas progestinas serían más seguras que otras. Se buscaron y analizaron artículos atingentes al tema en las bases de datos Google Scholar, PubMed, Science, SciELO y Cochrane, introduciendo los siguientes términos: terapia de reemplazo hormonal y cáncer de mama, progestinas y cáncer de mama, receptor de progesterona. Específicamente se ha asociado a las progestinas sintéticas acetato de medroxiprogesterona, noretisterona y levonorgestrel con un mayor riesgo de cáncer de mama, no así a la progesterona natural, a la progesterona oral micronizada ni a la didrogesterona. La progesterona natural, progesterona micronizada y didrogesterona serían más seguras en TRH para evitar el desarrollo de cáncer de mama, lo que estaría dado por la mayor especificidad en su acción.

In some studies, hormone replacement therapy (HRT) with estrogens and progestins has been associated with a higher risk of breast cancer than therapy with estrogens alone. However, depending on their nature, some progestins may be safer than others. This article analyzes the mode of action of progesterone in breast tissue and also the role of some progestins in the development of this pathology. Articles related to the subject were searched for and analyzed in Google Scholar, PubMed, Science, SciELO and Cochrane databases, introducing the following terms: hormone replacement therapy and breast cancer, progestins and breast cancer, progesterone receptor. Specifically, synthetic progestins medroxyprogesterone acetate, norethisterone, and levonorgestrel have been associated with an increased risk of breast cancer, but not natural progesterone, micronized oral progesterone, or dydrogesterone. Natural progesterone, micronized progesterone and dydrogesterone would be safer in HRT to prevent the development of breast cancer, which would be due to the greater specificity of their action.

Tibolone Improves Memory and Decreases the Content of Amyloid-ß Peptides and Tau Protein in the Hippocampus of a Murine Model of Alzheimer's Disease.

BACKGROUND: Alzheimer's disease (AD) affects women more than men and consequently has been associated with menopause. Tibolone (TIB) has been used as a hormone replacement therapy to alleviate climacteric symptoms. Neuroprotective effects of TIB have also been reported in some animal models. OBJECTIVE: This study aimed to assess the effect of TIB on memory and Aß peptides and tau protein content in the hippocampus and cerebellum of transgenic 3xTgAD ovariectomized mice. METHODS: Three-month-old female mice were ovariectomized. Ten days after surgery, animals were divided into four groups: wild-type (WT)+vehicle; WT+TIB (1 mg/kg); 3xTgAD+vehicle; and 3xTgAD+TIB (1 mg/kg). TIB was administered for three months, and memory was evaluated using the object-in-context recognition task. Subsequently, animals were decapitated, and the hippocampus and cerebellum were dissected. Using commercial ELISA kits, these brain structures were homogenized in a PBS buffer for quantifying Aß40 and Aß42 and phosphorylated and total tau.ResultsA long-term memory deficit was observed in the 3xTgAD+vehicle group. In contrast, TIB treatment improved long-term memory in the 3xTgAD+TIB group than those treated with vehicle (p < 0.05). Furthermore, TIB treatment decreased Aß and tau content in the hippocampus of 3xTgAD mice compared to vehicle-treated groups (p < 0.05). No significant changes were observed in the cerebellum. CONCLUSION: Chronic treatment with TIB showed neuroprotective effects and delayed AD neuropathology in the 3xTgAD mice. Our results support hormone replacement therapy with TIB in menopausal women for neuroprotection.

[Controversy in estimating glomerular filtration rate through traditional equations in transgender people: discussion through a case report].

Introduction: Chronic kidney disease (CKD) and the number of transgender people is on the rise. Hormone replacement therapy may be associated with the development of adverse effects, including kidney disease. Objective: To report the case of a transgender patient using hormone therapy who developed CKD. Case Report: Male transgender patient, 28 years old, using testosterone cypionate every 15 days, without any comorbidity. Evolved with hypertensive peaks of 160-150/110 mmHg and loss of kidney function (Ur 102 mg/dl, Cr 3.5 mg/dl, estimated Glomerular Filtration Rate (eGFR) of 22 ml/min/1.73m2 considering male gender and 16.6 ml/min/1.73m2 considering female gender). Abdominal ultrasound showed chronic parenchymal nephropathy. Due to the significant reduction in eGFR, the patient was referred for kidney transplantation, but he was not included in the list because he had a creatinine clearance of 23 ml/min/1.73m2 for males and 21.5 ml/min/1.73m2 for females in the most recent tests. Conclusion: Hormone replacement may have contributed to the increase in the patient's blood pressure and, consequently, to the development of CKD. There is still no well-established consensus on the best way to estimate the GFR in transgender people, and it seems to be more appropriate to consider the gender to which the person self-identifies or to perform the calculation for both genders, obtaining an estimate of the range in which the patient's GFR lies.

Terapia Hormonal e Hipertensão em Mulheres na Pós-Menopausa: Resultados do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) / Hormone therapy and Hypertension in Postmenopausal Women: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Resumo Fundamento A hipertensão arterial é considerada um importante fator de risco de morbidade e mortalidade cardiovascular em mulheres na pós-menopausa. Embora a terapia hormonal da menopausa (THM) seja um tratamento muito eficiente para sintomas vasomotores nesse período, a influência dessa terapia na pressão arterial ainda não está clara. Objetivo Avaliar a relação entre o uso de THM e a hipertensão em participantes do ELSA-Brasil. Métodos Um estudo transversal usando dados da linha de base da coorte ELSA-Brasil, com 2.138 mulheres que passaram por menopausa natural. Neste estudo, foi analisado a hipertensão, definida como pressão arterial ≥140/90 mmHg ou uso anterior de anti-hipertensivo, e o uso da THM, com participantes sendo classificadas em grupos daquelas que nunca usaram, que já usaram e que estavam em uso atual. As associações foram avaliadas usando-se um modelo de regressão logística multivariada com uma significância estatística definida em p<0,05. Resultados No total, 1.492 mulheres (69,8%) nunca tinham usado a THM, 457 (21,4%) tinham usado no passado, e 189 (8,8%) estavam em uso atual. O uso de THM foi mais comum em mulheres que tinham índice de massa corporal <25 kg/m2 e níveis de triglicérides <150 mg/dl, que eram fisicamente menos inativas, não fumantes e não diabéticas. As mulheres em uso atual da THM apresentaram menores chances de ter hipertensão (OR=0,59; IC 95%: 0,41-0,85), em comparação com as que nunca a usaram. Na maioria dos casos, a THM foi iniciada com idade até 59 anos, com menos de 10 anos de menopausa e o uso durou até cinco anos. Conclusão O uso atual da THM não esteve relacionado à hipertensão, especialmente em mulheres saudáveis e que tinham menos de 60 anos de idade.

Abstract Background Hypertension is a major risk factor for cardiovascular morbidity and mortality in post-menopausal women. Although menopausal hormone therapy (MHT) is a very effective treatment for vasomotor symptoms during this period, the influence of this therapy on blood pressure is not yet clear. Objective To evaluate the relationship between the use of MHT and hypertension in participants of the ELSA-Brasil. Methods A cross-sectional study using the baseline ELSA-Brasil data in a cohort of 2,138 women who had experienced natural menopause. This study analyzed hypertension, defined as arterial pressure ≥140/90 mmHg or previous antihypertensive use, and use of MHT, with participants being classified into never, past, and current users. Associations were assessed using an adjusted logistic regression model, with statistical significance set at p<0.05. Results Overall, 1,492 women (69.8%) had never used MHT, 457 (21.4%) had used it in the past, and 189 (8.8%) were current users. The use of MHT was more common in women who had a body mass index (BMI) <25 kg/m2and triglyceride levels <150 mg/dl, and who were physically less inactive, non-smokers, and non-diabetics. Current MHT users were less likely to have hypertension (OR=0.59; 95% CI: 0.41-0.85) compared to those who had never used MHT. In most cases, MHT was started at or before 59 years of age, within 10 years of becoming menopausal, and its use lasted for up to five years. Conclusion Current MHT use was not related to hypertension, particularly in healthy women and in those under 60 years of age.

Hormone therapy effect on menopausal systemic lupus erythematosus patients: a systematic review.

Systemic lupus erythematosus (SLE) primarily affects women, who may need hormone therapy (HT) in menopause. There is, however, some concern as to its efficacy and safety. This systematic review aimed to determine the effect of HT on the activity of SLE and its safety. The study was a qualitative systematic review. Research was conducted with data retrieved from Embase, MEDLINE and Cochrane databases using MESH terms up to April 2021, with no bar on date or language. Sixteen studies were selected for analysis. Most of them showed HT to be effective in the treatment of menopausal symptoms with no impact in SLE activity, but one randomized clinical trial showed an increase in the number of thrombotic events. The present systematic review demonstrated the efficacy of HT for treating the menopausal symptoms of SLE patients. The risk of flare and thrombosis seems to be very low.

Descrição de medicamentos prescritos para a terapia hormonal em serviços de saúde especializados para transexuais e travestis no Rio Grande do Sul, 2020 / Descripción de medicamentos recetados para terapia hormonal en servicios de salud especializados para transexuales y travestis en Rio Grande do Sul, Brasil, 2020 / Description of drugs prescribed for hormone therapy in specialized health services for transsexual and transvestite persons in Rio Grande do Sul, Brazil, 2020

Objetivo: Descrever os medicamentos prescritos para o tratamento hormonal do processo transexualizador em estabelecimentos de saúde de atendimento especializado para pessoas transexuais e travestis no Rio Grande do Sul, Brasil. Métodos: Estudo descritivo, com coleta de dados nesses estabelecimentos, no período maio-setembro/2020, utilizando-se instrumento elaborado pelos(as) pesquisadores(as). Obtiveram-se dados sobre o perfil de usuários(as) e características do cuidado farmacológico de tratamento hormonal. Resultados: A pesquisa contemplou todos os sete serviços do estado. Para mulheres transexuais e travestis, medicamentos antiandrogênicos e espironolactona foram prescritos em todos os serviços. Apenas um estabelecimento não prescreveu ciproterona. Todos os estabelecimentos de saúde realizaram prescrição de medicamentos a base de estrógenos, com diferenças na via de administração; para homens transexuais, todos prescreveram andrógenos por via intramuscular. Conclusão: A pesquisa aponta os medicamentos prescritos e sua diversidade, ratificando a necessidade da produção de informação para implementação das políticas de equidade no Sistema Único de Saúde.

Objetivo: Describir los medicamentos prescritos para el tratamiento hormonal en establecimientos de salud que brindan atención especializada a transexuales y travestis en Rio Grande do Sul, Brasil. Métodos: Estudio descriptivo, con recolección de datos en los establecimientos, entre mayo y septiembre de 2020, utilizando el instrumento desarrollado por los investigadores. Se obtuvieron datos sobre el perfil de usuarios (as) y características del cuidado farmacológico de tratamiento hormonal. Resultados: La encuesta abarcó los siete servicios estatales. Para las mujeres transgénero y travestis se prescribieron antiandrógenos y espironolactona en todos los servicios. Sólo un establecimiento no prescribió ciproterona. Todos los establecimientos de salud prescribieron medicamentos a base de estrógenos con diferencias en la vía de administración. Para los hombres transgénero, todos los andrógenos se recetan por vía intramuscular. Conclusión: La investigación destaca la diversidad de medicamentos prescritos, ratificando la necesidad de producir información para la implementación de políticas de equidad en el Sistema de Salud Brasileño.

Objective: To describe the drugs prescribed for hormone treatment as part of the transsexualization process in health facilities providing specialized care for transsexual and transvestite persons in the state of Rio Grande do Sul, Brazil. Methods: This was a descriptive study based on data collected in health facilities between May and September 2020 using the instrument developed by the researchers. Results: The survey covered all seven services in the state. Antiandrogen drugs and spironolactone were prescribed for transsexuals and transvestites women in all services. Only one service did not prescribe cyproterone. All health facilities prescribed estrogen-based drugs, although with differences in the route of administration. In the case of transsexuals men, all services prescribed androgens to be administered via the intramuscular route. Conclusion: The study indicates which drugs are prescribed and their diversity, ratifying the need to produce information for the implementation of equity policies in the Brazilian National Health System.

Reposição de testosterona em mulheres cisgênero na menopausa / Testosterone replacement in menopausal cisgender women

Ainda não existe consenso a respeito da prescrição de testosterona terapêutica para mulheres cisgênero na menopausa, seus benefícios e efeitos colaterais. Objetivo: Sumarizar os estudos recentes sobre o uso terapêutico da testosterona em mulheres na menopausa. Método: Revisão sistemática de literatura baseada nos dados da plataforma PubMed. Foram identificados 10.912 estudos potenciais. As palavras-chave usadas foram "testosterone", "women", "therapy", "treatment". Selecionou-se revisões sistemáticas e metanálises dos últimos 5 anos, todas na língua inglesa. Excluiram-se artigos duplicados, os que abordam uso de testosterona como anabolizantes e/ou em atletas e em transexuais e estudos que envolviam homens. O levantamento de dados foi realizado com 9 artigos. Resultados: O uso dessa terapia hormonal no período da pós-menopausa mostrou melhora dos sintomas sexuais. Há diferença entre as vias de aplicação, sendo que a via oral pode acarretar maiores prejuízos, principalmente em relação aos níveis lipídicos séricos. A testosterona intravaginal melhora a função sexual. A prescrição na prática se mostra um problema, pois as apresentações comercializadas não atendem à necessidade fisiológica feminina. Conclusão: A terapia mostra-se eficaz em curto prazo, apesar de ainda haver necessidade de estudos para uso em longo prazo

There is still no consensus regarding the prescription of testosterone therapy for cisgender menopausal woman, its benefits and side effects. Objective: Summarize recent studies on the therapeutic use of testosterone in menopausal woman. Methods: Systematic literature review based on data from the PubMed platform. A total of 10.912 potential studies were identified. The used keywords were "testosterone", "woman", "therapy", "treatment". Systematic reviews and meta-analyses from the last 5 years were selected, all in English. Were excluded: duplicated articles, the ones that address the use of testosterone as anabolic steroid and/or in athletes and transsexuals and studies that involved man. Tthe data collection was made with 9 articles. Results: The use of this hormone therapy in postmenopausal period showed sexual symptoms improvement. There are differences between the routes of administration, for the oral administration could lead to more damage, mainly related to the lipids serum levels. Intravaginal testosterone improves sexual function. The prescription in practice is shown to be a problem, since the commercialized presentations do not meet the feminine physiological necessities. Conclusion: This therapy proves to be effective in short term use, although there is still a need for studies for long-term use