RESUMEN

OBJECTIVE: To assess the correlation between menopausal symptoms and pain caused by temporomandibular disorder (TMD) and the impact of sociodemographic factors on the association. METHODS: In this cross-sectional study, a total of 74 women with TMD symptoms were enrolled and divided into three groups according to the Stages of Reproductive Aging Workshop + 10 (STRAW + 10) criteria: G1 (n = 25, late menopausal transition), G2 (n = 30, early postmenopause), and G3 (n = 19, late postmenopause). Sociodemographic data were collected, along with data on menopausal symptoms (Blatt-Kupperman menopausal index) and TMD-induced pain (craniomandibular index). Statistical analysis was performed using a chi-squared test and linear correlation tests (Spearman and Pearson). RESULTS: Analysis of the three groups showed that TMD-induced pain was more intense in G1 than in G3 (P = 0.0426, r  = 0.2364, r2 = 0.05589), and menopausal symptoms correlated with the intensity of TMD-induced pain (P = 0.0004, r  = 0.4020). This correlation was more significant during the late menopausal transition (G1: P  = 0.0267, r  = 0.4427, r2 = 0.1960). In G2, women with fewer than 4 years of schooling had a higher total Blatt- Kupperman menopausal index score (17.0 ±â€Š85.0) and craniomandibular index (0.29 ±â€Š0.23) than women with more than 4 years of schooling (P  = 0.02 for both indices). CONCLUSIONS: Our results suggest that TMD-induced pain and menopausal symptoms are correlated, and more strongly so in the late menopausal transition. Additionally, sociodemographic factors, such as schooling, have a major influence on symptoms in early postmenopause. Performing the TMD evaluation during the climacteric period may be important.

Asunto(s)

Posmenopausia , Trastornos de la Articulación Temporomandibular , Estudios Transversales , Femenino , Humanos , Menopausia , Dolor , Trastornos de la Articulación Temporomandibular/epidemiología

RESUMEN

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.

Asunto(s)

Envejecimiento , Artralgia/fisiopatología , Sofocos/fisiopatología , Menopausia , Obesidad/fisiopatología , Sobrepeso/fisiopatología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Adulto , Artralgia/etiología , Índice de Masa Corporal , Brasil , Distribución de Chi-Cuadrado , Femenino , Sofocos/etiología , Humanos , Registros Médicos , Persona de Mediana Edad , Enfermedades Neuromusculares/etiología , Enfermedades Neuromusculares/fisiopatología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Factores de Tiempo , Sistema Vasomotor/fisiopatología

RESUMEN

OBJECTIVE: The aim of this study was to construct and to validate a measure of the consequences of domestic violence on women's health during climacterium. METHODS: A questionnaire was administered at the Outpatient Climacterium Clinic to 124 women aged 40 to 65 years who were the victims of domestic and/or sexual violence (experimental group). They were divided into three groups: (1) those who were victims of violence exclusively during childhood/adolescence, (2) those who were victims of violence exclusively during adulthood, and (3) those who were victims of violence throughout their lives. The instrument included 34 items evaluating the beginning, frequency, and type of violence; the search for health assistance and reporting of the violence; the violence and the number of comorbidities; and violence and the Kupperman Menopausal Index. We also included a control group composed of perimenopausal and postmenopausal women who did not experience any violence (n = 120). RESULTS: The instrument presented a Cronbach α = 0.82, good reliability among the examiners (+0.80), and a good possibility of reproducibility. The mean age of menopause was 45.4 years, and the mean age in the control group was 48.1 years. Group 1 showed a mean of 5.1 comorbidities, Group 2 had 4.6, and Group 3 had 4.4. Sexual violence (43.5%) and other types of violence both presented average comorbidities (4.60) but represented a significant impairment in the victim's sexual life. There were significant associations in group 3 and a high Kupperman Menopausal Index score. In the experimental group, 80.6% did not seek health services for the violence they experienced. CONCLUSIONS: The questionnaire presented good internal consistency and a validated construction. It can be easily reproduced and is indicated to evaluate the consequences of domestic and/or sexual violence on women's health during climacterium.

Asunto(s)

Violencia Doméstica/psicología , Menopausia/fisiología , Menopausia/psicología , Delitos Sexuales/psicología , Encuestas y Cuestionarios , Adulto , Anciano , Comorbilidad , Femenino , Humanos , Persona de Mediana Edad

RESUMEN

OBJECTIVE: To search for predictors of metformin response in women with polycystic ovary syndrome (PCOS) through a detailed analysis of clinical and laboratory parameters. STUDY DESIGN: We designed a prospective study to investigate clinical and laboratory parameters to search for predictors of metformin response in women with PCOS. A total of 53 PCOS patients were given metformin 850 mg twice a day for 6 months, after which patients were classified as responders or non-responders. Parameters analyzed for comparison between the two groups were: plasma fasting insulin glucose/insulin ratio; oral glucose tolerance test (OGTT) with insulin (120 min); HOMA and QUICKI tests; total cholesterol and fractions, triglycerides; LH, FSH, estradiol, progesterone, testosterone, androstenedione, 17-OH progesterone, and DHEAS. RESULTS: From all patients, 30 (56.6%) were responders and 23 (43.3%) were non-responders. Multinomial analysis showed that the positive response to metformin was associated with higher levels of basal LH (p=0.038) and lower levels of high-density lipoprotein cholesterol (HDL-C) (p=0.015). CONCLUSION: In weight-matched PCOS subjects, laboratory markers might predict the metformin response. Higher levels of basal LH and lower levels of HDL-C are correlated with a positive response to metformin treatment in PCOS subjects.

Asunto(s)

HDL-Colesterol/sangre , Hormona Luteinizante/sangre , Metformina/uso terapéutico , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Adolescente , Adulto , Biomarcadores/sangre , Glucemia/metabolismo , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Insulina/sangre , Valor Predictivo de las Pruebas , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven

RESUMEN

Emerging data reveal that oral estrogen therapy can increase clinic blood pressure (BP) in post-menopausal women; however, it is important to establish its effects on ambulatory BP, which is a better predictor for target-organ damage. Besides estrogen therapy, aerobic training is widely recommended for post-menopausal women, and it can decrease ambulatory BP levels. This study was designed to evaluate the effect of aerobic training and estrogen therapy on the ambulatory BP of post-menopausal women. Forty seven healthy hysterectomized women were randomly divided (in a double-blind manner) into 4 groups: placebo-control (PLA-CO=12), estrogen therapy-control (ET-CO=14), placebo-aerobic training (PLA-AT=12), and estrogen therapy-aerobic training (ET-AT=09). The ET groups received estradiol valerate (1 mg/day) and the AT groups performed cycle ergometer, 3×/week at moderate intensity. Hormonal status (blood analysis), maximal cardiopulmonary exercise test (VO(2) peak) and ambulatory BP (24-h, daytime and nighttime) was evaluated before and 6 months after interventions. A significant increase in VO(2) peak was observed only in women who participated in aerobic training groups (+4.6±1.0 ml kg(-1) min(-1), P=0.00). Follicle-stimulating hormone was a significant decreased in the ET groups (-18.65±5.19 pg/ml, P=0.00), and it was accompanied by an increase in circulating estrogen (56.1±6.6 pg/ml). A significant increase was observed in the ET groups for daytime (P=0.01) and nighttime systolic BP (P=0.01), as well as nighttime diastolic BP (P=0.02). However, daytime diastolic BP was increased only in the ET-CO group (+3.4±1.2 mmHg, P=0.04), and did not change in any other groups. No significant effect was found in ambulatory heart rate. In conclusion, aerobic training abolished the increase of daytime ambulatory BP induced by estrogen therapy in hysterectomized, healthy, normotensive and postmenopausal women.

Asunto(s)

Presión Sanguínea/fisiología , Terapia de Reemplazo de Estrógeno/efectos adversos , Ejercicio Físico/fisiología , Monitoreo Ambulatorio de la Presión Arterial , Método Doble Ciego , Estrógenos/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Histerectomía , Persona de Mediana Edad , Consumo de Oxígeno , Posmenopausia/sangre , Posmenopausia/fisiología

Asunto(s)

Hormonas/uso terapéutico , Esclerodermia Sistémica/tratamiento farmacológico , Adulto , Femenino , Humanos , Esclerodermia Difusa/tratamiento farmacológico

RESUMEN

Acute hyperinsulinemia produces sympathetic activation, vasodilation, and cardiovascular changes in healthy young men. Postmenopausal period is accompanied by sympathetic, vascular and cardiovascular changes. Nevertheless, the effects of acute insulin infusion were not known in postmenopausal women. To study this aspect, 26 postmenopausal healthy women were submitted to an euglycemic hyperinsulinemic clamp performed during 120 min. Heart rate (HR: ECG), blood pressure (BP: oscillometric method), forearm blood flow (FBF: plethysmography), plasma norepinephrine (NE), plasma epinephrine (EP), and cardiovascular autonomic modulation (spectral analysis of R-R interval and BP variabilities) were measured before and during the clamp. Glycemia was kept similar to baseline during the clamp (84.6+/-1.2mg/dl versus 87.1+/-1.6 mg/dl), while plasma insulin increased significantly to a level of 89.3+/-5.6 microU/ml. Insulin infusion significantly increased plasma NE (+45+/-17 pg/ml), EP (+20+/-9 pg/ml), and low to high frequency ratio of R-R interval variability (LH/HF: 1.2+/-0.4), but did not change low frequency component of BP variability. FBF (+0.7+/-0.2 ml min(-1)100ml(-1)) was also significantly enhanced by hyperinsulinemia. HR and systolic BP increased with insulin infusion (+4+/-1 bat/min and +6+/-2 mmHg, respectively, P<0.05), while diastolic BP did not change. In conclusion, in healthy postmenopausal women, acute hyperinsulinemia produces sympathetic activation, and vasodilation, which results in HR and systolic BP enhancements, with no change in diastolic BP. This pattern of response is similar to the one usually observed in healthy young men.

Asunto(s)

Glucemia/metabolismo , Hiperinsulinismo/fisiopatología , Insulina/metabolismo , Posmenopausia/fisiología , Velocidad del Flujo Sanguíneo/fisiología , Epinefrina/metabolismo , Femenino , Técnica de Clampeo de la Glucosa , Hemodinámica , Humanos , Persona de Mediana Edad , Norepinefrina/metabolismo , Valores de Referencia

RESUMEN

OBJECTIVE: The present study was undertaken to assess the impact, effectiveness and safety of a monophasic hormone replacement treatment (HRT) for continuous use with regards to the clinical effects, bleeding patterns and lipid profile of menopausal women in four Latin American countries. DESIGN: Three hundred and six postmenopausal women with natural menopause and uterus present were recruited. This was a multicentre prospective, clinical trial; the participating countries were Brazil (BR), Colombia (CO), Mexico (MX) and Argentina (AR). The study period was 12 months. The HRT regime was formulated in tablets containing 2 mg estradiol E2 and 1mg norethisterone acetate (NETA); one visit every 3 months was solicited. METHODS: HRT was given as one tablet every day without interruption for 1 year. Climacteric complaints, side-effects, reason for discontinuation, bleeding patterns, lipid profile at baseline and 12 months of treatment were documented. RESULTS: There were no significant differences between the four populations on clinical measurements. Thirty-four women discontinued, 13 for bleeding problems. The five most common side-effects were mastalgia, bleeding problems, headache, pelvic pain and nausea. 44.8% of women experienced scanty vaginal bleeding during the first 3 months of therapy. Ninety seven percent of women had amenorrhea at the end of the study in MX, BR and AR, and 100% in CO. Body weight was constant during the study, and no correlation was found between body weight and total days with bleeding. The Kupperman index score was used to evaluate the climacteric complaints, and the score decreased from a mean of 25.4 to 5.1 at 12-months visit. Total cholesterol levels were significantly reduced in BR and CO (P < 0.05) between baseline and the final sample; serum triglycerides remained unchanged, HDL-cholesterol was significantly increased in MX (P < 0.05), and LDL-cholesterol was significantly reduced in CO (P < 0.05). The results of this 1-year study emphasize that a continuous combined HRT regimen with 2 mg E2/1 mg NETA is an attractive alternative for postmenopausal women who are at least 1 year after their menopause and optimally 2 years after their menopause. Although the combination of 2 mg E2 with 1 mg NETA in a continuous combined therapy scheme has been in use in the Nordic countries for over a decade and in Latin America for the last 6 years, there have been no previous published reports on its effectivity in Latin American women. This publication reports the experience in a group of 306 Latin American women, and it is the first Latin American publication with this formulation.

Asunto(s)

Anticonceptivos Sintéticos Orales/uso terapéutico , Estradiol/uso terapéutico , Terapia de Reemplazo de Estrógeno , Menopausia , Noretindrona/análogos & derivados , Noretindrona/uso terapéutico , Administración Oral , Adulto , Ansiedad/tratamiento farmacológico , Anticonceptivos Sintéticos Orales/efectos adversos , Depresión/tratamiento farmacológico , Mareo/tratamiento farmacológico , Estradiol/efectos adversos , Terapia de Reemplazo de Estrógeno/efectos adversos , Femenino , Cefalea/tratamiento farmacológico , Frecuencia Cardíaca/efectos de los fármacos , Sofocos/tratamiento farmacológico , Humanos , América Latina , Lípidos/sangre , Persona de Mediana Edad , Debilidad Muscular/tratamiento farmacológico , Noretindrona/efectos adversos , Acetato de Noretindrona , Parestesia/tratamiento farmacológico , Estudios Prospectivos

Asunto(s)

Calcio de la Dieta , Climaterio , Proteínas en la Dieta , Dieta , Femenino , Humanos , Política Nutricional

RESUMEN

OBJECTIVE: The objective was to study the polymorphism of collagen type 1 alpha 1 (COL1 A1) gene as a genetic marker, the biochemical markers of formation (osteocalcin) and bone reabsorption (cross-links of pyridinoline-CTx), bone mineral density and bone ultrasonometry compared to bone densitometry (DEXA). METHOD: The study included 82 women ranging in age from 45 to 60 years, menopausal from 1 to 10 years. Polymorphism of COL1 A1 was assessed by PCR (polymerase chain reaction), by the specific allele technique. Bone formation markers were studied using an ELISA (Novocalcin and Active Crosslaps). A Hologic 4500 A QDR (DEXA) densitometer and DBM Sonic 1200 IGEA ultrasonograph were employed. RESULTS: The bone reabsorption marker (cross-links of pyridinoline-CTx) demonstrated statistically significant negative correlation with bone mineral density (lumbar and femoral neck), while the bone formation marker (osteocalcin) did not display a correlation with bone mineral density. Bone ultrasonometry yielded a statistically significant positive correlation with bone densitometry. Collagen type 1 alpha 1 polymorphism was not identified by the technique employed. CONCLUSION: The bone reabsorption marker (cross-links of pyridinoline) and bone ultrasonometry and densitometry are measurements enabling evaluation of bone remodeling.

Asunto(s)

Densidad Ósea , Remodelación Ósea , Resorción Ósea/genética , Colágeno Tipo I , Colágeno/genética , Menopausia , Osteoporosis Posmenopáusica/genética , Polimorfismo Genético , Aminoácidos/metabolismo , Resorción Ósea/metabolismo , Resorción Ósea/fisiopatología , Climaterio , Colágeno/metabolismo , Cadena alfa 1 del Colágeno Tipo I , Densitometría , Ensayo de Inmunoadsorción Enzimática , Femenino , Marcadores Genéticos , Humanos , Persona de Mediana Edad , Osteocalcina/metabolismo , Osteoporosis Posmenopáusica/metabolismo , Reacción en Cadena de la Polimerasa

RESUMEN

OBJETIVOS: Verificar o comportamento da Prolactine (PRL) endometrial. CASUíSTICA E MÉTODOS: foram estudadas 40 mulheres, com média etária de 28,3 anos e selecionadas por apresentarem os seguintes sintomas: alteraçäo do ciclo menstrual e/ou esterilidade e/ou galactorréia. As pacientes foram divididas em dois grupos: Grupo A - dezenove mulheres hiperprolactinêmicas e Grupo B - vinte e uma mulheres normoprolactinêmicas. Exames laboratoriais foram realizados na fase folicular inicial (do terceiro ao nono dia), fase lútea inicial (do 15º ao 21º dia) e fase lútea tardia (do 22º ao 29º dia), nas pacientes que menstruavam (1ª, 2ª e 3ª amostras, respectivamente) e, nas que näo menstruam, no primeiro, 14º e 21º dia da consulta (1ª, 2ª e 3ª amostras, respectivamente). Na 1ª amostra, foram dosados LH, FSH, PRL e estradiol e nas 2ª e 3ª amostras a PRL e a progesterona. Todas as mulheres foram submetidas a duas biópsias de endométrio para a verificaçäo do padräo menstrual, dateamento e detecçäo imuno-histoquímica da PRL endometrial. Essas biópsias foram realizadas na 2ª e 3ª amostras. RESULTADOS: expressos em percentuais da PRL endometrial mostraram: as médias dos percentuais da PRL endometrial foram maiores na fase lútea inicial nas mulheres hiperprolactinêmicas e normoprolactinêmicas. CONCLUSöES: A PRL sérica näo se correlaciona com a endometrial e a síntese da PRL endometrial está em relaçäo direta a diferenciaçäo das células estromais, induzida pela progesterona, em endométrio decidualizado.

Asunto(s)

Humanos , Femenino , Adulto , Endometrio/metabolismo , Galactorrea , Hiperprolactinemia/fisiopatología , Trastornos de la Menstruación , Biopsia , Estradiol/metabolismo , Hormona Folículo Estimulante/sangre , Fase Folicular , Inmunohistoquímica , Fase Luteínica , Hormona Luteinizante/sangre , Progesterona/metabolismo , Prolactina/biosíntesis , Prolactina/sangre , Prolactina/metabolismo , Radioinmunoensayo