RESUMEN

OBJECTIVE: To assess the association between hot flashes (HFs) severity and oxidative stress (OS) in Mexican postmenopausal women. METHODS: A cross-sectional study was carried out with perimenopausal women aged 40-59 years community-dwelling from Mexico City, Mexico. They participated in Menopause and Oxidative Stress Project. The baseline sample consisted of 476 women recruited to participate; 161 women were excluded due to different reasons. Hence, 315 women were selected to establish two groups, a) 145 premenopausal women (yet with menstrual bleeding), and b) 170 postmenopausal women (without menses). All women were free of cardiovascular, kidney, hepatic or cancer disease, and without antioxidant supplement intake for at least six months prior to the beginning of the study; none had previously received hormone therapy. As OS markers, we measured plasma malondialdehyde using the TBARS assay, erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GPx), uric acid, and total antioxidant status; also, we calculated SOD/GPx ratio, antioxidant gap and an oxidative stress score ranging from 0 to 7. The HFs were evaluated using the Menopause Rating Scale. The women completed Spanish version of the Athens Insomnia Scale, Zung Self-Rating Anxiety Scale and Zung Self-Rating Depression Scale and a questionnaire of pro-oxidant factors. RESULTS: Stress score increased with HFs severity (mild 2.7±0.17, moderate 2.9±0.20 and severe 3.7±0.20, p = 0.001) in postmenopausal women. We observed a positive correlation between HFs severity and stress score, r = 0.247 (p = 0.001) in postmenopausal women; other test scores were not correlated. Severe HFs were a risk factor for OS (OR = 5.12, 95%CI: 1.99-13.17, p<0.05) in an adjusted multivariate analysis by different postmenopausal symptoms and pro-oxidant factors; we did not see any association in premenopausal women. CONCLUSION: Our findings suggest an association between HFs severity and OS in Mexican postmenopausal women.

Asunto(s)

Sofocos/sangre , Estrés Oxidativo , Posmenopausia/sangre , Adulto , Femenino , Glutatión Peroxidasa/sangre , Sofocos/epidemiología , Sofocos/fisiopatología , Humanos , Malondialdehído/sangre , México , Persona de Mediana Edad , Posmenopausia/fisiología , Superóxido Dismutasa/sangre , Ácido Úrico/sangre

RESUMEN

STUDY OBJECTIVES: For most women, the menopause is accompanied by hot flashes and sleep problems. Although hot flashes reportedly wake women from sleep, in the few studies that have used objective measures of both sleep and hot flashes, links between hot flashes and nocturnal awakening have been inconsistent. In a well-characterized cohort of midlife women, we examined the association between objectively assessed hot flashes and actigraphically defined wake from sleep. We hypothesized that wake episodes would be more likely during an objective hot flash relative to minutes without a hot flash. METHODS: Peri- and postmenopausal midlife women underwent simultaneous objective measurement of hot flashes (sternal skin conductance) and sleep (actigraphy) over 24 hours in the home. The likelihood of waking in the minutes during the hot flash relative to the minutes preceding the hot flash was compared using generalized estimating equations. RESULTS: We studied 168 women with at least one objective nocturnal hot flash and actigraphy data. Actigraphy-assessed wake episodes were concurrent with 78% of the objective hot flashes. We found an increased likelihood of wake in the minutes during the objective hot flash (0 to +5 min: OR [95% CI] = 5.31 (4.46 to 6.33); p < .0001) relative to the minutes preceding it (-10 to -1 min). The increased likelihood of wake occurred irrespective of whether the women reported the objective hot flash. CONCLUSION: Among these women who underwent objective measurement of sleep and hot flashes, nocturnal wakefulness was observed with the majority of hot flashes.

Asunto(s)

Sofocos/fisiopatología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Trastornos del Sueño-Vigilia/fisiopatología , Actigrafía , Estudios de Cohortes , Femenino , Humanos , Menopausia/fisiología , Persona de Mediana Edad , Sueño/fisiología

RESUMEN

PURPOSE: Calcitonin gene-related peptide (CGRP) is a neuropeptide widely distributed in the central and peripheral nervous systems, which is known as a potent vasodilator. Postmenopausal women who experience hot flushes have high levels of plasma CGRP, suggesting its involvement in menopausal vasomotor symptoms. METHODS: In this review, we describe the biochemical aspects of CGRP and its effects associated with deficiencies of sexual hormones on skin temperature, vasodilatation, and sweating as well as the possible peripheral and central mechanisms involved in these events. RESULTS: Several studies have shown that the effects of CGRP on increasing skin temperature and inducing vasodilatation are potentiated by a deficiency of sex hormones, a common condition of postmenopausal women. Additionally, the medial preoptic area of the hypothalamus, involved in thermoregulation, contains over 25-fold more CGRP-immunoreactive cells in female rodents compared with male rodents, reinforcing the role of female sex hormones on the action of CGRP. Some studies suggest that ovarian hormone deficiency decreases circulating endogenous CGRP, inducing an upregulation of CGRP receptors. Consequently, the high CGRP receptor density, especially in blood vessels, amplifies the stimulatory effects of this neuropeptide to raise skin temperature in postmenopausal women during hot flushes. CONCLUSIONS: The duration of the perception of each hot flush in a woman is brief, while local reddening after intradermal administration of α-CGRP persists for 1 to 6 h. This contrast remains unclear.

Asunto(s)

Péptido Relacionado con Gen de Calcitonina/fisiología , Sofocos/etiología , Menopausia/fisiología , Sistema Vasomotor/fisiopatología , Animales , Péptido Relacionado con Gen de Calcitonina/sangre , Femenino , Sofocos/sangre , Sofocos/fisiopatología , Humanos , Masculino , Menopausia/sangre , Roedores , Vasodilatación/fisiología

RESUMEN

OBJECTIVE: Hot flashes are experienced by most midlife women. Emerging data indicate that they may be associated with endothelial dysfunction. No studies have tested whether hot flashes are associated with endothelial function using physiologic measures of hot flashes. We tested whether physiologically assessed hot flashes were associated with poorer endothelial function. We also considered whether age modified associations. METHODS: Two hundred seventy-two nonsmoking women reporting either daily hot flashes or no hot flashes, aged 40 to 60 years, and free of clinical cardiovascular disease, underwent ambulatory physiologic hot flash and diary hot flash monitoring; a blood draw; and ultrasound measurement of brachial artery flow-mediated dilation to assess endothelial function. Associations between hot flashes and flow-mediated dilation were tested in linear regression models controlling for lumen diameter, demographics, cardiovascular disease risk factors, and estradiol. RESULTS: In multivariable models incorporating cardiovascular disease risk factors, significant interactions by age (P < 0.05) indicated that among the younger tertile of women in the sample (age 40-53 years), the presence of hot flashes (beta [standard error] = -2.07 [0.79], P = 0.01), and more frequent physiologic hot flashes (for each hot flash: beta [standard error] = -0.10 [0.05], P = 0.03, multivariable) were associated with lower flow-mediated dilation. Associations were not accounted for by estradiol. Associations were not observed among the older women (age 54-60 years) or for self-reported hot flash frequency, severity, or bother. Among the younger women, hot flashes explained more variance in flow-mediated dilation than standard cardiovascular disease risk factors or estradiol. CONCLUSIONS: Among younger midlife women, frequent hot flashes were associated with poorer endothelial function and may provide information about women's vascular status beyond cardiovascular disease risk factors and estradiol.

Asunto(s)

Arteria Braquial/diagnóstico por imagen , Endotelio Vascular/fisiopatología , Sofocos/fisiopatología , Perimenopausia/fisiología , Posmenopausia/fisiología , Adulto , Factores de Edad , Enfermedades Cardiovasculares/etiología , Distribución de Chi-Cuadrado , Cromatografía Liquida , Estradiol/análisis , Femenino , Sofocos/sangre , Humanos , Modelos Lineales , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Autoinforme , Estadísticas no Paramétricas , Espectrometría de Masas en Tándem , Ultrasonografía Intervencional , Salud de la Mujer

RESUMEN

OBJECTIVE: This study provides the description, protocol, and results from a novel prospective ambulatory digital hot flash phenomenon diary. METHODS: This study included 152 midlife women with daily hot flashes who completed an ambulatory electronic hot flash diary continuously for the waking hours of three consecutive days. In this diary, women recorded their hot flashes and accompanying characteristics and associations as the hot flashes occurred. RESULTS: Self-reported hot flash severity on the digital diaries indicated that the majority of hot flashes were rated as mild (41.3%) or moderate (43.7%). Severe (13.1%) and very severe (1.8%) hot flashes were less common. Hot flash bother ratings were rated as mild (43%), or moderate (33.5%), with fewer hot flashes reported bothersome (17.5%) or very bothersome (6%). The majority of hot flashes were reported as occurring on the face (78.9%), neck (74.7%), and chest (61.3%). Of all reported hot flashes, 32% occurred concurrently with prickly skin, 7% with anxiety, and 5% with nausea. A novel finding from the study was that 38% of hot flashes were accompanied by a premonitory aura. CONCLUSIONS: A prospective electronic digital hot flash diary allows for a more precise quantitation of hot flashes while overcoming many of the limitations of commonly used retrospective questionnaires and paper diaries. Unique insights into the phenomenology, loci, and associated characteristics of hot flashes were obtained using this device. The digital hot flash phenomenology diary is recommended for future ambulatory studies of hot flashes as a prospective measure of the hot flash experience.

Asunto(s)

Computadoras de Mano , Sofocos/fisiopatología , Registros Médicos , Menopausia/fisiología , Autoinforme , Ansiedad , Femenino , Sofocos/psicología , Humanos , Persona de Mediana Edad , Náusea , Estudios Prospectivos , Encuestas y Cuestionarios

RESUMEN

OBJECTIVE: The aim of the study was to compare the endothelial function of symptomatic (self-reported hot flashes >3 on a scale of 0-10) versus asymptomatic (≤3) women in different postmenopause stages, and to examine if the association between hot flashes and endothelial function was independent of classical cardiovascular risk factors observed during the analysis. METHODS: Noninvasive venous occlusion plethysmography within two groups: recent (recent postmenopause [RPM], <10 y, n = 63) and late (late postmenopause [LPM], ≥10 y, n = 67) postmenopause. RESULTS: Symptomatic women showed lower forearm blood flow and lower percentage increment of it during the reactive hyperemia response; higher systolic (P < 0.0001 in RPM and P = 0.0008 in LPM) and diastolic (P = 0.0005 in RPM and P = 0.0219 in LPM) blood pressure; highest score for perimenopausal hot flashes (P = 0.0007 in RPM and P < 0.0001 in LPM), longer duration of prior oral contraceptive use (P = 0.009 in RPM and P = 0.0253 in LPM), and higher current sleep disorders (P < 0.0001 in RPM and P = 0.0281 in LPM) compared with asymptomatic ones. In the LPM group, symptomatic women also had higher prevalence of previous hypertension diagnosis (P = 0.0092). During multivariate analysis, blood flow during the reactive hyperemia response was associated with hot flashes after adjusting for age, body mass index, and systolic blood pressure (odds ratio 0.55 [0.36-0.84] in RPM and odds ratio 0.7 [0.5-0.97] in LPM). CONCLUSIONS: In both phases, recent and late post menopause, hot flashes were associated with endothelial dysfunction and higher systolic and diastolic blood pressure, but the relationship between hot flashes and endothelial dysfunction was independent of blood pressure.

Asunto(s)

Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/etiología , Sofocos/fisiopatología , Hipertensión/etiología , Posmenopausia/fisiología , Anciano , Estudios Transversales , Femenino , Sofocos/complicaciones , Humanos , Hipertensión/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo

RESUMEN

INTRODUCTION: The etiology of depressive symptoms associated with the transition to menopause is still unknown; hormonal changes, serotonergic system or insomnia, could be a trigger to depressive symptomatology. The aim of the present study was to evaluate gonadal hormonal levels, platelet serotonin concentrations and platelet tryptophan concentrations in a group of depressed perimenopausal women and their healthy counterparts. METHODS: A total of 63 perimenopausal women between 45 and 55 years old were evaluated; of these, 44 were depressed patients, and 19 were perimenopausal women without depression. The instruments that were applied included the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Depression Rating Scale (HDRS) and the Green Climacteric Scale (GCS); gonadal hormone levels and platelet tryptophan and serotonin concentrations were measured in all participants. Differences in hormonal levels and tryptophan and serotonin concentrations were evaluated with respect to specific symptoms, such as insomnia, hot flashes, nervousness, depressed mood and loss of interest. RESULTS: No differences between groups were observed with respect to hormonal levels and tryptophan and serotonin concentrations; mean sleep hours and insomnia were significantly correlated with platelet tryptophan concentrations. CONCLUSIONS: In this sample, all symptoms of depression could not be explained by platelet tryptophan and serotonin concentrations and hormonal levels; differences were observed only when we evaluated insomnia and hot flashes.

Asunto(s)

Plaquetas/metabolismo , Depresión/etiología , Hormonas Gonadales/sangre , Perimenopausia/psicología , Serotonina/sangre , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Triptófano/sangre , Ansiedad/etiología , Ansiedad/fisiopatología , Depresión/sangre , Depresión/fisiopatología , Trastorno Depresivo/etiología , Trastorno Depresivo/fisiopatología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Sofocos/etiología , Sofocos/fisiopatología , Humanos , México , Persona de Mediana Edad , Perimenopausia/sangre , Escalas de Valoración Psiquiátrica , Autoinforme , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología

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

The objective of this study was to evaluate the efficacy of flaxseed meal and flaxseed extract in reducing climacteric symptoms of menopausal women. Ninety menopausal women were randomly distributed into three study groups: group I received 1 g per day of flaxseed extract containing at least 100 mg of secoisolariciresinol diglucoside (SDG), group II received 90 g per day of flaxseed meal containing at least 270 mg of SDG, and group III received 1 g per day of collagen (placebo group). Subjects were assessed for menopausal symptoms by the Kupperman index at the beginning and at the end of the 6 months of treatment. Subjects were also assessed for endometrial thickness and vaginal cytology. The Kupperman index values at the beginning and end of the treatments were analyzed using the paired t-test. Both the flaxseed extract (P=.007) and the flaxseed meal (P=.005) were effective in reducing the menopausal symptoms when compared with the placebo control (P=.082). Alternatively, the changes in Kupperman index were also computed and submitted to analysis of variance. In this case, no significant differences were found (P=.084) although the data indicate a decreasing tendency for the Kupperman index by both the flaxseed extract and the flaxseed meal groups. Neither the flaxseed extract nor the flaxseed meal exerted clinically important estrogenic effects on the vaginal epithelium or endometrium as revealed by the absence of changes in the blood levels of follicle stimulating hormone and estradiol, as well as in the endometrial thickness, and vaginal epithelial maturation value. No serious adverse events related to the treatments were reported. Although the results of the present study do not allow an unequivocal conclusion about the action of flaxseed on the menopausal symptoms, they suggest that it could be premature to conclude that no such action exists. Clearly the matter still deserves further experimental attention.

Asunto(s)

Suplementos Dietéticos , Lino/química , Sofocos/prevención & control , Menopausia , Extractos Vegetales/uso terapéutico , Semillas/química , Anciano , Brasil , Butileno Glicoles/administración & dosificación , Butileno Glicoles/efectos adversos , Butileno Glicoles/análisis , Butileno Glicoles/uso terapéutico , Suplementos Dietéticos/efectos adversos , Endometrio/diagnóstico por imagen , Endometrio/patología , Células Epiteliales/diagnóstico por imagen , Células Epiteliales/patología , Estradiol/sangre , Femenino , Lino/efectos adversos , Hormona Folículo Estimulante Humana/sangre , Glucósidos/administración & dosificación , Glucósidos/efectos adversos , Glucósidos/análisis , Glucósidos/uso terapéutico , Sofocos/fisiopatología , Humanos , Hipertrofia , Menopausia/sangre , Persona de Mediana Edad , Fitoestrógenos/administración & dosificación , Fitoestrógenos/efectos adversos , Fitoestrógenos/análisis , Fitoestrógenos/uso terapéutico , Extractos Vegetales/efectos adversos , Extractos Vegetales/química , Semillas/efectos adversos , Índice de Severidad de la Enfermedad , Ultrasonografía , Vagina/diagnóstico por imagen , Vagina/patología

RESUMEN

Hot flashes are a common and disturbing adverse effect of hormonal therapy for cancer. Their pathophysiology is poorly understood. At present, the leading mechanistic hypothesis rests on the assumption that abrupt hormone deprivation will result in loss of negative feedback over hypothalamic noradrenaline synthesis. In this article we critically review the different theories used to explain this phenomenon. A better understanding of the pathophysiology of hot flashes may facilitate the development of new therapeutic approaches.

Asunto(s)

Sofocos/fisiopatología , Animales , Retroalimentación Fisiológica/fisiología , Femenino , Humanos , Hipotálamo/fisiología , Masculino , Norepinefrina/biosíntesis

RESUMEN

OBJECTIVE: The aim of this study was to determine which factors could influence microcirculatory responses to an acute estradiol test during postmenopause. METHODS: Dynamic nailfold videocapillaroscopy was performed in 68 healthy 34- to 70-year-old postmenopausal women before and 1 hour after administration of 300 mug nasal estradiol. Red blood cell velocity (RBCV; mm/s) at rest and after the release of 60-second arterial occlusion (RBCVmax; mm/s) and time to reach it (TRBCVmax; s) were correlated to clinical and laboratory data. RESULTS: After estradiol administration, RBCV and RBCVmax increased by 13.4% and 9.4%, respectively, and TRBCVmax decreased by 29.1% (P = 0.0001 for all). These changes were not associated to the women's age but rather to time since menopause (P = 0.04; r = 0.245) and previous duration of hormone therapy (P = 0.03; r = 0.324). Past users of oral contraceptives presented higher velocities but smaller increases compared with never users (12.4% vs 17.7%, P = 0.022, for RBCV and 8.4% vs 13.7%, P = 0.028, for RBCVmax), and triglyceride levels were negatively associated to velocity increases (P = 0.05 and r = -0.243 for RBCV and P = 0.03 and r = -0.261 for RBCVmax) after estradiol administration. Previous smokers showed a smaller reduction in TRBCVmax, associated directly to total estimated number of smoked cigarettes (P = 0.03; r = -0.468). The reduction in TRBCVmax was also inversely related to the intensity of current vasomotor symptoms (P = 0.04; r = -0.252). CONCLUSIONS: Changes in RBCVs and TRBCVmax after estradiol administration indicate an increase in endothelial-dependent vasodilatation and vascular elasticity, respectively. Moreover, maintenance of endothelial responsiveness depends on cumulative exposure to sex steroids, duration of hormone deprivation, and triglyceride levels. Past smoking and current vasomotor symptoms could be associated to microvascular wall stiffness/elasticity.

Asunto(s)

Estradiol/administración & dosificación , Estrógenos/administración & dosificación , Microcirculación/fisiología , Administración Intranasal , Adulto , Anciano , Velocidad del Flujo Sanguíneo/fisiología , Anticonceptivos Orales/administración & dosificación , Endotelio Vascular/fisiología , Eritrocitos/fisiología , Femenino , Terapia de Reemplazo de Hormonas , Sofocos/fisiopatología , Humanos , Menopausia , Microscopía por Video , Persona de Mediana Edad , Fumar/fisiopatología , Factores de Tiempo , Triglicéridos/sangre , Vasodilatación/fisiología

RESUMEN

OBJECTIVE: To evaluate the perception of a group of women from Belo Horizonte, Minas Gerais, Brasil, with respect to menopause and its treatment. METHODS: A secondary analysis was performed on data from a population-based, cross sectional study carried out with 378 Brazilian born women between 40 and 65 years of age, with 11 years or more of formal education. Some women added spontaneous comments to the end of the questionnaire on sexuality handed out by research assistants and self-responded anonymously. There were those who provided comments at the end of the questionnaire and those who did not. The groups were compared with respect to sociodemographic and reproductive characteristics using Pearson's chi-square test. Comments were transcribed in their entirety to a computerized file for thematic content analysis, and units of meaning were identified and classified. RESULTS: Approximately one-third of the women (114/378) provided comments. Significantly more women with lower income levels provided comments as compared to those with higher income levels. The principal identified categories of analysis were: a) uncertainty and/or confusion, mainly with regard to anguish, stress and doubts about menopause; b) symptoms that lead to negative feelings, such as hot flushes, vaginal dryness and mood changes; and c) hormone replacement therapy, fears and perception of a lack of conviction in the physicians who prescribe it. CONCLUSION: The comments indicate that more attention must be given to the problems perceived in climacteric women with a special emphasis on those of the lower incomes levels.

Asunto(s)

Conocimientos, Actitudes y Práctica en Salud , Terapia de Reemplazo de Hormonas/psicología , Menopausia/efectos de los fármacos , Menopausia/psicología , Salud de la Mujer , Adulto , Anciano , Brasil , Distribución de Chi-Cuadrado , Estudios Transversales , Escolaridad , Femenino , Sofocos/fisiopatología , Humanos , Libido , Menopausia/fisiología , Persona de Mediana Edad , Posmenopausia/psicología , Calidad de Vida , Riesgo , Autoimagen , Encuestas y Cuestionarios , Resultado del Tratamiento

RESUMEN

OBJETIVO: Avaliar a percepção de um grupo de mulheres de Belo Horizonte (MG) sobre a menopausa e seu tratamento. MÉTODOS: Realizou-se análise secundária de dados de estudo populacional de corte transversal com 378 mulheres brasileiras natas, de 40 a 65 anos, com 11 anos ou mais de educação formal. Avaliaram-se os relatos escritos espontaneamente ao final de um questionário sobre sexualidade, entregue por auxiliares de pesquisa e auto-respondido anonimamente. As mulheres foram alocadas em dois grupos: as que escreveram comentários ao final do questionário e as que não escreveram. Compararam-se os grupos em relação às características sociodemográficas e reprodutivas por meio do teste Qui quadrado de Pearson. Os comentários foram transcritos na íntegra para arquivo computadorizado para realizar a análise temática de seu conteúdo, identificando-se e categorizando-se as unidades de significado. RESULTADOS: Aproximadamente um terço das mulheres escreveu comentários (114/378), o que foi significativamente mais freqüente entre as mulheres com menor renda familiar. As principais categorias de análise identificadas foram: a) insegurança/confusão, com as principais idéias referentes a angústia, estresse e dúvidas sobre a menopausa; b) sintomas que provocam sentimentos negativos, como ondas de calor, secura vaginal e alterações de humor; c) terapia de reposição hormonal, medos e sentimentos da falta de convicção por parte dos médicos em prescrevê-la. CONCLUSÃO: Os comentários indicam a necessidade de dar mais atenção aos problemas percebidos no climatério, particularmente direcionada às mulheres menos favorecidas economicamente.

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OBJECTIVE: To evaluate the perception of a group of women from Belo Horizonte, Minas Gerais, Brasil, with respect to menopause and its treatment. METHODS: A secondary analysis was performed on data from a population-based, cross sectional study carried out with 378 Brazilian born women between 40 and 65 years of age, with 11 years or more of formal education. Some women added spontaneous comments to the end of the questionnaire on sexuality handed out by research assistants and self-responded anonymously. There were those who provided comments at the end of the questionnaire and those who did not. The groups were compared with respect to sociodemographic and reproductive characteristics using Pearson's chi-square test. Comments were transcribed in their entirety to a computerized file for thematic content analysis, and units of meaning were identified and classified. RESULTS: Approximately one-third of the women (114/378) provided comments. Significantly more women with lower income levels provided comments as compared to those with higher income levels. The principal identified categories of analysis were: a) uncertainty and/or confusion, mainly with regard to anguish, stress and doubts about menopause; b) symptoms that lead to negative feelings, such as hot flushes, vaginal dryness and mood changes; and c) hormone replacement therapy, fears and perception of a lack of conviction in the physicians who prescribe it. CONCLUSION: The comments indicate that more attention must be given to the problems perceived in climacteric women with a special emphasis on those of the lower incomes levels.

Asunto(s)

Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , Terapia de Reemplazo de Hormonas/psicología , Menopausia/efectos de los fármacos , Menopausia/psicología , Salud de la Mujer , Brasil , Distribución de Chi-Cuadrado , Estudios Transversales , Escolaridad , Sofocos/fisiopatología , Libido , Menopausia/fisiología , Posmenopausia/psicología , Calidad de Vida , Encuestas y Cuestionarios , Riesgo , Autoimagen , Resultado del Tratamiento

RESUMEN

OBJECTIVE: The literature of sweat physiology and population variation in response to heat stress suggests that variation in sweating patterns may affect the measurement of hot flashes. This study examined variation in sweating patterns in Puebla, Mexico, and Amherst, MA, and compared the levels of concordance between subjective and objective measures of hot flashes. DESIGN: Thirteen women in Puebla, Mexico, and 15 women in Amherst, MA, aged 45 to 61, completed surveys, body diagrams of heat flow during a hot flash, anthropometric measures, and the measurement of hot flashes through skin conductance monitoring. Hot flashes were measured through sternal (Mexico and Massachusetts) and nuchal (Mexico only) skin conductance. RESULTS: Mexican women were significantly more likely to describe the heat of hot flashes on the back of their neck (100% vs 40%) and on their arms and/or hands (85% vs 40%) compared with women in Massachusetts. Hot flashes in the midback were associated with concordance between nuchal, but not sternal, measures of skin conductance and subjective report in Mexico. In comparing average scores for concordance between subjective and sternal measures of hot flashes, there was a higher mean score for true positives in Mexico (61% vs 29%, P=0.06) and a significantly higher mean score for false-negative measures in Massachusetts (57% vs 21%, P=0.04). CONCLUSIONS: Variation in rates of concordance between subjective and objective measures were not adequately explained by sweating patterns. Future studies should consider population variation in acclimatization and assess variation in the amount of sweat produced during a hot flash.

Asunto(s)

Comparación Transcultural , Sofocos/etnología , Sofocos/fisiopatología , Sudoración/fisiología , Femenino , Respuesta Galvánica de la Piel/fisiología , Humanos , Massachusetts/etnología , México/etnología , Persona de Mediana Edad

RESUMEN

Menopausal transition is a period that begins four years before menopause as a result of follicular decline. The first hormonal change is a decrease in B inhibin levels, followed by a decrease in estradiol and an increase in FSH levels; abrupt plasmatic oscillations of these hormones can be observed. Climacteric symptomatology may appear before cycle disorders and provoke an impairment in quality of life. Bone loss equally precedes menopause. Some authors, but not all of them, accept that during perimenopause there is an increased risk of cardiovascular disease. We point out the need of beginning hormonal therapy when the first clinical signs of estrogenic deficiency arise, independent of menstrual cycle and hormonal levels. Women aged over 45 are suitable for the classical sequential therapy, adjusting it to the cycle while it still persists; younger patients may use transdermal estrogens for short periods of time. Whenever contraception is required or there is irregular bleeding we indicate low dose estrogenic contraceptives, if possible the 28 days of the cycle. It is necessary to correct potentially dangerous daily habits and treat concomitant diseases that may enhance cardiovascular risk. The patient's education is an indispensable goal for the success of the treatment.

Asunto(s)

Menopausia/fisiología , Adulto , Enfermedades Cardiovasculares/etiología , Anticoncepción , Terapia de Reemplazo de Estrógeno , Femenino , Sofocos/fisiopatología , Humanos , Menopausia/efectos de los fármacos , Persona de Mediana Edad , Osteoporosis Posmenopáusica/etiología , Factores de Riesgo

RESUMEN

Menopausal transition is a period that begins four years before menopause as a result of follicular decline. The first hormonal change is a decrease in B inhibin levels, followed by a decrease in estradiol and an increase in FSH levels; abrupt plasmatic oscillations of these hormones can be observed. Climacteric symptomatology may appear before cycle disorders and provoke an impairment in quality of life. Bone loss equally precedes menopause. Some authors, but not all of them, accept that during perimenopause there is an increased risk of cardiovascular disease. We point out the need of beginning hormonal therapy when the first clinical signs of estrogenic deficiency arise, independent of menstrual cycle and hormonal levels. Women aged over 45 are suitable for the classical sequential therapy, adjusting it to the cycle while it still persists; younger patients may use transdermal estrogens for short periods of time. Whenever contraception is required or there is irregular bleeding we indicate low dose estrogenic contraceptives, if possible the 28 days of the cycle. It is necessary to correct potentially dangerous daily habits and treat concomitant diseases that may enhance cardiovascular risk. The patients education is an indispensable goal for the success of the treatment. (AU)

Asunto(s)

Animales , Femenino , Adulto , Persona de Mediana Edad , Menopausia/fisiología , Enfermedades Cardiovasculares/etiología , Anticoncepción , Menopausia/efectos de los fármacos , Factores de Riesgo , Sofocos/fisiopatología , Terapia de Reemplazo de Estrógeno , Osteoporosis Posmenopáusica/etiología