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OBJECTIVE: The aim of this study was to assess resilience, fear of COVID-19, sleep disorders, and menopause-related symptoms after the acute phase of COVID-19 in middle-aged women with positive reverse transcription-polymerase chain reaction and noninfected women. METHODS: This is a cross-sectional, analytical study of climacteric women from 9 Latin American countries, aged 40-64 years, attending a routine health checkup. We evaluated clinical characteristics and used the Connor-Davidson Resilience Scale, the Fear of COVID-19 Scale, the Jenkins Sleep Scale, and the Menopause Rating Scale to evaluate their health. RESULTS: A total of 1,238 women were studied, including 304 who were positive for COVID-19 reverse transcription-polymerase chain reaction. The median (interquartile range) age was 53 (12) years; years of studies, 16 (6); body mass index, 25.6 (5.1) kg/m 2 ; and time since first COVID-19 symptom, 8 (6) months. COVID-19 patients reported fatigability (18.8%), joint and muscular discomfort (14.1%), and anosmia (9.5%). They had a significantly lower resilience score (26.87 ± 8.94 vs 29.94 ± 6.65), higher Fear of COVID-19 score (17.55 ± 7.44 vs 15.61 ± 6.34), and a higher Jenkins Scale score (6.10 ± 5.70 vs 5.09 ± 5.32) compared with control women. A logistic regression model confirmed these results. There was not a significant difference in the total Menopause Rating Scale score, although the odds ratios for both severe menopausal symptoms (1.34; 95% confidence interval, 1.02-1.76) and the use of hypnotics were higher in women with COVID-19 (1.80; 95% confidence interval, 1.29-2.50) compared with those without infection. We found no decrease in studied outcomes between the initial 7 months versus those reported after 8 to 18 months since first COVID-19 symptoms. CONCLUSIONS: COVID-19 climacteric women have sleep disorders, lower resilience and higher fear of COVID-19.

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The hormonal deficit of post menopause is not only linked to the classic hot flashes, but also to a higher risk of chronic diseases. Menopausal hormone therapy (MHT) adequately treats climacteric symptoms and can prevent some chronic diseases such as osteoporosis. The Women's Health Initiative (WHI) study, which indicated risks of MHT in elderly postmenopausal women, caused a massive withdrawal of this therapy. But, in recent years the results of the WHI have been challenged by methodological problems and by several studies indicating that, if MHT is initiated early and the non-oral route is preferred, the risks could be minimized and it could improve not only the quality of life but also reduce the risk of chronic diseases. However, the US Preventive Services Task Force (USPSTF) recommends against the use of MHT for the prevention of chronic diseases, a position that has been challenged by publications of the North American Menopause Society and the International Menopause Society. This controversy persists so far. We report data that suggest a preventive role of MHT in perimenopausal women.

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The hormonal deficit of post menopause is not only linked to the classic hot flashes, but also to a higher risk of chronic diseases. Menopausal hormone therapy (MHT) adequately treats climacteric symptoms and can prevent some chronic diseases such as osteoporosis. The Women's Health Initiative (WHI) study, which indicated risks of MHT in elderly postmenopausal women, caused a massive withdrawal of this therapy. But, in recent years the results of the WHI have been challenged by methodological problems and by several studies indicating that, if MHT is initiated early and the non-oral route is preferred, the risks could be minimized and it could improve not only the quality of life but also reduce the risk of chronic diseases. However, the US Preventive Services Task Force (USPSTF) recommends against the use of MHT for the prevention of chronic diseases, a position that has been challenged by publications of the North American Menopause Society and the International Menopause Society. This controversy persists so far. We report data that suggest a preventive role of MHT in perimenopausal women.

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Menopause is associated with several symptoms which, if they reach certain intensity, can severely impair the quality of life. Overall, 90.9% of Latin American women will have at least one climacteric symptom and in 25%, these will be severe. Musculoskeletal pain, physical and mental fatigue and depressed mood are the most common climacteric symptoms. Dyspareunia, mood disorders and irritability can significantly alter female sexuality. Hot flashes are the symptoms most frequently related to menopause by both physicians and patients. However, it is one of the less common menopausal symptoms. This symptom reflects the neurochemical brain disorders caused by estrogen deficiency. The central nervous system (CNS) is also involved in changes of body composition leading to higher adipose tissue accumulation during climacterium, deteriorating quality of life and increasing the risk for chronic non-transmittable diseases. Menopausal discomfort also overloads health systems increasing the demand for medical services and decreasing productivity by labor absenteeism. Hormone therapy of menopause (HTM) decreases menopausal symptoms and improves quality of life. If we do not prescribe HTM to those women who need it, we could deprive them from several potential health benefits.

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Musculoskeletal pain (MSP) has been recently linked with high plasma leptin levels. Our objective was to study if obese women, who have higher leptin levels, could have a higher frequency of MSP. We studied 6079 Latin-American women, 40-59 years old. Their epidemiological data were recorded and the Menopause Rating Scale (MRS), Golberg Anxiety and Depression Scale and Insomnia Scale were applied. MSP was defined as a score ≥2 on MRS11. Women with MSP were slightly older, had fewer years of schooling and were more sedentary. They also complained of more severe menopausal symptoms (29.2% versus. 4.4%, p < 0.0001). Furthermore, they had a higher abdominal perimeter (87.2 ± 12.0 cm versus 84.6 ± 11.6 cm, p < 0.0001) and a higher prevalence of obesity (23.1% versus 15.2%, p < 0.0001). Compared to normal weight women, those with low body weight (IMC <18.5) showed a lower risk of MSP (OR 0.71; 95%CI, 0.42-1.17), overweight women had a higher risk (OR 1.64; 95%CI, 1.44-1.87) and obese women the highest risk (OR 2.06; 95%CI, 1.76-2.40). Logistic regression analysis showed that obesity is independently associated to MSP (OR 1.34; 95%CI, 1.16-1.55). We conclude that obesity is one identifiable risk factor for MSP in middle-aged women.

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OBJECTIVE: To estimate the prevalence of excessive daytime sleepiness (EDS) and to identify associated factors in women aged 35 to 49 years from the "Pindamonhangaba Health Project" (PROSAPIN). METHODS: This was a cross-sectional observational study of 372 women aged 35 to 49 years, randomly selected from the Family Health Strategy (FHS) program of the city of Pindamonhangaba, SP, Brazil, where the "Pindamonhangaba Health Project" (PROSAPIN) is being developed. EDS was assessed through interviews using the Epworth Sleepiness Scale and the associated factors through questions that investigated sociodemographic characteristics, gynecological history, presence of comorbidities, lifestyle, sleep routine, and use of drugs capable of altering the state of alertness; anthropometric variables were also measured. The prevalence of EDS was estimated with a 95% confidence interval (95% CI) and the associated factors were identified through a multiple logistic regression model performed with the Stata software, release 10.0. RESULTS: EDS prevalence was 18.5% (95% CI: 14.7-22.9) and the associated factors were: profession related to domestic services (OR = 2.2, 95% CI: 1.1-4.3), physical activity level above the mean of the study population (OR = 1.9, 95% CI: 1.1-3.4), and presence of features suggestive of anxiety (OR = 1.9, 95% CI: 1.1-3.4). CONCLUSION: The prevalence of EDS in women aged 35-49 years from PROSAPIN was high and associated with sociodemographic characteristics, presence of comorbidities, and lifestyle.

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OBJETIVO: Estimar a prevalência da sonolência diurna excessiva (SDE) e identificar os fatores associados em mulheres de 35 a 49 anos de idade do "Projeto de Saúde de Pindamonhangaba" (PROSAPIN). MÉTODOS: O estudo foi observacional transversal com 372 mulheres com idade entre 35 e 49 anos selecionadas aleatoriamente da Estratégia Saúde da Família (ESF) do município de Pindamonhangaba, São Paulo, onde é desenvolvido o "Projeto de Saúde de Pindamonhangaba" (PROSAPIN). A SDE foi avaliada por entrevista utilizando a Escala de Sonolência de Epworth e os fatores associados por meio de questões que investigaram as características sócio-demográficas, a história ginecológica, a presença de comorbidades, o estilo de vida, a rotina de sono e o uso de medicamentos capazes de alterar o estado de alerta, além de mensuradas as variáveis antropométricas. Estimou-se a prevalência da SDE com intervalo de confiança de 95% (IC 95%) e foram identificados os fatores associados por meio de um modelo de regressão logística múltipla realizado no Programa Stata, versão 10.0. RESULTADOS: A prevalência da SDE foi de 18,5% (IC 95%: 14,7- 22,9) e os fatores associados foram: profissão relacionada a serviços domésticos (OR = 2,2; IC 95%: 1,1-4,3), nível de atividade física acima da média da população estudada (OR = 1,9; IC 95%: 1,1-3,4); e a presença de características sugestivas de ansiedade (OR = 1,9; IC 95%: 1,1-3,4). CONCLUSÃO: A prevalência da SDE em mulheres de 35 a 49 anos do PROSAPIN foi elevada e associada à característica sociodemográfica, à presença de comorbidades e ao estilo de vida.

OBJECTIVE: To estimate the prevalence of excessive daytime sleepiness (EDS) and to identify associated factors in women aged 35 to 49 years from the "Pindamonhangaba Health Project" (PROSAPIN). METHODS: This was a cross-sectional observational study of 372 women aged 35 to 49 years, randomly selected from the Family Health Strategy (FHS) program of the city of Pindamonhangaba, SP, Brazil, where the "Pindamonhangaba Health Project" (PROSAPIN) is being developed. EDS was assessed through interviews using the Epworth Sleepiness Scale and the associated factors through questions that investigated sociodemographic characteristics, gynecological history, presence of comorbidities, lifestyle, sleep routine, and use of drugs capable of altering the state of alertness; anthropometric variables were also measured. The prevalence of EDS was estimated with a 95% confidence interval (95% CI) and the associated factors were identified through a multiple logistic regression model performed with the Stata software, release 10.0. RESULTS: EDS prevalence was 18.5% (95% CI: 14.7-22.9) and the associated factors were: profession related to domestic services (OR = 2.2, 95% CI: 1.1-4.3), physical activity level above the mean of the study population (OR = 1.9, 95% CI: 1.1-3.4), and presence of features suggestive of anxiety (OR = 1.9, 95% CI: 1.1-3.4). CONCLUSION: The prevalence of EDS in women aged 35-49 years from PROSAPIN was high and associated with sociodemographic characteristics, presence of comorbidities, and lifestyle.

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Fibromyalgia syndrome (FMS) is a disorder usually affecting middle aged women, who complain of diffuse musculoskeletal aches, pains or stiffness associated with tiredness, anxiety and poor sleep. Neurotransmission disorders linked both to pain perception as well as mood, sleep and cognition modulation are involved in FMS etiopathogenesys. Treatments that may be effective to decrease pain and fatigue include tricyclic antidepressants, dual reuptake inhibitors of serotonin/noradrenalin and pregabalin. The climacteric syndrome is a set of symptoms caused by the decline of ovarian hormone levels, which alters brain neurotransmission and provokes musculoskeletal pains, mood disorders, poor sleep quality and hot flushes. The hormone therapy reverses those symptoms and its risks are marginal if women's own hormones are used through transdermal route. Some antidepressants may be useful for patients with climacteric symptoms. We have found it surprising the epidemiological, etiopathogenic, symptomatic and therapeutic similarity between FMS and climacteric that could lead us to hypothesize that FMS is a part of the climacteric syndrome. However, the existence of FMS non-climacteric patients points out that hormone deficit is not the only physiopathological mechanism involved in this syndrome's etiopathogenesys. Nevertheless, it is likely that hormone disorders are involved in the symptoms genesis of most middle aged women with FMS. Keeping this in mind, we see the point in considering the use of HT in climacteric patients with FMS. Studies assessing the FMS clinical response to HT in a prospective manner and with the current diagnose criteria are still required.

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The health of many women is affected in the climacteric period, either by symptoms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most efficient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed according to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.

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Introducción. Pocos estudios han comparado el impacto del climaterio en la calidad de vida (CV) en diferentes etnias latinoamericanas. Objetivo: Evaluar la CV en mujeres post-menopáusicas colombianas de tres etnias distintas. Material y método: Estudio descriptivo transversal que incluyó mujeres sanas entre 40 y 59 años de edad, pertenecientes a las etnias hispánicas, indígenas y negras. La población evaluada hace parte del Estudio Calidad de Vida en la Menopausia y Etnias Colombianas (Cavimec). El instrumento utilizado para valorar CV fue el Menopause Rating Scale. Resultados: Se estudiaron 579 mujeres postmenopáusicas, 153 hispánicas, 295 indígenas y 131 afrodescendientes. Las hispánicas tenían en promedio 55.3 (DE 3.3) años de edad, 6.4 (DE 3.5) años de escolaridad y habían presentado su menopausia a los 48.3 (DE 2.5) años. Comparadas con las hispánicas, las indígenas tenían una edad similar, menor escolaridad (2.2 [DE 1.8] años, p<0.0001) y mayor edad al inicio de su menopausia (49.5 [DE 3.0] años, p<0.0001). Las afrodescendientes eran más jóvenes que las hispánicas (53.4 [3.3] años, p<0.0001) y con menor escolaridad (4.6 [DE 4.4] años, p<0.0001). Las hispánicas tienen la mejor CV (MRS 8.6 [DE 5.7] puntos), seguidas por las afrodescendientes (13.7 [DE 7.0] puntos, p<0.001) y las indígenas (14.7 [DE 2.4] puntos, p<0.0001). Las afrodescendientes tienen un mayor deterioro psicológico (dimensión psicológica 5.9 [DE 2.9] puntos) que las hispánicas (2.7 [DE 2.6] puntos, p<0.0001) o las indígenas (3.1 [DE 1.6] puntos, p<0.0001), y presentan más síntomas somáticos (dimensión somática 6.5 [DE 3.3] puntos, 4.6 [DE 2.9] puntos, y 5.3 [1.7] puntos, respectivamente; p<0.0001). Las indígenas presentan mayor sintomatología urogenital (dimensión urogenital 6.2 [DE 1.3] puntos) que las hispánicas (1.3 [DE 2.3] puntos, p<0.0001) y las afrodescendientes (1.1 [DE 1.9] puntos, p<0.0001). Conclusión: Las mujeres postmenopáusicas hispánicas tienen menos compromiso de calidad de vida que las mujeres indígenas o afrodescendientes. Las afrodescendientes presentan más severidad de síntomas psicológicos y somáticos, mientras que las indígenas presentan más sintomatología del área urogenital. [Monterrosa A, Blumel JE, Chedraui P. Calidad de vida de mujeres en postmenopausia. Valoración con "Menopause Rating Scale" de tres etnias colombianas diferentes. MedUNAB 2009; 12:80-85].

Abstract. Few studies have compared the impact of climacteric in life quality (LQ) in the different ethnic groups in Latin America. Objective: Evaluate the CV in postmenopausal Colombian women in three different ethnic groups. Material and Method: A descriptive cross-sectional study was done among healthy women aged between 40 and 59 years and who belong to Indigenous, Afrocaribbean or Hispanic ethnic groups. The assessed population is part of Life Quality in Menopause in Colombian Ethnic Groups Study (Cavimec). The instrument used to assess LQ was Menopause Rating Scale (MRS). Results: 579 menopausal women were studied, 153 Hispanic, 295 Indigenous, and 153 Afrocaribbean. Hispanic women were 55,3 (SD 3,3) years-old on average, had 6,4 (SD 3,5) years of school, they had been menopausal at 48,3 (SD 2,5) years old. Indigenous women were similar age to Hispanic women, but had less years of school (2,2 [SD 1,8], p<0,0001), and were older in their menopause time (49,5 [SD 3,0] years). Afrocaribbean women were younger (53,4 [3,3] years old, p<0,0001) and had less years of school (4,6 [SD 4,4], p<0,0001) than Hispanic women. Hispanic women have a better LQ (MRS score 8,6 [SD 5,7]) than Afrocaribbean women (13,7 [SD 7,0], p<0,001) or Indigenous women (14,7 [2,4]; p<0,0001). Afrocaribbean women had a greater psychological compromise (psychological score 5,9 [SD 2,9]) than Hispanic women (2,7 [SD 2,6], p<0,0001) or Indigenous women (3,1 [SD 1,6], p<0,0001); they presented a higher somatic symptoms (score 6,5 [SD 3,3], 4,6 [SD 2,9], and 5,3 [1,7], respectively; p<0,0001). By the other hand, Indigenous women had a greater urogenital symptomatology (score 6,2 [SD 1,3]) than Hispanic women (1,3 [SD 2,3], p<0,0001), or Afrocaribbean women (1,1 [SD 1,9], p<0,0001). Conclusion: Postmenopausal Hispanic women have less life compromise than Indigenous or Afrocaribbean women; these women present a greater severity in psychological and somatic symptoms. Indigenous women present more symptomatology in the urogenital area. [Monterrosa A, Blumel JE, Chedraui P. Women's life quality in the post menopause. Evaluation with "Menopause Rating Scale" in three different ethnic Colombian groups. MedUNAB 2009; 12:80-85].

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AIM: To evaluate sexual function among postmenopausal diabetic women. PATIENTS AND METHODS: A total of 72 postmenopausal women, 36 diabetic, with a stable partner were included in this study. Sexual functioning was assessed using the Female Sexual Functioning Index (FSFI) and depression using the Beck Depression Inventory scale. RESULTS: There was no difference between diabetic and control women regarding age, years of schooling, number of children, age at menarche, age at first sexual experience, years postmenopausal or body mass index. Diabetics had a worse score for depression (11.5 +/- 5.6 vs. 8.9 +/- 4.7, p < 0.03), a lower frequency of sexual intercourse per month (2.7 +/- 2.8 vs. 4.4 +/- 2.9, p < 0.01) and a more deteriorated marital relationship (scale of 0-20: 13.4 +/- 2.9 vs. 15.1 +/- 1.9, p < 0.009). Diabetics demonstrated worse scores globally (19.3 +/- 8.1 vs. 26.8 +/- 4.5, p < 0.0001) and in all domains of the FSFI: desire (2.6 +/- 1.4 vs. 3.8 +/- 1.1, p < 0.0001), arousal (3.5 +/- 1.9 vs. 4.7 +/- 0.8, p < 0.002), lubrication (3.2 +/- 1.9 vs. 4.5 +/- 1.3, p < 0.003), orgasm (3.2 +/- 1.8 vs. 4.5 +/- 1.1, p < 0.002), satisfaction (3.8 +/- 1.3 vs. 4.8 +/- 0.9, p < 0.0005) and pain (3.1 +/- 1.7 vs. 4.6 +/- 1.3, p < 0.0001) (values all mean +/- standard deviation). Considering sexual dysfunction as a score higher than 26.55, the prevalence of sexual dysfunction among diabetics was 75.0% vs. 30.6% in the control group (p < 0.001). After adjusting for depression, years of schooling, hysterectomy, marital relationship and age, diabetes mellitus remained an important risk factor for sexual dysfunction (odds ratio 6.2, 95% confidence interval 2.0-19.6, p < 0.02). CONCLUSION: Diabetes mellitus affects all areas of female sexuality and this condition is independent of depression.

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Introducción: Es diferente la prevalencia y la severidad de los síntomas relacionados con la menopausia cuando se evalúan diferentes grupos étnicos o poblacionales. Se ha señalado que las mujeres de raza negra pueden tener mayor riesgo de oleadas de calor que las mujeres caucásicas. Objetivos: Evaluar la frecuencia y severidad de síntomas menopáusicos entre mujeres afro descendientes colombianas. Método: Estudio transversal, parte del proyecto CAVIMEC (Calidad de vida en la menopausia y etnias colombianas), realizado en mujeres afro descendientes colombianas entre 40 y 59 años. Fueron evaluadas con Menopause Ranting Scale (MRS) para establecer la frecuencia e intensidad de síntomas menopáusicos. Resultados: 201 mujeres afro descendientes colombianas fueron incluidas. La edad promedio fue de 47.2±5.2 años,estando el 43% en premenopausia, 18% en perimenopausia y 38% en postmenopausia; el tiempo promedio desde la última regla fue de 3.2±2.7 años y con edad promedio de la menopausia fue 45.9±4.8 años; el 50% de las pacientes con menopausia natural. La mitad de las participantes manifestó tener síntomas de menopausia, siendo moderados en el 28% y severos o muy severos en el 9%. El 77% presenta síntomas musculares o articulares, 54% oleadas de calor, 64% irritabilidad y 16% problemas vesicales. La puntuación de MRS fue: dimensión somático-vegetativa 5.0±3.3, psicológica 4.8±3.3 y global 10.6±6.3. Conclusión: En mujeres afro descendientes colombianas se observa elevada puntuación en la escala MRS, dada por una elevada presencia de síntomas somático-vegetativos y psicológicos La puntuación observada supera significativamente la de otras poblaciones tomadas como referente.

Background: The existence and intensity of the symptoms related to menopause are different when evaluating different ethnic or population groups. It has been stated that black race women are prone to a bigger risk of heat waves than white women. Objective: To evaluate the frequency and intensity of the menopause symptoms among afro descendant Colombian women. Method: Transversal study, part of the CAVIMEC Project (Quality of life in menopause and Colombian ethnic groups), made with afro descendant Colombian women aged between 40 and 59 years old, who were evaluated through the Menopause Rating Scale (MRS) in order to determine the frequency and intensity of menopause symptoms. Results: 201 women were included; their average age was 47.2±5.2 years; 43% were in pre-menopause, 18% in peri-menopause and 38% in post-menopause. They rated 3.2±2.7 years since their last menstruation, and their menopause average age were 45.9±4.8; 50% had natural menopause. Half of participants had menopause symptoms, 28% mild and 9% severe to very severe; 77% had muscle or articulation symptoms, 54% heat waves, 64% irritability and 16% vesicle problems. The MRS score: somatic-vegetative dimension 5.0±3.3, psychological 4.8±3.3 and global punctuation 10.6±6.3. Conclusion: In afro descendant women it is observed a high MRS score due to a high presence of somatic-vegetative and psychological symptoms. The observed punctuation rises above those taken in other populations in a significant way.

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BACKGROUND: It has been suggested that hormonal changes and environmental alterations during the climacteric period are important in the development of psychological symptoms. OBJECTIVE: To evaluate the role of biological and psycho-social factors in the prevalence of climacteric symptoms. DESIGN: Open, cross-sectional, observational and descriptive study. MATERIAL AND METHODS: A total of 300 women between 40 and 59 years of age were evaluated using Greene scale for climacteric symptoms, Cooper questionnaire for psychosomatic symptoms of stress, Smilkstein family apgar for family dysfunction, Duke-UNC questionnaire for social support and Israel scale for vital events. All these tests have been previously validated in Spanish. RESULTS: Postmenopausal women do not have higher prevalence of psychological symptoms, they only have more vasomotor symptoms. Premenopausal women with vasomotor symptoms have more psychological and somatic symptoms and stress, independently of the vital events, family dysfunction or poor social support. Vasomotor symptoms in the premenopause are associated with increased risk of anxiety (OR: 3.7, IC: 1.4-9.7; P<0.008), depression (OR: 8.1, IC: 2.5-26.4; P<0.0005), somatic symptoms (OR: 14.9, IC: 3.4-65.3; P<0.0003), sexual dysfunction (OR: 7.2, IC: 2.5-20.6; P<0.0002) and stress (OR: 7.5, IC: 3.5-15.9; P<0.0001). Negative vital events and family dysfunction increase in minor intensity the risk of anxiety, depression and stress. CONCLUSION: In conclusion, psychological symptoms are frequent in the premenopause and are associated to vasomotor symptoms. This observation links psychological symptoms with menopausal transition and might suggest an organic base in their origin. The negative psycho-social environment is a factor that favours the development of these symptoms.

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OBJECTIVE: To assess the effect of the publication of the Women's Health Initiative (WHI) study on patients' and physicians' attitudes in relation to hormone therapy (HT). DESIGN: A survey focused on the degree of knowledge and on the reactions to the WHI study was administered to 600 women allocated in two groups according to their socioeconomic status, high (HSES) or low (LSES). Additionally, 283 physicians were surveyed to determine their attitudes regarding HT after the publication of the WHI study. The rates of HT prescription before and after publication of the study were compared. RESULTS: Among patients, HT use and knowledge of the WHI study were less common among women of lower socioeconomic status (LSES 16.7% v HSES 47.3%, and LSES 15.7% v HSES 67.3%; P < 0.0001). Of the women in the LSES group who were HT users and had knowledge on the subject of the WHI study (n = 30), 56.7% contacted their physicians and 6.6% abandoned HT. These rates were similar for women in the HSES group. Among physicians, 97.2% of physicians referred to being aware of the WHI study, and 64.7% modified their clinical approach. The main changes were that 21.5% applied more rigorous risk/benefit assessment, 20.1% lowered hormone dosage, 18.8% decreased continuous-combined therapy use, 12.1% shortened the duration of HT, 7.7% abandoned medroxyprogesterone or conjugated estrogen use, and 5.0% increased the use of transdermal estrogens, tibolone, or other alternatives. As for prescriptions, after the publication of the WHI study, there was an 8.6% drop in the rate of HT prescriptions. This decrease was more pronounced for prescriptions based on conjugated equine estrogen and medroxyprogesterone acetate. In contrast, prescription of transdermal estrogens and tibolone increased 5.2% and 16%, respectively. CONCLUSIONS: There was a significant change in physicians' and patients' attitudes toward HT after publication of the WHI study.

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OBJECTIVE: It has been suggested that approximately 40% of women between 40 and 64 years of age cease their sexual activity. Our objective was to examine the reasons that sexual activity has stopped and to determine the effect that this behavior has on the marital stability of those middle-aged women. DESIGN: A total of 534 healthy women between 40 and 64 years of age who were attending the Southern Metropolitan Health Service in Santiago, Chile, were asked to take part in the study. RESULTS: The main reasons for sexual inactivity in middle-aged women were sexual dysfunction (49.2%), unpleasant personal relationship with a partner (17.9%), and lack of a partner (17.7%). These reasons vary with aging; in women younger than 45 years, the most frequent reason was erectile dysfunction (40.7%); in those between 45 and 59, low sexual desire (40.5%); and, in women older than 60 years, the lack of a partner (32.4%). Sexual inactivity did not affect marital stability because women without sexual relationships (68.2% of the entire sample) were married. Among the divorced women, female sexual dysfunction was responsible for only 11.7% of the separations. CONCLUSION: Low sexual desire is the main reason for ceasing sexual activity. Nevertheless, stopping sexual relationships does not seem to be important in marital stability.

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La osteoporosis es una enfermedad que afecta a mujeres y hombres, pero principalmente es mayor en el sexo femenino, como consecuencia del déficit hormonal que se produce en la menopausia. El concepto de prevención de osteoporosis es complejo y abarca todas las edades. La prevención primaria es dirigida a estimular los factores determinantes de desarrollo normal del hueso para alcanzar el pico máximo de masa ósea. La prevención terciaria está dirigida a evitar fracturas en individuos con importante disminución de masa ósea. El objetivo del cualquiera de estas intervenciones es evitar en última instancia, la producción de facturas patológicas. Las estrategias higiénico-dietéticas y cambios en los estilos de vida están ampliamente justificadas en la base a múltiples estudios; en cambio, el tratamiento preventivo farmacológico tiene costo económico y puede producir efectos adversos en ciertos sujetos.

Osteoporosis affects women and men, but mainly the feminine sex as a consequence of the hormonal deficit following menopause. The concept of prevention of osteoporosis ¡s complex, and embraces all ages, Primary prevention is directed to stimulate factors of normal bone development so as to reach the maximum peak of bone mass. Secondary prevention is directed to avoid factors that accelerate the physiologic loss of bone mass. Tertiary prevention is directed to avoid liractures in individuals with important decrease of bone mass. The objective of any of these interventions is to ultimately avoid the production of pathological fractures. Based on multiple studies, hygienic-dietary strategies and changes in life-style are broadly justified,- on the other hand, the pharmacological preventive treatment has economic cost and can produce adverse outcomes in certain subjects.

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BACKGROUND: It is generally accepted that menopause significantly modifies cardiovascular risk. The effects of hormone replacement therapy (HRT) on this risk remain controversial. AIM: To study the prevalence of cardiovascular risk factors (RF) in middle-aged women and their changes with aging, menopause and hormone replacement therapy (HRT). MATERIAL AND METHODS: Cardiovascular risk factors were assessed in 576 women aged 40 to 59 years in 1991-92. Five years later, 467 of these women were reassessed. RESULTS: Sedentarism (87.2%), dyslipidemias (71.5%), high blood pressure (13.5%), obesity (13.1%), smoking (12.4%) and diabetes (2.8%) were the most prevalent RF. Five years later, the prevalence of hypertension increased to 20.9%, the prevalence of obesity increased to 27.3%, smoking increased to 20.8% and diabetes to 5.9%. The prevalence of dyslipidemia did not change, although triglycerides levels rose from 125.9 +/- 56.4 to 136.8 +/- 63.5 mg/dl (p < 0.001). Sedentarism dropped to 58.8%. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5 years follow-up from 3.8% to 35%. Women on HRT experienced 3% decrease in LDL-cholesterol and 9% increase in HDL-cholesterol levels. CONCLUSIONS: Middle aged women included in this cohort have a high prevalence of RF. There is a deterioration with age, but not with menopause. HRT improves the lipid profile.

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Existen condiciones clínicas en las cuales los anticonceptivos combinados orales podrían implicar riesgos, especialmente cardiovasculares. En estas situaciones el uso de anticonceptivos con progestágeno solo (APS) podría ser buena alternativa. Así por ejemplo, en mujeres con mayor riesgo trombótico, tanto arterial como venoso, el uso de algunos anticonceptivos combinados puede aumentar el riesgo de accidente cerebrovascular, infarto d miocardio o tromboembolismo venoso, lo que no se ha observado con la APS. Tampoco se ha descrito que su uso aumente el riesgo trombótico en fumadoras mayores de 35 años, como lo hacen los anticonceptivos combinados. La APS sería también una buena indicación en hipertrigliceridemia, ya que el etinilestradiol aumenta los niveles plasmáticos de triglicéridos. Por otra parte, como con la mayor edad y/o con la obesidad se incrementa la prevalencia de factores de riesgo, en ambas condiciones puede ser también adecuado el uso de APS. En hipertensas, dado la probabilidad de aumento de cifras tensionales inducidas por los estrógenos, es también recomendable su utilización. Su principal desventaja sería que no tienen un adecuado control de ciclo, como el dado por los anticonceptivos combinados. CONCLUSIONES: Los anticonceptivos con sólo progestágenos son una buena alternativa en mujeres con riesgos o con contraindicaciones.

There are some clinical conditions where combined oral contraceptives could imply risks, mainly cardiovascular. In these situations use of progestagen only pill (POP) contraceptives could be a good alternative. For example, in woman with higher both arterial or venous thrombosis risk some combined contraceptives could increase cerebro-vascular accident, myocardial infarction or venous thromboembolism risks, not observed with POP. Thrombosis risk is not increased in smokers over 35 year-old as with combined contraceptives. POP could also be indicated in hypertrigliceridemia, as ethynil estradiol increases triglycerides plasma levels. On the other hand, as risk factors increase with older age and /or obesity, POP could be used in both conditions. It could also be used in hypertensive women in whom blood pressure could increase with estrogens. The disadvantage is inadequate cycle control as that given by combined contraceptives. CONCLUSIONS: Progestagen only pill is a good alternative for women with risk factors or contraindications.

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BACKGROUND: Few trials have studied the prevalence of sexual dysfunction (SD) and related risk factors in postmenopausal women using the DSM-IV criteria. AIM: To evaluate the prevalence of SD in menopausal women and the impact of risk factors. PATIENTS AND METHODS: Five hundred thirty four healthy women, 40 to 64 years of age were interviewed using the Laumann test (DSM-IV). RESULTS: Mean age was 52.4 +/- 5.7 years. Eighty three percent were peri or postmenopausal, 23% used hormonal substitution therapy and 79.2% were sexually active. Among sexually active women, the prevalence of SD increased along with age, from 22.2% at the 40-44 years old range to 66.0% in the 60-64 years old group. Hormone users and healthy women had a low risk for SD (Odds ratio (OR): 0.1 IC: 0.0-0.1 and OR: 0.6 IC: 0.3-0.9, respectively). The risk increased in menopausal women (OR: 3.3 IC: 1.6-6.9), those older than 49 years (OR: 3.4 IC: 1.8-6.4), those subjected to hysterectomy (OR: 3.7 IC: 1.3-10.6) or those with an impotent sexual partner (OR: 3.2 IC: 1.2-8.6). CONCLUSIONS: There is a high prevalence of SD among climacteric women. Estrogens, either endogenous or exogenous, have a positive influence on sexuality.

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