RESUMO
OBJECTIVE: The aim of the study was to evaluate the laboratory and endometrial safety of topical testosterone versus topical estrogen for the treatment of vaginal atrophy in postmenopausal women. METHODS: This was a randomized, placebo-controlled trial of 60 postmenopausal women aged 40 to 70 years at the Menopause Clinic of CAISM UNICAMP. Women were randomized into three vaginal treatment groups: estrogen, testosterone, or placebo. The treatment was applied 3 times a week for 12 weeks. Hormonal laboratory values of follicle-stimulating hormone, luteinizing hormone, estradiol, estrone, androstenedione, total testosterone, free testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin were assessed at baseline and at 6 and 12 weeks. Metabolic laboratory values of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase were also assessed at baseline and at 6 and 12 weeks. Endometrial safety was assessed using ultrasonography at baseline and at 12 weeks. RESULTS: After 12 weeks of treatment, there were no significant differences in hormonal or metabolic laboratory values among all three groups. Two participants in the estrogen group had increased serum estradiol after 12 weeks of treatment. No change in endometrial thickening was reported in all three groups. CONCLUSIONS: Twelve weeks of treatment with topical testosterone or estrogen in postmenopausal women with symptoms of vaginal atrophy demonstrated laboratory and endometrial safety when compared with placebo.
Assuntos
Estrogênios/uso terapêutico , Pós-Menopausa , Testosterona/uso terapêutico , Doenças Vaginais/tratamento farmacológico , Adulto , Idoso , Atrofia , Endométrio/metabolismo , Terapia de Reposição de Estrogênios , Estrogênios/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Testosterona/administração & dosagem , Resultado do Tratamento , Vagina/patologia , Cremes, Espumas e Géis Vaginais , Doenças Vaginais/sangue , Doenças Vaginais/patologia , Vulva/patologiaRESUMO
OBJECTIVE: This study aims to compare the effects of a soy-based dietary supplement, low-dose hormone therapy (HT), and placebo on the urogenital system in postmenopausal women. METHODS: In this double-blind, randomized, placebo-controlled trial, 60 healthy postmenopausal women aged 40 to 60 years (mean time since menopause, 4.1 y) were randomized into three groups: a soy dietary supplement group (90 mg of isoflavone), a low-dose HT group (1 mg of estradiol plus 0.5 mg of norethisterone), and a placebo group. Urinary, vaginal, and sexual complaints were evaluated using the urogenital subscale of the Menopause Rating Scale. Vaginal maturation value was calculated. Transvaginal sonography was performed to evaluate endometrial thickness. Genital bleeding pattern was assessed. Statistical analysis was performed using χ(2) test, Fisher's exact test, paired Student's t test, Kruskal-Wallis test, Kruskal-Wallis nonparametric test, and analysis of variance. For intergroup comparisons, Kruskal-Wallis nonparametric test (followed by Mann-Whitney U test) was used. RESULTS: Vaginal dryness improved significantly in the soy and HT groups (P = 0.04). Urinary and sexual symptoms did not change with treatment in the three groups. After 16 weeks of treatment, there was a significant increase in maturation value only in the HT group (P < 0.01). Vaginal pH decreased only in this group (P < 0.01). There were no statistically significant differences in endometrial thickness between the three groups, and the adverse effects evaluated were similar. CONCLUSIONS: This study shows that a soy-based dietary supplement used for 16 weeks fails to exert estrogenic action on the urogenital tract but improves vaginal dryness.
Assuntos
Suplementos Nutricionais , Estradiol/farmacologia , Isoflavonas/farmacologia , Noretindrona/farmacologia , Pós-Menopausa/efeitos dos fármacos , Proteínas de Soja/farmacologia , Sistema Urogenital/efeitos dos fármacos , Adulto , Método Duplo-Cego , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Fitoterapia , Pós-Menopausa/fisiologia , Ultrassonografia , Sistema Urogenital/diagnóstico por imagem , Doenças Vaginais/tratamento farmacológicoRESUMO
OBJECTIVE: This study aims to evaluate multimorbidity and its associated factors in Brazilian women aged 50 years or older. METHODS: This is a cross-sectional, population-based study using self-reports. A total of 622 women aged 50 years or older were included. Multimorbidity was defined as two or more of the following morbidities: hypertension, osteoarthritis, cataracts, diabetes mellitus, osteoporosis, glaucoma, chronic bronchitis or asthma, urinary incontinence, cancer, myocardial infarction, stroke, and pulmonary emphysema. Sociodemographic, clinical, and behavioral factors were evaluated. Data were analyzed using χ test and Fisher's exact test, and Poisson multiple regression analysis was performed. Prevalence ratios and their 95% CIs were calculated. RESULTS: In this sample, 15.8% of participants reported no morbidities, whereas 26% reported having one morbid condition and 58.2% reported multimorbidity. With respect to morbidities, 55.9% of women reported having hypertension, 33.8% reported having osteoarthritis, 24.5% reported having cataracts, 22.7% reported having diabetes, 21.3% reported having osteoporosis, 9.9% reported having glaucoma, 9.2% reported having bronchitis, 8.9% reported having urinary incontinence, and 6.8% reported having cancer, whereas 4.8% reported having had a myocardial infarction, 2.7% reported having had a stroke, and 1.8% reported having pulmonary emphysema. Multiple regression analysis showed that for each additional year of life, women increased their likelihood of multimorbidity by 3% (95% CI, 1.02-1.04). Furthermore, for each point increase (kg/m) in their body mass index, women also increased their likelihood of multimorbidity by 3% (95% CI, 1.02-1.04). CONCLUSIONS: Multimorbidity is principally associated with aging and obesity.
Assuntos
Envelhecimento , Comorbidade , Obesidade/complicações , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Brasil/epidemiologia , Catarata/complicações , Catarata/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/epidemiologia , Osteoporose/complicações , Osteoporose/epidemiologia , Pós-Menopausa , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To compare the effects of daily ingestion of dietary soy supplementation, low-dose hormone therapy (HT) and placebo on psychological, somatic and urogenital symptoms in postmenopausal women. STUDY DESIGN: A double-blind, randomized, controlled trial. Sixty healthy, symptomatic, postmenopausal women of 40-60 years of age were allocated to use dietary soy supplementation (containing 90 mg of isoflavone) or HT (1mg estradiol and 0.5mg norethisterone acetate) or placebo. MAIN OUTCOME MEASURES: the Menopause Rating Scale (MRS) was used to assess menopausal symptoms at baseline and after 16 weeks of treatment. Intention-to-treat analyses were performed using the chi-square test, Fisher's exact test, the Kruskal-Wallis non-parametric test and analysis of variance (ANOVA). RESULTS: No statistically significant differences were found between the groups with respect to baseline clinical and sociodemographic characteristics. The psychological, somatic and urogenital symptoms analyzed in the MRS improved during treatment in all the groups, except for urogenital symptoms in the placebo group in which no significant changes were detected. Comparison between groups revealed a statistically significant improvement in somatic symptoms (hot flashes and muscle pain) in the users of HT (-45.6%) and dietary soy supplementation (-49.8%). Urogenital symptoms (vaginal dryness) improved significantly in HT users (-38.6%) and in users of the dietary soy supplementation (-31.2%). There was no statistically significant difference between the groups with respect to overall MRS score or to scores obtained in the psychological symptoms subscale. CONCLUSION: Dietary soy supplementation may constitute an effective alternative therapy for somatic and urogenital symptoms of the menopause.
Assuntos
Terapia de Reposição de Estrogênios/métodos , Estrogênios não Esteroides/administração & dosagem , Menopausa/efeitos dos fármacos , Proteínas de Soja/administração & dosagem , Sistema Vasomotor/efeitos dos fármacos , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Fogachos/prevenção & controle , Humanos , Isoflavonas/administração & dosagem , Menopausa/fisiologia , Pessoa de Meia-Idade , Dor/prevenção & controle , Valores de Referência , Resultado do Tratamento , Doenças Vaginais/prevenção & controleRESUMO
A adesao à TRH é um ponto crucial no tratamento de mulheres pós-menopausadas e climatéricas, já que os efeitos benéficos dos hormônios podem ser afetados ou mesmo perdidos se as mulheres nao mantiverem o tratamento. Apesar da relevância do assunto, poucas avaliaçoes têm sido realizadas neste sentido. O objetivo deste estudo foi avaliar o esquema de reposiçao hormonal e a adesao ao tratamento, no Ambulatório de Menopausa do CAISM/UNICAMP. Foi avaliado, retrospectivamente, o comportamento de 127 pacientes desta clínica diante da TRH durante o ano de 1992. A média etária das pacientes foi de 5O,6 anos (+ 7,4). O regime de reposiçao hormonal mais utilizado foi a associaçao de estrogênios e progestogênios de forma cíclica. A adesao à TRH nao foi afetada pelo tipo de esquema utilizado e foi considerada alta (86 por cento), talvez devido à assistência multiprofissional e à seleçao das pacientes, uma vez que, de 224 pacientes admitidas no Ambulatório, somente 127 (56,7 por cento) receberam TRH.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Estrogênios Conjugados (USP)/uso terapêutico , Menopausa , Progestinas/uso terapêutico , Terapia de Reposição de Estrogênios , Pacientes Desistentes do Tratamento , Estudos RetrospectivosRESUMO
Foi realizado um estudo com 1.853 casos de aborto internados para tratamento de suas complicaçoes na Enfermaria de Ginecologia do Centro de Assistência Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-UNICAMP), no período de janeiro de 1987 a dezembro de 1992. As complicaçoes foram a infecciosa, hemorrágica, traumática, maior e geral, sendo que as variáveis estudadas que poderiam estar relacionadas às complicaçoes foram o ano de internaçao, a cor e a idade da paciente, seu antecedente obstétrico, a utilizaçao de métodos contraceptivos, a idade gestacional em que ocorreu o aborto e o tipo do aborto (provocado ou espontâneo). Utilizou-se análise múltipla por regressao logística para determinar as variáveis associadas às complicaçoes do aborto. Observou-se que o aborto provocado e a falta de um companheiro estável associaram-se à complicaçao infecciosa. A cor nao branca, o ano de internaçao e a ausência de um companheiro associaram-se à complicaçao hemorrágica. Já o aborto provocado, a cor nao branca e a idade gestacional associaram-se à complicaçao maior. Finalmente, a presença de qualquer complicaçao teve como fator associado o número de partos anteriores.