Assuntos
Humanos , Feminino , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Climatério/efeitos dos fármacos , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Terapia de Reposição Hormonal , Doenças Urogenitais Femininas/tratamento farmacológico , Androgênios/uso terapêutico , Testosterona/efeitos adversos , Testosterona/uso terapêutico , Medicina Baseada em Evidências/métodosRESUMO
OBJETIVO: Evaluar la eficacia y la seguridad de Triticum vulgare en el tratamiento del síndrome genitourinario de la menopausia (SGUM). MÉTODO: Estudio cuasiexperimental (antes-después, con grupo control) en mujeres posmenopáusicas (amenorrea ≥ 36 meses, hormona estimulante del folículo > 40 U/l y estradiol < 25 pg/ml), sexualmente activas, con un índice de maduración vaginal (IMV) < 50 y pH ≥ 5, citología cervical negativa (Papanicolaou) y diagnóstico de SGUM, atendidas en el programa de climaterio y menopausia de una clínica privada de mediana complejidad, en Armenia, Quindío (Colombia). Se seleccionaron 207 mujeres con edad promedio de 55,19 ± 7,28 años. Se realizó un muestreo consecutivo. Se asignaron dos grupos: A (n = 105), que recibió T. vulgare, y B (n = 102), que recibió placebo. Se hizo seguimiento al inicio (basal) y 4, 8 y 12 semanas después, utilizando el IMV y el Índice de Función Sexual Femenina (IFSF). Los síntomas del SGUM se evaluaron con una escala visual analógica (EVA). Se aplicó estadística descriptiva. RESULTADOS: La puntuación media del IMV fue mayor en las semanas 4, 8 y 12 en todas las mujeres del grupo A (p = 0,01). Se observó una diferencia significativa en el promedio final de la puntuación del IMV de T. vulgare frente al placebo (p < 0,05). Al final del estudio, el grupo A mostró una mejoría significativa en la puntuación promedio del IFSF, en comparación con el grupo B (p < 0,001). Las puntuaciones de la EVA presentaron una disminución progresiva a lo largo del estudio, pero fueron comparables entre los dos grupos (p = 0,813). CONCLUSIONES: T. vulgare es una efectiva, segura e innovadora alternativa, no hormonal, para el tratamiento del SGUM. No se registraron eventos adversos, por lo que se demostró su seguridad.
OBJECTIVE: To evaluate the efficacy and safety of Triticum vulgare in the treatment of genitourinary syndrome of menopause. METHOD: Quasi-experimental study (before-after, with control group) in postmenopausal women (amenorrhea ≥ 36 months, FSH > 40 U/L and estradiol < 25 pg/ml), sexually active, with a vaginal maturation index (VMI) < 50 and pH ≥ 5, negative cervical cytology (Papanicolaou) and with a diagnosis of genitourinary syndrome of menopause (SGUM); who were treated in the climacteric and menopause program of a private clinic of medium complexity, in Armenia, Quindío (Colombia). 207 participants were selected, with a mean age of 55.19 ± 7.28 years. A consecutive sampling was carried out. Two groups were assigned: A (n = 105) with T. vulgare and B (n = 102) with placebo. Follow-up was done at baseline (baseline), four, eight and twelve weeks later, using the VMI and the female sexual function index (IFSF). Symptoms of SGUM were evaluated using a visual analog scale (VAS). Descriptive statistics were applied. RESULTS: The mean score of the IMV was higher in weeks 4, 8 and 12 in all the participants of group A (p = 0.01). A significant difference was observed in the final mean MVI score of T. vulgare versus placebo (p < 0.05). At the end of the study, group A showed a significant improvement in the mean IFSF score, compared to placebo (p < 0.001). The VAS scores showed a progressive decrease throughout the study but were comparable between the two groups (p = 0.813). CONCLUSIONS: T. vulgare is an effective, safe and innovative non-hormonal alternative for the treatment of SGUM. No adverse events were recorded, guaranteeing their safety.
Assuntos
Humanos , Feminino , Triticum/química , Menopausa , Doenças Urogenitais Femininas/tratamento farmacológico , Prurido Vulvar/tratamento farmacológico , Dispareunia/tratamento farmacológico , Saúde SexualRESUMO
The endemic character of urinary infections (UI) in sows makes collective antimicrobial therapies via feed a routine. This, however, generates sub-doses unable to heal and contribute to the selection of antibiotic-resistant bacteria. The use of individual therapy is the most appropriate procedure to be performed on animals with UI. With this study, we aimed to evaluate the occurrence of UI in sows housed in the western region of Paraná and the efficacy and cost-benefit of individual treatment. A total of 353 females were selected from five different herds, submitted to urine collection in the final third of pregnancy by spontaneous urination method. The samples were analyzed physically and chemically with the use of reagent strips, and the presence of nitrite was a determinant for positivity for UI. The animals with UI had urine submitted to a bacteriological evaluation, were treated with parenteral medication (marbofloxacin - single dose - 8 mg/kg), and submitted to a new urine collection 24h and 48h after the first. UI was observed in 4.53% of the females evaluated (16/353). Escherichia coli and Streptococcus sp. were the most frequently isolated agents. Seven days after the use of marbofloxacin 87.5% (14/16) of the animals were negative for UI, which demonstrates the efficacy of UI parenteral control. The diagnosis associated with individual therapy at the expense of collective medication was highly cost-effective, made it possible to drastically reduce the number of medicated animals, and was efficient in controlling UI. Thus, it is concluded that it is possible to make rational use of antibiotics by treating only sows that are proven to be positive for UI. This reduces the number of unnecessarily medicated animals and reduces the cost due to the use of antimicrobials only in sick animals.
O caráter endêmico das infecções urinárias (IU) em porcas faz com que seja rotina o uso de terapias antimicrobianas coletivas via ração, as quais geram subdoses que não promovem a cura e contribuem para a seleção de bactérias resistentes aos antibióticos. O uso de terapia individual é procedimento mais adequado a ser realizado nos animais com IU. Com este estudo objetivou-se avaliar a ocorrência de IU em matrizes alojadas na região Oeste do Paraná e a eficácia e custo-benefício do tratamento individual. Foram selecionadas 353 fêmeas, de cinco rebanhos distintos, submetidas à coleta de urina no terço final da gestação pelo método de micção espontânea. As amostras foram analisadas física e quimicamente com o uso de tiras reagentes, sendo que a presença de nitrito foi determinante de positividade para IU. Os animais com IU tiveram a urina submetida a avaliação bacteriológica, foram tratados com medicação parenteral (marbofloxacina - dose única - 8 mg/kg) e submetidos a nova coleta de urina 24h, 48h e sete dias após a primeira. IU foi observada em 4,53% das fêmeas avaliadas (16/353). Escherichia coli e Stretococcus sp. foram os agentes isolados com maior frequência. Sete dias após o uso da marbofloxacina 87,5% (14/16) dos animais foram negativos para IU, o que demonstra a eficácia do controle parenteral da IU. O diagnóstico associado à terapia individual em detrimento da medicação coletiva apresentou custo-benefício altamente vantajoso, possibilitou reduzir drasticamente o número de animais medicados e apresentou eficiência no controle da IU. Desta forma se conclui que é possível fazer uso racional de antibióticos mediante o tratamento apenas de porcas comprovadamente positivas para IU. Isto reduz o número de animais medicados desnecessariamente e reduz o custo em função do uso de antimicrobianos apenas em animais enfermos.
Assuntos
Animais , Feminino , Gravidez , Sus scrofa/microbiologia , Doenças Urogenitais Femininas/microbiologia , Doenças Urogenitais Femininas/tratamento farmacológico , Doenças Urogenitais Femininas/veterinária , Doenças Urogenitais Femininas/epidemiologia , Antibacterianos , Infecções Estafilocócicas/veterinária , Infecções Estreptocócicas/veterinária , Infecções por Escherichia coli/veterináriaRESUMO
OBJECTIVE: The aim of the study was to determine the most used methods for assessing genitourinary syndrome of menopause by the latest studies on the subject, and to critically assess their differences and comparability. METHODS: A narrative review of the literature was conducted, employing the terms genitourinary syndrome, vaginal atrophy, urogenital atrophy, and atrophic vaginitis, to analyze methods used to assess treatment efficacy. Only controlled randomized clinical trials assessing improvement of genitourinary syndrome of menopause, conducted in the last 5 years, and considering all types of treatment, were selected. RESULTS: Of the 37 studies included, 24 combined both objective and subjective methods thereby ensuring reproducibility and efficacy of symptom relief of the treatment analyzed. The vaginal maturation index was the most used objective method, followed by vaginal pH. One study used histological and immunohistochemistry tests. Regarding subjective methods, the "Most bothering Symptom" and other questionnaires as the Female Sexual Function Index for sex life, the Verbal Rating Scale, among others, were used. CONCLUSIONS: Despite the heterogeneity observed, particularly for subjective assessment of symptoms, there was a tendency to standardize methods and to use an objective method together with a subjective, which seems to be fundamental to guarantee reproducibility and comparability of results of each treatment analyzed. Histological and immunohistochemistry tests may be an option as an objective method in further studies, to better assess thickness, vascularization, among other parameters.
Assuntos
Atrofia/fisiopatologia , Doenças Urogenitais Femininas/fisiopatologia , Menopausa , Disfunções Sexuais Fisiológicas/etiologia , Doenças Vaginais/fisiopatologia , Atrofia/tratamento farmacológico , Atrofia/etiologia , Feminino , Doenças Urogenitais Femininas/complicações , Doenças Urogenitais Femininas/tratamento farmacológico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Disfunções Sexuais Fisiológicas/complicações , Síndrome , Doenças Vaginais/complicações , Doenças Vaginais/tratamento farmacológico , Saúde da MulherRESUMO
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.
A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas de morte no mundo. Embora afete mais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis por meios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.
Assuntos
Doenças Urogenitais Femininas , Tuberculose Pulmonar/complicações , Tuberculose Urogenital , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Feminino , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/tratamento farmacológico , Doenças Urogenitais Femininas/patologia , Humanos , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/patologia , Vulva/patologiaRESUMO
Abstract Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.
Resumo A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas demorte nomundo. Embora afetemais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis pormeios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/patologia , Tuberculose Urogenital/tratamento farmacológico , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/patologia , Doenças Urogenitais Femininas/tratamento farmacológico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Vulva/patologia , Antituberculosos/uso terapêuticoRESUMO
OBJECTIVES: To evaluate the efficacy and safety of estriol for the treatment of vulvovaginal atrophy in postmenopausal women. METHODS: A systematic literature review was performed. We searched the following electronic databases: Medline, Cochrane, Embase, Lilacs, CINHAL and Google Scholar. The studies selected included controlled clinical trials and quasi-experimental studies. Selections were made in pairs and independently, first by title and abstract and then complete texts. RESULTS: We identified 188 studies, 22 of which met the inclusion criteria; 13 were controlled clinical trials and nine were quasi-experimental, and 1217 women were included. These studies confirmed the efficacy of local estrogens to treat symptoms of vulvovaginal atrophy with few adverse effects reported. Following treatment, serum estriol levels rose, peaking at 1 h. At the 6-month follow-up, there was no increase in serum estriol in treated women. CONCLUSIONS: The available evidence (of low and moderate quality) shows that, when administered vaginally, estriol preparations appear to be safe for women who have risk factors related to systemic estrogen therapy.
Assuntos
Estriol/administração & dosagem , Doenças Urogenitais Femininas/tratamento farmacológico , Pós-Menopausa , Vagina/patologia , Vulva/patologia , Administração Intravaginal , Adulto , Idoso , Idoso de 80 Anos ou mais , Atrofia/tratamento farmacológico , Endométrio/efeitos dos fármacos , Estriol/efeitos adversos , Estriol/sangue , Feminino , Humanos , Concentração de Íons de Hidrogênio , MEDLINE , Pessoa de Meia-Idade , Vagina/químicaRESUMO
Sintomas relacionados com a atrofia vulvovaginal apresentam um impacto negativo sobre a qualidade de vida de até 50% das mulheres na pósmenopausa. No entanto, algumas recusam o uso de estrogênios, que é a terapia eficaz padrão, devido à publicidade negativa nos últimos anos e à disponibilidade de outras terapias opcionais. Esta revisão avaliou a eficácia de tratamentos hormonais, fitoterápicos de uso oral ou tópico para aliviar os sintomas da atrofia vaginal em mulheres na pósmenopausa. Foram avaliados estudos do Medline, Scopus e Cochrane Central Register de Ensaios Controlados com as palavraschaves vagina, postmenopause, isoflavones, estrogen, syndrome genitourinária, vulvovaginal atrophy, clinical applications. Estudos de revisão e ensaios clínicos randomizados foram incluídos neste estudo. Os dados mostraram que os estrogênios de uso sistêmico ou local são os mais indicados, as isoflavonas só mostraram efeitos positivos quando de uso local. Alguns tratamentos não hormonais, como hidratantes, lubrificantes e o uso de laser vaginal, também são indicados. Outra possibilidade de tratamento é o ospemifeno, um modulador de receptor hormonal seletivo (SERM) na dispareunia e na atrofia vulvovaginal. Assim, o uso de opções é benéfico para mulheres com risco de neoplasia relacionada aos estrogênios.(AU)
Symptoms related to atrophy vulvovaginal have a negative impact on quality of life up to 50% of women after menopause. However, some refuse the use of estrogens that is the standard effective therapy due to negative publicity in recent years and other available alternatives therapies. This review assessed the effectiveness of hormonal treatments, herbal oral or topical use to relieve the symptoms of vaginal atrophy in women after menopause. We evaluated studies of Medline, Scopus, Cochrane Central Register of Controlled Trials using vagina, postmenopause, isoflavones, estrogen, syndrome genitourinária, vulvovaginal atrophy, clinical applications, as keywords. Review studies and randomized controlled trials were included in this study. The data showed that the systemic or local use of estrogens are the most appropriate, and the isoflavones only showed positive effects when used locally. Some nonhormonal treatments such as moisturizing, lubricating and the use of vaginal laser are also suitable. Another possible treatment is ospemifene, a selective estrogen receptor modulator (SERM) on dyspareunia and vulvovaginal atrophy. Thus, the use of alternatives is beneficial for women with cancer risk related to estrogens.(AU)
Assuntos
Humanos , Feminino , Atrofia , Estrogênios/uso terapêutico , Doenças Urogenitais Femininas/tratamento farmacológico , Isoflavonas/uso terapêutico , Vagina/patologiaRESUMO
O uso de plantas na cura de enfermidades ainda é comum entre vários povos e bastante observado em comunidades ribeirinhas. Desse modo, o objetivo deste estudo foi conhecer as espécies vegetais utilizadas como medicinal, para transtornos do Sistema Geniturinário, por mulheres integrantes da Colônia de Pescadores Z-25 do município de Caravelas-BA, assim como suas formas de uso e manipulação. O estudo foi realizado em comunidades do distrito de Ponta de Areia, povoado de Barra de Caravelas e na Reserva Extrativista do Cassurubá. As entrevistas semiestruturadas e conversas informais foram realizadas com 40 mulheres, selecionadas a partir da técnica "Bola de Neve". Um total de 13 espécies vegetais foram indicadas para o cuidado ginecológico e/ou urinário, distribuídas em nove famílias botânicas, sendo as mais representativas Asteraceae (3 spp.), Anacardiaceae (2 spp.) e Malvaceae (2 spp.). Conforme os relatos, as espécies são utilizadas no tratamento da candidíase, corrimento, infecção urinária, ferida uterina, inflamação pélvica, hemorragia pélvica, reposição de hormônios, menopausa, cólica menstrual e ferida uterina. As plantas medicinais citadas possuem, em sua maioria, hábito do tipo herbáceo (7 spp.), seguido pelo arbóreo (4 spp.) e arbustivo (2 spp.).(AU)
The use of plants in the cure of diseases is still common among many folks and still quite observed in riverside communities. Thus, the aim of this study was to identify the plant species used as medicine for disorders of the genitourinary system by female members of the Colony of Fishermen Z 25 in the city of Caravelas, Bahia, as well as their forms of use and handling. The Study was conducted in communities belonging to the municipality of Caravelas: Ponta de Areia district, Barra de Caravelas thorp and on Cassurubá's Extractive Reserve. The semi-structured interviews and informal conversations were performed with 40 womens, selected from the "Snowball" technique. A total of 13 plant species were indicated for the gynecological and/or urinary care, distributed in 9 botanical families, being the most representative Asteraceae (3 spp.), Anacardiaceae (2 spp.) e Malvaceae (2 spp.). Mostly, the species are used in the treatment of candidiasis, discharge, urinary tract infection, uterine wound, pelvic inflammation, pelvic bleeding, hormone replacement therapy, menopause, menstrual cramps and uterine wound. The cited medicinal plants have, in most cases, the herbaceous type habit (7 spp.), followed by arboreal (4 spp.) and shrubs (2 spp.).(AU)
Assuntos
Humanos , Feminino , Fitoterapia/métodos , Plantas Medicinais , Brasil/etnologia , Etnobotânica , Doenças Urogenitais Femininas/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde/etnologiaRESUMO
OBJECTIVE: To analyze the short-term efficacy and safety over menopausal symptoms of three low-dose continuous sequential 17ß-estradiol (E)/progesterone (P) parental monthly formulations using novel non-polymeric microspheres. METHODS: This was a multicenter, randomized, single blinded study in which peri- and postmenopausal women were assigned to receive a monthly intramuscular injection of 0.5 mg E + 15 mg P (Group A, n = 34), 1 mg E + 20 mg P (Group B, n = 24) or 1 mg E + 30 mg P (Group C, n = 26) for 6 months. Primary efficacy endpoints included mean change in the frequency and severity of hot flushes and the effect over urogenital atrophy symptoms at 3 and 6 months. Safety variables included changes in the rate of amenorrhea, endometrial thickness and histopathology, and local and systemic adverse events. RESULTS: Compared to baseline at month 6, the three treatment schemes significantly decreased the rate of urogenital atrophy symptoms and the frequency (mean number per day) and severity (mean number graded as moderate and severe per month) of hot flushes. No differences in studied efficacy parameters were observed between studied groups at baseline or at the end of the study. For all groups the most frequent adverse event was pain at the injection site; however they were all rated as mild. At the end of the study peri- and postmenopausal women displayed no significant changes in endometrial thickness or histopathology in all treated groups. The rate of amenorrhea at the end of the study decreased for all studied groups yet was less evident among postmenopausal women as compared to perimenopausal ones. CONCLUSIONS: The three low-dose continuous sequential intramuscular monthly treatments of E/P using novel microsphere technology were effective at reducing menopausal symptoms at short-term with a low rate of adverse events. More long-term and comparative research is warranted to support our positive findings.
Assuntos
Estradiol/farmacologia , Doenças Urogenitais Femininas/tratamento farmacológico , Terapia de Reposição Hormonal/métodos , Fogachos/tratamento farmacológico , Menopausa , Progesterona/farmacologia , Adulto , Atrofia/tratamento farmacológico , Atrofia/patologia , Estradiol/administração & dosagem , Estradiol/efeitos adversos , Terapia de Reposição de Estrogênios/efeitos adversos , Terapia de Reposição de Estrogênios/métodos , Feminino , Doenças Urogenitais Femininas/patologia , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Injeções Intramusculares , Microesferas , Pessoa de Meia-Idade , Progesterona/administração & dosagem , Progesterona/efeitos adversos , Método Simples-Cego , Resultado do TratamentoRESUMO
BACKGROUND: Most contraceptive methods present benefits beyond contraception; however, despite a large body of evidence, many healthcare professionals (HCPs), users and potential users are unaware of those benefits. This review evaluates the evidence for non-contraceptive benefits of hormonal and non-hormonal contraceptive methods. METHODS: We searched the medical publications in PubMed, POPLINE, CENTRAL, EMBASE and LILACS for relevant articles, on non-contraceptive benefits of the use of hormonal and intrauterine reversible contraceptive methods, which were published in English between 1980 and July 2014. Articles were identified using the following search terms: 'contraceptive methods', 'benefits', 'cancer', 'anaemia', 'heavy menstrual bleeding (HMB)', 'endometrial hyperplasia', 'endometriosis' and 'leiomyoma'. RESULTS: We identified, through the literature search, evidence that some combined oral contraceptives have benefits in controlling HMB and anaemia, reducing the rate of endometrial, ovarian and colorectal cancer and ectopic pregnancy as well as alleviating symptoms of premenstrual dysphoric disorder. Furthermore, the use of the levonorgestrel-releasing intrauterine system also controls HMB and anaemia and endometrial hyperplasia and cancer, reduces rates of endometrial polyps in users of tamoxifen and alleviates pain associated with endometriosis and adenomyosis. Depot medroxyprogesterone acetate controls crises of pain associated with sickle cell disease and endometriosis. Users of the etonogestrel-releasing contraceptive implant have the benefits of a reduction of pain associated with endometriosis, and users of the copper intrauterine device have reduced rates of endometrial and cervical cancer. CONCLUSIONS: Despite the high contraceptive effectiveness of many hormonal and intrauterine reversible contraceptive methods, many HCPs, users and potential users are concerned mainly about side effects and safety of both hormonal and non-hormonal contraceptive methods, and there is scarce information about the many benefits that these methods offer beyond contraception.
Assuntos
Anticoncepcionais Femininos/uso terapêutico , Doenças Urogenitais Femininas/tratamento farmacológico , Dispositivos Intrauterinos Medicados , Anemia/tratamento farmacológico , Anticoncepção/métodos , Anticoncepcionais Orais Combinados/uso terapêutico , Feminino , Neoplasias dos Genitais Femininos/tratamento farmacológico , Humanos , Levanogestrel/uso terapêutico , Dor/prevenção & controle , Gravidez , Gravidez Ectópica/tratamento farmacológico , Transtorno Disfórico Pré-Menstrual/tratamento farmacológicoRESUMO
OBJECTIVE: Treatment of menopausal symptoms by compounds with tissue-selective estrogen agonist/antagonist effects, often called selective estrogen receptor modulators, has been researched as an alternative to the use of estrogen therapy. These structurally diverse molecules elicit tissue-dependent responses in hormone-responsive tissues and organs, exhibiting variations in estrogenic activity in preclinical models of postmenopausal reproductive tissues that may improve postmenopausal women's health (eg, prevention and treatment of breast cancer, osteoporosis, and vulvar and vaginal atrophy). METHODS: This literature review investigates whether preclinical data predicted the clinical effects of ospemifene on female reproductive and urinary tract tissues and compares these findings with the specific vaginal effects of other estrogen receptor agonists/antagonists (tamoxifen, raloxifene, and bazedoxifene) in preclinical and clinical studies. Lasofoxifene, although not currently available, is included because of its unique effects on vaginal tissue. RESULTS: The response of endometrial and vaginal tissues to estrogen receptor agonists/antagonists can be differentiated using transvaginal ultrasound, endometrial histopathology, cytologic examination of vaginal smears, assessment of physical changes in the vagina, and relief of symptoms associated with vulvar and vaginal atrophy (such as dyspareunia). CONCLUSIONS: Available evidence indicates that ospemifene has unique effects on tissue, leading to a favorable long-term profile for the relief of vulvar and vaginal atrophy compared with other estrogen receptor agonists/antagonists (eg, tamoxifen, raloxifene, and bazedoxifene) with no short-term concerns about endometrial safety (based on endometrial hyperplasia, carcinoma, endometrial spotting, and endometrial bleeding).
Assuntos
Antagonistas de Estrogênios/farmacologia , Menopausa/efeitos dos fármacos , Tamoxifeno/análogos & derivados , Pesquisa Translacional Biomédica , Sistema Urogenital/efeitos dos fármacos , Feminino , Doenças Urogenitais Femininas/tratamento farmacológico , Humanos , Tamoxifeno/farmacologiaRESUMO
The symptomatic treatment of pain associated with spasm of gastrointestinal or genitourinary origin can include the use of spasmolytic agents and/or non-steroidal anti-inflammatory drugs. However, the evidence of a superior effectiveness of combination in comparison with individual drugs is scarce and controversial. A double-blind, randomised, clinical trial study was designed to characterize the analgesic effect and safety of ketorolac and hyoscine butylbromide against hyoscine butylbromide alone in patients with ambulatory acute cramping pain of gastrointestinal and genitourinary origin. 160 patients with a pain level ≥4 in a 1-10 cm visual analogue scale were allocated to receive a fixed dose of ketorolac/hyoscine butylbromide (10 mg/20 mg) or hyoscine butylbromide (20 mg) alone at 6 h intervals, during a 48 h period. Both treatments were similarly effective when compared as a whole or when groups were classified by pain origin. Conversely, when treatments were grouped by pain intensity, ketorolac/hyoscine butylbromide combination showed a significant better pain relief profile than hyoscine butylbromide alone in pain intensity ≥7, but not <7. Data indicate that the oral ketorolac/hyoscine butylbromide mixture could be a better option than hyoscine butylbromide alone in the treatment of some acute intense cramping painful conditions.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Cólica/tratamento farmacológico , Doenças Urogenitais Femininas/tratamento farmacológico , Gastroenteropatias/tratamento farmacológico , Cetorolaco de Trometamina/uso terapêutico , Dor/tratamento farmacológico , Escopolamina/uso terapêutico , Anti-Inflamatórios não Esteroides/efeitos adversos , Química Farmacêutica , Antagonistas Colinérgicos/efeitos adversos , Cólica/etiologia , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Doenças Urogenitais Femininas/complicações , Gastroenteropatias/complicações , Humanos , Cetorolaco de Trometamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Escopolamina/efeitos adversosAssuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal , Fatores de Risco , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/patologia , Trabalho de Parto Prematuro/prevenção & controle , Trabalho de Parto Prematuro/terapia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Betametasona/administração & dosagem , Betametasona/uso terapêutico , Doenças Urogenitais Femininas/complicações , Doenças Urogenitais Femininas/tratamento farmacológico , Ruptura Prematura de Membranas Fetais , Maturidade dos Órgãos Fetais , Complicações na Gravidez , Tocolíticos/administração & dosagem , Tocolíticos/uso terapêutico , Ultrassonografia Pré-NatalAssuntos
Humanos , Feminino , Gravidez , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/patologia , Trabalho de Parto Prematuro/prevenção & controle , Trabalho de Parto Prematuro/terapia , Cuidado Pré-Natal , Fatores de Risco , Complicações na Gravidez , Doenças Urogenitais Femininas/complicações , Doenças Urogenitais Femininas/tratamento farmacológico , Ruptura Prematura de Membranas Fetais , Tocolíticos/administração & dosagem , Tocolíticos/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Ultrassonografia Pré-Natal , Maturidade dos Órgãos Fetais/efeitos dos fármacos , Betametasona/administração & dosagem , Betametasona/uso terapêuticoAssuntos
Humanos , Feminino , Gravidez , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/patologia , Trabalho de Parto Prematuro/prevenção & controle , Trabalho de Parto Prematuro/terapia , Cuidado Pré-Natal , Fatores de Risco , Complicações na Gravidez , Doenças Urogenitais Femininas/complicações , Doenças Urogenitais Femininas/tratamento farmacológico , Ruptura Prematura de Membranas Fetais , Tocolíticos/administração & dosagem , Tocolíticos/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Ultrassonografia Pré-Natal , Maturidade dos Órgãos Fetais , Betametasona/administração & dosagem , Betametasona/uso terapêuticoRESUMO
OBJECTIVE: This study evaluates the effect of intravaginal estriol on urogenital atrophy, Pap smear parameters, colposcopy parameters and discomfort during gynecological examination. METHODS: 31 postmenopausal women who had not used hormone therapy in the previous six months were studied. All women used intravaginal estriol, 1 mg/day for 21 days. The following variables were analyzed before and after treatment: complaints of urogenital atrophy; cytological parameters, colposcopic parameters, and subjective evaluation of discomfort during gynecologic examination. RESULTS: All urogenital atrophy complaints improved after treatment. At the first visit, 45.2% of women presented a predominance of profound cells, 51.6% with predominance of intermediate cells, and 3.2% with predominance of superficial cells. At the second visit, these rates were 35.5%, 64.5%, and 0%, respectively. Evaluation of the maturation index showed that 83.9% of women had atrophic Pap smears, and 16.1% showed good estrogenic level before treatment. At the second visit, atrophic smears occurred in 12.9%, and 87.1% of women exhibited good estrogenic level (chi2 = 20.045; p = 0.000). Colposcopy showed that 71% of women had atrophic colpitis and/or petequiae before treatment, while atrophy after therapy was present in only 6.4%. The evaluation of other colposcopic parameters also improved after treatment. Great discomfort was reported by 19.4% before and by 0% after treatment. CONCLUSION: Intravaginal estriol 1 mg/day for a period of 21 days was efficient in improving urogenital atrophy, Pap smear parameters and colposcopic evaluation in postmenopausal women.
Assuntos
Estriol/uso terapêutico , Doenças Urogenitais Femininas/tratamento farmacológico , Pós-Menopausa/efeitos dos fármacos , Sistema Urogenital/patologia , Vagina/patologia , Administração Intravaginal , Idoso , Atrofia/tratamento farmacológico , Estriol/administração & dosagem , Estriol/farmacologia , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Vagina/efeitos dos fármacosRESUMO
Urogenital atrophy is characterized by dryness, inflammation, and thinning of the epithelial lining of the vagina and lower urinary tract due to estrogen decline. Local estrogen therapy if effective to relieve signs and symptoms of vaginal atrophy without causing an elevation of serum estrogen levels. Although there are no big studies addressing the safety of this type of treatment, it can be maintained over long periods to avoid annoying symptoms. Special care must be taken with women with breast cancer in whom the effective dose must be titrated to avoid an increase in serum estrogens over the levels usually observed in postmenopausal women.
Assuntos
Humanos , Feminino , Doenças Urogenitais Femininas/tratamento farmacológico , Estradiol/administração & dosagem , Estriol/administração & dosagem , Estrogênios/administração & dosagem , Administração Intravaginal , Atrofia/tratamento farmacológico , Neoplasias da Mama , Climatério , Pomadas , Comprimidos , Cremes, Espumas e Géis Vaginais , Vagina , Vagina/patologiaRESUMO
Os sintomas decorrentes da atrofia vulvovaginal são muito comuns no climatério. Os estrogênios aplicados localmente na vagina se mostram eficazes no alívio de tais manifestações; no entanto, os estrogênios conjugados na forma de creme vaginal apresentam efeitos sistêmicos e o estriol aplicado localmente pode ser absorvido sistemicamente também. O promestrieno é um estrogênio cuja absorção sistêmica é desprezível quando empregado topicamente, porém a falta de revisão sistemática sobre o tema suscitou a realização da presente revisão. Foram incluídos 16 estudos publicados entre 1976 e 2009, que avaliaram eficácia do promestrieno no alívio dos sintomas decorrentes da atrofia vulvovaginal, ou que investigaram seus efeitos na citologia vaginal, e também aqueles que avaliaram a absorção da substância quando empregada topicamente. As evidências encontradas confirmaram a eficácia do promestrieno, utilizado localmente no tratamento das afecções atróficas genitais femininas decorrentes do hipoestrogenismo, aliada a absorção sistêmica desprezível
The symptoms resulting from vulvovaginal atrophy are very common during climacteric. Estrogens applied locally in the vagina are effective in relieving these manifestations, however, conjugated estrogens as vaginal cream have systemic effects and locally applied estriol may be systemically absorbed. Promestriene is an estrogen without systemic absorption when applied topically, but the lack of a systematic review on the substance motivated the idea to make this review. Sixteen studies published between 1976 and 2009 which evaluated the effectiveness of promestriene on the relief of symptoms resulting from vulvovaginal atrophy or which investigated its effects on vaginal cytology and those which evaluated the absorption of the substance when used locally were included. The found evidences confirmed the effectiveness of locally applied promestriene in the treatment of female genital atrophic disorders due to low estrogen levels coupled with negligible systemic absorption