RESUMO
The health of many women is affected in the climacteric period, either by symp-toms 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 effcient 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 ac-cording 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.
Assuntos
Feminino , Humanos , Doenças Cardiovasculares/etiologia , Climatério/fisiologia , Qualidade de Vida , Doenças Cardiovasculares/induzido quimicamente , Chile , Climatério/efeitos dos fármacos , Terapia de Reposição de Estrogênios/efeitos adversos , Hormônios Esteroides Gonadais/uso terapêutico , Estilo de Vida , Fatores de Risco , Sociedades MédicasRESUMO
La mayoría de las mujeres ve afectada su salud en el período climatérico, ya sea por sintomatología que le deteriora su calidad de vida (CV) o por la aparición de enfermedades crónicas que le afectan sus expectativas de vida. Por lo tanto, es básico evaluar estos dos aspectos, teniendo como objetivos centrales de las eventuales intervenciones terapéuticas, mejorar la CV y reducir el riesgo de enfermedades cardiovasculares y/o fracturas...
Assuntos
Feminino , Climatério/metabolismo , Densidade Óssea/fisiologia , Qualidade de VidaRESUMO
Background: Climacteric symptoms have a direct relationship with biological and sociocultural factors and significantly impair the quality of life of women. Aim: To assess quality of life and factors affecting it in women aged 40 to 59 years. Material and methods: The Menopause Rating Scale (MRS) was applied to 370 healthy women aged 49 ± 6 years, that accompanied patients to public hospitals in Santiago. Results: Forty four percent of women were postmenopausal and 6 percent used hormone replacement therapy. Half of the group had less than 12 years of formal education and 67 percent had a couple. The mean number of children was 2.8 ± 1.5. Total MRS score was 16.2 ± 8.5. The higher score was given by the psychological domain (7.7 + 4.4), followed by the somatic domain (5.8 ± 3.5). The urogenital domain had the lowest score (2.7 ± 2.9). Eighty percent of women had moderate to severe climacteric symptoms. A logistic regression analysis showed that the postmenopausal condition was the factor that caused the greatest derangement in quality of life, followed by her parity. Formal education had the lowest impact. Conclusions: In this sample of women, menopause significantly deteriorated quality of life and sociocultural factors such as the parity also had an impact.
Assuntos
Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Menopausa/psicologia , Qualidade de Vida/psicologia , Estudos de Coortes , Estudos Transversais , Terapia de Reposição de Estrogênios , Modelos Logísticos , Menopausa/efeitos dos fármacosRESUMO
Background: Pressure ulcers are a common complication among elderly patients confined to bed for long periods. The Braden scale is a commonly used risk assessment tool. Aim: To evaluate the use of Braden scale. Patients and methods: Seventy women aged 61 to 96 years, admitted to the Internal Medicine Service of Barros Luco-Trudeau Hospital, were studied. Their risk was evaluated using the Braden scale. The presence of pressure ulcer was diagnosed according to the National Pressure Ulcer Advisory Panel on admition, two weeks later and at discharge. Results: On admission, mean Braden scale score was 16.6±2.8 and 34 women had a score of 16 or less, that is considered of risk. Twenty five women (20 with a score of 16 or less) developed pressure ulcers, mostly superficial. The odds ratio of a score of 16 or less for the development of ulcers was 4.2 (95 percent CI 1.8-11.7, p <0.001). The sensitivity and specificity of such score were 80 and 69 percent respectively. Conclusions: The Braden scale predicts the risk of developing pressure ulcers with a good sensitivity and specificity in female elderly patients (Rev MÚd Chile 2004; 132: 595-600).
Assuntos
Humanos , Masculino , Feminino , Idoso , Valor Preditivo dos Testes , Úlcera por Pressão/diagnóstico , Úlcera por Pressão/epidemiologiaRESUMO
Objetivo. Aplicar y validar en una población chilena el "Indice de Función Sexual Femenina" establecido en el International Consensus Development Conference on Female Sexual Dysfunctions. Material y método. 383 mujeres sanas de 20 a 59 a¤os con actividad sexual, beneficiarias del Centro de Salud "Carol Urzúa". Instrumento: cuestionario de 19 preguntas, agrupadas en seis dominios: deseo, excitación, lubricación, orgasmo, satisfacción y dolor. Análisis estadístico: Se utilizó ANOVA, Kruskall-Wallis, Chi cuadrado, regresión logística y alpha de Cronbach. Resultados. Edad media: 35,3ñ10,9 a¤os, casadas (50,4 por ciento) o conviviente (17,0 por ciento), con educación media (48,2 por ciento). La consistencia interna del test fue buena (>0,70). La sexualidad logra su máxima expresión a los 35-40 a¤os (puntaje: 29,1ñ4,9) para caer posteriormente (21,0ñ6,0), especialmente el deseo y excitación. Después de los 44 a¤os se incrementa el riesgo de disfunción sexual (OR:3,6; IC: 2,1-6,3; p< 0,0001). La mayor educación y la estabilidad de pareja disminuyen el riesgo (OR: 0,45; IC:0,28-0,80; p< 0,005 y OR:0,58; IC:0,35-0,98; p< 0,05 respectivamente). Conclusiones. El Indice de Función Sexual Femenino es un instrumento sencillo de aplicar, con propiedades psicométricas adecuadas que permite evaluar la sexualidad en diferentes etapas de la vida. Es adecuado para estudios epidemiológicos y clínicos.
Assuntos
Humanos , Feminino , Comportamento Sexual/estatística & dados numéricos , Comportamento Sexual/psicologia , Disfunções Sexuais Psicogênicas/epidemiologia , SexualidadeRESUMO
The loss of sexuality observed in the climacteric period is difficult to evaluate. An important advance has been the development of the Female Sexual Function Index (FSFI), a test based on the norms of the International Consensus Development Conference on Sexual Female Dysfunctions. Aim: To study the effects of hormone replacement therapy (HRT) on sexuality, applying the FSFI. Material and methods: The FSFI was applied to 300 healthy women between 45-64 years, sexually active, beneficiaries of the Southern Metropolitan Health Service. Results: The mean age of the sample studied was 51±5 years, 27% were HRT users, 21% had had an hysterectomy and 98% had a stable couple. The total score of the FSFI decreased from 27.3±5.8 in women between 45 and 49 years of age to 19.3±7.0 in women between 60 and 64 years (p <0.01). A significantly better sexuality was observed in HRT users, with FSFI scores of 28.1±5.5 and 24.6±6.8 in HRT users and non users, respectively (p <0.01). Women on HRT obtained a higher score in all of the test domains, especially in lubrication, orgasm and sexual satisfaction. Conclusions: Female sexuality decreases with aging. HRT users have a better sexual function than non users (Rev Méd Chile 2003; 131: 1251-55 ).
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas , Terapia de Reposição de Estrogênios , Pós-Menopausa , Sexualidade/efeitos dos fármacos , Disfunções Sexuais Fisiológicas , Estudos de Coortes , Estudos Transversais , Libido/efeitos dos fármacos , Orgasmo/efeitos dos fármacos , Inquéritos e QuestionáriosRESUMO
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 percent), dyslipidemias (71.5 percent), high blood pressure (13.5 percent), obesity (13.1 percent), smoking (12.4 percent) and diabetes (2.8 percent) were the most prevalent RF. Five years later, the prevalence of hypertension increased to 20.9 percent, the prevalence of obesity increased to 27.3 percent, smoking increased to 20.8 percent and diabetes to 5.9 percent. The prevalence of dyslipidemia did not change, although triglycerides levels rose from 125.9Ý56.4 to 136.8Ý63.5 mg/dl (p <0.001). Sedentarism dropped to 58.8 percent. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5 years follow-up from 3.8 percent to 35 percent. Women on HRT experienced 3 percent decrease in LDL-cholesterol and 9 percent 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
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares , Hiperlipidemias , Menopausa , Fumar , Prevalência , Fatores de Risco , Estudos de Coortes , Terapia de Reposição Hormonal , Diabetes Mellitus , Obesidade , Fatores Socioeconômicos , Hipertensão/epidemiologiaRESUMO
Los gestágenos clásicamente han sido relacionado con el cáncer mamario. Por esto, cuando se requiere indicar un anticonceptivos hormonal en una paciente tratada por cáncer de mama, surge la opción del uso de anticonceptivos con gestágenos solos (POP). Algunos estudios sugieren un rol protector de los gestágenos en el cáncer de mama: 1) La progesterona inhibe la proliferación mamaria inducida por el estradiol. 2) Induce apoptosis celular, inhibiendo la síntesis de las proteínas antiapoptóticas, 3) Inhibe enzimas que aumentan la concentración de estrógenos en la mama. Contrariamente, otras investigaciones muestran una acción favorecedora del cáncer de mama: 1) La actividad mitótica en las mamas es máxima durante la fase lútea, período en que predomina la progesterona. 2) En cultivos celulares los gestágenos estimulan la proliferación de algunas líneas celulares de cáncer de mama. 3) El uso de anticonceptivos orales con progestágenos y la medroxiprogesterona de depósito aumentan en mujeres jóvenes el riesgo de cáncer mamario. 4) En el reemplazo hormonal postmenopáusico varios estudios sugieren que la medroxiprogesterona incrementa el riesgo oncogénico. Conclusión: No existen datos que permitan afirmar con certeza que el uso de POP no tiene riesgos en pacientes con cáncer de mama.
Assuntos
Feminino , Neoplasias da Mama , Anticoncepcionais Orais , Estrogênios , ProgesteronaRESUMO
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 52.4ñ5.7 years. Eighty three percent were peri or postmenopausal, 23 percent used hormonal substitution therapy and 79.2 percent were sexually active. Among sexually active women, the prevalence of SD increased along with age, from 22.2 percent at the 40-44 years old range to 66.0 percent 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
Assuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas , Climatério , Menopausa , Terapia de Reposição Hormonal , Fatores de RiscoRESUMO
Background: In Chile, 40 percent of deaths due to acute myocardial infarction occur in women. Aim: To assess the presence of cardiovascular risk factors in women with acute coronary syndromes. Patients and methods: Thirty four women aged 46 to 55 years old, admitted to the hospital due to an acute coronary syndrome and 102 age matched healthy women were studied. A clinical history was obtained, blood pressure and fasting serum lipids were measured. Results: A history of high blood pressure was present in 65 and 16 percent of patients and healthy controls respectively. Seventy seven percent of patients and 36 percent of controls smoked, 76 percent of patients and 48 percent of controls were postmenopausal, 21 percent of patients an 5 percent of controls were diabetic. In patients and controls respectively serum total cholesterol was 230.1ñ36.2 and 211.2ñ34.8 mg/dl, serum triacylglycerol was 213.4ñ109.4 and 143.2ñ76.9 mg/dl and serum HDL cholesterol was 44.1ñ10.8 and 49.8ñ13.3 mg/dl (p<0.001 or less). In univariate analysis, the risk of acute coronary syndrome increased with high blood pressure (OR: 9.3, CI: 2.5-18.6), menopause (OR: 8.3, CI: 2,2-31:5), smoking (OR: 6.9, CI: 2.5-18.6), diabetes mellitus (OR: 5.0, CI: 1.4-17.5), a high total cholesterol/HDL cholesterol ratio (OR: 6.6, CI: 1.8-12.5) and hypertriglyceridemia (OR: 3.6, CI: 1.5-8.5). Logistic regression analysis showed that hypertension and menopause had the higher predictive values for acute coronary syndrome. Conclusions: In this group of women with acute coronary syndromes, the main coronary risk factors were high blood pressure and menopause