Adriana Orcesi Pedro

Incontinência urinária entre mulheres climatéricas brasileiras: inquérito domiciliar

OBJECTIVE: To investigate the prevalence of stress urinary incontinence and its associated factors in perimenopause women using a population-based household survey. METHODS: A descriptive, exploratory cross-sectional population-based study with secondary analysis of a population-based household survey on perimenopause and menopause was conducted among women living in the city of Campinas, Brazil. Through a sampling process, 456 women between 45 and 60 years old were selected. Complaints of urinary incontinence and related risk factors, such as age, socioeconomic status, education level, race, parity, smoking habits, body mass index, previous gynecological surgeries, menopausal status, and hormonal replacement therapy were explored. Data were collected through home interviews using an adapted version of the structured pre-tested questionnaire elaborated by the International Health Foundation, International Menopause Society and the American Menopause Society. Statistical analysis were performed using prevalence rates (CI 95%). RESULTS: Thirty-five percent of the interviewees referred stress urinary incontinence. None of the sociodemographic factors studied was associated to the risk of urinary incontinence. In addition, parity did not significantly change the risk of urinary incontinence. Other factors, such as previous gynecological surgeries, body mass index, and smoking habits, were not associated with the prevalence of stress urinary incontinence. Also, menopausal status and hormonal replacement therapy did not change the risk of stress urinary incontinence. CONCLUSION: Though there was a high prevalence of stress urinary incontinence among perimenopause women, there was not found any associations with sociodemographic and reproductive factors.

Síndrome do climatério: inquérito populacional domiciliar em Campinas, SP

OBJECTIVES To study the prevalence of climacteric, urogenital and sexual symptoms in a population of Brazilian women. METHODS A cross-sectional descriptive population-based study was conducted. The selection of 456 women aged 45-60 years, living in Campinas, SP, in 1997, was done through area cluster sampling, according to data from the Brazilian Institute of Geography and Statistics. Data were collected via home interviews, using structured pretested questionnaires. Data were analyzed using the chi-squared test and the nonparametric Kruskal-Wallis test; a probability of <0.05 was considered statistically significant. The degree of climacteric symptoms was analyzed through circulatory and psychological indices. Analysis of the main components was used to determine symptom interrelationships. RESULTS The most prevalent symptoms were nervousness (82%), hot flushes (70%), headache (68%), irritability (67%) and sweating (59%). Hot flushes, sweating and insomnia were significantly more prevalent in the peri and postmenopausal phases. The frequency (severity) of vasomotor and psychological symptoms did not vary according to the menopause phase. The prevalence of urinary incontinence was 27.4%. Complaints of dyspareunia and vaginal dryness were infrequent. Decreased libido was the most frequent sexual complaint. It was observed that some climacteric complaints were interrelated. The first cluster included hot flushes and sweating (vasomotor cluster). The second cluster included nervousness, depression and irritability (psychological cluster). The third cluster included dizziness and palpitation (atypical cluster). CONCLUSION Climacteric symptoms in this population were highly prevalent and similar to those described in developed Western countries.OBJETIVO: Estudar a prevalencia de sintomas climatericos, urogeniatais e sexuais em populacao de mulheres do Brasil. METODOS: Estudo descritivo de corte transversal, de base populacional. Selecionaram-se, por meio de processo de amostragem, 456 mulheres, residentes no municipio de Campinas, SP, na faixa etaria de 45-60 anos de idade, em 1997, segundo informacoes da agencia local do Instituto Brasileiro de Geografia e Estatistica. Os dados foram coletados por meio de entrevistas domiciliares, com questionarios estruturados e pre-testados. A analise dos dados foi realizada pelo teste do qui-quadrado, teste nao parametrico de Kruskal-Wallis, com nivel de significância estatistica menor que 0,05. A intensidade dos sintomas climatericos foi analisada pelos indices circulatorio e psicologico. A analise de componentes principais foi utilizada para determinar a inter-relacao dos sintomas climatericos. RESULTADOS: Os sintomas climatericos mais prevalentes foram: nervosismo (82%), fogachos (70%), cefaleia (68%), irritabilidade (67%) e sudorese (59%). Os fogachos, a sudorese e a insonia foram significativamente mais prevalentes na peri e pos-menopausa. A frequencia (intensidade) dos sintomas vasomotores e psicologicos nao variou segundo o estado menopausal. A prevalencia de incontinencia urinaria foi de 27,4%. A queixa de dispareunia e secura vaginal foi pouco frequente. Em relacao as queixas sexuais, a diminuicao do interesse sexual foi a mais frequente. Constatou-se que algumas queixas climatericas sao inter-relacionadas. O primeiro aglomerado incluiu as ondas de calor e a sudorese (aglomerado vasomotor). O segundo, depressao, nervosismo e irritabilidade (aglomerado psicologico) e o terceiro, tontura e palpitacao (aglomerado atipico). CONCLUSOES: A prevalencia de sintomas climatericos na populacao estudada foi elevada e semelhante a descrita em paises ocidentais desenvolvidos.

Idade de ocorrência da menopausa natural em mulheres brasileiras: resultados de um inquérito populacional domiciliar

A descriptive, exploratory, cross-sectional, population-based study was conducted to identify age at menopause and its associated factors as well as socio-cultural, demographic, and economic characteristics of climacteric women in Campinas, Sao Paulo State. Subjects were 456 Brazilian women between 45 to 60 years of age, selected through area cluster sampling. Data were collected through home interviews using a structured, pre-tested questionnaire. This instrument was an adaptation, done by the authors, of questionnaires provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society. Statistical analysis was performed through life table analysis and Cox logistic regression. Mean age at menopause was 51.2 years. There was no association between study factors and age at natural menopause.

Procura de Serviço Médico por Mulheres com Incontinência Urinária

Purpose: to evaluate the percentage of 45- to 60-year-old women complaining of urinary incontinence, who look for medical treatment, and the factors possibly associated with the decision of visiting the doctor and the reasons for not doing so. Methods: a secondary analysis of a population-based survey on climacterium and menopause in women living in the city of Campinas, Sao Paulo state, was carried out through a descriptive, exploratory and cross-sectional population study. A total of 456 women between 45 and 60 years of age were selected through a sampling process. The age at menopause and its associated factors were evaluated, as well as the prevalence of climacteric symptoms, the use of medical care, self-perception of the health status, and the sociocultural, sociodemographic and socioeconomic characteristics. Urinary incontinence complaint and the search for medical help due to the presence of symptoms were explored. The data were collected through home interviews, using a structured and pretested questionnaire provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society, and adapted by the authors. The statistical analysis was performed using Fishers exact test. Results: thirty-five percent of the interviewees reported constant or intermittent stress incontinence, although only 59% of the patients with the complaint sought medical help. Conclusion: the majority of the women presenting urinary incontinence do not complain to the doctor if they are not questioned objectively.

The effect of dietary soy supplementation compared to estrogen and placebo on menopausal symptoms: A randomized controlled trial

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, Fishers 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.

Climacteric women seeking medical care, Brazil

OBJECTIVE To study the causes and factors associated with climacteric women seeking medical care. METHODS A descriptive exploratory cross-sectional population-based study was carried out. Subjects were 456 women aged 45 to 60 years resident in a metropolitan area of Southeastern, Brazil, selected through area cluster sampling. Data were collected through home interviews using a structured, pre-tested questionnaire. Statistical analysis were performed using Chi-square test, Cramers coefficient and logistic multiple regression. RESULTS About 80% sought medical care due to menstrual irregularities and climacteric symptoms. The main factors associated with women seeking medical care were hormone replacement therapy, marital status, and stronger psychological symptoms. The main reason for not seeking medical care was womens thought that their complaint did not justify medical attention. CONCLUSIONS There was a high demand for medical care by climacteric women, but a significant percentage did not seek medical attention because they believed their symptoms were ordinary.

Quality of life in women with postmenopausal osteoporosis: Correlation between QUALEFFO 41 and SF-36

OBJECTIVE To evaluate quality of life (QoL) in women with postmenopausal osteoporosis, correlating the QUALEFFO 41 with the short-form health survey 36 (SF-36) and evaluated some factors that can influenced the QoL of women with osteoporosis. METHODS A cross-sectional study was conducted in 220 postmenopausal women (ages ranging from 55 to 80 years). Of the total number, 110 women had osteoporosis and 110 women did not have osteoporosis and these women were age-matched (+/-3 years). Two questionnaires were administered to all subjects for evaluation of QoL: the quality of life questionnaire of the European foundation for Osteoporosis 41 (QUALEFFO 41) and the short-form health survey 36 (SF-36). For data analysis, a significance level of 5% was set (p<0.05). RESULTS Clinical characteristics between the groups were similar, with statistically significant differences only in body mass index (BMI), race, school education, age at menopause and use of hormone therapy (HT) (p<0.001). Women with osteoporosis had a worse QoL both in the QUALEFFO 41 and in the SF-36, in all domains studied. Data was adjusted for BMI, race, school education and use of HT (p<0.001). There was a significant correlation between all domains in the QUALEFFO 41 questionnaire and their corresponding domains in the SF-36 (p<0.001). The only factors related to worse QoL were BMI>25 and sedentary lifestyle. In contrast, paid work was associated with a better QoL (CI=95%). CONCLUSION Women with osteoporosis had an impaired QoL, especially relating to the physical, psychological and social aspects. The factors associated with QoL were obesity, sedentary lifestyle and paid work.

Quality of life and menopausal and sexual symptoms in gynecologic cancer survivors: a cohort study

Objectives:The aims of this study were to investigate the frequency of menopausal and sexual symptoms and the proportion of sexually active women and to assess and identify quality of life (QOL) predictors in gynecologic cancer survivors. Methods:A prospective case series following a cohort of women under radiation therapy was conducted, including 107 women (aged 21-75 y) with gynecologic cancer (cervical or endometrial cancer) who underwent pelvic radiotherapy in the Radiotherapy Division of the Womens Integral Healthcare Center at the Universidade Estadual de Campinas. Adverse effects of radiotherapy were evaluated using the Common Terminology Criteria Adverse Event Scale. QOL was measured using the abbreviated version of the World Health Organizations Quality of Life instrument before radiotherapy (T0) and at 4 months (T1), 1 year (T2), and 3 years (T3) after radiotherapy. QOL scores were assessed over time using the Wilcoxon signed-rank test. Multiple linear regression analysis was used to identify QOL predictors. Results:A decrease in the frequency of vaginal dryness (26.7% in T0 vs 8.3% in T3; P < 0.01) and an increase in the proportion of sexually active women (21.5% in T0 vs 44.2% in T3; P < 0.01) were observed. A significant increase in QOL scores was observed in the psychological domain and general health and overall QOL. Dyspareunia negatively affected the physical (P < 0.01), psychological (P < 0.01), and social relationship domains (P < 0.01); overall QOL (P = 0.01); and general health (P = 0.04). Family income was positively related to environment domain (P < 0.01), overall QOL (P = 0.04), and general health (P < 0.01). Conclusions:Data derived from this study indicated that gynecologic cancer survivors had a lower frequency of vaginal dryness and a higher proportion of these women were sexually active 3 years after completion of radiotherapy. Furthermore, QOL improved and dyspareunia negatively affected various QOL dimensions.

Prevalence of urinary incontinence and its association with multimorbidity in women aged 50 years or older: A population-based study.

To evaluate the prevalence and associated risk factors for urinary incontinence, as well as its association with multimorbidity among Brazilian women aged 50 or over.

Estudo exploratório da associação entre o perfil lipídico e a densidade mineral óssea em mulheres menopausadas, em hospital de referência de Campinas

A total of 72 postmenopausal patients presenting no risk factors for cardiovascular disease nor osteoporosis, were studied. The study evaluated total serum cholesterol and fractions and bone mass by densitometry of the lumbar spine and femur using a Lunar-DPX. There was no association between lipid profile variables and bone mineral density, except for high density lipoprotein (HDL), which showed an inverse correlation (p=0.001). Multiple regression showed that total cholesterol levels higher than 240 mg% had a positive association with BMD (p=0.026). In addition, the ratio between LDL and HDL (Castelli 2 index) showed a negative association with BMD (p=0.002). The diagnostic validation test showed that all lipid profile variables had low sensitivity and specificity as indicators for osteoporosis. The conclusions were that lipid profile variables did not show a significant association with bone mass and could not be used as indicators for bone mineral density.O objetivo deste estudo foi avaliar a possivel associacao entre algumas variaveis do perfil lipidico e a densidade mineral ossea e se estas variaveis poderiam ser usadas como indicadoras de massa ossea em mulheres menopausadas, atendidas no ambulatorio de menopausa do CAISM-Unicamp, no ano de 1995. Estudaram-se 72 pacientes pos-menopausadas, sem fatores de risco para doencas cardiovasculares e para osteoporose, por meio da dosagem de colesterol total e fracoes e da avaliacao da densidade mineral ossea por densitometria ossea em aparelho Lunar DPX (Dexa). Dentre as variaveis do perfil lipidico, a densidade mineral ossea associou-se inversamente a lipoproteina HDL de alta densidade (p = 0,001). A analise de regressao multipla observou que niveis de colesterol total acima de 240mg% associaram-se a menor densidade mineral ossea (p = 0,026). A razao entre a lipoproteina de baixa densidade e a lipoproteina de alta densidade (indice de Castelli 2) correlacionou-se positivamente com a densidade mineral ossea (p = 0,002). O teste de validacao diagnostica mostrou que todas as variaveis do perfil lipidico apresentaram baixa sensibilidade e especificidade como indicadoras de diminuicao de massa ossea. Conclui-se que, apesar de algumas variaveis do perfil lipidico apresentarem associacao estatisticamente significativa com a massa ossea, elas foram contraditorias e nao tem boa capacidade diagnostica.A total of 72 postmenopausal patients presenting no risk factors for cardiovascular disease nor osteoporosis, were studied. The study evaluated total serum cholesterol and fractions and bone mass by densitometry of the lumbar spine and femur using a Lunar-DPX. There was no association between lipid profile variables and bone mineral density, except for high density lipoprotein (HDL), which showed an inverse correlation (p = 0.001). Multiple regression showed that total cholesterol levels higher than 240 mg% had a positive association with BMD (p = 0.026). In addition, the ratio between LDL and HDL (Castelli 2 index) showed a negative association with BMD (p = 0.002). The diagnostic validation test showed that all lipid profile variables had low sensitivity and specificity as indicators for osteoporosis. The conclusions were that lipid profile variables did not show a significant association with bone mass and could not be used as indicators for bone mineral density.