Angela Maggio da Fonseca

The effects of systemic hormonal replacement therapy on the skin of postmenopausal women

Objective: The aim of this study was to determine the effects of hormonal replacement therapy on the skin of postmenopausal women. Method: Forty‐one postmenopausal women were randomly allocated to receive either hormonal replacement (valerate estradiol — 2 mg/day for 21 days and cyproterone acetate — 1 mg/day for 10 days) or placebo, both in a cyclic scheme for 6 months. Neither patients nor investigators were aware of the group allocation. Histologic changes were evaluated by skin biopsy of the left upper arm at baseline and after 6 months of treatment, utilizing computerized image analysis to assess the ratio area of epidermis/basement membrane length (AE/BML), ratio area of keratin/basement membrane length (AK/BML) and collagen and elastic fibers content. Result: Collagen content of the left upper arm increased after 6 months of treatment only in the hormonal group (+6.49%; P<0.05). Other parameters did not present any significant alteration after treatment in both groups. Conclusion: Hormonal replacement for climacterics increases skin collagen content.

Differentiation between women with vulvovaginal symptoms who are positive or negative for Candida species by culture

Objective: To investigate whether clinical criteria could differentiate between women with vulvovaginitis who were culture positive or negative for vaginal Candida species. Methods: Vulvovaginal specimens were obtained from 501 women with a vaginal discharge and/or pruritis. Clinical information and wet mount microscopy findings were obtained. All specimens were sent to a central laboratory for species identification. Results: A positive culture for Candida species was obtained from 364 (72.7%) of the specimens. C. albicans was identified in 86.4% of the positive cultures, followed by C. glabrata in 4.5%, C. parapsilosis in 3.9%, C. tropicalis in 2.7% and other Candida species in 1.4%.Women with a positive Candida culture had an increased utilization of oral contraceptives (26.1% vs. 16.8%, p = 0.02) and antibiotics (8.2% vs. 0.7%, p = 0.001), and were more likely to be pregnant (9.1% vs. 3.6%, p = 0.04) than the culture-negative women. Dyspareunia was more frequent in women without Candida (38.0% vs. 28.3%, p = 0.03) while vaginal erythema (p = 0.01) was more common in women with a positive Candida culture. Conclusions: Although quantitative differences were observed, the presence of vaginal Candida vulvovaginitis cannot be definitively identified by clinical criteria.

The insulin-like growth factor-I system and hormone replacement therapy.

OBJECTIVE To determine the effects of hormone replacement therapy on plasma concentrations of free and total insulin-like growth factor (IGF)-I, IGF binding protein (BP)-1, and IGFBP-3. DESIGN Clinical study. SETTING Gynecologic clinic at a university hospital. PATIENT(S) Seventy-one postmenopausal women. INTERVENTION(S) Six cycles of four different hormonal replacement therapy regimens: oral conjugated estrogens, transdermal estradiol, oral conjugated estrogens and norethisterone, and transdermal estradiol and norethisterone acetate. MAIN OUTCOME MEASURE(S) Blood samples were collected before and after treatment for measurement of free and total IGF-I, IGFBP-1, and IGFBP-3. RESULT(S) Conjugated estrogen replacement therapy is associated with a decrease in plasma concentration of total IGF-I and increase in concentrations of free IGF-I and IGFBP-1. Transdermal estrogens have no effect on total and free IGF-I and IGFBP-1 concentrations. Oral norethisterone plus conjugated estrogens increased free IGF-I and IGFBP-1 concentrations but did not change IGF-I concentrations. Transdermal conjugated estrogens plus norethisterone acetate increased free IGF-I concentrations but not total IGF-I or IGFBP-1 concentrations. The plasma concentration of IGFBP-3 did not change in any group. CONCLUSION(S) Alterations in total IGF-I concentration can occur depending on the route of hormone replacement therapy administration. Free IGF-I concentrations were elevated in all study groups except that treated with transdermal estrogens.

A randomized, placebo-controlled trial of the effects of physical exercises and estrogen therapy on health-related quality of life in postmenopausal women

Objective:The purpose of this study was to evaluate the isolated and associated effects of estrogen therapy (estradiol valerate 1 mg/d orally) and physical exercise (moderate aerobic exercise, 3 h/wk) on health-related quality of life (HRQOL) and menopausal symptoms among women who had undergone hysterectomy. Design:A 6-month, randomized, double-blind, placebo-controlled clinical trial with 44 postmenopausal women who had undergone hysterectomy. The interventions were physical exercise and hormone therapy (n = 9), being sedentary and hormone therapy (n = 14), physical exercise and placebo (n = 11), and being sedentary and placebo (n = 10). HRQOL was assessed by a Brazilian standard version of the Medical Outcome Study Short-Form Health Survey and symptoms by Kupperman Index at baseline and after 6 months. Results:There was a decrease in symptoms in all groups, but only groups who performed physical exercise showed an increase in quality of life. Analysis of variance showed that changes in physical functioning (P = 0.001) and bodily pain (P = 0.012) scores over the 6-month period differed significantly between women who exercised and women who were sedentary, regardless of hormone therapy. Hormone therapy had no effect, and there was also no significant association between physical exercise and hormone therapy in HRQOL. Conclusions:Physical exercises can reduce menopausal symptoms and enhance HRQOL, independent of whether hormone therapy is taken.

Sexual behavior and knowledge of sexually transmitted infections among university students in Sao Paulo, Brazil

To investigate the sexual behavior and knowledge about sexually transmitted infections (STIs) among undergraduate students in Sao Paulo, Brazil.

Efeitos do Trifolium pratense nos sintomas climatéricos e sexuais na pós-menopausa

OBJECTIVE To evaluate the effects of treatment with Trifolium pratense on climacteric symptoms and sexual satisfaction in postmenopausal women. METHODS This is a prospective, randomized, double-blind, placebo-controlled study. Initially, 120 women aged 45-65 years with menopausal symptoms, more than 12-month amenorrhea and no treatment in the past six months were selected. The participants were then divided into two groups: TG – receiving 40 mg Trifolium pratense, 1 capsule/day; PG – receiving placebo capsules containing lactose (control), 1 capsule/day. The duration of treatment was 12 months. The patients underwent clinical and laboratory evaluation before treatment and at four, eight and 12 months of treatment. The Kupperman Menopausal Index and the Golombok Rust Inventory of Sexual Satisfaction (GRISS) were used. At the end of the study, each group comprised 50 patients. RESULTS According to the Kupperman Menopausal Index, there was significant improvement in menopausal symptoms after four months of treatment, especially in relation to hot flashes, when compared to baseline data in both groups. However, no significant differences were observed between groups. There was no improvement in sexual satisfaction after treatment. CONCLUSION A 12-month treatment with a daily dose of 40 mg Trifolium pratense did not yield a significant improvement in menopausal symptoms and sexual satisfaction.

Impact of age and body mass on the intensity of menopausal symptoms in 5968 Brazilian women

Objective: To assess the relationship of onset of menopause and body mass on the menopausal symptoms in post-menopausal Brazilian women. Design: Observational study conducted by the selection and inclusion of 5968 Brazilian women after menopause. The following variables were analyzed in this study: time at menopause; the relationship between age at menarche and age at menopause; vasomotor symptoms compared with age at the time of menopause and the time of menopause; Kupperman menopausal index (KMI) versus total time of menopause; body mass index (BMI) compared to the time of menopause, vasomotor symptoms, and KMI total score. We used the Chi-square test, and the significance level was set at 5%. Results: The age at natural menopause ranged from 41 to 62 years (mean 48.1 ± 4.07 years). A younger age at menopause was associated with a high intensity of vasomotor symptoms. These symptoms were more intense in the first 5 years of menopause and decreased with time. The KMI total also decreased with time after menopause, with the exception of arthralgia, myalgia, and insomnia, which did not tend to improve over time. In addition, the vasomotor symptoms and total KMI were more frequent with increasing BMI. Conclusions: Our results suggested that the age of menopause and BMI may influence the intensity of vasomotor symptoms.

Sexuality in healthy postmenopausal women

Objective: To assess the influence of psychosocial factors, behavior and hormones on postmenopausal sexuality. Methods: Nine hundred and ninety-nine women (age range 41-60 years) underwent physical and supplementary tests and answered questionnaires regarding sexual behavior. Sixty healthy women with 1 or more years of amenorrhea, without hormone replacement therapy and with a partner capable of intercourse were chosen from this group. Logistic regression models with dependent variables (sexual satisfaction and orgasmic capacity) and independent variables (sexual initiation, psychosocial factors, behavior, relationship, menopause and hormones) were developed. Results: Important variables for sexual satisfaction were: good self-esteem (p< 0.01), first orgasm obtained by masturbation (p = 0.004), major personal income (p = 0.007), sexual initiation in adulthood (p = 0.008), value physical contact with partner (p = 0.021) and major orgasmic capacity p = 0.040). The following contributed (towards orgasmic capacity with the partner: sexual initiation in adulthood (p = 0.012), regular physical activity (p = 0.040) and higher testosterone levels (p = 0.050). Conclusions: The importance of relationship, psychological, hormonal, economic and behavioral factors confirm the complexity of sexuality, and we note that current as well as prior events seem to affect the sexual satisfaction and orgasmic capacity of healthy postmenopausal women.

Morphologic hysteroscopic criteria suggestive of endometrial hyperplasia

Objectives: To evaluate the morphologic hysteroscopic criteria leading to a diagnosis of endometrial hyperplasia and compare their accuracy with that of histology. Methods: A total of 95 hysteroscopic examinations were evaluated. Of these, 37 had a histologic diagnosis of normal endometrium and the remaining 58 of simple or complex endometrial hyperplasia. We compared the morphologic hysteroscopic criteria for the two groups using Pearsons chi‐squared and Fishers exact test. Results: Only the presence of endometrial glands presenting a cystic pattern at hysteroscopy gave statistically significant results (P < 0.05), with low sensitivity (15.79%), high specificity (97.29%) and a relative risk of 6.75. With a prevalence of endometrial hyperplasia of 22.97% in a population of women with metrorrhagia, the positive predictive value was 63.53% and the negative predictive value was 79.40%. Conclusion: Additional, prospective studies are needed to determine the real value of the diagnostic morphologic parameters under consideration.

Metformin versus lifestyle changes in treating women with polycystic ovary syndrome

Objective: To compare the efficacy of metformin with that of lifestyle changes in patients with polycystic ovary syndrome (PCOS).Design: Prospective, randomized clinical trial of 40 women with PCOS to analyze the effects of metformin and lifestyle intervention treatments on menstrual pattern and hormone and metabolic profile. The duration of treatment was 6 months. Statistical analysis was done using Student’s t-test.Results: Fifteen women in the metformin group and 12 in the lifestyle changes group completed the study. The menstrual pattern improved by ~67% in both groups. There was a significant decrease in waist circumference in the lifestyle changes group (101.8 ± 3.9 and 95.1 ± 3.6, at baseline and at 6 months of treatment, respectively; p < 0.001) and in body mass index (BMI) in both groups. The predictor of menstrual pattern improvement was BMI.Conclusions: Both metformin and lifestyle changes may increase the number of menstrual cycles in PCOS. This effect was related to a decrease in BMI.