Lúcia Helena Simões da Costa Paiva

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.

Bone Density Among Long-Term Users of Medroxyprogesterone Acetate as a Contraceptive

The bone density (BD) of 72 women using depot-medroxyprogesterone acetate (DMPA) for at least 1 year was compared with that of 64 women who were not users of hormonal contraceptives. The BD of lumbar spine, femoral neck, Wards triangle, and trochanter was measured by dual energy X-ray absorptiometry (DEXA-LUNAR DPX). Estradiol (E2) concentrations were measured by radioimmunoassay (RIA). The mean age of DMPA users and nonusers was 31.8 and 31.1 years, respectively. Mean E, was 55.7 pg/mL for users and 149.9 pg/mL for controls (p < 0.001). The BD was significantly lower for DMPA users than for controls in all sites (p < 0.01). In addition, young adult T-scores in the lumbar spine were significantly lower among DMPA users than in controls (p < 0.01). Differences were maintained in a subsample of 47 women per group paired by age and body mass index (BMI). Multiple regression analysis showed that older age, lower BMI, and longer amenorrhea were associated with lower BD in the femoral neck, whereas lower BMI and use of DMPA were associated with lower BD in the lumbar spine.

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.

Use of misoprostol prior to hysteroscopy in postmenopausal women: a randomized, placebo-controlled clinical trial.

STUDY OBJECTIVE To compare results of diagnostic hysteroscopy in postmenopausal women using misoprostol for cervical ripening. DESIGN A randomized, placebo-controlled clinical trial (Canadian Task Force classification Ib). SETTING Hospital Barão de Lucena, Instituto Materno Infantil de Pernambuco. PATIENTS One hundred-twenty postmenopausal women. INTERVENTION Postmenopausal women received 200 microg of vaginal misoprostol or placebo before hysteroscopy. MEASUREMENTS AND MAIN RESULTS Variables measured were procedure time, frequency of hysteroscopy carried out in each group (misoprostol and placebo), degree of pain during procedure, need for dilation, side effects, and complications of hysteroscopy. The chi2, Fishers exact, and Mann-Whitney tests were used and considered significant when alpha error was <5%. There were similarities between the groups in age (p = .09), body mass index (p = .55), time since menopause (p = .52), and genital bleeding (p = .52). Pain during the procedure, as measured by visual analog scale, was less severe in the misoprostol group than in the placebo group (median of 05 vs 07, p = .02), but there were similarities in duration (2.4 min vs 2.0 min, p = .3), pain during procedure and biopsy (p = .74 vs p = .19), need for dilation (p = .66), side effects, and complications. There were no differences in severity of post-procedure pain. CONCLUSIONS Previous use of misoprostol reduced pain severity during hysteroscopy.

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.

The Prevalence of the Components of Low Sexual Function and Associated Factors in Middle‐Aged Women

INTRODUCTION Female sexual function depends on biological, psychological, and sociocultural contexts. AIM The objective of the present study was to evaluate the prevalence of low levels of functioning in each of the sexual function domains (desire, arousal, and orgasm) and the factors associated with these phenomena, as well as to assess the frequency of sexual activity in this same sample population. METHODS A cross-sectional, population-based study was conducted using an anonymous self-response questionnaire completed by 378 Brazilian-born women of 40-65 years of age with 11 years or more of formal education. The evaluation instrument was based on the Short Personal Experiences Questionnaire. RESULTS The prevalence of low sexual desire was 60.6%; low arousal, 37%; and low orgasmic function, 31.1%. Multiple regression analysis showed that having a sexual partner (prevalence ratio [PR] = 0.69, confidence interval [CI] = 0.53-0.90) and nervousness (PR = 1.33, CI = 1.01-1.75) were factors associated with low sexual desire. Aging (PR = 1.04, CI = 1.02-1.06), having a sexual partner (PR = 0.57, CI = 0.41-0.81), feeling well/excellent (PR = 0.59, CI = 0.41-0.85), and having hot flashes (PR = 1.47, CI = 1.01 = 2.15) were factors found to be associated with low sexual arousal. Having a sexual partner (PR = 0.55, CI = 0.42-0.71), feeling well/excellent (PR = 0.68, CI = 0.49-0.94), and having hot flashes (PR = 2.08, CI = 1.43 = 3.04) were factors found to be associated with low sexual orgasmic function. Having a sexual partner (PR = 0.47, CI = 0.38-0.58), feeling well/excellent (PR = 0.78, CI = 0.69-0.89), and having hot flashes (PR = 1.15, CI = 1.05-1.26) were factors found to be associated with a frequency of sexual activity of once a week or less. CONCLUSIONS In this sample of middle-aged women, low sexual desire was the most prevalent sexual problem. These results highlight the importance of identifying and treating factors associated with each individual component of low female sexual function.

Expression of hormone receptors, Bcl‑2, Cox‑2 and Ki67 in benign endometrial polyps and their association with obesity

The present study examined the immunoexpression of the estrogen receptor (ER), the progesterone receptor (PR), B‑cell lymphoma 2 (Bcl‑2), cyclooxygenase‑2 (Cox‑2) and Ki67 in endometrial polyps and their association with obesity. In total, 515 premenopausal and postmenopausal females undergoing hysteroscopy with histological diagnosis of benign polyps were included. The immunohistochemical expression of the ER, PR, Bcl‑2, Cox‑2 and Ki67 was compared between obese and non‑obese females. The median final score demonstrated a higher PR expression in the stromal and glandular compartments of postmenopausal obese females as compared with no‑obese females. However, in this group, there was no difference in regard to the ER. No difference in hormone receptor expression was identified among premenopausal females. In postmenopausal females, the immunoexpression of Cox‑2 and Bcl‑2 in the glandular epithelium was higher in obese than in non‑obese females. Among premenopausal females, obese females demonstrated a higher Bcl‑2 expression in the glandular epithelium than non‑obese females. There were no differences in Ki67 expression between obese and non‑obese females. Polyps from obese females had a higher PR expression in the glandular and stromal compartments. The expression of Cox‑2 and Bcl‑2 was higher in the glandular compartment. These data suggested that the etiology and pathogenesis of polyps in obese females appear to be associated with the PR, the inhibition of apoptosis and cellular mechanisms linked with inflammation.

Saúde da mulher na imprensa brasileira: análise da qualidade científica nas revistas semanais

Este estudo, de corte transversal, avalia a qualidade cientifica de textos informativos sobre saude da mulher em revistas de circulacao nacional e descreve os temas abordados. Durante 12 meses consecutivos, foram coletados textos sobre saude da mulher nas principais revistas semanais brasileiras de atualidades: Veja, Epoca e Isto E. Foram selecionados oitenta textos, analisados de forma independente por dois medicos e dois jornalistas, por meio do questionario Index Of Scientific Quality, adaptado para o portugues e submetido a prova-piloto e reteste. O instrumento possui oito itens que variam de um a cinco pontos e medem: a aplicabilidade, opiniao versus fato, validade, alcance, precisao, coerencia, consequencia e um item global, que resume os outros itens e cuja mediana foi considerada para avaliacao. A mediana da qualidade cientifica dos textos referente ao item global foi igual a tres, demonstrando carater moderado em relacao as materias publicadas.

Fatores Associados à Obesidade e ao Padrão Andróide de Distribuição da Gordura Corporal em Mulheres Climatéricas

Purpose: to describe sociodemographic characteristics of a group of climacteric women in order to discover the frequency and the variables associated with obesity and android profile of body fat distribution. Methods: an observational study was carried out in 518 patients aged 45 to 65 years, in a climacterium outpatient clinic. Age, color, menopausal status, duration of menopause, physical activity, smoking status, diet, alcohol intake, personal and family antecedents of arterial hypertension, diabetes mellitus, cardiovascular disease, dyslipidemia and obesity were considered. Body mass index and the waist/hip ratio were the dependent variables. For the statistical analysis Wilcoxon test, Pearsons correlation coefficient, with a 5% level of significance, and multivariate analysis using regression model were used. Results: more than two thirds of the participants were nonobese with an android profile and postmenopausal. One fourth had physical activity and were smokers; half reported an inadequate diet and one fifth were alcoholics. Patients with an android profile presented higher mean age than women with gynecoid pattern. Personal antecedents of obesity, arterial hypertension, diabetes and family history of diabetes were related to obesity and android pattern. Postmenopausal status was significantly associated with the android profile. Conclusions: the majority of the participants were nonobese with an android profile, white, postmenopausal, sedentary, neither smokers nor alcoholics. The main factors related to obesity and android pattern were personal antecedents of obesity, arterial hypertension, diabetes, family history of diabetes and particularly, postmenopausal status with android profile.

Fatores associados à densidade mamográfica de mulheres na pós-menopausa

OBJETIVO: avaliar a associacao de fatores epidemiologicos, antropometricos, reprodutivos e hormonais com a densidade mamografica de mulheres na pos-menopausa. METODOS: estudo retrospectivo, tipo corte transversal, incluindo 144 mulheres com idade igual ou superior a 45 anos, com no minimo 12 meses de amenorreia e nao usuarias de terapia de reposicao hormonal nos ultimos seis meses. Foram revisados os prontuarios medicos, avaliando-se: idade, peso, altura, indice de massa corporea (IMC), paridade, idade a menarca, idade a menopausa e os niveis dos hormonios estradiol, foliculo-estimulante (FSH) e luteinizante. As mamografias foram analisadas nas incidencias crânio-caudal e medio-lateral obliqua por dois examinadores, de forma cega, sendo classificadas em densas e nao densas, segundo os criterios de Wolfe. Na analise estatistica, utilizou-se a frequencia, mediana, valores minimo e maximo, teste de Wilcoxon e odds ratio. Foi realizada analise de regressao logistica multipla, utilizando o processo de selecao passo a passo, com nivel de significância de 5%. RESULTADOS: a frequencia de mamas densas foi de 45%. As mulheres com mamas consideradas densas apresentaram menor peso (60,5 vs 71,9 kg - p<0,01), menor IMC (25,9 vs 31,0 kg/m2 - p<0,01), menor tempo de pos-menopausa (6,0 vs 10,0 anos - p<0,01) e maiores niveis de FSH (75,2 vs 60,3 mU/mL - p<0,01). A probabilidade de apresentar mamas densas diminuiu em mulheres com peso superior a 67 kg (OR = 4,0; IC 95%: 1,50-10,66), IMC superior a 30 kg/m2 (OR = 6,69; IC 95%: 2,54-17,65), com mais de dois partos (OR = 7,84; IC 95%: 1,67-36,81), tempo de pos-menopausa maior ou igual a sete anos (OR = 2,05; IC 95%: 1,05-3,99) e niveis de FSH inferiores a 134,8 mU/mL. CONCLUSAO: o peso, IMC, paridade, o tempo de menopausa e niveis de FSH associaram-se significativamente aos padroes de densidade mamografica.