Sônia Maria Rolim Rosa Lima

Nerve fibers in uterosacral ligaments of women with deep infiltrating endometriosis.

UNLABELLED Endometriosis is a disease of high prevalence and enigmatic origin. One aspect not yet clarified is the relationship between endometriosis and nerve tissue. OBJECTIVE To evaluate, by immunohistochemistry, the presence of sympathetic and parasympathetic nerve fibers in the uterosacral ligament and adjacent connective tissue in women with deep pelvic endometriosis and women without endometriosis. DESIGN Cross-sectional study (Canadian Task Force II). SETTING University Hospital. Obstetrics and Gynecology Department, Santa Casa Medical School, São Paulo, Brazil. METHODOLOGY We selected 49 patients, 20 of them with deep endometriosis in the uterosacral ligament and 29 patients without endometriosis. Secondary antibodies to NSE (pan-neuronal marker), NPY (that identifies sympathetic nerve fibers), and VIP (that identifies parasympathetic nerve fibers) were used for the immunohistochemistry analyses. RESULTS The immunohistochemical staining by the NSE antibody was positive in 40% of cases of women with endometriosis and in 20.7% of patients without endometriosis (non-significant). The immunohistochemical staining by the NPY antibody was positive in 60% of patients with endometriosis and in 20.7% of the control group (p=0.005), while staining by the VIP antibody was 60% in patients with endometriosis and 13.8% in patients without endometriosis (p=0.001). CONCLUSION Immunoexpression of NPY (sympathetic fibers) and VIP (parasympathetic fibers) is higher in women with deep pelvic endometriosis than in women without endometriosis.

Effects of Trifolium pratense and Cimicifuga racemosa on the endometrium of Wistar rats.

OBJECTIVE The aim of this study was to evaluate the effects of Trifolium pratense and Cimicifuga racemosa upon the endometrium of castrated female Wistar rats, comparing these results with a placebo and estradiol valerate. METHODS Thirty-two adult castrated female Wistar rats were divided into four groups (eight rats per group) that receiving either tap water, estradiol valerate, isoflavones from T. pratense or deoxyactein from C. racemosa daily. The doses used were equivalent to normal doses used in humans. The results were analyzed by endometrial histology and the expression of alpha-estrogen receptor and protein Ki67. Both alpha-receptor and Ki67 expressions were determined by immunohistochemical and morphometric analysis. RESULTS Endometrium histology stayed atrophic with both herbal extracts, but T. pratense supplementation increased the expression of alpha-estrogen receptors when compared to the placebo group, without protein Ki67 expression enhancement. Both herbal extracts presented a lower Ki67 expression when compared to the placebo group. CONCLUSION T. pratense presented alpha-estrogen receptor stimulation in the endometrium without increasing cell proliferation. Both herbal extracts reduced endometrial proliferation in comparison to the placebo group.

Sexuality evaluation in women submitted to hysterectomy for the treatment of uterine leiomyoma.

PURPOSE To evaluate the impact of hysterectomy on the sexuality of women with uterine leiomyoma. METHODS Prospective study including 33 sexually active women, with ages from 35 to 50 years old, with orgasmic experience and with a fit stable partner. All the women were submitted to two instruments for the evaluation or their sexuality: Sexual Quotient - Female Version (SQF) and Sexual Satisfaction Inventory - Female Version (SSIF). Both instruments were applied by the same examiner, before and six months after the hysterectomy. RESULTS The SQF has shown that 39.4% of the patients presented deterioration in the sexual intercourse, even though there has not been found an association between the SQF results before and after hysterectomy (chi2= 0.6; degree of freedom=12; p=0.05). The mean scores obtained after the application of the SSIF have shown significant deterioration in the following parameters: sexual satisfaction (p=0.03); expression of feminine sensuality (p=0.01); vaginismus/dyspareunia (p=0.02) and an orgasmia (p=0.04). CONCLUSIONS It seems that hysterectomy has a negative impact on womens sexual life, with reports of decreased libido, arousal and orgasmic capacity.

Effects of Glycine max (L.) Merr. soy isoflavone vaginal gel on epithelium morphology and estrogen receptor expression in postmenopausal women: A 12-week, randomized, double-blind, placebo-controlled trial

OBJECTIVE Evaluate the effects of vaginal administration of isoflavones derived from Glycine max (L.) Merr. as a treatment option for vaginal atrophy, on the morphology and expression of estrogen receptors in vaginal epithelium of postmenopausal women. METHODS The double-blind, randomized, placebo-controlled, clinical trial. Sixty women were treated for 12 weeks with isoflavone vaginal gel 4% (1g/day) and a placebo gel. After 4 and 12 weeks, the vaginal atrophy symptoms were classified at none, mild, moderate and severe and the vaginal cytology were taken to determine the maturation value. Vaginal pH was measured at the beginning and end of therapy. Microbiopsies in vaginal fornix were performed before the treatment and after 12 weeks of treatment. RESULTS Isoflavone vaginal gel was effective for relief of vaginal dryness and dyspareunia symptons and an increase in the intermediate and superficial cells was noted. The vaginal pH in the isoflavone group was 7.1 at baseline and 5.4 after 12 weeks, whereas in the placebo group there was no significant change. A significant increase in thickness after treatment was detected in the Isoflavone Group. The percentage of estrogen receptor positive cells in vaginal epithelium for the Isoflavone Group ranged from 58.5% at the beginning of treatment to 82.6% after 12 weeks. These results were superior to placebo gel. CONCLUSION Glycine max (L.) Merr. at 4% vaginal gel on a daily basis in postmenopausal women led to improvements in vaginal atrophy symptoms, maturation values, vaginal pH, morphology and expression of estrogen receptors in vaginal epithelium. Isoflavones proved good treatment options for relief of vulvovaginal atrophy.

Assessment of the Effects of Tribulus Terrestris on Sexual Function of Menopausal Women

OBJECTIVE The aim of this study was to study the effects of Tribulus terrestris on sexual function in menopausal women. METHODS This was a prospective, randomized, double-blind, placebo-controlled clinical trial that included 60 postmenopausal women with sexual dysfunction. The women were divided into two groups, placebo group and Tribulus group, and evaluated by using the Sexual Quotient-female version (SQ-F) and Female Intervention Efficacy Index (FIEI) questionnaires. RESULTS There was no significant difference between the groups in age, age at menopause, civil status, race, and religion. In the evaluation with the SQ-F questionnaire, there were significant differences between the placebo (7.6 ± 3.2) and Tribulus (10.2 ± 3.2) groups in the domains of desire and sexual interest (p ≤ 0.001), foreplay (3.3 ± 1.5 versus 4.2 ± 1.0) (p ≤ 0.01), arousal and harmonious interaction with the partner (5.7 ± 2.1 versus 7.2 ± 2.6) (p ≤ 0.01), and comfort in sexual intercourse (6.5 ± 2.4 versus 8.0 ± 1.9) (p ≤ 0.01). There was no significant difference between the placebo and Tribulus groups in the domains of orgasm and sexual satisfaction (p = 0.28). In the FIEI questionnaire, there was a significant improvement (p < 0.001) in the domains of vaginal lubrication during coitus and/or foreplay (20 versus 83.3%), sensation in the genitalia during sexual intercourse or other stimuli (16.7 versus 76.7%), sensation in the genital region (20 versus 70%), sexual intercourse and/or other sexual stimulations (13.3 versus 43.3%), and the ability to reach orgasm (20% versus 73.3%). There was no significant difference in adverse effects between the two groups. CONCLUSIONS After 90 days of treatment, at the doses used, we found Tribulus terrestris to be effective in treating sexual problems among menopausal women.

Avaliação da função sexual em mulheres após a menopausa portadoras de síndrome metabólica

PURPOSE To evaluate sexual function in postmenopausal women diagnosed with metabolic syndrome. METHODS Case-control study with 195 postmenopausal women (amenorrhea ≥1 year, FSH≥30 mIU/mL, aged 43 to 69 years) seen at the Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa de São Paulo and in the Basic Units of the Family Health Program of São Paulo. Clinical data were collected, and body mass index and waist circumference were evaluated. Total cholesterol, HDL and LDL cholesterols, triglycerides, and fasting glucose were determined for biochemical analysis. We considered women to have the metabolic syndrome when they met three or more diagnostic criteria: waist circumference>88 cm and triglycerides ≥150 mg/dL; cholesterol HDL <50 mg/dL; blood pressure ≥130/85 mmHg, and fasting glucose ≥110 mg/dL. The participants were divided into Control Group (n=87) and Metabolic Syndrome Group (n=108). The Female Sexual Function Index (FSFI) was employed to assess the sexual function. RESULTS Mean age was 54.0 ± 4.7 years. The rate of sexual dysfunction was significantly higher in women with the metabolic syndrome than in the Control Group, both when considering FSFI <26.5 (90/108 [83.3%] versus 42/87 [48.2%], p<0.0001) and FSFI <23 (62/108 [57.4%] versus 16/87 [18.39%], p<0.001). The domains desire, arousal, lubrication, orgasm (p<0.001), and satisfaction (p=0.002) had lower scores in women with the metabolic syndrome. For the pain scores, there was no significant difference (p=0.57) between groups. All components of the metabolic syndrome diagnosis were associated with higher levels of sexual dysfunction (p<0.001). CONCLUSION Postmenopausal women with metabolic syndrome present more frequently sexual dysfunction than those of the same age who do not have it.

Avaliação histológica de pólipos endometriais em mulheres após a menopausa e correlação com o risco de malignização

OBJETIVOS: caracterizar histologicamente polipos endometriais em mulheres apos a menopausa e avaliar o risco de lesoes hiperplasicas e neoplasicas neles contidos. METODOS: analise retrospectiva de 82 casos de mulheres portadoras de histopatologia confirmatoria de polipo endometrial, submetidas a polipectomia histeroscopica devido ao diagnostico de espessamento endometrial a ultra-sonografia transvaginal. Todos os prontuarios pertinentes foram revisados para obtencao da historia clinica, antecedentes, dados referentes ao exame histeroscopico e resultado final da histopatologia. RESULTADOS: das 82 mulheres avaliadas, 10,9% faziam uso de algum tipo de terapia hormonal e 28 (34,1%) queixavam-se de sangramento por via vaginal. Polipo solitario foi encontrado em 56 mulheres (68,3%), em 19 casos (23,2%) foram encontrados dois polipos e em 7 casos (3,6%), tres ou mais polipos. A avaliacao histologica definitiva evidenciou polipo benigno em 63 mulheres (76,8%), polipos com hiperplasia em 17 casos (20,8%), sendo dez com hiperplasia simples sem atipias (12,2%) e sete com hiperplasia complexa sem atipias (8,6%). Em dois polipos foi encontrada neoplasia associada (2,4%). Para a analise estatistica foi empregado o teste do c2, corrigido por Yates. Correlacionou-se a histologia dos polipos com a presenca ou nao de sangramento genital (p=0,0056), o numero de polipos encontrados por mulher (p=0,921), e o tempo decorrido apos a menopausa (p=0,720). CONCLUSOES: polipos endometriais sao entidades frequentemente encontradas apos a menopausa, associando-se com baixa frequencia a hiperplasias e carcinomas endometriais e apenas o estudo histologico de todo especime nos permite afastar malignidade.

Freqüência de Adenocarcinoma de Endométrio em Ambulatório de Histeroscopia: Um Estudo Multicêntrico

Purpose: to perform a census about the frequency of endometrial adenocarcinoma of women submitted to diagnostic hysteroscopy in five Brazilian hysteroscopic centers in Sao Paulo, Rio de Janeiro, Salvador, Caxias do Sul and Porto Alegre. Methods: information was collected from standard questionnaires about the presence of endometrial adenocarcinoma, hysteroscopic staging and histologic type, in pre- and postmenopausal women. Results: among 6,466 hysteroscopic procedures, endometrial adenocarcinoma was present in 92 patients (1.4%), confirmed by histology in 79 (1.2%) cases. For the hysteroscopic diagnosis of endometrial adenocarcinoma confirmed by histology, a sensitivity of 85.9%, specificity of 100%, positive predictive value of 100% and negative predictive value of 98.6% were obtained. In the premenopausal group, among 3,845 hysteroscopic exams, endometrial cancer was present in 83 (3.2%) and confirmed by histology in 71 cases (2.7%). Conclusions: this study points out the importance of epidemiological methods in the diagnostic and prevention programs of endometrial cancer, specially in postmenopause, revealing the need for further epidemiological studies on endometrial adenocarcinoma diagnostis and prevention programs.

Effects of low dose of tibolone on steroid receptors and Bcl-2 on the postmenopausal endometrium.

OBJECTIVE A prospective randomized controlled trial was conducted to evaluate the effect of low dose of tibolone on the histology, expression of estrogen (ER) and progesterone receptors (PR) and Bcl-2 protein, in endometrium of postmenopausal women. METHOD Forty postmenopausal women consented to treatment and were allocated into two groups of 20 women: Group 1 (Control) without hormone replacement therapy (HRT); Group 2 (Tibolone) treatment at the dose of 1.25 mg/day of oral tibolone administered for a 24-week period. The effect on the endometrium was assessed by histology and the apoptosis marker Bcl-2. The immunoexpression of ER and PR were also measured. RESULTS Tibolone group showed higher expression of ER, PR and Bcl-2 protein in glandular epithelium and stroma compared to control group. CONCLUSION Tibolone in a daily dose of 1.25 mg during 24 weeks demonstrated endometrial action that resulted in low proliferation and was shown to lead to atrophic endometrium. It had favorable effects on the postmenopausal endometrium due to its higher immunoexpression of PR and Bcl-2 protein in endometrial glandular epithelium, thereby creating a balance between pro-apoptotic and anti-apoptotic actions.

Effects of drospirenone/estradiol on steroid receptors and Bcl-2 in the postmenopausal endometrium

ABSTRACT Objective To evaluate the effect of drospirenone with 17b-estradiol on the histology and expression of estrogen and progesterone receptors and of Bcl-2 protein, in endometrium of postmenopausal women. Method Forty postmenopausal women, including controls, participated in this study evaluating oral hormone replacement treatment combining 2 mg/day of drospirenone with 1 mg/day of 17b-estradiol administered for a 24-week period. The effect on the endometrium was assessed by histology and the apoptosis marker Bcl-2. The immunoexpression of estrogen (ER) and progesterone (PR) receptors in the endometrium was also measured. Results No increase in endometrial thickness was evident after either treatment, although endometrial histology was atrophic in most biopsies. The drospirenone/estradiol group showed higher expression of ER and PR in glandular epithelium compared to stroma, but the Bcl-2 protein was more immunoreactive in stroma than in glandular epithelium. Compared to controls, drospirenone/estradiol users showed higher immunoexpression of ER, PR and Bcl-2 in both glandular epithelium and endometrial stroma. Conclusion A 24-week course of drospirenone with 17b-estradiol resulted in low proliferation and was shown to lead to atrophic endometrium. The novel progestogen drospirenone seems to have favorable effects on the endometrium of postmenopausal women due to its pro-apoptotic action in glandular epithelium.