Genitourinary symptoms and sexual function in women with primary ovarian insufficiency

OBJECTIVE

There are limited studies on urogenital symptoms in women who experience menopause before the age of 40 years due to primary ovarian insufficiency (POI) or bilateral oophorectomy (surgical POI). This study aimed to compare the urogenital symptoms, including sexuality, of women with POI to those without the condition.

METHODS

This cross-sectional study conducted was in seven Latin American countries, in which postmenopausal women (with POI and non-POI) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS) and the six-item Female Sexual Function Index (FSFI-6). The association of premature menopause with more urogenital symptoms and lower sexual function was evaluated with logistic regression analysis.

RESULTS

Women with POI experience more urogenital symptoms (MRS urogenital score: 3.54 ± 3.16 vs. 3.15 ± 2.89, p < 0.05) and have lower sexual function (total FSFI-6 score: 13.71 ± 7.55 vs. 14.77 ± 7.57 p < 0.05) than women who experience menopause at a normal age range. There were no significant differences in symptoms when comparing women based on the type of POI (idiopathic or surgical). After adjusting for covariates, our logistic regression model determined that POI is associated with more urogenital symptoms (odds ratio [OR]: 1.38, 95% confidence interval [CI] 1.06-1.80) and lower sexual function (OR: 1.67, 95% CI 1.25-2.25).

CONCLUSION

POI, whether idiopathic or secondary to bilateral oophorectomy, is associated with symptoms that affect vaginal and sexual health.

Association of bilateral oophorectomy and menopause hormone therapy with mild cognitive impairment: the REDLINC X study

BACKGROUND

Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women.

OBJECTIVE

This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI).

METHOD

The case-control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA).

RESULTS

Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m², respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20-0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10-0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20-2.38), parity (having >2 children; OR 1.69; 95% CI 1.21-2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09-2.24), hypertension (OR 1.41; 95% CI 1.01-1.96), being sexually active (OR 0.56; 95% CI 0.40-0.79), education >12 years (OR 0.46; 95% CI 0.32-0.65) and MHT use (OR 0.31; 95% CI 0.21-0.46).

CONCLUSION

Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.

Gender differences in the prevalence of vitamin D deficiency in a southern Latin American country: a pilot study

Aim: This study aimed to study the prevalence of vitamin D deficiency, assessing the influence of sex, age, and season of the year.Methods: A cross-sectional study was conducted with 1329 healthy subjects (668 women and 661 men) aged 18-89 years in Santiago, Chile. Age (years), body mass index, medical history, working status, sex, and date of blood sample were collected.Results: Men were slightly older than women (53.1 ± 18.2 vs. 50.0 ± 15.6 years; p < 0.01) and a higher percentage worked outside the home (73.1% vs. 51.9%, p < 0.001). The mean serum concentration of 25-hydroxyvitamin D (25(OH)-D) was 23.3 ± 9.3 ng/ml in women and 20.9 ± 9.5 ng/ml in men (p < 0.001). The levels of 25(OH)-D by season were 26.7 ± 9.0, 23.6 ± 9.7, 19.4 ± 8.5, and 19.1 ± 9.5 ng/ml (for summer, fall, winter, and spring, respectively; p < 0.05). The prevalence of vitamin D deficiency increases with age, rising from 36.5% under 40 years to 48.0% over 60 years (p < 0.004). Male sex, winter and spring, and age showed negative correlation with levels of 25(OH)-D (p < 0.05). Multivariate linear regression showed a final model that incorporates: age (coefficient: -0.06; 95% confidence interval [CI]: -0.09 to -0.03; p < 0.001), male sex (coefficient: -2.00; 95% CI: -2.96 to -1.05; p < 0.001), summer (coefficient: 7.30; 95% CI: 6.17 to 8.43; p < 0.001), and fall (coefficient: 4.27; 95% CI: 3.04 to 5.50; p < 0.001).Conclusions: Vitamin D deficiency is more prevalent in men than in women, in the elderly, and during the winter and spring seasons.

Menopausal symptoms are associated with non-adherence to highly active antiretroviral therapy in human immunodeficiency virus-infected middle-aged women

Objective: This study aimed to evaluate the association between the intensity of menopausal symptoms and highly active antiretroviral therapy (HAART) adherence in middle-aged women with human immunodeficiency virus (HIV) infection.Methods: In this cross-sectional study, 313 Peruvian women with HIV infection (age 40-59 years) were surveyed and classified as adherent or non-adherent to HAART based on the Antiretroviral Treatment Adherence Evaluation Questionnaire. The intensity of menopausal symptoms was assessed with the Menopause Rating Scale, and categorized as none, mild, moderate, and/or severe. Age, sexual orientation, used HAART scheme, time since HIV diagnosis, menopausal status, risk of depression, and presence of comorbidities were also assessed. Poisson generalized linear models with robust variance were performed in order to estimate crude prevalence ratios (PRs) and adjusted PRs using statistical (a₁PR) and epidemiological criteria (a₂PR).Results: A total of 19.9%, 32.6%, and 15.0% of all women presented mild, moderate, and severe menopausal symptoms, respectively. Overall, 70.6% women were non-adherent to HAART. The probability of non-adherence was higher in women with mild, moderate, and severe symptoms as compared to asymptomatic women in the non-adjusted model (PR: 1.79, 95% confidence interval [CI]: 1.39-2.29; PR: 1.76, 95% CI: 1.38-2.23; and PR: 2.07, 95% CI: 1.64-2.61, respectively) and the adjusted model.Conclusion: The severity of menopausal symptoms was associated with HAART non-adherence in HIV-infected middle-aged women.

Association between high levels of gynoid fat and the increase of bone mineral density in women

Introduction: In women, bone mineral density (BMD) is related to age, estrogenic action, and appendicular skeletal muscle mass (ASMM). The gynoid fat distribution is linked to estrogenic action.Objective: This study aimed to assess whether an increase of gynoid fat is associated with high BMD independent of age and ASMM.Methods: An observational study was performed in women aged between 20 and 79 years. Fat mass, ASMM, and BMD were measured with dual-energy X-ray absorptiometry. The binned scatterplots and multivariate linear regression models were used to study the relationship between hip BMD and age, height, android fat, gynoid fat, and ASMM.Results: Of 673 women invited, 596 accepted to participate. Their mean age was 55.4 ± 12.8 years, weight 63.4 ± 9.4 kg, height 1.61 ± 0.06 m, body mass index 24.54 ± 3.59 kg/m², average hip BMD 0.914 ± 0.122 g/cm², android fat 2.12 ± 0.83 kg, gynoid fat 4.54 ± 1.07 kg, and ASMM 15.15 ± 1.97 kg. The final regression model included age (linear coefficient -0.004; 95% confidence interval [CI]: -0.005 to -0.003; p < 0.001), ASMM (linear coefficient 0.013; 95% CI: 0.009 to 0.018; p < 0.001), and gynoid fat (linear coefficient 0.013; 95% CI: 0.005 to 0.022; p < 0.002).Conclusion: Gynoid fat is associated with BMD in the hip independently of age and ASMM.

Muscle health in Hispanic women. REDLINC VIII

Objectives: This study aimed to evaluate muscle strength and related factors in Hispanic women.Methods: We studied 593 women between 40 and 89 years old. The women were asked about personal and clinical information. The following instruments were applied: dynamometer (strength), Short Physical Performance Battery (physical performance), SARC-F (sarcopenia), International Physical Activity Questionnaire (physical activity), Menopause Rating Scale (quality of life), 36-item Short Form (general health), and Frailty (Fried's criteria).Results: Low muscle strength rises from 7.1% of women in their 40s to 79.4% in their 80s. Physical performance is low in 0.5% of the first group and rises to 60.5% in the second. The risk of sarcopenia increases significantly from 6.7% in younger women to 58.1% in older women. Frailty, which affects less than 1% of women under age 60 years, increases to 39.5% in their 80s. Sedentary lifestyle rises from 26% to 68.3%. Fragility impairs the quality of life and the perception of health (p < 0.0001). The deterioration of different tests of muscle function is significantly associated with age >70 years (OR 5-20) and with osteoarthritis (OR 4-9). Menopause before the age of 45 years increases the risk of sarcopenia (odds ratio 2.2; 95% confidence interval 1.2-4.0).Conclusion: With aging there is a decrease in muscle strength and an increase in frailty. This entails a decrease in the quality of life.

Menopause research in Latin America

For 15 years, the Collaborative Group for Research of the Climacteric in Latin America (REDLINC) has been conducting research on several topics including age of menopause, metabolic syndrome, quality of life and climacteric symptoms, sexual dysfunction, poor quality of sleep and insomnia, and use of menopausal hormone therapy (MHT) in the general population and among gynecologists. Examples of data to have emerged for this region include the age of menopause (49 years), a high prevalence of metabolic syndrome (42.9%), and a new waist circumference cut-off value for the Latin American population (88 cm). Sexual dysfunction, poor quality of life, and sleep disorders have a prevalence of over 50%, with obesity and sedentary lifestyles affected importantly. MHT use is still low (12.5%), lack of prescription the most important reason for not using it, and gynecologists use MHT for themselves but do not recommend it often to their patients. The prevalence of alternative therapy use, recommended by physicians, is high.

Risk factors of long-term mortality in middle-aged women: a 27-year follow-up cohort

OBJECTIVE

This study aimed to evaluate the impact of different risk factors on long-term mortality in middle-aged women.

METHODS

Women who received preventive health care control between 1990 and 1993 were recruited. Anamnesis and physical examination were recorded. Blood samples for the measurement of glycemia and lipids were taken. Data are reported as of December 2017.

RESULTS

We studied 1197 women aged between 40 and 60 years. We observed 183 deaths (survival 84.0%; 95% confidence interval [CI], 81.7-86.1, Kaplan-Meier survival analysis). The main causes of death were cancer (39.9%; 95% CI, 32.7-47.1), cardiovascular disease (22.9%; 95% CI, 16.8-29.1), infectious disease (13.7%; 95% CI, 8.6-18.7), other causes (7.1%, 95% CI, 3.4-10.9), and unspecified cause (6.6%; 95% CI, 2.9-10.2). The final Cox regression model showed the following hazard ratios for mortality: diabetes mellitus 2.51 (95% CI, 1.40-4.51), history of fracture 2.47 (95% CI, 1.15-5.30), history of heart illness 2.06 (95% CI, 1.15-3.72), arterial hypertension 1.51 (95% CI, 1.08-2.11), age 1.07 (95% CI, 1.04-1.10), body mass index 1.06 (95% CI, 1.02-1.09), and sexual intercourse 0.94 (95% CI, 0.89-0.98). Lipid disorders did not reach statistical significance as a risk factor.

CONCLUSION

Diabetes, a history of fractures, and cardiovascular risk factors, except lipids, are markers of long-term mortality in middle-aged women. Physicians should pay special attention to these risk factors.

A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI)

BACKGROUND

Menopausal hormone therapy (HT) has shown benefits for women; however, associated drawbacks (i.e. risks, costs, fears) have currently determined its low use.

OBJECTIVE

To determine the prevalence of current HT use among mid-aged women and describe the characteristics of those who have never used, have abandoned or are currently using HT. In addition, reasons for not using HT were analyzed.

METHOD

This was a cross-sectional study that analyzed a total of 6731 otherwise healthy women (45-59 years old) of 15 cities in 11 Latin American countries. Participants were requested to fill out the Menopause Rating Scale (MRS) and a questionnaire containing sociodemographic data and items regarding the menopause and HT use.

RESULTS

The prevalence of current HT use was 12.5%. Oral HT (43.7%) was the most frequently used type of HT, followed by transdermal types (17.7%). The main factors related to the current use of HT included: positive perceptions regarding HT (odds ratio (OR) 11.53, 95% confidence interval (CI) 9.41-14.13), being postmenopausal (OR 3.47, 95% CI 2.75-4.36) and having a better socioeconomic level. A total of 48.8% of surveyed women had used HT in the past, but abandoned it due to symptom improvement or being unconcerned; fear of cancer or any other secondary effects were also reported but in less than 10%. Among women who had never used HT, 28% reported the lack of medical prescription as the main reason, followed by the absence of symptoms (27.8%). Among those reporting lack of prescription as the main reason for not using HT, 30.6% currently had severe menopausal symptoms (total MRS score > 16); 19.5% of women were using alternative 'natural' therapies, with 35.1% of them displaying severe menopausal symptoms as compared to a 22.5% observed among current HT users.

CONCLUSION

The use of HT has not regained the rates observed a decade ago. Positive perceptions regarding HT were related to a higher use. Lack of medical prescription was the main reason for not using HT among non-users, many of whom were currently displaying severe menopausal symptoms.

The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III): prevalence of the metabolic syndrome in postmenopausal Latin American women

BACKGROUND

Metabolic syndrome (METS) is a strong predictor of cardiovascular risk. Since the prevalence of METS increases after menopause, gynecological routine consultation offers an excellent screening opportunity.

OBJECTIVES

To assess the prevalence of METS in Latin American postmenopausal women and factors modifying its risk; as well as to assess the role of simple routine care measurements in the diagnosis of the METS.

METHODS

A total of 3965 postmenopausal women, aged 45-64 years, seeking health care at 12 gynecological centers in major Latin American cities were included in this cross-sectional study. The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) guidelines were applied to assess METS. This was present if three or more of the following conditions were present: waist circumference > or = 88 cm; blood pressure > or = 130/85 mmHg; fasting plasma triglycerides > or = 150 mg/dl; high density lipoprotein (HDL) cholesterol < 50 mg/dl; glucose > or = 110 mg/dl or subjects were receiving treatment for their condition.

RESULTS

The prevalences of having at least two, three, four or five components were 62.5, 35.1, 13.5 and 3.2%, respectively. The prevalence increased from 28.1% in those aged 40-44 years to 42.9% in those aged 60-64 years. The risk of METS detection (multivariate analysis) increased with age (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.03-1.43), time elapsed since menopause (OR 1.18, 95% CI 1.00-1.38), smoking cigarettes (OR 1.40, 95% CI 1.19-1.65), obesity (OR 13.01, 95% CI 10.93-15.49) and hypertension (OR 9.30, 95% CI 7.91-10.94). In contrast, hormone therapy reduces this risk (OR 0.59, 95% CI 0.51-0.70).

CONCLUSION

There is a high prevalence of the metabolic syndrome in postmenopausal Latin American women seeking gynecologic health care. Age, years since menopause, obesity and hypertension are strong predictors of this condition.

Effect of androgens combined with hormone therapy on quality of life in post-menopausal women with sexual dysfunction

AIM

To evaluate with validated instruments changes in quality of life and sexuality in women receiving hormonal replacement therapy (AHT).

DESIGN

Randomised, double-blind, double-dummy study with two parallel treatment arms.

PATIENTS AND METHODS

Forty-seven healthy post-menopausal women, aged 45-64 years, were evaluated using the Female Sexual Function Index (FSFI) and the menopause-specific quality of life questionnaire (MENQOL). Of them, 40 diagnosed with sexual dysfunction were randomised (1:1) to receive daily 0.625 mg of conjugated estrogens plus 1.25 mg of methyl-testosterone and 100 mg of micronised progesterone or placebo. After 3 months follow-up, FSFI and MENQOL questionnaires were administered for a second time.

RESULTS

Quality of life was unchanged in the placebo group whereas AHT significantly improved scores of vasomotor, psychological, physical and sexual symptoms. As expected, FSFI was not modified in the placebo group while in AHT group the FSFI score improved significantly. In addition, at the end of the study, 68.7% of subjects of the AHT group did not fit did not fit the criteria for sexual dysfunction as per the FSFI (p < 0.0001).

CONCLUSIONS

Adding methyl-testosterone to hormone therapy improves quality of life and sexuality in post-menopausal women with sexual dysfunction.

Raloxifene inhibits cholesterol aortic content but not atherosclerotic plaque size in oophorectomised cholesterol-fed rabbits

Raloxifene, a selective oestrogen receptor modulator, is effective in the treatment of osteoporosis without stimulating the breast and the endometrium. Although it is associated with a decrease of cardiovascular risk markers the effect of these changes on atherogenesis, is not clear. In this study, we aimed to investigate the effect of raloxifene on aorta atherogenesis. A total of 32 cholesterol-fed New Zealand white rabbits were studied for 4 months. Twenty-four rabbits underwent bilateral ovariectomy; of these eight received raloxifene (group OR), eight received oestradiol valerate (group OE) and eight received placebo after sterilisation (group OP). Finally, another eight were sham-operated (non-ovariectomised) and received placebo with a hypercholesterolaemic diet (group SP). After the diet, total levels of cholesterol increased in group SP from 111.25 +/- 34.8 mg/dl to 1112.25 +/- 364.2, in group OP from 122.62 +/- 27.7 mg/dl to 1367.37 +/- 348.4, in group OE from 65.25 +/- 17.01 to 1710.5 +/- 356.2 and in group OR from 108.88 +/- 15.54 mg/dl to 1407.86 +/- 397.7 (no significant differences). At 4 months, in both treated and untreated rabbits, the cholesterol-rich diet caused atherosclerotic lesions affecting 24.51 +/- 16.1% for group SP, 30.47 +/- 12.2% for group OP, 30.31 +/- 18.07% for group OR and 17.91 +/- 10.19 for group OE (P<0.05) of the aortic surface, respectively. Aortic cholesterol expressed as mg of cholesterol/mg aortic weight was found to decrease in raloxifene-treated rabbits: 3.82 +/- 2.14 mg col/aortic mg versus 8.55 +/- 4.63 (group OP) and 11.97 +/- 11.33 (group SP). P<0.001. Raloxifene reduced aortic cholesterol content but not the atherosclerotic plaque extension in cholesterol-fed ovariectomised rabbits.

Age, menopause and hormone replacement therapy influences on cardiovascular risk factors in a cohort of middle-aged Chilean women

OBJECTIVE

To determine the prevalence of obesity and other cardiovascular risk factors (RF) in middle-aged women, to correlate them with each other, and to describe the prevalence of such a RF and their changes with aging, menopause and Hormone Replacement Therapy (HRT) in a cohort of Chilean workers.

MATERIAL AND METHOD

In 1991-1992 cardiovascular RFs were assessed in 467 women between 40 and 59 who were not taking HRT at that time. Five years later these women were re-evaluated.

RESULTS

Sedentarism (87.2%), dyslipidemias (71.5%), high blood pressure (13.5%), obesity (13.1%), smoking (12.4%) and diabetes (2.8%) were the more prevalent RF. These RF become more prevalent with age. In the second control, 5 years later, hypertension (20.9%), obesity (27.3%), smoking (20.8%) and diabetes (5.9%) were observed increased. Dyslipidemia did not changed, although triglyceride levels rose from 125.9+/-56.4 to 136.8+/-63.5 mg/dl (P<0.01). Sedentarism dropped to 58.8%. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5-years follow-up from 3.8 to 35%, and related to its use a decrease in LDL-cholesterol and an increase in HDL-cholesterol levels were detected.

CONCLUSION

Middle-aged women included in this cohort have a high prevalence of RF; these deteriorate with age, but no with menopause. HRT improves the lipid profile.

Alendronate daily, weekly in conventional tablets and weekly in enteric tablets: preliminary study on the effects in bone turnover markers and incidence of side effects

Bisphosphonates are now in the vanguard of osteoporosis treatment. Frequently, gastro-oesophageal symptoms are associated with these drugs. The objective of this study was to compare side effects and bone turnover markers in postmenopausal women who had received alendronate daily or weekly in tablets with or without enteric coating. We conducted a randomised, double-blind, 3-month trial. The trial involved 75 volunteers, aged 45-58 with moderate to severe osteopenia (T-score lower than -2 SD) assessed by quantitative ultrasound. Women were assigned randomly to receive: (a) alendronate 10mg/day: (b) alendronate 70 mg once a week: or (c) enteric alendronate 70 mg per week. We recorded side effects, C-telopeptide, osteocalcin and urine hydroxyproline at the start of the study and at 3 months. After 3 months, pyrosis (heartburn) was noted by seven women in group A (28%), three in group B (12%) and two in group C (8%); nausea: by one woman in group B; and headache by one patient in each group. C-telopeptide (A: 40.7%; B: 34.1% and C: 38.5%); hydroxyproline (A: 31.1%;B: 25.3% and C: 31.5%) and osteocalcin (A: 27.0%; B: 25.4% and C: 25.1%) decreased similarly in the three groups. Weekly intake of alendronate, whether conventional or enteric-coated; is associated with less heartburn and nausea. Enteric alendronate has a similar action to the conventional tablets on biochemical markers.

Effects of transdermal estrogens on endothelial function in postmenopausal women with coronary disease

OBJECTIVE

Oral estrogens improve endothelial function, and for this reason may be considered cardioprotective; however, in women with coronary heart disease there may also be an increase in the risk of thrombosis. Although transdermal estrogen administration may decrease this adverse effect, there are few data on endothelial function in women with coronary heart disease treated using such therapy. This study aimed to report the endothelial response in postmenopausal women with coronary heart disease treated with transdermal estrogen.

MATERIALS AND METHODS

This was a double-blind, prospective, randomized study. Eighteen patients with a history of acute coronary syndrome and nine healthy women were studied over 4 weeks. Coronary patients were assigned at random to receive a patch containing either 50 microg estradiol or placebo on a weekly basis. Endothelial function was assessed by flow-mediated vasodilatation of the brachial artery. Baseline blood flow (brachial artery diameter) was measured after 30 min rest and following ischemia, prior to treatment and after 4 weeks.

RESULTS

Flow-mediated vasodilatation in normal patients was 17.8%, whereas in women with coronary disease it was 1.2% (p = 0.0001). Arterial diameter for the resting period in coronary disease subjects increased from 4.22 +/- 0.59 to 4.41 +/- 0.56 mm (p < 0.004) after 4 weeks of estrogen therapy, whereas, in women receiving placebo, it did not change. Flow-mediated vasodilatation in the estrogen group was 3.4% and in the placebo group was 0.5% (p = 0.05).

CONCLUSIONS

Transdermal estrogen may improve endothelial function in women with coronary heart disease.

A simplified method to quantitate atherosclerosis in the rabbit aorta

A simple method to quantitatively evaluate atherosclerosis in the rabbit aorta by measuring macroscopic lesion areas (%) was attempted in the present study. Ten female New Zealand white rabbits were fed on a cholesterol-rich diet (5/1000 g of food) during 4 months. Five of them were oophorectomized at the beginning and all were sacrificed at the end. Total levels of cholesterol increased from 50.7+/-14.7 mg/dl to 782.8+/-296.0. No significant differences were observed between oophorectomized and intact rabbits. At 4 months, the cholesterol-rich diet caused in both, intact and oophorectomized rabbits, atherosclerotic lesions affecting 17 and 46% of the aortic surface, respectively. This method may be more practical, easy and useful for quantitative evaluation of aortic atherosclerosis in a large number of rabbits, than histological observations of serial sections of rabbit's aortas.

[Cardiovascular risk factors in middle-age women with acute coronary syndromes]

BACKGROUND

In Chile, 40% 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% of patients and healthy controls respectively. Seventy seven percent of patients and 36% of controls smoked, 76% of patients and 48% of controls were postmenopausal, 21% of patients an 5% of controls were diabetic. In patients and controls respectively serum total cholesterol was 230.1 +/- 36.2 and 211.2 +/- 34.8 mg/dl, serum triacylglycerol was 213.4 +/- 109.4 and 143.2 +/- 76.9 mg/dl and serum HDL cholesterol was 44.1 +/- 10.8 and 49.8 +/- 13.3 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.

Changes in body mass index around menopause: a population study of Chilean woman

OBJECTIVE

To evaluate the influence of menopause and hormone replacement therapy (HRT) on weight and the effect of weight gain on coronary risk factors.

DESIGN

From 1991 to 1992 cardiovascular risk factors were assessed in 271 premenopausal women between the ages of 40 and 53 years. The women were not receiving HRT at that time. Five years later, these women were reevaluated.

RESULTS

Weight and body mass index (BMI) increased steadily with age. During the observation period there was an average increase of 4.0 kg +/- 4.6 (p < 0.0001). Women who experienced menopause and those who did not experience menopause had a similar weight increase (3.8 +/- 4.4 kg vs. 4.3 +/- 4.8, p = 0.37). Likewise, weight gain was similar in those who did or did not use HRT (nonusers, 4.3 +/- 4.6 kg; users, 3.5 +/- 3.7 kg; ex-users, 3.4 +/- 5.8 kg). At their first checkups, overweight women and obese women already had significant differences in their risk factors, including higher systolic pressure (p < 0.02), diastolic pressure (p < 0.01), glucose (p < 0.02) and triglycerides (p < 0.0001), and lower high-density lipoprotein cholesterol (p < 0.004) as compared with women of normal weight. Unexpectedly, women of normal weight who became overweight or obese during the monitoring period did not show any deterioration in their risk factors.

CONCLUSIONS

During the perimenopausal period there is a weight gain that does not seem to depend on the menopause or HRT. Being overweight or obese during the menopausal transition is not necessarily associated with deterioration in coronary risk factors. This seems to imply the existence of different metabolic populations within this group of women.

A scheme of combined oral contraceptives for women more than 40 years old

OBJECTIVE

To study whether the addition of estrogen to the 7 hormone-free days of a combined oral contraceptive (OC) cycle improves the symptomatology in perimenopausal women with climacteric complaints.

DESIGN

A total of 56 women in their forties presenting with mood disorders and/or hot flashes were included in this randomized double-blind study. Symptoms were evaluated using the Greene test. Subjects were allocated into two groups: 23 women received an OC containing 20 microg of ethinyl-estradiol and 150 mg of desogestrel for 21 days and then 7 placebo tablets (placebo group); the other 33 women received 21 tablets with the same hormone combination, followed by 2 placebo tablets and 5 ethinyl-estradiol tablets of 10 microg each (estrogen group). After three cycles, symptoms were reassessed.

RESULTS

Symptoms were similar in the two groups at the start of the study. Three months later, vasomotor symptoms in the placebo group dropped from 3.3 +/- 1.7 to 1.7 +/- 1.8, and in the estrogen group, from 3.0 +/- 1.7 to 0.7 +/- 0.9 (p < 0.04). Similarly, symptoms of depression fell from 8.8 +/- 4.0 to 6.7 +/- 3.9 in the placebo group and from 10.3 +/- 3.5 to 3.8 +/- 2.9 in the estrogen group (p < 0.002). Somatic symptoms fell with placebo from 10.9 +/- 5.3 to 7.4 +/- 5.4, and with estrogen, from 9.7 +/- 4.9 to 4.0 +/- 2.5 (p < 0.03). Sexual dysfunction as measured by the Greene Scale (loss of sexual interest) also improved more in women who received additional estrogen: 2.0 +/- 0.9 to 0.5 +/- 0.9 vs. 1.8 +/- 1.2 to 1.2 +/- 1.2, p < 0.03. Anxiety symptoms improved in both groups but without any significant difference between them.

CONCLUSIONS

Adding 5 days of estrogen to the classic contraceptive scheme improves the climacteric symptoms of perimenopausal women who use OCs.

Do women using hormone replacement treatment have less pre-existing cardiovascular risk

BACKGROUND

Several studies have suggested that women who choose to use hormone replacement therapy (HRT) already, before starting this therapy, have a better cardiovascular risk profile than those who do not use it. Some of these studies contain factors of confusion and biases, such as HRT users' greater educational achievement or physical activity, which could have led to wrong conclusions.

AIM

To study a cohort, without confounding factors in order to analyse whether the cardiovascular risk profile is different in women who choose to use HRT.

MATERIAL AND METHODS

Coronary risk factors of 387 women between 45 and 64 were studied. This study was carried out at the Unit for the Preventive Medical Examination of the South Metropolitan Health Service in Santiago (Chile) during the annual check-up. The first evaluation was in 1991-1992; with a second evaluation 5 years later. Of all the women, 174 (45%) never received hormones (Group A), 124 (32%) were HRT users at the time (Group B), and 89 (23%) were former-users (Group C).

RESULTS

No differences were found between the three groups for age, body mass index (BMI), educational background, alcohol consumption, smoking or physical activity. Blood pressure was similar in the three groups. No significant differences were found in total cholesterol (A, 221.7+/-42.2; B, 228.2+/-47.0; and C, 227.3+/-44.9 mg/dl); high density lipoprotein (HDL, A, 53.5+/-13.2; B, 51.8+/-12.8; and C, 54.0+/-12.4 mg/dl); low density lipoprotein (LDL, A, 141.7+/-38.9; B, 148.5+/-43.1 and C, 148.3+/-43.8 mg/dl); triglycerides (A, 134.5+/-67.9; B, 141.0+/-66.1; and C, 127.3+/-68.5 mg/dl) and glucose plasma levels (A, 90.5+/-32.2; B, 87.7+/-15.3; and C, 85.0+/-8.8 mg/dl).

CONCLUSIONS

Our results suggest that women who choose to use HRT have a cardiovascular risk profile, before starting the therapy, similar to those who do not use it.

[Are transdermic estrogens cardioprotective?]

Transdermic estrogens share many of the oral estrogens cardiovascular effects, but so far there are no studies proving that they have a cardioprotective effect neither in animals nor in human beings. The doubt is outlined moreover, when most of the investigations performed with oral estrogens in animals show an antiatherogenic effect, while the few experimental studies that hare been carried out with estrogen patches show contradictory results. We will have to wait for more extensive clinical trials to be able to know if the transdermic estrogens are really cardioprotective, however if we want to achieve some cardiovascular risk improvement with the current knowledge we will probably have to support the use of oral estrogens.

Transdermal estrogens do not appear to modify the extent of lesional areas of aortic atherosclerosis in oophorectomized rabbits on a cholesterol-rich diet

Cardiovascular disease (CVD) is the leading cause of death in older women in industrialised countries. It has been suggested that it is the cessation of estrogen production by the ovaries that puts postmenopausal women at increased risk of CVD. Estrogen therapy has demonstrated a protective effect against CVD and several reports suggest that diverse mechanisms may be involved. Oral estrogen appears to be associated with a better lipid profile than the use of transdermal estrogens; however, it is assumed that estrogens, oral and non-oral, have direct actions on the blood vessels that may exert an important role in cardiovascular disease prevention. To investigate the effect of transdermal estrogen therapy on aorta atherogenesis, we studied 20 cholesterol-fed New Zealand White rabbits for 4 months. The rabbits were oophorectomized and randomly assigned to two groups. Ten rabbits underwent bilateral ovariectomy followed by treatment with transdermal 17-beta-estradiol (group E) and the other 10 received placebo after sterilization (Group C). After diet total levels of cholesterol increase in group C from 50. 0+/-12.5 to 820.9+/-186.0 mg/dl, and in group E from 52.6+/-9.4 to 811.4+/-213.0 mg/dl (no significant differences were observed between groups). Estrogen therapy increased twofold the total reactive antioxidant potential (TRAP group C: 22.5+/-16.7 mmol of Trolox/l vs. TRAP group E: 43.4+/-22.4 mmol of Trolox/l; P<0.04). At 4 months, the cholesterol-rich diet caused atherosclerotic lesions in both treated and untreated rabbits affecting 18.7+/-14.5 and 21. 6+/-9.7% of the aortic surface respectively. In summary, the principal result from this study was that although treatment with transdermal 17-beta-estradiol in cholesterol-fed ovariectomized rabbits increases the TRAP to pre-surgery values, it does not inhibit aortic cholesterol accumulation.

[HERS study disturbs hormonal replacement therapy]

Cardiovascular protection of hormonal replacement therapy was considered a fact. The effects of estrogens on lipid levels and vascular health gave biological support to estrogen cardioprotection. The recently published HERS study showing no protective effects of estrogen and progesterone replacement therapy on the risk of myocardial infarction or coronary deaths is provoking perplexity. These surprising results may have several causes such as the use of progesterone, the associated use of cardioprotective agents or the short observation period. However, the study results scope is restricted to secondary prevention. These cannot be extrapolated to frequent conditions of postmenopausal women such as primary prevention or sequential schemes. Likewise, this investigation underscores the importance of a critical and continued evaluation of apparently well established therapeutic approaches.

[Patterns of sexual behavior in Chilean women]

BACKGROUND

Sexuality has an individual connotation, is influenced by biological, environmental and cultural factors and is present throughout all life. AM: To assess the sexual behavior of a group of Chilean women.

SUBJECTS AND METHODS

A specially devised inquiry was applied to 301 women, aged 20 to 70 years old, that consulted in a medical service.

RESULTS

Seventy seven percent of women were sexually active. These figures ranged from 80% of women aged 40-44 years old to 40% of women over 60. Sixty percent of women living together, 53.7% of single women, 65.6% of divorced women, 94.2% of married women and 100% of widows were sexually active. Women aged 25 to 29 years old had a mean of 8.4 relations per month compared with 3.3 relations among women older than 55. The frequency of sexual intercourse was higher in women living together and lower in widows. The mean age at the first intercourse was 20.6 +/- 4.5 years. Ninety three percent had experienced sexual desire and the percentage of satisfactory sexual relations does not change with age. Less educated women had a lower frequency of orgasms.

CONCLUSIONS

Age and legal status of women are related to their sexual behavior and less educated women have a less satisfactory sexual life.

[Effects of estrogen supplementation on psychological variables in climacteric women]

BACKGROUND

The beneficial effects of estrogen supplementation in climacteric women are clear. However, their psychological effects are not well documented.

AIM

To study the effects of estrogen supplementation on psychological variables in climacteric women.

SUBJECTS AND METHODS

Forty postmenopausal women were divided in two groups to receive a daily dose of 2 mg oestradiol valerate and 2.5 mg medroxyprogesterone acetate or an identical placebo during six months. Initially and at the end of the treatment period, they were subjected to a psychiatric interview and the Graffar, Hamilton and Eysenk personality tests were applied. Also, an Analysis of Verbal Behavior was used, that results in hope and hopeless scores.

RESULTS

There were no differences in the initial assessment between the two treatment groups. In women receiving hormonal supplementation, the Hamilton score decreased from 11.2 to 4.9 (p < 0.002) and in women receiving placebo from 8.1 to 5.3 (NS). No other significant changes in psychological tests were observed.

CONCLUSIONS

Hormonal supplementation decreases the Hamilton depression score in postmenopausal women.

[Decrease of labor absenteeism associated with hormone replacement therapy in postmenopausal women]

Absenteeism affects efficiency and costs of health care. Most of health workers are middle age women, whose climacteric symptoms may reduce their work capacity working at a public hospital in Santiago during 1992. Fifty-eight percent were postmenopausal and 34.8% of these were receiving hormone replacement therapy. Global absenteeism rate was 17.1 days/year. These figures were 14.8 days/year for premenopausal and 17.8 days/year for postmenopausal women (NS). Among the latter, those women receiving hormone replacement therapy had a significantly lower absenteeism rate (9.4 days/year compared to 20.4 days/year among those not receiving hormones). Osteoarticular diseases were responsible for 44.3% and psychiatric diseases for 18.1% of sick leaves. No differences in absenteeism were observed between different professional levels. We conclude that hormone replacement therapy is associated with a better working capacity in postmenopausal women.