hormone replacement therapy Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , , , Summary
Rev Bras Ginecol Obstet. 2020;42(11):726-730
, , , , , The objective of the present study is to observe the frequency and severity of urinary symptoms in women with breast cancer (BC) being treated with oral hormone therapy, associating them to drug adherence.
The participants were interviewed once from June to October 2016. The evaluation of urinary symptoms was performed by two questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB). Adherence was evaluated by the Morisky-Green method. Statistical analysis was performed by the Mann-Whitney test, linear regression, and Spearman correlation.
Fifty-eight women were interviewed: 42 treated with tamoxifen and 16 with aromatase inhibitor. Twenty-seven women (46.5%) presented urinary incontinence symptoms and 15 (25.8%) presented stress urinary incontinence (SUI). Fourteen (24.1%) women had symptoms of overactive bladder (OAB). There was no statistical difference in symptoms between both treatments and duration of treatments. Higher scores in the ICIQ-SF questionnaire were associated with low/medium adherence and advanced age. Higher scores in the ICIQ-OAB questionnaire were associated with low/medium adherence.
The present study showed a high prevalence of urinary symptoms, such as urinary incontinence and OAB, associated with low/medium adherence and older age in women with BC being treated with oral hormone therapy. Health professionals should be alert to these symptoms since it could influence life quality and adherence to treatment.
Summary
Rev Bras Ginecol Obstet. 2020;42(11):726-730
, , , , , The objective of the present study is to observe the frequency and severity of urinary symptoms in women with breast cancer (BC) being treated with oral hormone therapy, associating them to drug adherence.
The participants were interviewed once from June to October 2016. The evaluation of urinary symptoms was performed by two questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB). Adherence was evaluated by the Morisky-Green method. Statistical analysis was performed by the Mann-Whitney test, linear regression, and Spearman correlation.
Fifty-eight women were interviewed: 42 treated with tamoxifen and 16 with aromatase inhibitor. Twenty-seven women (46.5%) presented urinary incontinence symptoms and 15 (25.8%) presented stress urinary incontinence (SUI). Fourteen (24.1%) women had symptoms of overactive bladder (OAB). There was no statistical difference in symptoms between both treatments and duration of treatments. Higher scores in the ICIQ-SF questionnaire were associated with low/medium adherence and advanced age. Higher scores in the ICIQ-OAB questionnaire were associated with low/medium adherence.
The present study showed a high prevalence of urinary symptoms, such as urinary incontinence and OAB, associated with low/medium adherence and older age in women with BC being treated with oral hormone therapy. Health professionals should be alert to these symptoms since it could influence life quality and adherence to treatment.
Summary
Rev Bras Ginecol Obstet. 2015;37(5):233-240
DOI 10.1590/SO100-720320150005333
To assess the effect of tibolone on mammary tissue of castrated rats over 3
different periods of time.
Sixty virgin female Wistar rats were submitted to oophorectomy. Twenty-one days
after surgery, with hypoestrogenism confirmed, the experimental rats were randomly
assigned to six groups: Tibolone 1 (n=10) received tibolone 1 mg/day for 23 days,
tibolone 2 (n=10) for 59 days and tibolone 3 (n=10) for 118 days. The groups
control 1 (n=8), control 2 (n=7) and control 2 (n=10) received distilled water for
23, 59 and 118 days, respectively. After treatment, all six pairs of mammary
glands were removed and stained with hematoxylin and eosin (HE) for histological
analysis after euthanasia. The histological parameters evaluated were: epithelial
cell proliferation and secretory activity. The variables were analyzed
statistically, with the level of significance set at 0.05.
Histological changes were observed in 20/55 rats, mild epithelial hyperplasia in
7/55, moderate epithelial hyperplasia in 5/55, alveolar-nodular hyperplasia in
7/55, atypia without epithelial proliferation in 1/55, and no cases of severe
epithelial hyperplasia were found. Secretory activity was observed in 31/55 rats.
The secretory activity was significantly higher in the tibolone groups compared to
control at all the time points assessed (p=0,001). The histological changes were
did not show significance when the control and tibolone groups were compared. The
time of exposure to tibolone did not show significance when the three different
periods of evaluation were compared.
No relation between histological modification and tibolone treatment was verified
after short-, medium- and long-term treatment.
Summary
Rev Bras Ginecol Obstet. 2015;37(5):233-240
DOI 10.1590/SO100-720320150005333
To assess the effect of tibolone on mammary tissue of castrated rats over 3
different periods of time.
Sixty virgin female Wistar rats were submitted to oophorectomy. Twenty-one days
after surgery, with hypoestrogenism confirmed, the experimental rats were randomly
assigned to six groups: Tibolone 1 (n=10) received tibolone 1 mg/day for 23 days,
tibolone 2 (n=10) for 59 days and tibolone 3 (n=10) for 118 days. The groups
control 1 (n=8), control 2 (n=7) and control 2 (n=10) received distilled water for
23, 59 and 118 days, respectively. After treatment, all six pairs of mammary
glands were removed and stained with hematoxylin and eosin (HE) for histological
analysis after euthanasia. The histological parameters evaluated were: epithelial
cell proliferation and secretory activity. The variables were analyzed
statistically, with the level of significance set at 0.05.
Histological changes were observed in 20/55 rats, mild epithelial hyperplasia in
7/55, moderate epithelial hyperplasia in 5/55, alveolar-nodular hyperplasia in
7/55, atypia without epithelial proliferation in 1/55, and no cases of severe
epithelial hyperplasia were found. Secretory activity was observed in 31/55 rats.
The secretory activity was significantly higher in the tibolone groups compared to
control at all the time points assessed (p=0,001). The histological changes were
did not show significance when the control and tibolone groups were compared. The
time of exposure to tibolone did not show significance when the three different
periods of evaluation were compared.
No relation between histological modification and tibolone treatment was verified
after short-, medium- and long-term treatment.
Summary
Rev Bras Ginecol Obstet. 2013;35(4):178-184
DOI 10.1590/S0100-72032013000400008
PURPOSE: To analyze the climacteric symptoms, nutritional status and distribution of abdominal fat in postmenopausal women using or not hormone therapy. METHODS: exploratory analytical study of the population survey type in the urban area of Maringa, Parana, conducted on 456 postmenopausal women aged 45 to 69 years. Data collection was based on the urbanized census sector (368) of the municipality, according to the Brazilian Demographic Census. A simple random sample proportional to women residing in each census sector was used, and a questionnaire was applied during a home visit, when anthropometric measurements were performed and blood pressure was determined. The Blatt and Kupperman Menopausal Index was used for the evaluation of climacteric symptoms. The outcome variable was the use of hormone therapy. RESULTS: Mean subject age was 58.7 years. Overweight was present in 72.6% of the women and abdominal obesity in 81.4% of them. Mild climacteric symptoms were observed in 69.5% of the women. Only 18.4% of the women studied were using hormone therapy and they were white, non-smokers, had no comorbidities, and had a partner. Users of hormone therapy had a lower frequency of overweight and obesity and had a lower prevalence of severe climacteric symptoms. CONCLUSION: Overweight and obesity were prevalent in this sample. Although fewer in number, the hormone therapy users had a lower frequency of overweight and mild and severe menopausal symptoms during the postmenopausal period.
Summary
Rev Bras Ginecol Obstet. 2013;35(4):178-184
DOI 10.1590/S0100-72032013000400008
PURPOSE: To analyze the climacteric symptoms, nutritional status and distribution of abdominal fat in postmenopausal women using or not hormone therapy. METHODS: exploratory analytical study of the population survey type in the urban area of Maringa, Parana, conducted on 456 postmenopausal women aged 45 to 69 years. Data collection was based on the urbanized census sector (368) of the municipality, according to the Brazilian Demographic Census. A simple random sample proportional to women residing in each census sector was used, and a questionnaire was applied during a home visit, when anthropometric measurements were performed and blood pressure was determined. The Blatt and Kupperman Menopausal Index was used for the evaluation of climacteric symptoms. The outcome variable was the use of hormone therapy. RESULTS: Mean subject age was 58.7 years. Overweight was present in 72.6% of the women and abdominal obesity in 81.4% of them. Mild climacteric symptoms were observed in 69.5% of the women. Only 18.4% of the women studied were using hormone therapy and they were white, non-smokers, had no comorbidities, and had a partner. Users of hormone therapy had a lower frequency of overweight and obesity and had a lower prevalence of severe climacteric symptoms. CONCLUSION: Overweight and obesity were prevalent in this sample. Although fewer in number, the hormone therapy users had a lower frequency of overweight and mild and severe menopausal symptoms during the postmenopausal period.
Summary
Rev Bras Ginecol Obstet. 2011;33(10):310-314
DOI 10.1590/S0100-72032011001000007
PURPOSE: to evaluate the effect of hormone replacement therapy (HT) on the weight on perimenopausal women as well as the effect of different treatment regimens on this parameter. METHODS: a retrospective study of 139 women with menopause for less than 2 years, who were monitored with periodical visits in our department. We compared two groups: women who started HT (n=89) with women who had no hormonal treatment (n=50) and in the two groups, we evaluated the changes in body weight over a 1-year period. In the first group, we assessed the same parameter as a function of different treatment regimens: estrogen alone versus estrogen combined with progestin and standard dose versus low dose. The SPSS® program was used for statistical analysis, with the level of significance set at p<0.05. RESULTS: the groups were similar with respect to demographic and baseline characteristics; weight gain was higher in the untreated group (434 vs 76 g), but the difference observed was not significant (p = 0.406); among HT users, those taking estrogen alone had an increased weight gain compared to women taking estrogen with progestin (775 vs 24 g), although no statistically significant difference was observed and the same applied when comparing the dose initially prescribed (92 vs 49 g). CONCLUSIONS: despite the common belief about weight gain associated with HT, the results of the present study seem to contradict this point, with no additional weight gain beyond that normally associated with this period in a woman´s life.
Summary
Rev Bras Ginecol Obstet. 2011;33(10):310-314
DOI 10.1590/S0100-72032011001000007
PURPOSE: to evaluate the effect of hormone replacement therapy (HT) on the weight on perimenopausal women as well as the effect of different treatment regimens on this parameter. METHODS: a retrospective study of 139 women with menopause for less than 2 years, who were monitored with periodical visits in our department. We compared two groups: women who started HT (n=89) with women who had no hormonal treatment (n=50) and in the two groups, we evaluated the changes in body weight over a 1-year period. In the first group, we assessed the same parameter as a function of different treatment regimens: estrogen alone versus estrogen combined with progestin and standard dose versus low dose. The SPSS® program was used for statistical analysis, with the level of significance set at p<0.05. RESULTS: the groups were similar with respect to demographic and baseline characteristics; weight gain was higher in the untreated group (434 vs 76 g), but the difference observed was not significant (p = 0.406); among HT users, those taking estrogen alone had an increased weight gain compared to women taking estrogen with progestin (775 vs 24 g), although no statistically significant difference was observed and the same applied when comparing the dose initially prescribed (92 vs 49 g). CONCLUSIONS: despite the common belief about weight gain associated with HT, the results of the present study seem to contradict this point, with no additional weight gain beyond that normally associated with this period in a woman´s life.
Summary
Rev Bras Ginecol Obstet. 2011;33(6):295-302
DOI 10.1590/S0100-72032011000600006
PURPOSE: To evaluate bone mineral density (BMD) and their risk factors associated with postmenopausal osteoporosis. METHODS: A cross-sectional clinical study was performed on 431 women (aged 40 - 75 years). Inclusion criteria: amenorrhea >12 months and age >45 years or, bilateral oophorectomy >40 years with BMD values (T-score of lumbar spine/femur neck) by DXA of the last 12 months. Risk factors evaluated: age, age and time of menopause, smoking, physical activity (30 min/5 times/week), rheumatoid arthritis (RA), use of corticotherapy and hormone therapy (HT), previous fracture, maternal hip fracture and body mass index (BMI=weight/height²). The χ2 test and the logistic regression method (Odds Ratio - OR) were used to determine osteoporosis risk. RESULTS: According to WHO criteria, 106 (24.6%) women showed osteoporosis (T-score <-2.5 DP), 188 (43.6%) osteopenia (-1.0/-2.4 DP), and 137 (31.8%) were normal (>-1.0 DP). Osteoporosis was detected in 12% of women aged 40 - 49 years, in 21.8% of women aged 50 - 59 years and in 45.7% of women aged >60 years (p<0.001). Osteoporosis occurred in 11.8% of women with a menopause period <5 years, in 29.4% with a menopause period from 6 to 10 years, and in 41% of women with a menopause period >10 years (p<0.001). Of the women with early menopause, 80% showed osteopenia/osteoporosis (p=0.03), and of those with BMI <20 kg/m², 50% were osteoporotic (p<0.001). The risk for osteoporosis detection increased with age (OR=1.1; CI95%=1.0-1.1), time of menopause (OR=1.1; CI95%=1.0-1.1), smoking (OR=1.9; CI95%=1.2-3.2), RA (OR=3.6; CI95%=1.3-9.6) and maternal fracture history (OR=2.1; CI95%=1.1-3.0) (p<0.05). In contrast, HT use (OR=0.3; 95%CI=0.2-0.6) and high BMI (OR=0.9; 95%CI=0.8-0.9) reduced the risk (p<0.05). CONCLUSION: In postmenopausal women, age, time of menopause, smoking and maternal history of fracture were clinical indicators of risk for osteoporosis, whereas HT use and high BMI proved to be protective factors.
Summary
Rev Bras Ginecol Obstet. 2011;33(6):295-302
DOI 10.1590/S0100-72032011000600006
PURPOSE: To evaluate bone mineral density (BMD) and their risk factors associated with postmenopausal osteoporosis. METHODS: A cross-sectional clinical study was performed on 431 women (aged 40 - 75 years). Inclusion criteria: amenorrhea >12 months and age >45 years or, bilateral oophorectomy >40 years with BMD values (T-score of lumbar spine/femur neck) by DXA of the last 12 months. Risk factors evaluated: age, age and time of menopause, smoking, physical activity (30 min/5 times/week), rheumatoid arthritis (RA), use of corticotherapy and hormone therapy (HT), previous fracture, maternal hip fracture and body mass index (BMI=weight/height²). The χ2 test and the logistic regression method (Odds Ratio - OR) were used to determine osteoporosis risk. RESULTS: According to WHO criteria, 106 (24.6%) women showed osteoporosis (T-score <-2.5 DP), 188 (43.6%) osteopenia (-1.0/-2.4 DP), and 137 (31.8%) were normal (>-1.0 DP). Osteoporosis was detected in 12% of women aged 40 - 49 years, in 21.8% of women aged 50 - 59 years and in 45.7% of women aged >60 years (p<0.001). Osteoporosis occurred in 11.8% of women with a menopause period <5 years, in 29.4% with a menopause period from 6 to 10 years, and in 41% of women with a menopause period >10 years (p<0.001). Of the women with early menopause, 80% showed osteopenia/osteoporosis (p=0.03), and of those with BMI <20 kg/m², 50% were osteoporotic (p<0.001). The risk for osteoporosis detection increased with age (OR=1.1; CI95%=1.0-1.1), time of menopause (OR=1.1; CI95%=1.0-1.1), smoking (OR=1.9; CI95%=1.2-3.2), RA (OR=3.6; CI95%=1.3-9.6) and maternal fracture history (OR=2.1; CI95%=1.1-3.0) (p<0.05). In contrast, HT use (OR=0.3; 95%CI=0.2-0.6) and high BMI (OR=0.9; 95%CI=0.8-0.9) reduced the risk (p<0.05). CONCLUSION: In postmenopausal women, age, time of menopause, smoking and maternal history of fracture were clinical indicators of risk for osteoporosis, whereas HT use and high BMI proved to be protective factors.
Summary
Rev Bras Ginecol Obstet. 2008;30(6):312-321
DOI 10.1590/S0100-72032008000600008
Sexual dysfunction prevalence is high among women. However, doctors rarely ask about their patients' sexual life, because they feel uncomfortable or because their knowledge about investigation techniques is insufficient. The PLISSIT model, a useful tool to access human sexual function, is composed by four elements: permission, limited information, specific suggestions, and intensive therapy, that favor dialogue between the doctor and the patient allowing the access to the sexual complaints. The therapeutics consists of counseling measures, drug prescription, basic orientations about sexual function and interventions on anatomic and functional aspects of the sexual apparatus with positive impact in the woman's sexual life. The present review shows how to use it. In addition, many aspects of female sexual dysfunction are discussed, such as prevalence, diagnostic and treatment options for female sexual dysfunction.
Summary
Rev Bras Ginecol Obstet. 2008;30(6):312-321
DOI 10.1590/S0100-72032008000600008
Sexual dysfunction prevalence is high among women. However, doctors rarely ask about their patients' sexual life, because they feel uncomfortable or because their knowledge about investigation techniques is insufficient. The PLISSIT model, a useful tool to access human sexual function, is composed by four elements: permission, limited information, specific suggestions, and intensive therapy, that favor dialogue between the doctor and the patient allowing the access to the sexual complaints. The therapeutics consists of counseling measures, drug prescription, basic orientations about sexual function and interventions on anatomic and functional aspects of the sexual apparatus with positive impact in the woman's sexual life. The present review shows how to use it. In addition, many aspects of female sexual dysfunction are discussed, such as prevalence, diagnostic and treatment options for female sexual dysfunction.
Summary
Rev Bras Ginecol Obstet. 2007;29(11):593-601
DOI 10.1590/S0100-72032007001100008
There is evidence that estrogen, progesterone and testosterone have modulatory effects over both cellular and humoral immune responses. These effects occur via immune-neuroendocrine interactions, involving the pituitary, gonadal steroids, thymic hormones, and the presence of specific receptors and messengers. These immune responses may be altered during pregnancy, gonadectomy, menopause and hormone therapy. Estrogen depresses the cellular immunity, suppresses the natural killer cell activity and increases the production of antibodies. Progesterone/progestogen suppresses the cellular immune system. Androgens, after metabolization in estrogens, might stimulate the humoral immune response. Hormone therapy is still broadly used in post-menopause women with the purpose of decreasing climacteric symptoms, as well as preventing genital atrophy and bone loss. Its use to attenuate the risk of cardiovascular and neurodegenerative diseases remains in debate. A few studies have been carried out to examine the effect of post-menopause hormone therapy on the immune system. There is evidence that the hypoestrogenic state, following menopause, could result in less resistance to infections. The present review examines the interaction between sexual steroids and the immune system and, based on epidemiological and clinical studies, evaluates the effects of hormone therapy on the immune responses. It was concluded that the hormone therapy normalizes the cellular immune response in post-menopausal women.
Summary
Rev Bras Ginecol Obstet. 2007;29(11):593-601
DOI 10.1590/S0100-72032007001100008
There is evidence that estrogen, progesterone and testosterone have modulatory effects over both cellular and humoral immune responses. These effects occur via immune-neuroendocrine interactions, involving the pituitary, gonadal steroids, thymic hormones, and the presence of specific receptors and messengers. These immune responses may be altered during pregnancy, gonadectomy, menopause and hormone therapy. Estrogen depresses the cellular immunity, suppresses the natural killer cell activity and increases the production of antibodies. Progesterone/progestogen suppresses the cellular immune system. Androgens, after metabolization in estrogens, might stimulate the humoral immune response. Hormone therapy is still broadly used in post-menopause women with the purpose of decreasing climacteric symptoms, as well as preventing genital atrophy and bone loss. Its use to attenuate the risk of cardiovascular and neurodegenerative diseases remains in debate. A few studies have been carried out to examine the effect of post-menopause hormone therapy on the immune system. There is evidence that the hypoestrogenic state, following menopause, could result in less resistance to infections. The present review examines the interaction between sexual steroids and the immune system and, based on epidemiological and clinical studies, evaluates the effects of hormone therapy on the immune responses. It was concluded that the hormone therapy normalizes the cellular immune response in post-menopausal women.
Summary
Rev Bras Ginecol Obstet. 2007;29(10):538-547
DOI 10.1590/S0100-72032007001000008
Exogenous female hormones used for contraception or postmenopausal hormonal replacement therapy are associated with an increase of venous thromboembolism (VTE) risk, mainly because they cause a hypercoagulable state. The risk is highest during the first year of use and it is not cumulative. The dose of estrogen, the type of estrogen and progestogen, the route of administration of female sex steroid hormones, and the hereditary risk factors for VTE of each patient can interfere on the final risk for VTE. The knowledge of their effect on hemostasis is essential for a correct prescription.
Summary
Rev Bras Ginecol Obstet. 2007;29(10):538-547
DOI 10.1590/S0100-72032007001000008
Exogenous female hormones used for contraception or postmenopausal hormonal replacement therapy are associated with an increase of venous thromboembolism (VTE) risk, mainly because they cause a hypercoagulable state. The risk is highest during the first year of use and it is not cumulative. The dose of estrogen, the type of estrogen and progestogen, the route of administration of female sex steroid hormones, and the hereditary risk factors for VTE of each patient can interfere on the final risk for VTE. The knowledge of their effect on hemostasis is essential for a correct prescription.
