Menopause Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):182-189
DOI 10.1590/S0100-72032008000400005
PURPOSE: to evaluate the anthropometric measures as predictors of cardiovascular and metabolic risk in non-transmissible chronic diseases in postmenopausal women. METHODS: a clinical and sectional study enrolling 120 sedentary postmenopausal women (amenorrhea for at least 12 months, age 45 to 70 years was conducted). Exclusion criteria included insulin-dependent diabetes and use of statins or hormone therapy within the preceding six months. Anthropometric indicators included: weight, height, body mass index (BMI=weight/height²), and waist circumference (WC). Metabolic profiles as total cholesterol (TC), HDL, LDL, triglycerides (TG), glycemia, and insulin were measured and the atherogenic index of plasma (AIP) and Homeostasis model assessment-insulin resistance (HOMA-IR) were calculated. One-way analysis of variance (ANOVA) and Odds Ratio (OR) were used in the statistical analysis. RESULTS: subjects were classified on average as overweight and showed central fat distribution. Overweight and obesity were observed in 76% and abdominal obesity in 87.3% of the patients. On average, TC, LDL and TG levels were higher than recommended in 67.8, 55.9 and 45.8% of the women, respectively, and HDL was low in 40.7%. Values of WC >88 cm were observed in 14.8% of women with normal weight, 62.5% overweight and 100% obesity p>0.05). On average, the values of AIP, TG, and HOMA-IR increased significantly along with values of BMI and WC, while decreased HDL (p<0.05). Among women with WC >88 cm, a risk association was observed with low HDL (OR=5.86; 95%CI=2.31-14.82), with higher TG (OR=2.61; 95%CI=1.18-5.78), with higher AIP (OR=3.42; 95%CI=1.19-9.78) and with IR (OR=3.63; 95%CI=1.27-10.36). There was a risk of low HDL (OR=3.1; 95%CI=1.44-6.85) with increased obesity (BMI>30 kg/m²). CONCLUSIONS: in the postmenopausal women, the simple measure of WC can predict cardiovascular and metabolic risk of non-transmissible chronic diseases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):182-189
DOI 10.1590/S0100-72032008000400005
PURPOSE: to evaluate the anthropometric measures as predictors of cardiovascular and metabolic risk in non-transmissible chronic diseases in postmenopausal women. METHODS: a clinical and sectional study enrolling 120 sedentary postmenopausal women (amenorrhea for at least 12 months, age 45 to 70 years was conducted). Exclusion criteria included insulin-dependent diabetes and use of statins or hormone therapy within the preceding six months. Anthropometric indicators included: weight, height, body mass index (BMI=weight/height²), and waist circumference (WC). Metabolic profiles as total cholesterol (TC), HDL, LDL, triglycerides (TG), glycemia, and insulin were measured and the atherogenic index of plasma (AIP) and Homeostasis model assessment-insulin resistance (HOMA-IR) were calculated. One-way analysis of variance (ANOVA) and Odds Ratio (OR) were used in the statistical analysis. RESULTS: subjects were classified on average as overweight and showed central fat distribution. Overweight and obesity were observed in 76% and abdominal obesity in 87.3% of the patients. On average, TC, LDL and TG levels were higher than recommended in 67.8, 55.9 and 45.8% of the women, respectively, and HDL was low in 40.7%. Values of WC >88 cm were observed in 14.8% of women with normal weight, 62.5% overweight and 100% obesity p>0.05). On average, the values of AIP, TG, and HOMA-IR increased significantly along with values of BMI and WC, while decreased HDL (p<0.05). Among women with WC >88 cm, a risk association was observed with low HDL (OR=5.86; 95%CI=2.31-14.82), with higher TG (OR=2.61; 95%CI=1.18-5.78), with higher AIP (OR=3.42; 95%CI=1.19-9.78) and with IR (OR=3.63; 95%CI=1.27-10.36). There was a risk of low HDL (OR=3.1; 95%CI=1.44-6.85) with increased obesity (BMI>30 kg/m²). CONCLUSIONS: in the postmenopausal women, the simple measure of WC can predict cardiovascular and metabolic risk of non-transmissible chronic diseases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(3):113-120
DOI 10.1590/S0100-72032008005000001
PURPOSE: to evaluate quality of life of climacteric women attended at a school hospital in Recife, Pernambuco, Brazil, adopting the Medical Outcome Study 36-item Short Form Health Survey (MOS SF-36 Health Survey) and the Women's Health Questionnaire (WHQ), as well as the modified Blatt-Kupperman index. METHODS: according to a descriptive, transversal study, 233 women, assisted from February to June 2006, were evaluated. Within a convenience sample, the inclusion criteria were age from 40 to 65 years old and agreement in participating of the research, excluding previous history of bilateral oophorectomy, hormonal therapy in the last semester and uncontrolled illnesses. The sample size was calculated admitting a prevalence of climacteric symptoms of 4% and a precision of 2.5%. The variables were: general health and physical and mental components based on the MOS SF-36 Health Survey; quality of health based on the WHQ and climacteric symptoms according to the modified Blatt-Kupperman index. Data were analyzed by the Statistical Package for Social Sciences, version 13.0 software. RESULTS: the quality of life was classified as bad. Based on the MOS SF-36 Health Survey, there was more damage in the mental component (18.53 versus 27.77% for physical components), higher losses in social functions (80.28%) and limitations for emotional problems (78.61%). According to WHQ, there were limitations due to sleep disturbances (69.77%), somatic (69.15%) and vasomotor symptoms (68.80%), considering regular sexual function and menstrual symptoms. Estrogenic deficiency symptoms were found in 53% of the women. The increase of hypoestrogenism symptoms were followed by worsening of general and menopausal health. CONCLUSIONS: it seemed reasonable to assume that menopause, for the researched women, was really configured as a biopsychosocial event, more than organic, derived predominantly from estrogenic deficiency.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(3):113-120
DOI 10.1590/S0100-72032008005000001
PURPOSE: to evaluate quality of life of climacteric women attended at a school hospital in Recife, Pernambuco, Brazil, adopting the Medical Outcome Study 36-item Short Form Health Survey (MOS SF-36 Health Survey) and the Women's Health Questionnaire (WHQ), as well as the modified Blatt-Kupperman index. METHODS: according to a descriptive, transversal study, 233 women, assisted from February to June 2006, were evaluated. Within a convenience sample, the inclusion criteria were age from 40 to 65 years old and agreement in participating of the research, excluding previous history of bilateral oophorectomy, hormonal therapy in the last semester and uncontrolled illnesses. The sample size was calculated admitting a prevalence of climacteric symptoms of 4% and a precision of 2.5%. The variables were: general health and physical and mental components based on the MOS SF-36 Health Survey; quality of health based on the WHQ and climacteric symptoms according to the modified Blatt-Kupperman index. Data were analyzed by the Statistical Package for Social Sciences, version 13.0 software. RESULTS: the quality of life was classified as bad. Based on the MOS SF-36 Health Survey, there was more damage in the mental component (18.53 versus 27.77% for physical components), higher losses in social functions (80.28%) and limitations for emotional problems (78.61%). According to WHQ, there were limitations due to sleep disturbances (69.77%), somatic (69.15%) and vasomotor symptoms (68.80%), considering regular sexual function and menstrual symptoms. Estrogenic deficiency symptoms were found in 53% of the women. The increase of hypoestrogenism symptoms were followed by worsening of general and menopausal health. CONCLUSIONS: it seemed reasonable to assume that menopause, for the researched women, was really configured as a biopsychosocial event, more than organic, derived predominantly from estrogenic deficiency.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):525-531
DOI 10.1590/S0100-72032007001000006
PURPOSE: to evaluate changes in mammographic breast density in postmenopausal women using raloxifene. METHODS: in this clinical trial, 80 women (mean age=61.1 years) were studied prospectively. Forty patients received 60 mg/day raloxifene, and 40 women comprised the non-treated group (control), paired by age and time of menopause. The treated group was composed of patients with osteoporosis of the lumbar spine. Those with history of breast surgery and users of hormone therapy up to six months prior to the study were excluded. The breast density was assessed qualitatively (subjective) and quantitatively (objective) in two moments, initial and final, after a 6-month follow-up. The 320 mammograms (craniocaudal and oblique) were interpreted qualitatively by the Breast Imaging Reporting and Data System (BI-RADS) classification and quantitatively by digital scanning and computer-assisted segmentation. For statistical analysis t-test, Wilcoxon Mann-Whitney, Spearman correlation and the kappa index were used. RESULTS: on the initial statistical comparison, the groups were considered homogenous for the variables: analyzed age, time of menopause, parity, breast feeding, previous hormonal therapy and body mass index. Baseline breast density, by qualitative and quantitative methods, correlated negatively with the age in both groups (p<0.05). Concerning the other variables, there was no correlation. After six months, no alteration was observed in the mammographic breast density in 38 women of raloxifene group and 38 of the control group, by qualitative method. However, by quantitative method, no alteration was observed in 30 women of the raloxifene group and 27 controls (p>0.05). It was observed a weak agreement rate (kappa=0.25) between the BI-RADS classification and digital scanning/computer-assisted segmentation. CONCLUSIONS: in post-menopausal women with osteoporosis, submitted to raloxifene treatment for six months, no alterations were observed on the mammographic breast density.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):525-531
DOI 10.1590/S0100-72032007001000006
PURPOSE: to evaluate changes in mammographic breast density in postmenopausal women using raloxifene. METHODS: in this clinical trial, 80 women (mean age=61.1 years) were studied prospectively. Forty patients received 60 mg/day raloxifene, and 40 women comprised the non-treated group (control), paired by age and time of menopause. The treated group was composed of patients with osteoporosis of the lumbar spine. Those with history of breast surgery and users of hormone therapy up to six months prior to the study were excluded. The breast density was assessed qualitatively (subjective) and quantitatively (objective) in two moments, initial and final, after a 6-month follow-up. The 320 mammograms (craniocaudal and oblique) were interpreted qualitatively by the Breast Imaging Reporting and Data System (BI-RADS) classification and quantitatively by digital scanning and computer-assisted segmentation. For statistical analysis t-test, Wilcoxon Mann-Whitney, Spearman correlation and the kappa index were used. RESULTS: on the initial statistical comparison, the groups were considered homogenous for the variables: analyzed age, time of menopause, parity, breast feeding, previous hormonal therapy and body mass index. Baseline breast density, by qualitative and quantitative methods, correlated negatively with the age in both groups (p<0.05). Concerning the other variables, there was no correlation. After six months, no alteration was observed in the mammographic breast density in 38 women of raloxifene group and 38 of the control group, by qualitative method. However, by quantitative method, no alteration was observed in 30 women of the raloxifene group and 27 controls (p>0.05). It was observed a weak agreement rate (kappa=0.25) between the BI-RADS classification and digital scanning/computer-assisted segmentation. CONCLUSIONS: in post-menopausal women with osteoporosis, submitted to raloxifene treatment for six months, no alterations were observed on the mammographic breast density.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):532-537
DOI 10.1590/S0100-72032007001000007
PURPOSE: to determine the effects of soy-derived isoflavone on hot flashes, menopausal symptoms, and endometrial thickness in postmenopausal women. METHODS: this double-blind, placebo-controlled, randomized study involved 90 postmenopausal patients aged 45-60 years old attended at the Outpatient Menopause Clinic. All patients had been experiencing hot flashes accompanied or not by other hypo-estrogenic symptoms. Patients were randomized to receive either two soy capsules containing 50 mg of soy-derived isoflavone or two identical placebo capsules, twice a day for 12 weeks in a double-blind fashion. Each patient was observed for 12 weeks, with two evaluations being made, one at baseline and the other at the end of the study. At each time point, the patients were given a diary to record the severity of the climacteric symptoms experienced, assessed with a modified Kupperman index, using a 100 mm Visual Analogue Scale (VAS). The intensity of hot flashes was also assessed separately. The patients were also submitted to a transvaginal echography for the measurement of endometrial thickness. Yates chi2, ANOVA or t de Student and Mann-Whitney were used for statistical analysis. RESULTS: no significant difference was detected in the Kupperman index (64 versus 82, p>0,05) or in the hot flashes (20 versus 20, p>0,05) between the isoflavone and placebo groups. No significant difference was either detected concerning the Kupperman index and hot flashes before and after treatment, when the two groups were analyzed separately. No difference was detected in the endometrial thickness either in the isoflavone or the placebo group (0.28 versus 0.26 mm, respectively, p>0.05). CONCLUSIONS: our results indicate that 100 mg of isoflavone are not more effective than placebo in reducing hot flashes and hypo-estrogenic symptoms in postmenopausal women and present no effect on the endometrium thickness.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):532-537
DOI 10.1590/S0100-72032007001000007
PURPOSE: to determine the effects of soy-derived isoflavone on hot flashes, menopausal symptoms, and endometrial thickness in postmenopausal women. METHODS: this double-blind, placebo-controlled, randomized study involved 90 postmenopausal patients aged 45-60 years old attended at the Outpatient Menopause Clinic. All patients had been experiencing hot flashes accompanied or not by other hypo-estrogenic symptoms. Patients were randomized to receive either two soy capsules containing 50 mg of soy-derived isoflavone or two identical placebo capsules, twice a day for 12 weeks in a double-blind fashion. Each patient was observed for 12 weeks, with two evaluations being made, one at baseline and the other at the end of the study. At each time point, the patients were given a diary to record the severity of the climacteric symptoms experienced, assessed with a modified Kupperman index, using a 100 mm Visual Analogue Scale (VAS). The intensity of hot flashes was also assessed separately. The patients were also submitted to a transvaginal echography for the measurement of endometrial thickness. Yates chi2, ANOVA or t de Student and Mann-Whitney were used for statistical analysis. RESULTS: no significant difference was detected in the Kupperman index (64 versus 82, p>0,05) or in the hot flashes (20 versus 20, p>0,05) between the isoflavone and placebo groups. No significant difference was either detected concerning the Kupperman index and hot flashes before and after treatment, when the two groups were analyzed separately. No difference was detected in the endometrial thickness either in the isoflavone or the placebo group (0.28 versus 0.26 mm, respectively, p>0.05). CONCLUSIONS: our results indicate that 100 mg of isoflavone are not more effective than placebo in reducing hot flashes and hypo-estrogenic symptoms in postmenopausal women and present no effect on the endometrium thickness.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(8):415-422
DOI 10.1590/S0100-72032007000800006
PURPOSE: to evaluate climacteric symptoms and related factors in women living in rural and urban areas of Rio Grande do Norte, Brazil. METHODS: a cross-sectional study involving 261 women in the climacteric was performed. A total of 130 women from Natal and Mossoró (urban group) and 131 from Uruaçu, in São Gonçalo do Amarante (rural group), were studied. Climacteric symptoms were assessed by the Blatt-Kupperman Menopausal Index (BKMI) and Greene Climacteric Scale (GCE). Statistical analysis involved comparison of median between groups and logistic regression analysis. Patients were defined as "very symptomatic" when the climacteric score was >20 for both questionnaires (dependent variable). Independent variables were: age, living area, schooling, obesity and physical activity. RESULTS: the urban group had significantly higher scores than those of the rural group, both for BKMI (median of 26.0 and 17.0, respectively; p<0.0001) and for GCE (median of 27.0 and 16.0, respectively; p<0.0001). For the entire sample, a total of 56.3% (n=147) of the women were classified as "very symptomatic". This prevalence was significantly higher in urban than in rural women (79.2 and 33.6%, respectively; p<0.05). Logistic regression analysis showed that the likelihood of belonging to the group defined as "very symptomatic" was greater for urban women [adjusted odds ratio (OR)=7.1; confidence interval at 95% (95%CI)=3.69-13.66] who were literate (OR=2.19; 95%CI=1.16-4.13). Individuals over the age of 60 years had less chance of having significant symptoms (OR=0.38; 95%CI=0.17-0.87). CONCLUSIONS: the prevalence of significant climacteric symptoms is less in women from a rural environment, showing that sociocultural and environmental factors are strongly related to the appearance of climacteric symptoms in our population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(8):415-422
DOI 10.1590/S0100-72032007000800006
PURPOSE: to evaluate climacteric symptoms and related factors in women living in rural and urban areas of Rio Grande do Norte, Brazil. METHODS: a cross-sectional study involving 261 women in the climacteric was performed. A total of 130 women from Natal and Mossoró (urban group) and 131 from Uruaçu, in São Gonçalo do Amarante (rural group), were studied. Climacteric symptoms were assessed by the Blatt-Kupperman Menopausal Index (BKMI) and Greene Climacteric Scale (GCE). Statistical analysis involved comparison of median between groups and logistic regression analysis. Patients were defined as "very symptomatic" when the climacteric score was >20 for both questionnaires (dependent variable). Independent variables were: age, living area, schooling, obesity and physical activity. RESULTS: the urban group had significantly higher scores than those of the rural group, both for BKMI (median of 26.0 and 17.0, respectively; p<0.0001) and for GCE (median of 27.0 and 16.0, respectively; p<0.0001). For the entire sample, a total of 56.3% (n=147) of the women were classified as "very symptomatic". This prevalence was significantly higher in urban than in rural women (79.2 and 33.6%, respectively; p<0.05). Logistic regression analysis showed that the likelihood of belonging to the group defined as "very symptomatic" was greater for urban women [adjusted odds ratio (OR)=7.1; confidence interval at 95% (95%CI)=3.69-13.66] who were literate (OR=2.19; 95%CI=1.16-4.13). Individuals over the age of 60 years had less chance of having significant symptoms (OR=0.38; 95%CI=0.17-0.87). CONCLUSIONS: the prevalence of significant climacteric symptoms is less in women from a rural environment, showing that sociocultural and environmental factors are strongly related to the appearance of climacteric symptoms in our population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):267-271
DOI 10.1590/S0100-72031998000500006
Objective:To analyze the levels of endogenous sexual steroids and gonadotrophin in women with and without endometrial cancer. Methodology:We developed a clinical comparative study on 20 postmenopausal women with endometrial cancer and 20 postmenopausal women without endometrial cancer. The age, the postmenopausal time and the index of body mass were used as matching variables. The plasma levels of the endogenous sexual steroids were measured using radioimmunoassay and immunoenzymatic methods. For the statistic analysis we used the Student's t test. Results: The levels of androstenedione (A), total testosterone (t) and free testosterone (TL) were higher in the women with endometrial cancer, and those of the luteinic hormone (LH) were significantly lower values in these women. We also observed that the ratio (E1/A) showed significantly lower in the group of women with cancer, while the ratio (E2/E1) did not present any differences between groups. Conclusions: We emphasize the potentiality of sexual steroids and gonadotrophins in the genesis of endometrial adenocarcinoma in postmenopausal women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):267-271
DOI 10.1590/S0100-72031998000500006
Objective:To analyze the levels of endogenous sexual steroids and gonadotrophin in women with and without endometrial cancer. Methodology:We developed a clinical comparative study on 20 postmenopausal women with endometrial cancer and 20 postmenopausal women without endometrial cancer. The age, the postmenopausal time and the index of body mass were used as matching variables. The plasma levels of the endogenous sexual steroids were measured using radioimmunoassay and immunoenzymatic methods. For the statistic analysis we used the Student's t test. Results: The levels of androstenedione (A), total testosterone (t) and free testosterone (TL) were higher in the women with endometrial cancer, and those of the luteinic hormone (LH) were significantly lower values in these women. We also observed that the ratio (E1/A) showed significantly lower in the group of women with cancer, while the ratio (E2/E1) did not present any differences between groups. Conclusions: We emphasize the potentiality of sexual steroids and gonadotrophins in the genesis of endometrial adenocarcinoma in postmenopausal women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):303-308
DOI 10.1590/S0100-72031998000600002
Objective: to compare mammographic density changes, case by case, according to image digitization in three consecutive evaluations of users or nonusers of hormonal replacement therapy (HRT). Methods: 59 postmenopausal women were evaluated, 43 being users of cyclic or continuous estro-progestin hormonal replacement therapy, and 16 nonusers. The criteria of inclusion were: amenorrhea for at least 12 months, a normal mammographic examination at the beginning of the HRT (users) or the clinical follow-up without HRT (nonusers), at two incidences (mediolateral and craniocaudal). The following variables were used for the evaluation of mammary density: initial change - the difference between the first mammography after HRT performed in 12 ± 3 months and the mammography performed before HRT-and final change - the difference between the second mammography after HRT performed in 24 ± 3 months and the mammography performed before HRT. Wilcoxon and c² tests were used in order to evaluate the differences in mammographic density changes. Results: more than half (56.3%) of the women, HRT users with initial increase in mammographic density remained with the increase after the final evaluation. This finding was not significant (p=0.617). In the same group, the initial nonincrease was significantly associated with the final nonincrease (p=0.017). Among the nonusers, all breasts that were not totally fat at the initial evaluation presented a mammographic density decrease at the final evaluation. Conclusions: the majority of HRT users presenting mammographic density increase at the first evaluation, after approximately one year of use, remained with the increase at a second evaluation. After some time, the nonusers tended to present a significant mammographic density decrease (p=0.003).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):303-308
DOI 10.1590/S0100-72031998000600002
Objective: to compare mammographic density changes, case by case, according to image digitization in three consecutive evaluations of users or nonusers of hormonal replacement therapy (HRT). Methods: 59 postmenopausal women were evaluated, 43 being users of cyclic or continuous estro-progestin hormonal replacement therapy, and 16 nonusers. The criteria of inclusion were: amenorrhea for at least 12 months, a normal mammographic examination at the beginning of the HRT (users) or the clinical follow-up without HRT (nonusers), at two incidences (mediolateral and craniocaudal). The following variables were used for the evaluation of mammary density: initial change - the difference between the first mammography after HRT performed in 12 ± 3 months and the mammography performed before HRT-and final change - the difference between the second mammography after HRT performed in 24 ± 3 months and the mammography performed before HRT. Wilcoxon and c² tests were used in order to evaluate the differences in mammographic density changes. Results: more than half (56.3%) of the women, HRT users with initial increase in mammographic density remained with the increase after the final evaluation. This finding was not significant (p=0.617). In the same group, the initial nonincrease was significantly associated with the final nonincrease (p=0.017). Among the nonusers, all breasts that were not totally fat at the initial evaluation presented a mammographic density decrease at the final evaluation. Conclusions: the majority of HRT users presenting mammographic density increase at the first evaluation, after approximately one year of use, remained with the increase at a second evaluation. After some time, the nonusers tended to present a significant mammographic density decrease (p=0.003).
