Articles - Revista Brasileira de Ginecologia e Obstetrícia

OBJECTIVE: to compare the prevalence of DNA of human papillomavirus (HPV), in samples of normal endometrial tissue, and tissue with endometrial carcinoma of women submitted to surgical treatment (hysterectomy), or between endometrial carcinoma and benign disease, through the PCR technique. METHODS: this is an observational control-case study where 100 women (50 with endometrial carcinoma and 50 with normal endometrial tissue) were analyzed for the detection of HPV DNA in samples of endometrial tissue kept in paraffin blocks by the PCR technique. The cases of endometrial carcinoma with uncertain primary site of the lesion as well as the cases with previous or current history of pre-neoplasic lesions or carcinoma of the lower genital tract were excluded. Variables as age, smoking habit, endometrial trophism, squamous differentiation and degree of tumor differentiation were also evaluated. RESULTS: the estimated relative risk of the presence of HPV in the endometrial carcinoma and in the normal endometrial tissue was the same. HPV was detected in 8% of the cases of carcinoma and 10% in the normal endometrial tissue. In spite of HPV having been 3.5 times more detected in women with smoking habit in the group without carcinoma, there was no statistical difference. The presence of HPV was also not correlated with the women’s age, endometrial trophism, squamous differentiation and degree of tumor differentiation. The HPV types 16 (5 cases) and 18 (4 cases) were the viruses most frequently found both in the normal endometrial tissue or in the tissue with carcinoma. No oncogenic low risk virus was detected in the samples. CONCLUSION: The same proportion of HPV is present in the endometrial tissue of women with endometrial cancer and with normal endometrium. It could not be demonstrated a possible correlation of DNA of HPV with the development of endometrial carcinoma.

Key points

•The risk of venous thromboembolism (VTE) is not increased in women using long-acting reversible contraceptive methods (LARCs) with progestogens.

•Oral contraceptives with levonorgestrel or norgestimate confer half the risk of VTE compared to oral contraceptives containing desogestrel, gestodene or drospirenone.

•Progestogen-only pills do not confer an increased risk of VTE.

•Women using transdermal contraceptive patches and combined oral contraceptives (COCs) are at an approximately eight times greater risk of VTE than non-users of hormonal contraceptives (HCs), corresponding to 9.7 events per 10,000 women/years.

•Vaginal rings increase the risk of VTE by 6.5 times compared to not using HC, corresponding to 7.8 events per 10,000 women/years.

•Several studies have demonstrated an increased risk of VTE in transgender individuals receiving hormone therapy (HT).

•Hormone therapy during menopause increases the risk of VTE by approximately two times, and this risk is increased by obesity, thrombophilia, age over 60 years, surgery and immobilization.

•The route of estrogen administration, the dosage and type of progestogen associated with estrogen may affect the risk of VTE in the climacteric.

•Combined estrogen-progesterone therapy increases the risk of VTE compared to estrogen monotherapy.

•Postmenopausal HT increases the risk of thrombosis at atypical sites.

Key points

• The balanced vaginal microbiome is the main factor defending the vaginal environment against infections. Lactobacilli play a key role in this regard, maintaining the vaginal pH within the normal range (3.8 to 4.5).

•Hormonal and immune adaptations resulting from pregnancy influence changes in the vaginal microbiome during pregnancy.

•An altered vaginal microbiome predisposes to human immunodeficiency virus (HIV) infection.

•Bacterial vaginosis is the main clinical expression of an imbalanced vaginal microbiome.

•Vulvovaginal candidiasis depends more on the host’s conditions than on the etiological agent.

•Trichomonas vaginalis is a protozoan transmitted during sexual intercourse.

•The use of probiotics is not approved for use in pregnant women.