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Rev Bras Ginecol Obstet. 2013;35(3):103-110
DOI 10.1590/S0100-72032013000300003
PURPOSE: To assess quality of life and climacteric symptoms in women with and without liver transplants. METHODS: This was a cross-sectional study of 52 women undergoing follow-up at a university hospital in southeastern Brazil from February 4th, 2009 to January 5th, 2011. Twenty-four of these women were 35 years old or older and had undergone liver transplantation at least one year before study entry. The remaining 28 women had no liver disease and were matched by age and menstrual patterns to the patients with transplants. The abbreviated version of the World Health Organization (WHOQOL-BREF) questionnaire was used to assess quality of life. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). Statistical analysis was carried out by Student's t-test, Mann-Whitney test and analysis of variance. Correlations between MRS and the WHOQOL-BREF were established by correlation coefficients. RESULTS: The mean age of the women included in the study was 52.2 (±10.4) years and the mean time since transplantation was 6.1 (±3.3) years. Women with liver transplants had better quality of life scores in the environment domain (p=0.01). No difference was noted between the two groups in any domain of the MRS. For women in the comparison group, there was a strongly negative correlation between somatic symptoms in the MRS and the physical domain of the WHOQOL-BREF (p<0.01; r=-0.8). In contrast, there was only a moderate association for women with liver transplants (p<0.01; r=-0.5). CONCLUSIONS: Women with liver transplants had better quality of life scores in the domain related to environment and did not exhibit more intense climacteric symptoms than did those with no liver disease. Climacteric symptoms negatively influenced quality of life in liver transplant recipients, although less intensely than in women without a history of liver disease.
Summary
Rev Bras Ginecol Obstet. 2013;35(3):103-110
DOI 10.1590/S0100-72032013000300003
PURPOSE: To assess quality of life and climacteric symptoms in women with and without liver transplants. METHODS: This was a cross-sectional study of 52 women undergoing follow-up at a university hospital in southeastern Brazil from February 4th, 2009 to January 5th, 2011. Twenty-four of these women were 35 years old or older and had undergone liver transplantation at least one year before study entry. The remaining 28 women had no liver disease and were matched by age and menstrual patterns to the patients with transplants. The abbreviated version of the World Health Organization (WHOQOL-BREF) questionnaire was used to assess quality of life. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). Statistical analysis was carried out by Student's t-test, Mann-Whitney test and analysis of variance. Correlations between MRS and the WHOQOL-BREF were established by correlation coefficients. RESULTS: The mean age of the women included in the study was 52.2 (±10.4) years and the mean time since transplantation was 6.1 (±3.3) years. Women with liver transplants had better quality of life scores in the environment domain (p=0.01). No difference was noted between the two groups in any domain of the MRS. For women in the comparison group, there was a strongly negative correlation between somatic symptoms in the MRS and the physical domain of the WHOQOL-BREF (p<0.01; r=-0.8). In contrast, there was only a moderate association for women with liver transplants (p<0.01; r=-0.5). CONCLUSIONS: Women with liver transplants had better quality of life scores in the domain related to environment and did not exhibit more intense climacteric symptoms than did those with no liver disease. Climacteric symptoms negatively influenced quality of life in liver transplant recipients, although less intensely than in women without a history of liver disease.
Summary
Summary
Rev Bras Ginecol Obstet. 2015;37(4):152-158
DOI 10.1590/SO100-720320150005282
To determine the average age at the onset of menopause and to investigate menopausal symptoms in women in a metropolitan region in Southeastern Brazil.
A descriptive, exploratory, cross-sectional study was conducted with 749 women (a population-based household survey). The dependent variable was the intensity of menopausal symptoms assessed by th Menopause Rating Scale (MRS). The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by the χ2 test and Poisson regression using the backward selection criteria.
The mean age of the women was 52.5 (±4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The mean age at the onset of menopause was 46.5 (±5.8) years. The intensity of menopausal symptoms was defined according to the median MRS score and was considered severe for values above 8. Depression/anxiety (PR=1.8; 95%CI 1.5-2.2; p<0.01), rheumatic diseases (PR 1.5; 95%CI 1.2-1.7; p<0.01), self-perception of health as fair/poor/very poor (PR 1.4; 95% CI 1.2-1.7; p<0.01), history of abortion (PR 1.3; 95%CI 1.1-1.4; p<0.01), current or previous treatment for menopausal symptoms (PR 1.2; 95%CI 1.1-1.4; p<0.01), peri- or postmenopausal status (PR 1.4; 95%CI 1.1-1.7; p<0.01), number of normal deliveries >1 (PR 1.2; 95%CI 1.02-1.4; p<0.01) and asthma (PR 1.2; 95%CI 1.01-1.4; p<0.01) were associated with more severe menopausal symptoms. Older age (PR 0.96; 95%CI 0.96-0.97; p<0.01) was associated with less severe symptoms.
The severity of menopausal symptoms was related to a wild range of factors, especially presence of chronic diseases, a larger number of pregnancies, use of hormone therapy, and worse self-rated health. A better understanding of these factors can help to reduce the impact of symptoms on quality of life, and to identify groups of women who are likely to need more care during and beyond menopause.
Summary
Rev Bras Ginecol Obstet. 2015;37(4):152-158
DOI 10.1590/SO100-720320150005282
To determine the average age at the onset of menopause and to investigate menopausal symptoms in women in a metropolitan region in Southeastern Brazil.
A descriptive, exploratory, cross-sectional study was conducted with 749 women (a population-based household survey). The dependent variable was the intensity of menopausal symptoms assessed by th Menopause Rating Scale (MRS). The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by the χ2 test and Poisson regression using the backward selection criteria.
The mean age of the women was 52.5 (±4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The mean age at the onset of menopause was 46.5 (±5.8) years. The intensity of menopausal symptoms was defined according to the median MRS score and was considered severe for values above 8. Depression/anxiety (PR=1.8; 95%CI 1.5-2.2; p<0.01), rheumatic diseases (PR 1.5; 95%CI 1.2-1.7; p<0.01), self-perception of health as fair/poor/very poor (PR 1.4; 95% CI 1.2-1.7; p<0.01), history of abortion (PR 1.3; 95%CI 1.1-1.4; p<0.01), current or previous treatment for menopausal symptoms (PR 1.2; 95%CI 1.1-1.4; p<0.01), peri- or postmenopausal status (PR 1.4; 95%CI 1.1-1.7; p<0.01), number of normal deliveries >1 (PR 1.2; 95%CI 1.02-1.4; p<0.01) and asthma (PR 1.2; 95%CI 1.01-1.4; p<0.01) were associated with more severe menopausal symptoms. Older age (PR 0.96; 95%CI 0.96-0.97; p<0.01) was associated with less severe symptoms.
The severity of menopausal symptoms was related to a wild range of factors, especially presence of chronic diseases, a larger number of pregnancies, use of hormone therapy, and worse self-rated health. A better understanding of these factors can help to reduce the impact of symptoms on quality of life, and to identify groups of women who are likely to need more care during and beyond menopause.
Summary
Rev Bras Ginecol Obstet. 2014;36(4):157-162
DOI 10.1590/S0100-720320140050.0002
It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS).
This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI).
Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD.
These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.
Summary
Rev Bras Ginecol Obstet. 2014;36(4):157-162
DOI 10.1590/S0100-720320140050.0002
It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS).
This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI).
Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD.
These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.
Summary
Rev Bras Ginecol Obstet. 2012;34(5):215-220
DOI 10.1590/S0100-72032012000500005
PURPOSE: To evaluate factors associated with morbidities among Brazilian women aged 40-65 years and with 11 or more years of schooling. METHODS: A secondary analysis of a cross-sectional population-based study was conducted, using an anonymous self-report questionnaire completed by 377 women. Were evaluated, with this instrument, some morbidities (hypertension, diabetes, insomnia and depression) and sociodemographic, behavioral, clinical and reproductive factors. The association between morbidities and independent variables was evaluated by the Χ2 test. Multiple logistic regression analysis with stepwise selection criteria was used to select the major factors associated with morbid conditions. RESULTS: In the multiple regression analysis, insomnia was associated with bad/fair self-perception of health (OR=2.3) and nervousness (OR=5.1). Depression was associated with bad/fair self-perception of health (OR=3.7) and bad/poor leisure (OR=2.8). Hypertension was associated with obesity (OR=3.1) and being in postmenopausal (OR=2.6). Diabetes was associated with age above 50 years (OR=3.9) and obesity (OR=12.5). CONCLUSIONS: The prevalence of morbidities was high and a worse self-perception of health and obesity were the main factors associated with morbidity.
Summary
Rev Bras Ginecol Obstet. 2012;34(5):215-220
DOI 10.1590/S0100-72032012000500005
PURPOSE: To evaluate factors associated with morbidities among Brazilian women aged 40-65 years and with 11 or more years of schooling. METHODS: A secondary analysis of a cross-sectional population-based study was conducted, using an anonymous self-report questionnaire completed by 377 women. Were evaluated, with this instrument, some morbidities (hypertension, diabetes, insomnia and depression) and sociodemographic, behavioral, clinical and reproductive factors. The association between morbidities and independent variables was evaluated by the Χ2 test. Multiple logistic regression analysis with stepwise selection criteria was used to select the major factors associated with morbid conditions. RESULTS: In the multiple regression analysis, insomnia was associated with bad/fair self-perception of health (OR=2.3) and nervousness (OR=5.1). Depression was associated with bad/fair self-perception of health (OR=3.7) and bad/poor leisure (OR=2.8). Hypertension was associated with obesity (OR=3.1) and being in postmenopausal (OR=2.6). Diabetes was associated with age above 50 years (OR=3.9) and obesity (OR=12.5). CONCLUSIONS: The prevalence of morbidities was high and a worse self-perception of health and obesity were the main factors associated with morbidity.
Summary
Rev Bras Ginecol Obstet. 2013;35(6):243-248
DOI 10.1590/S0100-72032013000600002
PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy.
Summary
Rev Bras Ginecol Obstet. 2013;35(6):243-248
DOI 10.1590/S0100-72032013000600002
PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy.
Summary
Rev Bras Ginecol Obstet. 2013;35(7):295-300
DOI 10.1590/S0100-72032013000700003
PURPOSE: To evaluate the prevalence of women aged 50 years or more who are sexually active and their self-perception with respect to their sexual lives. Associated factors were also assessed. METHODS: A cross-sectional, population-based, self-reported household survey involving 622 Brazilian women aged 50 years or more. Sociodemographic, clinical, and behavioral factors were evaluated. The sexual life self-perception was classified as very good, good, fair, poor, or very poor. Data were analyzed using the χ² test, Fisher's exact test, and Poisson multiple regression analysis. Prevalence ratios and their 95% confidence intervals were also calculated. RESULTS: Of the women in this sample, 228 (36.7%) reported having a sexual life and, of these, 53.5% classified it as very good or good, while 46.5% considered it fair, poor, or very poor. The bivariate analysis indicated that being postmenopausal (p=0.025) and using natural remedies to treat the menopause (p=0.035) were factors associated with the woman classifying their sexual lives as fair, poor, or very poor. Multiple regression analysis showed that more women who had used or were currently using natural remedies for the menopause scored their sexual lives as fair, poor, or very poor. CONCLUSIONS: More than half the women aged 50 years or more in this study were not sexually active. A poorer sexual life self-perception was associated with the use of natural remedies to treat menopausal symptoms. This may indicate a need to improve the way in which these women are evaluated and treated. Women's assessment of their own sexual lives may prove a useful tool in clinical practice.
Summary
Rev Bras Ginecol Obstet. 2013;35(7):295-300
DOI 10.1590/S0100-72032013000700003
PURPOSE: To evaluate the prevalence of women aged 50 years or more who are sexually active and their self-perception with respect to their sexual lives. Associated factors were also assessed. METHODS: A cross-sectional, population-based, self-reported household survey involving 622 Brazilian women aged 50 years or more. Sociodemographic, clinical, and behavioral factors were evaluated. The sexual life self-perception was classified as very good, good, fair, poor, or very poor. Data were analyzed using the χ² test, Fisher's exact test, and Poisson multiple regression analysis. Prevalence ratios and their 95% confidence intervals were also calculated. RESULTS: Of the women in this sample, 228 (36.7%) reported having a sexual life and, of these, 53.5% classified it as very good or good, while 46.5% considered it fair, poor, or very poor. The bivariate analysis indicated that being postmenopausal (p=0.025) and using natural remedies to treat the menopause (p=0.035) were factors associated with the woman classifying their sexual lives as fair, poor, or very poor. Multiple regression analysis showed that more women who had used or were currently using natural remedies for the menopause scored their sexual lives as fair, poor, or very poor. CONCLUSIONS: More than half the women aged 50 years or more in this study were not sexually active. A poorer sexual life self-perception was associated with the use of natural remedies to treat menopausal symptoms. This may indicate a need to improve the way in which these women are evaluated and treated. Women's assessment of their own sexual lives may prove a useful tool in clinical practice.
Summary
Rev Bras Ginecol Obstet. 2012;34(7):335-342
DOI 10.1590/S0100-72032012000700008
PURPOSE: To evaluate whether climacteric women undergoing liver transplantation had higher prevalence of decreased bone mass than those without any liver disease. METHODS: A cross-sectional study with 48 women receiving follow-up care at a university hospital in Southeastern Brazil, from February 4th 2009 to January 5th 2011, was conducted. Of these women, 24 were 35 years or older and had undergone liver transplantation at least one year before study entry. The remaining 24 women had no liver disease and their ages and menstrual patterns were similar to those of transplanted patients. Laboratorial tests (follicle-stimulating hormone and estradiol) and bone density measurements of the lumbar spine and femur (equipment Hologic, Discovery WI) were performed. Statistical analysis was carried out by Fisher's exact test, simple Odds Ratio (OR), and multiple logistic regression. RESULTS: Mean age of the women included in the study was 52.8 (±10.7) years-old, 27.1% were premenopausal and 72.9% were peri/postmenopausal. Approximately 14.6% of these women exhibited osteoporosis and 35.4% had low bone mass. The following items were associated with decreased bone mass: being postmenopausal (OR=71.4; 95%CI 3.8 - 1,339.7; p<0.0001), current age over 49 years-old (OR=11.4; 95%CI 2.9 - 44.0; p=0.0002), and serum estradiol levels lower than 44.5 pg/mL (OR=18.3; 95%CI 3.4 - 97.0; p<0.0001). Having a history of liver transplantation was not associated with decreased bone mass (OR=1.4; 95%CI 0.4 - 4.3; p=0.56). CONCLUSION: Liver transplantation was not associated with decreased bone mass in this group of climacteric women.
Summary
Rev Bras Ginecol Obstet. 2012;34(7):335-342
DOI 10.1590/S0100-72032012000700008
PURPOSE: To evaluate whether climacteric women undergoing liver transplantation had higher prevalence of decreased bone mass than those without any liver disease. METHODS: A cross-sectional study with 48 women receiving follow-up care at a university hospital in Southeastern Brazil, from February 4th 2009 to January 5th 2011, was conducted. Of these women, 24 were 35 years or older and had undergone liver transplantation at least one year before study entry. The remaining 24 women had no liver disease and their ages and menstrual patterns were similar to those of transplanted patients. Laboratorial tests (follicle-stimulating hormone and estradiol) and bone density measurements of the lumbar spine and femur (equipment Hologic, Discovery WI) were performed. Statistical analysis was carried out by Fisher's exact test, simple Odds Ratio (OR), and multiple logistic regression. RESULTS: Mean age of the women included in the study was 52.8 (±10.7) years-old, 27.1% were premenopausal and 72.9% were peri/postmenopausal. Approximately 14.6% of these women exhibited osteoporosis and 35.4% had low bone mass. The following items were associated with decreased bone mass: being postmenopausal (OR=71.4; 95%CI 3.8 - 1,339.7; p<0.0001), current age over 49 years-old (OR=11.4; 95%CI 2.9 - 44.0; p=0.0002), and serum estradiol levels lower than 44.5 pg/mL (OR=18.3; 95%CI 3.4 - 97.0; p<0.0001). Having a history of liver transplantation was not associated with decreased bone mass (OR=1.4; 95%CI 0.4 - 4.3; p=0.56). CONCLUSION: Liver transplantation was not associated with decreased bone mass in this group of climacteric women.