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, , , , Summary
Rev Bras Ginecol Obstet. 2022;44(2):142-153
, , , , To examine the possible effects of adrenal prohormones in the prediction of clinical and metabolic abnormalities in women with polycystic ovary syndrome (PCOS).
The present study enrolled 299 normal cycling non-PCOS, 156 normoandrogenemic, and 474 hyperandrogenemic women with PCOS. Baseline characteristics were compared using a chi-squared test or analysis of variance (ANOVA) as appropriate. The roles of adrenal prohormones and their ratios with total testosterone in predicting co-occurring morbidities in women PCOS were evaluated using univariate and multivariate logistic regression analyses.
Adrenal hyperandrogenism per dehydroepiandrosterone sulfate (DHEAS) levels were found in 32% of women with PCOS. In non-PCOS women, dehydroepiandrosterone (DHEA) and its sulfate had no predictive role concerning clinical, anthropometric, and metabolic parameters. In PCOS women, mainly in the hyperandrogenemic group, DHEA showed to be a significant predictor against most anthropometric-metabolic index abnormalities (odds ratio [OR]=0.36-0.97; p<0.05), and an increase in triglycerides (TG) levels (OR=0.76; p=0.006). Dehydroepiandrosterone sulfate presented a few predictive effects regarding PCOS-associated disorders. In controls, DHEAS predicted against the increase in estimated average glucose (OR= 0.38; p=0.036). In the normoandrogenic group, it predicted against elevation in the waist/hip ratio (WHR) (OR= 0.59; p=0.042), and in hyperandrogenemic PCOS women, it predicted against abnormality in the conicity index (CI) (OR=0.31; p=0.028).
Dehydroepiandrosterone was shown to be a better predictor of abnormal anthropometric and biochemical parameters in women with PCOS than DHEAS. Thus, regarding adrenal prohormones, DHEA measurement, instead of DHEAS, should be preferred in PCOS management. The effects of androgen prohormones on the prediction of PCOS abnormalities are weak.
Summary
Rev Bras Ginecol Obstet. 2022;44(2):142-153
, , , , To examine the possible effects of adrenal prohormones in the prediction of clinical and metabolic abnormalities in women with polycystic ovary syndrome (PCOS).
The present study enrolled 299 normal cycling non-PCOS, 156 normoandrogenemic, and 474 hyperandrogenemic women with PCOS. Baseline characteristics were compared using a chi-squared test or analysis of variance (ANOVA) as appropriate. The roles of adrenal prohormones and their ratios with total testosterone in predicting co-occurring morbidities in women PCOS were evaluated using univariate and multivariate logistic regression analyses.
Adrenal hyperandrogenism per dehydroepiandrosterone sulfate (DHEAS) levels were found in 32% of women with PCOS. In non-PCOS women, dehydroepiandrosterone (DHEA) and its sulfate had no predictive role concerning clinical, anthropometric, and metabolic parameters. In PCOS women, mainly in the hyperandrogenemic group, DHEA showed to be a significant predictor against most anthropometric-metabolic index abnormalities (odds ratio [OR]=0.36-0.97; p<0.05), and an increase in triglycerides (TG) levels (OR=0.76; p=0.006). Dehydroepiandrosterone sulfate presented a few predictive effects regarding PCOS-associated disorders. In controls, DHEAS predicted against the increase in estimated average glucose (OR= 0.38; p=0.036). In the normoandrogenic group, it predicted against elevation in the waist/hip ratio (WHR) (OR= 0.59; p=0.042), and in hyperandrogenemic PCOS women, it predicted against abnormality in the conicity index (CI) (OR=0.31; p=0.028).
Dehydroepiandrosterone was shown to be a better predictor of abnormal anthropometric and biochemical parameters in women with PCOS than DHEAS. Thus, regarding adrenal prohormones, DHEA measurement, instead of DHEAS, should be preferred in PCOS management. The effects of androgen prohormones on the prediction of PCOS abnormalities are weak.
, Summary
Rev Bras Ginecol Obstet. 2019;41(3):183-190
, Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception.
Summary
Rev Bras Ginecol Obstet. 2019;41(3):183-190
, Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception.
Summary
Rev Bras Ginecol Obstet. 2006;28(4):251-263
DOI 10.1590/S0100-72032006000400008
The human chorionic gonadotropin (hCG) results from a non-covalent linkage of two subunits, alpha (alphahCG) and beta (betahCG), separately synthesized by normal trophoblastic tissue, hydatiform mole, choriocarcinoma, pituitary cells, and tumoral tissues of different histologic types. The peptide chain and its further glycosylation in the secretory cell involves the complex action of different enzymes. This complexity results in the secretion of heterogeneous molecular forms. The different molecules might be found in serum, urine and amniotic fluid of pregnant women; serum, urine, and vesicles of patients with hydatiform mole or choriocarcinoma and in other biological fluids of normal non-pregnant women and men or patients with different embryonary types of cancer. Both the intact hCG molecule and its free subunits and the hyperglycosylated (H-hCG), nicked (N-hCG) and core fragment of betahCG (CF- betahCG) variant forms have relevant clinical use. Depending on the prevalent molecular form or the proportion of the variant form to the intact hCG in a determined clinical situation the measurement of a specific molecule is chosen. This review analyzes the clinical use of hCG and its related molecules in the early detection of ectopic pregnancy or patients with higher risk of abortion, in the identification of an embryo or fetus with chromosomal abnormalities, and in the evaluation of risk for preeclampsia or fetal growth restriction. The review also examines the use of hCG and variant forms as tumor markers. It is concluded that it is useful to measure hCG and/or related molecules in clinical practice, but difficulties in developing and achievement of more sensitive and specific new assays limit their use.
Summary
Rev Bras Ginecol Obstet. 2006;28(4):251-263
DOI 10.1590/S0100-72032006000400008
The human chorionic gonadotropin (hCG) results from a non-covalent linkage of two subunits, alpha (alphahCG) and beta (betahCG), separately synthesized by normal trophoblastic tissue, hydatiform mole, choriocarcinoma, pituitary cells, and tumoral tissues of different histologic types. The peptide chain and its further glycosylation in the secretory cell involves the complex action of different enzymes. This complexity results in the secretion of heterogeneous molecular forms. The different molecules might be found in serum, urine and amniotic fluid of pregnant women; serum, urine, and vesicles of patients with hydatiform mole or choriocarcinoma and in other biological fluids of normal non-pregnant women and men or patients with different embryonary types of cancer. Both the intact hCG molecule and its free subunits and the hyperglycosylated (H-hCG), nicked (N-hCG) and core fragment of betahCG (CF- betahCG) variant forms have relevant clinical use. Depending on the prevalent molecular form or the proportion of the variant form to the intact hCG in a determined clinical situation the measurement of a specific molecule is chosen. This review analyzes the clinical use of hCG and its related molecules in the early detection of ectopic pregnancy or patients with higher risk of abortion, in the identification of an embryo or fetus with chromosomal abnormalities, and in the evaluation of risk for preeclampsia or fetal growth restriction. The review also examines the use of hCG and variant forms as tumor markers. It is concluded that it is useful to measure hCG and/or related molecules in clinical practice, but difficulties in developing and achievement of more sensitive and specific new assays limit their use.
Summary
Rev Bras Ginecol Obstet. 2020;42(1):26-34
To assess the construct and criterion validity of the Postmenopause Sexuality Questionnaire (PMSQ).
The present methodological questionnaire validation study included postmenopausal women. The construct validity was tested by factor analysis and the criterion validity was performed using the correlation between the PMSQ and the Female Sexual Function Index (FSFI). The ROC curve was used to verify sensitivity, specificity and to determine the cutoff point of the PMSQ.
A total of 181 women with amean age of 56.4 ± 5.7 years old were evaluated. The exploratory factor analysis showed that the PMSQ presented Kaiser test = 0.88 and χ2 = 3293.7 (p < 0.001), commonalities ≥ 0.5, and extraction of 9 factors with eigenvalue ≥ 1; explaining 66.3% of the total variance. The PMSQ presented factor loadings between 0.4 and 0.8. A strong correlation between the 2 questionnaires (r = 0.79; p = 0.000) was shown. The cutoff point of the PMSQ was ≤ 55.5, assuming 87.9% sensitivity and 78.9% specificity (p < 0.001).
Since the PMSQ showed a strong correlation with the FSFI questionnaire, it presented good psychometric properties to assess the sexuality in postmenopausal women. Based on these results, the PMSQ could be widely tested as a specific instrument to examine the sexual function in postmenopausal women. Future studies, designed to examine the PMSQ instrument in different populations, are needed.
Summary
Rev Bras Ginecol Obstet. 2020;42(1):26-34
To assess the construct and criterion validity of the Postmenopause Sexuality Questionnaire (PMSQ).
The present methodological questionnaire validation study included postmenopausal women. The construct validity was tested by factor analysis and the criterion validity was performed using the correlation between the PMSQ and the Female Sexual Function Index (FSFI). The ROC curve was used to verify sensitivity, specificity and to determine the cutoff point of the PMSQ.
A total of 181 women with amean age of 56.4 ± 5.7 years old were evaluated. The exploratory factor analysis showed that the PMSQ presented Kaiser test = 0.88 and χ2 = 3293.7 (p < 0.001), commonalities ≥ 0.5, and extraction of 9 factors with eigenvalue ≥ 1; explaining 66.3% of the total variance. The PMSQ presented factor loadings between 0.4 and 0.8. A strong correlation between the 2 questionnaires (r = 0.79; p = 0.000) was shown. The cutoff point of the PMSQ was ≤ 55.5, assuming 87.9% sensitivity and 78.9% specificity (p < 0.001).
Since the PMSQ showed a strong correlation with the FSFI questionnaire, it presented good psychometric properties to assess the sexuality in postmenopausal women. Based on these results, the PMSQ could be widely tested as a specific instrument to examine the sexual function in postmenopausal women. Future studies, designed to examine the PMSQ instrument in different populations, are needed.
Summary
Rev Bras Ginecol Obstet. 2018;40(5):275-280
Gender incongruence is defined as a condition in which an individual self-identifies and desires to have physical characteristics and social roles that connote the opposite biological sex. Gender dysphoria is when an individual displays the anxiety and/or depression disorders that result from the incongruity between the gender identity and the biological sex. The gender affirmation process must be performed by a multidisciplinary team. The main goal of the hormone treatment is to start the development of male physical characteristics by means of testosterone administration that may be offered to transgender men who are 18 years old or over. The use of testosterone is usually well tolerated and improves the quality of life. However, there is still lack of evidence regarding the effects and risks of the long-term use of this hormone. Many different pharmacological formulations have been used in the transsexualization process. The most commonly used formulation is the intramuscular testosterone esters in a short-term release injection, followed by testosterone cypionate or testosterone enanthate. In the majority of testosterone therapy protocols, the male physical characteristics can be seen in almost all users after 6 months of therapy, and themaximum virilization effects are usually achieved after 3 to 5 years of regular use of the hormone. To minimize risks, plasmatic testosterone levels should be kept within male physiological ranges (300 to 1,000 ng/dl) during hormonal treatment. It is recommended that transgender men under androgen therapy be monitored every 3 months during the 1st year of treatment and then, every 6 to 12 months.
Summary
Rev Bras Ginecol Obstet. 2018;40(5):275-280
Gender incongruence is defined as a condition in which an individual self-identifies and desires to have physical characteristics and social roles that connote the opposite biological sex. Gender dysphoria is when an individual displays the anxiety and/or depression disorders that result from the incongruity between the gender identity and the biological sex. The gender affirmation process must be performed by a multidisciplinary team. The main goal of the hormone treatment is to start the development of male physical characteristics by means of testosterone administration that may be offered to transgender men who are 18 years old or over. The use of testosterone is usually well tolerated and improves the quality of life. However, there is still lack of evidence regarding the effects and risks of the long-term use of this hormone. Many different pharmacological formulations have been used in the transsexualization process. The most commonly used formulation is the intramuscular testosterone esters in a short-term release injection, followed by testosterone cypionate or testosterone enanthate. In the majority of testosterone therapy protocols, the male physical characteristics can be seen in almost all users after 6 months of therapy, and themaximum virilization effects are usually achieved after 3 to 5 years of regular use of the hormone. To minimize risks, plasmatic testosterone levels should be kept within male physiological ranges (300 to 1,000 ng/dl) during hormonal treatment. It is recommended that transgender men under androgen therapy be monitored every 3 months during the 1st year of treatment and then, every 6 to 12 months.
Summary
Rev Bras Ginecol Obstet. 2009;31(6):293-299
DOI 10.1590/S0100-72032009000600005
PURPOSE: to generate and validate a proper questionnaire to evaluate the sexual function in post-menopause women. METHODS: 251 women, within 2 to 15 years postmenopause, were included in the study. Questionnaire's reproductibility/reliability was evaluated by Pearson, intraclass and Lin's correlation coefficients. The internal consistance was examined by the Cronbach's alpha coefficient. Classical item theory guidelines were used for face, content and construct validation. RESULTS: an instrument with 57 items and nine domains was generated. Fourteen questions (24.5%) were eliminated by either poor correlation with the scale or low discriminative power. The final version with 43 items has shown good reproductibility (r=0.719, 95%CI=0.690-0.750; pc=0.887; 95%CI=0.850-0.930; p<0.001). Internal consistance was also adequate (α=0.951). About 60% of the reviewers have confirmed face and content validation. The construct validation was assessed by the Cronbach alpha 0.951. CONCLUSIONS: it was concluded that the new instrument is appropriate for evaluating the sexual function in post-menopause women.
Summary
Rev Bras Ginecol Obstet. 2009;31(6):293-299
DOI 10.1590/S0100-72032009000600005
PURPOSE: to generate and validate a proper questionnaire to evaluate the sexual function in post-menopause women. METHODS: 251 women, within 2 to 15 years postmenopause, were included in the study. Questionnaire's reproductibility/reliability was evaluated by Pearson, intraclass and Lin's correlation coefficients. The internal consistance was examined by the Cronbach's alpha coefficient. Classical item theory guidelines were used for face, content and construct validation. RESULTS: an instrument with 57 items and nine domains was generated. Fourteen questions (24.5%) were eliminated by either poor correlation with the scale or low discriminative power. The final version with 43 items has shown good reproductibility (r=0.719, 95%CI=0.690-0.750; pc=0.887; 95%CI=0.850-0.930; p<0.001). Internal consistance was also adequate (α=0.951). About 60% of the reviewers have confirmed face and content validation. The construct validation was assessed by the Cronbach alpha 0.951. CONCLUSIONS: it was concluded that the new instrument is appropriate for evaluating the sexual function in post-menopause women.
Summary
Rev Bras Ginecol Obstet. 2010;32(8):381-385
DOI 10.1590/S0100-72032010000800004
PURPOSE: to examine the association between cytogenetic characteristics and clinical and epidemiological changes in patients with Turner syndrome (TS). METHODS: Forty-two patients were included. Data were collected using a standardized questionnaire in interviews conducted with the responsible person and, when possible, with the patient. A detailed physical examination was performed. The association between karyotype, stigmata and clinical disorders were examined using the χ2 test. RESULTS: Sixty-four percent of TS patients were 45,X; 26,2% 45,X/46,X;7% 45,X/46Xi(Xq), and 2,3% 45,X/46,X,Del(Xq). Regardless of the karyotype, all patients had short stature. Low hair implantation was more frequent in patients with 45,X (p=0.03). Cardiovascular abnormalities (45%), otitis (43%), thyroid dysfunction (33%) and hypertension (26.6%) were the most frequent clinical disorders, but without correlation with the karyotype. Anthropometric measurements revealed a positive linear correlation of waist and hip circumference with age (r=0.9, p=0.01). Thirty-one patients (74%) were using or had previously used growth hormone (43%), sex steroids (30%), thyroxine (11.9%) or oxandrolone (9.5%). Comparison between gestational age at birth and learning difficulties showed a prevalence ratio of 1.71 (p>0.05). CONCLUSION: Low hair implantation is the most prevalent stigma in patients with a 45,X karyotype and the most common clinical changes were cardiovascular problems, otitis, thyroid dysfunction and hypertension; however, they did not show any correlation with the karyotype.
Summary
Rev Bras Ginecol Obstet. 2010;32(8):381-385
DOI 10.1590/S0100-72032010000800004
PURPOSE: to examine the association between cytogenetic characteristics and clinical and epidemiological changes in patients with Turner syndrome (TS). METHODS: Forty-two patients were included. Data were collected using a standardized questionnaire in interviews conducted with the responsible person and, when possible, with the patient. A detailed physical examination was performed. The association between karyotype, stigmata and clinical disorders were examined using the χ2 test. RESULTS: Sixty-four percent of TS patients were 45,X; 26,2% 45,X/46,X;7% 45,X/46Xi(Xq), and 2,3% 45,X/46,X,Del(Xq). Regardless of the karyotype, all patients had short stature. Low hair implantation was more frequent in patients with 45,X (p=0.03). Cardiovascular abnormalities (45%), otitis (43%), thyroid dysfunction (33%) and hypertension (26.6%) were the most frequent clinical disorders, but without correlation with the karyotype. Anthropometric measurements revealed a positive linear correlation of waist and hip circumference with age (r=0.9, p=0.01). Thirty-one patients (74%) were using or had previously used growth hormone (43%), sex steroids (30%), thyroxine (11.9%) or oxandrolone (9.5%). Comparison between gestational age at birth and learning difficulties showed a prevalence ratio of 1.71 (p>0.05). CONCLUSION: Low hair implantation is the most prevalent stigma in patients with a 45,X karyotype and the most common clinical changes were cardiovascular problems, otitis, thyroid dysfunction and hypertension; however, they did not show any correlation with the karyotype.
Summary
Rev Bras Ginecol Obstet. 2002;24(7):441-446
DOI 10.1590/S0100-72032002000700003
Purpose: to evaluate the reproductive aspects in climacteric women of the Family Health Program in Cuiabá. Methods: it was a cross-sectional study including 354 women, with ages between 40 and 65 years, attended at the Central-Western District Family Health Program of Cuiabá. A pretested questionnaire with specific questions regarding the present study was used. Data were analyzed using the Z test and chi² test for trend. The mean age of the 354 women was 49.7±7 years and the median 48 years. A total of 243 (68.6%) were born in Mato Grosso, and the others were migrants from different states. Most were married (65.8%), white (48.0%), catholic (73.4%), and had low schooling: 62.4% did not finish the elementary school and 19.2% were illiterate. About 84% were occupied only in domestic activities, and more than a half (58.2%) belonged to a lower social class. Results: the average number of pregnancies was 5.4±3.3. Nearly 5% were nulliparous and 7% had more than ten children. Almost 50% had the first pregnancy in adolescence and 14% after the age of 40 years. A total of 229 women (65%) were submitted to pelvic surgery: 78% to tubal sterilization, 20% to hysterectomy, and 7% to bilateral oophorectomy. Menopause was due to hysterectomy/oophorectomy in 25% of the women. Conclusion: almost 65% of the women were submitted to a pelvic surgery. The most frequent surgery was tubal sterilization followed by total hysterectomy.
Summary
Rev Bras Ginecol Obstet. 2002;24(7):441-446
DOI 10.1590/S0100-72032002000700003
Purpose: to evaluate the reproductive aspects in climacteric women of the Family Health Program in Cuiabá. Methods: it was a cross-sectional study including 354 women, with ages between 40 and 65 years, attended at the Central-Western District Family Health Program of Cuiabá. A pretested questionnaire with specific questions regarding the present study was used. Data were analyzed using the Z test and chi² test for trend. The mean age of the 354 women was 49.7±7 years and the median 48 years. A total of 243 (68.6%) were born in Mato Grosso, and the others were migrants from different states. Most were married (65.8%), white (48.0%), catholic (73.4%), and had low schooling: 62.4% did not finish the elementary school and 19.2% were illiterate. About 84% were occupied only in domestic activities, and more than a half (58.2%) belonged to a lower social class. Results: the average number of pregnancies was 5.4±3.3. Nearly 5% were nulliparous and 7% had more than ten children. Almost 50% had the first pregnancy in adolescence and 14% after the age of 40 years. A total of 229 women (65%) were submitted to pelvic surgery: 78% to tubal sterilization, 20% to hysterectomy, and 7% to bilateral oophorectomy. Menopause was due to hysterectomy/oophorectomy in 25% of the women. Conclusion: almost 65% of the women were submitted to a pelvic surgery. The most frequent surgery was tubal sterilization followed by total hysterectomy.