Isoformas de FSH, Inbinas B e PRO-'alfa'C em usuarias de acetato de medroxiprogesterona de deposito como contraceptivo na transição para a menopausa

Orientador: Luis BahamondesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Introdução: Este foi um estudo sobre a utilidade clínica da dosagem de FSH em mulheres que utilizavam o contraceptivo acetato de medroxiprogesterona de depósito (AMPD) no período da transição para menopausa. O objetivo deste estudo foi determinar o perfil sérico das isoformas do hormônio folículo-estimulante (FSH), das inibinas B e pró-aC em mulheres com idade igual ou superior a 45 anos, que estavam em amenorréia secundária ao uso de AMPD. Materiais e Métodos: Foram incluídas no estudo 11 usuárias de AMPD, com idade superior a 45 anos e que estavam em amenorréia há mais de 12 meses (grupo de estudo). Estas mulheres foram pareadas com 11 não usuárias por idade (± 1 ano) e peso (± 2kg). No grupo de estudo, as amostras de sangue foram coletadas imediatamente antes da injeção de AMPD (90 ± 5 dias da última injeção) e no grupo das não usuárias no nono dia do ciclo (± 1 dia). Foram realizadas dosagens séricas de estradiol, FSH, de inibinas B e pró-aC e determinação das isoformas de FSH. Resultados: As usuárias de AMPD tiveram níveis significativamente maiores de FSH e menores de estradiol, inibinas B e pró-aC do que as não usuárias (p<0,01). Não houve diferença na proporção de FSH isolada no pH abaixo de 4,1. A distribuição das isoformas de FSH mostrou similar proporção de UB (unbound), WB (weakly bound) e FB (firmly bound). Foram observadas correlações inversa (r= -0,48, p<0,05) e direta (r= 0,52, p< 0,05) entre idade e as isoformas de FSH UB e FB, respectivamente. Conclusões: As usuárias e não usuárias de AMPD na perimenopausa têm perfil de isoformas de FSH semelhante, apesar de as usuárias apresentarem menores níveis de estradiol. O ambiente hormonal provavelmente não foi determinante na regulação do polimorfismo do FSH e da sua atividade hormonal na transição para a menopausa. A dosagem de FSH por RIA em usuárias de AMPD para diagnóstico de pós-menopausa precisa ser reconsideradaAbstract: Background: There is a controversy about the possible clinical utility of FSH levels in users of the injectable contraceptive depot medroxyprogesterone acetate (AMPD) who are in amenorrhoea and in the menopausal transition. The objective of this study was to evaluate serum FSH polymorphism and inhibin B levels in long-term users of AMPD who were over 45 years old and in amenorrhoea. Materials and Methods: Eleven users of AMPD that were in amenorrhoea, matched with a group of 11 non-users by age (± 1 year) and weight (± 2kg). All women were 45 years old or older. Blood samples were collected at the day in which a new ampoule was administered (90 ± 5 days from the last ampoule) in the group of users and on day 9th (± 1 day) of the menstrual cycle in the group of non-users. Oestradiol, FSH, Inhibin B, pro-aC levels and the serum profile of FSH isoforms were determined. Results: AMPD users showed significantly higher level of FSH and lower levels of estradiol, inhibin B and Pro-aC than non-users (p<0.01). When the proportion of FSH isolated below pH 4.1 was analysed there were no differences between the two studied groups. The distribution of FSH isoforms showed similar proportion of unbound, weakly bound, and firmly bound FSH isoforms in women of both groups. A significant inverse (r= -0.48, p<0.05) and direct (r= 0.52, p< 0.05) correlation were observed between age and unbound and firmly bound FSH isoforms respectively. Conclusion: Women who were in the menopausal transition users and non-users of AMPD have a similar profile of FSH polymorphism even with the marked hypoestrogenism presented by users. The hormonal milieu probably is unable to regulate FSH polymorphism and hence hormonal activity in the menopausal transition. The determination of FSH by RIA in users of AMPD to determine if a women was or not in the post menopause should be reconsidered.MestradoTocoginecologiaMestre em Tocoginecologi

Densidade mineral ossea em usuarias de contraceptivos injetaveis combinados

Orientador: Luis Guillermo BahamondesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: O objetivo deste estudo foi avaliar a densidade mineral óssea (DMO) em usuárias de dois tipos de contraceptivos injetáveis combinados (CIC) mensais e comparar com controles. SUJEITOS E MÉTODOS: Estudo de corte transversal com 97 mulheres de 20 a 45 anos, usuárias de CIC com 25mg de acetato de medroxiprogesterona e 5mg de cipionato de estradiol (AMP/CypE2, Cyclofemina) por 12 a 82 meses (n=64) ou 50mg de enantato de norestisterona e 5mg de valerato de estradiol (NET-EN/ValE2, Mesigyna) por 12 a 60 meses (n=33), pareadas por idade (± 1ano) e índice de massa corpórea (IMC, kg/m2) (± 1) com usuárias de DIU TCu 380A como grupo de controle. A DMO foi avaliada nas regiões distal e ultradistal do rádio, no braço não dominante, utilizando a técnica de absorciometria óssea, com feixe duplo de raios-X (DXA). RESULTADOS: A DMO no midshaft da ulna foi de 0,457 ± 0,007 nas usuárias de Cyclofemina® e 0,465 ± 0,007 nos controles. Nas usuárias de Mesigyna® a DMO foi 0,463 ± 0,008 e 0,458 ± 0,009 nos controles. No rádio distal, a DMO foi 0,399 ± 0,011 e 0,401 ± 0,010 nas usuárias de Cyclofemina® e controles, e 0,400 ± 0,009 e 0,388 ± 0,10 nas usuárias de Mesigyna® e controles, respectivamente. Não houve diferença na DMO entre as usuárias de CIC e o grupo de controle. Não houve diferença entre as usuárias dos dois tipos de CIC e também não houve diferença entre as usuárias de CIC com relação ao tempo de uso menor ou igual e a partir de três anos. CONCLUSÕES: Mulheres com idade entre 20 e 45 anos, usuárias de CIC com AMP/CypE2 ou NET-EN/ValE2, apresentaram DMO similar entre os dois tipos de CIC e controles (usuárias do DIU TCu 380A), quando pareadas por idade e IMCAbstract: BACKGROUND: The objective of this study was to compare bone mineral density (BMD) between users of two kinds of once-a-month combined injectable contraceptives (CIC) and controls. SUBJECTS AND METHODS: This crosssectional study included 97 women of 20 to 45 years of age, using CIC containing either 25 mg of medroxyprogesterone acetate and 5 mg of estradiol cypionate (MPA/E2Cyp, Cyclofemina) (for 12 to 82 months) or 50 mg of norethindrone enanthate and 5mg of estradiol valerate (NET-EN/E2Val, Mesigyna) (for 12 to 60 months) matched by age (± 1 year) and body mass index (BMI, kg/m2) (± 1) with users of the TCu 380A intrauterine device as controls. BMD was evaluated at the midshaft of the ulna and at the distal section of the radius of the nondominant forearm using double X-ray absorptiometry. RESULTS: The BMD at the midshaft of the ulna was 0.457 ± 0.007 and 0.465 ± 0.007 in the MPA/oE2Cyp group and controls, respectively, and 0.463 ± 0.008 and 0.458 ± 0.009 in the NET-EN/oE2Val group and controls, respectively. At the distal radius, the BMD was 0.399 ± 0.011 and 0.401 ± 0.010 in users of MPA/oE2Cyp and controls, respectively and 0.400 ± 0.009 and 0.388 ± 0.010 in users of NET-EN/oE2Val and controls, respectively. There were no differences in BMD between users of either CIC and non-users at either section of the forearm studied. There were also no differences in BMD between users of the two CIC at either section of the forearm. CONCLUSIONS: Women aged 20 to 45 years old, currently using one of these two kinds of CIC, presented similar BMD to controls paired by age and BMI (kg/m2) and similar between both CICDoutoradoTocoginecologiaDoutor em Tocoginecologi

Inclusion of symptoms in the discrimination between benign and malignant adnexal masses

PURPOSE: To assess the association between clinical symptoms and the diagnosis of malignancy in women with adnexal tumors who underwent surgery. METHODS: Cross-sectional study, in which 105 women with adnexal tumors and indication for laparotomy/laparoscopy were included. All women were treated at a teaching hospital in the state of São Paulo between November 2009 and March 2011. All patients underwent a structured interview about the occurrence of 18 symptoms associated with ovarian cancer. The interview included the severity, frequency, and duration of these symptoms in the 12 months prior to the first medical consultation. The CA125 levels and the ultrasound classification of the tumors were also evaluated. We calculated for each symptom the prevalence ratio with 95% confidence intervals. The golden-standard was the result of the pathological examination of the surgical specimens. RESULTS: Of the 105 women included, 75 (71.4%) had benign tumors and 30 (28.6%) had malignant ones. In women with malignant tumors, the most frequent symptoms were: abdominal bloating (70%), increased abdominal size (67%), pelvic pain (60%), menstrual irregularity (60%), swelling (53%), abdominal pain (50%), backache (50%), and early repletion (50%). Women with benign tumors showed essentially pelvic pain (61%), menstrual irregularities (61%), and abdominal swelling (47%). Symptoms significantly associated with malignancy were: bloating (PR=2.0; 95%CI 1.01 - 3.94), increased abdominal size (PR=2.16; 95%CI 1.12 - 4.16), backache (RP=1.97; 95%CI 1.09 - 3.55), swelling (PR=2.25; 95%CI 1.25 - 4.07), early repletion (RP=2.06; 95%CI 1.14 - 3.70), abdominal mass (PR=1.83; 95%CI 1.01 - 3.30), eating difficulties (PR=1.98; 95%CI 1.10 - 3.56), and postmenopausal bleeding (PR=2.91; 95%CI 1.55 - 5.44). The presence of pelvic pain, constipation, dyspareunia, fatigue, abdominal pain, nausea or vomiting, menstrual irregularity, weight loss, diarrhea, and bleeding after intercourse was similar in both groups. CONCLUSIONS: In women with adnexal tumors including indication of surgical treatment, the preoperative evaluation of symptoms may help predicting malignancy.OBJETIVO: Avaliar a associação entre sintomas clínicos e malignidade em mulheres com tumores anexiais, submetidas à cirurgia. MÉTODOS: Estudo de corte transversal com coleta prospectiva, no qual foram incluídas 105 mulheres, atendidas em um hospital de ensino do Estado de São Paulo de novembro de 2009 a março de 2011, devido ao tumor anexial e à indicação de laparotomia/laparoscopia. Todas foram submetidas a uma entrevista estruturada sobre a ocorrência de 18 sintomas associados ao câncer de ovário. A entrevista incluiu gravidade, frequência e duração dos sintomas nos 12 meses prévios à primeira consulta. Também foram avaliados os níveis de CA125 e a classificação ultrassonográfica. Foi calculada para cada sintoma a razão de prevalência com intervalo de confiança de 95%. O padrão-ouro foi o resultado do exame anatomopatológico das peças cirúrgicas. RESULTADOS: Das 105 mulheres incluídas, 75 (71,4%) apresentaram tumores benignos e 30 (28,6%), malignos. Em mulheres com tumores malignos, os sintomas foram mais frequentes, dentre eles: inchaço abdominal (70%), aumento do volume abdominal (67%), dor pélvica (60%), irregularidade menstrual (60%), empachamento (53%), dor abdominal (50%), dor nas costas (50%) e saciedade precoce (50%). As mulheres com tumores benignos apresentaram essencialmente dor pélvica (61%), irregularidade menstrual (61%) e inchaço abdominal (47%). Os sintomas significativamente associados com malignidade foram: sensação de inchaço abdominal (RP=2,0; IC95% 1,01 - 3,94), aumento objetivo do volume abdominal (RP=2,16; IC95% 1,12 - 4,16), dor nas costas (RP=1,97; IC95% 1,09 - 3,55), empachamento (RP=2,25; IC95% 1,25 - 4,07), saciedade precoce (RP=2,06; IC95% 1,14 - 3,70), massa abdominal (RP=1,83; IC95% 1,01 - 3,30), dificuldade para deglutir (RP=1,98; IC95% 1,10 - 3,56) e sangramento pós-menopausa (RP=2,91; IC95% 1,55 - 5,44). A presença de dor pélvica, constipação, dispareunia, fadiga, dor abdominal, náusea e/ou vômito, irregularidade menstrual, perda de peso, diarreia e sinusorragia foram semelhantes nos dois grupos. CONCLUSÕES: Em mulheres com tumores anexiais com indicação cirúrgica, a avaliação pré-operatória dos sintomas pode auxiliar na predição da malignidade.51151

Efficacy of fractional CO2 laser, promestriene, and vaginal lubricant in the treatment of urinary symptoms in postmenopausal women : a randomized clinical trialal Women: A Randomized Clinical Trial

Evaluating the efficacy of the fractional CO2 laser, promestriene, and vaginal lubricant to treat urinary symptoms in women with genitourinary syndrome of menopause.We conducted a randomized clinical trial with 72 postmenopausal women aged 50 years or older. The participants were randomized to one intervention each in three treatment groups fractional CO2 laser, promestriene, and vaginal lubricant. Urinary symptoms were assessed prior to treatment and 2 weeks after treatment completion using validated questionnaires, the International Consultation on Incontinence Questionnaire (ICIQ‐UI SF), and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ‐OAB).There was a significant reduction in the total ICIQ‐UI SF score in the intragroup comparison (baseline vs. week 14) of the CO2 laser group (P = 0.004). This group also showed a statistically significant reduction in nocturia (1.33 ± 0.87 vs. 1.00 ± 0.76, respectively; P = 0.031). In the intergroup comparison after treatment, nocturia in the lubricant group had worsened compared with that of the other two groups (P = 0.002). Regarding the total ICIQ‐OAB score, the results of the CO2 laser group were superior to those of the lubricant group in the intergroup comparison (7.76 ± 3.36, P = 0.020; analysis of variance P = 0.038).The results were significantly different between the intravaginal fractional CO2 laser and topical estrogen groups for treating urinary symptoms related to the genitourinary syndrome of menopause. Further controlled and randomized studies are needed. Lasers Surg. Med

Comparison between two methods of the immediate post-placental insertion of copper intrauterine device in vaginal birth—a protocol for a randomized clinical trial

Abstract Background Ensuring effective and long-term contraception in the immediate postpartum period is an effective strategy for reducing unplanned pregnancies. In the meantime, the intrauterine device (IUD) is an excellent option. The aim of our study was to evaluate the best way to insert post-placental IUDs in the immediate postpartum period. Discomfort during insertion, expulsion rate, uterine perforation rate, and proper positioning 40–60 days postpartum will be analyzed. Methods Randomized, controlled, open clinical trial. The study group will be composed of women between 18 and 43 years old who are admitted for vaginal birth at the Women’s Hospital of the State University of Campinas and who wish to use the IUD as a contraceptive method. The sample will be randomized into two insertion groups: manual and forceps. To calculate the sample size, the method of comparing the proportion between 2 groups was used, setting the level of significance alpha at 5% (alpha=0.05) and the power of the sample at 80% (beta=0.20). Based on the results, it was estimated that a sample of n=186 women (n=93 with manual insertion and n=93 with forceps) would be representative for comparison of expulsion between the 2 groups. All participants will undergo a postpartum consultation 40–60 days after birth with transvaginal ultrasound to assess the proper placement of the IUD. Discussion Insertion of an IUD in the immediate postpartum period has been considered a good option to increase coverage and access to contraception, and its benefit outweighs the inconvenience of a higher expulsion rate. Trial registration This study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 50497321.4.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC) (number RBR-4j62jv6). This is the first version of the study protocol approved on 11/12/2021 prior to the start of participant recruitment

Neoplasia Intra-epitelial Vulvar: análise Clinicopatológica

Objetivo: investigar alguns aspectos epidemiológicos, clínicos e patológicos dos vários graus de neoplasia intra-epitelial vilvar (NIV) e sua relação com o papilomavírus humano (HPV). Métodos: foram analisados os prontuários de 46 mulheres atendidas no Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas de janeiro de 1986 a dezembro de 1997. Para análise estatística foram utilizados os testes do chi2, com correção de Yates quando necessário, e exato de Fisher. Em relação à gravidade da lesão vulvar, seis mulheres apresentavam NIV 1, seis NIV 2 e 34 NIV 3. Resultados: A idade, estado menstrual e idade da atividade sexual não estiveram relacionados com a gravidade da NIV, porém, as mulheres com mais de um parceiro sexual mostraram uma tendência maior a apresentar NIV 3 (p=0,090). O tabagismo esteve significativamente associado à gravidade da lesão vulvar (p= 0,031). O HPV foi mais freqüente nas mulheres com idade inferior a 35 anos (p=0,005) e naquelas com múltiplas lesões (p=0,089). Embora o número não tenha mostrado relação com a gravidade da NIV (p=0,703), lesões maiores que 2 cm estiveram significativamente associadas com NIV 3 (p=0,009). O tratamento mais utilizado para NIV 3 foi cirúrgico, com exérese ou vulvectomia simples. Entre as oito mulheres que apresentaram recidiva, apenas uma era portadora de NIV 2. Conclusões: Entre as mulheres com NIV, as fumantes e com mais de um parceiro sexual apresentaram lesões mais graves. A presença de HPV foi maior nas pacientes jovens com múltiplas lesões. Mulheres com NIV 3 apresentaram lesões maiores que 2 cm e uma alta taxa de recidiva, independentemente do tratamento utilizado

Fecal Incontinence or Pelvic Organ Prolapse Among Women with Premature Ovarian Insufficiency

Objectives To assess the status of the pelvic floor muscle (PFM) of premature ovarian insufficiency women (POI women) and the incidence of fecal incontinence (FI) and pelvic organ prolapse (POP). Methods A secondary analysis of a cross-sectional study with 150 women with POI was performed. Pelvic floor muscle assessment was performed with the PERFECT scale. The subscales POPDI-6 and CRADI-8 of the questionnaire Pelvic Floor Distress Inventory-20 (PFDI-20) were used for pelvic floor symptoms focused on FI and POP. Moreover, FI and POP were also assessed as dichotomous variables (yes/no). Results Women with FI and POP did not present differences in the PFM assessment across P (p = 0.61), E (p = 0.78), R (p = 0.22), and F (p = 0.79) variables when compared with women with POI; no differences were also seen between women with and without POP according the pelvic muscles: P (p = 0.91), E (p = 0.99), R (p = 0.62), and F (p = 0.10). Women with FI and POP presented higher scores in all PFDI-20 subscales and total score when compared with the control group (p < 0.05). Conclusions Pelvic floor muscle assessment within POI women with or without FI or POP did not differ. However, PF symptoms are more severe in the FI or POP groups

Subclinical Hypothyroidism In Young Women With Polycystic Ovary Syndrome: An Analysis Of Clinical, Hormonal, And Metabolic Parameters.

To analyze the relationship between selected clinical and metabolic parameters in young women with polycystic ovary syndrome (PCOS) and normal thyroid function or subclinical hypothyroidism (SCH). A cross-sectional cohort study. Tertiary care clinic. Women diagnosed with PCOS according to the Rotterdam criteria (n = 168). Clinical, hormonal, and metabolic parameters were evaluated. SCH was defined as TSH levels of 4.5-10 mIU/L. Separately, PCOS and SCH exert adverse effects on metabolic parameters; however, in conjunction their effect is unclear. This study evaluated whether SCH in women with PCOS affects clinical, hormonal, and metabolic parameters. The mean age of the 168 women was 24 ± 5.8 years. Mean body mass index was 33.4 ± 8.2 kg/m(2). Thyroid function was normal in 149 women, and 19 had SCH. Only serum low-density lipoprotein cholesterol and PRL levels were significantly higher in the women with SCH (122.6 ± 25.6 mg/dL and 17.7 ± 7.7 ng/mL, respectively) compared with those with normal thyroid function (105.6 ± 33 mg/dL and 14 ± 10.3 ng/mL, respectively). In young women with PCOS, SCH is associated with higher low-density lipoprotein cholesterol levels, albeit with no changes in other lipid profile parameters, insulin resistance, or phenotypic manifestations. This study adds to current evidence supporting an association between PCOS and SCH.99588-9

Polycystic Ovary Syndrome And Chronic Autoimmune Thyroiditis.

Polycystic ovary syndrome (PCOS) has been associated with an autoimmune origin, either per se or favoring the onset of autoimmune diseases, from a stimulatory action on the inflammatory response. Thus, autoimmune thyroiditis (AIT) could be more prevalent among women with PCOS. To evaluate the prevalence of AIT in women with PCOS. It was a cross-sectional study, in a tertiary center, including 65 women with PCOS and 65 women without this condition. Clinical and laboratory parameters were evaluated and a thyroid ultrasound scan was performed. Levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), anti-thyroid peroxidase (anti-TPO) antibodies, anti-thyroglobulin (anti-TG) antibodies, and thyroid ultrasound findings were evaluated. The prevalence of subclinical hypothyroidism (SCH) in women with PCOS was 16.9% and 6.2% in the non-PCOS group. AIT was more common in the PCOS group compared with the non-PCOS group (43.1% versus 26.2%). But, when it was adjusted by weight and insulin resistance, the difference in the thyroiditis risk was not observed (OR 0.78, CI 0.28-2.16). AIT risk was similar in the PCOS and the non-PCOS group. SCH are more common in women with PCOS, highlighting a need for periodic monitoring of thyroid function.3148-5