Sleep disturbance prevalence in postmenopausal women

PURPOSE: to evaluate the prevalence of reported sleep disturbances through polysomnographic recording (PSG) in a sample of postmenopausal women. METHODS: thirty-three postmenopausal women with a mean age of 56 years, a mean body mass index (BMI) of 27 kg/m², with 7.7 years of recognized postmenopausal period, and a mean Kupperman index of 17, were selected. The inclusion criteria were: age range from 50 to 65 years, at least one year of amenorrhea and an FSH which equaled or exceeded 30 mU/ml; they should not be undergoing hormone therapy, and should display normal laboratory test results. The patients with severe clinical diseases and/or decompensated were excluded; also the ones with suspicion of carcinoma of endometrium and/or breast cancer, a BMI over 30 kg/m² and those who ingested hypnotic drugs. The patients followed a routine climacteric check-up, answered a questionnaire about sleep and underwent an all-night PSG recording. Frequencies in percentage of emerging sleep complaints based on the questionnaire and those pertaining to PSG diagnosis were then calculated separately. RESULTS: the subjective prevalence of insomnia was 61% against 83% in the PSG recordings. The prevalence of apnea reported was 23% against 27% in the PSG. The subjective restless legs syndrome prevalence was 45%, and the objective, 27%. CONCLUSION: there was a high prevalence of sleep disturbances in postmenopausal patients, specially insomnia, apnea and restless legs.OBJETIVO: avaliar a prevalência das queixas de distúrbios do sono pela polissonografia em amostra de mulheres na pós-menopausa. MÉTODOS: foram selecionadas 33 mulheres na pós-menopausa com média de idade de 56 anos, índice de massa corporal médio de 27, tempo de pós-menopausa de 7,7 anos e índice de Kupperman de 17. Adotaram-se os seguintes critérios de inclusão: idade entre 50 e 65anos, no mínimo um ano de amenorréia e FSH plasmático superior ou igual a 30 mU/mL, sem uso de terapia hormonal prévia e exames laboratoriais normais. Foram excluídas as pacientes com doenças clínicas graves e/ou descompensadas, suspeita de câncer de endométrio e/ou mama; índice de massa corporal maior ou igual a 30 e uso de hipnóticos. As pacientes responderam a questionário específico contendo perguntas sobre as características do sono e foram submetidas a polissonografia completa durante uma noite inteira. Foram calculadas separadamente as freqüências em porcentagens das queixas de sono e dos diagnósticos polissonográficos. RESULTADOS: a prevalência de insônia subjetiva foi 61%, sendo que na polissonografia foi de 83%. A queixa de apnéia foi registrada em 23% e, na polissonografia, em 27%. A prevalência subjetiva de movimentos periódicos de pernas foi de 45% e a objetiva foi de 27%. CONCLUSÃO: houve alta prevalência de distúrbios do sono na pós-menopausa, em especial de insônia, apnéia e de movimentos periódicos das pernas. Nesta fase da vida, ocorre piora da qualidade do sono.Universidade Federal de São Paulo (UNIFESP) Departamento de Ginecologia ambulatório de Distúrbios do SonoUniversidade Federal de São Paulo (UNIFESP) Departamento de Psicobiologia Medicina e Biologia do SonoUNIFESP, Depto. de Ginecologia ambulatório de Distúrbios do SonoUNIFESP, Depto. de Psicobiologia Medicina e Biologia do SonoSciEL

The ACTH test in the diagnosis of hirsutism

The ACTH test has been used to confirm the diagnosis of adrenal insufficiency and the classic and the non-classic adrenal hyperplasia due to the 3-HSD, 21 OH e 110H deficiencies. This article reviews the historical aspects of the use of ACTH in the diagnosis of hirsutism and points out its mains indications. In spite of new biological molecular advances in the diagnosis of adrenal enzymatic deficiencies, the use of the ACTH test can help the physician to predict both genothipus and fenothipus in populations with hyperandrogenic manifestations due to non-classical or late-onset congenital adrenal hyperplasia.O teste com ACTH tem sido utilizado para diagnosticar patologias como a insuficiência supra-renal, e as formas clássica e não-clássica de hiperplasia supra-renal em decorrência de deficiências enzimáticas. Revisou-se vários aspectos históricos envolvendo o uso do ACTH no diagnóstico do hirsutismo e são analisadas suas principais indicações. Apesar dos novos avanços em biologia molecular no diagnóstico das deficiências enzimáticas das supra-renais, o uso do teste com ACTH pode ajudar o clínico a predizer o genótipo e fenótipo dos indivíduos que apresentam manifestações hiperandrogênicas devido à hiperplasia congênita da supra-renal na sua forma não-clássica.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of GynecologyUNIFESP, EPM, Department of GynecologySciEL

Effects of isoflavones on the skin of postmenopausal women: a pilot study

OBJECTIVE: The aim of this study was to evaluate the effects of isoflavones on the skin of postmenopausal women. DESIGN: A prospective study was performed with 30 postmenopausal women before and immediately after the end of treatment with 100 mg/day of an isoflavones-rich, concentrated soy extract for six months. A skin punch was performed in the gluteal region for sample collection before and immediately after the treatment program. Morphometric determination of epidermal thickness, the papillary index (wrinkling), and the amount of dermal elastic and collagen fibers was assessed. In addition, the number of blood vessels in the sample was also evaluated. The paired Student's t-test was used for statistical analysis (P < 0.05). RESULTS: Isoflavone treatment resulted in a 9.46% increase in the thickness of the epidermis in 23 patients. In addition, the papillary index was reduced in 21 women. The papillary index was inversely proportional to skin wrinkling, i.e., there were a large number of papillae after treatment. The amount of collagen in the dermis was increased in 25 women (86.2%). In 22 women (75.8%) we observed that the number of elastic fibers increased. The number of dermal blood vessels was significantly increased in 21 women. CONCLUSION: Our data show that the use of a concentrated, isoflavone-rich soy extract during six consecutive months caused significant increases in epithelial thickness, the number of elastic and collagen fibers, as well as the blood vessels.Federal University of São Paulo Gynecology DepartmentFederal University of São Paulo Morphology DepartmentUniversidade de São Paulo Faculdade de Medicina Laboratório de Ginecologia Estrutural e MolecularUniversidade de São Paulo Faculdade de Medicina Departamento de Obstetrícia e GinecologiaUNIFESP, Gynecology DepartmentUNIFESP, Morphology DepartmentSciEL

Efeitos da terapia de reposição hormonal estroprogestativa sobre o sistema de coagulação e de fibrinólise em mulheres na pós-menopausa

OBJECTIVE: To evaluate antithrombin III (AT), thrombin (Fragment 1+2 [F1+2] and thrombin-antithrombin [TAT]) generation markers, as well as other coagulation parameters, such as prothrombin time, partial activated thromboplastin time, thrombin time, fibrinogen, euglobulin lysis time, and platelet count, in postmenopausal women after hormonal therapy. STUDY DESIGN: Forty-five patients who received either 0.625 mg/day unopposed oral conjugated equine estrogen (CEE), 0.625 mg/day oral CEE plus medroxyprogesterone acetate (MP), or 50 &micro;g/day transdermal 17beta-estradiol plus MP, were included. Tests were performed before (T0) and after 3 (T3), 6 (T6) and 12 (T12) months of treatment. AT was determined by an amidolytic method, whereas F1+2 and TAT complex were measured by ELISA. RESULTS: There was a significant reduction in the AT level of patients who received oral CEE plus MP at T3. There was no AT reduction in patients taking either oral CEE alone or transdermal 17beta-estradiol plus MP. F1+2 increased in all patients, but it reached statistical significance only in patients receiving transdermal 17beta-estradiol MP at T3. CONCLUSIONS: The CEE associated with MP treatment may reduce AT levels, whereas unopposed CEE or transdermal 17beta-estradiol plus MP does not change AT. These changes might not be clinically relevant in the general population; however, hormonal replacement therapy may increase the risk of thrombosis in women with congenital or acquired thrombophilia.OBJETIVO: Avaliar os marcadores antitrombina III (AT), fragmento 1 + 2 da trombina (F1+2) e complexo trombina-antitrombina (TAT), bem como outros parâmetros da coagulação, como tempo de pró-trombina, tempo parcial de tromboplastina ativado, tempo de trombina, fibrinogênio e tempo de lise da euglobulina em mulheres na pós-menopausa após terapia hormonal. DESENHO DO ESTUDO: Foram incluídas 45 voluntárias que receberam estrogênios conjugados eqüinos (ECE) 0,625 mg/dia, isoladamente ou associado ao acetato de medroxiprogesterona (AMP) ou usaram o 17beta-estradiol (50 &micro;g/dia) transdérmico com AMP. Os exames foram realizados antes do tratamento (T0) e após três (T3), seis (T6) e doze (T12) meses após o início do tratamento. AT foi avaliada pelo método amidolítico, enquanto que o F1+2 e o complexo TAT por ELISA. RESULTADOS: Houve redução significante nos níveis de AT em pacientes que receberam ECE associado ao AMP no T3. Não houve redução na AT em mulheres que usaram ECE isoladamente ou aquelas com 17beta-estradiol transdérmico e AMP. O F1+2 aumentou em todos os grupos, mas apenas o grupo com 17beta-estradiol transdérmico e AMP apresentou diferença significante durante o T3. CONCLUSÕES: A associação de ECE e AMP pode reduzir os níveis de AT, enquanto ECE isoladamente ou 17beta-estradiol transdérmico com AMP não modificam-o acentuadamente. Essas alterações poderiam ser mais relevantes clinicamente na análise populacional. Todavia, a terapia de reposição hormonal aumentaria o risco de trombose em mulheres com trombofilia prévia congênita ou adquirida

IGF-1R and Leptin Expression Profile and the Effects of Metformin Treatment on Metabolic and Endocrine Parameters in PCOS Mice

We aim to assess the effects of metformin treatment on metabolic and endocrine parameters and genes expression related to the insulin-responsive pathway in polycystic ovary syndrome (PCOS). This study comprises twenty-eight obese mice divided into three metformin-treated groups for seven and twenty days and eight nonobese and nontreated ones. We found a significant decrease in glycemia after metformin treatment at days seven and twenty. However, we did not observe differences in body weight measurement. Histologically, after twenty days we observed follicular development with regression of androgenic effects. Levels of IGF-1R protein expression were low after twenty days of treatment, but LEP proteins showed an overexpression in the ovarian stroma. We assessed the IGF-1R and LEP mRNAs levelsdata showed a significant overexpression of LEP after seven days of treatment, while the IGF-1R was downregulated. Metformin therapy seems to exert a beneficial effect on histological and anovulatory features, reducing follicular number and pyknosis formation, possibly involved in the reversion of androgenic stimulus. Expression of IGF-1 and LEPR indicates a relevant role in androgenic features reversion present in PCOS, hormonal equilibrium, body weight regulation, and glucose metabolism, therefore, under phenotype obesity and infertility regulation in this model.Univ Fed Sao Paulo UNIFESP, EPM, Dept Obstet & Gynecol, Climacter Sect, 66 Embau St,Vila Clementino, BR-04039060 Sao Paulo, SP, BrazilUniv Sao Paulo, Sch Med, Dept Obstet & Gynecol, Lab Mol & Struct Gynecol, 455 Dr Arnaldo Ave,Room 4121,Cerqueira Cesar, BR-01246903 Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Morphol Dept, Hist & Biol Struct Div, 740 Botucatu St,Vila Clementino, BR-04023009 Sao Paulo, SP, BrazilUniv Ctr United Metropolitan Coll, 1239 Santo Amaro Ave,Vila Nova Conceicao, BR-04505001 Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Obstet & Gynecol, Climacter Sect, 66 Embau St,Vila Clementino, BR-04039060 Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Morphol Dept, Hist & Biol Struct Div, 740 Botucatu St,Vila Clementino, BR-04023009 Sao Paulo, SP, BrazilWeb of Scienc

Proliferation of the superficial epithelium of ovaries in senile female rats following oral administration of conjugated equine estrogens

OBJECTIVE: To evaluate the effect of different concentrations of estrogen on the ovarian superficial epithelium in senile female rats. Design: Fifty female rats at 15 months of age and with irregular estrous cycles were selected and randomly divided into five experimental groups containing equal numbers of animals in each: GPROP, control group receiving vehicle only; GE0.05mg, group receiving conjugated equine estrogens (CEE) at a dose of 50 µg/kg; GE0.5mg, group receiving CEE at 500 µg/kg; GE1mg, group receiving CEE at 1 mg/kg; and GE2mg, receiving CEE at 2 mg/kg. The length of treatment was 21 days. After this period, the animals were anesthetized and the ovaries were fixed in 10% formaldehyde and processed for routine histology. Histomorphology was analyzed by light microscopy, and histomorphometrics were evaluated using the Imagelab program. RESULTS: In the GPROP and GE0.05mg groups, the superficial epithelium of the ovary had a simple cuboidal shape, and as the estrogen dose increased, the epithelium thickened, with pseudo-stratified or stratified epithelium appearing in the GE2mg group. The animals in the group given the highest estrogen dose (GE2mg) showed the thickest ovarian epithelium and the largest perimeter and surface area of the surface ovarian epithelium (P < 0.01). However, the difference in epithelium thickness between the GE0.5mg and GE1mg groups was only slight. CONCLUSION: Our data suggest that CEE at a dose of 2 mg/kg may induce marked proliferation of rat ovarian epithelium.UNIFESP Morphology Department Histology and Cellular Biology DivisionUniversidade de São Paulo Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP) Faculdade de Medicina Gynecology DepartmentUNIFESP, Morphology Department Histology and Cellular Biology DivisionUNIFESP, Faculdade de Medicina Gynecology DepartmentSciEL

Effects of isoflavones on the pelvic floor and the periurethral vascularization of postmenopausal women

PURPOSE: to evaluate muscular strength of the pelvic floor and the periurethral vessels of postmenopausal women before and after six months of soybean extract treatment. METHODS: the study was conducted on 30 postmenopausal women before and after six consecutive months of soyabean extract (100 mg/day) administration. Urinary loss and muscular strength of the pelvic floor were investigated through digital perineometer and functional evaluation. Digital color Doppler in the periurethral region was used to count the number of vessels. For statistical analysis, the paired Student t test was applied to compare the results before and after the treatment. RESULTS: twenty women reported urinary incontinence before the treatment period. The amelioration of this symptom was observed in 15 (75%) women after the treatment. Vaginal pressure (muscular strength of the pelvic floor) was 12.95±1.73 and 15.86±1.86 Sauers, before and after the treatment, respectively (p<0.001). Twenty-two women (73.3%) presented an increase in the pressure at the end of this study. In relation to the function evaluation, 18 (60%) had improvement in muscular strength and 12 women did not present any change. On ultrasonography (Doppler), the number of vessels was 2.20±0.15 blood vessels/field in the beginning of this study and 3.46±0.25 blood vessels/field at the end of the treatment (p<0.001). An increase in the number of periurethral vessels was detected in 21 women (70%). CONCLUSION: it is important to emphasize that these are preliminary results. A double blind randomized and placebo-controlled clinical trial with a high number of participants is necessary. However, the treatment with concentrated soybean extract (100 mg per day) for six consecutive months may determine an improvement in pelvic floor muscular strength and an increase in the number of periurethral vessels in postmenopausal women.OBJETIVO: avaliar a força muscular do assoalho pélvico e os vasos periuretrais de mulheres na pós-menopausa, antes e após seis meses de uso contínuo de extrato de soja. MÉTODOS: estudo prospectivo com 30 mulheres na pós-menopausa antes e após o uso de extrato de soja (100 mg/dia) durante seis meses consecutivos. Foram investigadas a perda urinária e a força muscular do assoalho pélvico por perineômetro digital e avaliação funcional. Avaliou-se ainda o número de vasos da região peri-uretral pela dopplervelocimetria. Para comparar os resultados antes e após tratamento, utilizou-se o teste pareado t de Student. RESULTADOS: das 30 mulheres analisadas, 20 referiram alguma forma de perda urinária no inicio do experimento. A melhora deste sintoma ocorreu em 15 (75%) mulheres após o tratamento. A medida da pressão vaginal (força muscular do assoalho pélvico) foi 12,9±1,7 e 15,8±1,8 Sauers, respectivamente, antes e após o tratamento (p<0,001). Observou-se aumento da pressão em 22 (73,3%) mulheres no final do estudo. Na avaliação funcional, verificou-se que 12 mulheres não sofreram alteração da função muscular do assoalho pélvico, ou seja, 18 (60%) tiveram aumento da força muscular. Pelo exame ultra-sonográfico (Doppler) obtivemos no início do experimento 2,20±0,15 vasos sanguíneos/campo, passando para 3,4±0,2 vasos sanguíneos/campo ao final do experimento (p<0,001). Em 21 mulheres (70%) registrou-se aumento do número dos vasos peri-uretrais após os seis meses de tratamento. CONCLUSÃO: ressalta-se que são resultados preliminares, havendo necessidade de outras investigações com número maior de participantes em estudo duplo-cego, randomizado e controlado por placebo. Contudo, o tratamento com extrato de soja, por seis meses consecutivos, determinaria aumento da força muscular do assoalho pélvico e do número de vasos peri-uretrais em mulheres na pós-menopausa.Universidade Federal de São Paulo (UNIFESP) Departamento de GinecologiaUniversidade Federal de São Paulo (UNIFESP)Faculdade de Medicina de Catanduva Departamento de GinecologiaUniversidade de São PauloUNIFESP, Depto. de GinecologiaUNIFESPSciEL

Effects of combined estrogen and raloxifene therapy on rat endometrium

PURPOSE: to evaluate the effects of conjugated equine estrogens (CEE) and raloxifene (Ral), alone or combined, on the rat endometrium. METHODS: fifty-six adult rats were ovariectomized and randomly divided into seven groups: GCont (control); GCEE (CEE 50 µg/kg); GCEE/25 (CEE 25 µg/kg); GRal/0.75 (Ral 0.75 mg/kg); GRal/0.4 (Ral 0.4 mg/kg); GCEERal (50/0.75) - (CEE 50 µg/kg + Ral 0.75 mg/kg), and GCEE-Ral (25/0.4) - (CEE 25 µg/kg + Ral 0.4 mg/kg). The drugs were orally administered (gavage) for 21 consecutive days. At the end of the experiment, all animals were anesthetized and sacrificed. Fragments of uterus were removed, fixed in 10% formaldehyde and processed for paraffin inclusion. The histological sections were stained by HE and submitted to histomorphometric evaluation. The following parameters were analyzed: thickness of superficial epithelium and number of endometrial glands/mm² and of blood vessels/mm². The data were evaluated using ANOVA followed by the Turkey-Kramer test. RESULTS: in the GCont and only Ral treatment (GRal/0.75 and GRal/0.4) the endometrium showed signals of atrophy. In the groups treated with only CEE signs of endometrial proliferation were observed, mainly in group GCEE/50. Also, there was endometrial proliferation in the groups that received combined CEE and Ral (Ral GCEE (50/0.75) and GCEE-Ral (25/0.4)), but it was more intensive in the animals treated with isolated estrogen than in those that received combined estrogen and raloxifene. CONCLUSION: raloxifene may partially block the action of estrogen on the castrated adult rat endometrium.OBJETIVO: avaliar os efeitos dos estrogênios conjugados eqüinos (Ece) e do raloxifeno (Ral), isoladamente ou associados, sobre o endométrio de ratas adultas. MÉTODOS: foram utilizadas 56 ratas adultas, ooforectomizadas, divididas aleatoriamente em sete grupos: GCont (controle); GEce (Ece 50 µg/kg); GEce/25 (Ece 25 µg/kg); GRal/0,75 (Ral 0,75 µg/kg); GRal/0,4 (Ral 0,4 mg/kg); GEce-Ral (50/0,75) - (Ece 50 µg/kg + Ral 0,75 mg/kg) e GEce-Ral (25/0,4) - (Ece 25 µg/kg + Ral 0,4 mg/kg). As drogas foram administradas por gavagem durante 21 dias consecutivos. Ao final da administração todos os animais foram anestesiados e fragmentos dos úteros removidos, fixados em formol a 10% e processados para inclusão em parafina. Os cortes obtidos foram corados por HE e submetidos à avaliação histomorfométrica. Foram avaliados os seguintes parâmetros: espessura do epitélio superficial, número de glândulas endometriais/mm² e número de vasos sangüíneos presentes no miométrio/mm². Os dados obtidos foram submetidos a análise estatística de ANOVA seguida pelo teste de Tukey-Kramer. RESULTADOS: nos grupos controle (Gcont) e tratados isoladamente com raloxifeno (GRal/0,75 e GRal/0,4) o endométrio mostrou-se atrófico. Já nos grupos tratados com Ece isoladamente foi observado endométrio muito desenvolvido, sendo este efeito mais acentuado no grupo que recebeu 50 µg/kg, no qual encontramos aumento da espessura do epitélio superficial e da lâmina própria e no número de glândulas endometriais e de vasos sanguíneos. Notamos também proliferação endometrial nos grupos que receberam a associação de Ece e Ral (GEce-Ral - 50/0,75) e (GEce-Ral - 25/0,4). CONCLUSÃO: o raloxifeno parece bloquear parcialmente a ação do estrogênio no endométrio de ratas adultas castradas.Universidade Federal de São Paulo (UNIFESP) Departamento de Ginecologia e ObstetríciaUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de MorfologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de GinecologiaUNIFESP, Depto. de Ginecologia e ObstetríciaUNIFESP, Depto. de MorfologiaUNIFESP, Depto. de GinecologiaSciEL