Effects of oxytocin versus promestriene on genitourinary syndrome: a pilot, prospective, randomized, double-blind study

Objectives: In this pilot, prospective, randomized, double-blind study, the authors compared the efficacy of oxytocin with promestriene in improving vaginal atrophy of Genitourinary Syndrome of Menopause (GSM). Methods: A total of 51 postmenopausal women with symptoms of GSM were evaluated. They were randomized into two groups: oxytocin (25 patients) and promestriene (26 patients) and were evaluated before and after 90 days of treatment; the evaluation was based on the domains of the Female Sexual Function Index (FSFI) (lubrication, satisfaction, and pain during sexual intercourse), clinical visual examination, and vaginal wall thickness. Results: After the use of the medications, both groups showed significant improvement in the three evaluated FSFI domains (p < 0.05) and there was no significant difference between the groups (p > 0.05). On clinical examination, the medications improved all the evaluated parameters but without statistical significance (p > 0.05). The evaluation of the thickness of the vaginal epithelium showed that both treatments led to increase in the vaginal epithelium (p < 0.05); however, the efficacy of promestriene was higher than that of oxytocin (p < 0.05). Conclusions: Both medications were effective, however, studies with larger samples and longer follow-ups are needed to confirm the clinical applicability

Disparities in female breast cancer mortality rates in Brazil between 1980 and 2009

OBJECTIVE: To describe the temporal trends in female breast cancer mortality rates in Brazil in its macro-regions and states between 1980 and 2009. METHODS: This was an ecological time-series study using data on breast cancer deaths registered in the Mortality Data System (SIM/WHO) and census data on the resident population collected by the Brazilian Institute of Geography and Statistics (IBGE/WHO). Joinpoint regression analyses were used to identify the significant changes in trends and to estimate the annual percentage change (APC) in mortality rates. RESULTS: Female breast cancer mortality rates in Brazil tended to stabilize from 1994 onward (APC = 0.4%). Considering the Brazilian macro-regions, the annual mortality rates decreased in the Southeast, stabilized in the South and increased in the Northeast, North, and Midwest. Only the states of Sao Paulo (APC = -1.9%), Rio Grande do Sul (APC = -0.8%) and Rio de Janeiro (APC = -0.6%) presented a significant decline in mortality rates. The greatest increases were found in Maranhao (APC=12%), Paraiba (APC=11.9%), and Piaui (APC=10.9%). CONCLUSION: Although there has been a trend toward stabilization in female breast cancer mortality rates in Brazil, when the mortality rate of each macro-region and state is analyzed individually, considerable inequalities are found, with rate decline or stabilization in states with higher socioeconomic levels and a substantial increase in those with lower socioeconomic levels

A pilot study of the effects of hormone therapy on normal breast tissue of postmenopausal women

PURPOSE: to analyze breast tissue of postmenopausal women before and after six months of continuous combined estrogen-progestin replacement therapy (0.625 mg conjugated equine estrogens associated with 2.5 mg medroxyprogesterone acetate). METHODS: all patients were evaluated before treatment and considered eligible to receive the drug. The material was obtained from the upper outer left quadrant, through a percutaneous large-core breast biopsy. Epithelial density and nuclear volume on hematoxylin-eosin-stained plates were evaluated for the morphological study. Morphometry was graphically analyzed by optical microscopy (400X) after acquisition of image by a digital image-capturing system (Vidcap 32) and image analysis system (Imagelab 2000 Software®). RESULTS: after six months of estrogen-progestin replacement therapy, there was a significant increase in nuclear volume in late postmenopausal women (103.6 to 138.1 µm³). There was no difference in epithelial density with the treatment (before 0.08 and later 0.10). CONCLUSIONS: estrogen-progestin combined replacement therapy for six months induced an enhacement in nuclear volume of breast epithelial cells, suggesting an increase in their metabolic activity. However, it is important to emphasize that this finding was observed only in late postmenopausal women. The increased nuclear volume could precede other events that confirm the stimulation of cellular proliferation by these hormones.OBJETIVOS: avaliou-se o tecido mamário de mulheres antes e depois de seis meses de terapia estroprogestativa combinada contínua (0,625 mg de estrogênios conjugados eqüinos associados a 2,5 mg de acetato de medroxiprogesterona). MÉTODOS: todas as pacientes foram avaliadas antes de se instituir o tratamento e consideradas aptas para este. Foram obtidos fragmentos de tecido mamário por meio de biópsia percutânea com agulha grossa (acoplada a um propulsor automático - core-biópsia). O material foi fixado e os cortes corados por hematoxilina-eosina. Avaliou-se a densidade epitelial e o volume nuclear do epitélio mamário antes e após a terapia hormonal. Esses parâmetros morfométricos foram analisados graficamente com auxílio do programa Imagelab 2000 ®, após captura da imagem microscópica pelo sistema Vidcap 32. Esse programa permite que sejam selecionadas as áreas de interesse, possibilitando o cálculo de área, volume ou a relação da área ocupada entre diferentes estruturas. RESULTADOS: depois do uso da terapia, o volume nuclear nas mulheres em que o tratamento foi instituído em período mais tardio após a menopausa mostrou um aumento de cerca de 33% (de 103,6 para 138,1 µm³). A densidade epitelial não se modificou de forma significativa: o valor médio antes da terapia hormonal foi de 0,08 e após de 0,10. CONCLUSÕES: a terapia estroprogestativa combinada contínua empregada por seis meses induziu à alteração no volume nuclear das células epiteliais das mamas, sugerindo aumento de sua atividade metabólica. Provavelmente, esse evento precede outros que confirmariam o estímulo da proliferação celular por esses hormônios.Universidade Federal de São Paulo (UNIFESP) Departamento de GinecologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Anatomia PatológicaUNIFESP, Depto. de GinecologiaUNIFESP, Depto. de Anatomia PatológicaSciEL

Modulation of estrous cycle and LH, FSH and melatonin levels by pinealectomy and sham-pinealectomy in female rats

1. the pineal has been shown to have a role in controlling reproduction of polyestrus mammals (like humans and laboratory rodents). It influences the age of sexual maturation; the timing of the ovulatory cycle; and gonadal steroidogenesis.2. Here the authors report the early and late effects of pinealectomy (Px) and sham-pinealectomy (SPx) on the estrous cycle periodicity, plasma LH, FSH and urinary 6-sulphatoxymelatonin (6-SMT) excretion in female rats.3. Female Wistar rats (3-4 months of age) were maintained on 12/12 L/D cycle. Orbital venous plexus blood and urine samples were collected from the same rat during the estrus phase before surgery, 4-7 and 55-60 days post surgery.4. Daily vaginal smears were taken to monitor the estrous cycle and they showed a time dependent increase in the estrus stage duration in Pr rats (estrus stage: 1 day in control; 3-4 days after 45 days pr).5. the decrease of gonadotropins at early post Pr was due to surgical stress.6. 6-SMT levels were significantly lower at 4-7 days post SPx, but at 55-60d post surgery these levels returned to control values, which indicate pineal gland integrity. the reduction in urinary 6-SMT may be attributed to a possible high level of plasma corticosterone occurring after surgical manipulations.7. 6-SMT levels in Pr rats were extremely lower at 4-7 and 55-60 days post surgery, but not null, confirming the surgical removal of the pineal gland and indicating the synthesis of melatonin in sites other than the pineal gland.Universidade Federal de São Paulo, Dept Gynecol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Histol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Gynecol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Histol, São Paulo, BrazilWeb of Scienc

Estrogens plus raloxifene on endometrial safety and menopausal symptoms-semisystematic review

Objective: the aim of this study was to summarize the evidence of endometrial safety and quality of life assessment in postmenopausal women taking raloxifene (RLX) + estrogens (E).Methods: Clinical studies reporting RLX + E were identified using Medline and LILACS and through reviewing reference lists of highly significant publications. Articles published in Portuguese, Spanish, and English from the past 10 years were considered.Results: Six corresponding clinical trials were identified. Different estrogen formulations, doses, and routes were used. the primary outcome of the selected studies also differed. Most of the studies found a benefit profile on RLX + E on women's quality of life, satisfaction with the treatment, and vaginal dryness. Some studies showed an increased endometrial thickness after 3 months of treatment. Most biopsies revealed benign endometrial proliferation; only two women experienced endometrial hyperplasia, both of them after 24 weeks of treatment.Conclusions: There are only a few clinical trials that evaluated endometrial safety and quality of life with RLX + E in postmenopausal women. the benefits shown on quality of life and endometrial safety are not certified. Larger studies are deemed necessary to define the better estrogen form and to evaluate the safety and efficacy of long-term use of RLX + E.Universidade Federal de São Paulo, Fac Med, Dept Gynecol, São Paulo, BrazilUniversidade Federal de São Paulo, Fac Med, Dept Gynecol, São Paulo, BrazilWeb of Scienc

Disparities in female breast cancer mortality rates in Brazil between 1980 and 2009

OBJECTIVE: To describe the temporal trends in female breast cancer mortality rates in Brazil in its macro-regions and states between 1980 and 2009. METHODS: This was an ecological time-series study using data on breast cancer deaths registered in the Mortality Data System (SIM/WHO) and census data on the resident population collected by the Brazilian Institute of Geography and Statistics (IBGE/WHO). Joinpoint regression analyses were used to identify the significant changes in trends and to estimate the annual percentage change (APC) in mortality rates. RESULTS: Female breast cancer mortality rates in Brazil tended to stabilize from 1994 onward (APC = 0.4%). Considering the Brazilian macro-regions, the annual mortality rates decreased in the Southeast, stabilized in the South and increased in the Northeast, North, and Midwest. Only the states of Sao Paulo (APC = -1.9%), Rio Grande do Sul (APC = -0.8%) and Rio de Janeiro (APC = -0.6%) presented a significant decline in mortality rates. The greatest increases were found in Maranhao (APC=12%), Paraiba (APC=11.9%), and Piaui (APC=10.9%). CONCLUSION: Although there has been a trend toward stabilization in female breast cancer mortality rates in Brazil, when the mortality rate of each macro-region and state is analyzed individually, considerable inequalities are found, with rate decline or stabilization in states with higher socioeconomic levels and a substantial increase in those with lower socioeconomic levels