Selección de
Resúmenes de Menopausia
Semana del 6 al 12 de Agosto 2008
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad
de Chile
Arch Gynecol Obstet. 2008 Aug 5. [Epub ahead of print]
The
diagnosis of endometrial hyperplasia on curettage: how reliable is it?
Obeidat B, Mohtaseb A, Matalka I.
Department
of Obstetrics and Gynecology, Jordan University of Science and Technology, PO
Box 2954, Irbid, 21110, Jordan, b_obeidat@hotmail.com.
OBJECTIVE:
To evaluate the consistency of preoperative and postoperative histological
findings in cases of endometrial hyperplasia. MATERIALS AND METHODS: Fifty-five
patients with endometrial hyperplasia detected by surgical curettage were
treated by hysterectomy. The histopathological diagnoses found on curettage
specimens were compared and correlated with those found on hysterectomy.
Endometrial hyperplasia was classified according to the classification scheme
of the International Society of Gynecological Pathologists. RESULTS: Fifty-five
patients were diagnosed with endometrial hyperplasia on curettage specimens
performed for evaluation of various bleeding abnormalities. The average age of
the patients was 51.8 years (range 35-74). Thirty patients (55%) were
postmenopausal. The interval between curettage and hysterectomy was 1-33 weeks.
Of the patients, 26 (47%) had simple hyperplasia, 24 (44%) complex hyperplasia
and 5 patients (9%) had complex atypical hyperplasia. Histopathological
evaluation of hysterectomy specimens of these patients showed a total number of
35 cases (64%) with endometrial hyperplasia, 1 case of endometrial carcinoma
and 19 cases with other pathological findings. The consistency rate between
curettage and hysterectomy specimens was 45% (25/55 cases). Following
hysterectomy, we found that none of the 26 simple hyperplasia cases and only
one of the 24 complex hyperplasia cases coexisted with endometrial carcinoma.
On the other hand, three of the five cases of complex atypical carcinoma
coexisted with endometrial carcinoma. CONCLUSIONS: Curettage endometrial
pathology tends to be more consistent with final hysterectomy pathology in
simple hyperplasia. However, in cases of complex hyperplasia with atypia,
curettage seems to under diagnose the real pathology.
Optom Vis Sci. 2008
Aug;85(8):668-74.
Long-term
Incidence of Dry Eye in an Older Population.
Department
of Ophthalmology and Visual Sciences, University of Wisconsin School of
Medicine and Public Health, Madison, Wisconsin.
PURPOSE.:
To estimate the ten-year incidence of dry eye in an older population and
examine its association with various risk factors. METHODS.: The 43 to 86 year
old population of Beaver Dam, WI, was examined in 1988 to 1990 (n = 4926) and
1993 to 1995 (n = 3722). Dry eye data were first collected in 1993 to 1995.
Subsequent examinations or interviews occurred in 1998 to 2000 (n = 2827) and
2003 to 2005 (n = 2124). The incidence cohort comprised 2414 subjects not
reporting dry eye in 1993 to 1995. Risk factor information, ascertained in 1993
to 1995, included demographics, medical history, cardiovascular disease risk
factors, medications, and life-style factors. Ten-year cumulative incidence was
estimated by the product-limit method. RESULTS.: Over the 10-year period, 482
subjects developed a history of dry eye for an incidence of 21.6% (95%
confidence interval, 19.9 to 23.3%). Incidence increased significantly (p <
0.001) with age. Incidence was greater in women (25.0%) than men (17.2%, p <
0.001). After adjusting for age, incidence was greater (p < 0.05) in
subjects with arthritis, allergy or thyroid disease not treated with hormone,
using antihistamines, antianxiety medications, antidepressants, oral steroids
or vitamins, and poorer self-rated health. Incidence was less (p < 0.05) in
subjects consuming alcohol. It was not significantly associated with blood
pressure, hypertension, serum total or high density lipoprotein cholesterol,
body mass, diabetes, gout, osteoporosis, cardiovascular disease, smoking,
caffeine use, or taking calcium channel blockers or anticholesterol
medications. In a multivariable model with time-varying covariates, increased
incidence was associated with age, female gender, poorer self-rated health,
antidepressant or oral steroid use, and thyroid disease untreated with hormone.
It was lower for those using angiotensin-converting enzyme inhibitors or with a
sedentary lifestyle. CONCLUSIONS.: Dry eye incidence is substantial. However,
there are few associated risk factors. Some drugs (antihistamines, antianxiety
drugs, antidepressants, oral steroids) are associated with greater risk, while
angiotensin-converting enzyme inhibitors may be associated with lower risk.
Clin Obstet Gynecol. 2008
Sep;51(3):607-17
Association
of ovarian and uterine cancers with postmenopausal hormonal treatments.
Clinica
de Feminologia Holística, Lisbon, Portugal. manuel@neves-e-castro.org
During
hormone treatments for the relief of the symptoms of postmenopausal women a
number of side effects may occur. Some may be due to the wrong choice of the
steroids used for treatment or to the route of administration. However, the
more important ones deserving much attention are the rare occurrences of
malignancies of the uterus and ovaries. The risk for ovarian cancer, if it
exists, is minimal and clinically irrelevant. Estrogen only treatments are used
only in hysterectomized women. Continuous combined estrogen-progestin
treatments have a very low risk of association with endometrial cancers
compared with sequential regimens. Tibolone may be associated with a very small
risk for endometrial cancers and thus must be properly monitored by
transvaginal ultrasound. Breast cancer patients being treated with tamoxifen
require careful attention to the endometrium to exclude a carcinoma. For the
protection of the endometrium, a progestin-releasing intrauterine devise is an
attractive choice. Raloxifene used for a long time to prevent osteoporosis is
safe for the endometrium. None of the above-mentioned side effects is enough to
prevent a physician from using hormone treatment in postmenopausal women if there
are no past or current contraindications.
Ann Rheum Dis. 2008 Aug
3. [Epub ahead of print]
Clinical
subsequent fractures cluster in time after first fractures.
van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant GJ.
OBJECTIVES:
The risk of subsequent fractures is double the risk of having a first fracture.
We analysed whether this risk is constant or not over time. METHODS: A
population-based study in 4140 postmenopausal women, aged between 50 and 90
years, on radiographic confirmed clinical fractures from menopause onwards analysed
by Cox regression. RESULTS: 924 (22%) women had a first fracture and 234 (26%
of 924) a subsequent fracture. Four percent of all first fractures occurred in
each year from menopause onwards, while after a first fracture, 23% of all
subsequent fractures occurred within one year and 54% within five years. When
calculated from time of a first fracture, the relative risk (RR) of subsequent
fracture was 2.1 (95% confidence interval (CI): 1.7-2.6) and remained increased
during 15 years. When calculated for specific time intervals after a first
fracture, the RR was 5.3 (CI: 4.0-6.6) within one year, 2.8 (CI: 2.0-3.6)
within 2-5 years, 1.4 (1.0-1.8) within 6-10 years and 0.41 (CI: 0.29 -0.53)
after >10 years. CONCLUSIONS: From menopause onwards, clinical fractures
cluster in time indicating the need for early action to prevent subsequent
fractures.
J Nucl Cardiol. 2008
Jul-Aug;15(4):510-7. Epub 2008
Apr 8.
Cardiovascular
risk, obesity, and myocardial blood flow in postmenopausal women.
Motivala AA, Rose PA, Kim HM, Smith YR, Bartnik C, Brook RD, Muzik O, Duvernoy CS.
Division
of Cardiovascular Medicine, Department of Internal Medicine, University of
Michigan, Ann Arbor, Michigan, USA.
BACKGROUND:
This study was designed to determine whether overweight or obese status is independently
associated with myocardial flow reserve (MFR), an established predictor of
cardiovascular mortality, in a group of postmenopausal women with no previous
cardiovascular disease. Postmenopausal women are the largest group of
overweight and physically inactive individuals in the
J Med Assoc Thai. 2008
May;91(5):625-32.
Sexual
functioning in postmenopausal women not taking hormone therapy in the
Gynecological and Menopause Clinic, Songklanagarind Hospital measured by Female
Sexual Function Index questionnaire.
Peeyananjarassri K, Liabsuetrakul T, Soonthornpun K, Choobun T, Manopsilp P.
Department
of Obstetrics & Gynecology, Faculty of Medicine, Prince of Songkla
University, Hat Yai, Songkhla, Thailand. krantarat@yahoo.com
OBJECTIVE:
To study sexual functioning and attitudes towards sexuality in postmenopausal
women. MATERIAL AND METHOD: A cross-sectional study was conducted among 219
healthy postmenopausal women with a uterus, aged 45-55 years, and not taking
hormone therapy, who attended the gynecological and menopause clinic,
Semana del 30 de Julio al 5 de Agosto 2008
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Arch Intern Med. 2008 Jul 28;168(14):1568-75
Menopause and the
metabolic syndrome: the Study of Women's Health Across the Nation.
Janssen I, Powell LH, Crawford S, Lasley B, Sutton-Tyrrell K.
Department of Preventive Medicine, Rush University Medical Center,
Chicago, IL 60612, USA.
BACKGROUND: Cross-sectional studies suggest that prevalence of the
metabolic syndrome (MetS) increases from premenopause to postmenopause in
women, independent of age. Little is known about why. We hypothesized that the
incidence of the MetS increases with progression through menopause and that
this increase is explained by the progressive androgenicity of the hormonal
milieu. METHODS: This longitudinal, 9-year study of 949 participants in the
Study of Women's Health Across the Nation investigates the natural history of
the menopausal transition. Participants of 5 ethnicities at 7 geographic sites
were recruited when they were premenopausal or early perimenopausal and were
eligible for this study if they (1) reached menopause during the study; (2) had
never taken hormone therapy, and (3) did not have diabetes mellitus or the MetS
at baseline. The primary outcome was the presence of MetS using National
Cholesterol Education Program Adult Treatment Panel III criteria. Secondary
outcomes were the components of the MetS. RESULTS: By the final menstrual
period, 13.7% of the women had new-onset MetS. Longitudinal analyses, centered
at the final menstrual period, were adjusted for age at menopause, ethnicity,
study site, marital status, education, body mass index, smoking, and aging.
Odds of developing the MetS per year in perimenopause were 1.45 (95% confidence
interval, 1.35-1.56); after menopause, 1.24 (95% confidence interval,
1.18-1.30). These odds were significantly different (P < .001). An increase
in bioavailable testosterone or a decrease in sex hormone-binding globulin
levels increased the odds. CONCLUSIONS: As testosterone progressively dominates
the hormonal milieu during the menopausal transition, the prevalence of MetS
increases, independent of aging and other important covariates. This may be a
pathway by which cardiovascular disease increases during menopause.
Breast Cancer Res Treat. 2008 Aug 1. [Epub ahead of print
Venlafaxine versus clonidine
for the treatment of hot flashes in breast cancer patients: a double-blind,
randomized cross-over study.
Buijs C, Mom CH, Willemse PH, Marike Boezen H, Maurer JM, Wymenga AN, de Jong RS, et al.
Department of Medical Oncology,
Purpose Breast cancer patients with treatment-induced menopause
experience frequent and severe hot flashes (HF). We compared venlafaxine and
clonidine for the treatment of HF with regard to side effects, efficacy,
quality of life and sexual functioning. Methods In a double-blind, cross-over
study, 60 breast cancer patients experiencing HF were randomized to 8 weeks
venlafaxine followed by 2 weeks wash-out, and 8 weeks clonidine or vice versa.
HF frequency and severity, side effects, quality of life and sexuality were
assessed. Results Thirty patients started with venlafaxine and 30 with
clonidine. Premature discontinuation for toxicity occurred in 14/59 during
venlafaxine and 5/53 during clonidine (P = .038). Venlafaxine induced more side
effects. Median reduction in HF score was 49% for venlafaxine and 55% for
clonidine (ns). Conclusion Venlafaxine and clonidine are equally, but
moderately effective in HF reduction. Side effects are the main reason for drug
discontinuation, occurring more often with venlafaxine.
Arch Intern Med. 2008 Jul 28;168(14):1500-11
Low-fat dietary
pattern and risk of treated diabetes mellitus in postmenopausal women: the
Women's Health Initiative randomized controlled dietary modification trial.
Tinker LF, Bonds DE, Margolis KL, Manson JE, Howard BV, Larson J, et al; Women's Health Initiative.
Women's Health Initiative,
BACKGROUND: Decreased fat intake with weight loss and increased exercise
may reduce the risk of diabetes mellitus in persons with impaired glucose
tolerance. This study was undertaken to assess the effects of a low-fat dietary
pattern on incidence of treated diabetes among generally healthy postmenopausal
women. METHODS: A randomized controlled trial was conducted at 40
Cancer. 2008 Jul 29. [Epub ahead of print
Hip bone density predicts breast
cancer risk independently of Gail score: results From the Women's Health
Initiative.
Chen Z, Arendell L, Aickin M, Cauley J, Lewis CE, Chlebowski R.
Epidemiology and Biostatistics,
BACKGROUND.: The Gail model has been commonly used to estimate a woman's
risk of breast cancer within a certain time period. High bone mineral density
(BMD) is also a significant risk factor for breast cancer, but it appears to
play no role in the Gail model. The objective of the current study was to
investigate whether hip BMD predicts postmenopausal breast cancer risk
independently of the Gail score. METHODS.: In this prospective study, 9941
postmenopausal women who had a baseline hip BMD and Gail score from the Women's
Health Initiative were included in the analysis. Their average age was 63.0 +/-
7.4 years at baseline. RESULTS.: After an average of 8.43 years of follow-up,
327 incident breast cancer cases were reported and adjudicated. In a
multivariate Cox proportional hazards model, the hazards ratios (95% confidence
interval [95% CI]) for incident breast cancer were 1.35 (95% CI, 1.05-1.73) for
high Gail score (>/=1.67%) and 1.25 (95% CI, 1.11-1.40) for each unit of increase
in the total hip BMD T-score. Restricting the analysis to women with both BMD
and a Gail score above the median, a sharp increase in incident breast cancer
for women with the highest BMD and Gail scores was found (P < .05).
CONCLUSIONS.: The contribution of BMD to the prediction of incident
postmenopausal breast cancer across the entire population was found to be
independent of the Gail score. However, among women with both high BMD and a
high Gail score, there appears to be an interaction between these 2 factors.
These findings suggest that BMD and Gail score may be used together to better
quantify the risk of breast cancer.
J Bone Miner Res. 2008 Jul 29. [Epub ahead of print
Hormone Therapy
Improves Femur Geometry Among Ethnically Diverse Postmenopausal Participants in
the Women's Health Initiative Hormone Intervention Trials.
Chen Z, Beck T, Cauley JA, Lewis CE, Lacroix A, Bassford T, Wu G, Sherrill D, Going S.
Abstract Loss of bone strength underlies osteoporotic fragility
fractures. We hypothesized that hormone interventions significantly improve the
structural geometry of proximal femur cross-sections. Study participants were
from the Women's Health Initiative hormone intervention trials: either the
conjugated equine estrogen only (N(placebo) = 447, N(CEE) =422) trial or the
estrogen plus progestin (N(placebo) = 441, N(E+P) = 503) trial, who were 50-79
years old at baseline and were followed up to 6 years. Bone density scans by
dual-energy x-ray absorptiometry (DXA) were conducted at baseline, year1, year
3, and year 6. Femur geometry was derived from hip DXA scans using the hip
structural analysis (HSA) method. Mixed effect models with the intent-to-treat
analysis approach were used. There were no significant differences in treatment
effects between the E-alone and the E+P trial, so the analyses were conducted
with participants combined from both trials. Treatment benefits (p<0.05) on
femur geometry were observed as early as one year after the intervention. From
baseline to year 6, section modulus (a measure of maximum bending stress) was
preserved and buckling ratio (an index of cortical instability under
compression) was reduced by hormone interventions (p<0.05); the differences
in the percent changes from baseline to year 6 between women on hormone
intervention vs. women on placebo were 2.3% to 3.6% for section modulus and -
5.3% to - 4.3 % for buckling ratio. Hormone interventions led to favorable
changes in femur geometry, which may help explain the reduced fracture risk
observed in hormone interventions.
J Bone Miner Res. 2008 Jul 29. [Epub ahead of print
Efficacy of
Bazedoxifene in Reducing New Vertebral Fracture Risk in Postmenopausal Women
With Osteoporosis: Results From a 3-Year, Randomized, Placebo- and
Active-Controlled Clinical Trial*
Silverman SL, Christiansen C, Genant HK, Vukicevic S, Zanchetta JR, de Villiers TJ, et al
In this 3-year, randomized, double-blind, placebo- and active-controlled
study, healthy postmenopausal women with osteoporosis (aged 55-85 years) were
treated with bazedoxifene 20 or 40 mg/day, raloxifene 60 mg/day, or placebo.
The primary endpoint was incidence of new vertebral fractures after 36 months;
secondary endpoints included nonvertebral fractures, bone mineral density
(BMD), and bone turnover markers. Among 6,847 subjects in the intent-to-treat
population, the incidence of new vertebral fractures was significantly lower
(P<0.05) with bazedoxifene 20 mg (2.3%), bazedoxifene 40 mg (2.5%), and
raloxifene 60 mg (2.3%) compared with placebo (4.1%), with relative risk
reductions of 42%, 37%, and 42%, respectively. The treatment effect was similar
among subjects with or without prevalent vertebral fracture (P=0.89 for treatment
by baseline fracture status interaction). The incidence of nonvertebral
fractures with bazedoxifene or raloxifene was not significantly different from
placebo. In a post-hoc analysis of a subgroup of women at higher fracture risk
(femoral neck T-score </=-3.0 and/or >/=1 moderate or severe vertebral
fracture or multiple mild vertebral fractures; n=1,772), bazedoxifene 20 mg
showed a 50% and 44% reduction in nonvertebral fracture risk relative to
placebo (P=0.02) and raloxifene 60 mg (P=0.05), respectively. Bazedoxifene
significantly improved BMD and reduced bone marker levels (P<0.001 vs
placebo). The incidence of vasodilatation, leg cramps, and venous
thromboembolic events was higher with bazedoxifene or raloxifene compared with
placebo. In conclusion, bazedoxifene significantly reduced the risk of new
vertebral fracture in postmenopausal women with osteoporosis and decreased the
risk of nonvertebral fracture in subjects at higher fracture risk.
Menopause. 2008 Jul 24. [Epub ahead of print
A long-term user of
cosmetic cream containing estrogen developed breast cancer and endometrial
hyperplasia.
Komori S, Ito Y, Nakamura Y, Aoki M, Takashi T, Kinuta T, Tanaka H, Koyama K.
From the Department of Obstetrics and Gynecology,
A 93-year-old woman was referred to our clinic for abnormal genital
bleeding. It was found that she had endometrial hyperplasia and breast cancer.
Her uterus was as large as that of a normal adult menstruating woman. She
indicated that she had been applying cosmetic cream containing a low
concentration of ethynylestradiol to her face and body three times a day for 75
years. It is possible that this long-term use of the ethynylestradiol-containing
cream is related to the development of breast cancer and endometrial
hyperplasia.
Biol Psychiatry. 2008 Jul 25. [Epub ahead of print
Elevated
Neuroimmune Biomarkers in Sweat Patches and Plasma of Premenopausal Women with
Major Depressive Disorder in Remission: The POWER Study.
Cizza G, Marques AH, Eskandari F, Christie IC, Torvik S, Silverman MN, Phillips TM, Sternberg EM.
Clinical Endocrinology Branch, National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH),
BACKGROUND: Major depressive disorder (MDD) is inconsistently associated
with elevations in proinflammatory cytokines and neuropeptides. We used a skin
sweat patch, recently validated in healthy control subjects, and recycling
immunoaffinity chromatography to measure neuroimmune biomarkers in patients
with MDD mostly in remission. METHODS: We collected blood at
Open Clin Cancer J. 2008 Jan 18;2:1-6.
Metabolic profile
of breast cancer in a population of women in southern Spain.
Lopez-Saez JB, Martinez-Rubio JA, Alvarez MM, Carrera CG, Dominguez Villar M, et al.
Departamento de Medicina, Facultad de Medicina, Universidad de
Cádiz, Cádiz, Spain.
Background: There are indications that mortality in breast cancer is
related with dietary factors, but no study has been large enough to
characterise reliably how, this risk is influenced. To establish a logistic
regression equation that would predict breast cancer from factors in the
endocrinological and metabolic profile, we studied endocrinological and
metabolic risk factors that are modified by the diet, in a population of women
with breast cancer in southern Spain.Patients and Methods: We carried out a
simple a case-control study comparing 204 women with breast cancer (96
premenopausal and 108 postmenopausal women) and 250 healthy control subjects.
The predictive variables were basal glycaemia, insulin, glycosylated
haemoglobin (HbA1c), C-peptide, insulin-like growth factor-I (IGF-I), total
cholesterol, triglycerides, high density lipoprotein-c (HDL-C), low density
lipoprotein-c (LDL-C), selenium and Quetelet index (BMI).Results: The metabolic
profile differed between pre- and postmenopausal patients, and metabolic
alterations were greater in postmenopausal than in premenopausal women. The
differences between healthy subjects and breast cancer patients were clearly
significant.Conclusions: Our findings have several potential practical
applications in the early detection of breast cancer, especially in
premenopausal women; in primary prevention; and in the development of a
mathematical model of breast carcinogenesis.
J Clin Endocrinol Metab. 2008 Jul 29. [Epub ahead of print
Correlates of low
testosterone and symptomatic androgen deficiency in a population-based sample.
Hall SA, Esche GR, Araujo AB, Travison TG, Clark RV, Williams RE, McKinlay JB.
New England Research Institutes,
Risk factors for low testosterone and symptomatic androgen deficiency
(AD) may be modifiable. Objective: To examine demographic, anthropometric, and
medical correlates of low testosterone and symptomatic AD. Design: Data were
used from the Boston Area Community Health Survey, an epidemiologic study
conducted from 2002-2005. Setting: Community-based random sample of racially
and ethnically diverse men. Patients or other Participants: Data were available
for 1,822 men. Interventions: N/A Main outcome measures: Multivariate logistic
regression was used to estimate odds ratios (ORs) and 95% confidence intervals
(CIs) for associations of covariates with 1) low testosterone and 2)
symptomatic AD. The operational definition of \'low testosterone' was serum
total testosterone <300 ng/dl and free testosterone <5 ng/dl; symptomatic
AD was defined as the additional presence of symptoms: any of low libido,
erectile dysfunction, or osteoporosis; or 2 or more of sleep disturbance,
depressed mood, lethargy, or diminished physical performance. Results: Factors
associated with low testosterone included age (OR=1.36, 95% CI: 1.11, 1.66, per
decade); low per-capita income (</=$6,000 per household member vs.
>$30,000) (OR=2.86, 95% CI: 1.39, 5.87); and waist circumference (per 10-cm
increase) (OR=1.75, 95% CI: 1.45, 2.12). Only age (OR=1.36, 95% CI: 1.04,
1.77), waist circumference (OR=1.88, 95% CI: 1.44, 2.47) and health status
(OR=0.21, 95% CI: 0.05, 0.92, excellent vs. fair/poor) were associated with our
construct of symptomatic AD. Of all variables, waist circumference was the most
important contributor in both models. Conclusions: Waist circumference is a
potentially modifiable risk factor for low testosterone and symptomatic AD.
Manifestation of symptoms may be a consequence of generally poor health status.