[Comparative study between estradiol valerate combined with cyproterone acetate, and conjugated equine estrogens combined with medroxyprogesterone acetate as hormone replacement therapy in climacteric]

OBJECTIVE

To compare the effectiveness in the control of climacteric symptoms, the tolerability and the uterine bleeding pattern between two types of hormone replacement therapy.

MATERIAL AND METHODS

81 postmenopausal women between 40 and 60 years age with vasomotor symptoms were studied. Randomly it was administered: I. Conjugated equine estrogens (CEE)-Medroxyprogesterone acetate (MPA): 21 tablets with 0.625 mg of CEE and 10 tablets with 5 mg of MPA which were taken with the last ten tablets of CEE in each cycle (n = 3 7). II. E2V-CPA: 11 tablets with 2 mg of E2V and 10 tablets with 2 mg of E2V and 1 mg of CPA (n = 44). Each cycle comprised 28 days. The treatments were compared with squared Chi and Mann-Whitney U test.

RESULTS

The hot flushes presence was significantly greater in the group with CEE-MPA (p < 0.03). Severe throbs at the end of the study had a trend to be more frequent in the group with EC-MPA (p < 0.06). At the end of the study there was a greater frequency of breast tenderness in the group with CEE-MPA (P = 0.009).

CONCLUSIONS

Both treatments have good effectiveness, tolerability and same bleeding pattern. Only the frequency of hot flushes, the presence of severe throbs and breast tenderness were lower in the group with E2V-CPA, that makes this preparation an option that can have a better acceptance by the women.

Influence of weight and body fat distribution on bone density in postmenopausal women

OBJECTIVE

To determine whether obesity or body fat distribution induces a greater modification on bone remodeling biochemistry (BRB) and bone density in postmenopausal women.

METHODS

One hundred and thirteen postmenopausal patients were studied. They were initially divided according to body mass index (BMI), and afterwards by waist-hip ratio (WHR) as well as combinations of the two factors. Hormone measurements and assessments of BRB were also done. Dual-emission X-ray absorptiometry from the lumbar column and hip was performed with Lunar DPXL equipment, and the standard deviation in relation to young adult (T) and age-matched subjects (Z) was calculated. Statistical analysis was done by the Mann-Whitney U test. The relation of BMI and WHR with the variables was calculated by simple regression analysis.

RESULTS

When divided according to BMI, there was greater bone density in the femoral neck in those with normal weight. After dividing according to WHR, the Z scores had a trend to a lesser decrease in those with upper level body fat distribution. Divided according to BMI and WHR, obese patients with upper-level body fat distribution had greater bone density in the lumbar column than those with normal weight and lower-level body fat distribution. With the same WHR, those with normal weight had greater bone density than those who were obese.

CONCLUSIONS

A beneficial effect of upper-level body fat distribution on bone density was found. It is greater than that from obesity alone, and obesity and upper-level body fat distribution have an additive effect on bone density.

[Epidemiologic variables in postmenopausal women]

The objective was to know the characteristics of presentation, its clinical aspects and the modification in the diagnostic tools in a selected population of Mexican women with spontaneous menopause. The age at menarche, age at menopause, marital status, age at marriage, number of pregnancies and occupation of 1,099 women with spontaneous menopause were studied. In 619 women which were not receiving nor had received hormone replacement therapy the clinical, laboratory such as glucose, lipids, hormones, bone remodeling biochemistry; and X ray studies such as densitometry and mammography were analyzed. The age average of menarche presentation was at 13 years, and that of spontaneous menopause at 48.1 years 78% were married, with an age at marriage of 23 years, 66% had home duties. The screening tests showed that 30% of patients required cardiovascular evaluation, 40% showed alterations on lipids levels and at least 40% had some alteration on bone remodeling biochemistry or in densitometry. The mammography was normal in 81%. This study showed that most of the data in these group of women were similar to those of other populations, and many of them need intensive surveillance and adequate therapeutic prescriptions to diminish risk factors.

Changes in symptoms, blood pressure, glucose, hormones, and lipid levels according to weight and body fat distribution in climacteric women

OBJECTIVE

To evaluate how symptoms, blood pressure, glucose, hormones and lipid levels are modified in climacteric women according to obesity and body fat distribution.

METHODS

One hundred and thirteen women were studied and divided initially according to body mass index (BMI), and afterward to waist-hip ratio (WHR). Climacteric symptoms, blood pressure, fasting and post-breakfast glucose, hormone and lipid levels were analyzed. Statistical analysis was done by the chi square and Mann-Whitney U tests, and the relation of BMI and WHR with several variables was assessed by linear regression analysis.

RESULTS

When dividing patients according to BMI, the only differences were found in age, number of diabetic and hypertensive patients, and values of systolic and diastolic blood pressure, which were greater in the obese group. When dividing according to WHR it was found that high-density lipoproteins were lower in those with upper segment body fat distribution. Subgroup analysis showed that chronic diseases are frequently found in obese women, while android body fat distribution has an additive effect on obesity in some of these variables.

CONCLUSION

Chronic diseases are more frequently found in obese women, but most of the metabolic alterations are modified by body fat distribution in the upper segment.

[Relation between body mass index and bone mineral density in a sample population of Mexican women]

The purpose of this trial is to demonstrate that a women with high body mass index (BMI > or = 28) has greater bone mineral density (BMD) from that with lower BMI. We studied 922 healthy women who met the inclusion criteria. They were classified into four groups according to their BMI (> or = 28 and < 28) and age (> or = 35 and < 35 years). Bone mineral measurement was performed by dual-energy X-ray absorptiometry (DEXA) in the hip and at the lumbar region. BMD in overweight women older than 35 years was significantly higher in comparison with that of women with lower BMI, both in the hip and the lumbar spine. In overweight women younger than 35 years, we found greater BMD in the hip reaching statistical significance, but not at the lumbar spine. We conclude that obesity is associated with greater BMD (4% at the lumbar spine; 11% at the hip) probably due to both greater physical stress and higher estrogen levels.

Influence of previous bilateral partial tubal resection on symptoms, hormones, lipids, and bone density in postmenopausal women

The late effect of bilateral partial tubal resection (BPTR) on symptoms, hormone and lipid levels, and bone density in postmenopausal women was analyzed. Thirty-six postmenopausal women in whom BPTR was accomplished were studied; they were matched by age with a group without BPTR. They were subdivided according to time since BPTR into two groups: < or = 15 years > 15 years since the procedure. In both groups, the patients' general data were analyzed as well as the frequency of climacteric symptoms; serum levels of follicule-stimulating hormone (FSH), estradiol, total cholesterol, HDL-C, LDL-C, and triglycerides; and bone density in lumbar spine, femoral neck, Ward's triangle, and trochanter. The statistical analysis was done for the symptoms with chi-squared and for the rest of variables with Student's t-test. When comparing the groups, no differences were found in analyzed parameters; only hot flashes and sweating associated with hot flashes were frequently found in the BPTR group when the analysis was done in the group without any division. With the groups subdivided, hot flashes were found more frequently in the group for whom it had been more than 15 years since the BPTR procedure. The BPTR did not influence hormone and lipid levels or bone density.

Changes in symptomatology, hormones, lipids, and bone density after hysterectomy

OBJECTIVE

To evaluate the differences in symptoms, hormone and lipid levels, and bone density in two groups of women.

METHODS

Two hundred eighty-five women who attended for climacteric study with previous simple hysterectomy were studied. Three groups were formed according to time since surgery (group I < 10 years, group II > or = 10 and < 20 years, and group III > or = 20 years). They were paired by age with a group without hysterectomy (control group) that also attended for climacteric study. None of them were receiving nor had received hormone replacement therapy. Age, body mass index, gestations, deliveries, and climacteric symptoms were analyzed for all subjects. Follicle-stimulating hormone (FSH), estradiol, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels were determined, and atherogenic index was calculated. Bone density was measured with a Lunar DPXL appliance. Statistical analysis was done by the chi-square test, Student's t test, and linear regression analysis.

RESULTS

There were no differences among groups in body mass index, gestations, or deliveries. Depression was more frequent in the hysterectomy group, who also had lower levels of total cholesterol, HDL cholesterol, and FSH than controls.

CONCLUSIONS

It was observed that hysterectomy does not have a deleterious effect on hormone or lipid levels, nor on bone density, but depression was a frequent finding in hysterectomized women.

[Metabolic changes in climacteric women in terms of body mass index]

The objective was to identify climateric woman with cardiovasculary risk by the relation between size and weight, known as corporal mass index. Seven hundred and ninety seven postmenopausal patients, were studied; they attended the CECLIMEN, with one or two years of spontaneous menopause, and they were not receiving, nor had received replacement hormonal therapy (RHT). In all of them clinical history was taken, and blood pressure, weight, size and corporal mass index (CMI) (weight/(size)2), were evaluated; considering normal weight when CMI was < or = 27, and obesity when this index was greater than 27. Fastening and postprandial glucose at two hours, was determined, as well as total cholesterol, HDL-C, cholesterol of low density lipoproteins (LDL-C), triglicéridos (Tg), and aterogenic index was calculated by CtHDL-C. Besides, estradiol (E2) and follicle stimulating hormone (FSH) were measured in serum by radioimmunoanalysis RIA. Results were considered in the two groups, according to CMI: Group I with CMI < or = 27 (n = 566); and group II, with CMI > 27 (n = 231). Blood pressure, systolic and diastolic, triglicerides and aterogenic index were significantly greater in group II. There were higher levels of glucose in group II (tendency). CMI > 27 is useful to differentiate the postmenopausal women with a higher cardiovasculary risk.