Orientador: Rogério Dias / Banca: Jorge Nahas Neto / Banca: Reginaldo Guedes Coelho Lopes / Resumo: Para o diagnóstico de pólipo endometrial, dispõe-se da ultrassonografia e da histeroscopia ambulatorial, sendo a última considerada padrão ouro. A ultrassonografia avalia a espessura do endométrio, sua alteração de ecogenicidade e seus limites. Os resultados de tal exame pode sugerir a doença. A histeroscopia ambulatorial, por sua vez, é um exame mais preciso, pois permite uma melhor identificação do pólipo endometrial. Além disso, ela permite a confirmação do diagnóstico através da biópsia, assim como o tratamento. Comparar a ultrassonografia e a histeroscopia ambulatorial como métodos propedêuticos dos pólipos endometriais nas mulheres menopausadas do Serviço de Endoscopia Ginecológica e Planejamento Familiar da Disciplina de Ginecologia do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Botucatu-Hospital das Clínicas (UNESP). Estudo analítico e retrospectivo cujos dados foram obtidos através de consultas a 323 prontuários de mulheres menopausadas submetidas a ultrassonografia e a histeroscopia ambulatorial no referido setor, no período de março de 2003 a março de 2009. Foram incluídas no estudo 281 mulheres menopausadas na faixa etária de 41 a 82 anos, que haviam sido submetidas à histeroscopia ambulatorial por apresentarem sangramento uterino e/ou ultrassonografia transvaginal alterada (EE≥5 mm), e que, por esses motivos, foram encaminhadas ao ambulatório. A idade média das pacientes foi de 61,3 anos, sendo que 27,6% apresentaram diabetes mellitus tipo II, 70,5% eram hipertensas, 5,7% eram tabagistas. A média do índice de massa corpórea (IMC) foi de 31,6 kg/m2, e 73% eram multíparas (com 3 ou mais partos). A média do tempo de menopausa (amenorreia) foi de 10,7anos, sendo que 15,3% das pacientes eram usuárias de terapia hormonal, e 6,8% estavam em tratamento de câncer de mama com tamoxifeno. Do total de pacientes, 38,1%... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Ultrasonography and outpatient hysteroscopy are considered the "golden standard" for the diagnostic of endometrial polyp. Ultrasonography evaluates the endometrial thickness, the echogenicity and the limits. Its results can suggest the pathology. Outpatient hysteroscopy, on the other hand, is a more accurate exam, providing a better identification of the endometrial polyp and confirming the diagnostic through histological examination. It also may be used as a treatment. Comparison of the ultrasonography with the outpatient hysteroscopy as diagnostic methods for endometrial polyps in postmenopausal women from the Endoscopic and Gynecologic Service of the Medical School of Botucatu - UNESP. Analytical and retrospective study based on the files of 323 postmenopausal women submitted to ultrasonography and to outpatient hysteroscopy from March 2003 to March 2009, wich were performed in the Gynecologic and Obstetric Department of the Medical School of Botucatu (UNESP) - Gynecology Discipline of Botucatu Medical School. In this study, 281 postmenopausal women, with ages between 41 and 82 years, and that had been submitted to outpatient diagnostic hysteroscopy, were included. They had uterine bleeding and/or altered transvaginal ultrasound (EE≥5 mm). Patients mean age was 61,3 years; 27,6% had diabetes mellitus II; 70,5% had systemic arterial hypertension; and 5,7% were smokers. IMC was 31,6 kg/m2, and 73% were multiparae (3 or more deliveries). Average menopause time (amnorrhea) was 10,7 years; 15,3% were under hormonal therapy; and 6,8% were under breast cancer treatment with taximofen. From the 323 patients, 38,1% had uterine bleeding and 61,9% were asymptomatic. Ultrasonography detected endometrial polyp in 22,8% of the patients, endometrial thickness in 59,8%, being 10,5mm the mean thickeness. Comparing the ultrasonography with the histopathology, it was observed that endometrial... (Complete abstract click electronic access below) / Mestre

Estima-se que, no ano de 2025, 23% da população total dos países desenvolvidos estarão com mais de 60 anos, evidenciando-se assim o envelhecimento gradativo do contingente populacional destes países. Deste modo, é perceptível o contingente de mulheres que estarão vivenciando a fase da menopausa com seus efeitos biológicos, psicológicos e sociais. As mudanças hormonais e fisiológicas que acontecem nas mulheres durante a fase da menopausa, acompanhadas pela desvalorização estética do corpo e por toda uma sintomatologia física e psíquica, têm sido interpretadas como perda da feminilidade, sinalizando o envelhecimento inevitável e a finitude. No entanto, muitos dos desconfortos que as mulheres vivenciam nesta fase não se devem às mudanças biológicas, mas ao seu processo de socialização, caracterizando a influência de gênero. Neste contexto, este trabalho teve como objeto o estudo da influência da relação de gênero na vivência e no significado do processo da menopausa, tendo como objetivos: descrever a vivência da menopausa a partir da perspectiva de mulheres que a vivenciam e identificar as particularidades relacionadas ao gênero diretamente envolvidas na experiência da menopausa a partir da perspectiva das mulheres. Para desenvolvimento do trabalho foi utilizada abordagem qualitativa de natureza descritiva com vinte mulheres de idade entre 45 e 55 anos que apresentavam menopausa espontânea e eram clientes das Unidades Básicas de Saúde da cidade de Curitibanos-SC, no período de 1 a 15 de outubro de 2009. Para a coleta de dados foi utilizado um roteiro de entrevista semi-estruturada com uma questão norteadora: Fale-me como é para você estar vivenciando a menopausa. A interpretação e análise foram feitas através de análise de conteúdo do tipo temática descritas por Bardin. Nas narrativas, identificaram-se categorias que foram integradas em quatro temas principais: 1- Vivenciando a Menopausa, 2- Identificando Transformações no Corpo e na Vida, 3- Cuidando de Si, 4- Buscando Informações/Influências e Construindo Conhecimento. Foi possível identificar nessas categorias que as mulheres trazem o conceito de que a fase da menopausa é uma doença, e relacionam essa fase com envelhecimento e declínio físico, a qual traz grandes sofrimentos, o que demonstra a influência de gênero no vivenciar desta fase. As entrevistadas explicitaram em suas falas diversos sintomas que as incomodavam e interferiam em suas atividades diárias e na sua maneira de ser, repercutindo muitas vezes no seu comportamento familiar e profissional. O conhecimento sobre a menopausa, neste grupo de mulheres, foi construído ao longo de suas vidas e reflete as suas realidades culturais e sociais, deixando evidente a escassez de fontes de informação e os tabus relacionados com relação à fase da menopausa. Este estudo contribui com a geração de conhecimentos levando em consideração os efeitos que a influência de gênero pode ter na vivência e percepção da menopausa, desmistificando-a para que a vivência das mulheres durante esse período não seja condicionada por estereótipos e crenças relacionadas ao gênero. / They is esteem that, in the year of 2025, 23% of the total population of the developed countries will be with more than 60 years, what show the gradual aging of the population contingent of these countries. In this way, is perceivable the contingent of women who will be living deeply the phase of the menopause with its biological, psychological and social effects. The physiological and chemical changes that happen in the women during the menopauses phase, followed with the aesthetic depreciation of the body, have been interpreted as loss of the feminine characteristics, signaling the inevitable aging and the end of the life. However, many of the discomforts that the women live in this phase not must to the biological changes, but to its process of socialization, characterizing the genre influence. In this context, this work had as object the study of the influence of the relation of genre in the experience and meaning of the process of the menopause, having as objective: describes the experience of the menopause on the perspective of women and to identify the particularitities involved to the genre in the experience of the menopause on the perspective of the women. For development of the work, was done one research descriptive-qualitative with customers of the Basic Units of Health of the city of Curitibanos-SC, in the period of 1 to 15 of October of 2009. For the collect of data, one structured interview was used with an orienting question: It speaks to me, as are for you to be living the menopause. The interviews were done with 20 women, with ages between 45 and 55 years and that had presented spontaneous menopause. The interpretation and analysis was done by analysis of content of the thematic type described by Bardin. In the narratives, was done the identification of categories that was integrated in four main subjects: Living on the Menopause, Identifying Transformations in the Woman Body and in the Life, Cares Myself, Research Information/Influences and Building Knowledge. Was possible identify in these categories that the women bring the idea that the menopause phase is an illness, and relate this phase with aging and physical decline, which brings great sufferings, what it demonstrates to the influence of genre in this phase. The interviewed ones showed diverse symptoms in its words, this bother and intervene in the daily activities and its way to be, and this situation, influence many times in its familiar and professional behavior. The knowledge on the menopause, in this group of women, was constructed throughout its lives and reflects its cultural and social realities, leaving evident the scarcity of information sources and the taboos related with the subject. This work improve of knowledge in consideration the effect that the genre influence can have in the experience and perception of the menopause, demystifying the experience mode of the women during this period, not conditioning for stereotypes and beliefs related to the genre.

Made available in DSpace on 2014-06-11T19:29:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-15Bitstream added on 2014-06-13T20:20:18Z : No. of bitstreams: 1 cangussu_lm_me_botfm.pdf: 560084 bytes, checksum: e6b5d6f4f10f581592da0884c164a71a (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Avaliar a associação entre o equilíbrio postural e a densidade mineral óssea (DMO) em mulheres na pós-menopausa e correlacionar com o risco de quedas. Realizou-se estudo de corte transversal com 225 mulheres, idade 45-75 anos, atendidas em Hospital Universitário. Incluíram-se mulheres em amenorréia >12 meses e idade ≥ 45 anos, com valores de DMO (coluna lombar e colo de fêmur) pelo DXA, dos últimos 12 meses. E se excluíram aquelas com doenças neurológicas ou musculoesqueléticas, história atual de vestibulopatias, déficit visual sem correção, obesidade grau III e usuárias de drogas que alterem o equilíbrio. As mulheres foram divididas segundo a DMO em > -2,0 DP (n=140) e ≤ -2 DP (n=85). Foram analisados o histórico de quedas (últimos 24 meses) e as características clínicas e antropométricas. O equilíbrio postural foi avaliado pela estabilometria (plataforma de força), teste de Romberg, alcance funcional e teste do agachamento. Para análise estatística foram empregados o Teste de Wilcoxon para variáveis quantitativas, o teste do Qui-Quadrado ou Exato de Fisher para variáveis categóricas e o método de regressão logística para o risco de quedas (Odds Ratio-OR). As pacientes com DMO > -2,0 DP eram mais jovens e com menor tempo de menopausa, assim como apresentavam maior IMC e circunferência da cintura quando comparadas aquelas com baixa DMO (≤ -2 DP) (p<0,05). Observou-se que 57,8% (130/225) das participantes relataram episódio de queda nos últimos dois anos, sem diferença significativa na distribuição percentual entre os grupos (p=0,055). Nos parâmetros estabilométricos e no alcance funcional não foram demonstradas diferenças na comparação entre os grupos (p>0,05). No teste de Romberg notou-se aumento progressivo da positividade à medida que aumentava a dificuldade do teste, sendo observada diferença significante entre os grupos apenas com... / To analyze the association between postural balance and bone mineral density (BMD) in postmenopausal women and correlate it with risk for falls. A cross-sectional study was conducted on 225 women aged 45-75 years and cared for at a University Hospital. Women in amenorrhea >12 months and age ≥ 45 years, with BMD values (lumbar spine and femur neck) by DXA for the last 12 months, were included. Those with neurological or musculoskeletal disorders, current history of vestibulopathies, uncorrected visual deficit, level-III obesity or drug use that could affect balance were excluded. The women were divided, according to BMD, in > -2.0 DP (n=140) and ≤ -2 DP (n=85). Histories of falls (last 24 months) as well as clinical and anthropometric characteristics were evaluated. Postural balance was assessed by stabilometry (strength platform), Romberg’s test, functional reach test and the crouching test. For statistical analysis, Wilcoxon’s test was used for quantitative variables, the Chi-square or Fisher’s exact test for categorical variables and the logistic regression method for fall risk (Odds Ratio-OR). Patients with BMD > -2.0 DP were younger and had been menopausal for a shorter period of time; they also showed higher BMI and larger waist circumference as compared to those with low BMD (≤ -2 DP) (p<0.05). It was observed that 57.8% (130/225) of the participants reported fall episodes in the last two years, without significant difference in the percent distribution between the groups (p=0.055). No differences were found in the comparison between the groups (p>0.05) for stabilometric parameters or functional reach test. Concerning Romberg’s test, progressive positive increase was observed as the test difficulty increased, and significant difference between the groups was found only when the women kept their feet in a series and their eyes closed (p<0.05). When evaluating the ... (Complete abstract click electronic access below)

The aim of my work was to identify additional genetic and non-genetic factors influencing female reproductive ageing in humans. Although approximately 50% of population variation in age at menopause is due to genetics, less than 3% of variation had been accounted for by common genetic variants. Of non-genetic risk factors, only smoking had consistently been found to have a strong effect on age of menopause. In the wider context of female reproduction, our understanding of the role of genetics in determining sex hormone levels was limited. By combining the results of research in these different areas, I hoped to improve our knowledge of the biology of female reproductive ageing. Chapter 1 is an introduction in which I discuss the biology of menopause, describe relationships with health and present current knowledge regarding non-genetic and genetic risk factors influencing menopause age. Chapter 2 is an analysis of the associations between non-genetic risk factors occurring in early life with early menopause. We identified an association between multiple births and early menopause, connecting events pre-birth, when the oocyte pool is formed, with reproductive ageing in later life. Chapter 3 is a genome-wide association study to identify genetic variants associated with levels of nine sex hormone related phenotypes. We highlighted loci of relevance to reproductive function, which suggested overlaps in the genetic basis of hormone regulation. Chapter 4 is a genome-wide association study of menstrual cycle length. We showed that a common genetic variant related to follicle stimulating hormone levels and age at menopause is associated with several reproductive traits including length of menstrual cycle. Chapter 5 is an investigation of the relationship between differences in length of normal FMR1 triplet repeat alleles and timing of menopause. We found no association between the length of normal FMR1 alleles and timing of menopause, contradicting the results of smaller studies and replicating a null result in another large study. Chapter 6 is large genome-wide meta-analysis to identify common and low-frequency genetic variants associated with age at menopause. We identified 44 regions containing 54 independent common signals and two rare missense alleles of large effect. Finally, in Chapter 7 I evaluate how this work has benefitted our knowledge of female reproductive ageing and describe directions for future research.

M.Tech. (Homoeopathy) / Please refer to full text to view abstract

Class of 2008 Abstract / Objectives: The purpose of this study was to assess the effects of using compounded Bio-identical Hormone Replacement Therapy (BHRT) in menopausal women, by employing the MRS. Methods: This study used a one group pre-test/ post-test. Included were 25 menopausal women, whom at initial BHRT consultation at Reed’s Compounding Pharmacy filled out a baseline menopausal rating scale (MRS). Eleven weeks into therapy, patients were asked to participate in this study and if interest was expressed, they were asked to fill out another MRS for comparison. Results: There was a statistically significant decrease in overall MRS scores and in each of the 3 subscales (psychological, somatic and urogenital) (p</= 0.001). Additionally, when evaluating each MRS item individually, there were statistically significant decreases in all symptoms of menopause except for heart discomfort. Most improvements were seen in hot flushes/sweating, sleep and sexual problems (p<0.001). Conclusions: Patients using BHRT improved overall physically and mentally, which would be depicted by improved scores on the MRS.

Obesity is an excess of body fat. A person is considered overweight if his/her Body Mass Index (BMI) ranges 26 - 30 kg/m². The prevalence of obesity in adult women rises significantly each decade, until it begins tapering off late in life. The years surrounding the climacteric are especially associated with weight gain, which poses a great health risk as it increases the incidence of hypertension, elevated blood lipid levels and insulin resistance. Dr Reckeweg R59® is a homoeopathically prepared complex remedy that is indicated for obesity. The aim of this study is to determine the efficacy of R59® weight loss treatment in women in the climacteric and menopause between the ages of 45 and 65 who are overweight or obese. The proposed study was a quantitative, double blind study. The study involved fifty female subjects between the ages of forty-five and sixty-five. The subjects were recruited using pamphlets, brochures and advertisements throughout the eastern Johannesburg district and the University of Johannesburg. Research took place at the University of Johannesburg Homoeopathy Day Centre and the East Side Medical Centre in Kensington. The participants were randomly divided into two groups of twenty-five each. Both groups received an eating plan. Group A received a placebo. Group B received R59®. Participants were required to take ten drops of the medicine three times a day for eight weeks. During the first consultation and final follow up, the subject’s vital signs, BMI and fat percentage were recorded. The participant’s body circumference measurements and weight in kilograms were recorded weekly. The participant was required to keep a simple daily diary recording what food was consumed each day. Data was analysed using the independent sample t-tests, repeated measures Analysis of Variance (ANOVA) and repeated measures ANOVA with between-subjects factor. From statistical evaluation, it was determined that R59® did not cause weight loss but was a factor in accelerating weight reduction. Both groups A and B experienced weight loss and size reductions. The statistics indicated that the results were statistically insignificant. / Dr. B. A. Saunders Mrs. H. L. Matthews

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Basierend auf einer Analyse medizinischer Schriften aus Deutschland, Frankreich und England befasst sich diese Dissertation mit der Interpretation und Wahrnehmung der Wechseljahre und der Frau in den Wechseljahren zwischen 1800 und 1950. Obwohl sich das medizinische Verständnis des Wechseljahrsprozesses in dieser Zeit, in der die Sexualhormone entdeckt wurden, änderte, herrschte in diesen Schriften eine ständige, allgegenwärtige Pathologisierung der Menopause vor. Die (überwiegend männlichen) Autoren verwendeten eine sehr negative und oft dramatische Sprache, um die Wechseljahre und ihre Gefahren zu charakterisieren. Sie brachten die Wechseljahre insbesondere mit Nervenkrankheiten und psychischen Problemen in Verbindung. Darüber hinaus beschrieben sie in einer sehr abwertenden Sprache die Veränderungen des äußeren Erscheinungsbildes und der weiblichen Libido, die sie bei Frauen in den Wechseljahren und nach der Menopause beobachten zu können glaubten: pralles "Fleisch" und hervorstehende Bäuche, übermäßiges sexuelles Verlangen und "geile" Träume, die einige von ihnen quälten und die Umwandlung ihres Charakters in einen männlicheren. Rückblickend spiegelten diese Berichte in erheblichem Maße die zeitgenössische Wahrnehmung der gebrechlichen und reizbaren Natur der Frau und ihrer Rolle in der Gesellschaft wider, und laut den Ärzten teilten Frauen zu dieser Zeit diese Vorstellungen. Ich behaupte zudem, dass diese zutiefst negative Sichtweise der Menopause in der Geschichte der westlichen Kultur auch heute noch die Wahrnehmung und Erfahrung der Menopause beeinflussen kann. / Based on an analysis of medical writings from Germany, France and England, this dissertation looks at the interpretation and perception of menopause and the menopausal woman between 1800 and 1950. Although the medical understanding of the menopausal process changed considerably in this period, in which the sex hormones were discovered, i found a constant, pervasive pathologization of menopause in these writings. The (predominantly male) authors used a very negative and often dramatic language to characterize menopause and its dangers. They associated menopause, in particular, with nervous diseases and mental health issues. Moreover, they described in a highly judgmental and moralizing language the changes in outward appearance and in female libido they thought they could observe in menopausal and postmenopausal women: bulging flesh and protruding abdomens, excessive sexual desire and horny dreams that tormented some of them and a transformation of their character into a more masculine one. In retrospect, these accounts reflected, to a considerable degree the contemporary perception of the frail and irritable nature of women and their role in society and, according to the physicians, women at the time shared these ideas. I suggest that this profoundly negative view of menopause in the history of Western culture may still influence the perception and experience of menopause today.

Osteoporosis, the most common human bone disease, affects 8 million American women and has significant morbidity and mortality. Screening is important in older women and younger postmenopausal women with additional risk factors for osteoporosis/fracture. Preventive measures include avoiding smoking, excessive alcohol/caffeine intake, and falls in addition to maintaining adequate calcium/vitamin D intake and exercise. Estrogen/hormone therapy may be considered in some patients. Various medications have proven efficacy in treating postmenopausal osteoporosis; however, potential adverse effects such as hypocalcemia, worsening of renal impairment, and osteonecrosis of the jaw must be considered. The optimal duration of therapy requires further investigation.