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O hipoestrogenismo, decorrente da fase pós-menopausa, determina uma série de alterações físicas, psicológicas e metabólicas na mulher, com piora significativa em sua qualidade de vida. No entanto, são os efeitos da deficiência estrogênica a longo prazo que mais preocupam, pois podem levar a comprometimentos importantes, como as doenças cardiovasculares. Desta maneira, a terapia hormonal (TH) e o treinamento físico têm surgido como esquemas terapêuticos úteis para o controle das alterações presentes na pós-menopausa. Objetivos: o presente estudo teve como objetivos avaliar a modulação autonômica da freqüência cardíaca (FC) e a capacidade aeróbia de mulheres pós-menopausa em uso ou não de TH, antes e após um programa de treinamento físico (PTF). Casuística e Métodos: foram estudadas 18 mulheres sedentárias, divididas em 2 grupos, sendo: Grupo controle - 10 mulheres na pós-menopausa (50 a 60 anos) sem TH; Grupo TH - 8 mulheres na pós-menopausa (50 a 60 anos) com TH (valerato de estradiol + levonorgestrel). Ambos os grupos foram avaliados em dois momentos distintos: antes (avaliação) e após (reavaliação) um PTF de 3 meses de duração. Tanto na avaliação, como na reavaliação, as voluntárias foram submetidas a dois protocolos experimentais: protocolo 1 - para avaliação da modulação autonômica da FC, esta foi coletada em condições de repouso, nas posições supina e sentada, durante 15 minutos em cada posição; protocolo 2 - para avaliação da capacidade aeróbia, as voluntárias foram submetidas a um teste cardiopulmonar com protocolo incremental. Os índices avaliados no protocolo 1 foram: média da FC e dos intervalos R-R (iR-R), índice RMSSD dos iR-R, bandas de baixa (BF) e alta (AF) freqüência da análise espectral, em unidades normalizadas, e razão BF/AF. No protocolo 2 foram comparados os valores de potência, consumo de oxigênio (VO2) e FC no limiar de anaerobiose (LA) e no pico do exercício. Para comparação entre os grupos estudados, foi utilizado o teste t de student não-pareado; para a comparação intra-grupo entre as condições de avaliação e reavaliação, o teste estatístico utilizado foi o t de student pareado. Nível de significância estabelecido em 5%. Resultados: em relação ao protocolo 1, não foram observadas diferenças estatisticamente significativas tanto na comparação entre os grupos como na comparação entre as fases de avaliação e reavaliação, para os dois grupos estudados, em nenhum dos índices avaliados. Na análise dos resultados do protocolo 2, foram observadas diferenças estatisticamente significantes (p<0,05) entre a condição de avaliação para a condição de reavaliação dos parâmetros potência e VO2 no LA e no pico do exercício, para os dois grupos estudados. O grupo TH apresentou valores estatisticamente (p<0,05) superiores do VO2 na fase de reavaliação, quando comparado ao grupo controle. Ainda para o grupo controle, a FC no pico do exercício da reavaliação foi estatisticamente (p<0,05) superior à da avaliação. Conclusões: o programa de treinamento físico realizado na intensidade do LA durante 3 meses promoveu ganhos aeróbios significativos, embora não tenha alterado a modulação autonômica da freqüência cardíaca de mulheres menopausadas sem e em uso de terapia hormonal; tais ganhos parecem ser decorrentes principalmente de adaptações periféricas musculares. A terapia hormonal não teve influência importante sobre a variabilidade da freqüência cardíaca e teve apenas efeito discreto sobre a capacidade aeróbia na reavaliação; esse efeito se deve possivelmente à reserva de vasodilatação presente em mulheres usuárias de reposição estrogênica, que se evidencia apenas em altas intensidades de exercício. / Low levels of estrogen observed at menopause determine many physical, psychological and metabolic changes in women, resulting in a lower quality of life. However, long-term effects of estrogen deficit that could possibly lead to serious diseases, such as cardiovascular disease, are the problems that concern us the most. Within this context, hormone therapy (HT) and physical training are frequently used as useful therapeutic regimens for controlling postmenopausal alterations. Objectives: this study aimed to evaluate the autonomic modulation of heart rate (HR) and the aerobic capacity of postmenopausal women using and not using HT, prior and after a physical training program (PTP). Methods: 18 sedentary women were divided in two groups, as follows: Control Group - 10 postmenopausal women (50 to 60 years) without HT; HT Group - 8 postmenopausal women (50 to 60 years) receiving HT (estradiol plus levonorgestrel). Both groups were evaluated at two distinct moments: prior to (evaluation) and after (re-evaluation) a PTP lasting 3 months. Subjects were submitted to two experimental protocols at both moments: protocol 1 - HR was recorded in a resting condition, in supine and sitting positions, during 15 minutes in each position, for the evaluation of autonomic modulation of HR; protocol 2 - subjects were submitted to a cardiopulmonary test with incremental protocol for the evaluation of aerobic capacity. Autonomic indexes used for protocol 1: mean HR and mean R-R intervals (R-Ri), rMSSD of R-Ri index, low (LF) and high (HF) frequency bands of spectral analysis, in normalized units, and the LF/HF ratio. Aerobic capacity indexes used for protocol 2: workload, oxygen uptake (VO2) and HR values obtained at anaerobic threshold (AT) and at exercise peak. Unpaired Student\'s t-test was used for groups\' comparisons; for comparing evaluation and re-evaluation conditions within groups, paired Student\'s t-test was applied. The level of significance was set at 5%. Results: in relation to protocol 1, no statistically significant differences were found in the comparisons between groups and between evaluation and re-evaluation phases within groups, for any of the autonomic indexes. Protocol 2 analysis showed significant differences (p<0.05) between evaluation and re-evaluation phases for workload and VO2 values at AT and at exercise peak, for both groups. HT group presented significant (p<0.05) higher values of VO2 than control group, in the re-evaluation phase. The levels of HR at exercise peak for control group were statistically (p<0.05) higher than evaluation phase\'s. Conclusions: the 3-month anaerobic threshold-intensity physical training program significantly improved aerobic capacity although not changed the autonomic modulation of heart rate of postmenopausal women using and not using hormone therapy; the nature of this improvement seems to be related to muscle peripheral adaptations. Hormone therapy had not important influence on heart rate variability and a low-magnitude effect on aerobic capacity at re-evaluation test; this effect is possibly related to a vasodilatory reserve presented by HT women that becomes apparent only at high intensity levels of exercise.

Conclusion 1. The results of the research partly supported hypothesis 1a. There was a significant reduction in both endothelium-dependent arterial relaxation following a surgical menopause. The results of the research partly supported hypothesis 1b. There was a significant reduction in endothelium-dependent arterial relaxation but no significant effect on endothelium-independent arterial relaxation. / Conclusion 2. The results of the research partly supported hypothesis 2a. The addition of unopposed oestrogen significantly improved endothelium-dependent but not endothelium-independent arterial relaxation. The results of the research supported hypothesis 2b. The addition of oestradiol combined with progestogen (norethisterone acetate) reversed the reduction in arterial relaxation caused by a surgical menopause. The results of the research partly supported hypothesis 2c. The addition of tibolone reversed the reduction endothelium-dependent but not endothelium-independent arterial relaxation. The results of the research partly supported hypothesis 2d. The addition of oestradiol combined with a progestogen (norethisterone acetate) reversed the reduction in endothelium-dependent but not endothelium-independent arterial relaxation. / Conclusion 3. The results of the research partly supported hypothesis 3a. Endothelium-dependent arterial relaxation but no endothelium-independent arterial relaxation was improved after the addition of menopausal hormone therapy using oestrogen combined with a progestogen in a continuous manner. The results of the research did not support hypothesis 3b. Neither endothelium-dependent arterial relaxation nor the endothelium-independent arterial relaxation was improved by cyclical menopausal HT. / Conclusion 4. The results of the research did not support hypothesis 4. The addition of menopausal hormone therapy using combined oestrogen with progestogen did not improve arterial relaxation in postmenopausal women with established coronary heart disease. / Hypothesis 2. This hypothesis examined three different types of commonly used menopausal HT. That unopposed oestrogen (2a), oestrogen combined with a progestogen (2b and 2d) or a synthetic steriod that has oestrogenic, progestogenic as well as androgenic activity (tibolone, 2c), reverse the reduction in arterial relaxation following menopause in Hong Kong Chinese women. / Hypothesis 3. That menopausal hormone therapy using oestrogen combined with progestogen given in either continuous (3a) or cyclical (3b) regimens improves arterial relaxation in postmenopausal Hong Kong Chinese women. / Hypothesis 4. That menopausal hormone therapy using combined oestrogen with progestogen improves arterial relaxation in postmenopausal Hong Kong Chinese women with established coronary heart disease. / Menopausal HT can in general at least partially reverse changes in arterial relaxation in postmenopausal women. Different types of menopausal HT exhibit different effects on arterial relaxation. In healthy vessels, menopause HT mainly reverses the endothelium-dependent vascular effect, but it remains unclear how menopausal HT affects the endothelium-independent vascular effect. However, with established coronary heart disease, menopausal HT cannot reverse the changes in vascular reactivity. / Summary. Menopause results in a reduction in arterial relaxation. However, GnRHa temporarily induced menopause in young women, the endothelium-independent vasodilatation was not impaired. This difference can be partly explained by the difference in age as vascular reactivity is age dependent. Secondly, GnRHa works with an initial phase of increase in oestrogen production resulting in a shorter duration of hypo-oestrogenism resulting in the lack of impairment on endothelium-independent vasodilatation. / This thesis tested the following hypotheses: Hypothesis 1. That vascular reactivity decreases after the menopause as shown in premenopausal Hong Kong Chinese women with either a surgical (1a) or a medically induced (1b) menopause. / This thesis will examine the effects of menopause and menopausal HT on arterial reactivity which is an indirect measurement of vascular function. Previous studies have shown that oestrogen is a potent coronary artery vasodilator, and this effect may be mediated via both endothelium-dependent and endothelium-independent mechanisms. One method of assessing vascular reactivity is to use ultrasound measurement of changes in brachial artery diameter in response to certain stimuli. Using this technique, changes in both endothelium-dependent and endothelium-independent vasodilatation can be measured. Increased rather than decreased arterial relaxation after stimulus can be viewed as a favourable response. / Yim, So-fan. / Adviser: C. J. Haines. / Source: Dissertation Abstracts International, Volume: 68-09, Section: B, page: 5873. / Thesis (M.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 159-194). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Made available in DSpace on 2016-08-19T18:16:03Z (GMT). No. of bitstreams: 1 MARILIA LEAL FERREIRA LAGO.pdf: 216529 bytes, checksum: 435c5f8a55505185c35ba10df038cf6f (MD5) Previous issue date: 2010-11-24 / Objective: Check if there are differences in salivary flow of postmenopausal women with and without estroprogestative and estrogen hormone therapy Methods: We conducted a study of case-control, composed of 86 postmenopausal women, comprising in the case group, 47 users estroprogestative or estrogen HRT, and the control group, 39 women not taking HRT. All patients underwent history taking, through the application of a standard questionnaire, followed by the realization of sialometry stimulated whole. It was used as comparative values, the normal flow from 1.0 to 3.0 mL / min flow down from 0.7 to 1.0 mL / min; hyposalivation, less than 0.7 mL / min. Data were statistically analyzed by chi-square and Student t test (p <0.05). Results: There were no statistically significant differences in the variables analyzed, except for body mass index. Conclusion: In this sample, the flow of saliva in postmenopausal women is not influenced by hormone therapy, regardless of whether estroprogestative or estrogen. / Objetivo: Verificar se existem diferenças no fluxo salivar de mulheres na pós-menopausa com e sem terapia hormonal estroprogestativa e estrogênica. Métodos: Realizou-se um estudo do tipo caso-controle, composto por 86 mulheres na pósmenopausa, contendo, no grupo caso, 47 usuárias de TRH estroprogestativa ou estrogênica, e no grupo controle, 39 mulheres que não utilizavam a TRH. Todas as pacientes foram submetidas à anamnese, por meio da aplicação de um questionário padrão, seguido da realização de sialometria total estimulada e da obtenção do índice de massa corporal. Utilizou-se, como valores comparativos, fluxo normal de 1,0 a 3,0 mL/min, baixo fluxo de 0,7 a 1,0 mL/min; hipossalivação, menos de 0,7 mL/min. Os dados levantados foram submetidos à análise estatística, pelos testes qui-quadrado e t de student (p<0,05). Resultados: Não foram encontradas diferenças estatísticas significativas nas variáveis analisadas, exceto no índice de massa corporal. Conclusão: Na amostra estudada, o fluxo salivar de mulheres na pós-menopausa não sofre influência da terapia hormonal, independente de ser estroprogestativa ou estrogênica.

Introduction: Hormone therapy (HT) has been considered as a safe treatment for menopausal symptoms. Use of HT increased dramatically in the 1980s and 1990s. Results from large randomized clinical trials (RCT) could, around the turn of the century, however not find evidence for long-term benefits with HT. These results attracted great attention from media and the scientific community leading to changed treatment guidelines and decreased use of HT. Aim: The overall aim of this thesis was to explore Swedish women’s conceptions, knowledge, management, and attitudes regarding the menopausal transition and HT. Material and methods: To explore and describe women’s conceptions of the menopausal transition women seeking medical advice due to climacteric symptoms were interviewed (n=20) and their statements were analyzed with a qualitative method (paper I). In 1999 (n=1760) and 2003 (n=1733) attitudes to (paper II) and knowledge of (paper III) the menopausal transition and HT among 53- and 54 year old women were investigated with a cross-sectional design using postal questionnaires. We also analyzed if attitudes differed before and after new scientific findings were published on risks and benefits of HT and if knowledge differed between educational levels. Since many women try to abandon use of HT a RCT was performed to study the effect of two different methods to discontinue HT, on recurrence of hot flushes, resumption of HT and on health related quality of life (HRQoL). Women (n=87) with vasomotor symptoms before initiating HT participated. Results: We found that the majority of the middle aged women in our study viewed the menopausal transition as a natural process the nature of which is affected by both hormonal changes and by ageing. Each woman seems to experience a set of psychological and physical symptoms that are in some sense unique to her experience. Women’s answers to the questions about HT demonstrate that attitudes towards HT held by women going through menopause have changed rather dramatically between 1999 and 2003. These changes probably reflect the influence on the women of media reports based on research that identified risks associated with HT that had not been identified before 1998. Women’s knowledge of the effects of HT seems to be unsatisfactory from a clinical perspective. No differences in hot flush frequency and resumption of HT were found between the women randomized to two different modes of discontinuation of HT. Almost 50 % of the women restarted HT within one year after discontinuation. Deteriorated wellbeing and severity of hot flushes were important predicting factors for resumption of HT. Conclusion: It is important to be aware of the individual woman’s conceptions and attitudes about and knowledge of the menopausal transition and HT to be able to individualize the counselling situation. Women who initiate HT due to hot flushes may experience recurrence of vasomotor symptoms and deteriorated HRQoL after discontinuation. A great proportion of them may resume HT. At present knowledge of possible advantages for the taper-down method when discontinuing HT is still lacking.

Orientador: Lucia Helena Simões da Costa Paiva / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T03:23:51Z (GMT). No. of bitstreams: 1 LazarJunior_Felipe_D.pdf: 154939 bytes, checksum: 9790b7b84c0e5eb21859931d78316ca3 (MD5) Previous issue date: 2006 / Resumo: O objetivo deste estudo foi avaliar o conhecimento e as repercussões sobre a atitude e prática dos médicos ginecologistas três anos após a publicação dos resultados do estudo Women¿s Health Initiative. Sujeitos e Método: Um questionário auto-administrado e anônimo com 19 questões foi enviado aos 6000 ginecologistas da Associação de Obstetrícia e Ginecologia do Estado de São Paulo (SOGESP). Os questionários foram postados em novembro de 2005 com recepção concluída em dezembro de 2005. Resultados: O índice de resposta foi de 24,2% (1453 questionários preenchidos) com erro amostral de 2,23% e intervalo de confiança de 95%. Apesar de 95,9% dos ginecologistas referirem conhecer o estudo WHI, apenas 24,4% tinham conhecimento dos outros estudos (HERS I, HERS II, e Million Women Study) além do WHI. Apesar de 84,6% referirem que os resultados obtidos no estudo WHI não poderiam ser extrapolados para outros tipos de TH, 23,1% e 25,2% abandonaram o uso de EEC ou AMP, 63,7% diminuíram a dose, 55,2% passaram a prescrever drogas como bifosfonatos, tibolona e serms, e 46,3% passaram a utilizar calmantes, isoflavonas e drogas naturais. Além disso, 59,2% concordaram que o tempo ideal de TH deveria ser diminuído para 4-5 anos. Houve queda significativa nas prescrições para todas as indicações de TH (p<0.0001). Para os médicos, a causa mais importante de descontinuação da TH foi o maior risco de câncer de mama (62,3%), no entanto, segundo os médicos, o fator mais importante para as pacientes foi o medo da TH (80,3%) Conclusão: Os ginecologistas têm elevado conhecimento do estudo WHI e seguiram suas recomendações com relação à prevenção de doença cardiovascular, consequentemente, mudaram sua forma de abordar o tratamento das mulheres na pós-menopausa, restringindo as indicações, tempo de uso e dose da TH / Abstract: The objective of this study was to evaluate gynecologists¿ knowledge of the Women¿s Health Initiative study, and its repercussions on their attitudes and practice three years after publication. Design: A self-administered, anonymous questionnaire containing 19 questions was sent to 6000 gynecologists, members of the São Paulo Society of Obstetrics and Gynecology. Results: The response rate was 24.2% (1453 completed questionnaires) with a sample error of 2.23% and confidence level of 95%. Although 95.9% of gynecologists were aware of the WHI study, only 24.4% had knowledge of all the other studies mentioned (HERS I, HERS II and Million Women Study). Although 84.6% stated that the results of the WHI study could not be extrapolated to other forms of HT, 23.1% and 25.2%, respectively, stopped prescribing CEE or MPA, 63.7% decreased the dose, 55.2% opted for drugs such as bisphosphonates, tibolone and SERMS, and 46.3% began to prescribe tranquilizers, isoflavone and other natural medications. Moreover, 59.2% agreed that HT should be used for only 4-5 years. Prescriptions decreased significantly for all indications (p<0.0001). The principal reason for physicians to discontinue HT in a patient was increased risk of breast cancer (62.3%), whereas, according to the physicians, the most important factor for the patients was fear of HT (80.3%). Conclusion: A high percentage of gynecologists in this study knew of the WHI study and followed its recommendations concerning cardiovascular prevention; consequently they changed their management of the treatment of postmenopausal women by restricting indications for HT and decreasing its duration of use and dose / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

O hipoestrogenismo, decorrente da fase pós-menopausa, determina uma série de alterações físicas, psicológicas e metabólicas na mulher, com piora significativa em sua qualidade de vida. No entanto, são os efeitos da deficiência estrogênica a longo prazo que mais preocupam, pois podem levar a comprometimentos importantes, como as doenças cardiovasculares. Desta maneira, a terapia hormonal (TH) e o treinamento físico têm surgido como esquemas terapêuticos úteis para o controle das alterações presentes na pós-menopausa. Objetivos: o presente estudo teve como objetivos avaliar a modulação autonômica da freqüência cardíaca (FC) e a capacidade aeróbia de mulheres pós-menopausa em uso ou não de TH, antes e após um programa de treinamento físico (PTF). Casuística e Métodos: foram estudadas 18 mulheres sedentárias, divididas em 2 grupos, sendo: Grupo controle - 10 mulheres na pós-menopausa (50 a 60 anos) sem TH; Grupo TH - 8 mulheres na pós-menopausa (50 a 60 anos) com TH (valerato de estradiol + levonorgestrel). Ambos os grupos foram avaliados em dois momentos distintos: antes (avaliação) e após (reavaliação) um PTF de 3 meses de duração. Tanto na avaliação, como na reavaliação, as voluntárias foram submetidas a dois protocolos experimentais: protocolo 1 - para avaliação da modulação autonômica da FC, esta foi coletada em condições de repouso, nas posições supina e sentada, durante 15 minutos em cada posição; protocolo 2 - para avaliação da capacidade aeróbia, as voluntárias foram submetidas a um teste cardiopulmonar com protocolo incremental. Os índices avaliados no protocolo 1 foram: média da FC e dos intervalos R-R (iR-R), índice RMSSD dos iR-R, bandas de baixa (BF) e alta (AF) freqüência da análise espectral, em unidades normalizadas, e razão BF/AF. No protocolo 2 foram comparados os valores de potência, consumo de oxigênio (VO2) e FC no limiar de anaerobiose (LA) e no pico do exercício. Para comparação entre os grupos estudados, foi utilizado o teste t de student não-pareado; para a comparação intra-grupo entre as condições de avaliação e reavaliação, o teste estatístico utilizado foi o t de student pareado. Nível de significância estabelecido em 5%. Resultados: em relação ao protocolo 1, não foram observadas diferenças estatisticamente significativas tanto na comparação entre os grupos como na comparação entre as fases de avaliação e reavaliação, para os dois grupos estudados, em nenhum dos índices avaliados. Na análise dos resultados do protocolo 2, foram observadas diferenças estatisticamente significantes (p<0,05) entre a condição de avaliação para a condição de reavaliação dos parâmetros potência e VO2 no LA e no pico do exercício, para os dois grupos estudados. O grupo TH apresentou valores estatisticamente (p<0,05) superiores do VO2 na fase de reavaliação, quando comparado ao grupo controle. Ainda para o grupo controle, a FC no pico do exercício da reavaliação foi estatisticamente (p<0,05) superior à da avaliação. Conclusões: o programa de treinamento físico realizado na intensidade do LA durante 3 meses promoveu ganhos aeróbios significativos, embora não tenha alterado a modulação autonômica da freqüência cardíaca de mulheres menopausadas sem e em uso de terapia hormonal; tais ganhos parecem ser decorrentes principalmente de adaptações periféricas musculares. A terapia hormonal não teve influência importante sobre a variabilidade da freqüência cardíaca e teve apenas efeito discreto sobre a capacidade aeróbia na reavaliação; esse efeito se deve possivelmente à reserva de vasodilatação presente em mulheres usuárias de reposição estrogênica, que se evidencia apenas em altas intensidades de exercício. / Low levels of estrogen observed at menopause determine many physical, psychological and metabolic changes in women, resulting in a lower quality of life. However, long-term effects of estrogen deficit that could possibly lead to serious diseases, such as cardiovascular disease, are the problems that concern us the most. Within this context, hormone therapy (HT) and physical training are frequently used as useful therapeutic regimens for controlling postmenopausal alterations. Objectives: this study aimed to evaluate the autonomic modulation of heart rate (HR) and the aerobic capacity of postmenopausal women using and not using HT, prior and after a physical training program (PTP). Methods: 18 sedentary women were divided in two groups, as follows: Control Group - 10 postmenopausal women (50 to 60 years) without HT; HT Group - 8 postmenopausal women (50 to 60 years) receiving HT (estradiol plus levonorgestrel). Both groups were evaluated at two distinct moments: prior to (evaluation) and after (re-evaluation) a PTP lasting 3 months. Subjects were submitted to two experimental protocols at both moments: protocol 1 - HR was recorded in a resting condition, in supine and sitting positions, during 15 minutes in each position, for the evaluation of autonomic modulation of HR; protocol 2 - subjects were submitted to a cardiopulmonary test with incremental protocol for the evaluation of aerobic capacity. Autonomic indexes used for protocol 1: mean HR and mean R-R intervals (R-Ri), rMSSD of R-Ri index, low (LF) and high (HF) frequency bands of spectral analysis, in normalized units, and the LF/HF ratio. Aerobic capacity indexes used for protocol 2: workload, oxygen uptake (VO2) and HR values obtained at anaerobic threshold (AT) and at exercise peak. Unpaired Student\'s t-test was used for groups\' comparisons; for comparing evaluation and re-evaluation conditions within groups, paired Student\'s t-test was applied. The level of significance was set at 5%. Results: in relation to protocol 1, no statistically significant differences were found in the comparisons between groups and between evaluation and re-evaluation phases within groups, for any of the autonomic indexes. Protocol 2 analysis showed significant differences (p<0.05) between evaluation and re-evaluation phases for workload and VO2 values at AT and at exercise peak, for both groups. HT group presented significant (p<0.05) higher values of VO2 than control group, in the re-evaluation phase. The levels of HR at exercise peak for control group were statistically (p<0.05) higher than evaluation phase\'s. Conclusions: the 3-month anaerobic threshold-intensity physical training program significantly improved aerobic capacity although not changed the autonomic modulation of heart rate of postmenopausal women using and not using hormone therapy; the nature of this improvement seems to be related to muscle peripheral adaptations. Hormone therapy had not important influence on heart rate variability and a low-magnitude effect on aerobic capacity at re-evaluation test; this effect is possibly related to a vasodilatory reserve presented by HT women that becomes apparent only at high intensity levels of exercise.

L’hypothèse de l’hormono-dépendance du mélanome cutané est en débat dans la littérature depuis de nombreuses années. Dans ce contexte, il est essentiel de mieux connaître l’influence potentielle de la prise de traitements hormonaux sur le risque de ce cancer.L’objectif de ce projet de thèse était d’étudier l’influence de la prise de traitements hormonaux (contraceptifs oraux, traitements de l’infertilité, progestatifs pris seuls avant la ménopause et traitements hormonaux de la ménopause) sur le risque de mélanome cutané chez les femmes.Le projet a été conduit principalement à partir de la cohorte prospective E3N (Étude épidémiologique auprès de femmes de l’Éducation nationale) portant sur environ100 000 femmes âgées de 40 à 65 ans à l’inclusion en 1990. L’étude E3N inclut des données détaillées sur le profil pigmentaire, l’exposition solaire et la prise de traitements hormonaux des participantes, ainsi que sur la survenue éventuelle de mélanome cutané, dont les cas ont été confirmés par histologie (761 cas confirmés entre 1990 et 2011). Des données complémentaires sur l’exposition solaire, disponibles pour une fraction de la cohorte E3N, ont également été utilisées. Ces données détaillées sont issues de l’enquête cas-témoin nichée E3N-SunExp menée en 2008. Les analyses ont ensuite été étendues au consortium de cohortes européennes prospectives EPIC (European Prospective Investigation into Cancer and Nutrition), sur près de 334 500 femmes parmi lesquelles 1 734 cas de mélanomes incidents ont été diagnostiqués.Les résultats mettent en évidence des associations modestes entre la prise de traitements hormonaux et le risque de mélanome et ne soutiennent pas l’hypothèse de l’hormono-dépendance de ce cancer. Cependant, ils suggèrent un comportement d’exposition intentionnelle aux UV chez leurs utilisatrices, ce qui ouvre une nouvelle perspective pour les recherches futures dans ce domaine. / The hypothesis of a hormonal dependence of cutaneous melanoma has been debated in the literature over past decades. Within this context, it is critical to increase our knowledge on the influence of exogenous hormone use on the risk of this cancer.The aim of this project was to explore the influence of hormonal treatments (oral contraceptives, fertility drugs, premenopausal use of progestogens, and menopause hormone therapy) on the risk of cutaneous melanoma in women.The project was mainly based on the large E3N (Étude épidémiologique auprès de femmes de l’Éducation Nationale) prospective cohort, which included about 100,000 women aged 40-65 years at inclusion in 1990. The cohort collected data on pigmentary phenotype, sun exposure, hormonal treatment use, and medical data including cutaneous melanomas, which were ascertained through pathology reports (761 incident cases between 1990 and 2011). Additional information on sun exposure, available for a portion of the E3N cohort, was used. These detailed data were collected as part of the E3N-SunExp case-control study launched in 2008.Analyses were extended to the EPIC consortium (European Prospective Investigation into Cancer and Nutrition), which includes about 334 500 women and 1,734 incident melanoma cases.The results arising from this project show modest associations between exogenous hormone use and melanoma risk and suggest no strong direct influence of hormones on melanoma development. However, results suggest intentional UV exposure behaviors in exogenous hormone users, which opens new perspectives for future investigations in this field.

Under 2022 utkom nya rekommendationer från Socialstyrelsen gällande hormonbehandling för unga med könsdysfori, och de nya rekommendationerna innebar stramare regler för vilka som erbjuds hormonbehandling. Denna kvalitativa intervjustudie ämnar undersöka hur könsidentitetsmottagningar arbetar med Socialstyrelsens nya rekommendationer samt hur mottagningarnas vårdpersonal ställer sig till rekommendationerna. Socialstyrelsens nya rekommendationer bygger på en forskningssammanställning av SBU. Denna utgör, tillsammans med studier gällande personer med könsdysforis levnadsvillkor, hälsoeffekter av hormonbehandling, psykosociala hälsoeffekter samt detransition, studiens forskningsunderlag. Studiens material har samlats in genom åtta intervjuer med vårdpersonal och sakkunnig som har kodats och tematiserats för att kunna analyseras genom kvalitativ innehållsanalys. Studien har en socialkonstruktionistisk forskningsansats. Medikaliseringsteorin och teorin om minoritetsstress utgör studiens teoretiska ramverk genom vilka materialet har analyserats. Studiens resultat indikerar att rekommendationerna har förändrat vilka som erbjuds hormonbehandling samt i vilken utsträckning de erbjuds hormonbehandling. Resultatet pekar även på att en majoritet finner rekommendationerna negativa då de inte är i linje med deras kliniska erfarenhet samt gör det svårare att skapa en allians med patienterna. Ytterligare indikerar vårt resultat att patienters psykiska ohälsa samt självmedicinering befaras öka till följd av rekommendationerna, och att detta kan medföra en ansvarsförskjutning till patienten. Några få intervjupersoner uppfattar dock rekommendationerna som övergripande positiva och det finns över lag en trygghetskänsla hos intervjupersonerna till följd av rekommendationerna.

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