Background: The number of women participating in sports has increased dramatically, though research in sports are often performed on men. Physical exercise is known to increase physical performance and improve well-being. Although exercise has beneficial health effects for most of the women, it is known that strenuous exercise may also have negative health consequences. Common are menstrual dysfunctions and the medical effects of a long-standing amenorrhea are serious. Moreover, strenuous exercise without adequate recovery may lead to overreaching (OR) /overtraining syndrome (OTS). An improved muscle strength are of great importance in many sports, hence an increased understanding on how to generate optimal strength training programs in women without negative side effects are essential. The aims of this thesis were to investigate the effects on strength and power of high frequency periodised leg resistance training to evaluate a training regime and moreover to investigate if the training was well accepted and without potential exercise-related negative consequences. Moreover, to provide normative data on oxytocin and cortisol to elucidate if these hormones could be one diagnostic marker in combination with others to monitor and diagnose female athletes that may be at risk to develop OR/OTS. Methods: Fifty-nine women, participated in the four month intervention study. Two groups performed high frequency leg resistance training for two weeks of each menstrual/oral contraceptive (OC) cycle. The remaining part of the cycle they performed the leg training once a week. Group 1, trained with high frequency (5 times·w-1) during the first two weeks of each cycle, and group 2, during the last two weeks of each cycle. A control group performed regular (3 times·w-1) leg resistance training. Another 33 women participated in the observational study. The OC users and non-users, were followed over a nine-month period with monthly blood sampling of oxytocin and cortisol, and the Profile of Mood State (POMS) as a subjective measure of OR/OTS. Results: The women who performed high frequency leg resistance training, 5 times·w-1, during the first two weeks of each cycle showed significant increase in jump height, peak torque values in hamstrings, increased lean body mass of the legs, and their experiences of the training were positive. These results were not found when the periodised training was performed during the last two weeks of each cycle. In the control group an increase in jump height, and peak torque (left hamstring) was observed. There were no evident differences in the training effects between women with or without OC use. Moreover, no exercise-related negative consequences were detected in any of the three groups. The women in the observational study showed seasonal variations in oxytocin and cortisol, with different pattern in OC users to non-users. No convincing relationships to POMS were found.  Conclusions: The high frequency periodised leg resistance training during the first two weeks of the cycle is more beneficial to optimize resistance training, than the last two weeks. The high frequency periodised leg resistance training was not associated with exercise-related negative consequences and was well accepted when performed during the first two weeks of each cycle. Due to seasonality and impact of OC use, oxytocin and cortisol are not suggested to be optimal, diagnostic markers alone/in combination with others, to detect OR/OTS in physically active women.

Il apparaît, suite aux résultats de plusieurs études comportementales et d’imagerie cérébrale, que les hormones gonadiques peuvent moduler le fonctionnement cérébral chez la femme. Les asymétries cérébrales fonctionnelles (ACFs), en particulier, changeraient en fonction du niveau de progestérone et d’œstrogène. On a également observé que lorsque le taux d’œstrogène est bas, les performances aux tâches impliquant l’hémisphère droit sont améliorées. Par contre, les preuves de l’action physiologique de ces deux hormones sur le cerveau ne sont pas très nombreuses. Le peu d’études d’électrophysiologie cognitive qui ont porté sur les effets du cycle menstruel ont rapporté que la composante P300 y serait sensible. Aucune n’a cependant utilisé une tâche d’habileté spatiale ou de rotation mentale qui sont connues pour impliquer davantage l’hémisphère droit. Le but de la présente étude est de documenter les changements électrocorticaux reliés aux variations hormonales lors d’une tâche de rotation mentale. Notre hypothèse de départ est que le taux d’œstrogène influencera l’activité électrocorticale et la latéralisation. Les potentiels évoqués cognitifs ont été comparés chez les mêmes femmes (n=12) lors d’une tâche de rotation mentale, répétée à deux périodes du cycle menstruel. Nos résultats démontrent que la condition de rotation induit une latéralisation de l’activité pariétale, vers l’hémisphère gauche, quand le niveau d’œstrogène est bas. Par contre, lorsque le niveau d’œstrogène est élevé, il n’y a aucune latéralisation. Par ailleurs, nous avons observé une augmentation de l’amplitude de la P300 lors du niveau oestrogénique élevé. En conclusion, les fluctuations oestrogéniques du cycle menstruel ont un impact sur la latéralisation de l’activité électrocorticale, lors d’un effort de rotation mentale. / After many behavioral and some neuroimaging studies, it appears that the gonadic hormones can modulate the neuronal function of women's brain. In particular, the functional cerebral asymmetries can be affected by the level of progesterone and estrogens. It has been observed that when the level of estrogen is low, the performance at task that engages more the right hemisphere is enhanced. However, there is a lack of evidence for the physiological actions of these two hormones on the brain. The few event-related potential studies taking into account the menstrual cycle effects, had noticed that the component P300 can be affected. No electrophysiological study has used a mental rotation task or spatial ability tests which are known for their right hemisphere dominance. The aim of the present research is to document the effect of hormonal variations on the electrocortical activity, using a mental rotation task. Our hypothesis is that estrogen levels affect electrocortical activity and lateralization. The ERPs were compared in the same women (n = 12) during a mental rotation task, repeated over two periods of the menstrual cycle. Our results show a lateralization of the left parietal activity when estrogen levels are low and during the rotation. Whereas when the estrogen level is high, there is no lateralization. In addition, we observed an increase in the amplitude of P300 for this same high level. In conclusion, estrogens fluctuations associated with the menstrual cycle have an impact on the lateralization of electrocortical activity, when a mental rotation is needed.

Title: The effect of menstrual cycle phases on muscle tone Goals and methods: The aim of this thesis is to prove the effect of menstrual cycle phases and participating hormons on the viscoelastic properties of the sceletal calf muscle via the non-invasive myotonometer device. The research part of this thesis is a pilot study in which participated seven female probands aged inbetween 24 to 28. Each proband participated in four weekly tests. Only probands who had not used hormonal contraception for at least six months were selected. Results: The results of the tests are represented in graphs picturing parts of curves representing the force caused by the tip of the myotonometer. The muscle soleus tension is changing throughout the menstrual cycle but its impossible to eliminate other endogenous and exogenous factors. The measured relative values of muscle tension are different for each proband. The menstrual phase has the highest average value of muscle tension. However, it is not possible to make a generally valid conclusion. Key words: Menstrual cycle, menstrual phase, muscle tone, calf muscle, biomechanical properties, myotonometry, contraception 5

Title: The effect of menstrual cycle phases on muscle tone Goals and methods: The aim of this thesis is to prove the effect of menstrual cycle phases and participating hormons on the viscoelastic properties of the sceletal calf muscle via the non-invasive myotonometer device. The experimental part of this thesis is a pilot study in which participated seven female probands aged inbetween 24 to 28. Each proband participated in four weekly tests. Only probands who had not used hormonal contraception for at least six months were selected. Results: The results of the tests are represented in graphs picturing parts of curves representing the force caused by the tip of the myotonometer. The muscle soleus tension is changing throughout the menstrual cycle but its impossible to eliminate other endogenous and exogenous factors. The measured relative values of muscle tension are different for each proband. The menstrual phase has the highest average value of muscle tension. It is not possible to make a generally valid conclusion. Key words: Menstrual cycle, menstrual phase, muscle tone, calf muscle, biomechanical properties, myotonometry, contraception

Syftet med studien var att beskriva hur idrottande kvinnor gör för att må och prestera bra i sitt idrottande under menstruationscykeln. En kvalitativ metod av öppna brev användes för att samla in data. De öppna breven samlades in digitalt via plattformen www.enkät.se, som även säkerställde deltagarnas anonymitet. Tio idrottande kvinnor mellan 18–33 år deltog i studien genom att skriva det öppna brevet som började med meningen “Nu ska jag berätta hur jag gör för att må och prestera bra när jag idrottar under min menstruationscykel…”. Den skriftliga datan analyserades med en kvalitativ innehållsanalys. Utifrån analysen skapades ett huvudtema: Idrottande under menstruationscykeln - en fråga om kunskap och förhållningssätt och tre underteman: Vardagsrutiner för välmående, Idrottskvinnans prestation förutsätter egenmakt och valfrihet samt Idrottsrörelsens ansvar att skapa rätt förutsättningar. Huvudtemat tillsammans med de tre underteman beskriver hur deltagarna är beroende av sig själva, tränare och samhällsstrukturer för att må och prestera bra. Gemensamt för samtliga underteman är kunskap vilket utgör grunden för att kunna förhålla sig till ämnet på ett bra sätt. / The aim of this study was to describe what female athletes do to feel and perform well in sports during their menstrual cycle. A qualitative method with open letters was used to collect data. The open letters were collected by the digital plattform www.enkät.se who ensured that the participants remained anonymous. Ten female athletes between 18–33 years old participated in the study and wrote the open letter which started with the sentence "I am now going to tell you what I do to feel and perform well in sports during my menstrual cycle…". The collected data was analyzed with a qualitative content analysis. Based on the analysis a main theme was created: Sports during the menstrual cycle - a matter of knowledge and approach, together with three sub-themes: Everyday routines of wellbeing, The female athletes’ performance requires empowerment and freedom of choice and The sports movement's responsibility to create the right conditions. The main theme together with the three sub-themes describes how the participants are dependent on themselves, coaches and social structures in order to feel and perform well. Common to all sub-themes is knowledge, which is the basis for being able to relate to the subject in a good way.

As diferenças entre os sexos e o impacto dos hormônios sexuais no processamento emocional normal e patológico destacam-se na investigação do dimorfismo sexual na frequência, diagnóstico e terapêutica de patologias psiquiátricas. Transtornos depressivos e ansiosos não apenas são mais comuns em mulheres, quando comparadas aos homens, como parecem ser influenciados pelas concentrações hormonais séricas das mulheres em diferentes fases do ciclo reprodutivo. Ao mesmo tempo, o sexo e as concentrações dos hormônios sexuais, mostram influência na função do cérebro em uma diversidade de tarefas cognitivas e emocionais. O reconhecimento de expressões faciais de emoções básicas tem sido visto como função de extrema importância na adaptação social do indivíduo e existem evidências de que esteja relacionado com o desenvolvimento de transtornos psiquiátricos. Já foi demonstrado que esta tarefa é influenciada pelo sexo do indivíduo e seu ambiente hormonal, no entanto, a literatura carece de resposta sobre os mecanismos pelos quais estas diferenças acontecem. Em dois experimentos buscamos maior entendimento de como se dão as diferenças entre os sexos no reconhecimento de expressões faciais de emoções básicas (raiva, asco, medo, tristeza, surpresa e alegria). No experimento 1, 33 voluntários saudáveis do sexo masculino e 30 do sexo feminino foram testados quanto à acurácia no reconhecimento de expressões faciais, ao tipo de erro ao realizar esta tarefa e à emoção despertada durante este reconhecimento. No experimento 2, 24 voluntárias saudáveis foram testadas quanto à acurácia no reconhecimento de expressões faciais em três diferentes fases do ciclo menstrual: fase folicular precoce (primeiro ao quinto dia do ciclo), periovulatória (décimo segundo ao décimo quarto dia do ciclo), e lútea (vigésimo primeiro ao vigésimo terceiro dia do ciclo), em delineamento cruzado. Foi realizada dosagem sanguínea de estradiol, progesterona e testosterona ao final de cada sessão experimental, com o intuito de confirmar a fase do ciclo das voluntárias e buscar possíveis correlações entre esses hormônios e o processamento de expressões faciais. Utilizou-se análise de contraste na avaliação do desempenho no reconhecimento de todas as emoções básicas com o desempenho no reconhecimento da emoção alegria. No experimento 1, raiva e medo em faces femininas foram reconhecidos com maior acurácia por mulheres, quando comparadas aos homens. Não foram encontradas diferenças significativas entre os sexos quanto à emoção despertada durante a visualização de expressões faciais. O experimento 2 mostrou que o reconhecimento das emoções asco e tristeza em faces masculinas variou de maneira significativa durante as fases do ciclo menstrual. As mulheres na fase lútea obtiveram maior acurácia no reconhecimento de expressões de asco em comparação com a fase folicular precoce, enquanto o desempenho no reconhecimento de tristeza foi maior na fase periovulatória do que na fase lútea. Os resultados sugerem que as diferenças entre homens e mulheres na capacidade de reconhecer emoções não estejam relacionadas à valência da emoção despertada nos indivíduos durante o processamento emocional. A modulação do reconhecimento de expressões faciais pelas fases do ciclo menstrual aponta que este seja um dos fatores implicados nas diferenças entre os sexos nesta tarefa / The impact of sex and sexual hormones in the normal and pathological emotional processing has reached unique importance in the investigation of sexual dimorphism in prevalence, diagnostic features and therapeutics of psychiatric disorders. Depressive and anxiety disorders are not only more common in women compared to men, but they also seem to be influenced by the hormonal status of women at different stages of the reproductive cycle. At the same time, the sex of the subject and the level of sex hormones have been suggested to play a role in brain function in a variety of emotional and cognitive tasks. The recognition of facial expressions of basic emotions has been recognized not only as of extreme importance in social adjustment as there is also evidence of its relation to the development of psychiatric disorders. It has been shown that this task is influenced by the sex and hormonal status of subjects, however, the literature shows a gap in explanations about how these differences occur. In two experiments we sought a better understanding of how sex differences in facial expressions recognition of basic emotion (anger, disgust, fear, sadness, surprise, happiness and neutral) happens. In experiment 1, 33 male and 30 female healthy volunteers were tested for accuracy in the recognition of facial expressions, the type of error when performing this task as well as the emotion aroused during this recognition. In experiment 2, 24 healthy female volunteers were tested for accuracy in the recognition of facial expressions in 3 different phases of menstrual cycle, early follicular (days 1 to 5), periovulatory phase (days 12 to 14) and luteal phase (days 21 to 23), in a crossover study design. Volunteers were tested for blood levels of estrogen, progesterone and testosterone at the end of each experimental session in order to confirm cycle phase and look for possible correlations between hormones and processing of facial expressions. We used contrast analysis in the recognition of each basic emotion against the recognition of happiness. In experiment 1, anger and fear, in feminine faces, were more accurately recognized by women in comparison to men. No significant differences among sexes were found on the emotion aroused while viewing facial expressions. Experiment 2 showed that the recognition of the emotions disgust and sadness, in male faces, varied significantly during the menstrual cycle phases. Women in luteal phase showed greater accuracy in recognizing expressions of disgust than when in early follicular phase whereas the recognition of sadness were more accurate during periovulatory phase than during luteal phase. These results suggest that differences between men and women in the ability to recognize emotions are not related to the valence of the emotions aroused in the subjects during emotional processing. This study also showed that the role played by the menstrual cycle in the ability to recognize facial expressions points to this feature as an important factor implicated in sex differences in this task.

Introdução: o diagnóstico da Síndrome do Ovário Policístico (SOP) na adolescência é desafiador e vem sendo alvo de intensas discussões. Sua prevalência em mulheres adultas em idade fértil varia de 5-10%. Entretanto, a prevalência em adolescentes obesas ainda não foi descrita na literatura. Somado a isso, ainda não é bem estabelecida a relação da SOP com alterações metabólicas e cardiovasculares nesta população. Dessa maneira, objetivamos avaliar a prevalência e as características da SOP na população de adolescentes obesas acompanhadas em um centro hospitalar quaternário. Métodos: realizamos um estudo transversal com 49 adolescentes obesas pós-menarca, com idade média de 15,6 anos. Foi realizada avaliação antropométrica e revisão de prontuários médicos. O hiperandrogenismo clínico e laboratorial foram quantificados utilizando o índice de Ferriman-Gallwey e as dosagens androgênicas, respectivamente. A morfologia ovariana foi avaliada por ultrassonografia suprapúbica. Todas as pacientes tiveram seus perfis metabólicos analisados. Resultados: ao adotarmos a nova Diretriz para SOP na adolescência da Sociedade de Endocrinologia Pediátrica Americana, encontramos uma prevalência de 18,4% de SOP em nossa população de adolescentes obesas. Quando utilizamos os critérios de Rotterdam, da Sociedade de Excesso Androgênico e SOP e do Instituto Nacional de Saúde Americano, as prevalências foram de 26,4%, 22,4% e 20,4%, respectivamente. A irregularidade menstrual foi constatada em 65,3% das pacientes. O hiperandrogenismo clínico foi observado em 16,3% das meninas, e 18,4% tinham concentrações de testosterona total acima do valor de normalidade. A ultrassonografia revelou que 18,4% das meninas tinham ovários policísticos. Adolescentes obesas com SOP apresentaram maior prevalência de síndrome metabólica. Conclusão: a prevalência de SOP em adolescentes obesas é alta quando comparada àquela observada na literatura / Background: polycystic ovary syndrome (PCOS) in adolescence is a challenging diagnosis and therefore has raised intense discussions. Its prevalence in childbearing age women ranges from 5 to 10%. However, the prevalence in obese adolescents has not yet been reported. Besides, the relationship of PCOS with metabolic and cardiovascular disorders in this specific population has not been established. Thus, we aimed to assess the prevalence and characteristics of PCOS in a population of obese adolescents followed at a quarternary hospital. Methods: we performed a cross-sectional study with 49 postmenarcheal obese adolescents with a mean age of 15.6 years. Anthropometric assessment and review of medical records were performed. Clinical and laboratory hyperandrogenism were evaluated using Ferriman-Gallwey index and serum androgens, respectively. The ovarian morphology was evaluated by supra-pubic ultrasound. All patients had their metabolic profile evaluated. Results: the prevalence of PCOS in obese adolescents, according to the new guideline for PCOS in adolescence of the American Pediatric Endocrinology Society, was 18.4%. When assessed by the Rotterdam, the Androgen Excess and PCOS Society and the National Institute of Health criteria, the prevalence of PCOS was 26.4%, 22.4% and 20.4%, respectively. Menstrual irregularity was found in 65.3% of the patients. Clinical hyperandrogenism was observed in 16.3% while 18.4% had total testosterone concentrations above the normal range. Ultrasonography revealed that 18.4% had polycystic ovaries. Obese adolescents with PCOS had higher prevalence of metabolic syndrome. Conclusion: the prevalence of PCOS in obese adolescents is high compared to that observed in the literature

Einleitung: Es wird angenommen, dass die zyklusbedingten, hormonellen Änderungen die vegetative Ansteuerung des Herzens bei normotensiven Frauen beeinflussen. Die Herzfrequenzvariabilität (HRV) stellt einen der am häufigsten untersuchten, nicht-invasiven Parameter des Herz-Kreislauf-Systems dar. Deshalb war es das Ziel dieser Studie, den Verlauf der HRV Parameter bei ausdauertrainierten als auch untrainierten normotensiven Frauen in Abhängigkeit vom Menstruationszyklus zu untersuchen. Methode: Normotensive, untrainierte als auch trainierte Frauen nahmen an der Studie teil. Die Athletinnen absolvierten individuell abgestimmte Trainingspläne (>5h/Woche) während der Studie. Die HRV Messungen wurden in den folgenden fünf Zyklusphasen aufgezeichnet: In der Menstruation (M), der Mitte der Follikel- (MidF), der Ovulations- (O), der Mitte der Luteal- (MidL) und der Pre-Menstruationsphase (PreM). Die Basaltemperatur als auch die Hormonanalysen des Luteinisierenden (LH) und des Follikelstimulierenden Hormons (FSH), des β-17 Östrogens (E2) und des Progesterons (P) dienten der Verifizierung der Zyklusphasen. Die HRV Messungen wurden bei Spontanatmung im Liegen (20 min) wie auch während eines Orthosthase Tests aufgezeichnet. Parameter der Zeit als auch der Frequenzdomäne für Kurzzeitmessungen wurden ausgewertet. Resultate: Alle Frauen hatten einen normotensiven Menstruationszyklus mit typischen hormonellen Schwankungen und einem signifikanten Verlauf (p / Introduction: The autonomic control of the heart is assumed to be affected by endogenous hormonal fluctuations in normal ovulatory females. Analyzing heart rate variability (HRV) had become a tool for the noninvasive measurement of cardiac autonomic control. The purpose of the present study was to investigate the course of the HRV parameters in moderately active as well as in long time endurance trained women during the menstrual cycle. Methods: Normal ovulatory females, untrained and trained were enrolled. Female athletes were involved in individually different training patterns (>5h/week) during the study. HRV recordings were obtained during five different menstrual cycle phases: menstruation (M), middle of follicular (MidF), ovulation (O), middle of luteal (MidL) and pre menstruation phase (PreM). Phases were verified by basal body temperature and analysis of luteinizing hormone (LH), follicular stimulation hormone (FSH), β-17 estrogen (E2) and progesterone (P). HRV measurements took place at subjects’ spontaneous breathing frequency in supine position (20 min) as well as during an orthostatic test. Parameters of short-term recording were calculated in time and frequency domain. Results: All women had normal ovulatory menstrual cycles including typical endogenous hormonal fluctuations; levels of LH, FSH, E2 and P were significantly different (p

O objetivo deste trabalho foi analisar o comportamento das interleucinas 12 (IL- 12) e 18 (IL-18) em pacientes com endometriose pélvica comparando-as a pacientes de um grupo controle com sintomas sugestivos de endometriose e ausência comprovada da doença. Avaliamos, também, as dosagens das referidas interleucinas em relação à fase do ciclo menstrual, quadro clínico, local da doença, estadiamento e classificação histológica. PACIENTES E MÉTODOS: Foram avaliadas 105 pacientes entre 18 e 40 anos submetidas à videolaparoscopia, ; divididas em 2 grupos: 72 pacientes com endometriose e 33 controles. Colheu-se sangue periférico e fluido peritoneal no intra-operatório e procedeu-se a avaliação das interleucinas, relacionando-se as dosagens entre o grupo controle e o grupo com endometriose e também entre os parâmetros já mencionados. Dividimos as pacientes segundo a fase do ciclo menstrual, o quadro clínico, o local de maior gravidade da doença (peritoneal, ovariana ou profunda), o estadiamento e a classificação histológica. As dosagens das interleucinas foram feitas através do método de ELISA e a análise estatística pela aplicação dos testes Kruskal-Wallis e Dunn. RESULTADOS: A média das dosagens da IL-12 no fluido peritoneal foi significativamente maior nas pacientes com endometriose (82,37 +/- 16,61 pg/mL) que no grupo controle (29,20 +/- 10,21pg/mL), p < 0,001. Não houve diferenças significativas na comparação das dosagens séricas de IL-12 entre pacientes e grupo controle. As médias das dosagens da IL-12 no sangue de pacientes com endometriose avançada foi significativamente mais elevada (196,74 +/- 33,71 pg/mL) que aquela de pacientes com doença inicial (82,04 +/- 16,63 pg/mL), p = 0,007. Não houve diferenças significativas entre as dosagens de IL-18 no sangue e no fluido peritoneal de pacientes e grupo controle, nem em relação à comparação entre doença inicial e doença avançada. As médias das dosagens de IL-12 no fluido peritoneal foram mais elevadas em pacientes com endometriose com dismenorréia severa/incapacitante (82,21 +/- 20,54 pg/mL; p = 0,02), dispareunia de profundidade (101,62 +/- 29,25 pg/mL; p = 0,02) e dor acíclica (101,93 +/- 26,14 pg/mL; p = 0,02). As médias das dosagens de IL-18 no sangue foram mais elevadas em pacientes com endometriose com dismenorréia severa/incapacitante (77,59 +/- 16,50 pg/mL; p = 0,01) e dispareunia de profundidade (61,34 +/- 14,05 pg/mL; p = 0,03). Não houve diferenças significativas entre as dosagens de IL-12 e IL-18, no sangue ou no fluido peritoneal, de acordo com a localização da doença (peritônio, ovário ou doença profunda). Não houve diferenças significativas entre as dosagens de IL-12 e IL- 18, no sangue ou no fluido peritoneal, de acordo com a classificação histológica da doença (estromal, bem-diferenciada, padrão misto de diferenciação e indiferenciada). CONCLUSÕES: A interleucina 12 esteve aumentada no fluido peritoneal de pacientes com endometriose, e no sangue nos estádios avançados da doença. Não houve diferenças nas dosagens da interleucina 18 no sangue ou fluido peritoneal na endometriose em relação a mulheres sem a doença. / The aim of this work was to evaluate the behavior of interleukines 12 (IL-12) and 18 (IL-18) in patients with pelvic endometriosis comparing them with a control group that presented suggestive symptoms of endometriosis and proven absence of the disease, evaluating, also, the levels of the interleukines in relation to the phase of menstrual cycle, clinical symptoms, primary location, disease stage and histological classification. PATIENTS AND METHODS: 105 patients aging from 18 to 40 years have been submitted to the laparoscopic surgery and classified in 2 groups: 72 patients with endometriosis and 33 controls. Peripheral blood and peritoneal fluid were extracted and interleukins were evaluated, correlating the levels between the control group and the group with endometriosis, and also between the parameters previously mentioned. Patients were grouped according to the phase of the menstrual cycle, clinical symptoms, primary location, disease stage and histological classification. Interleukin levels have been measured by ELISA . Statistical analysis was performed by the application of Kruskal-Wallis and Dunn tests. RESULTS: Average levels of IL-12 in the peritoneal fluid was significantly higher in patients with endometriosis (82,37 +/- 16.61 pg/mL) when compared to the control group (29,20 +/- 10,21pg/mL), p < 0,001. No significant differences were found in the comparison of the serum levels of IL-12 between patients and control group.) Average levels of IL-12 in blood of patients with advanced endometriosis were significantly increased (196,74 +/- 33.71 pg/mL) when compared to patients with initial disease (82,04 +/- 16,63 pg/mL), p = 0,007. There were no significant differences between the levels of IL-18 in blood and in peritoneal fluid of patients and control group, nor between patients with initial disease and advanced disease. Average levels of IL-12 in peritoneal fluid were higher in patients with endometriosis with complaints of severe / incapacitating dysmenorrhea (82.21 +/- 20,54 pg/mL; p = 0,02), deep dyspareunia (101,62 +/- 29,25 pg/mL; p = 0,02) and acyclic pain (101,93 +/- 26,14 pg/mL; p = 0,02). Average levels of IL-18 in the blood were higher in patients with endometriosis and severe /incapacitating dysmenorrhea (77,59 +/- 16,50 pg/mL; p = 0,01) and deep dyspareunia (61,34 +/- 14,05 pg/mL; p = 0,03). There were no significant differences between the levels of IL-12 and IL-18, in blood or in peritoneal fluid, according to the primary location of the disease (peritoneal, ovarian or deep infiltrative disease). No significant differences were found between the levels of IL-12 and IL-18, in blood or peritoneal fluid, in accordance to the histological classification of the disease (estromal, well-differentiated, combined standard of differentiation and undifferentiated). CONCLUSIONS: Interleukin 12 wss increased in peritoneal fluid of patients with endometriosis, and in blood in advanced stages of the disease. There were no differences in the levels of interleukin 18 in blood or peritoneal fluid in endometriosis compared to women without the disease.

Não há consenso na literatura quanto à utilização da laserterapia de baixa intensidade (LLLT) no tratamento da DTM dolorosa. O objetivo deste estudo foi analisar a efetividade da LLLT ativa e placebo na redução da dor, da ansiedade e do cortisol salivar de mulheres com dor miofascial em função das flutuações hormonais relacionadas ao ciclo menstrual. 124 mulheres, 94 diagnosticadas com dor miofascial (Research Diagnostic Criteria for Temporomandibular Disorders) foram divididas em: grupo laser (31), placebo (30), sem tratamento (33) e controle (30). A LLLT foi aplicada em pontos pré-estabelecidos da região orofacial, 2x/semana, oito sessões (780 nm, masseter e temporal anterior = 5 J/cm2, 20 mW, 10 segs. e região da ATM = 7,5 J/cm2, 30 mW, 10 segs.). A dor foi mensurada quanto à sua intensidade (Escala Visual Analógica), sensibilidade (limiar de dor à pressão em pontos orofaciais e corporais, LDP) e aspectos qualitativos/afetivos (Versão Reduzida do Questionánio de Dor de McGill, SF-MPQ). Além disso, foi dosado o cortisol salivar matutino a fim de se estabelecer os níveis de estresse, e aplicado o Inventário de Ansiedade de Beck para avaliar a ansiedade percebida. Foram também coletados dados relativos ao ciclo menstrual (data da última menstruação, uso de anticoncepcional, menopausa). Para as comparações intra-grupos ao longo da LLLT foram utilizados os Testes de Friedman e Kruskal-Wallis; para as comparações inter-grupos, o Mann-Whitney (p < 0,05). As mulheres com dor miofascial apresentaram LDP reduzido em relação às controles, não houve variação do LDP para nenhum grupo após a LLLT. Foi observada redução da intensidade de dor para os três grupos em comparação ao momento inicial (p < 0,05): Laser (80%), Placebo (85%) e Sem Tratamento (43%). Apenas no grupo Laser houve manutenção da redução da intensidade de dor de mulheres que não faziam uso de anticoncepcionais após 30 dias de finalização da LLLT (p < 0,001). O período pré-menstrual se mostrou crítico para todas as variáveris analisadas. Houve redução do escore total do SF-MPQ e da ansiedade para todos os grupos (p < 0,05). Os níveis de cortisol não diferiram entre mulheres com dor miofascial e controles, e também não variaram ao longo do tratamento. A LLLT ativa e placebo são capazes de reduzir variáveis subjetivas (intensidade de dor, índices do SF-MPQ e ansiedade), porém não alteram a sensibilidade à dor da região orofacial ou de pontos corporais, e o cortisol salivar. Ambas apresentam efetividade clínica similar em mulheres com dor miofascial durante o período de tratamento (sessões de laser), embora o laser ativo seja mais efetivo na manutenção dos resultados em mulheres em idade fértil sem o uso de anticoncepcionais (maior flutuação hormonal) / There is no consensus in the literature regarding the use of low-level laser therapy (LLLT) in the treatment of painful TMD. The aim of this study was to analyze the effectiveness of active and placebo LLLT in reducing pain, anxiety and salivary cortisol in women with myofascial pain based on the hormonal fluctuations related to the menstrual cycle. 124 women, 94 diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorders) were divided into: laser group (31), placebo (30), without treatment (33) and control (30). The LLLT was applied at pre-established points of the orofacial region, 2x/week, eight sessions (780 nm, masseter and anterior temporal = 5 J/cm2, 20 mW, 10 sec. and ATM region = 7.5 J/cm2, 30 mW, 10 sec.). The pain was measured in terms of intensity (Visual Analogue Scale), sensitivity (pressure pain threshold at orofacial and corporal points, PPT) and qualitative/affective aspects (Short-Form of the McGill Pain Questionnaire, SF-MPQ). In addition, the morning salivary cortisol was measured to establish the stress levels, and the Beck Anxiety Inventory was applied to evaluate the perceived anxiety. Data of the menstrual cycle were also collected (date of last menstruation, use of oral contraceptives, menopause). For intra-group comparisons over LLLT, the Friedman and Kruskal-Wallis tests were used; for intergroup comparisons, Mann-Whitney (p < 0.05). Women with myofascial pain showed reduced PPT when compared to controls, there was no change in PPT for any group after LLLT. Pain intensity reduction was observed for all groups compared to the baseline (p < 0.05): Laser (80%), Placebo (85%) and Without Treatment (43%). Only in the Laser group, pain intensity reduction was maintained in women who did not use oral contraceptives after 30 days of LLLT completion (p < 0.001). The pre-menstrual period was critical for all variables analyzed. There was a reduction in SF-MPQ total scores and anxiety for all groups (p < 0.05). Cortisol levels did not differ between women with myofascial pain and controls, besides they did not vary with the treatment. Active and placebo LLLT can reduce subjective variables (pain intensity, SF-MPQ indices and anxiety), but they do not change pain sensitivity at orofacial and corporal points, and salivary cortisol. Active and placebo LLLT shows similar clinical effectiveness in women with myofascial pain during the treatment period (laser sessions), although the active laser is more effective in maintaining the results in women of fertile age without oral contraceptives use (higher hormonal fluctuation)