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Postmenopausal hyperandrogenism constitutes a very rare condition of tumoral or non-tumoral origin primarily residing either in the ovary or in the adrenal glands. We present herein two cases with this condition; one with abnormal postmenopausal genital bleeding and mild increase in facial hair, and the second with slow-developing hirsutism and virilization. Both cases shared a notorious increase in libido. The laboratory tests showed high levels of testosterone (>100 ng/ml). A normal value of dehydroepiandrosterone sulfate and a normal cortisol level at 9 am after 1 mg of dexamethasone administered at midnight (Nugent test) made an adrenal etiology very unlikely. On the other hand, a high level of inhibine B oriented to an ovarian source. Transvaginal sonography failed to demonstrate an ovarian tumor, but an abdominal and pelvic computed tomography scan or magnetic resonance imaging detected an ovarian tumor and normal adrenal glands. A laparoscopic oophorectomy was performed, and the histological study demonstrated a steroidal cell tumor in the first case and a Leydig cell tumor in the second.

Objective: To estimate the prevalence of excessive daytime sleepiness (EDS) and to identify associated factors in women aged 35 to 49 years from the "Pindamonhangaba Health Project" (PROSAPIN)., Methods: This was a cross-sectional observational study of 372 women aged 35 to 49 years, randomly selected from the Family Health Strategy (FHS) program of the city of Pindamonhangaba, SP, Brazil, where the "Pindamonhangaba Health Project" (PROSAPIN) is being developed. EDS was assessed through interviews using the Epworth Sleepiness Scale and the associated factors through questions that investigated sociodemographic characteristics, gynecological history, presence of comorbidities, lifestyle, sleep routine, and use of drugs capable of altering the state of alertness; anthropometric variables were also measured. The prevalence of EDS was estimated with a 95% confidence interval (95% CI) and the associated factors were identified through a multiple logistic regression model performed with the Stata software, release 10.0., Results: EDS prevalence was 18.5% (95% CI: 14.7-22.9) and the associated factors were: profession related to domestic services (OR = 2.2, 95% CI: 1.1-4.3), physical activity level above the mean of the study population (OR = 1.9, 95% CI: 1.1-3.4), and presence of features suggestive of anxiety (OR = 1.9, 95% CI: 1.1-3.4)., Conclusion: The prevalence of EDS in women aged 35-49 years from PROSAPIN was high and associated with sociodemographic characteristics, presence of comorbidities, and lifestyle.

Background: Few studies have addressed the impact of menopausal symptom severity over quality of life (QoL) in Latin American women with different ethnics., Objective: To assess menopausal symptom severity and the QoL among postmenopausal Colombian women with three different ethnicities., Method: Data of healthy naturally occurring postmenopausal Hispanic, indigenous and black women aged 40-59 years who participated in a cross-sectional study filling out the Menopause Rating Scale (MRS) and a general questionnaire was analysed., Results: A total of 579 women were included, 153 Hispanic, 295 indigenous and 131 Afro-descendent. Hispanic women had an average age of 55.3 +/- 3.3 years. Indigenous and black women were less educated than the Hispanic ones (2.2 +/- 1.8 and 4.6 +/- 4.4 vs. 6.4 +/- 3.5 years, p < 0.0001). Hispanic women displayed lower total MRS scores (better QoL) when compared to indigenous and black women. Urogenital scoring was worse among indigenous women compared to Hispanic and black women. Black women presented higher MRS psychological and somatic scorings than Hispanic and indigenous women. After adjusting for confounding factors, indigenous and black women continued to display a higher risk for impaired QoL, total MRS score > 16 (OR: 3.11, 95% CI: 1.30-7.44 and OR: 5.29, 95% CI: 2.52-11.10, respectively), which was significantly higher among indigenous women due to urogenital symptoms (OR: 102.75, 95% CI: 38.33-275.47) and black women due to psychological (OR: 6.58, 95% CI: 3.27-13.27) and somatic symptoms (OR: 3.88, 95% CI: 1.83-8.22)., Conclusion: In this postmenopausal Colombian series, menopausal symptoms in indigenous (urogenital) and black (somatic/psychological) women were more severe (impaired QoL) when compared to Hispanic ones.

Background: The Female Sexual Function index (FSFI), is a scale designed to evaluate sexuality and diagnose the presence of sexual dysfunction in women., Aim: To apply the FSFI to climacteric women., Patients and Methods: The FSFI was applied to 370 healthy women aged between 40 and 59years old (49 +/- 6years) that accompanied patients to public health services in Santiago., Results: Fifty six percent of women were married, 44% were postmenopausal, 6% used hormone replacement therapy, 67% were sexually active, and sexual dysfunction was present in 57% of them. Thirty two percent of women aged between 40 and 44 years and 65% of women aged between 55 and 59 years, had sexual dysfunction (p <0.01). In a logistic regression model, the risk of sexual dysfunction increased among women that perceive having health problems (Odds ratio (OR) 3-9; 95%o confidence intervals (95% CI): 1.1-13-8), women older than 48 years (OR 1.9; 95% CI: 1.1-3-4) and women that gave birth to two or more children (OR 1.8; 95% CI: 1.0-3-1)., Conclusions: Climateric women have high prevalence of sexual dysfunction. Age is its main risk factor.

Background: Climacteric symptoms have a direct relationship with biological and sociocultural factors and significantly impair the quality of life of women., Aim: To assess quality of life and factors affecting it in women aged 40 to 59 years., Material and Methods: The Menopause Rating Scale (MRS) was applied to 370 healthy women aged 49 +/- 6 years, that accompanied patients to public hospitals in Santiago., Results: Forty four percent of women were postmenopausal and 6% used hormone replacement therapy. Half of the group had less than 12 years of formal education and 67% had a couple. The mean number of children was 2.8 +/- 1.5. Total MRS score was 16.2 +/- 8.5. The higher score was given by the psychological domain (7.7 + 4.4), followed by the somatic domain (5.8 +/- 3.5). The urogenital domain had the lowest score (2.7 +/- 2.9). Eighty percent of women had moderate to severe climacteric symptoms. A logistic regression analysis showed that the postmenopausal condition was the factor that caused the greatest derangement in quality of life, followed by her parity. Formal education had the lowest impact., Conclusions: In this sample of women, menopause significantly deteriorated quality of life and sociocultural factors such as the parity also had an impact.

Background: Increased frequency and severity of menopausal symptoms have been associated to black race. However, this situation has not been described in any Latin American population., Objective: Compare frequency and severity of menopausal symptoms among Afro and non-Afro Hispanic Colombian climacteric women., Methods: In this cross-sectional study, healthy Afro and non-Afro-Colombian women aged 40-59 years were asked to fill out the Menopause Rating Scale (MRS) questionnaire in order to compare symptom frequency and intensity., Results: A total of 578 women were surveyed (201 Afro-Colombian and 377 non-Afro-Colombian). Mean age of the whole sample was 47.9+/-5.9 years (median 47), with no differences among studied groups in terms of age, parity, and hormone therapy (HT) use. Intensity of menopausal symptoms, assessed with the total MRS score, was found to be significantly higher among Afro-Colombian women (10.6+/-6.7 vs. 7.5+/-5.7, p=0.0001), which was due to higher somatic and psychological subscale scores. In this group, the frequency of somatic symptoms, heart discomfort and muscle and joint problems, was found to be higher than in non-Afro-Colombian women (38.8% vs. 26.8% and 77.1% vs. 43.5%, respectively, p<0.05); equally, all items of the psychological subscale (depressive mood, irritability, anxiety and physical exhaustion) were also found to be higher among black women. On the other hand, compared to black women non-Afro-Colombian ones presented more bladder problems (24.9% vs. 14.9%, p=0.005). After adjusting for confounding factors, logistic regression analysis determined that black race increased the risk for presenting higher total MRS scorings (OR: 2.31; CI 95%: 1.55-3.45, p=0.0001)., Conclusion: Despite the limitations of this study, as determined with the MRS Afro-Colombian women exhibited more impaired quality of life (QoL) when compared to non-Afro-Colombian ones, due to a higher rate and severity of menopausal somatic and psychological symptoms.

The object of this study was to evaluate the effect of different doses of a compound containing isoflavones 60 mg, primrose oil 440 mg and vitamin E 10 mg. (IOVE) on menopausal complaints. This was an open, multicentre, randomised, group comparative, efficacy and safety trial. A total of 1,080 postmenopausal women, with climacteric symptoms, were allocated into one of two treatment groups to receive one (Group 1; n = 562) or two IOVE capsules (Group 2; n = 518) per day. The Blatt - Kupperman scale and safety parameters including weight, body mass index, blood pressure and adverse effects were assessed at the first visit before initiating the treatment, and 3 - 6 months thereafter. In addition, cholesterol, high density lipoprotein (HDL), low-density lipoprotein (LDL) and triglyceride levels were measured at baseline and at the 6th month visit. Finally, at the end of follow-up, the patient's satisfaction was assessed. No differences between groups at the beginning of the study and during the follow-up were observed. A significant reduction in Blatt - Kupperman scores were observed in the two groups. In addition, the reduction of the symptoms was more intense in the first 3 months. Increasing doses of IOVE add no beneficial effects since both studied doses were equally effective in the reduction of climacteric complaints.

Background: The loss of sexuality observed in the climacteric period is difficult to evaluate. An important advance has been the development of the Female Sexual Function Index (FSFI), a test based on the norms of the International Consensus Development Conference on Sexual Female Dysfunctions., Aim: To study the effects of hormone replacement therapy (HRT) on sexuality, applying the FSFI., Material and Methods: The FSFI was applied to 300 healthy women between 45-64 years, sexually active, beneficiaries of the Southern Metropolitan Health Service., Results: The mean age of the sample studied was 51 +/- 5 years, 27% were HRT users, 21% had had an hysterectomy and 98% had a stable couple. The total score of the FSFI decreased from 27.3 +/- 5.8 in women between 45 and 49 years of age to 19.3 +/- 7.0 in women between 60 and 64 years (p < 0.01). A significantly better sexuality was observed in HRT users, with FSFI scores of 28.1 +/- 5.5 and 24.6 +/- 6.8 in HRT users and non users, respectively (p < 0.01). Women on HRT obtained a higher score in all of the test domains, especially in lubrication, orgasm and sexual satisfaction., Conclusions: Female sexuality decreases with aging. HRT users have a better sexual function than non users.

Menopausal transition is a period that begins four years before menopause as a result of follicular decline. The first hormonal change is a decrease in B inhibin levels, followed by a decrease in estradiol and an increase in FSH levels; abrupt plasmatic oscillations of these hormones can be observed. Climacteric symptomatology may appear before cycle disorders and provoke an impairment in quality of life. Bone loss equally precedes menopause. Some authors, but not all of them, accept that during perimenopause there is an increased risk of cardiovascular disease. We point out the need of beginning hormonal therapy when the first clinical signs of estrogenic deficiency arise, independent of menstrual cycle and hormonal levels. Women aged over 45 are suitable for the classical sequential therapy, adjusting it to the cycle while it still persists; younger patients may use transdermal estrogens for short periods of time. Whenever contraception is required or there is irregular bleeding we indicate low dose estrogenic contraceptives, if possible the 28 days of the cycle. It is necessary to correct potentially dangerous daily habits and treat concomitant diseases that may enhance cardiovascular risk. The patient's education is an indispensable goal for the success of the treatment.

Objective: To assess the impact of menopause and some sociodemographic variables on quality of life (QoL)., Materials and Methods: Four hundred and eighty-one women aged 40-59 years attending the Southern Metropolitan Health Service in Santiago de Chile were studied using the Specific Quality of Life Questionnaire for Menopause from Toronto University., Results: Univariate analysis showed that menopausal women have worse QoL scores than women conserving cycles in the four areas of the questionnaire: They show a 10.6-fold higher risk for suffering vasomotor disorders affecting QoL, a 3.5-fold higher risk for psychosocial impairment, a 5.7-fold higher risk for physical disorders, and a 3.2-fold higher risk for sexual disorders (P < 0.0001). Regarding the influence of social markers (age, marital status, school years, work, number of children and sexual activity), housewives were found to have higher, worse, scores than working women in all test components (vasomotor, 3.11+/-1.90 versus 2.57+/-1.71, P < 0.003; psychosocial, 3.44+/-1.59 versus 2.92+/-1.45, P < 0.0007; physical, 3.45+/-1.36 versus 2.96+/-1.20, P < 0.0001; sexual, 3.63+/-2.23 versus 2.49+/-1.95, P < 0.0001). However, logistic regression demonstrated that the only variable found to cause a significant impairment in QoL was menopause., Conclusion: Menopause causes a decrease in quality of life, which is independent from age and other sociodemographic variables.

The benefits of hormonal replacement therapy are widely known. In spite of this, the proportion of women under treatment is low. The study aims to evaluate the amount of knowledge that patients have, about menopause, and how it influences compliance with therapy. In our study, 494 women attending the outpatient's clinic of Hospital Barros Luco-Trudeau were interviewed; 93.5% considered that menopause has adverse effects upon health; 87.9% believes that it produces emotional disturbances; 55.1% bone-related and 40.9% cardiac problems. Sixty six point eight percent of the consulted women know that there is a treatment for menopause. Half of the women interviewed had consulted the physician specifically for this reason; however, only one third are or were under treatment. Obesity, hirsutism and cancer are considered to be the main secondary effects to treatment. Patients who have not received hormone therapy have a much lower degree of knowledge about menopause than the treated ones, and amongst the latter, those who abandon treatment have less information than the ones that remain under treatment. As a conclusion, we may say that our patients have information about menopause and also that they attend to the physician's office for this reason. The knowledge about the matter and related beliefs influence both adherence to and compliance with therapy.

Unlabelled: To describe the symptoms of the climacteric female, 287 climacteric patients had their symptoms evaluated according to the criteria of Blatt-Kupperman for menopause. The median age was 50 years (P10 = 43 and P90 = 58). The main complaint was flushing in 46%, psychiatric symptoms in 17.8% a health examination in 14.6%, osteoporosis in 11.1%, menstrual problems in 6.3%, and other symptoms in 4.5%. Asthenia was a prominent symptom in 82% of patients, followed closely by headache, irritability and depression. Flushing was present in 77% of patients. Symptoms not usually associated to menopause, such as vertigo, palpitations and bone pain were quite prevalent. Only 69% of females were sexually active. Among them, 45% complained of dyspareunia and 58% of decreased or absent libido. The median Blatt index was 27. Working capacity was affected in 87% of patients., Conclusion: The menopausal period is associated to many symptoms which may motivate females to consult an internist.

Although valproic acid as well as its derivatives are effective in the treatment of some epileptic seizures, they are not free of adverse side effects. The purpose of this work was to describe the collateral clinical effects of valproic acid, the associated changes that take place in some serum laboratory parameters, and correlations among these adverse clinical effects, drug serum level and therapeutic response. One hundred patients aged 7 months to 19 years (average 5 year and 6 month old) were followed for at least 13 months. Clinical collateral effects were observed in 14% patients, anorexia and hair loss being the most frequent. One third of patients showed raised serum alkaline phosphatase and transaminases values, while lower than normal prothrombin time and platelet counts were detected in 4% and 1% of patients, respectively. In one patient treatment was interrupted because of low platelet counts which persisted in spite of drug withdrawal, but basal counts were not done, so it is not possible to establish causal relationships between both events. No correlation between adverse clinical symptoms and valproic acid plasma levels was observed. In spite of the fact that basal laboratory values were not known and that abnormal tests were not repeated for confirmation, collateral clinical effects and laboratory findings associated to treatment with valproic acid seemed not severe in this series. Anyway, taking into account drug characteristics, it should always be used with caution.

As life expectancy lengthens, the period that women must live deprived of estrogens is also lengthened. Not only does this hormonal deficit produce the known vasomotor symptoms, but it also increases the risk of cardiovascular disease and bone fractures. The fact that replacement therapy using hormones during the postmenopause attenuates these risks has lead to the thought that we might be facing a disease. Moreover, menopause meets the criteria that define disease. In spite of considering that to define menopause as a disease might be daring, we cannot rule it out.

In a previous study we reported a relatively low incidence of hip fracture in our population compared to figures reported elsewhere and speculated that this could be related to differences in bone density. Accordingly, we measured bone density in 259 subjects at necropsy. In 172 males we found that bone density decreased from 0.88 g/cc at age 21-30 to 0.80 at age 70 (NS). In women, density decreased from 1.0 at age 21-30 to 0.84 at age 50, 0.69 at age 60 and 0.64 in those older than 70 years (p less than 0.01). These figures are higher than those reported from USA at all ages and could explain the lower incidence of hip fractures in our population.

We measured total, HDL and LDL cholesterol and triglycerides in 183 postmenopausal women before and 4 weeks after hormone therapy. Ethinyl estradiol or conjugated estrogens alone or in association with medroxyprogesterone, norethyndrone or norgestrel were used in different dosages either continuously or sequentially. Total cholesterol decreased from 206 to 196 mg/dl and HDL raised from 47 to 53 mg/dl (p less than 0.001) except in the group treated with estradiol-levonorgestrel in which HDL fell from 41 to 36 mg/dl (p less than 0.001). HDL cholesterol decreased from 133 to 113 mg/dl, overall. The total cholesterol/HDL ratio decreased from 4.8 to 4.2 in all groups except the group previously mentioned. Estrogen therapy, isolated or in association to medroxyprogesterone induced a moderate increase in serum triglyceride levels (132 to 149 mg/dl, p less than 0.001). Thus, the administration of estrogens in postmenopausal women is associated with a decrease in total, LDL and total/HDL cholesterol ratio and an increase in triglycerides. Norgestrel but not medroxyprogesterone partially revert these effects.