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S

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554

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2015; 61(6):553-556

The effects of hypoestrogenism on the weight gain is

unclear, but several experimental studies have demon-

strated the relationship between oophorectomy and an

increase in adipocytes, tissue inflammation and the de-

velopment of hepatic steatosis and insulin resistance.

11

Weight gain is more related to age than menopause it-

self.

12,13

In a previous study which included body mass in-

dex (BMI), calculated by weight (in kg) divided by height

(in meters) squared, it was observed that 68.13% of wom-

en were overweight or obese.

12

The prevalence of abdominal obesity is higher in age

groups above 60 years and relates to cardiovascular risk

and metabolic disease. In addition, this correlation wors-

ens after menopause, with accumulation of visceral fat

and changes in the concentration of inflammatory mark-

ers and serum hormone binding globulin carrier (SHBG)

levels, which are inversely related to insulin resistance.

12,13

Visceral obesity is also related to sexual dysfunction, breast

and endometrial cancer.

13,14

In a study in Latin America, obesity is associated with

hypertension, depressive symptoms, physical inactivity

and worsening of climacteric symptoms.

13

Recent Brazil-

ian studies show obesity as a major risk factor for wors-

ening of menopausal symptoms and increased cardiovas-

cular risk (hypertension, hyperglycemia and low serum

levels of high-density protein).

3,12

A better understanding of these factors can help re-

duce the impact of symptoms on women’s health in late

postmenopausal women, and identify groups likely to re-

quire care after menopause. This same group of women

is often out of the window of opportunity to use hor-

mone therapy and, therefore, multidisciplinary support

to reduce the harmful effects of these factors is impor-

tant to maintain an adequate quality of life.

Thus, multidisciplinary support with changes in life-

style, encouraging aerobic physical activity and a balanced

diet are guidelines adopted by educational programs dur-

ing climacteric.

5

Studies have demonstrated benefits for

climacteric symptoms, particularly improvement in va-

somotor symptoms, depressed mood, arthralgia and my-

algia.

8,9

In female aging, effects in lower genital tract are com-

mon and related to late post-menopause, being atrophic

vulvovaginitis and urogenital dysfunctions common com-

plaints brought by patients.

15,16

Atrophic vulvovaginitis affects 40% of postmenopaus-

al women. Effects of prolonged hypoestrogenism are ob-

served on physical examination of the vulva and vagina

and clinical findings include loss of vaginal

rugae

, reduced

elasticity, sparse vaginal content and thinning of the vag-

inal mucosa.

15

All these aspects influence the daily lives

of patients on account of clinical manifestations, such as

symptoms of vaginal dryness, pain or discomfort during

intercourse, and urinary symptoms such as dysuria and

urgency.

14,16

Genitourinary dysfunction, in turn, characterized by

sagging, dystopia and incontinence, may be made worse

with the decrease in collagen secondary to hypoestrogen-

ism affecting the support mechanisms,

fasciae

, and liga-

ments of the pelvic floor. There is also a reduction in the

periurethral vascular cushion and estrogen receptor al-

pha and beta in the urethra, both involved in the urinary

continence process.

16

Symptoms related to the late post-menopause in-

clude cognition and memory, which may adversely af-

fect the working lives of women due to estrogen levels

that interact with other neurotransmitters, as well as

glucocorticoids in the brain. Memory and cognition dys-

function in post-menopause is transient and not progres-

sive. The worsening of symptoms may be related to other

comorbidities such as

diabetes mellitus

and Alzheimer’s

disease.

17

Another important aspect of women’s health during

the aging process is osteoporosis and fracture risk. What

preventive measures are considered for women in late

post-menopause? The focus of prevention, or better, of

health promotion is the identification of individuals at

risk, that is, with low bone mass and risk factors, in or-

der to prevent fractures.

18

The risk of osteoporosis and fracture increases with

age and involves other risk factors for low bone mineral

density and fractures such as: female gender, low body

weight (<50 kg) or weight loss, smoking, family history,

habits and behaviors such as alcohol and caffeine, low in-

take of calcium and vitamin D. In addition, secondary

causes of osteoporosis include use of corticosteroids,

transplant recipients, use of antiretroviral drugs and an-

ticonvulsants.

18,19

Bone densitometry is a relevant exam-

ination in climacteric women, since there is significant

deterioration in bone mineral density over the years of

menopause, as well as low body mass index. This obser-

vation is relevant because it allows establishing preven-

tive and therapeutic measures that will undoubtedly im-

prove the quality of life of older women.

10

In the case of populations with no risk of fracture

due to fragility or secondary causes, subjects could have

a different course of evaluation, without screening before

the age of 65 years. There are some gaps in tracking pa-

tients using bone densitometry, for example in black pop-

ulations, and the maximum age at which to perform the