Teses e Dissertações

• Teses
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ARTIGOS

 

1-      Premenstrual symptoms and syndrome according to age at menarche in a 1982 birth cohort in Southern Brazil

 

Abstract

 

Premenstrual symptoms and syndrome were studied in young women who have been followed since birth. Data were collected on the intensity of four symptoms: irritability, anxiety or stress, depressed mood, and affective lability. Premenstrual syndrome was defined according to intensity of symptoms. Association between age at menarche and premenstrual symptoms and syndrome were investigated through Poisson

regression. Adjusted analysis was conducted, controlling for possible confounding factors. The symptoms most frequently reported by the women from the 1982 Pelotas, Rio Grande do Sul, Brazil, birth cohort who were interviewed in 2004-2005 were: irritability (52.3%) and anxiety (40.2%). The prevalence rates for moderate and severe premenstrual syndrome were 13.4% and 5.8%, respectively. Mean age at menarche

was 12.4 (± 1.5) years. Prevalence rates for symptoms and premenstrual syndrome were higher in women whose age at menarche was less than 11 years, but this difference was not statistically significant. Information on symptoms and premenstrual

syndrome is scarce in other studies.

 

Keywords: Premenstrual Syndrome; Menstrual Cycle; Menarche; Women

 

2-      Use of oral contraceptives for treatment of premenstrual symptoms: a systematic review

 

Abstract

 

Objective: Regular use of oral contraceptives by women of reproductive age

may relieve premenstrual symptoms. The present article was aimed at providing a systematic review of studies measuring the effect of oral contraceptives on

premenstrual symptoms.

 

Methods: We searched the Medline, Web of Science, Popline, Lilacs, and

Scielo databases using the following key words: premenstrual syndrome or

premenstrual dysphoric disorder, treatment, contraceptive, and clinical trial. There were no restrictions as to language or year of publication. Abstracts were examined in order to select controlled studies, which were classified according to quality criteria. We selected studies having as outcomes premenstrual symptoms or syndrome and whose exposures were use of oral contraceptives containing ethynylestradiol in association with different formulations of progesterone. Results were evaluated as reported by the authors (differences in proportions or mean scores and subjective reports of improvement or worsening of symptoms).

 

Results: We located 63 references in PubMed, 19 in Web of Science, and 6 in

Popline. Based on these abstracts, 25 full articles were selected for evaluation. Ten controlled studies were included. Methodological quality scores ranged from 14 to 24 (mean = 18) points. Progestogens studied included drospirenone, levonorgestrel, desogestrel, gestodene, and norethindrone. There was consistent improvement in symptoms with use of any of these active contraceptives; however, differences in the comparisons made were not always significant. Duration of follow-up ranged from 3 to 26 menstrual cycles, and subject age, from 18 to 45 years. Most analyses were by intention to treat.

 

Conclusions: The results of these studies suggest that oral contraceptives with different formulations can improve premenstrual symptoms, even though only a few symptoms were evaluated. There is a lack of studies of higher quality, using similar and validated instruments, and with longer follow-up periods.

 

Keywords: Contraceptives; premenstrual symptoms;  review

 

 

3- Diagnóstico de síndrome pré-menstrual por registro diário e outros critérios de mensuração

 

Objetivo: Validar um questionário retrospectivo de sintomas pré-menstruais comparando com o diagnóstico da SPM obtido pelo registro diário dos mesmos sintomas.

 

Métodos: Mulheres jovens foram entrevistadas em seus domicílios quando 22 sintomas prémenstruais e a auto-percepção da SPM foram questionados. Na mesma visita, essas mulheres foram orientadas para o preenchimento do registro diário desses sintomas por dois ciclos menstruais, nas semanas anteriores e posteriores à menstruação. Critérios de validação foram utilizados para comparar a SPM autoreferida ou obtida do questionário retrospectivo com escore construído a partir do registro diário. Foram consideradas com SPM pelo escore as mulheres que somaram 44 pontos e sintomas 30% mais altos no período pré-menstrual. No diagnóstico de SPM pelo questionário utilizaram-se todos os sintomas e uma versão reduzida com apenas quatro sintomas emocionais.

 

Resultados: Foram entrevistadas 375 mulheres, dessas, 235 (73,8%) completaram o registro diário por quatro semanas. A prevalência de auto-percepção de SPM foi 62,8% e com o padrão ouro foi 37,9%. Os valores de sensibilidade variaram desde 21,3% até 98,9%. O diagnóstico de SPM com questionário retrospectivo mostrou desempenho fraco nos testes de validação, seja com quatro sintomas emocionais ou com todos os sintomas juntos. Mulheres com mais alto grau de escolaridade apresentaram prevalência, sensibilidade e acurácia mais altas para a maior parte das formas de SPM comparada com o padrão ouro. Para rastreamento, os melhores parâmetros de sensibilidade e acurácia foram obtidos pela SPM nas formas moderadas e pela autoreferida, embora com valores preditivos positivos baixos.

 

Conclusões: A proposta de validar quatros sintomas não mostrou melhores resultados que o questionário com todos os sintomas, quando comparados ao registro diário (padrão ouro). A SPM auto-referida pode ser uma alternativa rápida e prática no início da investigação diagnóstica, pois atende aos critérios de rastreamento.

 

Descritores: Síndrome pré-menstrual. Sensibilidade e especificidade. Estudos

epidemiológicos. Questionários.