Vascular Effect of Tibolone in the Brachial Artery
Vascular Effect of Tibolone in the Brachial Artery
The interruption of the secretion of sex steroids occurring during menopause, causes a change
 in vascular pattern at various levels. As a result, several agencies have side effects that
 interfere with women's health. The use of hormone replacement therapy has contributed to the
 improvement in these effects. In previous studies the investigators showed the effect of sex
 steroids in premenopausal women in the conjugated equine estrogens, medroxyprogesterone
 acetate and tibolone in menopausal women, on the central retinal arteries. The aim of this
 study is to evaluate the effects of Tibolone in Flow-Mediated Dilatation of the brachial
 artery.
Menopause is a transitional phase of the biological evolution of women where there is loss of
 reproductive capacity. The phenomena are the most striking manifestations represented by
 vasomotor hot flushes and sweating, the consequent fall in estradiol production by the
 ovaries. The main landmark of the menopause is menopause, which is the last period governed
 by the ovaries, reflecting the depletion of the same follicle.

 The main clinical manifestations of the climacteric are vascular, acting through mechanisms
 of action not fully understood. Several studies were published showing its effect on
 vasomotor tone and demonstrating the production of vasoactive substances by vascular cells
 induced by them.

 The main objective of HRT (Hormone Replacement Therapy), is to improve the physical and
 psychological state of women who have climacteric disorders, leading to improved quality of
 life. The American College of Physicians, after careful review of available evidence, it is
 recommended that all postmenopausal women should be considered eligible to receive HRT and
 that the decision to treat or not should be individualized. Besides the knowledge of the
 pattern of endocrine patients climate, the investigators must subject it to full physical
 examination (pelvic) and exams before planning to start HRT. Complementary tests must be
 clinically oriented, respecting the resources available. There is no need to make routine use
 of doses of gonadotropins and sex steroids, which are reserved for certain diagnostic
 situations where there is any doubt, for example, premature ovarian failure syndrome.

 He is currently a world consensus that the best available treatment for menopause is hormone
 replacement therapy because exogenously resets once the hormones produced by the ovaries. HRT
 fulfills several objectives: reverse neurovegetative symptoms, improves trophism genital
 atrophy and genital-urinary, acts in the prevention and treatment of osteoporosis, leading to
 lower incidence of colorectal cancer, promotes a later onset, lower incidence, evolution and
 improvement in symptoms of Alzheimer's disease has a positive influence on the view.

 The development of HRT and the results that prove their individual benefits and
 epidemiological brought new questions about the most appropriate way to use the various
 schemes available. The treatment regimens are designed to establish a hormonal profile
 similar to that of premenopausal using: estrogens, progestogens and androgens in different
 doses and routes of administration.

 Estrogens are the most commonly used conjugated estrogens. The subcutaneous implants (17 beta
 estradiol) The percutaneous estradiol in the form of gels, transdermal devices (patches) and
 Tibolone.

 Hormones can be used alone or combined, cyclic or continuous, always trying to individualize
 each situation in order to provide patients with a regimen that suits your needs and desires.

 Since its description in 1989, the extent of dilatation of the brachial artery flow-mediated
 (FMD) has been used to assess endothelial function. It is believed that ischemia induced by
 inflation of the cuff cause a dilation of the vessel, leading to an increase in brachial
 artery flow. This effect seems to be mediated by NO production by normal endothelial cells.

 In patients whose bioactivity of NO is decreased or absent on endothelial function
 impairment, this dilatory response does not happen. The dilation of the brachial artery is
 thus higher in patients with normal endothelial function than in patients who have a
 pathology that leads to endothelial injury, among them, Hypertension, Coronary heart disease,
 diabetes mellitus, smoking, hyperlipidemia and Pre-Eclampsia.

 Patients will be randomly divided into two groups of 30, using code envelope with the
 medication, without her or responsible for the study to know the component to be used
 (double-blind study), with groups divided as follows:

 -  Group 1 placebo for 30 days;

 -  Group 2: Tibolone 2.5 mg / day for 30 days Patients will be evaluated before the use of
 drugs and the end of their use (28-30 days of medication use).
Inclusion Criteria:

 -  Women without menstrual cycles within the last 12 months and FSH > 30IU/L

 -  Healthy women

 -  Women that were not using drugs with potential vascular effect within the last 1 year

 -  Women that never used hormone replacement therapy

 Exclusion Criteria:

 -  Smoking

 -  Blood Pressure > 160/90 mm Hg.

 -  Breast and or endometrial cancer

 -  History of acute myocardial infarction

 -  Diabetes

 -  Vaginal bleeding of any origin

 -  Hepatic disease

 -  Thrombophlebitis or thromboembolic disorders