Menopausal Treatment Research Articles

Effect of estetrol, a selective nuclear estrogen receptor modulator, in mouse models of arterial and venous thrombosis.

Estetrol (E4) is a natural estrogen synthesized exclusively during pregnancy by the human fetal liver, and the physiological role of this hormone is unknown. Interestingly, E4 was recently evaluated in preclinical and phase II-III clinical studies in combination with a progestin, with the advantage to not increase the circulating level of coagulation factors, at variance to oral estradiol or ethinylestradiol. Here, we evaluated the effect of E4 on hemostasis and thrombosis in mouse. Following chronic E4 treatment, mice exhibited a prolonged tail-bleeding time and were protected from arterial and also venous thrombosis in vivo. In addition, E4 treatment decreased ex vivo thrombus growth on collagen under arterial flow conditions. We recently showed that E4 activates uterine epithelial proliferation through nuclear estrogen receptor (ER) α. To analyze the impact of nuclear ERα actions on hemostasis and thrombosis, we generated hematopoietic chimera with bone marrow cells deficient for nuclear ERα. E4-induced protection against thromboembolism was significantly reduced in the absence of hematopoietic nuclear ERα activation, while the increased tail-bleeding time was not impacted by this deletion. In addition to its "liver friendly" profile described in women, our data shows that E4 has anti-thrombotic properties in various mouse models. Altogether, the natural fetal estrogen E4 could represent an attractive alternative to classic estrogens in oral contraception and treatment of menopause.

Principles of management of premature and surgical menopause in women with initial reproductive health problems

Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms and genitourinary menopausal syndrome and has been shown to prevent bone loss and destruction. This circumstance makes it possible to consider menopausal hormone therapy as the main method for the treatment of premature and surgical menopause. It is important to note that despite the similarity of the long-term consequences bilateral oophorectomy and premature fading in ovarian function differ significantly in the dynamics of the hormones concentration decrease. The risks of menopausal hormone therapy vary depending on the type, dose, duration of use, route of administration, timing of onset, and the use of estrogens and progestins. Treatment should be individualized by selecting the most appropriate formulation, dose, route of administration and duration of use, and also using the best data on maximizing benefits and minimizing possible risks with periodic reassessment of the benefits and risks of continuing or stopping the use of menopausal hormone therapy. Key recommendations of American Association of clinical endocrinologists and the American college of endocrinology (2017) are: for women with early menopause and primary ovarian failure, there are health risks that can include persistent vasomotor symptoms, bone loss, mood changes and an increased risk of cardiovascular diseases, dementia, stroke, Parkinson’s disease, ophthalmic disorders and overall mortality. The results of studies in older women do not apply to women with early menopause, and recent evidence suggests that such patients should use menopausal hormone therapy at least until the middle age of menopause. Transdermal oestrogen preparations are less likely to develop thrombotic risk and, possibly, the risk of developing stroke and coronary heart disease compared to oral oestrogens. If a progestagenic component is required, a more safest alternative is micronized progesterone.

The Influence of Menopausal Hormone Therapy and Potential Lifestyle Interactions in Female Cancer Development-a Population-Based Prospective Study.

The past decades have seen contradictory research results on the health benefits and risks of menopausal hormone therapy (HT). In particular, long-term associations with overall cancer incidence and the potential interplay with other lifestyle factors remain undetermined. In a population-based prospective cohort, 29,152 women aged 50-64years at entry (1993-1997) were followed through 2013 for incidence of cancer (99% complete follow-up). Cox' proportional hazards models were used to estimate cancer incidence according to baseline HT alone and in combination with lifestyle factors including alcohol intake, BMI, physical activity, diet, and smoking. Among 5484 women diagnosed with cancer, baseline HT was associated with an overall higher risk of cancer (HR 1.28; 95%CI, 1.21-1.36)-in particular, a higher risk of breast (HR 1.77; 95%CI, 1.61-1.95), ovarian (HR 1.68; 95%CI, 1.26-2.26), and endometrial (HR 1.86; 95%CI, 1.45-2.37) cancer. Combination with other lifestyle risk factors largely displayed additive associations. The risk of colorectal cancer was significantly lower (HR 0.79; 95%CI, 0.66-0.95). However, in the interaction analysis, only "healthy" subgroups of women using HT had a lower risk of colorectal cancer. With an overall higher risk of cancer among women on HT, this study underlined the importance of considering all female cancer risks in menopausal treatment guidelines. The largely additive associations between HT and the investigated lifestyle factors support the notion that high levels of hormones in itself play an important etiological role in female reproductive cancers, whereas the possible protective impact in colorectal cancer might be limited to women with an otherwise healthy lifestyle.

077 On the Initial Treatment Experience of CO2 Fractional Laser for Vulvovaginal Atrophy Symptom in a Single Institute

Volvovaginal atrophy (VVA) symptoms in women with menopause develop because female hormone secretion decreases. Unlike general menopausal treatment, systemic and local hormone replacement therapy and traditional Chinese medicine treatment may be refractory to VVA symptoms and there is no established treatment method. Presently, fractional CO2 laser therapy of the vulva has started for such symptoms. Since 2017, our department started the laser therapy for VVA patients who showed resistance to female hormone replacement therapy. We will review and report on the outcome of the treatment retrospectively. CO2 fractional laser was performed on patients with VVA. The maximum number of lasers treatments was three (number of treatments, according to the patient's symptoms). Each treatment interval was 4 to 6 weeks. During the operation, percutaneous anesthesia was performed on the vulva, and anesthesia time of 15 minutes or more was set. We evaluated improvement of main symptoms before and after treatment (VAS), change in vaginal health index and side effects (pain, infections, discharge and bleeding).

Therapeutic Perspectives of 8-Prenylnaringenin, a Potent Phytoestrogen from Hops.

Hop (Humulus lupulus L.), as a key ingredient for beer brewing, is also a source of many biologically active molecules. A notable compound, 8-prenylnaringenin (8-PN), structurally belonging to the group of prenylated flavonoids, was shown to be a potent phytoestrogen, and thus, became the topic of active research. Here, we overview the pharmacological properties of 8-PN and its therapeutic opportunities. Due to its estrogenic effects, administration of 8-PN represents a novel therapeutic approach to the treatment of menopausal and post-menopausal symptoms that occur as a consequence of a progressive decline in hormone levels in women. Application of 8-PN in the treatment of menopause has been clinically examined with promising results. Other activities that have already been assessed include the potential to prevent bone-resorption or inhibition of tumor growth. On the other hand, the use of phytoestrogens is frequently questioned regarding possible adverse effects associated with long-term consumption. In conclusion, we emphasize the implications of using 8-PN in future treatments of menopausal and post-menopausal symptoms, including the need for precise evidence and further investigations to define the safety risks related to its therapeutic use.

Menopausal Treatment

The objective of this chapter is to review the current body of knowledge in the treatment of menopausal symptoms and provide succinct conclusions and recommendations that can serve as the primary source of literature for clinicians, medical professionals, and students. The following includes in-depth evaluations of multiple studies including Cochrane Database reviews, systematic reviews, large randomized clinical studies, retrospective and prospective cohort studies, and animal studies. This chapter contains two large tables reviewing the current medications on the market for the treatment of menopausal symptoms. These tables include the brand and generic names, dosing, route of administration, side effects, FDA status, and literature supporting the medication’s use. This is designed to provide readers with an easy and accurate reference. In addition, this chapter contains information and links to online and downloadable references and guides for both patients and providers to assist in ease of starting, changing, or discontinuing treatment of menopause. This review contains 1 highly rendered figure, 9 tables, and 45 references Key Words: Menopausal treatment; hot flashes; vaginal dryness; genitourinary syndrome of menopause; hormone replacement therapy; HRT or HT; non-hormonal therapy

Frontotemporal Dimentia (FTD), Late Onset Secondary to Total Abdominal Hysterectomy-Bilateral Salpingo-Oophorectomy: A Case Report in Malaysia

The relationship between cognitive impairment and depression were established. However, the exact mechanism is virtually unknown. Frontotemporal dementia (FTD) is second most common type of dementia after Alzheimer’s disease. To date, there is no proposed specific treatment for FTD, the mainstay of treatment is a combination of symptomatic pharmacological and psychosocial or behavioural intervention. The connection between FTD and level of estrogen was poorly understood. Interestingly recent findings reflect that there is association between estrogen use and development of FTD. Primary function of estrogen is in the development of sexual characteristics. Apart from that, it plays a vital role in the metabolism and mental health. Abrupt reduction of estrogen level in the blood and internal sustained low level of estrogen correlate with significant mood and cognitive changes. Estrogen replacement therapy (ERT) introduced to as a treatment for menopause, but it has linked with increased risk for breast cancer and thromboembolism phenomenon. We describe the case of post-menopausal women secondary to TAHBSO with underlying treatment-resistant major depressive disorder presented with cognitive disturbance. This case illustrates a challenge in the determination of correct diagnosis and decision of appropriate management that subsequently can affect the prognosis.

Making sense of hormone replacement therapy

Hormone replacement therapy remains the most effective treatment for the relief of menopausal symptoms and is an essential part of the management of women with premature ovarian failure. Over recent months, media coverage of HRT has left women anxious over its safety, and some prescribers may be unclear of the current evidence. This article summarises the current evidence so prescribers may be confident in offering this treatment for menopause, based on individualized risk.

Genitourinary syndrome of menopause treatment using lasers and temperature-controlled radiofrequency.

Perimenopausal changes caused by oestrogen deficiency are accompanied by a decrease in the content of collagen and elastin in the tissues, leading to thinning of the epithelium and the resultant disappearance of the superficial layer, which leads to smooth muscle dysfunction as well as connective tissue degradation. This aetiopathogenetic chain results in a set of symptoms experienced by approximately 50% of women in the peri- and postmenopausal period. Symptoms of dryness, burning, dyspareunia and urgency contribute to a significant reduction in the quality of sexual function and general comfort of life due to recurrent infections of the vagina, vulva and urinary tract. Different therapeutic methods may benefit genitourinary syndrome of menopause (GSM), while innovative methods such as lasers or radiofrequency deserve further study in this area.

Novel menopause treatment rapidly reduces hot flashes

Novel menopause treatment rapidly reduces hot flashes

Follicle-stimulating hormone promotes the transformation of cholesterol to estrogen in mouse adipose tissue

Follicle-stimulating hormone (FSH) levels increase estrogen biosynthesis in obese menopausal women. Ovariectomized mice and 3T3-L1 cells were used to explore estrogen biosynthesis in the decline of ovarian function. After ovariectomy, lipid deposition, and FSH and estrogen levels changed, and feed intake increased significantly. In mouse adipose tissue, FSH was found to have a role in accelerating lipid deposition via the peroxisome proliferators-activated receptor pathway, and in inducing estrogen biosynthesis via the steroid hormone metabolism pathway. Furthermore, FSH bound to the FSH receptor promoted CREB phosphorylation, which was activated by cAMP-PKA. Moreover, pCREB could up-regulate PPARγ and SREBP2 mRNA levels, resulting in an increased transformation of cholesterol to estrogen. Overall, this study shows that FSH induces fat deposition and promotes the transformation of cholesterol to estrogen through CREB activation by cAMP-PKA in mouse adipose tissue. Our findings provide a new understanding of menopause treatment.

Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making

BackgroundIn recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)—despite concerns within the medical community and the availability of new FDA approved “bioidentical” products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women.MethodsWe analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process.ResultsAlthough women’s individual motivations varied, two overarching themes emerged: “push motivations” that drove women away from conventional HT and from alternative therapies, and “pull motivations” that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention.ConclusionsThis study finds that women draw upon a range of “push” and “pull” motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.

Clinical trials in menopause.

Clinical trials in menopause have undergone much scrutiny over the years. This has led to significant shifts in the treatment of symptomatic menopause and a substantial impact on women. We aim to delineate the key studies contributing to this controversy and highlight new directions specifically related to menopausal hormone therapy (HT) and vascular disease risk. We performed a search of sentinel studies delineating the risks and benefits of HT in otherwise healthy postmenopausal women. Using PubMed we input the following search terms: hormone replacement therapy, cardiovascular disease, coronary artery disease, coronary atherosclerosis, myocardial infarction, angina, coronary heart calcification, carotid intimal thickness, lipids, and/or lipoproteins. We included studies of menopausal women (surgical or natural) using combined estrogen/progestogen therapy or estrogen-only therapy that looked at cardiovascular disease risk factors or outcomes. Studies were evaluated for inclusion by the authors; however, this is not intended to be a systematic or an exhaustive analysis. In women close to the time of menopause, there is a decreased risk of subclinical and clinical coronary heart disease with menopausal HT. Additionally, HT confers a significant benefit to vasomotor symptoms of menopause, bone health, and colorectal cancer. There is an increased risk of venous thromboembolism with oral formulations that appears mitigated with transdermal estradiol. Mixed data regarding breast cancer risk are available, with some studies suggesting an increased risk of invasive breast cancer with estrogen/progestogen therapy and a null effect with estrogen-only therapy. Other more long-term epidemiologic studies identify a decreased risk. The available literature suggests that HT is a viable option for the primary prevention of cardiovascular disease in postmenopausal women. Newer trials will likely verify this assessment. If this is enough to change clinical practice, however, remains to be seen given the general fear of HT by many with prescriptive authority, and also the women in our care.

Efficacy of zolendronic acid in post menopausal osteoporosis treatment

Efficacy of zolendronic acid in post menopausal osteoporosis treatment

Consensus statement for non-hormonal-based treatments for menopausal symptoms.

Since the June 2014 consensus statement published in Post Reproductive Health we have had definitive guidelines on menopause treatment from the National Institute for Clinical Excellence in November 2015. These included robust and evidence based information about many non-estrogen based treatments, which are particularly useful for patients who do not wish to take hormone replacement therapy, or who have medical contraindications to hormonal therapy such as hormone dependent cancers. Whilst none of these therapies is as effective as hormones, we must be able to advise patients about them and recommend which treatments may be helpful for individual women.

The management of menopause in women with a history of endometriosis: a systematic review.

BACKGROUNDEndometriosis is typically regarded as a premenopausal disease, resolving after natural or iatrogenic menopause due to declining oestrogen levels. Nonetheless, case reports over the years have highlighted the incidence of recurrent postmenopausal endometriosis. It is now clear that both recurrence and malignant transformation of endometriotic foci can occur in the postmenopausal period. Postmenopausal women are commonly treated with hormone replacement therapy (HRT) to treat climacteric symptoms and prevent bone loss; however, HRT may reactivate endometriosis and stimulate malignant transformation in women with a history of endometriosis. Given the uncertain risks of initiating HRT, it is difficult to determine the best menopausal management for this group of women.OBJECTIVE AND RATIONALThe aim of this study was to systematically review the existing literature on management of menopausal symptoms in women with a history of endometriosis. We also aimed to evaluate the published literature on the risks associated with HRT in these women, and details regarding optimal formulations and timing (i.e. initiation and duration) of HRT.SEARCH METHODSFour electronic databases (MEDLINE via OVID, Embase via OVID, PsycINFO via OVID and CINAHL via EbscoHost) were searched from database inception until June 2016, using a combination of relevant controlled vocabulary terms and free-text terms related to ‘menopause’ and ‘endometriosis’. Inclusion criteria were: menopausal women with a history of endometriosis and menopausal treatment including HRT or other preparations. Case reports/series, observational studies and clinical trials were included. Narrative review articles, organizational guidelines and conference abstracts were excluded, as were studies that did not report on any form of menopausal management. Articles were assessed for risk of bias and quality using GRADE criteria.OUTCOMESWe present a synthesis of the existing case reports of endometriosis recurrence or malignant transformation in women undergoing treatment for menopausal symptoms. We highlight common presenting symptoms, potential risk factors and outcomes amongst the studies. Sparse high-quality evidence was identified, with few observational studies and only two randomized controlled trials. Given this paucity of data, no definitive conclusions can be drawn concerning risk.WIDER IMPLICATIONSDue to the lack of high-quality studies, it remains unclear how to advise women with a history of endometriosis regarding the management of menopausal symptoms. The absolute risk of disease recurrence and malignant transformation cannot be quantified, and the impact of HRT use on these outcomes is not known. Multicentre randomized trials or large observational studies are urgently needed to inform clinicians and patients alike.

Pregnancy, Hormonal Treatments for Infertility, Contraception, and Menopause in Women After Ischemic Stroke

Pregnancy has been reported to be associated with an increased risk of ischemic stroke, and stroke occurring during pregnancy is one of the leading causes of maternal death.1 Kuklina et al2 reported that the rate of any stroke among antenatal hospitalizations increased by 47% (from 0.15 to 0.22 per 1000 deliveries) and among postpartum hospitalizations by 83% (from 0.12 to 0.22 per 1000 deliveries) when comparing the period 1994–1995 to 2006–2007. The American Heart Association Stroke Guidelines for Women have been published recently,3 which deal with risk factors unique to women, including reproductive factors, and those factors that are more common in women, including migraine, obesity, metabolic syndrome, and atrial fibrillation. However, the lifelong management of hormonal issues in women who have had stroke was not fully addressed regarding the following: future pregnancies, type of delivery, labor induction, and secondary prevention during future pregnancy and lactation. This consensus provides multidisciplinary approaches compiled by stroke neurologists, gynecologists, and endocrinologists, based on a thorough review of current literature through computerized searches up until July 26, 2016. Literature on pregnancy, secondary stroke prevention, labor induction, hormonal contraceptive therapy, ovarian stimulation, and hormone replacement therapy was reviewed. The panel collected relevant articles using computerized searches of medical literature up until July 26, 2016. The search strategy was designed to identify studies on pregnancy, delivery, labor induction, breast-feeding, ovarian stimulation, hormonal contraceptive therapy, hormone replacement therapy, and their stroke risks. The included studies were identified from the Medline/PubMed database, EMBASE, and the Cochrane Database. Additional papers were identified from reference lists of retrieved articles, abstract lists of recent scientific meetings, and Internet-based sources (http://www.tctmd.com, http://www.cxvascular.com; Figure). Figure. Flow chart of the research strategy. A list of treatment recommendations, including evaluations of evidence strength, is provided in Table 1. View this table: Table 1. Recommendations …

ASYMPTOMATIC VERTEBRAL COMPRESSION FRACTURES IN POSTMENOPAUSAL WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that most commonly occurs in women. Improved treatments for SLE have led to a substantial increase in the life expectancy of patients, so the problems of complications of both the disease itself and its therapy have come to be top priority. The most common complications of SLE among the musculoskeletal system lesions are osteoporosis and related vertebral compression fractures (VCFs). However, only one third of these fractures has clinical manifestations and causes the patient to seek medical advice. More VCFs remain undetected because they have no or scarce symptoms. The question of the influence of various factors (gender, age, menopause, etc.) on the incidence of VCFs in patients with SLE remains open. It should be expected that in postmenopausal women with SLE, the incidence of VCFs may be considerably higher than that in the population. Objective : to determine the frequency of and to evaluate the role of various factors in the development of asymptomatic vertebral fractures in postmenopausal women with SLE (a retrospective study). Subjects and methods . A total of 86 postmenopausal women (mean age, 59±7.9 years) with a diagnosis of SLE, which met the 2012 Systemic Lupus Collaborating Clinics (SLICC) criteria, were examined. The mean duration of the disease and menopause was 15±8.3 and 12.8±7 years, respectively. All the patients with SLE were treated with glucocorticoids (GC) at a dose of 15±5 mg/day calculated with reference to prednisolone for more than 12 months (mean, 159.7±90.9 months) and had a low disease activity (the mean SLEDAI-2K score was 5.1±3.9). The ACR damage index for SLE averaged 5.5±2.6. All the patients underwent vertebral fracture assessment (VFA) using a Hologic Explorer bone densitometer to identify VCFs in the thoracic and lumbar spine. The anterior, middle, and posterior heights of ТhIV–LV, and the height of each vertebra as well as the underlying vertebra were calculated and compared. If the differences in the anterior, middle, or posterior vertebral heights were >20–25%, this deformation was regarded as VCFs. Bone mineral density (BMD) in the hip and spine was measured with an X-ray bone densitometer. Results. VFA revealed VCFs in 40 (46.5%) patients with SLE; these were detected for the first time in 22 (55%) patients since they had no significant clinical manifestations. VCFs happened most commonly in the mid-thoracic spine (ThVI–IX). All the patients with asymptomatic VCFs had a fracture of only one vertebra. The patients with VCFs had a longer duration of SLE and menopause, more frequently received cytostatic therapy, and had a higher cumulative dose and a longer duration of GC therapy. They also had a higher damage index and lower BMD values in LI–IV than patients without VCFs (p 0.05). Conclusion. The detection rate for VCFs is nearly 50% in postmenopausal women with SLE, and about every two VCFs remain undetected. The long duration of SLE, menopause, and GC treatment, a high cumulative dose, a high damage index and low BMD values in LI–IV were associated with VCFs. VFA is an effective screening method to detect asymptomatic VCFs.

The Tissue-Selective Estrogen Complex (Bazedoxifene/Conjugated Estrogens) for the Treatment of Menopause.

The tissue-selective estrogen complex (TSEC) pairs conjugated estrogens (CE) with a selective estrogen receptor modulator (SERM), bazedoxifene acetate (BZA). A 2-year treatment with the TSEC improved vasomotor symptoms, quality of life, and vaginal atrophy in healthy postmenopausal women. In addition, the TSEC prevented vertebral and hip bone loss without increasing mammographic density, breast tenderness, the risk of myocardial infarction, stroke, or venous thromboembolism. Finally, the BZA 20 mg/CE 0.45 mg dose did not increase the risk of endometrial hyperplasia. Based on these findings, the TSEC can be considered as a first-line treatment for symptomatic postmenopausal women.

Features of menopausal syndrome treatment in women with endometriosis

Correction of menopausal disorders on the endometriosis background has certain specificity, due to the fact that the menopausal hormone therapy in this group of women is extremely limited because of the possible endometriosis manifestations, which requires the development of new integrated scheme of nonhormonal therapy. Given the major impact of chronic stress in the mechanism of the endometriosis development and menopausal syndrome, authors found it necessary to use the anti-stress therapy for the treatment of this pathology. Authors had developed a treatment regimen without menopausal hormone therapy for women with mild to moderate climacteric syndrome and with history of endometriosis. Noofen was selected like the main drug as a stabilizer cognitive disorders and antihypoxant, as additional drug was used anxiolytic adaptol. 60 women with climacteric syndrome of mild to moderate severity and with history of endometriosis received treatment during the 6 weeks, which were divided into two groups of 30 women: the first group received monotherapy with noofen, women in the second group received the combined therapy that included adaptol and noofen. Evaluation of the clinical status of patients and severity of menopausal disorders was conducted on a Menopause Rating Scale (MRS). The level of anxiety was measured on a Spielberg scale. Changing the assessment of life quality during therapy was determined by questionnaire Freiburg Personality Inventory (FPI). The therapy result showed a significant improvement in the evaluated parameters in patients of both groups. In second group of women already in the first two weeks after complex therapy the improvements were found in comparison with the group receiving monotherapy. Thus, the chosen regimen helps to quickly eliminate the climacteric syndrome in women with endometriosis, improve and stabilize their psychological profile, recover, improve and adapt the quality of life.