Função física no envelhecimento feminino: o papel da menopausa e da terapia de reposição hormonal em diferentes contextos socioculturais

Abstract

Introduction: Physical function is an important marker of health outcomes during the aging process. In women, it appears to be influenced by hormonal changes that occur during menopause. However, studies evaluating the association between physical function and menopausal status or the use of Hormone Replacement Therapy (HRT) have shown conflicting results. Understanding these relationships is essential for planning and directing practices aimed at preventing disability in this population. Objective: Study 01: To evaluate the association between menopausal status and physical function in community-dwelling older women through a systematic review; Study 02: To examine the association between Hormone Replacement Therapy (HRT) and physical performance among women in the Canadian Longitudinal Study on Aging CLSA; Study 3: To investigate the relationship between HRT and Activities of Daily Living (ADLs) between older Brazilian women. Methods: The first study was a systematic review of the associations between menopausal status and physical function in women. Observational studies assessing menopausal status and physical function in different socioeconomic contexts were included. The review followed a protocol that was previously developed and registered on the Prospective Register of Systematic Reviews platform. Meta-analysis was conducted using RevMan software. The second study was a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) with 12,506 postmenopausal women. Participants who had used or were currently using HRT were compared with those who had never used it concerning measures of grip strength, gait speed, the Timed Up and Go (TUG) test, sit-to-stand, and balance. Multiple linear regression analyses investigated the relationships, adjusting for covariates. The third study analyzed data from the 2019 National Health Survey (PNS) involving Brazilian women from all regions of the country who were postmenopausal. Data on reported use of HRT and difficulty in performing ADLs were used, with analysis conducted using Binary Logistic Regression. The analyses for Studies 2 and 3 accounted for sample weights derived from complex sampling. Results: Study 01: The systematic review protocol was published in the journal Plos One and the article with its results was submitted to the scientific journal Climacteric. Twenty-one studies were included. The results indicate that women in natural or surgical postmenopause exhibit worse physical function compared to women in pre- and perimenopause in most functional tests considered. The differences are attenuated when adjusting for covariates such as age and body weight. The results are consistent across different socioeconomic contexts. Study 02: HRT was associated with better physical performance in the gait speed and TUG tests in the Canadian sample, with no difference between the groups in relation to the other tests. In analysis by age subgroup, the results remained significant only among those over 65 years old. Study 03: The results indicate that women who have never used HRT have more difficulty in all activities of daily living compared to those who have used it. When adjusted analyses accounted for socioeconomic data, physical exercise, lifestyle habits, chronic diseases, and age at menopause, the use of HRT remained a protective factor for 2 out of the 5 activities analyzed: difficulty bathing and walking. Conclusion: The menopausal transition represents a critical period during which physical function tends to decline, underscoring the importance of implementing health strategies for women during this phase. HRT is associated with improved markers of physical function, such as gait speed, the TUG test, and reported performance of ADLs. However, for some outcomes, the differences were small, and clinical relevance remains to be determined. Further prospective studies are needed to confirm whether HRT use leads to better functional outcomes over time.