Fertility preferences, condom use, and concerns among HIV-positive women in serodiscordant relationships in the era of antiretroviral therapy

Objective

To assess preferences and concerns about infecting partner or child among HIV-positive women undergoing antiretroviral therapy and whose partners are HIV-negative.

Method

In this cross-sectional study conducted in Nigeria, 55 HIV-positive women undergoing antiretroviral therapy and married to seronegative men answered an anonymous questionnaire regarding whether they preferred to conceive naturally or by means of an assisted reproductive technique (ART).

Results

Compared with older women (mean age 33.6 ± 5.1 years), younger women (mean age, 29.8 ± 3.9 years) were significantly more likely to choose natural conception than ART (P = 0.02). Moreover, whereas 23 respondents (48.9%) reported consistent condom use, 11 (23.4%) reported never using condoms after initiation of antiretroviral therapy. There was a significant difference in the consistent use of condoms between those who preferred natural conception and those who preferred ART (56.8% vs 20%, P = 0.049).

Conclusion

With improving immunologic and clinical status once antiretroviral therapy is initiated, HIV-positive women wishing to become pregnant may engage in risky sexual practices. This trend needs to be addressed because of its consequences for public health.     

Sublingual misoprostol prior to insertion of a T380A intrauterine device in women with no previous vaginal delivery

Abstract

Objective To investigate whether sublingual misoprostol administered one hour before intrauterine device (IUD) insertion reduces failed insertions, insertion-related complications and pain in parous women delivered only by elective caesarean section (CS).

Methods Single-blind randomised controlled trial conducted in Ismailia, Egypt, between July 2010 and December 2011. Women who had never delivered otherwise than by elective CS and desirous of using an IUD were randomly allocated to receive sublingually 400 μg misoprostol and 100 mg diclofenac (misoprostol group) or 100 mg diclofenac alone (control group) one hour before IUD insertion. Outcome measures were failed insertion, ease of insertion judged by the investigators, insertion-related complications, and patients’ satisfaction.

Results In all, 255 women (130 and 125 in the study and control groups, respectively) had an IUD inserted. Seven insertions failed: five in the control group, and two in the study group. Ease of insertion and patients’ satisfaction were comparable in both groups. Abdominal pain and nausea were the commonest side effects reported in the misoprostol group.

Conclusion Sublingual administration of misoprostol one hour before IUD insertion in parous women with no previous vaginal delivery does not facilitate the procedure and may cause undesirable side effects. This approach is not recommended as a standard treatment.     

Maternal toxicity and pregnancy complications in human immunodeficiency virus-infected women receiving antiretroviral therapy: PACTG 316

OBJECTIVE: The purpose of this study was to evaluate rates of maternal toxicity, pregnancy complications, and peripartum morbidity by type and duration of antiretroviral therapy (ART) during pregnancy. STUDY DESIGN: The Pediatric AIDS Clinical Trials Group (PACTG) Protocol 316 (PACTG 316) study evaluated the addition of intrapartum/neonatal nevirapine to background ART to reduce perinatal transmission of human immunodeficiency virus-1 (HIV-1). For this secondary analysis, women were categorized into one of six groups on the basis of ART during pregnancy (monotherapy [monoRx], combination without protease inhibitor [PI], combination with PI), and start time (early: before or during first trimester; late: second or third trimester). RESULTS: One thousand four hundred seven women were included: 288 monoRx late, 34 monoRx early, 327 combo, no PI late, 175 combo, no PI early, 320 combo, PI late, and 263 combo, PI early. Symptoms and laboratory abnormalities of moderate grade or more occurred in less than 5% of women. Only gestational diabetes (highest in combo PI early) varied significantly by therapy group. CONCLUSION: In HIV-infected women receiving prenatal care and ART, adverse events were uncommon.     

Dysmenorrhea in women with intrauterine contraceptive device. Treatment with a prostaglandin synthetase inhibitor, naproxen

Twenty-one women with intrauterine contraceptive devices (IUCD) and severe dysmenorrhea were studied. All the women who participated in the study had primary dysmenorrhea of varying intensities. The insertion of IUCD increased the intensity of dysmenorrheic pain. The effect of naproxen (Naprosyn) on pain alleviation was studied in a double-blind cross-over trial using naproxen and placebo. The effect of naproxen was significantly better than that of placebo (P less than 0.01). No severe side effects occurred during the treatment. There was no difference in the duration and amount of the menstrual blood flow during naproxen treatment compared to placebo according to the women's own judgement.     

Trends in management and outcome of pregnancies in HIV-infected women in the UK and Ireland, 1990-2006

Objective  To describe the changing demographic profile of diagnosed HIV-infected pregnant women over time and trends in pregnancy outcome, uptake of interventions and mother-to-child transmission.
Design  National surveillance study.
Setting  UK and Ireland.
Population  Diagnosed HIV-infected pregnant women, 1990–2006.
Methods  Active surveillance of obstetric and paediatric HIV conducted through the National Study of HIV in Pregnancy and Childhood.
Main outcome measures  Maternal characteristics, pregnancy outcome, use of antiretroviral therapy, mode of delivery and mother-to-child transmission.
Results  A total of 8327 pregnancies were reported, increasing from 82 in 1990 to 1394 in 2006, with an increasing proportion from areas outside London. Injecting drug use as the reported risk factor for maternal HIV acquisition declined from 49.2% (185/376) in 1990–1993 to 3.1% (125/4009) in 2004–2006 ( P < 0.001), while the proportion of women born in sub-Saharan Africa increased from 43.5% (93/214) in 1990–1993 to 78.6% (3076/3912) in 2004–2006 ( P < 0.004). Reported pregnancy terminations decreased from 29.6% (111/376) in 1990–1993 to 3.4% (135/4009) in 2004–2006 ( P < 0.001). Most (56.4%, 3717/6593) deliveries were by elective caesarean section, with rates highest in 1999 (66.4%, 144/217). Vaginal deliveries increased from 16.6% (36/217) in 1999 to 28.3% (321/1136) in 2006 ( P < 0.001). Use of antiretroviral therapy in pregnancy increased over time, reaching 98.4% (1092/1110) in 2006, and the overall mother-to-child transmission rate declined from 18.5% (35/189) in 1990–1993 to 1.0% (29/2832) in 2004–2006.
Conclusions  The annual number of reported pregnancies increased dramatically between 1990 and 2006, with changing demographic and geographic profiles and substantial changes in pregnancy management and outcome.     

Medical methods for cervical ripening before the removal of intrauterine devices in postmenopausal women: a systematic review

In China, most women with intrauterine devices (IUDs) ask to have them removed following the menopause. As the cervix is stenotic after the menopause and most IUDs do not have a thread attached, various medical methods are used for cervical ripening prior to IUD removal. A systematic review of the relevant literature was conducted to compare different medical methods for cervical priming with no treatment, or with other methods, prior to IUD removal in postmenopausal women. Multiple electronic databases including the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, the WHO Reproductive Health Library (2011) and the Chinese Biomedical Literature Database were searched systematically. Reference lists of articles published in English or Chinese between 1980 and 2011 were searched. All randomized controlled trials (RCTs) on IUD removal following the menopause using medical agents compared with no treatment, or with other treatments, were included. Outcomes were the ease of IUD removal, need for forced cervical dilatation, cervical width, procedure time, severe pain and any side-effects. Data were processed using RevMan 5 software. Thirty original RCTs were eligible for inclusion. Most medical agents such as oestrogens, mifepristone, misoprostol and methyl carboprost were highly effective for facilitating IUD removal, and reduced the need for further dilatation during the procedure. In particular, treatment with mifepristone or misoprostol prior to IUD removal was found to increase the width of the cervical canal and reduce the procedure time. Mifepristone was more effective than vaginal misoprostol for cervical dilatation, but it showed similar effectiveness to misoprostol and nilestriol in terms of the ease of IUD removal. Sublingual misoprostol was superior to oral misoprostol for facilitating IUD removal. A dose of misoprostol as low as 200 μg was effective for cervical priming. For vaginal and oral misoprostol, the optimum times of application were 2–3 h and 1 day prior to the procedure, respectively. All the prophylactic medical methods were able to alleviate pain during IUD removal, and vaginal misoprostol was more effective than nilestriol. Uterine injury was more common with no treatment and with nilestriol. Gastrointestinal side-effects such as nausea and diarrhoea were common with oral misoprostol and vaginal misoprostol, respectively. Therefore, mifepristone or sublingual misoprostol should be the medical treatments of choice. Oestrogen regimens might be alternatives when mifepristone or misoprostol are contraindicated, and there is a need for further study on combined regimens for cervical priming.     

Bleeding patterns of HIV-infected women using an etonogestrel-releasing contraceptive implant and efavirenz-based or lopinavir/ritonavir-based antiretroviral therapy

Objectives: The use of progestogen-only contraceptives may cause a change in bleeding pattern, which is a common cause of discontinuation of these methods. Co-administration with some antiretroviral therapies (ART) changes the bioavailability of the etonogestrel (ENG)-releasing contraceptive implant, possibly affecting the bleeding pattern. Bleeding patterns were evaluated in HIV-positive users of the ENG implant co-administered with two common ART regimens.

Methods: Forty-five HIV-positive women who wished to use an ENG implant were included in this study: 15 had received zidovudine/lamivudine (AZT/3TC) + lopinavir/ritonavir (LPV/r) for ≥3 months (LPV/r-based ART group), 15 had received AZT/3TC?+?efavirenz (EFV) for ≥3 months (EFV-based ART group), and 15 had not received ART (non-ART group). Bleeding patterns were evaluated at 3 and 6 months after implant placement using a standard bleeding calendar.

Results: Amenorrhoea and infrequent bleeding rates were higher in the LPV/r-based ART group (50% and 36%, respectively) than in the other groups (non-ART group, 36% and 29%, respectively; EFV-based ART group, 7% and 14.5%, respectively; p?=?0.01). The EFV-based ART group more frequently had regular bleeding (71.5%) compared with the other groups (LPV/r-based ART group, 7%; non-ART group, 21%; p?=?0.01). The proportions of women with frequent and prolonged bleeding were similar (p?>?0.05) in the three groups.

Conclusions: The co-administration of EFV-based or LPV/r-based ART with the ENG implant affected the expected bleeding patterns during use of the implant, although unfavourable bleeding (frequent and prolonged) was not associated with the medications under evaluation.     

Risk factors for unwanted pregnancy and subsequent abortion among women aged 16 to 25 years in Latvia

Objective?To explore key factors influencing young women when choosing between two methods of emergency contraception (EC).

Methods?We interviewed 26 young women who accessed community sexual and reproductive health services for emergency contraception after they had chosen an EC.

Results?Most women had an unrealistically high expectation about efficacy of the emergency contraceptive pill (ECP) and lacked knowledge of the intrauterine device (IUD) as an alternative method of EC. Previous use, easy accessibility, ease of use, and advice from peers, influenced women to choose the ECP, whereas past experience of abortion, firm motivation to avoid pregnancy, presentation after 72 hours, and considering that an IUD may provide long-term contraception as well, inclined women to choose the IUD. When participants were shown the IUD, many found it to be smaller and less frightening than they had imagined.

Conclusions?Women need better information and education about the IUD as a highly effective method of EC. Health professionals must provide such information at every opportunity. Showing the IUD during counselling might help correct misconceptions and would improve acceptability. Wider availability of expertise concerning EC-IUDs is essential to assist more women in making informed decisions when choosing a method for EC.     

A comparison of intrauterine balloon,intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study

Objective

To compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman's syndrome.

Study design

Retrospective cohort study of 107 women with Asherman's syndrome who were treated with hysteroscopic division of intrauterine adhesions. After hysteroscopic adhesiolysis, 20 patients had intrauterine balloon inserted, 28 patients had intrauterine contraceptive device (IUD) fitted, 18 patients had hyaluronic acid gel instilled into the uterine cavity, and 41 control subjects did not have any of the three additional treatment measures. A second-look hysteroscopy was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society classification system.

Results

Both the intrauterine balloon group and the IUD group achieved significantly (P < 0.001) greater reduction in the adhesion score than that of the hyaluronic acid gel group and control group. The efficacy of the balloon was greater than that of the IUD (P < 0.001). There was no significant difference in results between the hyaluronic acid gel group and the control groups.

Conclusion

The insertion of an intrauterine balloon or intrauterine device is more effective than the use of hyaluronic acid gel in the prevention of intra-uterine adhesion reformation.     

The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

OBJECTIVE: To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART). DESIGN: Cohort of 143 pregnant HIV-1-infected women including a matched case-control study in a 2:1 ratio of controls to cases (n=98). SETTING: Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands. POPULATION: Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women. MAIN OUTCOME MEASURES: MTCT, preterm delivery, low birthweight, pre-eclampsia. RESULTS: MTCT was 0% (95% CI 0-2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11-27) in women infected with HIV-1 and 9% (95% CI 5-13) in controls (P=0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls. CONCLUSIONS: We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAART-associated increase in preterm delivery rate is mainly seen after first trimester HAART use.     

Sexual behaviour and contraceptive use among unmarried, young women migrant workers in five cities in China

This paper reports the results of exploratory research on reproductive and sexual health knowledge and sexual behaviour of young, unmarried women who migrate to cities from rural areas for work, and their access to and needs in relation to family planning in Beijing, Guangzhou, Shanghai, Guiyang and Taiyuan, in China. Focus group discussions were conducted with 146 young women aged 16-25 and 58 in-depth interviews with key informants. Some of the young female migrant workers were sexually active and living with their boyfriends, most of whom expected to marry each other. Most of the women lacked basic information about reproduction and contraception, and did not know where or how to obtain contraception. There were social, psychological and economic barriers to accessing services. Only a small proportion of those who were unmarried were using contraception, so induced abortion was often the outcome of unprotected premarital sex. Pleasing male partners also played an important role in unprotected sex. The training, attitudes and approach of the entire family planning service system in relation to unmarried and young people in China, including this migrant population, needs to be reorientated so as to provide them with appropriate and adequate services.     

放置宫内节育器对子宫内膜血管内皮生长因子及其激酶受体表达及微血管密度变化的影响

目的探讨放置固定式带铜宫内节育器(FCu-IUD)和含吲哚美辛FCu-IUD(FICu-IUD),对子宫内膜组织中血管内皮生长因子(VEGF)及其激酶受体(KDR)表达以及微血管密度(MVD)变化的影响及意义.方法采用免疫组化法及原位杂交法,检测放置FCu-IUD妇女(10例,FCu-IUD组)及放置FICu-IUD妇女(10例,FICu-IUD组)放置IUD前后子宫内膜VEGF、VEGF mRNA及KDR的表达,并计数子宫内膜MVD.结果 FCu-IUD组放置IUD后,VEGF及KDR蛋白为0.568±0.027,0.244±0.022,均高于放置IUD前的0.357±0.032,0.215±0.029,放置IUD前后比较,差异有显著性(P<0.05).FCu-IUD组放置IUD前VEGF mRNA表达为0.359±0.022,低于放置IUD后的0.425±0.019,放置IUD前后比较,差异有显著性(P<0.05).FICu-IUD组放置IUD前后VEGF、KDR蛋白及VEGF mRNA表达比较,差异无显著性(P>0.05). FCu-IUD组放置IUD后MVD为19.8±4.8,明显高于放置IUD前的15.4±2.8,且与VEGF蛋白的表达呈正相关关系(r=0.847,P<0.01).FICu-IUD组放置IUD前后MVD比较,差异无明显性(P>0.05).结论放置FCu-IUD可促进子宫内膜VEGF及KDR的表达,FICu-IUD可抑制子宫内膜VEGF及KDR的生成.VEGF及KDR可能参与了FCu-IUD 及FICu-IUD所引起的子宫内膜微血管结构和功能的改变.     

High rates of abortion and low levels of contraceptive use among adolescent female sex workers in Kunming,China: A cross-sectional analysis

Abstract

Purpose: To gather preliminary data about menstrual hygiene product use and associated risk of intrauterine device (IUD) expulsion.

Materials and methods: We conducted an Internet-based survey using the Amazon Mechanical Turk (MTurk) platform and Researchmatch.org. Eligible participants were women at least 18 years old and self-identified as current or previous IUD users.

Results: Of 902 survey responses, 71% reported current or previous IUD use and 19.7% reported menstrual cup use. IUD users were significantly more likely than non-IUD users to use a menstrual cup or tampons. Among all IUD users, 56 individuals reported experiencing at least one expulsion (8.8%). We found a positive association between concurrent menstrual cup use and IUD expulsion (OR: 2.75, 95% CI: 1.40–5.42, p = .002), but no association with concurrent tampon or pad use. Of concurrent IUD and cup users who experienced an expulsion, one reported it occurring ‘while using a menstrual cup’, with others reporting the expulsion during other events.

Conclusions: Menstrual cup use may be higher than previously reported, particularly in IUD users. Concurrent menstrual cup use may increase the risk of IUD expulsion. Prospective research is necessary to fully explore the relationship between menstrual hygiene product use and IUD expulsions.     

Disclosure of HIV serostatus to male partner and use of modern contraceptives among women receiving HIV care services in Kampala,Uganda

Objective

To investigate whether disclosure of HIV status is associated with use of modern contraceptives (MCs) among women attending HIV care services at an AIDS Information Center (AIC) in an urban setting in Uganda.

Methods

In a cross-sectional study between March and April 2010, HIV-positive married women aged 15–49 years who had received their HIV-positive serostatus results at least 4 weeks previously were interviewed at the AIC, Kampala, Uganda. Female use of MCs was compared by HIV disclosure to male marital partners. Log–binomial regression models were used to obtain crude and adjusted prevalence risk ratios (PRRs) and corresponding 95% confidence intervals (CIs).

Results

Nearly three-quarters (72.6%) of the women had disclosed their HIV-positive status to their partner. Overall, use of MCs was reported by 41.0% of the participants. Use of only 1 MC method was similar between those disclosing (81.1%) and those not disclosing (84.3%), but use of dual methods tended to be higher among disclosers (14.4%) than among non-disclosers (10.8%). In adjusted analyses, MC use was 41.0% lower among disclosers than among non-disclosers (adjusted PRR, 0.59; 95% CI, 0.46–0.77).

Conclusion

HIV serostatus disclosure was associated with lower use of MCs among HIV-positive women in Kampala, Uganda.     

The effect of vitamin B1 on bleeding and spotting in women using an intrauterine device: A double-blind randomised controlled trial

Abstract

Objectives Excessive menstrual bleeding, the most common complication caused by intrauterine devices (IUDs), often leads to discontinuation of use. Our study investigates the effect of vitamin B₁ on menstrual bleeding and spotting after insertion of the TCu380A IUD.

Methods This double-blind, randomised controlled trial involved 110 Iranian women. We recruited women who noted that their menstrual flow (duration, amount, and number of sanitary pads needed) or intermenstrual spotting had increased one month after the insertion of a TCu380A, and randomly assigned them to two groups. The intervention group and the control group received 100 mg of vitamin B₁ or a placebo, respectively, daily, for three months. We followed all participants for four months. The Higham scale was used for estimating the volume of menstrual bleeding. The Mann-Whitney test, paired t-test, independent t-test and Repeated Measure test were used for statistical purposes.

Results In the intervention group the duration of menstrual bleeding, the number of sanitary pads and the amount of spotting decreased significantly compared to the control group (p < 0.001).

Conclusion Vitamin B₁ is a safe, natural and cost-effective supplement that is devoid of side effects and reduces menstrual bleeding and spotting caused by a copper bearing-IUD.     

Acceptability and performance of a nonwoven device for vaginal drug delivery among women and their male partners in KwaZulu-Natal,South Africa

Abstract

Background: Multipurpose prevention technologies are needed to provide protection against HIV and sexually transmitted infections. Gel-based vaginal microbicides inserted via an applicator are prone to leakage. A novel device for vaginal drug delivery was developed to contain gel-based formulations, aiming to improve gel retention and reduce leakage. The objectives of this study were to assess acceptability and performance of a nonwoven vaginal delivery device.

Methods: A nonwoven vaginal delivery device was prepared, pre-saturated with a commercially available water-based lubricant, with a finger pocket for insertion and string for removal. Quantitative and qualitative methods were used to collect data from interviews with 40 women and 10 male partners recruited from a sexual and reproductive health clinic in Durban, KwaZulu-Natal, South Africa. Women wore one device in the clinic and one device overnight or with their partner during intercourse. The primary endpoint was acceptability including comfort, ease of insertion and removal, and opinions on device attributes.

Results: Most women said the device was ‘easy’ to insert and remove. Six women reported leakage after insertion and 34 reported having sexual intercourse while wearing the device. One woman was lost-to-follow-up and five women only wore the device overnight because their partners did not agree to intercourse with the inserted device. The best-liked attribute was the device’s lubrication (22 women, 7 men); the least-liked was the removal string (9 women, 8 men).

Conclusions: Data are promising for further development of this nonwoven device for vaginal drug delivery.

Plain English summary

Multipurpose prevention technologies (MPTs) that protect against HIV and sexually transmitted infections (STIs) are urgently needed. A variety of vaginal gel-based products are actively being researched; however, these products can often have challenges with vaginal leakage and retention. This research investigates the acceptability and performance of a nonwoven device to deliver vaginal gel formulations. The gel used in this study was a currently available marketed personal lubricant. In South Africa, 40 women (and 10 male partners) were recruited and given the opportunity to comment on various device attributes after insertion, overnight wear and sexual intercourse with their male partners. Generally, participants found the device easy to use and acceptable, where many factors possibly contributed to the device’s acceptability (i.e., similarity to tampons, saturation with lubricant, minimal leakage, ease of insertion, comfort during intercourse and the male partners’ willingness to have vaginal intercourse with the device in place). Further studies of the vaginal delivery device for acceptability, safety and efficacy using a gel-based formulation with an active ingredient are warranted.     

Influence of habitual physical activity on body composition,fat distribution and metabolic variables in early postmenopausal women receiving hormonal therapy

Objective

To determine whether there is an association between the level of habitual physical activity, body composition and anthropometric and metabolic variables in postmenopausal patients before and after hormone replacement therapy (HRT).

Study design

Thirty-four healthy, recent postmenopausal women (50 ± 2.7 years; 23.8 ± 10 months since menopause) consulting for symptoms of estrogen deficiency were included in the study. Anthropometric assessment, percent of body fat (BF) estimated by skinfold measures, and metabolic evaluation were performed before and 4 months after the start of HRT, which included non-oral or low-dose oral preparations. The status of physical activity was defined by counting steps with a pedometer. Patients were stratified as active (6000 steps ore more per day) or inactive (fewer than 6000 steps per day). Results are expressed as mean ± SD or median and interquartile range. log 10 transformation was used to normalize the distribution of non-Gaussian variables. ANOVA for repeated measures was performed for the active and inactive groups, before and after HT. Pearson correlation coefficient was used to investigate the relationship between anthropometric and metabolic variables and habitual physical activity.

Results

BMI and BF did not change with HRT in comparison with baseline. In contrast, a decline was observed in waist circumference (WC) and waist to hip ratio (WHR) after HRT in both active and inactive women (P < 0.01). While triglycerides and glucose did not change after HRT, total and LDL-cholesterol decreased from baseline. In contrast, after HRT, active patients were found to have lower BF than inactive women (active: 25.4 ± 2.5; inactive: 26.6 ± 2, P = 0.01). There was a significant negative correlation between habitual physical activity (number of steps per day) and BF (r = −0.36, P = 0.04). After HRT, when only active patients were considered, a significant negative correlation was found between the number of steps and WC (r = −0.42, P = 0.04) and WHR (r= −0.58, P = 0.03).

Conclusion

Habitual physical activity plays a major role in preserving a favorable cardiovascular profile in postmenopausal patients using HRT.