The 28th Infirmary of the Santa Casa da Misericordia of Rio de Janeiro is inserted in the context of assistance to the population of the state of Rio de Janeiro, paying attention to the needy female population of the state in Reproductive Health area that includes care in Gynecology Children and Pubertal, premenopausal , Menopause, Contraception, Mastology, Urogynecology and Infertility in isolation.
In fact the proposed service aims to cover all the stages that women go through lifelong: child, teen, adult and climacteric. Each of these phases requires expert attention that will be supplied by the Integrated Center for Attention to Women’s Health of the 28th Infirmary of the Santa Casa da Misericordia of Rio de Janeiro.
It happens that this service lacks the resources to create the Integrated Center for Attention to Women’s Health of the 28th Infirmary of the Santa Casa of Rio de Janeiro.
This Center aims to integrate the service in different areas of the Gynecological Clinic, providing better quality of care for women.
The 28th Ward of the Holy House of Mercy is also the Ministry of Health Reference Center for Menopause and contraception, as well as being recognized by the Brazilian Society of Mastology.
It is developed parallel to medical care, an education sector recognized by the Ministry of Education and Sports (MEC), which are taught specialized courses (through the Santa Casa Postgraduate Studies Center – CESANTA); still work to medical residency and internship also recognized by the Ministry of Education and Sports and the Brazilian Federation of Societies of Gynecology and Obstetrics (FEBRASGO).


The 28th Infirmary of the Santa Casa da Misericordia of Rio de Janeiro is necessarily, for a reflection on the need for attention to needy women of the State of Rio de Janeiro, not only to pregnant women, but also and especially to women outside of pregnancy. Undoubtedly the number of patients needing care is greater outside of pregnancy if we take into account children, teenagers, adults and menopausal women.
During childhood problems related infections, endocrine disorders are the most frequent. By the very old, it is necessary to offer local and personal with specific training for this type of care.
In adolescence, the events related to pregnancy are noteworthy, since the number of teenage pregnancies has increased. It is in this period that the guidance and the provision of various contraceptive methods are essential for the physical and emotional balance of the teenager, in relation to an attitude of true reproductive health.
In premenopausal focus more gynecological problems with emphasis on benign and malignant diseases that generate surgeries often difficult to be performed with the frequency and timely manner.
It is understood by the climacteric stage of the aging process during which a woman passes from the reproductive stage to the non-reproductive stage of life; It is a period of one to two years preceding the menopause (premenopausal) and menopause period senescence and menopause (postmenopause).
The general menopause occurs around age 50 in the Brazilian woman, and imagining that she can live up to 80 years, this means that it will spend about 30 years postmenopausal.

Identified problems and epidemiological data

It is known and accepted by the scientific community, with ovarian failure, metabolic changes occur and cause that may arise characteristic symptoms of this period can often due to its incidence, cause difficult problems for the health system.
Thus, with menopause, the woman starts to present own age problems: cardiovascular disease (myocardial infarction, cerebrovascular disease), osteoporosis (femoral neck fractures and spine), etc.
Nowadays, the main role that the doctor should perform is to prevent disease.

Cardiovascular diseases

Cardiovascular diseases are the leading cause of morbidity and mortality after 50 years.
Changes lipoproteins that occur after menopause would be coronary risk factor.
From menopause, cardiovascular diseases have the same woman / man mortality rate.
The life habit changes, such as nutrition education and physical activity are now the largest proven cardiovascular protection factors.


Osteoporosis is defined as a disease characterized by low bone mass, microarchitectural deterioration of bone tissue leading to an increase in bone fragility and a consequent increase in fracture risk.
Estrogen deficiency is considered the predominant factor in bone loss that occurs during the first two decades after physiological menopause. Consequently, it is considered the main pathogenic factor of osteoporosis in postmenopausal women. Osteoporosis occurs by ovariectomy determines significant and rapid bone loss.
US socio-economic impact of bone fractures due to osteoporosis are major public health problems and only through estrogen replacement therapy in postmenopausal women is that the serious consequences of osteoporosis can markedly reduce the incidence of hip fractures and vertebrae .
Seventy-five percent of all fractures in women over 45 years old are secondary to osteoporosis. Eighty percent of hip fractures occur in osteoporotic bones, and 15-34% of patients with this type of fracture shall die from complications within six months.

Gynecological Cancer and Breast Cancer

The age range of higher mortality from breast cancer and gynecological is in menopause.
One in eight women will develop breast cancer. Similarly, gynecological cancer of the cervix, vagina and endometrial focus on this age group.
Hence the need for a program designed specifically for screening of various types of cancer incidents in women throughout life.


Family planning is of utmost importance at all stages of life of women and especially during menopause (premenopausal), where the frequency of risk factors often makes it difficult to contraceptive method selection that has no contraindication and present low failure rate.
In old pregnant woman, and a higher incidence of chronic diseases (hypertension, diabetes, etc.) there is increased risk of fetal abnormality. In menopause, contraceptive options decrease, but the choice should provide security in the not gestate woman option.
Part of contraception education and information of the changes in women’s reproductive health.


We can not stand apart from the issue of assistance to women in the various stages of their lives.
The situations and the problems mentioned are sufficient to justify the creation and maintenance of the Integrated Attention to Women’s Health of the 28th Ward Core Santa Casa da Misericordia of Rio de Janeiro involving care programs for women the level of public health as well as to opportunity to better monitoring of conditions in relation to other diseases that affect this period, as well as guide the basic health care.
This program should be based on high social value that represents the huge attendance number of needy patients underserved by the current health system.