Article information
Los trastornos de la menopausia pueden ser evitados y combatidos administrando terapia de reemplazo hormonal, que tradicionalmente se ha considerado beneficiosa para la prevención de la osteoporosis y de las enfermedads cardiovasculares. Sin embargo, recientes estudios, como el estudio WHI, han puesto en duda los beneficios de la terapia de reemplazo hormonal, llegando a considerarla perjudicial a corto y medio plazo por ser un factor de riesgo para la enfermedad cardiovascular, accidente cerebrovascular, enfermedad tromboembólica venosa y cáncer de mama. Tras realizar una extensa revisión bibliográfica este trabajo pretende evaluar los riesgos y beneficios de la terapia hormonal sustitutiva aplicada a mujeres posmenopáusicas, así como dar una serie de recomendaciones sobre el uso de estrógenos y gestágenos en terapia de reemplazo hormonal.
Palabras clave:
enfermedades cardiovasculares
terapia de reemplazo hormonal (TRH)
posmenopausia
Menopause disorders may be avoided and fought against by administering hormone replacement therapy, which has classically been considered beneficial for the prevention of osteoporosis and cardiovascular diseases. However, recent studies, such as the WHI study, have questioned the benefits of hormone replacement therapy, even considering it harmful in the short and middle term, as it is a risk factor for cardiovascular disease, cerebrovascular accident, venous thromboembolic disease and breast cancer. After performing an extensive bibliographic review, this study aims to assess the risks and benefits of hormone replacement therapy applied to post-menopausic women as well as give a series of recommendations on estrogen and gestagen use in hormone replacement therapy.
Key words:
cardiovascular diseases
hormone replacement therapy (HRT)
post-menopause
Full text is only aviable in PDF
Bibliografía
[1.]
G.A. Greendale, M. Espeland, S. Slone, R. Marcus, E. Barrett-Connor.
para los Investigadores del Estudio de seguimiento de seguridad de PEPI (PSFS, PEPI, Safety Follow-up Study). Bone mass response to discontinuation of long-term hormone replacement therapy: results from the Postmenopausal Estrogen/Progestin Interventions (PEPI) safety follow-up study.
Arch Intern Med, 162 (2002), pp. 665-672
[2.]
G.A. Greendale, B. Wells, R. Marcus, E. Barret-Connor.
para los investigadores del estudio PEPI (Postmenopausal Estrogen/Progestin Interventions). How many women lose bone mineral density while taking hormone replacement therapy? Results from the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial.
Arch Intern Med, 160 (2000), pp. 3065-3071
[3.]
R.M. Adams, T.C. Register, D.L. Golden, J.D. Wagner, J.K. Williams.
Medroxyprogesterona acetate antagonizes inhibitory effects of conjugated equine estrogens on coronary artery atherosclerosis.
Arterioscler Thromb Vasc Biol, 17 (1997), pp. 217-221
[4.]
D. Archer, M. Dorin, V. Lewis, D.L. Schneider, J.H. Pickar.
Effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate on endometrial bleeding.
Fertil Steril, 75 (2001), pp. 1080-1087
[5.]
Collaborative Group on Hormonal Factors in Breast Cancer.
Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer.
Lancet, 350 (1997), pp. 1047-1059
[6.]
J.A. Simon, J. Hsia, J.A. Cauley, C. Richards, F. Harris, J. Fong, et al.
Postmenopausal hormone therapy and risk of stroke: the Heart and Estrogen-progestin Replacement Study (HERS).
Circulation, 103 (2001), pp. 638-642
[7.]
D.M. Herrington, E. Vittinghoff, F. Lin, J. Fong, J. Harris, D. Hunninghake, et al.
para el Grupo de estudio de HERS. Statin therapy, cardiovascular events, and total mortality in the Heart and Estrogen/Progestin Replacement Study (HERS).
Circulation, 105 (2002), pp. 2962-2967
[8.]
M. Enserink.
Despite safety concerns, UK hormone study to proceed.
Science, 297 (2002), pp. 492
[9.]
T.B. Clarkson.
The new conundrum: do estrogens have any cardiovascular benefits?.
Int J Fertil, 47 (2002), pp. 61-68
[10.]
F. Grodstein, J.A. Manson, G.A. Colditz, W.C. Willet, F.E. Speiger, W.C. Willett.
A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease.
Ann Intern Med, 133 (2000), pp. 933-941
[11.]
K. Miyagawa, J. Rösch, F. Stanczyk, K. Hermsmeyer.
Medroxyprogesterone interferes with ovarian steroid protection against coronary vasospasm.
Nature Med, 3 (1997), pp. 324-327
[12.]
M.A. Hlatky, D. Boothroyd, E. Vittinghoff, P. Sharp, M.A. Whooley.
para el Grupo de investigación del estudio HERS (Heart and Estrogen/ progestin Replacement Study). Qualify-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Herat and Estrogen/Progestin Replacement Study (HERS) trial.
JAMA, 287 (2002), pp. 591-597
[13.]
J. Hsia, J.A. Simon, F. Lin, W.B. Applegate, M.T. Vogt, D. Hunninghake, et al.
Peripheral arterial disease in randomized trial of estrogen with progestin in women with coronary heart disease; the Heart and Estrogen/ Progestin Replacement Study.
Circulation, 102 (2000), pp. 2228-2232
[14.]
N.H. Hodis, W.J. Mack, R.A. Lobo, D. Shoupe, A. Sevanian, P.R. Malver, et al.
Estrogen in the prevention of atherosclerosis; a randomized, double-blind, placebo-controlled trial.
Ann Intern Med, 135 (2001), pp. 939-953
[15.]
B. Ettinger.
Personal perspective on low-dosage estrogen therapy for postmenopausal women.
Menopause, 6 (1999), pp. 273-276
[16.]
C.M. Viscoli, L.M. Brass, W.N. Kernan, P.M. Sarrel, S. Suissa, R.I. Horwitz.
A clinical trial of estrogen-replacement therapy after ischemic stroke.
N Engl J Med, 345 (2001), pp. 1243-1249
[17.]
O. Herkert, H. Kuhl, J. Sandow, R. Busse, V.B. Schini-Kerth.
Sex steroids used in hormonal treatment increase vascular procoagulant activity by inducing thrombin receptor (PAR-1) expression. Role of the glucocoticoid receptor.
Circulation, 104 (2001), pp. 2825-2831
[18.]
S. Hulley, C. Furberg, E. Barrett-Connor, J. Cauley, D. Grady, W. Haskell, et al.
Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and estrogen/progestin replacement study follow-up (HERS II).
JAMA, 288 (2002), pp. 58-66
[19.]
Heart and estrogen/progestin replacement study follow-up (HERS II).
Part 2. Non-cardiovascular outcomes during 6.8 years of hormone therapy.
JAMA, 288 (2002), pp. 58-66
[20.]
M.R. Vickers, T.W. Meade, H.C. Wilkes.
Hormone replacement therapy and cardiovascular disease: the case for a randomized trial.
Ciba Found Symp, 191 (1995), pp. 150-160
[21.]
S. Hulley, D. Grady, T. Bush, C. Furberg, D. Herrington, B. Riggs, et al.
Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women.
JAMA, 280 (1998), pp. 605-613
[22.]
The Women's Health Initiative Study Group.
Design of the Women's Health Initiative clinical trial and observational study.
Control Clin Trials, 19 (1998), pp. 61-109
[23.]
S.W. Fletcher, G.A. Colditz.
Failure of estrogen plus progestin therapy for prevention.
JAMA, 288 (2002), pp. 366-368
[24.]
A.R. Genazzani, M. Gambacciani.
Hormone replacement therapy: the perspectives for the 21st century. Cardiovascular disease and hormone replacement therapy. International Menopause Society Expert Workshop. 13-16 October 2000, Royal Society of Medicine, London, UK.
Climateric, 3 (2000), pp. 233-240
[25.]
IMS Health graph.
Drop in prescriptions and stock.
The New York Times on the web, (November 10, 2002),
[26.]
A.R. Genazzani, A. Gadducci, M. Gambacciani.
Controversial issues in climacteric medicine II. Hormone replacement therapy and cancer International Menopause Society Expert Workshop. 9-12 June 2001, Opera del Duomo, Pisa, Italy.
Climacteric, 4 (2001), pp. 181-193
[27.]
M.H. Gail, L.A. Brinton, D.P. Byar, D.K. Carle, S.B. Green, C. Schairer, et al.
Projecting individualized probabilities of developing breast cancer for white females who are being examined annually.
J Natl Cancer Inst, 81 (1989), pp. 1879-1886
[28.]
R. Peto, J. Boreham, M. Clarke, C. Davies, V. Beral.
UK and USA breast cancer deaths down 25% in the year 2000 at ages 20-69 years.
Lancet, 355 (2000), pp. 1822
[29.]
T.S. Mikkola, T.B. Clarkson.
Estrogen replacement therapy: atherosclerosis, and vascular function.
Cardivoasc Res, 53 (2002), pp. 619
[30.]
M. Gambacciani, P. Monteleone, A.R. Genazzani.
Low-dose hormone replacement therapy: effects on bone.
Climateric, 5 (2002), pp. 135-139
[31.]
Writing Group for the Women's Health Initiative Investigators.
Risk and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women'Health Initiative randomized controlled trial.
JAMA, 188 (2002), pp. 321-333
[32.]
R. Lindsay, J.C. Gallagher, M. Kleerekoper, J.H. Pickar.
Effect of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women.
JAMA, 287 (2002), pp. 2668-2676
[33.]
R.A. Lobo, M.I. Whitehead.
Is low-dose hormone replacement therapy for postmenopausal women efficacious and desirable?.
Climacteric, 4 (2001), pp. 110-119
[34.]
D. Grady, D. Herrington, V. Bittner, R. Blumenthal, M. Davidson, M. Hlatky, et al.
for the HERS Research Group. Heart and estrogen/ progestin replacement study follow-up (HERS II): Part 1. Cardiovascular outcomes during 6.8 years of hormone therapy.
JAMA, 288 (2002), pp. 49-57
[36.]
Therapeutics Initiative. Levels of evidence for clinical decisions: Menopausal hormone therapy revisited. Therapeutics Letter 30 (June/July 1999).
Copyright © 2004. Elsevier España, S.L. y Sociedad Española de Medicina Rural y Generalista (SEMERGEN)
