Current position about the use of estrogen therapy in women during the climacteric period
Main Article Content
Keywords
Menopause, Estrogens, Hormone replacement therapy
Abstract
The hormonal therapy should begin only in order to control the symptoms of the climacteric in women; its use is not recommended to prevent other types of affections associated to the posmenopause, because, despite some other recognizable benefits have been described, many of them have not been demonstrated. Before beginning the treatment of hormonal therapy, it is recommended to analyze the risk factors for heart attack or other cardiovascular diseases, and also estimate risk for osteoporosis and breast cancer. Diverse presentations and ways of administration of the hormonal therapy have been used, with which outcome have been obtained that vary in connection with predominant symptoms. Recently, the introduction of the concept based on the combined use of an estrogen associated to selective estrogen receptor modulator (SERM), the tissue selective estrogen complex (TSEC), allows a better clinical profile for the patient. With this combination it is obtained endometrial protection and positive action about the changes that the menopause produces. The decision to continue the hormonal therapy should be individualized, based on the severity of the symptoms and recurrence, considering the risk-benefit foreseen with the woman in the clinic.
References
Hansen LB, Portman D. Hormone therapy update. Current recommendations for menopausal symptoms. US Pharm. 2006;31(9):86-9.
Hernández-Valencia M, Córdova N, Vargas A, Basurto L, Saucedo R, Vargas C, et al. Symptomatic changes in postmenopause with different methods of hormonal therapy. Open J Prev Med. 2011;1(2):20-4.
Zárate A, Hernández-Valencia M. Terapia de reemplazo hormonal en menopáusicas tratadas por cáncer mamario. Rev Med Inst Mexicano Seguro Soc. 2002;40(5):369-71.
Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, et al.; Writing Group for the Women´s Health Initiative Investigators. Risks and benefits of estrogens plus progestin in healthy postmenopausal women: principal results from the Women´s Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-33.
Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, et al; Women´s Health Initiative Steering Committee. Effects of conjugated equine estrogen in healthy postmenopausal women with hysterectomy: the Women´s Health Initiative randomized controlled trial. JAMA. 2004;291(14):1701-12.
North American Menopause Society. The 2012 hormone therapy position statement of the North American Menopause Society. Menopause. 2012;19(3):257-71.
Reimer A, Johnson L. Atrophic vaginitis: signs, symptoms, and better outcomes. Nurse Pract. 2011; 36(1):22-8.
Zárate A, Saucedo R, Hernández-Valencia M. El lugar de la terapia de reemplazo hormonal para la mujer menopáusica en la actualidad. Acta Med Grupo Ángeles. 2004;2(2):129-30.
Hernández-Valencia M, Córdova N, Basurto L, Saucedo R, Vargas C, Vargas A, et al. Frecuencia de los síntomas del síndrome climatérico. Ginecol Obstet Mex. 2010;78(4):232-7.
Medina M, Calzada L, Loustaunau E, Torres R, Zárate A. Receptores de estradiol y progesterona en el carcinoma mamario. Arch Invest Med. 1987;18(3):235-40.
Medina M, Torres R, Loustaunau E, Calzada L, Chávez J, Zárate A. Cuantificación de receptores de estradiol y progesterona en el cáncer de mama para la elección del tratamiento. Ginecol Obst Mex. 1987; 55:261-5.
Shoham Z, Schachter M. Estrogen biosynthesis-regulation, action, remote effects, and value of monitoring in ovarian stimulation cycles. Fertil Steril. 1996;65(4):687-701.
Gruber CJ, Tschugguel W, Schneeberger C, Huber JC. Production and actions of estrogens. N Engl J Med. 2002;346(5):340-52.
Zárate A, Fonseca E, Ochoa R, Basurto L, Hernández M. Low-dose conjugated equine estrogens elevate circulating neurotransmitters and improve the psychological well-being of menopausal women. Fertil Steril. 2002;77(5):952-5.
Zárate A, Hernández-Valencia M, Saucedo R. Lugar de la tibolona en la terapia de reemplazo hormonal en la postmenopausia. Acta Med Grupo Ángeles. 2004;2(3):193-5.
Galván RE, Saucedo R, Hernández-Valencia M, Mora C, Basurto L, Zárate A. Efecto del reemplazo hormonal transdérmico en la postmenopausia sobre el índice de masa corporal y la concentración de leptina. Acta Med Grupo Ángeles. 2004;2(3):147-9.
Hernández-Valencia M, Ángeles L, Saucedo R, Mora C, Zárate A. Efectividad del estradiol por vía nasal como terapia de reemplazo hormonal. Acta Med Grupo Ángeles. 2003;1(2):80-3.
Smith AL, Wein AJ. Estrogen replacement therapy for the treatment of postmenopausal genitourinary tract dysfunction. Discov Med. 2010;10(55):500-10.
Komm BS, Mirkin S. Incorporating bazedoxifene/conjugated estrogens into the current paradigm of menopausal therapy. Int J Womens Health. 2012;4:129-40.
Hernández-Valencia M, Córdova N, Vargas A, Basurto L, Saucedo R, Vargas C, et al. Symptomatic changes in postmenopause with different methods of hormonal therapy. Open J Prev Med. 2011;1(2):20-4.