2008, Número 05
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Ginecol Obstet Mex 2008; 76 (05)
Dosis bajas de terapia hormonal durante el climaterio
Carranza LS
Idioma: Español
Referencias bibliográficas: 40
Paginas: 267-274
Archivo PDF: 198.64 Kb.
RESUMEN
Desde hace tiempo, la terapia hormonal se indica por varias razones durante el climaterio; sin embargo, luego del estudio WHI se reconsideró su prescripción. De acuerdo con los diversos consensos, hoy se indica para el control de los síntomas vasomotores. Al parecer las dosis bajas se relacionan con menores riesgos que con las dosis convencionales. En los estudios de pacientes a quienes se han indicado dosis bajas y ultrabajas se han reportado ventajas. Este trabajo revisa la bibliografía relacionada con la prescripción de terapia hormonal, en dosis bajas y ultrabajas, en la etapa del climaterio, que son una alternativa para pacientes sintomáticas.
REFERENCIAS (EN ESTE ARTÍCULO)
Stampfer MJ, Colditz GA, Willett WC, Manson JE, et al. Postmenopausal estrogen therapy and cardiovascular disease, Ten-year follow-up from the nurses’ health study. N Engl J Med 1991;325(11):756-62.
The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA 1995;273(3):199-208.
Ettinger B, Friedman GD, Bush T, Quesenberry CP Jr. Reduced mortality associated with long-term postmenopausal estrogen therapy. Obstet Gynecol 1996;87(1):6-12.
Grady D, Herrington D, Bittner V, Blumenthal R, et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy. Herat and Estrogen/Progestin Replacement Study Follow-up (HERS II). JAMA 2002;288(1):49-57.
Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, et al. Risk and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288(3):321-33.
Harman SM, Brinton EA, Clarkson T, Heward CB, et al. Is the WHI relevant to HRT started in the perimenopause? Endocrine 2004;24(3):195-202.
Burke AP, Farb A, Malcom G, Virmani R. Effect of menopause on plaque morphologic characteristics in coronary atherosclerosis. Am Heart J 2001;141(2 Suppl):S58-62.
Boothby LA, Doering PL, Kipersztok S. Bioidentical hormone therapy: a review. Menopause 2004;11(3):356-67.
Utian WH, Shoupe D, Bachmann G, Pinkerton JV, Pickar JH. Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate. Fertil Steril 2001;75(6):1065-79.
Panay N, Ylikorkala O, Archer DF, Gut R, Lang E. Ultra-Iowdose estradiol and norethisterone acetate: effective menopausal symptom relief. Climacteric 2007;10(2):120-31.
Carranza-Lira S, MacGregor GAL, Velasco-Díaz G, Solano J, Arzola-Paniagua A. Low and ultra low-dose estrogen therapy for climacteric symptom control. Preliminary report. Int J Fertil 2006;51(4):171-5.
De Aloysio D, Rovatí LC, Giacovelli G, Setnikar I, Bottiglioni F. Efficacy on climacteric symptoms and safety of low dose estradiol transdermal matrix patches. A randomized, double-blind placebo-controlled study. Arzneimittelforschung 2000;50(3):293-300.
Ettinger B. Vasomotor symptom relief versus unwanted effects: role of estrogen dosage. Am J Med 2005;118 (Suppl 12B):74-78.
Pickar JH, Yeh I, Wheeler JE, Cunnane MF, Speroff L. Endometrial effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate. Fertil Steril 2001;76(1):25-31.
Ettinger B. Use of low-dosage 17 beta-estradiol for the prevention of osteoporosis. Clin Ther 1993;15(6):950-62.
Heikkinen J, Vaheri R, Kainulainen P, Timonen U. Long-term continuous combined hormone replacement therapy in the prevention of postmenopausal bone loss: a comparison of high- and low-dose estrogen-progestin regimens. Osteoporos Int 2000;11(11):929-37.
Samsioe G, Dvorak V, Genazzani AR, Hamann B, et al. Oneyear endometrial safety evaluation of a continuous combined transdermal matrix patch delivering low-dose estradiol-norethisterone acetate in postmenopausal women. Maturitas 2007;57(2):171-81.
Lobo RA, Bush T, Carr BR, Pickar JH. Effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate on plasma lipids and lipoproteins, coagulation factors, and carbohydrate metabolism. Fertil Steril 2001;76(1):13-24.
Eilertsen AL, Liestol S, Mowinckel MC, Hemker HC, Sandset PM. Differential impact of conventional and low-dose oral hormone therapy, tibolone and raloxifene on functionality of the activated protein C system. Thromb Haemost 2007;97(6):938-43.
Kernohan AF, Sattar N, Hilditch T, Cleland SJ, et al. Effects of low-dose continuous combined hormone replacement therapy on glucose homeostasis and markers of cardiovascular risk in women with type 2 diabetes. Clin Endocrinol (Oxf) 2007;66(1):27-34.
McKenzie J, Jaap AJ, Gallacher S, Kelly A, et al. Metabolic, inflammatory and haemostatic effects of a low-dose continuous combined HRT in women with type 2 diabetes: potentially safer with respect to vascular risk? Clin Endocrinol (Oxf) 2003;59(6):682-9.
Kernohan AF, Spiers A, Sattar N, Hillier C, et al. Effects of lowdose continuous combined HRT on vascular function in women with type 2 diabetes. Diab Vasc Dis Res 2004;1(2):82-8.
Brosnan JF, Sheppard BL, Norris LA. Haemostatic activation in post-menopausal women taking low-dose hormone therapy: less effect with transdermal administration? Thromb Haemost 2007;97(4):558-65.
Christodoulakos GE, Lambrinoudaki IV, Vourtsi AD, Vlachou S, et al. The effect of low dose hormone therapy on mammographic breast density. Maturitas 2006;54(1):78-85.
Lundström E, Bygdeson M, Svane G, Azavedo E, von Schoultz B. Neutral effect of ultra-low-dose continuous combined estradiol and norethisterone acetate on mammographic breast density. Climacteric 2007;10(3):249-56.
Grady D, Vittinghoff E, Lin F, Hanes V, Ensrud K, et al. Effect of ultra-Iow-dose transdermal estradiol on breast density in postmenopausal women. Menopause 2007;14(3 Pt 1):391-6.
Gambacciani M, Ciaponi M, Cappagli B, Genazzani AR. Effects of low-dose continuous combined conjugated estrogens and medroxyprogesterone acetate on menopausal symptoms, body weight, bone density, and metabolism in postmenopausal women. Am J Obstet Gynecol 2001;185(5):1180-5.
Recker RR, Davies KM, Dowd RM, Heaney RP. The effect of low-dose continuous estrogen and progesterone therapy with calcium and vitamin D on bone in elderly women. A randomized, controlled trial. Ann Intern Med 1999;130(11):897-904.
Mizunuma H, Shiraki M, Shintani M, Gorai I, et al. Randomized trial comparing low-dose hormone replacement therapy and HRT plus 1 alpha-OH-vitamin D3 (alfacalcidol) for treatment of postmenopausal bone loss. J Bone Miner Metab 2006;24(1):11-5.
Mizunuma H, Okano H, Soda M, Kagami I, et al. Prevention of postmenopausal bone loss with minimal uterine bleeding using low dose continuous estrogen/progestin therapy: a 2- year prospective study. Maturitas 1997;27(1):69-76.
Warming L, Ravn P, Spielman D, Delmas P, Christiansen C. Trimegestone in a low-dose, continuous-combined hormone therapy regimen prevents bone loss in osteopenic postmenopausal women. Menopause 2004;11(3):337-42.
García-Pérez MA, Moreno-Mercer J, Tarín JJ, Cano A. Similar efficacy of low and standard doses of transdermal estradiol in controlling bone turnover in postmenopausal women. Gynecol Endocrinol 2006;22(4):179-84.
Evans SF, Davie MW. Low and conventional dose transdermal oestradiol are equally effective at preventing bone loss in spine and femur at all post-menopausal ages. Clin Endocrinol (Oxf) 1996;44(1):79-84.
Kaplan B, Neri A, Kitai E, Pardo Y, et al. Low dose estrogen replacement therapy in early postmenopausal women effect on urinary magnesium and calcium:creatinine ratios. Clin Exp Obstet Gynecol 1994;21(3):170-2.
Rubinacci A, Peruzzi E, Modena AB, Zanardi E, et al. Effect of low-dose transdermal E2/NETA on the reduction of postmenopausal bone loss in women. Menopause 2003;10(3):241-9.
Rebar RW, Trabal J, Mortola J. Low-dose esterified estrogens (0.3 mg/day): long-term and short-term effects on menopausal symptoms and quality of life in postmenopausal women. Climacteric 2000;3(3):176-82.
Yaffe K, Vittinghoff E, Ensrud KE, Johnson KC, et al. Effects of ultra-low-dose transdermal estradiol on cognition and healthrelated quality of Iife. Arch Neurol 2006;63(7):945-50.
Ettinger B. Rationale for use of lower estrogen doses for postmenopausal hormone therapy. Maturitas 2007;57(1):81-4.
Van de Weijer PH, Mattsson LA, Ylikorkala O. Benefits and risks of long-term low-dose oral continuous combined hormone therapy. Maturitas 2007;56(3):231-48.
Gambacciani M, Monteleone P, Genazzani AR. Low-dose hormone replacement therapy: effects on bone. Climacteric 2002;5(2):135-9.