Menopausia: panorama actual de manejo

  • Luis Ernesto Pérez A. Universidad Militar Nueva Granada
  • Ingrid C. Rojas Universidad Militar Nueva Granada
Palabras clave: menopausia, terapia de reemplazo hormonal, alteraciones sexuales, enfermedades cardiovasculares, osteoporosis, cáncer de mama

Resumen

Aún existe, desde 2002, una marcada disminución en el uso de terapia hormonal clásica (TH), para el manejo de la menopausia, debido a los riesgos determinados en el estudio Iniciativa de salud para las mujeres (WHI: Women’s Health Initiative). No obstante, revisiones del WHI y evidencias actuales determinan que la TH: (a) es la terapia más efectiva de los síntomas vasomotores, de sus potenciales consecuencias (disminución en calidad del sueño, irritabilidad, reducción en calidad de vida), y para tratar la atrofia urogenital. (b) Previene la osteoporosis y en pacientes con endotelios sanos, reduce el riesgo de hipertensión arterial, diabetes II y enfermedad coronaria, siendo el cociente beneficio/ riesgo mayor cuando se inicia tempranamente al sucederse el hipoestrogenismo. (c) Existe la tendencia a utilizar dosis mínimas, estrógenos no orales y progestágenos puros, para disminuir sus riesgos. (d) Tibolona y paroxetina son las mejores alternativas para tratar los síntomas vasomotores. (e) Finalmente, los cambios a estilo de vida saludable son coadyuvantes excelentes de la TH en el manejo de los síntomas menopaúsicos y en la prevención de las enfermedades crónicas de la postmenopausia, las cuales ameritan tratamientos específicos.

Biografía del autor/a

Luis Ernesto Pérez A., Universidad Militar Nueva Granada
Profesor Titular, Facultad de Medicina, Universidad Militar Nueva Granada, Hospital Militar, Bogotá, DC, Colombia
Ingrid C. Rojas, Universidad Militar Nueva Granada
Médico general, Universidad Militar Nueva Granada, Bogotá, DC, Colombia

Descargas

La descarga de datos todavía no está disponible.

Biografía del autor/a

Luis Ernesto Pérez A., Universidad Militar Nueva Granada
Profesor Titular, Facultad de Medicina, Universidad Militar Nueva Granada, Hospital Militar, Bogotá, DC, Colombia
Ingrid C. Rojas, Universidad Militar Nueva Granada
Médico general, Universidad Militar Nueva Granada, Bogotá, DC, Colombia

Referencias

Gómez G. Menopausia: Una visión Global. En: Pérez L E. Infertilidad y Endocrinología Reproductiva. Tercera edición basada en evidencias. Barranquilla - Colombia. Grafimpresos Donado; 2007. p 423-33.

Brantes S. Perimenopausia. En: Climaterio y Menopausia en el siglo XXI. Santiago de Chile. Imprenta Naval LTDA; 2010. p 22-28.

Van Rooij I, Broekmans F, Scheffer G. et al. Serum antimullerian Hormone levels best reflect the reproductive decline with age in normal women with proven fertility: a longitudinal study. Fertil Steril. 2005;83:979-87.

Daley A, Stokes-Lampard H, Macarthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2011;11; 5:CD006108.

Holloway D. An overview of the menopause: assessment and management. Nurs Stand. 2011;5;25(30):47-57.

Arteaga Urzua E. Terapia de reemplazo hormonal clásica. En: Climaterio y Menopausia en el siglo XXI. Santiago de Chile. Imprenta Naval LTDA; 2010.p 241-9.

The Women’s Health Initiative Steering Committee. Benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women’s health Initiative randomized controlled trial. JAMA. 2002; 288:321-33.

The Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogens in postmenopausal women with hysterectomy: The Women’s Health Initiative randomized controlled trial. JAMA. 2004;291:1701-1.

The North American Menopause Society (NAMS). Estrogen and progestogen use in peri-and postmenopausal women: march 2007 position statement of the North American Menopause society. Menopause. 2007;14:1-17.

The North American Menopause Society (NAMS). Estrogen and progestagen use in postmenopausal women: position statement 2008. Menopause. 2008;15(4):584-603.

The North American Menopause Society (NAMS). Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause society. Menopause. 2010;17:242-55.

The society of Obstetricians and Gynaecologist of Canada. Menopausia and osteoporosis: Vasomotor symptoms, update 2009. JOGC. 2009;1(S9).

Cuadros J L, Fernández-Alonso A M, Chedraui P, et al. Metabolic and hormonal parameters in post-menopausal women 10 years after transdermal oestradiol treatment, alone or combined to micronized oral progesterone. Gynecol Endocrinol. 2011;27(3):156-62.

Wang P H, Horng H C, Cheng M H, Chao H T, Chao K C. Standard and low-dose hormone therapy for postmenopausal women—focus on the breast. Taiwan J Obstet Gynecol. 2007;46(2):127-34.

Harman S M, Brinton E A, Cedars M, et al. KEEPS: The Kronos Early Estrogen Prevention Study. Climacteric. 2005 Mar;8(1):3-12.

Rossouw J E, Prentice R L, Manson J E, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007;297(13):1465-77.

Hodis H N, Mack W J. Coronary heart disease and hormone replacement therapy after the menopause. Climacteric. 2009;12(1):71-5.

Manson J E, Allison M A, Rossouw J E, et al. Estrogen therapy and coronary-artery calcification. N Engl J Med. 2007;356(25):2591-602

Hofling M, Carlstrom K, Svane G, et al. Different effects of tibolone and continuous combined estrogen plus progestogen hormone therapy on sex hormone binding globulin and free testosterone levels – an association with mammographic density. Gynecol Endocrinol. 2005:20(2):110-15.

Segovia A. Tibolona. En: Climaterio y Menopausia en el siglo XXI. Santiago de Chile. Imprenta Naval LTDA; 2010. p 250-256.

Archer D F. Endometrium and breast endpoints study (THEBES). RCT multicenter. Fertil Steril. 2007;88(4):866-78.

Broutin G. Terapia no hormonal para el manejo del síndrome climatérico. En: Climaterio y Menopausia en el siglo XXI. Santiago de Chile. Imprenta Naval LTDA; 2010.p 268-72.

Lethaby AE, Brown J, Marjoribanks J, Kronenberg F, Roberts H, Eden J. Phytoestrogens for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2007;(4):CD001395.

Jacobs A, Wegewitz U, Sommerfeld C, Grossklaus R, Lampen A. Efficacy of isoflavones in relieving vasomotor menopausal symptoms – A systematic review. Mol Nutr Food Res. 2009;53(9):1084-97.

Bolaños R, Del Castillo A, Francia J. Soy isoflavones versus placebo in the treatment of climacteric vasomotor symptoms: systematic review and meta-analysis. Menopause. 2010;17(3):660-6.

Pastore L M, Carter R A, Hulka B S, Wells E. Self-reported urogenital symptoms in postmenopausal women: Women’s Health Initiative. Maturitas. 2004;49:292-303.

Society of Obstetricians and Gynecologists of Canada. The detection and management of vaginal atrophy. Int J Gynaecol Obstet. 2005;88:222-8.

Subak L L, Brown J S, Kraus S R, Brubaker L, Lin F, Richter H E, et al; Diagnostic Aspects of Incontinence Study Group. The “costs” of urinary incontinence for women. Obstet Gynecol. 2006;107:908-16.

The society of Obstetricians and Gynaecologist of Canada. Menopausia and osteoporosis: Urogenital health. Update. 2009. JOGC. 2009;1(S27).

Graziottin A. Menopause and sexuality: key issues in premature menopause and beyond. Ann N Y Acad Sci. 2010;1205:254-61.

Nappi R E, Lachowsky M. Menopause and sexuality: prevalence of symptoms and impact on quality of life. Maturitas. 2009;63(2):138-41.

Bromberger J, Matthews K, Schott LL, Brockwell S, Avis NE, Kravitz HM, et al. Depressive symptoms during the menopausal transition: the Study of Women’s Health Across the Nation (SWAN). J Affect Disord. 2007;103:267-72.

Woods N F, Smith-DiJulio K, Percival D B, Tao E Y, Mariella A, Mitchell ES. Depressed moo d during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health study. Menopause. 2008;15:223-32.

Sherwin B B, Henry J F. Brain aging modulates the neuroprotective effects of estrogen on selective aspects of cognition in women: A critical review. Front Neuroendocrinol. 2008;29(1):88-113.

Almeida O P, Lautenschlager N, Vasikaram S, Leedman P, Flicker L. Association between physiological serum concentration of estrogen and the mental health of community-dwelling postmenopausal women age 70 years and over. Am J Geriatr Psychiatry. 2005;13(2):142-9.

Hogervorst E, Bandelow S. Sex steroids to maintain cognitive function in women after the menopause: meta-analyses of treatment trials. Maturitas. 2010;66(1):56-71.

Coker L H, Espeland M A, Rapp S R, Legault C, Resnick S M, Hogan P et al. Postmenopausal hormone therapy and cognitive outcomes: the Women’s Health Initiative Memory Study (WHIMS). J Steroid Biochem Mol Biol. 2010;118(4-5):304-1.

The society of Obstetricians and Gynaecologist of Canada. Menopausia and osteoporosis: Mood, memory and cognition. Update 2009. JOGC 2009;1(S31).

Daviglus M L, Bell C C, Berrittini W et al. Stete of the science. Conference statement: preventing Alzheimer disease and cognitive decline. Ann Int Med. 2010;153(3):176-81.

Melgarejo E. El problema riesgo cardiovascular en la mujer: la ignorancia que mata. Epidemiología, fisiopatología. En, Asociación colombiana de menopausia. Taller salud cardiovascular en el climaterio. Bogotá. Editorial Guadalupe; 2010. p 11-14.

Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998;280(7):605-13.

Allison M A, Manson J E, Langer R D et al. Oophorectomy, hormone therapy and subclinical coronary artery disease in women with hysterectomy; the WHI coronary artery calcium study. Menopause. 2008;15:639-47.

Stevenson J C, Nodis H N, Pickar J H et al. Coronary heart disease and menopause management: The swinging pendulum of HRT. Atherosclerosis. 2009;207:336-40.

Harman S M, Vittinghoff E, Brinton E A et al. Timing and duration of menopausal hormone treatment may affect cardiovascular outcomes. Am J Med. 2011;124(3):199-205.

LaCroix A Z, Chlebowski R T, Manson J E et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: A randomized controlled trial. JAMA. 2011;305(13):1305-14.

Salpeter S R, Cheng J, Thabane L, Buckley NS, Salpeter EE. Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women. Am J Med. 2009;122(11):1016-22.

The society of Obstetricians and Gynaecologist of Canada. Menopausia: Cardiovascular disease. Update 2009. JOGC. 2009;1(S11).

Pollak F. Alteraciones del metabolismo de los hidratos de carbono en la menopausia. En: Climaterio y Menopausia en el siglo XXI. Santiago de Chile. Imprenta Naval LTDA; 2010.p. 137-43.

Chlebowski R T, Anderson G L, Gass M, et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 2010;304(15):1684-92.

Bolland M J, Barber P A, Doughty R N, Mason B, Horne A, Ames R et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008;336(7638):262-6.

Agarwal S, Agarwal N, Arya S C. Hypovitaminosis D3 in menopausal women in a tertiary care hospital in Delhi. Women’s Health. 2011;7(5):607-10.

Society of Obstetricians and Gynecologists of Canada. Menopause and osteoporosis update 2009. Journal of Obstetrics and Gynecology. 2009;2:27-29.

Khosla S. Update on estrogens and the skeleton. J Clin Endocrinol Metab. 2010;95(8):3569-77.

Britto R, Araújo L, Barbosa I, Silva L, Rocha S, Valente A P. Hormonal therapy with estradiol and testosterone implants: bone protection? Gynecol Endocrinol. 2011;27(2):96-100.

Lee W L, Chao H T, Cheng M H, Wang P H. Rationale for using raloxifene to prevent both osteoporosis and breast cancer in postmenopausal women. Maturitas. 2008;60(2):92-107.

Messalli E M, Scaffa C. Long-term safety and efficacy of raloxifene in the prevention and treatment of postmenopausal osteoporosis: an update. Int J Women Health. 2010;1:11-20.

Delmas P D, Adami S, Strugala C et al. Intravenous ibandronate injections in postmenopausal women with osteoporosis: one-year results from the dosing intravenous administration study. Arthritis Rheum. 2006;54:1838-46.

Deeks E D, Perry C M. Zoledronic acid: a review of its use in the treatment of osteoporosis. Drugs Aging. 2008;25(11):963-86.

Finkelstein J S, Wyland J J, Lee H, Neer R M. Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis. J Clin Endocrinol Metab. 2010 Apr; 95(4):1838-45.

Lyritis G P, Georgoulas T, Zafeiris C P. Bone anabolic versus bone anticatabolic treatment of postmenopausal osteoporosis. Ann N Y Acad Sci. 2010;1205:277-83.

Deek E D, Dhillon S. Strontium ranelate: A review of its use in the treatment of postmenopausal osteoporosis. Drugs. 2010;70(6):733-59.

Cranney A, Tugwell P, Zytaruk N, et al. Meta-analyses of therapies for postmenopausal osteoporosis. VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. Endocr Rev. 2002;23(4):540-51.

Bogado C E, Boailchuk J A, Zanchetta M B, Massari F E, Zanchetta J R. Denosumab: An update. Drugs Today. 2011;47(8):605-13.

Cómo citar
Pérez A., L. E., & C. Rojas, I. (2011). Menopausia: panorama actual de manejo. Revista Med, 19(1), 56-65. https://doi.org/10.18359/rmed.1226
Publicado
2011-06-30
Sección
Artículos