Evolução da Terapia Hormonal na Menopausa

1. A Evolução da Terapia
Hormonal na Menopausa
DOLORES PARDINI

2. … 78 a atrás
1942
1960/70 Associação do uso
do ECC isolado na
THM com Ca
endometrial
1980/90
2004
FDA aprova o
Premarin 1,25
p/tratamento dos
sintomas
climatéricos
Evolução da THM
Association of Exogenous Estrogen and Endometrial
Carcinoma
317 patients with adenocarcinoma of the endometrium;
152 patients used estrogen
54 controls
The risk of endometrial cancer was 4.5 times greater among
women exposed to estrogen therapy.
Exogenous estrogen therapy is associated with an
increased risk of endometrial carcinoma.
Smith DC et al N Engl J Med 1975; 293:1164-1167
1978
Estudos observacionais
sugeriam que a THM
prevenia DCV,
demência e perda óssea
The Nurses' Health Study: 20-year contribution
to the understanding of health among women.
Colditz GA.J Womens Health. 1997
Feb;6(1):49-62.
PEPI TRIAL
JAMA 1995;273;199
2000
Cerca de 15 milhões de
mulheres americanas
estavam usando THM
FDA. Am J Med 118.2005
Heart and Estrogen/progestin Replacement Study
Risks 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):321-333
Women’s Health
Initiative
Heart and Estrogen/progestin Replacement Study
Randomized trial of estrogen plus progestin for secondary
prevention of coronary heart disease in postmenopausal women.
Research Group ( HERS I)
JAMA. 1998 Aug 19;280(7):605-13
Estrogeno
Isolado

3. Lobo RA .Arch Intern Med. 2004;164(5):482-484
The incidence of CHD events was evaluated in 4065
young, healthy postmenopausal women
Conclusion
HT therapy for symptoms early in the menopause, these data
suggest that the benefits may outweigh the risks
Evaluation of Cardiovascular Event Rates With
Hormone Therapy in Healthy, Early Postmenopausal
Women

4. Ettinger B et
al.Menopause2012;19(6);610

5. Postmenopausal Hormone Therapy. An
Endocrine Society Scientific Statement.
J Clin Endocrinol & Metab 2010;95(7) Suppl 1:S1-S6

6. Clapauch R, Athayde A, Meirelles RMR, Weiss RV, Pardini DP, Leão
LM, Marinheiro LP.
Arq Bras Endocrinol Metab 2005;49/3:449-454
Terapia Hormonal da Menopausa: Posicionamento do
Departamento de Endocrinologia Feminina e Andrologia
da SBEM em 2004.

7. ...após 10 anos de controvérsias

8. Hormone Therapy and breast cancer risk 10 years after WHI
Gompel A, Santen RJ
E P

9. The Women’s Health Initiative (WHI) and other studies
strongly suggest that it is the progestogen component
of HRT that is more significant in any increase in breast
cancer risk rather than the estrogen. Thus, it seems
prudent to minimize progestogen use .
International Menopause Society Consensus
Statement
Updated recommendations on menopause hormonal
therapy.
Climacteric
2011;14:302:320
The Estrogen plus progestin increased
risk for breast cancer
whereas estrogen alone decreased risk for
breast cancer.
Ann Intern Med 2012:187

10. Convincing evience from both clinical trials and
epidemiological studies indicates that combined
estrogen-progestogen therapy confers a
higher risk of breast cancer compared to
estrogen monotherapy. Concerning the different
types of progestogens, data from large observational studies
suggest that natural progesterone and dydrogesterone are
associated with a lower risk of breast cancer compared with the
other progestins
Maturitas 77 (2014) 311-317

11. RCT
1006 mulheres ( 45-58a) c/ 3-24 meses de menopausa
502 c/ TH
504 s/ TH
10a randomizado e 16a de seguimento
Schirbeck IL et al. BMJ.345;2012
Effect of hormone replacement therapy on cardiovascular
events in rcently postmenopausal women: a randomised trial (
DOPS )

12. • ELITE Early versus Late Intervention Trial with Estradiol
•KEEPS: Kronos Early Estrogen Preventio
Study J Cardiol Trans Res.2009:2;228
Hodis HN,et al. NEJM 2016;374(13):1221

13. 13
... e 22 anos depois
JAMA. 2020;324(4):369-380.
Association of Menopausal Hormone Therapy With Breast Cancer
Incidence and Mortality During Long-term Follow-up of the Women’s
Health Initiative Randomized Clinical Trials

14. 14
80.396♀ (40-79a)
391494 ♀controles
1 episódio de TEV entre 1998-2017
E2 < EEC
E2 < E+P
Pn < MP
VO>>>>>>> VTd
doi: 10.1136/bmj.k4810 | BMJ 2019;364:k4810

15. Perfil
da
Paciente
Estradiol
≠
EEC
THM
Estrógeno Isolado
≠
E+P
Dose
Via
de
Administração
“Timing”
≠
Progestógenos

16. 93,8% - importante saber tratar a menopausa
v183 residentes
50% MI ; 40% GO
v183 residentes
183 residentes
20
20 programas
americanos
20% - Não haviam recebido nenhuma informação sobre o tema
Achavam-se preparados para tratar menopausa
6,8%-MI 24% -GO
ªMayo Clin Proc. 2019;94(2):242-253

18. Obrigada
DOLORES PARDINI