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Such document,
written up in occasion of National Conference SIGO (Italian Society of
Gynecology and Obstetrics) in Bologna (Italy) from the 20 to the 24/09/2005,
synthetizes the opinion of the scientific associations of Italian Gynecology on
the substitutive hormonal therapy for the Menopause.
What
agrees for hormonal replacement therapy (HRT)
For hormonal replacement therapy in the woman in menopause the somministrazione
of estrogens agrees and/or progestogen it finalizes to equilibrate the
postmenopausal hormonal deficit in charge of subjective symptoms (as the flushes
ones of heat and disturbs uro-genita them) and of responsible organic
modifications also of serious pathologies like the osteoporosis.
The hormonal replacement therapy for the cure of the
symptoms of the menopause
The hormonal replacement therapy is the only therapy in a position to
alleviating with effectiveness the subjective symptoms from often present
hormonal deficit a lot in menopause.
The main symptoms are the flushes ones of heat, disturb of humor, it disturbs
uro-genita them (vaginal dryness and genito-urinary disturbs). In theirs with these
symptoms they plague a great number of women heavy conditioning sometimes the
relation life, the working activity and the personal lived one.
The hormonal replacement therapy in the prevention of
the postmenopausal osteoporosis
The hormonal replacement therapy represents the first choice of therapy
for the prevention of the osteoporosis in the women to elevated osteoporotic
risk when it comes begun in coincidence with the menopausal transition. The
hormonal therapy represents moreover a possible option for the women in age
advanced in the cases of intolerance to other therapies, or when
the other therapies are contraindicated or ineffective.
Many studies on to have demonstrated the osteoprotective
effectiveness to us of the hormonal replacement therapy. All the types of
substitutive therapy hormonal (estrogenic, estro-progestogen, tibolone) are in a
position to cancelling the present loss of bony mass during and after the
menopausale transition and reducing the risk of fracture in the already
osteoporotics women.
Other not hormonal substances have been demonstrated effective in the secondary
prevention and the treatment of the osteoporotics fractures, but the
substitutive hormonal therapy is the only druggist garrison for the prevention
of the osteoporosis currently offered by the National Health Service.
The hormonal replacement therapy in the prevention of
the cardiovascular disease
Searches experience have demonstrated them that the estrogens beneficially
influence on the greater part of the factors of cardiovascular risk (obesity,
distribution of the fat,, lipidic order, glicemic control, and endoteliai functions). The epidemiologists studies lead on relatively young
women have demonstrated one smaller incidence of coronarics serious events
between the users of substitutive hormonal therapy. For these reasons
the substitutive hormonal therapy, begun in menopausale age for the control of
menopausal symptoms, has been also proposed in the primary prevention of the
coronaric disease (that is in women eventually with factors of cardiovascular
risk but still sure it knows some, to the aim to avoid the insorgence of the
disease).
Today but longitudinal studies do not exist control to you that they allow to
confirm such hypothesis. Therefore, to the state they puts into effect, is not
advised the use of the hormonal replacment therapy to the exclusive scope of
the primary prevention of the cardiovascular disease.
Studies lead on women in advanced age more (advanced to 60 years) with important
factors of risk or previous of cardiovascular pathologies have demonstrated that
the hormonal replacement therapy in these patients is accompanied from the
minimal increase, but statistically meaningful, of the risk of coronaric
disease (7 cases every 10,000 women), of every deep venous thrombosis (18 cases
every 10,0 (x) women) and of ictus cerebral (8 cases 10,000 women). Therefore,
in presence of important factors of risk or assessed cardiovascular pathology
the substitutive hormonal therapy is not advisable.
Hormonal replacement therapy and neoplasie
The substitutive hormonal therapy does not increase to the incidence of the
tumor of the uterus (endometrium) and the ovary and reduces the incidence of the
cancer of the colon.
The substitutive hormonal therapy with estrogens in combination with progesterone.
it increases in modest way and not statistically meaningful (0,8 cases every
1000 dealt women in order at least 5 years) the risk of appearance of tumor to
the breast and such increase would seem to be legacy to a promuovente effect the
increase of a tumor already begun but not still diagnosed. The substitutive
hormonal therapy of it would anticipate only the diagnosis. The increase of the
risk stops with the interruption of the therapy. Therefore v'è difference in
the risk between who has not used in passed the hormonal therapy and who of it
has not never made use.
The progestogen one associated to the estrogen seems in a some way to be in
charge of the increase of the risk. The therapy with single estrogens seems not
to increase the frequency of the tumor to the breast, but indeed light reduction,
not meaningful would involve one, of the risk. The rebelled tumors to the breast
during the substitutive hormonal therapy have one better prognosis.
Conclusions:
The hormonal replacement therapy, to the par of whichever therapy, has a
therapeutic risk that for being diminished goes estimated case for
case in relation to the clinical case it characterizes them and to the real
therapeutic necessities that are various from woman to woman and, in the same
woman, they can modify in the time (“individualization of the therapy”).
The hormonal therapy meaningfully improves the quality of life of the women in
menopausale age.
The hormonal replacement therapy is indicated in the treatment of the symptoms
of the climateric syndrome and of it disturbs legacies to alterations of the
genitourinary trophism.
The hormonal replacement therapy is effective in the prevention of the
osteoporosis and the osteoporotics fractures.
They do not exist given that they demonstrate a cardiovascular risk when the
substitutive hormonal therapy is begun in women knows some in coincidence with
the advent of the menopause.
The hormonal replacement therapy goes used with caution in advanced age and is
adviced against in presence of risk factors and cardiovascular pathologies.
AOGOI =
Associatione Ostetrici Ginecologi Ospedalieri Italiani
(President: C. Sbiroli)
AOGUI = Associatione Ostetrici Ginecologi Universitari
Italiani
(President: M. Moscarini)
SIGO = Società Italiana di Ginecologia e Ostetricia
(President: T. Ambrosini)
SIGITE = Società Italiana di Ginecologia per la Terza Età
(President: To. Becorpi)
ISIM = Società italiana per la Menopausa
(President: 5. Guaschino)
GOERM = Operating Group Emilia Romagna Menopause
(President: To. Vixen)
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