Amenorrea: Tratamiento Hormonal

Dr. Germán Barón Castañeda, M.D.

La paciente hipoestrogénica que no es candidata para la inducción de ovulación requiere un tratamiento de suplencia hormonal. Se incluyen todas las pacientes en las cuales se ha llegado al diagnóstico de falla ovárica, amenorrea hipotalámica y ooforectomía. Es bien conocido el impacto a largo plazo de los estados hipoestrogénicos en términos de enfermedad cardiovascular, perfil de lipoproteínas y densidad ósea. Incluso en mujeres jóvenes, atletas, el ejercicio no alcanza a ser suficiente para compensar la pérdida ósea del estado hipoestrogénico. Se emplea el esquema usual de suplencia estrógeno – progestacional: estrógenos equinos conjugados 0.625 mg diarios del 1 al 21 de cada mes, adicionando 10 mg de acetato de medroxiprogesterona los últimos 12 días. La menstruación ocurre alrededor de 3 días después de terminada la progesterona; si hay sangrado en cualquier otra época se puede inferir que la función endógena se ha restaurado. En este momento se suspende el tratamiento hormonal y se sigue clínicamente la paciente con el fin de comprobar la reanudación de su ovulación.

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