Riesgos de la terapia hormonal

– Los estrógenos aumentan el riesgo de cáncer endometrial; la adición de una progestina disminuye o anula este riesgo.
– El estudio WHI mostró el incremento no significativo de cáncer de mama y sugirió que la medroxiprogesterona podría ser la causante. Las nuevas progestinas no implicarán mayor riesgo.
– En mujeres mayores la TH oral aumenta el riesgo cardiovascular.

Para disminuir los riesgos:

– Cáncer de mama/endometrio: Usar nuevas progestinas (p. ej. Progesterona micronizada, 100 mg/vaginal) o 200 mg (oral) por 12 días.
– Riesgo trombótico: Usar E2 transdérmico en parches (50 μg), o transcutáneo en geles (0,5-1, 5 mg/día).
– Otra opción son las dosis bajas de estrógenos orales (EEC 0.3-E2 1 mg).

Otras opciones hormonales:

– Tibolona: Además de disminuir bochornos, mejora ánimo, atrofia genitourinaria y sexualidad. No estimula endometrio ni aumenta densidad mamaria. Puede bajar HDL.

– Estrógenos vaginales: Un metaanálisis señala que las cremas, tabletas, óvulos y anillos vaginales son igualmente efectivos. Estriol 0.5 mg (crema, óvulos), estradiol tabletas de 25 μg.

Cambios de estilo de vida

– Actividad física: Mejora los factores de riesgo CV, disminuye hasta el 43% el riesgo coronario.
– Dieta: El riesgo coronario disminuye 4% por cada fruta o porción de verdura que se ingiera al día.
– Cigarrillo: Aumenta el riesgo de eventos coronarios y cerebro-vasculares. Su abandono provoca una reducción del 36% en la mortalidad coronaria.

Recomendaciones

1. Evaluar en toda mujer climatérica la calidad de vida y el riesgo de enfermedades crónicas.
2. Si hay deterioro clínico, indicar terapias.
3. Las principales medidas terapéuticas son mejorar los estilos de vida y las terapias farmacológicas específicas.

Consentimiento informado

XII. Bibliografía

1. Sánchez Torres, Fernando. Temas de ética médica. p. 46.
2. Pellegrini, E.D. «The relationship of anatomy and integrity in medical ethics». Bulletin PAHO 1990;24:361.
3. Faden I Beauchamp. «A history and theory of informed consent» citado por Sánchez Torres Fernando. Op. cit.
4. Ley 23 de 1981, Artículo 16 y Decreto reglamentario 3380 de 1981, artículo 12.

Progestágenos

1. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010;17:242-255.
2) Santen RJ, Craig DA, Stacy P, Archer DF, et al. Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement.J Clin Endocrinol Metab 2010;95(Suppl ):S1-S66.

Andrógenos

1. Lasley BL, Santoro N, Randolf JF, et al. The relationship of circulating dehydroepiandrosterone, testosterone, and estradiol to stages of the menopausal transition and ethnicity. J Clin Endocrinol Metab 2002;87:3760-3767.
2. Davison SL, Bell R, Donath S, Montalto JG, Davis SR. Androgen Levels in adult Females: Changes with Age, Menopause, and Oophorectomy. J Clin Endocrinol Metab 2005; 90:3847-3853.
3. Arlt W. Dehydroepiandrosterone and ageing. Best Pract Res Clin Endocrinol Metab 2004;18:363-380.
4. Bachmann G, Bancroft J, Braunstein G, Burger H, Dabis S, et al. Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment. Fertil Steril 2002;77:660-665.
5. Basson R, Desindes S, Graves G, et al. Canadian Consensus Conference on Menopause, 2006 Update. J Obstet Gynecol Canadian 2006;28(Supp 1):S51-S92.

Tibolona

1. Swanson SG, Drosman S, Helmond FA, Stathopoulos VM. Menopause 2006;13:917-925.
2. Hammar M, Christiau S, Nathorst-Böös J, Rud T, Garre K. Br J Obstet Gynecol 1998;105:904-911.
3. Nelson H, Fu R, Griffin J, Nygren P, Smith B, Humphrey L. Ann Intern Med 2009;151:703-715.
4. Delmas PD, Davis SR, Hensen J, Adami S, van OS S, Nijland EA. Osteoporos Int 2008;19:1153-1160.
5. Cummings SR, Ettinger B, Delmas PD, Kenemans P, Stathopulos V, Verweij P, y cols. N Engl J Med 2008;359:697-708.
6. Archer DF, Hendrix S, Gallagher JC, Rymer J, Skouby S, Ferenczy A, y cols. J Clin Endocrinol Metab 2007;92:911-918.
7. Kenemans P, Bundred NJ, Foidart JM, Kubista E, von Schoultz B, Sismondi P, y cols. Lancet Oncol 2009;10:135-146.
8. Nijland EA, Weijmar Schultz WC, Nathorst- Böös J, Helmon FA, van Lunsen RH, y cols. J Sex Med 2008;5:646-656.
9. Demirol A, Guven S, Guvendag Guven ES, Kirazil S, Gurgan T, Ayhan A. Fertil Steril 2007;87:842-848.
10. Winkler UH, Altkemper R, Kwee B, Helmond FA, Coelingh Bennink HJ. Fertil Steril 2000;74:10-19.
11. Langer RD, Landgren BM, Rymer J, Helmond FA. Am J Obstet Gynecol 2006;195(5):1320-1327.
12. Eilertsen AL, Karssemeijer N, Skaane P, Qvigstad E, Sandset PM. Differential impact of conventional and low-dose oral hormone therapy, tibolone and raloxifene on mammographic breast density, assessed by an automated quantitative method. BJOG. 115:773-779.

Origen de los síntomas vasomotores. Teorías Actuales

1. Genazzani AR, Shneider HP, Panay N, y cols. Gynecol Endocrinol 2006;22:369-375.
2. Gold EB, Bromberger J, Crwaford S, y cols. Am J Epidemiol 2001;153:865-874.
3. Blumel JE, Chedraui P, Baron G, Gomez G, Monterrosa A, Onatra W, y cols. Menopause 2011;8:778-785. Collaborative Group for Research of the Climacteric in Latin America (REDLINC).
4. Deecher DC, Dorries K. Arch Womens Ment Health 2007;10:247-257.
5. Freedman RR, Semin Reprod Med 2005; 23:117-125.
6. Frey BN, Lord C, Soares CN. Menopause int 2008;14:123-128.
7. Freedman RR, Semin Reprod Med 2005; 23:117-125.
8. Slopien R, Meczekalski B, Warenik-Szymankiewicz A. Climateric 2003;6:53-57.
9. Rapkin AJ. Am J Obstet Gynecol 2007; 196:97-106.
10. Stearns V, Ullmer L, Lopez JF, y cols. Lancet 2002;360:1851-1861.
11. Genazzani AR, Pluchino N, Luisi S, Luisi M. Human Reproduction Update 2007;13:175-187.
12. Rupprecht R, di Michele F, Hermann B, y cols. Brain Res Brain Res Rev 2001;37:59-67. 13. Archer DE, Sturdee DW, Baber R, y cols. Climateric 2011;14:515-528.
14. Hay DL, Poyner DR. Maturitas 2009;64:104-108.
15. Gupta P, Harte AL, da Silva NF, y cols. Menopause 2007;14:1031-1038.
16. Dormire SL. Biol Res Nurs 2009;10:241-247.

Cerebro y estrógenos

1. Okie S. Enfrentar la enfermedad de Alzheimer. N Engl J Med 2011;365:1069-1072.
2. D’Esposito M, Gazzaley A. ¿Puede asociados con la edad la pérdida de memoria ser tratados? N Engl J Med 2011;365:1346-1347.
3. Cummings JL Alzheimer’s Disease. N England J Med 2004;351:56-67.
4. Querfurth HW, LaFerla FM. Alzheimer’s Disease. N England J Med 2010;362:329-344.
5. Brinton RD. Alzheimer Sindrome Learn Mem: 2001;8:121-133.
6. Wise PM, et al. Are Estrogens Protective or Risk Factors in Brain Injury and Neurodegeneration? Reevaluation after the Women’s Health Initiative. Endocrine Reviews 2005;26:308-312.
7. Turgeon J L, et al. Complex actions of sex steroids in adipose tissue, the cardiovascular system, and brain: Insights from Basic Science and Clinical Studies. Endocrine Reviews 2006;27:575-605.
8. Joel A. Simon postmenopausal hormone therapy and Risk of Stroke : The Heart and Estrogen-progestin Replacement Study (HERS). Circulation 2001;103:638-642.
9. Wassertheil-Smoller S, et al. Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women: The Women’s Health Initiative: A Randomized Trial. JAMA 2003;289(20):2673-2684.
10. Shumake SA, et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women.The Women’s Health Initiative Memory Study: A Randomized Controlled Trial. JAMA 2003;289:2651.
11. Stephen RR, et al. Effect of estrogen plus progestin on global cognitive function in postmenopausal women. The women’s health initiative memory study: A randomized controlled trial. JAMA 2003;289:2663-2672.
12. Mulnard RA. Estrogen replacement therapy for treatment of mild to moderate Alzheimer disease a randomized controlled trial. JAMA2000;283:1007-1015.

Terapia hormonal, función cognitiva y demencia

1. North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010;17:242-55.
2. Santen RJ, et al. Postmenopausal hormone therapy: an endocrine society scientific statement. The Journal of Clinical Endocrinology & Metabolism 2010;95(1):S1-S66.
3. Sturdee DW, Pines A; International Menopause Society Writing Group, Archer DF, Baber RJ, Barlow D, Birkhäuser MH, Brincat M, Cardozo L, de Villiers TJ, Gambacciani M, Gompel AA, Henderson VW, Kluft C, Lobo RA, MacLennan AH, Marsden J, Nappi RE, Panay N, Pickar JH, Robinson D, Simon J, Sitruk-Ware RL, Stevenson JC. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011;14:302-320.

Terapia hormonal e insomnio-depresión

1. Postmenopausal Hormone Therapy. An endocrine society scientific statement. J Clin Endocrinol Metab 2010;95:s1-s66 originally published online Jun 21, 2010; doi: 10.1210/jc.2009-2509.
2. Position statement. Estrogen and progestogen use in postmenopausal women: 2010. Menopause: 2010;17:242-255.
3. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health on behalf of the International Menopause Society. D. W. Sturdee and A. Pines. Writing Group: D. F. Archer, R. J. Baber, D. Barlow, M. H. Birkhäuser, M. Brincat, L. Cardozo, T. J. de Villiers, M. Gambacciani, A. A. Gompel, V. W. Henderson, C. Kluft, R. A. Lobo, A. H. MacLennan, J. Marsden, R. E. Nappi, N. Panay, J. H. Pickar, D. Robinson, J. Simon, R. L. Sitruk-Ware and J. C. Stevenson.

Síntomas vasomotores y consecuencias cardiovasculares

1. Gorodeski EZ, Gorodeski GI. Epidemiology and risk factors of cardiovascular disease in postmenopausal women. In: Lobo RA, ed. Treatment of the Postmenopausal Woman: Basic and Clinical Aspects, 3rd ed. Burlington, MA: Academic Press 2007;405-452.
2. Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007;297:1465-1477.
3. Gast GC, Grobbee DE, Pop VJ, et al. Menopausal complaints are associated withcardiovascular risk factors. Hypertension 2008;51:1492-1498.
4. Thurston RC, Sutton-Tyrrell K, Everson-Rose SA, Hess R, Matthews KA. Hot flashes and subclinical cardiovascular disease: findings from the Study of Women’s Health Across the Nation Heart Study. Circulation 2008; 118:1234-1240.
5. Svartberg J, von Muhlen D, Kritz-Silverstein D, Barrett-Connor E. Vasomotor symptoms and mortality: the Rancho Bernardo Study. Menopause 2009;16:888-891.
6. Leal M, Díaz J, Serrano E, et al. Hormone replacement therapy for oxidative stress in postmenopausal women with hot flushes. Obstet Gynecol 2000;95:804-809.
7. Leal M, Díaz J, Serrano E, et al. Hormone replacement therapy for oxidative stress in postmenopausal women with hot flushes. Obstet Gynecol 2000;95:804-809.
8. Van der Schouw YT, Grobbe DE. Menopausal complaints, oestrogens, and heart disease risk: an explanation for discrepant findings on the benefits of postmenopausal hormone therapy. Eur Heart J 2005;26:1358-1361.
9. Gerrie-Cor M. Gast, et al. Vasomotor menopausal symptoms are associated with increased risk of coronary heart disease. Menopause 18(2):146-151.
10. Rebecca C. Thurston, et al. Hot flashes and subclinical cardiovascular disease: findings from the study of women’s health across the nation heart study. Circulation 2008; 118(12): 1234-1240.
11. JoAnn E. Manson, et al. Estrogen therapy and coronary-artery calcification. N Engl J Med 2009;356:25.

Terapia hormonal y riesgo cardiovascular

1. Aging, menopause, cardiovascular disease and HRT. International Menopause Society Consensus Statement. The Writing Group on behalf of the Workshop Consensus Group. Climacteric 2009;12:368-377.
2. Hodis HN, Mack WJ, Lobo RA, et al. (Estrogen in the Prevention of Atherosclerosis Trial Research Group). Estrogen in the Prevention of Atherosclerosis: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001;135:939-953. (N. Evidencia 1).
3. Grodstein F, Manson JE, Stampfer MJ. Postmenopausal hormone use and secondary prevention of coronary events in the Nurses’ Health Study: a prospective, observational study. Ann Intern Med 2001;135:1-8. (N. Evidencia 2b).
4. Hulley S, Grady D, Bush T, et al. (Heart and Estrogen/ Progestin Replacement Study [HERS] Research Group). Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998;280:605-613. (N. Evidencia 1).
5. Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003;349:523-534. (N. Evidencia 1).
6. Rossouw JE, Anderson GL, Prentice RL, et al. (Writing Group for the Women’s Health Initiative Investigators). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288:321-333. (N. Evidencia 1).

Terapia hormonal de reemplazo y riesgo de enfermedad coronaria

1. Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992;117:1016-1037.
2. JM Sullivan. La arteriografía coronaria en las mujeres tratadas con estrógenos posmenopáusicas. Prog Cardiovasc Dis 1995;38: 211-22.
3. Rossouw JE, Prentice RL, Manson JE, et al. Wu L, Barad D, Barnabei VM, Ko M, LaCroix AZ, Margolis KL, Stefanick ML. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA [Erratum (2008) 299:1426] 2007;297:1465-1477.
4. Clarkson TB. Estrogen effects on arteries vary with stage of reproductive life and extent of subclinical atherosclerosis progression. Menopause 2007;14:373-384.
5. Shufelt CL, Johnson BD, Berga SL, et al. Timing of hormone therapy, type of menopause, and coronary disease in women: data from the National Heart, Lung, and Blood Institutesponsored Women’s Ischemia Syndrome Evaluation. Menopause 2011;18:943-950.

Efectos a nivel osteomuscular

1. Health Care Guideline: Diagnosis and treatment of Osteoporosis. Institute for clinical Systems Improvement. Seventh Edition. 2011.
2. Kanis JA, Cooper C, Burlet N, et al. Guía europea para el diagnóstico y tratamiento de la osteoporosis en la mujer menopáusica. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. ESCEO. 2005.
3. Management of osteoporosis. A national clinical guideline. Scottish Intercollegiate Guidelines Network. 2003.
4. Sturdee DW, Pines A. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. International Menopause Society. Climaterica 2001;14:302-320.

Dolor osteoarticular y muscular

1. Christiansen C. An update review of cellular mechanisms conferring the indirect and direct effects of estrogen on articular cartilage. Climacteric 2008;11:4-16.
2. Bay-Jensen AC, Tabassi NC, Sondergaard LV, Andersen TL, Dagnaes-Hansen F, Garnero P, Kassem M, Delaisse JM. The response to estrogen deprivation on cartilage collage degradation markers; CTX-II is unique compared to other markers of collagen turnover. Arthritis Res Ther 2009;11:R9.
3. Baron YM, Brincat MP, Galea R, Calleja N. Intervertebral disc height in treated and untreated overweight post-menopausal women. Hum Reprod 2005;20:3566-3570.
4. Gambacciani M, Pepe A, Cappagli B, Palmieri E, Genazzani AR. The relative contributions of menopause and aging to postmenopausal reduction in intervertebral disk height. Climacteric 2007;10:298-305.
5. Cirillo DJ, Wallace RB, Wu L, Yood RA. Effect of hormone therapy on risk of hip and knee joint replacement in the Women’s Health Initiative. Arthritis Rheum 2006;54:3194-3204.
6. Muscat Baron Y, Brincat MP, Galea R, Calleja N. Low intervertebral disc height in postmenopausal women with osteoporotic vertebral fractures compared to hormonetreated and untreated postmenopausal women and premenopausal women without fractures. Climacteric 2007;10:314-319.
7. Writing Group for the Women’s Health Initiative. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321-333.
8. Niveles de 25 hidroxivitamina D y su correlación clínica con diferentes variables metabólicas y cardiovasculares en una población de mujeres posmenopáusicas. Acta Médica Colombiana 2011;36(1).

Ejercicio, tabaquismo, nutrición y Autocuidados

1. Schneider HJ, Frieddrich N, Klotsche J, et al. The predictive value of different measures of obesity for incident cardiovascular events and mortality. J Clin Endocrinol Metab 2010;95:1777-1785.
2. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 2003;348:1625-1638.
3. Encuesta Nacional de Salud 2007. Resultados Nacionales Instituto Colombiano para el desarrollo de la ciencia y la tecnología. Colciencias y el Ministerio de Protección Social.
4. Thurston RC, Joffe H, Soares CN, Harlow BL. Physical activity and risk of vasomotor symptoms in women with and without a history of depression: results from the Harward Study of Moods and Cycles. Menopause 2006;13:533-560.
5. Daley A. Mac Arthur C, M Mutrie N, Stokes-Lampard H. Exercise for Vasomotor
Menopausal Symptoms. Cochrane Database Syst Rev 2007;(4):CD 006108.
6. Orzano AJ, Scott JG. Diagnosis and Treatment of Obesity in Adults: an applied evidencebased review. J Am Board Fam Pract 2004;17:359-360.
7. Schneider HJ, Friedrich N, Klotsche J, et al. The predictive value of different measures of obesity for incident cardiovascular event and mortality. J Clin Endocrinol Metab 2010;95:1777-1785.

Calidad de vida en el climaterio

1. Monterrosa A, Angel PC, Romero Perez IP. La calidad de vida de las mujeres en edad media varía según el estado menopáusico.

Nivel de evidencia: nivel II-3

2. Utian WH. Quality of life (QOL) in menopause. Maturitas 2007;57:100-102.

Síndrome metabólico

1. Ervin RB. Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006. Nivel de evidencia Ilb.
2. Meigs JB, Wilson PWF, Nathan DM, D’Agostino RB, Williams K and Haffner SM. Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes 2003;52:2160-2167. Nivel de evidencia IIb.
3. Escobedo J, Schargrodsky H, Champagne B, Silva H, Boissonnet CP, Vinueza R, Torres M, Hernandez R, Wilson E. Prevalence of the metabolic syndrome in Latin America and its association with sub-clinical carotid atherosclerosis:the Carmela cross sectional study. Cardiovascular Diabetology 2009;8:52. Nivel de evidencia Ilb.
4 . The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III): prevalence of the metabolic syndrome in postmenopausal Latin American women and for the Collaborative Group for Research of the Climacteric in Latin America. The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III): prevalence of the metabolic syndrome in postmenopausal Latin American women. Climacteric 2007;10:164-70.5. Nivel de evidencia Ilb.
5. Gómez G, Carvajal JA, Benavides JP. Síndrome metabólico en la menopausia. Rev Col Menop 2005; 11-16. Nivel de evidencia IIb.
6. Sánchez F, Jaramillo N, Vanegas A, Echeverri JG, Alviar CL, Echavarría E, Montoya L, Torres Y. Prevalencia y comportamiento de los factores de riesgo del síndrome metabólico según los diferentes intervalos de edad, en una población femenina del área de influencia de la Clínica Las Américas, en Medellín-Colombia. Rev Colomb Cardiol 2008;15:102-110. Nivel de evidencia Ilb.
7 . Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci 2006;331:166-174. Nivel de evidencia I.
8. Hoang KC, Ghandehari H, Lopez VA, Barboza MG and Wong ND. Global coronary heart disease risk assessment of individuals with the metabolic syndrome in the U.S. Diabetes Care 2008;31:1405-1409.
9. Dekker JM, Girman C, Rhodes T, Nijpels G, Stehouwer CD, Bouter LM, Heine RJ. Metabolic syndrome and 10-year cardiovascular disease risk in the horn study. Circulation 2005;112:666-673. Nivel de evidencia Ia.
10. Mcneill A.M. The Metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 2005;28:385-390. Nivel de evidencia Ia.
11. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, Rinfret S, Schiffrin El, Eisenberg MJ. The metabolic syndrome and cardiovascular risk. A systematic review and meta-analysis J Am Coll Cardiol 2010; 56:1113-1132. Nivel de evidencia Ia.
12. Ford ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 2005;28:2745-2749. Nivel de evidencia Ia.
13. Hunt KJ, Resendez RG, Williams K, Haffner SM. and Stern MP. Metabolic syndrome in relation to all-cause and cardiovascular mortality in national cholesterol education program versus world health organization the San Antonio. Heart Study. Nivel de evidencia Ia.
14. Canonico M, Oger E, Plu-Bureau G, Conard J, Meyer G, Lévesque H, Trillot N, Barrellier MT, Wahl D, Emmerich J. Scarabin PY. Hormone therapy and venous thromboembolism among postmenopausal women impact of the route of estrogen administration and progestogens: the Esther Study. Circulation 2007;115:840-845. Nivel de evidencia llb.
15. Chu MC, Cosper P, Nakhuda GS and Lobo RA. A comparison of oral and transdermal short-term estrogen therapy in postmenopausal women with metabolic syndrome Fertil Steril 2006;86:1669-1675. Nivel de evidencia lb.
16. Wild RA. North American Menopause Society 21st Annual Meeting; Oct. 6-9, 2010; Chicago. Lowry F. Hormone Therapy Raises CHD Risk in Women With Metabolic Syndrome. North American Menopause Society 21st Annual Meeting: Abstract 3 https://www.medscape.com/viewarticle/730307 Nivel de evidencia IV.
17. Lower doses of estrogen in hormone therapy carry less cardiovascular risk. North American Menopause Society 21st Annual Meeting; Oct. 6-9, 2010; Chicago. https://www.medscape.com/viewarticle/730361 Nivel de evidencia IV.

Diabetes

1. Endocrine Society Scientific Statement. Postmenopausal Hormone Therapy: J Clinic Endocrinol Metabolism. J Clin Endocrinol Metab 2010;95(Suppl 1):S1-S66. Nivel de evidencia III.
2. 2010 Position statement of The North American Menopause Society. Estrogen and progestogen use in postmenopausal women: Menopause 2010;17:242-255. Nivel de evidencia III.
3. Cynthia K. Sites, Georgia D. L’Hommedieu, Michael J. Toth, Martin Brochu, Brian C. Cooper, and Penny A. Fairhurst. The Effect of Hormone replacement Therapy on Body Composition, Body Fat Distribution, and Insulin sensitivity in Menopausal Women: A Randomized, Double-Blind, Placebo-Controlled Trial. J Clinic Endocrinol Metabolism 2005;90:2701-2707. Nivel de evidencia l.
4. Margolis KL, Bonds DE, Rodabough RJ, Tinker L, Phillips LS, Allen C, Bassford T, Burke G, Torrens J, Howard BV. Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women’s Health Initiative Hormone Trial. Diabetología 2004;47:1175-1187. Nivel de evidencia l.
5. Bonds DE, Lasser N, Qi L, Brzyski R, Caan B, Heiss G, Limacher MC, Liu JH, Mason E, Oberman A, O’Sullivan MJ, Phillips LS, Prineas RJ, Tinker L. The effect of conjugated equine oestrogen on diabetes incidence: the Women’s Health Initiative randomised trial. Diabetología 2006;49:459-468. Nivel de evidencia l.
6. Kanaya AM, Herrington D, Vittinghoff E, Lin F, Grady D, Bittner V, Cauley JA, Barrett- Connor E. Glycemic effects of postmenopausal hormone therapy: the Heart and Estrogen/Progestin Replacement Study. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2003;138:1-9. Nivel de evidencia l.
7. Bonds DE, Lasser N, Qi L, Brzyski R, Caan B, Heiss G, Limacher MC, Liu JH, Mason E, Oberman A, O’Sullivan MJ, Phillips LS, Prineas RJ, Tinker L. The effect of conjugated equine oestrogen on diabetes incidence: The Women’s Health Initiative randomised trial Diabetología 2006;49:459-468. Nivel de evidencia l.
8. Manson JE, Rimm EB, Colditz GA, Willett WC, Nathan DM, Arky RA, Rosner B, Hennekens CH, Speizer FE, Stampfer MJ. A prospective study of postmenopausal estrogen therapy and subsequent incidence of non-insulin-dependent diabetes mellitus. Ann Epidemiol 1992; 2:665-673. Nivel de evidencia II.
9 Sites CK, L’Hommedieu GD, Toth MJ, Brochu M, Cooper BC, Fairhurst PA. The effect of hormone replacement therapy on body composition, body fat distribution, and insulin sensitivity in menopausal women: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 2005;90:2701-2707. Nivel de evidencia l.
10. Munoz J, Derstine A, Gower BA. Fat distribution and insulin sensitivity in postmenopausal women: influence of hormone replacement. Obes Res 2002;10:424-431. Nivel de evidencia ll-2.
11. Kalish GM, Barrett-Connor E, Laughlin GA, Gulanski BI. Postmenopausal Estrogen/ Progestin Intervention Trial. Association of endogenous sex hormones and insulin resistance among postmenopausal women: results from the Postmenopausal Estrogen/Progestin Intervention Trial. J Clin Endocrinol Metab 2003;88:1646-1652. Nivel de evidencia ll-2.
12. Salpeter SR, Walsh JM, Ormiston TM, Greyber E, Buckley NS, Salpeter EE. Meta-analysis: effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes Obes Metab 2006;8(5):538-54. Nivel de evidencia l.
13. U.S. Preventive Services Task Force. Hormone therapy for the prevention of chronic conditions in postmenopausal women: Recommendations from the U.S. Preventive services task force. Ann Intern Med 2005;142: 855-860. Nivel de evidencia I. Grado de recomendación D.

Endometriosis

1. Moen MH, Rees M, Brincat M, et al. EMAS position statement: Managing the menopause in women with past history of endometriosis. Maturitas 2010;67:94-97.
2. Maclennan AH. HRT in difficult circumstances: are there any absolute contraindication? Climateric 2011;14:409-417.
3. Al Kadri H, Hassan S, Al Fozan HM, Hajjer A. Hormone therapy for endometriosis and surgical menopause. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005997. DOI: 10.1002/14651858. CD005997.pub2.
4. Fedele L, Bianchi S, Rafaelli R, Zanconato G. Comparison of transdermal estradiol and tibolone for the treatment of oophorectomized women with deep residual endometriosis. Maturitas 1999;32:189-193.
5. Matorras R, Elorriage MA, Pijoan JI, Ramon O, Rodriguez- Escudero FJ. Recurrence of endometriosis in women with bilateral adnexectomy (with or without total hysterectomy) who recieved hormone replacement therapy. Fertility and Sterility 2002;77(2):303-308.

Colelitiasis

1. The Heart and Estrogen/progestin Replacement Study (HERS) Research Group. Effect of estrogen plus progestin on risk for biliary tract surgery in postmenopausal women with coronary artery disease. Ann Intern Med 2001;135:493-501. Nivel de evidencia I.
2. Boland LL, Folsom AR, Rosamond WD. Atherosclerosis Risk in Communities Study I: hyperinsulinemia, dyslipidemia, and obesity as risk factors for hospitalized gallbladder disease: a prospective study. Ann Epidemiol 2002;12:131-140. Nivel de evidencia II-1.
3. Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol 2006;20(6):981-96. Nivel de evidencia II-2.
4. Schwarz S, Völzke H, Baumeister S E, Hampe J and Dören M. Menopausal hormone therapy and gallbladder disease: the Study of Health in Pomerania (SHIP) Clinical Endocrinology 2007;67:51-59. Nivel de evidencia II-1.
5. Women Study Collaborators. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study. BMJ 2008;337:1-9. Nivel de evidencia I.
6. Kim SS, Lee JG, Kim DW, Kim BH, Jeon YK, Kim MR, Huh1JE, Mok1JY, Kim S-J, Kim YK, and Kim IJ. Insulin Resistance as a Risk Factor for Gallbladder Stone Formationin Korean Postmenopausal Women. korean J Intern Med 2011;26:285-293. Nivel de evidencia II-1.
7. Uhler ML, Marks JW & Judd HL. Estrogen replacement therapy and gallbladder disease in postmenopausal women. Menopause 2000;7:162-167.
8. George ED, Schluger LK. Special women’s health issues in hepatobiliary diseases. Clinics in family practice 2000;2:155-169.
9. Grodstein F, Colditz GA, Stampfer MJ. Postmenopausal hormone use and cholecystectomy in a large prospective study. Obstet Gynecol 1994;83:5-11. Nivel de evidencia II-2.
10. Cirillo DJ, Wallace RB, Rodabough RJ, et al. Effect of estrogen therapy on gallbladder disease. JAMA 2005; 293:330-339. WHI Nivel de evidencia I.
11. Hart AR, Luben R, Welch A, Bingham S, Khaw KT. Hormone replacement therapy and symptomatic gallstones – a prospective population study in the EPIC-Norfolk cohort. Digestion 2008;77(1):4-9. Nivel de evidencia I.
12. Million Women Study Collaborators. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study. BMJ 2008;337:1-9. Nivel de evidencia I.
13. Uhler ML, Marks JW, Voigt BJ, Judd HL. Comparison of the impact of transdermal versus oral estrogens on biliary markers of gallstone formation in postmenopausal women. J Clin Endocrinol Metab 1998;83:410-414. Nivel de evidencia I.
14. U.S. Preventive Services Task Force. HormoneTherapy for the Prevention of Chronic Conditions in Postmenopausal Women: Recommendations from the U.S. Preventive Services Task Force. Ann Intern Med 2005;142:855-860. Nivel de evidencia I. Grado de recomendación D.
15. An Endocrine Society Scientific Statement. Postmenopausal Hormone Therapy: J. Clinic. Endocrinol. Metabolism. J Clin Endocrinol Metab 2010;95(Suppl 1):S1-S66. WHI Nivel de evidencia I.

Miomatosis

1. Reed SD, Cushing-Haugen KL, Daling JR, Scholes D, Schwartz SM. Postmenopausal estrogen and progestogen therapy and the risk of uterine leiomyomas. Menopause 2004;11:214-222.
2. Shozu M, Murakami K, Inoue M. Aromatase and leiomyoma of the uterus. Semin Reprod Med 2004;22:51-60.
3. Basson R, Desindes S, Graves G, et al. Canadian Consensus Conference on Menopause, 2006 Update. J Obstet Gynecol Canadian 2006;28(sup1):S51-S92.

Enfermedad venosa y autoinmunidad

1. Ashraf M and Vongpatanasin W. Postmenopausal Hormone Therapy and Hypertension. Curr Hypertension 2006;8:368-376.
2. Salpeter SR. Walash JME, Ormiston TM. Effect of hormone-replacement therapy on diabetes and metabolic syndrome. Diabetes Obesity and Metabolism 2006;8:538-554.
3. Modena MG, Simondi PS, Mueck A. Transdermal postmenopausal hormone therapy differs from oral hormone in risks and benefits. The TREAT collaborative study group. Maturitas 2005;84:489-496.
4. Lisa Martin, JoAnn V. Pinkerton, David R. Rubinow, Helena Teede, Diane M. Thiboutot and Wulf H. Utian Jarjour, Richard H. Karas, Michael Kleerekoper, Roger A. Lobo, JoAnn E. Manson, Jo Marsden, Kathryn A. Martin, Burger, Graham A. Colditz, Susan R. Davis, Marco Gambacciani, Barbara A. Gower, Victor W. Henderson, Wael N. Richard J. Santen, D. Craig Allred, Stacy P. Ardoin, David F. Archer, Norman Boyd, Glenn D. Braunstein, Henry G. Postmenopausal Hormone Therapy. An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2010;95:s1-s66.
5. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010;17(2):242-255.
6. D. W. Sturdee and A. Pines on behalf of the International Menopause Society Writing Group: D. F. Archer, R. J. Baber, D. Barlow, M. H. Birkhäuser, M. Brincat, L. Cardozo, T. J. de Villiers, M. Gambacciani, A. A. Gompel, V. W. Henderson, C. Kluft, R. A. Lobo, A. H. MacLennan, J. Marsden, R. E. Nappi, N. Panay, J. H. Pickar, D. Robinson, J. Simon, R. L. Sitruk-Ware and J. C. Stevenson. Updated IMS recommendations on postmenopausal. 7. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health D. W. Sturdee and A. Pines on behalf of the International Menopause Society Writing Group: D. F. Archer, R. J. Baber, D. Barlow, M. H. Birkhäuser, M. Brincat, L. Cardozo, T. J. de Villiers, M. Gambacciani, A. A. Gompel, V. W. Henderson, C. Kluft, R. A. Lobo, A. H. MacLennan, J. Marsden, R. E. Nappi, N. Panay, J. H. Pickar, D. Robinson, J. Simon, R. L. Sitruk-Ware and J. C. Stevenson.

Sistema urogenital

1. Arias Raquel. Webcast of 2011 Annual meeting Washington, DC september 21-24 2011 https://nams,tri-digital,com/sessions/nams.
2. Utian W, Bachamanan H, et al. Estrogen and progestogen use in posmenopausal women 2010. Position statement of North American Menopause Society, Menopause 2010;17:242-553.
3. Sturdee DW and Panay N. Recommendations for the management of posmenopausal vaginal atrophy, Climateric 2010;13:507-508.
4. Santen RJ, et al. Posmenopausal Hormone Therapy: An endocrine Society Scientific statement. J Clin Endocrinol 2010;95:S510-560.
5. Sturdee and Pines. Update IMS recommendations on posmenopuasal hormone therapy strategias for midlife Climateric 2011;14: 302-320.

Masa corporal en el climaterio

1. Pisabarro R. Metabolismo y climaterio. Rev Med Uruguay 2000;16:144-151.
2. Wu SI, et al. The impact of years since menopause on the development of impaired glucose tolerance. J Clin Epidemiol 2001;54: 117-120.
3. Despres JP, et al. Abdominal obesity and metabolic syndrome. Nature 2006;444: 881-887.
4. NAMS Position Statement. Menopause 2008;15:584-602.
5. Estrogen and progestogen hormone replacement therapy for peri-menopausal women: weight and body fat distribution (Review) Cochrane Database of Systematic Reviews, Issue 1, 2009. The Cochrane Collaboration. Published by JohnWiley & Sons, DOI: 10.1002/14651858.CD001018.
6. Estudio y tratamiento de mujeres en el climaterio y la posmenopausia. Punto de vista de la Asociación Mexicana para el Estudio del Climaterio. Ginecol Obstet Mex 2010;78(8):423-440.

Hemorragia uterina anormal en el climaterio

1. Alanis FJ, et al. Hallazgos por histeroscopia en paciente con hemorragia posmenopáusica. Ginecol Obstet Mex 2007;75(5):253-258.
2. Brown SE, et al. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 2000;74:1029-1034.
3. Kelecsi S, et al. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-age women with or without abnormal uterine bleeding. Fertil Steril 2005;84:682-686.
4. North American Menopause Society. Estrogen and progestogen use in postmenopausal women: position statement of The North American Menopause Society. Menopause 2008;15:584-602.
5. International Menopause Society. Recommendations on postmenopausal hormone therapy. 2007. www.imsociety.org.
6. Estudio y tratamiento de mujeres en el climaterio y la posmenopausia. Punto de vista de la Asociación Mexicana para el Estudio del Climaterio. Ginecol Obstet Mex 2010;78(8): 423-440.

Mastalgia y terapia hormonal de reemplazo

1. National Cancer Institute Fact Sheet. Menopausal Hormone Remplacement Therapy Use and Cancer: Questions and Answer. September 27, 2010.
2. Chlebowski RT, Kuller LH, Prentice Rl, Wactawski-Wende, et al. Brest cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med 2009;360(6): 573-587.

Terapia hormonal de reemplazo y riesgo de enfermedad coronaria (ECV)

1. Lisabeth LD, Beiser AS, Brown DL, et al. Age at natural menopause and risk of ischemic stroke: the Framingham Heart Study. Stroke 2009;40:1044-1049.
2. Lloyd-Jones D, Adams R, Carnethon M, et al. 2009 Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119: 480-486.
3. Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005;352:1293-1304.
4. Grodstein F, Manson JE, Stampfer MJ. Postmenopausal hormone use and secondary prevention of coronary events in the Nurses’ Health Study: a prospec- tive, observational study. Ann Intern Med. 2001;135:1-8. (LOE 2b).
5. Wassertheil-SmollerS, HendrixSL,LimacherM, et al. Effect of estrogen plus progestin on stroke in postmenopausal women: the Women’s Health Initiative: a randomized trial. JAMA 2003;289:2673-2684.
6. Hendrix SL, Wassertheil-Smoller S, Johnson KC, et al. Effects of conjugated equine estrogen on stroke in the Women’s Health Initiative. Circulation 2006;113:2425-2434.
7. Bath PM, Gray LJ Association between hormone replacement therapy and subsequent stroke: a meta-analysis. BMJ 2005;330:342.

THR y riesgo de tromboembolismo venonoso (TEV)

1. Rachon D, Teede H. Postmenopausal hormone therapy and the risk of venous thromboembolism. Climacteric 2008;11: 273-279.
2. Curb JD, Prentice RL, Bray PF, et al. Venous thrombosis and conjugated equine estrogen in women without a uterus. Arch Intern Med 2006;166:772-780.
3. Scarabin PY, Alhenc-Gelas M, Plu-Bureau G, et al. Effects of oral and transdermal estrogen/ progester- one regimens on blood coagulation and fibrinolysis in postmenopausal women. A randomized controlled trial. ArteriosclerThromb Vasc Biol 1997;17:3071-78 18.
Teede HJ, McGrath BP, Smolich JJ, Malan E, Kotsopoulos D, Liang YL, Peverill RE. Postmenopausal hormone replacement therapy increases coagulation activity and fibrinolysis. Arterioscler Thromb Vasc Biol 2000;20:1404-1409.
4. Canonico M, Oger E, Plu-BureauG, C et al. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation 2007;115: 840-845.
5. Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ 2008;336:1227-1231.
6. Herrington DM, Vittinghoff E, Howard TD, Factor V. Leiden, hormone replacement therapy, and risk of venous thromboembolic events in women with coronary disease. Arterioscler Thromb Vasc Biol 2002;22:1012-1017.
7. Straczek C, Oger E, Yon de Jonage-Canonico MB, et al. Prothrombotic mutations, hormone therapy, and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration. Circulation 2005;112:3495-3500.
8. Mosca L, Collins P, Herrington DM, Mendelsohn ME. Hormone replacement therapy and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 2001;104:499-50.

Terapia hormonal y cáncer

1. Consenso NAMS Menopause 2010;17: 242-255
2.
• Consenso en Postmenopausal Hormone Therapy, an Endocrine Society Scientific Statement – J Clin Endocrino Metab 2010;95 Supp1(07):S1-S66.
• American Association of Clinical Endocrinologist. Medical Guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice 2006;3:315-333.