Posición de Terapia Hormonal, Enfermedad de Alzheimer

Enfermedad de Alzheimer

Cuatro estudios observacionales apoyan la visión que el momento de iniciación de la TH es un determinante significativo de riesgo de enfermedad de Alzheimer, con la iniciación temprana disminuyendo el riesgo e iniciación posterior asociada con mayor riesgo.165-168

Demencia 

En el estudio de la memoria WHI, EEC/ AMP, este duplicó el riesgo de demencia de todas las causas (23 casos por cada 10.000 iniciado en mujeres mayores de 65 años,164 mientras que la EEC solos no aumentó significativamente el riesgo de demencia.169 El efecto de la TH puede ser modificado por la función cognitiva de base, con efectos más favorables en las mujeres con función cognitiva normal antes de la iniciación de la TH.170,171

Puntos clave

• En ausencia de hallazgos más definitivos, la TH no puede ser recomendado a cualquier edad para prevenir o tratar una función cognitiva o demencia.
• Sobre la base del Estudio de la Memoria del WHI, debe ser tomado con cautela el inicio continuo-combinado diario de CEE/ MPA en mujeres mayores de 65 años, dado el aumento relativamente pequeño o riesgo poco frecuente de demencia de 23 casos adicionales por cada 10.000 años-persona visto en el WHI, es efectivo.
• ¿La terapia de estrógeno puede tener beneficios cognitivos positivos cuando se inició inmediatamente después de la menopausia quirúrgica temprana, pero TH en el período posmenopáusico natural temprano tiene efectos neutros sobre la función cognitiva actual.
• Solo un apoyo limitado (estudios observacionales) está disponible para una hipótesis de la ventana crítica de TH en la prevención de enfermedad de Alzheimer.
• El efecto de TH puede ser modificado por la función basal cognitiva, con efectos más favorables en mujeres con función cognitiva normal antes de la iniciación de TH.
• La evidencia es insuficiente para apoyar el uso de TH en el tratamiento de la depresión clínica. En ECA pequeños, TE fue eficaz en mejorar la depresión clínica en la perimenopausia pero no en mujeres posmenopáusicas.
• Las progestinas pueden contribuir al trastorno del estado de ánimo.
• Las mujeres cuya depresión mejora con TH son susceptibles a experimentar un empeoramiento del estado de ánimo después de retirar de estrógeno.

El Alzheimer tiene tres subtipos diferentes

Agradecimientos

The NAMS 2017 Hormone Therapy Position Statement Advisory Panel: Chair, JoAnn V. Pinkerton, MD, NCMP, NAMS Executive Director; Professor of Obstetrics and Gynecology; Division Director, Midlife Health Center; University of Virginia Health System, Charlottesville, Virginia. Dr. Fernando Sánchez Aguirre, Asociación Mexicana para el Estudio del Climaterio A.C.; Mexico City, Mexico. Jennifer Blake, MD, MSc, FRCS, Chief Executive Officer, the Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada. Felicia Cosman, MD, Professor of Medicine, Columbia University College of Physicians and Surgeons; Medical Director, Clinical Research Center; Helen Hayes Hospital, West Haverstraw, New York. Howard N.

Hodis, MD, Harry J. Bauer and Dorothy Bauer Rawlins Professor of Cardiology; Professor of Medicine and Preventive Medicine; Professor of Molecular Pharmacology and Toxicology; Director of the Atherosclerosis Research Unit, Division of Cardiovascular Medicine; Kent School of Medicine; University of Southern California, Los Angeles, California. Susan Hoffstetter, PhD, WHNP-BC, FAANP, Associate Professor, St. Louis University School of Medicine; Department of Obstetrics, Gynecology, and Women’s Health; Division of Uro-Gynecology; St. Louis, Missouri. Andrew M. Kaunitz, MD, NCMP, University of Florida Research Foundation Professor and Associate Chair, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Medical Director and Director, Menopause and Gynecologic Ultrasound Services, UF Southside Women’s Health, Jacksonville, Florida. Sheryl A. Kingsberg, PhD, Chief, Division of Behavioral Medicine; University Hospitals Cleveland Medical Center; MacDonald Women’s Hospital; Professor, Departments of Reproductive Biology and Psychiatry; Case Western Reserve University School of Medicine; Cleveland, Ohio. Pauline M. Maki, PhD, Associate Professor of Psychiatry and Psychology; Director, Women’s Mental Health Research; University of Illinois at Chicago College of Medicine; Chicago, Illinois.

JoAnn E. Manson, MD, Dr.PH, NCMP, Chief, Division of Preventive Medicine; Brigham and Women’s Hospital; Professor of Medicine and the Michael and Lee Bell Professor of Women’s Health; Harvard Medical School; Boston, Massachusetts. Polly Marchbanks, PhD, MSN, Captain, USPHS (Retired); Epidemiologist; Atlanta, Georgia. Michael R. McClung, MD, Founding Director, Oregon Osteoporosis Center, Portland, Oregon. Lila E. Nachtigall, MD, NCMP, Professor of Obstetrics and Gynecology; New York University School of Medicine; New York. Lawrence M. Nelson, MD, MBA, Director, Strategic Alliances, Mary Elizabeth Conover Foundation, Inc, McLean, Virginia.

Diane Todd Pace, PhD, APRN, FNPBC, NCMP, FAANP, Associate Professor, Department of Advanced Practice and Doctoral Studies; Director, DNP Program; Family Nurse Practitioner and Methodist Teaching Practice; University of Tennessee Health Science Center; College of Nursing; Memphis, Tennessee. Robert L. Reid, MD. Professor of Obstetrics and Gynaecology; Chair, Division of Reproductive Endocrinology and Infertility; Queen’s University; Kingston, Ontario, Canada.

Lea También: Declaración de Posición de la Terapia Hormonal NAMS 2017

Philip M. Sarrel, MD, Emeritus Professor of Obstetrics, Gynecology, and Reproductive Services and of Psychiatry; Yale University; New Haven, Connecticut. Jan L. Shifren, MD, NCMP, Professor of Obstetrics, Gynecology, and Reproductive Biology; Harvard Medical School; Director, Midlife Women’s Health Center; Massachusetts General Hospital; Boston, Massachusetts. Cynthia A. Stuenkel, MD, NCMP, Clinical Professor of Medicine; University of California, San Diego, School of Medicine; La Jolla, California.

Wulf H. Utian, MD, PhD, DSc (Med), NCMP, NAMS Honorary Trustee and Executive Director Emeritus; Professor Emeritus, Case Western Reserve University School of Medicine; Scientific Director, Rapid Medical Research; Cleveland, Ohio. NAMS recognizes the contributions of Ms. Carolyn Develen, NAMS Chief Operating Officer, and Ms. Kathy Method, MA, NAMS Communications Manager. The position statement was reviewed and approved by the 2016-2017 NAMS Board of Trustees: President, Marla Shapiro, C.M., MDCM, CCFP, MHSC, FRCPC, FCFP, NCMP, Professor, Department of Family and Community Medicine; University of Toronto; Ontario, Canada. President-Elect, Sheryl A. Kingsberg, PhD, Chief, Division of Behavioral Medicine; University Hospitals Cleveland Medical Center; MacDonald Women’s Hospital; Professor, Departments of Reproductive Biology and Psychiatry; Case Western Reserve University School of Medicine; Cleveland, Ohio.

Immediate Past President, Peter F. Schnatz, DO, FACOG, FACP, NCMP, Associate Chairman and Residency Program Director; Department of Obstetrics and Gynecology; The Reading Hospital and Medical Center; Reading, Pennsylvania. Treasurer, James H. Liu, MD, NCMP, Arthur H. Bill Professor of Obstetrics and Gynecology; University Hospitals Cleveland Medical Center; MacDonald Women’s Hospital; Department of Reproductive Biology; Case Western Reserve University School of Medicine; Cleveland, Ohio.

Secretary, Andrew M. Kaunitz, MD, NCMP, University of Florida Research Foundation Professor and Associate Chair, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Medical Director and Director, Menopause and Gynecologic Ultrasound Services, UF Southside Women’s Health, Jacksonville, Florida. JoAnn V. Pinkerton, MD, NCMP, NAMS Executive Director; Professor of Obstetrics and Gynecology; Division Director of Midlife Health; University of Virginia Health System; Charlottesville, Virginia. Lisa Astalos Chism, DNP, APRN, NCMP, FAANP, Clinical Director, Women’s Wellness Clinic; Sexual Health Counselor and Educator, Karmanos Cancer Institute; Adjunct Assistant Professor, Wayne State University School of Medicine; Detroit, Michigan.

Howard N. Hodis, MD, Harry J. Bauer and Dorothy Bauer Rawlins Professor of Cardiology; Professor of Medicine and Preventive Medicine; Professor of Molecular Pharmacology and Toxicology; Director, Atherosclerosis Research Unit, Division of Cardiovascular Medicine; Krek School of Medicine; University of Southern California; Los Angeles, California. Michael R. McClung, MD, Founding Director, Oregon Osteoporosis Center, Portland, Oregon.

Katherine M. Newton, Senior Investigator, Group Health Research Institute; Metropolitan Park East; Seattle, Washington. Gloria A. Richard-Davis, MD, FACOG, NCMP, Division Director, Reproductive Endocrinology and Infertility; University of Arkansas Medical Sciences; Department of Obstetrics and Gynecology; Little Rock, Arkansas. Nanette F. Santoro, MD, Professor and E. Stewart Taylor Chair of Obstetrics and Gynecology; University of Colorado School of Medicine; Aurora, Colorado. Rebecca C.

Thurston, PhD, Director, Women’s Biobehavioral Health Laboratory; Professor of Psychiatry, Psychology, Epidemiology, and Clinical and Translational Science; University of Pittsburgh; Pittsburgh, Pennsylvania.

Isaac Schiff, CM, MD, Editor-in-Chief, Menopause; Joe Vincent Meigs Distinguished Professor of G necology; Harvard Medical School; Chief, Department of Obstetrics and Gynecology Emeritus, The Women’s Care Division, Massachusetts General Hospital; Boston, Massachusetts. Wulf H. Utian, MD, PhD, DSc (Med), NAMS Honorary Trustee and Executive Director Emeritus; Professor Emeritus, Case Western Reserve University School of Medicine; Scientific Director, Rapid Medical Research; Cleveland, Ohio.

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