Actualización de la Recomendación previa de USPSTF

Como en su recomendación de 2012 sobre el uso de la terapia hormonal de la menopausia para la prevención primaria de las enfermedades crónicas, la USPFTS continúa recomendando contra el uso de estrógenos combinados con progestina para la prevención primaria de enfermedades crónicas en mujeres posmenopáusicas y contra el uso de estrógeno solo en la posmenopausia en mujeres que han tenido una histerectomía. Le puede interesar: Declaración de Posición de la Terapia Hormonal NAMS

Recomendaciones de otros 

La American Heart Association33 y el American College of Obstetricians and Gynecologists34 no recomiendan el uso de la terapia hormonal para la prevención primaria o secundaria de enfermedad coronaria, y la mayoría de las guías clínicas, que incluyen Canadian Task Force on Preventive Health Care35 y American Academy of Family Physicians,36 no recomiendan el uso de la terapia hormonal para la prevención de cualquier condición crónica.

La American Association of Clinical Endocrinologists37,38 recomienda que el riesgo cardiovascular, la edad y el tiempo de la menopausia sean considerados cuando se usa terapia hormonal en los síntomas de mujeres posmenopáusicas y señala que la terapia hormonal está aprobada por la FDA para su uso en mujeres con mayor riesgo de osteoporosis y fracturas. Lea También: No se encontró un vínculo entre la Terapia Hormonal y las tasas de mortalidad por causas de WHI

Efecto de la terapia hormonal

El American College of Obstetricians and Gynecologists menciona que el efecto de la terapia hormonal sobre el riesgo de la enfermedad cardiovascular puede diferir según la iniciación temprana o tardía de la terapia hormonal con relación al inicio de la menopausia.

La North American Menopause Society39 se enfoca principalmente en consideraciones para mujeres con síntomas; nota que la terapia hormonal ha demostrado prevenir las fracturas y ese tratamiento debería ser individualizado para equilibrar los posibles beneficios y riesgos de salud para cada mujer.

La Endocrine Society40 también se enfoca principalmente sobre el uso de la terapia hormonal para el tratamiento de los síntomas de la menopausia. Pero los resultados no fueron concluyentes.21,41

Miembros de la US Preventive Services Task Force (USPSTF): David C. Grossman, MD, MPH; Susan J. Curry, PhD; Douglas K. Owens, MD, MS; Michael J. Barry, MD; Karina W. Davidson, PhD, MASc; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Alex R. Kemper, MD, MPH, MS; Alex H. Krist, MD, MPH; Ann E. Kurth, PhD, RN, MSN, MPH; C. Seth Landefeld, MD; Carol M. angione, MD, MSPH; Maureen G. Phipps, MD, MPH; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE.

Referencias

  1. Gartlehner G, Patel S, Viswanathan M, et al. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: An Evidence Review for the US Preventive Services Task Force: Evidence Synthesis No. 155. Rockville, MD: Agency for Healthcare Research and Quality; 2017. AHRQ publication 15-05227-EF-1.
  2. Pfizer Inc. Premarin [package insert]. http://labeling.pfizer.com/showlabeling.aspx?id=131. 2014. Accessed October 17, 2017.
  3. U.S. Preventive Services Task Force. Medications to decrease the risk for breast cancer in women: recommendations from the U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013; 159(10):698-708.
  4. LeFevre ML; U.S. Preventive Services Task Force. Behavioral counseling to promote a healthful diet (0.48-0.89] and self-reported incident diabetes in the WHI trial (mean followup, and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(8):587-593.
  5. Bibbins-Domingo K; U.S. Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016; 164(12):836-845.
  6. McKinlay SM. The normal menopause transition: an overview. Maturitas. 1996; 23(2):137-145.
  7. Social Security Administration. Actuarial life table: period life table, 2014. https://www.ssa.gov/oact/STATS/table4c6.html. Accessed October 17, 2017.
  8. Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. Natl Vital Stat Rep. 2016;64(2):1-119.
  9. Healthcare Cost and Utilization Project. Total number of discharges by age group, by sex, for CCSprincipal diagnosis category 226, fracture of neck of femur. https://hcupnet.ahrq.gov/. 2014. Accessed February 14, 2017.
  10. Ensrud KE. Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci. 2013; 68(10):1236-1242.

    Bibliografías

  11. Heiss G, Wallace R, Anderson GL, et al; WHI Investigators. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA. 2008;299(9): 1036-1045.
  12. La Croix AZ, Chlebowski RT, Manson JE, et al; WHI Investigators. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA. 2011;305(13):1305-1314.
  13. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13): 1353-1368.
  14. Hulley S, Furberg C, Barrett-Connor E, et al; HERS Research Group. Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA. 2002;288(1):58-66.
  15. Herrington DM, Reboussin DM, Brosnihan KB, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med. 2000;343(8):522-529.
  16. Miller VT, La Rosa J, Barnabei V, et al; Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA. 1995;273(3):199-208.
  17. Veerus P, Hovi SL, Fischer K, Rahu M, Hakama M, Hemminki E. Results from the Estonian Postmenopausal Hormone Therapy Trial [ISRCTN35338757]. Maturitas. 2006; 55(2): 162-173.
  18. Vickers MR, MacLennan AH, Lawton B, et al; WISDOM Group. Main morbidities recorded in the Women’s International Study of Long Duration Oestrogen After Menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women. BMJ. 2007;335(7613):239.
  19. Cherry N, Gilmour K, Hannaford P, et al; ESPRIT Team. Oestrogen therapy for prevention of reinfarction in postmenopausal women: a randomised placebo controlled trial. Lancet. 2002;360(9350):2001-2008.
  20. Hodis HN, MackWJ, Lobo RA, et al; Estrogen in the Prevention of Atherosclerosis Trial Research Group. Estrogen in the prevention of atherosclerosis: a randomized, doubleblind, placebo- controlled trial. Ann Intern Med. 2001;135 (11):939-953.

    Lecturas Recomendadas

  21. Tierney MC, Oh P, Moineddin R, et al. A randomized double-blind trial of the effects of hormone therapy on delayed verbal recall in older women. Psychoneuroendocrinology. 2009;34(7): 1065-1074.
  22. Shumaker SA, Legault C, Rapp SR, et al; WHIMS Investigators. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women’s Health Initiative Memory Study. JAMA. 2003;289(20):2651-2662.
  23. Shumaker SA, Legault C, Kuller L, et al; Women’s Health Initiative Memory Study. Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women. JAMA. 2004;291(24):2947-2958.
  24. Cirillo DJ, Wallace RB, Rodabough RJ, et al. Effect of estrogen therapy on gallbladder disease. JAMA. 2005;293(3):330-339.
  25. Hendrix SL, Cochrane BB, Nygaard IE, et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA. 2005;293(8): 935-948.
  26. Steinauer JE, Waetjen LE, Vittinghoff E, et al. Postmenopausal hormone therapy: does it cause incontinence? Obstet Gynecol. 2005; 106(5, pt 1): 940-945.
  27. Waetjen LE, Brown JS, Vittinghoff E, et al. The effect of ultralow-dose transdermal estradiol on urinary incontinence in postmenopausal women. Obstet Gynecol. 2005;106(5, pt 1):946-952.
  28. Kanaya AM, Herrington D, Vittinghoff E, et al; Heart and Estrogen/progestin Replacement Study. Glycemic effects of postmenopausal hormone therapy: a randomized, doubleblind, placebo-controlled trial. Ann Intern Med. 2003;138 (1):1-9.
  29. Cherry N, McNamee R, Heagerty A, et al. Long-term safety of unopposed estrogen used by women surviving myocardial infarction: 14-year follow-up of the ESPRIT randomized controlled trial. BJOG. 2014;121(6):700-705.
  30. Anderson GL, Judd HL, Kaunitz AM, et al. Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women’s Health Initiative randomized trial. JAMA. 2003;290(13):1739-1748.

    Referencias Bibliográficas

  31. Manson JE, Aragaki AK, Rossouw JE, et al; WHI Investigators. Menopausal hormone therapy and long-term all-cause and causespecific mortality: the Women’s Health Initiative randomized trials. JAMA. 2017;318(10):927-938.
  32. Chlebowski RT, Anderson GL. Changing concepts: menopausal hormone therapy and breast cancer. J Natl Cancer Inst. 2012; 104(7):517-527.
  33. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation. 2011;123(11):1243-1262.
  34. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 565: hormone therapy and heart disease. Obstet Gynecol. 2013;121(6):1407-1410.
  35. Wathen CN, Feig DS, Feightner JW, et al; Canadian Task Force on Preventive Health Care. Hormone replacement therapy for the primary prevention of chronic diseases: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ. 2004;170(10):1535-1537.
  36. American Academy of Family Physicians. Clinical preventive service recommendation: hormone replacement therapy. http://www.aafp.org/patient-care/clinical-recommendations/all/hrt.html. 2012. Accessed October 17, 2017.
  37. Goodman NF, Cobin RH, Ginzburg SB, et al; American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocr Pract. 2011; 17(suppl 6):1-25.
  38. Cobin RH, Goodman NF; AACE Reproductive Endocrinology Scientific Committee. American Association of Clinical Endocrinologists and American College of Endocrinology position statement on menopause—2017 update. Endocr Pract. 2017;23(7):869-880.
  39. NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of the North American Menopause Society. Menopause. 2017;24(7):728-753.
  40. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975- 4011.
  41. USPSTF Recommendation Statement: Hormone Therapy After Menopause US Preventive Services Task Force Clinical Review& Education. JAMA. 2017;318(22): 2224-2233. doi:10.1001/jama.2017.18261
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