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      Menopausia y Terapia Hormonal de la Menopausia Las recomendaciones 2018 de la Unidad de Endocrinología Ginecológica de Clínica Alemana de Santiago -Sociedad Italiana de la Menopausia y la Sociedad Chilena de Endocrinología Ginecológica

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          ABSTRACT In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these Recommendations is to provide a simple and updated reference on postmenopausal MHT. The term MHT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential (Seq) when progestogen is added to ERT for 10-14 days a month, or continuous combined (CC) when progestogen is administered continuously every day along with a fixed amount of estrogen. MHT also includes Tibolone and the Tissue Selective Estrogen Complex (TSEC).

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          Breast cancer and hormone-replacement therapy in the Million Women Study.

          Current use of hormone-replacement therapy (HRT) increases the incidence of breast cancer. The Million Women Study was set up to investigate the effects of specific types of HRT on incident and fatal breast cancer. 1084110 UK women aged 50-64 years were recruited into the Million Women Study between 1996 and 2001, provided information about their use of HRT and other personal details, and were followed up for cancer incidence and death. Half the women had used HRT; 9364 incident invasive breast cancers and 637 breast cancer deaths were registered after an average of 2.6 and 4.1 years of follow-up, respectively. Current users of HRT at recruitment were more likely than never users to develop breast cancer (adjusted relative risk 1.66 [95% CI 1.58-1.75], p<0.0001) and die from it (1.22 [1.00-1.48], p=0.05). Past users of HRT were, however, not at an increased risk of incident or fatal disease (1.01 [0.94-1.09] and 1.05 [0.82-1.34], respectively). Incidence was significantly increased for current users of preparations containing oestrogen only (1.30 [1.21-1.40], p<0.0001), oestrogen-progestagen (2.00 [1.88-2.12], p<0.0001), and tibolone (1.45 [1.25-1.68], p<0.0001), but the magnitude of the associated risk was substantially greater for oestrogen-progestagen than for other types of HRT (p<0.0001). Results varied little between specific oestrogens and progestagens or their doses; or between continuous and sequential regimens. The relative risks were significantly increased separately for oral, transdermal, and implanted oestrogen-only formulations (1.32 [1.21-1.45]; 1.24 [1.11-1.39]; and 1.65 [1.26-2.16], respectively; all p<0.0001). In current users of each type of HRT the risk of breast cancer increased with increasing total duration of use. 10 years' use of HRT is estimated to result in five (95% CI 3-7) additional breast cancers per 1000 users of oestrogen-only preparations and 19 (15-23) additional cancers per 1000 users of oestrogen-progestagen combinations. Use of HRT by women aged 50-64 years in the UK over the past decade has resulted in an estimated 20000 extra breast cancers, 15000 associated with oestrogen-progestagen; the extra deaths cannot yet be reliably estimated. Current use of HRT is associated with an increased risk of incident and fatal breast cancer; the effect is substantially greater for oestrogen-progestagen combinations than for other types of HRT.
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            Clinical practice. Primary ovarian insufficiency.

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              Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group.

              Observational studies have found lower rates of coronary heart disease (CHD) in postmenopausal women who take estrogen than in women who do not, but this potential benefit has not been confirmed in clinical trials. To determine if estrogen plus progestin therapy alters the risk for CHD events in postmenopausal women with established coronary disease. Randomized, blinded, placebo-controlled secondary prevention trial. Outpatient and community settings at 20 US clinical centers. A total of 2763 women with coronary disease, younger than 80 years, and postmenopausal with an intact uterus. Mean age was 66.7 years. Either 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate in 1 tablet daily (n = 1380) or a placebo of identical appearance (n = 1383). Follow-up averaged 4.1 years; 82% of those assigned to hormone treatment were taking it at the end of 1 year, and 75% at the end of 3 years. The primary outcome was the occurrence of nonfatal myocardial infarction (MI) or CHD death. Secondary cardiovascular outcomes included coronary revascularization, unstable angina, congestive heart failure, resuscitated cardiac arrest, stroke or transient ischemic attack, and peripheral arterial disease. All-cause mortality was also considered. Overall, there were no significant differences between groups in the primary outcome or in any of the secondary cardiovascular outcomes: 172 women in the hormone group and 176 women in the placebo group had MI or CHD death (relative hazard [RH], 0.99; 95% confidence interval [CI], 0.80-1.22). The lack of an overall effect occurred despite a net 11% lower low-density lipoprotein cholesterol level and 10% higher high-density lipoprotein cholesterol level in the hormone group compared with the placebo group (each P<.001). Within the overall null effect, there was a statistically significant time trend, with more CHD events in the hormone group than in the placebo group in year 1 and fewer in years 4 and 5. More women in the hormone group than in the placebo group experienced venous thromboembolic events (34 vs 12; RH, 2.89; 95% CI, 1.50-5.58) and gallbladder disease (84 vs 62; RH, 1.38; 95% CI, 1.00-1.92). There were no significant differences in several other end points for which power was limited, including fracture, cancer, and total mortality (131 vs 123 deaths; RH, 1.08; 95% CI, 0.84-1.38). During an average follow-up of 4.1 years, treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of CHD events in postmenopausal women with established coronary disease. The treatment did increase the rate of thromboembolic events and gallbladder disease. Based on the finding of no overall cardiovascular benefit and a pattern of early increase in risk of CHD events, we do not recommend starting this treatment for the purpose of secondary prevention of CHD. However, given the favorable pattern of CHD events after several years of therapy, it could be appropriate for women already receiving this treatment to continue.
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                Journal
                rchog
                Revista chilena de obstetricia y ginecología
                Rev. chil. obstet. ginecol.
                Sociedad Chilena de Obstetricia y Ginecología (Santiago, , Chile )
                0048-766X
                0717-7526
                November 2018
                : 83
                : 5
                : 527-550
                Affiliations
                [10] Trieste orgnameHospital de Niños Burlo Garofolo Italia
                [3] orgnameAzienda Sanitaria Universitaria Integrata Udine orgdiv1Departamento de Obstetricia, Ginecología y Pediatría Italia
                [1] Pisa orgnameHospital Universitario de Pisa orgdiv1Departamento de Obstetricia y Ginecología Italia
                [20] Santiago de Chile orgnameUniversidad Finis Terrae orgdiv1Falcultades de Medicina orgdiv2Departamentos de Ginecología y Obstetricia Chile
                [6] Siena orgnameUniversidad de Siena orgdiv1Policlínico Santa Maria le Scotte orgdiv2Departamento de Obstetricia y Ginecología Italia
                [5] Bari orgnameUniversidad de Bari orgdiv1Facultad de Medicina orgdiv2Departamento de Obstetricia y Ginecología Italia
                [22] Bío-Bío orgnameUniversidad San Sebastián orgdiv1Falcultades de Medicina orgdiv2Departamentos de Ginecología y Obstetricia Chile
                [18] Santiago de Chile orgnameUniversidad de Chile orgdiv1Unidad de Ginecología y obstetricia Chile
                [4] orgnameUniversidad de Catania orgdiv1Departamento de Cirugía General y Especialidades Médico Quirúrgicas Italia
                [17] Santiago de Chile orgnameUniversidad de Chile orgdiv1Hospital Barros Luco-Trudeau orgdiv2Facultad de Medicina Chile
                [12] Cagliari orgnameUniversidad de Cagliari orgdiv1Hospital Universitario de Cagliari orgdiv2Departamento de Cirugía, Obstetricia y Ginecología Italia
                [7] Catanzaro orgnameUniversidad Magna Græcia orgdiv1Departamento de Obstetricia y Ginecología Italia
                [11] Roma orgnameUniversità Cattolica del Sacro Cuore orgdiv1Departamento de Obstetricia y Ginecología y Pediatría Italy
                [13] Roma orgnameDemetra Medical Center Italia
                [21] Santiago de Chile orgnameUniversidad de Chile orgdiv1Facultad de Medicina Chile
                [14] Milán orgnameHospital Humanitas / S.Pio X Italia
                [8] Roma orgnameUniversidad Sapienza de Roma Italia
                [9] Brescia orgnameUniversidad de Brescia orgdiv1Departamento de Endocrinología Ginecológica Italia
                [15] Módena orgnamePoliclínica de Módena Italia
                [19] orgnameClínica Universidad de Los Andes orgdiv1Unidad de Endocrinología Chile
                [2] Turin orgnameUniversidad de Turin orgdiv1Departamento de Ginecología Italia
                [16] Santiago orgnameObstetricia Clínica Alemana de Santiago orgdiv1Unidad de Endocrino Ginecologia orgdiv2Departamento de Ginecología Chile
                Article
                S0717-75262018000500527
                10.4067/s0717-75262018000500527
                0b8dea96-4dd2-4b2b-ba52-0e5c12b69f3e

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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