Menopausia: panorama actual de manejo
Resumo
Aún existe, desde 2002, una marcada disminución en el uso de terapia hormonal clásica (TH), para el manejo de la menopausia, debido a los riesgos determinados en el estudio Iniciativa de salud para las mujeres (WHI: Women’s Health Initiative). No obstante, revisiones del WHI y evidencias actuales determinan que la TH: (a) es la terapia más efectiva de los síntomas vasomotores, de sus potenciales consecuencias (disminución en calidad del sueño, irritabilidad, reducción en calidad de vida), y para tratar la atrofia urogenital. (b) Previene la osteoporosis y en pacientes con endotelios sanos, reduce el riesgo de hipertensión arterial, diabetes II y enfermedad coronaria, siendo el cociente beneficio/ riesgo mayor cuando se inicia tempranamente al sucederse el hipoestrogenismo. (c) Existe la tendencia a utilizar dosis mínimas, estrógenos no orales y progestágenos puros, para disminuir sus riesgos. (d) Tibolona y paroxetina son las mejores alternativas para tratar los síntomas vasomotores. (e) Finalmente, los cambios a estilo de vida saludable son coadyuvantes excelentes de la TH en el manejo de los síntomas menopaúsicos y en la prevención de las enfermedades crónicas de la postmenopausia, las cuales ameritan tratamientos específicos.
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