Visión actual de la terapia de sustitución hormonal en la mujer posmenopáusica
DOI:
https://doi.org/10.18597/rcog.558Palabras clave:
postmenopausia, terapia de reemplazo hormonalResumen
Durante casi una década se esperaron los resultados del estudio WHI (Women’s Health Initiative) que se suponía, brindarían información definitiva respecto al empleo de la terapia de reemplazo hormonal en la mujer menopáusica. Para sorpresa de la mayoría, a partir de julio de 2002 han aparecido informes de este estudio, que en general son contrarios a lo que se esperaba y a las creencias que se tenían previamente con respecto a los beneficios y a los riesgos de estas terapias. Las críticas y las posibles explicaciones a estos resultados no se hicieron esperar, y hoy existe bastante confusión al respecto, no sólo para los profesionales de la salud sino especialmente para las mujeres. En el presente artículo se hace una revisión de los aspectos metodológicos más relevantes del estudio WHI y se hace un análisis de las posibles explicaciones para la resistencia a aceptar sus resultados. Se concluye que el estudio tiene validez interna, sus resultados son importantes y la posibilidad de extrapolarlos es bastante alta; también, que en el momento, la única indicación aceptable para la terapia de sustitución hormonal es el control de la sintomatología vasomotora. Es necesario esperar otros reportes antes de aceptar como terapia de reemplazo otros preparados similares.Biografía del autor/a
John Jairo Zuleta
Referencias bibliográficas
Fletcher RH, Fletcher S, Wagner EH. Epidemiología clínica. Aspectos fundamentales. 2ª ed. Barcelona; 1998.
Rossouw JE. Estrogens for prevention of coronary heart disease. Putting the brakes on the bandwagon. Circulation 1996;94:2982-5.
Mathews KA, Kuller LH, Wing RR, Meilahn EN, Plantinga P. Prior to use of estrogen replacement therapy, are user healthier than nonusers? Am J Epidemiol 1996;143:971-8.
Barrett-Connor E. Postmenopausal estrogen and prevention bias. Ann Intern Med 1991;115:455-6.
Sturgeon S, Schairer C, Brinton LA, Pearson T, Hoover R. Evidence of healthy estrogen user survivor effect. Epidemiology 1995;6:227-31.
Posthuma W, Westendorp RG, Vanderbrouche JP. Cardioprotective effect of hormone replacement therapy in posmenopausal women: is the evidence biased? BMJ 1994;308:1268-9.
Grondstein F. Invited commentary: can selection bias explain the cardiovascular benefits of estrogen replacement therapy? Am J Epidemiol 1996;143:979-82.
Hemminki E, McPherson K. Impact of postmenopausal hormone therapy on cardiovascular events and cancer: pooled data from clinical trials. BMJ 1997;315:149-53.
Zuleta J. Terapia de reemplazo hormonal y enfermedad coronaria: beneficios explicados por los sesgos en la investigación. Rev Colomb Obstet Ginecol 2003;54:113-20.
The Women’s Health Initiative Group. Design of the Women’s Health Initiative Clinical trial and observational study. Controlled Clin Trials 1998;19:61-109.
Freedman L, Anderson G, Kipnis V, Prentice R, Wang CY, Rossow J, et al. Approached to monitoring the results of long-term disease prevention trials: examples from the Women’s Health Initiative. Controlled Clin Trials 1996; 17:509-25.
Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al; Writing Group for the Women’s Health Initiative Investigators. Risk and benefits of estrogen plus progestin in healthy posmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321-33.
Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, et al; The Women’s Health Initiative Steering Commitee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 2004;291:1701-12.
White C. Second long term HRT trial sttoped early. BMJ 2002;325:987.
Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 1993;270:2598-601.
Montori VM, Guyatt GH. Intention-to-treat principle. CMAJ 2001;165:1339-41.
Kleinbum D, Kupper LL, Morgenstern H. Chapter 13. Confounding. In: Kleinbum D, Kupper L, Morgenstern H. Epidemiologic research: principles and quantitative methods. New York: Van Nostrand Company; 1982. p. 243-65.
Kleinbaum D. The Cox Proportional Hazard Model and its characteristics. In: Kleinbaum D. Survival Analysis. A self-learning text. 1st ed. New York: Springer Verlag; 1996.
Manson J, Hsia J, John son K, Rossouw J, Assaf AR, Lasser N, et al; Women’s Health Initiative Investigators. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003;349:523-34.
Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998;280:605-13.
Cauley JA, Robbins J, Chen Z, Cummings SR, Jackson RD, LaCroix A, et al. Women’s Health Initiative Investigators. Effects of estrogen plus progestin on risk of fracture and bone mineral density. The Women’s Health Initiative randomized trial. JAMA 2003;290: 1729-38.
Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, et al; WHI Investigators. Influence of estrogen plus progestin on breast cancer and mammography in healthy posmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA 2003;289:3243-53.
Chlebowski R, Wactawski-Wende J, Ritenbaugh C, Hubbell A, Ascensao J, Rodabough R, et al; Women’s Health Initiative Investigators. Estrogen plus progestin and colorrectal cancer in posmenopausal women. N Engl J Med 2004;350:991-1004.
Cauley JA, Norton L, Lippman ME, Eckert S, Krueger KA, Purdie DW, et al. Continued breast cancer risk reduction in posmenopausal women treated with raloxifene: 4-year results from the MORE trial. Multiple outcomes of raloxifene evaluation. Breast Cancer Res Treat 2001;65:125-34.
The GUSTO investigators. An international randomized trial comparing four thrombolityc strategies for acute miocardial infarction. N Engl J Med 1993;329:673-82.
Silverstein F, Faich G, Goldstein JL, Simon LS, Pincus T, Whelton A, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controled trial. JAMA 2000;284:1247-55.
http://www.channing.harvard.edu/nhs/questionnaires/qx_all.shtml. Acceso el 23 de octubre de 2004
Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Willett WC, Rosner B, et al. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med 1996;335:453-61.
Grodstein F, Stampfer MJ, Colditz GA, Willett WC, Manson JE, Joffe M, et al. Postmenopausal hormone therapy and mortality. N Engl J Med 1997; 336:1769-75.
Grodstein F, Martinez ME, Platz EA, Giovannucci E, Colditz GA, Kautzky M, et al. Postmenopausal hormone use and risk for cancer and adenoma. Ann Intern Med 1998;128:705-12.
Grodstein F, Manson JE, Stampfer MJ. Postmenopausal hormone use and secondary prevention of coronary events in the nurses’ health study. Ann Intern Med 2001;135:1-8.
Cherry N, Gilmour K, Hannaford P, Heagerty A, Khan MA, Kitchener H; ESPRIT team. Oestrogen therapy for prevention of reinfarction in postmenopausal women: a randomized placebo controlled trial. Lancet 2002;360:2001-8.
Herrington DM, Reboussin DM, Brosnihan KB, Sharp PC, Shumaker SA, Snyder TE, et al. Effects of estrogen replacement on the progression of coronary artery atheroesclerosis. N Engl J Med 2000;343:522-9.
Viscoli C, Brass LM, Kernan WN, Sarrel PM, Suissa S, Horwitz RI. A clinical trial of estrogen-replacement therapy after ischemic stroke. N Engl J Med 2001;345:1243-9.
Moynihan R, Health I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002;324:886-91.
Avorn J, Chen M, Hartley R. Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med 1982;73:4-8.
Orlowski JP, Wateska L. The effects of pharmaceutical frim enticements on physician prescribing patterns. There’s no such thing as a free lunch. Chest 1992;102:270-3.
Moynihan R. Who pays for the pizza? Redefining the relationships between doctors and drug companies. 1: entanglement. BMJ 2003;326:1189-92.
Melander H, Ahlqvist-Rastad J, Meijer G, Beermann B. Evidenced based medicine--selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. BMJ 2003;326:1171-3.
Rennie D. Thyroid storm. JAMA 1997;277:1238-43.
Moynihan R. Drug company secretly briefed medical societies on HRT. BMJ 2003;326:1161.
Koch K. Schering uses German medical association to promote HRT. BMJ 2003;326:1161.
Hays J, Ockene JK, Brunner RL, Kotchen JM, Manson JE, Petterson RE, et al; Women’s Health Initiative Investigators. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med 2003;348:1839-54.
Shumaker SA, Legault C, Rapp SR, Thal L, Wallace RB, Ockene JK, et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in posmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial. JAMA 2003;289:2651-62.
Rapp SR, Espeland MA, Shumaker SA, Henderson VW, Brunner RL, Manson JE, 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;289:2663-72.
Shumaker SA, Legault C, Kuller L, Rapp SR, Thal L, Lane DS, et al. Conjugated equine estrogen and incidence of probable dementia and mild cognitive impairment in postmenopausal women. Womens’ Health Initiative Memory Study. JAMA 2004;291:2947-58.
Espeland MA, Rapp SR, Shumaker SA, Brunner R, Manson JE, Sherwin BB, et al. Conjugated equine estrogen and global cognitive function in postmenopausal women. Womens’ Health Initiative Memory Study. JAMA 2004;291:2959-68.
Kang JH, Weuve J, Grodstein F. Postmenopausal hormone therapy and risk of cognitive decline in community-dwelling aging women. Neurology 2004;63:101-7.
Zuckerman D. Hype in health reporting: “checkbook science” buys distortion of medical news. Intl J Health Serv 2003;33:383-9.
Stampfer MJ, Colditz GA. Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence. Prev Med 1991;20:47-63.
Stampfer M. Commentary: hormones and heart disease: do trials and observational studies address different questions? Int J Epidemiol 2004; 33: 454-5.
Fletcher SW, Colditz GA. Failure of estrogen plus progestin therapy for prevention. JAMA 2002;288:366-8.
Grady D, Rubin SM, Petiti DB, Fox CS, Black D, Ettinger B, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992;117:1016-37.
Grady D. Postmenopausal hormones-- therapy for symptoms only. N Engl J Med 2003;348:1835-7.
Petitti D. Commentary: hormone replacement therapy and coronary heart disease: four lessons. Int J Epidemiol 2004;33:461-3.
Hulley SB, Grady D. The WHI estrogen-alone trial - do things look any better? JAMA 2004;291:1769-71.
Grodstein F, Clarkson TB, Manson JE. Understanding the divergent data on postmenopausal hormone therapy. N Engl J Med 2003,348:645-50.
Naftolin F, Taylor HS, Karas R, Brinton E, Newman I, Clarkson TB, et al; Women’s Health Initiative. The Women’s Health Initiative could not have detected cardioprotective effects of starting hormone therapy during the menopausal transition. Fertil Steril 2004;81:1498-501.
Neves-E-Castro M. Menopause in crisis post-Women Health Initiative? A view based on personal clinical experience. Hum Reprod 2003;18:2512-8.
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