Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement

Abstract

The major conclusions related to the overall benefits and risks of MHT expressed as the number of women per 1000 taking MHT for 5 yr who would experience benefit or harm. Primary areas of benefit included relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes. Risks included venothrombotic episodes, stroke, and cholecystitis. In the subgroup of women starting MHT between ages 50 and 59 or less than 10 yr after onset of menopause, congruent trends suggested additional benefit including reduction of overall mortality and coronary artery disease. In this subgroup, estrogen plus some progestogens increased the risk of breast cancer, whereas estrogen alone did not. Beneficial effects on colorectal and endometrial cancer and harmful effects on ovarian cancer occurred but affected only a small number of women. Data from the various Women's Health Initiative studies, which involved women of average age 63, cannot be appropriately applied to calculate risks and benefits of MHT in women starting shortly after menopause. At the present time, assessments of benefit and risk in these younger women are based on lower levels of evidence.

Postmenopausal Serum Sex Steroids and Risk of Hormone Receptor–Positive and -Negative Breast Cancer: a Nested Case–Control Study

“…Observations from studies relating breast cancer risk and population incidence rates with the use of postmenopausal hormone (estrogen alone, or estrogen plus progestin) therapy suggest that effects of estrogens on breast tumor development could be essentially late stage (29,30). In our study, interestingly, serum estradiol concentrations were associated more strongly with risk of breast cancer diagnosed at least 2 years after blood donation than for breast cancer diagnosed within a less than a 2-year interval.…”

Reducing posttreatment relapse in cleft lip palatal expansion using an injectable estrogen–nanodiamond hydrogel

“…In particular, estrogen, a naturally occurring steroid, holds great promise due to its well-known benefits in bone homeostasis (13,14). However, estrogen is a pleiotropic hormone that has multiple physiological functions (15) and its effects in the body are dependent on its route of administration (16). When taken orally, most 17β-estradiol (E2) is converted in the liver into estrone (E1), which is 10-fold less potent than E2 (17).…”

Terapia de reposição hormonal na menopausa

“…Os efeitos da THM no metabolismo dos hidratos de carbono podem ser diretos, isto é, no pâncreas ou na musculatura esquelética, melhorando a sensibilidade à insulina, ou indiretos, reduzindo o acúmulo de gordura visceral. Esses efeitos dependem da via de administração, da dose e do tipo do estrogênio utilizado na reposição pós-menopausa (7,15).…”

“…Essas publicações geraram 10 anos de controvérsia na análise detalhada de seus resultados. A Endocrine Society Scientific Statements, ao rever toda a literatura publicada sobre THM, valendo-se apenas dos ensaios clínicos com metodologia controlada e classificando todas as conclusões com o método GRADE (Grading of Recommendations Assessment, Development and Evaluation) (6), publicou um posicionamento rigorosamente documentado e com todas as conclusões a respeito dos riscos e benefícios da THM classificadas de acordo com o grau de evidência (7). As conclusões estão divididas naquelas que permaneceram inalteradas com o passar do tempo, com base em estudos experimentais de melhor consistência (grau de evidência A), aquelas que permaneceram inalteradas, porém com um nível menor de certeza, baseadas em estudos experimentais ou observacionais de menor consistência (grau de evidência B), e aquelas baseadas em relatos de caso e estudos não controlados (grau de evidência C, D).…”