REPUBLICA BOLIVARIANA DE VENEZUELA

MINISTERIO DE EDUCACION SUPERIOR

INSTUTITO VENEZOLANO DE LOS SEGUROS SOCIALES
POSTGRADO DE PEDIATRIA Y PUERICULTURA
CATEDRA: INGLES
PROFESOR: VICTOR SANCHEZ

Menopausia y terapia de reemplazo hormonal

Menopause and hormone replacement therapy

Valera, Mayo de 2016

DEFINITION:
Menopause is defined as the one-year cessation of menstrual secondary to
a permanent and definitive failure of ovarian follicular function cycles. The absence
of menstrual cycles for a year is not seen very often since many women consult at
the onset of menstrual changes and even, in a preventive manner, even when
cycles are normal. Natural menopause is inserted into a change process called
climacteric, which begins when the woman is still in reproductive stage and
culminates in the late postmenopause. The climacteric is characterized by a
progressive decline of ovarian follicular function with initial manifestations, such as
ovulatory dysfunction, luteal phase failure, short cycles and / or episodes of oligoamenorrhea, hot flushes associated or not (premenopause). To the extent that
ovarian failure increases, begin to appear characteristic symptoms and signs of
hypoestrogenism

relative,

as

frequent

hot

flashes,

excessive

sweating

predominantly nocturnal, insomnia, emotional lability, depression and significant

alterations of menstrual cycles, dominated by oligo amenorrhea variable duration.
Finally, after a variable duration of this transition, the patient becomes permanent
amenorrhea by a fall of endogenous estradiol production to minimum levels,
product of a final follicular depletion.
Most frequent reasons of consultation in this period are:

Vasomotor symptoms: Hot flashes, night sweats and tachycardia.

Alteration of menses: Oligo-amenorrhea.
Genitourinary annoyances: Vulvovaginal dryness, dyspareunia and dysuria.
Psychic manifestations: Emotional lability, depression, anxiety and memory

loss.
Preventive control: Added as frequent consultation product of the best
information from the susceptible population.

CONSEQUENCES OF ESTROGEN DEFICIENCY

There are different signs and symptoms that occur as a result of estrogen
deficiency. The time and intensity of onset is highly variable in different ethnic
groups and cultures and also between different individuals. Some of these

symptoms and signs are transient, start some time before menopause and last for
a few years. Others are permanent, usually appear after menopause, sometimes
late and some are even considered as a disease.
Estrogen deficiency is associated with emotional disturbances, as these
affect the activity of neurotransmitters in the central nervous system, especially
serotonin.
The decrease in specific activity of neurotransmitters in the hypothalamus
synapses can have a negative effect on the sense of emotional well-being.
OBJECTIVES OF HORMONE REPLACEMENT THERAPY (HRT)
When the doctor decides that a particular patient is a candidate for hormone
replacement therapy should consider, first, what or what are the reasons why they
should receive hormone supplementation and guide treatment in that regard.
The objectives of HRT will be individual and should be taken into account
symptoms, risk factors and evolution of these during therapy. These objectives are:

Trying general symptomatology.

Curbing osteoporosis hypoestrogenism.
Reduce cardiovascular risk.
Improve mental condition.
Improve quality of life.

ACCEPTANCE AND COLLATERAL EFFECTS OF HRT

Since the first years of use hormone replacement therapy has had little
acceptance among users because of fears about potential side effects, such as
body changes, risk of cancer and symptoms associated with their use.
In developed countries, acceptance rates of HRT does not exceed 30-40%
of the population, despite having been lot of information and promotion of the
benefits of HRT, and the average for Latin America is much lower still It is not more
than 5-6% of the population

Reasons for low acceptance:

Collateral effects: Breast tenderness / breast pain, uterine bleeding.

Fear of cancer.
Fear of bodily changes: Weight gain, water retention and hair distribution.

RISKS AND BENEFITS ASSOCIATED WITH TRH

In addition to the relief of vasomotor and urogenital symptoms associated
with

estrogen

deficiency

in

menopause,

hormone

replacement

prevents

osteoporosis and may protect cardiovascular diseases. Estrogens prevent

osteoporosis by increasing bone mineral density, reducing resorption and bone
loss, thereby decreasing the incidence of fractures osteoporotic bone.
More recently, estrogen therapy has been shown to prevent or delay the
onset of Alzheimer's disease by improving cognitive function, relieving symptoms
of dementia, and increasing regional cerebral blood flow.
Other reported benefits of HRT include improved quality of life, reduced the
relative risk of death, and decreased risk of colorectal cancer. Although hormone
replacement offers numerous health benefits, there are clearly potential risks. The
most common risk is endometrial cancer when used monotherapy estrogen in
women with an intact uterus, risk has been minimized by the combination of a
progestogen.
Main risks associated with HRT in the long term:

Increased risk of breast cancer.

Increased risk of biliary lithiasis.
Increased incidence of thromboembolic disease.
Weight gain and water retention.

ESTROGEN AND CARDIOVASCULAR DISEASE:

About 30 years of data from observational studies suggest that different

HRT regimens are cardioprotective in postmenopausal women, substantially
reducing the risk of morbidity and mortality from coronary heart disease.
The results of a meta-analysis revealed a relative risk of 0.7 for users of
estrogen as hormone replacement and 0.66 for users of combination therapy. The
study of nurses showed greater risk reduction in women with increased baseline
risk factors. The results of these observational studies may be due primarily to a
"healthy cohort effect".
NEW TENDENCIES
With the aim of improve the adherence of patients and physicians to
hormone replacement therapy, they have developed strategies that seek to reduce
side effects and risks in the short and long term.