1) O documento discute os benefícios e riscos da terapia hormonal na menopausa (TRH) para a saúde cardiovascular, cognição e outras condições. 2) Estudos observacionais iniciais mostraram benefícios da TRH, mas estudos controlados como o WHI encontraram aumento de risco para alguns eventos. 3) Recomenda-se o uso de baixas doses de estrógenos isolados por via não oral para condições como atrofia genital.
1. Disciplina de Ginecologia e Obstetrícia Faculdade de Ciências Médicas Universidade de Pernambuco Laura Olinda Bregieiro Fernandes Costa
2. Maclennan AH . Cochrane Database Syst Rev 4:CD002978 296, 2004 . Nelson HD. JAMA 291:1610–1620 2004 Bachmann GA. Obstet Gynecol 110:771–779 2007. *doses standart Baixas doses efetivas Principal indicação* Melhora da freqüência: 75% Melhora da intensidade: 87% Reflexo na qualidade de vida
3. Sintomas urogenitais Hipo- estrogenismo Disúria Urgência miccional Noctúria ITU recorrente Incontinência Urinária de Esforço Atrofia Vulvo-vaginal 50% das mulheres 5 a 6 anos após menopausa
4. Estrogenioterapia tópica tratamento mais efetivo ATROFIA VAGINAL: - perda da elasticidade - secura vaginal - contratura do intróito vulvar - distúrbios no coito 15 a 20% comprometem a qualidade de vida NAMS, 2008 Suckling J, Cochrane Database Sy s t Rev 4: CD 001500 2006
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6. Cardozo L, 2004 Acta Obstet Gynecol Scand 83:892–897 TRH NA MENOPAUSA E INCONTINÊNCIA URINÁRIA Estrogênio tópico melhor que oral
7. fluxo fluxo vagina veia artéria Estrógeno via vaginal
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9. TERAPIA HORMONAL NA MENOPAUSA CONTROVÉRSIAS Doenças cardiovasculares Demência senil (Alzheimer) Câncer de mama
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17. menacme ooforectomia 2 anos Pós-menopausa TRH e aterogênese Janela de oportunidade Área da placa (Relativa ao controle) Clarkson TB et al (1996): Br J Obstet Gynecol 103 Suppl 13,53–57. Dieta saudável EC + dieta aterogênica 70% menor Dieta aterogênica EC + dieta aterogênica 50% menor Dieta saudável dieta aterogênica sem EC Dieta saudável + EC 0% menor
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19. R AVC: RR= 1,32 (IC 95%: 1,12-1,56) Rossouw et al: JAMA. 2007;297:1465-1477
20. Bayesian Meta-analysis of Hormone Therapy and Mortality in Younger Postmenopausal Women (x=55 anos) Salpeter SR, AJM 2009,
23. Manson et al: N Engl J Med. 2007 Jun 21;356(25):2591-602 WHI: 50-59 anos, estrógeno isolado -TC basal, aos 7,5a e aos 8,5a - Score de calcificação coronária
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26. TRH - Prevenção das DCV Estrogen and progestogen use in peri- and Postmenopausal women: March 2010 position statement of The North American Menopause Society Menopause, 2010 I Diretriz Brasileira sobre Prevenção de Doenças Cardiovasculares em Mulheres Climatéricas e a Influência da Terapia de Reposição Hormonal (TRH) Arq Bras Cardiol, 2007
33. Colocar tabela 2 ao invés de escrito 45 x 22 casos / 10.000 mulheres / ano (p<0,01) 23 casos a mais Shumaker et al, JAMA 2003 289:2651-2662 Women’s Health Initiative – WHI Women’s Health Initiative Memory Study WHIMS
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).
estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261). estrogen as a treatment for SUI, investigators reported variable results without evidence of consistent improvement for this condition (261, 263, 264). In one study, EP appeared to increase the incidence of SUI (261).