hormonal replacement therapy: does aging limit therapeutic benefits?

HORMONAL REPLACEMENT THERAPY: DOES AGING

LIMIT THERAPEUTIC BENEFITS?

CECI MENDES CARVALHO LOPES

CLÍNICA GINECOLÓGICA DO HCFMUSP

Therapy?

Estrogens?

Therapy?

Estrogens?

Progestogens?

Therapy?

HRT• Better quality of life

– Acting positively on

• Symptoms• Lipids• Bone mass• Skin

HRT• Better quality of life

– Acting positively on• Symptoms• Lipids• Bone mass• Skin

– But there are risks and adverse effects!• Thromboembolism• Cancer

HERS II (Cardiac events/ 10000)

NS

What to conclude?

• It seems there is cardioprotection – if HRT is iniciated in early menopause

• Indeed it is the best choice for symptoms

• It is beneficial to genitourinary problems

• Prevents genitourinary atrophy

• Preserves bone mass

• Maintains skin appearance

Until when?

• It is a permanent question

– Good until it is beneficial

– The minimum dose, the minimum time

Until when?

• It is a permanent question

– Good until it is beneficial

– The minimum dose, the minimum time

... ??? ...

Which hormones?

• Estrogens– Conjugated equine estrogens?

• Progestins– Medroxyprogesterone?

Which hormones?

• Estrogens– Conjugated equine estrogens?– 17β-estradiol?

• Progestins– Medroxyprogesterone?– Dydrogesterone?– Drospirenone?– Trimegestone?

Which hormones?

• Estrogens– Conjugated equine estrogens?– 17β-estradiol?

• Progestins– Medroxyprogesterone?– Dydrogesterone?– Drospirenone?– Trimegestone?

Which hormones?

• Estrogens– Conjugated equine estrogens?– 17β-estradiol?

• Progestins– Medroxyprogesterone?– Dydrogesterone?– Drospirenone?– Trimegestone?

Treatment without hormones?

• One medicine to each problem

• Results maybe not so good

• Less risk?

Treatment without hormones?

• One medicine to each problem

• Results maybe not so good

• Less risk?

ceci.lopes@hcnet.usp.br