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Hormone replacement is the best response to the effects of menopause


The new Brazilian consensus on hormone therapy in menopause reinforces the safety and benefits of the treatment


Summary

Specialist Igor Padovesi states that reading the Brazilian Consensus on Climateric Hormone Therapy 2024 should be mandatory for all gynecologists and endocrinologists.





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At the beginning of May, the “Brazilian Consensus on Climacteric Hormone Therapy 2024” was published, which updates the guidelines relating to the administration of hormone therapy in menopause (HT), reinforcing the high efficacy and safety of the treatment. Created by the Brazilian Association of Climateria and Obstetrics (SOBRAC) in collaboration with the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo), the document was presented during the XIII Brazilian Congress of Climateria and Menopause, which will take place from 2 to 4 May in São Paolo.

“This new consensus represents the most recent and reliable information on hormone replacement in menopause, reinforcing the many benefits of this treatment, which significantly outweigh the possible risks. Hormone therapy is recommended for almost all women who suffer from menopause symptoms, with few contraindications,” explains the gynecologist. Igor Padovesimenopause specialist and member of the North American Menopause Society (NAMS), the International Menopause Society (IMS) and the Brazilian Menopause Association.

According to the expert, the consensus was drawn up on the basis of excellent quality publications and a very high level of scientific evidence, making its conclusions indisputable. This new SOBRAC consensus adds to numerous other publications from international institutions, such as the North American Menopause Society and the International Menopause Society, which indicate hormone therapy as the best option not only to alleviate the symptoms of menopause, but also to prevent diseases and increase longevity. .

Four known indications

The document reiterates the effectiveness of hormone therapy for the four already consolidated indications: the treatment of the famous hot flashes, the genitourinary syndrome of menopause (already called urogenital atrophy), the prevention and treatment of bone mass loss related to menopause, and early menopause (before 45 years). But, in addition, the consensus points to numerous other already recognized benefits of hormone treatment.

“HT has been shown to provide cardiovascular protection to women, reduce mortality from various causes, reduce the risk of diabetes, improve sleep, depressive symptoms, sexual function, reduce the risk of colorectal cancer and even of Alzheimer’s. All this is expressly written in the consent,” says the gynecologist.

“Proper treatment also reduces the accumulation of body fat, especially in the abdominal region, and stabilizes the damage caused by estrogen deficiency in the skin, which gives it an aged and wrinkled appearance,” he adds.

The consensus also provides guidelines on the ideal way to administer these hormones to improve their effectiveness and reduce risks. “It is currently recommended to carry out hormone therapy with hormones ‘non-orally’, for example through the skin. Most of the known risks of hormone therapy are due to incorrect administration or the use of synthetic and oral hormones, therapeutic schemes used in the past”, explains Igor, who explains that hormonal HT presents some risks, but they are very small and can be checked by following the correct recommendations also highlighted in the document.

“Uterine cancer is a possible risk of HT, which occurs due to uncontrolled development of the endometrium caused by estrogen. But, to control this process, we also administer progesterone. Another possibility is breast cancer, but this risk is very small: less than one in a thousand women. Therefore, the vast majority of women can undergo hormone therapy without any worries.”

Contraindications to hormone therapy

The publication also addresses contraindications to menopausal hormone therapy, such as decompensated liver disease, certain cardiovascular and venous diseases, breast and endometrial cancer, and vaginal bleeding of unknown cause. But even these situations cannot be considered absolute contraindications.

“Hormone therapy may often be indicated, after a careful evaluation of the risks and benefits. It is necessary to remember that not using hormone therapy also entails risks, such as an increased risk of cardiovascular diseases, osteoporosis and fractures, as well as symptoms that can significantly affect the quality of life”, underlines the specialist.

“The recommendation is to personalize the treatment, as symptoms can vary greatly and there are different types of hormones, doses and routes of administration. Evaluation by an experienced professional is essential,” she adds.

Igor Padovesi underlines that reading the Brazilian Consensus on Climateric Hormone Therapy 2024 should be mandatory for all gynecologists and endocrinologists.

“Even today there are doctors who oppose hormone therapy on the basis of what they learned several years ago, leaving countless patients without assistance, with their quality of life completely compromised and even with a greater risk of cardiovascular diseases, which are the leading cause of death in women,” he specifies.

Igor also adds that hormone therapy is especially important for greater longevity.

“Today, a woman’s life expectancy is around 80 years. In other words, considering that the first symptoms begin to appear around the age of 40 and menopause usually arrives around the age of 50, we can say that a woman spends almost half of her life in menopause. And today’s fifty-year-old woman is completely different from previous generations: she is an active woman, at the peak of her career, who wants to preserve her sexuality, take care of herself and delay the effects of aging. Therefore it is essential that patients and doctors are aware of the effectiveness and safety of hormone therapy in menopause,” she concludes.

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Source: Terra

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