Those seen all the data from the studies on this subject, certainty can be established on hormone replacement therapy (HRT) of menopause to consider a more thoughtful and less media future of this type of treatment for women menopause , say the researchers from Inserm Toulouse in the Letter of NSFA ( New French Atherosclerosis Society ) .
HRT : Benefits and Risks
In the opinion of Inserm, four certainties on HRT may be cited :
1 / HRT remains the most effective treatment for functional symptoms of menopause , especially hot flashes .
2 / HRT reduces the risk of fractures by about 40% in postmenopausal women .
3 / The transdermal route of administration is preferable to oral, thus avoiding the effect of first -pass metabolism and therefore reduce some adverse systemic effects of the hormone .
4 / We can not expect the classic HRT coronary protection.
What is the area of probable ...
" The atherosclerotic process develops gradually in the early decades and tends to increase throughout the life based on traditional risk factors (hypertension, hypercholesterolemia , diabetes, smoking , physical inactivity, obesity) and genetic factors are essentially to discover , "recalls team Toulouse researchers.
According to them , endogenous estrogens have a beneficial probably in the early stages of the formation of the fatty streak effect , reflecting a degree of cardiovascular protection of women than men before menopause.
" However, they warn , the more a woman gets older and the addition of estrogen can be harmful , especially beyond ten years of menopause untreated ."
However, they add, " the immediate stage of the menopause , our understanding of the pathophysiology associated with the findings of recent studies seems at least in favor of neutrality of HRT in terms of coronary risk."
Regarding the risk of breast cancer on HRT, the increased risk is the data most clearly established.
" The studies emphasize the deleterious effect of the addition of a progestin but the type of the latter also comes into play : in fact , the risk of breast cancer is not increased when the HRT is based on the association natural estrogen + progesterone and when the route of administration is transdermally for estrogen with micronized progesterone , as highlights the E3N study coordinated by Inserm and as pointed out by the results presented at the World Congress of menopause in Buenos Aires (Argentina) , " according to the researchers , while emphasizing the need to understand the mechanisms of the effects of estrogens and progestins different , as well as interference between different molecules.
What can we expect in the future ?
" If the protective effect of endogenous estrogens through an effect on the endothelium (inner lining of the arteries) , the prescribed HRT in postmenopausal women increases the cardiovascular risk through a pro-inflammatory effect of estrogens that promote fracture of unstable atheroma in the arteries during the first year following the introduction of plates treatment " , comment the researchers from Inserm .
" This hypothesis remains difficult to confirm clinically, because of the great difficulty in exploring as well as vascular endothelial inflammatory immune system," they continue .
According to them, the risk of coronary accident to the introduction of HRT would be higher if the patient has an endothelial dysfunction and / or unstable plaques .
Besides environmental factors that may influence the effect of HRT on cardiovascular diseases , it is likely that a number of genetic polymorphisms involved in the variability of individual responses , they say. " This is the case of the decrease in blood protein C that potentiates the thromboembolic risk in patients carriers of factor V Leiden ( coagulation factor ) mutated ," they cite as an example .
All of these data makes it difficult the possibility of optimal individualization of risk / benefit ratio of HRT . "This is the reason why several pharmaceutical companies are developing other molecules called SERMs (Selective Estrogen Receptor Modulators ) which are effective on hot flashes (those available on the market not being so ) ," inform researchers.
"Meanwhile, they conclude, it appears to us that the cardiovascular risk should not intervene in a major way in the decision to treat hot flashes HRT , especially as the traditional risk factors of the patient are absent or controlled . "
SHARE THIS POST
