13 apr. 2007 PERSPECTIVE ALE TERAPIEI HORMONALE SI A BOLII CARDIOVASCULARE LA MENOPAUZA – partea a II-a Terapia cu progestative/progesteron
Manuela Russu
Clinica de Obstetrica – Ginecologie “Dr. I. Cantacuzino”, UMF “Carol Davila” Bucuresti
Rezumat
Deficienta estrogenica la pre si postmenopauza se asociaza cu un risc crescut al bolilor cardiovasculare, datorita progresiei aterosclerozei, care este motivul terapiei hormonale, mult analizata de diferite studii. Datorita sigurantei endometriale sub terapia estrogenica în postmenopauza, progesteronul/progestativele sunt obligatorii la femeile cu uter intact, adaugarea lor a fost cauza multor dezbateri privind riscul cardiovascular.
Exista multe tipuri de progestative diferite de progesteronul natural si între ele (derivati de 19 nor- testosteron, derivati de progesteron) în ceea ce priveste efectele lor asupra lipidelor sanguine, metabolismelor, coagularii, tonusului vascular când se asociaza diferitelor tipuri de estrogeni.
Majoritatea studiilor experimentale pe animale, observationale si statistice în limba engleza asupra aterosclerozei în postmenopauza au fost efectuate cu estrogeni ecvini conjugati si medroxiprogesteron acetate, motiv pentru care mi-am concentrat atentia asupra unor noi clase de progestative: dienogest, drospirenona, si derivatii de 19 nor- progesteron: nestoron, nomegestrol acetat, si trimegestone, ca si asupra progesteronului natural (didrogesteron si micronizat), asupra caii vaginale de administrare ( progesteron micronizat) si dozelor reduse.
Abstract
Estrogen deficiency in pre and postmenopause is associated with an increased risk of cardiovascular disturbances, because of atherosclerosis progression, which is the reason of estrogen replacement therapy in perimenopause and menopause, much analyzed in different studies. Because of endometrial safety on estrogen therapy in postmenopause, progesterone/progestogens are mandatory for women with intact uterus, their addition was reason for many debates regarding the cardiovascular risk.
There are many types of progestogens very different from natural progesterone and from each category (19 nor- testosterone derivates, progesterone derivates) according to their effects on blood lipids metabolism, and coagulation, vasculature tonus, when associated with different types of estrogens.
Most of the animal, observational and statistical studies in English language were done upon conjugated equine estrogens and medroxyprogesterone acetate effects on atherosclerosis in postmenopause, my attention is focused upon the new classes of progestogens (dienogest, drospirenone, and 19 nor – progesterone derivates: nestorone, nomegestrol acetate, and trimegestone) and on natural progesterone (micronized progesterone, dydrogesterone), vaginal route of administering (micronized progesterone), and on low doses.