Author/Editor		Franić, Damir
Title		Nadomestno hormonsko zdravljenje v pomenopavzi - kje smo danes?
Translated title		Hormone replacement therapy in postmenopause - where we stand?
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 76, št. 2
Publication year		2007
Volume		str. 101-8
Language		slo
Abstract		The findings of most relevant randomized clinical studies such as HERS, CHI and MSS, performed in the last decade have shown that hormonal replacement therapy (HRT') users are at increased risk for the development of breast cancer, stroke and pulmonary edema. On the other hand they are at a lower risk for the development of large bowel cancer and for hip and vertebral fractures; the incidences of endometrial cancer and coronary heart disease have not been proved to be significantly affected by HRT As for the prevention of cardiovascular diseases, the findings of these studies differed from those provided by observational studies, it became an imperative to find the causes of these discrepancies. The major criticism of randomized clinical studies was aimed at the inclusion criteria, as the mean women's age in HERS and in CHI study was 63 years. The women of that age may no longer be healthy, and are particularly exposed to cardiovascular diseases. In all studies the same type of HRT was used, i. e. conjugated equine estrogen alone or in combination with medroxyprogesterone acetate. In Europe, this combination is rarely prescribed; we do not prescribe it in Slovenia either The same type of HRT used in randomized clinical studies was further criticized, the basic idea of HRT being an individual approach to each woman requiring HRT For rather sensational and often misinterpreted findings of randomizedstudies, the largest menopause societies worldwide, the lnternational Menopause Society (IMS), the European Menopause and Andropause Society (EMAS) and the North American Menopause Society (NAMS), have revised the guidelines for HRT use in postmenopause. These guidelines have been adopted by the Slovene Menopause Society as well. (Abstract truncated at 2000 characters)
Summary		V zadnjih desetih letih so izsledki najvažnejših randomiziranih kliničnih raziskav (RKR), kot so študije HERS, WHI in MWS, pokazali, da imajo uporabnice nadomestnega hormonskega zdravljenja (NHZ) povečano tveganje za nastanek raka na dojki, možganske kapi in pljučnega edema. Hkrati imajo zmanjšano tveganje za nastanek raka debelega črevesa ter za zlome kolka in vretenc; na incidenco endometrijskega raka in na koronarno srčno bolezen ni statistično značilnega vpliva. Ker imajo izsledki RKR drugačne rezultate glede preprečevanja bolezni srca in ožilja (BSO), kot so jih prikazovale observacijske študije, je potrebno razjasniti, zakaj je do teh razlik prišlo. Glavna kritika RKR se nanaša na vključitvena merila (povprečna starost žensk tako v študiji HERS kot WHI je bila 63 let). Ženske v tej starosti niso več zdrave, zlasti kar zadeva BSO. V vseh študijah je bila uporabljena ista oblika NHZ - konjugirani konjski estrogen (KKE) sam ali v kombinaciji z medroksiprogesteron qcetatom (MPA). Ta kombinacija zdravil ni običajna v Evropi, zlasti ne uporabljamo teh zdravilza NHZ. v Sloveniji. Glavna kritika enotni izbiri NHZ v RKR je ta, da je na ta način porušena osnovna ideja in načelo NHZ -tj, individualni pristop za vsako posameznico, ki potrebuje NHZ. Zaradi medijsko zelo odmevnih in večkerat napačno tolmačenih izsledkov RKR so največja svetovna menopavzna združenja International Menopause Society (IMS), European Menopause and Andropause Society (EMAS) in North American Menopause Society (NAMS) izdala prenovljene smernice za uporabo NHZ v pomenopavzi. Te smernice je sprejelo tudi Slovensko društvo za menopavzo. (Izvleček skrajšan na 2000 znakov)
Descriptors		POSTMENOPAUSE ESTROGEN REPLACEMENT THERAPY PRACTICE GUIDELINES