[Current status of hormone therapy during the menopausal transition and post-menopause]. / Terapia hormonal en la transición a la menopausia y en la posmenopausia: estado actual.

Starting from prospective clinical studies that have evaluated its benefits and risks, hormone replacement therapy in menopause women has been reassessed in its indications in the last four years. In October, 2004 a Latinamerican Experts Consensus was carried out, such report with some modifications is presented in this publication. The conclusions the experts reached were the following: 1) Hormone Therapy is the gold standard for the control of moderate to severe vasomotor symptoms; 2) this therapy must be indicated in an individual manner and only in symptomatic women in which the benefit is greater than the risk; 3) the least effective dose must be used; 4) it must be used neither for cardiovascular prevention, osteoporosis, colon cancer nor for mental disorder; 5) the patient must be informed about the benefits and risks.

A 13-month multicenter clinical experience of a low-dose monophasic oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene in Latin American women.

This prospective, multicenter study was conducted to evaluate the contraceptive reliability, cycle control and tolerability of a 21-day oral contraceptive regimen containing 20 microg ethinylestradiol and 75 microg gestodene in four Latin American countries (Mexico, Argentina, Brazil and Colombia). Participants took trial medication daily for 21 days. Contraceptive efficacy, cycle control and tolerability were evaluated over a period of 13 cycles. Efficacy data gathered from 5,109 treatment cycles were obtained from 393 participants. The trial medication proved to be an effective contraceptive and provided good cycle control. One pregnancy because of poor compliance was recorded. This resulted in a study Pearl index of 0.25. Forty-six percent of Latin American women reported one intracyclic spotting bleeding episode and 37.6% reported one intracyclic breakthrough bleeding (medium/excessive bleeding) episode during cycles 2-4 (primary target). Overall, intracyclic bleeding was reported in 41%. Overall, there was a trend towards a lower incidence of spotting in all the countries and this difference had statistical significance between Argentina and the others three countries (p < 0.05) during cycles 2-4. This trend was also apparent with respect to breakthrough bleeding, but again the difference did not achieve statistical significance. The discontinuation rate because of adverse events was low (3%); no serious adverse events were reported. More than 78% of the women in the four countries maintained constant body weight or lost weight (2 kg) during the study. The treatment effect on blood pressure was negligible. There were no appreciable changes in mean laboratory values over the course of the study.

Terapia hormonal en la transición a la menopausia y en la posmenopausia: estado actual / Current status of the hormone therapy during the menopausal transition and post-menopausa

La terapia hormonal para la mujer en menopausia ha sido revalorizada en sus indicaciones en los últimos cuatro años, a partir de estudios clínicos prospectivos que han evaluado sus beneficios y riesgos. En octubre de 2004 se efectuó un Consenso de Expertos Latinoamericanos cuyo informe, con algunas modificaciones, se presenta en esta publicación. Las conclusiones a las que arribaron los expertos indican que: 1) la terapia hormonal es el estándar de oro para el control de los síntomas vasomotores moderados a severos; 2) esta terapia se debe indicar de manera individualizada y solo en mujeres sintomáticas en las que el beneficio sea mayor que el riesgo; 3) se debe utilizar la menor dosis efectiva; 4) no se debe indicar solo para prevención cardiovascular, osteoporosis, cáncer de colon ni para el deterioro mental; 5) se debe informar a la paciente de los beneficios y los riesgos.

Starting from prospective clinical studies that have evaluated its benefits and risks, hormone replacement therapy in menopause women has been reassessed in its indications in the last four years. In October, 2004 a Latin-American Experts Consensus was carried out, such report with some modifications is presented in this publication. The conclusions the experts reached were the following: 1) Hormone Therapy is the gold standard for the control of moderate to severe vasomotor symptoms; 2) this therapy mutt be indicated in an individual manner and only in symptomatic women in which the benefit is greater than fue risk; 3) fue least effective dose must be used; 4) it must be used neither for cardiovascular prevention, osteoporosis, colon cancer nor for mental disorder; 5) the patient must be informed about the benefits and risks.

Histerectomía vaginal: resultados y comparación con otras técnicas / Vaginal hyssterectomy: results and comparison with other techniques

Describir la evolución de lahissterectomía vaginal (HV) en la Argentina. Presentar los resultados obtenidos en 430 casos realizados o supervisados por el autor. Efectuar una revisión bibliográfica comparativa entre los resultados de la HV y los de la histerectomía abdominal (HA) la histerectomía laparoscópica (HL) y la resección endometrial (RE) Establecer el lugar que ocupa la HV con respecto a las otras técnicas. Analizar los factoress que pueden limitar su aplicación y proponer soluciones para facilitar su enseñanza y difusión

Uso de estradiol transdérmico continuo y medroxiprogesterona oral trimestral / Continous transdermal estradiol use and medroxiprogesterone oral quarterly

Uno de los métodos para reducir o evitar los efectos colaterales de los progestágenos y así mejorar el cumplimiento de la hormonoterapia de reemplazo(HTR) es el agregado de dichos esteroides a los estrógenos en esquemas no diarios en esquemas no mensuales. El objetivo de este estudio fue evaluar el uso de uno de estos esquemas alternativos: estrógeno continuo y progrestágeno cada tres meses sobre los síntomas climatéricos, el sangrado uterino, la presión arterial, el peso corporal, los lípidos en sangre, la histología endometrial y su aceptabilidad. Ciento siete pacientes posmenopáusicas recibieron 50 mcg de estradiol transdérmico en forma continua durante seis meses y 10 mg de acetato de medroxiprogesterona (AMP) por vía oral durante 14 días cada tres meses.En síntesis, el uso de estradiol transdérmico continuo y AMP oral trimestral mostró ser un tratamiento eficaz los síntomas climatéricos, inducir un sangrado uterino aceptable, siendo bien tolerado por las pacientes y sin provocar lesiones de riesto en el endometrio