Associations between Menopausal Hormone Therapy and Colorectal, Lung, or Melanoma Cancer Recurrence and Mortality: A Narrative Review.

Objective: to develop eligibility criteria for use in non-gynecological cancer patients. Methods: We searched all the articles published in peer-reviewed journals up to March 2021. We utilized the PICOS standards and the following selection criteria: menopausal women with a history of non-gynecological and non-breast cancer who underwent hormone replacement therapy (HRT) using various preparations (oestrogens alone or in combination with a progestogen, tibolone, or tissue selective oestrogen complex) and different routes of administration (including oral, transdermal, vaginal, or intra-nasal). We focused on randomized controlled trials as well as relevant extension studies or follow-up reports, specifically examining recurrence and mortality outcomes. Results: Women colorectal cancer survivors who use MHT have a lower risk of death from any cause than those survivors who do not use MHT. Women who are skin melanoma survivors using MHT have a longer survival rate than non-MHT survivors. There is no evidence that women lung cancer survivors who use MHT have a different survival rate than those who do not use MHT. Conclusions: MHT is safe for women who have a history of colorectal, lung, or skin melanoma cancers.

[The fibroid as clinical problem]. / El mioma como problema clínico.

Uterine fibroids are the most common benign tumours that affect women of reproductive age and they represent the main indication for surgery for benign uterine pathology. In 25% of cases, they become clinically apparent, causing heavy menstrual bleeding, pelvic pain and/or infertility. Therefore, fibroids have a notable impact on the economic costs for the health system and also on the quality of life of the women they afflict. Although MRI is the most precise technique to diagnose fibroids, ultrasound remains the most cost-effective method. Surgery has been the treatment of choice for years, and several minimally invasive procedures have recently been developed. There are a wide variety of conservative medical treatment options, which are continually expanding. Research on the biology of these tumours can lead to new therapeutic options for the management of fibroids as we better understand the role that growth factors and genetic mutations play in them.

El mioma como problema clínico / The fibroid as clinical problem

Los miomas uterinos son los tumores benignos más frecuentes en la mujer en edad reproductiva y constituyen la principal indicación de cirugía por patología uterina benigna. En el 25% de los casos se manifiestan clínicamente, causando sangrado menstrual abundante, dolor pélvico y/o infertilidad. Tienen, por lo tanto, un impacto notable en el coste económico que supone su seguimiento y tratamiento para el sistema sanitario por un lado y, por otro, influyen sustancialmente en la calidad de vida de las mujeres que los padecen. A pesar de que la resonancia magnética es la técnica más precisa para su diagnóstico, la ecografía sigue siendo la técnica de elección por ser la más coste-efectiva. La cirugía ha sido, durante años, el tratamiento de elección. En los últimos años se han desarrollado técnicas quirúrgicas mínimamente invasivas para su tratamiento. Sin embargo hay un amplio abanico de posibilidades terapéuticas conservadoras que, día a día, se va ampliando. La investigación de la biología de estos tumores puede proporcionar nuevas opciones terapéuticas, puesto que conocemos mejor el papel que ejercen los factores de crecimiento y las mutaciones genéticas en ellos (AU)

Uterine fibroids are the most common benign tumours that affect women of reproductive age and they represent the main indication for surgery for benign uterine pathology. In 25% of cases, they become clinically apparent, causing heavy menstrual bleeding, pelvic pain and/or infertility. Therefore, fibroids have a notable impact on the economic costs for the health system and also on the quality of life of the women they afflict. Although MRI is the most precise technique to diagnose fibroids, ultrasound remains the most cost-effective method. Surgery has been the treatment of choice for years, and several minimally invasive procedures have recently been developed. There are a wide variety of conservative medical treatment options, which are continually expanding. Research on the biology of these tumours can lead to new therapeutic options for the management of fibroids as we better understand the role that growth factors and genetic mutations play in them (AU)

Acetato de ulipristal 5 mg en el manejo de los miomas uterinos / No disponible

No disponible

Pauta de tratamiento inicial en pacientes con osteoporosis: uso de antirresortivos y suplementos farmacológicos (calcio y vitamina D) en la práctica clínica / Initial treatment trends in patient with osteoporosis: use of antiresorptive agents and pharmacologic supplements (calcium and vitamin D) in clinical practice

Objetivo. Describir el porcentaje de prescripción de suplementos farmacológicos en pacientes que inician pauta de tratamiento con antirresortivos (TAR) en pacientes con osteoporosis y por especialidades médicas. Diseño. Estudio transversal, con recogida de información retrospectiva, naturalístico y multicéntrico. Emplazamiento. Participaron 88 médicos españoles de atención primaria (AP), unidades de metabolismo óseo y mineral (UMO)/reumatología y ginecología. Participantes. Mujeres con osteoporosis que inician tratamiento TAR en los 12-36 meses previos a la visita. Mediciones principales. Variables clínicas generales y relativas al tratamiento de la osteoporosis (TAR, suplementos farmacológicos) y encuesta de opinión sobre suplementos farmacológicos. Resultados. Se incluyó a 480 pacientes. La edad media ± DE era de 65,8 ± 9,2 años. Se prescribieron suplementos farmacológicos en el 69,6% de las pacientes, siendo más frecuente en aquellas pacientes tratadas en consultas de UMO/reumatología (89,1%) que en las pacientes tratadas en AP (60,3%) y en ginecología (55,6%). En la encuesta realizada a los médicos el 72% de los médicos de UMO/reumatología y el 66,7% de ginecólogos respondieron que los suplementos de vitamina D son necesarios en el tratamiento habitual de la osteoporosis frente al 38,5% de los médicos de AP (p=0,058). Conclusiones. El uso de suplementos farmacológicos en la pauta inicial de tratamiento con TAR representa más del 60% de la muestra, aunque se detectan diferencias según tipo de especialista, con un mayor porcentaje de pacientes con suplementos en las consultas de UMO/Reumatología que en AP y ginecología, pese a que las guías recomiendan el uso mayoritario de suplementos farmacológicos en estas pacientes (AU)

Initial treatment trends in patient with osteoporosis: use of antiresorptive agents and pharmacologic supplements (calcium and vitamin D) in clinical practice objetive To describe the percentage of prescription of pharmacologic supplements in patients starting antiresorptive treatment (ART) for osteoporosis by specialists. Design. Cross-sectional, naturalistic, multicenter study with retrospective data collection. Patients and methods. 88 Spanish primary care (PC) physicians participated as well as those from Bone Metabolism Unit / Rheumatology and Gynecology units. Patients were females with osteoporosis who started ART in the 12 to 36 months prior to the visit. Main outcomes. General clinical variables and those related to osteoporosis treatment (both ART and pharmacologic supplements) and an opinion survey on pharmacologic supplements. Results. 480 patients were included. Mean age (SD) was 65.8 (9.2) years. Pharmacologic supplements were prescribed in 69.6% of patients and were more frequent in patients treated in Bone Metabolism/Rheumatology Units (89.1%) than patients treated by PC (60.3%) and Gynecology (55.6%). In the physician survey, 72% of the Bone Metabolism / Rheumatology Unit physicians responded that the Vitamin D supplements were necessary for treatment of osteoporosis vs. 38.5% of PC physicians (p=0.058). Conclusions. The use of pharmacologic supplements in the onset of treatment with ART represents more than 60% of the sample, although differences were seen between specialists, with a greater percentage of patients with supplements in the Bone Metabolism/Rheumatology Units than in PC and Gynecology, despite guidelines primarily recommend the use of pharmacologic supplements in these patients (AU)

Observational study of treatment compliance in women initiating antiresorptive therapy with or without calcium and vitamin D supplements in Spain.

OBJECTIVE: The aims of this study were to evaluate the compliance with antiresorptive therapy (ART) and supplements in Spain and to analyze the validity of the different treatment compliance assessment methods. METHODS: A cross-sectional study with retrospective data collection was carried out in women starting ART, evaluating indirect objective compliance, self-reported compliance, and the Morisky-Green questionnaire. RESULTS: A total of 480 women with a mean (SD) age of 65.8 (9.2) years were studied. Of these women, 62.9% received calcium and/or vitamin D supplements in addition to ART. According to the objective compliance method, 76.9% of the women were compliers (≥80%) with bisphosphonates; 69.4%, with selective estrogen receptor modulators; and 61.8%, with supplements (P < 0.01). Using the self-reported compliance, we identified 91% compliers with antiresorptive drugs and 75% with supplements. Using the Morisky-Green test, we classified 60.8% of the women as compliers with antiresorptive drugs and 48.4% with supplements. Combining the objective and self-reported compliance, 29.5% of the women did not adequately comply with ART and 56% with the drug supplements. CONCLUSIONS: With all three compliance measures, supplements were the treatment yielding the lowest percentage of compliers. Bisphosphonates constituted the treatment offering the best objective compliance: 38.2% of the women with drug supplements and between 23.1% and 30.6% of the women with ART failed to exceed the theoretical value of 80% regarded as representing good compliance.

Preimplantation genetic diagnosis for inherited breast cancer: first clinical application and live birth in Spain.

Carriers of a mutation in BRCA1/2 genes confront a high lifetime risk of breast and ovarian cancer and fifty percent probability of passing the mutation to their offspring. Current options for risk management influence childbearing decisions. The indications for preimplantation genetic diagnosis (PGD) have now been expanded to include predisposition for single-gene, late-onset cancer but few cases have been reported to date despite the favorable opinion among professionals and carriers. A 28-year-old BRCA1 mutation carrier (5273G>A in exon 19) with a strong maternal history of breast cancer and 2 years of infertility decided to pursue PGD to have a healthy descendent after an accurate assessment of her reproductive options. The procedure was approved by the national regulation authority and a PGD cycle was initiated. Four out of 6 embryos harbored the mutation. The two unaffected embryos were implanted in the uterus. A singleton pregnancy was achieved and a male baby was delivered at term. Consented umbilical cord blood testing confirmed the accuracy of the technique. Individualized PGD for inherited breast predisposition is feasible in the context of a multidisciplinary team.

[Initial treatment trends in patient with osteoporosis: use of antiresorptive agents and pharmacologic supplements (calcium and vitamin D) in clinical practice]. / Pauta de tratamiento inicial en pacientes con osteoporosis: uso de antirresortivos y suplementos farmacológicos (calcio y vitamina D) en la práctica clínica.

OBJECTIVE: To describe the percentage of prescription of pharmacologic supplements in patients starting antiresorptive treatment (ART) for osteoporosis by specialists. DESIGN: Cross-sectional, naturalistic, multicenter study with retrospective data collection. PATIENTS AND METHODS: 88 Spanish primary care (PC) physicians participated as well as those from Bone Metabolism Unit / Rheumatology and Gynecology units. Patients were females with osteoporosis who started ART in the 12 to 36 months prior to the visit. MAIN OUTCOMES: General clinical variables and those related to osteoporosis treatment (both ART and pharmacologic supplements) and an opinion survey on pharmacologic supplements. RESULTS: 480 patients were included. Mean age (SD) was 65.8 (9.2) years. Pharmacologic supplements were prescribed in 69.6% of patients and were more frequent in patients treated in Bone Metabolism/Rheumatology Units (89.1%) than patients treated by PC (60.3%) and Gynecology (55.6%). In the physician survey, 72% of the Bone Metabolism / Rheumatology Unit physicians responded that the Vitamin D supplements were necessary for treatment of osteoporosis vs. 38.5% of PC physicians (p=0.058). CONCLUSIONS: The use of pharmacologic supplements in the onset of treatment with ART represents more than 60% of the sample, although differences were seen between specialists, with a greater percentage of patients with supplements in the Bone Metabolism/Rheumatology Units than in PC and Gynecology, despite guidelines primarily recommend the use of pharmacologic supplements in these patients.

Optimización del manejo de la mujer osteoporótica en la consulta de ginecología / Optimal management of osteoporotic women in the gynecological consultation

La osteoporosis es un trastorno metabólico prevalente en la mujer menopáusica, que favorece la aparición de fracturas por impactos de baja energía. La densidad mineral ósea, los marcadores de remodelado óseo y los factores de riesgo para la osteoporosis permiten identificar a las pacientes que se pueden beneficiar del tratamiento. Entre las mujeres menopáusicas de menos de 65 años existe un número significativo de fracturas vertebrales. El tratamiento de la osteoporosis y la osteopenia asociada a una fractura previa se debe sustentar en fármacos potentes y de fácil adherencia, junto con el aporte de suplementos de vitamina D y calcio para evitar el hiperparatiroidismo asociado al déficit de vitamina D (AU)

Osteoporosis is a skeletal metabolic disorder characterized by compromised bone strength predisposing to an increased risk of low-impact fractures. This disorder is highly prevalent in postmenopausal women. Evaluation of bone mineral density, bone markers and osteoporosis risk factors allow to identify patients that may benefit from specific treatment to be identified. Vertebral fractures are common among postmenopausal women aged less than 65 years. The treatment of osteoporosis and osteopenia associated with a previous fracture should be based on adherence to potent drugs along with vitamin D and calcium supplements to prevent the hyperparathyroidism associated with low vitamin D levels (AU)

Factores reguladores del recambio óseo: estrógenos y vitamina D / Regulatory factors involved in bone turnover: estrogens and vitamin D

El tejido óseo es un efector de las hormonasgonadales esteroides y de la vitamina D. Elrecambio óseo es el proceso de renovación deltejido deteriorado y los estrógenos desempeñan unpapel significativo en el tejido, la regulación celulary a nivel molecular. A partir de la menopausiapredomina la resorción ósea y aumenta el riesgo deosteoporosis. El sistema endocrino de la vitamina Dregula el metabolismo celular óseo a través dereceptores específicos y por mecanismos nogenómicos. El déficit de vitamina D es un problemamuy extendido en la población general que guardarelación con la baja exposición solar y baja ingestade precursores de la vitamina. El suplemento devitamina D es una parte importante de las accionesterapéuticas de los tratamientos antirresortivos y paramantener la salud osteomuscular (AU)

Bone tissue responds to gonadal steroid hormones and vitamin D. Bone turnover is the process of replacing deteriorated tissue, and estrogens play a significant role at the tissular, cellular and molecular levels. After menopause, bone resorption predominates and increases the risk of osteoporosis. The vitamin D endocrine system also regulates bone metabolism through specific receptors and non-genomic mechanisms. Vitamin D deficiency is widespread among the general population and has been related to low sun exposure and low dietary intake. Vitamin D supplementation is an important antiresorptive measure and helps to maintain musculoskeletal health (AU)

Available medical choices for the management of menopause.

The age at which menopause occurs is a critical factor in the magnitude of its consequences. Most of the medium-to-long-term effects of oestrogen deprivation depend on their duration. The timing of the last menstruation is therefore important, but hypoestrogenic amenorrhoea during the reproductive age is also a relevant factor in the evaluation of individual risks. In recent years, moving post-menopausal women from the lowest point of ovarian hypofunction has been the most important motivation for developing guidelines for the hormonal management of menopause. However, recent data suggest that this may be associated with an unacceptable increase in morbidity in a number of women. Concerns about long-term hormone replacement therapy (HRT) at menopause have recently enhanced interest in a group of molecules that act on the oestrogen receptor with selective effects, known as selective oestrogen receptor modulators (SERMs). Of these, Raloxifene has been approved for the treatment and prevention of osteoporosis, and exhibits a pattern of actions particularly well matched to the needs and concerns of post-menopausal women. Further studies on SERMs may open up new vistas in patient-specific management of post-menopausal health. Finally, debates on the specific health consequences of menopause deal mainly with the risk of chronic disease. Gynaecologists and other health professionals would be advised to develop intervention strategies at menopause according to the continuum of a woman's life, beginning at the post-menarche and extending into later life.

The lipid and clinical effects of sequential transdermal estradiol and estradiol/norethisterone acetate in 674 women.

OBJECTIVE: To measure lipid changes induced by patches delivering continuous estradiol (E(2)) and sequential norethisterone acetate (NETA) in a large population of symptomatic menopausal women, compared with a non-symptomatic control group. PATIENTS AND METHODS: A total of 748 women recruited in 42 different hospital services and clinics in Spain were invited to participate in a prospective, open, controlled study for 48 weeks. Six hundred and seventy-four women were evaluated in the treatment group, and 74 in the control group. Treatment consisted of patches delivering 0.05 mg/day E(2) for the first 14 days of the cycle, and 0.05 mg/day E(2) plus 0.25 mg/day NETA for another 14 days. RESULTS: Use of patches led to a slight, but significant decrease of 1.3% and 0.9% in concentrations of total cholesterol and low-density lipoprotein cholesterol (LDL-C), respectively. A substantial 37.0% decrease in triglycerides concentration was observed in treated women. The treatment effectively reduced climacteric symptoms (Kupperman index) for the duration of the study. Compliance was acceptable, with 489 (72.6%) women completing the study. Adverse events were reported by 137 (20.3%) women. CONCLUSIONS: Transdermal administration of E(2) and sequential NETA for a period of 48 weeks (twelve 28-day cycles) was associated with beneficial changes, albeit of differing magnitudes, in the concentration of total cholesterol, LDL-C and triglycerides. This protective lipid profile, together with satisfactory clinical efficacy and acceptable safety and compliance, makes this system a good alternative in hormone replacement therapy.

Relevancia de los resultados del estudio WHI para la atención de las mujeres posmenopáusicas en España / WHI study on the attention of menopause in Spain: significance of its results

No disponible