RESUMO
Aún existe, desde 2002, una marcada disminución en el uso de terapia hormonal clásica (TH), para el manejo de la menopausia, debido a los riesgos determinados en el estudio Iniciativa de salud para las mujeres (WHI: Women's Health Initiative). No obstante, revisiones del WHI y evidencias actuales determinan que la TH: (a) es la terapia más efectiva de los síntomas vasomotores, de sus potenciales consecuencias (disminución en calidad del sueño, irritabilidad, reducción en calidad de vida), y para tratar la atrofia urogenital. (b) Previene la osteoporosis y en pacientes con endotelios sanos, reduce el riesgo de hipertensión arterial, diabetes II y enfermedad coronaria, siendo el cociente beneficio/ riesgo mayor cuando se inicia tempranamente al sucederse el hipoestrogenismo. (c) Existe la tendencia a utilizar dosis mínimas, estrógenos no orales y progestágenos puros, para disminuir sus riesgos. (d) Tibolona y paroxetina son las mejores alternativas para tratar los síntomas vasomotores. (e) Finalmente, los cambios a estilo de vida saludable son coadyuvantes excelentes de la TH en el manejo de los síntomas menopaúsicos y en la prevención de las enfermedades crónicas de la postmenopausia, las cuales ameritan tratamientos específicos...
There has been a marked decline in hormonal therapy (HT) for menopausal symptoms, since 2002, due the understanding of the benefits and risks as described in the Women's Health Initiative (WHI). Nevertheless, revisions of the WHI and current evidences determine that the HT: (a) is the most effective treatment for menopause vasomotor symptoms and their potential consequences (diminished sleep quality, irritability, and reduced quality of life), and to treat urogenital atrophy. (b) prevents the osteoporosis and, in women with healthy endothelial arteries, it reduces the risk of hypertension, diabetes II and coronary heart disease; but, the benefit-risk ratio is favorable for women who initiate HT close to ovarian failure or menopause. (c) There is the tendency to minimize dose, give no oral estrogens and pure progestagens, in order to diminish its potential risks. (d) Tibolona and Paroxetine are good alternatives to treat menopausal vasomotor symptoms. (e) Finally, the changes in the lifestyle are excellent HT adittional aids to prevent postmenopausal chronic diseases; but these diseases deserve specific treatments...
Ainda permanece, desde 2002, uma diminuição acentuada no uso de terapia hormonal clássica (TH) para a abordagem da menopausa, devido aos riscos identificados no estudo Iniciativa de saúde para mulheres (WHI: Women's Health Initiative). No entanto, revisiões WHI e as evidências atuais determinam que o TH: (a) é a terapia mais eficaz para os sintomas vasomotores, as suas possíveis conseqüências (diminuição da qualidade de sono, irritabilidade, redução da qualidade de vida), e tratamento de atrofia urogenital. (b) Previne a osteoporose, e em pacientes com endotélio saudável, reduz o risco de hipertensão, diabetes tipo II e doença arterial coronariana, com a relação risco / benefício maior quando o inicio do hipoestrogenismo é cedo. (c) Há uma tendência a utilizar pequenas doses, de estrógenos não-orais e progestágenos puros, para reduzir seus riscos. (d) Tibolona e paroxetina são as melhores alternativas para o tratamento de sintomas vasomotores. (e) Finalmente, as alterações a estilos de vida saudável são excelentes auxiliares da HT na abordagem dos sintomas da menopausa e prevenção de doenças crônicas na pós-menopausa, que merecem um tratamento específico...
Assuntos
Feminino , Neoplasias da Mama , Doenças Cardiovasculares , Terapia de Reposição Hormonal , Menopausa , OsteoporoseRESUMO
Hydrochloric acid was added to destilled water in increasing amounts to obtain a final pH of 6.9, 3.0, 2.5, 2.0 and 1.5. Eighteen commercial calcium preparations were incubated in these solutions for 60 min and dissolution velocity was measured as the percentage of elemental calcium found in solution after this incubation period. Calcium carbonate preparations had a pH 1.5. Using the solution with pH 1.5 the dissolution velocity of different preparations varied widely from 56 to 100 percent. Calcium acetate, followed by calcium citrate and dicalcic phosphate were the salts in tablets with better dissolution velocities. Among powders and effervescent preparations, those containing calcium lactogluconate and citrate had the better dissolution velocities (95 to 115 percent), that were independent of the solution's pH. A studied preparation with integral bone had a very low dissolution velocity, not surpassing 33 mg of calcium per tablet. The dissolution velocity of different calcium carbonate preparations varies greatly and in conditions of achlorhydria, it is negligible. Calcium lactogluconate and citrate dissolution velocities are independent of the solution's pH
