1
|
Palacios S, Rebelo C, Casquilho A, Costa AR, Cagnacci A, Cano A, Castelo-Branco C, Di Carlo C, Romão F, Geraldes F, Gambacciani M, Fasero M, Coronado P, Carvalho MJ, Nappi RE. POESIT recommendations on management of body-identical hormones in menopausal symptoms. Climacteric 2024; 27:340-350. [PMID: 38978340 DOI: 10.1080/13697137.2024.2368486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/28/2024] [Accepted: 06/09/2024] [Indexed: 07/10/2024]
Abstract
Many women seek treatment to improve menopausal vasomotor symptoms (VMS). The selection of women most likely to benefit from menopause hormone therapy (MHT) is crucial in clinical practice. There is general agreement that women younger than 60 years or who initiate MHT within the first 10 years of menopause, with no contraindications, have greater benefits considering symptomatic relief and additional advantages. This group may have the advantage of protection from osteoporosis and from other chronic diseases that affect postmenopausal women, namely cardiovascular disease (CVD). Cumulating evidence supports MHT for symptomatic women. However, inadequate use according to the needs of symptomatic women led to a burden of suffering worldwide. In recent years, the emergent use of non-regulated body-identical hormones (non-rBHT) can expose patients to potential harms. These hormone preparations are not regulated through the same tests of safety, efficacy or dosing consistency as regulated-BHT (r-BHT). The POESIT (Portugal + Spain + Italy) recommendations highlight the use of 17β-estradiol (E2) and micronized progesterone (P4) as the real r-BHT. In addition, the group emphasizes as an example the data from the REPLENISH study with 1 mg E2/100 mg P4. The combination of the two hormones in one convenient pill showed a clear reduction or elimination of hot flashes and an improvement in sleep quality and, consequently, quality of life. At the same time, this combination has shown high rates of amenorrhea and no significant impact on lipid, glucose or coagulation parameters. Both the REPLENISH study and a real-life retrospective study pointed to the possibility of a lower risk of venous thromboembolism (VTE) with this formulation than with other combinations.
Collapse
Affiliation(s)
- Santiago Palacios
- Service of Gynecology, Palacios' Institute of Women's Health, Madrid, Spain
| | - Cláudio Rebelo
- Department of Gynaecology and Obstetrics, Hospital CUF-Porto, Porto, Portugal
| | - Ana Casquilho
- Department of Obstetrics and Gynaecology, Faro Hospital, Faro, Portugal
| | - Ana Rosa Costa
- Department of Gynaecology and Obstetrics, Universitary and Clinical Centre São João, Porto, Portugal
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Infant Health, University of Genova, Italy
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - Camil Castelo-Branco
- Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Surgery and Medical-Surgica Specialities - Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Costantino Di Carlo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fátima Romão
- Hospital do SAMS - Lisboa, Hospital da Luz - Setúbal, Setúbal, Portugal
| | - Fernanda Geraldes
- Gynecology Service, Department of Gynecology, Obstetrics and Neonatology, Hospitalar, Universitary Centre of Coimbra, Coimbra, Portugal
| | - Marco Gambacciani
- Menopause and Osteoporosis Unit, San Rossore Clinical Center, Pisa, Italy
| | - Maria Fasero
- Service of Obstetrics and Gynecology, Hospital Sanitas La Zarzuela, Madrid, Spain
- Service of Gynecology, Clinica Corofas. Corofas Menopause, Madrid, Spain
- Department of Gynecology, Universidad Francisco de Vitoria, Madrid, Spain
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
| | - Pluvio Coronado
- Asociación Española para el Estudio de la Menopausia (AEEM), Spain
- Women's Health Institute of the Hospital Clínico San Carlos, IdISSC. Complutense University, Madrid, Spain
| | - Maria João Carvalho
- Gynecology Service, Department of Gynecology, Obstetrics and Neonatology, Hospitalar, Universitary Centre of Coimbra, Coimbra, Portugal
- Universitary Clinic of Gynecology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute of Biophysics and Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Chief of the Research Center for Reproductive Medicine and Director of the Gynecological Endocrinology & Menopause Unit, IRCCS San Matteo Foundation, Pavia, Italy
| |
Collapse
|