RISCO ONCOLÓGICO NA TERAPIA HORMONAL DO CLIMATÉRIO: EVIDÊNCIAS ATUAIS E PROTOCOLOS DE SEGURANÇA
DOI:
https://doi.org/10.56238/levv16n51-096Palavras-chave:
Climatério, Terapia Hormonal, Risco Oncológico, Câncer de Mama, Câncer Ginecológico, Segurança TerapêuticaResumo
A terapia hormonal (TH) representa uma importante estratégia no manejo sintomático do climatério, promovendo alívio de sintomas vasomotores, melhora da qualidade de vida e efeitos benéficos sobre o metabolismo ósseo. No entanto, o risco oncológico associado à sua utilização permanece como um dos principais entraves clínicos e éticos na sua prescrição, especialmente diante do histórico do estudo WHI e das evidências subsequentes. Esta revisão sistemática teve como objetivo avaliar criticamente os dados mais atuais sobre a associação entre a TH e a ocorrência ou recorrência de neoplasias em mulheres climatéricas. Foram analisados 41 estudos entre ensaios clínicos, coortes, revisões sistemáticas e metanálises, identificando padrões distintos de risco conforme o tipo de hormônio, a duração do uso, o perfil da paciente e a via de administração. Observou-se maior risco de câncer de mama com a TH combinada, enquanto o estrogênio isolado demonstrou perfil mais seguro em mulheres histerectomizadas. No tocante ao endométrio e ovário, os riscos estão mais relacionados à ausência de oposição progestagênica e ao histórico de endometriose, respectivamente. Em neoplasias menos frequentes, como tireoide e linfoma, há sinalizações moleculares relevantes, mas ainda sem consistência clínica definitiva. Conclui-se que a prescrição da TH deve ser personalizada, embasada em evidências atualizadas e com vigilância rigorosa, especialmente em pacientes com antecedentes oncológicos ou fatores de risco relevantes.
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