RIESGO ONCOLÓGICO EN LA TERAPIA HORMONAL EN EL CLIMATERIO: EVIDENCIA ACTUAL Y PROTOCOLOS DE SEGURIDAD
DOI:
https://doi.org/10.56238/levv16n51-096Palabras clave:
Climaterio, Terapia Hormonal, Riesgo Oncológico, Cáncer de Mama, Cáncer Ginecológico, Seguridad TerapéuticaResumen
La terapia hormonal (TH) representa una estrategia importante en el manejo sintomático de la menopausia, promoviendo el alivio de los síntomas vasomotores, mejorando la calidad de vida y teniendo efectos beneficiosos sobre el metabolismo óseo. Sin embargo, el riesgo oncológico asociado a su uso sigue siendo uno de los principales obstáculos clínicos y éticos para su prescripción, especialmente considerando los antecedentes del estudio WHI y la evidencia posterior. Esta revisión sistemática tuvo como objetivo evaluar críticamente los datos más recientes sobre la asociación entre la TH y la aparición o recurrencia de neoplasias en mujeres menopáusicas. Se analizaron cuarenta y un estudios, incluyendo ensayos clínicos, cohortes, revisiones sistemáticas y metaanálisis, identificando distintos patrones de riesgo según el tipo de hormona, la duración del uso, el perfil de la paciente y la vía de administración. Se observó un mayor riesgo de cáncer de mama con la TH combinada, mientras que el estrógeno solo demostró un perfil más seguro en mujeres histerectomizadas. En cuanto al endometrio y los ovarios, los riesgos están más relacionados con la ausencia de hormona progestágena y el antecedente de endometriosis, respectivamente. En neoplasias menos frecuentes, como la tiroides y el linfoma, existen señales moleculares relevantes, pero aún carecen de consistencia clínica definitiva. Se concluye que la prescripción de terapia hormonal (TH) debe ser personalizada, basada en la evidencia actualizada y con un seguimiento riguroso, especialmente en pacientes con antecedentes de cáncer o factores de riesgo relevantes.
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