Usporedba transdermalne i oralne primjene hormonskog nadomjesnog liječenja kod žena u postmenopauzi

master's thesis

• Title (english): Comparison of transdermal and oral hormone replacement treatment in postmenopausal women
• Author: Zrinka Polančec
• Mentor: Marina Šprem Goldštajn (mentor)
• Committee member: Miro Kasum (predsjednik povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Committee member: Marina Šprem Goldštajn (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Ovaj rad donosi pregled literature o sličnostima i razlikama oralne i transdermalne primjene hormonskog nadomjesnog liječenja, poglavito estrogena, u postmenopauzi. Hormonsko nadomjesno liječenje upotrebljava se u svrhu prevencije i liječenja bolesti povezanih sa starenjem i menopauzom, a to su vazomotorni simptomi, urogenitalna atrofija i osteoporoza. Ponajviše se koriste estrogeni u kombinaciji s gestagenima u žena koje imaju maternicu, dok se u žena koje ju nemaju koriste samo estrogeni.
Oralna primjena hormonskog nadomjesnog liječenja, iako vrlo učinkovita u smanjenju menopauzalnih simptoma, nosi povećan rizik za razvoj venske tromboembolije, karcinoma dojke, koronarne bolesti srca i moždanog udara. Venska tromboembolija je najčešća ozbiljna nuspojava uzimanja hormonske nadomjesne terapije. Do povećanog rizika za te bolesti dolazi primarno zbog metaboliziranja estrogena u jetri i učinaka koji se ostvaruju prvim prolaskom kroz jetru, nefiziološkog omjera estradiola i estrona u cirkulaciji, te potrebe za primjenom većih doza estrogena zbog manje bioraspoloživosti. Zbog toga se u zadnja 2 desetljeća intenzivno istražuju niže doze estrogena, kao i drukčiji putevi primjene, poput transdermalnog i vaginalnog puta. Vaginalni put se koristi primarno za ublažavanje simptoma urogenitalne atrofije. Transdermalno liječenje je jednako učinkovito u smanjenju vazomotornih simptoma kao i oralno. Kod takvog puta primjene nema metaboliziranja estrogena u jetri i učinaka prvog prolaska kroz jetru, te on ne nosi povećan rizik za razvoj venske tromboembolije, za razliku od oralnog puta primjene. Pretpostavlja se da bi transdermalni estrogeni mogli biti korisni i u smanjenju ostalih simptoma oralne terapije zbog toga što se njihovom primjenom održava fiziološki omjer estradiola i estrona sličan onome u reproduktivnom razdoblju. Također, bioraspoloživost im je mnogo veća te se mogu primijeniti u vrlo niskim dozama. U ovom su radu prikazani neki od spomenutih rizika i utjecaj drukčijeg puta primjene na njih.

Abstract (english)

The purpose of this review paper is to compare the similarities and differences of oral and transdermal hormone replacement therapy, mainly estrogen, in postmenopause. Hormone replacement therapy is used to prevent and treat menopause-related symptoms such as vasomotor symptoms, vulvovaginal atrophy, and osteoporosis. It consists mostly of estrogens combined with progestins in women who have a uterus, and estrogens in women who have been hysterectomized. Oral hormone replacement therapy, although very effective in the reduction of most menopausal symptoms, is associated with an increased risk of venous thromboembolism, breast carcinoma, coronary heart disease, and stroke. Venous thromboembolism is the most common serious side effect of taking hormone replacement therapy. The increased risk is primarily associated with the liver metabolism of oral estrogens and their first-pass effect on the liver, non-physiological estradiol/estrone ratio in the circulation, and high doses of estrogen due to decreased bioavailability. Low-dose estrogen and different routes of administration, such as the transdermal and vaginal route, have been reasearched in the last two decades due to the mentioned side effects and risks. The vaginal route is used primarily for treating vulvovaginal atrophy. Transdermal therapy has been proven to be as effective as oral therapy in reducing vasomotor symptoms. In the transdermal route of administration, there is a significantly lower liver metabolism and first-pass effect on the liver, and therefore it does not increase the risk of venous thromboembolism, unlike oral therapy. It is possible that transdermal estrogen can be beneficial in regard to other adverse side effects of oral therapy since it maintains a similar physiological serum estradiol/estrone ratio to that found in women of reproductive age. Moreover, its bioavailability is much higher and therefore it can be administered in lower doses. This paper reviews some of the adverse side effects of hormone replacement therapy and how different routes of administration can affect them.

• Keywords: menopauza; hormonsko nadomjesno liječenje; transdermalno; venska tromboembolija; vazomotorni simptomi; karcinom dojke
• Keywords (english): menopause; hormone replacement therapy; transdermal; venous thromboembolism; vasomotor symptoms; breast carcinoma
• Language: croatian
• URN:NBN: urn:nbn:hr:105:968407
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-10-24 11:01:29