Efectos de la terapia hormonal con drospirenona / 17 β - estradiol sobre los parámetros del síndrome metabólico en posmenopáusicas

Ana Donnino; José R. Urdaneta Machado; Charles Sanabria; José Rafael Núñez G; Nasser Baabel Zambrano; Alfi Contreras Benítez; Mariem Encarnación Fernández Correa; Laurenis Labarca

Authors

Ana Donnino Servicio de Ginecología y Obstetricia de. Hospital “Dr. Manuel Noriega Trigo”. Instituto Venezolano de los Seguros Sociales. Maracaibo, Venezuela
José R. Urdaneta Machado Escuela de Bioanálisis. Facultad de Medicina. Universidad del Zulia. Maracaibo, Venezuela
Charles Sanabria Escuela de Medicina. Facultad de Medicina. Universidad del Zulia. Maracaibo, Venezuela
José Rafael Núñez G Escuela de Medicina Facultad de Medicina. Universidad del Zulia. Maracaibo, Venezuela
Nasser Baabel Zambrano Escuela de Medicina Facultad de Medicina. Universidad del Zulia. Maracaibo, Venezuela
Alfi Contreras Benítez Escuela de Odontología. Facultad de Odontología. Universidad del Zulia y Programa de Doctorado en Ciencias Médicas. Facultad de Medicina. Universidad del Zulia. Maracaibo, Venezuela
Mariem Encarnación Fernández Correa Programa de Doctorado en Ciencias Médicas. Facultad de Medicina. Universidad del Zulia. Maracaibo, Venezuela
Laurenis Labarca Programa de Doctorado en Ciencias Médicas. Facultad de Medicina. Universidad del Zulia. Maracaibo, Venezuela

Keywords:

drospirenone, menopause, metabolic syndrome, hormonal replacement therapy

Abstract

Aim: To assess the effects of hormone therapy (HT) with drospirenone (DRSP)/17 β -estradiol (E2) on the parameters of the metabolic syndrome (MS) in postmenopausal patients. Methods: We performed a comparative and applied research, with quasi-experimental, case-control, single-blind, prospective and field design. The study was realized in the Gynecology consultation. Hospital "Dr. Manuel Noriega Trigo". San Francisco, Estado Zulia. Venezuela. 120 women were included, they were separated to receive either the combination DRSP/E2 (Group A) or placebo (Group B). We assess MS components before and after 6 months of receiving HT. Results: We found a high prevalence in both groups before receiving treatment (53.3% and 48%, group A and B respectively). After treatment, DRSP/E2 when compared to placebo, significantly reduced both the prevalence of MS as the risk of setting it (21.7% versus 48.3%, OR [95%] = 0.29 [0.13-0.65] p <0.001), with a significant reduction (p <0.001) of hypertension, impaired fasting glucose, hypertriglyceridemia, central obesity; and a significant reduction in vasomotor symptoms, psychological symptoms and urinary incontinence (p <0.001). In group B the prevalence of MS was unchanged, except for impaired fasting glycemia and vasomotor and psychological symptoms showed a significant reduction (p <0.001). Conclusion: DRSP/E2 (2mg /1mg), proved to be effective after 6 months of treatment both for the control of the parameters that define the SM, with few and mild side effects

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References

- U.S. Bureau of the Census. International Data Base [Documento en línea]. 2011; Disponible en: http://www.census.gov/population/international/data/idb/informationGateway.php Fecha de consulta: 27 de Septiembre de 2011.

- Álvarez R, Martín E, Bordones M. Conocimiento y actitud sobre el climaterio en mujeres entre 40 y 50 años. Rev Venez Obstet Ginecol. 2008; 68(1): 32-40.

- Gelfand MM, Moreau Mi, Ayotte NJ, Hilditch JR, Wong BA, Lau CY. Clinical assessment and quality of life of postmenopausal women treated with a new intermittent progestogen combination hormone replacement therapy: a placebo-controlled study. Menopause. 2003; 10(1): 29-36.

- Batukan C, Muderris I, Ozcelik B, Orturz A. Comparison of two oral contraceptives containing either drospirenone or cyproterone acetate in the treatment of hirsutims. Gynecol Endocrinol. 2007; 23(1): 38–44.

- Rosano GMC, Vitale C, Fini M. Aspectos cardiovasculares de la terapia de reemplazo hormonal en la menopausia. Rev del climaterio. 2010; 13 (74): 85-92.

- Zárate A, Saucedo R, Basurto L, Martínez C. La enfermedad cardiovascular como amenaza actual para la mujer adulta mayor. La relación con los estrógenos. Ginecol Obstet Mex. 2007; 75(5): 286–292.

- Morato L, Malacara J. Condiciones metabólicas y hormonales en la menopausia. Rev Endocrinol Nutr. 2006; 14(3): 149-155.

- Lobo R. Síndrome metabólico en el síndrome de ovario poliquístico. En: Moran C. (Ed). Conceptos actuales en hiperandrogenismo, síndrome de ovario poliquístico y resistencia a la insulina. Rev Endocrinol Nutr. 2006; 14(1): 25-32.

- Díaz L. Ausencia de asociación entre síndrome metabólico y síntomas depresivos en adultos colombianos. Rev Méd Chil. 2007; 135(1): 990-996.

- Velázquez EM. Prevención cardiovascular en la mujer postmenopáusica. Revisión. Rev Venez Endocrinol Metab. 2009; 7(2): 3-16.

- Ministerio del poder popular para la Salud. Anuario de Mortalidad 2011. [Documento en línea] 2012. Disponible en: http://www.mpps.gob.ve./index.php?option=com_content&view=article&id=577&Itemid=692. Fecha de recuperación: 12 de Agosto de 2013.

- Schwarz S, Völzke H, Alte D, Schwahn C, Grabe HJ, Hoffmann W, et al. Menopause and determinants of quality of life in women at midlife and beyond: the study of health in Pomerania (SHIP). Menopause. 2007; 14(1): 123–134.

- White WB, Hanes V, Chauhan V, Pitt B. Effects of a new hormone therapy, drospirenone and 17-beta-estradiol, in postmenopausal women with hypertension. Hypertension. 2006; 48(2): 246–53.

- Foidart JM, Faustmann T. Advances in hormone replacement therapy: weight benefits of drospirenone, a 17alpha-spirolactone-derived progestogen. Gynecol Endocrinol. 2007; 23(12): 692-699.

- Sitruk-Ware R, Nath A. The use of newer progestins for contraception. Contraception. 2010; 82(5): 410-417.

- Guido M, Romualdi D, Giuliani M, Suriano R, Selvaggi L, Apa R, et al. Drospirenone for the treatment of hirsute women with polycystic ovary syndrome: a clinical, endocrinological, metabolic pilot study. J Clin Endocrinol Metab. 2004; 89: 2817–2823

- Preston RA, White WB, Pitt B, Bakris G, Norris PM, Hanes V. Effects of drospirenone/17-beta estradiol on blood pressure and potassium balance in hypertensive postmenopausal women. Am J Hypertens. 2005; 18(6): 797-804.

- National Cholesterol Education Program (NCEP). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. JAMA. 2001; 285(3): 2486-97.

- Lean M, Han T, Morrison N. Waist circumference indicates the need for weight management. British Medical Journal. 2005; 311(2): 158-61.

- Tabares MK, Velásquez B, Aguilera JR. Implicaciones del síndrome metabólico durante el climaterio. Rev Col Salud Libre. 2010; 5(2): 150–166.

- Chu MC, Cushman M, Solomon R, Lobo RA. Metabolic syndrome in postmenopausal women: The influence of oral or transdermal estradiol on inflammation and coagulation markers. Am J Obstet Gynecol. 2008; 199(11): 526.e1-526.e7.

- Schneider JG, Tompkins C, Blumenthal RS, Mora S. The Metabolic Syndrome in Women. Cardiology in Review. 2006; 14: 286–291.

- Figueiredo JA, Durans E, Barbosa JB, de Flores F, Cardoso GR, da Silva VJ, de Abreu RV. Síndrome Metabólica e Menopausa: Estudo Transversal em Ambulatório de Ginecologia. Arq Bras Cardiol. 2010; 95(3): 339–345.

- Heidari R, Sadeghi M, Talaei M, Rabiei K, Mohammadifard N, Sarrafzadegan N. Metabolic syndrome in menopausal transition: Isfahan Healthy Heart Program, a population based study. Diabetology & Metabolic Syndrome. 2010; 2(1): 59.

- Onatra W, García C, Gamboa C, Sánchez J, Castro J. Prevalencia del Síndrome Metabólico en mujeres posmenopáusicas en dos centros clínicos de Bogotá. Revista U.D.C.A. Actualidad & Divulgación Científica. 2006; 9(1): 43–53.

- Aguilar Z, García L. Tamiz para el síndrome metabólico en la perimenopausia. Ginecol Obstet Mex. 2009; 77(3): 123–127.

- Gambacciani M, Rosano G, Cappagli B, Pepe A, Vitale C, Genazzani AR. Clinical and metabolic effects of drospirenone-estradiol in menopausal women: a prospective study. Climacteric. 2011; 14(1): 18–24.

- Lee BS, Kang BM, Yoon BK, Choi H, Park HM, Kim JG. Efficacy and tolerability of estradiol 1 mg and drospirenone 2 mg in postmenopausal Korean women: a double-blind, randomized, placebo-controlled, multicenter study. Maturitas. 2007; 57(4): 361-369.

- Lobo RA. Síndrome metabólico después de la menopausia y el papel de las hormonas. Rev del climaterio. 2009; 13(73): 1–10.

- Sánchez F, Jaramillo N, Vanegas A, Echeverri JG, León C, Echavarría E, et al. Prevalencia y comportamiento de los factores de riesgo del síndrome metabólico según los diferentes intervalos de edad, en una población femenina del área de influencia de la Clínica Las Américas, en Medellín – Colombia. Rev Col Cardiología. 2008; 15(3): 102–110.

- Villa P, Suriano R, Ricciardi L, Tagliaferri V, De Cicco S, De Franciscis P, et al. Low-dose estrogen and drospirenone combination: effects on glycoinsulinemic metabolism and other cardiovascular risk factors in healthy postmenopausal women. Fertil Steril. 2011; 95(1): 158–163.

- Aedo S, Porcile A, Laiz D, Urzúa F. Implicancias de diferentes modalidades de THR oral en los componentes del síndrome metabólico en las mujeres en climaterio del Servicio de Salud Metropolitano Oriente (Santiago de Chile). Rev Obstet Ginecol. - Hosp. Santiago Oriente Dr. Luis Tisné Brousse. 2006; 1(1): 23–29.

- Boldo A, White WB. Blood Pressure Effects of the Oral Contraceptive and Postmenopausal Hormone Therapies. Endocrinol Metab Clin N Am. 2011; 40: 419–432.

- White WB, Pitt B, Preston RA, Hanes V. Antihypertensive Effects of Drospirenone With 17-Estradiol, a Novel Hormone Treatment in Postmenopausal Women With Stage 1 Hypertension. Circulation. 2005; 112(13): 1979-1984.

- Battaglia C, Cianciosi A, Mancini F, Persico N, Sisti G, Facchinetti F, Busacchi P. Angeliq versus Activelle in normotensive postmenopausal women: a prospective, randomized pilot study. Menopause. 2009; 16(4): 803-809.

- Knuuti J, Kalliokoski R, Janatuinen T, Hannukainen J, Kalliokoski KK, Koskenvuo J, et al. Effect of Estradiol-Drospirenone Hormone Treatment on myocardial perfusion reserve in postmenopausal women with Angina Pectoris. Am J Cardiol. 2007; 99:1648–1652.