Hormone replacement therapy and venous disease.
Hormone replacement therapy was first proposed as a magic solution to all the health problems of middle aged women, however, recently a great number of side effects were proven, including an increased incidence of thromboembolic events. In the last decades, a great number of women around the world were in use of HRT, believing that they would have fewer heart attacks and hip fractures. Nevertheless, large clinical trials failed to show the benefits attributed to the use of estrogen and progestin. They proved that not only HRT exposed its users to a higher risk of thromboembolic events, breast cancer and gall bladder disease, but also did not protect the women against heart attacks as it was first thought, although fewer hip fractures occurred. The truth is that we do not know the precise mechanisms by which hormones act, as we do not know all the aspects concerning coagulation and fibrinolysis. We already know that the vessel wall, as well as other target organs, have a large number of estrogen and progestagen receptors which distribution is variable from person to person, rendering a reasonably number of persons more sensitive to the hormone effects. There are still questions about the risks and benefits of the hormone replacement therapy, including its action on the chronic venous disease. Despite the impact of the recent clinical trials, many women still remained on HRT and a great number are under treatment with tamoxifene and raloxifene, for breast cancer and osteoporosis prevention.
Santos
M E Rennó de Castro
ME
Hospital Santa Casa de Belo Horizonte. beth.renno@globo.com
D000818:Animals; D003094:Collagen / Q000187:drug effects; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000494:pharmacology*; D005260:Female; D006801:Humans; D003668:Pressure Ulcer / Q000517:prevention & control; D013923:Thromboembolism / Q000139:chemically induced; D014647:Varicose Ulcer / Q000517:prevention & control; D014648:Varicose Veins / Q000517:prevention & control; D014655:Vascular Resistance / Q000187:drug effects; D020246:Venous Thrombosis / Q000139:chemically induced
D004967:Estrogens; D003094:Collagen