Enjeux et perspectives du traitement de la ménopause : une femme, un THS ?

Abstract

Le traitement hormonal substitutif apporte-t-il seulement bien-etre et energie aux femmes menopausees? Ou diminue-t-il aussi le nombre de fractures, d' accidents cardiovasculaires et de demences ? Seize pour cent seulement des femmes menopausees recoivent un traitement hormonal substitutif. Est-ce une simple desinformation ? Ou bien est-ce parce que l' evaluation du rapport benefice-risque reste a faire Lors des contre-indications au traitement hormonal substitutif, les SERM (selective estrogen receptors modulators) representent une possibilite d' alternative, la plus originale et prometteuse. Jusqu' a quel point ?

Hormone replacement therapy (HRT) represents a major breakthrough for post-menopausal women: better quality of life and protection against osteoporosis are widely acknowledged benefits, while cardiovascular protection and prev ention of dementia are appealling questions to which current large clinical trials should provide answers in the future. The perspectives imply: (1) optimization of HRT, in terms of the drugs, the route of administration, and adjustable dosage forms; (2) alternatives are essential in case of contraindications to HRT. Neither androgens, nor phytoestrogens are acceptable alternatives to HRT. Selective estrogen receptor modulators (SERMs) are the most original and promising agents today. Raloxifen has been the most, widely studied, yet little is known about its potential adverse effects, and it seems more appropriate for osteoporosis prevention than a true HRT alternative. Lastly, the social and economic aspects also need to be dealt with: compliance with HRT must be improved in, the future, in particular by offering constantly up-dated continuous medical education, and by optimizing the cost/efficacy ratio of HRT in order to make it readily available. [References: 49]