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Terapia hormonal de la menopausia y cáncer de mama: Equilibrando riesgos y beneficios
Rishitha Bollam1, Jana Karam2, Chrisandra Shufelt3
1Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA.
Maturitas
|February 25, 2026
Resumen
La terapia hormonal de la menopausia trata eficazmente los síntomas vasomotores y previene la pérdida ósea. El riesgo de cáncer de mama varía según la formulación, la duración y los factores del paciente, y la terapia solo con estrógenos puede reducir la incidencia y la mortalidad.
Área de la Ciencia:
- Endocrinología reproductiva
- Oncología
- Farmacología
Sus antecedentes:
- La terapia hormonal de la menopausia (THM) es el tratamiento más eficaz para los síntomas vasomotores y la prevención de la pérdida ósea.
- Las preocupaciones sobre el riesgo de cáncer de mama han influido históricamente en las percepciones de seguridad de la THM.
- La evidencia reciente refina la comprensión del riesgo de cáncer de mama de la THM, destacando los impactos de la formulación y la duración.
Objetivo del estudio:
- Sintetizar la evidencia actual sobre los beneficios y riesgos de la THM, centrándose en el cáncer de mama.
- Analizar los modificadores de riesgo que influyen en los resultados de la THM, incluida la formulación, la duración, el momento y la vía.
- Guiar la toma de decisiones clínicas basadas en la evidencia en el manejo de la menopausia.
Principales métodos:
- Revisión narrativa de la evidencia acumulada durante las últimas dos décadas.
- Análisis de datos observacionales sobre formulaciones de terapia hormonal y tipos de progestágenos.
- Síntesis de estudios que examinan el momento de inicio y la vía de administración.
Principales resultados:
- La terapia solo con estrógenos muestra reducciones en la incidencia y mortalidad del cáncer de mama.
- La terapia combinada de estrógenos y progestágenos se asocia con un mayor riesgo de cáncer de mama.
- La progesterona micronizada puede ofrecer un perfil de riesgo de cáncer de mama más favorable que los progestágenos sintéticos.
- El momento, la duración y la vía de administración influyen en los resultados de la THM.
Conclusiones:
- La THM ofrece beneficios significativos para los síntomas de la menopausia y la salud ósea.
- El riesgo de cáncer de mama asociado con la THM es matizado y depende del régimen específico y los factores del paciente.
- La selección individualizada de la THM, considerando los modificadores de riesgo, es crucial para un manejo óptimo de la menopausia.
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