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La terapia hormonal para la menopausia aumenta el riesgo de sangrado gastrointestinal
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La terapia hormonal para la menopausia aumenta el riesgo de sangrado gastrointestinal

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La terapia hormonal para la menopausia aumenta el riesgo de sangrado gastrointestinal

Un estudio muestra que las mujeres que reciben terapia hormonal experimentan un aumento del riesgo de hemorragia del 50 %, frente a quienes nunca se han sometido a este tratamiento.

Las usuarias de la terapia hormonal para la menopausia (MHT) tienen más del doble de probabilidades que las que no siguen esa terapia de desarrollar sangrado gastrointestinal y colitis isquémica, especialmente si utilizan la terapia durante más tiempo, según un estudio hecho público en la Semana de Enfermedades Digestivas 2015.

"Sabemos que el estrógeno y la progesterona, las dos hormonas involucradas en la terapia hormonal para la menopausia, inducen la coagulación de la sangre, pero no sabemos si causan hemorragias gastrointestinales", señala Prashant Singh, médico residente en el Departamento de Medicina Interna del 'Massachusetts General Hospital', en Boston, Estados Unidos. "Este estudio confirma nuestra especulación de que la terapia hormonal aumenta el riesgo, especialmente en el tracto gastrointestinal inferior", añade.

Previamente, se había identificado la colitis isquémica, que es el bloqueo del flujo de sangre al intestino grueso, como una complicación de la MHT. Esta enfermedad puede hacer que los vasos sanguíneos se coagulen, lo que lleva a la mucosa gastrointestinal a morir y causar hemorragia digestiva baja.

Los científicos del Massachusetts General Hospital realizaron un estudio de cohorte prospectivo de 73 863 mujeres, comparando los episodios de sangrado gastrointestinal entre quienes tomaban MHT, quienes la habían tomado y quienes nunca la tomaron. Los investigadores ajustaron otros factores de riesgo conocidos de sangrado gastrointestinal, incluyendo el índice de masa corporal, el tabaquismo, el uso de anticonceptivos orales y el uso de la 'Aspirina' y fármacos antiinflamatorios no esteroideos (AINES).

Singh y su equipo vieron que las mujeres que recibían MHT experimentan un aumento del riesgo de hemorragia del 50 %, frente a quienes nunca se habían sometido a este tratamiento. Además, las primeras presentaban más del doble de probabilidades de experimentar colitis isquémica y hemorragia digestiva baja.

Cuanto más dura el tratamiento, más probabilidades de hemorragia

Sin embargo, no hubo diferencia en la incidencia de sangrado gastrointestinal superior entre quienes tomaban MHT y quienes nunca la tomaron, respecto a quienes la habían tomado. Los investigadores también midieron la correlación entre los episodios de sangrado gastrointestinal y la duración del tratamiento de MHT y vieron que cuanto más dura el tratamiento, más posibilidades hay de sufrir una hemorragia gastrointestinal importante. Singh también señala que en las usuarias de MHT había un mayor riesgo de sangrado en el tracto gastrointestinal inferior que en el superior porque hay menos vasos sanguíneos que irrigan la parte inferior, por lo que la coagulación tiene mucho mayor impacto.

"Es importante que las pacientes sepan que la terapia hormonal para la menopausia es un tratamiento efectivo -explica Singh-. Sin embargo, los médicos y las pacientes deben ser más cautelosas en el uso de esta terapia en algunos casos, como con las pacientes que tienen antecedentes de colitis isquémica. La decisión debe basarse en si los beneficios de la terapia hormonal para la menopausia superan los riesgos". mayo 24/2015 (,

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