Terapia hormonal para a menopausa (TH): múltiplos interesses a considerar

Abstract

In 2002, the Women's Health Initiative (WHI) study was interrupted as evidence indicated that the use of hormones increased the risk of cardiovascular disease and of breast cancer. Since then scientific literature has pointed to three nuclei of interest for that issue: women, the doctor and the pharmaceutical industry. Regarding women, the following issues are emphasized: the cultural aspects of menopause, the feminist movements' struggle and the absence of enough epidemiological studies. With respect to doctors the lack of information on the safety of drugs is an important topic. Regarding the pharmaceutical industry the prevailing motivation is their economic interests.

Treatment of postmenopausal osteoporosis in women: a systematic review

“…However, there is controversy concerning the reduction in fracture risk and increase in BMD, and its use has been associated with increased risk of coronary disease, breast cancer, aneurysm, and pulmonary embolism 47,48,49 . A study in the United States with postmenopausal women concluded that the effect of HRT on decrease in fracture risk is valid for short time periods (< 5 years) and that the effect decreased after interrupting its use 50 .…”

Postmenopausal hormone therapy in the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil): who still uses it?

“…Although state and municipal healthcare managers have the autonomy to buy other drugs based on regional needs, the drugs are not always available, which may contribute to the reduction in use in women who rely exclusively on the healthcare services of the SUS. As in other countries, the influence of the pharmaceutical industry on drug prescription, both in private settings and in public healthcare, must be considered . In Brazil, 64.2% of the physicians who are involved in patient care in the public sector also work in the private sector, and this dual role may promote what has been described as the “chameleon phenomenon,” which is the adoption of different behaviors for each workplace and profile of clients .…”

“…In addition, despite the accumulation of evidence indicating limits related to age, to the duration of HT and to the time since menopause, the posture assumed by the specialist medical associations on the subject has been quite liberal, stressing the importance of clinical judgment, the cost–benefit ratio, and individualization . These aspects emphasize the subjective character of the prescription, leaving the decision in the hands of the doctor and the patient, based on their own individual beliefs, which are strongly influenced by advertising and the media . In a study conducted by the Brazilian Health Surveillance Agency (ANVISA), 64.9% of the physicians surveyed admitted to taking advertising information into consideration when choosing a product for prescription.…”

“…As in other countries, the influence of the pharmaceutical industry on drug prescription, both in private settings and in public healthcare, must be considered. [38][39][40] In Brazil, 64.2% of the physicians who are involved in patient care in the public sector also work in the private sector, 39 and this dual role may promote what has been described as the "chameleon phenomenon," which is the adoption of different behaviors for each workplace and profile of clients. 41 In addition, despite the accumulation of evidence indicating limits related to age, to the duration of HT and to the time since menopause, the posture assumed by the specialist medical associations on the subject has been quite liberal, stressing the importance of clinical judgment, the cost-benefit ratio, and individualization.…”

Entre o campo e o laboratório: a dinâmica de produção de conhecimento no Ambulatório de Menopausa do Caism/Unicamp

“…Cerca de 72 milhões de mulheres no mundo, entre as quais dois milhões de brasileiras, relatam sintomas da menopausa (Rozenfeld, 2007). Apesar do número expressivo, pesquisas comparativas indicam que, em algumas sociedades, a ocorrência da menopausa é desconhecida, não havendo sequer um termo para designar tal fase (Vigeta, Brêtas, 2006).…”