«1°Congresso Nazionale AIGEF-Associazione Italiana di Ginecologia Estetica e Funzionale.Il benessere genitale femminile»ROMA 16-17 GENNAIO 2015NH Hotel Leonardo Da VinciVia dei Gracchi,324 -00192 ROMA

Dr. Carlo Mapelli – Direttivo Nazionale SIGITECentro Menopausa Ospedale Niguarda Milano

www.menopausaitaliana.itmapellister@gmail.com

International Journal of General Medicine 2013:6

Vaginal atrophy

Loss of foldsFolds or rugae

Muscular coat

Erectile tissue

Inner lining contains large amount glycogen

Loss of inner lining and glandular function

PREMENOPAUSA POSTMENOPAUSA

Samsioe G, A profile of the Menopause 1995; 49 (Fig. 6.4)

The Oncologist 2008;13:222–231

MATURITAS 79 2014)349-354

CLIMATERIC 2012;15:36-44

SI SENTE SECCA-ASCIUTTA ?

PROVA DOLORE DOPO IL RAPPORTO SESSUALE ?

SENTE BROCIORE-PRURITO ?

HA SENSO DI IRRITAZIONE O PERDITE VAGINALI ?

PROVA QUALCHE FASTIDIO URINARIO –DISURIA-AUMENTATA FREQUENZA URINARIA-URGENZA ?

SI SENTE A DISAGIO A CAUSA DI QUESTI DISTURBI ?

TERAPIE NON ORMONALI

LUBRIFICANTI

IDRATANTI

EUTROFIZZANTI

LASER VAGINALE(CO2-ERBIUM)

TERAPIA ORMONALE

SISTEMICA

TOS-TIBOLONE-SERM(OSPEMIFENE)

LOCALE

(ESTRADIOLO-ESTRIOLO-PROMESTRIENE)

ESTRADIOLO COSTI IN EURO

CANDELETTE 25 MICROGRAMMI 15 CP VAG 11.36 CLASSE A

CANDELETTE 10 MICROGRAMMI

ESTRIOLO

OVULI 1 MG 20 OVULI 7.85 CLASSE A

OVULI 0.5MG

CREMA VAGINALE 0,0125% 30 GR. 6 APPLICATORI 3.18 CLASSE A

OVULI 0,03MG+LATTOBACILLI 17.30 CLASSE C

GEL VAGINALE 50 MICROGRAMMI 10 GRAMMI 18 CLASSE C

PROMESTRIENE

Caps.vaginali 10 mg 4.80 CLASSE A

Crema vaginale 1% 30 g 4.80 CLASSE A

CLIMACTERIC 2003;6:45–52ESTRIOLO OVESTIN

Breast Cancer Res Treat Aprile 2014

How to use vaginal estrogens in gyn.onc.?

u Only local estrogens (Promestriene)

u Very low dose and gradual increase

u Follow up

Del Pup Boll Ginecol Endocrin 2010

0

100

200

300

400

500

600

700

800

900

1000

PRE POST

0

50 0

10 0 0

150 0

2 0 0 0

2 50 0

3 0 0 0

PR E POST

Biogerontology 3: 337–345, 2002.

© 2002 Kluwer Academic Publishers. Printed in the Netherlands.

Am J Clin Dermatol 2003; 4 (11): 737-743 THERAPY IN PRACTICE 1175-0561/03/0011-0737/$30.00/0

HR Rischio assoluto Rischio assoluto HR

1.29 +7/10.000/a CHD n.s. 0.91

1.26 +8/10.000/a Breast Ca. -7/10.000/a 0.77

1.41 +8/10.000/a Stroke +12/10.000/a 1.39

2.13 +8/10.000/a VTE +7/10.000/a 1.33

0.63 -6/10.000/a Colorectal Ca. n.s. 1.08

0.66 -5/10.000/a Hip fracture -6/10.000/a 0.61

0.83 n.s. Endometrial Ca.

JAMA 2002;288:321-333 JAMA 2004;291:1701-1712

EPT ET

WHI

STOP 5,2 anni (31.5.2002) STOP 6,8 anni (2.2.2004)

Studio multicentrico randomizzato controllato

Follw-up di 8,5 anni (Marzo 2005)

Absolute Risk of Breast Cancer

Each 50-year-old woman has

approximately a 2.8% chance of

developing breast cancer by age 60

This translates to an absolute risk

of 2.8 per 100 women

All Women Aged 50 in the General Population

Risk for Breast Cancer by Age 60

Breast Cancer Facts and Figures 2001-2002. Available at: www.cancer.org/downloads/STT/BrCaFF2001.pdf.

In 100 women, 2.8 are at risk

WHI results indicate a hazard risk for breast

cancer of 1.26 after 5 years of HRT use (a

26% increase in risk)

This translates into an absolute risk of 3.5 per

100 users

Risk of Breast Cancer by Age 60 After 5 Years of HRT Use

(Assuming a 26% Increase in Risk)

3.5 of 100 women who are HRT users are at risk

(<1 additional woman over baseline risk)

+0.7%

Unopposed Estrogen Therapy and the Risk of Invasive Breast Cancer

the Nurses' Health Study, a prospective cohort study, 28 835 women

Wendy Y. Chen, et al., Arch Intern Med. 2006;166:1027-1032 Vol. 166 No. 9, May 8, 2006.

P for trend <.001

1.13-1.770.95-1.480.87-1.30

0.73-1.120.75-1.22

Obstetrics & GynecologyIssue: Volume 121(1), January 2013, p 172–176Copyright: © 2013 The American College of Obstetricians and GynecologistsPublication Type: [Current Commentary]DOI: http://10.1097/AOG.0b013e31827a08c8ISSN: 0029-7844 Accession: 00006250-201301000-00026

“Estrogen plus progestin therapy, but not estrogen therapy, increased the risk of breast cancer”

Rossouw, Jacques E. MD; Manson, JoAnn E. MD, DrPH; Kaunitz, Andrew M. MD; Anderson, Garnet L. PhD

The E3N cohort study French cohort study

mean follow-up period of 8.1 years, 2,354 cases of invasive breast cancer

were observed among 80,377 French postmenopausal women

HRT use

Breast cancer RR 95%C.I.

micronized P 1.00 0.83 - 1.22

dydrogesterone 1.16 0.94–1.43

Other syntetic progestins 1.69 1.50-1.91

Modified from Fournier, Berrino, Clavel-Chapelon, Breast Cancer Res Treat. 2008 January ; 107(1): 103–111

Wertheimer MD et al “Increasing the effort toward breast cancer detection” JAMA. 1986;255:1311-1315.