Las mujeres postmenopáusicas que toman tratamiento hormonal (TH) de la menopausia tienen menor riesgo de desarrollar fases avanzadas de la degeneración macular relacionada con la edad, especialmente cuando se han tomado con anterioridad anovulatorios.

Neovascular or wet age-related macular degenerationLa degeneración macular relacionada con la edad (DME) es la principal causa de pérdida de visión y ceguera entre los adultos. Aunque los factores genéticos son importantes en el origen de la enfermedad, los factores ambientales también tienen importancia. La DME es mucho más frecuente en las mujeres que en los varones, se relaciona con enfermedad cardiovascular y se piensa que pueda tener alguna relación con los estrógenos. La Dra. Diane Feskanich, del Brigham and Women's Hospital y la Facultad de Medicina, en Boston, ha encontrado que el tratamiento hormonal de la menopausia, el uso anterior de oral contraceptivos, y la historia reproductiva juegan significativas influencias en la evolución de la DME.

El estudio se ha basado en los datos de 74.996 mujeres postmenopáusicas del Nurses' Health Study, controladas entre 1980 y 2002. Las mujeres que llevaban TH tuvieron 48% menor riesgo de alteraciones neovasculares de DME en comparación con las que nunca usaron TH.

Arch Ophthalmol. 2008 Apr;126(4):519-24.Menopausal and reproductive factors and risk of age-related macular degeneration.

Feskanich D, Cho E, Schaumberg DA, Colditz GA, Hankinson SE.

Brigham and Women's Hospital and Harvard Medical School, Channing Laboratory, 181 Longwood Ave, Boston, MA 02115. diane.feskanich@channing.harvard.edu.

OBJECTIVE: To investigate whether estrogen exposures are associated with lower risks of age-related macular degeneration (AMD). METHODS: Postmenopausal hormone (PMH) use, past use of oral contraceptives (OCs), ages at menarche and menopause, and parity were assessed among 74 996 postmenopausal women. Over 22 years, cases of early (n = 554) and neovascular (n = 334) AMD with a visual acuity of 20/30 or worse were identified. Cox models were used to calculate the relative risk for each exposure, adjusted for smoking and other factors. RESULTS: Current PMH users had a notable 48% lower risk of neovascular AMD compared with those who had never used PMH, although risk did not decline linearly with longer durations of use. Risk was lowest for PMH users who had used OCs in the past (P value for interaction, .03). In contrast, risk of early AMD was a notable 34% higher among current PMH users and OC use was unassociated with risk. The only remarkable finding for the endogenous estrogenic factors was a 26% lower risk of early AMD for parous women. CONCLUSIONS: Although PMH and OC use were associated with a lower risk of neovascular AMD, no benefit was observed for early AMD. Factors influencing lifetime exposure to estrogens were not consistently associated with the disease.