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Authors
Advisor(s)
Abstract(s)
Introdução
A menopausa corresponde à perda fisiológica ou iatrogénica da menstruação
confirmada pela ausência desta após 12 meses, na ausência de causa patológica e é,
frequentemente, acompanhada de sintomas transitórios como ondas de calor, sudorese
noturna, distúrbios do sono, humor depressivo, entre outros.
Existem vários tratamentos disponíveis para o controlo destas manifestações como a
mudança de estilos de vida e a terapia hormonal que consiste na administração das
hormonas através de comprimidos, adesivos transdérmicos, cremes ou comprimidos de
aplicação vaginal.
Mais recentemente, colocou-se a hipótese do uso de tecido ovárico autólogo, através de
criopreservação e posterior transplante do mesmo, como forma de terapia hormonal. O
transplante pode ser realizado de duas formas, ortotópicamente (cavidade pélvica) e
heterotópicamente (extra-ovárico).
Objetivos
O objetivo desta dissertação é determinar se a criopreservação e posterior transplante
de tecido ovárico, pode ser vir a usado como terapia hormonal na menopausa na
prática corrente do tratamento dos sintomas da menopausa e num futuro próximo.
Metodologia
Foi realizada uma vasta pesquisa bibliográfica, com recurso à plataforma PubMed,
durante outubro de 2022 a janeiro de 2023. Foram usadas as seguintes palavras-chave:
menopausa, criopreservação e transplante tecido ovárico e terapia hormonal na
menopausa. Adicionalmente, foram consultados pareceres de sociedades mundiais de
relevo para o tema e guidelines atuais. Após a análise do material recolhido, foi
realizada esta revisão.
Resultados e Discussão
O transplante de tecido ovárico criopreservado permite a restauração da função
endócrina na maioria dos casos e seu efeito hormonal pode durar até 10 anos, se o
excerto for substituído regularmente. Durante os processos de recolha de tecido,
transplantação e revascularização parte da reserva folicular é perdida por processos de
isquemia, o que pode resultar numa menopausa anos antes do que seria natural para cada mulher. De forma a reduzir estes danos, moléculas como o VEGF e a S1F,
permitem aumentar a densidade vascular e acelerar o processo de revascularização e
assim tornar mais rentável esta técnica.
Conclusão
Apesar de ser uma solução mais fisiológica, esta técnica é dispendiosa e invasiva e, por
isso, só indicada em casos específicos. A população alvo para este procedimento são
mulheres que o usem quer para tratamento dos sintomas da menopausa induzida como
para restauração da fertilidade, nas quais é mais apelativo e custo-efetivo.
Introduction Menopause corresponds to the physiological or iatrogenic loss of menstruation confirmed by the absence of menstruation after 12 months, in the absence of a pathological cause, and is often accompanied by transient symptoms such as hot flashes, night sweats, sleep disorders, depressive mood, among others. There are several treatments available to control these manifestations, such as changing lifestyles and hormone therapy, which consists of administering hormones through pills, transdermal patches, creams or pills for vaginal application. More recently, the hypothesis of the use of autologous ovarian tissue, through cryopreservation and subsequent transplantation, as a form of hormone therapy, has been hypothesized. Transplantation can be performed in two ways, orthotopically (pelvic cavity) and heterotopically (extra-ovarian). Objectives The aim of this dissertation is to determine whether cryopreservation and subsequent transplantation of ovarian tissue can be used in future as an hormone replacement therapy in current practice in the treatment of menopausal symptoms. Methods An extensive bibliographical research was carried out, using the PubMed platform, from october 2022 to january 2023. The following keywords were used: menopause, cryopreservation and ovarian tissue transplantation and hormone therapy in menopause. Additionally, opinions from relevant world societies on the subject and current guidelines were consulted. After analyzing the collected material, this review was carried out. Results and discussion Transplantation of cryopreserved ovarian tissue allows the restoration of endocrine function in most cases and its hormonal effect can last up to 10 years if the tissue is replaced regularly. During tissue harvesting, transplantation and revascularization processes, part of the follicular reserve is lost due to ischemia processes, which can result in menopause years before what would be natural for each woman. In order to reduce this damage, molecules such as VEGF and S1F allow the increase of vascular density and accelerate the revascularization process, thus making this technique more profitable. Conclusion Despite being a more physiological solution, this technique is expensive and invasive and, therefore, only indicated in specific cases. The target population for this procedure is women who use it both to treat medically induced menopausal symptoms and to restore fertility, and thus it is more appealing and cost-effective.
Introduction Menopause corresponds to the physiological or iatrogenic loss of menstruation confirmed by the absence of menstruation after 12 months, in the absence of a pathological cause, and is often accompanied by transient symptoms such as hot flashes, night sweats, sleep disorders, depressive mood, among others. There are several treatments available to control these manifestations, such as changing lifestyles and hormone therapy, which consists of administering hormones through pills, transdermal patches, creams or pills for vaginal application. More recently, the hypothesis of the use of autologous ovarian tissue, through cryopreservation and subsequent transplantation, as a form of hormone therapy, has been hypothesized. Transplantation can be performed in two ways, orthotopically (pelvic cavity) and heterotopically (extra-ovarian). Objectives The aim of this dissertation is to determine whether cryopreservation and subsequent transplantation of ovarian tissue can be used in future as an hormone replacement therapy in current practice in the treatment of menopausal symptoms. Methods An extensive bibliographical research was carried out, using the PubMed platform, from october 2022 to january 2023. The following keywords were used: menopause, cryopreservation and ovarian tissue transplantation and hormone therapy in menopause. Additionally, opinions from relevant world societies on the subject and current guidelines were consulted. After analyzing the collected material, this review was carried out. Results and discussion Transplantation of cryopreserved ovarian tissue allows the restoration of endocrine function in most cases and its hormonal effect can last up to 10 years if the tissue is replaced regularly. During tissue harvesting, transplantation and revascularization processes, part of the follicular reserve is lost due to ischemia processes, which can result in menopause years before what would be natural for each woman. In order to reduce this damage, molecules such as VEGF and S1F allow the increase of vascular density and accelerate the revascularization process, thus making this technique more profitable. Conclusion Despite being a more physiological solution, this technique is expensive and invasive and, therefore, only indicated in specific cases. The target population for this procedure is women who use it both to treat medically induced menopausal symptoms and to restore fertility, and thus it is more appealing and cost-effective.
Description
Keywords
Criopreservação e Transplante Tecido Ovárico Futuro Menopausa Terapia Hormonal de Substituição