{"id":637,"date":"2019-03-09T11:04:38","date_gmt":"2019-03-09T08:04:38","guid":{"rendered":"http:\/\/blog.ulubat.org\/?p=637"},"modified":"2020-08-29T18:52:48","modified_gmt":"2020-08-29T15:52:48","slug":"hormon-replasman-tedavisinin-endometrium-kanseriyle-iliskisi","status":"publish","type":"post","link":"https:\/\/blog.ulubat.org\/index.php\/genel\/hormon-replasman-tedavisinin-endometrium-kanseriyle-iliskisi\/","title":{"rendered":"Hormon Replasman Tedavisi ve Endometrium Kanseri"},"content":{"rendered":"\n

Hormon Replasman Tedavisi (HRT) Nedir? HRT kimlere uygulan\u0131r?<\/strong><\/p>\n\n\n\n

Hormon replasman (yerine koyma) tedavisi, menopoz d\u00f6neminde \u00f6strojen hormonunun d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcne ba\u011fl\u0131 olu\u015fan s\u0131cak basmas\u0131 ve vajinal kuruluk gibi semptomlar\u0131 hafifletmek i\u00e7in ve ayn\u0131 zamanda osteoporozu \u00f6nlemek i\u00e7in kullan\u0131lan bir tedavi y\u00f6ntemidir. Bu tedavi y\u00f6nteminde, menopoza ba\u011fl\u0131 olarak kad\u0131nda eksik olan hormonlar oral, transdermal veya lokal yoldan uygulan\u0131r. HRT, kimi zaman \u00f6strojen ve progesteronun kombine olarak uyguland\u0131\u011f\u0131, kimi zaman da \u00f6strojenin tek ba\u015f\u0131na verildi\u011fi bir tedavi y\u00f6ntemidir. HRT, di\u011fer bilinen adlar\u0131yla “hormon tedavisi, menopozal hormon tedavisi ve \u00f6strojen replasman tedavisi, menopoz ve perimenopoz semptomlar\u0131n\u0131 hafifletmek i\u00e7in kullan\u0131labilecek en etkili y\u00f6ntemdir.<\/p>\n\n\n\n

HRT, menopozal semptomlar\u0131 ya\u015fayan, meme, uterus ve yumurtal\u0131k kanseri ge\u00e7irmemi\u015f, kan bas\u0131nc\u0131 normal s\u0131n\u0131rlar i\u00e7erisinde olan ve karaci\u011fer hastal\u0131\u011f\u0131 ge\u00e7irmemi\u015f kad\u0131nlara jel veya tablet yoluyla uygulanabilir.<\/p>\n\n\n\n

HRT nas\u0131l uygulan\u0131r?<\/strong><\/p>\n\n\n\n

G\u00fcn\u00fcm\u00fczde d\u00f6rt farkl\u0131 y\u00f6ntemle uygulanabilmektedir. Bunlardan birincisi, “tek ba\u015f\u0131na \u00f6strojen i\u00e7eren HRT” dedi\u011fimiz histerektomi ameliyat\u0131 ge\u00e7irdi\u011fi i\u00e7in progesterona ihtiyac\u0131 olmayan kad\u0131nlara \u00f6strojenin tek ba\u015f\u0131na oral tabletle veya transdermal \u00fcr\u00fcnlerle verildi\u011fi tedavi y\u00f6ntemidir.<\/p>\n\n\n\n

\u0130kinci olarak, “ard\u0131\u015f\u0131k HRT” menstrual d\u00f6ng\u00fcyle beraber perimenopozal semptomlar\u0131 ya\u015fayan kad\u0131nlara, ayl\u0131k periyotlar\u0131 ya\u015famalar\u0131n\u0131 sa\u011flayacak bir \u015fekilde uygulan\u0131r. T\u00fcm periyot boyu d\u00fczenli al\u0131nan \u00f6strojenin yan\u0131nda belirli g\u00fcnlerde tedaviye progesteron eklenir. Progesteron i\u00e7eren farkl\u0131 renkteki tabletlerin bitmesini takiben ayl\u0131k adet kanamalar\u0131 olu\u015fur. Bu tedavi, adetleri tamamen sona ermi\u015f kad\u0131nlar\u0131n yeniden adet g\u00f6rmelerini de sa\u011flayan bir y\u00f6ntemdir.<\/p>\n\n\n\n

\u00dc\u00e7\u00fcnc\u00fc y\u00f6ntemin ad\u0131 “kesintisiz kombine HRT”. Bu teknik bir y\u0131ldan uzun s\u00fcredir adet g\u00f6rmeyen kad\u0131nlara uygulan\u0131r. S\u00fcrekli ve kombine olarak \u00f6strojen+ progesteron verilerek rahimde ayl\u0131k kanamay\u0131 olu\u015fturan yap\u0131 geriletilerek kanamalar\u0131n tamamen kesilmesi sa\u011flan\u0131r. 28 g\u00fcn boyunca al\u0131nan ve i\u00e7eri\u011finde dengeli miktarda \u00f6strojen ve progesteron i\u00e7eren tabletler ile hem menopozal \u015fikayetler engellenir hem de ayl\u0131k kanamalar \u00f6nlenmi\u015f olur.<\/p>\n\n\n\n

D\u00f6rd\u00fcnc\u00fc y\u00f6ntemin ad\u0131 “lokal hormon tedavisi”. \u00d6strojen eksikli\u011finin vajende ve idrar yollar\u0131nda olu\u015fturdu\u011fu istenmeyen etkilerin giderilmesi i\u00e7in kullan\u0131lan krem, ov\u00fcl, jel veya vajinal tablet formundaki preparatlar ile bu tedavi uygulan\u0131r.<\/p>\n\n\n\n

Menstrual D\u00f6ng\u00fc ve Menopoz \u00dczerine Birka\u00e7 Detay<\/p>\n\n\n\n

Ergenlik ve menopoz d\u00f6nemleri aras\u0131nda her ay, sa\u011fl\u0131kl\u0131 her di\u015fi bireyin v\u00fccudunda muhtemel hamilelik i\u00e7in birtak\u0131m de\u011fi\u015fiklikler meydana gelir. Steroid hormonlar taraf\u0131ndan kontrol edilen bu d\u00f6ng\u00fcye menstrual d\u00f6ng\u00fc ad\u0131n\u0131 veririz. Menstrual d\u00f6ng\u00fcde, \u00f6strojen ve progesteronun \u00f6nemi b\u00fcy\u00fckt\u00fcr.<\/p>\n\n\n\n

Rahim duvar\u0131 olarak bilinen endometriumsa, her ay adet d\u00f6neminde at\u0131lan, rahim i\u00e7 duvar\u0131n\u0131 \u00f6rten ince bir tabakad\u0131r. Endometrium adet ba\u015flang\u0131c\u0131 ile yumurtal\u0131klardan sal\u0131nan \u00f6strojen ile kal\u0131nla\u015f\u0131r ve bu kal\u0131nla\u015fma progesteronun sal\u0131nmas\u0131yla birlikte yava\u015flar. B\u00f6ylece gebelikte embriyon i\u00e7in uygun ortam olu\u015fturulur. Hamilelik ger\u00e7ekle\u015fmedi\u011fi takdirde bu iki hormonun seviyesi azal\u0131r ve adet kanamalar\u0131yla birlikte bu doku d\u0131\u015far\u0131 at\u0131l\u0131r.<\/p>\n\n\n\n

Hayat\u0131n do\u011fal bir s\u00fcreci olarak, yumurtalar i\u00e7in gerekli olan takviyeler zamanla azal\u0131r. Yumurta say\u0131s\u0131n\u0131n azalmas\u0131yla birlikte, \u00f6strojen hormonunun seviyesi de d\u00fc\u015fmeye ba\u015flar. En sonunda yumurta \u00fcretimi ve menstrual d\u00f6ng\u00fc sona erer ve menopoz ba\u015flar. Buna ba\u011fl\u0131 olarak da \u00e7o\u011fu kad\u0131n 40’l\u0131 ya\u015flar\u0131n\u0131n sonuna do\u011fru bu hormon de\u011fi\u015fikliklerinin etkilerini s\u0131cak basmas\u0131, vajinal kuruluk, uykusuzluk, kar\u0131n b\u00f6lgesinde ya\u011flanma, osteoporoz gibi semptomlarla beraber deneyimler.<\/p>\n\n\n\n

Endometrium Kanseri <\/strong><\/p>\n\n\n\n

En s\u0131k g\u00f6r\u00fclen jinekolojik kanser tipi olan endometrium kanseri rahmin her ay d\u00f6k\u00fclen i\u00e7 k\u0131sm\u0131ndan kaynaklanan bir kanserdir. Anormal vajinal kanamaya sebebiyet verdi\u011fi i\u00e7in, genellikle erken te\u015fhis sonucu uterusun tamamen al\u0131nmas\u0131yla (histerektomi) tedavi edilir. Di\u011fer semptomlar\u0131 aras\u0131nda periyotlar aras\u0131nda kanama, pelvik b\u00f6lgede a\u011fr\u0131 ve sulu veya hafif kanl\u0131 bir ak\u0131nt\u0131 da vard\u0131r. Risk fakt\u00f6rleri tamamiyle bilinmese de aralar\u0131nda obezitenin, ya\u015f\u0131n, hi\u00e7 gebe kalmaman\u0131n ve ergenli\u011fe erken girmemin oldu\u011fu bilinmektedir.<\/p>\n\n\n\n

<\/p>\n\n\n\n

HRT ile endometrium kanseri aras\u0131ndaki ili\u015fki nedir?<\/strong><\/p>\n\n\n\n

<\/p>\n\n\n\n

HRT ilk kez 1940’l\u0131 y\u0131llarda bulunan ama 1960’l\u0131 y\u0131llarda kullan\u0131m\u0131 yayg\u0131nla\u015fan bir tedavi y\u00f6ntemidir. 1975 y\u0131l\u0131nda yap\u0131lan \u00e7al\u0131\u015fmada, yaln\u0131z \u00f6strojen i\u00e7eren HRT’nin endometrium kanseri riskini art\u0131rd\u0131\u011f\u0131 ortaya \u00e7\u0131km\u0131\u015ft\u0131r. Bu riski minimalize etmek i\u00e7in, histerektomi ameliyat\u0131 olmam\u0131\u015f kad\u0131nlara progesteronla kombine edilmi\u015f HRT uygulanmaya ba\u015flanm\u0131\u015ft\u0131r. Y\u0131llar boyunca s\u00fcren \u00e7al\u0131\u015fmalar, HRT’nin yumurtal\u0131k, endometrium ve meme kanseri riskini artt\u0131rd\u0131\u011f\u0131n\u0131 g\u00f6sterdi. “Million Women Study” bu \u00e7al\u0131\u015fmalar\u0131n aras\u0131nda en \u00f6nemli \u00e7al\u0131\u015fmalardan biridir.<\/p>\n\n\n\n

“Million Women Study” 1996-2001 y\u0131llar\u0131 aras\u0131nda B\u00fcy\u00fck Britanya’da y\u00fcr\u00fct\u00fclm\u00fc\u015f, 50 ya\u015f\u0131n\u0131 a\u015fan postmenopozal kad\u0131nlar\u0131n kat\u0131ld\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmad\u0131r. Bu \u00e7al\u0131\u015fmada HRT kullanan ve kullanmayan toplam 828.923 kad\u0131nda kanser riski incelenmi\u015f ve \u00e7al\u0131\u015fma sonucunda edinilen bulgulara g\u00f6re;<\/p>\n\n\n\n

\u2022 yaln\u0131z \u00d6strojen i\u00e7eren HRT yumurtal\u0131k, endometrium ve meme kanseri riskini art\u0131rd\u0131\u011f\u0131,
\n\u2022 kombine HRT ise endometrium kanseri riskini azalt\u0131rken, meme kanseri riskini “yaln\u0131z \u00f6strojen i\u00e7eren HRT”ye oranla daha fazla art\u0131rd\u0131\u011f\u0131,
\n\u2022 HRT tedavisi ne kadar uzun s\u00fcrerse meme kanseri riskinin bir o kadar artt\u0131\u011f\u0131,
\n\u2022 HRT tedavisi durdurulduktan sonra meme kanseri riskinin ortadan kayboldu\u011fu,
\n\u2022 transdermal \u00f6strojenin ven\u00f6z tromboz riskini artt\u0131rmad\u0131\u011f\u0131 tespit edilmi\u015ftir.<\/p>\n\n\n\n

HRT’nin kullan\u0131m\u0131n\u0131n sonu\u00e7lar\u0131na ili\u015fkin bu bulgular\u0131n 2002-2003 y\u0131llar\u0131nda yay\u0131nlanmas\u0131, d\u00fcnyada hem HRT kullananlarda hem de doktorlarda panik yaratm\u0131\u015ft\u0131r. T\u0131p camias\u0131, HRT’nin uygulan\u0131p uygulanmamas\u0131na dair ikiye b\u00f6l\u00fcnm\u00fc\u015f, kimi doktorlar hastalar\u0131na hemen bu tedaviyi b\u0131rakt\u0131rm\u0131\u015f, kimi doktorlarsa bu tedaviyi uygulamaya devam etmi\u015ftir. Bununla beraber d\u00fcnyada HRT kullanan hastalar\u0131n say\u0131s\u0131 2 milyondan 1milyona d\u00fc\u015fm\u00fc\u015ft\u00fcr. 2015 y\u0131l\u0131nda NICE guardline “yaln\u0131z \u00f6strojen i\u00e7eren HRT”nin kanser riskini hesaba katmad\u0131klar\u0131n\u0131 a\u00e7\u0131klam\u0131\u015ft\u0131r.<\/p>\n\n\n\n

HRT’ye dair yap\u0131lan bir \u00e7ok \u00e7al\u0131\u015fma g\u00f6steriyor ki, \u00f6strojen tek ba\u015f\u0131na endometrium kanseri riskini artt\u0131r\u0131rken, progesteronla kombine oldu\u011fu zaman endometrium kanseri riskini azalt\u0131yor. Peki “yaln\u0131z \u00f6strojen i\u00e7eren HRT”de endometrium kanserine sebep olan fakt\u00f6r nedir? Daha \u00f6nce yukar\u0131da da belirtildi\u011fi gibi \u00f6strojen endometriumun yap\u0131lanma ve b\u00fcy\u00fcmesini, progesteron ise endometrium b\u00fcy\u00fcmesinin yava\u015flamas\u0131n\u0131 sa\u011fl\u0131yor. Progesteron yoklu\u011fu endometrium tabakas\u0131n\u0131n s\u0131n\u0131rs\u0131z b\u00fcy\u00fcmesine sebep oluyor. Bu durum da en sonunda endometrium kanseri olu\u015fumuna neden oluyor.<\/p>\n\n\n\n

HRT yerine kullan\u0131labilecek alternatifler nelerdir?<\/strong><\/p>\n\n\n\n

Perimenopoz d\u00f6nemindeki bir kad\u0131n, replasman tedavisi g\u00f6rmek istemiyorsa, hayat\u0131nda al\u0131\u015fkanl\u0131k haline getirmesi gerekebilece\u011fi davran\u0131\u015flar mevcut. Bunlar:<\/p>\n\n\n\n

\u2022 Kafein, alkol kullan\u0131m\u0131 azaltmak
\u2022 Baharatl\u0131 yemeklerden ka\u00e7\u0131nmak
\u2022 Sigara i\u00e7memek
\u2022 D\u00fczenli egzersiz yapmak
\u2022 Serin bir odada uyumak
\u2022 Serinletici jeller kullanmak<\/p>\n\n\n\n

<\/p>\n\n\n\n

KAYNAKLAR:<\/p>\n\n\n\n

<\/p>\n\n\n\n

  1. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17000581<\/li>
  2. http:\/\/www.womens-health-concern.org\/help-and-advice\/factsheets\/hrt-the-history\/<\/li>
  3. http:\/\/www.mayoclinic.org\/diseases-conditions\/endometrial-cancer\/symptoms-causes\/syc-20352461<\/li>
  4. http:\/\/www.trsgo.org\/menu\/154\/rahim-ici-zari-endometriyum-kanseri<\/li>
  5. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15866308<\/li>
  6. http:\/\/www.novonordisk.com.tr\/hastalara-ozel\/hormon-replasman-tedavisi.html<\/li>
  7. http:\/\/www.jinekolognet.com\/hormon-tedavisi.asp<\/li>
  8. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27451318<\/li>
  9. http:\/\/www.nhs.uk\/conditions\/hormone-replacement-therapy-hrt\/<\/li>
  10. http:\/\/www.webmd.com\/menopause\/guide\/menopause-hormone-therapy#2<\/li>
  11. http:\/\/www.nhsinform.scot\/tests-and-treatments\/medicines-and-medical-aids\/types-of-medicine\/hormone-replacement-therapy-hrt<\/li>
  12. http:\/\/www.medicalnewstoday.com\/articles\/321837.php<\/li>
  13. http:\/\/academic.oup.com\/humupd\/article\/13\/4\/405\/2457861<\/li>
  14. http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4767501\/<\/li><\/ol>\n\n\n\n
    \"\"<\/figure>\n","protected":false},"excerpt":{"rendered":"

    Hormon Replasman Tedavisi (HRT) Nedir? HRT kimlere uygulan\u0131r? Hormon replasman (yerine koyma) tedavisi, menopoz d\u00f6neminde \u00f6strojen hormonunun d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcne ba\u011fl\u0131 olu\u015fan<\/p>\n","protected":false},"author":52,"featured_media":4464,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[135,85,83,86,55,133,89,87,88,134,84],"acf":[],"views":1440,"_links":{"self":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/637"}],"collection":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/users\/52"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/comments?post=637"}],"version-history":[{"count":7,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/637\/revisions"}],"predecessor-version":[{"id":7392,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/637\/revisions\/7392"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media\/4464"}],"wp:attachment":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media?parent=637"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/categories?post=637"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/tags?post=637"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}