I sintomi climaterici: il marcatore surrogato in menopausa

I sintomi climaterici: il marcatore surrogato in menopausa

I disturbi o disordini della menopausa vengono genericamente distinti in sintomi a breve termine – o, più propriamente, sintomi della transizione menopausale o sintomi climaterici – e condizioni patologiche a medio-lungo termine, altrimenti definibili come patologie croniche menopausa – correlate.

I sintomi climaterici più frequenti sono quelli vasomotori (VMS, vasomotor symptoms – ovvero le vampate di calore/hot flashes e le sudorazioni notturne), la secchezza vaginale, i disturbi del sonno e le modificazioni del tono dell’umore.

Da notare che i VMS, che  – ancorchè classificati tra gli short-term – possono persistere per decenni, di per sé impattano negativamente sulla qualità della vita anche favorendo/aggravando i disturbi del sonno e dell’umore; in tal senso, non vanno trascurate le problematiche correlate alla sessualità. Le patologie croniche a comparsa più o meno tardiva sono le malattie cardiovascolari (CVD, cardiovascular diseases),  l’osteoporosi (OP) ed il decadimento cognitivo; l’allungamento dell’aspettativa di vita ne ha ovviamente incrementato l’incidenza.

Attualmente una mole crescente di evidenze dimostra che i sintomi climaterici, in particolare i VMS, possono essere dei biomarcatori surrogati per CVD, Op e decadimento cognitivo. In uno studio personale si è potuto dimostrare, ad esempio, che i sintomi climaterici – complessivamente valutati secondo la scala climaterica di Greene – si associano al peggioramento di alcuni noti fattori di rischio biochimico per aterosclerosi e CVD, in particolare trigliceridemia e rapporto trigliceridi/HDL- colesterolo.

Nella vasta coorte del trial Women’s Healt Initiative (WHI) è stato recentemente dimostrato che i VMS, in particolare le sudorazioni notturne, correlano con un più elevato rischio di diabete. E’ altresì documentato in numerosi studi, tra cui lo SWAN (Study of Women’s Health Across the Nation), un link (mediato dal sistema nervoso simpatico) tra VMS e ipertensione arteriosa: le donne con vampate di calore mostrano un’incidenza maggiore di ipertensione essenziale e di ipertensione sistolica rispetto a quelle che non riferivano le vampate. Inoltre, sempre nel WHI, un’anamnesi positiva per hot flashes protratti nel tempo correla con calcificazioni aortiche. Nell’ambito dello studio italiano The Lady Acute Coronary Sindrome, è emerso che in donne con sindrome coronarica acuta, una storia di VMS si associa ad un’età più precoce di comparsa della sindrome, indipendentemente dal “carico” della vasculopatia (addirittura più basso rispetto alle donne senza VMS) e del quadro coronarografico (simile nei due gruppi a confronto).

Sulla base anche di una recente metanalisi, quindi, emerge che le evidenze disponibili sono concordanti nella dimostrazione di una significativa correlazione tra VMS e altri sintomi climaterici ed un aumentato rischio di malattie cardiovascolari, incremento “mediato” principalmente dall’impatto sfavorevole di tali sintomi sui tradizionali fattori di rischio cardiovascolare.

Altri dati suggeriscono analoghe associazioni “a medio–lungo termine” tra sintomi vasomotori/climaterici e:

  • Deficit mnesici, non dovuti quindi a fattori psicologici, e/o iperintensità della sostanza bianca, ovvero lesioni cerebrali potenzialmente correlate a decadimento cognitivo – da notare che le evidenze più significative sono per i sintomi vasomotori notturni;
  • Riduzione della densità minerale ossea ed incremento dell’incidenza di fratture osteoporotiche;
  • Prolasso degli organi pelvici (vescica, utero, retto), che inoltre correla con un incremento di fratture di femore incidentali;
  • Incontinenza urinaria da stress e da urgenza.

Alla luce di queste considerazioni si capisce la grande importanza di gestire in maniera PERSONALIZZATA ogni singola paziente già a partire dalla fase PREMENOPAUSALE.

Diverse sono le possibilità preventive e terapeutiche che si possono proporre.

SOGGETTIVIZZARE gli interventi è una missione che il medico deve impegnarsi a capire e difendere, per dare alle persone, in questo caso alle donne, una qualità di vita migliore e un sano approccio all’invecchiamento.

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