La Sociedad Chilena de Endocrinología Ginecológica participa en ISGE 2016 con un Simposio dedicado al avance del plan nacional de manejo integral del climaterio.

La sesión será presidida por la Dra. Paulina Villaseca (SOCHEG) y por el Dr. Nicholas Panay (IMS)


Saturday 5th of March 2016 - 08:30 → 09:30
AFFARI 4 Scientific Society Symposium

Sociedad Chilena de Endocrinología Ginecológica
Fundada el 1 de septiembre de 2006 para diseminar el conocimiento en Endocrinología Ginecológica, Reproducción y Andrología

Chilean national guideline and organization for care of climacteric women, by levels of complexity
(organized by Sociedad Chilena de Endocrinología Ginecológica (SOCHEG)

Chairperson/s: Villaseca Paulina (CL), Panay Nicholas (GB)

Overview of a national comprehensive care plan for climacteric women.
Porcile Arnaldo (CL)

Addressing morbidity and HTM for each woman, keeping the focus on quality of life.
Vanhauwaert Paula (CL)

Definition of levels of care and HTM according to criteria of complexity.
Barriga Patricio (CL)

Installing the national program for care of climacteric women, state of progress.
Brantes Sergio (CL)


Overview of a national comprehensive care plan for climacteric women.
Arnaldo Porcile Jiménez (CL) Universidad de Chile

Worldwide, there is a big and growing population of menopausal middle-aged women requiring care in organized health networks. In Chile, according to national population records, to morbidity and mortality statistics and to different national surveys of health needs, these women have shown to have a high prevalence of problems in the physical, psychological, sexual and social spheres. Highlights include: depression (40%), obesity (44%), hypertension (40%), type 2 diabetes mellitus (19%), dyslipidemia (60%), smoking (32%), osteopenia (45%), sedentarism (91% ), amongst others.
A pilot project in an outpatient clinic of the public health system in Santiago de Chile, demonstrated a positive impact of a holistic management approach of the menopausal woman, improving the quality of life of these women (data will be shown). The need to care on middle-aged women with epidemiological criteria was evidenced, as well as the need to address care in a comprehensive way to cover the full range of problems affecting menopausal women. They need to relieve symptoms, prevent disease and also confront social problems: changing roles related to children or grandchildren, partner relationship, work, eventually helping sick relatives and others. We concluded that the clinical management programs of middle-aged women should identify the hierarchy of problems affecting each individual case and generate algorithms for treatment, including hormone therapies and effective interventions for the current morbidity.
We worked together with the national health authorities to create a comprehensive management plan with accurate algorithms for the evaluation and clinical management of major health problems of women, including quality of life. We describe the basis of the program developed for the comprehensive management of menopause.

Addressing morbidity and HTM for each woman, keeping the focus on quality of life.
Paula Vanhauwaert Sudy (CL) SOCHEG

The Chilean Ministry of Health program for management of the climacteric woman (OT) have 3 main objectives: improve the quality of life (QoL), detect and treat comorbidities and the prevention of chronic illnesses. To achieve this a structured multidisciplinary program was established.
The program begins with a pre-established anamnesis including the Menopause Rating Scale (MRS), a physical examination and laboratory tests. With all this a diagnosis is made and a plan of treatment is designed according the recommendations of the OT.
The decisions involving QoL are taken according to the MRS score. The MRS evaluates different symptoms of the menopause syndrome and gives an evaluation of the QoL. The OT stablished a score above which the health professionals must offer a treatment because not doing so would be unethical. The hormonal treatment (HT) is the treatment of choice if no contraindication exist. If HT is excluded other treatments must be offered.
The detection of comorbidities is essential for both, prescription of HT and health issues. For metabolic diseases the OT promotes the use of the ATPIII criteria. The evaluation of anthropometric parameters, habits and other psychosocial factors are useful to intervene on healthy life style modifications.
The peri and post menopause is also an excellent time window to intervene and prevent the development of other pathologies such as osteoporosis and neoplasia so the screening and strategies to prevent them are also included in the OT
The psychosocial aspects are evaluated and worked out trough group workshops with structured methodologies and specific objectives designed to achieve the transfer of skills in interpersonal relationships, stress management, empowerment and self-esteem
Finally a global, personalized plan of treatment and follow up is made with the main goal of improve her quality of life.

Definition of levels of care and HTM according to criteria of complexity
Patricio Barriga Pooley (CL) Universidad Finis Terrae, Universidad San Sebastian

To plan a comprehensive management of menopause, which is massive through networks of health, it is essential to establish criteria that determine the complexity level of the main clinical situations to be handled in the health network, including the prescription of menopausal hormone therapy (MHT). The primary level is the equivalent to General Practitioner clinics. The second level is the specialized care reference center.
The Chilean Ministry of Health program for management of the climacteric woman defines the clinical situations that we considered can be handled at the primary level. The program defines, as well, the criteria proposed for deriving patients to the secondary level in the health network. We describe these definitions and also special conditions that merit special guidelines, as major depression or adjustment disorder, which is particularly prevalent in Chilean middle-aged female population.
Another group to be derived to the secondary level are women who remain eligible for MHT but require more knowledge by the prescriber for higher-risk situations, such as thrombophilia, hypertension or decompensated or parenchymal damage diabetes and anticonvulsive therapy as in the case of epilepsy.

Installing the national program for care of climacteric women, state of progress.
Sergio Brantes Glavic (CL) Universidad de Chile

The guidelines of the Chilean Ministry of Health for care of the climacteric woman presented in this symposium, were approved by the government recently, in 2014. Coverage targets and impact in the medium and long term were defined by the Ministry of Health. It is being introduced in 1800 outpatient primary care facilities and 200 secondary referral centers, throughout the country. We show the strategy for the implementation of the program. We describe the methods used to train professionals through classroom courses, teleconferences, instructional videos, and joint workshops.
We discuss the acceptance and the difficulties encountered during the implementation of the program along the country. It is notable that these management guidelines are fully applicable in any medical office or health care network.
The description of this experience in the International Congress of Gynecological Endocrinology has the objective to show this plan of management of climacteric women, looking forward for international consensus discussions for improvement of the standards in the comprehensive care for women in menopause age.

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