The hormonal background in a woman’s body constantly changes throughout her life. With a lack of sex hormones, the course of biochemical processes is complicated. Only special treatment can help. The necessary substances are introduced artificially. In this way, the vitality and activity of the female body is prolonged. The drugs are prescribed according to an individual regimen, since if the possible consequences are not taken into account, they can have a detrimental effect on the condition of the mammary glands and genital organs. The decision to carry out such treatment is made on the basis of an examination.

Hormones are regulators of all processes occurring in the body. Without them, hematopoiesis and the formation of cells of various tissues are impossible. If they are deficient, the nervous system and brain suffer, and serious deviations in the functioning of the reproductive system appear.

There are 2 types of hormonal therapy:

1. Isolated HRT - treatment is carried out with drugs containing one hormone, for example, only estrogens (female sex hormones) or androgens (male hormones).
2. Combined HRT – several hormonal substances are introduced into the body at the same time.

There are various forms of release of such funds. Some of them are included in gels or ointments that are applied to the skin or inserted into the vagina. Medicines of this type are also available in tablet form. It is possible to use special patches, as well as intrauterine devices. If long-term use of hormonal drugs is necessary, they can be used in the form of implants inserted under the skin.

Note: The goal of treatment is not to completely restore the reproductive function of the body. With the help of hormones, symptoms that arise as a result of improper functioning of the most important life-supporting processes in a woman’s body are eliminated. This can significantly improve her well-being and avoid the occurrence of many diseases.

The principle of treatment is that to achieve maximum success, it must be prescribed promptly, before hormonal imbalances become irreversible.

Hormones are taken in small doses, and most often natural substances are used rather than their synthetic counterparts. They are combined in such a way as to reduce the risk of negative side effects. Treatment usually takes a long time.

Video: When is hormonal treatment prescribed for women?

Indications for prescribing HRT

Hormone replacement therapy is prescribed in the following cases:

• when a woman experiences early menopause due to depletion of the ovarian reserve and decreased estrogen production;
• when it is necessary to improve the condition of a patient over the age of 45-50 years when she experiences age-related menopausal ailments (hot flashes, headaches, vaginal dryness, nervousness, decreased libido and others);
• after removal of the ovaries, carried out in connection with purulent inflammatory processes, malignant tumors;
• in the treatment of osteoporosis (the appearance of repeated fractures of the limbs due to a violation of the composition of bone tissue).

Estrogen therapy is also prescribed to a man if he wants to change his sex and become a woman.

Contraindications

The use of hormonal drugs is absolutely contraindicated if a woman has malignant tumors of the brain, mammary glands and genital organs. Hormonal treatment is not carried out in the presence of blood and vascular diseases and a predisposition to thrombosis. HRT is not prescribed if a woman has had a stroke or heart attack, or if she suffers from persistent hypertension.

An absolute contraindication to such treatment is the presence of liver disease, diabetes mellitus, as well as allergies to the components included in the drugs. Treatment with hormones is not prescribed if a woman has uterine bleeding of an unknown nature.

Such therapy is not carried out during pregnancy and breastfeeding. There are also relative contraindications to the use of such treatment.

Sometimes, despite the possible negative consequences of hormonal therapy, it is still prescribed if the risk of complications of the disease itself is too great. For example, treatment is undesirable if the patient has migraines, epilepsy, fibroids, or a genetic predisposition to breast cancer. In some cases, there are restrictions on the use of estrogen preparations without the addition of progesterone (for example, with endometriosis).

Possible complications

Replacement therapy for many women is the only way to avoid severe manifestations of a lack of hormones in the body. However, the effect of hormonal drugs is not always predictable. In some cases, their use can lead to increased blood pressure, blood thickening and the formation of blood clots in the vessels of various organs. There is a risk of worsening existing cardiovascular diseases, including heart attack or cerebral hemorrhage.

Possible complication of cholelithiasis. Even a small overdose of estrogen can provoke cancer in the uterus, ovary or breast, especially in women over 50 years of age. The occurrence of tumors is more often observed in nulliparous women with a genetic predisposition.

Hormonal shifts lead to metabolic disorders and a sharp increase in body weight. Carrying out such therapy for a period of more than 10 years is especially dangerous.

Video: Indications and contraindications for HRT

Preliminary diagnosis

Hormone replacement therapy is prescribed only after a special examination with the participation of specialists such as a gynecologist, mammologist, endocrinologist, and therapist.

Blood tests are carried out for coagulation and the content of the following components:

1. Pituitary hormones: FSH and LH (regulating the functioning of the ovaries), as well as prolactin (responsible for the condition of the mammary glands) and TSH (a substance on which the production of thyroid hormones depends).
2. Sexual hormones (estrogen, progesterone, testosterone).
3. Proteins, fats, glucose, liver and pancreatic enzymes. This is necessary to study the metabolic rate and the condition of various internal organs.

Mammography and osteodensitometry (X-ray examination of bone density) are performed. In order to ensure the absence of malignant tumors of the uterus, a PAP test (cytological analysis of a smear from the vagina and cervix) and transvaginal ultrasound are performed.

Carrying out replacement therapy

The prescription of specific medications and the choice of treatment regimen are made purely individually and only after a complete examination of the patient has been carried out.

The following factors are taken into account:

• age and period of a woman’s life;
• the nature of the cycle (if there are menstruation);
• presence or absence of the uterus and ovaries;
• the presence of fibroids and other tumors;
• presence of contraindications.

Treatment is carried out using various techniques depending on its goals and the nature of the symptoms.

Types of HRT, drugs used

Monotherapy with estrogen-based drugs. It is prescribed only to women who have undergone a hysterectomy (removal of the uterus), since in this case there is no risk of developing endometrial hyperplasia. HRT is carried out with drugs such as estrogel, divigel, progynova or estrimax. Treatment begins immediately after the operation. It lasts for 5-7 years. If the age of the woman who has undergone such an operation is approaching menopause, then treatment is carried out until the onset of menopause.

Intermittent cyclic HRT. This technique is used during the onset of perimenopausal symptoms in women under 55 years of age or with the onset of early menopause. Using a combination of estrogen and progesterone, a normal menstrual cycle of 28 days is simulated.

To carry out hormone replacement therapy in this case, combined drugs are used, for example, femoston or klimonorm. The Klimonorm package contains yellow dragees with estradiol and brown dragees with progesterone (levonorgestrel). Yellow pills are taken for 9 days, then brown pills for 12 days, after which they take a break for 7 days, during which menstrual-like bleeding appears. Sometimes combinations of estrogen-containing and progesterone-containing drugs (for example, estrogel and utrozhestan) are used.

Continuous cyclic HRT. A similar technique is used in the case when a woman 46-55 years old has not had menstruation for more than 1 year (that is, menopause has occurred), and there are quite serious manifestations of menopausal syndrome. In this case, hormonal drugs are taken for 28 days (there is no imitation of menstruation).

Combined cyclic intermittent HRT estrogens and progestins are carried out in various modes.

It is possible to carry out treatment in monthly courses. Moreover, it begins with daily intake of estrogen preparations, and from the middle of the month progesterone-based products are also added to prevent overdose and the occurrence of hyperestrogenism.

A course of treatment lasting 91 days may be prescribed. In this case, estrogens are taken for 84 days, progesterone is added from day 71, then a break is taken for 7 days, after which the treatment cycle is repeated. This replacement therapy is prescribed to women aged 55-60 years who have reached postmenopause.

Combined continuous estrogen-progestogen HRT. Hormonal medications are taken without interruption. The technique is used for women over 55 years of age, and after 60 years of age, the dosage of drugs is reduced by half.

In some cases, estrogens are combined with androgens.

Examinations during and after treatment

The types and doses of medications used may be changed if signs of complications appear. In order to prevent dangerous consequences from occurring, the patient’s health condition is monitored during therapy. The first examination is carried out 1 month after the start of treatment, then after 3 and 6 months. Subsequently, the woman must visit a gynecologist every six months to check the condition of the reproductive organs. It is necessary to undergo regular mammological examinations, as well as visit an endocrinologist.

Blood pressure is controlled. A cardiogram is taken periodically. A biochemical blood test is performed to determine the content of glucose, fats, and liver enzymes. Blood clotting is checked. If serious complications occur, treatment is adjusted or discontinued.

HRT and pregnancy

One of the indications for prescribing hormone replacement therapy is the onset of early menopause (this sometimes happens at 35 years of age or earlier). The reason is a lack of estrogen. The level of these hormones in a woman’s body determines the growth of the endometrium, to which the embryo should attach.

To restore hormonal levels, patients of childbearing age are prescribed combination drugs (femoston most often). If the level of estrogen can be increased, then the mucous membrane of the uterine cavity begins to thicken, and in rare cases, conception is possible. This may occur after a woman stops taking the drug after several months of treatment. If there is any suspicion that pregnancy has occurred, it is necessary to stop treatment and consult a doctor about the advisability of maintaining it, since hormones can negatively affect the development of the fetus.

Addition: Before starting treatment with such drugs (in particular, femoston), a woman is usually warned about the need for additional use of condoms or other non-hormonal contraceptive devices.

HRT drugs can be prescribed for infertility caused by lack of ovulation, as well as during IVF planning. A woman’s ability to bear children, as well as the chances of a normal pregnancy, are assessed by the attending physician individually for each patient.

Hormone replacement therapy - abbreviated HRT - is now actively used in many countries around the world. To prolong their youth and replenish sex hormones lost with age, millions of women abroad choose hormonal therapy for menopause. However, Russian women are still wary of this treatment. Let's try to figure out why this happens.

Should I take hormones during menopause?or 10 myths about HRT

After the age of 45, women’s ovarian function begins to gradually decline, which means the production of sex hormones decreases. Along with a decrease in estrogen and progesterone in the blood comes a deterioration in physical and emotional condition. Menopause is ahead. And almost every woman begins to worry about the question: what can she do take during menopause to avoid aging?

In these difficult times, the modern woman comes to the aid of. Because during menopause estrogen deficiency develops, it is these hormones that have become the basis for all medications drugs HRT. The first myth about HRT is associated with estrogens.

Myth No. 1. HRT is unnatural

There are hundreds of queries on the Internet on the topic:how to replenish estrogen for a woman after 45-50 years . No less popular are queries about whether they useherbal remedies for menopause. Unfortunately, few people know that:

• HRT preparations contain only natural estrogens.
• Today they are obtained by chemical synthesis.
• Synthesized natural estrogens are perceived by the body as their own due to complete chemical identity with the estrogens produced by the ovaries.

And what could be more natural for a woman than her own hormones, analogues of which are taken to treat menopause??

Some might argue that herbal remedies are more natural. They contain molecules that are similar in structure to estrogens, and they act on receptors in a similar way. However, their action is not always effective in relieving the early symptoms of menopause (hot flashes, increased sweating, migraines, blood pressure surges, insomnia, etc.). They also do not protect against the consequences of menopause: obesity, cardiovascular diseases, osteoporosis, osteoarthritis, etc. In addition, their effect on the body (for example, on the liver and mammary glands) has not been well studied and medicine cannot vouch for their safety.

Myth No. 2. HRT is addictive

Hormone replacement therapy for menopause- just a replacement for the lost hormonal function of the ovaries. Drugs HRT is not a drug; it does not disrupt the natural processes in a woman’s body. Their task is to compensate for estrogen deficiency, restore the balance of hormones, and also improve overall well-being. You can stop taking the medications at any time. True, it is better to consult a gynecologist before this.

Among the misconceptions about HRT, there are truly crazy myths that we get used to from our youth.

Myth No. 3. HRT will make a mustache grow

The negative attitude towards hormonal drugs in Russia arose quite a long time ago and has already moved to the subconscious level. Modern medicine has come a long way, but many women still trust outdated information.

The synthesis and use of hormones in medical practice began in the 50s of the 20th century. A real revolution was made by glucocorticoids (adrenal hormones), which combined powerful anti-inflammatory and antiallergic effects. However, doctors soon noticed that they affected body weight and even contributed to the manifestation of masculine characteristics in women (the voice became rougher, excess hair growth began, etc.).

Much has changed since then. Preparations of other hormones (thyroid, pituitary, female and male) were synthesized. And the type of hormones has changed. Modern medications contain hormones that are as “natural” as possible, and this makes it possible to significantly reduce their dose. Unfortunately, all the negative qualities of outdated high-dose drugs are attributed to new, modern ones. And this is completely unfair.

The most important thing is that HRT preparations contain exclusively female sex hormones, and they cannot cause “masculinity.”

I would like to draw your attention to one more point. A woman's body always produces male sex hormones. And that's okay. They are responsible for a woman’s vitality and mood, interest in the world and sex drive, as well as the beauty of her skin and hair.

When ovarian function declines, female sex hormones (estrogens and progesterone) stop being replenished, while male sex hormones (androgens) are still produced. In addition, they are also produced by the adrenal glands. That's why you shouldn't be surprised that older ladies sometimes need to pluck their mustache and chin hair. And HRT drugs have absolutely nothing to do with it.

Myth No. 4. People get better from HRT

Another unreasonable fear is to gain weight while taking drugs hormone replacement therapy. But everything is quite the opposite. Prescription of HRT during menopause can have a positive effect on women's curves and shapes. HRT contains estrogens, which generally have no ability to influence changes in body weight. As for the gestagens (these are derivatives of the hormone progesterone) included innew generation of HRT drugs, then they help distribute adipose tissue “according to the female principle” and allow during menopause keep your figure feminine.

Don’t forget about the objective reasons for weight gain in women after 45. First: at this age, physical activity noticeably decreases. And second: the influence of hormonal changes. As we have already written, female sex hormones are produced not only in the ovaries, but also in adipose tissue. During menopause, the body tries to reduce the lack of female sex hormones by producing them in fatty tissues. Fat is deposited in the abdominal area, and the figure begins to resemble a man’s. As you can see, HRT drugs do not play any role in this matter.

Myth No. 5. HRT can cause cancer

The idea that taking hormones can cause cancer is an absolute misconception. There is official data on this topic. According to The World Health Organization, thanks to the use of hormonal contraceptives and their oncoprotective effect, annually manages to prevent about 30 thousand cases of cancer. Indeed, estrogen monotherapy increased the risk of endometrial cancer. But such treatment is far in the past. Includednew generation HRT drugs includes progestogens , which prevent the risk of developing endometrial cancer (body of the uterus).

As for breast cancer, there has been plenty of research on the effect of HRT on its occurrence. This issue has been seriously studied in many countries around the world. Especially in the USA, where HRT drugs began to be used back in the 50s of the 20th century. It has been proven that estrogens, the main component of HRT preparations, are not oncogenes (that is, they do not unblock the gene mechanisms of tumor growth in the cell).

Myth No. 6. HRT is bad for the liver and stomach

There is an opinion that a sensitive stomach or liver problems may be a contraindication for HRT. This is wrong. New generation HRT drugs do not irritate the gastrointestinal mucosa and do not have a toxic effect on the liver. It is necessary to limit the use of HRT drugs only in cases where there are pronounced liver dysfunctions. And after the onset of remission, it is possible to continue HRT. Also, taking HRT drugs is not contraindicated for women with chronic gastritis or peptic ulcers of the stomach and duodenum. Even during seasonal exacerbations, you can take tablets as usual. Of course, simultaneously with therapy prescribed by a gastroenterologist and under the supervision of a gynecologist. For women who are especially concerned about their stomach and liver, special forms of HRT preparations are produced for topical use. These may be skin gels, patches or nasal sprays.

Myth No. 7. If there are no symptoms, then HRT is not needed

Life after menopause not all women immediately aggravated by unpleasant symptoms and a sharp deterioration in well-being. In 10 - 20% of the fair sex, the autonomic system is resistant to hormonal changes and therefore for some time they are spared from the most unpleasant manifestations during menopause. If there are no hot flashes, this does not mean at all that you do not need to see a doctor and let the course of menopause take its course.

The serious consequences of menopause develop slowly and sometimes completely unnoticed. And when after 2 years or even 5-7 years they begin to appear, it becomes much more difficult to correct them. Here are just a few of them: dry skin and brittle nails; hair loss and bleeding gums; decreased sexual desire and vaginal dryness; obesity and cardiovascular diseases; osteoporosis and osteoarthritis and even senile dementia.

Myth No. 8. HRT has many side effects

Only 10% of women feel certain discomfort when taking HRT drugs. Those who smoke and are overweight are most susceptible to unpleasant sensations. In such cases, swelling, migraines, swelling and tenderness of the breast are noted. Usually these are temporary problems that disappear after reducing the dosage or changing the dosage form of the drug.

It is important to remember that HRT cannot be carried out independently without medical supervision. Each specific case requires an individual approach and constant monitoring of results. Hormone replacement therapy has a specific list of indications and contraindications. Only a doctor, after conducting a number of studies, will be able tochoose the right treatment . When prescribing HRT, the doctor observes the optimal balance between the principles of “usefulness” and “safety” and calculates at what minimum doses of the drug the maximum result will be achieved with the least risk of side effects.

Myth No. 9. HRT is unnatural

Is it necessary to argue with nature and replenish sex hormones lost over time? Of course you need it! The heroine of the legendary film “Moscow Doesn’t Believe in Tears” claims that after forty, life is just beginning. And this is indeed true. A modern woman at the age of 45+ can live a life no less interesting and eventful than in her youth.

Hollywood star Sharon Stone turned 58 years old in 2016 and she is sure that there is nothing unnatural in a woman’s desire to remain young and active as long as possible: “When you are 50, you feel that you have a chance to start life anew: a new career, a new love ... At this age we know so much about life! You may be tired of what you did for the first half of your life, but that doesn't mean you should sit back and play golf in your backyard. We are too young for this: 50 is the new 30, a new chapter."

Myth No. 10. HRT is an understudied treatment method

The experience of using HRT abroad is more than half a century, and all this time the technique has been subjected to serious control and detailed study. Gone are the days when endocrinologists, through trial and error, searched for optimal methods, regimens and dosages of hormonal drugs for menopause. To Russia hormone replacement therapycame only 15-20 years ago. Our compatriots still perceive this treatment method as little studied, although this is far from the case. Today we have the opportunity to use proven and highly effective remedies with a minimum number of side effects.

HRT for menopause: pros and cons

For the first time, HRT drugs for women in menopause began to be used in the USA in the 40-50s of the 20th century. As treatment became more popular, it was found that the risk of disease increased during the treatment period uterus ( endometrial hyperplasia, cancer). After a thorough analysis of the situation, it turned out that the reason was the use of only one ovarian hormone - estrogen. Conclusions were drawn, and in the 70s biphasic drugs appeared. They combined estrogens and progesterone in one tablet, which inhibited the growth of the endometrium in the uterus.

As a result of further research, information was accumulated about positive changes in a woman’s body during hormone replacement therapy. To date known that its positive effect extends not only to menopausal symptoms.HRT during menopauseslows down atrophic changes in the body and becomes an excellent prophylactic agent in the fight against Alzheimer's disease. It is also important to note the beneficial effects of therapy on a woman’s cardiovascular system. While taking HRT drugs, doctors recorded improving lipid metabolism and reducing blood cholesterol levels. All these facts make it possible today to use HRT as a prevention of atherosclerosis and heart attack.

Information was used from the magazine [Climax - it’s not scary / E. Nechaenko, - Magazine “New Pharmacy. Pharmacy assortment”, 2012. - No. 12]

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INTERACTIVE

It is extremely important for women to know everything about their health - especially for initial self-diagnosis. This rapid test will allow you to better listen to the state of your body and not miss important signals in order to understand whether you need to see a specialist and make an appointment.

Hormone replacement therapy (HRT) becomes relevant for women after menopause.

The body no longer produces estrogens in the required quantities, and to maintain hormonal hemostasis, a decision must be made to take conjugate drugs.

And if, after removal of the ovaries at a young age, hormone replacement therapy becomes the only option for a full life in the future, during menopause many women are overcome by doubts whether it is worth interfering with the natural course of events and compensating for the decline in hormonal activity.

Such an important decision should be approached with full responsibility and studied everything related to HRT - its purpose, the mechanism of action of the drugs, contraindications and side effects, as well as the possible benefits it provides.

Estrogens (the term “estrogen” is often used) is a group of steroid sex hormones that in women are synthesized by cells and some other organs - the adrenal cortex, brain, bone marrow, lipocytes, subcutaneous fatty tissue and even hair follicles.

Yet the main producer of estrogen is the ovaries.

The exception is Livial.

Means Livial

Livial is a drug for the treatment of symptoms of menopause, which, if discontinued, does not cause bleeding. The main active ingredient of the drug is tibolone.

It has a slight antiandrogenic effect, estrogenic and progestogenic properties.

Tibolone is rapidly absorbed, its working dose is very low, metabolites are excreted mainly in bile and feces. The substance does not accumulate in the body.

Hormone replacement therapy with Livial is used to eliminate signs of natural and surgical menopause, and to prevent osteoporosis due to estrogen deficiency.

Livial is not a contraceptive.

It is prescribed immediately after oophorectomy or one year after the last menstrual bleeding.

In case of overdose, bleeding may occur.

The drug is used with caution for migraines, epilepsy, diabetes, kidney disease, and high blood cholesterol.

Therapy for any type of menopause with tibolone involves daily oral administration of the drug, 1 tablet (2.5 mg) per day for a long period of time.

Improvement occurs after 3 months of taking the drug. It is advisable to take the drug at the same time of day to maintain a constant concentration of the active substance in the blood.

Hormone replacement therapy with Livial may have side effects: fluctuations in body weight, uterine bleeding, swelling of the extremities, headaches, diarrhea, liver dysfunction.

Combined Femoston

Femoston is a combination drug for HRT. The substitutive effect of the drug is provided by 2 components: estrogen - estradiol and progestogen - dydrogesterone.

The dose and ratio of hormones in the drug depends on the form of release:

• 1 mg estradiol and 5 mg dydrogesterone;
• 1 mg estradiol and 10 mg dydrogesterone;
• 2 mg estradiol and 10 mg dydrogesterone.

Femoston contains estradiol, identical to natural, which allows you to compensate for the lack of estrogen and relieve the psycho-emotional component of menopause: hot flashes, increased excitability, mood swings, migraines, a tendency to depression, hyperhidrosis.

Estrogen therapy using Femoston prevents age-related changes in the mucous membranes of the genitourinary system: dryness, itching, painful urination and sexual intercourse, irritation.

Estradiol plays an important role in the prevention of osteoporosis and bone fragility.

Dydrogesterone, in turn, stimulates the secretory function of the endometrium, preventing the development of hyperplasia, endometriosis and cancerous degeneration of endometriocytes, the risk of which increases significantly when taking estrodiol.

This hormone does not have a glucocorticosteroid, anabolic or antiandrogenic effect. In combination, the drug allows you to control cholesterol levels.

Hormone replacement therapy with Femoston is complex and low-dose. It is prescribed for both physiological and surgical menopause.

Doses and treatment regimens are selected strictly individually depending on the reason for prescribing the drug.

Replacement therapy with Femoston may be accompanied by side effects such as migraines, nausea, indigestion, leg cramps, vaginal bleeding, chest and pelvic pain, and fluctuations in body weight.

Therapy for porphyria with the use of Femoston is not used.

Angelique drug

The composition of the drug Angeliq includes 1 mg of estradiol and 2 mg of drospirenone. This drug is prescribed to compensate for deficiency and to prevent osteoporosis.

Drospirenone is an analogue of the natural hormone progestogen. This complex treatment is most effective for hypogonadism, ovarian dystrophy and menopause, regardless of its cause.

Angelique, like Femoston, eliminates the clinical manifestations of menopause.

In addition, Angelique has an antiandrogenic effect: it is used to treat androgenetic alopecia, seborrhea, and acne.

Drospirenone prevents the formation of swelling, arterial hypertension, weight gain, and pain in the chest area.

The hormones estradiol and drospirenone potentiate each other's action.

In addition to the classic properties for a replacement therapy drug, Angeliq prevents the malignant degeneration of rectal and endometrial tissue during the postmenopausal period.

The drug is taken 1 time per day, 1 tablet.

Possible side effects: brief bleeding at the beginning of therapy, chest pain, headache, irritability, abdominal pain, nausea, dysmenorrhea, benign neoplasms in the mammary glands and cervix, asthenic syndrome, local edema.

Proginova differs from other drugs used for HRT in that it contains only estradiol in an amount of 2 mg.

The drug is prescribed to compensate for the lack of estrogen after removal of the ovaries and uterus, the onset of menopause, and for the prevention of osteoporosis. If the uterus is preserved, additional progestogen is necessary.

The drug Proginova is prescribed both before and after the onset of menopause after a complete examination.

One package of the drug contains 21 tablets, which are taken once a day during the first 5 days after the start of menstrual bleeding or at any time if the cycle is already completed.

Proginova is taken continuously during the postmenopausal period or cyclically until menopause.

Taking the drug may be accompanied by the usual side effects and contraindications for estradiol.

Modern hormone replacement therapy drugs contain the minimum permissible therapeutic dose of estradiol, and therefore their ability to cause cancer is minimized.

However, taking estradiol alone for a long time (longer than 2 years) increases the risk of developing endometrial cancer. This danger is eliminated by combining estradiol with a progestin.

In turn, the latter contributes to the development of atherosclerosis. Currently, the most effective combinations of hormones for HRT are still being studied, taking into account its effects on the cardiovascular and other body systems.

The goal of scientific research is to develop the most effective replacement therapy regimen with the lowest risk of developing malignant neoplasms and side effects.

As a woman ages, the level of estrogen in a woman's body begins to decrease. This leads to a number of symptoms that cause discomfort. This is an increase in subcutaneous fat, hypertension, dry genital mucosa, and urinary incontinence. Medications can help eliminate and reduce the risk of complications associated with menopause to avoid such an unpleasant condition. Such drugs include “Klimonorm”, “Klimadinon”, “Femoston”, “Angelik”. New generation HRT should be carried out with extreme caution and can only be prescribed by a qualified gynecologist.

Don't want to take hormones during menopause?

If hormone replacement therapy is contraindicated for you or you do not want to use it for other reasons, ask your gynecologist about the possibility of taking a non-hormonal one. The complex of low-molecular polypeptides in the drug normalizes the function of the pituitary gland and the balance of hormones, thereby easing the uncomfortable symptoms of menopause: hot flashes, excessive sweating, headaches, palpitations, sleep disturbances and emotional instability. Conducted double placebo-controlled studies showed a significant decrease in the severity of menopausal disorders during a course of treatment with Pineamin. The recommended course is 10 days and is carried out under the supervision of a doctor. Contact your gynecologist to find out more information about the treatment of menopausal syndrome with the innovative drug Pineamin.

Release form of the drug "Klimonorm"

The medicine belongs to the class of antimenopausal drugs. It is made in the form of two types of dragees. The first type of dragee is yellow. The main substance in the composition is estradiol valerate 2 mg. The second type of dragee is brown. The main components are estradiol valerate 2 mg and levonorgestrel 150 mcg. The medicine is packaged in blisters of 9 or 12 pieces each.

With the help of this medication, HRT is often performed during menopause. New generation drugs have good reviews in most cases. Side effects do not develop if you follow your doctor’s recommendations.

Effect of the drug "Klimonorm"

"Klimonorm" is a combination drug that is prescribed to eliminate the symptoms of menopause and consists of estrogen and gestagen. Once in the body, the substance estradiol valerate is converted into estradiol of natural origin. The substance levonorgestrel added to the main drug is the prevention of endometrial cancer and hyperplasia. Thanks to the unique composition and special dosage regimen, it is possible after treatment to restore the menstrual cycle in women with a non-removed uterus.

Estradiol completely replaces natural estrogen in the body at the moment when menopause occurs. Helps cope with vegetative and psychological problems that arise during menopause. You can also slow down the formation of wrinkles and increase the collagen content in the skin when carrying out HRT during menopause. The drugs help lower total cholesterol and reduce the risk of intestinal diseases.

Pharmacokinetics

When taken orally, the medicine is absorbed in the stomach in a short period. In the body, the drug is metabolized to form estradiol and estrol. Already within two hours the maximum activity of the drug in plasma is observed. The substance levonorgestrel is almost 100% bound to blood albumin. Excreted in urine and slightly in bile. Particular attention should be paid to selecting medications for HRT during menopause. Level 1 drugs are considered potent and can significantly improve the condition of the fairer sex after 40 years. Medicines from this group also include the drug “Klimonorm”.

Indications and contraindications

The drug can be used in the following cases:

• hormone replacement therapy for menopause;
• involutional changes in the skin and mucous membrane of the genitourinary system;
• insufficient estrogen levels during menopause;
• preventive measures for osteoporosis;
• normalization of the monthly cycle;
• therapeutic process for amenorrhea of ​​primary and secondary type.

Contraindications:

• bleeding not associated with menstruation;
• breast-feeding;
• hormone-dependent precancerous and cancerous conditions;
• breast cancer;
• liver diseases;
• acute thrombosis and thrombophlebitis;
• hypotension;
• diseases of the uterus.

HRT is not always indicated during menopause. New generation drugs (the list is presented above) are prescribed only if menopause is accompanied by a significant deterioration in the woman’s well-being.

Dosage

If you still have your period, then treatment should begin on the fifth day of the cycle. For amenorrhea and menopause, the treatment process can begin at any time of the cycle, unless pregnancy is excluded. One package of the medicine “Klimonorm” is designed for 21 days of use. The product is drunk according to the following algorithm:

• for the first 9 days the woman takes yellow tablets;
• the next 12 days - brown pills;

After treatment, menstruation appears, usually on the second or third day after taking the last dose of the medicine. There is a break for seven days, and then you need to drink the next package. The pills should be taken without chewing and washed down with water. It is necessary to take the drug at a certain time, without missing it.

It is imperative to adhere to the HRT regimen during menopause. New generation drugs may also have negative reviews. You will not be able to achieve the desired effect if you forget to take the pills in a timely manner.

In case of an overdose, unpleasant phenomena such as stomach upset, vomiting and bleeding not associated with menstruation may occur. There is no specific antidote for the drug. In case of overdose, symptomatic treatment is prescribed.

Medicine "Femoston"

The medication belongs to the group of antimenopausal drugs. Available in the form of tablets of two types. In the package you can find a white dragee with a film shell. The main substance is estradiol at a dose of 2 mg. The first type also includes gray tablets. The composition contains estradiol 1 mg and dydrogesterone 10 mg. The product is packaged in blisters of 14 pieces each. The second type includes pink tablets containing 2 mg estradiol.

Replacement therapy is often carried out with the help of this remedy. When it comes to HRT for menopause, medications are selected with special attention. Femoston reviews are both positive and negative. Good statements still prevail. The medication can eliminate many menopausal symptoms.

Action

"Femoston" is a two-phase combination drug for the treatment of postmenopause. Both components of the drug are analogues of the female sex hormones progesterone and estradiol. The latter replenishes the supply of estrogen during menopause, removes symptoms of a vegetative and psycho-emotional nature, and prevents the development of osteoporosis.

Dydrogesterone is a progestogen that reduces the risk of developing uterine hyperplasia and cancer. This substance has estrogenic, androgenic, anabolic and glucocorticoid activity. When it enters the stomach, it is quickly absorbed and then completely metabolized. If HRT is indicated for menopause, the drugs “Femoston” and “Klimonorm” should be used first.

Indications and contraindications

The medication is used in the following cases:

• HRT during menopause and after surgery;
• prevention of osteoporosis, which is associated with menopause

Contraindications:

• pregnancy;
• lactation;
• breast cancer;
• malignant tumors that are hormone-dependent;
• porphyria;
• thrombosis and thrombophlebitis;
• hypersensitivity to components;
• diabetes mellitus;
• hypertension;
• endometrial hyperplasia;
• migraine.

HRT will help improve your well-being during menopause. Reviews of the drugs are mostly positive. However, they should not be used without first consulting a doctor.

Dosage

Femoston tablets containing estradiol in a dose of 1 mg are taken once a day at the same time. Treatment is carried out according to a special scheme. In the first 14 days you need to take white tablets. In the remaining 14 days - a medicine of a gray shade.

Pink tablets containing 2 mg estradiol are taken for 14 days. For women whose menstrual cycle has not yet been disrupted, treatment should begin on the first day of bleeding. For patients with irregular cycles, the drug is prescribed after two weeks of treatment with Progestagen. For everyone else, if you don’t have your period, you can start taking the medicine any day. You need to follow the treatment regimen to get positive results from HRT during menopause. New generation drugs will help keep a woman feeling good and prolong her youth.

The drug "Klimadinon"

The medicine belongs to the means for improving well-being during menopause. It has a phytotherapeutic composition. Available in the form of tablets and drops. The tablets are pink with a brown tint. Contains dry cohosh extract 20 mg. The drops contain liquid cohosh extract 12 mg. The drops have a light brown tint and the smell of fresh wood.

Indications:

• vegetative-vascular disorders associated with menopausal symptoms.

Contraindications:

• hormone-dependent tumors;
• hereditary lactose intolerance;
• alcoholism;
• hypersensitivity to components.

It is necessary to carefully study the instructions before starting HRT during menopause. Preparations (patch, drops, pills) should be used only on the recommendation of a gynecologist.

The medicine "Klimadinon" is prescribed one tablet or 30 drops twice a day. It is advisable to carry out therapy at the same time. The course of treatment depends on the individual characteristics of the body.

The drug "Angelique"

Refers to drugs that are used to treat menopause. Available in the form of gray-pink tablets. The drug contains estradiol 1 mg and drospirenone 2 mg. The product is packaged in blisters, 28 pieces each. A specialist will tell you how to properly carry out HRT during menopause. New generation drugs should not be used without prior consultation. can have both benefit and harm.

The medication has the following indications:

• hormone replacement therapy during menopause;
• prevention of osteoporosis during menopause.

Contraindications:

• bleeding from the vagina of unknown origin;
• breast cancer;
• diabetes mellitus;
• hypertension;
• thrombosis.

Dosage of the medicine "Angelique"

One package is designed for 28 days of use. You should take one tablet daily. It is better to drink the medicine at the same time, without chewing and with water. Therapy should be carried out without skipping. Neglecting the recommendations will not only not bring a positive result, but can also provoke vaginal bleeding. Only correct adherence to the regimen will help normalize the menstrual cycle during HRT during menopause.

New generation drugs (“Angelik”, “Klimonorm”, “Klimadinon”, “Femoston”) have a unique composition, thanks to which it is possible to restore female

"Klimara" patch

This medication comes in the form of a patch containing 3.8 mg estradiol. The oval-shaped product is glued to an area of ​​skin hidden under clothing. During the use of the patch, the active component is released, improving the woman’s condition. After 7 days, the product must be removed and a new one applied to a different area.

Side effects from using the patch are quite rare. Despite this, the hormonal drug should be used only after consultation with the doctor.

Menopause is a natural biological process of transition from the reproductive period of a woman’s life to old age, which is characterized by the gradual decline of ovarian function, a decrease in estrogen levels, and the cessation of menstrual and reproductive functions. The average age of menopause for women in the European Region is 50-51 years.

Menopause includes several periods:

• premenopause - the period from the appearance of the first symptoms of menopause to menopause;
• menopause - cessation of spontaneous menstruation, diagnosis is made retrospectively after 12 months. after the last spontaneous menstruation;
• postmenopause - the period after the cessation of menstruation until old age (69-70 years);
• perimenopause is a chronological period that includes premenopause and 2 years of menopause.

Premature menopause is the cessation of spontaneous menstruation before the age of 40, early menopause - before the age of 40-45. Artificial menopause occurs after surgical removal of the ovaries (surgical), chemotherapy and radiation therapy.

Only 10% of women do not feel the clinical manifestations of approaching menopause and postmenopause. Thus, the majority of the female population needs qualified consultation and timely initiation of therapy when menopausal syndrome (CS) occurs.

CS, developing under conditions of estrogen deficiency, is accompanied by a complex of pathological symptoms that arise depending on the phase and duration of this period.

The earliest signs of CS are neurovegetative disorders (hot flashes, sweating, lability of blood pressure, palpitations, tachycardia, extrasystole, dizziness) and psycho-emotional disorders (mood instability, depression, irritability, fatigue, sleep disturbances), which persist in 25-30% more than 5 years.

Later, urogenital disorders develop in the form of dryness, burning and itching in the vagina, dyspareunia, cystalgia and urinary incontinence. On the part of the skin and its appendages, dryness, the appearance of wrinkles, brittle nails, dryness and hair loss are noted.

Metabolic disorders manifest themselves in the form of diseases of the cardiovascular system, osteoporosis, Alzheimer's disease and develop under conditions of prolonged hypoestrogenism.

According to modern research, various options for the treatment of CS have been proposed, starting with the most accessible, simple ones and ending with hormone replacement therapy (HRT).

Non-drug methods include following a diet rich in fiber and low in fat, physical exercise, a healthy lifestyle (quitting smoking, eliminating coffee and alcoholic beverages), limiting nervous and mental stress.

If a woman has a history of diseases of the cardiovascular and nervous system, the manifestations of which are often aggravated by CS, pathogenetic therapy is carried out with antihypertensive, sedative, hypnotic drugs and antidepressants. HRT is carried out taking into account contraindications to the use of these drugs.

Often, one of the first stages of treatment for CS is therapy with drugs that include black cohosh. This group of drugs is mainly effective in women with mild CS and mildly expressed vegetative-vascular symptoms.

Despite the widespread use of non-drug methods of therapy, a significant proportion of women fail to achieve a full clinical effect and the issue is resolved in favor of HRT. Currently, both positive and negative experience has been accumulated in the treatment of CS with hormonal drugs. The results of numerous studies have proven the positive effects of HRT, which include regulating the menstrual cycle, treating endometrial hyperplasia in premenopausal women, eliminating the symptoms of CS and preventing osteoporosis.

The evolution of HRT has come a long way from drugs containing only estrogens to combined estrogen-progestogen, estrogen-androgen and progestogen drugs.

Modern HRT preparations contain natural estrogens (17b-estradiol, estradiol valerate), which are identical in chemical structure to estrogens synthesized in the female body. Progestogens included in HRT preparations are represented by the following groups: progesterone derivatives (dydrogesterone), nortestosterone derivatives, spironolactone derivatives.

No less important was the development of individual regimens for the use of HRT drugs, depending on the period of menopause, the presence or absence of a uterus, the woman’s age and concomitant extragenital pathology (tablet forms, patches, gels, intravaginal and injectable drugs).

HRT is carried out in three modes and includes:

• monotherapy with estrogens and progestogens in a cyclic or continuous mode;
• combination therapy with estrogen-gestagen drugs in a cyclic mode (intermittent and continuous dosing regimens);
• combination therapy with estrogen-gestagen drugs in a monophasic continuous mode.

If a uterus is present, combination therapy with estrogen-gestagen drugs is prescribed.

In premenopause (up to 50-51 years) - these are cyclic drugs that imitate the normal menstrual cycle:

• estradiol 1 mg/dydrogesterone 10 mg (Femoston 1/10);
• estradiol 2 mg/dydrogesterone 10 mg (Femoston 2/10).

If postmenopause lasts more than 1 year, HRT drugs are prescribed continuously without menstrual-like bleeding:

• estradiol 1 mg/dydrogesterone 5 mg (Femoston 1/5);
• estradiol 1 mg/drospirenone 2 mg;
• tibolone 2.5 mg.

In the absence of a uterus, estrogen monotherapy is carried out in a cyclic or continuous mode. If surgery is performed for genital endometriosis, therapy should be carried out with combined estrogen-gestagen drugs in order to prevent further growth of unremoved lesions.

Transdermal forms in the form of patches, gel and intravaginal tablets are prescribed in a cyclic or continuous mode, taking into account the period of menopause in the presence of contraindications for the use of systemic therapy or intolerance to these drugs. Estrogen drugs are also prescribed in a cyclic or continuous mode (in the absence of the uterus) or in combination with progestogens (if the uterus is not removed).

According to recent studies, an analysis was carried out of the long-term use of HRT during various periods of menopause and its effect on diseases of the cardiovascular system and the risk of breast cancer. These studies allowed us to draw a number of important conclusions:

• The effectiveness of HRT against neurovegetative and urogenital disorders has been confirmed.
• The effectiveness of HRT in preventing osteoporosis and reducing the incidence of colorectal cancer has been confirmed.

It is believed that the effectiveness of HRT in relation to the treatment and prevention of urogenital disorders and osteoporosis depends on how early this therapy is started.

• The effectiveness of HRT for the prevention of cardiovascular disease and Alzheimer's disease has not been confirmed, especially if therapy is started in postmenopause.
• A slight increase in the risk of breast cancer (BC) has been established with a duration of HRT of more than 5 years.

However, according to clinical and epidemiological studies, HRT is not a significant risk factor for breast cancer compared with other factors (hereditary predisposition, age over 45 years, overweight, high cholesterol, early age at menarche and late menopause). Duration of HRT up to 5 years does not have a significant effect on the risk of developing breast cancer. It is believed that if breast cancer is first detected during HRT, then, most likely, the tumor has already existed for several years before the start of therapy. HRT does not cause the development of breast cancer (as well as other localizations) from healthy tissue or organ.

In connection with the currently accumulated data, when deciding whether to prescribe HRT, the benefit-risk ratio is first assessed, which is analyzed throughout the entire duration of therapy.

The optimal time to start HRT is the premenopausal period, since it is at this time that complaints characteristic of CS first appear, and their frequency and severity are maximum.

Examination and monitoring of a woman during HRT allows her to avoid unfounded fear of hormonal drugs and complications associated with the therapy. Before starting therapy, a mandatory examination includes a consultation with a gynecologist, assessment of the condition of the endometrium (ultrasound examination) and mammary glands (mammography), a smear for oncocytology, and determination of blood sugar. Additional examination is carried out according to indications (total cholesterol and blood lipid spectrum, assessment of liver function, hemostasiogram parameters and hormonal parameters - follicle-stimulating hormone, estradiol, thyroid hormones, etc.).

Before starting treatment, risk factors are taken into account: individual and family history, especially for diseases of the cardiovascular system, thrombosis, thromboembolism and breast cancer.

Dynamic monitoring during HRT (ultrasound of the pelvic organs, hemostasiogram, colposcopy, smears for oncocytology and blood biochemistry - according to indications) is carried out once every 6 months. Mammography for women under 50 years of age is performed once every 2 years, and then once a year.

Among the numerous medications proposed for the treatment of CS, combined estrogen-progestin drugs, which include 17b-estradiol and dydrogesterone (Duphaston) in various dosages (Femoston 2/10, Femoston 1/10 and Femoston 1/5), deserve attention. which allows them to be used both in premenopause and postmenopause.

The micronized form of estradiol, unlike the usual crystalline form found in other drugs, is well absorbed in the gastrointestinal tract and metabolized in the intestinal mucosa and liver. The progestogen component, dydrogesterone, is close to natural progesterone. Due to the peculiarities of the chemical structure, the activity of the drug increases when taken orally, which gives it metabolic stability. A distinctive feature is the absence of side estrogenic, androgenic and mineralocorticoid effects on the body. Dydrogesterone in a dose of 5-10 mg provides reliable protection of the endometrium, without reducing the positive effect of estrogens on blood lipid composition and carbohydrate metabolism.

The drugs are available in a package containing 28 tablets. The pills are taken continuously from cycle to cycle, which greatly simplifies the treatment.

In premenopausal women with severe neurovegetative and psychoemotional disorders against the background of a regular or irregular rhythm of menstruation, as well as in the presence of symptoms of urogenital disorders, the drugs of choice are Femoston 2/10 or Femoston 1/10. In these preparations, estradiol in a dose of 2 or 1 mg, respectively, is contained in 28 tablets, and dydrogesterone in a dose of 10 mg is added in the second half of the cycle for 14 days. The cyclic composition of the drugs provides a cyclic regimen of therapy, as a result of which a menstrual-like reaction occurs every month. The choice of these drugs depends on the age of the patient and allows the use of Femoston 1/10, reducing the total dose of estrogen in premenopausal women with mild neurovegetative symptoms. The drug Femoston 2/10 is indicated for significantly severe symptoms of menopause or insufficient effect of therapy with Femoston 1/10.

The administration of these drugs in a cyclic mode is effective in regulating the menstrual cycle, treating endometrial hyperplasia, vegetative and psycho-emotional symptoms of menopause.

In a comparative study of two regimens for prescribing cyclic drugs for HRT: intermittent (with a 7-day break in taking estrogen) and continuous, it was concluded that 20% of women during the period of drug withdrawal, especially in the first months of treatment, experienced menopausal symptoms are resumed. In this regard, it is believed that a continuous regimen of HRT (used in the preparations Femoston 1/10 and Femoston 1/10 “2/10) is preferable to intermittent treatment regimens.

In postmenopause, a drug containing estradiol 1 mg/dydrogesterone 5 mg (Femoston 1/5) is prescribed continuously for 28 days. The content of the estrogen and gestagen component in all tablets is the same (monophasic mode). With a constant regimen of taking this drug, the endometrium is in an atrophic, inactive state and cyclic bleeding does not occur.

A pharmacoeconomic study conducted in perimenopausal women showed the high cost-effectiveness of HRT for CS.

Data from a clinical study of a group of women who received Femoston 2/10 for 1 year indicate a decrease in the frequency and severity of menopausal symptoms after 6 weeks. after the start of treatment (hot flashes, increased sweating, decreased performance, sleep disturbance). As for the effect of low doses of estrogens and gestagens (Femoston 1/5), the almost complete disappearance of vasomotor symptoms (treatment was started in postmenopause) and a decrease in the manifestation of urogenital disorders was noted after 12 weeks. from the start of taking the drug. Clinical effectiveness was maintained throughout the entire duration of therapy.

Contraindications are practically no different from contraindications to the use of other estrogen-gestagen drugs: pregnancy and lactation; hormone-producing ovarian tumors; dilated myocardiopathy of unknown origin, deep vein thrombosis and pulmonary embolism; acute liver diseases.

Low-dose forms of the drug Femoston 1/10 for perimenopause and Femoston 1/5 for postmenopause allow you to prescribe HRT in any period of menopause in full compliance with modern international recommendations for HRT - therapy with the lowest effective doses of sex hormones.

In conclusion, it should be noted that the management of women during such a difficult period of life as menopause should be aimed not only at maintaining the quality of life, but also at preventing aging and creating the basis for active longevity. For most patients with severe menopausal symptoms, HRT continues to be the optimal treatment method.

T.V. Ovsyannikova, N.A. Sheshukova, State Educational Institution Moscow Medical Academy named after. I.M. Sechenov.