Contraindications to hormone replacement therapy are. Risks of hormone replacement therapy. Examinations during and after treatment

Menopause is a natural biological process of transition from the reproductive period of a woman's life to old age, which is characterized by a gradual extinction 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.

The climacteric includes several periods:

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

Premature menopause - the cessation of independent menstruation up to 40 years, early - up to 40-45 years. 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, a large part of the female population needs a qualified consultation and timely therapy in the event of a climacteric syndrome (CS).

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

The earliest signs of CS are neurovegetative disorders (hot flashes, sweating, blood pressure lability, palpitations, tachycardia, extrasystole, dizziness) and psycho-emotional disorders (mood instability, depression, irritability, fatigue, sleep disturbances), which persist in 25-30% over 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 CS therapy 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, exercising, a healthy lifestyle (quitting smoking, avoiding 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 against the background of CS, pathogenetic therapy is carried out with antihypertensive, sedative, hypnotic drugs and antidepressants. HRT is carried out, taking into account contraindications to the appointment of these drugs.

Often, one of the first stages of CS therapy is therapy with drugs that include cimicifuga. This group of drugs is mainly effective in women with mild CS and mild vegetative-vascular symptoms.

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

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

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

No less important was the development of individual schemes for the use of HRT preparations, depending on the period of menopause, the presence or absence of the uterus, the woman's age and concomitant extragenital pathology (tablets, patches, gels, intravaginal and injectable preparations).

HRT is carried out in the form of three modes and includes:

monotherapy with estrogens and progestogens in a cyclic or continuous mode;
combined therapy with estrogen-progestogen drugs in a cyclic mode (intermittent and continuous regimens of drugs);
combined therapy with estrogen-gestagenic drugs in monophasic continuous mode.

In the presence of the uterus, combination therapy with estrogen-gestagen preparations is prescribed.

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

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

With a postmenopausal duration of more than 1 year, HRT preparations 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 the uterus, estrogen monotherapy is carried out in a cyclic or continuous mode. If the operation is performed for genital endometriosis, therapy should be carried out with combined estrogen-gestagen preparations in order to prevent further growth of non-removed 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 preparations are also prescribed in a cyclic or continuous regimen (in the absence of a uterus) or in combination with progestogens (if the uterus is not removed).

According to recent studies, an analysis was made of the long-term use of HRT in various periods of menopause and its effect on diseases of the cardiovascular system, the risk of breast cancer. These studies led to a number of important conclusions:

The effectiveness of HRT against neurovegetative and urogenital disorders has been confirmed.
The efficacy 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 diseases and Alzheimer's disease has not been confirmed, especially if therapy is started in postmenopausal women.
A slight increase in the risk of breast cancer (BC) has been established with the duration of HRT for 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, elevated cholesterol, early age of menarche and late menopause). The duration of HRT up to 5 years does not significantly affect the risk of developing breast cancer. It is believed that if breast cancer was first detected against the background of ongoing HRT, then, most likely, the tumor had already occurred for several years before the start of therapy. HRT does not cause the development of breast cancer (as well as other localizations) from a healthy tissue or organ.

In connection with the currently accumulated data, when deciding on the appointment of HRT, first of all, the benefit-risk ratio is evaluated, which is analyzed throughout the entire duration of therapy.

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

Examination and monitoring of a woman in the process of conducting HRT allows you to avoid unreasonable fear of hormonal drugs and complications during therapy. Prior to the start of therapy, a mandatory examination includes a consultation with a gynecologist, an assessment of the condition of the endometrium (ultrasound examination - ultrasound) and mammography (mammography), a smear for oncocytology, and determination of blood sugar. An 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: an individual and family history, especially for diseases of the cardiovascular system, thrombosis, thromboembolism and breast cancer.

Dynamic control against the background of HRT (ultrasound of the pelvic organs, hemostasiogram, colposcopy, smears for oncocytology and blood biochemistry - according to indications) is carried out 1 time in 6 months. Mammography for women under 50 years old is carried out 1 time in 2 years, and then - 1 time per year.

Among the numerous drugs offered for the treatment of CS, combined estrogen-progestin preparations deserve attention, which include 17b-estradiol and dydrogesterone (Dufaston) in various dosages (Femoston 2/10, Femoston 1/10 and Femoston 1/5), which allows them to be used both in premenopausal and postmenopausal women.

The micronized form of estradiol, unlike the usual crystalline form included in other drugs, is well absorbed in the gastrointestinal tract, metabolized in the intestinal mucosa and liver. The progestogenic 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 at a dose of 5-10 mg provides reliable protection of the endometrium, while not reducing the positive effect of estrogens on blood lipid composition and carbohydrate metabolism.

The drugs are available in a package containing 28 tablets. Taking pills is carried out 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, Femoston 2/10 or Femoston 1/10 are the drugs of choice. In these preparations, estradiol at a dose of 2 or 1 mg, respectively, is contained in 28 tablets, and dydrogesterone at 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 pronounced symptoms of menopause or insufficient effect from therapy with Femoston 1/10.

The appointment of these drugs in a cyclic mode is effective in relation to the regulation of the menstrual cycle, the treatment of endometrial hyperplasia, autonomic and psycho-emotional symptoms of menopause.

In a comparative study of two schemes 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, menopausal symptoms are resumed. In this regard, it is believed that the continuous regimen of HRT (used in the preparations Femoston 1/10 and Femoston 1/10 - 2/10 is preferable to intermittent regimens of therapy.

In postmenopausal women, a drug containing estradiol 1 mg / dydrogesterone 5 mg (Femoston 1/5) is prescribed continuously for 28 days. The content of the estrogenic and progestogen 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 a high cost-effectiveness of HRT in 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, excessive 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 postmenopausal women) and a decrease in the manifestation of urogenital disorders were noted after 12 weeks. from the start of the drug. Clinical efficacy was maintained throughout the duration of therapy.

Contraindications practically do not differ from contraindications to the use of other estrogen-gestagenic drugs: pregnancy and lactation; hormone-producing ovarian tumors; dilated myocardiopathy of unknown origin, deep vein thrombosis and pulmonary embolism; acute liver disease.

Low-dose forms of the drug Femoston 1/10 for the period of perimenopause and Femoston 1/5 for postmenopause allow the appointment of HRT in any period of menopause in full accordance 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 in 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. In the majority of patients with severe menopausal symptoms, HRT continues to be the optimal treatment.

T.V. Ovsyannikova, N.A. Sheshukova, GOU Moscow Medical Academy. I.M. Sechenov.

Climax, even with a mild course, is perceived as a necessary evil. The state of health worsens, and in different directions, disturbing thoughts visit more often. But few people try to fight this with the help of drugs, or women, due to incompetence, choose the wrong means themselves.

Meanwhile, menopausal hormone therapy can work wonders, turning an elderly, tired woman into a healthy and full of strength.

Read in this article

Why is HRT needed?

Many women have a prejudice against menopausal hormone therapy that its harm far outweighs the positive effect. Fears are groundless, the body has been functioning for many years, thanks to these components. They ensured a normal metabolism, the operation of all systems. Rather, it serves to cause disease, ultimately leading to premature old age and even death.

This does not mean that analogues of substances can be taken independently and uncontrolled. In each case, the choice should be based on a variety of body parameters of a particular woman. It also depends on the stage.

In postmenopause, that is, a year from the last menstruation and later, other means are needed than in its initial phase. The final stage of menopause can be described using several features:

The work of the cardiovascular system worsens. Blood does not circulate as actively throughout the body, becoming more viscous. Vessels are less elastic, deposits appear on them. Hot flashes provoke heart failure, bringing the likelihood of a heart attack and stroke closer;
Arises. Vegetative-vascular disorders caused by the disappearance of the influence of sex hormones lead to increased neuro-psychological excitability, rapid fatigue. Hot flashes also interfere with sleep;
Atrophic processes of the genital and urinary organs develop, manifested by discomfort, burning of the mucous membrane, and itching. This provokes an inflammatory and infectious nature, as well as problems with urination,;
The risk of injuries and fractures increases due to (weakening of bone tissue as a result of loss), changes in the joints are noticed.

This is the general list of manifestations that the menopause “bestows”. At this age, individual symptoms may also be detected.

But even with their minimal presence, postmenopausal HRT improves well-being and quality of life, prolonging it. Drugs for menopause:

They normalize the lipid spectrum of the blood no worse than the statins intended for this;
Reduce the risk of cardiovascular disease by 30%;
Have a positive effect on carbohydrate metabolism;
Prevents the destruction of bones.

In a word, hormone therapy is one of the main methods.

Is it shown to everyone?

The funds used for HRT are based on estrogens, progesterone, or only the first substance. They affect the body in a complex way. Estrogens allow the endometrium to grow, progesterone reduces this effect.

In some diseases, the struggle of hormones can lead to the development of ailments. Therefore, HRT is not prescribed if diagnosed:

Acute hepatitis;
Thrombosis;
Tumors of the mammary glands or reproductive organs;
Meningioma.

What to do before taking hormonal drugs?

Given the contraindications and possible unexpected manifestations, menopausal hormone therapy, which is necessary for protection against diseases, is prescribed only according to the results of the examination. It should include:

Ultrasound of the reproductive organs;
Blood test for biochemistry;
A study on oncocytology of material taken from the cervix;
Breast ultrasound and mammography;
The study of hormonal status with the detection of the concentration of TSH, FSH, estradiol, prolactin, glucose;
Blood clotting test.

In addition to these studies, which are mandatory for all studies, it is advisable for some to conduct:

Lipidogram, that is, an analysis of cholesterol;
Densitometry, which measures bone density.

Features of HRT at the final stage of menopause

Hormone replacement therapy in postmenopausal women is prescribed not only taking into account the existing symptoms of the condition that need to be stopped, and potential threats. Important features of the female body, such as the presence of reproductive organs.

If the uterus is preserved, when exposed to estrogen-containing drugs, the mucosa is likely to grow, that is, creating a danger and endometrial cancer. Therefore, in this case, the doctor will give preference to drugs with progestins and androgens in order to remove the threat. For some women, the uterus is removed if processes dangerous to health occur in it. Hormone replacement therapy under these conditions will be estrogen.

The timing of treatment depends on what signs of menopause or probable ones need to be eliminated. Palpitations, hot flashes will take less time to use drugs. Longer treatment will be needed to prevent and treat osteoporosis. Stopping it on your own is just as dangerous as starting it.

Extension beyond the required period, excess dosages are fraught with an increased risk of tumor formation, thrombosis, heart attack, stroke. Therefore, the entire process of therapy is accompanied by control by a specialist.

Estrogen therapy for menopause

In such a fragile state as, HRT preparations should contain the necessary minimum of hormones. They contain only estrogens, are suitable for use after 12 months from the last menstruation and later the following remedies:

Premarin. In addition to reducing vegetative-vascular manifestations, it fights against the loss of calcium and phosphorus by bones, lowers low-density lipoproteins in the blood, increases HDL volume, and improves glucose excretion. Take the remedy in cycles of 21 days, then take a week break. Extended use is also possible. 0.3-1.25 mcg is prescribed per day, lowering or increasing the dose depending on how you feel;
Proginova. In fact, this is estradiol valerate, a synthetic analogue of what was previously produced by the ovaries. The drug keeps the bone tissue dense, preventing osteoporosis, maintains the tone of the mucous membranes in the urogenital area. Take 1 tablet, without crushing, cyclically or continuously;
Dermestril. It exists in several dosage forms (tablets, spray, injection, patch). Eliminates vasomotor signs of menopause, inhibits the excretion of calcium from bones and clogging of blood vessels with cholesterol;
Klimara. containing estradiol gamihydrate, which is released and enters the bloodstream in portions of 50 mcg. Its action extends to the relief of all symptoms of menopause, but it is necessary to fix the remedy on the body not near the pelvic organs and mammary glands;
Estrofem. The main substance is estradiol, which prevents the development of osteoporosis, cardiovascular diseases and atrophic vaginitis. Requires continuous intake of 1 tablet per day. If after 3 months of use the effect on stopping severe manifestations of postmenopause is insufficient, the doctor may change the dosage;
Ovestin. Estriol, which forms its basis, inhibits the leaching of calcium from the bones. The drug also reduces the possibility of inflammation of the vagina and other reproductive organs, due to the restoration of the mucosa. It exists in the form of suppositories, tablets and vaginal cream. Orally take 4-8 mg per day. Long-term use of high doses is undesirable, it is necessary to strive to reduce them.

If the listed funds are prescribed to a woman with a preserved uterus, they are combined with gestagen-containing or containing androgens.

Combined drugs for postmenopausal HRT

Combined HRT drugs postmenopause forces the use of savings if necessary. The estrogens contained in them perform their task, as in monophasic agents. But their negative influence is neutralized by the work of gestagens or androgens. Experts make a choice among such funds from the following names:

Climodien. It combines estradiol valerate with dienogest. The latter contributes to the atrophy of the endometrium, preventing its thickening, penetration into the muscular layer of the uterus and. Normalizes the ratio of "bad" and "good" cholesterol, removing the risk of cardiovascular disease. Climodien is taken continuously, as long as there is a need for therapy, one tablet per day;
Cliogest. This is a "team" of estriol and norethisterone acetate. The drug is indispensable in the prevention and treatment of osteoporosis, prevents the development of cardiac and urogenital ailments. Problems with the endometrium that are possible when taking estriol do not arise, thanks to norethisterone, which has gestagenic and slightly androgenic effects. For daily continuous use as part of the course of treatment, 1 tablet is enough. Similar to Kliogest in composition and effects on the body are the drugs Pauzogest, Eviana, Activel, Revmelide;
Livial. Its active ingredient is tibolone, which simultaneously has the properties of an estrogen, androgens and gestagens. Thanks to this, the agent keeps the endometrium thin enough, helps to save calcium, and normalizes the condition of the vessels. The latter quality reduces the risk of heart disease, restores blood supply to the brain;
Femoston 1/5. The drug is a combination of estradiol and dydrogesterone. Saves from osteoporosis, vascular disorders, returns libido, thanks to the normalization of the state of the mucous membranes of the genital and urinary organs. Does not allow pathological changes in the endometrium. A low dose of estrogen makes it possible to use it for a long time without threatening consequences. Take Femoston once a day.

Homeopathy

Substitution in postmenopause may not only be in taking hormonal drugs. The following have a similar effect on the signs of menopause:

Klimadinon;
Inoklim;
Klimonorm;
Qi-Klim.

They are quite effective in preventing complications of menopause, do not have such contraindications as hormones. And yet, they should be used only on the advice of a doctor.

Menopausal, properly chosen hormone therapy can not only prevent coronary heart disease, osteoporosis and bowel cancer. It has been proven that it reduces the risk of age-related visual impairment, Alzheimer's disease. The preparations also contribute to the preservation of external youthfulness.

What are the features of menopausal endocrinology?

Most researchers in the modern concept of female reproductive aging give the leading role to the gradual depletion of the ovarian follicular apparatus.

It is known that by the time of birth, about 2 million oocytes are in the ovaries of a girl, by the pubertal period there are about 300-400 thousand of them, and by the age of 50 most women have only a few hundred of them.

With age, along with the depletion of follicles, the expression of gonadotropin receptors also decreases. This helps to reduce the sensitivity of the ovaries to their own gonadotropic stimuli and reduce the frequency of ovulatory cycles. By the time of menopause, hormonal changes reflect a decrease in the number of follicles in the ovaries. With a change in the regularity of the cycles (at the age of about 46 years), only a few thousand follicles are available. As menopause approaches, the supply of follicles is less than 1000, which is not enough to provide the cyclical hormonal processes needed for menstruation. A particularly rapid decline in the number of follicles begins at the age of 37-38 years. Thus, changes in the hypothalamic-pituitary system associated with a decrease in ovarian function and fertility occur many years before menopause, starting from 35-38 years. In this case, regular ovulatory cycles are usually maintained.

With a decrease in the number of follicles, there is a selective decrease in the secretion of immunoreactive inhibin B by the ovaries, which usually precedes a decrease in estradiol secretion. Therefore, an early marker of previous menopause is an increase in FSH levels, since there is an inverse relationship between inhibin and FSH. Since the secretion of LH is not interconnected with inhibin, the increase in LH occurs later and the degree of its increase is less than that of FSH.

Due to the increase in the frequency of anovulatory cycles, already in the premenopausal period (40-45 years), the biosynthesis of progesterone in the ovaries is disrupted, which leads to the development of luteal phase insufficiency (LFP). A clinical reflection of the altered function of the ovaries in premenopause are menstrual cycles, which are characterized by alternation of delays in menstruation of various durations with metrorrhagia. It should be noted that a single determination of the level of gonadotropic (FSH, LH) and steroid (E2, progesterone) hormones in the blood serum is informative only for a given cycle or a given period of time. The fact is that the same woman during one year of premenopause may experience cycles that are different in endocrine characteristics: from full-fledged ovulatory or ovulatory ones with luteal phase insufficiency to anovulatory ones; from normal levels of estradiol to reduced or occasionally elevated; normal to elevated FSH levels (> 30 IU/L). Accordingly, in the endometrium there can be both a full-fledged secretion phase and atrophy or, more often, hyperplasia of the endometrium, depending on the hormonal function of the ovaries in the period closest to the study of the endometrium. Therefore, the endometrium is influenced by various concentrations of estrogens, and, accordingly, the state of the endometrium can be different - from the phase of proliferation to secretion or hyperplasia. Given the diverse hormonal characteristics of perimenopause, some researchers have attempted to systematize them with the allocation of several phases of this transitional period (Table 1).

The secretion of estrogens and progesterone by the ovaries in postmenopause practically stops. Despite this, in all women, estradiol and estrone are determined in the blood serum. They are formed in peripheral tissues from androgens secreted by the adrenal glands. Most estrogens are derived from androstenedione, which is secreted primarily by the adrenal glands and, to a lesser extent, by the ovaries. It occurs predominantly in muscle and adipose tissue. In this regard, with obesity, the levels of estrogen in the blood serum increase, which in the absence of progesterone increases the risk of hyperplastic processes and cancer of the uterine body. Thin women have lower serum estrogen levels, so they have an increased risk of osteoporosis. Interestingly, the clinical manifestations of climacteric syndrome are noted in obese women even with high levels of estrogen.

Thus, the perimenopausal period is characterized by the following physiological mechanisms:

1. Acceleration of follicle atresia processes.

2. An increase in the frequency of chromosomal abnormalities in eggs.

3. Decrease and termination of fertility.

4. Progressive decrease in the level of inhibin B.

5. Progressive increase in FSH levels.

6. Diversity in the nature of menstrual cycles:

- from regular to prolonged and meno-, metrorrhagia;

- from ovulatory cycles to NLF and anovulation;

- from hyperestrogenism to hypoestrogenism.

7. Reduction of the follicular phase of cycles.

In postmenopausal women, only single follicles are found in the ovaries, which then completely disappear, the level of estradiol progressively decreases (< 80 пмоль/л), повышается концентрация ФСГ и ЛГ, причем содержание ФСГ значительно превышает таковое ЛГ. В постменопаузе яичники не прекращают синтез андрогенов в клетках теки и стромы, однако их основным источником в постменопаузе является кора надпочечников. Степень снижения уровня эстрадиола более выражена, чем эстрона, поэтому величина соотношения Е2/Е1 после менопаузы составляет менее 1.

Postmenopause is characterized by the following hormonal criteria:

- low level of estradiol (< 80 пмоль/л);

- the value of the ratio E2 / E1 is less than 1, relative hyperandrogenism is possible;

— low level of GSPS;

- extremely low levels of inhibin, especially type B.

What is the complexity of the transition period and perimenopause?

From a clinical point of view, it is very important to single out the transition period and perimenopause, when, on the one hand, the doctor needs to decide on the start of both non-drug and drug prevention and treatment of menopausal disorders proper, on the other hand, the development of a number of diseases begins.

The initial period of perimenopause is characterized by the predominance of progesterone deficiency over estrogen (Fig. 1). This is due to the increase in anovulatory cycles without the formation of a corpus luteum, which leads to the occurrence of progesterone deficiency. As a result, relative hyperestrogenism occurs and the development of estrogen-dependent pathology is possible (menstrual irregularities, the occurrence and growth of uterine leiomyomas, endometrial hyperplasia, dysfunctional uterine bleeding, dyshormonal diseases of the mammary glands, etc.).

A further decrease in ovarian activity causes a decrease in estrogen production, which is confirmed in a laboratory study by a decrease in the level of estradiol and an increase in FSH. Clinically, estrogen deficiency manifests itself in the form of vegetovascular, psycho-emotional and metabolic-endocrine menopausal disorders.

Quite often, urogenital disorders develop (urinary incontinence, chronic recurrent inflammatory processes, urination disorders, dysuria, etc.) and disorders of sexual function. It is not customary to talk about this, but the problem remains acute, which adversely affects the quality of life of a woman at this age.

Thus, the transition period and perimenopause are characterized by unpredictable fluctuations in the levels of sex hormones. At the same time, the clinical manifestations of altered ovarian function in the phase of the menopausal transition are menstrual cycles, which are characterized by some features:

- the presence of regular cycles up to the onset of menopause;

- alternation of regular cycles with prolonged ones;

- delayed menstruation (oligomenorrhea) lasting from a week to several months;

- alternation of delays in menstruation of various durations with bleeding.

What are the goals of hormone replacement therapy?

Hormone replacement therapy (HRT) has been used for the prevention and treatment of menopausal disorders for over 60 years and is today one of the well-studied and widely used methods of therapy. More than 100 million women currently have experience with hormone replacement therapy in menopause. However, most studies have shown that in the ratio of "benefit - risk" in patients taking sex hormones for the treatment of menopausal disorders for a short time, the benefits certainly outweigh the risks. At present, no one doubts that HRT is the gold standard of therapy for patients who suffer from hot flashes, night sweats, atrophic changes in the genitourinary tract, osteopenic syndrome, and improves the quality of life of this contingent of women.

How to choose the right drug when prescribing hormone replacement therapy?

The selection of drugs should be individual in relation to each patient, and many parameters should be taken into account: age, current condition (perimenopause, postmenopause and its duration), the presence of concomitant pathology, personal and family history, body mass index, etc.

When choosing a drug, first of all, the regimen that is suitable for the patient is taken into account.

There are the following modes of hormone replacement therapy:

- monotherapy, that is, the use of one steroid;

- combination therapy.

Estrogen monotherapy can only be prescribed to patients after a total hysterectomy (hysterectomy), unless this operation was associated with endometriosis (in these cases, combined therapy is prescribed).

Combination therapy is prescribed for women with an unremoved uterus, as well as those who have undergone a subtotal hysterectomy (supravaginal amputation of the uterus), since this operation often does not exclude the preservation of a certain amount of endometrial tissue.

Developed cyclical and monophasic modes of HRT.

Cyclic mode combination therapy is used in perimenopause and in early postmenopause (with the consent of the woman to maintain menstrual bleeding). Switching to 28-day hormonal therapy (Fig. 2) eliminated 7-day breaks in treatment and, consequently, the actual loss of 1/4 of the year from the process of hormone replacement therapy, making it continuous.

Monophasic combined mode provides for the cessation of menstrual-like bleeding with the transfer of the endometrium to an inactive phase or a state of atrophy. To this end, the mode enhanced the effect of the progestogen component, which the patient receives with estradiol constantly.

It should be noted that an increase in the progestogenic effect on the endometrium is usually accompanied by breakthrough or spotting bleeding, especially in the first months or even years of admission. Therefore, it is recommended to start monophasic combination therapy 1-2 years after the onset of menopause, that is, already against the background of pronounced involutive changes in the endometrium, which reduces the likelihood of bleeding and, therefore, refusal to continue taking the drug.

What are the latest recommendations from the International Menopause Society regarding hormone therapy?

The International Menopause Society (IMS) was the first organization to highlight the importance of age in hormone therapy risk profiling in its statement on hormone therapy in February 2004 (document updated February 2007). In addition, IMS experts once again pointed out the positive effect of hormone therapy in the treatment of estrogen deficiency conditions and the need to prescribe it to all patients who need it.

After discussing the results of the WHI (Women's Health Initiative) and MWS (Million Women Study), conclusions and recommendations were made by the executive committee of the International Menopause Society (first discussion - December 2003, revision - February, October 2004, February 2007):

1. Continue the previously accepted global practice of hormone replacement therapy.

2. It is not justified to reduce the duration of hormone therapy with its effectiveness.

3. Termination of hormone replacement therapy may contribute to an increase in the incidence of cardiovascular disease.

4. The question of the duration and / or termination of hormone replacement therapy is decided individually.

5. Hormone replacement therapy provides a reduction in the incidence of colorectal cancer and fractures, but is associated with a small increase in the risk of breast cancer, deep vein thrombosis and thromboembolism.

6. Metabolic disorders, tumors, cardiovascular diseases are typical for all women at the end of reproductive age, and not only for those receiving hormone replacement therapy.

7. It is useful to combine hormone replacement therapy with other drugs (statins, anticoagulants, etc.).

8. At the risk of thrombosis, the parenteral route of administration is preferable.

9. Unified approaches to evaluating the effectiveness of hormone replacement therapy are impossible: different formulations and regimens contribute to different tissue and metabolic effects.

10. The results of population studies are needed for general guidance. They should not be extended to individual patients.

What are the recommendations of the International Menopause Society Expert Working Group regarding estrogen doses in HRT preparations?

Recommendations of the Expert Working Group of the International Menopause Society (February 16-17, 2004) regarding estrogen doses: estrogen dose
should be as low as possible and at the same time stop menopausal symptoms. Recommended starting doses are:

- 0.5-1 mg of 17 β-estradiol;

- 0.3-0.45 mg of conjugated equine estrogens;

- 25-37.5 mcg of transdermal estradiol (patch);

- 0.5 mcg of estradiol gel.

After 8-12 weeks from the start of treatment, the symptoms should be reassessed and, if necessary, the doses may be revised. In about 10% of cases, higher doses may be required. At the same time, doses should be reviewed from time to time and reduced where possible.

What components are used for combined hormone replacement therapy?

As the estrogenic components of HRT, "natural" estrogens are recommended for use. Natural estrogens are drugs that are identical in chemical structure to estradiol, which is synthesized in the body of women. Currently, 17 β-estradiol and estradiol valerate are most often used for oral forms in the clinical practice of European countries.

The progestogen component of HRT is prescribed to protect the endometrium and prevent the development of endometrial hyperplasia and endometrial cancer. With cyclic administration, gestagens should be prescribed for at least 10-14 days every month. The main requirement for the progestogen component is its metabolic neutrality, since it is necessary that it does not reduce the cardioprotective effect of estrogens (dydrogesterone).

So, for example, dydrogesterone, which is part of Femoston, is devoid of androgenic effects and reliably protects the endometrium.

What are the contraindications for hormone replacement therapy?

Recently, the number of contraindications for HRT has decreased, and contraindications, previously considered absolute, have become relative. This is due to the fact that during a certain period, contraindications to the use of hormonal contraceptives were automatically transferred to HRT. The main differences between these 2 groups of drugs are in the types of estrogen used, as well as in the doses and types of progestogens. Combined oral contraceptives use synthetic estrogen - ethinyl estradiol, which is not used for HRT. As part of HRT, progesterone derivatives are more often used, and in oral contraceptives, nortestosterone derivatives are used.

Absolute contraindications for HRT are:

- bleeding from the genital tract of unknown origin;

- breast and endometrial cancer;

- acute hepatitis;

- acute deep vein thrombosis;

- untreated tumors of the genital organs and mammary glands;

- Allergy to HRT ingredients;

- cutaneous porphyria.

Contraindications to some sex hormones should be highlighted separately:

1) for estrogens:

— breast cancer ER+ (history);

- endometrial cancer (in history);

- severe liver dysfunction;

- porphyria;

2) for gestagens:

- meningioma.

Relative contraindications for HRT:

- uterine fibroids, endometriosis;

- migraine;

- venous thrombosis or embolism (in history);

- familial hypertriglyceridemia;

- cholelithiasis;

- epilepsy;

- ovarian cancer (history).

Endometriosis: monotherapy with estrogens is contraindicated, however, combined estrogen-gestagen therapy with an adequate dose of active progestogen is possible.

uterine fibroids: combined therapy is indicated for uterine fibroids of small size and asymptomatic course. Women should be under special supervision; Ultrasound is recommended every 3 months. According to the data available to date, the response of fibroids to HRT, as well as to progestogen monotherapy, largely depends on the predominance of A- or B-progesterone receptors in myomatous nodes. It has been established that, depending on this, growth, regression or neutral reaction of nodes can be observed. The clinical picture and the size of the nodes on ultrasound testify to the reaction of myomatous nodes to HRT of a particular patient.

What examination should be carried out before the appointment of HRT?

Mandatory before prescribing HRT for each woman are:

- collection of anamnesis (clarification of heredity factors, the nature of the transferred somatic, oncological diseases, thromboembolism, diseases of the liver, blood vessels, reactions to combined oral contraceptives, etc.);

– gynecological examination with oncocytology;

– Ultrasound of the genital organs with a mandatory assessment of the thickness and structure of the endometrium;

- mammography or ultrasound of the mammary glands.

Evaluation of ultrasound data on the thickness of the endometrium in postmenopause:

- thickness of the endometrium up to 4 mm- HRT is not contraindicated;

- thickness of the endometrium 4 to 8 mm- biopsy of the endometrium, as well as the appointment of gestagens for 12-14 days and repeated ultrasound on the 5th day of a menstrual-like reaction;

- thickness of the endometrium over 8 mm- hysteroscopy or diagnostic curettage of the endometrium with a histological examination of the material is indicated.

Conducted according to indications additional examinations:

- biochemical blood test (lipid spectrum, glucose);

- coagulogram;

- physical examination, determination of the main hemodynamic parameters (BP, pulse);

- hormonal examination: FSH, LH, estradiol, TSH, T3, T4;

– consultation of specialists: neuropathologist, cardiologist, therapist, urologist, endocrinologist;

- densitometry.

How to monitor HRT?

The first control should be carried out 3 months after the start of therapy, then every 6 months. Against the background of taking HRT, an annual cytomorphological study of the cervical epithelium, ultrasound of the genital organs and mammography, as well as an assessment of lipid metabolism and coagulogram indicators are shown.

When should HRT be started?

After discussing the results of the WHI and MWS study, it was concluded that early initiation of HRT is necessary. At the 12th World Congress of Endocrine Gynecology in 2006, an audit of the Women's Health Initiative and the Million Women Study was carried out and the need for early initiation of HRT at the beginning of the transition period to menopause, perimenopause and early postmenopause was shown. “This approach to starting HRT will provide all those useful properties of HRT, which were described 20 years ago, in particular the prevention of diseases of the heart and blood vessels. The main thing is the timing, and then a window of therapeutic possibilities opens.

To date, the most optimal time to start HRT is premenopause. Considering the presence of relative hyperestrogenism in this period, even against the background of an absolute decrease in estrogen levels, it is reasonable to use Femoston 1/10 as a starting drug, which contains 1 mg of 17 β-estradiol and 10 mg of dydrogesterone and is the most suitable drug for starting HRT in perimenopause in in accordance with modern requirements for the use of low doses of estrogens.

What are the features of the beginning of HRT depending on the state of the endometrium?

Starting HRT in perimenopause:

1. Regular menstruation persists, there are no estrogen-dependent problems of the endometrium (normal structure of the endometrium): treatment with Femoston 1/10 should be started from the 1st day of the menstrual cycle.

2. Delays in menstruation up to 1-3 months, there are no estrogen-dependent problems of the endometrium (normal structure of the endometrium): "hormonal curettage" - gestagens for 10-14 days (for example, Dufaston 10 mg 2 times a day), then from 1- th day of menstruation - Femoston 1/10.

3. Menstruation delay up to 1-3 months, estrogen-dependent endometrial problems (dysfunctional uterine bleeding, endometriosis, uterine fibromyoma, endometrial hyperplasia): treatment of estrogen-dependent conditions under the control of the histological state of the endometrium and ultrasound control (anti-inflammatory therapy; Dufaston 20-30 mg / day . from the 5th (11th) to the 25th day of the MC 6-9 months). The decision on the possibility of using HRT is made individually.

If menopause symptoms persist while taking a low-dose cyclic drug Femoston 1/10, switch to a drug with a higher dose of estrogen (2 mg), for example, Femoston 2/10, etc.

Starting HRT in postmenopausal women (absence of menstruation for 12 months):

1. The normal structure of the endometrium, its thickness, determined by ultrasound (M-echo), is less than 4 mm: Femoston Conti 1/5 or other postmenopausal drugs from any day.

2. The normal structure of the endometrium, its thickness, determined by ultrasound (M-echo), is more than 4 mm: endometrial biopsy and, in the absence of pathology, hormonal curettage for 10-14 days (Dufaston 10 mg 2 times a day), then Femoston conti 1/5 or other postmenopausal drugs.

3. Changes in the endometrium (hyperplasia, polyps), its thickness, determined by ultrasound (M-echo), is more than 5 mm: hysteroscopy or diagnostic curettage with a histological examination of the endometrium and treatment of pathological conditions.

How to switch from cyclic HRT to monophasic?

If the woman's age corresponds to the postmenopausal period (over 50 years), there are no menstrual bleeding (or a significant decrease in their number and duration), the thickness of the endometrium (ultrasound signs) is less than 4 mm, then it is possible to switch from cyclic HRT to monophasic. When switching from a cyclic regimen (for example, Femoston 1/10 or 2/10) to a monophasic intake of a monophasic drug (for example, Femoston Conti), you should start at the end of the estrogen-progestin phase without interruption in taking the tablets.

In Europe, in the arsenal of clinicians there is a fairly wide range of drugs for HRT, which makes it possible for an individual approach to prescribing both the estrogen component and the progestogen component, the choice of their administration routes and the required dosage, taking into account the particular health status of each woman.

Thus, in the hands of a competent clinician who has a wide range of HRT preparations, guided by the principles of an individual approach in their choice and constantly monitoring the patient's health, mindful of the risk-benefit ratio, the benefits of using HRT still prevail over the risk.

Bibliography

1. Textbook of Perimenopausal Gynecology / Ed. by N. Santoro, S.R. goldstein. - The parthenon Publishig Group, 2003. - 164 s.

2. Medicine of menopause / Ed. V.P. Smetnik. - M., 2006. - 847 p.

3. The Menopause Comprehensive Management / Ed. by B.A. Eskin. — Fourth edition. - The Parthenon Publishing Group, 2000. - 311 s.

4. Stoppard M. Menopause. The complete practical guide to managing your life and maintaining physical and emotional well-being. - London: Dorling Kindersley Limited, 1995. - 219 s.

5. Menopause. Current Concepts / Ed. by C.N. Purandare. - FOGSI, 2006. - 277 s.

6. Keating F.S.J., Manassiev N., Stevenson J.C. Estrogens and Osteoporosis // Menopause: Biology and Pathology / E d. by R.A. Lobo, J. Kelsey and R. Marcus. — San Diego; Tokyo: Academic Press, 2000. - P. 509-534.

7. Pitkin J. Compliance with estrogen replacement therapy: current issues 2002. No. 5 (Suppl. 2). - P. 12-19.

8. Rosano G.M.C., Mercuro G., Vitale C. et al. How progestins influence the cardiovascular effect of hormone replacement therapy // Gynecological endocrinology. - 2001. - No. 6, Vol. 15. - P. 9-17.

9. Schindler A.E. Progestins and endometrial cancer // Gynecological endocrinology. - 2001. - No. 6, Vol. 15. - P. 29-36.

10 Schneider H.P.G. The wiev of The International Menopause Society on the Women's Health Initiative // Climacteric. - 2002. - No. 5. - P. 211-216.

11. Tosteson A.N.A. Decision Analysis Applied to postmenopausal Hormone Replacement Therapy // Menopause: Biology and Pathology / Ed. by R.A. Lobo, J. Kelsey and R. Marcus). — San Diego; Tokyo: Academic Press, 2000. - P. 649-655.

12. Writing Group for the Women's Health Initiative investigators. Risks and benefits of estrogen plus progestine in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial // JAMA. - 2002. - 288. - 321-33.

13. The Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy // JAMA. - 2004. -291. - 1701-12.

14. Manson J.E., Hsia J., Johnson K.C. et al Estrogenes plus progestine and the risk of coronary heart disease // N. Engl. J. Med. - 2003. - 349. - 523-34.

15. Hsia J., Langer R.D., Manson J.E. et al. Conjugated equine estrogenes and coronary heart disease: the Women's Health Initiative. Conjugated equine estrogenes // Arth. Intern. Med. - 2006. - 166. - 357-65.

16. Practical recommendations for hormone replacement therapy in the peri- and postmenopause // Climacteric. - 2004. - Vol. 7. - P. 210-216.

17. Rossouw J.E., Prentice R.L., Manson J.E. et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause // JAMA. - 2007. - 297. - 1465-77.

18. Pines A., Strude D., Birkhauser M. Hormone therapy and cardiovascular disease in early posmenopause: the WHI data revisited. International Menopause Society, 2007.

In our country, many patients, and even some specialists, are wary of HRT as charlatanism, although in the West the value of such therapy is highly valued. What is it really and is it worth trusting such a method - let's figure it out.

Hormone therapy - pros and cons

In the early 2000s, when the use of hormone replacement therapy was no longer questioned, scientists began to receive information about the increasing side effects associated with such treatment. As a result, many specialists have stopped actively prescribing drugs for postmenopausal women after 50 years of age. However, recent studies by scientists at Yale University have shown a high percentage of premature death among patients who refuse to take. The results of the survey are published in the American Journal of Public Health.

Did you know? Studies by Danish endocrinologists have shown that the timely administration of hormones in the first two years of menopause reduces the risk of developing tumors. The results are published in the British Medical Journal.

Mechanisms of hormonal regulation

Hormone replacement therapy is a course of treatment to restore a deficiency in the sex hormones of the steroid group. Such treatment is prescribed at the first symptoms of menopause, to alleviate the patient's condition, and can last up to 10 years, for example, in the prevention of osteoporosis. With the onset of female menopause, estrogen production by the ovaries worsens, and this leads to the appearance of various autonomic, psychological and urogenital disorders. The only way out is to replenish the hormone deficiency with the help of appropriate HRT preparations, which are taken either orally or topically. What is it? By nature, these compounds are similar to natural female steroids. The woman's body recognizes them and starts the mechanism for the production of sex hormones. The activity of synthetic estrogens is three orders of magnitude lower than that characteristic of the hormones produced by the female ovaries, but their continuous use leads to the required concentration in.

Important! Hormonal balance is especially important for women after removal or extirpation. Women who have undergone such operations may die during menopause if they refuse hormonal treatment. Female steroid hormones reduce the risk of osteoporosis and heart disease in these patients.

Rationale for the need to use HRT

Before prescribing HRT, the endocrinologist directs patients to mandatory medical examinations:

study of anamnesis in the sections of gynecology and psychosomatics;
using an intravaginal sensor;
examination of the mammary glands;
study of hormone secretion, and if it is impossible to perform this procedure, the use of functional diagnostics: analysis of a vaginal smear, daily measurements, analysis of cervical mucus;
allergic tests for drugs;
study of lifestyle and alternative therapies.

According to the results of observations, therapy is prescribed, which is used either for prevention purposes or as a long-term treatment. In the first case, we are talking about the prevention of such diseases in women in menopause as:

angina;
ischemia;
myocardial infarction;
atherosclerosis;
dementia;
cognitive;
urogenital and other chronic disorders.

In the second case, we are talking about a high probability of developing osteoporosis at the menopause stage, when a woman after 45 cannot do without hormone replacement therapy, since osteoporosis is the main risk factor for fractures in the elderly. In addition, it has been found that the risk of developing cancer of the uterine mucosa is significantly reduced if HRT is supplemented with progesterone. This combination of steroids is prescribed to all patients in menopause, except for those whose uterus has been removed.

Important! The decision on treatment is made by the patient, and only the patient, based on the recommendations of the doctor.

The main types of HRT

Hormone replacement therapy has several types, and preparations for women after 40 years of age, respectively, contain different groups of hormones:

estrogen-based monotypic treatment;
combination of estrogens with progestins;
combining female steroids with male ones;
monotypic progestin-based treatment
androgen-based monotypic treatment;
tissue-selective stimulation of hormonal activity.

Forms of drug release are very different: tablets, suppositories, ointments, patches, parenteral implants.

Impact on appearance

Hormonal imbalance accelerates and intensifies age-related changes in women, which affects their appearance and negatively affects their psychological state: the loss of external attractiveness reduces self-esteem. These are the following processes:

Overweight. With age, muscle tissue decreases, while fatty tissue, on the contrary, increases. More than 60% of women of “Balzac age”, who previously had no problems with being overweight, are subject to such changes. After all, with the help of the accumulation of subcutaneous fat, the female body "compensates" for the decrease in the functionality of the ovaries and thyroid gland. The result is a metabolic disorder.
Violation of the general hormonal background during menopause, which leads to the redistribution of adipose tissue.
deterioration in health and During menopause, the synthesis of proteins responsible for the elasticity and strength of tissues deteriorates. As a result, the skin becomes thinner, becomes dry and irritable, loses elasticity, wrinkles and sags. And the reason for this is a decrease in the level of sex hormones. Similar processes occur with hair: they become thinner and begin to fall out more intensively. At the same time, hair growth begins on the chin and above the upper lip.
Deterioration of the dental picture during menopause: demineralization of bone tissues, disorders in the connective tissues of the gums and tooth loss.

Did you know? In the Far East and Southeast Asia, where the menu is dominated by plant foods containing phytoestrogens, menopausal disorders are 4 times less common than in Europe and America. Asian women are less likely to suffer from dementia because they consume up to 200 mg of plant estrogens daily with food.

HRT, prescribed in the premenopausal period or at the very beginning of menopause, prevents the development of negative changes in appearance associated with aging.

Hormone therapy drugs for menopause

New generation drugs intended for different types of HRT with menopause are divided into several groups. Synthetic estrogenic products used at the beginning of postmenopause and at its last stage are recommended after removal of the uterus, with mental disorders and impaired performance of the organs of the urinary-genital system. These include such pharmaceutical products as Sygethinum, Estrofem, Dermestril, Proginova and Divigel. Products based on a combination of synthetic estrogen and synthetic progesterone are used to eliminate the unpleasant physiological manifestations of menopause (increased sweating, nervousness, palpitations, etc.) and prevent the development of atherosclerosis, endometrial inflammation and osteoporosis.

This group includes: Divina, Klimonorm, Trisequens, Cyclo-Proginova and Climen. Combined steroids that relieve the painful symptoms of menopause and prevent the development of osteoporosis: Divitren and Kliogest. Vaginal tablets and suppositories based on synthetic estradiol are intended for the treatment of genitourinary disorders and the revival of the vaginal microflora. Vagifem and Ovestin. Highly effective, harmless and non-addictive, prescribed to relieve chronic menopausal stress and neurotic disorders, as well as vegetative somatic manifestations (vertigo, dizziness, hypertension, respiratory distress, etc.): Atarax and Grandaxin.

Drug regimens

The regimen for taking steroids with HRT depends on the clinical picture and the stage of postmenopause. There are only two schemes:

Short-term therapy - for the prevention of menopausal syndrome. It is prescribed for a short time, from 3 to 6 months, with possible repetitions.
Long-term therapy - to prevent late consequences, such as osteoporosis, senile dementia, heart disease. Appointed for 5-10 years.

Taking synthetic hormones in tablets can be prescribed in three different modes:

cyclic or continuous monotherapy with one or another type of endogenous steroid;
cyclic or continuous, 2-phase and 3-phase treatment with combinations of estrogens and progestins;
a combination of female sex steroids with male ones.

Menopause is the second "transitional age" in a woman's life, which, unlike teenage changes, is very difficult. This happens because in the body there is a gradual extinction of the functions of the sex glands. A decrease in the hormonal level cannot but affect the condition of a woman, and only HRT, that is, hormone replacement therapy, can normalize it in 90% of cases - with menopause, this method is used quite often.

A change in the hormonal level in a woman with menopause affects the functioning of the organs, and in order to eliminate this, it is necessary to conduct HRT

The main task of the doctor when using HRT is to fight against the symptomatic manifestations of menopause, which are expressed:

sudden mood swings;
a feeling of a rush of heat to the upper part of the body and face;
uncontrolled fluctuations in blood pressure;
the appearance of delays in menstruation and / or their complete cessation;
demineralization of bone tissue;
deterioration in the condition of hair, skin and nails;
structural (physiological and physical) changes in the mucous membranes, especially in the genitourinary system.

Hormonal changes affect the condition of the bones

In order to achieve the maximum effect in preventing and eliminating changes in the functions of internal organs and glands, the HRT complex uses drugs of plant or synthetic origin, which in the vast majority of cases need to be drunk for quite a long time - from a year to 2-3 years. In some cases, the course should be continued for 10 years or more.

What is hormone replacement therapy

In the classical sense, hormone therapy for menopause is a treatment with medications that contain sex hormones (mainly female). The goal of treatment is to eliminate the acute lack of estrogen and progesterone, resulting from a decrease in their synthesis by the endocrine glands.

In medicine, there are two types of HRT:

Short-term hormone therapy is a treatment that is directed against the symptomatic manifestations of menopause, not complicated by severe depressive states, vasomotor pathologies, and changes in the functions of other organs and systems. The period during which it is recommended to take the medicines prescribed by the doctor is from 12 to 24 months.
Long-term hormonal therapy is a treatment that is directed against menopausal disorders aggravated by serious changes in the functioning of the central nervous system, cardiovascular system, endocrine glands. The period during which you need to take hormonal drugs is from 2 to 4, and in rare cases up to 10 years.

Depending on the symptoms and complications, HRT can be prescribed both for a short time and for a long time.

If you follow the doctor's recommendations, you can achieve a significant improvement in the condition of menopausal women. So, hormonal drugs, especially the new generation, reduce phenomena such as hot flashes and nervous excitement, reduce pain and restore the condition of the mucous membranes, skin, hair and nails. In a word, they do not allow a woman's body to age rapidly.

Indications for the use of HRT

Complex measures, including HRT, are used as symptomatic and prophylactic agents. In the first case, their action is directed against the already existing symptoms of menopause, in the second - against possible pathologies arising from hormonal changes in the late stage of menopause (osteoporosis, arterial hypertension, and others).

The list of unconditional indications for the use of HRT includes:

cases of early onset of menopause;
a history suggesting a high risk of osteoporosis;
pathologies of the heart and blood vessels associated with menopause;
high risk of developing CCC pathologies (diabetes, hyperlipidemia, hereditary predisposition to arterial hypertension).

Women cannot do without HRT if they have heart problems during menopause

Preparation for hormone replacement therapy

Before you start using HRT as a method of overcoming the unpleasant symptoms of menopause, you need to conduct a thorough examination, which includes laboratory and instrumental studies for existing changes. The list of diagnostic measures includes:

ultrasound examination of the abdominal cavity and thyroid gland;
external and instrumental examination of the mammary glands (mammography, ultrasound of the mammary glands, etc.);
laboratory examination of a smear from the cervix;
laboratory blood tests for hormones (setting the hormonal status, the degree of tendency to thrombosis);
measurement of blood pressure;
general medical examination.

Before starting HRT, an ultrasound of the thyroid gland and other organs is performed.

When chronic diseases are detected, it is necessary to choose a treatment directed against the causes that provoked their occurrence, as well as to eliminate the changes that have occurred.

Despite the fact that in menopausal age it is very difficult to completely cure concomitant diseases, it is recommended to minimize their effect on the body. Only after chronic diseases are treated, a woman begins to select drugs for HRT, which will effectively act against age-related and hormonal changes.

Choice of funds: types and forms of hormonal drugs for menopause

There are several types and forms of drugs that can be used to implement HRT. First, they can be organic (homeopathic) and synthetic. The former are made on the basis of plants containing phytohormones, the latter are produced in laboratories from a variety of artificial chemical components. Secondly, drugs are divided into several groups depending on the route of entry of active components into the body:

oral form - tablets, pills, dragees;
transdermal form - subcutaneous implants or injections;
local form - suppositories, creams and gels for application to the vaginal mucosa or to the skin in the abdomen, thighs and chest.

Hormonal drugs can be used in various forms

Each dosage form, the names of which will be given below, has a list of advantages and disadvantages that must be considered when prescribing certain drugs to a particular patient. So, hormonal pills are convenient to take, they are quickly absorbed and are inexpensive. However, many oral HRT products adversely affect the stomach and liver.

If a woman has diseases of these organs, she is recommended to use local or transdermal forms of hormonal preparations. They, unlike tablets, do not affect the digestive tract and practically do not interact with other drugs. Because of this, they can be taken in conjunction with a large list of pharmaceuticals.

Hormonal drugs for HRT - a list

tides;
sleep disorders;
involutive changes in the mucous membranes;
headaches and dizziness;
increased nervous excitability;
pain that occurs in the lower back or in the suprapubic region after sexual contact.

Taking hormonal drugs helps get rid of headaches during menopause

Among the most popular and effective drugs for menopause, doctors include the following hormonal drugs:

Femoston is a two-phase combination medicine in the form of tablets;
Dermestril is a one-component estrogen-containing drug in the form of a patch;
Klimara - a combined hormonal agent for external use (patch);
Klimonorm - a combined remedy in the form of a dragee;
Estroferm is a one-component drug in the form of tablets;
Trisequens is a combination medicine in the form of tablets;
Ovestin is a one-component medicine in the form of tablets and suppositories;
Angeliq - a combined remedy in the form of tablets;
Cyclo-Proginova - a combination medicine in the form of tablets;
Divigel is a one-component preparation in the form of a gel for topical use.

These hormonal drugs show high efficiency in eliminating the symptoms of menopause.

All of these drugs are new generation products, which include hormones in microdoses. Due to this, they retain therapeutic properties, as they slow down the natural age-related decrease in the hormonal background of a woman. At the same time, against the background of their intake, there are no changes in the functions of internal organs, as happens if you take hormonal anabolics.

When prescribing HRT with the use of hormonal drugs to patients who have entered menopause, the details obtained during the preliminary examination are taken into account. Based on the data obtained, the doctor calculates the dosage of hormones that a woman needs to take. You will have to drink tablets and use creams and suppositories daily, preferably at the same time. Patches and injections are used less often, once a week or once a month, depending on the concentration of hormones in them and the speed of their release.

Despite the absence of obvious harm to health, the doctor must weigh the pros and cons of hormonal drugs. If there is a slight risk, they should be replaced with drugs with herbal substitutes for human hormones.

It is not allowed to independently change the dosage of funds from this group. This can lead to significant changes in the hormonal status of a woman and to a change in the functions of the endocrine glands and organ systems. In addition, a systematic increase in dosages can lead to the formation of tumors, especially if women are diagnosed with benign neoplasms or have a hereditary predisposition to their occurrence.

All drugs for hormone replacement therapy should be taken only after a doctor's prescription.

Non-hormonal drugs for menopause

In addition to hormonal drugs, doctors often prescribe tablets to drink, which include phytoestrogens - plant analogues of female hormones. They are used if a woman has contraindications to the use of hormonal agents during HRT. The drugs of this group are also representatives of a new generation of drugs that contain exactly those dosages that actively act against the symptoms of menopause, without causing negative changes.

Non-hormonal medications suitable for HRT include:

Klimadinon and Klimadinon Uno in the form of tablets;
Estrovel in the form of tablets;
Menopace capsules;
Qi-Klim tablets;
Red brush in drops and bags for brewing tea;
Bonisan in the form of tablets and gel;
Remens in the form of tablets;
Klimakt Hel in the form of a gel;
Ladys Formula Menopause in capsule form;
Klimaksan in the form of capsules.

Non-hormonal drugs are also effective in menopause.

The listed remedies are mostly represented by homeopathic preparations and biological food supplements. To feel a noticeable therapeutic effect, you will need to drink them for at least 3 weeks. In this regard, the course of HRT with them lasts longer than when using hormones.

The means of this group are especially effective if you drink them for a long time. At the same time, doctors recommend that women switch to a diet rich in fiber. Due to this, the effectiveness of HRT will be even higher.

Phytoestrogens do not act against the symptoms very quickly, but they have a cumulative effect - after the end of the course, the woman does not undergo the so-called "withdrawal syndrome", and the hormone level is maintained at the achieved level. It is recommended to drink medicines of this type daily in the dosages prescribed by the doctor. Increasing or changing the dosage of phytoestrogens is not recommended, as this can worsen a woman's condition or cause serious complications.