Hormone replacement therapy: a panacea or another tribute to fashion?

M. V. Maiorov, Women's consultation of the city polyclinic No. 5 of Kharkov

"Sapiens nil affirmant, quod non probet"
(“A wise man does not assert anything without evidence”, Lat.)

“Once again these harmful hormones!” exclaim negatively minded patients. "Great effect! They are accepted by many ex-stars of Hollywood, remaining young, beautiful and sexually irresistible! Virtually no side effects! Magnificent prospects for widespread use! .. ”- doctors-enthusiasts admire. “The method is interesting and, perhaps, useful, but still, “God saves the safe.” We can learn about undesirable effects only after a few years, as has happened more than once. Is it worth the risk? - summarize cautious skeptical doctors. Who is right?

Of course, “Suum quisque iudicium habet” (“Everyone has his own judgment”), although, as you know, “Verum plus uno esse non potest” (“There cannot be more than one truth”). The search for this truth is a rather difficult problem.

The reproductive life expectancy of a woman, unlike a man, is limited. Figuratively speaking, women's biological clocks are programmed and, in the words of Welldon (1988), "While men have full ownership of their reproductive organs, women only temporarily rent them." The lease term ends with the onset of menopause.

Menopause (MP), i.e. the last spontaneous menstruation, in European countries occurs in women between 45-54 years old (most often around 50 years old) and depends on many factors, including the age of birth of the first child, the number of births, the duration of the menstrual cycle and lactation, smoking, climate, genetic factors, etc. (Leush S. S. et al., 2002). So, for example, with short menstrual cycles, MP comes earlier, taking hormonal contraceptives contributes to its later onset. (Smetnik V.P. et al., 2001) etc. According to WHO forecasts, by 2015, 46% of the female population of the planet will be over the age of 45, and 85% of them (!) Will encounter menopausal problems.

It is necessary to adhere to the following terminology and classification of the described states. Perimenopause is a period of age-related decline in ovarian function, mainly after 45 years, including premenopause and one year after menopause or 2 years after the last spontaneous menstruation. Menopause is the last independent menstruation due to the function of the reproductive system. Its date is set retrospectively - after 12 months of absence of menstruation. Early MP occurs at the age of 41-45 years, late MP - after 55 years, postmenopause - a period of a woman's life that occurs 1 year after the last menstruation and continues until old age (according to the latest gerontological views - up to 70 years). Surgical MP occurs after bilateral oophorectomy or hysterectomy with removal of the appendages.

According to most researchers, MP is considered premature if it occurs in women under 40 years of age. Its causes can be: gonadal dysgenesis, genetic factors (most often, Turner's syndrome), premature ovarian failure ("wasted ovary syndrome", resistant ovary syndrome, hypergonadotropic amenorrhea), autoimmune disorders, exposure to toxins, viruses, radiation and chemotherapy, etc. , as well as surgical interventions that cause surgical MP.

The transitional period of a woman is characterized by pronounced hormonal changes. In premenopause, the function of the reproductive system fades, the number of follicles decreases, their resistance to the influence of pituitary hormones increases, and anovulatory cycles begin to prevail. The process of folliculogenesis is disturbed, atresia and death of steroid-producing cells are noted. All this, long before the onset of MP, contributes to a decrease in the secretion of progesterone, and then to a decrease in the synthesis of immunoreactive inhibin and estradiol. Since there is an inverse relationship between inhibin levels and follicle-stimulating hormone (FSH), a decrease in inhibin levels, usually preceding a decrease in estradiol, leads to an increase in FSH levels in the blood. The level of luteinizing hormone (LH) rises to a lesser extent and later than FSH. FSH and LH levels peak 2 to 3 years after the last menstrual period and then begin to decline gradually. With the existing assumption about the premature onset of menopause, it is informative to study the level of FSH, which is an early marker of the upcoming MP. After the end of perimenopause, when the fluctuation of ovarian hormones stops, the level of estrogen is consistently low. At the same time, testosterone production increases due to stimulation of interstitial cells by gonadotropic hormones, the level of which is increased during menopause. There is "relative hyperandrogenism".

These changes lead to a number of characteristic, often estrogen-dependent, "climacteric complaints": vasomotor symptoms (hot flushes, chills, night sweats, palpitations, cardialgia, unstable blood pressure), myalgia and arthralgia, irritability, weakness, drowsiness, mood swings, and feeling anxiety, frequent urination (especially at night), severe dryness of the mucous membranes of the urogenital tract (up to atrophic processes), decreased libido, depression, anorexia, insomnia, etc.

A change in the estrogen / androgen ratio in some women is manifested by symptoms of hyperandrogenism (excessive body hair, voice change, acne). Estrogen deficiency leads to degeneration of collagen fibers, sebaceous and sweat glands, sclerosis of skin blood vessels, which causes skin aging, brittle nails and hair, and alopecia. Postmenopausal osteoporosis increases the risk of bone fractures and tooth loss by 30%. Significantly increases the risk of coronary heart disease and hypertension. All this, quite naturally, significantly worsens not only the quality of life, but also its duration.

Having tried to find an answer to the sacramental question "who is to blame?", Let's turn to the no less sacramental and very relevant - "what to do?"

Since MP is a hormone-deficient condition, the “gold standard” for the prevention and treatment of menopausal disorders is recognized worldwide as hormone replacement therapy (HRT), which is a pathogenetic method. The frequency of HRT use varies significantly in different European countries, due to the economic situation, as well as cultural and household traditions. For example, in France and Sweden, HRT is used by every third woman.

Over the past years, there has been a positive trend in relation to HRT not only for Ukrainian doctors, but also for domestic patients.

According to A. G. Reznikov (1999, 20002), basic principles of HRT are as follows:

1. Administration of minimally effective doses of hormones. This is not about replacing the physiological function of the ovaries in the reproductive age, but about maintaining tissue trophism, preventing and eliminating menopausal and menopausal disorders.
2. Use of natural estrogens. Synthetic estrogens (ethinyl estradiol) are not used for HRT, since in women of late reproductive and postmenopausal age, their hypertensive, hepatotoxic and thrombogenic effects are possible. Natural estrogens for systemic use (preparations of estradiol and estrone) are included in the normal hormonal metabolic cycle. The weak estrogen estriol is used mainly for the local treatment of trophic disorders (vaginal administration).
3. Combination of estrogens with progestins. An increase in the frequency of endometrial hyperplastic processes is a natural result of estrogen monotherapy, which in its pure form is used only in women with a removed uterus. With a preserved uterus, it is mandatory to add progestin to estrogen for 10-12 days once a month or 14 days once every 3 months (Table 1). Due to this, a cyclic secretory transformation and rejection of the surface layers of the endometrium occurs, which prevents its atypical changes.
4. The duration of treatment is 5–8 years. To ensure optimal results, the use of HRT preparations should be long enough. 5-8 years are the terms that guarantee the maximum safety of HRT drugs, primarily in relation to the risk of breast cancer. Often, this treatment is carried out for longer, but then more careful medical supervision is necessary.
5. The timeliness of the appointment of HRT. It should be noted that in some cases, HRT can quite realistically stop the development of the pathological consequences of estrogen deficiency, without providing restitution. But to stop the development of osteoporosis, to slow down, and even more so to prevent it, is possible only if the timely start and sufficient duration of HRT.

Table 1. The daily dose of gestagens required for a protective effect on the endometrium during HRT
(according to Birkhauser M. H., 1996; Devroey P. et al., 1989)

Types of gestagens	Daily dose (mg) for cyclic use 10-14 days / 1-3 months	Daily dose (mg) with constant use
1. Oral:
progesterone natural micronized;	200	100
medroxyprogesterone acetate;	5–10	2,5
medrogeston;	5	-
didrogeston (dufaston);	10–20	10
cyproterone acetate;	1	1
norethisterone acetate;	1–2,5	0, 35
norgestrel;	0,15	-
levonorgestrel;	0,075	-
desogestrel	0,15	-
2. Transdermal
norethisterone acetate	0,25	-
3. Vaginal
progesterone natural micronized	200	100

The modern classification of drugs used for the treatment of menopausal disorders and the treatment of postmenopausal osteoporosis is as follows (Kompaniets O., 2003):

1. Traditional HRT:
   • "pure" estrogens (conjugated, estradiol-17-β, estradiol valerate);
   • combined estrogen-progestogen therapy (cyclic or continuous mode)
   • combined estrogen-androgen therapy.
2. Selective estrogen receptor modulators - SERMs; raloxifene.
3. Tissue-selective regulators of estrogenic activity (gonadomimetics with estrogenic, gestagenic and androgenic effects) - STEAR; tibolone.

It should be noted that along with the traditional oral method of using drugs, there are alternative parenteral routes for individual components of HRT: vaginally (in the form of cream and suppositories), transdermally (patch, gel), and also in the form of subcutaneous implants.

Indications and contraindications for the use of HRT should be clearly defined, as defined by the European Coordination Conference on the menopause problem (Switzerland, 1996).

Absolute contraindications to the appointment of HRT:

• history of breast cancer;
• acute liver diseases and severe violations of its function;
• porphyria;
• a history of endometrial cancer;
• estrogen-dependent tumors;
• meningioma.

The appointment of HRT is mandatory for:

• vegetative-vascular disorders;
• urogenital disorders (atrophic vulvitis and colpitis, urinary incontinence, urinary tract infections);
• perimenopausal cyclic disorders.

The appointment of HRT is desirable for:

• metabolic and endocrine disorders;
• depressive states and other psycho-emotional disorders;
• muscle pain and joint pain;
• atrophic changes in the epithelium of the oral cavity, skin and conjunctiva.

Indications for the use of HRT for prophylactic purposes:

• ovarian dysfunction and oligoamenorrhea (Turner's syndrome, psychogenic anorexia, etc.) in history;
• early menopause (surgical, chemotherapy and radiotherapy, premature ovarian failure, etc.);
• bone mass below the appropriate age norm;
• history of bone fractures;
• cardiovascular diseases (myocardial infarction, etc.) in history;
• risk of developing cardiovascular diseases: lipid metabolism disorders, etc., especially in combination with diabetes mellitus, hypertension, smoking, family tendency to coronary insufficiency (especially in the presence of cardiovascular diseases in close relatives under the age of 60), familial dyslipoproteinemia ;
• familial predisposition to Alzheimer's disease.

In addition, the so-called HRT-neutral states, which are not contraindications to the use of hormonal drugs, but the type of drug, dose, ratio of components, route of administration and duration of its use in these patients should be selected individually after a detailed examination by coordinated actions of a gynecologist and a specialist of the relevant profile. HRT-neutral conditions: varicose veins, phlebitis, history of ovarian cancer (after surgical treatment), surgical interventions (postoperative period with prolonged bed rest), epilepsy, sickle cell anemia, bronchial asthma, otosclerosis, convulsive syndrome, general atherosclerosis, collagenoses, prolactinoma, melanoma, liver adenoma, diabetes, hyperthyroidism, endometrial hyperplasia, uterine fibromyoma, endometriosis, mastopathy, familial hypertriglyceridemia, risk of developing breast cancer.

At the X International Menopause Congress (Berlin, June 2002) Researchers at the Obstetrics and Gynecology Clinic of the University of Prague presented their experience non-traditional use of HRT in adolescents and young women with hypogonadism with delayed sexual development and other cases of primary amenorrhea, with castration in childhood, with long-term and severe secondary amenorrhea against the background of hypoestrogenism. In such cases, HRT is necessary for the development of secondary sexual characteristics, the formation of sexual behavior, the growth of the uterus and the proliferation of the endometrium, as well as for the growth, maturation and mineralization of bones. In addition, in these cases, HRT has a positive effect on the psycho-emotional sphere.

Before prescribing HRT, it is necessary to conduct a thorough comprehensive examination of the patient to exclude possible contraindications: a detailed history, gynecological examination, colpocervicoscopy, ultrasound (vaginal sensor) of the pelvic organs (with the obligatory determination of the structure and thickness of the endometrium), mammography, coagulogram, lipid profile, bilirubin, transaminases and other biochemical parameters, measurement of blood pressure, weight, ECG analysis, examination of ovarian and gonadotropic (LH, FSH) hormones, colpocytological examination. We have given a detailed version of the complex of clinical and laboratory examination, the implementation of which should be striven for. However, in the absence of opportunities and, most importantly, strong evidence, this list can be reasonably reduced.

After choosing a drug for HRT (figure), regular planned monitoring of patients is necessary: ​​the first control after 1 month, the second after 3 months and then every 6 months. At each visit, it is necessary: ​​gynecological, colpocytological and colpocervicoscopic examination (in the presence of the cervix), control of blood pressure and body weight, ultrasound of the pelvic organs. With a postmenopausal endometrial thickness of more than 8-10 mm or an increase in the endometrial-uterine ratio, an endometrial biopsy is necessary, followed by a histological examination.

When using HRT, as with any method of drug therapy, side effects are possible:

• engorgement and pain in the mammary glands (mastodynia, mastalgia);
• fluid retention in the body;
• dyspeptic phenomena;
• feeling of heaviness in the lower abdomen.

In order to maximize the optimization of the selection of drugs and regimens and dosing regimens, it is convenient to use Table. 2, 3.

Table 2. Modes of application of HRT
(Methodological recommendations, Kiev, 2000)

Mode of administration (drugs)	Contingent of patients
Estrogen monotherapy: proginova, estrofem, vagifem, divigel, estrogel, estrimax	Only women after total hysterectomy
Cyclic intermittent combination therapy (28-day cycle): cyclo-progynova, klimen, kliane, klimonorm, divina, estrogel + utrogestan, pauzogest, divigel + depo-provera	Women in perimenopause and early postmenopause under the age of 55
Cyclic continuous combination therapy (28-day cycle): trisequenz, femoston, estrogel + utrogestan, proginova + dufaston	Women in perimenopause and early postmenopause under the age of 55, especially with recurrence of menopausal symptoms like premenstrual syndrome on estrogen-free days.
Cyclic intermittent combination therapy (91-day cycle): Divitren, Divigel + Depo-Provera	Women in perimenopause and early postmenopause aged 55–60 years
Permanent combined estrogen-gestagen therapy: kliogest, estrogel + utrogestan	Women over 55 who are postmenopausal for more than 2 years
Permanent combined estrogen-gestagen therapy (in half dosage): active, estrogel + utrogestan, divigel + depo-prover, livial (tibolone).	Women over 60-65 years old.

Table 3 Choice of HRT for surgical menopause
(Tatarchuk T.F., 2002)

Diagnosis before surgery	Type of transaction	Therapy	Preparations
endometriosis, adenomyosis	Ovariectomy + hysterectomy	Estrogen + gestagen in continuous mode	Kliane or proginova + gestagen (continuously)
Fibroma etc.	Ovariectomy + hysterectomy	Estrogen monotherapy	Proginova
Cysts, inflammatory tumors of the ovaries	Ovariectomy with preserved uterus	Estrogen + gestagen Cyclic mode or continuous mode (no cyclic bleeding)	Klimonorm Kliane

Principles of HRT for surgical MP: Patients under the age of 50 years should be prescribed HRT immediately after total oophorectomy, regardless of the presence of neurovegetative disorders, the minimum duration of therapy is 5–7 years, possibly until the age of natural MP.

Having a large selection of treatment regimens, for better individualization, the doctor must involve the patient in the choice. If she does not actively participate in the selection process, the risk of her rejection of treatment, the development of side effects, and reduced compliance increases. Informed consent increases the likelihood of long-term use of HRT and its effectiveness. An indispensable condition for success is the corresponding high professional level of the doctor prescribing and implementing HRT. At the same time, dilettantism often encountered, based on superficial awareness, is absolutely unacceptable.

Recently, some medical publications have published the findings of the so-called WHI study (Women's Health Initiative), conducted in the United States, stating that the estrogen-progestogen combination HRT supposedly increases the risk of invasive breast cancer, myocardial infarction and venous thrombosis. However, at many international congresses and conferences, new data about this study were presented, criticizing the correctness of its conduct and analysis of the data obtained.

The available results of the successful use of HRT in many countries over a number of years convincingly prove the feasibility of using this highly effective and promising method, which significantly and significantly improves the quality of life and health of the beautiful half of the human race.

Literature

1. Topical issues of hormone replacement therapy // Proceedings of the conference November 17, 2000, Kiev.
2. Grishchenko O. V., Lakhno I. V. Treatment of menopausal syndrome in women // Medicus Amicus.— 2002.— No. 6.— P. 14–15.
3. Derimedved L. V., Pertsev I. M., Shuvanova E. V., Zupanets I. A., Khomenko V. N. Drug interaction and the effectiveness of pharmacotherapy. Kharkov: Megapolis, 2002.
4. Zaydiyeva Ya. Z. The effect of hormone replacement therapy on the state of the endometrium in perimenopausal women // Schering News.— 2001.— P. 8–9.
5. Clinic, diagnosis and treatment of postovariectomy syndrome // Methodical recommendations. - Kiev, 2000.
6. Leush S. St., Roshchina G. F. Menopausal period: endocrinological status, symptoms, therapy // New in gynecology.— 2002.— No. 2.— P. 1–6.
7. Mayorov M. V. Non-contraceptive properties of oral contraceptives // Pharmacist. - 2003. - No. 11. - P. 16–18.
8. Principles and methods of correction of hormonal disorders in peri- and postmenopause // Methodical recommendations. - Kiev, 2000.
9. Reznikov A. G. Is hormone replacement therapy necessary after menopause? // Medicus Amicus.— 2002.— No. 5.— P. 4–5.
10. Smetnik V.P. Perimenopause — from contraception to hormone replacement therapy // Journal of Obstetrics and Women's Diseases.— 1999.— No. 1.— P. 89–93.
11. Smetnik V. P., Kulakov V. I. Guide to menopause. - Moscow: Medicine, 2001.
12. Tatarchuk T. F. Differentiated approaches to the use of HRT in women of different age groups // Schering News.— 2002.— No. 3.— P. 8–9.
13. Urmancheeva A. F., Kutusheva G. F. Oncological issues of hormonal contraception and hormone replacement therapy // Journal of Obstetrics and Women's Diseases.— 2001.— Issue. 4, volume L, p. 83–89.
14. Hollihn U. K. Hormone Replacement Therapy and the Menopause.- Berlin.— 1997.
15. Reproductive Endocrinology (4 edition), - London, 1999.
16. Singer D., Hunter M. Premature menopause. A multidisciplinary approach. London, 2000.

After 45-50 years, the level of estrogen in the blood of a woman begins to gradually decrease. This can lead to symptoms such as night sweats, insomnia, calcium leaching from the bones.

Hormone replacement therapy aims to replace estrogen deficiency with drugs containing synthetic (artificial) hormones and prevent these symptoms.

Why is hormone replacement therapy (HRT) needed for menopause?

Hormone replacement therapy can reduce or eliminate the symptoms of menopause, as well as reduce the risk of developing some of the consequences of menopause, such as osteoporosis, heart disease, atrophic vaginitis (exhaustion of the vaginal mucosa), and others.

Who needs hormone replacement therapy for menopause?

Despite the fact that hormone replacement therapy can reduce the manifestations of menopause, it is not always necessary to take hormones during menopause and, most importantly, is safe.

Hormone replacement therapy is prescribed:

To relieve severe hot flashes and night sweats, if these symptoms cause severe discomfort and interfere with daily life.

With the appearance of such symptoms as: severe dryness and discomfort in the vagina,.

Hormone replacement therapy is not prescribed if the only problem associated with menopause is depression. Although hormones can sometimes help combat depressed mood, depression is preferably treated with antidepressants.

Who should not take hormones during menopause?

• You have had breast cancer
• You had
• You have serious liver disease and liver failure
• You have high triglyceride levels in your blood
• You have had deep vein thrombosis
• You
• You
• You

What tests should be done before you start taking hormones?

In order to make sure that you need hormone replacement therapy, and you have no contraindications for prescribing hormones, you need to undergo the following examinations and pass the following tests:

• Height and weight measurement, definition.
• Measurement of blood pressure.
• Examination by a mammologist and mammography (to exclude diseases of the mammary glands)
• Examination at the gynecologist
• General blood analysis
• General urine analysis
• Measurement of triglyceride and cholesterol levels in the blood
• Measuring blood sugar
• (pap test)

In some cases, your doctor may order other tests or tests, depending on your medical history.

What medications are prescribed for hormone replacement therapy?

Preparations containing estrogens are the most effective treatment for the symptoms of menopause (vaginal dryness, hot flashes, osteoporosis).

Hormones can be prescribed not only in the form of tablets, but also in the form of intramuscular injections, hormonal patches, subcutaneous implants, vaginal suppositories, etc. The choice of a drug for hormone replacement therapy depends on how long the period has stopped, what symptoms are bothering you, and also what diseases and operations you have had before.

There are many different drugs prescribed for hormone replacement therapy. We list only some of them available in Russia:

• In the form of tablets (or dragees): Premarin, Hormoplex, Klimonorm, Klimen, Proginova, Cyclo-proginova, Femoston, Trisequens and others.
• In the form of intramuscular injections: Ginodian-Depot, which is administered every 4 weeks.
• In the form of hormonal patches: Estraderm, Klimara, Menorest
• In the form of skin gels: Estrogel, Divigel.
• In the form of an intrauterine device: .
• In the form of vaginal suppositories or vaginal cream: Ovestin.

Attention: the choice of the drug is carried out only by the attending gynecologist. Self-administration of any of the listed drugs can be dangerous.

Can I get pregnant while taking hormones?

Hormone replacement therapy does not suppress ovulation, which means you still have a theoretical risk of pregnancy. Therefore, you need to use 1 more year after your last period if you are 50 or older, or 2 years after your last period if you are under 50.

How long can hormone replacement therapy last?

Most gynecologists are of the opinion that hormone replacement therapy is safe if it lasts no more than 4-5 years. However, there is evidence that the treatment may be safe for 7-10 consecutive years. Taking hormones for 10 years or more can increase the risk of ovarian cancer and other complications.

Unfortunately, after you stop taking hormones, some symptoms (dryness in the vagina, urinary incontinence, etc.) may return.

What are the side effects of hormone replacement therapy?

Side effects may occur during hormone replacement therapy. Some of these effects are safe and disappear after a few months, others are a reason to stop hormonal treatment.

Often appear on the background of hormonal treatment. Most often, these are only minor spotting discharges that disappear 3-4 months after the start of hormone therapy. If spotting lasts longer or appears later than 4 months after starting hormone therapy, then the woman needs a more thorough examination to make sure that it is not a polyp or endometrial cancer.

Swelling and tenderness of the breasts are also common side effects of hormonal treatment, but these symptoms go away after a few months.

Water retention in the body can lead to edema and weight gain.

What are the risks of hormone replacement therapy?

Hormone replacement therapy is undoubtedly an effective method of treatment, and yet, against the background of long-term hormonal treatment, the following complications may develop:

Breast cancer. Whether hormone therapy causes breast cancer is still a matter of debate in the scientific world. Research in this area gives conflicting results. However, most gynecologists are of the opinion that hormone replacement therapy slightly increases the risk of breast cancer, especially with long duration of treatment in women over 50 years of age.

Studies have shown that the use of certain hormone replacement therapy drugs for 5 years or more may increase the risk of endometrial cancer. The main symptom of endometrial cancer is spotting and irregular uterine bleeding, so when these symptoms appear in a woman in menopause, she needs an examination (endometrial biopsy).

The risk of blood clots may be increased in women taking hormonal drugs. That is why, if you previously had thrombosis, then hormone replacement therapy is not recommended.

The risk of gallstones (cholelithiasis) is slightly increased among menopausal women who take hormonal drugs.

Ovarian cancer. Against the background of long-term hormonal treatment (10 years or more), the risk of ovarian cancer increases. Hormone replacement therapy for less than 10 years does not increase this risk.

How to reduce the risk of these complications?

To minimize the risk of complications and side effects of hormone therapy, first of all, it is necessary for the doctor to choose the treatment that is right for you. In this case, the doctor must prescribe the smallest dose of the drug that gives the desired effect, and the treatment should last exactly as long as necessary.

Since hormone replacement therapy can last for years, you need to see a doctor regularly, even if nothing bothers you:

A month after the start of hormonal treatment, you need to pass a biochemical blood test to determine the level of fats (lipids) in the blood, liver function indicators (ALT, AST, bilirubin), a general urine test, and measure blood pressure.

At each subsequent visit: urinalysis, blood pressure measurement.

Every 2 years: a biochemical blood test to determine the level of fats (lipids) in the blood, liver function indicators (ALT, AST, bilirubin), blood sugar levels, urinalysis, mammography.

According to experts, new generation HRT drugs are the best method for treating menopausal syndrome. The composition of the funds includes a minimum amount of synthetic hormones, which makes the drugs practically harmless and suitable for long-term use. Consider reviews about.

Hormone Replacement Therapy

For many women, menostasis becomes a very difficult life period. However, it is completely wrong to regard menopause as a disease, as well as to treat hormone therapy as a treatment for menopause. HRT with menopause with new generation drugs, according to doctors, is only helping the body more smoothly move into the stage of complete cessation of childbearing function, without the risk of developing dangerous pathologies caused by a sharp estrogen deficiency. Not everyone can take synthetic estrogens, and even in the absence of contraindications, gynecologists do not advise some ladies to resort to hormone therapy.

For example, a woman does not experience strong hot flashes, her hormonal levels are within acceptable limits, and the risks of developing osteoparosis are low - specialists cannot advise such a lady on HRT, since it is clear that her body copes with hormonal changes and does not require treatment. Another thing is when a patient comes to the doctor with complaints of a significant decrease in the quality of life, frequent and intense hot flashes, nervous exhaustion and the inability to continue their usual lifestyle. Such a lady is carefully examined, and in the absence of contraindications, HRT may be recommended to her.

Absolute contraindications:

• Uterine bleeding;
• Suspicions of oncology;
• Oncology in history;
• Hypertension;
• Atherosclerosis;
• Ischemia;
• Benign neoplasms;
• Diabetes;
• Pathology of the liver;
• Pathology of the kidneys;
• Pregnancy and lactation.

Important! Treatment with HRT is possible only under the strict supervision of a specialist. Self-medication is strictly prohibited!

Early menopause is a pathology that is dangerous primarily by the development of complications. Menostasis is considered early if the childbearing function began to fade before the age of 40 years. Such patients most often experience severe symptoms of menopause, because, in fact, the body is not yet ready for hormonal changes, and a sharp estrogen deficiency leads to early hypertension, heart disease, osteoporosis, benign neoplasms, Alzheimer's disease and other diseases.

In the absence of contraindications, women with early menopause should definitely take hormonal pills. It is HRT in this case that will delay menopause for several years and smooth out unpleasant manifestations, and will also prevent the occurrence of the above pathologies. The same can be said about patients with surgical menopause, they also need to take HRT to protect themselves from these diseases.

Important! Before prescribing HRT for early menopause, it is necessary to identify the cause of the deviation.

Non-hormonal drugs taken during menopause to relieve symptoms

Hormone-free treatments are alternative methods for relieving menopausal symptoms. Today, there are a lot of herbal medicines on sale that have an estrogen-like effect and, not being synthetic analogues of sexual substances, can also eliminate the unpleasant symptoms of menostasis. Phytohormones are quite effective with long-term use, but in order to feel the first positive changes in well-being, they need to be taken for at least 2-3 months.

Phytohormones are not drugs, they have practically no contraindications and are easily tolerated by patients. Many ladies today choose herbal remedies for menopause, and experts agree with this choice, but only if the patient does not require serious hormonal treatment. The choice of treatment always remains with the patient, but experts insist that if you are prescribed certain pills, it is better to follow the doctor's recommendations so that you do not face unpleasant complications in the future.

Important! Non-hormonal therapy also requires the supervision and control of a doctor, because dietary supplements also have contraindications and side effects.

Many reviews about can really alert. Ladies in social networks and forums share their sad stories when hormones, in their opinion, cause the development of cancer, fibroids, cysts and other dangerous diseases, but gynecologists insist that with an adequate approach, hormone replacement therapy cannot cause these diseases. Consider the most common myths about, which often become a reason for refusing to accept funds from this group:

• HRT causes cancer. This is of course the most terrible and most widespread myth. However, according to official statistics, cases of oncology on the background of taking hormone therapy are approximately 1 out of 5,000 diseases. At the same time, more than half of the cases occur in women with a genetic predisposition to oncology, and another 30% are detected when taking medications on their own without prior examination and observation.
• Hormone therapy is the cause of obesity. This is a fundamentally wrong statement, on the contrary, with the right medication and dosage, medications in this group prevent weight gain. You just need to know that fat reserves in menopause are just a reaction of the body to a lack of estrogen. The body, thus, is trying to compensate for the deficiency of the sex hormone, because fat synthesizes one of the types of estrogen.
• Hormone therapy is forever. Completely wrong. Patients who claim that it is impossible to stop taking hormones should simply contact an experienced doctor. Both entry and exit from hormone replacement therapy should be smooth, by changing the dosage and schedule of taking the medication.

In addition, there are still a lot of myths that are passed from mouth to mouth and acquire terrifying details, but experts advise paying attention to the advantages that treatment can give, namely:

• Absence of hot flashes and other manifestations of menostasis. Thanks to replacement therapy, the body does not face estrogen deficiency, which means that all organs and systems continue to work properly.
• Prevention of long-term complications of menostasis. To date, only hormone replacement therapy can guarantee the prevention of osteoporosis, hypertension, heart attack and stroke due to a lack of sex hormones.
• Lovely appearance. Patients taking replacement therapy do not experience drastic aging and look much younger than their peers who refuse treatment. It should be noted that youth is preserved not only on the face, but also in the internal organs, blood vessels, reproductive system, etc.
• Cheerfulness and stable mood. The absence of depression, irritability and apathy allows ladies to lead a normal life and continue to enjoy everyday little things. Such women are sociable and cheerful, they enjoy life and can afford to do what they love.
• Complete sex life. One of the problems of menostasis is a decrease in libido and vaginal dryness, which often become a reason for the complete rejection of physical intimacy. Hormone replacement therapy eliminates these deviations and allows you to have a normal sex life, which undoubtedly has a positive effect on self-esteem, family relationships, health, etc.

Important! Despite all the positive aspects of replacement therapy, this treatment cannot be used as a rejuvenating agent or applied in advance, even before the onset of unpleasant symptoms.

List of new generation HRT drugs

Reviews of hormone replacement therapy drugs for menopause are quite diverse, but patients and doctors highlight the most effective new generation medications, namely:

• Klimonorm. The composition of the product includes two synthetic analogues of the sex hormones estrogen and histagen, which avoids hormonal imbalance, which in some cases becomes an impetus for the development of oncology.
• . This is a new generation biphasic combination drug that effectively relieves the main menopausal manifestations and is the prevention of long-term complications of menopause.
• . The composition of the tablets includes the active substances estradiol and drospirenone. The remedy is prescribed both for early and timely menostasis as a prevention of long-term complications, and a remedy that significantly improves the well-being of a lady with menopause.
• Levial. The active substance is tibolone. This medication is gaining more and more popularity, because it rarely causes side effects and perfectly fights all manifestations of menopause. According to gynecologists, this is the drug of the 21st century.

Hormonophobia is firmly rooted in the minds of our women. “On the forums, ladies scare each other with horrors about hormone replacement therapy (HRT), from which they get fat, covered with hair, and even get cancer. Is this really so, let's try to figure it out together!

Menopause- This is one of the physiological processes that affect the female body as a whole.

I. Depending on the age of cessation of the last menstruation, menopause is divided into:

• premature menopause- cessation of menstruation at 37-39 years.
• early menopause- cessation of menstruation at 40-44 years.
• late menopause- cessation of menstruation after 55 years.

II. In menopause, the following phases are distinguished:

perimenopause This is the period from the onset of a decrease in ovarian function to the onset of menopause.
And the clinical reflection of the altered function of the ovaries in premenopause are menstrual cycles, which can have the following character: regular cycles, alternation of regular cycles with delays, delays in menstruation from a week to several months, alternation of delays in menstruation with uterine bleeding.
The duration of premenopause varies from 2 years to 10 years.

Menopause- This is the last independent menstruation in a woman's life. The age of menopause is determined retrospectively - after 12 months of absence of menstruation.

Postmenopause lasts from menopause to almost complete cessation of ovarian function. This phase of menopause precedes the onset of old age. There are early - (3-5 years) and late postmenopause.
Menopause characterized by a complete violation of the secretion of sex hormones - estrogens, progesterone and androgens. It is well known that estrogen deficiency leads to the appearance of psychovegetative symptoms (hot flashes, feeling unwell), urogenital atrophy, the formation of osteopenia syndrome (osteoporosis), the development of obesity and metabolic syndrome (increases the risk of diabetes mellitus), lipid metabolism disorders (increases the risk of atherosclerosis).

*You can learn more about all the processes that occur during menopause from our article "MANOPAUSE".

HRT It's not just life expectancy. Sex hormones provide a woman with the preservation of health and, to a certain extent, prolong youth. Why are we and our patients in no hurry to take HRT? According to Professor V.P. Smetnik, in Moscow, only 33% of gynecologists take HRT themselves, in St. Petersburg - 17%, while, for example, in Sweden, this figure is 87% . If we doctors are in no hurry to help ourselves, is it any wonder that only 0,6% Russian women take HRT.

Why is the gap between foreign and domestic data on HRT so large? Unfortunately, Russian "bastard" medicine continues to base its prescriptions on personal experience, prejudices, conjectures, a single authoritative (authoritarian) opinion of luminaries, or simply works in the old fashioned way. World medicine bases its recommendations on the basis of evidence-based medicine - the results of clinical trials, on scientifically proven facts.

So, what does evidence-based medicine tell us about HRT:

* the use of low-dose HRT (1 mg / day of estradiol) has the same effect on the blood lipid spectrum as statins (drugs to lower cholesterol);

* Early initiation of HRT (perimenopause) can reduce overall mortality by 30%, due to a reduced risk of cardiovascular disease;

* Evaluation of the effect of HRT on carbohydrate metabolism showed that HRT either does not affect, or has a positive effect on such indicators as glycated hemoglobin, fasting glycemia, insulin concentration. A study involving 14,000 women with diabetes showed that women taking HRT had significantly lower levels of glycated hemoglobin compared to those who did not receive estrogen therapy;

Very often, patients ask a question about the effect of HRT on the risk of breast cancer:

- studies of HERS and WHI, which are considered the "gold standard", showed that the combined use of conjugated ethinyl estradiol and medroxyprogesterone acetate (this component is contained in Divin, Divisek, Indivina preparations) led to a slight increase in the risk of developing aggressive breast cancer;

- in the WHI study, an increase in the incidence of aggressive breast cancer was observed with the use of estrogens and progestins, while in the estrogen-only group, the incidence rate decreased;

- in the E3N study, a decrease in the risk of breast cancer was shown against the background of the use of a combination of 17-b-estradiol and dydrogesterone (Femoston). There is no unequivocal explanation for this fact, it is possible that this positive effect can be mediated through a decrease in the severity of obesity, a known risk factor for breast cancer;

- detected cases breast cancer especially the first three years of HRT indicate quicker about the manifestation of the tumor process already present before the start of HRT;

- the position of the international society on menopause (2007): women taking HRT should be warned that risk of developing breast cancer does not increase within 7 years of taking HRT.

So, the use of hormone replacement therapy provides a real opportunity to correct the manifestations of estrogen deficiency and, therefore, to treat and prevent early and late complications of menopausal syndrome in women of the older age group. HRT, started before the age of 60, reduces overall mortality by 30-35%, is the prevention of many diseases, including cardiovascular, osteoporosis and Alzheimer's disease.

Like any other treatment, HRT has its contraindications and side effects.

Contraindications for hormone replacement therapy are:

• pregnancy;
• acute hepatitis;
• acute deep vein thrombosis;
• acute thromboembolic disease;
• untreated tumors of the genital organs, mammary glands;
• meningioma.

Contraindications to the use of certain sex hormones:

For estrogens:

• mammary cancer;
• endometrial cancer;
• severe liver dysfunction;
• porphyria;
• estrogen dependent tumors.

For progestogens:

• meningioma.

Examination of the patient before HRT

Mandatory:

• Ultrasound of the pelvic organs (uterus and ovaries);
• A smear for oncocytology from the cervix;
• Examination by a mammologist (mammography or ultrasound of the mammary glands);
• Blood hormones: TSH, FSH, estradiol, prolactin, blood sugar;
• Blood clotting - coagulogram;
• blood biochemistry: ASAT, ALAT, total bilirubin, blood sugar.

Optional:

• lipidogram;
• densitometry
• genetic predisposition to arterial and venous thrombosis when using HRT.

Preparations for hormone replacement therapy:

1. "Pure" natural estrogens - estrogel, divigel in the form of a gel, climar patch, proginova, estrophem.
2. Combination of estrogens with gestagens: a modern combination of natural hormones "estrogel-utrogestan", two-phase combined (climen, climonorm, divina, cycloprogynova, femoston 2/10, divitren - estradiol valerate for 70 days, then 14 days of medroxyprogesterone acetate).
3. Monophasic combined preparations: kliogest, femoston 1/5, gynodian-depot.
4. Tissue-selective regulator of estrogen activity: Livial.

How to understand this endless ocean of HRT drugs, which drug to choose? Answering the following questions can help with this:

What are the components of HRT?

The composition of HRT preparations usually includes 2 components: estrogen and progestin (gestagen). Estrogen eliminates the main manifestations of estrogen deficiency: hot flashes, urogenital disorders, osteoporosis, atherosclerosis, etc. Progestins are necessary to protect the uterus from the protective (stimulating) effect of estrogens (endometrial hyperplastic processes, etc.). In the absence of a uterus, estrogen alone, without progestin, can be used as HRT.

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What drug to choose?

The main principle of HRT is the choice of the safest drugs that can be used in women with various extragenital pathologies in order to prevent osteoporosis and atherosclerosis. The evolution of HRT preparations went mainly in two directions:

I. Improvement of the progestogenic (gestagenic) component, devoid of influence on the woman's weight, her coagulation system, but at the same time protecting the uterus from the influence of the estrogen component. Today, the closest to natural progesterone (UTROZHESTAN) is dydrogesterone, drospirinone, dienogest.

II. Reducing the dose of the estrogen component. The basic principle is "as much as necessary, as little as possible". Much is necessary to improve overall well-being, prevent osteoporosis, atherosclerosis, and prevent urogenital disorders. Little - perhaps to reduce or level the side effects on the uterus. In our country, natural estrogen (ESTROGEL, DIVIGEL), estradiol valerate and 17 β-estradiol are used.

Therefore, when choosing an HRT drug, your gynecologist should be guided by the properties of the progestogen component, which provides reliable protection of the endometrium, does not affect carbohydrate and fat metabolism, and does not provoke the development of breast cancer. The preparations of the third generation of progestogens - dydrogesterone, drospirenone, dienogest - are closest to natural progesterones.

Comparative table of the effect of progestins on lipid, carbohydrate metabolism and blood coagulation

*Note: HDL, high-density lipoprotein; LDL - low density lipoproteins; TG - triglycerides 0 - no effect ↓ - slight decrease ↓↓ - strong decrease - slight increase - strong increase - very strong increase

Thus, only 3 gestagens: natural progesterone and dydrogesterone, drospirenone do not worsen cholesterol metabolism and do not aggravate the development of atherosclerosis, and do not affect sugar metabolism, do not have a thrombotic effect, are the safest in relation to the development of breast cancer. Therefore, you, together with the gynecologist, must choose a drug for HRT containing one of these substances (utrogestan, dydrogesterone or drospirenone) as the second component.

These requirements are met by the following drugs: estrogel (divigel) + utrogestan; femoston; angelik.

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What is the best way to use drugs?

Oral administration is the use of tablet forms of drugs, therefore these drugs will necessarily affect the liver.

In patients with liver pathology, transdermal administration of estrogens (percutaneous estrogel or divigel gel) in combination with intravaginal use of utrogestan (or MIRENA coil) is preferable.

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What treatment regimens to choose?

In the presence of a uterus perimenopause prescribe combination therapy with cyclic drugs - estrogen + gestagen, imitating the normal menstrual cycle. Preferably, drugs with a low content of estrogen up to 1 mg (estrogel or divigel or climara + utrogestan or duphaston or MIRENA; Femoston 1/10 and 2/10, etc.).

V postmenopausal in the presence of the uterus, continuous estrogen + gestagen therapy is indicated, which does not give menstrual bleeding, preferably low doses of estrogens (estrogel or divigel or climara + utrogestan or duphaston or MIRENA; femoston 1/5, angelic).

At surgical menopause- with a removed uterus (without a cervix), one component of HRT is enough - estrogen (since endometrial protection is no longer needed), drugs can be used for this purpose - estrogel, divigel, climar, proginova, estrophem.

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How long to take HRT?

The duration of HRT is not limited today. For the relief of symptoms of menopause, as a rule, 3-5 years are enough.

Every year, the gynecologist, together with the patient, evaluates the benefit-risk and individually decides on the duration of HRT.

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How often to visit a gynecologist and be examined while using HRT?

During the period of HRT, a woman should visit a gynecologist at least once a year to perform colposcopy, ultrasound of the pelvic organs, ultrasound of the mammary glands or mammography and study of biochemical blood parameters (blood sugar, ALT, AST, coagulogram)!

The patient discusses all questions regarding HRT with her gynecologist. If the gynecologist refuses to prescribe HRT to the patient and does not explain the reason for this, consult another specialist and resolve all your questions

Hormone replacement therapy - abbreviated as HRT - is actively used today in many countries of 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.

Is it necessary to drink hormones during menopause,or 10 myths about HRT

After the age of 45, the function of the ovaries begins to gradually fade in women, which means that the production of sex hormones is reduced. Along with a decrease in blood estrogen and progesterone comes a deterioration in physical and emotional state. Ahead is menopause. And almost every woman begins to worry about the question: what can she do take with menopause, so as not to age?

In this difficult time, a modern woman comes to the rescue. Because with menopause estrogen deficiency develops, it is these hormones that have become the basis for all medicinal drugs HRT. The first myth about HRT is associated with estrogens.

Myth #1. HRT is not natural

There are hundreds of queries on the Internet on the topic:how to replenish estrogens for a woman after 45-50 years old . No less popular are inquiries about whetherherbal 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 the complete chemical identity of the estrogen produced by the ovaries.

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

Some may argue that herbal preparations 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 far from always effective for 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) is not well understood and medicine cannot vouch for their safety.

Myth #2. HRT is addictive

Hormone replacement therapy for menopause- just a replacement for the lost hormonal function of the ovaries. Preparations HRT is not a drug, it does not disrupt the natural processes in a woman's body. Their task is to fill the estrogen deficiency, restore the balance of hormones, and also facilitate overall well-being. You can stop taking 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 very youth.

Myth #3. Mustache will grow from HRT

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

The synthesis and use of hormones in medical practice began in the 1950s. A real revolution was made by glucocorticoids (adrenal hormones), which combined a powerful anti-inflammatory and anti-allergic effect. However, doctors soon noticed that they affect body weight and even contribute to the manifestation of male characteristics in women (the voice became rougher, excessive hair growth began, etc.).

Much has changed since that time. Preparations of other hormones (thyroid, pituitary, female and male) were synthesized. And the type of hormones has changed. The composition of modern drugs includes hormones as "natural" as possible, and this allows you to significantly reduce their dose. Unfortunately, all the negative qualities of outdated high-dose drugs are also attributed to new, modern ones. And this is completely unfair.

Most importantly, HRT preparations contain exclusively female sex hormones, and they cannot serve as a reason for “masculinity”.

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

When ovarian function declines, female sex hormones (estrogens and progesterone) cease to be replenished, while male sex hormones (androgens) continue to be 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 mustaches and chin hairs. And HRT drugs have absolutely nothing to do with it.

Myth number 4. Get better from HRT

Another unfounded fear is to gain weight while taking drugs hormone replacement therapy. But everything is quite the opposite. Purpose of HRT with menopause can positively affect female curves and shapes. The composition of HRT includes estrogens, which generally do not have the ability to influence changes in body weight. As for the gestagens (these are derivatives of the hormone progesterone), which are part ofnew generation HRT drugs, then they help distribute adipose tissue “according to the female principle” and allow with menopause keep a feminine figure.

Do not 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 already wrote, 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 abdomen, and the figure begins to look like a man's. As you can see, HRT drugs do not play any role in this issue.

Myth number 5. HRT can cause cancer

The fact that taking hormones can provoke cancer is an absolute delusion. There are 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 a thing of the past. Partnew generation HRT drugs includes progestogens that prevent the risk of developing endometrial cancer (the body of the uterus).

With regard to breast cancer, studies on the effect of HRT on its occurrence have been conducted in abundance. This issue has been seriously studied in many countries of the world. Especially in the USA, where HRT drugs began to be used as early as the 50s of the XX 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 number 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 not true. New generation HRT drugs do not irritate the mucosa of the gastrointestinal tract and do not have a toxic effect on the liver. It is necessary to limit the intake of HRT drugs only when there are pronounced liver dysfunctions. And after the onset of remission, it is possible to continue HRT. Also, taking HRT drugs is not contraindicated in women with chronic gastritis or with peptic ulcer of the stomach and duodenum. Even during seasonal exacerbations, you can take the pills as usual. Of course, simultaneously with therapy prescribed by a gastroenterologist and under the supervision of a gynecologist. For women who are especially worried about their stomach and liver, they produce special forms of HRT preparations for topical use. These can be skin gels, patches, or nasal sprays.

Myth number 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 vegetative system is resistant to hormonal changes and therefore for some time they are spared 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 menopause go by itself.

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 dryness in the vagina; obesity and cardiovascular disease; osteoporosis and osteoarthritis and even senile dementia.

Myth number 8. HRT has many side effects

Only 10% of women feel some discomfort when taking HRT drugs. The most susceptible to discomfort are those who smoke and are overweight. In such cases, swelling, migraines, swelling and soreness of the chest are noted. Usually these are temporary problems that disappear after the dosage is reduced or the dosage form of the drug is changed.

It is important to remember that HRT cannot be carried out independently without medical supervision. In each case, an individual approach and constant monitoring of the results are necessary. Hormone replacement therapy has a specific list of indications and contraindications. Only a doctor after a series of studies will be able tofind the right treatment . When prescribing HRT, the doctor observes the optimal ratio of 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 number 9. HRT is unnatural

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

Hollywood star Sharon Stone turned 58 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 have to sit back and play golf in your yard now. We are too young for this: 50 is the new 30, a new chapter."

Myth number 10. HRT is an understudied method of treatment

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, by trial and error, were looking 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 method of treatment as little studied, although this is far from being the case. Today we have the opportunity to use already proven and highly effective products with a minimum number of side effects.

HRT with menopause: pros and cons

For the first time HRT preparations for women in menopause began to be used in the United States in the 1940s and 1950s. As the treatment became more and more popular, it turned out that the risk of disease increases during the treatment period. uterus ( endometrial hyperplasia, crayfish). After a thorough analysis of the situation, it turned out that the reason was the use of only one ovarian hormone - estrogen. Conclusions were made, and in the 70s, biphasic preparations appeared. They combined estrogens and progesterone in one pill, 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 influence extends beyond menopausal symptoms.HRT for menopauseslows down atrophic changes in the body and becomes an excellent prophylactic in the fight against Alzheimer's disease. It is also important to note the beneficial effects of therapy on the cardiovascular system of women. Against the background of taking HRT drugs, doctors fixed improving lipid metabolism and lowering blood cholesterol levels. All these facts make it possible to use HRT today as a prevention of atherosclerosis and heart attack.

Used information from the magazine [Climax - it's not scary / E. Nechaenko, - Magazine “New Pharmacy. Pharmacy assortment”, 2012. - No. 12]

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It is extremely important for women to know everything about their health - especially for primary 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 contact a specialist and make an appointment.