Means for hormone replacement therapy during menopause. Hormone replacement therapy for menopause - all the pros and cons What is hormone replacement therapy in women

Fatigue, aging skin, insomnia - this is not the whole bouquet of what a woman can feel during menopause.

“You have to endure this, it happens to everyone, you don’t die from it,” our mothers and grandmothers and, unfortunately, many gynecologists assure.

“If I hadn’t started taking hormones on time, I would have lost my youth,” Madonna boldly states in one interview.

Why are our compatriots so afraid of replacement hormone therapy(HRT) during menopause, and abroad women during menopause are required to seek help from doctors so that they can prescribe them a hormonal drug that will help them survive the menopause?

We’ll talk about this on the women’s website “Beautiful and Successful”.

How does menopause occur?

After 40 years, the female body rises to a new level. The new “stage” is quite medical name– menopause (by the way, “menopause” is literally translated as “step”). This period is directly related to the process of production of sex hormones, or more precisely, with a decrease in the production of these hormones - estrogen and progesterone. Due to their lack, significant changes begin to occur in the female body.

The restructuring of the body for menopause begins at 40-45 years old and ends at 51-53 years old - the time of the last menstruation.

After this age, hormonal changes continue to occur in a woman’s body, and she constantly feels all the delights of menopause. Is it worth enduring the ebbs and flows, depression and headaches all these years if hormonal therapy can help? What should women do with?

Why does menopause have so many symptoms?

The work of the mammary glands, genital organs, brain, cardiovascular system, the condition of the skin and hair, the functioning of the liver, large intestine and genitourinary system depend on estrogen - the female sex hormone. The lack of this hormone, which occurs during menopause, immediately affects all systems in the body.

There are more than 30 symptoms that women experience due to menopause after 40 years.

The most common mistake modern women is that they are accustomed to letting everything take its course, especially if the symptoms are not pronounced. Like, this will pass. But at this time, a woman just needs to undergo the first diagnosis in order to start helping her body in a timely manner.

Why are women afraid of HRT?

In our country there is a “widespread hormone phobia”. Doctors often prescribe hormones for early menopause or after surgery, but, having no experience in using these drugs during menopause, they refuse to use them. Many of our compatriots are afraid of hormones, believing that they:

1. Total chemistry;
2. Contrary to feminine nature and cause cancer;
3. They make you fat and masculine;
4. Affects the liver and stomach;
5. Cause addiction;

So it turns out that there is a mutual responsibility: doctors don’t prescribe – women endure. But why be afraid of what has been practiced abroad for several decades?

How does HRT work?

Job female body conditionally can be divided into 2 periods: the first, when he has enough hormones, and the second, when hormones cease to be produced, their deficiency is observed. The second period is called menopause (menopause).

Hormone production stops when the ovaries stop producing eggs, or after female organs removed surgically. Lack of hormones manifests itself in different ways:

• Hot flashes in women during menopause indicate that she lacks estrogen.
• Weakness and malaise in women during menopause occur due to a lack of another hormone - progesterone.

The principle of action of HRT drugs during menopause is quite simple - the body is given a certain dose of hormones so that this deficiency is not felt. That is, the body receives what nature took from it. New generation drugs cope well with this. Only the drug must be prescribed in a timely manner after mandatory diagnosis.

When should you start taking hormones?

It is better to prescribe hormonal therapy as soon as a lack of estrogen begins, so you need to go for diagnosis at 40–45 years old - at the beginning of the premenopausal period.

It is also mandatory to prescribe HRT for early menopause - the drugs are selected strictly by the doctor after a preliminary examination, and for artificial menopause.

If 5 years have passed since menopause, then it is already too late to prescribe hormones - it is almost impossible to stop the aging process of the female body and help it.

Is it possible to do without hormonal drugs?

Let us remember that the main goal of hormonal therapy is to alleviate a woman’s condition during menopause. Therefore, you can not take hormones, but start fighting each symptom of menopause separately: take medications for headaches, antidepressants, medications to improve the functioning of the gastrointestinal tract, antipyretics for hot flashes, for osteoporosis, medications for blood pressure, etc. Note that such therapy also effective, but in comparison with hormonal it is:

• expensive
• troublesome
• not always effective
• psychologically difficult (“do I really need so much medication at this age to feel good?”)

Why take each drug separately if HRT has a complex effect on the cause and does not remove individual symptoms?

Prescribing new generation HRT drugs during menopause will help prevent many problems associated with a woman’s health: reduce the risk of diabetes and Alzheimer’s disease, obesity and skin aging.

Of course, you can go through menopause without HRT. There are alternative options for how to do without hormones during this period.

• First, you need to seriously think about healthy way life: stop smoking, eat a balanced diet, monitor your sleep and wakefulness, limit exposure to the sun.
• Secondly, you need to constantly use the services of modern cosmetology, including expensive skin tightening operations and rejuvenation sessions.
• Well, and, of course, we must not forget about homeopathic medicines and dietary supplements, which are so widely popular in the modern world.

New generation HRT drugs

HRT drugs for menopause have always caused controversy for and against. Let's dispel several myths about the unnaturalness and danger of HRT for women's health.

• HRT drugs have gone through a long journey of testing and research. We can consider ourselves lucky - only new generation drugs reach our shelves, which can only be produced by serious pharmacological companies.
• Hormone replacement drugs of the modern generation are completely natural - they have a composition of hormones identical to those produced by the female body.
• The dosage of hormones in the drug is minimal. There is no addiction to hormonal drugs. This is just a remedy that helps a woman survive hormonal changes. After discussing with your doctor, medications can be stopped at any time.
• During menopause, the body does not stop producing male hormones. Natural estrogens, which are included in the main composition of all HRT preparations, are female. It is their production that stops during menopause. Reception female hormones neutralizes the effects of male hair: it will stop hair growth in unnecessary places, allow you to maintain female shapes and proportions, improve skin condition, and prevent snoring.
• The hormones that make up HRT do not lead to obesity. On the contrary, they stop the production of estrogen in adipose tissue. It is not the use of HRT that leads to obesity during menopause, but the age-related prerequisites for this: it decreases physical activity, metabolism slows down.
• Many people are afraid to take HRT, believing that they have a bad effect on the gastrointestinal tract. Modern hormonal drugs do not affect the gastrointestinal tract in any way, and for those who are very afraid for their stomach, alternative forms of the drug have been released - patches, gels, ointments and suppositories, which are absorbed through the skin.
• HRT contains components that prevent cancer, rather than provoke it. Hormonal reason oncological diseases due to HRT use has not been proven.

A woman who takes hormonal medications during menopause must be observed by a doctor: monitor the condition of the endometrium and vaginal mucosa, mammary glands, hormone levels, etc.

The best HRT drugs

If yesterday doctors considered menopause to be a period in a woman’s life that needs to be overcome, today menopause is considered to be a period of lack of hormones that can be given to the body. A doctor should prescribe HRT after preliminary diagnosis, so the site will only familiarize its readers with the list modern drugs, but we will not recommend them for admission. All new generation drugs have a low dosage, which allows you to choose the optimal safe dose for every woman. It can be lowered or raised.

• We have received good reviews about the drugs “Femoston”, “Angelik”, “Atarax”, “Grandaxin”, “Sigetin”, etc.

Of course, there are many among us who consider themselves to be opponents of everything hormonal. Homeopathic and herbal remedies will come to the aid of such women, although they are less effective than modern HRT drugs.

Of course, menopause is a natural process in our body. And it’s very good that modern women have the opportunity to choose products that help improve their quality of life during this period.

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

Hormone replacement therapy aims to correct estrogen deficiency using medications containing synthetic (artificial) hormones and prevent these symptoms.

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

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

Who needs hormone replacement therapy during menopause?

Despite the fact that hormone replacement therapy can ease the symptoms of menopause, taking hormones during menopause is not always really necessary and, most importantly, 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.

When symptoms such as: severe dryness and discomfort in the vagina appear.

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
• Do you have serious illness liver and liver failure
• Your blood triglyceride levels are elevated
• You have had deep vein thrombosis in your legs
• You have
• You have
• You have

What tests need to be done before starting to take 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 take the following tests:

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

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

What medications are prescribed for hormone replacement therapy?

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

Hormones can be prescribed not only in the form of tablets, but also in the form intramuscular injections, hormonal patches, subcutaneous implants, vaginal suppositories, etc. The choice of drug for hormone replacement therapy depends on how long ago your periods stopped, what symptoms bother you, and what diseases and surgeries you have had previously.

There are many different drugs prescribed for hormone replacement therapy. We will list just a few of them available in Russia:

• In the form of tablets (or dragees): Premarin, Hormoplex, Klimonorm, Klimen, Proginova, Cyclo-proginova, Femoston, Trisequence and others.
• In the form of intramuscular injections: Gynodian-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 intrauterine device: .
• In the form of vaginal suppositories or vaginal cream: Ovestin.

Can I get pregnant while taking hormones?

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

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 treatment can be safe for 7-10 years in a row. Taking hormones for 10 years or more may increase the risk of ovarian cancer and other complications.

Unfortunately, after stopping taking hormones, some symptoms (vaginal dryness, urinary incontinence, etc.) may return.

What side effects can hormone replacement therapy cause?

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

They often appear during hormonal treatment. Most often, this is only a slight spotting that disappears 3-4 months after the start of hormonal therapy. If spotting last longer, or appeared later than 4 months after the start of hormonal therapy, then the woman needs a more thorough examination to make sure that it is not a polyp or endometrial cancer.

Swelling and increased sensitivity Breast problems are also a common side effect 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 effective method treatment, and nevertheless, 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. scientific world. Research conducted in this area provides conflicting results. However, most gynecologists are of the opinion that hormone replacement therapy slightly increases the risk of breast cancer, especially with a long duration of treatment in women over 50 years of age.

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

The risk of blood clots may increase in women taking hormonal medications. That is why, if you have previously had thrombosis, hormone replacement therapy is not recommended.

Risk of stone formation in gallbladder(cholelithiasis) is slightly increased among postmenopausal women taking hormonal medications.

Ovarian cancer. Long-term hormonal treatment (10 years or more) increases the risk of ovarian cancer. Hormone replacement therapy lasting less than 10 years does not increase this risk.

How can you reduce the risk of these complications?

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

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

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

At each subsequent visit: general urinalysis, blood pressure measurement.

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

This is also a common myth, and it is often acts as a kind of “horror story”, encouraging a woman to unreasonably refuse to take HRT. Below we will talk about HRT and cancer of the female genital organs, HRT and breast cancer; cancers of other organs are not a direct contraindication to HRT, and it can be prescribed after a joint discussion of the patient’s management tactics by the gynecologist and oncologist.

• Cancer of the uterus (endometrial cancer). To the surprise of many, we note that in women taking HRT, the risk of its development is much lower, since HRT preparations include components that protect the lining of the uterine cavity from this process.
• Timely correction of endocrine and gynecological pathologies, normalization of body weight and treatment inflammatory diseases female genitalia, as well as rational protection from pregnancy during the reproductive period can quite effectively prevent the development of this disease, even despite unfavorable heredity. Regarding contraception, according to the World Health Organization, women who regularly use modern hormonal contraceptives are 50% less likely to develop endometrial cancer.
• Cervical cancer is non-hormonal in nature and is caused by the human papilloma virus (a sexually transmitted infection).

Ways to prevent it: using a condom to protect against infections, monogamous sexual relations, competent protection from unwanted pregnancy using modern methods, visiting a gynecologist at least once every 6 months and at least once a year, examining the cervix using a special microscope (colposcope) and cytological examination of a smear from the cervix (to determine the “correctness” of the cellular composition its mucous membrane).

• Ovarian cancer. Although the ovaries are a hormone-producing organ, hormonal cause their cancer has not been proven. Heredity plays a major role in the development of this disease, ignoring modern methods contraception, abortion (it is known that in women taking hormonal contraceptives the risk of this disease is reduced by 80% (data from the World Health Organization)).
• Breast cancer and HRT. This topic causes greatest number disputes. The current data on it is as follows.

Today there are many known causes of this disease. The risk of developing breast cancer increases with age (it most often affects postmenopausal women; after 60 years, the risk of its development increases 90 times); heredity plays a large role in its development, as well as the absence of childbirth, a large number of abortions in the anamnesis, smoking, overweight, long-term chronic stress and depression, deterioration of the environmental situation, etc.

A lot of research has been and is being done around the world on the effect of taking HRT on the risk of developing breast cancer, both in the USA (they started using HRT before anyone else, in the 60s of the 20th century) and in Europe. All these studies, serious, extensive, multi-year and expensive, however, cannot give a clear answer to the question of the effect of HRT on the risk of developing breast cancer. This disease is multifactorial, and it is in principle impossible to exclude all other influences during the study (age, number of births and abortions, heredity, living in poor environmental conditions), leaving only the use of HRT.

But, summing up the data from these studies, we can clearly say that estrogens(the main therapeutic component of HRT drugs) are not oncogenes(i.e. they do not unblock the gene mechanisms of tumor growth in the cell).

American researchers analyzed the use of their drugs: in the USA, unlike Europe, a different type of estrogens (conjugated) and gestagens of the previous generation are used. In our country and in Europe, modern HRT drugs include the lowest doses to date (further reduction is already simply ineffective) natural estrogens and gestagens latest generation. In America, a different age limit for receiving HRT has also been adopted; they consider it possible to start taking it during late menopause, which is categorically unacceptable in Europe.

So, Americans, when taking their HRT drugs for more than 10 years, received an increase in the relative (i.e., theoretical) risk of developing breast cancer, which, after stopping HRT, returned to normal numbers in the population. European scientists, when conducting similar studies using their drugs (which, in particular, are used in Russia), did not receive confirmation of these data. Moreover, neither American nor European studies showed an increase in the absolute risk of developing breast cancer during HRT.

European scientists also tend to explain the data obtained by the Americans on the increase in the relative risk of developing breast cancer after more than 10 years of taking HRT by the fact that patients receiving HRT are regularly and correctly monitored by a gynecologist. Due to better diagnosis of this pathology, the frequency of its detection in them is higher than in the general population.

All studies have also shown that even if a patient receiving HRT was diagnosed with breast cancer (not directly related to taking HRT), it was less malignant, had a lower stage of spread, was less prone to metastasis, and responded better to treatment.

In any case, until 2004, the duration of taking HRT for up to 5 years was considered safe for health. In 2004, the International Menopause Society published a consensus that revised its views on the timing of HRT use: “there is currently no new basis for imposing restrictions on the duration of therapy.” And in October 2005, the 11th International Congress on Menopause, held in Argentina, completely abolished restrictions on the duration of taking HRT.

This congress is held once every 4 years and brings together scientists and doctors from around the world specializing in various fields of medicine related to menopause problems; It highlights the latest achievements and innovations in the field of age-related medicine, discusses complex clinical problems, and agrees on the management of patients in these situations.

The opinion of such an authoritative meeting is indeed worth listening to. Moreover, the experience of using HRT abroad goes back about half a century, and in Russia – about 15-20 years. And in this we are truly lucky: today the market for HRT drugs in our country is represented by the most modern, low-dose, highly effective drugs with few side effects. We had the opportunity to “collect the cream”, since the “capitalists” (may the reader forgive me!) tried all the drugs that do not meet the high quality standards in this area on themselves and stopped producing them a long time ago.

Menopause is the second “transitional age” in a woman’s life, which, unlike teenage changes, is very difficult. This happens because the body gradually fades away the functions of the sex glands. A decrease in hormonal levels cannot but affect a woman’s condition, and in 90% of cases only HRT, that is, hormone replacement therapy, can normalize it - during menopause, this method is used quite often.

Changes in hormonal levels in a woman during menopause affect the functioning of organs, and to eliminate this, it is necessary to carry out HRT

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

• 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 of hair, skin and nails;
• structural (physiological and physical) changes in the mucous membranes, especially in the genitourinary system.

Hormonal changes affect bone health

To achieve maximum effectiveness in preventing and mitigating feature changes internal organs and glands, the HRT complex uses drugs of plant or synthetic origin, which in the vast majority of cases need to be taken for quite a long time - from a year to 2-3 years. In some cases, the course must be continued for 10 years or more.

What is hormone replacement therapy

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

In medicine, there are two types of HRT:

1. Short-term hormone therapy is a treatment that is aimed 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 medications prescribed by a doctor ranges from 12 to 24 months.
2. Long-term hormonal therapy is a treatment that is aimed against climacteric disorders aggravated by serious changes in the functioning of the central nervous system, cardiovascular system, and endocrine glands. The period during which you need to take hormonal drugs ranges from 2 to 4, and in rare cases up to 10 years.

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

If you follow your doctor's recommendations, you can achieve a significant improvement in the condition of menopausal women. Thus, hormonal drugs, especially the new generation, reduce phenomena such as hot flashes and nervous agitation, reduce pain and restore the condition of the mucous membranes, skin, hair and nails. In short, they prevent a woman’s body from rapidly aging.

Indications for use of HRT

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

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

• cases of early menopause;
• medical history suggesting a high risk of osteoporosis;
• pathologies of the heart and blood vessels accompanying menopause;
• high risk of developing cardiovascular pathologies (diabetes, hyperlipidemia, hereditary predisposition to arterial hypertension).

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

Preparing for hormone replacement therapy

Before starting to use HRT as a method of overcoming unpleasant symptoms 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 abdominal cavity And thyroid gland;
• external and instrumental examination of the mammary glands (mammography, ultrasound of the mammary glands, etc.);
• laboratory examination of a cervical smear;
• laboratory blood tests for hormones (establishing hormonal status, degree of susceptibility to thrombus formation);
• blood pressure measurement;
• general medical examination.

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

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

Despite the fact that during menopause it can be very difficult to completely cure concomitant diseases, it is recommended to minimize their effect on the body. Only after they have been treated chronic diseases, the woman begins to select drugs for HRT that will effectively act against age-related and hormonal changes

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

There are several types and forms of drugs that can be used to implement HRT. Firstly, they can be organic (homeopathic) and synthetic. The former are made from 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 the 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.

Hormones can be used in various forms

Each dosage form, the names of which will be given below, there is a list of advantages and disadvantages that must be taken into account when prescribing certain drugs to a specific patient. Thus, hormonal pills are convenient to take, they are absorbed fairly quickly and are inexpensive. However, many oral HRT drugs have a negative effect on the stomach and liver.

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

Hormonal drugs for HRT - list

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

Taking hormonal medications helps get rid of headaches during menopause

Among the most popular and effective medicines For menopause, doctors use the following hormonal drugs:

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

These hormonal drugs show high effectiveness in eliminating the symptoms of menopause

All of the listed drugs are new generation products that contain microdoses of hormones. Thanks to this, they retain therapeutic properties, as they slow down natural age-related decline. hormonal levels women. At the same time, when taking them, there are no changes in the functions of internal organs, as happens when taking hormonal anabolic steroids.

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 the woman needs to take. You will have to take tablets and use creams and suppositories every day, preferably at the same time. Patches and injections are used less frequently - once a week or 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 hormonal drugs. If there is a slight risk, they should be replaced with medications containing herbal substitutes for human hormones.

It is not allowed to independently change the dosage of drugs from this group. This can lead to significant changes in a woman’s hormonal status and to changes in the functions of the endocrine glands and organ systems. In addition, systematically increasing dosages can lead to the formation of tumors, especially if women are diagnosed with benign neoplasms or there is 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 medications, doctors often prescribe pills that contain phytoestrogens - plant analogues of female hormones. They are used if a woman has contraindications to the use of hormonal drugs during HRT. Medicines in this group are also representatives of a new generation of medicines that contain exactly the 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 tablet form;
• Estrovel in tablet form;
• Menopace capsules;
• Qi-Klim in tablets;
• Red brush in drops and tea bags;
• Bonisan in the form of tablets and gel;
• Remens in tablet form;
• Climact Hel in gel form;
• Lady's Formula Menopause in capsule form;
• Klimaxan in capsule form.

Non-hormonal drugs are also effective for menopause

The listed funds are mostly represented homeopathic medicines and biological food additives. 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.

This group of drugs is especially effective if taken for a long time. At the same time, doctors recommend that women switch to a diet rich in fiber. Thanks to this, the effectiveness of HRT will be even higher.

Phytoestrogens do not act against symptoms very quickly, but they have a cumulative effect - after completing the course, the woman does not experience the so-called “withdrawal syndrome,” and the hormone level is maintained at the achieved level. It is recommended to take medications of this type daily in the dosages prescribed by your doctor. It is not recommended to increase or change the dosage of phytoestrogens, as this can worsen the woman’s condition or provoke serious complications.

Contraindications to the use of HRT

In the presence of certain pathologies, the use of HRT is strictly contraindicated.

The presence of thrombosis in a woman is a direct contraindication to hormone replacement therapy

Such diagnoses include:

• liver pathologies in acute and chronic form - hepatitis, oncology;
• thrombosis, thromboembolism;
• oncology of the mammary glands and/or genital organs and glands;
• oncology of the endometrial layer of internal organs;
• complicated diabetes mellitus;
• bleeding from the genitals of unknown origin;
• estrogen-dependent tumors;
• complicated pathologies of the heart and blood vessels.

In addition, pregnancy, which can occur at an early stage of menopause, is considered a contraindication to the use of hormone replacement therapy.

From the video you will learn in what cases hormonal therapy is required:

Hormone replacement therapy: a panacea or just another fad?

M. V. Mayorov, Women's consultation of the city clinic No. 5, Kharkov

"Sapiens nil affirmant, quod non probet"
(“A smart person doesn’t claim anything without evidence,” lat.)

“Back with these harmful hormones!” exclaim negatively-minded patients. “Wonderful effect! Many ex-Hollywood stars accept them, remaining young, beautiful and sexually irresistible! There are virtually no side effects! Excellent prospects for widespread use!..” Enthusiast doctors are delighted. “The method is interesting and, perhaps, useful, but still “God saves the best.” We can learn about undesirable effects only after a few years, as has happened more than once. Is it worth the risk? cautious skeptic doctors summarize. Who is right?

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

The reproductive life span 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 complete ownership of their reproductive organs, women only temporarily rent them." The “rent” period ends with the onset of menopause.

Menopause (MP), i.e. the last spontaneous menstruation, in European countries occurs in women between 45–54 years of age (most often around 50 years of age) and depends on many factors, including the age of birth of the first child, number of births, duration of the menstrual cycle and lactation, smoking, climate, genetic factors, etc. (Leush S. S. et al., 2002). So, for example, for short menstrual cycles MP comes earlier, reception 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 45 years of age, and 85% of them (!) will encounter problems with menopause.

It is necessary to adhere to the following terminology and classification of the described conditions. 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 is the period of a woman’s life that begins 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 appendages.

According to most researchers, MP is considered premature if it occurs in women under 40 years of age. Its causes may be: gonadal dysgenesis, genetic factors (most often Turner syndrome), premature ovarian failure (“depleted ovarian syndrome”, resistant ovarian syndrome, hypergonadotropic amenorrhea), autoimmune disorders, exposure to toxins, viruses, radiation and chemotherapy, etc. , and also surgical interventions, causing surgical MP.

The transition period of a woman is characterized by pronounced hormonal changes. During 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 disrupted, 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 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. Luteinizing hormone (LH) levels rise less and later than FSH. FSH and LH levels reach their maximum values ​​2–3 years after the last menstrual period and then begin to gradually decline. Given the assumption of a premature onset of menopause, it is informative to study the level of FSH, which is an early marker of the onset of MP. After perimenopause, when the fluctuation of ovarian hormones stops, estrogen levels remain stable. At the same time, testosterone production increases due to stimulation of interstitial cells gonadotropic hormones, the level of which is increased during menopause. “Relative hyperandrogenism” occurs.

These changes lead to the appearance of a number of characteristic, often estrogen-dependent, “menopausal complaints”: vasomotor symptoms (hot flashes, 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, change in voice tone, acne). Estrogen deficiency leads to degeneration of collagen fibers, sebaceous and sweat glands, hardening of the 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%. The risk of developing coronary disease hearts 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 question: “what to do?”

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

Throughout recent years There has been a positive trend towards HRT not only among Ukrainian doctors, but also among domestic patients.

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

1. Prescribing minimally effective doses of hormones. This is not about replacing the physiological function of the ovaries during 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 they may have hypertensive, hepatotoxic and thrombogenic effects. Natural estrogens for systemic use (estradiol and estrone preparations) are included in the normal hormonal metabolic cycle. The weak estrogen estriol is used mainly for topical treatment trophic disorders(vaginal insertion).
3. Combination of estrogens with progestins. An increase in the frequency of endometrial hyperplastic processes is a natural result of estrogen monotherapy, which in pure form used only in women with a removed uterus. If the uterus is preserved, it is necessary to add progestin to estrogens for 10-12 days once a month or 14 days once every 3 months (Table 1). Due to this, cyclic secretory transformation and rejection of the surface layers of the endometrium occur, which prevents its atypical changes.
4. Duration of treatment is 5–8 years. To ensure optimal results, the use of HRT drugs should be sufficiently long. 5–8 years these are the terms that guarantee maximum safety of HRT drugs, primarily with regard to the risk of breast cancer. Often this treatment is carried out longer, but then more careful medical supervision is necessary.
5. Timely prescription 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 ensuring restitution. But stopping the development of osteoporosis, slowing it down, and even more so preventing it is possible only if HRT is started in a timely manner and for a sufficient duration.

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

Modern classification medicines, 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-progestin therapy (cyclic or continuous regimen)
   • combined estrogen-androgen therapy.
2. Selective estrogen receptor modulators SERM; 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 administration medicines, for individual components of HRT there are also alternative parenteral routes: vaginally (in the form of cream and suppositories), transdermally (patch, gel), and also in the form of subcutaneous implants.

The indications and contraindications for the use of HRT, as defined by the European Consensus Conference on Menopause (Switzerland, 1996), should be clearly defined.

Absolute contraindications to the use of HRT:

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

Prescription of HRT is mandatory for:

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

Prescribing HRT is advisable for:

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

Indications for the use of HRT for prophylactic purposes:

• history of ovarian dysfunction and oligoamenorrhea (Turner syndrome, psychogenic anorexia, etc.);
• early menopause (surgical, chemotherapy and radiotherapy, premature ovarian failure, etc.);
• bone mass is below the appropriate age norm;
• history of bone fractures;
• history of cardiovascular diseases (myocardial infarction, etc.);
• 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 through the coordinated actions of a gynecologist and a specialist in the relevant field. 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, collagenosis, prolactinoma, melanoma, liver adenoma, diabetes, hyperthyroidism, endometrial hyperplasia, uterine fibroids, endometriosis, mastopathy, familial hypertriglyceridemia, risk of breast cancer.

At the X International Congress on Menopause (Berlin, June 2002) research fellows 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 hypoestrogenia. In such cases, HRT is necessary for the development of secondary sexual characteristics, the formation of sexual behavior, uterine growth and endometrial proliferation, 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: detailed medical history, gynecological examination, colpocervicoscopy, ultrasound (vaginal probe) of the pelvic organs (with mandatory determination of the structure and thickness of the endometrium), mammography, study of coagulogram, lipid profile, bilirubin, transaminases and other biochemical indicators, measurement of blood pressure, weight, ECG analysis , study of ovarian and gonadotropic (LH, FSH) hormones, colpocytological study. We have presented a detailed version of a complex of clinical and laboratory examinations, the implementation of which should be strived for. However, in the absence of opportunities and, most importantly, compelling evidence, this list can be reduced within reasonable limits.

After choosing a drug for HRT (Figure), regular scheduled 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), monitoring of blood pressure and body weight, ultrasound of the pelvic organs. If the thickness of the endometrium in postmenopause is more than 8-10 mm or an increase in the endometrial-uterine ratio, an endometrial biopsy is required, followed by 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 symptoms;
• feeling of heaviness in the lower abdomen.

In order to maximize the optimization of the selection of medications and dosage regimens and regimens, it is convenient to use the table. 2, 3.

Table 2. Modes of use of HRT
(Methodical recommendations, Kyiv, 2000)

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

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 breast cancer.

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 rejecting treatment, developing side effects, and reducing compliance increases. Informed consent increases the likelihood of necessary long-term use of HRT and its effectiveness. An indispensable condition for success is the appropriate high professional level of the doctor prescribing and administering HRT. At the same time, the often encountered amateurism based on superficial knowledge is absolutely unacceptable.

Recently, some medical publications have published the findings of the so-called WHI (Women's Health Initiative) study conducted in the USA, claiming that the estrogen-progestogen combination of HRT supposedly increases the risk of invasive cancer breast, 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 for a number of years convincingly prove the feasibility of using this highly effective and promising method, which reliably and significantly improves the quality of life and level of health of the fair half of the human race.

Literature

1. Current issues of hormone replacement therapy // Conference materials November 17, 2000, Kyiv.
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. Interaction of drugs and the effectiveness of pharmacotherapy. Kharkov: Megapolis, 2002.
4. Zaidieva Ya. Z. The influence of hormone replacement therapy on the condition of the endometrium in perimenopausal women // Schering News. 2001. P. 8–9.
5. Clinic, diagnosis and treatment of post-variectomy syndrome // Methodological 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 for correcting hormonal disorders in peri- and postmenopause // Methodological recommendations. Kyiv, 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. Vol. 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.