The best zgt. Hormone replacement therapy in menopause. Thrombotic episodes and coagulopathy

Hormone replacement therapy in menopause plays an important role in the regulation and pathological changes occurring in female body during this critical period.

Despite the existence of a number of myths about the great danger of such an event, numerous reviews suggest otherwise.

What hormones are missing?

The result of the development of menopause is a sharp decrease in the ability of the ovaries to produce progesterone, and subsequently estrogen due to the degenerative shutdown of the follicular mechanism and changes in the brain nerve tissues. Against this background, the sensitivity of the hypothalamus to these hormones decreases, which leads to a decrease in the production of gonadotropin (GnRg).

The response is an increase in the work of the pituitary gland in terms of the production of luteinizing (LH) and follicle-stimulating (FSH) hormones, which are designed to stimulate the production of lost hormones. Due to excessive activation of the pituitary gland, the hormonal balance is stabilized for a certain period of time. Then, the lack of estrogen affects, and the functions of the pituitary gland gradually slow down.

Decreased production of LH and FSH leads to a decrease in the amount of GnRh. The ovaries slow down the production of sex hormones (progestins, estrogens and androgens), up to the complete cessation of their production. It is a sharp decrease in these hormones that leads to menopausal changes in the female body..

Read about the norm of FSH and LH during menopause.

What is hormone replacement therapy

Hormone replacement therapy for menopause (HRT) is a treatment that introduces drugs similar to sex hormones, the secretion of which is slowed down. The female body recognizes these substances as natural, and continues to function normally. This ensures the necessary hormonal balance.

The mechanism of action of drugs is determined by the composition, which can be based on real (animal), plant (phytohormones) or artificial (synthesized) ingredients. The composition may contain hormones of only one specific type or a combination of several hormones.

In a number of ways, as active substance estradiol valerate is used, which in the body of a woman turns into natural estradiol, which exactly mimics estrogen. Combined options are more common, where in addition to the indicated ingredient, progestogen-forming components are contained - dydrogesterone or levonorgestrel. There are also drugs with a combination of estrogens and androgens.

The combined composition of the new generation of drugs helped to reduce the risk of tumor formations that may occur due to an excess of estrogens. The progestogen component reduces the aggressiveness of estrogen hormones, making their effect on the body more gentle.

There are 2 main treatment regimens for hormone replacement therapy:

1. Short term treatment. Its course is designed for 1.5-2.5 years and is prescribed for a mild menopause, without obvious failures in the female body.
2. Long term treatment. With the manifestation of pronounced violations, incl. in the organs of internal secretion, cardiovascular system or psycho-emotional nature, the duration of therapy can reach 10-12 years.

Indications for the appointment of HRT may be such circumstances:

1. Any phase of menopause. The following tasks are set - premenopause - normalization of the menstrual cycle; menopause - symptomatic treatment and reduced risk of complications; postmenopause - the maximum relief of the condition and the exclusion of neoplasms.
2. Premature menopause. Treatment is needed to stop the inhibition of reproductive female functions.
3. After surgical procedures associated with the removal of the ovaries. HRT helps maintain hormonal balance, which prevents sudden changes in the body.
4. Prevention of age-related disorders and pathologies.
5. Sometimes used as a contraceptive measure.

Points for and against

There are many myths around HRT that frighten women, which sometimes causes them to be skeptical about such treatment. To make the right decision, you need to deal with the real arguments of opponents and supporters of the method.

Hormone replacement therapy provides a gradual adaptation of the female body to the transition to other conditions, which avoids serious disturbances in the functioning of a number of internal organs and systems .

In favor of HRT, speaking such positive effects:

1. Normalization of the psycho-emotional background, incl. elimination panic attacks, mood swings and insomnia.
2. Improving the functioning of the urinary system.
3. Inhibition of destructive processes in bone tissues due to the preservation of calcium.
4. Prolongation of the sexual period as a result of increased libido.
5. Normalization of lipid metabolism, which reduces cholesterol. This factor reduces the risk of atherosclerosis.
6. Protection of the vagina from atrophy, which ensures the normal condition of the penis.
7. Significant relief of menopausal syndrome, incl. softening of the tides.

Therapy becomes effective preventive measure to prevent the development of a number of pathologies - cardiological diseases, osteoporosis, atherosclerosis.

The arguments of the opponents of HRT are based on such arguments:

• insufficient knowledge of the introduction into the system of regulation of hormonal balance;
• difficulty in choosing the optimal treatment regimen;
• introduction into natural, natural processes of aging of biological tissues;
• the inability to establish the exact consumption of hormones by the body, which makes it difficult to dose them in preparations;
• unconfirmed real effectiveness in complications in the later stages;
• the presence of side effects.

The main disadvantage of HRT is the risk of such side disorders - pain in the mammary gland, tumor formations in the endometrium, weight gain, muscle cramps, gastrointestinal problems (diarrhea, gas formation, nausea), changes in appetite, allergic reactions(redness, rash, itching).

NOTE!

It should be noted that with all the difficulties, HRT proves its effectiveness, which is confirmed by numerous positive reviews. A properly chosen treatment regimen can significantly reduce the likelihood of side effects.

Basic drugs

Among the drugs for HRT, there are several main categories:

Estrogen-based products, names:

1. Ethinylestradiol, Diethylstilbestrol. They are oral contraceptives and contain synthetic hormones.
2. Klikogest, Femoston, Estrofen, Trisequens. They are based on the natural hormones estriol, estradiol and estrone. To improve their absorption in the gastrointestinal tract, hormones are presented in a conjugated or micronized version.
3. Klimen, Klimonorm, Divina, Proginova. The drugs include estriols and estrone, which are ether derivatives.
4. Hormoplex, Premarin. They contain only natural estrogens.
5. Gels Estragel, Divigel and Klimara patches are intended for external use.. They are used for serious liver pathologies, pancreatic diseases, hypertension and chronic migraine.

Means based on progestogens:

1. Duphaston, Femaston. They belong to dydrogesterones and do not give metabolic effects;
2. Norkolut. Based on norethisterone acetate. It has a pronounced androgenic effect and is useful in osteoporosis;
3. Livial, Tibolone. These drugs are effective in osteoporosis and are in many ways similar to the previous drug;
4. Klimen, Andokur, Diane-35. The active substance is cyproterone acetate. It has a pronounced antiandrogenic effect.

Universal preparations containing both hormones. The most common are Angelique, Ovestin, Klimonorm, Triaklim.

List of new generation drugs

Currently, new generation drugs are becoming more widespread. They have such advantages - the use of ingredients that are absolutely identical to female hormones; complex impact; the ability to use in any phase of menopause; the absence of most of these side effects. They are produced for convenience in different forms - tablets, cream, gel, patch, injection solution.

The most famous drugs:

1. Klimonorm. The active substance is a combination of estradiol and levonornesterol. Effective for eliminating the symptoms of menopause. Contraindicated in ectopic bleeding.
2. norgestrol. It is a combined remedy. It copes well with a neurogenic type disorder and autonomic disorders.
3. Cyclo-Proginova. Helps increase female libido, improves the functioning of the urinary system. Can not be used for liver pathologies and thrombosis.
4. Klymen. It is based on cyproterone acetate, valerate, an antiandrogen. Fully restores hormonal balance. When used, the risk of weight gain and depression increases nervous system. Allergic reactions are possible.

herbal remedies

A significant group of drugs for HRT are herbal remedies and medicinal plants themselves.

Such plants are considered to be quite active suppliers of estrogens.:

1. Soya. With its use, you can slow down the onset of menopause, facilitate the manifestation of hot flashes, and reduce the cardiological effects of menopause.
2. Black cohosh. It is able to alleviate the symptoms of menopause, blocks changes in bone tissue.
3. Red clover. It has the properties of previous plants, and is also able to reduce cholesterol.

On the basis of phytohormones, such preparations are produced:

1. Estrofel. It contains phytoestrogen, folic acid, vitamins B6 and E, calcium.
2. Tibolone. Can be used to prevent osteoporosis.
3. Inoklim, Feminal, Tribustan. Means are based on phytoestrogen. Provide gradually increasing healing effect with climax.

Main contraindications

In the presence of any chronic disease of the internal organs, the doctor should evaluate the possibility of conducting HRT, taking into account the characteristics of the female body.

This therapy is contraindicated in such pathologies.:

• uterine and ectopic nature (especially for unexplained reasons);
• tumor formations in the reproductive system and mammary gland;
• uterine diseases and diseases of the mammary gland;
• serious renal and hepatic pathologies;
• adrenal insufficiency;
• thrombosis;
• lipid metabolism anomalies;
• endometriosis;
• diabetes;
• epilepsy;
• asthma.

How to distinguish bleeding from menstruation, read.

Features of the treatment of surgical menopause

artificial or occurs after the removal of the ovaries, which leads to the cessation of the production of female hormones. In such circumstances, HRT can significantly reduce the risk of complications.

The therapy includes such schemes:

1. After removal of the ovaries, but the presence of the uterus (if a woman is under 50 years old), cyclic treatment is used in such options - estradiol and cipraterone; estradiol and levonorgestel, estradiol and dydrogesterone.
2. For women over 50 years old - monophasic estradiol therapy. It can be combined with norethisterone, medroxyprogesterone, or drosirenone. Tibolone is recommended.
3. At surgical treatment endometriosis. To eliminate the risk of recurrence, estraradiol therapy is carried out in combination with dienogest, dydrogesterone.

For most women, the menopause is filled with unpleasant symptoms that interfere with the usual course of life. Therefore, with timely access to specialists, a woman is prescribed hormone replacement therapy using new generation drugs. Which is able to relieve the symptoms of pathological menopause and reduce possible risks complications.

Klimonorm is one of the new generation HRT drugs

Action HRT in the climax. New generation drugs to eliminate symptoms. Consequences of taking drugs

The only way to eliminate the symptoms of pathological menopause, doctors consider the use of hormone replacement therapy drugs. W gt are analogues of female sex steroid hormones. They can be divided on the:

• HRT containing only estrogen.
• HRT combined action, which are composed estrogen and progesterone.

Application gzt Maybe not only during the period of natural menopause, but also during artificial menopause. In any of these cases, the use of drugs should be under the supervision of a specialist, because they have absolute contraindications:

• If a histological examination of the breast confirmed the presence of cancer cells.
• Contraindications are not only breast cancer, but also cancer of any endometrium.
• melanomas.
• Vascular disease of the upper or lower extremities. Thrombophlebitis.
• Any diseases that are autoimmune in nature.
• Pathological changes in the liver.
• Diseases biliary ducts.
• Any abnormalities in the work of the cardiovascular system.
• The presence in the body of estrogen-dependent tumors (endometriosis, uterine fibroids).

Cyclo-Proginova, like other drugs, has a number of contraindications

How do new generation drugs work?

Since all disorders during menopause in a woman's body are associated with insufficient production of estrogen and an excess of progesterone, the use of drugs gzt helps to fill the shortage and normalize well-being.

Application gzt new generation eliminates the symptoms of pathological menopause:

• Tides. A short-term increase in the temperature of the upper body, accompanied by increased sweating, a rapid heartbeat, and a feeling of anxiety.
• Dryness of all mucous membranes. During menopause, women experience a decrease in the overall level of sex hormones in the blood, which leads to problems in: urinary system; excretory and reproductive organs. The mucous membranes dry out, thin out, which leads to the appearance of unpleasant symptoms (incontinence, itching in the perineum, exacerbation of healed STD).
• High blood pressure, tachycardia.
• Systematic disorder of the central nervous system, expressed by mood swings.

The tides are the brightest symptom of a pathological menopause, which manifests itself as a failure in the thermoregulation of the body by the hypothalamus. This failure contributes lack of estrogen, which easily eliminated by appointment gzt.

Klimen normalizes the cycle of menstruation

The consequences of the use of drugs

Since hormone replacement therapy preparations contain a high content of estradiol, long-term use without consulting a doctor is fraught with the occurrence of estrogen-dependent neoplasms.

Therefore, if any symptoms of a pathological menopause occur, you should not prescribe therapy yourself. The best solution would be:

• Take tests for the level of sex hormones in the blood.
• Check the thyroid gland for function.
• Seek appropriate treatment from a gynecologist.

What medications are HRT drugs. Trade names and uses

In pharmacies you can find more than 50 types of drugs used in under various trade names . They can be divided into several groups, which differ only in the way they are introduced:

• Orally. Tablets for oral administration.
• Intramuscular injections.
• Transdermal topical preparations.
• intravaginal introductions.

The method of administration of the drug into the body is selected individually, taking into account the severity of the course of the disease or personal preferences. The most common form of drug administration is oral.

Your doctor may give you a list of drugs to choose from. pharmacological properties but under different trade names. Because of which you can independently choose a hormone replacement therapy drug based on your own budget.

Femoston is available in the form of tablets.

The most common remedies that help eliminate the symptoms of pathological menopause:

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

The body no longer produces the required amount of estrogens, and in order to maintain hormonal hemostasis, it is necessary to make a decision on taking conjugated drugs.

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

It is worth approaching such an important decision with all responsibility and studying everything related to HRT - its purpose, the mechanism of action of drugs, contraindications and side effects and the possible benefits it provides.

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

Yet the main producer of estrogen is the ovaries.

The exception is Livial.

Means Livial

Livial is a drug for the treatment of symptoms of menopause, in case of withdrawal of which bleeding does not occur. The main active ingredient of the drug is tibolone.

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

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

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

Livial is not a contraceptive.

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

In case of an overdose, bleeding is possible.

The drug is used with caution in migraine, epilepsy, diabetes mellitus, kidney disease, high level cholesterol in the blood.

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

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

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

Combined Femoston

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

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

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

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

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

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

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

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

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

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

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

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

Preparation Angeliq

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

Drospirenone - analogue natural hormone progestogen. The most effective is complex treatment with hypogonadism, ovarian dystrophy and menopause, regardless of its cause.

Angelique, like Femoston, eliminates clinical manifestations menopause.

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

Drospirenone prevents the formation of edema, arterial hypertension, weight gain, pain in the chest.

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

In addition to the classic properties for the drug of substitution therapy, Angeliq prevents the malignant degeneration of the tissues of the rectum and endometrium in the postmenopausal period.

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

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

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

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

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

One package of the drug contains 21 tablets, which are taken 1 time per day during the first 5 days after the onset of menstrual bleeding or at any time if the cycle has already been completed.

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

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

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

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

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

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

With the onset of premenopause, menopausal symptoms associated with a deficient level of estrogen begin to appear in a woman's body.

Particular discomfort is caused by such manifestations as increased sweating, a quick set of extra pounds, a violation of the rhythm of the heartbeat, a feeling of dryness on the mucous surface of the vagina, and a manifestation of urinary incontinence. To eliminate all the unpleasant menopausal symptoms will help hormonal drugs with menopause.

All hormonal drugs are divided into 2 main groups:

1. Estrogen-containing, prescribed mainly after a hysterectomy (surgical removal of the uterus).
2. Combined products containing progesterone, which protects the endometrium, as well as estrogen.

Hormonal pills for menopause are effective way getting rid of severe menopausal consequences. The basis of treatment with hormone replacement therapy is the systematic intake of hormones, observation by a specialist and periodic examination of the whole body to identify pathologies associated with menopause.

It is also necessary to make sure before taking HRT preparations that it is suitable for the body, and there are no contraindications. Hormone replacement therapy for menopause should only be prescribed by a qualified specialist.

Let us consider in more detail why hormone therapy is prescribed and its positive aspects.

The positive side of hormone therapy

With the onset of menopause in women, involutional changes begin in the body, characterized by the extinction hormonal background, the functionality of the ovaries, a change in the structure of tissues in the brain, leading to a decrease in the production of progesterones, and then estrogens, and the appearance of the corresponding symptoms, manifested in the form of:

• climacteric syndrome. In premenopause, it occurs in 35% of the female population, in 39-42% of women with the onset of menopause, in 19-22% after 12 months from the onset of menopause and in 3-5% after 4-5 years after the menopausal period.

The manifestation of the climacteric syndrome is associated with the formation of hot flashes and a sudden sensation of heat, increased sweating, followed by chills, psycho-emotional instability, increased blood pressure and its erratic nature. Also, an increase in the rhythm of the heartbeat, the appearance of a feeling of numbness at the fingertips, painful sensations in the region of the heart, sleep disturbance and the appearance of insomnia, depression and other associated symptoms.

• Disorders from the genitourinary system of a woman, manifested in the form of a decrease in libido against the background of a decrease in testosterone, the appearance of dryness on the mucous surfaces in the vaginal area, urinary incontinence, especially during a sharp sneeze, cough or fright. You may also experience pain during urination.
• Dystrophic changes in the skin and their appendages, accompanied by the formation of diffuse alopecia, dry skin, increased fragility of the nail plates, the appearance of deeper wrinkles.
• Violations of metabolic processes in the body: this type of pathological changes is accompanied by a manifested decrease in appetite and a simultaneous increase in the mass of the subcutaneous fat layer. Also, fluid from the body begins to be excreted at a slower pace, which leads to the formation of pastosity in the face and the appearance of swelling of the legs.
• The development of late manifestations related to the formation of osteoporosis, which occurs against the background of a decrease in the level of calcium in the skeletal system of the body, as well as hypertension, ischemia, Alzheimer's disease and other equally serious pathologies.

Consequently, all menopausal changes occurring in a woman's body can occur with the development of certain symptoms with varying degrees of severity.

Hormone replacement therapy for menopause is effective method contributing to the prevention, elimination or significant reduction of violations of the functionality of all organ systems and reduce the risk of serious pathological processes occurring against the background of hormonal deficiency.

The main principles of hormone replacement therapy are:

1. The appointment of drugs, the main composition of which is similar to female sex hormones.
2. Taking small doses corresponding to the level of endogenous estradiols, especially in the proliferative stage.
3. Treatment with various combinations of estrogen and progesterone intake, which helps to exclude the occurrence of endometrial hyperplasia.
4. After a hysterectomy (surgical removal of the uterus), the possibility of taking drugs containing only estrogens.
5. Prophylactic use of hormonal drugs, aimed at eliminating the occurrence of pathologies such as osteoporosis and cardiac ischemia, should be at least 5 years.

The main active component of hormonal drugs are estrogens. When gestagens are added, a kind of prevention of the hyperplastic process on the mucous membranes of the uterus and control of its condition is carried out. Consider a list of the most effective hormonal drugs.

HRT preparations

Taking HRT for menopause and new generation drugs should be prescribed only by a qualified specialist.

Klimonorm

This medicine belongs to the group of anticlimacteric drugs. Part this drug includes two active components - estrogen and gestagen, the main action of which is aimed at eliminating menopausal symptoms and preventing the occurrence of endometrial cancer and hyperplasia.

The unique composition of the drug and adherence to a special regimen in combination give a chance to restore the menstrual cycle in women who have not undergone a hysterectomy procedure.

The active ingredient estradiol contained in Klimonorm completely replaces the lack of natural estrogen in the body of a woman during menopause. This contributes to the elimination of vegetative and psychological problems that arise in the menopause against the background of a decrease in testosterone and sexual activity. With the correct intake of the drug, it is possible to achieve a decrease in the rate of occurrence of deep wrinkles, an increase in the content of collagen in the skin. Moreover, the drug provides a decrease in the level of cholesterol in the blood and the risk of gastrointestinal pathologies.

With an incomplete menstrual cycle and the manifestation of at least rare menstrual flow, treatment should be started from the fifth day after the onset of menstruation. With the development of amenorrhea at the beginning of the menopausal period, treatment can be started at any time, provided there is no pregnancy.

One package of the drug is designed for a 3-week course of treatment. To achieve the desired result, it is necessary to take hormones according to the prescribed treatment regimen. When taking high doses of the drug, adverse reactions of the body may occur, manifested by indigestion, vomiting and bleeding that are not associated with the menstrual cycle. You can get rid of the symptoms of an overdose with the help of a systematic treatment prescribed by your doctor.

Femoston

Postmenopausal hormone replacement therapy involves taking this two-phase combination drug, if there are no contraindications for a woman. The two active ingredients that make up this drug - estradiol and progesterone, have a similar effect on the body as natural female sex hormones.

Together, estradiol and progesterone contribute to:

• Elimination of vegetative symptoms;
• Elimination of psycho-emotional disorders;
• Prevention of the development of osteoporosis, cancer in the uterus and hyperplasia.

Femoston tablets should be taken at the same time interval once a day. Treatment should be carried out according to the prescribed scheme. In the first two weeks, it is recommended to drink hormones in white tablets. The next two weeks of course treatment need to take gray pills.

For women with a predominant menstrual cycle, treatment is prescribed from the first day of menstruation. For those who have irregularities in the menstrual cycle, course treatment is initially prescribed with the help of the Progestogen preparation, then Femoston is taken, according to a special treatment regimen. Women who do not have a menstrual cycle can start taking the drug at any time.

To get the desired result female hormones in tablets it is necessary to drink, strictly observing the treatment regimen, the only way to improve overall well-being and delay the onset of old age.

Klimadinon

This drug belongs to the group of phytopreparations containing phytohormones in its composition. It is prescribed for the treatment of menopausal symptoms and the elimination of vegetative-vascular disorders, when there are obvious contraindications and hormones should not be taken during menopause.

The treatment regimen and duration of administration are prescribed depending on the individual characteristics of the woman's body.

Angelique

Angelique, like Klimonorm, are drugs for menopause in women, helping to get rid of unpleasant symptoms and improve overall well-being.

Angeliq is used for:

• Normalization of general well-being;
• Eliminate unpleasant symptoms during hot flashes and reduce the frequency of their occurrence;
• Prevention of osteoporosis;
• Increasing the level of testosterone, and, consequently, the normalization of sexual activity.

Do not take this drug if you have any of the following:

• The presence of bleeding from the vagina of unclear etiology;
• The development of a cancerous tumor in the area of ​​​​the mammary glands;
• With diabetes mellitus, hypertension and venous thrombosis.

Angeliq contains in its composition the necessary hormones for menopause, which are an excellent solution for improving well-being and recovery hormonal imbalance, especially for women over 45-46 years old.

Klimara

This is a hormonal drug produced in the form of a patch, which contains estradiol at a dose of 3.8 mg. The patch is glued to a specific area of ​​the skin, after which the release begins active component and improving the general well-being of women. Wearing one patch is recommended for no more than a week. On the last day of the week, it is necessary to replace the used patch with a new one, be sure to change the place for fixing it.

Under the influence of the patch, the level of testosterone in the body increases, which has a positive effect on the psycho-emotional state and increased libido. There are no special contraindications to the use of the patch, but before using it, you should consult with a specialist.

Female hormones during menopause under the influence of age-related changes and the transition period decrease, worsening the condition of the woman. Therefore it is necessary to use HRT preparations, capable of saving a woman from violations of the autonomic system, a decrease in testosterone levels and the ensuing consequences: changes in the psycho-emotional state in a short period of time. Among other things, hormonal drugs are generally well absorbed and do not have adverse reactions.

In order to find out what to drink with menopause, you need to undergo a complete diagnosis of the state of the body and consult with a specialist.

Spontaneous intake of hormonal drugs can be not only useless for the body, but also dangerous, entailing irreversible consequences. Therefore, you need to take hormonal drugs only as directed by a doctor.

Interesting and informative video

With the further progress of developed capitalism on the territory of Russia, a woman is increasingly faced with the need to maintain an attractive appearance and sexual activity right up to the grave.

It has long been known that since the onset of menopause, the level of estrogen providing:

• not only fertility,
• but also an acceptable state of the cardiovascular,
• musculoskeletal systems,
• skin and its appendages,
• mucous membranes and teeth

falls catastrophically.

The only hope of an aging lady some thirty years ago was the fat layer, due to which the last estrogen, estrone, was formed from androgens through metabolism through steroids. However, rapidly changing fashion brought to the catwalks, and then to the streets, a population of slender women, more reminiscent of drag queens and ingénue-pipis than heroine mothers and hard workers.

In pursuit of a slim figure, women somehow forgot about what a heart attack is at fifty and osteoporosis at seventy. Fortunately, gynecologists with the latest achievements in the pharmaceutical industry in the field of hormone replacement therapy pulled themselves up to help frivolous compatriots. From about the beginning of the nineties, this direction, standing at the junction of gynecology and endocrinology, began to be considered a panacea for all women's misfortunes, from early menopause to femoral neck fractures.

However, even at the dawn of the popularization of hormones, in order to keep a woman flourishing, sound demands were made not to prescribe drugs to everyone indiscriminately, but to make an acceptable sample, separating women with high risks of oncogynecology and directly protecting them from realizing the risks.

Hence the moral: every vegetable has its time

Aging - although natural, is by no means the most pleasant episode in the life of every person. It brings with it such changes that do not always set the lady in a positive way and often quite the opposite. Therefore, with menopause, drugs and medications are often simply necessary to take.

Another question is how safe and effective they will be. It is precisely the maintenance of a balance between these two parameters that is the biggest problem of modern pharmaceutical industry and practical medicine: neither shooting a sparrow from a cannon, nor chasing an elephant with a slipper is impractical, and sometimes even very harmful.

Hormone replacement therapy in women today is very ambiguously evaluated and prescribed:

• Only in women without risk of breast, ovarian, endometrial cancer.
• If there are risks, but they were not noticed, the development of breast or ovarian cancer will be highly likely, especially if there is a zero stage of these cancers.
• Only in women with minimal risk of thrombotic complications, therefore better in non-smokers with a normal body mass index.
• It is better to start in the first ten years from the last menstruation and not to start in women over 60. At least the effectiveness in younger women is much higher.
• Mostly patches from a combination of a small dose of estradiol with micronized progesterone.
• To reduce vaginal atrophy, local estrogen suppositories can be used.
• Benefits in key areas (osteoporosis, ischemic changes myocardial infarction) does not compete with safer drugs or is not, to put it mildly, proven.
• Almost all ongoing studies have certain errors that make it difficult to draw unambiguous conclusions about the predominance of the benefits of substitution therapy over its risks.
• Any prescription of therapy should be strictly individual and take into account the specifics of the situation of a particular woman, for whom not only an examination before prescribing drugs is necessary, but also ongoing dispensary observation for the entire duration of treatment.
• Domestic serious randomized trials with their own conclusions have not been conducted, national recommendations are based on international recommendations.

The further into the forest, the more firewood. With the accumulation of clinical experience with the practical use of hormone replacement, it became clear that women with initially low risks of breast cancer or uterine mucosa are not always safe, taking some categories of "pills of eternal youth."

How is the situation today, and on whose side is the truth: adherents of hormones or their opponents, let's try to figure it out here and now.

Combined hormonal agents

As hormone replacement therapy in menopause, combined hormonal agents and pure estrogens. Which drug will be recommended by the doctor depends on many factors. These include:

• patient's age,
• presence of contraindications
• body mass,
• severity of climacteric symptoms,
• concomitant extragenital pathology.

Klimonorm

One package contains 21 tablets. The first 9 yellow tablets contain an estrogenic component - estradiol valerate at a dosage of 2 mg. The remaining 12 tablets are brown in color and include estradiol valerate 2 mg and levonorgestrel 150 mcg.

The hormonal agent must be taken 1 tablet daily for 3 weeks, at the end of the package, a 7-day break should be taken, during which menstrual discharge will begin. In the case of a preserved menstrual cycle, tablets are taken from the 5th day, with irregular periods- on any day with the condition of excluding pregnancy.

The estrogen component eliminates negative psycho-emotional and autonomic symptoms. Common ones include: sleep disorders, hyperhidrosis, hot flashes, vaginal dryness, emotional lability, and others. The gestagenic component prevents the occurrence of hyperplastic processes and endometrial cancer.

Femoston 2/10

This drug is available as Femoston 1/5, Femoston 1/10 and Femoston 2/10. The listed types of funds differ in the content of estrogen and progestogen components. Femosten 2/10 contains 14 pink and 14 yellow tablets (28 pieces in total in a package).

Pink tablets contain only the estrogenic component in the form of estradiol hemihydrate in an amount of 2 mg. The yellow tablets consist of 2 mg estradiol and 10 mg dydrogesterone. Femoston must be taken daily for 4 weeks, without interruption. After the end of the package, you should start a new one.

Angelique

The blister contains 28 tablets. Each tablet contains estrogen and progestogen components. The estrogenic component is represented by estradiol hemihydrate at a dose of 1 mg, the progestogen component is drospirenone at a dose of 2 mg. Tablets should be taken daily, without observing a weekly break. After the end of the package, the reception of the next one begins.

pausegest

The blister contains 28 tablets, each contains estradiol in an amount of 2 mg and norethisterone acetate in a dose of 1 mg. Tablets begin to drink from the 5th day of the cycle with preserved menstruation and on any day with irregular periods. The drug is taken constantly, without observing a 7-day break.

Cyclo-Proginova

There are 21 tablets in a blister. The first 11 white tablets contain only the estrogenic component - estradiol valerate at a dosage of 2 mg. The next 10 light brown tablets consist of estrogenic and progestogen components: estradiol in the amount of 2 mg and norgestrel in a dosage of 0.15 mg. Cyclo-Proginova should be taken daily for 3 weeks. Then it is necessary to observe a week break, during which menstrual-like bleeding will begin.

Divigel

The drug is available in the form of a 0.1% concentration gel, which is used for external use. One sachet of Divigel contains estradiol hemihydrate in the amount of 0.5 mg or 1 mg. The drug must be applied to clean skin once a day. Recommended places for rubbing the gel:

• lower abdomen,
• small of the back,
• shoulders, forearms,
• buttocks.

The area of ​​application of the gel should be 1 - 2 palms. Recommended daily change of skin areas for rubbing Divigel. It is not allowed to apply the drug to the skin of the face, mammary glands, labia and irritated areas.

menorest

Produced in the form of a gel in a tube with a dispenser, the main active ingredient of which is estradiol. The mechanism of action and method of application are similar to Divigel.

Klimara

The drug is a transdermal therapeutic system. Produced in the form of a patch measuring 12.5x12.5 cm, which must be glued to the skin. The composition of this anti-menopausal agent includes estradiol hemihydrate in the amount of 3.9 mg. The patch is attached to the skin for 7 days, at the end of the week period, the previous patch is peeled off and a new one is attached. Recommended places for application of Climara are the gluteal and paravertebral regions.

Ovestin is available in tablets, vaginal suppositories, and as a cream for vaginal use. The most commonly prescribed form of the drug is vaginal suppositories. The composition of one suppository includes micronized estriol in the amount of 500 mcg. Candles are administered intravaginally daily, without interruption. The main role of the drug is to replenish estrogen deficiency in menopausal and postmenopausal periods.

estrogel

The drug is available in the form of a gel for external use in tubes with a dispenser. The tube contains 80 gr. gel, in one dose - 1.5 mg of estradiol. The main action is the elimination of the lack of estrogens in menopause and postmenopause. The rules for applying the gel are the same as for Divigel.

Advantages and disadvantages of application various forms drugs. Click to enlarge.

Hormonal background

For a woman, the basic sex hormones can be considered estrogens, progestins and, paradoxically, androgens.

In a rough approximation, all these categories can be characterized as follows:

• estrogens are female hormones
• progesterone - pregnancy hormone
• androgens - sexuality.

estradiol, estriol, estrone are steroid hormones produced by the ovaries. It is also possible to synthesize them outside the reproductive system: the adrenal cortex, adipose tissue, bones. Their precursors are androgens (for estradiol - testosterone, and for estrone - androstenedione). In terms of effectiveness, estrone is inferior to estradiol and replaces it after menopause. These hormones are effective stimulators of the following processes:

• maturation of the uterus, vagina, fallopian tubes, mammary glands, growth and ossification of the long bones of the limbs, development of secondary sexual characteristics (female-type hair, pigmentation of the nipples and genital organs), proliferation of the epithelium of the vaginal and uterine mucosa, vaginal mucus secretion, endometrial rejection in uterine bleeding.
• An excess of hormones leads to partial keratinization and desquamation of the vaginal lining, proliferation of the endometrium.
• Estrogens prevent the resorption of bone tissue, promote the production of blood coagulation elements and transport proteins, reduce the level of free cholesterol and low-density lipoproteins, reducing the risk of atherosclerosis, increase the blood level of the thyroid hormone, thyroxine,
• adjust receptors to the level of progestins,
• provoke edema due to the transition of fluid from the vessel into the intercellular spaces against the background of sodium retention in the tissues.

Progestins

mainly provide the onset of pregnancy and its development. They are secreted by the adrenal cortex, the corpus luteum of the ovaries, and during gestation - by the placenta. Also, these steroids are called gestagens.

• In non-pregnant women, they balance estrogen, preventing hyperplastic and cystic changes uterine mucosa.
• In girls, they help the maturation of the mammary glands, and in adult women they prevent breast hyperplasia and mastopathy.
• Under their influence, the contractility of the uterus and fallopian tubes decreases, their susceptibility to substances that increase muscle tension (oxytocin, vasopressin, serotonin, histamine) decreases. Due to this, progestins reduce the pain of menstruation and have an anti-inflammatory effect.
• Reduce the sensitivity of tissues to androgens and are androgen antagonists, inhibiting the synthesis of active testosterone.
• A decrease in progestin levels determines the presence and severity of premenstrual syndrome.

Androgens, testosterone, in the first place, literally fifteen years ago, were accused of all mortal sins and were considered only harbingers in the female body:

• obesity
• acne
• increased hair growth
• hyperandrogenism was automatically equal to polycystic ovaries, and it was prescribed to deal with it by all available means.

However, with the accumulation of practical experience, it turned out that:

• a decrease in androgens automatically reduces the level of collagen in tissues, including the pelvic floor
• worsens muscle tone and leads not only to the loss of a tightened appearance women, but
• problems with urinary incontinence and
• excess weight gain.

Also, women with androgen deficiency clearly have a drop in sexual desire and are more likely to have an uneasy relationship with orgasm. Androgens are synthesized in the adrenal cortex and ovaries and are represented by testosterone (free and bound), androstenedione, DHEA, DHEA-C.

• Their level gradually begins to fall in women after 30 years.
• With natural aging, spasmodic falls, they do not give.
• A sharp decrease in testosterone is observed in women against the background of artificial menopause (after surgical removal of the ovaries).

climacteric

The concept of climax is known to almost everyone. Almost always in everyday life, the term has an irritable-tragic or even abusive connotation. However, it is worth understanding that the processes of age-related restructuring are completely natural events, which normally should not become a sentence or signify a dead end in life. Therefore, the term menopause is more correct, when, against the background of age-related changes, the processes of involution begin to dominate. In general, menopause can be divided into the following periods:

• Menopausal transition (on average, after 40-45 years) - when not every cycle is accompanied by the maturation of the egg, the duration of the cycles changes, they are called “confused”. There is a decrease in the production of follicle-stimulating hormone, estradiol, anti-Mullerian hormone and inhibin B. Against the background of delays, psychological stress, flushing of the skin, urogenital signs of estrogen deficiency may already begin to appear.
• Menopause is usually referred to as the last menstruation. Since the ovaries are turned off, after her menstruation no longer goes. This event is established retrospectively, after a year of absence of menstrual bleeding. The timing of the onset of menopause is individual, but there is also an “average temperature in the hospital”: in women under 40, menopause is considered premature, early - up to 45, timely from 46 to 54, late - after 55.
• Perimenopause refers to menopause and the 12 months after it.
• Postmenopause is the period after. All the various manifestations of menopause are more often associated with early postmenopause, which lasts 5-8 years. In the late part of postmenopause, there is a pronounced physical aging of organs and tissues, which prevails over autonomic disorders or psycho-emotional stress.

What do you have to fight

perimenopause

can respond in a woman's body as episodes advanced level estrogen and lack of egg maturation ( uterine bleeding, breast engorgement, migraine), and manifestations of estrogen deficiency. The latter can be divided into several groups:

• psychological difficulties: irritability, neurotypization, depression, sleep disturbances, performance decline,
• vasomotor phenomena: increased sweating, hot flashes,
• genitourinary disorders: vaginal dryness, itching, burning, increased urination.

Postmenopause

gives the same symptoms due to lack of estrogen. Later they are supplemented and replaced:

• metabolic abnormalities: accumulation of abdominal fat, a drop in the body's susceptibility to its own insulin, which can result in type 2 diabetes.
• cardiovascular: an increase in the level of atherosclerosis factors (total cholesterol, low density lipoproteins), dysfunction of the vascular endothelium,
• musculoskeletal: accelerated resorption of bone mass, leading to osteoporosis,
• atrophic processes in the vulva and vagina, urinary incontinence, urination disorders, inflammation of the bladder.

Menopausal hormone therapy

Treatment hormonal drugs in women with menopause, they have the task of replacing deficient estrogens, balancing them with progestins in order to avoid hyperplastic and oncological processes in the endometrium and mammary gland. When choosing dosages, they proceed from the principle of minimum sufficiency, in which the hormones would work, but would not have side effects.

The purpose of the appointment is to improve the quality of life of a woman and prevent late metabolic disorders.

These are very important points, since in assessing the benefits and harms synthetic hormones, as well as the achievement or failure to achieve the goals of such therapy, the arguments of supporters and opponents of natural female hormone substitutes are based.

The principles of therapy are the appointment in women under 60 years of age, despite the fact that the last unstimulated menstruation was in the lady no earlier than ten years ago. Combinations of estrogens with progestins are preferred, with low estrogen doses consistent with those of young women in the endometrial proliferating phase. Therapy should be started only after obtaining informed consent from the patient, confirming that she is familiar with all the features of the proposed treatment and is aware of its pros and cons.

When to start

Hormone replacement therapy preparations are indicated for:

• vasomotor disorders with mood changes,
• sleep disorders,
• signs of atrophy of the genitourinary system,
• sexual dysfunction,
• premature and early menopause,
• after removal of the ovaries,
• with a low quality of life against the background of menopause, including those caused by pain in the muscles and joints,
• prevention and treatment of osteoporosis.

Let's make a reservation right away that basically this is how Russian gynecologists look at the problem. Why this reservation, we will consider a little lower.

Domestic recommendations, with some delay, are formed on the basis of the opinions of the International Menopause Society, whose recommendations in the 2016 edition of the list list almost the same, but already supplemented items, each of which is supported by a level of evidence, as well as the recommendations of the American Association of Clinical Endocrinologists in 2017, which emphasize precisely on the proven safety of certain variants of gestagens, combinations and forms of drugs.

• According to them, tactics for women during the menopausal transition and for older age categories will differ.
• Appointments should be strictly individual and take into account all manifestations, the need for prevention, the presence of concomitant pathologies and family history, the results of studies, as well as the expectations of the patient.
• Hormonal support is only part of a general strategy to normalize a woman's lifestyle, which includes diet, rational physical activity, and the rejection of bad habits.
• Replacement therapy should not be initiated unless there are clear signs of estrogen deficiency or the physical consequences of this deficiency.
• A patient receiving therapy is invited to a gynecologist for a preventive examination at least once a year.
• Women whose natural or postoperative menopause occurs before age 45 have a higher risk of osteoporosis, cardiovascular disease, and dementia. Therefore, for them, therapy should be carried out at least until the average age of menopause.
• The issue of continuing therapy is decided individually, taking into account the benefits and risks for a particular patient, without critical age restrictions.
• Treatment should be at the lowest effective dosage.

Contraindications

In the presence of at least one of the following conditions, even if there are indications for replacement therapy, no one prescribes hormones:

• bleeding from the genital tract, the cause of which is not clear,
• breast oncology,
• endometrial cancer,
• acute deep vein thrombosis or thromboembolism,
• acute hepatitis,
• allergic reactions to drugs.

Estrogens are not indicated for:

• hormone dependent breast cancer
• endometrial cancer, including in the past,
• hepatocellular insufficiency,
• porphyria.

Progestins

• in case of meningioma

The use of these funds may be unsafe in the presence of:

• uterine fibroids,
• ovarian cancer in the past
• endometriosis,
• venous thrombosis or embolism in the past,
• epilepsy,
• migraine,
• cholelithiasis.

Application Variations

Among the routes of administration of replacement hormones are known: tableted through the mouth, injectable, transdermal, local.

Table: Pros and cons of different administration of hormonal drugs.

There are different tactics for different groups of patients.

One drug containing estrogen or progestin.

• Estrogen monotherapy is indicated after hysterectomy. In the course of estradiol, estradiolavalerate, estriol in a discontinuous course or continuously. Possible tablets, patches, gels, vaginal suppositories or tablets, injections.
• Isolated gestagen is prescribed in the menopausal transition or perimenopause in the form of progesterone or dydrogesterone in tablets to correct cycles and treat hyperplastic processes.

Combination of estrogen with progestin

• In intermittent or continuous cyclic mode (provided there are no endometrial pathologies) - usually practiced during the menopausal transition and perimenopause.
• For postmenopausal women, a continuous combination of estrogen and progestin is more commonly chosen.

At the end of December 2017, a conference of gynecologists was held in Lipetsk, where one of the central places was occupied by the issue of hormone replacement therapy in postmenopause. V.E. Balan, MD, Professor, President of the Russian Association for Menopause, voiced the preferred directions of substitution therapy.

Preference should be given to transdermal estrogens in combination with a progestin, preferably micronized progesterone. Compliance with these conditions reduces the risk of thrombotic complications. In addition, progesterone not only protects the endometrium, but also has an anti-anxiety effect, helping to improve sleep. The optimal dosage is 0.75 mg of transdermal estradiol per 100 mg of progesterone. For perimenopausal women, the same drugs are recommended at a ratio of 1.5 mg per 200.

Women with premature ovarian failure (premature menopause)

those with higher risks for strokes, heart attacks, dementia, osteoporosis, and sexual dysfunction should receive higher doses of estrogens.

• At the same time, combined oral contraceptives can be used in them until the time of the middle onset of menopause, but transdermal combinations of estradiol and progesterone are preferred.
• For women with low sexual desire (especially against the background of removed ovaries), it is possible to use testosterone in the form of gels or patches. Since specific female preparations have not been developed, the same agents are used as in men, but at lower dosages.
• Against the background of therapy, there are cases of the onset of ovulation, that is, pregnancy is not excluded, so drugs for replacement therapy cannot be considered contraceptives at the same time.

Pros and cons of HRT

Assessing the ratio of the risks of complications from sex hormone therapy and their benefits in combating the symptoms of a deficiency of these hormones, it is worth analyzing each item of the alleged profit and harm separately, referring to serious clinical studies with a decent representative sample.

Breast cancer on the background of substitution therapy: oncophobia or reality?

• A lot of noise has been made lately by the British Medical Journal, which previously distinguished itself in heavy legal battles with the Americans about the safety and dosing regimen of statins and came out of these clashes very, very worthily. In early December 2017, the journal published data from almost a decade of research in Denmark, which analyzed the stories of about 1.8 million women from 15 to 49 years old who used different variations of modern hormonal contraceptives(combinations of estrogens and progestins). The findings were disappointing: the risk of invasive breast cancer in women who received combined contraceptives, exists, and it is higher than that of those who abstain from such therapy. The risk increases with the duration of contraception. Among those who use this method of contraception for a year, the drugs give one extra case of cancer in 7690 women, that is, the absolute increase in risk is small.
• Expert statistics presented by the President of the Russian Menopause Association that only every 25 women in the world die from breast cancer, and most common cause deaths become cardiovascular episodes - so-so consolation.
• The WHI study shows hope that the estrogen-progestin combination begins to significantly increase the risk of breast cancer no earlier than after five years of use, stimulating the growth of pre-existing tumors (including poorly diagnosed zero and first stages).
• However, the International Menopause Society also notes the ambiguity of the effects of replacement hormones on breast cancer risks. The risks are higher, the higher the body mass index of the lady, and the less active lifestyle she leads.
• According to the same society, the risks are less when using transdermal or oral forms of estradiol in combination with micronized progesterone (versus its synthetic variants).
• Thus, hormone replacement therapy after 50 increases the risk of progestin joining estrogen. A larger safety profile shows micronized progesterone. At the same time, the risk of recurrence in women who have previously had breast cancer does not allow them to prescribe replacement therapy.
• To reduce the risks, women with a low initial risk of breast cancer should be selected for replacement therapy, and annual mammograms should be performed against the background of ongoing therapy.

Thrombotic episodes and coagulopathy

• This is, first of all, the risk of strokes, myocardial infarctions, deep vein thrombosis and pulmonary embolism. Based on WHI results.
• In early postmenopausal women, this is the most common type of estrogen complication and increases as women age. However, with initially low risks in young people, it is low.
• Transcutaneous estrogens in combination with progesterone are relatively safe (data from less than ten studies).
• The frequency of deep vein thrombosis and PE is approximately 2 cases per 1000 women per year.
• According to the WHI, the risk of PE is less than in normal pregnancies: +6 cases per 10,000 with combination therapy and +4 cases per 10,000 with estrogen monotherapy in women 50-59 years old.
• The prognosis is worse in those who are obese and have had previous episodes of thrombosis.
• These complications are more common in the first year of therapy.

However, it should be noted that the WHI study was aimed more at identifying long-term effects replacement therapy for women more than 10 years after menopause. The study also used only one type of progestin and one type of estrogen. It is more suitable for testing hypotheses, and cannot be considered flawless with the maximum level of evidence.

The risk of stroke is higher in women whose therapy was started after the age of 60, while we are talking about an ischemic disorder cerebral circulation. At the same time, there is a dependence on oral long-term intake of estrogens (data from the WHI and the Cochrane study).

Oncogynecology is represented by cancer of the endometrium, cervix and ovaries

• Endometrial hyperplasia has a direct relationship with the intake of isolated estrogens. At the same time, the addition of progestin reduces the risk of uterine neoplasms (data from the PEPI study). However, the EPIC study, on the contrary, noted an increase in endometrial lesions during combination therapy, although the analysis of these data attributed the results to the probably lower adherence of the studied women to therapy. For the time being, the International Menopause Society has suggested that micronized progesterone at a dose of 200 mg per day for 2 weeks in the case of sequential therapy and 100 mg per day when combined with estrogen for continuous use is considered safe for the uterus.
• An analysis of 52 studies confirmed that hormone replacement therapy increased the risk of ovarian cancer by about 1.4 times, even if it was used for less than 5 years. For those who have at least a blueprint in this area, these are serious risks. An interesting fact is that early signs of ovarian cancer that have not yet been confirmed can be masked as manifestations of menopause, and it is for them that hormone therapy can be prescribed, which will undoubtedly lead to their progress and accelerate tumor growth. However, there are currently no experimental data in this direction. So far, we have agreed that there is no confirmed data on the relationship between the use of replacement hormones and ovarian cancer, since all 52 studies differed at least by some errors.
• Cervical cancer today is associated with the human papillomavirus. The role of estrogens in its development is poorly understood. Long-term cohort studies have found no association between the two. But at the same time, cancer risks were assessed in countries where regular cytological studies make it possible to timely detect cancer of this localization in women even before menopause. Data from the WHI and HERS studies were evaluated.
• Cancer of the liver and lung has not been associated with hormones, there is little information on stomach cancer, and there are suspicions that it is reduced during hormone therapy, as is colorectal cancer.

Expected benefit

Pathologies of the heart and blood vessels

This is the main cause of disability and mortality in postmenopausal women. It is noted that the use of statins and aspirin does not have the same effect as in men. In the first place should go to reduce body weight, the fight against diabetes, arterial hypertension. Estrogen therapy may have a protective effect on the cardiovascular system when approaching the time of menopause and negatively affect the heart and blood vessels if its onset is delayed by more than 10 years from the last menstruation. According to the WHI, women 50-59 years of age had fewer infarcts during therapy, and there was a developmental benefit coronary disease heart, subject to the start of therapy before 60 years of age. An observational study in Finland confirmed that estradiol preparations (with or without progestin) reduced coronary mortality.

The largest studies in this area were DOPS, ELITE and KEEPS. The first, Danish study, mainly focused on osteoporosis, incidentally noted a reduction in coronary deaths and hospitalizations for myocardial infarction among women with recent menopause who received estradiol and norethisterone or went without therapy for 10 years, and then were followed up for another 16 years. .

In the second, earlier and later prescription of estradiol tablets was evaluated (in women up to 6 years after menopause and later than 10 years). The study confirmed that for the state coronary vessels early initiation of replacement therapy is important.

The third compared conjugated equine estrogens with placebo and transdermal estradiol, finding no significant difference in vascular health in relatively young healthy women over 4 years.

Urogenycology is the second direction, the correction of which is expected from the appointment of estrogen

• Unfortunately, as many as three large studies have shown that systemic use estrogen not only aggravates already existing urinary incontinence, but also contributes to new episodes of stress incontinence. This circumstance can greatly impair the quality of life. The latest mathematic analysis by the Cochrane Group noted that only oral preparations have such an effect, and topical estrogens seem to reduce these manifestations. As an additional plus, estrogens have been shown to reduce the risk of recurrent urinary tract infections.
• With regard to atrophic changes in the vaginal mucosa and urinary tract, here estrogens were at their best, reducing dryness and discomfort. At the same time, the advantage remained with local vaginal preparations.

Bone thinning (postmenopausal osteoporosis)

This is a large area, the fight against which is dedicated to a lot of effort and time of doctors of various specialties. Its most terrible consequences are fractures, including those of the femoral neck, which rapidly disable a woman, significantly reducing her quality of life. But even without fractures, loss of bone density is accompanied by chronic pain syndrome in the spine, joints, muscles and ligaments, which I would like to avoid.

No matter how nightingales gynecologists are filled with the topic of the benefits of estrogens for maintaining bone mass and preventing osteoporosis, even the International Menopause Organization in 2016, whose recommendations are essentially written off domestic replacement therapy protocols, vaguely wrote that estrogens are the most appropriate option for preventing fractures in early postmenopausal women, but the choice of osteoporosis therapy should be based on a balance of efficacy and cost.

Rheumatologists are even more categorical in this respect. So, selective estrogen receptor modulators (raloxifene) have not been shown to be effective in preventing fractures and cannot be considered the drugs of choice for the management of osteoporosis, giving way to bisphosphonates. Also, the prevention of osteoporotic changes is given to combinations of calcium and vitamin D3.

• Thus, estrogens are able to inhibit bone loss, but their oral forms have been mainly studied in this direction, the safety of which in relation to oncology is somewhat doubtful.
• Data on a decrease in the number of fractures on the background of replacement therapy have not been received, that is, today estrogens in terms of prevention and elimination severe consequences osteoporosis are inferior to safer and more effective drugs.