Menopause therapy: history and new generation drugs. Taking hormonal drugs for menopause: HRT of a new generation Cyclic HRT

It does not require treatment, because this is a normal physiological process, and not a pathology. But menopause is a difficult "step" in the life of every woman, affecting absolutely all spheres of a woman's life. The lack of sex hormones affects health, psycho-emotional state, appearance and self-confidence, sexual life, relationships with loved ones and even labor activity, and the quality of life in general. Therefore, any woman in this period requires help from both professional doctors and reliable support and support from her closest relatives.

How to alleviate the condition with menopause?

• Do not withdraw into yourself, accept the fact that menopause is not a vice or a shame, it is the norm for all women;
• lead a healthy lifestyle ;
• fully rest;
• reconsider your diet in favor of plant-based and low-calorie foods;
• move more;
• not to succumb to negative emotions, to receive positive even from the smallest;
• take care of your skin;
• observe all the rules of intimate hygiene;
• consult a doctor in a timely manner for a preventive examination and in the presence of complaints;
• follow the doctor's prescriptions, do not skip the recommended medications.

• Monitor the state of the body, identify and prevent the development of diseases associated with menopause;
• if necessary, prescribe treatment with sex hormones - hormone replacement therapy;
• Assess symptoms and recommend medications to relieve them.

• Show patience for the emotional outbursts of a woman;
• do not leave alone with the problems that have piled up;
• attention and care of loved ones work wonders;
• give positive emotions;
• support with the word: "I understand", "all this is temporary", "you are so beautiful and attractive", "we love you", "we need you" and everything in that mood;
• lighten the load on the household;
• protect from stress and trouble;
• participate in trips to doctors and other manifestations of care and love.

Treatment of menopause - hormone replacement therapy (HRT)

Hormone replacement therapy has already been successfully used massively throughout the world. So, in European countries, more than half of women entering the menopause receive it. And in our country, only 1 out of 50 women receives such treatment. And all this is not because our medicine is lagging behind in some way, but because of the many prejudices that make women refuse the proposed hormonal treatment. But many studies have proven that such menopause therapy is not only effective, but also absolutely safe.
Factors that affect the effectiveness and safety of hormonal drugs for the treatment of menopause:

• The timeliness of the appointment and withdrawal of hormones;
• usually use small doses of hormones;
• correctly selected drugs and their doses, under the control of laboratory studies;
• the use of preparations containing natural sex hormones identical to those produced by the ovaries, and not their analogues, only similar in their chemical structure;
• adequate assessment of indications and contraindications;
• regular medication.

Hormone therapy for menopause: pros and cons

The most common prejudices regarding the treatment of menopause with female hormones:
1. "Climax is normal, but its treatment is unnatural" , supposedly all our ancestors experienced it - and I will survive. Until recently, the problems of menopause were a closed and "shameful" topic for women, almost like sexually transmitted diseases, so there was no question of his treatment. But women during menopause have always suffered. And do not forget that the women of those times are noticeably different from modern women. The past generation aged much earlier, and most people took this fact for granted. Nowadays, all ladies strive to look as good and younger as possible. The intake of female hormones will not only alleviate the symptoms of menopause, but also prolong the youth of both the appearance and the internal state of the body.
2. "Hormonal drugs are not natural." New trends against "synthetics", for a healthy lifestyle and herbal preparations. So, the hormonal drugs taken to treat menopause, although produced by synthesis, are natural, since in their chemical structure they are absolutely identical to estrogen and progesterone, which are produced by the ovaries of a young woman. At the same time, natural hormones that are extracted from plants and animal blood, although similar to human estrogen, are still poorly absorbed due to differences in structure.
3. "Hormonal treatment is always overweight." Menopause is often manifested by excess weight, so that with the correction of hormonal levels, weight gain can be avoided. To do this, it is important to take not only estrogens, but also progesterone in a balanced dose. In addition, many studies have shown that sex hormones do not increase the risk of obesity, but vice versa. While hormones of plant origin (phytoestrogens) will not fight overweight.
4. "After hormone therapy, addiction develops." Hormones are not drugs. Sooner or later in the body of a woman there is a decrease in sex hormones, without them you still have to live. And hormonal therapy with sex hormones only slows down and facilitates the onset of menopause, but does not exclude it, that is, menopause will occur anyway.
5. "The hormones will start to grow hair in unwanted places." Facial hair grows in many women after menopause, and this is due to a lack of female sex hormones, so taking HRT will prevent and delay this process.
6. "Hormones kill the liver and stomach." Among the side effects of estrogen and progesterone preparations, there are indeed points regarding liver toxicity. But microdoses of hormones used for HRT usually do not affect the functioning of the liver, problems can arise when taking drugs against the background of liver pathologies. You can get around the toxic effects on the liver by changing tablets to gels, ointments, and other dosage forms applied to the skin. HRT has no irritating effect on the stomach.
7. "Hormone replacement therapy with sex hormones increases the risk of cancer." The very deficiency of sex hormones increases the risk of cancer, as well as their excess. Properly selected doses of female sex hormones normalize the hormonal background, thereby reducing this risk. It is very important not to use estrogen-only therapy - progesterone neutralizes many of the negative effects of estrogen. It is also important to cancel HRT in time, such therapy after 60 years is really onco-dangerous in relation to the uterus and mammary glands.
8. "If I tolerate menopause well, why do I need HRT?" A logical question, but the main goal of hormonal treatment for menopause is not so much to relieve hot flashes as to prevent the development of diseases associated with menopause, such as osteoporosis, mental disorders, hypertension and atherosclerosis. It is these pathologies that are more undesirable and dangerous.

There are still disadvantages of hormonal therapy for menopause. Incorrectly selected, namely high doses of estrogen preparations, can really do harm.

Possible side effects of taking high doses of estrogen include:

• development of mastopathy and increased risk of breast cancer;
• painful menstruation and pronounced premenstrual syndrome, lack of ovulation;
• can contribute to the development of benign tumors of the uterus and appendages;
• fatigue and emotional instability;
• increased risk of developing cholelithiasis;
• uterine bleeding due to the development of uterine hyperplasia;
• increased risk of developing hemorrhagic strokes.

• bleeding from the vagina, not associated with the menstrual cycle;
• increased gas formation in the intestines (flatulence);
• when using only estrogen preparations without progesterone, or vice versa, excess weight gain is possible.

In any case, replacement therapy should be carried out under the supervision of a physician. If an increased risk of developing a particular side effect is detected, the doses, scheme, routes of administration of hormones and the advisability of further use of HRT are reviewed.

Indications for hormone replacement therapy (HRT) with menopause

• Any pathological menopause (after removal of the uterus, ovaries, radiation and chemotherapy);
• early menopause at the age of 40-45 years;
• severe menopause;
• the presence of complications and the development of diseases associated with menopause: hypertension, atherosclerosis, osteoporosis, polycystic ovaries, urinary incontinence, severe vaginal dryness, etc.;
• the desire to improve the quality of life during menopause.

Drugs for menopause for hormone replacement therapy (tablets, suppositories, creams, gels, ointments, patches)

Drug group	List of drugs	Application Features*
The best combined hormonal drugs of the new generation: Estrogen + Progesterone	Tablets and dragees: Klymen; Klimonorm; Angelique; Climodien; Divina; Pausegest; Activel; Revmelid; Cliogest; Cyclo-Proginova; Ovidon and others.	These drugs are usually in blisters of 21 tablets or dragees, each of them has its own serial number, according to which they must be taken in turn. Each of these tablets has its own dose of drugs. Doses are adapted to the natural fluctuations of hormones depending on the phases of the menstrual cycle. After the 21st day, they take a break for 7 days, then start a new package. Angeliq, Femoston, Pauzogest, Actitvel, Revmelid and Kliogest are available in a pack of 28 tablets, some of which are placebo, that is, they do not contain hormones (this is a break). These tablets are taken daily and continuously.
Preparations containing only estrogen	Tablets: Estrofem; Estrimax; Premarin; Microfollin; Triaclim; Esterlan.	Estrogen-only menopause replacement drugs are usually used in cases of hysterectomy. With a preserved uterus, an additional intake of progestins is required, it can be an intrauterine system, a cream or a patch. Estrogen tablets are taken daily without interruption. If menopause has not occurred, then they begin on the 5th day of the menstrual cycle.
	Vaginal suppositories, creams and gels: Ovestin cream; Orniona cream; Ovipol clio; Kolpotrofin; Estriol; Estrocad; Estronorm and others.	Vaginal suppositories, creams and gels containing estrogens are used to treat vaginal atrophy and in the presence of urinary problems associated with menopause. The drugs are administered once a day at bedtime. Start with the maximum dose, then gradually reduce. The course of treatment with local estrogens is usually short, on average 1-3 months. When they are used, it is necessary to stop taking estrogen in the form of tablets.
	Gels and ointments for application to the skin: estrogel; Divigel; Dermestril; Menorest; Octodiol; Patches: Klimara; Estraderm; Menostar; Estramon; Alora. Subdermal implants with estrogen	Gel applied daily 1 time per day on the skin of the abdomen, shoulders and lumbar region (where the fat layer is most pronounced) using a special applicator. If the gel is applied correctly, it is completely absorbed into the skin in 2-3 minutes. 1. Means for intimate hygiene with menopause are very important not only to eliminate dryness, but also for the daily prevention of various inflammatory processes of the vagina. There are also a lot of them on the shelves of shops and pharmacies. These are gels, panty liners, napkins. A woman in menopause should wash herself at least twice a day, and also after sexual intercourse. Basic requirements for intimate hygiene products: the product must contain lactic acid, which is normally found in vaginal mucus and determines the acid-base balance; should not contain alkalis and soap solutions; should include in its composition antibacterial and anti-inflammatory components; washing gel should not have preservatives, dyes, aggressive fragrances; the gel should not cause irritation and itching in a woman; panty liners should not be colored or scented, should not consist of synthetic materials and should not injure the delicate intimate area. 2. The right choice of underwear: it should be comfortable, not be narrow; consist of natural fabrics; should not shed and stain the skin; should always be clean; should be washed with laundry soap or fragrance-free powder, after which the linen should be well rinsed. 3. Prevention sexually transmitted diseases : monogamy, the use of condoms and chemical methods of contraception (Pharmatex, etc.). Vitamins for menopause With menopause in a woman's body, changes occur in many systems, organs and processes. The lack of sex hormones always entails a slowdown in metabolism. Vitamins and microelements are such catalysts for many biochemical processes in the body of each person. That is, they accelerate metabolic processes, are also involved in the synthesis of their own sex hormones and increase defenses, facilitate the manifestations of menopause, hot flashes, and improve the tolerability of hormone therapy. Therefore, a woman after 30, and especially after 50 years, simply needs to replenish her reserves with useful substances. Yes, many vitamins and microelements come to us with food, they are the most useful and better absorbed. But this is not enough in the menopause, so it is necessary to get vitamins in other ways - these are drugs and biologically active additives (BAA). In most cases, a woman is assigned

For European women, hormone replacement therapy (HRT) for menopause is a common thing.

Our attitude towards her is one of fear and distrust.
Are we right? Or are the stereotypes outdated?

According to statistics, hormone replacement therapy is used by 55% of English women, 25% of German women, 12% of French women over 45 years old and ... less than 1% of Russian women. Paradox: our women are afraid of HRT preparations, which are identical to their own hormones, call them "chemistry", but calmly take antibiotics - a real alien chemistry. We fearlessly drink hormonal contraceptives to avoid unwanted pregnancies, and refuse HRT, which helps to at least delay unwanted old age. Maybe because we do not fully understand what we are losing?

Almighty

The imbalance of sex hormones, which increases after 40 years, is not only a gynecological problem. In fact, they rule our lives. “The name “sex hormones” is very arbitrary, says gynecologist-endocrinologist Sergey Apetov. – They not only affect the reproductive organs, but also perform a huge number of functions in the body: monitor cholesterol levels, blood pressure, carbohydrate metabolism, bladder function, calcium content in bones. They also help overcome depression, stimulate libido and give joy to life.”

To support all this, hormone replacement therapy is called. But hormonophobia is firmly rooted in the minds of our women. “On the forums, ladies scare each other with horrors about HRT, from which they get fat, get covered with hair, or even get cancer. In fact, everything they are so afraid of happens just without hormones: hypertension, diabetes, osteoporosis, heart attack, obesity, and even hair growth, ”says Professor Kalinchenko.

When to start hormone replacement therapy?

If menstruation has stopped, then there is no estrogen. Here, most women are sure, old age sets in. And they are deeply mistaken. Aging begins much earlier, when the amount of estrogen is just starting to slide down. Then the first SOS signal goes to the pituitary gland, and it reacts by increasing the production of the hormone FSH (follicle-stimulating hormone). This is the first warning: the aging program has been set in motion.

That's why from the age of 35, it makes sense for every woman to control her FSH level every six months. If it starts to rise, then it's time to make up for the estrogen deficiency. And not only them. « It is more correct to talk about polyhormonal therapy, - Leonid Vorslov believes. “With age, the amount of almost all hormones decreases, and all of them need to be supported.”

Over the years, the level of only two hormones increases: leptin, a hormone of adipose tissue, and insulin, which leads to type 2 diabetes. If you maintain normal estrogen and testosterone levels with the help of hormone replacement therapy, then leptin and insulin will stop growing, which means that the risk of obesity, diabetes, atherosclerosis and other diseases will disappear. “The main thing is to start treatment on time,” continues Professor Vorslov. “Once a blood test detects an increase in FSH, we can safely say that the amount of estrogen is steadily decreasing and atherosclerosis is already secretly beginning to develop.”

But the problem is that the range of FSH norms is huge, and it is different for every woman. Ideally, you need to take blood tests for hormones and biochemistry during the period of maximum prosperity - from 19 to 23 years. This will be your individual ideal norm. And starting from the age of 45, annually compare the results with it. But even if you hear about FSH for the first time, it’s better late than never: at 30, 35, 40 years old, it makes sense to find out your hormonal status so that you have something to focus on closer to the critical age.

Professor Vorslov assures: “If hormone replacement therapy is prescribed when the first harbingers of menopause appear, then osteoporosis, coronary heart disease, hypertension, atherosclerosis, and many other diseases associated with aging can be prevented. HRT is not an elixir of immortality, it will not give extra years of life, but it will greatly improve the quality of life».

Analysis without analysis

The level of estrogen has decreased if:

• broken cycle,
• papillomas appeared,
• dry skin and mucous membranes,
• the pressure rises
• have atherosclerosis.

Testosterone levels have decreased if:

• decreased sex drive
• lost confidence,
• excess weight does not lend itself to diets,
• the inside of the shoulders became flabby,
• the usual physical activity seems too heavy.

Men's protection

For a woman, not only estrogens are important, but also testosterone, a male sex hormone that is produced in the adrenal glands. Of course, we have less of it than men, but libido, insulin levels, general tone and activity depend on testosterone.

In the postmenopausal period, when estrogens and progestogens disappear, it is testosterone that will support the cardiovascular system for some time. Those whose levels of this hormone are initially high will be more likely to endure menopausal syndrome., since testosterone is responsible for our activity and resistance to emotional stress.

It also protects us from age-related fragility of bones: the density of the periosteum depends on testosterone. That is why in the West, doctors prescribe women not only estrogen-progestin HRT, but also testosterone. Testosterone patches for women have been certified since 2006. And in the near future, European pharmacists promise to create a comprehensive HRT: one tablet will contain progestogen, estrogen, and testosterone.

Much more than the upcoming fractures, many women are afraid of excess weight growing after menopause. Moreover, at this age we get fat like an “apple”, that is, instead of albeit lush, but feminine forms, we acquire an ugly belly. And testosterone will help here too: without it, it is impossible to resist the accumulation of fat.

2 facts about testosterone

HE RETURNS LIBIDO. Deficiency of this hormone can occur when taking certain hormonal contraceptives - in particular, those that increase the level of testosterone-binding protein. A vicious circle is formed: a woman takes pills in order to lead a full sexual life, and as a result she does not feel any desire. In this situation, additional testosterone supplementation can help.

WE ARE AFRAID OF HIM OUT OF INERTIA. In the 1950s and 1960s, Soviet doctors prescribed testosterone for uterine fibroids, endometriosis, and menopause. The mistake was that women were prescribed the same dosages as men - from this, unwanted hair did grow and other side effects arose. Testosterone in the correct doses will not bring anything but good.

Attention, the doors are closing

For different ages, hormone dosages differ: there are drugs for women under 45, from 45 to 50, from 51 and older. In perimenopause (before menopause), high doses are prescribed, then they are gradually reduced.

Unfortunately, you can be late to jump into the last car of the outgoing train. If, for example, atherosclerosis has already developed, then he managed to close the estrogen receptors, and no doses of the hormone will force them to act. That is why it is so important to start taking sex hormones as early as possible, even if the climacteric syndrome is not yet pressing: hot flashes, sweating attacks, insomnia, irritability, hypertension do not torment.

There is a term "therapeutic window". After 65 years, hormone therapy, as a rule, is not prescribed: sex hormones will no longer be able to properly engage in the work of the human mechanism. But if hormone replacement therapy is started on time, then it can be continued as long as the heart is beating. If there are no contraindications.

Hormones and beauty

Anna Bushueva, dermatocosmetologist of the Department of Therapeutic Cosmetology of the Clinic of Professor Kalinchenko:
- Any hormonal changes affect the condition of the skin. Cosmetic procedures in themselves are effective only up to 40 years. After that, injections of hyaluronic acid, botulinum toxin, peelings are only half the battle, first of all, you need to normalize the hormonal status.

When doing a circular lift, cut off excess tissue, but the quality of the skin remains the same. If there is no estrogen, the skin will be dry, dehydrated, without the proper amount of collagen and elastin. Wrinkles will appear again and again. If you replace the level of estrogen with hormone replacement therapy, the emerging wrinkles will not disappear, but will no longer deepen. And the weight will not increase.

A decrease in testosterone leads to a decrease in muscle mass - the buttocks are flattened, the cheeks and the skin of the inner surface of the shoulders sag. This can be avoided by including testosterone preparations in the HRT course.

Contraindications for hormone replacement therapy

As an experiment, let's go to a commercial diagnostic center. In response to the fairy tale about hot flashes, insomnia, lost libido, the doctor gives a huge list of tests, including complete blood biochemistry, all hormones, pelvic ultrasound, mammography and fluorography. “Does HRT require a total examination?” I wonder, counting how much eternal youth will cost. “We must eliminate all contraindications! Do you have an ovarian cyst or endometriosis? Or liver problems? After all, hormones "plant" the liver. And keep in mind that against the background of hormone replacement therapy, you will have to donate blood for hormones and do an ultrasound first every three months, and then every six months!

After hearing all this, I was heartbroken. Goodbye youth. To drink hormones, you must have the health of an astronaut ...

“Don't be scared,” says Sergey Apetov, a gynecologist-endocrinologist. - Many medical centers really make you take a lot of unnecessary tests before HRT. This is a relatively honest way of withdrawing money from the population. In fact, the list of contraindications and examinations is much shorter.”

* The two main contraindications to hormone replacement therapy are a history of breast or uterine cancer. Any non-hormone-dependent tumors, including cervical or ovarian cancer, are not a contraindication to HRT. On the contrary, the latest research suggests that HRT itself is able to prevent the development of some neoplasms (in particular, skin).

* As for the ovarian cyst, it matters what hormones it depends on. If not from the sex hormones, but from the pituitary hormones, then there are no obstacles to prescribing HRT. By the way, cysts form when the pituitary gland produces a large amount of the already mentioned FSH hormone, and they are just hinting: it's time to do HRT.

* Fibroids and endometriosis are in most cases compatible with hormone replacement therapy.“Cases when uterine fibroids grew against the background of HRT are extremely rare,” says Sergey Apetov. “It is important to understand that the doses of sex hormones in modern drugs are hundreds of times less than in hormonal contraceptives, which everyone drinks indiscriminately.”

* Contraindications may be diseases associated with increased thrombus formation. Most often they are hereditary. “Such women should be prescribed HRT with caution, in small doses, under the strict supervision of a doctor,” says Leonid Vorslov. “It is necessary to take measures to prevent new blood clots and do everything possible to dissolve the old ones.”

* If a woman has had a real myocardial infarction (the one that happened due to coronary heart disease), then the time for HRT, alas, is lost. “A heart attack at a relatively young age suggests that the woman had a long history of estrogen deficiency and caused the development of atherosclerosis,” explains Professor Vorslov. “But even in this case, there is a chance to start treatment with small doses of estrogen.”

* Fibroadenoma (benign tumor of the breast) on the background of doses of estrogen can turn into cancer. Therefore, if it is available, the doctor decides on the appointment of HRT individually.

Not everything is so scary

In many ways, hormone phobia was generated by a well-known study by American scientists conducted in the 80s of the twentieth century. It showed that hormones can be taken for no more than 5 years, since beyond this period, treatment is fraught with stroke, breast and uterine cancer.

“Don't panic,” Leonid Vorslov reassures. – The results of this study were subjected to serious criticism by scientists from other countries. Firstly, in those years, HRT, unlike the modern one, was not safe for the heart and blood vessels. Secondly, the program included women only from 60 years old, 25% of whom were over 70 years old. Moreover, all of them were given drugs in the same doses, which in itself is a big mistake!”

So what about analyses?

* Mammography, ultrasound of the uterus and ovaries always required.

* It is important to check the blood for clotting and glucose levels not to miss diabetes.

* If you are overweight, you should find out what is causing it. Is it possible that thyroid dysfunction causes increased production of prolactin, which leads to obesity? Or maybe the fault is the increased activity of the adrenal cortex, where hormones are produced that are responsible for the accumulation of fat?

* The liver does not need to be checked, unless, of course, you have complaints. “Allegations that these drugs plant the liver are unproven,” says Sergey Apetov. “There is no study on this topic.”

After the appointment of HRT, it is enough to be examined once a year. Also, when starting therapy, it is very important to remember that hormones are not a magic wand. The effect may be reduced due to malnutrition. Everyone knows what proper nutrition is today: a lot of vegetables and fruits, lean meat, fish is required several times a week, plus vegetable oil, nuts and seeds.

How estrogens affect blood vessels

All arterial vessels are lined from the inside with a thin layer of endothelial cells. Their task is to expand or narrow the vessel in time, as well as protect it from cholesterol and blood clots. The endothelium depends on estrogens: if suddenly it is damaged, estrogens help it recover. When there are few of them, endothelial cells do not have time to recover. Vessels "age": they lose elasticity, become overgrown with cholesterol plaques, narrow. And since the vessels cover all organs, it turns out that estrogens act on the work of the heart, kidneys, liver, lungs ... There are estrogen receptors in all cells of a woman's body.

Will herbs help?

Recently, phytohormones have been actively promoted as the best and safest remedy for menopausal syndrome. Yes, and many gynecologists advise drinking dietary supplements with phytoestrogens during the period of perimenopause.

Plant hormone-like substances really work, help to cope with hot flashes, insomnia, irritability. But few people know that against their background, endometrial hyperplasia (growth of the inner layer of the uterus) is more common. A similar property of estrogen and estrogen-like substances in standard HRT compensates for the gestagen - it does not allow the endometrium to grow. Exclusively estrogen (without gestagen) is prescribed to women if the uterus is removed. True, recent studies show the beneficial effect of progestogen on both the central nervous system and the mammary glands - it prevents the development of neoplasms. Unfortunately, unlike real estrogens, phytoanalogues do not affect metabolism, calcium absorption, or the state of blood vessels in any way.

Plant hormones - a compromise and salvation for those to whom real HRT is contraindicated. But the control of the doctor and regular examinations are also necessary.

conclusions

• Hormone Replacement Therapy- not for pensioners. The sooner you figure out your ideal harmony of hormones, the longer, healthier and more beautiful you will live.
• Hormonophobia is an ancient horror story. There are fewer contraindications to HRT than we used to think. There is no reason for fear if there is a qualified doctor.
• HRT will be truly effective only if you eat right and lead a healthy lifestyle.

The whole truth about hormone replacement therapy

I take the liberty of describing the benefits and fears of prescribing hormone replacement therapy (HRT). I assure you - it will be interesting!

Menopause, according to modern science, is not health, it is a disease. Its characteristic specific manifestations are vasomotor instability (hot flashes), psychological and psychosomatic disorders (depression, anxiety, etc.), urogenital symptoms - dry mucous membranes, painful urination and nocturia - "night going to the toilet". Long-term effects: CVD (cardiovascular disease), osteoporosis (low bone density and fractures), osteoarthritis, and Alzheimer's disease (dementia). As well as diabetes and obesity.

HRT in women is more complex and multifaceted than in men. If a man needs only testosterone to replace, then a woman needs estrogen, progesterone, testosterone, and sometimes thyroxine.

HRT uses lower doses of hormones than hormonal contraceptives. HRT preparations do not have contraceptive properties.

All the materials below are based on the results of a large-scale clinical study of HRT in women: Womens Health Initiative (WHI) and published in 2012 in the consensus on hormone replacement therapy of the Research Institute of Obstetrics and Gynecology. IN AND. Kulakova (Moscow).

So, the main postulates of HRT.

1. HRT can be taken up to 10 years after the end of the menstrual cycle
(taking into account contraindications!). This period is called the “window of therapeutic opportunity.” Over 60 years of age, HRT is usually not prescribed.

How long is HRT given? - "As much as needs" To do this, in each case, it is necessary to decide on the purpose of using HRT in order to determine the timing of HRT. The maximum period of use of HRT: "the last day of life - the last tablet."

2. The main indication for HRT is vasomotor symptoms of menopause(these are climacteric manifestations: hot flashes), and urogenital disorders (dyspariunia - discomfort during intercourse, dry mucous membranes, discomfort during urination, etc.)

3. With the right choice of HRT, there is no evidence of an increase in the incidence of breast and pelvic cancer, the risk may increase with the duration of therapy for more than 15 years! And also HRT can be used after the treatment of stage 1 endometrial cancer, melanoma, ovarian cystadenomas.

4. When the uterus is removed (surgical menopause) - HRT is received as estrogen monotherapy.

5. When HRT is started on time, the risk of cardiovascular diseases and metabolic disorders is reduced. That is, during hormone replacement therapy, a normal metabolism of fats (and carbohydrates) is maintained, and this is a prevention of the development of atherosclerosis and diabetes mellitus, since a deficiency of sex hormones in postmenopause aggravates existing, and sometimes provokes the onset of metabolic disorders.

6. The risk of thrombosis increases when using HRT with BMI (body mass index) = more than 25, that is, with excess weight!!! Conclusion: excess weight is always harmful.

7. The risk of thrombosis is higher in women who smoke.(especially when smoking more than 1/2 pack per day).

8. It is desirable to use metabolically neutral progestogens in HRT(this information is more for doctors)

9. Transdermal forms (external, i.e. gels) are preferable for HRT, they exist in Russia!

10. Psycho-emotional disorders often prevail in menopause(which does not allow one to see a psychogenic illness behind their “mask”). Therefore, HRT can be given for 1 month for trial therapy for the purpose of differential diagnosis with psychogenic diseases (endogenous depression, etc.).

11. In the presence of untreated arterial hypertension, HRT is possible only after stabilization of blood pressure.

12. The appointment of HRT is possible only after the normalization of hypertriglyceridemia **(triglycerides are the second, after cholesterol, "harmful" fats that trigger the process of atherosclerosis. But transdermal (in the form of gels) HRT is possible against the background of an increased level of triglycerides).

13. In 5% of women, menopausal manifestations persist for 25 years after the cessation of the menstrual cycle. For them, HRT is especially important to maintain normal well-being.

14. HRT is not a cure for osteoporosis, it is a prevention.(it should be noted - a cheaper way to prevent than later the cost of treating osteoporosis itself).

15. Weight Gain Often Accompanies Menopause, sometimes it is additionally + 25 kg or more, this is caused by a deficiency of sex hormones and related disorders (insulin resistance, impaired carbohydrate tolerance, decreased insulin production by the pancreas, increased production of cholesterol and triglycerides by the liver). This is called the general word - menopausal metabolic syndrome. Timely prescribed HRT is a way to prevent menopausal metabolic syndrome(provided that it was not there before, before the menopause period!)

16. By the type of menopausal manifestations, it is possible to determine which hormones a woman lacks in the body, even before blood sampling for hormonal analysis. According to these features, menopausal disorders in women are divided into 3 types:

a) Type 1 - only estrogen-deficient: weight is stable, there is no abdominal obesity (at the level of the abdomen), there is no decrease in libido, there is no depression and urinary disorders and muscle mass decrease, but there are menopausal hot flashes, dry mucous membranes (+ dyspariunia), and asymptomatic osteoporosis;

b) Type 2 (only androgen-deficient, depressive) if a woman has a sharp weight gain in the abdomen - abdominal obesity, increased weakness and decreased muscle mass, nocturia - "night urge to go to the toilet", sexual disorders, depression, but no hot flashes and osteoporosis according to densitometry (this is an isolated lack of "male" hormones);

c) type 3, mixed, estrogen-androgen-deficient: if all the previously listed disorders are expressed - hot flashes and urogenital disorders (dyspariunia, dry mucous membranes, etc.), a sharp increase in weight, a decrease in muscle mass, depression, weakness are expressed - then there is not enough both estrogen and testosterone, both are required for HRT.

It cannot be said that one of these types is more favorable than the other.
**Classification based on the materials of Apetov S.S.

17. The question of the possible use of HRT in the complex therapy of stress urinary incontinence in menopause should be decided individually.

18. HRT is used to prevent cartilage degradation and, in some cases, to treat osteoarthritis. An increase in the incidence of osteoarthritis with multiple joint involvement in women after menopause indicates the involvement of female sex hormones in maintaining homeostasis of the articular cartilage and intervertebral discs.

19. Proven benefits of estrogen therapy in relation to cognitive function (memory and attention).

20. Treatment with HRT prevents the development of depression and anxiety., which is often realized with menopause in women predisposed to it (but the effect of this therapy occurs if HRT therapy is started in the first years of menopause, and preferably premenopause).

21. I no longer write about the benefits of HRT for a woman's sexual function, aesthetic (cosmetological) aspects- prevention of "sagging" of the skin of the face and neck, prevention of aggravation of wrinkles, gray hair, loss of teeth (from periodontal disease), etc.

Contraindications to HRT:

Main 3:
1. Breast cancer in history, currently or if it is suspected; in the presence of heredity for breast cancer, a woman needs to do a genetic analysis for the gene of this cancer! And with a high risk of cancer - HRT is no longer discussed.

2. Past or current history of venous thromboembolism (deep vein thrombosis, pulmonary embolism) and current or past history of arterial thromboembolic disease (eg, angina pectoris, myocardial infarction, stroke).

3. Liver diseases in the acute stage.

Additional:
estrogen-dependent malignant tumors, for example, endometrial cancer or if this pathology is suspected;
bleeding from the genital tract of unknown etiology;
untreated endometrial hyperplasia;
uncompensated arterial hypertension;
allergy to active substances or to any of the components of the drug;
cutaneous porphyria;
type 2 diabetes mellitus

Examinations before the appointment of HRT:

History taking (to identify risk factors for HRT): examination, height, weight, BMI, abdominal circumference, blood pressure.

Gynecological examination, sampling of smears for oncocytology, ultrasound of the pelvic organs.

Mammography

Lipidogram, blood sugar, or sugar curve with 75 g of glucose, insulin with HOMA index calculation

Optional (optional):
analysis for FSH, estradiol, TSH, prolactin, total testosterone, 25-OH-vitamin D, ALT, AST, creatinine, coagulogram, CA-125
Densitometry (for osteoporosis), ECG.

Individually - ultrasound of veins and arteries

About the drugs used in HRT.

In women 42-52 years old, with a combination of regular cycles with cycle delays (as a phenomenon of premenopause), who need contraception, do not smoke !!!, you can use not HRT, but contraception - Jess, Logest, Lindinet, Mercilon or Regulon / or the use of an intrauterine system - Mirena (in the absence of contraindications).

Cutaneous etrogens (gels):

Divigel 0.5 and 1 gr 0.1%, Estrogel

Combined E/H preparations for cyclic therapy: Femoston 2/10, 1/10, Kliminorm, Divina, Trisequens

E/G combination preparations for continuous use: Femoston 1/2.5 Conti, Femoston 1/5, Angelique, Klmodien, Indivina, Pauzogest, Klimara, Proginova, Pauzogest, Ovestin

Tibolone

Gestagens: Dufaston, Utrozhestan

Androgens: Androgel, Omnadren-250

Alternative treatments include
herbal preparations: phytoestrogens and phytohormones. There are insufficient data on the long-term safety and efficacy of this therapy.

In some cases, a one-time combination of hormonal HRT and phytoestrogens is possible. (for example, with insufficient relief of hot flashes with one type of HRT).

Women receiving HRT should visit a doctor at least once a year. The first visit is scheduled 3 months after the start of HRT. The doctor will prescribe the necessary examinations for monitoring HRT, taking into account the characteristics of your health!

Important! Message from the site administration about questions on the blog:

Dear readers! By creating this blog, we set ourselves the goal of giving people information on endocrine problems, methods of diagnosis and treatment. And also on related issues: nutrition, physical activity, lifestyle. Its main function is educational.

As part of the blog in response to questions, we cannot provide full-fledged medical consultations, this is due to the lack of information about the patient and the time spent by the doctor in order to study each case. Only general answers are possible on the blog. But we understand that not everywhere there is an opportunity to consult with an endocrinologist at the place of residence, sometimes it is important to get another medical opinion. For such situations, when you need a deeper immersion, the study of medical documents, we have a format of paid correspondence consultations on medical records in our center.

How to do it? In the price list of our center there is a correspondence consultation on medical documentation, costing 1200 rubles. If this amount suits you, you can send to the address [email protected] site scans of medical documents, a video recording, a detailed description, everything that you consider necessary for your problem and questions that you want to get answers to. The doctor will see if it is possible to give a full conclusion and recommendations based on the information provided. If yes, we will send the details, you pay, the doctor will send a conclusion. If, according to the documents provided, it is impossible to give an answer that could be considered as a doctor's consultation, we will send a letter stating that in this case, absentee recommendations or conclusions are not possible, and, of course, we will not take payment.

Sincerely, the administration of the Medical Center "XXI century"

Article from the journal QUALITY CLINICAL PRACTICE No. 4, 2002,
reprint edition

Yu.B. Belousov 1 , O. I. Karpov 2 , V. P. Smetnik 3 , N.V. Toroptsova 4 , D.Yu. Belousov 5 , V.Yu. Grigoriev 5

Risks of hormone replacement therapy

Despite the established and emerging benefits of HRT, estrogen is a potent hormone that causes unwanted side effects in some women, including irregular vaginal bleeding, breast tenderness, fluid retention, headache, and more serious complications such as venous thromboembolism and gallstone disease. Although over the past 15 years the number of contraindications to HRT has decreased, some of them remain. These contraindications are listed in Table. 2 [show] .

Mammary cancer. More than any other aspect of treatment, the fear of breast cancer (BC) repels women from HRT. In the Russian Federation, breast cancer ranks first in the structure of the incidence of women, and its frequency is steadily increasing. In 1980, the incidence of breast cancer was 22.6 per 100 thousand of the population, and in 1996 it was already 34.8, i.e. increased by 1.54 times. The death rate from this form of cancer is constantly increasing. In 1989, 15,658 people died from breast cancer, and in 1996 - 19,843 people. The following figures speak about the dynamics of mortality from this form of oncological pathology: in 1980, mortality from breast cancer was 10.7, and in 1996 - 16.4 per 100 thousand people, thus, mortality increased by 53, 3%.

The stimulatory effect of estrogen on the mammary gland is well documented; studies have shown that estrogen causes proliferation of the epithelium of the mammary gland ducts. However, it is not clear whether there is an association between exogenous estrogen use and the development of breast cancer. Like other aspects of HRT, the relationship with breast cancer has been studied mainly in phenomenological studies on groups of patients.

Conducting HRT is accompanied by an increase in the density of breast tissue - a condition that in vivo is associated with an increased risk of developing breast cancer. According to the authors of the PEPI study, HRT, and especially the combination of estrogen with a progestogen, significantly increases breast density (measured using mammography) in the first year of its implementation. Researchers found this effect in about 8% of women who received estrogen alone and in 19-24% of women who received estrogen with a progestogen. Conversely, placebo-treated women rarely experienced an increase in breast density.

The question of whether HRT really increases the risk of developing breast cancer remains controversial. A large number of studies have found a small but significant increase in the risk of developing breast cancer with the use of a full dose of estrogen (0.625 mg CLE). These studies also showed that the risk of developing breast cancer increases with the duration of treatment. A 1997 reanalysis of the results of 51 epidemiological studies, which collectively involved more than 160,000 women, found an increase in the risk of developing breast cancer by 2.3% for each year of HRT. The 1999 Synthesis Panel on HRT Clinical Data Synthesis Conference concluded that for every thousand women receiving HRT for 10 years after the age of 50, the incidence of breast cancer increases from 45 to 51 cases.

If a woman receiving HRT develops breast cancer, then most often the disease proceeds with mild symptoms and is not very aggressive; the prognosis for patients is relatively favorable. Several large-scale studies have found that women diagnosed with breast cancer who received HRT at the time of diagnosis or earlier were more likely to develop a local tumor with favorable histological characteristics. In comparison, women who did not receive HRT had a higher incidence of fast-growing tumors with damage to the axillary lymph nodes and distant metastases, which is accompanied by a worse prognosis.

Findings from the Nurses' Health Study suggest that while HRT increases the risk of developing breast cancer, it appears to reduce the overall risk of dying from any type of cancer (the relative risk for women who received HRT is 0.71).

Meanwhile, the clinical guidelines of the North American Menopause Society suggest that risk factors for developing breast cancer (eg, family history of breast cancer, early puberty, late menopause) should be considered in the decision to start HRT, and that for women at increased risk of developing breast cancer, the risks of HRT may outweigh the benefits.

Although a history of breast cancer was previously considered a contraindication to HRT, researchers and clinicians are gradually revising this view based on the lack of clear data to suggest an increased risk of recurrence. Now, when deciding to start HRT, the presence of breast cancer in history is considered more of an additional risk factor, and not an absolute contraindication. The Synthesis Panel on HRT Conference in 1999 suggested that women with a history of breast cancer should be cautious about starting HRT.

The WHI study concluded that if 10,000 women took Prempro (estrogen/MPA) therapy for a year and 10,000 did not take it, women in the first group would have 8 more cases of breast cancer, which served as reason to stop the study. There was no increase in deaths from combination therapy for breast cancer or other causes. It is important to understand that these increased risks apply to the entire population of women studied. The increased risk for the individual woman is small. For example, every woman in the estrogen/progestin study had an increased risk of breast cancer of less than 0.1% annually. Women should consult their doctor and weigh the benefits against their personal risk of developing breast cancer. Also, when taking HRT, women should regularly undergo mammography and self-palpation of the mammary glands.

It should be noted that in women (population over 10,000) who took estrogen monotherapy, there was no increase in breast cancer compared to the placebo group, so the WHI study will continue with this group of women until 2005, as originally planned.

Based on current data and expert opinion on menopause issues, pending further results from randomized clinical trials, we believe that the protection against osteoporosis and other beneficial effects of HRT in most women outweigh the possible adverse effects on breast cancer risk.

endometrial cancer. Over the past two decades, there has been a clear trend worldwide towards an increase in the incidence of hormone-dependent tumors, which primarily refers to endometrial cancer (EC). Over the past 5 years, RE has ranked fourth in the structure of the incidence of malignant neoplasms among the female population of Russia, accounting for 6.4-6.5%. At the same time, the increase in standardized incidence rates for this period amounted to 24.2%. Despite the fact that RE is more common in pre- and postmenopausal women (75% of women over the age of 50), the trend of recent years is the rejuvenation of the contingent of patients suffering from this disease. Thus, over a 10-year period (1989-1998), the incidence in the age group up to 29 years increased by 47%. According to MNIOI them. P.A. Herzen, in women under 40 years of age, endometrial adenocarcinoma is detected in 10% of cases. In addition, a significant increase in the incidence of EC is observed in the age groups of 40-49 years (by 12.3%) and 50-56 years (by 15.6%).

Estrogen monotherapy stimulates the uterus and increases the risk of endometrial hyperplasia and cancer.

An international study published in 1999 showed that estrogen replacement monotherapy, whether CLE or estradiol, increases the relative risk of developing EC by 3 times, with this risk increasing by 17% per year, and higher doses cause an even greater risk . This is generally natural without the addition of progestogens with an intact uterus.

The addition of progestogen to the HRT regimen largely prevents the development of endometrial hyperplasia, which avoids an increased risk of cancer. A cross-sectional analysis conducted in 1992 showed that the relative risk of developing EC in women receiving a combination of estrogen with a progestogen for a long time is 1.0, i.e. equal to the risk in women not receiving HRT.

Ovarian cancer. The incidence of ovarian cancer (OC) in the Russian Federation is 12.1 per 100,000 female population, and the mortality rate is 6.6 [121]. In the economically developed countries of Europe and North America, the incidence of ovarian cancer ranks second among malignant tumors of the female genital organs, and mortality is the first, exceeding the corresponding figures for cervical and uterine cancer combined.

A recent meta-analysis of 15 controlled studies did not reveal a significant relationship between HRT and the development of OC, as well as a relationship between the incidence of OC and the duration of estrogen use.

However, in a recent study published July 17, 2002 in the journal JAMA, researchers from the National Cancer Institute (USA) (National Cancer Institute / NCr) found that women using HRT after menopause had an increased risk of development of ovarian cancer.

The researchers followed 44,241 women who took a combination of estrogen and medroxyprogesterone acetate for 20 years. In postmenopausal women, the risk of developing ovarian cancer is 60% greater in those taking HRT (estrogen / MPA) than in women not using hormone replacement therapy. The risk increases with the duration of estrogen use. The study included women who underwent screening mammography between 1973 and 1980. Participants in the Breast Cancer Detection Demonstration Project were recruited from 1979 to 1998. Women who received HRT for 10 years or more had a significantly increased risk of ovarian cancer. The relative risk for women who took HRT from 10 to 19 years was 1.8, i.e. 80% more than women who did not take estrogen. This risk increased in women who took estrogen for 20 years or more, and reached 3.2 (220% more than in women who did not take estrogen).

Two recent large studies have found a link between hormone use and ovarian cancer. A large prospective study found that estrogen use for 10 years or more was associated with an increased risk of dying from ovarian cancer. A recent study in Sweden found evidence that estrogen used alone or with progestin (progestin for 10 days) may be associated with an increased risk of ovarian cancer. In contrast, estrogen/progestin used continuously (progestin for 28 days) did not increase the risk of developing ovarian cancer.

Vaginal bleeding. Vaginal bleeding may be a sign of endometrial cancer or normal endometrial rejection caused by withdrawal of combined estrogen and progestogen. With cyclic combination therapy, progestogen is added in the last 10-14 days of the month; immediately after stopping the progestogen, "bleeding" begins. It is appropriate to note here that there are two modes of taking HRT, depending on the phase of menopause. In perimenopause, including premenopause plus two years after the last menstruation, HRT is prescribed in a cyclic mode (estrogen plus progestogen in the last 10-14 days of the "cycle"). Therefore, cyclic blood discharge at the end of progestogen intake is a natural menstrual-like reaction to the "decline" of hormones in the body. Since the ovaries have not yet "turned off" and fluctuations of endogenous hormones are noted, the appointment of HRT in a cyclic mode helps prevent hyperplastic processes and endometrial cancer. In postmenopausal women (after two years from the last menstruation), women with an intact uterus are prescribed combined HRT in a continuous mode, which avoids fluctuations in hormones and sharply reduces blood discharge, which often occurs in the first three months of taking HRT.

In continuous combination therapy regimens, women take daily small doses of a progestogen. With this scheme, irregular profuse bleeding may appear, especially in the first 3 months. treatment. However, within 6-12 months. in 60-95% of women constantly receiving combined HRT, bleeding stops.

Vaginal bleeding is the second most important reason (after the possible risk of developing breast cancer) for women to refuse to continue HRT. Most women not only consider the absence of menstrual bleeding to be one of the beneficial effects of menopause, but also fear acyclic (as opposed to regular) bleeding as a possible sign of cancer. It is important for a woman to explain the possibility of acyclic blood discharge and, most importantly, HRT is prescribed after an ultrasound that evaluates the thickness of the endometrium (5 mm). However, the appearance of bleeding on the background of HRT after a long period of their absence requires the exclusion of chronic changes in the uterus (polyp, hyperplasia, cancer), including the use of ultrasound, endometrial biopsy and hysteroscopy. Each case of bleeding after a period of its absence requires examination (ultrasound and / or endometrial biopsy).

thromboembolic disease. Phenomenological studies and clinical results of studies have shown an increased risk of developing thromboembolic complications (i.e. deep vein thrombosis and pulmonary embolism) during HRT.

The HERS study included 1380 women who received estrogen plus progesterone and 1383 women who received placebo. During the first year of treatment, the risk of thromboembolic complications in women receiving HRT was 3 times higher than in women receiving placebo. Subsequently, this risk decreased. It is believed that transdermal rather than oral HRT may reduce this risk, although this assumption has not yet been confirmed.

The recently published HERS II study showed that long-term use of HRT leads to the fact that the relative risk of developing venous thromboembolic events may decrease after the second year of hormone therapy (p = 0.08). Decreasing risk over time is likely due to a "blurring" of the sensitive subgroup or the development of tolerance.

The results of the WHI study showed that estrogen/progestin therapy increased the incidence of thrombosis. It has been demonstrated that if 10,000 women took HRT for a year and 10,000 did not take it, women from the first group would have 18 more episodes of thromboembolic complications, including 8 cases of pulmonary embolism.

Surgical operations on the gallbladder. A few years ago, a randomized trial from the Coronary Drug Project found that high-dose estrogen therapy caused gallbladder disease, probably due to changes in bile cholesterol levels, and phenomenological studies of women taking estrogen for the treatment of postmenopausal disorders had similar results. J.A. Simon et al. previously reported a 38% increase in biliary tract surgery in women taking HRT (p = 0.09). The longer follow-up period showed a statistically significant increased risk. The incidence of gallbladder was 3 times greater than that of venous thromboembolism in the HERS study.

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

Hormone therapy - pros and cons

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

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

Mechanisms of hormonal regulation

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

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

Rationale for the need to use HRT

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

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

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

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

The main types of HRT

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

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

Impact on appearance

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

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

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

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

Hormone therapy drugs for menopause

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

Drug regimens

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

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

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