Hormone replacement therapy - abbreviated as HRT - is actively used today in many countries of the world. To prolong their youth and replenish sex hormones lost with age, millions of women abroad choose hormonal therapy for menopause. However, Russian women are still wary of this treatment. Let's try to figure out why this happens.

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

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

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

Myth #1. HRT is not natural

There are hundreds of queries on the Internet on the topic:how to replenish estrogens for a woman after 45-50 years old . No less popular are inquiries about whetherherbal remedies for menopause. Unfortunately, few people know that:

• HRT preparations contain only natural estrogens.
• Today they are obtained by chemical synthesis.
• Synthesized natural estrogens are perceived by the body as their own due to the complete chemical identity of the estrogen produced by the ovaries.

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

Some may argue that herbal preparations are more natural. They contain molecules that are similar in structure to estrogens, and they act on receptors in a similar way. However, their action is far from always effective for relieving the early symptoms of menopause (hot flashes, increased sweating, migraines, horse racing). blood pressure, insomnia, etc.). They also do not protect against the consequences of menopause: obesity, cardiovascular diseases, osteoporosis, osteoarthritis, etc. In addition, their effect on the body (for example, on the liver and mammary glands) is not well understood and medicine cannot vouch for their safety.

Myth #2. HRT is addictive

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

Among the misconceptions about HRT, there are truly crazy myths that we get used to from our very youth.

Myth #3. Mustache will grow from HRT

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

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

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

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

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

When ovarian function declines, female sex hormones (estrogens and progesterone) cease to be replenished, while male sex hormones (androgens) continue to be produced. In addition, they are also produced by the adrenal glands. That's why you shouldn't be surprised that older ladies sometimes need to pluck their mustaches and chin hairs. A HRT preparations absolutely nothing here.

Myth number 4. Get better from HRT

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

Do not forget about the objective reasons for weight gain in women after 45. First: at this age, physical activity noticeably decreases. And second: the influence of hormonal changes. As we already wrote, female sex hormones are produced not only in the ovaries, but also in adipose tissue. During menopause, the body tries to reduce the lack of female sex hormones by producing them in fatty tissues. Fat is deposited in the abdomen, and the figure begins to look like a man's. As you can see, HRT drugs do not play any role in this issue.

Myth number 5. HRT can cause cancer

The fact that taking hormones can provoke cancer is an absolute delusion. There are official data on this topic. According to The World Health Organization, thanks to the use of hormonal contraceptives and their oncoprotective effect, it is possible to prevent about 30 thousand cases annually. oncological diseases. Indeed, estrogen monotherapy increased the risk of endometrial cancer. But such treatment is a thing of the past. Partnew generation HRT drugs includes progestogens that prevent the risk of developing endometrial cancer (the body of the uterus).

With regard to breast cancer, studies on the effect of HRT on its occurrence have been conducted in abundance. This issue has been seriously studied in many countries of the world. Especially in the USA, where HRT drugs began to be used as early as the 50s of the XX century. It has been proven that estrogens - the main component of HRT preparations - are not oncogenes (that is, they do not unblock the gene mechanisms of tumor growth in the cell).

Myth number 6. HRT is bad for the liver and stomach

There is an opinion that a sensitive stomach or liver problems may be a contraindication for HRT. This is wrong. New generation HRT drugs do not irritate the mucous membrane gastrointestinal tract and do not have a toxic effect on the liver. It is necessary to limit the intake of HRT drugs only when there are pronounced liver dysfunctions. And after the onset of remission, it is possible to continue HRT. Also, taking HRT drugs is not contraindicated in women with chronic gastritis or with peptic ulcer stomach and duodenum. Even during seasonal exacerbations, you can take the pills as usual. Of course, simultaneously with therapy prescribed by a gastroenterologist and under the supervision of a gynecologist. For women who are especially worried about their stomach and liver, they produce special forms of HRT preparations for topical use. These can be skin gels, patches, or nasal sprays.

Myth number 7. If there are no symptoms, then HRT is not needed.

Life after menopause not all women immediately aggravated by unpleasant symptoms and a sharp deterioration in well-being. In 10 - 20% of the fair sex, the vegetative system is resistant to hormonal changes and therefore for some time they are spared the most unpleasant manifestations during menopause. If there are no hot flashes, this does not mean at all that you do not need to see a doctor and let the menopause go by itself.

Serious consequences of menopause develop slowly and sometimes completely unnoticed. And when after 2 years or even 5-7 years they begin to appear, it becomes much more difficult to correct them. Here are just a few of them: dry skin and brittle nails; hair loss and bleeding gums; decreased sexual desire and dryness in the vagina; obesity and cardiovascular disease; osteoporosis and osteoarthritis and even senile dementia.

Myth number 8. HRT has many side effects

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

It is important to remember that HRT cannot be carried out independently without medical supervision. In each case, an individual approach and constant monitoring of the results are necessary. Hormone replacement therapy has a specific list of indications and contraindications. Only a doctor after a series of studies will be able tofind the right treatment . When prescribing HRT, the doctor observes the optimal ratio of the principles of "usefulness" and "safety" and calculates at what minimum doses of the drug the maximum result will be achieved with the least risk of side effects.

Myth number 9. HRT is unnatural

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

Hollywood star Sharon Stone turned 58 in 2016 and she is sure that there is nothing unnatural in a woman’s desire to remain young and active as long as possible: “When you are 50, you feel that you have a chance to start life anew: a new career, a new love ... At this age, we know so much about life! You may be tired of what you did for the first half of your life, but that doesn't mean you have to sit back and play golf in your yard now. We are too young for this: 50 is the new 30, a new chapter."

Myth number 10. HRT is an understudied method of treatment

The experience of using HRT abroad is more than half a century, and all this time the technique has been subjected to serious control and detailed study. Gone are the days when endocrinologists, by trial and error, were looking for optimal methods, regimens and dosages of hormonal drugs for menopause. In Russia hormone replacement therapycame only 15-20 years ago. Our compatriots still perceive this method of treatment as little studied, although this is far from being the case. Today we have the opportunity to use already proven and highly effective means with a minimum number of side effects.

HRT with menopause: pros and cons

For the first time HRT preparations for women in menopause began to be used in the United States in the 1940s and 1950s. As the treatment became more and more popular, it turned out that the risk of disease increases during the treatment period. uterus ( endometrial hyperplasia, cancer). After a thorough analysis of the situation, it turned out that the reason was the use of only one ovarian hormone - estrogen. Conclusions were made, and in the 70s, biphasic preparations appeared. They combined estrogens and progesterone in one pill, which inhibited the growth of the endometrium in the uterus.

As a result of further research, information was accumulated about positive changes in a woman's body during hormone replacement therapy. To date known that its positive influence extends beyond menopausal symptoms.HRT for menopauseslows down atrophic changes in the body and becomes an excellent prophylactic in the fight against Alzheimer's disease. It is also important to note the beneficial effects of therapy on the cardiovascular system of women. Against the background of taking HRT drugs, doctors fixed improving lipid metabolism and lowering blood cholesterol levels. All these facts make it possible to use HRT today as a prevention of atherosclerosis and heart attack.

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

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INTERACTIVE

It is extremely important for women to know everything about their health - especially for primary self-diagnosis. This rapid test will allow you to better listen to the state of your body and not miss important signals in order to understand whether you need to contact a specialist and make an appointment.

Hormone replacement therapy in menopause plays an important role in the regulation and pathological changes occurring in the 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 products, estradiol valerate is used as an active substance, which in a woman's body turns into natural estradiol, which exactly imitates 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, of cardio-vascular 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 syndrome in the mammary gland, tumor formations in the endometrium, weight gain, muscle spasms, gastrointestinal problems (diarrhea, gas, 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. He has a pronounced androgenic effect and 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. 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 a gradually increasing therapeutic effect in menopause.

Main contraindications

In the presence of any chronic disease 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 production 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 the 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.

(HRT) for women provides an opportunity to improve the quality of life, but is an interference with the mechanism endocrine system. Understanding the essence of HRT allows you to make the right decision about its necessity.

Hormone replacement therapy for menopause

So, are they needed at all for women after 40 and older? Necessity hormone therapy for women during menopause and the pre-menopausal period in our country continues to be not the most popular way to avoid problems associated with age-related changes. Many gynecologists, and even their patients, are of the opinion that if menopause does not create acute problems, then you can do without such treatment. But there is another point of view supported by practice.

In the West, hormonal preparations for gynecological purposes have been quite actively used for about three decades, significantly helping women to look and feel better. And in order to determine for yourself whose opinion is more correct, you should familiarize yourself with the essence of the processes and actions of HRT in the woman’s body and find out which hormonal drugs should be taken during menopause.

For most people, menopause is its external manifestations. Changes in appearance: the skin becomes dry, less elastic, weight is gained, posture changes. Changes in behavior - irritability increases, the tendency to despondency and depression increases, mood swings become more frequent. Changes in well-being - headaches may become more frequent and intensify, sweating and so-called hot flashes occur, sexual desire decreases. Some women develop urinary incontinence when physical effort or coughing can cause inappropriate urination.

Preservation of a certain state of the body and its normal functioning is provided by a self-regulating hormonal system. It connects the organs of internal secretion, the nervous and cardiovascular systems, the musculoskeletal system. Moreover, all these parts of the body are interdependent - a change in one internal factor cannot leave others unchanged. So, in particular, the hypothalamus produces a certain hormone that causes the anterior pituitary gland to produce another hormone that stimulates the activity of the ovaries. And the estrogens produced by the ovaries, in turn, regulate the activity of the hypothalamus.

Both natural and induced surgical intervention or disease, characterized by the extinction of the reproductive system. The ovaries begin to produce less first progesterone, then estrogen, which affects the state of the body as a whole. A decrease in the content of some hormones necessarily affects the level of others, and so on. It is this period of restructuring that is especially difficult for the body, and the results of the changes most often have a negative effect.

Side effects from HRT

• Deterioration of the condition of the genitourinary system. In addition to involuntary urination, this may be vaginal dryness, which makes it difficult to have sexual contact, and painful urination. Some women suffer from intermittent pain syndrome.
• Climacteric syndrome - sweating and hot flashes, palpitations, instability of the psycho-emotional sphere and blood pressure. As a result, there are pains in the heart, sleep and memory disorders, headaches.
• Metabolic disorders, resulting in a decrease in appetite with an increase in body weight, swelling of the tissues of the face and limbs, as well as a deterioration in the condition of the skin and its appendages. The body's tolerance to glucose may decrease, which is fraught with development.
• Deterioration of the skin, hair, nails. The skin becomes dry and flabby, damage heals worse. Increased hair loss and brittleness. Brittle nails may develop.
• Decreased bone mineral density, leading to bone fragility and osteoporosis (typical of the late period).
• Atherosclerosis - very often progresses in women just after the onset of menopause.
• Cardiac ischemia.
• - an incurable disease caused by the death of the neural systems of the brain and characterized by a deterioration in memory, thinking, will (also characteristic of the late period).

Do I need HRT

Replacement hormone therapy. Photo: promesyachnye.live

Hormone therapy for menopause and menopause is justified by nature itself developing pathologies. Its main goal is to prevent, reduce, or at least reduce disruptions in the functioning of body systems and individual organs. Helps reduce the risk of developing many diseases caused by insufficiency of sex hormones. This will help to avoid the health and well-being problems that are characteristic of the onset of menopause, to avoid or delay the onset of some pathological conditions that are characteristic of old age. In fact, HRT should improve the quality of life during perimenopause and menopause, delay the onset of the senile state. In most cases, it does not increase life expectancy.

In order to confidently determine which hormonal drugs should be taken during menopause and whether it is possible to do without hormone therapy in this case, you should make sure that the woman absolutely calmly endures the onset of menopause. Moreover, in old age, attention should also be paid to possible new changes associated with further hormonal disorders, for example, bone fragility or changes in the psycho-emotional background, intelligence.

Hormones play an important role in a woman's life from the onset of puberty to old age. Therefore, in women, the dependence on the hormonal background is more significant than in men. Each change in hormone levels is fraught with many consequences, sometimes very serious. Therefore, when prescribing HRT, all the pros and cons should be taken into account in the complex and with an eye to future prospects.

At the very beginning, the consequences of taking hormonal drugs in women were not very successful. After reaching the first positive result, such as improving the appearance of well-being, sometimes thrombosis, tumors, and other negative consequences developed.

Over the past decades, pharmacists, in collaboration with gynecologists and other specialists, have developed a more gentle concept of HRT, providing a subtle and individual approach. A certain selection of hormones will even allow you to restore cyclic bleeding, if the state of the uterus allows it, but for women over 40-45 years old this is already undesirable, since it will almost certainly lead to a significant hormonal imbalance.

First of all modern hormonal pills for women have a fairly low dosage of active ingredients, allowing you to smoothly restore close to normal hormonal background. Manufacturers are guided by average indicators, but at the same time they strive to produce hormonal drugs in several types of dosage for various occasions. After all, each woman has her own natural level of hormonal levels, and the effect of hormonal drugs on a woman's body in each case will be somewhat different.

Side effects when using drugs for women after 45

• Taking hormonal drugs for women who smoke is fraught with an increase in platelets in the blood, and this is a serious risk of blood clots and even stroke.
• Increase in body weight. But this does not happen to all women, so it may be the result of incorrectly chosen therapy and the characteristics of the body.
• The risk of development increases when taking estrogen in those who already have such a risk. Therefore, for those women whose uterus has not been removed, it is recommended that estrogens and gestogens be taken simultaneously. The gestogenic component will reduce the risk of developing cancer, though along the way it will also reduce the positive effect of estrogens on the heart.
• An unsuccessfully selected drug or an incorrectly chosen dosage may not balance the hormonal background, but provoke an imbalance, but in the other direction. The result can be a feeling of swelling or pain in the mammary glands, emotional instability, and sleep disturbances.

HRT contraindications. Photo: health-kz.com

• Previously transferred or microstroke,.
• Enhanced Level platelets, thrombosis.
• and kidneys, serious diseases of these organs.
• High levels of triglycerides in the blood.
• Hypertonic disease.
• The presence of oncological formations in the female genital organs, including the mammary glands.
• for the drug.
• Cutaneous porphyria tardive (hepatic porphyria) is a skin pathology characterized by brown pigmentation, blistering of the skin, vulnerability and atrophy of the skin.

Types of HRT

cyclic

It is used mainly in the perimenopausal or postmenopausal period. With regular menstruation and the absence of estrogen-dependent endometrial problems - estrogen + progestogen (for example) daily, starting from the 1st day of the menstrual cycle. With delays in menstruation and healthy endometrium - gestagens (for example) 10-14 days, then starting from the 1st day of the cycle - Femoston or a similar drug. With problems of the endometrium, treatment is necessary, after which a decision is made on the possibility of HRT. It is usually recommended to start with a low dosage, in the absence of a noticeable effect, an increase in dosage is possible. In the absence of menstruation for more than a year and the absence of endometrial problems - estrogen + progestogen from any day. If necessary, a preliminary intake of estrogen + progestogen for 10-14 days can be prescribed.

Monophasic

It is used for women over 50 years old, with an endometrial thickness of less than 4 mm and no problems with the endometrium and bleeding. It is recommended to start after the end of the next cycle of the cyclic mode of HRT. The choice of drug depends on the state of the woman's body and the reaction to previously taken drugs.

It is also worth noting that HRT is often carried out as part of complex therapy symptoms and consequences of menopause. In addition to hormonal drugs, tranquilizers, sleeping pills, antidepressants, and drugs that prevent a decrease in bone density can be prescribed.

If the first scientific work in this area allowed the use of hormone replacement drugs for decades - from the onset of perimenopause to very old age. Now the official point of view is completely different. If the ideal time to start a full-fledged HRT is still considered the first few months, a maximum of the first year and a half from the onset of premenopause, then the duration of therapy is proposed to be limited to about 5 years. To eliminate the so-called hot flashes - from a year to two. For the prevention of osteoporosis and coronary artery disease - up to 5 years. Although some women today have been using HRT for a longer period of time and are generally satisfied with the results. But they absolutely need to constantly monitor the state of the body - check the level of hormones, examine the condition of the genital organs, and possibly periodically do a blood test for the content of tumor markers.

There is also a well-supported opinion that HRT should be started several years after the end of menstruation with even greater caution. But it is quite real.

In any case, the decision to start hormone replacement therapy drugs for women after 45 should only be taken by a doctor after studying the state of health of the woman and taking into account the results of the examination. Every woman planning HRT should be aware that any treatment carries both positive and negative factors, and therapy should be agreed with a clear predominance of benefits over risks.

Important: in no case do not select the drug on your own and without examination! No one can be completely confident in the state of their health and internal organs, in the absence of a predisposition to cancer or thrombosis. HRT - only according to the results of the examination and under regular medical supervision.

How to normalize the hormonal background of a woman with folk remedies

Hormone replacement therapy for women. Photo: naturmedicin-svendborg.dk

Those who continue to be wary of hormonal drugs are interested in how to even out the hormonal background in a woman with folk remedies and how realistic is it? The most relevant are plants that help eliminate the symptoms of menopause. helps to relieve hot flashes, reduce pain, has a calming effect. During perimenopause, oregano tea helps to mitigate hormonal fluctuations. Women who do not suffer from changes in blood pressure can be recommended a decoction of dill seeds, which improves bowel activity, relieves sleep disturbances and hot flashes.

There are also a number of plants containing substances that are similar in composition and effect on the body to hormones produced by healthy female body. The effect of these substances is usually much milder and weaker than the effect of hormonal drugs, however, with regular use, it can help to more easily survive the onset of menopause.

A small list for those who are interested in how to normalize a woman's hormonal background with folk remedies:

1. Red clover containing the phytoestrogen coumestrol and the isoflavones biochanin-A and formononetin.
2. Soy. Contains daidzein and genistein - phytoestrogens from the group of isoflavones, the breakdown of which releases aglycone, which exhibits estrogenic activity similar to that of estradiol.
3. Alfalfa, a relative of red clover, also contains coumestrol and formononetin.
4. Flaxseed contains special phytoestrogens, which are converted in the body into enterodiol and enterolactone, which exhibit estrogenic activity.
5. contains a phytoestrogen from the group of isoflavones - glabridin, which in large doses tends to suppress the development of cancer cells.
6. Red grapes and red wine contain the phytoestrogen resveratrol, which has a strong antioxidant effect.

There are also other folk remedies, facilitating menopause, for example, vegetable juices, some bee products, but their effect is almost always weaker than that of hormonal drugs and less directed.

Menopause is an inevitable phenomenon for women who have crossed the 45-year mark. Aging of the body is a large-scale process in which hormones play a decisive role. Hormone replacement therapy (drugs for women over 45) is a topical method of eliminating physical and psychological discomfort with proven effectiveness.

What is HRT

Balzac's age is characterized by pronounced age-related changes, unpleasant for any woman. These are not only cosmetic problems in the form of deterioration of the skin, hair and nails. Hormonal restructuring of the body observed at this age is characterized by a decrease in the level of hormones secreted by the adrenal glands, depletion of the ovarian follicular reserve, the appearance of osteoporosis, and psycho-emotional instability.

The search for the elixir of youth is a problem that has been relevant for thousands of years. Hormone replacement therapy in the form of drugs for women over 45 is an effective way to prolong youth and maintain quality of life. HRT in women can be seen as a deception of the body, which is no longer able to produce the necessary hormones on its own. How dangerous is the use of hormone replacement therapy for the female body?

The media contain conflicting information about the rationality of the use of hormones.

A negative attitude towards the appointment of HRT drugs appeared due to the following circumstances:

• the risk of interference with the natural aging processes of the body with the risk of hormonal regulation disorders;
• insufficient awareness of the population about the effectiveness and safety of new generation HRT;
• fear of side effects;
• the assumption that synthetic analogs of hormones cannot be dosed without knowing the real need for them in the body;
• fear of developing oncology against the background of the use of hormone replacement agents.

You can understand where the myth is and where the reality is by understanding the mechanism of action of hormones.

To ensure the coordinated work of the body while maintaining a constant internal environment, the hormonal system functions on the principle of feedback between the systems of the body and the brain (pituitary gland, hypothalamus).

The releasing hormone synthesized in the hypothalamus stimulates the production of follicle-stimulating and luteinizing hormones. They, in turn, provoke the production of sex hormones. These include the following:

1. Estrogen. They stimulate the proliferation of the endometrium, the epithelium of the vaginal mucosa, control the growth of the mammary glands, and maintain the elasticity of blood vessels. directly affect the preservation female beauty, skin tenderness.
2. Progesterones. Smooth out the proliferative action of the hormone estrogen. Participate in the preparation of the body for pregnancy or the full course of the menstrual cycle.
3. Androgens. Participate in the synthesis of estrogen, blood and liver proteins, regulate blood glucose levels. These hormones are responsible for sexual desire, aggression, initiative.

The imbalance of hormones observed with age-related changes is provoked by the following factors:

• depletion of the follicular reserve and hormonal dysfunction as a result of aging;
• decreased sensitivity of the hypothalamus to hormones;
• hereditary factor (genetic predisposition);
• violation of the metabolism of hormones in the body;
• surgery, organ removal reproductive system(ovaries, uterus, appendages);
• uncontrolled intake of hormonal drugs.

Indications for the appointment of HRT

Deficiency of sex hormones threatens the development of menopausal symptoms with varying degrees of severity. The most common indications for the appointment of hormone replacement therapy include the following circumstances.

1. Severe menopausal manifestations in the form of hot flashes, chills, hyperhidrosis, palpitations, increased blood pressure, migraine. Vegetative disorders of memory, sleep, depression, decreased libido are typical manifestations of menopause.
2. Removal of the uterus, ovaries, appendages contributes to the onset of artificial menopause. In this case, hormone replacement therapy for women in the form of the latest generation of drugs is vital.
3. Disorders of the genitourinary system in the form of pain during urination, false urges, urinary incontinence, the appearance of dryness and burning in the intimate area.
4. Prolapse of the uterus and vagina as a result of hormonal deficiency.
5. Violation of metabolic processes in organs and tissues (severe swelling due to difficulty in removing fluid from the body, increased blood glucose levels).
6. Structural changes in the epidermis (dryness, peeling, hair loss and brittleness, delamination of the nail plates, the appearance of deep wrinkles).
7. Development systemic diseases endocrine, nervous system (diabetes mellitus, ischemic disease heart disease, myocardial infarction, atherosclerosis, Alzheimer's disease). In this case, a special approach to prescribing the treatment regimen and determining the dosage is required. With a genetic predisposition to osteoporosis, HRT is a necessary protection for bone tissue.

Hormone therapy can be of 2 types:

1. Short-term (3-6 months). Its goal is to eliminate or prevent menopausal syndrome (including those arising from the use of various drugs).
2. Long (5-7 years). It is aimed at preventing the development of late menopausal manifestations against the background of existing systemic diseases.

Preparations

The list of new generation drugs with proven effectiveness includes:

Properly prescribed hormone therapy after removal of the uterus (hysterectomy), fallopian tubes, ovaries is of great importance. Even young women who have undergone surgery feel all the unpleasant moments of menopausal syndrome in the form of autonomic dysfunctions (hot flashes, night sweats, irritability). With a removed uterus, estrogen can be used in its pure form, without worrying about the likelihood of oncology.

Drugs that are indicated for use as hormone replacement therapy after surgery.

Important Aspects

According to the recommendations of the World Health Organization, the appointment of hormone replacement drugs is indicated in the period of premenopause and menopause with severe symptoms and after the cessation of menstruation. If an acceptable level of estrogen is detected during the diagnostic process, then hormone treatment can be delayed for some time. As an alternative, antidepressants, vitamin therapy, and agents that correct autonomic disorders are used.

It is much more difficult to adjust the treatment regimen after the age of 60, since at this age the effectiveness of hormone therapy decreases markedly. For elderly women, an increased content of hormones is dangerous for the body if there are diseases of the liver, kidneys, stomach, and the hematopoietic system.

IN last years homeopathic remedies are very popular. Women prefer to take herbal preparations with the fewest side effects. However, the effectiveness of such a drug is highly questionable. Homeopathic remedies do not give the expected result in violations of the cardiovascular system. They are absolutely not effective in osteoporosis, even in combination with calcium preparations.

Search effective remedy against the background of existing contraindications, it is often difficult even for an experienced specialist. The decision to use hormone replacement drugs after 45 years is an individual decision, which must be agreed with the doctor. Sometimes consulting a gynecologist is not enough. For help, you can turn to an endocrinologist, psychotherapist, oncologist.

The use of any drug presents a certain risk to the body. The search for an effective remedy and the development of an individual treatment regimen is the task of the attending physician.

After the use of hormones, there may be side effects as:

• severe headaches;
• the appearance of puffiness;
• muscle spasms;
• dyskinesia of the gastrointestinal tract;
• rapid fatigue;
• dryness of the intimate area;
• blood clotting disorders.

Like any medicine, hormonal drugs have a list of side effects. This creates the prerequisites for limiting their use.

Contraindications for HRT are as follows:

• bleeding of unknown etiology;
• operated breast cancer;
• malignant tumors or suspicion of them;
• precancerous conditions (dysplasia);
• varicose disease;
• thrombophlebitis, thromboembolism;
• cardiovascular diseases;
• stones in the gallbladder;
• violation of the synthesis of fats in the liver upon ingestion of food (external use is indicated);
• liver damage (hepatitis, cirrhosis);
• rheumatism;
• severe form diabetes;
• kidney failure;
• epilepsy;
• bronchial asthma;
• obesity;
• individual intolerance.

The appointment of hormone replacement therapy should be preceded by a thorough diagnosis of the body. In addition to a gynecological examination, it is imperative to examine the mammary glands. Cytological examination cervical mucus, blood clotting analysis, pregnancy exclusion are also included in the complex of previous diagnostics. Comprehensive examination and appropriate therapy helps to eliminate unpleasant symptoms menopause, preserve the social and sexual activity of women.

Catad_tema Menopausal syndrome and hormone replacement therapy - articles

Modern pharmacological market of hormone replacement therapy drugs

A wide selection of drugs for HRT in the Russian pharmaceutical market makes it possible to rationally use and select the necessary drug in each case. Before prescribing HRT and during treatment, a gynecologist's examination, ultrasound of the genitals, examination of the mammary glands, oncocytology, Pipel endometrial biopsy, measurement of blood pressure, height, body weight, examination of the hemostasis system and lipid spectrum blood, blood sugar, general analysis urine. Contraindications for HRT are: history and current thromboembolic complications, malignant tumors of the endometrium, uterus, breast, severe forms of liver dysfunction and severe diabetes mellitus, vaginal bleeding of unknown etiology. In the first months of HRT treatment, soreness of the mammary glands, in rare cases, nausea, headache, swelling and some other side effects, usually of a transient nature, and do not require discontinuation of the drug. If you experience unusually severe or frequent headaches, visual or hearing problems, the first signs of thrombosis, jaundice, or epileptic seizures, as well as in the event of pregnancy, HRT preparations should be canceled and an appropriate examination should be carried out.

Menopause - the period of the last menstruation, established retrospectively after 12 months of their absence. The age at which natural menopause develops is 45-55 years. However, menopause can occur earlier: after surgery, radiation exposure, etc. Menopause is characterized by estrogen deficiency, which contributes to a sharp increase in the risk of occurrence and progression of various dysfunctional conditions. The clinical symptoms of menopausal disorders depend on the age of the woman and the variant of the onset of menopause, a large role in the development clinical symptoms play hereditary, environmental factors and somatic condition to the period of menopause.

Menopause divides menopause into 2 phases: premenopause (before menopause) and postmenopause (after menopause). The feasibility of conducting HRT in women with the help of steroid sex hormones in the pre- and post-menopausal period is undeniable. However, its effectiveness and safety depend on the individual characteristics of the woman and the correct choice of the drug. The range of hormonal preparations is constantly expanding, as is the scope of indications for their use.

Most epidemiological studies have found that more than 80% of women suffer from certain disorders in the menopause (table 1), but only 10-15% of them seek medical help.

Table 1
The most common menopausal complaints in women aged 45-54 years

As a rule, ovarian dysfunction begins at a relatively early age. As a result, many women, for more than a third of their lives, are forced to endure manifestations of estrogen deficiency, which often overshadows their lives. In almost 90% of women, the estrogen deficiency that accompanies menopause negatively affects their physical condition and leads to an increase in their biological age.

Currently, women have the opportunity to live through the menopause without pathological manifestations or any changes in their lifestyle, remaining young, energetic, sexy and attractive thanks to a number of drugs being introduced into medical practice in the Russian Federation. Treatment and prevention of menopausal disorders includes the use of drugs of sex hormones and non-hormonal agents. Specific hormonal drug should choose a doctor taking into account age features and the concentration of hormones in the blood.

It is generally accepted in the world to use conjugated estrogens, estradiol acetate and valerate, 17-b-estradiol, estriol, estriol succinate and cyproterone acetate for HRT. In the USA, conjugated estrogens are widely used, in European countries - estradiol acetate and valerate. Unlike synthetic ones, the listed estrogens do not have a pronounced effect on the liver, coagulation factors, carbohydrate metabolism, etc., their positive action on the cardiovascular system. The cyclic addition of progestogens to esgrogens for 10-12-14 days is mandatory, which avoids endometrial hyperplasia.

PHARMACOECONOMICS OF HRT

Pharmacoeconomic studies show that long-term use of HRT is more effective in terms of treatment costs than symptomatic treatment of individual manifestations of menopause. Surveys of Japanese women have shown that HRT is more effective in managing menopause than traditional oriental medicine and methods. Horisberber et al. (1993) compared different schemes symptomatic treatment menopause. The authors showed that the most economically advantageous is the use of oral estrogens, which leads to the complete elimination of pathological symptoms. Of the transdermal forms, estradiol gel turned out to be the cheapest and most convenient, which cannot be said about the transdermal patch.

Most pharmacoeconomic assessments assume that menopausal symptoms only indirectly affect the cost of treatment due to their impact on quality of life. However, it has been shown that the use of HRT avoids more than a quarter of all medical prescriptions made to women in the pre- and postmenopausal period.

WOMEN'S READINESS TO RECEIVE HRT

To achieve the full positive effect of HRT, including the prevention of osteoporosis and cardiovascular disease, long-term treatment (about 10 years) is necessary. However, 5-50% of women stop taking HRT during the first year of treatment, with the main reason women refuse therapy being reluctance to return to menstrual bleeding, and the doctor's attitude to HRT is crucial. To obtain the maximum effect from HRT, it is necessary to seek the consent of patients to conduct this type of therapy. Receiving HRT should be preceded by a careful selection of drugs, taking into account the individual requirements of women.

If you do not want to return to the monthly menstrual cycle, women can choose HRT, in which bleeding is observed once every three months. Transdermal therapy may also provide an acceptable bleeding rate.

DESCRIPTION OF INDIVIDUAL DRUGS

Conjugated equine estrogens are obtained from the urine of pregnant mares. They include a mixture: estrone sulfate - 25% and specific equine estrogens: equine sulfate - 25% and dihydroequilin - 15%.

Preparations containing conjugated estrogens include:

Premarin (USA) - 0.625 mg, 20, 40, 60 pieces per pack. The usual dose for cyclic use is 0.625-1.25 mg per day. Alternate reception for 3 weeks with a break of 1 week. In the presence of menstrual-like bleeding, the reception is started from the 5th day of the menstrual cycle, and from the 15th to the 25th day, any progestogen preparation is additionally prescribed.

Hormoplex (Yugoslavia) - dragee 1.25 mg, 20 pcs in a box. It is a mixture of conjugated estrogens (mainly estrone and equilin sulfates). Recommended daily dose 1.25 mg, 20 or 29 days with breaks of 7 days.

Estrofeminal (Germany) - capsules containing 0.3, 0.6 or 1.25 mg of conjugated estrogens. Intended for cyclic treatment at a dose of 0.6-1.25 mg for 21 days with a break of 7 days.

Natural estrogens, depending on the route of administration, are divided into 2 groups: for oral use and parenteral. HRT preparations containing estrogen and progestin are widely used in the world. These include drugs of monophasic, biphasic and triphasic types.

Biphasic type drugs for HRT supplied to the Russian pharmaceutical market include:

Divina (Finland) - calendar pack with 21 tablets: 11 white tablets contain 2 mg estradiol valerate and 10 tablets blue color consisting of 2 mg estradiol valerate and 10 mg medroxyprogesterone acetate. The dosing regimen of this drug, as well as other drugs of the two-phase type, is as follows: 1 tablet daily, starting from the 5th day of the cycle and further along the calendar scale, then a break of 7 days is taken.

Klimonorm (Germany) - a calendar package with 21 tablets: 9 yellow tablets containing 2 mg of estradiol valerate and 12 turquoise tablets, which include 2 mg of estradiol valerate and 0.15 mg of levonorgestrel.

Klimen (Germany) - a calendar package with 21 tablets, of which 11 white tablets contain 2 mg of estradiol valerate, and 10 pink tablets contain 2 mg of estradiol valerag and 1 mg of cyproterone acetate.

Cyclo-progynova (Germany) - a calendar package with 21 tablets, of which 11 white tablets contain 2 mg of estradiol valerate, and 10 light brown tablets contain 2 mg of estradiol valerate and 0.5 mg of norgestrel.

Femoston (Germany) - a calendar package with 28 tablets, of which 14 orange tablets contain 2 mg of estradiol, and 14 yellow tablets contain 2 mg of estradiol and 10 mg of digidogesterone. The drug compensates for the deficiency of sex hormones in the body of a woman, relieves menopausal symptoms during natural menopause, after surgical removal ovaries. Also, the drug is used for the treatment and prevention of osteoporosis in postmenopausal women.

The drug affects lipid metabolism to a much greater extent than other drugs for HRT, normalizes lipid metabolism, significantly reduces the risk of atherosclerosis and other diseases of the cardiovascular system. Femoston does not affect carbohydrate metabolism. Even with prolonged therapy, the drug does not cause thrombosis or thromboembolic disorders. Causes an adequate secretory phase of the endometrium. It improves the quality of life of patients by reducing the number of complaints and objectively detectable menopausal symptoms. Femoston is the base drug for HRT in the presence of diseases of the cardiovascular system.

Divitren (Finland) - a modified drug, a calendar package with 91 tablets: 70 white tablets contain 2 mg of estradiol valerate, 14 blue tablets contain 2 mg of estradiol valerate and 20 mg of progesterone acetate and 7 yellow tablets without active substance (placebo) . The drug is taken continuously, menstrual bleeding occurs only once every three months.

Three-phase preparations for HRT on the pharmacological market of the Russian Federation are represented by Trisequens and Trisequens-forte (Novo Nordisk, Denmark), containing estradiol and norethisterone acetate, which ensure the intake of estradiol throughout the 28 days of the cycle. Due to this, the woman does not experience the recurrence of menopausal symptoms such as hot flashes and night sweats during the menstrual phase of the cycle.

Trisequens - tablets of 28 pieces per pack in the form of a calendar disk: 12 blue tablets containing 2 mg of estradiol, 10 white tablets - 2 mg of estradiol and 1 mg of norethisterone acetate and 6 red tablets - estradiol 1 mg.

Trisequens forte - retard tablets of 28 pieces per pack: 12 yellow tablets - 4 mg of estradiol, 10 white tablets - 4 mg of estradiol and 1 mg of norethisterone acetate and 6 red tablets - 1 mg of estradiol.

Monophasic drugs are more often used in postmenopausal women, and it is recommended to start treatment no earlier than a year after menopause, in a continuous mode, because. they do not cause endometrial proliferation. The absence of menstrual bleeding with these drugs makes them more acceptable to postmenopausal patients. These are drugs such as:

Kliogest (Novo Nordisk, Denmark) - 28 tablets per pack. 1 tablet contains 1 mg of estradiol and 2 mg of norethisterone acetate. This drug also has a beneficial effect on the blood lipid spectrum: it reduces the level of total cholesterol and LDL cholesterol by approximately 20%, without significantly affecting the concentration of HDL cholesterol, and at the same time it is highly effective for the prevention of osteoporosis.

Livial (Netherlands) - in the package of 28 white tablets, consisting of 2.5 mg of tibolone. This drug has estrogenic, progestogenic and weak androgenic activity, relieves menopausal symptoms and helps maintain bone integrity.

Monocomponent preparations for oral administration include:

Proginova (Germany) - a calendar package with 21 white dragees, each of which contains 2 mg of estradiol valerate.

Estrofem (Novo Nordisk, Denmark) - blue tablets of 2 mg, 28 pieces per pack.

Estrofem forte - yellow tablets 4 mg, 28 pieces per pack.

With parenteral administration of drugs, the primary metabolism of estrogens in the liver is excluded, therefore, smaller doses of the drug are required to achieve therapeutic effect compared to oral preparations. With parenteral use of natural estrogens, various routes of administration are used: intramuscular, cutaneous, transdermal and subcutaneous. The use of ointments, suppositories, tablets with estriol allows you to achieve a local effect in urogenital disorders.

Combined drug HRT for intramuscular injection developed and supplied to the Russian Federation from Germany - this is Ginodian-Depot, 1 ml of which contains 200 mg of prasterone enanthate and 4 mg of estradiol valerate in an oil solution. The drug is administered intramuscularly, 1 ml every 4 weeks.

Percutaneous and cutaneous routes of administration of estradiol into the body are possible when using the following drugs :

Estraderm TTS (Switzerland) - active substance: 17-b estradiol. The transdermal therapeutic system is a patch with a contact surface of 5, 10 and 20 cm 2 and a nominal amount of released estradiol of 25, 50 and 100 μg/day, respectively. Plaster 6 pieces per pack. The patch is applied to a clean and dry area of ​​​​the back, abdomen, buttocks or thighs, the places of applications are alternated. Treatment begins with a dose of 50 mcg, the dose is further adjusted depending on the severity of the clinical effect. For maintenance therapy, a patch containing 25 μg of the active substance is usually used. The drug is used cyclically, the treatment is supplemented with gestagens. In the case of hysterectomy, the drug is prescribed continuously.

Klimara (Germany) - is a transdermal therapeutic system in the form of a patch consisting of 3 layers: a translucent polyethylene film, an acrylic area with an adhesive surface containing estriol, a protective polyester tape. The patch with an area of ​​12.5 cm 2 contains 3.9 mg of estradiol. The package contains 4 and 12 pieces.

Klimara-forte (Germany) - a similar patch with an area of ​​​​25 cm 2 contains 7.8 mg of estradiol, in a package of 4 and 12 pieces.

Menorest (USA-Germany) is a transdermal patch containing 17-b-estradiol. Release form: menorest-25, menorest-50, menorest-75, menorest-100. Release per day, respectively, 25, 50, 75, 100 mcg. The dosing regimen is similar when using Estraderm TTS.

Estrogel (Finland) - skin gel containing 0.6-1 mg of estradiol, 80 mg in tubes with a measuring spatula. The gel is applied to any part of the skin (with the exception of the genitals and mammary glands), on the largest possible area. It is used in a continuous or cyclic mode, the dose is set individually, the treatment is supplemented with gestagenic preparations.

Divigel (Finland) - dermal gel containing 500 mcg of estradiol hemihydrate in 1 sachet, 25 sachets per pack. Dosing regimen is similar to estrogel.

For the treatment of local urogenital disorders, the drug Ovestin (Netherlands) is used, which is oral tablets of 30 pieces per pack, containing 1 or 2 mg of estriol; vaginal cream in tubes of 15 g; vaginal suppositories 0.5 mg estriol.

These drugs are indicated for atrophy of the mucous membrane of the lower urinary tract due to estrogen deficiency, for pre- and postoperative treatment in the postmenopausal period during vaginal operations, as well as for diagnostic purposes with unclear results of a vaginal smear.

CONCLUSION

A wide selection of drugs for HRT in the Russian pharmaceutical market makes it possible to rationally use and select the necessary drug in each case. However, it should be remembered that before prescribing HRT and during treatment, a gynecologist's examination, ultrasound of the genitals, examination of the mammary glands, oncocytology, Paypel endometrial biopsy (Paipel Cornier - Pharma med, Canada), measurement of blood pressure, height, body weight, examination of the system hemostasis and lipid spectrum of blood, blood sugar, urinalysis. The first examination by a gynecologist a month after the start of hormone therapy, then after 3 months for 1 year, then 2 times a year.

Contraindications for HRT are: history and current thromboembolic complications, malignant tumors of the endometrium, uterus, breast, severe forms of liver dysfunction and severe diabetes mellitus, vaginal bleeding of unknown etiology.

It should be borne in mind that in the first months of treatment there may be soreness of the mammary glands, in rare cases, nausea, headache, swelling and some other side effects. These symptoms are usually transient and do not require discontinuation of the drug. However, with the appearance of unusually severe, migraine-like or frequent headaches, with visual or hearing impairments, the first signs of thrombosis, the appearance of jaundice or epileptic seizures, the onset of pregnancy, HRT preparations should be discontinued and an appropriate examination should be carried out.

LITERATURE

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THE MODERN PHARMACOLOGICAL MARKET DRUGS of SUBSTITUTIVE HORMONAL THERAPY (SHT)

Syzov D.J., Gurevich K.G., Popkov S.A.
Moscow State University of Medicine and Dentistry

The wide choice of drugs for SHT in the Russian pharmaceutical market enables of rational application and selection of a necessary drug in each concrete case. Before assignment SHT and during treatment the masses of a body, research of the system of a hemostasis and lipide spectrum of a blood, contents of saccharum in a blood, bulk analysis of urine are necessary gunecology survey, research of lactic Ferri lactases, oncocutology, Paypel biopsy of endometrium, measurement a HELL, body height.