Catad_tema Menopausal syndrome and hormone replacement therapy - articles

Modern pharmacological market of hormone replacement therapy drugs

A wide selection of drugs for HRT on 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 blood lipid spectrum, blood sugar, general urine analysis are necessary. 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 can be observed, in rare cases, nausea, headache, swelling and some other side effects, usually of a transient nature, and do not require discontinuation of the drug. With the appearance of unusually strong or frequent headaches, visual or hearing impairments, the first signs of thrombosis, the appearance of jaundice or epileptic seizures, as well as the onset of pregnancy, HRT preparations should be discontinued 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; hereditary, environmental factors and the somatic state by the menopause period play an important role in the development of clinical symptoms.

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. A specific hormonal drug should be selected by a doctor, taking into account age characteristics 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 effect on the cardiovascular system is noted. 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 regimens for the symptomatic treatment of 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 drugs during the first year of treatment, with the main reason for women not taking therapy being the reluctance to return to monthly 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). The recommended daily dose is 1.25 mg, for 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 blue tablets, consisting of 2 mg estradiol valerate and 10 mg medroxyprogesterone acetate. The dosage 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 a woman's body, relieves menopausal symptoms during natural menopause, after surgical removal of the 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 disc: 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 a therapeutic effect compared to drugs for oral use. 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.

The combined preparation of HRT for intramuscular administration was 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 with the use of 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 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 on 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, soreness of the mammary glands, in rare cases, nausea, headache, swelling and some other side effects may be observed. 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

1. Beskrovny S.V., Tkachenko N.N. etc. Skin patch "Estraderm". Mat. 21st Scientific session of the Research Institute of Obstetrics. and gynec. 1992, p. 47.
2. Gurevich K.G., Bulgakov R.V., Aristov A.A., Popkov S.A. Hormone replacement therapy for pre- and postmenopausal disorders. Farmateka, 2001. No. 2. S. 36-39.
3. Popkov S.A. HRT in the correction of functional and metabolic disorders in women with heart disease in menopause. - diss. MD M., 1997. - 247 p.
4. Popkov S.A. (ed.) The use of hormone replacement therapy drugs in clinical practice. In book. Actual problems of clinical railway medicine. M., 1999. S. 308-316.
5. Smetnik V.P. Rationale and principles of HRT in menopause. Problems of reproduction, 1996. No. 3. S. 27-29.
6. Smetnik V.P. Treatment and prevention of climacteric disorders. Wedge. pharmacol. and ter., 1997. No. 6 (2). pp. 86-91.
7. Borgling N.E., Staland B. Oral treatment of menopausal symptoms with natural estrogen. Acta Obst. Gynecol. Scand., 1995. S.43. P.1-11.
8. Cheung A.P., Wreng B.G. A cost-effectiveness analysis of hormone replacement therapy in the menopause. Med J. 1992. V. 152. P. 312-316.
9. Daly E., Roche M et al. HRT: an analysis of benefits, risks and costs. Br. Med. Bull., 1992. V. 42. P. 368-400.
10. Fujino S., Sato K. et al. A qualitative analysis of improvement in symptoms of menopausal diso-ders. Yakuri to Chiryo, 1992. V.20. P.5115-5134.
11. Fujino S., Sato K. et al. The qualitative analysis of estradiol-TTS on the improvement of menopausal disturbances: the quality of live index, based from clinical trials. In: Medical-economic aspects of hormone replacement therapy. N.Y.: Parthenon Publ. Gr., 1993. P. 97-130.
12. Horisberger B., Gessner U., Berger D. Avoiding the consequences of menopause. How and what price? Results of a study on menopausal complaints in Portuguese women. In: Medical-economic aspects of hormone replacement therapy. N.Y.: Parthenon Publ. Gr., 1993. P. 59-96.
13. Tieffenberg J.A. Menopause: socio-economic analysis of hormone replacement therapy. Association for Health Res. Developm., 1993.
14. Tieffenberg J.A. Socio-economic analysis of hormone replacement therapy in postmenopausal women. In: Medical-economic aspects of hormone replacement therapy. N.Y.: Parthenon Publ. Gr., 1993. P. 131-165.
15. Whittingdon R., Faulds D. Hormone replacement therapy. A pharmacoeconomical appraisal of its use in menopausal symptoms and urogenital estrogen deficiency. Pharmacoeconomics, 1994. V. 5. P. 419-445.

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.

The site presents a new column of a recognized beauty expert, the owner of the Jean Louis David salon network Tatyana Rogachenko. Our columnist devoted the last issue to hormone replacement therapy of natural origin. The topic turned out to be so burning for you, dear readers, that Tatyana decided to interview a gynecologist-endocrinologist in order to identify all the pros and cons of this method.

Tatyana Rogachenko decided to once again discuss menopause and hormone therapy

You know, many people in my place after reading the comments would never have written a single article. But I'm not so easy to kick out of the saddle. On the contrary, when I saw your comments, I realized that I need to continue writing in order to eliminate mass illiteracy in matters of at least health.

I am not a doctor. I am a 51 year old woman who is waiting for the X hour. I don’t know where you get the information, but I repeat once again: I don’t have and never had a young husband, I gave birth to children myself - without IVF and surrogate mothers and ... Although we are discussing menopause and hormone therapy, not me and my personal life.

Therefore, I addressed the questions received from you to Vera Efimovna Balan - a gynecologist-endocrinologist, a doctor of the highest category, a doctor of medical sciences, a professor with more than 35 years of experience.

Doctor of Medical Sciences, Professor, President of the Russian Association "Menopause", Head of the outpatient department of the State Budgetary Healthcare Institution of the Moscow Region of the Moscow Region MONIIAG, Vera Balan

Tatyana Rogachenko: Many women believe that HRT "leads" to cancer. Tell us briefly about the pros and cons of this therapy. What side effects can there be during and after the end of taking hormonal drugs?

Vera Balan: Menopausal hormone therapy (MHT) is part of a unified strategy to maintain the quality of life and health of women in pre- and early menopause. When it is appointed, certain rules must be observed.

The indications include:

Vasomotor symptoms (hot flashes) with mood changes and sleep disturbance;
Symptoms of urogenital atrophy, sexual dysfunction;
Prevention and treatment of osteoporosis;
Poor quality of life associated with menopause, including arthralgia (joint pain), muscle pain and memory loss;
Premature and early menopause;
Ovariectomy (removal of the ovaries).

There are absolute contraindications (including breast cancer) and relative (in which the appointment of therapy depends on the competence of the doctor and the desire of the patient). In the first place in women of all European countries and America, mortality from cardiovascular diseases, and not from cancer. In Russia, almost 60% of the fair sex die from stroke and heart attack, and in general, from all types of cancer - 14% (from breast cancer - about 4%).

Before prescribing MHT, a number of examinations are carried out, among them mandatory mammography (breast examination) and ultrasound. Importantly, for every 1,000 women, timely administration of MHT can save 6 lives, prevent heart disease in 8 women, and prevent thrombosis in 5 women.

Prescribing MHT to women in early postmenopause and/or under 60 years of age, both as estrogen monotherapy and combination therapy, reduces overall mortality by 30-52%!

Early prescription and consideration of contraindications is the basis for safety, high efficiency and prevention of cardiovascular diseases, osteoporosis, mental disorders and genitourinary disorders, including urinary incontinence. With properly and individually selected hormone therapy, the risks of complications are minimal.

All drugs in Europe are safer than those taken in America (KEE and medroxyprogesterone acetate, the most unfavorable progestogen for the mammary gland). Combined drugs slightly increase the risk, and estrogen monotherapy, on the contrary, reduces them.

Tatyana Rogachenko is sure that hormone replacement therapy improves overall health, skin and hair, restores muscle tone, and also heals internal organs and resists many age-related changes.

TR: When is it necessary to start HRT and what is the duration of therapy?

V.B.: The optimal time to start MHT is early postmenopause and/or under 60 years of age, or less than 10 years postmenopausal. The debut of MHT after age 60 or after 10 years of menopause increases the risk of stroke.

Continue for 4-5 years, but it is possible until the end of life, especially since microdosed preparations have now appeared (for example, Angelik Micro and Femoston mini). In fact, it all depends on personal preference, if there are no side effects or contraindications.

Of course, this is not an elixir of youth. However, early initiation of therapy can mitigate or delay:

weight gain and development of abdominal obesity
development of insulin resistance
arterial hypertension
lipid metabolism disorder
loss of bone mineral density
cartilage loss
decrease in muscle mass
maintenance of cognitive function
urogenital atrophy

TR: Can a woman get pregnant after 50?

VB: You can drink contraceptives until the age of 55, but not any. After one year of menopause, the probability of pregnancy is not 0. However, this is a completely psychological thing. You believe that you can get pregnant - you believe in your youth. There are hormonal criteria and it is not necessary to go to the point of absurdity. Pregnancy is possible with the help of IVF with a donor egg.

The optimal time to start MHT is early postmenopause and/or under 60 years of age, or less than 10 years of postmenopause

TR: How do you feel about herbal preparations that are sold without a prescription in a pharmacy?

VB: This is an alternative therapy, it is effective only in mild forms, and in severe cases it is useless.

TR: What can you say about Femoston*, which is very popular in Russia?

VB: A good drug for any period of menopause: from a cyclic regimen to "Femoston mini" for deep postmenopause. It contains dydrogesterone, one of the best progestogens close to its own progesterone.

T.R.: What can you say about BHRT (bioidentical hormone therapy), are there specialists in it in Russia?

VB: Bioidentical therapy is not supported by the medical community. It is not known what is mixed, in what dose. I don't think she is safe. I don't know about such experts.

VB: Watch your lifestyle, weight and do not forget about physical activity. When symptoms appear, you need to find a competent specialist and decide on MHT or an alternative.

And then you make your choice and continue to suffer from ebb and flow (the most common symptom) or live a fulfilling life. And believe me, it's better to be seriously puzzled on this topic than to discuss how terrible I look at 51! Because it's just jealousy! And jealousy is not good!

* There are contraindications. It is necessary to read the instructions for use or seek expert advice.

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?

What can a woman do to relieve 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;
• live a healthy life ;
• 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.

What can doctors do?

• 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.

What can family members do?

• 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)

Modern medicine believes that, despite the physiology, menopause should be treated in many women. And the most effective and adequate treatment for hormonal disorders is hormone replacement therapy. That is, the lack of their own sex hormones is compensated by hormonal drugs.

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 due to the fact that 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

Most people are unreasonably afraid of treatment with any hormones, everyone has their own arguments and fears about this. But for many diseases, hormonal treatment is the only way out. The basic principle is that if the body lacks something, it must be replenished by ingestion. So, with a deficiency of vitamins, microelements and other useful substances, a person consciously or even at the subconscious level tries to eat food with a high content of missing substances, or takes dosage forms of vitamins and microelements. It is the same with hormones: if the body does not produce its own hormones for any reason, they must be replenished with foreign hormones, because with any hormonal shift, more than one organ and process in the body suffers.

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. Taking 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 the 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.

Other possible side effects of HRT that are not associated with high doses of estrogen include:

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 agent 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 dietary supplements (BAA).

In most cases, a woman is prescribed multivitamin complexes, which contain all groups of vitamins and basic trace elements at once, and all this is balanced for the daily requirement. The choice of such drugs and biologically active substances is very large, for every taste and budget, they can be in the form of capsules, tablets, syrups, solutions. Some of them designed specifically for women over 40:

• Hypotrilone;
• Doppel Hertz Active Menopause;
• Woman 40 Plus;
• Orthomol Femin;
• Qi-clim;
• Hypotrilone;
• Feminal;
• Estrovel;
• Klimadinon Uno and others.

Vitamins are necessary for a woman in menopause all the time, so they must be used regularly or in courses throughout the entire period of manifestations of menopause.

What vitamins and trace elements are most important during menopause?

1. Vitamin E (tocopherol) - vitamin of youth and beauty. Promotes the production of its own estrogen. It also improves the condition of the skin, hair and nails. In addition to oral intake, vitamin E should be included in skin care products.
2. Vitamin A (retinol) - is also indispensable for any woman. It has many positive effects on the body:

• antioxidant action, frees body tissues from harmful free radicals;
• simulates the ovaries and the production of its own estrogen;
• positive effect on the skin: prevents the development

If you weigh everything correctly, then not prescribing hormone therapy is much more dangerous, he believes. Svetlana K alinchenko, professor, doctor of medical sciences, head of the department of endocrinology, FPK MR RUDN University.

Svetlana Chechilova, AiF:​ I remember that we did the first article with you about male impotence. And today you are engaged in women's issues?

Svetlana Kalinchenko: Indeed, in the beginning, my colleagues and I enthusiastically tackled hormonal balance in men in their prime and beyond. We set a criterion: a healthy man is a person without obesity, with a waist less than 93 cm, he does not suffer from nocturia (does not wake up at night from the urge to go to the toilet), does not experience problems with sleep, does not complain of erectile dysfunction ...

We quickly learned how to make men healthy. But, when the ability to have sex returned to them, their families began to collapse.

- Men began to leave from the same age to the young?

That's exactly what happened. And we understood that next to a healthy man there should be a healthy woman. What does his cousin look like? Obesity, waist more than 80 cm, folds sagging on the back and sides, she sleeps badly, urine leaks during dancing and sneezing, sexual intimacy is not happy ...

But give her estrogen, vitamin D (in fact, it is the most important fat-burning hormone) and testosterone, which are responsible for the quantity and quality of muscle mass, bladder tone and libido, and the problems are solved. Before us is again a beautiful, youthful woman who is still interesting to her partner. A woman's sexuality is much more complex than a man's. Not every woman experiences and should experience an orgasm, but if she once liked the caresses, touches of her partner, she should keep these feelings.

- There are many versions of why a person grows old. Which one do you share?

It seems to me that the endocrine theory of aging is correct, its author is our compatriot Vladimir Dilman. We begin to get sick and grow old, when with age all the glands begin to work with reduced activity and there is a drop in the production of important energy hormones of the thyroid gland, growth hormone, adrenal hormones, sex ...

A century ago, the average life expectancy was 49 years, and today in civilized countries - 80. Thanks to the achievements of medicine, we reach the age of ill health and live in a state of illness for a significant part of our lives. We began to live up to the main disease - deficiency of sex hormones.

- That is, you think that if our body receives a sufficient amount of hormones, then old age can be canceled?

Yes. Decreased production of sex hormones is a key moment of aging. Our life is divided into two periods. First - there are plenty of sex hormones, the body can easily and simply cope with most diseases. The second - after the onset of a deficiency of sex hormones, when diseases become progressive in nature, their irreversible course goes on. Things should be called by their proper names: menopause in women and androgen deficiency in men is an unnatural condition. And any pathological condition must be treated. If the lack of sex hormones is eliminated in time, how many problems can be avoided! Prevent osteoporosis (if the diagnosis is made, alas, the treatment is late), prevent diabetes, obesity, Alzheimer's disease from developing ...

- And how, then, to explain that today diabetes, stroke, heart attack have become younger?

Because very young people eat up obesity, and the bad hormone leptin is formed in adipose tissue. It leads to a decrease in the production of sex hormones. Leptin secretion only increases with age. Obese men and women have a hormonal deficiency early, they age prematurely.

- But many women enter menopause without feeling any problems.

Believe me, there is no healthy menopause. If today a 45-year-old woman has no complaints about her health, about menopausal hot flashes, she does not have excess weight, then all the same, in ten years, illnesses will catch up with her. Women enter menopause in different ways.

Someone feels a lack of estrogen, someone lacks testosterone or vitamin D. Outwardly, this can be seen even with the naked eye. Estrogens are hormones responsible for beauty, so a woman with their deficiency develops wrinkles early. And her peer with a lack of testosterone gains weight, social activity disappears, and sexuality decreases. She is still beautiful, but she does not want to use her attractiveness at all.

Here is my patient's story. Her fate is very common for Russia: at the age of 38, her uterus was removed, but the doctors did not prescribe HRT, because she did not complain about anything. The years went by. The family broke up, the husband left for another woman. Nevertheless, she takes care of herself, practices yoga.

At 42, I finally prescribe HRT to her, but she again goes to other doctors who simply intimidate her: “Look how beautiful you are, you will still be fine, and hormones will trigger obesity and cancer.” At that time, she still had a lot of testosterone, so she did not gain weight, she did not suffer from hot flashes. But very soon the moment came when testosterone began to decline, and the woman's libido disappeared. Then she came back to me. Total - 5 years of inactivity.

Old age has come to the woman, she has no desire to visit, she does not need sex. Wrinkles appeared on the back (the so-called lambrequins), cellulite on the hips, the skin on the arms sagged - there are all signs of a lack of testosterone.

Hormones are vital for hysterectomized women Tens of thousands of post-hysterectomy women who are in menopause die prematurely because they refuse estrogen therapy, years of research confirms. In the 1990s, about 90% of women aged 50 or older who had a hysterectomy took estrogen, and it lasted 4 to 5 years. Doctors noticed that estrogen reduced the risk of osteoporosis and heart disease in these patients. But in 2002, data began to come in about a high incidence of side effects on the background of HRT. As a result, over the next 1.5 years, many doctors stopped prescribing estrogen to postmenopausal women. Recently, researchers at Yale University set out to quantify the number of premature deaths that occurred among women aged 50-59 years who had a hysterectomy after they stopped taking estrogen. Doctors were horrified: over the past 10 years, 48,000 women have died, this study result is published in the American Journal of Public Health.

- Is there any other evidence of age-related endocrine disorders in the body?

Signs of elevated insulin levels can be seen: the skin turns dark - pigmentation is visible on the elbows, neck. Insulin is a bad hormone, it stimulates cell division and triggers malignant neoplasms. When there is a decrease in the production of sex hormones and vitamin D, there is an increase in insulin. But the body does not feel it, so-called insulin resistance develops. Dermatologists of the 19th century knew that serious diseases of the heart and blood vessels, the threat of oncology, were hidden behind the dark staining of the skin, but these were rare cases. Because at that time, only a few people lived to a deficiency of sex hormones and insulin resistance. And there was no vitamin D deficiency at all.

People spent a lot of time in the air, the skin under the influence of ultraviolet synthesized a sufficient amount of vitamin D - this hormone is part of the secretory secretions of the skin. Today, dark elbows are much more common.

When is it necessary to prescribe hormone replacement therapy?

As soon as there was a deficiency, because every day, month, year, lived without hormones, deals an irreversible blow. Atherosclerosis, which has started, can no longer be stopped. HRT, appointed late, will slow down the progression, but it does not guarantee getting rid of the disease. In order not to miss the moment, it is necessary to pass a test to determine not only ovulation, but also the follicle-stimulating hormone, which is produced in the pituitary gland. When a woman's estrogen levels are low, she may still be menstruating, but that doesn't mean she has enough hormones. Therefore, the International Menopause Society recommends that women, starting at age 35, determine the level of follicle-stimulating hormone. And when it rises, it's time to start HRT. This is the concept of the XXI century - preventive medicine. In the world, the deficiency of sex hormones and vitamin D has learned not only to determine and replenish, but also to prevent - to take the necessary steps in advance.

Many women associate estrogen intake with the occurrence of breast cancer, which claims many lives.

There are many fallacies in this statement. In fact, breast cancer is the cause of death in 4% of cases. The leading cause of premature death is cardiovascular disease, which, as I have already explained, is triggered by insulin resistance. And it does not happen without hormonal disorders. That is, if there is arterial hypertension, then you need to look for what is missing: vitamin D, estrogens, gestagens, testosterone ...

As for breast cancer itself, by the time doctors detect it on a mammogram, the disease is over a decade old. Cancer develops very slowly. If suddenly a woman who missed estrogen-sensitive cancer on the mammography window (and today it is a contraindication to HRT), still receives hormones, then the drugs will only help to reveal the existing oncology. She will find herself sooner. And this should be treated well.

- Pretty bold statement. It seems to me that most doctors with this point of view are unlikely to agree.

Alas. But there is such an oncologist-mammologist Chingiz Mustafin, who fully shares my opinion. By the way, here's the real story. The famous writer Lyudmila Ulitskaya was diagnosed with breast cancer. She writes that she took HRT for 10 years: "The hormones gave me youth, beauty, but they also caused cancer." Ulitskaya is wrong. Hormone therapy only showed her cancer, which means it helped the writer: the neoplasm was discovered on time, the operation was performed right there in Israel, Ulitskaya continues to live and write new books.

But if she had not taken HRT, then the cancer would still have manifested itself, but it is not known when. Probably, oncology would have been detected at a different stage. Would an operation help?

But, probably, modern hormones, which are delivered directly to the organ that needs them, reduce the risk of side effects?

Certainly. New low-dose and highly selective drugs are aimed clearly at the target. Doctors for 8 years observed 80 thousand women who received HRT. If the therapy included estrogens, then osteoporosis and oncology did not occur. The risk of cancer was manifested only in women who received the old gestagens. Today there are already unique gestagens, metabolically neutral, they do not lead to obesity and at the same time do not lower testosterone if a woman does not have an excess of it. New treatment regimens have also been developed. If a woman has her uterus removed, pure estrogen should be given to her.

If a woman is no longer menstruating, she should receive both estrogen and progestogen all the time. If a woman is still in the premenopausal period and she periodically has periods, then she needs to take estrogen for 14 days first, and estrogen with progestogen for the next 14 days ...

- Oh, how difficult it is! ..

The selection of HRT is not an easy intellectual task, a woman cannot choose therapy for herself. This is only possible for a very competent doctor. Unfortunately, there are very few of them in Russia. Today, many of our gynecologists still believe that testosterone is a male hormone. And in Europe, patches, gels, testosterone injections have been created for women.

Our doctors, overcome by hormone phobia, do not prescribe HRT to patients also because they do not have their own experience in using this therapy. And in Sweden, for example, in 2011, 87% of gynecologists of the appropriate age received HRT, which is why they prescribed it to more than half of the country's women. Fears pass when a person gains his own experience. And how many of our doctors have tried hormones? counted units. Result: today, as 15 years ago, less than 1% of Russian women receive HRT.

You should know it

2 secrets from Dr. Kalinchenko 1) Osteoporosis is terrible with fractures. But even a person with osteoporosis will not have a fracture until he falls. Therefore, today foreign doctors do not prescribe drugs that cause dizziness to patients. Unfortunately, Russian doctors still prescribe these drugs to patients. 2) Vitamin D cannot be obtained by drinking fish oil. It is a misconception that the required dose can be obtained from food. Vitamin D needs to be supplemented.

- It seems to me that doctors are afraid of hormones, because they burned themselves on the previous contraceptives.

Indeed, all the bad information about hormones was obtained after the use of old contraceptives - excessive doses of estrogens and progestogens. Modern HRT is safe because it only makes up for what is missing. And the more serious health problems a woman has, the more she needs hormones.

I came across dermatological diseases that no one can cure. But, surprisingly, even psoriasis goes away if the patient receives sex hormones and vitamin D.

- Do the patients themselves ask for HRT? After all, they must have read about foreign practice.

Women are poorly informed about HRT. I have been taking hormones myself since the 90s. And I can count on my fingers the rare patients who have since come to me for advice about taking HRT.

- Probably, the rest go to a beauty salon for youth, and not to a gynecologist.

In fact, a good beautician will tell you that you can’t hide your age with Botox alone. We need sex hormones. And cosmetologists, not gynecologists, remain leaders in prescribing HRT. Because as soon as the sex hormones go away, all the numerous procedures that are offered in the salons cease to help. Believe me, Madonna does not look so good because she had plastic surgery. She receives hormone therapy - estrogens, progestogens, testosterone and vitamin D.

Hormone replacement therapy (HRT) is used to balance the levels of estrogen and progesterone in a woman's body during menopause.

HRT is also called hormone therapy or menopausal hormone therapy. This type of treatment eliminates, and other symptoms characteristic of menopause. HRT may also reduce the risk of developing osteoporosis.

Hormone replacement is also used in male hormone therapy and in the treatment of individuals who have undergone sex reassignment surgery.

As part of this article, we will focus on studying information about hormone replacement therapy used to relieve symptoms in women during.

The content of the article:

Fast Facts About Hormone Replacement Therapy

1. Hormone replacement therapy is an effective way to get rid of symptoms and menopause.
2. This type of treatment can reduce the intensity of hot flashes and reduce the risk of osteoporosis.
3. Studies have found a link between HRT and cancer, but this link has not been fully explored at this time.
4. HRT can rejuvenate the skin, but it cannot reverse or slow down the aging process.
5. If a woman is considering using hormone replacement therapy, she should first discuss this with a doctor who is intimately familiar with her medical history.

Benefits of hormone replacement therapy

Menopause can be uncomfortable for a woman and increase health risks, but hormone replacement therapy usually relieves menopausal symptoms and reduces its harmful effects.

Progesterone and estrogen are two important hormones for the female reproductive system.

Estrogen stimulates the release of eggs, and progesterone prepares the uterus for the implantation of one of them.

As the body ages, the number of released eggs naturally decreases.

Along with the decrease in egg production, the volume of estrogen excretion also decreases.

Most women begin to observe these changes in themselves in the second half of the forties. During this period, menopause begins to manifest itself with hot flashes, or other problems.

perimenopause

For some time, women are still observed, although changes are already taking place. This period is called perimenopause, and its duration can be from three to ten years. On average, perimenopause lasts four years.

Menopause

When perimenopause ends, menopause occurs. The average age at which this phenomenon is observed in women is 51 years.

Postmenopause

After 12 months from the time of the last menstruation, a woman enters a period. Symptoms usually last another two to five years, but it can last ten years or more.

Women also have an increased risk of osteoporosis after menopause.

Besides the natural aging process, menopause is also brought about with the removal of both ovaries and cancer treatment.

Smoking also speeds up the onset of menopause.

Consequences of menopause

Changes in hormonal levels can cause severe discomfort and increase health risks.

The effects of menopause include:

• dryness of the vagina;
• decreased bone density or osteoporosis;
• problems with urination;
• hair loss;
• sleep disorders;
• hot flashes and night sweats;
• psychological depression;
• reduced fertility;
• difficulty concentrating and memory;
• breast reduction and accumulation of fat deposits in the abdominal region.

Hormone replacement therapy can reduce or eliminate these symptoms.

Hormone replacement therapy and cancer

Hormone replacement therapy is used to relieve the symptoms of menopause, protect against osteoporosis and diseases of the cardiovascular system.

However, the benefits of this type of treatment were called into question after two studies, the results of which were published in 2002 and 2003. It turned out that HRT is associated with endometrial, breast and ovarian cancer.

This has led many people to stop using this type of treatment, and it is now less widely practiced.

Further studies of this issue called into question the above studies. Critics point out that their results were not unambiguous, and because different combinations of hormones can have different effects, the results did not fully show how dangerous or how safe HRT can be.

In the case of breast cancer, the combination of progesterone and estrogen causes one case per thousand women per year.

More recent research has shown that the benefits of hormone replacement therapy may outweigh the risks, but so far there is no certainty in this regard.

Other studies suggest that hormone replacement therapy is able to:

• improve muscle function;
• reduce the risk of heart failure and heart attacks;
• reduce mortality in young postmenopausal women;
• show efficacy in preventing skin aging in some women and when used with caution.

Currently, it is believed that HRT is not as dangerous for women as previously discussed. The considered type of therapy in many developed countries is officially approved for the treatment of menopausal symptoms, the prevention or treatment of osteoporosis.

However, every woman who is considering using hormone replacement therapy should make such a decision carefully and only after talking with a doctor who understands the individual risks.

More data is needed to understand the association between HRT and cancer, and research is ongoing.

It is important to understand that human aging is a natural process. If hormone replacement therapy is able to protect a woman from some age-related changes, then it cannot prevent aging.

Who should not use HRT?

HRT should not be used in the treatment of women who have a history of:

• uncontrolled hypertension or high blood pressure;
• heavy;
• thrombosis;
• stroke
• heart disease;
• endometrial, ovarian, or breast cancer.

It is now believed that the risk of developing breast cancer increases if hormone replacement therapy is used for more than five years. The risk of stroke and blood clotting problems is not considered high for women aged 50 to 59.

This type of treatment should not be used by women who are pregnant or may become pregnant.

One of the most common misconceptions about hormone replacement therapy is that it causes weight gain. Women often gain weight around menopause, but studies have shown that HRT is not necessarily the cause.

Other possible causes of weight gain are reduced physical activity, redistribution of body fat due to changes in hormonal levels, and increased appetite as a result of falling estrogen levels.

A healthy diet and regular exercise will help keep you in shape.

Types of HRT used in menopause

Hormone replacement therapy is done with pills, patches, creams, or vaginal rings.

HRT involves the use of various combinations of hormones and the intake of various forms of the corresponding drugs.

• Estrogen HRT. It is used for women who do not need progesterone after they have had a hysterectomy where their uterus or uterus and ovaries have been removed.

• Cyclic HRT. It can be used by women who are menstruating and have perimenopausal symptoms. Usually such cycles are carried out monthly with the intake of portions of estrogen and progesterone, which are prescribed at the end of the menstrual cycle for 14 days. Or it could be daily doses of estrogen and progesterone for 14 days every 13 weeks.

• Long-term HRT. Used during postmenopause. The patient has been taking doses of estrogen and progesterone for a long time.

• Local estrogenic HRT. Includes the use of pills, creams and rings. It can help in solving urogenital problems, reduce vaginal dryness and irritation.

How does a patient go through the process of hormone replacement therapy?

The doctor prescribes the smallest possible doses to treat the symptoms. Their quantitative content can be found by trial and error.

Ways to take HRT include:

• creams and gels;
• vaginal rings;
• pills;
• skin applications (plasters).

When treatment is no longer required, the patient gradually stops taking doses.

Alternatives to Hormone Replacement Therapy

Alternative methods for reducing menopausal symptoms include using a ventilator

Women going through perimenopause can use alternative methods to reduce their symptoms.

They include:

• reducing the amount of caffeine, alcohol and spicy foods consumed;
• to give up smoking;
• regular exercise;
• wearing loose clothing;
• sleep in a well-ventilated, cool room;
• using a fan, applying cooling gels and cooling pads.

Some SSRI antidepressants (SSRIs) selective serotonin reuptake inhibitors) help relieve hot flashes. Antihypertensive drugs, clonidine, can also help in this regard.

Ginseng, black cohosh, red clover, soybeans, and intoxicating pepper are believed to be effective for menopausal symptoms. At the same time, reputable health organizations do not recommend regular treatment with herbs or supplements, since no research has established their benefit.

Hormone replacement therapy is an effective treatment for excessive sweating and hot flashes, but before practicing HRT, you should discuss its safety with your doctor.