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

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

All hormonal drugs are divided into 2 main groups:

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

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

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

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

The positive side of hormone therapy

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

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

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

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

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

Hormone replacement therapy for menopause is an effective method that helps prevent, eliminate or significantly reduce dysfunction of all organ systems and reduce the risk of serious pathological processes occurring against the background of hormonal deficiency.

The main principles of hormone replacement therapy are:

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

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

HRT preparations

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

Klimonorm

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

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

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

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

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

Femoston

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

Together, estradiol and progesterone contribute to:

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

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

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

To obtain the desired result, female hormones in tablets must be drunk, strictly following the treatment regimen, this is the only way to improve overall well-being and delay the onset of old age.

Klimadinon

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

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

Angelique

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

Angeliq is used for:

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

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

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

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

Klimara

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

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

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

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

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

Interesting and informative video

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 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 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

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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.
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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.
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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.

The whole truth about hormone replacement therapy

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

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

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

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

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

So, the main postulates of HRT.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Contraindications to HRT:

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

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

3. Liver diseases in the acute stage.

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

Examinations before the appointment of HRT:

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

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

Mammography

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

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

Individually - ultrasound of veins and arteries

About the drugs used in HRT.

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

Cutaneous etrogens (gels):

Divigel 0.5 and 1 gr 0.1%, Estrogel

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

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

Tibolone

Gestagens: Dufaston, Utrozhestan

Androgens: Androgel, Omnadren-250

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

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

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

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

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

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

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

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

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 takes place. 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 women who have undergone hysterectomy and who are in menopause die prematurely due to the failure of estrogen therapy, many years of research confirm. 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 Society for Menopause 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 hormonophobia-ridden doctors do not prescribe HRT to patients because they do not have their own experience with 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 gestagens. 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.

Despite the fact that menopause is a physiological process, many women need medication to make it easier to survive this period of life. The change in the hormonal background during menopause, which is based on the stoppage of estrogen synthesis, negatively affects the working capacity, appearance, physical health and psycho-emotional state of the lady. Then special drugs can help with menopause.

Specialists prescribe drug therapy to many menopausal women, giving preference to homeopathic remedies, antidepressants, dietary supplements and other drugs that do not contain hormones. The limitation of the use of hormonal drugs is justified by the fact that they have a large number of side effects.

In this topic, we want to tell you how and when experts recommend taking non-hormonal drugs for menopause from hot flashes, depression, fluctuations in blood pressure and other unpleasant symptoms that a woman may experience in this period of life. We will also analyze in what cases and what hormonal preparations a gynecologist can prescribe, as well as how to take them correctly in order to avoid undesirable health consequences.

Hormone replacement therapy for the relief of menopausal symptoms is used by specialists in many European countries, since it has been proven to be highly effective and safe. But domestic gynecologists are afraid to relieve menopause in women with the help of hormone replacement drugs, since they have an impressive list of side effects.

But in the process of clinical observations, European physicians have established a number of conditions to minimize the risk of side effects, namely:

• timely appointment and cancellation of hormonal drugs for menopause;
• indications for hormone therapy;
• the use of microdoses of drugs from which undesirable effects will not appear;
• selection of drugs and its dosage, based on the results of a blood test for sex hormones;
• the appointment of drugs, which include exclusively natural hormones;
• strict adherence by the patient to the recommendations of the attending doctor.

But many patients still refuse hormonal drugs for the following reasons:

• consider the use of hormone therapy unnatural, since menopause is a physiological process;
• do not want to take hormonal drugs, because they consider them unnatural;
• afraid to get better
• afraid of addiction;
• afraid of the appearance of hair in unwanted places;
• think that hormonal agents damage the gastric mucosa;
• It is believed that taking drugs with sex hormones increases the risk of developing malignant neoplasms in the female body.

But these are all just prejudices, because by observing the conditions that we talked about earlier, negative health consequences can be avoided.

Thus, if the body lacks its own sex hormones, then it needs foreign hormones, since hormonal imbalance leads to disruption of the work of all organs and systems.

Indications for the use of hormonal drugs for menopause

Hormonal drugs are prescribed in the following situations:

• pathological menopause, which developed as a result of the removal of the uterus, the use of chemotherapeutic agents or radiation treatment;
• menopause in women under 40;
• too pronounced signs of menopause;
• the development of complications and diseases that appeared against the background of menopause (hypertension, atherosclerosis, polycystic ovaries, dryness of the vaginal mucosa, urinary incontinence, and others);
• the desire of the patient to eliminate unpleasant symptoms.

Hormonal drugs for menopause in women: side effects and contraindications

• increased fatigue;
• emotional lability;
• swelling;
• weight gain;
• flatulence;
• mastopathy;
• breast tumors;
• severe symptoms of premenstrual syndrome;
• painful menstruation;
• anovulatory menstrual cycle;
• the development of benign tumors in the uterus and appendages;
• uterine bleeding;
• increased risk.

Proper selection of the dose, strict adherence to the appointments of a specialist, the regularity of administration and the combination of estrogens with allows you to avoid the above side effects.

Absolute contraindications to hormonal drugs are the following conditions:

• allergy to the components of the hormonal drug;
• malignant neoplasms of the mammary glands and female genital organs, including a history;
• metrorrhagia;
• thrombophilia;
• stroke;
• myocardial infarction;
• varicose veins and blood clots in the veins of the lower extremities;
• increased blood coagulation;
• hypertension of the third stage;
• severe liver disease (cirrhosis, liver failure, hepatitis);
• autoimmune diseases (scleroderma, systemic lupus erythematosus and others).

Relative contraindications include:

• endometriosis;
• uterine fibroids;
• migraine;
• epilepsy;
• precancerous diseases of the uterus and mammary glands;
• calculous cholecystitis and cholelithiasis.

The best drugs for menopause: list, description, price

The best reviews of gynecologists and patients about the latest generation of combined hormonal drugs that contain both estrogen and progesterone.

HRT for menopause includes new generation drugs:

• Angelica - 1300 rubles;
• Klimen - 1280 rubles;
• Femoston - 940 rubles;
• Kliminorm - 850 rubles;
• Divina - 760 rubles;
• Ovidon - the drug is not yet commercially available;
• Climodien - 2500 rubles;
• Activel - the drug is not commercially available;
• Cliogest - 1780 rubles.

The listed drugs perform the following tasks:

• eliminate anxiety, improve mood, activate memory and improve sleep;
• increase the tone of the muscles of the sphincter of the bladder;
• retain calcium in bone tissue;
• prevent the development of periodontal disease;
• restore the endometrium;
• eliminate dryness of the mucous membranes of the genital organs;
• normalize blood cholesterol levels.

These drugs are available in the form of pills and tablets. One blister, where each tablet is numbered, is enough for 21 days of admission. After the woman takes the last pill, you need to take a break for seven days and only then proceed to a new blister. Each tablet has its own dose of hormones, which corresponds to the day of the cycle.

Femoston, Activel, Cliogest, as well as Angeliq are available in 28 tablets in a blister, seven of which are pacifiers, that is, they do not contain hormones.

Estrogens

Preparations that contain only estrogen in their composition are produced mainly in the form of gels, creams, patches or implants that are placed under the skin of a woman.

The following gels and ointments with estrogens are the most effective for menopause:

• Divigel - 620 rubles;
• Estrogel - 780 rubles;
• Octodiol - the drug is not commercially available;
• Menorest - the drug is not commercially available;
• Proginova - 590 rubles.

Among the estrogen patches, they showed themselves well, such as:

• Estraderm - the drug is not commercially available;
• Alora - 250 rubles;
• Klimara - 1214 rubles;
• Estramon - 5260 rubles;
• Menostar.

Gels and ointments are quite convenient to use, as they only need to be applied once a day to the skin of the shoulders, abdomen, or lower back.

Hormonal patches are an even more convenient dosage form, since they need to be changed once every seven days.

The implants, which are sewn under the skin, last for six months, releasing a small dose of estrogen into the blood every day.

Gels, ointments, creams, patches and implants have a number of advantages over oral or injectable forms of hormonal agents, namely:

• ease of dosage selection;
• the gradual penetration of estrogen into the blood;
• the hormone enters directly into the bloodstream without passing through the liver;
• maintaining a balance of different types of estrogen;
• minimal risk of side effects;
• can be used even if there are contraindications to the appointment of estrogens.

Progestins

To avoid the development of side effects, estrogens are prescribed in combination with progesterone. But if the uterus was extirpated, then the patient is shown estrogen monotherapy.

Progesterone preparations are mainly prescribed from the 14th to the 25th day of the menstrual cycle.

There are many progestins on the modern pharmaceutical market, but a number of drugs have the best performance.

1. Tablets and dragees:

• Duphaston - 550 rubles;
• Utrozhestan - 4302 rubles;
• Norkolut - 130 rubles;
• Iprozhin - 380 rubles.

1. Gels and vaginal suppositories:

• Utrozhestan;
• Crinon - 2450 rubles;
• Progestogel - 900 rubles;
• Prajisan - 260 rubles;
• progesterone gel.

1. Intrauterine hormonal systems:

• Mirena - 12500 rubles.

Recently, specialists and patients prefer the Mirena intrauterine device, which is not only a contraceptive, but also contains progesterone and gradually releases it into the uterus.

Instructions for the use of hormonal drugs

The choice of a hormone therapy regimen, the selection of the drug and its dosage should be handled exclusively by a gynecologist. Medicines are prescribed based on the results of a study of the hormonal background of a woman, as well as taking into account the state of health in general. Self-treatment can lead to irreversible consequences!

Treatment of menopause begins when the first signs of a lack of sex hormones appear. The duration of treatment depends on the severity of menopause symptoms and can take from one to three years, and sometimes up to ten years.

Most experts believe that taking hormonal drugs should be stopped by the age of sixty, since cancer can develop.

Rules for taking hormonal drugs:

• vaginal suppositories and tablets should be taken at the same time of day, as directed by your doctor.
• basically, all hormones are prescribed daily or cyclically, that is, 21 days with seven-day breaks;
• if the patient forgot to take the drug, then the usual dose should be taken within the next 12 hours, and the next pill at the appointed time;
• it is strictly forbidden to independently change the dose of the drug or the drug itself;
• you can not take the hormone for life;
• during hormone therapy, you need to regularly visit a gynecologist - once every six months.

Treatment of menopause with non-hormonal drugs

Expert opinions on the advisability of hormone therapy today differ. In addition, many women refuse to take hormone-containing drugs because they are afraid of their side effects, do not have the financial ability to constantly buy them, or for other reasons.

In such cases, you can use the treatment of menopause without hormones, which consists in the use of phytohormones, homeopathic medicines, dietary supplements, etc.

Homeopathic remedies for menopause

Homeopathy for menopause is very popular. The basis of the effect of homeopathic remedies is the activation of the natural mechanisms of the body. Patients are prescribed small doses of substances that, in large doses, can lead to negative consequences.

Homeopathic remedies will help eliminate menopause symptoms such as:

• hyperhidrosis (excessive sweating);
• menopausal vertigo (dizziness);
• hot flashes during menopause;
• dryness of the mucous membranes of the vagina;
• mood swings;
• and others.

The benefits of homeopathy for menopause include the following:

• natural origin of the components;
• relatively low cost;
• there are practically no side effects, only an allergy to the components of the product;
• safety of use in the elderly.

Consider the most effective homeopathic remedies used for menopause.

• Remens - 580 rubles. The drug consists of soy phytohormones, which activate the synthesis of sex hormones at the level of the hypothalamus and pituitary gland. Remens effectively relieves a woman of hot flashes during menopause and prevents the appearance of vaginitis. In addition, with the help of Remens, you can prevent urinary incontinence and cystitis during menopause.
• Estrovel - 385 rubles. This preparation contains phytoestrogens of soy and wild yam, as well as a complex of vitamins and microelements. Estrovel allows you to reduce the number and reduce the intensity of hot flashes and sweating.
• Feminal - 670 rubles. This preparation contains liquid extracts of nettle, oregano, celandine, hawthorn, shepherd's purse herb, centaury, St. John's wort, thyme, celandine and calendula. Feminal helps to get rid of hot flashes, excessive sweating, emotional lability and dizziness during menopause, and women do not get better from this medicine.
• Climaxin - 120 rubles. This remedy consists of sepia, lachesis and cimicifuga. The action of Climaxin is mainly aimed at regulating vegetative-vascular disorders (insomnia, irritability, palpitations, excessive sweating, dizziness) during menopause.
• Klimakt-Hel - 400 rubles. This drug perfectly eliminates the symptoms caused by menopause.

Preparations for menopause of plant origin

Herbal preparations for menopause contain phytoestrogens - substances that can perform the function of female sex hormones and eliminate the symptoms of aging in the female body.

Plant estrogens are analogues of female sex hormones derived from soy products. For example, the innovative Italian formula Flavia Night contains phytoestrogens - genistein and daidzein, which have a mild replacement effect during menopause and menopause and help a woman cope with hot flashes, sweating and poor health.

Flavia Night also contains melatonin for normal sleep, vitamin D and calcium for bone strengthening, vitamins B6, B9 and B12 for normal metabolism and alpha-linolenic acid for antioxidant protection.

Flavia Night is a unique Italian formula designed specifically for active women who want to lead a vibrant life and not experience menopause symptoms. Just one capsule at bedtime will help a woman get through this difficult time. Flavia Night - works while you rest.

Another effective and popular drug for menopause symptoms is Inoklim, which is a biological supplement based on phytoestrogens.

Inoklim effectively fights such menopausal symptoms as a feeling of heat in the body, dryness of the vagina, increased sweating, and also prevents the development of complications.

The drug has practically no contraindications and side effects. Inoklim is not prescribed only for those who are allergic to the substances that make up its composition.

Thus, we have analyzed what drugs to take with menopause in order to alleviate its symptoms. But drug therapy can and should be supplemented with proper and balanced nutrition, drinking enough fluids, playing sports, taking vitamin and mineral complexes. Also, do not forget about the positive emotions that communication with loved ones, hobbies or needlework can give you.

Watch a video about drugs for menopause.