Hormone replacement therapy drugs. Taking hormonal drugs for menopause: a new generation of HRT

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

Hormone replacement therapy for menopause

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

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

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

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

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

Side effects from HRT

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

Do I need HRT

Replacement hormone therapy. Photo: promesyachnye.live

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

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

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

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

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

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

Side effects when using drugs for women after 45

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

HRT contraindications. Photo: health-kz.com

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

Types of HRT

cyclic

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

Monophasic

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

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

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

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

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

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

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

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

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

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

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

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

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

New generation HRT preparations for menopause are taken under the supervision of a doctor. The main disorders during this period are associated with a deficiency of female sex hormones. HRT with menopause suppress pain.

With such therapy, it is recommended to strive for a minimum dosage of drugs that provide estrogen levels that make women feel better. Therapy quickly relieves the symptoms of menopause. This is a good protection against the development of complications.

New generation HRT drugs for menopause are taken under the supervision of a physician

A hormone replacement complex of drugs during menopause relieves a woman of the signs of menopause, preventing osteoporosis. Therapy is carried out after examination of the patient. During HRT, such diagnostics are carried out annually. During the examination, doctors assess the condition of the genital organs, especially the uterus and mammary glands.

If menopause occurs, the dosage of the medication is reduced. But their reception continues under the strict supervision of a gynecologist. The medicine is selected by the doctor individually. The pharmaceutical market has various drugs for hormonal treatment of menopause. This allows you to make the best choice for every woman. If the patient has a uterus, the doctor prescribes the medicine latest generation, which includes a small dosage of estrogens and progestogens.

During menopause, a woman may be prescribed one of the following two therapies:

• short-term HRT - treatment is aimed at eliminating the symptoms of menopause, not complicated by severe depression, hormonal drugs are taken for 12-24 months;
• long-term - therapy is aimed at eliminating serious changes in the central nervous system, cardiovascular system. HRT lasts 2-4 years, less often - 10 years.

The type of HRT is prescribed taking into account the degree of symptoms and complications. If the patient follows the recommendations of the gynecologist, then she will be able to achieve good results in the shortest possible time. With the help of the latest hormonal preparations, hot flashes, nervous excitations decrease, pain decreases, mucous membranes are restored.

Menopause and hormone replacement therapy (video)

Contraindications for treatment

HRT is not prescribed in the following cases:

• the likelihood of a cancerous process in the mammary glands;
• previous cancer;
• endometrial tumor;
• unknown bleeding;
• endometrial hyperplasia, not previously treated;
• thrombosis formed in a deep vein;
• arterial thrombosis;
• uncontrolled hypertension.

A cured cervical tumor is not a contraindication to HRT. If the patient had cancer, then therapy is carried out a year after the elimination of the disease.

Then the patient is prepared for the upcoming treatment. For this, instrumental and laboratory diagnostics are carried out:

• Ultrasound of the peritoneum, thyroid and mammary glands;
• mammography;
• cervical smear;
• blood pressure control;
• general medical examination.

If the patient has a chronic disease, the doctor selects a therapy directed against the cause of its occurrence. During menopause, it is difficult to cure concomitant pathology, but it is recommended to minimize its effect on the body. After such treatment, HRT begins.

Therapy quickly relieves the symptoms of menopause. This is a good protection against the development of complications.

Medication treatment

If the patient had the uterus removed, she is shown estrogen monotherapy in a constant or cyclic mode. The hormonal agents of the new generation include a gel with estradiol (Divigel, Estrogel) and a patch. The gel is applied to the skin in the buttocks or abdomen daily. If a patch is used, then it is glued to the skin once every 7 days.

If the patient has uterine fibroids, dysfunctional uterine bleeding, monotherapy with gestagens is prescribed. The unique Mirena intrauterine system, presented in the form of a spiral, is more often used.

The patient may be prescribed new generation hormonal drugs such as Duphaston, Utrozhestan, Provera. If the patient has preserved the uterus, there are no pathologies of this organ, HRT is carried out with combined preparations in a cyclic or continuous mode (Femoston, Divina, Angelik, Klimonorm).

The above medicines are taken as prescribed by the attending gynecologist. In this case, the following side effects may be observed:

• weight gain;
• mood swings;
• migraine;
• nausea;
• pain in the abdomen and mammary glands.

Rare events associated with the use of hormonal drugs include:

• vomiting;
• diarrhea;
• edema;
• low sex drive;
• skin rash;
• urticaria;
• breast enlargement.

Less commonly, there is rapid weight loss, increased libido, erythema, and discharge from the chest and vagina. When the above symptoms appear, a doctor's consultation is required. If there are some indications, the doctor cancels the drug, changes the regimen or dosage.

The action of medicines

Since during menopause in the female body there is insufficient production of estrogen, but there is an excess of progesterone, taking new generation hormonal agents helps to normalize the patient's well-being. With the help of HRT, the following signs of pathological menopause are eliminated:

• hot flashes - fever accompanied by sweating, frequent heartbeat, anxiety;
• dryness of mucous membranes - reduced general level sex hormones in the blood, which adversely affects urination and reproduction, the mucous membranes dry out, thinning, this provokes itching in the vagina;
• increased blood pressure is a systematic disorder of the central nervous system, in which mood swings are observed.

Hot flashes are a vivid clinic of pathological menopause associated with a failure in the thermoregulation of the female body by the hypothalamus. A gynecologist can prescribe a woman one or more of the 50 existing names of the latest generation of drugs. These funds are available under various trademarks. Preparations for HRT are divided into groups that differ from each other by the method of administration:

• pills;
• injections;
• suppositories.

The method of administration of a hormonal agent is selected individually. This takes into account the severity of the course of the disease and other personal preferences of the patient. Tablets are more commonly prescribed.

If the patient has a chronic disease, the doctor selects a therapy directed against the cause of its occurrence.

Names of medicines

List of new generation hormonal drugs:

1. Klimonorm - the composition includes estradiol and levonorgestrel. The tool quickly eliminates the symptoms of menopause. Klimonorm is prescribed for artificial menopause after surgery and for dysfunction of the appendages. The drug easily normalizes the cycle. But it is not taken for ectopic bleeding.
2. Norgestrel - reduces the symptoms of menopause. Does not affect the general hormonal background of the female body. The composition includes estradiol valerate, which quickly normalizes the cycle, effectively eliminating the symptoms of pathological menopause. At the same time, Norgestrel treats psychosis and autonomic disorders provoked by menopause.
3. Cyclo-Proginova - effectively reduces libido and increased nervous excitability. At the same time, the mucous membrane of the genitourinary system is moistened. But the medication is not taken during lactation and pregnancy, with ectopic bleeding, hepatic tumor, thrombosis.
4. Klimen - the composition includes valerate, cyproterone acetate, estrogen antiandrogen. The tool has a pronounced histogenic effect. This HRT drug completely restores the deficiency of female hormones in the body. Cyproterone acetate renews the thinned epithelium of the uterus, maintaining the moisture content of the mucous organs of the urinary and reproductive systems. With the help of Klimen, the symptoms of pathological menopause are quickly eliminated. The drug is prescribed to patients after oophorectomy. But it is characterized by such adverse reactions as a sharp weight gain, CNS depression. With HRT Klimen, pain in the epigastric region may appear, gas formation may increase, appetite may increase. Of the adverse reactions, skin rash, allergies, and edema are distinguished. Not accepted during lactation.

To alleviate the condition of a woman during menopause, Femoston is taken. With the help of this tool, the estrogen balance is effectively restored, osteochondrosis and complications in the cardiovascular system are prevented. The medicine is taken until there is no risk of complications. But Femoston is contraindicated for pregnant women and women with cancer.

HRT medicine Climodien is an analogue of estradiol valerate. Against the background of an overdose of the first drug, thrush may develop. Climodien effectively stops the fungus, but contributes to an increase in body weight. If the patient has hypertension, the use of the drug can only aggravate the condition. Against the background of its excessive intake, the frequency of hot flashes increases.

Hormone therapy (video)

Non-hormonal medicines

HRT includes taking pills consisting of phytoestrogens. Plant female hormones are necessary if a woman has contraindications to taking hormonal drugs. Medicines in this group contain a dose of phytohormone, which actively eliminates the symptoms of menopause. There are no negative reactions observed.

The natural non-hormonal drugs included in HRT include:

• Estrovel;
• Qi-Klim;
• Remens.

The above remedies are presented in the form of homeopathic remedies and dietary supplements. They take 3 weeks. Therefore, the course of HRT with non-hormonal drugs lasts longer than when taking hormones.

At the same time, it is recommended to eat foods rich in fiber. In this case, there will be high efficiency HRT. Phytoestrogens act slowly against the signs of menopause, but have a cumulative effect. Therefore, after the end of therapy, the patient does not undergo a “withdrawal syndrome”. In this case, the hormonal level is maintained at the same level. These medications are taken at the dosage prescribed by the doctor. Do not increase or change the dosage. Otherwise, the patient's condition will worsen or serious complications will arise.

Menopause is not a reason to limit normal life. But it is necessary to abandon bad habits, as they increase the risk of osteoporosis and heart disease during menopause. Women during this period should actively rest and move, eat well, without gaining weight. With HRT, in 95% of cases, the symptoms of menopause disappear or decrease.

Minasyan Margarita

Every woman, approaching the threshold of middle age, notices the changes that occur to her. This is due to the fact that by the age of 45, the gradual extinction of the reproductive function begins. This period, called menopause, is characterized, and as a result, by cardinal changes in the work of all systems and organs. At this moment, the body especially needs our support, and often a healthy lifestyle and proper nutrition are indispensable. Medications come to the rescue, which not only eliminate discomfort, but also solve the problem at the root. The most effective and common method in this case is hormone replacement therapy. It is effective on anyone, but it has a number of features and contraindications, so it is not suitable for everyone. What is HRT for menopause and new generation drugs, what are the features of hormonal drugs, you will learn in this article.

Features and indications for the use of HRT

HRT has been successfully used by specialists in menopause for about 20 years. It is widely spread in Europe, while compatriots treat it with some apprehension, trusting more natural remedies, phytohormones or homeopathy.

This kind of therapy is used only after a thorough diagnosis and exclusion of a number of diseases.

Hormone replacement therapy for menopause is based on treatment with substances similar to hormones, in particular, female hormones. During menopause, the endocrine glands reduce the production of hormones such as estrogen and progesterone. Due to their deficiency, the body fails, showing various symptoms. In this case, hormonal substances are introduced from the outside in order to support and eliminate the deficiency of these hormones. Thus, the body does not see much difference and continues to function in its usual mode. Hormone treatment can be short-term, when menopause is not complicated by pronounced disorders (course 1-2 years), and long-term, when serious changes and disturbances in the psycho-emotional state occur, the work of the endocrine glands, the cardiovascular system is affected. In the second case, treatment can last several, up to ten years.

Hormone replacement therapy is used:

1. With standard menopause at all its stages: in premenopause, during menopause to relieve symptoms and prevent the development of cardiovascular diseases, osteoporosis, in postmenopause - to avoid the development of neoplasms and tumors, maintain the body and improve the quality of life.
2. With early menopause to avoid premature stop of reproductive function and normalization of the menstrual cycle.
3. With and removal of the ovaries in order to maintain the hormonal background and avoid the consequences of a sharp restructuring of the body.
4. As a preventive measure age-related diseases and tumors.
5. In some cases, they are used as contraceptives (with a certain combination of hormones).

In the menopause, HRT is prescribed when the following symptoms appear:

• Psycho-emotional disorders in the form climacteric neuroses, sudden mood swings, irritability, stress, apathy, insomnia, drowsiness.
• Atrophy of the genital organs.
• Violations of thermoregulation, manifested by hot flashes, chills, palpitations, a sharp change in temperature, hyperhidrosis.
• Complications in the work of the cardiovascular system: jumps in blood pressure, headaches and heart pain, dizziness, shortness of breath.
• Pain in the lower abdomen, in the lower back, in the limbs.
• Painful bleeding.
• Deterioration in the quality of sexual life, decreased libido, dryness in the vagina and other mucous membranes.
• Circulatory disorders.

Mechanism of action

The mechanism of action of new generation hormonal drugs is due to their composition. They can contain both natural hormones and synthetic ones, and lovers of everything natural will like phytohormones.

These medicines may contain hormones of a certain type, or their combined form.

Some drugs for menopause contain only estrogen. As a rule, the active substance in them is estradiol valerate, which, when ingested, turns into natural estradiol. He, in turn, fully simulates the action of estrogen, helping to avoid psycho-emotional and vegetative menopausal disorders.

Most often, such drugs are found in a combined form, i.e. with the addition of progestogen-like substances, dydrogesterone or levonorgestrel.

The addition of progestogens is very important for such therapy, since they help estrogens to have a sparing effect, preventing tumors (uterine fibroids, endometriosis) from developing due to excessive amounts of estrogen hormones.

A combination of estrogens with androgens can also be used.

In order to choose an effective remedy and not harm the body, you must definitely contact a specialist to diagnose and prescribe a suitable medication in the correct dosage. New generation drugs include microdoses of hormonal substances, but the slightest excess or deficiency in a certain situation can not only harm the body, but also provoke the development of unpleasant diseases.

The normal functioning of the hormonal system is ensured by the coordinated work of three components: the hypothalamus, pituitary gland and ovaries. The first component is responsible for the synthesis of GnRg (gonadotropin-releasing hormone), which promotes the formation of FSH and LH (follicle-stimulating and luteinizing hormones) by the pituitary gland. FSH and LH help the ovaries produce the sex hormones estrogens, progestins, and estrogens. The slightest disruption of this system leads to hormonal “hills” – an overabundance or deficiency of certain hormones, as a result of which the work of the whole organism fails. Hormone replacement therapy for menopause prevents such disorders by maintaining the coordinated work of this system.

Advantages and disadvantages of hormone replacement therapy

Advantages

The main advantage of this type of treatment is its effectiveness. After all, the action is not aimed at temporary relief. discomfort but on solving the problem at the deepest level. Hormonal drugs stop the symptoms of menopause not at the periphery, but at the very root level - the level of hormone synthesis.

New generation drugs involve the use of only substances that are identical to natural hormones. Therefore, the body does not perceive them as foreign substances, and in most cases responds positively to the use of these agents.

Such therapy has complex action and helps to get rid of a number of symptoms, and sometimes even without feeling discomfort even once.

HRT is not only a treatment, but also a prevention of a number of diseases, especially cardiovascular diseases, osteoporosis, and some tumors.

Anticlimacteric medicines that contain hormones are available in various convenient forms, both internal and external. It can be tablets, creams, patches, injections. It is possible to use hormone therapy both in menopause, and in premenopause, and in postmenopause. The sooner you start taking these drugs, the greater the chance to protect yourself from menopausal disorders in the future.

disadvantages

Along with the advantages, hormone replacement has some disadvantages. Hormonal regulation is a very delicate mechanism, intervention in which is fraught with irreversible consequences. That is why it is very important before applying such treatment to undergo complete diagnostics such systems as the gastrointestinal tract, thyroid gland, mammary glands, conduct all kinds of blood tests, incl. on hormones, be sure to take a smear from the cervix, monitor blood pressure for a certain time, and it is also important to take into account heredity.

The hormonal background changes quite quickly, therefore, during the examination and appointment, one scheme for the use of drugs may be relevant, and at the time of the start of the use of drugs, the clinical picture may change radically.

Statistics show that menopausal hormone therapy is used only in 25% of cases due to a number of contraindications and side effects, which is also a significant disadvantage.

• uterine and vaginal bleeding of unknown origin, especially in postmenopausal women;
• tumors of the genital organs and mammary glands or suspicion of them;
• diseases of the uterus and mammary glands;
• kidney and liver diseases;
• renal, adrenal and liver failure;
• thrombosis and thromboembolism;
• lipid metabolism disorders;
• ovarian endometriosis;
• mastopathy;
• diabetes;
• bronchial asthma, epilepsy;
• pregnancy and breastfeeding.

This list is not exhaustive. If you have any other disease, you should consult a doctor before using it, since hormones affect the work of every cell in the body.

Another significant disadvantage of these medications is the many side effects:

• Soreness and enlargement of the mammary glands.
• Neoplasms in the endometrium.
• Weight gain.
• Various allergic manifestations - itching, redness, rashes.
• Spasms in the muscles.
• Gastrointestinal disorders: nausea, vomiting, diarrhea, flatulence.
• Excessive appetite or, conversely, its absence.
• The development of hormone-dependent tumors.

From this we can conclude that before deciding on a substitution hormonal treatment, it is necessary to compare the possible risk with the expected benefit, take into account all contraindications and do not exclude hereditary factor and predispositions.

Preparations

Foreign and domestic manufacturers offer a wide range of HRT preparations. They are presented as complex and mono-means. Experts have provided for the convenience of consumers different forms these medicines: tablets, dragees, injections, hormonal patches, creams, essences.

To combined preparations combining estrogens and progesterones include:

Klimonorm. There are two types of pills. The main active substance of the first tablets is estradiol valerate, the second - levonorgestrel. Klimonorm successfully stops the manifestations of menopause at all its stages.

The combination of estradiol and dydrogesterone. Improves the quality of life in menopause, prevents the development of cardiovascular and bone diseases. There are often discussions about which or Femoston is better. It all depends on clinical picture the patient and her characteristics. Both drugs are effective, have the same contraindications and are in the same price category.

Another famous remedy is Angelique. Contains estradiol and drospirenone. Like Femoston, it is aimed at eliminating the problems that arise during menopause and has a rejuvenating effect. You can get acquainted with the opinion of doctors and, you can follow the link.

Estrogen-only medications are mainly used after hysterectomy. These are tablets such as Triaclim, Estrofem, Estrimax; vaginal suppositories and creams - Estriol (they are usually used without the use of hormonal tablets, as monopreparations); creams for external use - Divigel, Estrogel, Proginova.

Utrozhestan, Norkolut tablets can be attributed to preparations containing only progesterone; . In most cases, such medications are combined with estrogen-containing ones.

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

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

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

falls catastrophically.

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

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

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

Hence the moral: every vegetable has its time

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

Another question is how safe and effective they will be. It is precisely the balance between these two parameters that is the biggest problem of modern pharmaceutical industry and practical medicine: it is not advisable to shoot a sparrow from a cannon or drive an elephant with a slipper, and sometimes it is even very harmful.

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

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

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

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

Combined hormonal agents

Combined hormonal agents and pure estrogens can be prescribed as hormone replacement therapy in menopause. Which drug will be recommended by the doctor depends on many factors. These include:

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

Klimonorm

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

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

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

Femoston 2/10

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

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

Angelique

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

pausegest

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

Cyclo-Proginova

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

Divigel

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

• hypogastrium,
• small of the back,
• shoulders, forearms,
• buttocks.

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

menorest

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

Klimara

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

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

estrogel

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

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

Hormonal background

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

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

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

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

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

Progestins

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

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

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

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

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

• a decrease in androgens automatically reduces the level of collagen in tissues, including the pelvic floor
• impairs muscle tone and leads not only to the loss of a woman’s taut appearance, but also
• problems with urinary incontinence and
• excess weight gain.

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

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

climacteric

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

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

What do you have to fight

perimenopause

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

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

Postmenopause

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

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

Menopausal hormone therapy

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

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

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

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

When to start

Hormone replacement therapy preparations are indicated for:

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

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

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

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

Contraindications

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

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

Estrogens are not indicated for:

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

Progestins

• in case of meningioma

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

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

Application Variations

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

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

Pros:	Minuses:
Estrogen tablets
Just accept. A lot of experience has been accumulated in the application. The drugs are inexpensive. A lot of them. Can go in combination with progestin in one tablet.	Due to the different absorbability, an increased dose of the substance is required. Reduced absorption against the background of diseases of the stomach or intestines. Not indicated for lactase deficiency. Influence the synthesis of proteins by the liver. More contain less effective estrone than estradiol.
Skin gel
Easy to apply. The dose of estradiol is optimally low. The ratio of estradiol and estrone is physiological. Not metabolized in the liver.	Must be applied daily. More than pills. Suction may vary. Progesterone cannot be added to the gel. Less effectively affect the lipid spectrum.
skin patch
Low content of estradiol. Does not affect the liver. Estrogen can be combined with progesterone. There are forms with different dosages. You can quickly stop treatment.	Suction fluctuates. It does not stick well if it is humid or hot. Estradiol in the blood begins to decrease over time.
Injections
May be prescribed for the ineffectiveness of tablets. May be prescribed in patients with arterial hypertension, disorders of carbohydrate metabolism, pathologies gastrointestinal tract, migraines. Provide fast and lossless delivery active substance into the body.	Complications from soft tissue injuries during injections are possible.

There are different tactics for different groups of patients.

One drug containing estrogen or progestin.

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

Combination of estrogen with progestin

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

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

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

Women with premature ovarian failure (premature menopause)

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

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

Pros and cons of HRT

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

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

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

Thrombotic episodes and coagulopathy

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

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

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

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

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

Expected benefit

Pathologies of the heart and blood vessels

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

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

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

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

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

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

Bone thinning (postmenopausal osteoporosis)

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

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

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

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

Menopause is a pretty serious test for a woman. In a very simplified way, the problem can be described as follows: hormonal imbalance is accompanied by a variety of and rather unpleasant symptoms. Hormones have a direct effect on all organs and systems (the body works through neurohumoral regulation). A failure in their well-coordinated work leads to disturbances and responses in the form of hot flashes, insomnia, weakness, fatigue, etc. (more details about the symptoms of menopause can be found in the article "").

Lack of the female sex hormone estrogen causes sudden mood swings, which can lead to nervous breakdowns, stress and even severe depression. Additionally, the psycho-emotional state of women at this age is influenced by external signs natural aging processes, decreased sex drive and attractiveness. It is in order to reduce the severity of symptoms and stabilize the hormonal background that HRT (hormone replacement therapy) is used. Its goal is to compensate for the lack of hormones, the level of which gradually decreases with menopause. This solution allows you to successfully solve a number of problems that women have.

Unfortunately, many women have prejudices and are often afraid or even refuse to take hormones. Their fears are caused by various reasons (negative reviews, possible side effects, etc.). But medicine does not stand still, the new generation perfectly helps to remove negative manifestations. However, they no longer have negative consequences that are usually attributed to them. Accurate information about modern hormone-containing drugs for menopause will help women make the right decision and reduce critical attitudes towards drugs of this type.

What hormones do women need

To understand which hormones you need to take during menopause, consider how it proceeds in terms of hormonal balance. This period is usually divided into several phases:

• (can last from 5 to 10 years);
• (the countdown starts one year after the last menstruation);
• (begins 5 years after the last menstruation and ends at 70-75 years).

The body reacts most sharply in the first two periods of menopause. female hormones gradually cease to be produced by the body. Initially, the regressive process begins in the ovaries, this is facilitated by the depletion of the follicular apparatus. Naturally, the body begins to respond to the lack of progesterone and estrogen, including compensatory reactions. At this point, the pituitary gland begins to intensively produce LH and FSH (luteinizing and follicle-stimulating hormones). Against this background, the sensitivity of hormone-dependent receptors, which also play a role in the normal functioning of the female reproductive system, gradually decreases.

For a while, compensatory mechanisms allow the body to cope with. But the synthesis of sex hormones continues to decline, the increased function of the pituitary gland no longer gives the desired results, and its sensitivity to their hormonal deficiency decreases. At this moment, more obvious and frequent manifestations of the menopause begin: they stop, and the main systems of the body begin to respond to the restructuring of the hormonal background. Symptoms are varied (there are about 30 manifestations of menopause), most often suffer from:

• cardiovascular system (hypertension, rapid pulse, increased risk of heart attacks and strokes);
• nervous system: suffers especially strongly, migraine pains, psycho-emotional instability, etc.;
• endocrine system: manifests itself as age-related weight gain, often leading to obesity, thyroid disease, diabetes mellitus, etc .;
• genitourinary system: in addition to ovarian dysfunction and a decrease in the size of the uterus, hypotension of all muscles is observed, which leads to pain during intercourse (this contributes to a decrease in the volume of secretion in the vagina), accompanied by frequent urge to urinate (subsequently, incontinence is possible), etc.

This is far from complete list symptoms in menopause, causing discomfort to a woman.

The most typical complaints are vasomotor reactions ("hot flashes", and dizziness, etc.) and psycho-emotional reactions. The risk of developing a number of gynecological diseases, especially hormone-dependent ones, increases. Violations of the normal synthesis of hormones increases the risk of oncology. Should appropriate measures be taken in such a situation? Naturally, because the symptoms of menopause, unpleasant in itself, carry a number of threats and contribute to the development of various pathological conditions. HRT in this situation can become the only way take off acute conditions caused by a lack of hormones.

Menopause itself is a natural process, but for each woman it proceeds differently. Hormone replacement therapy is not indicated for everyone, it has a number of contraindications. HRT is not used without a need, and drugs are selected taking into account the characteristics of each patient after a comprehensive examination. But to refuse because of prejudice at a time when hormones are simply necessary for the female body means to risk your own health in the future.

What is hormone replacement therapy and how does it work?

Maintaining a woman's health is the main task of HRT. The balance of hormones is disturbed due to natural causes, but the body's response to such changes can become pathological. Partial compensation for the lack of hormones from the outside - this is HRT, which relieves the severity of symptoms.

Hormone replacement therapy for menopause can be aimed at restoring the level of hormones of the gestagen or estrogen group, they can be prescribed in the form of mono- or complex drugs, contain androgens, etc. That is, the variety of modern medications allows you to choose the most effective tactic in each case.

The change in the hormonal background takes place gradually, a decrease in the activity of the production of one group of hormones during menopause sequentially starts the whole mechanism. As a result, almost the entire organism is involved in the process, responding in one way or another to the changes taking place. The reactions of each woman can proceed in their own way: some calmly survive all periods of menopause, without experiencing any special problems from periodically appearing symptoms. In others, the age-related restructuring of the body proceeds rapidly and sharply. During menopause, a woman should especially carefully monitor her health, this will help to understand in a timely manner when the symptoms are rampant and take action in time.

Does hormone replacement therapy bring benefits to the female body or is it one harm? There is no single opinion on this matter. Many patients have a negative attitude towards the very intake of hormones, believing that it is easier to survive the unpleasant symptoms of menopause. Among doctors, there is also no unambiguous agreement on this issue, but recently HRT has been used more and more often.

The goal of hormone replacement therapy is to help the body cope with the lack of hormones with the least loss. In European countries, HRT has become a standard option for medical care, and is currently being actively used in domestic medicine. In the menopause, HRT is the simplest and most effective method get rid of the unpleasant symptoms of menopause and restore the balance of hormones at the time of body restructuring.

Hormone therapy - pros and cons

For women during menopause, hormone replacement therapy is not always prescribed. There are a number of contraindications in which hormones are strictly prohibited. Doctors' recommendations are based on:

• the general condition of the patient's body;
• severity of symptoms;
• survey results.

This takes into account which hormone the female body needs in a particular period of menopause.

The benefits of using hormonal drugs for menopause are as follows:

• it is possible to compensate for the lack of a particular group of hormones;
• the severity of symptoms is relieved, menopause is less painful;
• the body gets the opportunity to rebuild gradually, without sudden changes in hormone levels;
• aging processes are slowed down;
• HRT is taken under medical supervision, which allows you to adjust the course of treatment as needed;
• drugs are selected individually, taking into account the health status of a particular patient.

Such treatment can be harmful if a woman starts taking hormonal drugs uncontrollably, based on the reviews of friends or her own opinion. The appointment of such medicines a specialized specialist is a prerequisite for successful hormone replacement therapy without side effects and negative consequences.

Do I need to drink hormones during menopause

Drink hormones in any of menopause- This is a completely modern and effective way to relieve unpleasant symptoms and help the body cope with hormonal stress. But this should be done only on the recommendations of doctors and after a comprehensive examination.

The selection of drugs is carried out only after passing tests that show the level of hormones. Symptoms of menopause can manifest as a reaction to all changes in the hormonal background, but it is important to determine which one needs to be replaced. Sometimes combined medicines are required.

Hormones during menopause will help adjust their balance in the body, remove acute manifestations that arise as a response to natural age-related changes. The aging process slows down and is less painful. It should be remembered that one of the typical manifestations of menopause is sharp psycho-emotional reactions. HRT will help to correct these symptoms. That is, women usually only benefit from its use, which allows us to talk about the benefits of such treatment.

Dosing regimen

How to take hormonal drugs during menopause? Only an experienced specialist can solve this issue based on the results of the survey. Presently modern medicine offers two tactics:

• short-term use: with mild menopause, not complicated by acute reactions, therapy can last 1-2 years;
• long-term therapy: treatment can be carried out for 2 to 4 years.

It is important to understand that we are talking about a course of taking drugs, with HRT, one drug can be replaced by another. Correction occurs on the basis of the results of tests for hormone levels. The patient during treatment needs medical supervision, this is how you can achieve the greatest efficiency and minimize any risks.

Indications for HRT

Indications for the use of HRT are a number of symptoms that are especially threatening to the female body. These include:

• surgical menopause;
• the risk of developing cardiovascular diseases;
• hereditary predisposition to osteoporosis, diabetes mellitus, obesity, hypertension and other pathological conditions.

Also, hormones should be taken if menopause causes acute psycho-emotional reactions in order to eliminate the risk of developing neuroses and depressive states.

Contraindications

Menopausal hormone therapy for some pathologies is never prescribed to patients. There are a number of serious diseases that are not compatible with HRT. It is dangerous to prescribe hormones in such cases, so consultation of a specialized specialist and comprehensive examination- a prerequisite for starting HRT.

Contraindications:

• bleeding of unknown etiology;
• estrogen-dependent tumors (benign and malignant);
• oncological diseases;
• some pathologies of the heart and cardiovascular system;
• thrombosis, thromboembolism and blood clotting disorders associated with increased thrombus formation;
• sharp and chronic diseases liver, hepatic and / or renal failure;
• complicated diabetes mellitus;
• a number of autoimmune diseases;
• individual intolerance to drugs containing hormones.

The use of HRT will be useful and safe only if the doctor selects the drugs.

Possible side effects

Hormone replacement therapy for menopause can cause a number of side effects, namely:

• fluid retention in the body (edema, pastosity);
• hypo- or hypersecretion of mucus in the vagina, menstrual-like bleeding;
• increased fatigue, weakness, headaches;
• various reactions from the gastrointestinal tract;
• soreness of the mammary glands;
• muscle spasms;
• seborrhea and acne.

These and other reactions can manifest themselves in a single form or in combination, their appearance requires a visit to a doctor to correct treatment tactics.

The main principles of HRT

Hormones for menopause are prescribed based on the results of the examination. Basic Principles modern therapy are:

• the use of hormonal drugs similar to natural ones;
• low dosages;
• the use of combined drugs to minimize the risks of endometrial hyperplasia;
• the duration of the course, stabilizing the hormonal background.

The choice of HRT funds: types and forms of drugs

Choosing the right therapy is currently not difficult. In addition to a diverse combination of hormones, there is also the opportunity to choose the method of administration:

• tablets, dragees or capsules;
• topical application: gels, suppositories, creams, patches;
• injections;
• subcutaneous implants.

Hormone therapy for surgical menopause

HRT for menopause is prescribed if we are talking about patients who have undergone surgery to remove the uterus. The method of using hormones for:

• women under 51 years of age with the removal of the ovaries and the preserved uterus;
• women over 51 after amputation of the uterus with ovaries;
• after surgical removal endometriosis subject to the risk of recurrence.

Dispelling myths about HRT

Menopausal hormone therapy is often the subject of controversy and fear. Patients refuse HRT, believing that their use can lead to:

• addictive;
• obesity
• complications from the gastrointestinal tract;
• the risk of oncology;
• long-term negative results.

Many also believe that hormonal drugs are poorly researched and contain a large number of synthetic analogues of natural hormones. Modern HRT is a new generation of drugs that contain a minimum amount of hormones, natural and completely identical to women. They need and can be taken, since most of the symptoms are signs of natural processes in menopause. HRT does not enhance, but slows down their development. Medicines undergo preclinical and clinical trials. And the lack of data on long-term results in domestic medicine is compensated by studies abroad, where HRT has been actively used for several decades.

List of HRT drugs

The principles of hormone replacement therapy for menopause allow you to choose the most effective course of treatment for each patient. After 40 years, a woman should prepare for the upcoming restructuring of the body. At this point, regular examination becomes an important and indispensable condition for maintaining the normal functioning of the body. HRT helps to restore the level of hormones, the level of which will inevitably decrease. Even with normal menses it is important to know the concentration of hormones, which will help to use effective drugs for menopause in a timely manner.

As the synthesis function fades, the main symptoms of menopause increase. After consultation and examination, a drug is prescribed, which at the moment will help correct hormonal imbalance. It can be:

• . As the name of this group implies, the composition includes natural analogues of estrogens. These include: Klimadinon, Femicaps,. Each of them is available in the form of tablets and is drunk in a course;
• bioidentical hormones. Combined remedies Janine and Femoston in tablets also help relieve symptoms of menopause. as a derivative of progesterone, it is prescribed for its deficiency and to neutralize the action of estrogen;
• Estrogen containing. Any hormonal remedy of this type contains synthetic estrogen in its composition. Most often use Klimonorm, Premarin, Ovestin;
• Androgenic effect for the prevention and treatment of osteoporosis provides Norkolut, Livial, Tibolone;
• Modern drugs with antiandrogenic effect are represented by Androkur, Klimen, Diane-35;
• The best combined remedies - Triaklim,.

List effective means is not limited to this list, there are also Klimara and Dermestil patches, Divigel hormonal gel, Ovestin suppositories, etc. An alternative form of release (gels, patches or suppositories) is used if topical application is necessary.

Non-hormonal agents

Non-hormonal drugs for menopause as an alternative to HRT are prescribed for individual intolerance or inability to use hormone-containing drugs. According to modern classification, this group includes natural phytoestrogens. They are available in the form of homeopathic remedies and. In addition to the above funds, to replace the missing hormones in menopause, use:

• gels Bonisan, Klimakt Hel;
• tea or drops with Red brush;
• tablets QI-clim, Estrovel;
• capsules , Menopace etc.

How long to drink hormones

Hormones should be taken under the supervision and as prescribed by a doctor, even if we are talking about dietary supplements, herbal remedies or homeopathic remedies. There are several admission schemes designed for several years:

• monotherapy;
• two- and three-phase course;
• combined.

Each medicine has its own timing of administration, some drugs can be replaced by others, which is necessary when the symptoms of menopause change.