Hormone therapy pros and cons. Hormone therapy for menopause. Should I Prepare for Hormone Replacement Therapy?

Climax, even with a mild course, is perceived as a necessary evil. The state of health worsens, and in different directions, disturbing thoughts visit more often. But few people try to fight this with the help of drugs, or women, due to incompetence, choose the wrong means themselves.

Meanwhile, menopausal hormone therapy can work wonders, turning an elderly, tired woman into a healthy and full of strength.

Read in this article

Why is HRT needed?

Many women have a prejudice against menopausal hormone therapy that its harm far outweighs the positive effect. Fears are groundless, the body has been functioning for many years, thanks to these components. They ensured a normal metabolism, the operation of all systems. Rather, it serves to cause disease, ultimately leading to premature old age and even death.

This does not mean that analogues of substances can be taken independently and uncontrolled. In each case, the choice should be based on a variety of body parameters of a particular woman. It also depends on the stage.

In postmenopause, that is, a year from the last menstruation and later, other means are needed than in its initial phase. The final stage of menopause can be described using several features:

• The work of the cardiovascular system worsens. Blood does not circulate as actively throughout the body, becoming more viscous. Vessels are less elastic, deposits appear on them. Hot flashes provoke heart failure, bringing the likelihood of a heart attack and stroke closer;
• Arises. Vegetative-vascular disorders caused by the disappearance of the influence of sex hormones lead to increased neuro-psychological excitability, rapid fatigue. Hot flashes also interfere with sleep;
• Atrophic processes of the genital and urinary organs develop, manifested by discomfort, burning of the mucous membrane, and itching. This provokes an inflammatory and infectious nature, as well as problems with urination,;
• Increased risk of injury and fracture due to (weakening bone tissue as a result of loss), changes in the joints are noticed.

This is the general list of manifestations that the menopause “bestows”. At this age, individual symptoms may also be detected.

But even with their minimal presence, postmenopausal HRT improves well-being and quality of life, prolonging it. Drugs for menopause:

• They normalize the lipid spectrum of the blood no worse than the statins intended for this;
• Reduce the risk of cardiovascular disease by 30%;
• Have a positive effect on carbohydrate metabolism;
• Prevents the destruction of bones.

In a word, hormone therapy is one of the main methods.

Is it shown to everyone?

The funds used for HRT are based on estrogens, progesterone, or only the first substance. They affect the body in a complex way. Estrogens allow the endometrium to grow, progesterone reduces this effect.

In some diseases, the struggle of hormones can lead to the development of ailments. Therefore, HRT is not prescribed if diagnosed:

• Acute hepatitis;
• Thrombosis;
• Tumors of the mammary glands or reproductive organs;
• Meningioma.

What to do before taking hormonal drugs?

Given the contraindications and possible unexpected manifestations, menopausal hormone therapy, which is necessary for protection against diseases, is prescribed only according to the results of the examination. It should include:

• Ultrasound of the reproductive organs;
• Blood test for biochemistry;
• A study on oncocytology of material taken from the cervix;
• Breast ultrasound and mammography;
• The study of hormonal status with the detection of the concentration of TSH, FSH, estradiol, prolactin, glucose;
• Blood clotting test.

In addition to these studies, which are mandatory for all studies, it is advisable for some to conduct:

• Lipidogram, that is, an analysis of cholesterol;
• Densitometry, which measures bone density.

Features of HRT at the final stage of menopause

Hormone replacement therapy in postmenopausal women is prescribed not only taking into account the existing symptoms of the condition that need to be stopped, and potential threats. Important features of the female body, such as the presence of reproductive organs.

If the uterus is preserved, when exposed to estrogen-containing drugs, the mucosa is likely to grow, that is, creating a danger and endometrial cancer. Therefore, in this case, the doctor will give preference to drugs with progestins and androgens in order to remove the threat. For some women, the uterus is removed if processes dangerous to health occur in it. Hormone replacement therapy under these conditions will be estrogen.

The timing of treatment depends on what signs of menopause or probable ones need to be eliminated. Palpitations, hot flashes will take less time to use drugs. For the prevention and treatment of osteoporosis will need more long treatment. Stopping it on your own is just as dangerous as starting it.

Extension beyond the required period, excess dosages are fraught with an increased risk of tumor formation, thrombosis, heart attack, stroke. Therefore, the entire process of therapy is accompanied by control by a specialist.

Estrogen therapy for menopause

In such a fragile state as, HRT preparations should contain the necessary minimum of hormones. They contain only estrogens, are suitable for use after 12 months from the last menstruation and later the following remedies:

• Premarin. In addition to reducing vegetative-vascular manifestations, it fights against the loss of calcium and phosphorus in the bones, lowers low-density lipoproteins in the blood, increases HDL volume, and improves glucose excretion. Take the remedy in cycles of 21 days, then take a week break. Extended use is also possible. 0.3-1.25 mcg is prescribed per day, lowering or increasing the dose depending on how you feel;
• Proginova. In fact, this is estradiol valerate, a synthetic analogue of what was previously produced by the ovaries. The drug keeps the bone tissue dense, preventing osteoporosis, maintains the tone of the mucous membranes in the urogenital zone. Take 1 tablet, without crushing, cyclically or continuously;
• Dermestril. It exists in several dosage forms (tablets, spray, injection, patch). Eliminates vasomotor signs of menopause, inhibits the excretion of calcium from bones and clogging of blood vessels with cholesterol;
• Klimara. containing estradiol gamihydrate, which is released and enters the bloodstream in portions of 50 mcg. Its action extends to the relief of all symptoms of menopause, but it is necessary to fix the remedy on the body not near the pelvic organs and mammary glands;
• Estrofem. The main substance is estradiol, which prevents the development of osteoporosis, cardiovascular diseases and atrophic vaginitis. Requires continuous intake of 1 tablet per day. If after 3 months of use the effect on stopping severe manifestations of postmenopause is insufficient, the doctor may change the dosage;
• Ovestin. Estriol, which forms its basis, inhibits the leaching of calcium from the bones. The drug also reduces the possibility of inflammation of the vagina and other reproductive organs, due to the restoration of the mucosa. It exists in the form of suppositories, tablets and vaginal cream. Orally take 4-8 mg per day. Long-term use high doses undesirable, it is necessary to strive to reduce them.

If the listed funds are prescribed to a woman with a preserved uterus, they are combined with gestagen-containing or containing androgens.

Combined drugs for postmenopausal HRT

Combined HRT drugs postmenopause forces the use of savings if necessary. The estrogens contained in them perform their task, as in monophasic agents. But their negative influence is neutralized by the work of gestagens or androgens. Experts make a choice among such funds from the following names:

• Climodien. It combines estradiol valerate with dienogest. The latter contributes to the atrophy of the endometrium, preventing its thickening, penetration into the muscular layer of the uterus and. Normalizes the ratio of "bad" and "good" cholesterol, removing the risk of cardiovascular disease. Climodien is taken continuously, as long as there is a need for therapy, one tablet per day;
• Cliogest. This is a "team" of estriol and norethisterone acetate. The drug is indispensable in the prevention and treatment of osteoporosis, prevents the development of cardiac and urogenital ailments. Problems with the endometrium that are possible when taking estriol do not arise, thanks to norethisterone, which has gestagenic and slightly androgenic effects. For daily continuous use as part of the course of treatment, 1 tablet is enough. Similar to Kliogest in composition and effects on the body are the drugs Pauzogest, Eviana, Activel, Revmelide;
• Livial. His active substance is tibolone, which simultaneously has the properties of estrogen, androgens and gestagens. Thanks to this, the agent keeps the endometrium thin enough, helps to save calcium, and normalizes the condition of the vessels. The latter quality reduces the risk of heart disease, restores blood supply to the brain;
• Femoston 1/5. The drug is a combination of estradiol and dydrogesterone. Saves from osteoporosis, vascular disorders, returns libido, thanks to the normalization of the state of the mucous membranes of the genital and urinary organs. Doesn't allow pathological changes in the endometrium. A low dose of estrogen makes it possible to use it for a long time without threatening consequences. Take Femoston once a day.

Homeopathy

Substitution in postmenopause may not only be in taking hormonal drugs. The following have a similar effect on the signs of menopause:

• Klimadinon;
• Inoklim;
• Klimonorm;
• Qi-Klim.

They are quite effective in preventing complications of menopause, do not have such contraindications as hormones. And yet, they should be used only on the advice of a doctor.

Menopausal, properly chosen hormone therapy can not only prevent coronary heart disease, osteoporosis and bowel cancer. It has been proven that it reduces the risk of age-related visual impairment, Alzheimer's disease. The preparations also contribute to the preservation of external youthfulness.

Similar articles

The drugs that fight them are also not hormonal, but they can and should be ... Antihypertensive drugs in the treatment of hot flashes. For those who have high blood pressure and hot flashes with menopause, treatment without hormones is required ...

Content

Age-related changes that occur in the body of a woman entering menopause do not please anyone. The skin becomes dry and flabby, wrinkles appear on the face. Deficiency of sex hormones provokes pressure surges, a decrease in sexual desire. Hormone replacement therapy helps to cope with the manifestations of menopause.

What hormones are lacking in menopause

Hormones during menopause are reduced to a critical level, after which the woman stops menstruating. In the last stage of menopause, they generally cease to stand out, because of this, the function of the ovaries fades. A decrease in the level of sex hormones leads to numerous metabolic disorders, which provokes phenomena such as nausea, tinnitus, increased blood pressure.

There are three phases of menopause: premenopause, menopause, postmenopause. Combines their process of falling hormone levels. In the first half menstrual cycle estrogen (female hubbub) predominates, in the second - progesterone (male). Premenopause is characterized by a lack of estrogen, which leads to irregular monthly cycle. During menopause, the level of progesterone, which coordinates the thickness of the uterine endometrium, drops. In postmenopause, the production of hormones stops completely, the ovaries and uterus decrease in size.

Hormone therapy for menopause

The changes that occur in the female body during menopause are manifested as follows:

• mood swings;
• insomnia, anxiety;
• skin elasticity and firmness decrease;
• changes in body weight and posture;
• osteoporosis develops;
• urinary incontinence occurs;
• prolapse of the pelvic organs;
• development of atherosclerosis, diabetes mellitus;
• disruption of work nervous system.

Hormone replacement therapy for menopause helps to maintain health. By eliminating the above symptoms, a general rejuvenation of the body occurs, a change in figure, atrophy of the genital organs is prevented. However, hormone replacement therapy during menopause has its drawbacks. With long-term use, it can provoke a myocardial infarction, increases the risk of stroke. In addition, homone replacement therapy promotes intravascular coagulation.

Is hormone replacement therapy safe for menopause?

Not everyone can drink hormonal drugs during menopause. First, the doctor prescribes an examination by a therapist, gynecologist, cardiologist, hepatologist and phlebologist. Hormone replacement therapy for menopause is contraindicated if the following diseases are found in a woman:

• uterine bleeding obscure origin;
• malignant tumors of the internal genital organs or mammary glands;
• renal or liver failure;
• the presence of adenomyosis or endometriosis of the ovaries;
• severe stage of diabetes;
• increased blood clotting;
• lipid metabolism disorder;
• worsening of the course of mastopathy, bronchial asthma, epilepsy, rheumatism;
• hypersensitivity to hormone replacement drugs.

Hormonal drugs for menopausal syndrome

Hormonal preparations are selected for menopause of a new generation, depending on the duration and severity of the condition, as well as on the age of the patient. In substitution hormone therapy(HRT) is needed by women whose menopause is difficult. Prescribe drugs parenterally or orally. Depending on the disorders in menopausal syndrome, hormone replacement therapy is selected individually.

Phytoestrogens

During menopause, the level of estrogen in the female body drops sharply, so bad cholesterol begins to form, fat metabolism is disturbed, and immunity is weakened. To avoid these symptoms, doctors prescribe natural phytohormones for menopause. The use of these drugs does not disturb the hormonal balance, but relieves the symptoms. Dietary supplements with plant substances act as analogues natural hormones that are not sold at a high price. Hormone replacement phytoestrogens include:

1. Klimadinon. The active ingredient is an extract of cymifugi-racimose. With its help, the intensity of hot flashes decreases, the lack of estrogens is eliminated. Therapy usually lasts three months. The medicine is taken 1 tablet daily.
2. Femicaps. Contributes to the normalization of estrogens, corrects the psychological state, improves the mineral-vitamin balance. Contains soy lecithin, vitamins, magnesium, passionflower, evening primrose. Drink tablets 2 capsules per day. Doctors prescribe to drink the medicine for at least three months.
3. Remens. Harmless homeopathic remedy. It has a general strengthening effect on the female body, eliminates the lack of estrogen. Contains sepia, lachesis, cimicifuga extract. 2 courses are prescribed for three months.

Bioidentical Hormones

During hormone replacement therapy for menopause, bioidentical hormonal preparations are prescribed. They are part of tablets, creams, gels, patches, suppositories. Reception of these hormones is carried out for 3-5 years, until the secondary menopausal manifestations disappear. Popular bioidentical hormone replacement drugs that are sold at an affordable price:

1. Femoston. Combined medicine that prolongs the youth of a woman. Contains estradiol and dydrogesterone, which are identical to natural ones. These hormones provide therapy for psycho-emotional and autonomic symptoms. Assigned to 1 tab./day.
2. Janine. A low-dose combination drug that suppresses ovulation, making it impossible for a fertilized egg to implant. It is used not only for contraception. During menopause, the drug is prescribed for the intake of estrogen in the body to alleviate the symptoms of menopause.
3. Duphaston. It is a derivative of progesterone. Resists the negative effect of estrogens on the endometrium, reduces the risk of oncology. It is used according to an individual treatment regimen 2-3 times a day.

Estrogen preparations for women

In gynecology, synthetic estrogen tablets are used to make life easier during menopause. Female hormones control the production of collagen, stimulate the nervous system. Products containing estrogen:

1. Klimonorm. Replenishes estrogen deficiency, provides treatment of mucous membranes genitourinary system reduces the risk of cardiovascular disease. Apply one tablet per day according to the scheme: 21 days, after - a week break and repeat the course.
2. Premarin. Facilitates the manifestations of menopausal syndrome, prevents the appearance of osteoporosis. Cyclic use - 1, 25 mg / day for 21 days, after - a break of 7 days.
3. Ovestin. Restores the vaginal epithelium, increases the resistance of the genitourinary system to inflammatory processes. Assign daily 4 mg for 3 weeks. The course of therapy or its extension is determined by the doctor.

How to choose hormonal pills for menopause

If in menopause a woman does not have health problems, then hormone replacement drugs are not needed. HRT is carried out only after consulting a doctor, since drugs have side effects. There are frequent cases of individual intolerance and allergic reactions. The safest are herbal and homeopathic medicines. But they do not help all patients, so clinical indications and a doctor's consultation is required.

Price

All hormonal preparations can be purchased at the pharmacy chain at a different price or bought in an online store (order from a catalog). In the latter version, the drugs will be inexpensive. Prices for phytoestrogens range from 400 rubles (Klimadinon tablets 60 pcs.) To 2400 rubles. (Femicaps capsules 120 pcs.). The cost of drugs with estrogen varies from 650 rubles (Klimonorm dragee 21 pcs.) to 1400 rubles. (Ovestin 1 mg/g 15 g cream).

Video

Did you find an error in the text?
Select it, press Ctrl + Enter and we'll fix it!

It is constantly expanding, as is the scope of indications for their use. Today, modern medicine has a fairly wide choice good drugs for HRT, experience in the use of drugs for HRT, indicating a marked predominance of benefits over the risk of HRT, good diagnostic capabilities, which allows you to track both positive and negative effects treatment.

Although there is all evidence of a positive effect of taking HRT on health, in general, the risks and benefits of this therapy, according to many authors, can be considered comparable. In many cases, the benefits of long-term HRT will outweigh the risks; in others, the potential risks will outweigh the benefits. Therefore, the use of HRT should meet the needs and demands of a particular patient, be individual and permanent. When selecting a dose, it is necessary to take into account both the age and weight of the patients, and the characteristics of the anamnesis, as well as the relative risk and contraindications for use, which will ensure the best treatment result.

A comprehensive and differentiated approach to the appointment of HRT, as well as knowledge about the features and properties of the components that make up most drugs, will help to avoid possible undesirable consequences and side effects and lead to the successful achievement of the intended goals.

It must be remembered that the use of HRT is not a prolongation of life, but an improvement in its quality, which may decrease under the influence of the adverse effects of estrogen deficiency. And the timely solution of the problems of menopause is a real way to good health and well-being, maintaining working capacity and improving the quality of life of an ever-increasing number of women entering this "autumn" period.

Various classes of estrogens are used to provide hormone replacement therapy that relieves menopausal problems and the difficulties of the transition period in most women.

• The first group includes native estrogens - estradiol, estrone and estriol.
• The second group includes conjugated estrogens, mainly sulfates - estrone, equilin and 17-beta-dihydroequilin, which are obtained from the urine of pregnant mares.

As you know, the most active estrogen is ethinyl estradiol used in preparations for oral contraception. Its doses, which are necessary for the relief of menopausal symptoms, are 5-10 mcg / day, orally. However, due to the narrow range of therapeutic doses, the high likelihood of side effects and not such a favorable effect on metabolic processes as natural estrogens, it is not advisable to use this hormone for the purposes of HRT.

Currently, the following types of estrogens are most widely used in HRT:

1. PRODUCTS FOR ORAL ADMINISTRATION
   • Esters of estradiol [show] .

     Estradiol esters are

     • Estradiol valerate
     • Estradiol benzoate.
     • Estriol succinate.
     • Estradiol hemihydrate.

     Estradiol valerate is an ester of the crystalline form of 17-beta-estradiol, which, when administered orally, is well absorbed in the gastrointestinal tract (GIT). For oral administration it is impossible to use the crystalline form of 17-beta-estradiol, since in this case it is practically not absorbed in the gastrointestinal tract. Estradiol valerate is rapidly metabolized to 17-beta-estradiol, so it can be considered a precursor to natural estrogen. Estradiol is not a metabolite or end product of estrogen metabolism, but is the main circulating estrogen in premenopausal women. Therefore, estradiol valerate seems to be an ideal estrogen for oral hormone replacement therapy, given that its goal is to restore hormonal balance to levels that existed before ovarian failure.

     Regardless of the form of estrogen used, its dosage should be sufficient both for the relief of the most pronounced menopausal disorders and the prevention of chronic pathology. In particular, effective prevention osteoporosis involves taking 2 mg of estradiol valerate per day.

     Estradiol valerate has a positive effect on lipid metabolism, manifested by an increase in the level of high density lipoproteins and a decrease in the level of low density lipoproteins. Along with this, the drug does not have a pronounced effect on protein synthesis in the liver.

     Among oral drugs for HRT, doctors (especially in Europe) most often prescribe drugs containing estradiol valerate, a prodrug of endogenous 17-beta-estradiol. At a dose of 12 mg of estradiol, valerate for oral administration as monotherapy or in combination with gestagens showed high efficacy in the treatment of menopausal disorders (drugs Klimodien, Klimen, Klimonorm, CycloProginova, Proginova, Divina, Divitren, Indivina).

     However, preparations containing micronized 17-beta-estradiol (Femoston 2/10, Femoston 1/5) are no less popular.

   • conjugated estrogens [show] .

     The composition of conjugated equiestrogens obtained from the urine of pregnant mares includes a mixture of sodium sulfates, estrone sulfate (they make up about 50%). Most of the other components of hormones or their metabolites are specific to horses - these are equilin sulfate - 25% and alphadihydroequilin sulfate - 15%. The remaining 15% are inactive estrogen sulfates. Equilin has a high activity; it is deposited in adipose tissue and continues to act even after the drug is discontinued.

     Horse urine estrogens and their synthesized analogues have a more dramatic effect on the synthesis of the renin substrate and hormone-binding globulins compared to estradiol valerate.

     An equally significant factor is the biological half-life of the drug. Horse urine estrogens are not metabolized in the liver and other organs, while estradiol is rapidly metabolized with a half-life of 90 minutes. This explains the very slow excretion of equilin from the body, which is evidenced by its preservation. advanced level in blood serum, noted even three months after cessation of therapy.

   • Micronized forms of estradiol.
2. PREPARATIONS FOR INTRAMUSCULAR INTRODUCTION [show]

   For parenteral administration, there are preparations of estradiol for subcutaneous administration (the classic form - depot - the drug Ginodian Depot, which is administered once a month).

   • Estradiol valerate.
3. PREPARATIONS FOR INTRAVAGINAL INTRODUCTION
4. PREPARATIONS FOR TRANSDERMAL INTRODUCTION [show]

   The most physiological way to create the desired concentration of estrogens in the blood of women should be recognized as the transdermal route of administration of estradiol, for which skin patches and gel preparations were developed. The Klimara patch is applied once a week and provides a constant level of estradiol in the blood. Divigel and Estrogel gel is used once a day. The pharmacokinetics of estradiol during its transdermal administration differs from that which occurs after its oral administration. This difference lies primarily in the exclusion of extensive initial metabolism of estradiol in the liver and a significantly lower effect on the liver. With transdermal administration, estradiol is less converted to estrone, which, after oral administration of estradiol preparations, exceeds the level of the latter in blood plasma. In addition, after oral administration of estrogens, they undergo hepatic recirculation to a large extent. As a result, when using a patch or gel, the ratio of estrone / estradiol in the blood is close to normal and the effect of the primary passage of estradiol through the liver disappears, but the favorable effect of the hormone on vasomotor symptoms and protection of bone tissue from osteoporosis remain. Transdermal estradiol, compared with oral, has about 2 times less effect on lipid metabolism in the liver; does not increase the level of sexsteroid-binding globulin in serum and cholesterol in bile.

   Gel for external use 1 g of gel contains: estradiol 1.0 mg, excipients q.s. up to 1.0 g DIVIGEL is a 0.1% alcohol-based gel, the active ingredient of which is estradiol hemihydrate. Divigel is packaged in aluminum foil sachets containing 0.5 mg or 1.0 mg of estradiol, which corresponds to 0.5 g or 1.0 g of gel. The package contains 28 sachets. Pharmacotherapeutic group Replacement hormone therapy. Pharmacodynamics Pharmacodynamics and clinical efficacy Divigel is similar to oral estrogens. Pharmacokinetics When the gel is applied to the skin, estradiol penetrates directly into circulatory system, thus avoiding the first stage of hepatic metabolism. For this reason, fluctuations in plasma estrogen concentration when using Divigel are much less pronounced than when using oral estrogens. Transdermal application of estradiol at a dose of 1.5 mg (1.5 g of Divigel) creates a plasma concentration of approximately 340 pmol / l, which corresponds to the level of the early follicle stage in premenopausal women. During treatment with Divigel, the estradiol/estrone ratio remains at 0.7; whereas with oral estrogen it usually drops to less than 0.2. Metabolism and excretion of transdermal estradiol occurs in the same way as natural estrogens. Indications for use Divigel is prescribed for the treatment of menopausal syndrome associated with natural or artificial menopause, which developed as a result of surgical intervention, as well as for the prevention of osteoporosis. Divigel should be used strictly according to the doctor's prescription. Contraindications Pregnancy and lactation. Severe thromboembolic disorders or acute thrombophlebitis. Uterine bleeding of unknown etiology. C-strogen-dependent cancer (breast, ovary or uterus). Severe liver disease, Dubin-Johnson syndrome, Rotor syndrome. Hypersensitivity to the constituent components of the drug. Dosage and administration Divigel is intended for long-term or cyclic treatment. Doses are selected by the doctor, taking into account the individual characteristics of patients (from 0.5 to 1.5 g per day, which corresponds to 0.5-1.5 mg of estradiol per day, in the future the dose can be adjusted). Usually, treatment begins with the appointment of 1 mg of estradiol (1.0 g of gel) per day. Patients with an "intact" uterus during treatment with Divigel are recommended to prescribe a progestogen, for example, medroxyprogesterone acetate, norethisterone, norethisterone acetate or dydrogestron for 10-12 days in each cycle. In patients in the postmenopausal period, the duration of the cycle can be increased up to 3 months. The dose of Divigel is applied once a day to the skin of the lower part of the anterior abdominal wall, or alternately to the right or left buttocks. The application area is equal in size to 1-2 palms. Divigel should not be applied to the mammary glands, face, genital area, as well as to irritated skin. After applying the drug, wait a few minutes until the gel dries. Accidental contact of Divigel with eyes should be avoided. Wash your hands immediately after applying the gel. If the patient has forgotten to apply the gel, this should be done as soon as possible, but no later than within 12 hours from the time the drug was applied as scheduled. If more than 12 hours have passed, then the application of Divigel should be postponed until the next time. With irregular use of the drug, menstrual-like uterine bleeding of a “breakthrough” may occur. Before starting therapy with Divigel, you should undergo a thorough medical examination and in the process of treatment, visit a gynecologist at least once a year. Under special supervision should be patients suffering from endometriosis, endometrial hyperplasia, diseases of the cardiovascular system, as well as cerebrovascular disorders, arterial hypertension, thromboembolism in history, disorders of lipid metabolism, renal failure, breast cancer in history or family history. During treatment with estrogens, as well as during pregnancy, some diseases may worsen. These include: migraines and severe headaches, benign tumors breast, liver dysfunction, cholestasis, cholelithiasis, porphyria, uterine fibroids, diabetes mellitus, epilepsy, bronchial asthma, otosclerosis, multiple sclerosis. Such patients should be under the supervision of a physician if they are treated with Divigel. drug interaction There is no information about the likely cross interaction Divigel with other drugs. Side effect Side effects are usually mild and very rarely lead to discontinuation of treatment. If they are nevertheless noted, then usually only in the first months of treatment. Sometimes observed: engorgement of the mammary glands, headaches, swelling, violation of the regularity of menstruation. Overdose As a rule, estrogens are well tolerated even at very high doses. Possible signs of an overdose are the symptoms listed in the "Side Effects" section. Their treatment is symptomatic. Shelf life 3 years. The drug should not be used later than the date indicated on the package. Store at room temperature out of the reach of children. The drug is registered in the Russian Federation. Literature 1. Hirvonen et al. Transdermal estradiol gel in the treatment of the climacterium: a comparison with oral therapy. Br J of Ob and Gyn 1997, Vol 104; Suppl. 16:19-25. 2. Karjalainen et al. Metabolic changes induced by oral estrogen and transdermatjfylktradiol gel therapy. Br J of Ob and Gyn 1997, Vol 104; Suppl. 16:38-43. 3. Hirvonen et al. Effects of transdermal oestrogen therapy in postmenopausal women: a comparative study of an oestradiol gel and an oestradiol delivering patch. Br J of Ob and Gyn 1997, Vol 104; Suppl. 16:26-31. 4. Marketing research 1995, Data on tiles, Orion Pharma. 5. JArvinen et al. Steady-state pharmacokinetics of oestradiol gel in postmenopausal women: effects of application area and washing. Br J of Ob and Gyn 1997, Vol 104; Suppl. 16:14-18.

   

   • Estradiol.

Existing data on pharmacological properties ah of various estrogens indicate the preference for the use of drugs containing estradiol for the purposes of HRT.

For 2/3 of all women, the optimal doses of estrogens are 2 mg of estradiol (oral) and 50 mcg of estradiol (transdermal). However, in each case, during HRT, women should be examined in the clinic to adjust these doses. In women after 65 years of age, there is a decrease in renal and especially hepatic clearance of hormones, which requires special care in prescribing estrogens in high doses.

There is evidence that lower doses of estradiol (25 mcg/day) may be sufficient to prevent osteoporosis.

Currently, there are data indicating the presence of pronounced differences in the effect of conjugated and natural estrogens on cardiovascular system and the hemostasis system. In the work of C.E. Bonduki et al. (1998) compared conjugated estrogens (oral 0.625 mg/day, continuous) and 17-beta-estradiol (transdermal 50 µg/day) in menopausal women. All women took medroxyprogesterone acetate (orally 5 mg/day) for 14 days every month. It was found that conjugated estrogens, unlike estradiol, cause a statistically significant decrease in plasma antithrombin III after 3, 6, 9 and 12 months after the start of therapy. At the same time, both types of estrogen did not affect prothrombin time, factor V, fibrinogen, platelet count, and euglobulin lysis time. For 12 months, no thromboembolic complications occurred among the study participants. According to these results, conjugated estrogens reduce the level of antithrombin III, while HRT with 17-beta-estradiol does not affect this indicator. The level of antithrombin III is of key importance in the development of myocardial infarction and thromboembolism.

Antithrombin III deficiency can be congenital or acquired. The lack of ability of conjugated estrogens to have a protective effect in women with myocardial infarction may be due precisely to their effect on the content of antithrombin III in the blood. Therefore, natural estrogens are preferred over oral conjugated estrogens when prescribing HRT to patients with risk factors for thrombosis.

In this regard, it should be noted that the historically recent years the increased use of conjugated estrogens in the US cannot be considered the best and recommended in all cases. These obvious facts could not be discussed if there were no statements in the literature in favor of the use of conjugated estrogens, based only on their wide use in the USA and the existence of a sufficiently large number of studies of their properties. In addition, one cannot agree with the statements about the best properties among the gestagens that are part of various combinations of HRT, medroxyprogesterone acetate in relation to their effect on lipid metabolism. Existing data show that among the gestagens on the market, along with progesterone, there are both its derivatives - 20-alpha- and 20-beta-dihydrosterone, 17-alpha-hydroxyprogesterone, and 19-nortestosterone derivatives, the use of which allows you to get the desired effect. .

Hydroxyprogesterone derivatives (C21-gestagens) are chlormadinone acetate, cyproterone acetate, medroxyprogesterone acetate, dydrogesterone, etc., and 19-nortestosterone derivatives are norethisterone acetate, norgestrel, levonorgestrel, norgestimate, dienogest, etc.

The choice of a drug from the group of combined estrogen-progestin drugs is due to the period of age-related hormonal changes in a woman.

Specially designed to improve the effectiveness of hormone replacement therapy and preventive use taking into account the requirements of maximum drug safety. This drug, characterized by an optimal ratio of hormones, not only has a positive effect on the lipid profile, but also contributes to the rapid reduction of menopausal symptoms. It has not only a preventive, but also a therapeutic effect on osteoporosis.

Klimonorm is highly effective in atrophic disorders of the genitourinary system and skin atrophic disorders, as well as for the treatment of psycho-somatic disorders: irritability, depression, sleep disorders, forgetfulness. Klimonorm is well tolerated: more than 93% of all women taking Klimonorm note only positive changes in their well-being (Czekanowski R. et al., 1995).

Klimonorm is a combination of estradiol valerate (2 mg) and levonorgestrel (0.15 mg), providing the following benefits of this drug:

• rapid and effective reduction in the severity of menopausal symptoms;
• prevention and treatment of postmenopausal osteoporosis;
• maintaining the positive effect of estrogen on the atherogenic index;
• anti-atrophogenic properties of levonorgestrel positive action with changes in the mucous membranes of the genitourinary system and weakness of the sphincters;
• while taking Klimonorm, the cycle is well controlled and no phenomena of endometrial hyperplasia were noted.

Klimonorm should be considered the drug of choice for the purposes of HRT during pre- and perimenopause in most women with osteoporosis, psychosomatic disorders, atrophic changes in the mucous membranes of the genitourinary system, hypercholesterolemia, hypertriglyceridemia, with high risk colon cancer, Alzheimer's disease.

The dose of levonorgestrel included in Klimonorm provides good cycle control, sufficient protection of the endometrium from the hyperplastic effect of estrogen and, at the same time, maintaining the beneficial effect of estrogen on lipid metabolism, the cardiovascular system, prevention and treatment of osteoporosis.

It has been shown that the use of Klimonorm in women aged 40 to 74 years for 12 months leads to an increase in the density of spongy and cortical bone tissue by 7 and 12%, respectively (Hempel, Wisser, 1994). The mineral density of the lumbar vertebrae in women aged 43 to 63 years with the use of Klimonorm for 12 and 24 months increases from 1.0 to 2.0 and 3.8 g / cm 2, respectively. Treatment with Klimonorm for 1 year of premenopausal women with ovaries removed is accompanied by recovery to normal level values ​​of bone mineral density and markers of bone metabolism. In this parameter, Klimonorm is superior to Femoston. Additional androgenic activity of levonorgestrel, apparently, is also very significant for the formation of a state of mental comfort. If Klimonorm eliminates or reduces the symptoms of depression, then Femoston in 510% of patients increases the symptoms of depressive mood, which requires interruption of therapy.

An important advantage of levonorgestrel as a progestogen is its almost 100% bioavailability, which ensures the stability of its effects, the severity of which practically does not depend on the nature of the woman's diet, the presence of gastrointestinal diseases and her activity. hepatic system, which metabolizes xenobiotics during their primary passage. Note that the bioavailability of dydrogesterone is only 28%, and its effects are therefore subject to marked differences, both interindividual and interindividual.

In addition, it should be noted that cyclic (with a seven-day break) taking Klimonorm provides excellent cycle control and a low frequency of intermenstrual bleeding. Femoston, used in continuous mode, in this regard, controls the cycle less, which may be due to the lower progestogenic activity of dydrogesterone compared to levonorgestrel. If, when taking Klimonorm, the regularity of menstrual bleeding is observed in 92% of all cycles and the number of cases of intermenstrual bleeding is 0.6%, then when using Femoston, these values ​​are 85 and 4.39.8%, respectively. At the same time, the nature and regularity of menstrual bleeding reflect the state of the endometrium and the risk of developing its hyperplasia. Therefore, the use of Klimonorm from the point of view of preventing possible hyperplastic changes in the endometrium is preferable to Femoston.

It should be noted that Klimonorm has a pronounced activity in relation to the treatment of menopausal syndrome. When analyzing its action in 116 women, a decrease in the Kupperm index from 28.38 to 5.47 was revealed for 6 months (after 3 months it decreased to 11.6) with no effect on blood pressure and body weight (Czekanowski R. et al ., 1995).

At the same time, it should be noted that Klimonorm compares favorably with preparations containing other 19-nortestosterone derivatives (norethisterone) with more pronounced androgenic properties as a progestogen. Norethisterone acetate (1 mg) counteracts the positive effect of estrogens on HDL-cholesterol levels and, in addition, can increase low-density lipoprotein levels, thereby increasing the risk of cardiovascular disease.

For women who need additional protection against hyperplastic processes in the endometrium, it is better to prescribe Cyclo-Proginova, in which the activity of the progestogen component (norgestrel) is 2 times higher compared to Klimonorm.

Combined estrogen-gestagenic drug. The action is due to the estrogen and progestogen components that make up the drug. The estrogenic component - estradiol is a substance of natural origin and after entering the body quickly turns into estradiol, which is identical to the hormone produced by the ovaries and has its own effects: it activates the proliferation of the epithelium of the organs of the reproductive system, including the regeneration and growth of the endometrium in the first phase of the menstrual cycle, the preparation of the endometrium for action progesterone, increased libido in the middle of the cycle, affects the metabolism of fats, proteins, carbohydrates and electrolytes, stimulates the production of globulins by the liver that bind sex hormones, renin, TG and blood clotting factors. Through participation in the implementation of positive and negative feedback in the hypothalamic-pituitary-ovarian system, estradiol can also cause moderately pronounced central effects. It plays an important role in the development of bone tissue and the formation of bone structure.

The second component of the drug Cyclo-Proginova is an active synthetic progestogen - norgestrel, which is superior in strength to the natural hormone of the corpus luteum progesterone. Promotes the transition of the uterine mucosa from the proliferation stage to the secretory phase. Reduces the excitability and contractility of the muscles of the uterus and fallopian tubes, stimulates the development of the terminal elements of the mammary glands. It blocks the secretion of hypothalamic LH and FSH release factors, inhibits the formation of gonadotropic hormones, inhibits ovulation, and has slight androgenic properties.

Klimen is a combined preparation containing the natural estrogen estradiol (in the form of valerate) and the synthetic progestogen with antiandrogenic effect cyproterone (in the form of acetate). Estradiol, which is part of Klimen, compensates for the estrogen deficiency that occurs during natural menopause and after surgical removal of the ovaries (surgical menopause), eliminates menopausal disorders, improves blood lipid profile and provides prevention of osteoporosis. Cyproterone is a synthetic progestogen that protects the endometrium from hyperplasia, preventing the development of cancer of the uterine mucosa.

In addition, cyproterone is a strong antiandrogen, blocks testosterone receptors and prevents the effect of male sex hormones on target organs. Cyproterone enhances the beneficial effect of estradiol on the blood lipid profile. Due to the antiandrogenic effect, Klimen eliminates or reduces such manifestations of hyperandrogenism in women as excessive facial hair growth ("lady's mustache"), acne (blackheads), hair loss on the head.

Klimen prevents the formation of male-type obesity in women (accumulation of fat in the waist and abdomen) and the development of metabolic disorders. When taking Klimen during a 7-day break, a regular menstrual-like reaction is observed, and therefore the drug is recommended for premenopausal women.

It is a combined, modern, low-dose hormonal drug, the therapeutic effects of which are due to estradiol and dydrogesterone included in the composition.

Currently, three varieties of Femoston are produced - Femoston 1/10, Femoston 2/10 and Femoston 1/5 (Konti). All three varieties are produced in a single dosage form - tablets for oral administration (28 tablets per pack), and differ from each other only in the dosage of the active ingredients. The numbers in the name of the drug indicate the content of the hormone in mg: the first is the content of estradiol, the second is dydrogesterone.

All varieties of Femoston have the same therapeutic effect, and various dosages of active hormones allow you to choose the optimal drug for each woman, which is best suited for her.

Indications for use for all three varieties of Femoston (1/10, 2/10 and 1/5) are the same:

1. Hormone replacement therapy of natural or artificial (surgical) menopause in women, manifested by hot flashes, sweating, palpitations, sleep disturbances, excitability, nervousness, vaginal dryness and other symptoms of estrogen deficiency. Femoston 1/10 and 2/10 can be used six months after the last menstruation, and Femoston 1/5 - only a year later;
2. Prevention of osteoporosis and increased fragility of bones in women during menopause with intolerance to other drugs intended to maintain normal bone mineralization, prevent calcium deficiency and treat this pathology.

Femoston is not indicated for the treatment of infertility, however, in practice, some gynecologists prescribe it to women who have problems conceiving to increase the growth of the endometrium, which significantly increases the likelihood of implantation of a fertilized egg and pregnancy. In such situations, doctors use the pharmacological properties of the drug to achieve a certain effect in conditions that are not an indication for use. A similar practice of off-label prescriptions exists all over the world and is called off-label prescriptions.

Femoston compensates for the deficiency of sex hormones in a woman's body, thereby eliminating various disorders(vegetative, psycho-emotional) and sexual disorders, and also prevents the development of osteoporosis.

Estradiol, which is part of Femoston, is identical to the natural one, which is normally produced by the ovaries of a woman. That is why it replenishes the estrogen deficiency in the body and provides smoothness, elasticity and slow aging of the skin, slows down hair loss, eliminates dry mucous membranes and discomfort during intercourse, and also prevents atherosclerosis and osteoporosis. In addition, estradiol eliminates such manifestations of the menopausal syndrome as hot flashes, sweating, sleep disturbance, excitability, dizziness, headaches, atrophy of the skin and mucous membranes, etc.

Dydrogesterone is a progesterone hormone that reduces the risk of endometrial hyperplasia or cancer. This progesterone hormone does not have any other effects, and was introduced into Femoston specifically to level the risk of hyperplasia and endometrial cancer, which is increased due to the use of estradiol.

In the postmenopausal period, drugs intended for continuous use should be used. Of these, Climodien has additional benefits associated with good tolerability, since dienogest, which is part of it, has moderate antiandrogenic activity and optimal pharmacokinetics.

Contains 2 mg of estradiol valerate and 2 mg of dienogest per tablet. The first component is well known and described, the second is new and should be described in more detail. Dienogest combined in one molecule with almost 100% bioavailability the properties of modern 19-norprogestagens and progesterone derivatives. Dienogest - 17-alpha-cyanomethyl-17-beta-hydroxy-estra-4.9(10) diene-3-one (C 20 H 25 NO 2) - differs from other norethisterone derivatives in that it contains a 17-cyanomethyl group (-CH 2 CM) instead of the 17 (alpha)-ethynyl group. As a result, the size of the molecule, its hydrophobic properties and polarity changed, which, in turn, affected the absorption, distribution and metabolism of the compound and gave dienogest, as a hybrid gestagen, a unique spectrum of effects.

The progestogenic activity of dienogest is especially high due to the presence of a double bond in position 9. Since dienogest has no affinity for plasma globulins, approximately 90% of its total amount is bound to albumin, and it is in a free state in fairly high concentrations.

Dienogest is metabolized through several pathways - mainly by hydroxylation, but also by hydrogenation, conjugation and aromatization into completely inactive metabolites. Unlike other nortestosterone derivatives that contain an ethynyl group, dienogest does not inhibit the activity of enzymes containing cytochrome P450. Due to this, dienogest does not affect the metabolic activity of the liver, which is its undoubted advantage.

The half-life of dienogest in the terminal phase is quite short compared to other progestogens, similar to that of norethisterone acetate and ranges between 6.5 and 12.0 hours. This makes it convenient to use it daily in a single dose. However, unlike other progestogens, the accumulation of dienogest with daily oral administration is negligible. Compared to other oral progestogens, dienogest has a high renal excretion/fecal ratio (6.7:1). About 87% of the administered dose of dienogest is eliminated after 5 days (mostly in the urine in the first 24 hours).

As a result of the fact that mainly metabolites are found in the urine, and unchanged dienogest is detected in small quantities, a sufficiently high amount of unchanged substance remains in the blood plasma until elimination.

The lack of androgenic properties of dienogest makes it the drug of choice for use in combination with estrogens in continuous hormone replacement therapy.

In studies on molecular models, it was shown that, unlike other 19-norprogestins, dienogest not only did not have androgenic activity, but became the first 19-norprogestogen, which has a certain antiandrogenic activity. Unlike most nortestosterone derivatives (eg, levonorgestrel and norethinodrone), dienogest does not compete with testosterone for binding to sex steroid-binding globulin and therefore does not increase the free fractions of endogenous testosterone.

Since the estrogenic component of hormone replacement therapy stimulates the synthesis of this globulin in the liver, a progestogen with partially androgenic activity can counteract this effect. Unlike most nortestosterone derivatives, which reduce plasma globulin, dienogest does not affect the estrogen-induced increase in its level. Therefore, the use of Climodien leads to a decrease in the level of free testosterone in serum.

It has been shown that dienogest is also able to alter the biosynthesis of endogenous steroids. In vitro studies have shown that it reduces the synthesis of ovarian steroids by inhibiting the activity of 3-beta-hydroxysteroid dehydrogenase. Moreover, similar to progesterone, dienogest has been found to locally reduce the conversion of testosterone to its more active form, dihydrotestosterone, by inhibiting 5-alpha reductase by a competitive mechanism in the skin.

Dienogest is well tolerated and has a low incidence of side effects. In contrast to the estrogen-dependent increase in renin levels during the control cycle, no increase in renin was observed with dienogest.

In addition, dienogest causes less platelet aggregation than medroxyprogesterone acetate, and also has an antiproliferative effect on breast cancer cells.

Thus, dienogest is a strong oral progestogen that is ideal for combined use with estradiol valerate in Climodien hormone replacement therapy. Its chemical structure determines the combination of the positive properties of 19-norprogestins with those of C21-progestogens (Table 2).

Table 2. Pharmacokinetic and pharmacodynamic properties of dienogest

Climodien effectively relieves the manifestations and symptoms of menopause associated with a decrease in hormone levels after menopause. The Kupperm index on when taking Climodien decreased from 17.9 to 3.8 for 48 weeks, improved verbal and visual memory, eliminated insomnia and breathing disorders during sleep. Compared with estradiol valerate monotherapy, the combination of estradiol valerate with dienogest had a more pronounced positive effect on atrophic changes in the genitourinary tract, manifested by vaginal dryness, dysuria, frequent urge to urinate, etc.

Taking Climodien was accompanied by favorable changes in lipid metabolism, which, firstly, are useful for preventing atherosclerosis, and, secondly, contribute to the redistribution of fat according to the female type, making the figure more feminine.

Specific markers of bone metabolism (alkaline phosphatase, pyridinoline, deoxypyridinoline) when taking Climodien changed in a characteristic way, indicating inhibition of osteoclast activity and a pronounced suppression of bone resorption, which indicates a decrease in the risk of osteoporosis.

The description of the pharmacological properties of Climodien will be incomplete if we do not note its ability to increase the content of endogenous mediators mediating vasodilation in postmenopausal women - cGMP, serotonin, prostacyclin, relaxin, which makes it possible to attribute this drug to drugs with vasorelaxant activity that can improve blood circulation.

The use of Climodien leads to atrophic changes in the endometrium in 90.8% of women, and therefore prevents the development of endometrial hyperplasia. Bloody discharge, which is relatively common in the first months of therapy, decreases with increasing duration of treatment. The frequency of adverse and side effects is similar in the treatment of postmenopausal women with other similar drugs. At the same time, there was no adverse effect on chemical laboratory parameters, which is especially important, on hemostasis and carbohydrate metabolism.

Thus, we can conclude that for postmenopausal women, the drug of choice for a continuous combined regimen of hormone replacement therapy is Climodien, which, meeting all the necessary standards of efficacy and tolerability, helps to maintain femininity after menopause.

• provides quick and effective relief of menopausal symptoms;
• provides reliable "protection" of the endometrium and better control of breakthrough bleeding, compared with Kliogest, without reducing the beneficial effects of estrogen;
• contains a dienogestprogestogenic component that does not bind to sex steroid-binding globulin, as a result of which endogenous steroids testosterone and cortisol are not displaced from their binding sites with transport proteins;
• lowers testosterone levels in women;
• contains dienogest, which has a partial antiandrogenic effect;
• according to the study of indicators of bone metabolism, it exhibits an inhibitory effect of estradiol on bone resorption. Dienogest does not counteract this effect of estradiol;
• according to the results of the study of endothelial markers during the treatment period, there is a vasodilating effect of estradiol and nitric oxide on the vasculature;
• does not have an adverse effect on the lipid profile;
• does not change blood pressure values, coagulation factors or body weight;
• improves mood, cognitive function, eliminates insomnia and normalizes sleep in patients with its disorders, if they are associated with menopause.

Climodiene is a highly effective, well-tolerated and easy-to-use combination hormone replacement therapy that is designed for long-term use. It stops all manifestations of menopausal syndrome and causes amenorrhea after 6 months from the start of administration.

Climodien is indicated for continuous combined treatment of menopausal disorders in postmenopausal women. Additional benefits of Climodien include the antiandrogenic properties of its progestogen, dienogest.

Of great interest today is the emergence of a new monophasic combination drug Pauzogest for the treatment of postmenopausal patients.

Pauzogest is the drug of choice for long-term treatment of women who are more than a year postmenopausal and who prefer HRT without periodic bleeding.

Pauzogest is a combination of estrogen and progesterone. One tablet of Pauzogest contains 2 mg of estradiol (2.07 mg as estradiol hemihydrate) and 1 mg of norethisterone acetate. The drug is available in a package - 1 or 3 blisters of 28 tablets. Tablets covered film shell. Daily dose is 1 tablet and is taken daily continuously. The drug compensates for the lack of female sex hormones in the postmenopausal period. Pauzogest relieves vegetative-vascular, psycho-emotional and other menopausal estrogen-dependent symptoms in the postmenopausal period, prevents bone loss and osteoporosis. The combination of estrogen with progestogen allows you to protect the endometrium from hyperplasia and at the same time prevent unwanted bleeding. Active substances The drug is well absorbed when taken orally and is actively metabolized in the intestinal mucosa and when passing through the liver.

Similarly to endogenous estradiol, exogenous estradiol hemihydrate, which is part of Pauzogest, affects a number of processes in the reproductive system, the hypothalamic-pituitary system and other organs; it stimulates bone mineralization.

Taking estradiol hemihydrate once a day provides a stable constant concentration of the drug in the blood. It is excreted completely within 72 hours after entering the body, mainly with urine, in the form of metabolites and, partially, unchanged.

Recent studies have shown that the role of the progestogen component in HRT is not limited to protecting the endometrium. Gestagens can weaken or enhance some of the effects of estradiol, for example, in relation to cardiovascular and skeletal system, and also have their own biological effects, in particular, a psychotropic effect. Side effects and tolerability of the drug for HRT are also largely determined by the progestogen component. The properties of the progestogen component in the composition of continuous combination therapy are especially important, since the duration of administration and the total dose of the progestogen in this regimen is greater than in cyclic regimens.

Norethisterone acetate, which is part of Pauzogest, belongs to testosterone derivatives (C19 progestogens). Apart from common property derivatives of C21-gestagens and C19-gestagens cause transformation of the endometrium, norethisterone acetate has various additional "characteristics" that determine their use in therapeutic practice. It has a pronounced antiestrogenic effect, reducing the concentration of estrogen receptors in target organs and inhibiting the action of estrogen at the molecular level ("down-regulation"). On the other hand, moderately pronounced mineralocorticoid activity of norethisterone acetate can be successfully used in the treatment of climacteric syndrome in women with primary chronic adrenal insufficiency, and androgenic activity can be used both to achieve a positive anabolic effect and to compensate for androgen deficiency in menopause, leading to a decrease in sexual desire.

A number of undesirable effects of norethisterone acetate appear during its passage through the liver and, most likely, are due to the presence of the same residual androgenic activity. Oral administration norethisterone acetate prevents estrogen-dependent synthesis of lipoprotein apoproteins in the liver and therefore reduces the beneficial effect of estradiol on the blood lipid profile, and also impairs glucose tolerance and increases blood insulin levels.

Norethisterone acetate is well absorbed when taken orally. It is excreted mainly in the urine. With the simultaneous administration of estradiol hemihydrate, the characteristics of norethisterone acetate do not change.

Thus, Pauzogest has a positive effect on all peri- and postmenopausal symptoms. Clinical evidence suggests that Pauzogest reduces bone loss, is the prevention of bone loss in postmenopausal women, thereby reducing the risk of fractures caused by osteoporosis. The proliferation of the endometrium, which occurs under the influence of estrogen, is effectively inhibited by the continuous intake of norethisterone acetate. This minimizes the risk of developing hyperplasia and endometrial cancer. Most women do not experience uterine bleeding while taking Pauzogest in monophasic mode, which is preferable for postmenopausal patients. Long-term use of Pauzogest (less than 5 years) does not increase the risk of developing breast cancer. The drug is well tolerated. Side effects include breast engorgement, mild nausea, rarely headache, and peripheral edema.

Thus, the results of many clinical studies indicate that the arsenal of means for HRT in postmenopausal women has been replenished with another worthy drug with high efficacy, safety, good tolerability, acceptability and ease of use.

Conclusion

When choosing a drug for HRT in women, it is necessary to consider:

• age and weight of patients
• features of the anamnesis
• relative risk and contraindications for use

The choice of HRT regimen depends on the severity of the climacteric syndrome and its period.

• In perimenopause, it is preferable to use two-phase combined preparations in a cyclic mode.
• In postmenopause, it is advisable to constantly use a combination of estrogen with a progestogen; since at this age in women, as a rule, insulin resistance is increased and hypercholesterolemia is observed, it is better for them to use Climodien, the only drug for continuous use that contains a progestogen with antiandrogenic activity.

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

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

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

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

Myth #1. HRT is not natural

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

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

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

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

Myth #2. HRT is addictive

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

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

Myth #3. Mustache will grow from HRT

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

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

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

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

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

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

Myth number 4. Get better from HRT

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

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

Myth number 5. HRT can cause cancer

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

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

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

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

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

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

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

Myth number 8. HRT has many side effects

Only 10% of women feel some discomfort when taking HRT drugs. Most susceptible unpleasant sensations those who smoke and are overweight. In such cases, swelling, migraines, swelling and soreness of the chest are noted. Usually these are temporary problems that disappear after the dosage is reduced or the dosage form of the drug is changed.

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

Myth number 9. HRT is unnatural

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

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

Myth number 10. HRT is an understudied method of treatment

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

HRT with menopause: pros and cons

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

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

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

98406 0 0

INTERACTIVE

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

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

Specialists prescribe to many menopausal women drug therapy, giving preference to homeopathic remedies, antidepressants, dietary supplements and other drugs that do not contain hormones. 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 which 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;
• believe 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

Most best reviews gynecologists and patients about combined hormonal drugs latest generation which 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, Kliogest, as well as Angeliq are available in blister packs of 28 tablets, 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 even more convenient dosage form because 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 drug 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) with 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 the symptoms of menopause. Just one capsule at bedtime will help a woman survive 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 a proper and balanced diet, 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.