HRT hormones. Hormone replacement therapy: what you need to know? Video about hormone replacement therapy for menopause

Content

Entering the age of forty, many women notice changes in appearance, health status. This happens because this period is dangerous with a decrease in the level of female sex hormones, and this is displayed on general well-being. Hormone replacement therapy solves many problems - from eliminating depression to prolonging youth for many years. Having mastered the necessary information, women without a threat to health can easily survive menopause with its unpleasant symptoms.

Benefits of hormone replacement therapy

Many women feel the need for additional hormones, but not all resort to their help, fearing side effects. Gynecologists say that modern hormonal preparations for women, they do not pose a threat, and fears are inspired by myths about the dangers of HRT. Doctors note the many benefits of therapy with medications containing hormones. Through experiments, it has been proven that cases of cardiovascular diseases are less common in women taking modern hormonal drugs than in those who do not accept such treatment.

With menopause

During menopause in women, estrogen levels remain extremely low for a long time, which has consequences that worsen the quality of life:

1. Depression becomes a frequent guest during menopause.
2. Headaches often visit women after 45 years.
3. Women complain about the weakening of memory with the advent of menopause.
4. The condition of the skin worsens: it becomes less elastic, unwanted wrinkles appear.
5. There is increased sweating, a feeling of heat at the most inopportune moment.

With hormone replacement therapy, the following positive effects are observed:

1. Reduces the risk of vascular diseases that can occur in women after forty years. Estrogen protects blood vessels from cholesterol plaques, when its level decreases, problems with the cardiovascular system begin.
2. Reduces the risk of thrombosis.
3. The body receives protection from osteoporosis, because the mineral density of bone tissue increases.
4. Modern hormone therapy is able to stabilize the weight, the excess of which affects women with menopause.

For breast cancer

With such terrible disease taking hormones is a prerequisite for a speedy recovery and maintaining the health of a woman during this difficult period. This treatment is relevant only after surgical intervention during amputation of the mammary gland. HRT has the following effect:

1. Reducing the risk of metastases, both in nearby organs and tissues, and distant ones.
2. Relief of the condition with menopause: complete or partial removal of symptoms.
3. Life extension for decades.

After removal of the uterus and ovaries

Apoplexy (rupture of an ovarian cyst), fibroids, malignant formations uterus and appendages can be the reason for a very responsible step - the removal of these organs. After the operation, even in young women, all the unpleasant symptoms of menopause are observed:

• irritability;
• depression;
• frequent headaches;
• lack of libido;
• dryness of the vagina;
• hot flashes, feeling hot, redness of the face and hands.

To prolong a woman's youth and improve the quality of life, sex hormone therapy is prescribed, which, after removal of the uterus and ovaries, are secreted by the adrenal glands, but in insufficient quantities. Some patients refuse such treatment, taking menopause for granted. Making a choice in favor proper nutrition, sports and positive thoughts, the girl will be able to live a long and happy life!

What examinations need to be done before prescribing hormones

The selection of hormonal therapy is individual in nature and cannot be prescribed independently. To exclude contraindications before taking hormones, it is necessary to conduct a series of examinations. So, you need to write in your plan:

1. Visit a gynecologist who will conduct a visual and palpation examination in a medical chair.
2. Make a smear from the cervix to examine the flora and exclude tumor markers.
3. Expanded blood test.
4. A blood test for hormones (packages of genital, thyroid, so-called sugar).
5. Samples demonstrating the state of the liver.
6. Ultrasound examination of the pelvic organs to exclude tumors.
7. Visiting a mammologist for the diagnosis of mammary glands.
8. Thyroid examination.

Forms of hormonal drugs

Modern drugs for menopause are available in different forms:

1. Oral tablets are the most popular and frequently used among this type of medicine. It contains not only estrogens, but also gestagens.
2. External form: a gel or patch containing estrogen is prescribed for women who have undergone surgery to remove the ovaries and uterus, because. they are allowed to take this hormone in its pure form.
3. Form for local application in the form of creams or suppositories. This medicine for menopause is used if a woman has hypertrophy of the mucous membrane of the genitourinary system.
4. A hormonal implant is prescribed for women who are contraindicated in estrogen. It is installed by a simple surgical intervention under the skin for 3 years, but if desired, it is easy to remove. This type of medication contains progesterone, which can protect against unwanted pregnancy during menopause.

Hormone replacement therapy drugs after 40 years

Modern pharmacology provides a large selection of drugs containing hormones for women after forty years of age. The most popular drugs for menopause, which have only good feedback in patients:

1. "Klimonorm" is available in the form of tablets containing estradiol (one of the types of the female hormone estrogen), is prescribed when the internal genital organs are removed: the ovaries and uterus, to relieve symptoms during menopause. Contraindicated in diabetes mellitus, jaundice and peptic ulcer stomach. It is applied once a day, 21 days. Then a seven-day break is made and a new package begins. Tablets are designed for a long term: from 5 to 10 years. This drug does not protect against pregnancy.
2. "Trisequens" - tablets consisting of estrogen and progesterone. It is prescribed by gynecologists to relieve painful symptoms upon the onset menopause in women over forty years of age. Contraindicated in internal bleeding and malignant tumors. The medication is taken once every 12 hours for 28 days, then a new package begins. Sometimes there are side effects in the form of itching in the vagina, frequent headaches, swelling of the legs. In such cases, it is necessary to stop taking the drug.
3. "Kliogest" - a drug for the prevention of osteoporosis, hot flashes, high blood pressure in women after forty. Allowed to take long time, if there are no side effects: migraine, hepatic colic, internal bleeding.
4. "Estrofem". The estrogen in this drug is estradiol. plant origin. It is prescribed to relieve climatic symptoms and prevent cardiovascular diseases in women. Contraindicated in violation of the kidneys, peptic ulcer.
5. "Proginova" is prescribed as a replenishment of the necessary female hormones. The estrogen contained in the tablets fully compensates for the lack of this component after the removal of appendages in women. Side effects may occur: skin allergy, itching all over the body. With such manifestations, this drug should be replaced with a more suitable one.
6. "Livial" - female hormones in tablets, which are prescribed for the prevention of osteoporosis, high blood pressure. The medicine relieves unpleasant symptoms during menopause. Doctors recommend taking the drug for no longer than five years, after which a six-month break is taken. Contraindicated in pregnancy.
7. "Femoston" is available in the form of tablets containing the hormone estradiol. It is prescribed to increase bone density during menopause in a woman. This drug is also used to treat the prostate in men. Reduces the risk of heart attack in menopausal women. Long-term use of such hormones is dangerous with unwanted sensations from the gastrointestinal tract. Finding side effects, a woman should consult a doctor.

Contraindications for use

Not all women will benefit from hormone replacement therapy, there are contraindications for use:

• malignant tumors mammary gland;
• uterine bleeding;
• diabetes 2 types;
• jaundice.

Video about hormone replacement therapy for menopause

For clarity and a better understanding of the processes that occur in the female body, watch the video. A practicing obstetrician-gynecologist with many years of experience in a well-known clinic will talk about the role of estrogens for female beauty, about the causes and signs of a deficiency of sex hormones in the blood. Watching this video will be useful for every woman: the doctor will explain whether homeopathy is effective in menopause, what studies and analyzes should be done so that the appointment is correct and beneficial.

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment, based on individual features specific patient.

After 45-50 years, the level of estrogen in the blood of a woman begins to gradually decrease. This can lead to symptoms such as night sweats, insomnia, calcium leaching from the bones.

Hormone replacement therapy aims to replace estrogen deficiency with drugs containing synthetic (artificial) hormones and prevent these symptoms.

Why is hormone replacement therapy (HRT) needed for menopause?

Hormone replacement therapy can reduce or eliminate the symptoms of menopause, as well as reduce the risk of developing some of the consequences of menopause, such as osteoporosis, heart disease, atrophic vaginitis (exhaustion of the vaginal mucosa), and others.

Who needs hormone replacement therapy for menopause?

Despite the fact that hormone replacement therapy can reduce the manifestations of menopause, it is not always necessary to take hormones during menopause and, most importantly, is safe.

Hormone replacement therapy is prescribed:

To relieve severe hot flashes and night sweats, if these symptoms cause severe discomfort and interfere with daily life.

With the appearance of such symptoms as: severe dryness and discomfort in the vagina,.

Hormone replacement therapy is not prescribed if the only problem associated with menopause is depression. Although hormones can sometimes help combat depressed mood, depression is preferably treated with antidepressants.

Who should not take hormones during menopause?

• You have had breast cancer
• You had
• Do you have serious illness liver and liver failure
• You have high triglyceride levels in your blood
• You have had deep vein thrombosis
• You
• You
• You

What tests should be done before you start taking hormones?

In order to make sure that you need hormone replacement therapy, and you have no contraindications for prescribing hormones, you need to undergo the following examinations and pass the following tests:

• Height and weight measurement, definition.
• Measurement of blood pressure.
• Examination by a mammologist and mammography (to exclude diseases of the mammary glands)
• Examination at the gynecologist
• General blood analysis
• General urine analysis
• Measurement of triglyceride and cholesterol levels in the blood
• Measuring blood sugar
• (pap test)

In some cases, your doctor may order other tests or tests, depending on your medical history.

What medications are prescribed for hormone replacement therapy?

Preparations containing estrogens are the most effective tool in the treatment of symptoms of menopause (dryness in the vagina, hot flashes, osteoporosis).

Hormones can be prescribed not only in the form of tablets, but also in the form of intramuscular injections, hormonal patches, subcutaneous implants, vaginal suppositories etc. The choice of a drug for hormone replacement therapy depends on how long the menstruation stopped, what symptoms bother you, and also what diseases and operations you have had before.

There are many different drugs prescribed for hormone replacement therapy. We list only some of them available in Russia:

• In the form of tablets (or dragees): Premarin, Hormoplex, Klimonorm, Klimen, Proginova, Cyclo-proginova, Femoston, Trisequens and others.
• In the form of intramuscular injections: Ginodian-Depot, which is administered every 4 weeks.
• In the form of hormonal patches: Estraderm, Klimara, Menorest
• In the form of skin gels: Estrogel, Divigel.
• In the form of an intrauterine device: .
• In the form of vaginal suppositories or vaginal cream: Ovestin.

Can I get pregnant while taking hormones?

Hormone replacement therapy does not suppress ovulation, which means you still have a theoretical risk of pregnancy. Therefore, you need to use 1 more year after your last period if you are 50 or older, or 2 years after your last period if you are under 50.

How long can hormone replacement therapy last?

Most gynecologists are of the opinion that hormone replacement therapy is safe if it lasts no more than 4-5 years. However, there is evidence that the treatment may be safe for 7-10 consecutive years. Taking hormones for 10 years or more can increase the risk of ovarian cancer and other complications.

Unfortunately, after you stop taking hormones, some symptoms (dryness in the vagina, urinary incontinence, etc.) may return.

What are the side effects of hormone replacement therapy?

Side effects may occur during hormone replacement therapy. Some of these effects are safe and disappear after a few months, others are reason to stop. hormonal treatment.

Often appear on the background of hormonal treatment. Most often, these are only minor spotting discharges that disappear 3-4 months after the start of hormone therapy. If a bloody issues last longer, or appear later than 4 months after the start of hormone therapy, then the woman needs a more thorough examination to make sure that this is not a polyp or endometrial cancer.

swelling and hypersensitivity Breast cancer is also a common side effect of hormonal treatment, but these symptoms go away after a few months.

Water retention in the body can lead to edema and weight gain.

What are the risks of hormone replacement therapy?

Hormone replacement therapy is undoubtedly effective method treatment, and yet, against the background of long-term hormonal treatment, the following complications may develop:

Breast cancer. Whether hormone therapy causes breast cancer is still a matter of debate in the scientific world. Research in this area gives conflicting results. However, most gynecologists are of the opinion that hormone replacement therapy slightly increases the risk of breast cancer, especially with long duration of treatment in women over 50 years of age.

Studies have shown that the use of certain hormone replacement therapy drugs for 5 years or more may increase the risk of endometrial cancer. The main symptom of endometrial cancer is spotting and irregular uterine bleeding, so when these symptoms appear in a woman in menopause, she needs an examination (endometrial biopsy).

The risk of blood clots may be increased in women taking hormonal drugs. That is why, if you previously had thrombosis, then hormone replacement therapy is not recommended.

The risk of stone formation in gallbladder(gallstone disease) is slightly increased among menopausal women taking hormonal drugs.

Ovarian cancer. Against the background of long-term hormonal treatment (10 years or more), the risk of ovarian cancer increases. Hormone replacement therapy for less than 10 years does not increase this risk.

How to reduce the risk of these complications?

To minimize the risk of complications and side effects of hormone therapy, first of all, it is necessary for the doctor to choose the treatment that is right for you. In this case, the doctor must prescribe the smallest dose of the drug that gives the desired effect, and the treatment should last exactly as long as necessary.

Since hormone replacement therapy can last for years, you need to see a doctor regularly, even if nothing bothers you:

One month after the start of hormonal treatment, you need to pass biochemical analysis blood to determine the level of fats (lipids) in the blood, indicators of liver function (ALT, AST, bilirubin), general analysis urine, measure blood pressure.

At each subsequent visit: urinalysis, blood pressure measurement.

Every 2 years: a biochemical blood test to determine the level of fats (lipids) in the blood, liver function indicators (ALT, AST, bilirubin), blood sugar levels, urinalysis, mammography.

Hormone replacement therapy in menopause plays an important role in the regulation and pathological changes occurring in the female body during this critical period.

Despite the existence of a number of myths about the great danger of such an event, numerous reviews suggest otherwise.

What hormones are missing?

The result of the development of menopause is a sharp decrease in the ability of the ovaries to produce progesterone, and subsequently estrogen due to the degenerative shutdown of the follicular mechanism and changes in the brain nerve tissues. Against this background, the sensitivity of the hypothalamus to these hormones decreases, which leads to a decrease in the production of gonadotropin (GnRg).

The response is an increase in the work of the pituitary gland in terms of the production of luteinizing (LH) and follicle-stimulating (FSH) hormones, which are designed to stimulate the production of lost hormones. Due to excessive activation of the pituitary gland, the hormonal balance is stabilized for a certain period of time. Then, the lack of estrogen affects, and the functions of the pituitary gland gradually slow down.

Decreased production of LH and FSH leads to a decrease in the amount of GnRh. The ovaries slow down the production of sex hormones (progestins, estrogens and androgens), up to the complete cessation of their production. It is a sharp decrease in these hormones that leads to menopausal changes in the female body..

Read about the norm of FSH and LH during menopause.

What is hormone replacement therapy

Hormone replacement therapy for menopause (HRT) is a treatment that introduces drugs similar to sex hormones, the secretion of which is slowed down. The female body recognizes these substances as natural, and continues to function normally. This ensures the necessary hormonal balance.

The mechanism of action of drugs is determined by the composition, which can be based on real (animal), plant (phytohormones) or artificial (synthesized) ingredients. The composition may contain hormones of only one specific type or a combination of several hormones.

In a number of products, estradiol valerate is used as an active substance, which in a woman's body turns into natural estradiol, which exactly imitates estrogen. Combined options are more common, where in addition to the indicated ingredient, progestogen-forming components are contained - dydrogesterone or levonorgestrel. There are also drugs with a combination of estrogens and androgens.

The combined composition of the new generation of drugs helped to reduce the risk of tumor formations that may occur due to an excess of estrogens. The progestogen component reduces the aggressiveness of estrogen hormones, making their effect on the body more gentle.

There are 2 main treatment regimens for hormone replacement therapy:

1. Short term treatment. Its course is designed for 1.5-2.5 years and is prescribed for a mild menopause, without obvious failures in the female body.
2. Long term treatment. With the manifestation of pronounced violations, incl. in the organs of internal secretion, cardiovascular system or psycho-emotional nature, the duration of therapy can reach 10-12 years.

Indications for the appointment of HRT may be such circumstances:

1. Any phase of menopause. The following tasks are set - premenopause - normalization menstrual cycle; menopause - symptomatic treatment and reduced risk of complications; postmenopause - the maximum relief of the condition and the exclusion of neoplasms.
2. Premature menopause. Treatment is needed to stop the inhibition of reproductive female functions.
3. After surgical procedures associated with the removal of the ovaries. HRT helps maintain hormonal balance, which prevents sudden changes in the body.
4. Prevention of age-related disorders and pathologies.
5. Sometimes used as a contraceptive measure.

Points for and against

There are many myths around HRT that frighten women, which sometimes causes them to be skeptical about such treatment. To make the right decision, you need to deal with the real arguments of opponents and supporters of the method.

Hormone replacement therapy provides gradual adaptation female body to the transition to other conditions, which avoids serious disruptions in the functioning of a number of internal organs and systems .

In favor of HRT, speaking such positive effects:

1. Normalization of the psycho-emotional background, incl. elimination panic attacks, mood swings and insomnia.
2. Improving the functioning of the urinary system.
3. Inhibition of destructive processes in bone tissues due to the preservation of calcium.
4. Prolongation of the sexual period as a result of increased libido.
5. Normalization of lipid metabolism, which reduces cholesterol. This factor reduces the risk of atherosclerosis.
6. Protection of the vagina from atrophy, which ensures the normal condition of the penis.
7. Significant relief of menopausal syndrome, incl. softening of the tides.

Therapy becomes an effective preventive measure to prevent the development of a number of pathologies - cardiac diseases, osteoporosis, atherosclerosis.

The arguments of the opponents of HRT are based on such arguments:

• insufficient knowledge of the introduction into the system of regulation of hormonal balance;
• difficulty in choosing the optimal treatment regimen;
• introduction into natural, natural processes of aging of biological tissues;
• the inability to establish the exact consumption of hormones by the body, which makes it difficult to dose them in preparations;
• unconfirmed real effectiveness in complications in the later stages;
• the presence of side effects.

The main disadvantage of HRT is the risk of such side disorders - pain in the mammary gland, tumor formations in the endometrium, weight gain, muscle cramps, gastrointestinal problems (diarrhea, gas formation, nausea), changes in appetite, allergic reactions(redness, rash, itching).

NOTE!

It should be noted that with all the difficulties, HRT proves its effectiveness, which is confirmed by numerous positive reviews. A properly chosen treatment regimen can significantly reduce the likelihood of side effects.

Basic drugs

Among the drugs for HRT, there are several main categories:

Estrogen-based products, names:

1. Ethinylestradiol, Diethylstilbestrol. They are oral contraceptives and contain synthetic hormones.
2. Klikogest, Femoston, Estrofen, Trisequens. They are based on the natural hormones estriol, estradiol and estrone. To improve their absorption in the gastrointestinal tract, hormones are presented in a conjugated or micronized version.
3. Klimen, Klimonorm, Divina, Proginova. The drugs include estriols and estrone, which are ether derivatives.
4. Hormoplex, Premarin. They contain only natural estrogens.
5. Gels Estragel, Divigel and Klimara patches are intended for external use.. They are used for serious liver pathologies, pancreatic diseases, hypertension and chronic migraine.

Means based on progestogens:

1. Duphaston, Femaston. They belong to dydrogesterones and do not give metabolic effects;
2. Norkolut. Based on norethisterone acetate. It has a pronounced androgenic effect and is useful in osteoporosis;
3. Livial, Tibolone. These drugs are effective in osteoporosis and are in many ways similar to the previous drug;
4. Klimen, Andokur, Diane-35. The active substance is cyproterone acetate. It has a pronounced antiandrogenic effect.

Universal preparations containing both hormones. The most common are Angelique, Ovestin, Klimonorm, Triaklim.

List of new generation drugs

Currently, new generation drugs are becoming more widespread. They have such advantages - the use of ingredients that are absolutely identical to female hormones; complex impact; the ability to use in any phase of menopause; the absence of most of these side effects. They are produced for convenience in different forms - tablets, cream, gel, patch, injection solution.

The most famous drugs:

1. Klimonorm. The active substance is a combination of estradiol and levonornesterol. Effective for eliminating the symptoms of menopause. Contraindicated in ectopic bleeding.
2. norgestrol. It is a combined remedy. It copes well with a neurogenic type disorder and autonomic disorders.
3. Cyclo-Proginova. Helps increase female libido, improves the functioning of the urinary system. Can not be used for liver pathologies and thrombosis.
4. Klymen. It is based on cyproterone acetate, valerate, an antiandrogen. Fully restores hormonal balance. When used, the risk of weight gain and depression increases nervous system. Allergic reactions are possible.

herbal remedies

A significant group of drugs for HRT are herbal remedies and medicinal plants themselves.

Such plants are considered to be quite active suppliers of estrogens.:

1. Soya. With its use, you can slow down the onset of menopause, facilitate the manifestation of hot flashes, and reduce the cardiological effects of menopause.
2. Black cohosh. It is able to alleviate the symptoms of menopause, blocks changes in bone tissue.
3. Red clover. It has the properties of previous plants, and is also able to reduce cholesterol.

On the basis of phytohormones, such preparations are produced:

1. Estrofel. It contains phytoestrogen, folic acid, vitamins B6 and E, calcium.
2. Tibolone. Can be used to prevent osteoporosis.
3. Inoklim, Feminal, Tribustan. Means are based on phytoestrogen. Provide gradually increasing healing effect with climax.

Main contraindications

In the presence of any chronic disease internal organs, the doctor should evaluate the possibility of conducting HRT, taking into account the characteristics of the female body.

This therapy is contraindicated in such pathologies.:

• uterine and ectopic nature (especially for unexplained reasons);
• tumor formations in the reproductive system and mammary gland;
• uterine diseases and diseases of the mammary gland;
• serious renal and hepatic pathologies;
• adrenal insufficiency;
• thrombosis;
• lipid metabolism anomalies;
• endometriosis;
• diabetes;
• epilepsy;
• asthma.

How to distinguish bleeding from menstruation, read.

Features of the treatment of surgical menopause

artificial or occurs after the removal of the ovaries, which leads to the cessation of the production of female hormones. In such circumstances, HRT can significantly reduce the risk of complications.

The therapy includes such schemes:

1. After removal of the ovaries, but the presence of the uterus (if a woman is under 50 years old), cyclic treatment is used in such options - estradiol and cipraterone; estradiol and levonorgestel, estradiol and dydrogesterone.
2. For women over 50 years old - monophasic estradiol therapy. It can be combined with norethisterone, medroxyprogesterone, or drosirenone. Tibolone is recommended.
3. At surgical treatment endometriosis. To eliminate the risk of recurrence, estraradiol therapy is carried out in combination with dienogest, dydrogesterone.

The whole truth about hormone replacement therapy

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

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

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

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

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

So, the main postulates of HRT.

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

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

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

3.When right choice HRT no data on increased incidence of breast and pelvic cancers, the risk may increase with the duration of therapy for more than 15 years! And also HRT can be used after the treatment of stage 1 endometrial cancer, melanoma, ovarian cystadenomas.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

17. Question about possible application HRT in complex therapy stress incontinence urine in menopause must be addressed individually.

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

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

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

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

Contraindications to HRT:

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

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

3. Liver diseases in the acute stage.

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

Examinations before the appointment of HRT:

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

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

Mammography

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

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

Individually - ultrasound of veins and arteries

About the drugs used in HRT.

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

Cutaneous etrogens (gels):

Divigel 0.5 and 1 gr 0.1%, Estrogel

Combined drugs E/G for cyclic therapy: Femoston 2/10, 1/10, Kliminorm, Divina, Trisequens

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

Tibolone

Gestagens: Dufaston, Utrozhestan

Androgens: Androgel, Omnadren-250

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

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

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

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

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

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

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

Sincerely, administration medical center"XXI Century"