Hormone therapy pros and cons. The use of HRT during menopause

With the onset of premenopause, a woman’s body begins to experience menopausal symptoms associated with a deficient level of estrogen.

Particular discomfort is caused by such manifestations as increased sweating, rapid dialing extra pounds, disturbance of the rhythm of the heartbeat, a feeling of dryness on the vaginal mucosa, the manifestation of urinary incontinence. Hormonal medications for menopause will help eliminate all unpleasant menopausal symptoms.

All hormonal drugs are divided into 2 main groups:

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

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

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

Let's take a closer look at why hormone therapy is prescribed and its positive aspects.

The positive side of hormone therapy

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

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

The manifestation of menopausal syndrome is associated with the formation of hot flashes and a sudden feeling of heat, increased sweating, followed by chills, psycho-emotional instability, increased blood pressure and his spasmodic character. Also, an increase in the rhythm of the heartbeat, the appearance of a feeling of numbness at the tips of the fingers, painful sensations in the heart area, sleep disturbances and the appearance of insomnia, depressive state and other associated symptoms.

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

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

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

The main principles of hormone replacement therapy are:

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

The main active component of hormonal drugs is estrogens. When adding gestagens, a kind of prevention of the hyperplastic process on the mucous membranes of the uterus and control of its condition is carried out. Let's look at the list of the most effective hormonal drugs.

HRT drugs

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

Klimonorm

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

The unique composition of the drug and adherence to a special dosage regimen in combination provide a chance for recovery menstrual cycle in women who have not undergone a hysterectomy.

The active component estradiol contained in Klimonorm completely replaces the lack of natural estrogen in a woman’s body during menopause. This helps eliminate vegetative and psychological problems that occur during menopause due to a decrease in testosterone and sexual activity. At correct intake the drug can reduce the rate of occurrence of deep wrinkles, increase the collagen content in skin. Moreover, the drug reduces blood cholesterol levels and the risk of gastrointestinal pathologies.

If the menstrual cycle is not completed and even rare menstrual discharge occurs, treatment should begin on the fifth day after the start of menstruation. If amenorrhea develops at the beginning of the menopausal period, treatment can be started at any time, provided there is no pregnancy.

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

Femoston

Hormone replacement therapy during the postmenopausal period involves taking this two-phase combination drug if the woman has no contraindications. The two active components that make up this drug, estradiol and progesterone, have a similar effect on the body as natural female sex hormones.

Together, estradiol and progesterone contribute to:

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

The tableted drug Femoston must be taken at the same time period once a day. Treatment should be carried out according to the prescribed regimen. In the first two weeks it is recommended to take hormone tablets white. For the next two weeks of course treatment, you need to take gray tablets.

For women with a predominant menstrual cycle, treatment is prescribed from the first day of menstruation. For those who have irregularities in the menstrual cycle, a course of treatment with the drug “Progestagen” is initially prescribed, then Femoston is taken, according to a special treatment regimen. Women who have no menstrual cycle at all can start taking the drug at any time.

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

Klimadinon

This drug belongs to the group of herbal medicines containing phytohormones. Prescribed for the treatment of menopausal symptoms and elimination of vegeto vascular disorders when there are obvious contraindications and hormones cannot be taken during menopause.

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

Angelique

Angelique, like Klimonorm, are medications for menopause in women that help get rid of unpleasant symptoms and improve overall well-being.

Angeliq is used for:

• Normalization of general well-being;
• Eliminating unpleasant symptoms of hot flashes and reducing the frequency of their occurrence;
• Prevention of osteoporosis;
• Increasing testosterone levels, and, consequently, normalizing sexual activity.

Do not take this medicine if you have the following conditions:

• The presence of bleeding from the vagina of unknown etiology;
• Development of a cancerous tumor in the mammary glands;
• For diabetes, hypertension and venous thrombosis.

Angelique contains essential hormones during menopause, which are an excellent solution for improving well-being and recovery. hormonal imbalance, especially for women over 45-46 years old.

Klimara

This is a hormonal drug, produced in the form of a patch, which contains estradiol in a dose of 3.8 mg. The patch is glued to a certain area of ​​the skin, after which release begins active component and improving the overall well-being of women. It is recommended to wear one patch for no more than a week. On the last day of the week, it is necessary to replace the used patch with a new one, making sure to change the place for its fixation.

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

During menopause, female hormones decrease under the influence of age-related changes and the transition period, worsening the woman’s condition. Therefore, it is necessary to use HRT drugs that can, in a short period of time, relieve a woman from disorders of the autonomic system, decreased testosterone levels and the ensuing consequences: changes in psychosis emotional state. Among other things, hormonal drugs are generally well absorbed and have no adverse reactions.

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

Spontaneous intake of hormonal drugs can be not only useless for the body, but also dangerous, entailing irreversible consequences. Therefore, you should take hormonal medications only as prescribed by your doctor.

Interesting and educational video

Menopause, even with a mild course, is perceived as an inevitable evil. Well-being worsens, and in different directions, and disturbing thoughts come to mind more often. But few people try to fight this with the help of medications, or women, due to incompetence, choose inappropriate remedies themselves.

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

Read in this article

Why is HRT needed?

Many women have a prejudice against menopausal hormone therapy that its harm far outweighs its positive effect. The fears are unfounded; the body has functioned for many years thanks to these components. They ensured normal metabolism and the functioning of all systems. Rather, it serves to cause disease, ultimately leading to premature aging 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 many parameters of the body of a particular woman. It also depends on the stage.

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

• The functioning of the cardiovascular system deteriorates. Blood does not circulate as actively throughout the body, becoming more viscous. The vessels are less elastic and deposits appear on them. Hot flashes provoke heart failure, increasing the likelihood of heart attack and stroke;
• Arises. Vegetative-vascular disorders caused by the disappearance of the influence of sex hormones lead to increased neuropsychological excitability and rapid fatigue. Hot flashes also interfere with sleep;
• Atrophic processes in 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;
• The risk of injury and fractures increases due to (weakening of bone tissue as a result of loss), changes in the joints are noticed.

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

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

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

In short, hormone therapy is one of the main methods.

Is it shown to everyone?

The products used for HRT are based on estrogen, progesterone, or only the first substance. They affect the body comprehensively. Estrogens allow the endometrium to grow, while progesterone reduces this effect.

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

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

What to do before taking hormonal drugs?

Taking into account contraindications and possible unexpected manifestations, menopausal hormonal therapy, necessary for protection against diseases, is prescribed only based on the results of the examination. It should include:

• Ultrasound of reproductive organs;
• Blood test for biochemistry;
• Oncocytology examination of material taken from the cervix;
• Ultrasound of the mammary glands and mammography;
• Studying hormonal status with detection of the concentration of TSH, FSH, estradiol, prolactin, glucose;
• Blood clotting test.

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

• Lipidogram, that is, a cholesterol test;
• Densitometry, which reveals bone density.

Features of HRT at the final stage of menopause

Hormone replacement therapy in postmenopause is prescribed not only taking into account the existing symptoms of the condition that need to be relieved and potential threats. Such features of the female body as the presence of reproductive organs are important.

If the uterus is preserved, when exposed to estrogen-containing drugs, the mucous membrane is likely to grow, that is, creating a danger of endometrial cancer. Therefore in in this case the doctor will give preference to products with progestins and androgens to relieve the threat. Some women have their uterus removed if processes that are dangerous to health occur in it. Replacement therapy hormones under such 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 require less time to use the drugs. To prevent and treat osteoporosis, more long treatment. Stopping it on your own is just as dangerous as starting it.

Prolongation beyond the required period, exceeding dosages are fraught with an increased risk of tumor formation, thrombosis, heart attack, and stroke. Therefore, the entire therapy process is accompanied by supervision from a specialist.

Estrogen therapy for menopause

In such a fragile state as this, HRT preparations must contain the required minimum of hormones. The following products contain only estrogens and are suitable for use 12 months after the last menstrual period and later:

• Premarin. In addition to reducing vegetative-vascular manifestations, it fights the loss of calcium and phosphorus in the bones, lowers low-density lipoproteins in the blood, increases the volume of HDL, and improves glucose excretion. Take the drug in cycles of 21 days, then take a week break. Prolonged use is also possible. 0.3-1.25 mcg per day is prescribed, decreasing or increasing the dose depending on how you feel;
• Proginova. In fact, it is estradiol valerate, a synthetic analogue of what was previously produced by the ovaries. The drug keeps bone tissue dense, preventing osteoporosis, and maintains the tone of the mucous membranes in the urogenital area. Take 1 tablet, without crushing, cyclically or continuously;
• Dermestril. It exists in several dosage forms (tablets, spray, injection solution, patch). Eliminates vasomotor signs of menopause, inhibits the removal of calcium from bones and the clogging of blood vessels with cholesterol;
• Klimara. , containing estradiol gamihydrate, which is released and enters the blood in portions of 50 mcg. Its effect extends to the relief of all symptoms of menopause, but it is necessary to fix the drug 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 use of 1 tablet per day. If after 3 months of use the effect of relieving severe symptoms of postmenopause is insufficient, the doctor may change the dosage;
• Ovestin. Estriol, which forms its basis, suppresses the leaching of calcium from bones. The drug also reduces the possibility of inflammation of the vagina and other reproductive organs, thanks to the restoration of the mucous membrane. Available in the form of suppositories, tablets and vaginal cream. Take 4-8 mg orally per day. Long-term use of high doses is undesirable; it is necessary to strive to reduce them.

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

Combined drugs for postmenopausal HRT

Postmenopause forces combined HRT drugs to use savings if necessary. The estrogens they contain perform their task, as in monophasic products. But their Negative influence neutralized by the work of gestagens or androgens. Experts make a choice among such means from the following names:

• Climodien. It combines estradiol valerate with dienogest. The latter promotes endometrial atrophy, preventing its thickening and penetration into muscle layer uterus and Normalizes the ratio of “bad” and “good” cholesterol, reducing the risk of cardiovascular diseases. Climodien is taken continuously as long as there is a need for therapy, one tablet per day;
• Cliogest. This is a “combination” of estriol and norethisterone acetate. The drug is indispensable in the prevention and treatment of osteoporosis, prevents the development of cardiac and urogenital ailments. Possible problems with the endometrium when taking estriol do not arise, thanks to norethisterone, which has gestagenic and slightly androgenic effects. For daily continuous use within the course of treatment, 1 tablet is sufficient. Similar to Kliogest in composition and effect on the body are the drugs Pauzogest, Eviana, Aktivel, Revmelid;
• Livial. Its active ingredient is tibolone, which simultaneously has the properties of estrogen, androgens and gestagens. Thanks to this, the product keeps the endometrium quite thin, helps conserve calcium, and normalizes the condition of blood vessels. Last quality reduces the risk of heart disease, restores blood supply to the brain;
• Femoston 1/5. The product is a combination of estradiol and dydrogesterone. Saves from osteoporosis, vascular disorders, returns libido, thanks to the normalization of the mucous membranes of the genital and urinary organs. Does not 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 can consist not only of taking hormonal drugs. The following have a similar effect on the signs of menopause:

• Klimadinon;
• Inoclim;
• Klimonorm;
• Qi-Clim.

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

Menopausal, correctly chosen hormonal therapy can not only prevent ischemic disease heart disease, osteoporosis and colon cancer. It has been proven that it reduces the risk of age-related visual impairment and Alzheimer's disease. The drugs also help maintain external youthfulness.

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Menopause is a natural biological process of transition from the reproductive period of a woman’s life to old age, which is characterized by a gradual decline in ovarian function, a decrease in estrogen levels, cessation of menstrual and reproductive function. The average age of menopause for women in the European Region is 50-51 years.

Menopause includes several periods:

• premenopause - the period from the appearance of the first symptoms of menopause to menopause;
• menopause - cessation of spontaneous menstruation, diagnosis is made retrospectively after 12 months. after the last spontaneous menstruation;
• postmenopause - the period after the cessation of menstruation until old age (69-70 years);
• perimenopause is a chronological period that includes premenopause and 2 years of menopause.

Premature menopause is the cessation of spontaneous menstruation before the age of 40, early menopause - before the age of 40-45. Artificial menopause occurs after surgical removal ovaries (surgical), chemotherapy and radiation therapy.

Only 10% of women do not feel the clinical manifestations of approaching menopause and postmenopause. Thus, the majority of the female population needs qualified consultation and timely initiation of therapy when menopausal syndrome (CS) occurs.

CS, developing under conditions of estrogen deficiency, is accompanied by a complex pathological symptoms, which arise depending on the phase and duration of this period.

The earliest signs of CS are neurovegetative disorders (hot flashes, sweating, lability of blood pressure, palpitations, tachycardia, extrasystole, dizziness) and psycho-emotional disorders (mood instability, depression, irritability, fatigue, sleep disturbances), which persist in 25-30% more than 5 years.

Later, urogenital disorders develop in the form of dryness, burning and itching in the vagina, dyspareunia, cystalgia and urinary incontinence. On the part of the skin and its appendages, dryness, the appearance of wrinkles, brittle nails, dryness and hair loss are noted.

Metabolic disorders manifest themselves in the form of diseases of the cardiovascular system, osteoporosis, Alzheimer's disease and develop under conditions of prolonged hypoestrogenism.

According to modern research Various options for CS therapy have been proposed, starting with the most accessible, simple ones and ending with hormone replacement therapy (HRT).

Non-drug methods include following a diet rich in fiber and low in fat, physical exercise, a healthy lifestyle (quitting smoking, eliminating coffee and alcoholic beverages), limiting nervous and mental stress.

If a woman has a history of diseases of the cardiovascular and nervous system, the manifestations of which are often aggravated by CS, pathogenetic therapy is carried out with antihypertensive, sedative, hypnotic drugs and antidepressants. HRT is carried out taking into account contraindications to the use of these drugs.

Often, one of the first stages of treatment for CS is therapy with drugs that include black cohosh. This group of drugs is mainly effective in women with mild degree CS and slightly expressed vegetative-vascular symptoms.

Despite the widespread use non-drug methods therapy, a significant proportion of women fail to achieve the full clinical effect and the issue is resolved in favor of HRT. Currently, both positive and negative experience has been accumulated in the treatment of CS with hormonal drugs. The results of numerous studies have proven the positive effects of HRT, which include regulating the menstrual cycle, treating endometrial hyperplasia in premenopausal women, eliminating the symptoms of CS and preventing osteoporosis.

The evolution of HRT has come a long way from drugs containing only estrogens to combined estrogen-progestogen, estrogen-androgen and progestogen drugs.

Modern HRT preparations contain natural estrogens (17b-estradiol, estradiol valerate), which are identical in chemical structure to estrogens synthesized in the female body. Progestogens included in HRT preparations are represented by the following groups: progesterone derivatives (dydrogesterone), nortestosterone derivatives, spironolactone derivatives.

No less important was the development of individual regimens for the use of HRT drugs, depending on the period of menopause, the presence or absence of a uterus, the woman’s age and concomitant extragenital pathology (tablet forms, patches, gels, intravaginal and injectable drugs).

HRT is carried out in three modes and includes:

• monotherapy with estrogens and progestogens in a cyclic or continuous mode;
• combination therapy estrogen-gestagen drugs in a cyclic mode (intermittent and continuous dosage regimens);
• combination therapy with estrogen-gestagen drugs in a monophasic continuous mode.

If a uterus is present, combination therapy with estrogen-gestagen drugs is prescribed.

In premenopause (up to 50-51 years) - these are cyclic drugs that imitate the normal menstrual cycle:

• estradiol 1 mg/dydrogesterone 10 mg (Femoston 1/10);
• estradiol 2 mg/dydrogesterone 10 mg (Femoston 2/10).

If postmenopause lasts more than 1 year, HRT drugs are prescribed continuously without menstrual-like bleeding:

• estradiol 1 mg/dydrogesterone 5 mg (Femoston 1/5);
• estradiol 1 mg/drospirenone 2 mg;
• tibolone 2.5 mg.

In the absence of a uterus, estrogen monotherapy is carried out in a cyclic or continuous mode. If surgery is performed for genital endometriosis, therapy should be carried out with combined estrogen-gestagen drugs in order to prevent further growth of unremoved lesions.

Transdermal forms in the form of patches, gel and intravaginal tablets are prescribed in a cyclic or continuous mode, taking into account the period of menopause in the presence of contraindications for the use of systemic therapy or intolerance to these drugs. Estrogen drugs are also prescribed in a cyclic or continuous mode (in the absence of the uterus) or in combination with progestogens (if the uterus is not removed).

According to recent studies, an analysis of long-term use of HRT in different periods menopause and its impact on diseases of the cardiovascular system, the risk of breast cancer. These studies allowed us to draw a number of important conclusions:

• The effectiveness of HRT against neurovegetative and urogenital disorders has been confirmed.
• The effectiveness of HRT in preventing osteoporosis and reducing the incidence of colorectal cancer has been confirmed.

It is believed that the effectiveness of HRT in relation to the treatment and prevention of urogenital disorders and osteoporosis depends on how early this therapy is started.

• The effectiveness of HRT for the prevention of cardiovascular disease and Alzheimer's disease has not been confirmed, especially if therapy is started in postmenopause.
• A slight increase in the risk of breast cancer (BC) has been established with a duration of HRT of more than 5 years.

However, according to clinical and epidemiological studies, HRT is not a significant risk factor for breast cancer compared with other factors (hereditary predisposition, age over 45 years, overweight, high cholesterol, early age at menarche and late menopause). Duration of HRT up to 5 years does not have a significant effect on the risk of developing breast cancer. It is believed that if breast cancer is first detected during HRT, then, most likely, the tumor has already existed for several years before the start of therapy. HRT does not cause the development of breast cancer (as well as other localizations) from healthy tissue or organ.

In connection with the currently accumulated data, when deciding whether to prescribe HRT, the benefit-risk ratio is first assessed, which is analyzed throughout the entire duration of therapy.

The optimal time to start HRT is the premenopausal period, since it is at this time that complaints characteristic of CS first appear, and their frequency and severity are maximum.

Examination and monitoring of a woman during HRT allows her to avoid unfounded fear of hormonal drugs and complications associated with the therapy. Before starting therapy, a mandatory examination includes a consultation with a gynecologist, assessment of the condition of the endometrium (ultrasound examination) and mammary glands (mammography), a smear for oncocytology, and determination of blood sugar. Additional examination is carried out according to indications (total cholesterol and blood lipid spectrum, assessment of liver function, hemostasiogram parameters and hormonal parameters - follicle-stimulating hormone, estradiol, hormones thyroid gland and etc.).

Before starting treatment, risk factors are taken into account: individual and family history, especially for diseases of the cardiovascular system, thrombosis, thromboembolism and breast cancer.

Dynamic monitoring during HRT (ultrasound of the pelvic organs, hemostasiogram, colposcopy, smears for oncocytology and blood biochemistry - according to indications) is carried out once every 6 months. Mammography for women under 50 years of age is performed once every 2 years, and then once a year.

Among the many medications, proposed for the treatment of CS, combined estrogen-gestagen drugs, which include 17b-estradiol and dydrogesterone (Duphaston) deserve attention. different dosages(Femoston 2/10, Femoston 1/10 and Femoston 1/5), which allows them to be used both in premenopause and postmenopause.

The micronized form of estradiol, unlike the usual crystalline form found in other drugs, is well absorbed in the gastrointestinal tract and metabolized in the intestinal mucosa and liver. The progestogen component, dydrogesterone, is close to natural progesterone. Due to the peculiarities of the chemical structure, the activity of the drug increases when taken orally, which gives it metabolic stability. Distinctive feature is the absence of side estrogenic, androgenic and mineralocorticoid effects on the body. Dydrogesterone at a dose of 5-10 mg provides reliable protection endometrium, without reducing the positive effect of estrogens on lipid composition blood and carbohydrate metabolism.

The drugs are available in a package containing 28 tablets. The pills are taken continuously from cycle to cycle, which greatly simplifies the treatment.

In premenopausal women with severe neurovegetative and psycho-emotional disorders against the background of a regular or irregular rhythm of menstruation, as well as in the presence of symptoms of urogenital disorders, the drugs of choice are Femoston 2/10 or Femoston 1/10. In these preparations, estradiol in a dose of 2 or 1 mg, respectively, is contained in 28 tablets, and dydrogesterone in a dose of 10 mg is added in the second half of the cycle for 14 days. The cyclic composition of the drugs provides a cyclic regimen of therapy, as a result of which a menstrual-like reaction occurs every month. The choice of these drugs depends on the age of the patient and allows the use of Femoston 1/10, reducing the total dose of estrogen in premenopausal women with mild neurovegetative symptoms. The drug Femoston 2/10 is indicated for significantly severe symptoms menopause or insufficient effect of Femoston therapy 1/10.

The administration of these drugs in a cyclic mode is effective in regulating the menstrual cycle, treating endometrial hyperplasia, vegetative and psycho-emotional symptoms of menopause.

In a comparative study of two regimens for prescribing cyclic drugs for HRT: intermittent (with a 7-day break in taking estrogen) and continuous, it was concluded that 20% of women during the period of drug withdrawal, especially in the first months of treatment, experienced menopausal symptoms are resumed. In this regard, it is believed that a continuous regimen of HRT (used in the drugs Femoston 1/10 and Femoston 1/10 - 2/10) is preferable to intermittent treatment regimens.

In postmenopause, a drug containing estradiol 1 mg/dydrogesterone 5 mg (Femoston 1/5) is prescribed continuously for 28 days. The content of the estrogen and gestagen components in all tablets is the same (monophasic mode). With a constant regimen of taking this drug, the endometrium is in an atrophic, inactive state and cyclic bleeding does not occur.

A pharmacoeconomic study conducted in perimenopausal women showed the high cost-effectiveness of HRT for CS.

Data from a clinical study of a group of women who received Femoston 2/10 for 1 year indicate a decrease in the frequency and severity of menopausal symptoms after 6 weeks. after the start of treatment (hot flashes, increased sweating, decreased performance, sleep disturbance). As for the effect of low doses of estrogens and gestagens (Femoston 1/5), the almost complete disappearance of vasomotor symptoms (treatment was started in postmenopause) and a decrease in the manifestation of urogenital disorders was noted after 12 weeks. from the start of taking the drug. Clinical effectiveness was maintained throughout the entire duration of therapy.

Contraindications are practically no different from contraindications to the use of other estrogen-gestagen drugs: pregnancy and lactation; hormone-producing ovarian tumors; dilated myocardiopathy of unknown origin, deep vein thrombosis and pulmonary embolism; acute diseases liver.

Low-dose forms of the drug Femoston 1/10 for perimenopause and Femoston 1/5 for postmenopause allow you to prescribe HRT in any period of menopause in full compliance with modern international recommendations for HRT - therapy with the lowest effective doses of sex hormones.

In conclusion, it should be noted that the management of women during such a difficult period of life as menopause should be aimed not only at maintaining the quality of life, but also at preventing aging and creating the basis for active longevity. In most patients with severe menopausal symptoms HRT continues to be the optimal treatment method.

T.V. Ovsyannikova, N.A. Sheshukova, State Educational Institution Moscow Medical Academy named after. I.M. Sechenov.

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

Should I take hormones during menopause?or 10 myths about HRT

After the age of 45, women’s ovarian function begins to gradually decline, which means the production of sex hormones decreases. Along with a decrease in estrogen and progesterone in the blood comes a deterioration in physical and emotional condition. Menopause is ahead. And almost every woman begins to worry about the question: what can she do take during menopause to avoid aging?

In these difficult times, the modern woman comes to the aid of. Because during menopause estrogen deficiency develops, it is these hormones that have become the basis for all medications drugs HRT. The first myth about HRT is associated with estrogens.

Myth No. 1. HRT is unnatural

There are hundreds of queries on the Internet on the topic:how to replenish estrogen for a woman after 45-50 years . No less popular are queries about whether they useherbal preparations during 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 complete chemical identity with the estrogens produced by the ovaries.

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

Some might argue that herbal remedies 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 not always effective in relieving the early symptoms of menopause (hot flashes, increased sweating, migraines, blood pressure surges, 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) has not been well studied and medicine cannot vouch for their safety.

Myth No. 2. HRT is addictive

Hormone replacement therapy for menopause- just a replacement for a lost one hormonal function ovaries. Drugs HRT is not a drug, it does not violate natural processes in a woman's body. Their task is to compensate for estrogen deficiency, restore the balance of hormones, and also improve overall well-being. You can stop taking the 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 youth.

Myth No. 3. HRT will make a mustache grow

The negative attitude towards hormonal drugs in Russia arose quite a long time ago and has already moved to the subconscious level. Modern medicine has come a long way, but many women still trust outdated information.

The synthesis and use of hormones in medical practice began in the 50s of the 20th century. A real revolution was made by glucocorticoids (adrenal hormones), which combined powerful anti-inflammatory and antiallergic effects. However, doctors soon noticed that they affected body weight and even contributed to the manifestation of masculine characteristics in women (the voice became rougher, excess hair growth began, etc.).

Much has changed since then. Preparations of other hormones (thyroid, pituitary, female and male) were synthesized. And the type of hormones has changed. Part modern medicines The hormones included are as “natural” as possible, and this allows you to significantly reduce their dose. Unfortunately, all the negative qualities of outdated high-dose drugs are attributed to new, modern ones. And this is completely unfair.

The most important thing is that HRT preparations contain exclusively female sex hormones, and they cannot cause “masculinity.”

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

When ovarian function declines, female sex hormones (estrogens and progesterone) stop being replenished, while male sex hormones (androgens) are still 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 mustache and chin hairs. And HRT drugs have absolutely nothing to do with it.

Myth No. 4. People get better from HRT

Another unreasonable fear- gain weight while taking it drugs hormone replacement therapy. But everything is quite the opposite. Prescription of HRT during menopause can have a positive effect on women's curves and shapes. HRT contains estrogens, which generally have no ability to influence changes in body weight. As for the gestagens (these are derivatives of the hormone progesterone) included innew generation of HRT drugs, then they help distribute adipose tissue “according to the female principle” and allow during menopause keep your figure feminine.

Don’t forget about the objective reasons for weight gain in women after 45. First: at this age, physical activity noticeably decreases. And second: the influence of hormonal changes. As we have already written, 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 abdominal area, and the figure begins to resemble a man’s. As you can see, HRT drugs do not play any role in this matter.

Myth No. 5. HRT can cause cancer

The idea that taking hormones can cause cancer is an absolute misconception. There is official data on this topic. According to World Health Organization, thanks to the use hormonal contraceptives and their oncoprotective effect annually prevents about 30 thousand cases of cancer. Indeed, estrogen monotherapy increased the risk of endometrial cancer. But such treatment is far in the past. Partnew generation HRT drugs includes progestogens , which prevent the risk of developing endometrial cancer (body of the uterus).

As for breast cancer, there has been plenty of research on the effect of HRT on its occurrence. This issue has been seriously studied in many countries around the world. Especially in the USA, where HRT drugs began to be used back in the 50s of the 20th century. It has been proven that estrogens - main component HRT drugs are not oncogenes (that is, they do not unblock the gene mechanisms of tumor growth in the cell).

Myth No. 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 wrong. New generation HRT drugs do not irritate the mucous membranes gastrointestinal tract and do not have a toxic effect on the liver. It is necessary to limit the use of HRT drugs only in cases where there are pronounced liver dysfunctions. And after the onset of remission, it is possible to continue HRT. Also, taking HRT drugs is not contraindicated for women with chronic gastritis or peptic ulcer stomach and duodenum. Even during seasonal exacerbations, you can take tablets as usual. Of course, simultaneously with therapy prescribed by a gastroenterologist and under the supervision of a gynecologist. For women who are especially concerned about their stomach and liver, special forms of HRT preparations are produced for topical use. These may be skin gels, patches or nasal sprays.

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

Life after menopause not all women immediately burdened unpleasant symptoms and a sharp deterioration in health. In 10 - 20% of the fair sex, the autonomic system is resistant to hormonal changes and therefore for some time they are spared from 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 course of menopause take its course.

The 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 vaginal dryness; obesity and cardiovascular diseases; osteoporosis and osteoarthritis and even senile dementia.

Myth No. 8. HRT has many side effects

Only 10% of women feel certain discomfort when taking HRT drugs. Those who smoke and are overweight are most susceptible to unpleasant sensations. In such cases, swelling, migraines, swelling and tenderness of the breast are noted. Usually these are temporary problems that disappear after reducing the dosage or replacing dosage form drug.

It is important to remember that HRT cannot be carried out independently without medical supervision. In each specific case it is necessary individual approach and continuous monitoring of results. Hormone replacement therapy has a specific list of indications and contraindications. Only a doctor, after conducting a number of studies, will be able tochoose the right treatment . When prescribing HRT, the doctor observes the optimal balance between 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 No. 9. HRT is unnatural

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

Hollywood star Sharon Stone turned 58 years old 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 should sit back and play golf in your backyard. We are too young for this: 50 is the new 30, a new chapter."

Myth No. 10. HRT is an understudied treatment method

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, through trial and error, searched 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 treatment method as little studied, although this is far from the case. Today we have the opportunity to use proven and highly effective remedies with a minimum number of side effects.

HRT for menopause: pros and cons

For the first time, HRT drugs for women in menopause began to be used in the USA in the 40-50s of the 20th century. As treatment became more popular, it was found that the risk of disease increased during the treatment period uterus ( endometrial hyperplasia, cancer). After a thorough analysis of the situation, it turned out that the reason was the use of only one ovarian hormone - estrogen. Conclusions were drawn, and in the 70s biphasic drugs appeared. They combined estrogens and progesterone in one tablet, 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 effect extends not only to menopausal symptoms.HRT during menopauseslows down atrophic changes in the body and becomes an excellent prophylactic agent in the fight against Alzheimer's disease. It is also important to note the beneficial effects of therapy on cardiovascular system women. While taking HRT drugs, doctors recorded improving lipid metabolism and reducing blood cholesterol levels. All these facts make it possible today to use HRT as a prevention of atherosclerosis and heart attack.

Information from the magazine was used [Climax is not scary / E. Nechaenko, - Magazine “ New pharmacy. Pharmacy assortment”, 2012. - No. 12]

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INTERACTIVE

It is extremely important for women to know everything about their health - especially for initial 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 see a specialist and make an appointment.

HELL. Makatsaria, V.O. Bitsadze
Department of Obstetrics and Gynecology, Faculty of Preventive Medicine, MMA named after. THEM. Sechenov

Non-enzymatic glycosylation of essential cellular components, including DNA and proteins, leads to cross-linking and accumulation of cross-linked proteins in cells and tissues, causing negative effects on cellular function, particularly biosynthesis and energy systems. The “hardwired” theory implies that the aging process is the result of a genetic program similar to those that control embryogenesis and growth. It is believed that at least several genes are involved in the genetic control of maximum lifespan. Recently, in vitro experiments showed that activation of telomerase in human cells can significantly slow down physiological aging.

A wide range of physiological changes in the normal aging process occur independently of disease. In this regard, when managing geriatric patients, it is necessary to take into account the decrease in functional reserves of all organs and systems. From a modern point of view, the theory of the “programmed” process of aging and death seems most attractive, taking into account recent advances in the study of the process of apoptosis - “programmed” cell death - in the pathogenesis of many diseases, and, first of all, in the process of atheromatosis and atherosclerosis, as well as cancer diseases. However, one should not discount the fact that, along with “programmed” aging, damage and death of cells, free radicals and glycosylation as exogenous damaging factors can also play an important additional role.

Perhaps some “confusion” in the mechanisms of aging, apoptosis, atherosclerosis, lipid metabolism and endothelial disorders, as well as the lack of consideration of a number of changes in the hemostasis system (both acquired and genetically determined) became the reason for the very contradictory results of the widespread use of HRT. Since estrogen-containing medications have been found to have a positive effect on lipid profile, it was suggested (from our point of view, very lightly) that HRT can significantly reduce the risk of developing cardiovascular complications. It should be noted that this idea originated in those times when the exclusive, if not the only, cause of atherosclerosis, ischemic heart disease, acute myocardial infarction and stroke was considered high level cholesterol and low-density lipoproteins (LDL) in the blood.

Observational studies in the early 1980s confirmed the hypothesis of the cardioprotective effect of HRT. There was a significant reduction in the incidence of cardiovascular diseases and mortality from these diseases. Against the backdrop of the first very encouraging results, it was unexpected for many researchers that HRT is associated with an increased risk of thrombosis and thromboembolic complications.

When the side effects of HRT were first studied in 1974, a slight predominance of women receiving HRT among patients with venous thrombosis was noted (14 and 8%, respectively). However, subsequent studies did not reveal an increase in the incidence of thrombosis during HRT (Young, 1991; Devor, 1992). Bounamex et al. (1996) also did not find significant changes in hemostasis parameters, especially with the transdermal route of administration.

Later studies showed a higher risk of developing venous thrombosis(2–4 times higher than in women not receiving HRT). Subsequently, case-control studies and prospective observational studies have also confirmed the relationship between HRT and venous thrombosis. It is characteristic that the greatest risk of developing venous thrombosis is observed in the first year of taking HRT. An increased incidence of thrombosis was found with both oral and transdermal routes of HRT administration; both when using conjugated estrogens and estradiol.

The contradictory results of early and late studies are due to at least three factors:

– imperfection of objective diagnostic methods detection of venous thrombosis in early studies;

– low prevalence of HRT use in early studies, which resulted in unreliable results in determining the difference in relative risk.

Thus, in early studies, the frequency of HRT use among a healthy population of women was 5–6%;

– lack of accounting possible availability hidden genetic forms of thrombophilia and/or antiphospholipid syndrome (APS).

The fact that both with hormonal contraception and with HRT the incidence of thrombosis is higher during the first year indicates to a large extent the existence of additional risk factors, in particular latent genetic thrombophilia (FV Leiden mutation, prothrombin G20210A mutation, etc.) or APS . Regarding the latter, it should be noted: APS is often ignored, since a complicated obstetric history (fetal loss syndrome, severe gestosis, premature abruption of a normally located placenta) is not taken into account when prescribing HRT drugs, not to mention the laboratory detection of antiphospholipid antibodies. The results of the HERS study (The Heart and Estrogen/Progestin Replacement Study), in addition, indicate an increased risk of arterial thrombosis in patients with genetically determined and acquired (APS) thrombophilia during HRT.

In light of the above, the results of one randomized trial (EVTET, 2000) on the use of HRT in women with a history of venous thrombosis are very interesting. The study was stopped early based on the results obtained: the rate of recurrent thrombosis was 10.7% in the group of patients with a history of thrombosis during HRT and 2.3% in the placebo group.

All cases of thrombosis were noted during the first year of HRT. Most women with recurrent venous thrombosis while taking HRT had a genetically determined (Factor V Leiden mutation) or acquired (antiphospholipid antibodies) hemostasis defect. At re-analysis In the Oxford case-control study, the risk of thrombosis was higher in women with resistance and APS. According to Rosendaal et al., if the risk of deep vein thrombosis (DVT) in the presence of the FV Leiden mutation or prothrombin G20210A mutation increases the risk by 4.5 times, and HRT increases the risk of developing venous thrombosis by 3.6 times, then their combination is observed an 11-fold increase in risk. Thus, HRT, as well as combined oral contraception(COC), has a synergistic effect with genetic and acquired thrombophilia regarding the risk of developing venous thrombosis. Recently, there have been reports of an 11-fold increase in the risk of developing MI in patients with the prothrombin G20210A mutation and hypertension during HRT.

The biological effects of HRT on the hemostatic system are similar to those of COCs, however, it should be taken into account that while COC users are mainly young women, then HRT is used by peri- and postmenopausal women, which increases the risk of developing thrombosis, since in addition to the effects of HRT, possible hidden thrombophilic disorders , are also superimposed age characteristics functions of the hemostasis system (Table.

The effect of HRT on hemostasis is being intensively studied, but today it is known that activation of coagulation occurs. Data on the effect of HRT on individual coagulation factors are very contradictory, but it is known that along with the activation of coagulation, fibrinolysis is also activated, as evidenced by an increase in the level of t-PA and a decrease in PAI-1.

Regarding the effect of HRT on factor VII, it should be noted that when taking unconjugated estrogens orally, its level increases, while in most studies, when taking combined drugs or the transdermal route of administration, the level of factor VII does not change or decreases slightly.

In contrast to the effects of COCs and pregnancy, HRT reduces fibrinogen levels (both combined and purely estrogenic HRT preparations). Because high levels of factor VII and fibrinogen are associated with a high risk of cardiovascular disease, reducing them may be successful in reducing this risk. However, the success of reducing fibrinogen levels (factor VII levels decrease less frequently) may be minimized by the effect of HRT on natural anticoagulants - a decrease in AT III, protein C and protein S. Although some studies indicate an increase in protein C levels and no effect on protein S HRT, the emergence of resistance to APC is clearly determined in all studies. And if we consider that with age, APC_R, which is not associated with the factor V Leiden mutation, can also appear (due to a possible increase in factor VIII:C), then the risk of developing thrombosis also increases. And, of course, the likelihood of thrombosis increases significantly if, in addition to the two reasons mentioned above, one also adds hidden form factor V Leiden mutations or other forms of thrombophilia.

Markers of thrombophilia, as well as F1+2, fibrinopeptide A and soluble fibrin, increase during HRT. Despite various effects HRT for individual coagulation factors, all of them indicate activation of the coagulation system. An increase in the levels of D-dimer and plasmin-antiplasmin complexes indicates that with HRT not only coagulation activity is increased, but fibrinolysis is also activated.

Table 1. Changes in the hemostatic system caused by HRT and age

However, some studies do not find an increase in F1+2, TAT, or D-dimer levels. In those cases where activation of the coagulation cascade and fibrinolysis is detected, there is no correlation between the level of increase in markers of thrombinemia and fibrinolysis. This indicates that activation of fibrinolysis during HRT is not a response to increased coagulation activity. Since lipoprotein (a) (Lpa) is an independent risk factor for atherosclerosis and coronary artery disease, its determination in women receiving HRT is also of great interest. Lpa is structurally similar to plasminogen and elevated level Lpa, competing with plasminogen, inhibits fibrinolytic activity. In postmenopausal women, Lpa levels are usually elevated, which may influence the prothrombotic tendency. According to some studies, HRT reduces Lpa levels, which may partly explain the decrease in PAI-1 during HRT and the activation of fibrinolysis. HRT has a wide range of biological effects. In addition to the above, against the background of HRT, there is a decrease in soluble E-selectin along with another soluble marker of inflammation, ICAM (intercellular adhesion molecules). However, the results clinical trial PEPI (Postmenopausal Estrogen/Progestin Interventions) and other studies indicate an increase in C-reactive protein levels, which complicates the interpretation of the previously reported anti-inflammatory effects of HRT.

When discussing the antiatherogenic effects of HRT, one cannot ignore the issue of the effect on homocysteine ​​levels. IN last years hyperhomocysteinemia is considered an independent risk factor for atherosclerosis, ischemic heart disease, and veno-occlusive diseases, so the effect of HRT on homocysteine ​​levels is of great interest. Current evidence suggests that HRT reduces plasma homocysteine ​​levels. Thus, in a double-blind, randomized, placebo-controlled study, 390 healthy women In a postmenopausal study by Walsh et al., after 8 months of therapy with conjugated estrogens (0.625 mg/day in combination with 2.5 mg/day medroxyprogesterone acetate) or use of the selective estrogen receptor modulator raloxifene, a decrease in homocysteine ​​levels was observed (an average of 8% compared to placebo). Of course, this is a positive effect of HRT.

One of the earliest identified effects of HRT is the normalization of lipid metabolism, with an increase in high-density lipoprotein levels, a decrease in LDL and an increase in triglyceride levels.

Rice. 2. Protective effects of estrogens.

Table 2. Main characteristics and results of the HERS, NHS and WHI studies

Although the cardioprotective effect of HRT was previously noted due to a beneficial effect on the lipid profile, endothelial function (Fig. 2) (due to some anti-inflammatory effects), recent data (HERS and others) demonstrate that in the first year of HRT not only is the risk of venous thrombosis increased, but there is also a slight increase in the risk of myocardial infarction. Considering the above, the question of the long-term effectiveness of HRT for the prevention of cardiovascular complications remains unresolved and requires additional research. At the same time, the risk of thrombotic complications is increased by 3.5–4 times. In addition, the HERS and NHS (Nurses’ Health Study) studies have shown that the positive effect of HRT in the prevention of coronary vascular disease largely depends on functional state endothelium coronary vessels. In this regard, when prescribing HRT, the patient’s age should be taken into account and the degree of damage should be assessed accordingly. coronary arteries. In conditions of “safe”, functioning endothelium, HRT (both estrogen drugs alone and combined) in healthy postmenopausal women significantly improves endothelial function, vasodilator response, lipid profile, significantly inhibits the expression of inflammatory mediators and, possibly, reduces homocysteine ​​levels - the most important factor atherosclerosis and coronary vascular diseases. Elderly age and atherosclerotic vascular damage are accompanied by a decrease in the functional activity of the endothelium (antithrombotic) and, in particular, a decrease in the number of estrogen receptors, which, accordingly, significantly reduces the potential cardioprotective and vasculoprotective effects of HRT. Thus, the cardioprotective and endothelial protective effects of HRT are now increasingly being considered in connection with the concept of the so-called “healthy” endothelium.

In this regard, the beneficial effects of HRT are observed in relatively young postmenopausal women without coronary artery disease or other coronary risk factors or a history of myocardial infarction and/or thrombosis. A higher risk of arterial thromboembolism is associated with such associated risk factors as age, smoking, diabetes, hypertension, hyperlipidemia, hyperhomocysteinemia, migraine, and a family history of arterial thrombosis.

In this regard, it should be noted that the HERS studies on secondary prevention arterial diseases in 2500 women with coronary artery disease using HRT for more than 5 years showed an increase in the number of venous thromboses and no positive effect on arterial disease.

Also, in the large placebo-controlled primary prevention study WHI (Women's Health Initiative), which planned to enroll 30,000 women, there was an increase in both the incidence of myocardial infarction and venous thrombosis in the first 2 years.

The results of the HERS, NHS and WHI studies are presented in table. 2. Read the ending in the next issue of the magazine.