Do you need a doctor's opinion for HRT? Hormone replacement therapy: types of HRT, treatment features, drugs

With the further progress of developed capitalism in Russia, a woman is increasingly faced with the need to maintain an attractive appearance and sexual activity until death.

It has long been known that from the onset of menopause, the level of estrogen provides:

• not only fertility,
• but also acceptable cardiovascular condition,
• musculoskeletal systems,
• skin and its appendages,
• mucous membranes and teeth

falls catastrophically.

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

In pursuit of a slender figure, women somehow forgot about what a heart attack at fifty and osteoporosis at seventy are. Fortunately, gynecologists with the latest achievements of the pharmaceutical industry in the field of hormone replacement therapy came to the aid of frivolous compatriots. Around the beginning of the nineties, this direction, standing at the intersection of gynecology and endocrinology, began to be considered a panacea for all women's misfortunes, from early menopause to hip fractures.

However, even at the dawn of the popularization of hormones, in order to keep a woman blooming, there were common-sense demands not to prescribe drugs to everyone indiscriminately, but to make an acceptable sample, separating women with high risks of gynecological oncology and directly protecting them from the realization of risks.

Hence the moral: every vegetable has its time.

Aging, although natural, is by no means the most pleasant episode in the life of every person. It brings with it changes that do not always put the woman in a positive mood and often quite the opposite. Therefore, during menopause, drugs and medicines are often necessary to take.

Another question is how safe and effective they will be. Maintaining a balance between these two parameters is the most a big problem modern pharmaceutical industry and practical medicine: neither firing a cannon at a sparrow nor chasing an elephant with a slipper is inappropriate, and sometimes even very harmful.

Hormone replacement therapy in women today is very controversially assessed and prescribed:

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

The further into the forest, the more firewood. As clinical experience in the practical use of hormone replacement has accumulated, it has become clear that women with an initially low risk of breast or uterine cancer are not always safe when taking certain categories of “pills of eternal youth.”

Let’s try to figure out how things stand today, and on whose side the truth is: the adherents of hormones or their opponents, here and now.

Combined hormonal agents

As hormone replacement therapy in menopause combinations may be prescribed hormonal agents and pure estrogens. Which drug will be recommended by your doctor depends on many factors. These include:

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

Klimonorm

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

The hormonal product must be taken 1 tablet daily for 3 weeks; after completing the package, you should take a 7-day break, during which menstrual-like discharge will begin. In the case of a preserved menstrual cycle, taking pills begins on the 5th day, in case of irregular menstruation - on any day, provided that pregnancy is excluded.

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

Femoston 2/10

This drug is available as Femoston 1/5, Femoston 1/10 and Femoston 2/10. The listed types of products differ in the content of estrogen and gestagen components. Femosten 2/10 contains 14 pink tablets and 14 yellow tablets (a total of 28 pieces in the package).

Pink tablets contain only the estrogen component in the form of estradiol hemihydrate in an amount of 2 mg. Yellow pills consist of 2 mg estradiol and 10 mg dydrogesterone. Femoston must be taken daily for 4 weeks, without interruption. After finishing the packaging, you should start a new one.

Angelique

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

Pauzogest

The blister contains 28 tablets, each containing 2 mg of estradiol and 1 mg of norethisterone acetate. The tablets should be taken from the 5th day of the cycle if menstruation continues and on any day if menstruation is irregular. The drug is taken continuously, without observing a 7-day break.

Cyclo-Proginova

The blister contains 21 tablets. The first 11 white tablets contain only the estrogenic component - estradiol valerate at a dosage of 2 mg. The following 10 light brown tablets consist of estrogen and progestin components: estradiol in an amount of 2 mg and norgestrel in a dosage of 0.15 mg. Cyclo-Proginova should be taken daily for 3 weeks. Then you need to take a week's break, during which menstrual-like bleeding will begin.

Divigel

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

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

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

Menorest

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

Klimara

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

Ovestin is available in tablets, vaginal suppositories, and as a cream for vaginal use. The most commonly prescribed form of the drug is vaginal suppositories. One suppository contains micronized estriol in an amount of 500 mcg. Suppositories are administered intravaginally daily, without interruption. The main role of the drug is to compensate for estrogen deficiency during menopause and postmenopausal periods.

Estrogel

The drug is available in the form of a gel for external use in tubes with a dispenser. The tube contains 80 g. gel, in one dose – 1.5 mg of estradiol. The main effect is to eliminate the lack of estrogen in menopause and postmenopause. The rules for applying the gel are the same as for Divigel.

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

Hormonal background

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

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

• estrogens - hormones of femininity,
• progesterone - pregnancy hormone,
• androgens – sexuality.

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

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

Progestins

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

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

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

• obesity
• blackheads
• increased hair growth
• hyperandrogenism automatically equaled polycystic ovary syndrome, and it was prescribed to fight it with all available means.

However, as practical experience accumulated, it turned out that:

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

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

• Their level gradually begins to fall in women after 30 years.
• With natural aging, they do not give rise to sudden drops.
• A sharp decrease in testosterone is observed in women during artificial menopause (after surgical removal of the ovaries).

Menopause

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

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

What you have to fight with

Perimenopause

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

• psychological difficulties: irritability, neuroticism, depression, sleep disturbances, decreased performance,
• vasomotor phenomena: increased sweating, hot flashes,
• genitourinary disorders: vaginal dryness, itching, burning, increased urination.

Postmenopause

gives the same symptoms caused by a lack of estrogen. Later they are supplemented and replaced:

• metabolic abnormalities: accumulation of abdominal fat, a decrease in the body’s sensitivity to its own insulin, which can result in type 2 diabetes.
• cardiovascular: increased levels of atherosclerosis factors (total cholesterol, low-density lipoproteins), vascular endothelial dysfunction,
• musculoskeletal: accelerated bone resorption leading to osteoporosis,
• atrophic processes in the vulva and vagina, urinary incontinence, urination disorders, inflammation of the bladder.

Menopausal hormone therapy

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

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

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

The principles of therapy are prescribed for women under 60 years of age, despite the fact that the woman had her last unstimulated menstruation no earlier than ten years ago. Preference is given to combinations of estrogens with progestins, given that the doses of estrogens are low, corresponding to those in young women in the endometrial proliferation phase. Therapy should be started only after obtaining informed consent from the patient, confirming that she is familiar with all the features of the proposed treatment and understands its pros and cons.

When to start

Hormone replacement therapy drugs are indicated for:

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

Let us immediately make a reservation that this is basically how the view of the problem looks like: Russian gynecologists. Let's look at why this clause is a little lower.

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

• According to them, tactics towards women during the menopausal transition and among older age categories will vary.
• Prescriptions must be strictly individual and take into account all manifestations, the need for prevention, the presence of concomitant pathologies and family history, research results, as well as the patient’s expectations.
• Hormonal support is only part of an overall strategy to normalize a woman’s lifestyle, including diet, rational physical activity, and refusal bad habits.
• Replacement therapy should not be prescribed without clear evidence of estrogen deficiency or the physical consequences of this deficiency.
• The patient receiving therapy is invited to see a gynecologist for a preventive examination at least once a year.
• Women whose natural or postoperative menopause occurs before age 45 have a higher risk of osteoporosis, cardiovascular disease and dementia. Therefore, for them, therapy should be carried out at least until the average age of menopause.
• The question of continuing therapy is decided individually, taking into account the benefits and risks for a particular patient, without critical age restrictions.
• Treatment should be carried out with the lowest effective dosage.

Contraindications

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

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

Estrogens are not indicated for:

• hormone-dependent breast cancer,
• endometrial cancer, including in the past,
• hepatic cell failure,
• porphyria.

Progestins

• in case of meningioma

The use of these products may be unsafe if:

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

Application Variations

Among the known routes of administration of hormone replacement are: oral tablets, injection, transdermal, local.

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

Pros:	Minuses:
Estrogens in tablets
Just accept. Extensive experience in application has been accumulated. The drugs are inexpensive. A lot of them. They can be combined with a progestin in one tablet.	Due to different absorption, an increased dose of the substance is required. Absorption is reduced due to diseases of the stomach or intestines. Not indicated for lactase deficiency. Affects protein synthesis by the liver. More contain less effective estrone than estradiol.
Skin gel
Convenient to apply. The dose of estradiol is optimally low. The ratio of estradiol and estrone is physiological. Not metabolized in the liver.	Must be applied daily. More expensive than pills. Absorption may vary. Progesterone cannot be added to the gel. Less effective effect on the lipid spectrum.
Skin patch
Low estradiol content. Does not affect the liver. Estrogen can be combined with progesterone. There are forms with different dosages. Treatment can be stopped quickly.	Suction fluctuates. Doesn't stick well if it's humid or hot. Estradiol in the blood begins to decrease over time.
Injections
May be prescribed if tablets are ineffective. Possible use in patients with arterial hypertension, carbohydrate metabolism disorders, gastrointestinal pathologies, migraines. They provide rapid and loss-free delivery of the active substance to the body.	Complications from soft tissue injuries during injections are possible.

There are different tactics for different groups of patients

One drug containing estrogen or progestin.

• Estrogen monotherapy is indicated after hysterectomy. Estradiol, estradiol valerate, estriol are used in a continuous course or continuously. Tablets, patches, gels, vaginal suppositories or tablets, injections are possible.
• Isolated gestagen is prescribed during the menopausal transition or perimenopause in the form of progesterone or dydrogesterone in tablets for the purpose of correcting cycles and treating hyperplastic processes.

Combination of estrogen with progestin

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

At the end of December 2017, a conference of gynecologists was held in Lipetsk, where one of the central issues was occupied by the issue of hormone replacement therapy in postmenopause. V.E. Balan, MD, professor, president of the Russian Menopause Association, voiced the preferred areas of replacement therapy.

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

Ladies with premature ovarian failure (premature menopause)

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

• In this case, combined oral contraceptives can be used in them until the average onset of menopause, but transdermal combinations of estradiol and progesterone are preferred.
• For women with low sexual desire (especially after having their ovaries removed), it is possible to use testosterone in the form of gels or patches. Since specific drugs for women have not been developed, the same drugs are used as for men, but in lower dosages.
• During therapy, there are cases of ovulation occurring, that is, pregnancy is not excluded, therefore, drugs for replacement therapy cannot be considered at the same time as contraceptives.

Pros and cons of HRT

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

Breast cancer during replacement therapy: oncophobia or reality?

• Made a lot of noise for Lately A British medical journal that has previously distinguished itself in difficult legal battles with the Americans regarding the harmlessness and dosage regimen of statins and emerged from these clashes very, very honorably. At the beginning of December 2017, the magazine published data from almost a decade of research in Denmark, which analyzed the stories of about 1.8 million women from 15 to 49 years old who used different variations of modern hormonal contraceptives(combinations of estrogens and progestins). The findings were disappointing: the risk of invasive breast cancer in women receiving combined contraceptives exists, and it is higher than in those who abstain from such therapy. The risk increases with the duration of contraception. Among those who use this method of contraception throughout the year, the drugs cause one extra case of cancer per 7,690 women, that is, the absolute increase in risk is small.
• Expert statistics presented by the President of the Russian Menopause Association that only every 25 women in the world die from breast cancer, and the most common cause of death are cardiovascular episodes, is only so-so consolation.
• The WHI study inspires hope, according to the results of which the estrogen-progestin combination begins to significantly increase the risk of breast cancer no earlier than after five years of use, predominantly stimulating the growth of existing tumors (including poorly diagnosed stages zero and first).
• However, the International Menopause Society also notes the ambiguity of the effects of replacement hormones on breast cancer risks. The higher the woman’s body mass index and the less active her lifestyle, the higher the risks.
• According to the same society, the risks are lower when using transdermal or oral forms of estradiol in combination with micronized progesterone (versus its synthetic variants).
• Thus, hormonal replacement therapy after 50, the risks from the addition of progestin to estrogen increases. Micronized progesterone shows a better safety profile. At the same time, the risk of relapse in women who have previously had breast cancer does not allow them to be prescribed replacement therapy.
• To reduce risks, it is worth selecting women with an initial low risk of breast cancer for replacement therapy, and conducting annual mammograms during therapy.

Thrombotic episodes and coagulopathies

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

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

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

Gynecological oncology is represented by endometrial, cervical and ovarian cancer

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

Expected benefit

Pathologies of the heart and blood vessels

This is the main cause of disability and mortality in postmenopausal women. It is noted that the use of statins and aspirin does not have the same effect as in men. Losing body weight, combating diabetes mellitus, and arterial hypertension should come first. Estrogen therapy may have a protective effect on the cardiovascular system when approaching menopause and has a negative effect on the heart and blood vessels if its initiation is delayed more than 10 years from the last menstrual period. According to the WHI, women 50-59 years of age experienced fewer heart attacks during therapy, and there was a benefit in relation to the development of coronary heart disease if therapy was started before 60 years of age. An observational study from Finland confirmed that estradiol (with or without a progestin) reduced coronary mortality.

The largest studies in this area were DOPS, ELITE and KEEPS. The first, a Danish study focusing primarily on osteoporosis, noted a reduction in coronary deaths and hospitalizations for myocardial infarction among recently menopausal women who received estradiol and norethisterone or went without treatment for 10 years and were followed for an additional 16 years. .

The second assessed earlier and later administration of tablet estradiol (in women up to 6 years after menopause and after 10 years). The study confirmed that for the condition coronary vessels early initiation of replacement therapy is important.

The third compared conjugated equine estrogens with placebo and transdermal estradiol, finding little difference in vascular health in relatively young subjects. healthy women for 4 years.

Urogenicology is the second direction, the correction of which is expected from the administration of estrogens

• Unfortunately, three large studies have shown that systemic estrogen use not only worsens existing urinary incontinence, but also contributes to new episodes of stress incontinence. /This circumstance can greatly worsen the quality of life. The latest meta-analysis conducted by the Cochrane group noted that only oral drugs have this effect, and local estrogens seem to reduce these manifestations. As an additional benefit, estrogens have been noted to reduce the risk repeated infections urinary tract.
• As for atrophic changes in the vaginal mucosa and urinary tract, estrogens were at their best, reducing dryness and discomfort. At the same time, the advantage remained with local vaginal preparations.

Loss of bone tissue (postmenopausal osteoporosis)

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

No matter how nightingales gynecologists talk about the benefits of estrogens for preserving bone mass and preventing osteoporosis, even the International Menopause Organization in 2016, whose recommendations are essentially based on domestic replacement therapy protocols, vaguely wrote that estrogens are the most suitable option for the prevention of fractures in early postmenopause, however, the choice of osteoporosis therapy should be based on a balance of effectiveness and cost.

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

• Thus, estrogens are capable of inhibiting bone loss, but their oral forms have been predominantly studied in this direction, the safety of which in relation to oncology is somewhat questionable.
• There is no data on a decrease in the number of fractures during replacement therapy, that is, today estrogens are inferior to safer and more effective drugs in terms of preventing and eliminating the severe consequences of osteoporosis.

Hormone replacement therapy for menopause plays an important role in regulating the pathological changes that occur in the female body during this critical period.

Despite the existence of a number of myths about the enormous danger of such an event, numerous reviews indicate the opposite.

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 takes its toll, 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 the sharp decrease in these hormones that leads to menopausal changes in the female body.

Read about the normal levels of FSH and LH during menopause.

What is hormone replacement therapy

Hormone replacement therapy for menopause (HRT) is a treatment method in which drugs similar to sex hormones are administered, 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 only one specific type of hormone 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 is converted into natural estradiol, which absolutely imitates estrogen. Combination options are more common, where in addition to the specified ingredient, they contain gestagen-forming components - dydrogesterone or levonorgestrel. Preparations with a combination of estrogens and androgens are also available.

The combined composition of new generation drugs helped reduce the risk of tumor formations that can occur due to an excess of estrogen. 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 mild menopause, without obvious disruptions in the female body.
2. Long-term treatment. When pronounced violations occur, incl. in the internal secretion organs, cardiovascular system or psycho-emotional nature, the duration of therapy can reach 10-12 years.

The following circumstances may be indications for prescribing HRT::

1. Any phase of menopause. The following tasks are set: premenopause - normalization of the menstrual cycle; menopause – symptomatic treatment and reducing the risk of complications; postmenopause – maximum relief of the condition and exclusion of neoplasms.
2. Premature menopause. Treatment is necessary to stop the inhibition of female reproductive functions.
3. After surgical procedures involving 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 makes them skeptical about such treatment. To make the right decision, you need to understand the real arguments of opponents and supporters of the method.

Hormone replacement therapy ensures gradual adaptation of the female body to the transition to other conditions, which helps to avoid serious disturbances in the functioning of a number of internal organs and systems .

In favor of HRT, there are such positive effects:

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

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

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

• insufficient knowledge of the introduction into the system of regulating hormonal balance;
• difficulties in choosing the optimal treatment regimen;
• introduction into the 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 medications;
• lack of confirmation of real effectiveness for complications in late stages;
• 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 spasms, gastrointestinal problems (diarrhea, gas, nausea), changes in appetite, allergic reactions (redness, rashes, itching).

NOTE!

It should be noted that despite all the difficulties, HRT proves its effectiveness, which is confirmed by numerous positive reviews. A correctly 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, Trisequence. They are based on 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 migraines.

Progestogen-based products:

1. Duphaston, Femaston. They are classified as dydrogesterones and do not produce metabolic effects;
2. Norkolut. Based on norethisterone acetate. It has a pronounced androgenic effect and is useful for osteoporosis;
3. Livial, Tibolon. These drugs are effective for osteoporosis and are in many ways similar to the previous drug;
4. Klymen, Andokur, Diane-35. Active substance– cyproterone acetate. 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 increasingly widespread. They have the following advantages: the use of ingredients that are absolutely identical to female hormones; complex impact; possibility of use in any phase of menopause; absence of most of the indicated 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 menopause symptoms. Contraindicated for ectopic bleeding.
2. Norgestrol. It is a combination remedy. Copes well with neurogenic disorders and autonomic disorders.
3. Cyclo-Proginova. Helps increase female libido, improves the functioning of the urinary system. Cannot 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 of the nervous system increases. Allergic reactions are possible.

Herbal remedies

A significant group of drugs for HRT consists of plant origin and the medicinal plants themselves.

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

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

The following preparations are produced based on phytohormones::

1. Estrophel. Contains phytoestrogen, folic acid, vitamins B6 and E, calcium.
2. Tibolone. Can be used to prevent osteoporosis.
3. Inoclim, Feminal, Tribustan. The products are based on phytoestrogen. Provide gradually increasing healing effect during menopause.

Main contraindications

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

This therapy is contraindicated in such pathologies:

• uterine and ectopic (especially for unknown reasons);
• tumor formations in the reproductive system and mammary gland;
• uterine and breast diseases;
• serious kidney and liver pathologies;
• adrenal insufficiency;
• thrombosis;
• abnormalities of lipid metabolism;
• endometriosis;
• diabetes;
• epilepsy;
• asthma.

How to distinguish bleeding from menstruation, read.

Features of the treatment of surgical menopause

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

Therapy includes the following regimens::

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

The hormonal background in a woman’s body constantly changes throughout her life. With a lack of sex hormones, the course of biochemical processes is complicated. Only special treatment can help. The necessary substances are introduced artificially. In this way, the vitality and activity of the female body is prolonged. Drugs are prescribed according to an individual regimen, since, if you do not take into account possible consequences, they can have a detrimental effect on the condition of the mammary glands and genitals. The decision to carry out such treatment is made on the basis of an examination.

Hormones are regulators of all processes occurring in the body. Without them, hematopoiesis and the formation of cells of various tissues are impossible. If they are lacking, it suffers nervous system and brain, serious deviations in the functioning of the reproductive system appear.

There are 2 types of hormonal therapy:

1. Isolated HRT - treatment is carried out with drugs containing one hormone, for example, only estrogens (female sex hormones) or androgens (male hormones).
2. Combined HRT– several hormonal substances are introduced into the body at the same time.

Exist various shapes release of such funds. Some of them are included in gels or ointments that are applied to the skin or inserted into the vagina. Medicines of this type are also available in tablet form. It is possible to use special patches, as well as intrauterine devices. If long-term use of hormonal drugs is necessary, they can be used in the form of implants inserted under the skin.

Note: The goal of treatment is not full recovery reproductive function body. With the help of hormones, symptoms that arise as a result of improper functioning of the most important life-supporting processes in a woman’s body are eliminated. This can significantly improve her well-being and avoid the occurrence of many diseases.

The principle of treatment is that to achieve maximum success, it must be prescribed in a timely manner, while hormonal disorders did not become irreversible.

Hormones are taken in small doses, and most often natural substances are used rather than their synthetic counterparts. They are combined in such a way as to reduce the risk of negative side effects. Treatment usually takes a long time.

Video: When is hormonal treatment prescribed for women?

Indications for prescribing HRT

Hormone replacement therapy is prescribed in the following cases:

• when a woman experiences early menopause due to depletion of the ovarian reserve and decreased estrogen production;
• when it is necessary to improve the condition of a patient over the age of 45-50 years when she experiences age-related menopausal ailments (hot flashes, headaches, vaginal dryness, nervousness, decreased libido and others);
• after removal of the ovaries due to purulent inflammatory processes, malignant tumors;
• in the treatment of osteoporosis (the appearance of repeated fractures of the limbs due to a violation of the composition of bone tissue).

Estrogen therapy is also prescribed to a man if he wants to change his sex and become a woman.

Contraindications

The use of hormonal drugs is absolutely contraindicated if a woman has malignant tumors brain, mammary glands and genitals. Hormonal treatment is not performed in the presence of blood and vascular diseases and a predisposition to thrombosis. HRT is not prescribed if a woman has had a stroke or heart attack, or if she suffers from persistent hypertension.

An absolute contraindication to such treatment is the presence of liver disease, diabetes mellitus, as well as allergies to components included in the preparations. Treatment with hormones is not prescribed if a woman has uterine bleeding of an unknown nature.

Such therapy is not carried out during pregnancy and breastfeeding. There are also relative contraindications to the use of such treatment.

Sometimes, despite the possible negative consequences of hormonal therapy, it is still prescribed if the risk of complications of the disease itself is too great. For example, treatment is undesirable if the patient has migraines, epilepsy, fibroids, as well as genetic predisposition to the occurrence of breast cancer. In some cases, there are restrictions on the use of estrogen preparations without the addition of progesterone (for example, with endometriosis).

Possible complications

Replacement therapy for many women is the only way to avoid severe manifestations of a lack of hormones in the body. However, the effect of hormonal drugs is not always predictable. In some cases, their use can lead to increased blood pressure, blood thickening and the formation of blood clots in the vessels of various organs. There is a risk of worsening existing cardiovascular diseases, including a heart attack or cerebral hemorrhage.

Possible complication of cholelithiasis. Even a small overdose of estrogen can provoke cancer in the uterus, ovary or breast, especially in women over 50 years of age. The occurrence of tumors is more often observed in nulliparous women with a genetic predisposition.

Hormonal shifts lead to metabolic disorders and a sharp increase in body weight. Carrying out such therapy for a period of more than 10 years is especially dangerous.

Video: Indications and contraindications for HRT

Preliminary diagnosis

Hormone replacement therapy is prescribed only after a special examination with the participation of specialists such as a gynecologist, mammologist, endocrinologist, and therapist.

Blood tests are carried out for coagulation and the content of the following components:

1. Pituitary hormones: FSH and LH (regulating the functioning of the ovaries), as well as prolactin (responsible for the condition of the mammary glands) and TSH (a substance on which the production of thyroid hormones depends).
2. Sexual hormones (estrogen, progesterone, testosterone).
3. Proteins, fats, glucose, liver and pancreatic enzymes. This is necessary to study the metabolic rate and the condition of various internal organs.

Mammography and osteodensitometry (X-ray examination of bone density) are performed. In order to ensure the absence of malignant tumors of the uterus, a PAP test (cytological analysis of a smear from the vagina and cervix) and transvaginal ultrasound are performed.

Carrying out replacement therapy

The prescription of specific medications and the choice of treatment regimen is made purely individually and only after a complete examination of the patient has been carried out.

The following factors are taken into account:

• age and period of a woman’s life;
• the nature of the cycle (if there are menstruation);
• presence or absence of the uterus and ovaries;
• the presence of fibroids and other tumors;
• presence of contraindications.

Treatment is carried out using various techniques depending on its goals and the nature of the symptoms.

Types of HRT, drugs used

Monotherapy medicines based on estrogen. It is prescribed only to women who have undergone a hysterectomy (removal of the uterus), since in this case there is no risk of developing endometrial hyperplasia. HRT is carried out with drugs such as estrogel, divigel, progynova or estrimax. Treatment begins immediately after the operation. It lasts for 5-7 years. If the age of the woman who has undergone such an operation is approaching menopause, then treatment is carried out until the onset of menopause.

Intermittent cyclic HRT. This technique is used during the onset of perimenopausal symptoms in women under 55 years of age or with the onset of early menopause. Using a combination of estrogen and progesterone, a normal menstrual cycle of 28 days is simulated.

To carry out hormone replacement therapy in this case, combined drugs are used, for example, femoston or klimonorm. The Klimonorm package contains yellow dragees with estradiol and brown dragees with progesterone (levonorgestrel). Yellow pills are taken for 9 days, then brown pills for 12 days, after which they take a break for 7 days, during which menstrual-like bleeding appears. Sometimes combinations of estrogen-containing and progesterone-containing drugs (for example, estrogel and utrozhestan) are used.

Continuous cyclic HRT. A similar technique is used in the case when a woman 46-55 years old has not had menstruation for more than 1 year (that is, menopause has occurred), there are enough serious manifestations climacteric syndrome. In this case, hormonal drugs are taken for 28 days (there is no imitation of menstruation).

Combined cyclic intermittent HRT estrogens and progestins are carried out in various modes.

It is possible to carry out treatment in monthly courses. Moreover, it begins with daily intake of estrogen preparations, and from the middle of the month progesterone-based products are also added to prevent overdose and the occurrence of hyperestrogenism.

A course of treatment lasting 91 days may be prescribed. In this case, estrogens are taken for 84 days, progesterone is added from day 71, then a break is taken for 7 days, after which the treatment cycle is repeated. This replacement therapy is prescribed to women aged 55-60 years who have reached postmenopause.

Combined continuous estrogen-progestogen HRT. Hormonal medications are taken without interruption. The technique is used for women over 55 years of age, and after 60 years of age, the dosage of drugs is reduced by half.

In some cases, estrogens are combined with androgens.

Examinations during and after treatment

The types and doses of medications used may be changed if signs of complications appear. In order to prevent the appearance dangerous consequences During therapy, the patient’s health condition is monitored. The first examination is carried out 1 month after the start of treatment, then after 3 and 6 months. Subsequently, the woman must visit a gynecologist every six months to check the condition of the reproductive organs. It is necessary to undergo regular mammological examinations, as well as visit an endocrinologist.

Blood pressure is controlled. A cardiogram is taken periodically. Held biochemical analysis blood to determine the content of glucose, fats, liver enzymes. Blood clotting is checked. If serious complications occur, treatment is adjusted or discontinued.

HRT and pregnancy

One of the indications for prescribing hormone replacement therapy is the onset of early menopause (this sometimes happens at 35 years of age or earlier). The reason is a lack of estrogen. The level of these hormones in a woman’s body determines the growth of the endometrium, to which the embryo should attach.

To restore hormonal levels, patients of childbearing age are prescribed combination drugs (femoston most often). If estrogen levels can be increased, the lining of the uterine cavity begins to thicken, and in rare cases, conception is possible. This may occur after a woman stops taking the drug after several months of treatment. If there is a suspicion that pregnancy has occurred, it is necessary to stop treatment and consult a doctor about the advisability of maintaining it, since hormones can negatively affect the development of the fetus.

Addition: Before starting treatment with such drugs (in particular, femoston), a woman is usually warned about the need for additional use of condoms or other non-hormonal contraceptive devices.

HRT drugs can be prescribed for infertility caused by lack of ovulation, as well as during IVF planning. A woman’s ability to bear children, as well as the chances of a normal pregnancy, are assessed by the attending physician individually for each patient.

Menopause can be a challenging time for many women. The thing is that with the onset of menopause, the body experiences a gradual decline in reproductive function, as well as serious hormonal changes that affect different systems and organs. Hence the symptoms of menopause. In most cases, only special drugs as part of hormone replacement therapy can normalize the condition of the fair sex. What kind of means are these? What are their indications for use and are there any contraindications? Which HRT drugs are most commonly prescribed?

Briefly about menopause

The menopause is a natural stage in the life of every woman, the next step, and not a disease, as many representatives of the fair sex believe, awaiting its onset with horror. On average, the onset of menopause occurs at 45-55 years of age, but there can be earlier or later menopause, which is influenced by certain factors.

All changes that occur in the body during this period are a consequence of a deficiency of female sex hormones due to the shutdown of ovarian function. This can happen with age or involuntarily if there has been surgery to remove the ovaries, chemotherapy or radiation therapy.

Lack of estrogen leads to symptoms that can appear in a woman even before her last period. Early symptoms of menopause include:

• frequent hot flashes;
• increased sweating;
• sudden changes in mood, irritability, anxiety;
• sleep disorders;
• fast fatiguability;
• changes in blood pressure;
• cardiopalmus;
• memory loss.

Many women do not feel such symptoms or they are mild, so they ignore them, which is fundamentally wrong. You should definitely consult a doctor to prevent more complex consequences of menopause, in particular:

• deterioration of the condition of the skin, hair, nails;
• unpleasant sensations in the vagina, which is expressed in dryness, itching, pain during sexual intercourse;
• problems with urination ( frequent urge, involuntary urination, cystitis);
• diseases of the heart and blood vessels (heart attack, stroke, increased arterial decrease in libido;
• blood pressure, atherosclerosis);
• diseases of bones and joints.

What methods of solving the problem exist?

The following options will help you live through the menopause beautifully without being a hostage to its symptoms:

1. Modern cosmetology.
2. Healthy lifestyle. It is very important here to give up bad habits, eat a balanced and healthy diet, and also be physically active, but not overload the body.
3. Treatment with non-hormonal drugs. Each drug, selected exclusively by a doctor, is aimed at overcoming a specific symptom. Such treatment is quite expensive and may not always give the expected effect.
4. Hormone replacement therapy (HRT). Timely treatment with hormonal drugs will help cope with many unpleasant manifestations of menopause.

HRT: what is it?

The method of treatment with drugs that contain predominantly female sex hormones is called hormone replacement therapy. Treatment is aimed at eliminating the lack of estrogen and progesterone, and this is caused by a decrease in the production of sex hormones by the endocrine glands.

Hormone replacement therapy for menopause can be of two types:

• Long lasting. Treatment of serious changes in the body, in particular the functioning of the heart, blood vessels, central nervous system, and endocrine glands. The course of treatment is 2-4 years, in some cases treatment can last 10 years.
• Short-term. Treatment of menopause symptoms. The course of treatment is 1-2 years.

Taking hormonal medications requires strict adherence to the doctor’s recommendations; only in this case can you count on successful treatment. New generation hormonal drugs can reduce pain and restore mucous membranes, reduce the frequency and intensity of hot flashes, and improve the condition of the skin, nails, and teeth.

Benefits of hormone replacement treatment

• New generation hormone replacement drugs may contain female sex hormones, as well as thyroid and pituitary hormones. They do not contain male hormones. The new generation of drugs have synthetic hormones that are as close in composition as natural hormones, which makes it possible to reduce the dosage and the manifestation of male characteristics in women, in particular hair growth and deepening of the voice.
• They do not contain narcotic substances, so the body is not addictive. You can stop treatment at any time, but only after consulting your doctor.
• Hormone-containing drugs prescribed for menopause do not cause weight gain. The cause may be a decrease in physical activity.
• Hormone-containing drugs contain hormones synthesized in the laboratory, the composition of which is completely identical to the hormones produced by the female body. This is what determines their widespread effect. If we compare these drugs with phytohormones, the latter are many times weaker and only temporarily alleviate the condition.
• Progesterone in modern hormonal drugs reduces the risk of the formation of estrogen-dependent tumors, and drugs selected individually - good prevention against oncology.
• It is convenient to use, because HRT for menopause, new generation drugs are available in various dosage forms. For gastrointestinal diseases, a type of hormonal medication such as a gel or patch can be used.

Indications and contraindications for hormone treatment

Hormone replacement therapy for menopause is symptomatic and preventive method. Treatment with hormonal drugs is aimed at overcoming existing symptoms of menopause. If we talk about prevention, it is carried out to reduce the risk of complications of menopause that can arise due to hormonal changes at a late stage, in particular osteoporosis, arterial hypertension.

HRT is prescribed for menopause in the following cases:

• early menopause;
• pathologies of the heart and blood vessels;
• high risk of developing osteoporosis;
• high probability of developing diabetes mellitus.

There are contraindications to HRT in the presence of the following pathologies:

• liver diseases;
• thrombosis;
• estrogen dependent tumors;
• pathologies of the heart and blood vessels (complicated);
• diabetes mellitus (complicated);
• cancer of the genital organs, mammary glands, endometrium of internal organs;
• uterine bleeding of unknown nature;
• pregnancy (possible during early stages menopause).

Can there be side effects from the treatment?

HRT has a selective effect, and the drugs are prescribed in low dosages, so the risk side effects kept to a minimum. Adverse reactions organism may occur in rare cases, and their intensity is weakly expressed.

So, more often than other reactions, a woman may experience engorgement of the mammary glands. This phenomenon will go away on its own after a few months, when the body adapts to the introduction of female sex hormones.

It is extremely rare to have symptoms such as nausea and headache.

It is prohibited to discontinue medications on your own, as well as change the dosage. Only the doctor who prescribed it can correct HRT.

Do I need to prepare for hormone replacement therapy?

Taking hormonal medications on your own is highly not recommended. HRT can only be prescribed by a doctor, and the selection of drugs is made by the doctor individually and only after diagnosis.

The examination consists of laboratory and instrumental methods, which allows you to get the most complete picture of the state of the female body.

Diagnostic measures before prescribing HRT:

• Ultrasound of the thyroid gland and abdominal cavity;
• examination and diagnosis of mammary glands;
• taking a smear from the cervix;
• blood test for hormones;
• blood pressure measurement.

Other diagnostic methods may be prescribed, as well as consultations with doctors if a woman has chronic diseases. In this case, it is necessary to minimize the impact of these diseases on the body, only then the doctor will be able to select hormonal drugs that will help reduce menopausal symptoms.

Mandatory observations with a doctor

When taking hormone-containing drugs, you must be observed by a gynecologist so that the doctor can monitor the progress of treatment and, if the need arises, adjust it to obtain a better effect.

The first time you need to visit a gynecologist is 3 months after the start of treatment. Follow-up visit after 6 months. Next, you need to visit the gynecologist regularly every six months.

Once a year you will also need to do a gynecological ultrasound, mammography, and a cytological analysis of a smear from the cervix.

Forms of HRT for menopause

The drugs included in HRT can be produced in the following dosage forms:

• for oral use (dragées, tablets, pills);
• for topical use (gels, suppositories, creams, patches);
• transdermal form (injections, subcutaneous implants).

Each HRT product has both advantages and disadvantages, and can only be prescribed by a doctor in each individual case.

The most convenient form of hormonal drugs are tablets; they are quickly absorbed and have a low cost, but they are contraindicated for problems with the gastrointestinal tract. In this case, local or transdermal forms of hormones are prescribed, which do not affect the gastrointestinal tract; they can be used with many drugs, because do not interact with them.

Popular hormone-containing drugs for menopause

Among the most effective drugs Hormone replacement therapy for menopause includes the following list:

• Femoston tablets;
• Cyclo-Proginova tablets;
• Ovestin tablets and suppositories;
• Estroferm tablets;
• Angelique tablets;
• Trisequence tablets;
• Klimara patch;
• Dermestril patch;
• Klimonorm dragee;
• Divigel gel.

These hormonal drugs are a new generation of drugs, because the hormones are in minimal doses. They have wonderful medicinal properties, do not cause changes in the functions of internal organs.

When prescribing each drug, the doctor calculates the dosage, as well as the regimen, which must be followed.

Independently changing the dosage prescribed by the doctor can further affect the hormonal level, and increasing the dosage threatens oncology, especially in cases where there is a hereditary predisposition or benign tumors.

We can conclude that hormone replacement therapy can provide significant support to the female body during such a difficult menopausal period for her, especially with pronounced symptoms. Adequately selected medications can reduce the unpleasant symptoms of menopause, as well as minimize the likelihood of complications. Each medicine and its dosage should be prescribed only by a doctor based on the examination. Only in this case can you count on a positive effect of therapy.

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 hormonal therapy for 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 remedies for menopause. Unfortunately, few people know that:

• HRT preparations contain only natural estrogens.
• Today they are obtained by chemical synthesis.
• Synthesized natural estrogens are perceived by the body as their own due to 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 the lost hormonal function of the ovaries. Drugs HRT is not a drug; it does not disrupt the 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

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.

Synthesis and use of hormones in medical practice began in the 50s of the XX 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. Modern medications contain hormones that are as “natural” as possible, and this makes it possible 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 is to gain weight while taking 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 The World Health Organization, thanks to the use of hormonal contraceptives and their oncoprotective effect, annually manages to prevent about 30 thousand cases oncological diseases. 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, the main component of HRT preparations, are not oncogenes (that is, they do not unblock the gene mechanisms of tumor growth in the cell).

Myth 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 gastrointestinal mucosa 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 aggravated by unpleasant symptoms and a sharp deterioration in well-being. 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 have excess weight. 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. A modern woman at the age of 45+ can live a life no less interesting and eventful than in her 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

Experience use of 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 a woman’s cardiovascular system. 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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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.