In recent decades, doctors have routinely prescribed hormone replacement therapy and drugs to treat menopause and menopausal symptoms, as well as reducing the risks of osteoporosis and cancer.
But recent research, which has raised serious questions about the benefits and risks of such treatment, has led most women to stop using hormones.
So what to do? Is it worth treating this way or not?
This treatment is used to restore the body's natural hormonal levels, either as estrogen in women who have had a hysterectomy or as estrogen plus progesterone for most women who have gone through menopause.
Why is hormone replacement performed and who needs it?
Many women of childbearing age have hormonal problems which lead to infertility and the inability to bear a child. Then, to prepare the lining of the uterus for egg implantation, women take estrogen in combination with progesterone, which, in addition, perform many other functions.
They help the body retain calcium (important for strong bones), help maintain healthy cholesterol levels, and support healthy vaginal flora.
With the onset of menopause, the amount of natural estrogen and progesterone produced by the ovaries drops sharply, which in turn can lead to symptoms such as hot flashes, night sweats, vaginal dryness, painful intercourse, mood swings and trouble sleeping.
Menopause can also increase your risk of developing osteoporosis. By replenishing the body's supply of estrogen, hormone replacement therapy for menopause can help relieve menopausal symptoms and prevent osteoporosis.
Estrogen alone is usually prescribed to women who have had their uterus or uterus removed. But the combination of estrogen and progesterone is suitable for those who have a preserved uterus, but who need hormone replacement therapy during menopause. For these women, taking estrogen alone may increase the risk of developing endometrial (the lining of the uterus) cancer.
This happens because during reproductive years, endometrial cells are shed during menstruation, and if menstruation stops and the endometrium is no longer shed, the addition of estrogen can cause uterine cell proliferation, which in turn leads to cancer.
Supplementing with progesterone reduces the risk of endometrial cancer by inducing menstruation every month.
Who can take treatment and who can't?
Women who have menopausal symptoms and those who have osteoporosis as a hereditary condition are candidates for hormone replacement therapy.
This treatment is contraindicated for women who have had breast cancer, have a history of cardiovascular disease, liver disease or blood clots, or women without menopausal symptoms.
When should a woman start hormone replacement therapy during menopause and how long does treatment last?
Although the average age for menopause is considered to be 50 years, and in many cases the most severe symptoms often last for two to three years, there is no exact limit on the age at which menopause can begin.
According to doctors, taking low-dose medications is the most effective way to get the benefits of hormone replacement therapy after 50 years. These drugs reduce possible risks heart disease and breast cancer. Doctors limit such treatment for women to four to five years. During this time the most severe symptoms disappear, and you can continue to live without taking medications.
What types of drugs are there?
Both are estrogen-based and are available as a tablet, gel, patch, and vaginal cream or ring (the latter two are most often recommended for vaginal-related symptoms only).
According to some doctors, low doses in the patch are The best way treatment because it delivers hormones directly into the bloodstream, bypassing the liver, and therefore reduces possible consequences reception. For hormone replacement therapy, drugs must be chosen especially carefully and only as prescribed by a doctor.
What is menopause?
Menopause is the time when menstrual cycle. This diagnosis is made after 12 months have passed without menstruation. Menopause can occur between 40 and 50 years of age.
Menopause is natural biological process. But physical symptoms such as hot flashes and emotional instability can interfere with sleep, reduce vitality and affect health. There are many effective ways Treatments range from lifestyle changes to hormonal therapy.
There are three stages of natural menopause:
- premenopause (or menopause transition) is the period of time between the onset of symptoms and 1 year after the last menstruation;
- menopause - one year after the last menstruation;
- Postmenopause is all the years after menopause.
Symptoms
In the months or years before menopause (perimenopause), you may experience following signs and symptoms:
- irregular periods;
- vaginal dryness;
- tides;
- chills;
- night sweats;
- sleep problems;
- mood changes;
- weight gain and slow metabolism;
- thinning hair and dry skin;
- loss of breast firmness.
Symptoms, including changes in menstruation, are different for every woman.
The disappearance of periods during perimenopause is common and expected. Often, the menstrual cycle disappears for a month and returns, or disappears for several months, and then continues as usual for a while. Bleeding may last less time, therefore, the cycle itself decreases. Despite irregular periods, pregnancy is still possible. If you feel a delay, but are not sure whether the menopausal transition has begun, take a pregnancy test.
When should you see a doctor?
Every woman should visit her doctor regularly to prevent disease and maintain her health, and continue to receive prescriptions during and after menopause.
Preventative treatment may include recommended health screening tests such as colposcopy, mammography, and ultrasonography uterus and ovaries. Your doctor may recommend other tests, including a physical examination. thyroid gland, if there hereditary diseases. With hormone replacement therapy after 50 years, the frequency of doctor visits should be increased.
Always see a doctor if you have vaginal bleeding after menopause.
Menopause or thyroid problems?
The thyroid gland is a small organ located in the front of the neck above the collarbone. Its main task is to produce hormones that regulate metabolism. These powerful hormones affect almost every cell, tissue and organ in the body. When the hormones produced by it become unbalanced, then the problem of hypothyroidism or hyperthyroidism arises.
Hypothyroidism (low thyroid function) occurs when the thyroid gland does not produce enough hormones for the body to function properly. If left untreated, it can lead to high level cholesterol, osteoporosis, heart disease and depression. Some symptoms of hypothyroidism are similar to those during the menopause transition period. These include fatigue, forgetfulness, mood swings, weight gain, irregular menstrual cycles and cold intolerance.
Hyperthyroidism (overactive) occurs when the thyroid gland produces too much hormone. Some symptoms of hyperthyroidism can also mimic the onset of menopause, including hot flashes, heat intolerance, palpitations (sometimes rapid heartbeat), tachycardia (persistent rapid heartbeat), and insomnia. The most common symptoms of thyrotoxicosis are unplanned weight loss, goiter (enlarged thyroid gland), and exophthalmos (bulging eyes).
Hypothyroidism is usually treated with oral thyroid hormone medications to replenish your supply. Treatment options for thyrotoxicosis are radioactive thyroid therapy or surgery thyroid gland.
A little about hormones
Before you go for your annual checkup, try to find out more about menopause and hormones (estrogens, progesterone and androgens) and various types hormone therapy to relieve menopause-related symptoms and reduce the long-term risk of diseases such as osteoporosis. This test can help determine which hormones may be right for you.
Estrogen is “ female hormone”, which contributes to the development and maintenance of female sexual characteristics and the ability to bear and give birth to offspring. The three main types of estrogen - estrone, estradiol (the most biologically active) and estriol (increases during pregnancy) - decrease during menopause, and this decrease can lead to menopausal symptoms such as hot flashes and vaginal dryness.
Progesterone is often called the “care hormone.” It signals the uterus to prepare tissue to receive a fertilized egg. It is also aimed at maintaining pregnancy and developing mammary glands (breasts). In menstruating women, progesterone is produced in the ovary only after ovulation (or the release of an egg from the ovary). If the egg is not fertilized, progesterone levels will drop and menstruation will occur. The end of ovulation during menopause means the end of progesterone production.
Androgens are also produced in the female body, like testosterone and dehydroepiandrosterone, but in much smaller quantities than in men. Insufficient androgen levels at any age contribute to fatigue, mood changes and decreased sex drive. There is nothing wrong with changes in androgen levels during menopause.
Hormone replacement therapy: pros and cons
It was first used in the 1940s but became more widely used in the 1960s, creating a revolution in the management of menopausal symptoms. This therapy was usually prescribed to women during menopause to relieve symptoms such as hot flashes, night sweats, sleep disturbances, psychological and genitourinary problems - frequent urination and vaginal dryness - and to prevent osteoporosis.
In the 1990s, two largest studies were conducted among women using hormone replacement therapy after 50 years of age. The published results of these two studies raised safety concerns. These problems revolved around two main issues:
- Long-term use of hormones may increase the risk of breast cancer,
- using them may increase the risk of heart disease.
The research results received wide public response, which caused panic among women.
After the results were published, the regulatory authorities adopted urgent measures safety, suggesting that clinicians prescribe the lowest effective dose to relieve symptoms, use it only as second-line treatment for the prevention of osteoporosis, and not use it in the absence of menopausal symptoms.
Many doctors stopped prescribing hormone replacement therapy after 50 (drugs), and women immediately abandoned it, after which all menopausal symptoms returned. The number of women taking hormones has declined, and almost an entire generation of women has been denied the opportunity to improve their quality of life during menopause.
Subsequent publication of the full study results showed a clear increase in the risk of breast cancer, which was only found in those who were taking HRT before entering the study. Additionally, because the authors initially stated that age had no effect on the effects of the drug, further analyzes showed no increase in the risks of heart disease in women who began treatment within 10 years of menopause.
Treatment today: key points
The balance of benefits and harms must always be assessed, but the health benefits appear to be greater. Patients can be confident in this following conditions:
- Hormone replacement therapy for women is taken to relieve symptoms of menopause. She plays important role in the prevention of osteoporosis, but long-term use is not required.
- Therapy is taken in the required quantity at the lowest possible effective dose.
- Patients receiving treatment undergo medical examination at least once a year.
If women start taking hormones during menopause, the risk of side effects is very small.
Many women are looking for information about the effects of hormone replacement therapy on sexual activity and desire after 50 years and which drugs have this effect. There's no definitive answer yet, but research suggests that estrogen may help maintain or restore sex drive. But this is certainly hampered by other menopausal symptoms such as vaginal dryness and pain during intercourse. If vaginal symptoms are the only problem, then using topical treatment in the form of vaginal estrogen suppositories may be preferable.
Is it only during menopause?
There are more than 50 types of hormonal medications. They can be taken:
- orally (in tablets),
- transdermal (through the skin),
- subcutaneously (long-term implantation),
- vaginally.
The cyclic dosage regimen simulates the normal menstrual cycle. Hormone replacement therapy is usually prescribed after age 40 for women whose menstruation has stopped too early. Estrogen and progestogen are taken every day for 21 days. At the end of each course, bleeding occurs as the body “refuses” hormones and rejects the uterine lining. Progesterone regulates bleeding and protects the endometrium from harmful precancerous changes. These drugs have a contraceptive effect, which helps women with unsettled or early menopause protect themselves from unwanted pregnancy. The drug is also prescribed for the treatment of secondary infertility. Prescription in such cases often gives positive result: After several cycles of use, women manage to get pregnant.
Estrogen alone is usually prescribed to women who have had their uterus removed (hysterectomy).
"Tibolone" is an estrogen-progestin drug prescribed to patients whose menstrual cycle ended no earlier than a year ago. If you start taking the drug too early, it may cause bleeding. Indications for use are the onset of menopause and osteoporosis.
With long-term use of hormonal drugs, you should have a blood test every three months, as there is a risk of blood clots.
Topical estrogen (eg. vaginal tablets, creams or rings) is used to treat local urogenital problems such as vaginal dryness, irritation, problems with frequent urination or infections.
Women considering treatment should carefully discuss the benefits and risks with their doctor, taking into account age, medical history, risk factors, and personal preferences. When choosing hormone replacement therapy, you should not rely on reviews - the drugs should be prescribed by a doctor.
For most patients using medications as a short-term treatment for menopausal symptoms, the benefits of treatment outweigh the risks.
Women on HRT should see their doctor at least annually. For some women, long-term use of medications may be necessary to further improve symptoms and quality of life.
Hormonal medications for women over 50 years of age are not prescribed to everyone. If such treatment is nevertheless carried out, then strictly as prescribed and under the supervision of a doctor. Many gynecologists are trying to replace the use of hormonal drugs with non-hormonal drugs. Dangerous consequences treatment with hormones can cause thrombosis and stimulate the growth of undetected hormone-dependent tumors.
Causes of hormonal imbalance after 50
After 40 years, a woman’s body begins to experience a gradual decline in hormonal levels due to depletion of the ovarian reserve. This means that there are fewer and fewer maturing eggs left in the ovaries and not every menstrual cycle (MC) ends with ovulation (the release of an egg from the ovary). And since sex hormones are secreted by the walls of the follicles in which the egg matures, the hormonal level gradually decreases. When the eggs are completely depleted, own estrogens are produced in small quantities by adipose tissue and the adrenal glands.
Additional problems are created by the pituitary gland, which begins to intensively secrete its gonadotropic hormones (GTG) to stimulate the secretion of female hormones. The concentration in the blood of follicle-stimulating hormone (FSH - the first half of the MC, which stimulates the secretion of estrogen) especially increases. By the increase in FSH, you can determine the onset of menopause even before the appearance of its first symptoms. The amount of luteinizing hormone (LH) also increases, but to a lesser extent than FSH.
Symptoms of hormonal imbalance
Many people endure this period painlessly, but some women develop menopausal syndrome: a set of symptoms associated with autonomic disorders against the background of decreased hormonal levels.
The autonomic nervous system (ANS) innervates internal organs and walls blood vessels. Therefore, if it is violated, symptoms such as:
- attacks of increased heart rate;
- long-term aching pain in heart;
- horse racing blood pressure(HELL);
- hot flashes to the face and upper body, which are accompanied by redness of the face and sweating; in severe climacteric syndrome, hot flashes are repeated 10 or more times per hour, and can occur at night, leading the woman to neurosis;
- the woman’s mood and behavior changes: she becomes irritable, her mood constantly changes from tearfulness and despondency to euphoria.
At age 50, most women experience their last menstrual period (menopause) and enter postmenopause. For some, this period begins before 50, for others later. But after it came autonomic symptoms gradually decline, and by the age of 55-60 they disappear completely. A new period begins when age-related metabolic changes associated with a deficiency of female hormones come to the fore.
Female sex hormones (mainly estrogens) supported all the activities of the body, so when they decrease, such serious disorders appear as:
- osteoporosis,
- degenerative-dystrophic disorders of the joints and spine;
- atherosclerosis and associated angina, myocardial infarction;
- diabetes with damage to small blood vessels and nerves;
- obesity, which increases the load on the cardiovascular and musculoskeletal systems;
- decreased thyroid function and hypothyroidism with dry skin, swelling and decreased intelligence;
- decreased immunity.
By the age of fifty, in most cases, a woman still has vegetative disorders, but also changes metabolic processes also make themselves felt.
Study of a woman's hormonal background
You can confirm the presence of menopause by passing the following tests::
- Blood test for FSH— due on the 4th – 5th day of the MC; the norm during the reproductive period is on average 10 mIU/ml. This indicator increases in the first half of the MC and decreases in the second. During menopause, FSH increases, increasing several times (from 20 to 100 and above).
- Blood test for LH— handed over on the 4th – 5th day of the MC. The norm in reproductive age is 0.6-50 mIU/ml, depending on the phase of MC. During menopause, this figure steadily increases to 30 - 50.
- Estradiol(one of the estrogens, the most important) - given on the 4th - 5th day of the MC. The norm during the reproductive period ranges from 90 to 1600 pmol/l, depending on the phase of MC; during menopause, the indicator drops to 73 and below.
- Progesterone— given on days 18–21 of the cycle. The norm during the reproductive period is 0.3 – 56 nmol/l, depending on the phase of MC. During menopause, the value drops to 0.6 and below.
- Testosterone— rented out any day at the MC. The norm during the reproductive period is 0.52-1.72 nmol/l. During menopause this figure decreases. Increased level speaks of an ovarian tumor.
- Prolactin— available for rent on any day at the MC. The norm is 109 - 557 mU/ml, an increase may indicate the presence of a tumor
The presence of menopause is indicated by a decrease in estrogen levels against the background of high levels of FSH and LH.
Thyroid hormones are also checked. An increase in them indicates the presence of hyperthyroidism, but during menopause this rarely happens. This condition is characterized by hypothyroidism, a condition in which reduced thyroid function provokes even greater metabolic disturbances.
Rules for donating hormones:
- blood is donated in the morning on an empty stomach;
- on the day before donating blood, the following should be excluded: drinking alcohol, physical exercise, sexual intercourse;
- You should not visit the bathhouse, sauna or solarium on the eve of the test.
- Possible medications taken on the eve of the study should be discussed with your doctor in advance.
Types of drugs used
Two types of drugs are used for hormone replacement therapy (HRT):
- containing only estradiol(one type of estrogen); taking such a drug is usually combined with taking gestagens (progesterone analogues) - Duphaston or Utrozhestan;
- containing estradiol and progestogens; These drugs are prescribed for complete replacement therapy.
Estradiol-containing drugs include drugs with the following names:
Proginova (Bayer Pharma, Germany)
Contains estradiol. While taking Proginova, the secretion of a woman’s own hormones does not suppress. Relieves vegetative symptoms of menopause and prevents the development of severe metabolic processes. The medicine can be taken daily without breaks or cyclically for 21 days in a row with a 7-day break. But women with an unremoved uterus are recommended to take gestagens every month for 10 days to prevent uterine cancer.
Estroferm (Novo Nordisk, Denmark)
Contains estradiol. Take continuous courses of one tablet a day, for no more than three months in a row.
Products containing estrogens and gestagens include drugs with the names:
Angelique (Bayer Pharma, Germany)
The drug is prescribed in postmenopause (after the onset of the last menstruation) to eliminate autonomic disorders, prevent osteoporosis and atherosclerosis. Take one tablet per day continuously.
Cyclo-Proginova (Bayer Pharma, Germany)
The drug is available in the form of two types of tablets and is taken cyclically. The first 11 days of the cycle take tablets containing only estradiol, the next 10 days - tablets with estradiol and gestagen, after which they take a break for 10 days. Relieves the symptoms of menopause, prevents the development of osteoporosis and atherosclerosis.
Klimonorm (Bayer Pharma, Germany)
Contains both types of hormones and is taken cyclically. For the first 9 days, take a tablet containing only estradiol, then 10 days a tablet with two female hormones, after which they take a week break. It relieves the symptoms of menopause well and regulates circulatory cycles during premenopause.
Trisequence (Novo Nordisk, Denmark)
The drug is available in the form of blue and white. Blue ones contain only estradiol and are taken for 12 days, white ones contain estradiol and gestagen and are taken for 10 days, after which they take a break for 6 days.
Femoston (Abbott, Netherlands)
Contains two types of hormones and is taken in continuous courses.
The duration of treatment is determined by the doctor individually.
Dosage forms of drugs for HRT
HRT products are available in the following dosage forms:
- in tablets for oral administration under the names: Femiston, Trisequence, Klimonorm, Cyclo-Proginova, Proginova, Angelique, Estroferm; most women prefer this particular dosage form;
- as a solution for subcutaneous injection— Gynodian Depot, administered once a week; some women prefer injections, since they are done infrequently and situations arise less often with forgetting to re-administer the medicine;
- in the form of transdermal therapeutic systems — skin patches (Klimara); this is the safest way for hormones to enter the body, as it has a much less negative effect on the liver; patches are applied to the skin once a week;
- in the form of products for external and local use– creams, gels, vaginal suppositories (Divigel, Estrogel, Ovestin); applied daily and used to eliminate dryness of the mucous membranes of the genitourinary tract.
Indications for taking hormonal drugs
Indications for HRT are:
- severe climacteric syndrome with pronounced:
- autonomic disorders;
- changes in the genitourinary tract, accompanied by impaired urination and pain during sexual intercourse;
- depression.
- prevention severe violations metabolism: osteoporosis, atherosclerosis and diabetes.
Contraindications and side effects
HRT has many contraindications:
- bleeding from the genitals of unknown origin;
- hormone-dependent tumors of the genital organs and mammary glands;
- benign or malignant tumors liver, including in the past;
- severe liver disease;
- increased blood clotting, tendency to thrombosis;
- taking hormonal contraceptive drugs(combined oral contraceptives- KOK).
With caution and after a thorough examination, HRT is prescribed for diabetes mellitus, persistently high blood pressure, jaundice of any origin, uterine fibroids, and endometriosis.
The side effects of these drugs make you think about the rationality of their use:
- the appearance of acyclic (intermenstrual) and increased cyclic uterine bleeding;
- painful periods;
- nervous and autonomic disorders before menstruation, similar to premenstrual syndrome;
- soreness and enlargement of the mammary glands;
- disorders of the digestive system associated with the digestion of food and stagnation of bile;
- rash, dark spots on the skin;
- headaches (sometimes migraine-type), dizziness, increased anxiety, depression, high fatigue;
- swelling, increased blood pressure;
- thrombosis and thromboembolism;
- skeletal muscle cramps;
- increase in body weight.
The biggest danger with HRT is the ability of female hormones to stimulate the growth of hormone-dependent tumors. Hormones do not cause tumors, but if a tumor already exists, they powerfully stimulate its growth.
Under the influence of HRT, the course of some diseases may worsen. Such diseases include:
- endometriosis;
- uterine fibroids;
- thrombophlebitis;
- diseases of cardio-vascular system;
- liver disease;
- diabetes;
- migraine;
- systemic connective tissue diseases (lupus erythematosus, scleroderma, etc.);
- epilepsy;
- bronchial asthma;
- severe kidney disease.
Choice of drug
Medicines for HRT are selected individually, taking into account the woman’s complaints, her age, weight, diseases suffered in the past and diseases existing at the time of treatment. Contraindications for the use of a particular product must be taken into account.
Preparations containing only estrogens, without taking gestagens, can be taken by women with a removed uterus. If you take Proginova or Estroferm without gestagens with a non-removed uterus, then due to the growth of the mucous membrane (endometrium), the risk of developing uterine cancer increases.
Preparations containing 2 hormones (estrogens and gestagens) are prescribed for intact uterus and for women suffering from endometriosis (gestagens suppress the stimulating effect of estrogens on endometriosis). In case of severe climacteric syndrome in premenopause, such treatment is prescribed in a cyclic mode, and in postmenopause - in a constant mode.
Transdermal drugs are suitable for all women, but are especially indicated for diseases of the digestive system, including after removal of the gallbladder.
Video, choosing a drug for HRT:
Hormonal drugs for HRT for women over 50 years of age should be selected individually, taking into account indications and contraindications. If all these factors are not taken into account, it will be impossible to avoid serious complications. IN Lately More and more doctors are trying to prescribe non-hormonal drugs for menopause.
Hormone replacement therapy during menopause plays an important role in regulating and pathological changes, occurring 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 decline the ability of the ovaries to produce progesterone, and subsequently estrogens due to 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:
- Short-term treatment. Its course is designed for 1.5-2.5 years and is prescribed for mild cases. menopause, without obvious disruptions in the female body.
- 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::
- 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.
- Premature menopause. Treatment is necessary to stop the inhibition of female reproductive functions.
- After surgical procedures involving removal of the ovaries. HRT helps maintain hormonal balance, which prevents sudden changes in the body.
- Prevention age-related disorders and pathologies.
- 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 the gradual adaptation of the female body to the transition to other conditions, which avoids serious disturbances in the functioning of a number of internal organs and systems .
In favor of HRT, there are such positive effects:
- Normalization of the psycho-emotional background, incl. elimination panic attacks, mood swings and insomnia.
- Improved functioning urinary system.
- Inhibition of destructive processes in bone tissue by preserving calcium.
- Prolongation of the sexual period as a result of increased libido.
- Normalization of lipid metabolism, which reduces cholesterol levels. This factor reduces the risk of atherosclerosis.
- Protection of the vagina from atrophy, which ensures the normal condition of the sexual organ.
- Significant relief of menopausal syndrome, incl. softening of tides.
Therapy becomes effective preventative 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 formation, 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 carrying out HRT There are several main categories:
Estrogen-based products, names:
- Ethinylestradiol, Diethylstilbestrol. They are oral contraceptives and contain synthetic hormones.
- 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.
- Klimen, Klimonorm, Divina, Proginova. The drugs include estriols and estrone, which are ether derivatives.
- Hormoplex, Premarin. They contain only natural estrogens.
- 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:
- Duphaston, Femaston. They are classified as dydrogesterones and do not produce metabolic effects;
- Norkolut. Based on norethisterone acetate. It has a pronounced androgenic effect and is useful for osteoporosis;
- Livial, Tibolon. These drugs are effective for osteoporosis and are in many ways similar to the previous drug;
- 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, Triaclim.
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:
- Klimonorm. The active substance is a combination of estradiol and levonornesterol. Effective for eliminating menopause symptoms. Contraindicated for ectopic bleeding.
- Norgestrol. Is combined agent. Copes well with neurogenic disorders and autonomic disorders.
- Cyclo-Proginova. Helps increase female libido, improves the functioning of the urinary system. Cannot be used for liver pathologies and thrombosis.
- Klymen. It is based on cyproterone acetate, valerate, an antiandrogen. Fully restores hormonal balance. When used, the risk of weight gain and depression increases nervous system. Allergic reactions are possible.
Herbal remedies
A significant group of drugs for HRT consists of plant origin and the medicinal plants themselves.
Such plants are considered to be quite active suppliers of estrogens:
- Soybeans. When used, you can slow down the onset of menopause, alleviate the manifestation of hot flashes, and reduce the cardiac effects of menopause.
- Black cohosh. It is able to alleviate the symptoms of menopause and blocks changes in bone tissue.
- Red clover. It has the properties of previous plants and is also able to reduce cholesterol.
The following preparations are produced based on phytohormones::
- Estrophel. Contains phytoestrogen, folic acid, vitamins B6 and E, calcium.
- Tibolone. Can be used to prevent osteoporosis.
- 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::
- 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.
- 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.
- At surgical treatment endometriosis. To eliminate the risk of relapse, therapy is carried out with estradiol in combination with dienogest and dydrogesterone.
Menopause is an inevitable phenomenon for women who have crossed the 45-year mark. Aging of the body is a large-scale process in which hormones play a decisive role. Substitute hormone therapy(drugs for women over 45 years of age) is current method eliminating physical and psychological discomfort with proven effectiveness.
What is HRT?
Balzac's age is characterized by pronounced age-related changes that are unpleasant for any woman. These are not only cosmetic problems in the form of deterioration of the skin, hair and nails. Hormonal changes in the body observed at this age are characterized by a decrease in the level of hormones secreted by the adrenal glands, depletion of the ovarian follicular reserve, the appearance of osteoporosis, and psycho-emotional instability.
The search for the elixir of youth is a problem that has been relevant for thousands of years. Hormone replacement therapy in the form of drugs for women after 45 years of age - effective way prolong youth and maintain quality of life. HRT in women can be considered as a deception of the body, which is no longer able to produce the necessary hormones on its own. How dangerous is the use of hormone replacement therapy for the female body?
Facilities mass media contain conflicting information about the rationality of using hormones.
Negative attitude towards the appointment HRT drugs arose due to the following circumstances:
- risk of interference with natural processes aging of the body with the risk of disruption of hormonal regulation;
- insufficient awareness of the population about the effectiveness and safety of new generation HRT;
- fear of side effects;
- the assumption that synthetic analogues of hormones cannot be dosed without knowing the body’s real need for them;
- fear of developing cancer due to the use of hormone replacement drugs.
You can figure out where the myth is and where the reality is by understanding the mechanism of action of hormones.
To ensure the harmonious functioning of the body while maintaining constant internal environment, the hormonal system functions on the principle of feedback between the body systems and the brain (pituitary gland, hypothalamus).
Releasing hormone synthesized in the hypothalamus stimulates the production of follicle-stimulating and luteinizing hormones. They, in turn, provoke the production of sex hormones. These include the following:
- Estrogen. They stimulate the proliferation of the endometrium, the epithelium of the vaginal mucosa, control the growth of the mammary glands, and maintain the elasticity of blood vessels. Directly affect conservation female beauty, skin tenderness.
- Progesterones. Smoothes out the proliferative effect of the hormone estrogen. Participate in preparing the body for pregnancy or the full course of the menstrual cycle.
- Androgens. Participate in the synthesis of estrogens, blood and liver proteins, regulate blood glucose levels. These hormones are responsible for sexual desire, aggression, and initiative.
Hormone imbalance seen with age-related changes, provoke the following factors:
- depletion of follicular reserves and hormonal dysfunction as a result of aging;
- decreased sensitivity of the hypothalamus to hormones;
- hereditary factor (genetic predisposition);
- disruption of hormone metabolism in the body;
- surgical manipulations, removal of reproductive system organs (ovaries, uterus, appendages);
- uncontrolled use of hormonal drugs.
Indications for prescribing HRT
- Severe menopausal manifestations in the form of hot flashes, chills, hyperhidrosis, palpitations, increased blood pressure, migraines. Autonomic memory and sleep disturbances, depression, decreased libido are typical manifestations of menopause.
- Removal of the uterus, ovaries, and appendages contributes to the onset of artificial menopause. In this case, hormone replacement therapy for women in the form of drugs latest generation is vital.
- Disorders genitourinary system in the form of pain when urinating, false urges, urinary incontinence, dryness and burning in the intimate area.
- Prolapse of the uterus and vagina as a result of hormonal deficiency.
- Disruption of metabolic processes in organs and tissues (severe swelling due to difficulty removing fluid from the body, increased blood glucose levels).
- Structural changes in the epidermis (dryness, flaking, hair loss and fragility, delamination of nail plates, appearance of deep wrinkles).
- Development of systemic diseases of the endocrine and nervous systems (diabetes mellitus, ischemic disease heart, myocardial infarction, atherosclerosis, Alzheimer's disease). In this case, a special approach to prescribing a treatment regimen and determining the dosage is required. At genetic predisposition to osteoporosis, HRT is a necessary protection for bone tissue.
Hormonal therapy can be of 2 types:
- Short-term (3-6 months). Its goal is to eliminate or prevent menopausal syndrome (including those arising from the use of various medications).
- Long-term (5-7 years). It is aimed at preventing the development of late menopausal manifestations against the background of existing systemic diseases.
Drugs
The list of new generation drugs with proven effectiveness includes:
Correctly prescribed hormone therapy after removal of the uterus (hysterectomy), fallopian tubes, ovaries is of great importance. Even young women who have undergone surgery feel all the unpleasant moments of menopausal syndrome in the form autonomic dysfunctions(tides, night sweats, irritability). If the uterus has been removed, estrogen can be used in pure form without worrying about the likelihood of cancer.
Drugs that are indicated for use as hormone replacement therapy after surgery.
Ovariectomy (removal of the ovaries) | Removal of the uterus and uterine appendages | Surgical procedures for endometriosis |
Application in cycles | Monophasic type of reception |
|
| Estradiol + Cyproterone acetate | Estradiol + Norethisterone (Norkolut, Livial) | Dienogest + Estradiol (Cliogest, Estrofem) |
| Levonorgestrel + Dydrogesterone | Estradiol + Medroxyprogesterone | Estradiol + Femoston (Trisequence) |
| Klimonorm | Estradiol and Drospirenone | Dydrogesterone |
| Tibolone | Duphaston | |
| Proginova | Femoston | |
Important aspects
According to the recommendations of the World Health Organization, the use of hormone replacement drugs is indicated during premenopause and menopause with severe symptoms and after the cessation of menstruation. If the diagnostic process reveals an acceptable level of estrogen, then treatment with hormones can be delayed for some time. As an alternative, antidepressants, vitamin therapy, and drugs that correct autonomic disorders are used.
It is much more difficult to adjust the treatment regimen after 60 years, since at this age the effectiveness of hormone therapy noticeably decreases. For older women, increased levels of hormones pose a danger to the body if there are diseases of the liver, kidneys, stomach, or hematopoietic system.
IN last years Homeopathic remedies are especially popular. Women prefer to take drugs for plant based with the least amount of side effects. However, the effectiveness of such a medicine is highly questionable. Homeopathic remedies do not give the expected result for disorders of the cardiovascular system. They are absolutely not effective for osteoporosis, even in combination with calcium supplements.
Search effective remedy Given the existing contraindications, it is often difficult even for an experienced specialist. The decision to use hormone replacement drugs after 45 years of age is an individual decision, which mandatory agreed with the doctor. Sometimes consulting a gynecologist is not enough. For help, you can contact an endocrinologist, psychotherapist, or oncologist.
The use of any medicine poses a certain risk to the body. Finding an effective remedy and developing an individual treatment regimen is the task of the attending physician.
After using hormones, side effects may occur in the form of:
- severe headaches;
- the appearance of swelling;
- muscle spasms;
- gastrointestinal dyskinesia;
- fatigue;
- dryness of the intimate area;
- bleeding disorders.
Like any medicine, hormonal drugs have a list of side effects. This creates preconditions for limiting their use.
The contraindications for HRT are as follows:
- bleeding of unknown etiology;
- operated breast cancer;
- malignant tumors or suspicion of them;
- precancerous conditions (dysplasia);
- varicose veins;
- thrombophlebitis, thromboembolism;
- cardiovascular diseases;
- gallstones;
- disruption of fat synthesis in the liver upon intake of food (external use is indicated);
- liver damage (hepatitis, cirrhosis);
- rheumatism;
- severe form of diabetes mellitus;
- renal failure;
- epilepsy;
- bronchial asthma;
- obesity;
- individual intolerance.
The appointment of hormone replacement therapy should be preceded by a thorough diagnosis of the body. Besides gynecological examination, it is imperative to examine the mammary glands. Cytological examination cervical mucus, blood clotting analysis, exclusion of pregnancy are also included in the complex of previous diagnostics. A comprehensive examination and adequate therapy help eliminate unpleasant symptoms menopause, maintain social and sexual activity of women.
