Menopause is a difficult time in a woman's life, especially if she suffers from chronic diseases. There is a special hormone replacement therapy for women over 50 years old, the drugs are aimed at eliminating unpleasant symptoms. When taking female hormones for menopause, it is important to take into account chronic diseases in order to avoid negative consequences. Therefore, it is important to consult a gynecologist after a comprehensive examination.
Hormone therapy and diseases
Does hormone replacement therapy (HRT) alleviate menopausal symptoms? Menopause, which is characterized by the last menstruation in life, occurs at an average age of 51 years. Almost 1/3 of our life falls on the postmenopausal period, while there is an increase in the deficiency of sex hormones.
Hormone therapy regulates this period, but can it be used with any chronic diseases? Of course, provided that the disease is well controlled. There are no contraindications to the use of hormone therapy in cases of the following diseases:
- diabetes,
- hypertension,
- asthma,
- joint diseases,
- liver disease.
However, the gynecologist must be especially careful. It is necessary to take into account not only the underlying disease, but also limitations in chronic diseases.
Female hormones with menopause in tablets - a list of drugs
Hormone therapy can be in the form of oral tablets, patches glued to the skin, and vaginal tablets. The latter form is used when symptoms associated with changes in the urogenital tract are most annoying. For example, frequent bladder infections, stress incontinence.
Vaginal tablets only work locally and do not help with night sweats and hot flashes. However, vaginal tablets in combination with an oral low dose of the hormone are an effective therapy for 3 months of treatment.
With menopause, there is a decrease in the female hormone estrogen. Therefore, substitution therapy is aimed at replenishing it. Oral contraceptives (OC) with androgenic action are prescribed as the main drugs.
- Yarina.
- Diana-35.
- Norkolut.
- Androcur.
Tablets are prescribed by a doctor after analyzing the level of the hormone in the blood.
Drugs such as Livial and Norkolut are indicated for women with signs of osteoporosis, which is often observed during menopause.
Depending on the symptoms of the disease, the specialist may prescribe a monophase regimen or the simultaneous use of 2-3 drugs.
If the medicine is not effective, the doctor will suggest another medicine or a different form of medicine. Therapy can be interrupted at any time (but only after consulting a doctor) and if menopausal symptoms return - only to resume it. If necessary, you can take a short break from using hormones (for example, during surgery).
Contraindications for hormone therapy for women 50-60 years old
Hormone therapy can be used with most chronic diseases because the doctor can choose therapy that will not affect the underlying disease, as well as significantly improve the quality of life during menopause. There are few absolute contraindications to HRT. These include:
- Thrombosis (developing over the past 5 years).
- Acute liver failure.
- Unexplained vaginal bleeding.
- Heart attack or stroke.
- Serious cardiovascular disease.
- Advanced atherosclerosis.
- breast cancer.
- endometrial cancer.
- Melanoma.
- Meningioma.
During the intake of hormone replacement therapy for women after 50 years of age, patients with chronic diseases should be well examined and be under the constant supervision of a gynecologist. At the first visit, you should return to the doctor one month after the start of treatment, and then after 3 and 6 months.
In addition, annual examinations should be performed:
- glucose,
- cholesterol
- coagulation,
- liver tests.
These regular checks will help to detect the disease at an early stage of development and, thus, its effective recovery.
diabetes and menopause
Women with type 1 diabetes go through menopause earlier than healthy people. In the case of type 2 diabetes combined with obesity and additional secretion of estrogen from adipose tissue - occurs after menopause.
During menopause, the ovaries stop producing estrogen and progesterone. Since hormonal levels affect metabolism, these changes also affect insulin levels. A decrease in the level of female sex hormones can lead to an increase in blood glucose levels, as it increases insulin resistance.
In the following months, blood glucose levels rapidly decrease. Decreased progesterone levels increase insulin sensitivity, while estrogen levels decrease it.
Low estrogen levels contribute to osteoporosis and cardiovascular disease. In women after menopause, the symptoms of menopause and diabetes tend to be similar. Feeling hot, disturbed sleep, night sweats, and lack of concentration can cause hypoglycemia to be misdiagnosed, and thus the glucose-insulin balance is increased through excessive eating.
In order to improve the quality of life and reduce the severity of symptoms, many women decide to resort to hormone therapy. But HRT is not indicated for women with uncontrolled diabetes.
With the further progress of developed capitalism on the territory of Russia, a woman is increasingly faced with the need to maintain an attractive appearance and sexual activity right up to the grave.
It has long been known that since the onset of menopause, the level of estrogen providing:
- not only fertility,
- but also an acceptable state of the cardiovascular,
- musculoskeletal systems,
- skin and its appendages,
- mucous membranes and teeth
falls catastrophically.
The only hope of an aging lady some thirty years ago was the fatty 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 drag queens and ingénue-pipis than heroine mothers and hard workers.
In pursuit of a slim figure, women somehow forgot about what a heart attack is at fifty and osteoporosis at seventy. Fortunately, gynecologists with the latest achievements in the pharmaceutical industry in the field of hormone replacement therapy pulled themselves up to help frivolous compatriots. Approximately from the beginning of the nineties, this direction, standing at the junction of gynecology and endocrinology, began to be considered a panacea for all female misfortunes, from early menopause to fractures of the femoral neck.
However, even at the dawn of the popularization of hormones, in order to keep a woman flourishing, sound demands were made not to prescribe drugs to everyone indiscriminately, but to make an acceptable sample, separating women with high risks of oncogynecology and directly protecting them from realizing the 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 such changes that do not always set the lady in a positive way and often quite the opposite. Therefore, with menopause, drugs and medications are often simply necessary to take.
Another question is how safe and effective they will be. It is precisely the maintenance of a balance between these two parameters that is the biggest problem of modern pharmaceutical industry and practical medicine: neither shooting a sparrow from a cannon, nor chasing an elephant with a slipper is impractical, and sometimes even very harmful.
Hormone replacement therapy in women today is very ambiguously evaluated and prescribed:
- Only in women without risk of breast, ovarian, 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 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, local estrogen suppositories can be used.
- The benefits in the main areas (osteoporosis, ischemic changes in the myocardium) do not compete with safer drugs or are not completely proven, to put it mildly.
- Almost all ongoing studies have certain errors that make it difficult to draw unambiguous conclusions about the predominance of the benefits of substitution therapy over its risks.
- Any prescription of therapy should be strictly individual and take into account the specifics of the situation of a particular woman, for whom not only an examination before prescribing drugs is necessary, but also ongoing dispensary observation for the entire duration of treatment.
- Domestic serious randomized trials with their own conclusions have not been conducted, national recommendations are based on international recommendations.
The further into the forest, the more firewood. With the accumulation of clinical experience with the practical use of hormone replacement, it became clear that women with initially low risks of breast cancer or uterine mucosa are not always safe, taking some categories of "pills of eternal youth."
How is the situation today, and on whose side is the truth: adherents of hormones or their opponents, let's try to figure it out here and now.
Combined hormonal agents
Combined hormonal agents and pure estrogens can be prescribed as hormone replacement therapy in menopause. Which drug will be recommended by the doctor depends on many factors. These include:
- patient's age,
- presence of contraindications
- body mass,
- severity of climacteric symptoms,
- concomitant extragenital pathology.
Klimonorm
One package contains 21 tablets. The first 9 yellow tablets contain an estrogenic component - estradiol valerate at a dosage of 2 mg. The remaining 12 tablets are brown in color and include estradiol valerate 2 mg and levonorgestrel 150 mcg.
The hormonal agent must be taken 1 tablet daily for 3 weeks, at the end of the package, a 7-day break should be taken, during which menstrual discharge will begin. In the case of a preserved menstrual cycle, tablets are taken from the 5th day, with irregular menstruation - on any day with the condition of excluding pregnancy.
The estrogen component eliminates negative psycho-emotional and autonomic symptoms. Common ones include: sleep disorders, hyperhidrosis, hot flashes, vaginal dryness, emotional lability, and others. The gestagenic 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 funds differ in the content of estrogen and progestogen components. Femosten 2/10 contains 14 pink and 14 yellow tablets (28 pieces in total in a package).
Pink tablets contain only the estrogenic component in the form of estradiol hemihydrate in an amount of 2 mg. The yellow tablets consist of 2 mg estradiol and 10 mg dydrogesterone. Femoston must be taken daily for 4 weeks, without interruption. After the end of the package, you should start a new one.
Angelique
The blister contains 28 tablets. Each tablet contains estrogen and progestogen components. The estrogenic component is represented by estradiol hemihydrate at a dose of 1 mg, the progestogen component is drospirenone at a dose of 2 mg. Tablets should be taken daily, without observing a weekly break. After the end of the package, the reception of the next one begins.
pausegest
The blister contains 28 tablets, each contains estradiol in an amount of 2 mg and norethisterone acetate in a dose of 1 mg. Tablets begin to drink from the 5th day of the cycle with preserved menstruation and on any day with irregular periods. The drug is taken constantly, without observing a 7-day break.
Cyclo-Proginova
There are 21 tablets in a blister. The first 11 white tablets contain only the estrogenic component - estradiol valerate at a dosage of 2 mg. The next 10 light brown tablets consist of estrogenic and progestogen components: estradiol in the amount of 2 mg and norgestrel in a dosage of 0.15 mg. Cyclo-Proginova should be taken daily for 3 weeks. Then it is necessary to observe a week break, during which menstrual-like bleeding will begin.
Divigel
The drug is available in the form of a 0.1% concentration gel, 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:
- lower abdomen,
- small of the back,
- shoulders, forearms,
- buttocks.
The area of application of the gel should be 1 - 2 palms. Recommended daily change of skin areas for rubbing Divigel. It is not allowed to apply the drug to the skin of the face, mammary glands, labia and irritated areas.
menorest
Produced 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. Produced in the form of a patch measuring 12.5x12.5 cm, which must be glued to the skin. The composition of this anti-menopausal agent 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 period, the previous patch is peeled off and a new one is attached. Recommended places for application of Climara are the gluteal and paravertebral regions.
Ovestin is available in tablets, vaginal suppositories, and as a cream for vaginal use. The most commonly prescribed form of the drug are vaginal suppositories. The composition of one suppository includes micronized estriol in the amount of 500 mcg. Candles are administered intravaginally daily, without interruption. The main role of the drug is to replenish estrogen deficiency in menopausal 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 gr. gel, in one dose - 1.5 mg of estradiol. The main action is the elimination of the lack of estrogens in menopause and postmenopause. The rules for applying the gel are the same as for Divigel.
Advantages and disadvantages of using different forms of preparations. Click to enlarge.
Hormonal background
For a woman, the basic sex hormones can be considered estrogens, progestins and, paradoxically, androgens.
In a rough approximation, all these categories can be characterized as follows:
- estrogens are female hormones
- progesterone - pregnancy hormone
- androgens - sexuality.
estradiol, estriol, estrone are steroid hormones produced by the ovaries. It is also possible to synthesize them outside the reproductive system: the adrenal cortex, adipose tissue, 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 the long bones of the limbs, development of secondary sexual characteristics (female-type hair, pigmentation of the nipples and genital organs), proliferation of the epithelium of the vaginal and uterine mucosa, secretion of vaginal mucus, rejection of the endometrium in uterine bleeding.
- An excess of hormones leads to partial keratinization and desquamation of the vaginal lining, proliferation of the endometrium.
- Estrogens prevent the resorption of bone tissue, promote the production of blood coagulation elements and transport proteins, reduce the level of free cholesterol and low-density lipoproteins, reducing the risk of atherosclerosis, increase the blood level of the thyroid hormone, thyroxine,
- adjust receptors to the level of progestins,
- provoke edema due to the transition of fluid from the vessel into the intercellular spaces against the background of sodium retention in the tissues.
Progestins
mainly provide 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. Also, these steroids are called gestagens. 
- In non-pregnant women, they balance estrogens, 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, their susceptibility to substances that increase muscle tension (oxytocin, vasopressin, serotonin, histamine) decreases. Due to this, progestins reduce the pain of menstruation and have an anti-inflammatory effect.
- Reduce the sensitivity of tissues to androgens and are androgen antagonists, inhibiting the synthesis of active testosterone.
- A decrease in progestin levels determines the presence and severity of premenstrual syndrome.
Androgens, testosterone, in the first place, literally fifteen years ago, were accused of all mortal sins and were considered only harbingers in the female body: 
- obesity
- acne
- increased hair growth
- hyperandrogenism was automatically equal to polycystic ovaries, and it was prescribed to deal with it by all available means.
However, with the accumulation of practical experience, it turned out that:
- a decrease in androgens automatically reduces the level of collagen in tissues, including the pelvic floor
- impairs muscle tone and leads not only to the loss of a woman’s taut appearance, but also
- problems with urinary incontinence and
- excess weight gain.
Also, women with androgen deficiency clearly have a drop in sexual desire and are more likely to have an uneasy 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, spasmodic falls, they do not give.
- A sharp decrease in testosterone is observed in women against the background of artificial menopause (after surgical removal of the ovaries).
climacteric
The concept of climax is known to almost everyone. Almost always in everyday life, the term has an irritable-tragic or even abusive connotation. However, it is worth understanding that the processes of age-related restructuring are completely natural events, which normally should not become a sentence or signify a dead end in life. Therefore, the term menopause is more correct, when, against the background of age-related changes, the processes of involution 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 called “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 stress, flushing of the skin, urogenital signs of estrogen deficiency may already begin to appear.
- Menopause is usually referred to as the last menstruation. Since the ovaries are turned off, after her menstruation no longer goes. This event is established retrospectively, after a year of absence of menstrual bleeding. The timing of the onset of menopause is individual, but there is also an “average temperature in the hospital”: in women under 40, menopause is considered premature, early - up to 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 more often associated with early postmenopause, which lasts 5-8 years. In the late part of postmenopause, there is a pronounced physical aging of organs and tissues, which prevails over autonomic disorders or psycho-emotional stress.
What do you have to fight
perimenopause
can respond in a woman's body, both with episodes of elevated estrogen levels and the absence of egg maturation (uterine bleeding, breast engorgement, migraine), and manifestations of estrogen deficiency. The latter can be divided into several groups:
- psychological difficulties: irritability, neurotypization, depression, sleep disturbances, performance decline,
- vasomotor phenomena: increased sweating, hot flashes,
- genitourinary disorders: vaginal dryness, itching, burning, increased urination.
Postmenopause
gives the same symptoms due to lack of estrogen. Later they are supplemented and replaced:
- metabolic abnormalities: accumulation of abdominal fat, a drop in the body's susceptibility to its own insulin, which can result in type 2 diabetes.
- cardiovascular: an increase in the level of atherosclerosis factors (total cholesterol, low density lipoproteins), dysfunction of the vascular endothelium,
- musculoskeletal: accelerated resorption of bone mass, 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 with menopause has the task of 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, in which the hormones would work, but would not have side effects.
The purpose of the appointment 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 substitutes for natural female hormones are based on the 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 the appointment in women under 60 years of age, despite the fact that the last unstimulated menstruation was in the lady no earlier than ten years ago. Combinations of estrogens with progestins are preferred, with low estrogen doses consistent with those of young women in the endometrial proliferating 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 is aware of its pros and cons.
When to start
Hormone replacement therapy preparations 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 the ovaries,
- with a low quality of life against the background of menopause, including those caused by pain in the muscles and joints,
- prevention and treatment of osteoporosis.
Let's make a reservation right away that basically this is how Russian gynecologists look at the problem. Why this reservation, we will consider a little lower.
Domestic recommendations, with some delay, are formed on the basis of the opinions of the International Menopause Society, whose recommendations in the 2016 edition of the list list almost the same, but already supplemented items, each of which is supported by a level of evidence, as well as the recommendations of the American Association of Clinical Endocrinologists in 2017, which emphasize precisely on the proven safety of certain variants of gestagens, combinations and forms of drugs.
- According to them, tactics for women during the menopausal transition and for older age categories will differ.
- Appointments should be strictly individual and take into account all manifestations, the need for prevention, the presence of concomitant pathologies and family history, the results of studies, as well as the expectations of the patient.
- Hormonal support is only part of a general strategy to normalize a woman's lifestyle, which includes diet, rational physical activity, and the rejection of bad habits.
- Replacement therapy should not be initiated unless there are clear signs of estrogen deficiency or the physical consequences of this deficiency.
- A patient receiving therapy is invited to 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 issue of continuing therapy is decided individually, taking into account the benefits and risks for a particular patient, without critical age restrictions.
- Treatment should be at the lowest effective dosage.
Contraindications
In the presence of at least one of the following conditions, 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,
- hepatocellular insufficiency,
- porphyria.
Progestins
- in case of meningioma
The use of these funds may be unsafe in the presence of:
- uterine fibroids,
- ovarian cancer in the past
- endometriosis,
- venous thrombosis or embolism in the past,
- epilepsy,
- migraine,
- cholelithiasis.
Application Variations
Among the routes of administration of replacement hormones are known: tableted through the mouth, injectable, transdermal, local.
Table: Pros and cons of different administration of hormonal drugs.
| Pros: | Minuses: |
Estrogen tablets |
|
|
|
Skin gel |
|
|
|
skin patch |
|
|
|
Injections |
|
|
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. In the course of estradiol, estradiolavalerate, estriol in a discontinuous course or continuously. Possible tablets, patches, gels, vaginal suppositories or tablets, injections.
- Isolated gestagen is prescribed in the menopausal transition or perimenopause in the form of progesterone or dydrogesterone in tablets to correct cycles and treat hyperplastic processes.
Combination of estrogen with progestin
- In intermittent or continuous cyclic mode (provided there are no endometrial pathologies) - usually practiced during the menopausal transition and perimenopause.
- For postmenopausal women, a continuous combination of estrogen and progestin is more commonly chosen.
At the end of December 2017, a conference of gynecologists was held in Lipetsk, where one of the central places was occupied by the issue of hormone replacement therapy in postmenopause. V.E. Balan, MD, Professor, President of the Russian Association for Menopause, voiced the preferred directions of substitution therapy.
Preference should be given to transdermal estrogens in combination with a progestin, preferably micronized progesterone. Compliance with these conditions reduces the risk 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 transdermal estradiol per 100 mg of progesterone. For perimenopausal women, the same drugs are recommended at a ratio of 1.5 mg per 200.
Women with premature ovarian failure (premature menopause)
those with higher risks for strokes, heart attacks, dementia, osteoporosis, and sexual dysfunction should receive higher doses of estrogen.
- At the same time, combined oral contraceptives can be used in them until the time of the average onset of menopause, but transdermal combinations of estradiol and progesterone are preferred.
- For women with low sexual desire (especially against the background of removed ovaries), it is possible to use testosterone in the form of gels or patches. Since specific female preparations have not been developed, the same agents are used as in men, but at lower dosages.
- Against the background of therapy, there are cases of ovulation, that is, pregnancy is not excluded, so drugs for replacement therapy cannot be considered contraceptives at the same time.
Pros and cons of HRT
Assessing the ratio of the risks of complications from sex hormone therapy and their benefits in combating the symptoms of a deficiency of these hormones, it is worth analyzing each item of the alleged profit and harm separately, referring to serious clinical studies with a decent representative sample.
Breast cancer on the background of substitution therapy: oncophobia or reality?
- A lot of noise has been made lately by the British Medical Journal, which previously distinguished itself in heavy legal battles with the Americans about the safety and dosing regimen of statins and came out of these clashes very, very worthily. In early December 2017, the journal published data from a nearly ten-year study in Denmark that analyzed the histories of about 1.8 million women aged 15 to 49 who used various variations of modern hormonal contraceptives (combinations of estrogens and progestins). The conclusions were disappointing: the risk of invasive breast cancer in women who received 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 for a year, the drugs give one extra case of cancer in 7690 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 of breast cancer, and cardiovascular episodes are the most common cause of death, are so-so consolation.
- The WHI study shows hope that the estrogen-progestin combination begins to significantly increase the risk of breast cancer no earlier than after five years of use, stimulating the growth of pre-existing tumors (including poorly diagnosed zero and first stages).
- However, the International Menopause Society also notes the ambiguity of the effects of replacement hormones on breast cancer risks. The risks are higher, the higher the body mass index of the lady, and the less active lifestyle she leads.
- According to the same society, the risks are less when using transdermal or oral forms of estradiol in combination with micronized progesterone (versus its synthetic variants).
- Thus, hormone replacement therapy after 50 increases the risk of progestin joining estrogen. A larger safety profile shows micronized progesterone. At the same time, the risk of recurrence in women who have previously had breast cancer does not allow them to prescribe replacement therapy.
- To reduce the risks, women with a low initial risk of breast cancer should be selected for replacement therapy, and annual mammograms should be performed against the background of ongoing therapy.
Thrombotic episodes and coagulopathy
- This is, first of all, the risk of strokes, myocardial infarctions, deep vein thrombosis and pulmonary embolism. Based on WHI results.
- In early postmenopausal women, this is the most common type of estrogen complication and increases as women age. However, with initially low risks in young people, it is low.
- Transcutaneous estrogens in combination with progesterone are relatively safe (data from less than ten studies).
- The frequency of deep vein thrombosis and PE is approximately 2 cases per 1000 women per year.
- According to the WHI, the risk of PE is less than in normal pregnancies: +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 in those who are obese and have had previous episodes of thrombosis.
- These complications are more common 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 have passed more than 10 years after menopause. The study also 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, while we are talking about ischemic cerebrovascular accident. At the same time, there is a dependence on oral long-term intake of estrogens (data from the WHI and the Cochrane study).
Oncogynecology is represented by cancer of the endometrium, cervix and ovaries
- Endometrial hyperplasia has a direct relationship with the intake of isolated estrogens. At the same time, the addition of progestin reduces the risk of uterine neoplasms (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 the probably lower adherence of the studied women to therapy. For the time being, the International Menopause Society has suggested 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 estrogen for continuous use is considered safe for the uterus.
- An analysis of 52 studies confirmed that hormone replacement therapy increased the risk of ovarian cancer by about 1.4 times, even if it was used for less than 5 years. For those who have at least a blueprint in this area, these are serious risks. An interesting fact is that early signs of ovarian cancer that have not yet been confirmed can be masked as manifestations of menopause, and it is for them that hormone therapy can be prescribed, which will undoubtedly lead to their progress and accelerate tumor growth. However, there are currently no experimental data in this direction. So far, we have agreed that there is no confirmed data on the relationship between the use of replacement hormones and ovarian cancer, since all 52 studies differed at least by 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 make it possible to timely detect cancer of this localization in women even before menopause. Data from the WHI and HERS studies were evaluated.
- Cancer of the liver and lung has not been associated with hormones, there is little information on stomach cancer, and there are suspicions that it is reduced during hormone therapy, as is 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. Weight loss, the fight against diabetes, arterial hypertension should come first. Estrogen therapy may have a protective effect on the cardiovascular system when approaching the time of menopause and negatively affect the heart and blood vessels if its onset is delayed by more than 10 years from the last menstruation. According to the WHI, women aged 50-59 years on the background of therapy were less likely to experience heart attacks, and there was a benefit in relation to the development of coronary heart disease, provided that therapy was started before 60 years of age. An observational study in Finland confirmed that estradiol preparations (with or without progestin) reduced coronary mortality.
The largest studies in this area were DOPS, ELITE and KEEPS. The first, Danish study, mainly focused on osteoporosis, incidentally noted a reduction in coronary deaths and hospitalizations for myocardial infarction among women with recent menopause who received estradiol and norethisterone or went without therapy for 10 years, and then were followed up for another 16 years. .
In the second, earlier and later prescription of estradiol tablets was evaluated (in women up to 6 years after menopause and later than 10 years). The study confirmed that early initiation of replacement therapy is important for the condition of the coronary vessels.
The third compared conjugated equine estrogens with placebo and transdermal estradiol, finding no significant difference in vascular health in relatively young healthy women over 4 years.
Urogenycology is the second direction, the correction of which is expected from the appointment of estrogen
- Unfortunately, as many as three large studies have proven that systemic estrogen use not only exacerbates existing urinary incontinence, but also contributes to new episodes of stress incontinence. This circumstance can greatly impair the quality of life. The latest mathematic analysis by the Cochrane Group noted that only oral preparations have such an effect, and topical estrogens seem to reduce these manifestations. As an additional plus, estrogens have been shown to reduce the risk of recurrent urinary tract infections.
- As for atrophic changes in the vaginal mucosa and urinary tract, estrogens were at their best here, reducing dryness and discomfort. At the same time, the advantage remained with local vaginal preparations.
Bone thinning (postmenopausal osteoporosis)
This is a large area, the fight against which is dedicated to a lot of effort and time of doctors of various specialties. 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 density is accompanied by chronic pain in the spine, joints, muscles and ligaments, which we would like to avoid.
No matter how nightingales gynecologists are filled with the topic of the benefits of estrogens for maintaining bone mass and preventing osteoporosis, even the International Menopause Organization in 2016, whose recommendations are essentially written off domestic replacement therapy protocols, vaguely wrote that estrogens are the most appropriate option for preventing fractures in early postmenopausal women, but the choice of osteoporosis therapy should be based on a balance of efficacy and cost.
Rheumatologists are even more categorical in this respect. Thus, selective estrogen receptor modulators (raloxifene) have not been shown to be effective in preventing fractures and cannot be considered the drugs of choice for the management of osteoporosis, giving way to bisphosphonates. Also, the prevention of osteoporotic changes is given to combinations of calcium and vitamin D3.
- Thus, estrogens are able to inhibit bone loss, but their oral forms have been mainly studied in this direction, the safety of which in relation to oncology is somewhat doubtful.
- Data on the reduction in the number of fractures on the background of replacement therapy have not been received, that is, today estrogens in terms of preventing and eliminating the severe consequences of osteoporosis are inferior to safer and more effective drugs.
What makes a person young? First of all - the harmony of hormones. No plastic will replace the youthful gleam in the eyes. Let's talk about hormone replacement therapy and its pros and cons with gynecologist-endocrinologist Svetlana Pivovarova.
P With age-related deficiency of sex hormones, most women in the West take HRT (hormone replacement therapy). In Russia, they are still afraid of her. Why is HRT so important? How justified are these fears? Let's find out from our expert.
Svetlana Viktorovna, many women are convinced that old age comes to us with menopause. Isn't it a too pessimistic view of such a seemingly natural course of things?
S.P.:Yes, this statement is not without foundation. Estrogens - the main female sex hormones - are indeed a kind of keepers of youth. They affect more than 200 points in the female body. From them - to a greater or lesser extent - depends on the work of any organ, any cell. As soon as the level of estrogen decreases, we gradually begin to develop different symptoms. And with the onset of menopause, the whole body often “crumbles”.
Everyone knows about hot flashes and sweating. But this is just the tip of the iceberg. Which organs are under the brunt?
S.P.:First of all, the female reproductive organs suffer from estrogen deficiency: uterus, ovaries, mammary glands. The mucous membrane of the vagina becomes thinner and loses its secret, dryness and itching appear. This is not an infection, but the result of exposure of the nerve endings of the vagina. The number of lactobacilli decreases (in the absence of estrogen, the milk bacillus does not survive), pathogenic bacteria from the intestine take their place, and endless cystitis begins to torment the woman. Gradually, the tone of the muscle and connective tissues decreases, which leads to the prolapse of the uterus and vagina, weakening of the bladder sphincter that holds urine. Hence the frequent urge to urinate, symptoms of stress incontinence - coughing, sneezing, lifting weights.
The second blow, oddly enough, falls on our bone tissue. It is also a hormone dependent organ. With a decrease in the level of estrogen, the bones cease to absorb calcium, and with the advent of menopause, it is washed out of the bones in all women without exception. This is a direct road to osteoporosis. The situation is aggravated if during the life there were endocrine disorders (problems with the thyroid gland, uncompensated diabetes mellitus, menstrual irregularities) and vitamin D deficiency (the scourge of all northern countries). Severe osteoporosis is associated with one in five fractures in women over 50 years of age.
And finally, female sex hormones affect the normal tone of the vessels and the epithelium lining them. They do not allow cholesterol to gain a foothold on their walls, and prevent the formation of plaques. Why do coronary heart disease and angina pectoris develop in women after 50 years, and in men - after 40? Because before menopause, we are protected by estrogens.
And, of course, our emotions are of great importance. With the onset of menopause, mood worsens, irritability appears, libido decreases, which often affects family relationships.
Unfortunately, outwardly we are also changing not for the better ....
S.P.:Of course. With a deficiency of estrogen, the production of collagen, hyaluronic acid and lipids in the skin decreases, and the condition of the connective tissue worsens. Hence the wrinkles and folds. But there is also the loss of the male hormone testosterone, which is also present in a certain amount in the female body. He is responsible for muscle strength, ligamentous apparatus, cognitive functions, for which he is often called the "hormone of the mind." For example, ligaments cannot be strengthened by physical activity; their condition is also affected by testosterone levels.
We can talk endlessly about the effect of hormones on our body ...
HRT, in fact, is the only way to make up for the age deficit and slow down the aging process. But many refuse it because of the fear of side effects. How justified are these fears?
S.P.:With a huge number of positive aspects, HRT has several negative ones. First, female sex hormones increase blood clotting. Therefore, women with varicose veins, a tendency to thrombosis, should not take estrogen. Hypertension, on the contrary, is not a contraindication, and sometimes taking HRT drugs stabilizes hypertension. Secondly, being powerful metabolites, estrogens can provoke oncological diseases, including in estrogen-dependent organs - the mammary glands, ovaries and uterus. HRT is contraindicated in large fibroids, endometrial hyperplasia, fibroadenoma and severe fibrosis in the mammary glands. Fibrocystic mastopathy is not a contraindication. It is important to understand that estrogens do not cause cancer. But if the cancer cell is already "sitting" inside, it can begin to develop.
When women find out about this, they start to worry. But at the same time, for some reason, they are not at all worried when taking hormonal contraceptives, which contain a 15-30 times higher dose of estrogens. Rarely, when receiving oral contraceptives, regularly donates blood for a coagulogram, but clotting increases! In my opinion, if you go through all the examinations in advance and conduct HRT under the constant supervision of a doctor, it is quite safe.
What tests and examinations are required?
S.P.:General and biochemical tests, the level of certain hormones, blood clotting tests, ultrasound of the genital organs, abdominal cavity, smear for cytology from the surface of the cervix, mammography, densitometry (test for osteoporosis).
And from what age can HRT be recommended? Some doctors of the "western school" recommend starting it as early as possible, taking as a guide the level of the pituitary hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone). Their increase indicates the arrival of premenopause. Such a proactive approach….
S.P.:I think this approach is not always justified. Yes, we can prescribe HRT for high levels of FSH and LH. But why do this if the woman has no symptoms yet? I would focus on the period of natural menopause - 46-54 years. Of course, we are not talking about those cases when, for some reason, menopause occurs earlier, including after surgical removal of the ovaries.
What are modern drugs? Can they re-induce menstruation?
S.P.:They are available in the form of tablets, patches and gel: the latter are mainly prescribed to those women who have had their uterus removed. Premenopausal and early postmenopausal drugs give a regular mild menstrual-like response. Drugs used a year or two after menopause have lower doses of hormones, are taken without interruption, and do not cause menstrual blood.
Another common question. How do phytoestrogens help with menopause?
S.P.:They reduce the intensity of hot flashes, slightly cheer up, to some extent improve the condition of the skin. But they do not affect the entire body - neither the restoration of bone density, nor the reduction in the progression of atherosclerosis, nor the "youth" of the genitals and bladder.
How long can HRT be taken? At anti-age conferences, I heard - until the end of my life.
S.P.:Yes, the president of the International Menopause Society once jokingly said: “We cancel the last pill the day before natural death ....” In our country, doctors decided that you can prescribe up to 60 years. Safe reception averages seven to ten years. If I am asked to prescribe HRT by a 62-year-old woman who has never taken estrogens before, I will refuse her. The benefits from them will be less than the harm. On the other hand, if a 60-year-old woman has already taken drugs, constantly undergoes examinations, has no contraindications, feels well and wants to continue taking them ... Why not?
As I said, estrogen is really akin to an elixir of youth. I have given HRT to women who, for various reasons, have lived in severe estrogen deficiency for most of their lives. They crossed the 48-year milestone as “grandmothers”. They had severe osteoporosis (although at this age the bone tissue is just beginning to break down), widespread atherosclerosis (coronary heart disease, angina pectoris), hypertension, suffered from depression and years of insomnia, symptoms of genital atrophy. Starting to take estrogens, they got a second female youth. Several of my patients decided to get a second education, entered the institute, and began to study foreign languages for the first time. One lady suddenly discovered the talent of an artist - she began to paint pictures. Yes, we all get old! But why, if there are no contraindications, not take the opportunity to prolong youth? No surgeon's plastic surgery can replace the youthful sparkle in the eyes that appears in women using estrogens!
By the way!
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In youth, few people think about age. It seems to many that the 40-year milestone will not come soon. Therefore, not everyone thinks about their future health. After 40, all women have a special period in the body, in which production is sharply reduced.
It is this hormone that is responsible for the state of women's health, affects sexual function, skin condition.
Estrogen deficiency in the female body leads to various consequences. Among them may be:
- depression;
- insomnia;
- illness;
- causeless change of mood;
- irritability;
- headache;
- decrease in sexual desire;
- fading of the skin.
To maintain a stable level of hormones in a woman's body, a whole set of hormones is used. Hormone therapy allows women at the age to return the feeling of youth, as well as to normalize their health and avoid serious diseases.
Necessary conditions to start taking hormones
Hormone therapy for women over forty should not be self-administered. Specialist consultation required. To prescribe hormones, the following conditions are required:
- obligatory visit to the gynecologist in order to identify failures in the hormonal system;
- a complete blood count;
- examination of the genital organs for the presence of tumors;
- examination of the cervix for the presence of tumor markers and in order to study its microflora;
- testing for malfunctions in the thyroid gland;
- performing liver tests;
- visiting a mammologist in order to study the condition of the mammary glands;
- a blood test specifically for hormones.
If there are no contraindications to start therapy, then the doctor can advise which hormones should be taken.
Cases when hormone therapy is unacceptable
It is important to point out cases when it is better for women over 40 to refrain from taking hormones. These are the following cases:
- the presence of problems with the liver, oncological diseases, a high risk of internal bleeding, thrombosis in the vessels;
- age over 60 years, when hormone treatment can lead to complications;
- intolerance to drugs based on hormones;
- More than 10 years have passed since the onset of menopause.
In these cases, hormone therapy can be harmful to women's health. It is necessary to consult with your doctor in advance regarding the use of hormonal drugs.
Varieties of drugs for hormone therapy in the form of tablets
Hormone therapy preparations can be produced in the form of suppositories, ointments, patches, subcutaneous implants and tablets. Special attention should be focused on the last and most common form of hormonal drugs - tablets.
There are two main female hormones in pills for taking at 40:
- estrogen;
- progesterone.
Estrogen is multifunctional. This is the main female hormone that improves the condition of the heart, blood vessels, blood, brain, bones. He is responsible for sexual desire and skin condition. Participates in the activity of all major organs of the female body.
Progesterone acts on the uterus, preventing it from growing too much. He is also responsible for the production of breast milk and is involved in the process of pregnancy.
Overview of popular hormonal drugs
There are 7 most popular and effective medicines in the form of tablets recommended for women who have crossed the 40-year age limit: These include:
- "Livial";
- "Estrofem";
- "Klimonorm";
- "Kliogest";
- "Femoston";
- "Trisequens";
"Livial" is recommended for women suffering from high blood pressure. It is also recommended by doctors for the prevention of osteoporosis. The drug has its own interval of reception - 5 years. After that, it is important to take a six-month break. Prohibited for use during pregnancy.
"Estrofem" has a good effect on the heart and is a reliable prophylactic hormonal remedy for cardiovascular diseases. Contains plant-derived estrogen. The tool should not be used by women who have problems with the stomach and kidneys.
"Klimonorm" is more often prescribed to those women who have undergone surgery to remove the uterus or ovaries. It has its own contraindications for women with stomach ulcers, jaundice or diabetes. Women taking this hormone should remember that it is not a contraceptive.
"Kliogest", like "Livial", is recommended to drink as a prevention of osteoporosis and high blood pressure. But this medicine has many side effects. They are expressed in the form of colic in the liver, headaches and bleeding in the internal organs.
Femoston is a universal hormone in tablets. The drug can be used by both women and men for the treatment of prostate. In women, the remedy strengthens bone tissue and blood vessels well, but has a negative effect on the stomach and intestines. This medicine should only be taken under constant medical supervision.
"Trisequens" contains two hormones at once. In addition to estrogen, it contains the hormone progesterone. The drug well relieves pain during menopause. May cause vaginal itching and swelling of the legs. It is highly recommended for women with malignant tumors. It is unacceptable to take with internal bleeding.
"Proginova" is prescribed as a drug that replenishes the blood of women. From the appearance of itching on the skin can be distinguished. The tool is often prescribed to women with removed appendages.
Taking phytoestrogens as part of hormone therapy
It is known that hormones are able to produce some types of plants. Among such plants is cimicifuga. It contains phytoestrogens, which are useful for women who have crossed the line of 45 years. On the basis of cimicifuga, the hormonal preparation "Chi-Klim" was created. It is available in both tablet and ointment form.
Phytoestrogens, which are part of this drug, have the following effect:
- smooth out the manifestation of menopause;
- reduce inflammation;
- relieve pain during menopause;
- improve skin condition;
- increase sexual desire;
- reduce the appearance of wrinkles and age spots on the skin.
Phytoestrogens act as a substitute for estrogen. In this case, hormone therapy will be safer than taking strong drugs. Qi-Klim is a relatively safe remedy. Side effects can include allergies and digestive problems. Most often, the tool acts as an additive. Not recommended for women with malignant tumors.
Taking birth control pills containing hormones
After 40, a woman's sex life does not stop. But there are factors that affect its quality. Menopause and hormonal changes can cause disturbances in sexual desire, which can result in various diseases.
Do not forget that even in adulthood, a woman can become pregnant. Childbirth at this age is fraught with numerous complications, so not every representative of the weaker sex will decide on pregnancy. To avoid an unplanned pregnancy, women are advised to take birth control pills that contain hormones.
Any contraceptive hormonal therapy has its own contraindications:
- migraine;
- high pressure;
- problems with the circulatory system (for example, varicose veins);
- angina in a chronic form;
- excess weight;
- diabetes;
- oncological diseases.
The most effective drugs are in the form of tablets. They have a high percentage of efficiency. Most often on sale there are such drugs:
- "Silest";
- "Regulon";
"Silest" affects the egg and reduces its work, and also makes the walls of the uterus soft.
"Regulon" acts as a good prevention of the appearance of uterine fibroids in women. This hormonal contraceptive normalizes menstrual cycles.
"Jess" has a small number of side effects and is even used to treat gynecological diseases. Well removes water from the female body, removing puffiness. There is an additional drug called Jess Plus.
Marvelon operates multifunctionally. In addition to the contraceptive effect, it also improves skin condition. Additionally, it reduces the growth of hair on the body.
As additional contraceptive drugs, there are:
- "Trisiston", holding back sperm by secreting mucus into the vagina;
- "Janine", changing the composition of the uterine mucosa during ovulation;
- "Trikvilar", which makes ovulation difficult;
- "Novinet", which maintains a stable background of hormones in a woman;
- "Femoden", which regulates menstruation and fights anemia.
The gynecologist must decide which hormonal contraceptive pills should be taken by a particular woman. Self-administration of hormonal agents is unacceptable due to the risk of complications. Any at the age of 40 are prescribed taking into account the personal characteristics of the patients.
Features of taking hormones
Any need to drink dosed and in a timely manner. For most hormones, the approximate period is 3 weeks. Then a pause is made for the period of menstruation (about 7 days). At this time, you need to monitor your health. If you experience pain in the head or discharge, it is recommended to immediately stop taking hormonal pills.
It is important for women who have frequent sexual activity to remember that the simultaneous use of hormonal contraceptives and antibiotics significantly reduces the effectiveness of the former. In such cases, a protected act is needed with the use of condoms and various lubricants and vaginal gels.
Hormonal drugs that fight menopause and cancer
In addition to the above means of hormone therapy, it is permissible to take such drugs in tablets that fight not only the manifestations of menopause, but also serve as a prevention of cancer in women. These funds include:
- "Chlortrianisen", taken in the treatment of breast cancer;
- "Microfollin", correcting the cycle of menstruation;
- "Vagifem", which relieves pain during menopause;
- "Estrofeminal", acting analgesic in menopause.
It is important that women drink these drugs with strict adherence to the dosage and pauses between doses during menopause.
Hormone replacement therapy - abbreviated as HRT - involves the additional introduction into the body of those hormones that are lacking to maintain a normal hormonal background. Modern medicine actively uses HRT, including menopause.
Hormone replacement therapy for menopause comes down to the fact that the necessary amount of sex hormones is introduced into the female body in order to maintain the hormonal background that changes during this period at a relatively constant level. We will talk in detail about HRT.
HRT preparations for women who entered the age of menopause were first prescribed in the United States, appearing in the 40-50s of the last century. Hormone treatment very quickly became popular due to the obvious positive results.
Most of the numerous studies have found that the cause of such consequences was the use of only one sex hormone in hormonal drugs -. Appropriate conclusions were made, and already in the 70s, two-phase tablets appeared.
Their composition includes natural hormones - which inhibits the growth of the endometrium in the uterus.
Constant monitoring of the health status of women who use hormones for menopause allows doctors to conclude that positive changes are taking place in the body.
The drugs not only cope with menopausal symptoms, but slow down atrophic changes, lower blood cholesterol levels, and improve lipid metabolism.
Expert opinion
Alexandra Yurievna
Thus, new generation drugs not only reduce the symptoms of menopause and prevent the female body from rapidly aging, but also have a beneficial effect on the cardiovascular system. Studies by American scientists have shown that HRT should be used to prevent heart attack and atherosclerosis.
Hormonal balance in menopause
Female sex hormones affect the formation of a regular menstrual cycle in the body, which is manifested by menstruation. In this process, follicle-stimulating hormone (FSH) plays an important role, as well as the following hormones: luteinizing (LH), estrogen and progesterone.
After the age of 40, a woman's body is subject to hormonal changes. They are associated with the depletion of the supply of eggs in the ovaries.
In women after 45 years, menopause begins, which includes three important stages:
- - lasts from the first signs of ovarian dysfunction to the last independent menstruation.
- - one year after the last menstruation during which the menstrual function was completely absent.
- - occurs immediately after menopause and continues until the end of life.
At the stage of premenopause, due to a decrease in the activity of the ovaries, less estrogen is produced. Since all hormones are very closely interconnected with each other, a deficiency of one will certainly cause a drop in the level of all other female hormones during menopause.
Periods come less often and often without the formation of an egg. Its absence leads to the fact that the level of progesterone, which is responsible for the mucous membrane of the uterus, decreases.
As a result, thinning of the endometrium occurs. In menopause, estrogen levels drop to a critical value and provoke a decrease in the level of other sex hormones.
Menstruation no longer comes, because the body no longer has the conditions for tissue renewal. At the postmenopausal stage, the ovaries completely stop producing hormones.
What you need to know about hormonal imbalance
The starting factor for the onset of menopause is the age-related depletion of the hormonal function of the ovaries and the follicular apparatus, as well as changes in the nervous tissue of the brain. As a result, the ovaries begin to produce less progesterone and estrogen, and the hypothalamus becomes less sensitive to them.
Since everything in the body is interconnected, the pituitary gland increases the amount of FSH and LH in order to stimulate the production of female hormones, which are not enough. FSH hormones, as it were, "spur" the ovaries and thanks to this, a normal level of sex hormones is maintained in the blood. But at the same time, the pituitary gland functions in a stressful mode and synthesizes an increased amount of hormones. What do blood tests show?
Over time, the fading of ovarian function will lead to the production of estrogen in a smaller volume than the norm in women. They will not be enough for the pituitary gland to "launch" its compensatory mechanism. Insufficient levels of hormones provoke changes in the work of other endocrine glands and lead to hormonal imbalance.
You must be screened before starting HRT.
Hormonal imbalance is manifested by such syndromes and symptoms:
- Climacteric syndrome, which is observed in women during premenopause or menopause. The hallmark of the syndrome is hot flashes - a sudden influx of blood to the head and upper body, which is accompanied by an increase in temperature. In addition to hot flashes, women experience the following symptoms: increased sweating, unstable psycho-emotional state, jumps in blood pressure, and headaches. Many are faced with sleep disturbance, memory impairment and depression.
- Disorders of the genitourinary system - urinary incontinence, pain when urinating, decreased sexual activity, dryness of the vaginal mucosa, which is accompanied by itching or burning.
- Metabolic and metabolic disorders - weight gain, swelling of the limbs, etc.
- Changes in appearance - dry skin, deepening of wrinkles, brittle nails.
Later manifestations of the syndrome are the development of osteoporosis (decrease in bone density), as well as coronary heart disease and hypertension. Some women may develop Alzheimer's disease.
How HRT can help with menopause
In fact, menopause is a natural physiological stage in a woman's life, associated with the extinction of reproductive function.
All its stages are accompanied by a certain set of symptoms that manifest themselves with varying severity and severity. They are caused by a deficiency of sex hormones, as well as the fact that the pituitary gland produces more follicle-stimulating hormone.
Hormone replacement therapy for menopause is a treatment with medications containing sex hormones. What hormones are lacking in the body, these will be used with HRT. The purpose of this therapy is to eliminate the acute deficiency of estrogen and progesterone that has arisen in the female body due to a decrease in their production by the ovaries.
Depending on your condition and the type of drug chosen, the dosage and treatment time vary greatly.
Two types of HRT are used in gynecology:
- Short-term - the doctor prescribes a medication course lasting from 12 to 24 months.
Such treatment is aimed at alleviating the symptoms of menopause. It is not used when a woman is in a severe depressive state or has organ pathologies. Such patients need non-hormonal therapy. - Long-term - assumes that the drugs will be constantly taken for 2-4 years, and sometimes up to 10 years.
It is prescribed for women whose menopause is accompanied by serious changes in the functioning of the cardiovascular system, endocrine glands, the functioning of the central nervous system, as well as acute manifestations of menopausal symptoms.
A very good result is given by hormonal therapy for endometriosis. Now this disease has become very common and ranks third after inflammation and uterine fibroids.
- This is a pathological process of growth of endometrial tissue outside the uterine mucosa. The development of the disease is associated with ovarian function.
Doctors prescribe hormone therapy. This method gives good results. If there is no effect for 3-4 months of taking hormones, then the patient is operated on.
How GTZ is prescribed for menopause
Many ladies are wary of HRT. They believe that hormones will harm them more than help them. But these fears are unfounded. The female body has been functioning for many years thanks to sex hormones. They ensured not only the reproductive function, but also the normal metabolism and the functioning of all body systems.
But hormonal failure contributes to the development of diseases and rapid aging. But it is undesirable to take hormone-containing drugs on your own.
For a woman who has begun menopause, hormones are prescribed taking into account many parameters of her body and based on the results of tests. In addition, the choice of drugs for hormone replacement therapy depends on the stage of menopause.
Features of HRT in postmenopausal women
Postmenopause is the final stage of menopause. During this period, a woman falls much earlier than 60 years.
A woman has not had her period for a year or more and she needs drugs that correspond to the characteristics of the state of the body:
- The work of the cardiovascular system has deteriorated.
- The lack of sex hormones provokes vegetative-vascular disorders.
- Atrophic processes of the genital and urinary organs cause severe discomfort with itching or burning of the mucosa.
- Due to the development of osteoporosis, the risk of fractures increases.
This general list of manifestations of menopause may be supplemented by symptoms of other diseases or have no changes. By taking hormones during postmenopause, most women will be able to improve their health indicators. Thus, it will help your body, as well as improve the quality of life in general.
Properly selected HRT preparations are capable of:
- reduce the risk of cardiovascular disease;
- normalize the lipid spectrum of the blood;
- prevent the destruction of bones;
- have a positive effect on carbohydrate metabolism.
Thus, hormone replacement therapy in postmenopausal women becomes an effective method of preventing possible complications at this stage of menopause.
Who is contraindicated for HRT?
Hormone replacement therapy is carried out with drugs created either on the basis of estrogens and progesterone, or only on the basis of the first substance.
Estrogens allow the endometrium to grow, and progesterone reduces this effect. The action of these hormones in menopause is complex. When the uterus is removed, drugs are prescribed only with estrogens.
After removal of the uterus and ovaries (hysterectomy), it is not necessary to enter into the female body. In a number of diseases, the use of hormones is not desirable. They can lead to the progression of the disease.
Contraindications to HRT:
- tumors of the mammary glands, as well as organs of the reproductive system;
- various diseases of the uterus;
- liver disease;
- hypotension;
- bleeding not associated with menstruation;
- acute thrombosis and thrombophlebitis;
- hypersensitivity to the components of the drug.
Since there are contraindications to HRT, before prescribing it, the doctor must send the patient for a comprehensive examination. A woman needs to undergo breast ultrasound and mammography and ultrasound of the reproductive system.
In addition, take such tests: for biochemistry, for blood clotting, as well as for the study of hormonal status (they reveal the concentration of TSH, FSH, glucose, prolactin and estradiol). If high cholesterol is suspected during menopause, a special analysis is taken - a lipidogram. Densitometry is required to determine bone density.
Brief characteristics of drugs
We can distinguish the following new generation drugs for HRT with menopause, which allow you to restore hormonal imbalance: Klimonorm, Klimadinon, Femoston and Angelik. In addition to the name, we will give a short description of each drug.
Undoubtedly, only a doctor should prescribe a hormone-containing drug. Self-medication a woman can harm her health or aggravate an existing problem.
The drug "Klimonorm"
The medicine is in the form of a pill. One blister contains 9 pieces of yellow dragees (the main component is 2 mg of estradiol valerate) and 12 pieces of brown dragees (2 mg of estradiol valerate and 150 mcg of levonorgestrel are included).
In the body of a woman, estradiol valerate is converted to estradiol. It fully replaces the natural hormone estrogen, which the ovaries do not produce during menopause.
The substance not only copes with the psychological and vegetative problems that a premenopausal lady encounters, but also improves her appearance. By increasing the content of collagen in a woman's skin, the formation of wrinkles slows down. Youth is preserved. Reducing the level of total cholesterol prevents diseases of the cardiovascular system and intestines.
Expert opinion
Alexandra Yurievna
General practitioner, associate professor, teacher of obstetrics, work experience 11 years.
The drug is prescribed during menopause, after surgery and to prevent osteoporosis associated with menopause. A woman who is still on her period starts taking the medicine on the 5th day of the cycle.
In the absence of menstruation, treatment begins on any day of the cycle. They take hormones for 21 days (first yellow pills, and then brown ones). After that, you need not to drink hubbub for 7 days. Then continue the treatment of menopause with the next package of the drug.
The drug "Femoston"
Two types of tablets are produced: white in film protection (estradiol 2 mg) and gray (estradiol 1 mg and dydrogesterone 10 mg), which are packed in blisters of 14 pieces. It is used to treat postmenopause. Hormones remove or significantly reduce psycho-emotional and vegetative symptoms. The drug prevents the development of osteoporosis.
The course of admission is 28 days: drink white for 14 days, and then the same amount of gray. A lady with an undisturbed menstrual cycle takes the medicine starting from the first day of menstruation. In the absence of menstruation, it is considered normal to start using the drug from any day.
A woman with an irregular cycle begins to take the drug only after she has been drinking Progestan for two weeks.
The drug "Klimadinon"
The drug contains plant hormones. It is available both in the form of tablets and drops. Pink tablets with a brown tint (the main component is dry extract of cimicifuga plants 20 mg), and drops are light brown in color (contain liquid extract of cimicifuga 12 mg).
The drug is prescribed for vegetative-vascular disorders associated with menopause. The doctor prescribes a course of treatment, taking into account the hormonal background of the lady.
The preparation "Angelik"
Gray-pink tablets (estradiol 1 mg and drospirenone 2 mg) packed in blisters of 28 pcs. Menopausal hormone replacement therapy includes this drug. Hormones during menopause are also aimed at preventing osteoporosis. The medicine begins to be taken as directed by the doctor.
To obtain the effect of treatment with these drugs, you must adhere to the following simple rules:
- Medications should be taken at the same time without gaps;
- Tablets or dragees are not food and therefore are not chewed. They are drunk whole with water.
Therefore, you should neither increase the prescribed course of taking the drugs, nor independently stop taking them without consulting your doctor. It is necessary to take hormones until the last day appointed by a specialist.
Outcome
At the end of our article, let's summarize the facts that we learned:
- Hormone therapy for menopause has two directions of action: firstly, it relieves the unpleasant symptoms of the menopause, and secondly, it reduces the risk of complications after the end of the menopause stage (oncological diseases).
- Only a doctor can prescribe such a method of treatment, since there are a number of contraindications for prescribing hormones.
- Every woman who cares about her health should not only know which hormones should be taken during menopause, but also understand a number of new generation drugs for HRT with menopause, their effects and side effects.
Dear ladies, what do you think about hormone replacement therapy for menopause?
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