Not all women who have reached menopause tolerate it easily. It is known that at this time a global hormonal change occurs in a woman’s body. But the complexity of menopause also lies in the activation of various diseases, as well as the psychological state of the woman and other factors.
Today, hormonal therapy is increasingly used to relieve the symptoms of menopause. replacement therapy. This treatment is a kind of prevention of complications that can appear during menopause, in particular heart and vascular diseases, osteoporosis. Today, analogues of female hormones are presented in a wide range, but self-medication is unacceptable. Hormone replacement therapy for women in gynecology is prescribed exclusively by a doctor. What is substitute hormone therapy? What kind of medicines are these and how to choose them? Are there any contraindications for hormone replacement therapy? To consider hormone replacement therapy in detail, you need to understand how to recognize the onset of menopause and what symptoms signal this.
How to recognize menopause? Its symptoms
It must be said right away that menopause proceeds differently for all women. For example, one representative of the fair sex may not feel changes in her body at all, while the second suffers from the manifestations of menopause in such a way that they cause her a lot of trouble.
The following symptoms may indicate the approach of menopause:
- dysfunction of the heart and blood vessels;
- changes blood pressure;
- tides;
- decreased sex drive;
- memory impairment;
- dizziness, headaches, migraines;
- increased sweating;
- sudden changes in mood, depression;
- sleep disturbance;
- constant fatigue.
However, you need to be prepared for the fact that the listed symptoms indicate the presence of some disorders in the body, and not the approach of menopause. It is for this reason that it is so important to visit a doctor and get diagnosed, even if at least one of these signs appears.
Over time, the symptoms of menopause become more pronounced. Now diagnosing menopause is becoming easier. A woman may be bothered by the following symptoms:
- uterine bleeding that is difficult to control;
- sexual dysfunction;
- urinary incontinence;
- dry skin, appearance of wrinkles, age spots;
- hair condition worsens;
- changes in the mucous membranes of the genital organs;
- diseases of the cardiovascular system become more active;
- excessive weight.
What is hormone replacement therapy and its duration
Female sex hormones obtained synthetically are part of hormone replacement therapy, which is aimed at treating menopausal symptoms.
The preparations contain exclusively natural estrogens, which female body perceives as his own. This is achieved by complete identity chemical composition natural estrogens produced by the ovaries. What could be more suitable and natural for a woman than her hormones, analogues of which are prescribed to treat the unpleasant manifestations of menopause?
Or maybe it’s better to take herbal preparations containing molecules that have a structure similar to estrogen, as well as a similar effect on receptors? But herbal preparations cannot always effectively relieve the negative manifestations of menopause. They cannot protect the body from the adverse effects of menopause, such as osteoporosis, heart and vascular diseases, and obesity. In addition, the effect of herbal preparations on organs and systems has not been fully studied to date.
Hormone replacement therapy can be either short-term or long-term. Thanks to properly selected drugs with synthetic female hormones, the fading functions of the ovaries during menopause are replaced.
If the symptoms of menopause are pronounced, short-term hormone replacement treatment is prescribed, the duration of which is determined by the severity of the symptoms, but not more than 1-2 years.
A long course is preventative measure against diseases of the heart, blood vessels, and pelvic organs. Duration – up to 10 years. It is important to understand that there are no short-term courses for HRT, because such treatment has an important goal - to help a woman’s body cope with hormonal changes and get used to a new condition.
For those who plan to take drugs with female hormone analogues for several months and then forget about them, it is better not to start such treatment at all. The drugs have a full effect on the early symptoms of menopause, and the effect can already be observed in the first week of treatment. But it is much more important not just to improve the condition, but to consolidate positive result treatment. To help the body as much as possible during menopause, it is very important long-term therapy. A woman can receive hormone replacement therapy until she is 65-70 years old, but only if such treatment was started during premenopause and was continuous.
When is treatment with female hormone analogues indicated?
HRT helps eliminate early manifestations menopause, as well as disturbances in the functioning of the body that may appear against its background. In addition, hormone replacement therapy is preventive measure against late complications of menopause.
Treatment with analogues of female hormones as part of HRT is especially indicated for the early onset of menopause (before 45 years) or in cases where surgery has taken place to remove both ovaries. In both the first and second cases, changes in the body occur faster than during natural menopause. A woman needs to know that even if she does not have hot flashes or they are not very intense, this is not an indicator of the severity of the menopause.
When is hormone replacement therapy contraindicated?
Hormone replacement therapy drugs are not toxic, as many people believe. Big list The package insert for such drugs contains more contraindications and warns against self-medication, which many women love to indulge in.
Absolute contraindications to HRT include:
- uterine bleeding of unknown nature;
- severe hypertension if untreated;
- stroke, myocardial infarction;
- the level of triglycerides in the blood is greatly increased;
- deep vein thrombosis;
- chronic liver and kidney diseases in the acute stage;
- oncology of the breast or genital area (hormone-dependent tumor of a malignant nature);
- period of pregnancy and breastfeeding.
If you have any diseases, you need to inform your doctor so that he can choose the right medications for treatment.
Can there be side effects with HRT?
The drugs are prescribed in low dosages, and their action is selective, so adverse reactions of the body, although rare, are mild in severity.
Most often, during HRT, the mammary glands may swell. This reaction of the body can be regarded as an addiction to the introduction of an additional volume of female sex hormones. As a rule, this phenomenon is mild and does not require action. If breast swelling is very bothersome, you need to notify your doctor in order to add certain medications to alleviate this reaction of the body. But even if you do not take any measures, this phenomenon will pass a couple of months after the start of treatment, when the body fully adapts to it. In rare cases, symptoms such as fluid retention in the body, nausea, and headache may occur. In any case, you should not stop treatment with prescribed drugs on your own, only after consulting a doctor.
Menstrual function and HRT
Everyone knows that with the onset of menopause, periods gradually become scanty and then disappear altogether. For some women this is a joy, while others believe that with the cessation of menstruation comes old age.
Among the drugs included in HRT, there are those that can cause menstruation in women, but with other drugs, menstruation does not appear. Therefore, when selecting HRT drugs, the doctor is guided by what phase the woman is in. this moment: premenopause or postmenopause, as well as her age.
There are also situations when a woman is in the postmenopausal phase, but the ovaries cease to function before reaching 45 years of age, and the absence of menstruation causes some psychological discomfort. In this case, the doctor will select cyclic HRT, which is aimed at restoring menstruation.
It is also possible to restore menstruation with the help of hormone replacement therapy if a woman has undergone surgery to remove the ovaries. If her uterus was removed, then it is impossible to restore menstrual function.
What should be the diagnosis before HRT?
Hormone replacement treatment cannot be prescribed by a doctor simply at will. To select drugs, mandatory diagnostics is required, which includes methods:
- determination of hormonal levels;
- ultrasound diagnostics (pelvis, thyroid, peritoneal organs);
- mammography with mandatory consultation with a mammologist;
- taking smears from the cervix for histological examination;
- measuring blood pressure;
- blood test for coagulability and cholesterol levels;
- treatment of chronic somatic diseases.
What drugs are included in hormone replacement therapy?
Drugs used in HRT for menopause can be produced in dosage forms: injections, suppositories, gels, patches, tablets. Conventionally, they can be divided into two categories. The first category includes drugs that contain estrogen and progesterone, and they are prescribed in cycles of 3 weeks, with a break between courses of 7 days. These may be the following drugs: Clement, Divina, Klimonorm, Cycloproginova, etc.
Women who have had their uterus removed or whose menopause began more than a year ago require continuous hormone replacement therapy. Treatment is carried out with drugs that contain only estrogens, for example: Proginova, Livial, Premarin.
Depending on the woman’s complaints, HRT may include the following drugs:
- Injections with Gynodian-Depot (male sex hormones included) - a remedy for dry skin and wrinkles.
- Cream, tablets, suppositories Ovestin, tablets for local application Estriol for urinary incontinence, vaginal dryness, painful sensations during sex;
- Sedatives help cope with neuropsychiatric disorders.
- Miacalcic, Xidifon, etc. to prevent the development of osteoporosis.
If there are contraindications to HRT, drugs may be prescribed plant origin, for example, Klimadion, Klimaktoplan.
While taking any hormone replacement therapy drug, you must be observed by a gynecologist. Each woman’s body is individual, so the reaction to drugs may be different. And some drugs may pose a health hazard. Therefore, physician control over the course of treatment should be mandatory.
The first visit to the gynecologist should be made three months after the start of treatment, unless, of course, any unpleasant symptoms arise before this period. The next follow-up examination with a gynecologist is in 6 months, after which visits to the doctor should be made at intervals of six months. The doctor examines the woman and evaluates all the data, after which a decision is made regarding continuation or termination of treatment. Correct selection HRT drugs are effective method treatment that will make it easier for a woman to endure menopause.
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. Hormone replacement therapy (drugs for women over 45 years of age) is a current method of 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.
A negative attitude towards the prescription of HRT drugs appeared due to the following circumstances:
- the risk of interfering with the natural processes of aging of the body with the risk of disruption hormonal regulation;
- insufficient awareness of the population about the effectiveness and safety of new generation HRT;
- fear of manifestation 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, hormonal system operates on the principle feedback between 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.
The imbalance of hormones observed with age-related changes is provoked by 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 disorders memory, sleep, 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 of the 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 endocrine diseases, nervous system(diabetes, 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. If you have a 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, has ovaries great importance. Even young women who have undergone surgery feel all the unpleasant moments climacteric syndrome in the form of autonomic dysfunctions (hot flashes, night sweats, irritability). If the uterus is removed, estrogen can be used in its 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 means 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. Comprehensive examination and adequate therapy help eliminate the unpleasant symptoms of menopause and preserve the woman’s social and sexual activity.
In our country, many patients, and even some specialists, view HRT with caution as quackery, although in the West the importance of such therapy is valued very highly. What is it really and is it worth trusting such a method - let's figure it out.
Hormone therapy - pros and cons
In the early 2000s, when the use of hormone replacement therapy was no longer questioned, scientists began to receive information about increased side effects associated with such treatment. As a result, many specialists have stopped actively prescribing drugs for postmenopausal women over 50 years of age. However, recent studies by Yale University scientists have shown a high rate of premature mortality among patients who refuse to take the drug. The results of the research were published in the American Journal of Public Health. 
Did you know? Research by Danish endocrinologists has shown that timely administration of hormones in the first two years of menopause reduces the risk of developing tumors. The results were published in the British Medical Journal.
Mechanisms of hormonal regulation
Hormone replacement therapy is a course of treatment to restore the deficiency of sex hormones of the steroid group. This treatment is prescribed at the first symptoms of menopause, to alleviate the patient’s condition, and can last up to 10 years, for example, for the prevention of osteoporosis. With the onset of female menopause, the production of estrogen by the ovaries deteriorates, and this leads to the appearance of various disorders of a vegetative, psychological and genitourinary nature. The only way out- replenishment of hormone deficiency with the help of appropriate HRT drugs, which are taken either orally or locally. What is it? By their nature, these compounds are similar to natural female steroids. The woman’s body recognizes them and triggers the mechanism for producing sex hormones. The activity of synthetic estrogens is three orders of magnitude lower than that characteristic of hormones produced by female ovaries, but their continuous use leads to the required concentration of . 
Important! Hormonal balance is especially important for women after removal or extirpation. Women who undergo such operations may die during menopause if they refuse hormonal treatment. Female steroid hormones reduce the likelihood of developing osteoporosis and heart disease in such patients.
Justification for the need to use HRT
Before prescribing HRT, the endocrinologist directs patients to mandatory medical examinations:
- study of anamnesis in the sections of gynecology and psychosomatics;
- using an intravaginal sensor;
- breast examination;
- study of hormone secretion, and if this procedure is not possible, use functional diagnostics: vaginal smear analysis, daily measurements, cervical mucus analysis;
- allergy tests for drugs;
- study of lifestyle and alternative methods treatment.
- angina pectoris;
- ischemia;
- myocardial infarction;
- atherosclerosis;
- dementia;
- cognitive;
- urogenital and other chronic disorders.
In the second case, we are talking about a high probability of developing osteoporosis at the menopause stage, when a woman after 45 can no longer do without hormone replacement therapy, since osteoporosis is the main risk factor for fractures in older people. In addition, it has been found that the risk of developing cancer of the uterine lining is significantly reduced if HRT is supplemented with progesterone. This combination of steroids is prescribed to all patients during menopause, except for those whose uterus has been removed. Important! The decision about treatment is made by the patient, and only the patient, based on the doctor’s recommendations.
Main types of HRT
Hormone replacement therapy has several types, and preparations for women after 40 years of age respectively contain different groups hormones:
- monotypic estrogen-based treatment;
- combining estrogens with progestins;
- combining female steroids with male ones;
- monotypic progestin-based treatment
- monotypic androgen-based treatment;
- tissue-selective stimulation of hormonal activity.
Impact on appearance
Hormonal imbalance accelerates and intensifies age-related changes in women, which affects their appearance and negatively affects psychological state: Loss of external attractiveness reduces self-esteem. We are talking about the following processes:
- Overweight. With age, muscle tissue decreases, and fat tissue, on the contrary, increases. More than 60% of women of “Balzac age” who previously had no problems with excess weight are subject to such changes. Indeed, with the help of the accumulation of subcutaneous fat, the female body “compensates” for the decreased functionality of the ovaries and thyroid gland. As a result, metabolic disorders occur.
- General hormonal imbalance during menopause, which leads to redistribution of adipose tissue.
- Deterioration of health and During menopause, the synthesis of proteins responsible for the elasticity and strength of tissues deteriorates. As a result, the skin becomes thinner, becomes dry and irritable, loses elasticity, wrinkles and sags. And the reason for this is a decrease in the level of sex hormones. Similar processes occur with hair: it becomes thinner and begins to fall out more rapidly. At the same time, hair growth begins on the chin and upper lip.
- Deterioration of the dental picture during menopause: demineralization of bone tissue, disturbances in connective tissues gums and tooth loss.
Did you know? In the Far East and South-East Asia, where the menu is dominated by plant foods containing phytoestrogens, disorders associated with menopause are 4 times less common than in Europe and America. Asian women are less likely to suffer from dementia because they consume up to 200 mg of plant estrogens daily.
HRT prescribed during the premenopausal period or at the very beginning of menopause prevents the development of negative changes in appearance associated with aging.
Hormone therapy drugs for menopause
New generation drugs intended for different types of HRT during menopause are divided into several groups. Synthetic estrogen products, used at the beginning of postmenopause and at its last stage, are recommended after removal of the uterus, for mental disorders and dysfunction of the genitourinary system. These include the following pharmaceutical products: Sygethinum, Estrofem, Dermestril, Proginova and Divigel. Products based on a combination of synthetic estrogen and synthetic progesterone are used to eliminate the unpleasant physiological manifestations of menopause (increased sweating, nervousness, palpitations, etc.) and prevent the development of atherosclerosis, endometrial inflammation and osteoporosis.
Drug regimens
The regimen for taking steroids during HRT depends on clinical picture and postmenopausal stages. There are only two schemes:
- Short-term therapy - for the prevention of menopausal syndrome. Appointed to a short time, from 3 to 6 months, with possible repetitions.
- Long-term therapy - for prevention late consequences such as osteoporosis, senile dementia, heart diseases. Appointed for 5-10 years.
Taking synthetic hormones in tablets can be prescribed in three different regimens: - cyclic or continuous monotherapy with one or another type of endogenous steroid;
- cyclic or continuous, 2-phase and 3-phase treatment with combinations of estrogens and progestins;
- a combination of female sex steroids with male ones.
the site presents a new column by Tatyana Rogachenko, a recognized beauty expert, owner of the Jean Louis David salon chain. Our columnist devoted the last issue to hormone replacement therapy of natural origin. The topic turned out to be so pressing for you, dear readers, that Tatyana decided to interview a gynecologist-endocrinologist to identify all the pros and cons of this method.
You know, many in my place, after reading the comments on the material about hormone replacement therapy, would never have written a single article. But it’s not so easy to knock me out of the saddle. On the contrary, after seeing your comments, I realized that I need to continue writing in order to eliminate mass illiteracy in matters of at least health.
I am not a doctor. I am a 51-year-old woman who is waiting for hour X. I don’t know where you get your information, but I repeat once again: I do not and never have had a young husband, I gave birth to children myself - without IVF and surrogate mothers and... Although we are discussing menopause and hormonal therapy, not me and my personal life.
Therefore, I addressed the questions I received from you to Vera Efimovna Balan, a gynecologist-endocrinologist, a doctor of the highest category, Dr. medical sciences, a professor with more than 35 years of experience.
Tatyana Rogachenko: Many women believe that HRT “leads” to cancer. Tell us in a few words about the pros and cons of this therapy. What side effects can there be during and after stopping taking hormonal medications?
Vera Balan: Menopausal hormone therapy (MHT) is part of a unified strategy to maintain the quality of life and health of women in pre- and early menopause. When prescribing it, certain rules must be followed.
Indications include:
Vasomotor symptoms(hot flashes) with mood changes and sleep disturbances;
Symptoms of urogenital atrophy, sexual dysfunction;
Prevention and treatment of osteoporosis;
Low quality of life associated with menopause, including arthralgia (joint pain), muscle pain and memory loss;
Premature and early menopause;
Ovariectomy (removal of the ovaries).
There are absolute contraindications (including breast cancer) and relative (in which the prescription of therapy depends on the competence of the doctor and the wishes of the patient). In first place for women of all European countries and America's mortality rate is from cardiovascular disease, not cancer. In Russia, almost 60% of the fair sex die from stroke and heart attack, and in general, from all types of cancer - 14% (from breast cancer - about 4%).
Before prescribing MHT, a number of examinations are carried out, including mandatory mammography (breast examination) and ultrasound. It is important that for every 1000 women, when prescribed in a timely manner, MHT can save 6 lives, prevent the development of heart disease in 8 women and thrombosis in 5 women.
Prescribing MHT to women in early postmenopause and/or under the age of 60 years, both in the form of estrogen monotherapy and a combination therapy regimen, reduces overall mortality by 30-52%!
Early prescription and consideration of contraindications is the basis for safety, high effectiveness and prevention of cardiovascular diseases, osteoporosis, mental disorders and genitourinary disorders, including urinary incontinence. With correctly and individually selected hormone therapy, the risks of complications are minimal.
All drugs in Europe are safer than those taken in America (KEE and medroxyprogesterone acetate, the most unfavorable gestagen for the mammary gland). Slightly increase risk combination drugs, and estrogen monotherapy, on the contrary, reduces them.
T.R.: When is it necessary to start HRT and what is the duration of therapy?
V.B.: The optimal time to start MHT is early postmenopause and/or age younger than 60 years, or postmenopause no more than 10 years. The debut of MHT after 60 years or after 10 years of postmenopause increases the risk of stroke.
Continue for 4-5 years, but it is possible until the end of your life, especially since micro-dosed drugs have now appeared (for example, Angelique Micro and Femoston mini). In fact, it all depends on personal preference, as long as there are no side effects or contraindications.
Of course, this is not the elixir of youth. However, early initiation of therapy can mitigate or delay:
weight gain and development abdominal obesity
development of insulin resistance
arterial hypertension
lipid metabolism disorder
loss of bone mineral density
cartilage loss
decline muscle mass
maintenance of cognitive function
urogenital atrophy
T.R.: Can a woman get pregnant after 50?
V.B.: You can take contraceptives up to 55 years of age, but not just any kind. After one year of menopause, the probability of pregnancy is not 0. However, this is an absolutely psychological thing. If you believe that you can get pregnant, you believe in your youth. There are hormonal criteria and there is no need to go to the point of absurdity. Pregnancy is possible using IVF with a donor egg.
T.R.: How do you feel about herbal preparations that are sold without a prescription in pharmacies?
V.B.: This is alternative therapy, it is effective only in mild forms, and in severe forms it is useless.
T.R.: What can you say about the drug “Femoston”*, which is very popular in Russia?
V.B.: A good drug for any period of menopause: from the cyclic regimen to “Femoston mini” for deep postmenopause. It contains dydrogesterone - one of the best gestagens, close to its own progesterone.
T.R.: What can you say about BHRT (bioidentical hormone therapy), are there any specialists on it in Russia?
V.B.: Bioidentical therapy is not supported by the medical community. It is not known what is being mixed, in what dose. I don't think it's safe. I don't know about such specialists.
V.B.: Watch your lifestyle, weight and don’t forget about physical activity. If symptoms appear, you need to find a competent specialist and decide on MHT or an alternative.
And then you make your choice and continue to suffer from ebbs and flows (the most common symptom) or live full life. And believe me, it’s better to be seriously concerned about this topic than to discuss how terrible I look at 51! Because it's simple envy! But envy is not good!
*There are contraindications. It is necessary to read the instructions for use or consult a specialist.
Hormone replacement therapy - abbreviated HRT - is now actively used in many countries around the world. To prolong their youth and replenish sex hormones lost with age, millions of women abroad choose hormonal therapy for menopause. However, Russian women The attitude towards this treatment is still wary. Let's try to figure out why this happens.
Should I take hormones during menopause?or 10 myths about HRT
After the age of 45, women’s ovarian function begins to gradually decline, which means the production of sex hormones decreases. Along with a decrease in estrogen and progesterone in the blood comes deterioration in physical and emotional state. Menopause is ahead. And almost every woman begins to worry about the question: what can she do take during menopause to avoid aging?
In these difficult times, the modern woman comes to the aid of. Because during menopause estrogen deficiency develops, it is these hormones that have become the basis for all medications drugs HRT. The first myth about HRT is associated with estrogens.
Myth No. 1. HRT is unnatural
There are hundreds of queries on the Internet on the topic:how to replenish estrogen for a woman after 45-50 years . No less popular are queries about whether they useherbal remedies for menopause. Unfortunately, few people know that:
- HRT preparations contain only natural estrogens.
- Today they are obtained by chemical synthesis.
- Synthesized natural estrogens are perceived by the body as their own due to complete chemical identity with the estrogens produced by the ovaries.
And what could be more natural for a woman than her own hormones, analogues of which are taken to treat menopause?
Some might argue that herbal remedies are more natural. They contain molecules that are similar in structure to estrogens, and they act on receptors in a similar way. However, their action is not always effective in removing early symptoms menopause (hot flashes, increased sweating, migraines, blood pressure surges, insomnia, etc.). They also do not protect against the consequences of menopause: obesity, cardiovascular diseases, osteoporosis, osteoarthritis, etc. In addition, their effect on the body (for example, on the liver and mammary glands) has not been well studied and medicine cannot vouch for their safety.
Myth No. 2. HRT is addictive
Hormone replacement therapy for menopause- just a replacement for the lost hormonal function of the ovaries. Drugs HRT is not a drug, it does not violate natural processes in a woman's body. Their task is to compensate for estrogen deficiency, restore the balance of hormones, and also alleviate general health. You can stop taking the medications at any time. True, it is better to consult a gynecologist before this.
Among the misconceptions about HRT, there are truly crazy myths that we get used to from our youth.
Myth No. 3. HRT will make a mustache grow
The negative attitude towards hormonal drugs in Russia arose quite a long time ago and has already moved to the subconscious level. Modern medicine has stepped far forward, and many women still trust outdated information.
Synthesis and use of hormones in medical practice began in the 50s of the XX century. The real revolution was made by glucocorticoids (adrenal hormones), which combined powerful anti-inflammatory and antiallergic effect. However, doctors soon noticed that they affected body weight and even contributed to the manifestation of masculine characteristics in women (the voice became rougher, excess hair growth began, etc.).
Much has changed since then. Preparations of other hormones (thyroid, pituitary, female and male) were synthesized. And the type of hormones has changed. Part modern medicines The hormones included are as “natural” as possible, and this allows you to significantly reduce their dose. Unfortunately, all the negative qualities of outdated high-dose drugs are attributed to new, modern ones. And this is completely unfair.
The most important thing is that HRT preparations contain exclusively female sex hormones, and they cannot cause “masculinity.”
I would like to draw your attention to one more point. A woman's body always produces male sex hormones. And that's okay. They are responsible for a woman’s vitality and mood, interest in the world and sex drive, as well as the beauty of her skin and hair.
When ovarian function declines, female sex hormones (estrogens and progesterone) stop being replenished, while male sex hormones (androgens) are still produced. In addition, they are also produced by the adrenal glands. That's why you shouldn't be surprised that older ladies sometimes need to pluck their mustache and chin hairs. And HRT drugs have absolutely nothing to do with it.
Myth No. 4. People get better from HRT
Another unreasonable fear is to gain weight while taking drugs hormone replacement therapy. But everything is quite the opposite. Prescription of HRT during menopause can have a positive effect on women's curves and shapes. HRT contains estrogens, which generally have no ability to influence changes in body weight. As for the gestagens (these are derivatives of the hormone progesterone) included innew drugs generations of HRT , then they help distribute adipose tissue“according to the female principle” and allow during menopause keep your figure feminine.
Don’t forget about the objective reasons for weight gain in women after 45. First: at this age, physical activity noticeably decreases. And second: the influence of hormonal changes. As we have already written, female sex hormones are produced not only in the ovaries, but also in adipose tissue. During menopause, the body tries to reduce the lack of female sex hormones by producing them in fatty tissues. Fat is deposited in the abdominal area, and the figure begins to resemble a man’s. As you can see, HRT drugs do not play any role in this matter.
Myth No. 5. HRT can cause cancer
The idea that taking hormones can cause cancer is an absolute misconception. There is official data on this topic. According to World Health Organization, thanks to the use hormonal contraceptives and their oncoprotective effect annually prevents about 30 thousand cases of cancer. Indeed, estrogen monotherapy increased the risk of endometrial cancer. But similar treatment remains far in the past. Partnew generation HRT drugs includes progestogens , which prevent the risk of developing endometrial cancer (body of the uterus).
As for breast cancer, there has been plenty of research on the effect of HRT on its occurrence. This issue has been seriously studied in many countries around the world. Especially in the USA, where HRT drugs began to be used back in the 50s of the 20th century. It has been proven that estrogens, the main component of HRT preparations, are not oncogenes (that is, they do not unblock the gene mechanisms of tumor growth in the cell).
Myth No. 6. HRT is bad for the liver and stomach
There is an opinion that a sensitive stomach or liver problems may be a contraindication for HRT. This is wrong. New generation HRT drugs do not irritate the mucous membranes gastrointestinal tract and do not have a toxic effect on the liver. It is necessary to limit the use of HRT drugs only in cases where there are pronounced liver dysfunctions. And after the onset of remission, it is possible to continue HRT. Also, taking HRT drugs is not contraindicated for women with chronic gastritis or peptic ulcer stomach and duodenum. Even during seasonal exacerbations, you can take tablets as usual. Of course, simultaneously with therapy prescribed by a gastroenterologist and under the supervision of a gynecologist. For women who are especially concerned about their stomach and liver, special forms of HRT preparations are produced for topical use. These may be skin gels, patches or nasal sprays.
Myth No. 7. If there are no symptoms, then HRT is not needed
Life after menopause not all women immediately burdened unpleasant symptoms And sharp deterioration well-being. In 10 - 20% of the fair sex, the autonomic system is resistant to hormonal changes and therefore for some time they are spared from the most unpleasant manifestations during menopause. If there are no hot flashes, this does not mean at all that you do not need to see a doctor and let the course of menopause take its course.
The serious consequences of menopause develop slowly and sometimes completely unnoticed. And when after 2 years or even 5-7 years they begin to appear, it becomes much more difficult to correct them. Here are just a few of them: dry skin and brittle nails; hair loss and bleeding gums; decreased sexual desire and vaginal dryness; obesity and cardiovascular diseases; osteoporosis and osteoarthritis and even senile dementia.
Myth No. 8. HRT has many side effects
Only 10% of women feel certain discomfort when taking HRT drugs. Most susceptible unpleasant sensations those who smoke and have excess weight. In such cases, swelling, migraines, swelling and tenderness of the breast are noted. Usually these are temporary problems that disappear after reducing the dosage or replacing dosage form drug.
It is important to remember that HRT cannot be carried out independently without medical supervision. Each specific case requires an individual approach and constant monitoring of results. Hormone replacement therapy has a specific list of indications and contraindications. Only a doctor, after conducting a number of studies, will be able tochoose the right treatment . When prescribing HRT, the doctor observes the optimal balance between the principles of “usefulness” and “safety” and calculates at what minimum doses of the drug the maximum result will be achieved with the least risk of side effects.
Myth No. 9. HRT is unnatural
Is it necessary to argue with nature and replenish sex hormones lost over time? Of course you need it! The heroine of the legendary film “Moscow Doesn’t Believe in Tears” claims that after forty, life is just beginning. And indeed it is. A modern woman at the age of 45+ can live an equally interesting and rich life than in my youth.
Hollywood star Sharon Stone turned 58 years old in 2016 and she is sure that there is nothing unnatural in a woman’s desire to remain young and active for as long as possible: “When you are 50, you feel that you have a chance to start life again: a new career, new love... At this age we know so much about life! You may be tired of what you did for the first half of your life, but that doesn't mean you should sit back and play golf in your backyard. We are too young for this: 50 is the new 30, a new chapter."
Myth No. 10. HRT is an understudied treatment method
The experience of using HRT abroad is more than half a century, and all this time the technique has been subjected to serious control and detailed study. Gone are the days when endocrinologists used trial and error to find best practices, regimens and dosages of hormonal drugs for menopause. In Russia hormone replacement therapycame only 15-20 years ago. Our compatriots still perceive this treatment method as little studied, although this is far from the case. Today we have the opportunity to use proven and highly effective remedies with a minimum number of side effects.
HRT for menopause: pros and cons
For the first time, HRT drugs for women in menopause began to be used in the USA in the 40-50s of the 20th century. As treatment became more popular, it was found that the risk of disease increased during the treatment period uterus ( endometrial hyperplasia, cancer). After a thorough analysis of the situation, it turned out that the reason was the use of only one ovarian hormone - estrogen. Conclusions were drawn, and in the 70s biphasic drugs appeared. They combined estrogens and progesterone in one tablet, which inhibited the growth of the endometrium in the uterus.
As a result of further research, information was accumulated about positive changes in a woman’s body during hormone replacement therapy. To date known what's her positive influence applies not only to menopausal symptoms.HRT during menopauseslows down atrophic changes in the body and becomes an excellent prophylactic agent in the fight against Alzheimer's disease. It is also important to note the beneficial effects of therapy on cardiovascular system women. While taking HRT drugs, doctors recorded improving lipid metabolism and reducing blood cholesterol levels. All these facts make it possible today to use HRT as a prevention of atherosclerosis and heart attack.
Information from the magazine was used [Climax is not scary / E. Nechaenko, - Magazine “New Pharmacy. Pharmacy assortment”, 2012. - No. 12]
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