Hormone replacement therapy (HRT) for menopause. The use of HRT during menopause. New generation drugs Conducting replacement therapy

After 45-50 years, the level of estrogen in a woman’s blood begins to gradually decrease. This can lead to symptoms such as night sweats, insomnia, and calcium leaching from bones.

Hormone replacement therapy aims to correct estrogen deficiency using medications containing synthetic (artificial) hormones and prevent these symptoms.

Why is hormone replacement therapy (HRT) needed during menopause?

Hormone replacement therapy can weaken or eliminate the symptoms of menopause, as well as reduce the risk of developing some consequences of menopause, such as osteoporosis, heart disease, atrophic vaginitis (depletion of the vaginal mucosa) and others.

Who needs hormone replacement therapy during menopause?

Despite the fact that hormone replacement therapy can ease the symptoms of menopause, taking hormones during menopause is not always really necessary and, most importantly, safe.

Hormone replacement therapy is prescribed:

To relieve severe hot flashes and night sweats, if these symptoms cause severe discomfort and interfere with daily life.

When symptoms such as: severe dryness and discomfort in the vagina appear.

Hormone replacement therapy is not prescribed if the only problem associated with menopause is depression. Although hormones can sometimes help combat depressed mood, depression is preferably treated with antidepressants.

Who should not take hormones during menopause?

• You have had breast cancer
• You had
• You have serious liver disease and liver failure
• Your blood triglyceride levels are elevated
• You have had deep vein thrombosis in your legs
• You
• You
• You

What tests need to be done before starting to take hormones?

In order to make sure that you need hormone replacement therapy and you have no contraindications for prescribing hormones, you need to undergo the following examinations and take the following tests:

• Height and weight measurement, definition.
• Blood pressure measurement.
• Examination by a mammologist and mammography (to exclude diseases of the mammary glands)
• Examination by a gynecologist
• General blood analysis
• General urine analysis
• Measuring triglycerides and cholesterol levels in the blood
• Measuring blood sugar levels
• (pap test)

In some cases, your doctor may order other tests or examinations, depending on your medical history.

What medications are prescribed for hormone replacement therapy?

Preparations containing estrogens are the most effective treatment for the symptoms of menopause (vaginal dryness, hot flashes, osteoporosis).

Hormones can be prescribed not only in the form of tablets, but also in the form of intramuscular injections, hormonal patches, subcutaneous implants, vaginal suppositories, etc. The choice of drug for hormone replacement therapy depends on how long ago your periods stopped, what symptoms bother you, and what diseases and surgeries you have had previously.

There are many different drugs prescribed for hormone replacement therapy. We will list just a few of them available in Russia:

• In the form of tablets (or dragees): Premarin, Hormoplex, Klimonorm, Klimen, Proginova, Cyclo-proginova, Femoston, Trisequence and others.
• In the form of intramuscular injections: Gynodian-Depot, which is administered every 4 weeks.
• In the form of hormonal patches: Estraderm, Klimara, Menorest
• In the form of skin gels: Estrogel, Divigel.
• In the form of an intrauterine device: .
• In the form of vaginal suppositories or vaginal cream: Ovestin.

Can I get pregnant while taking hormones?

Hormone replacement therapy does not suppress ovulation, which means you still have a theoretical risk of becoming pregnant. Therefore, you need to use an additional 1 year after your last menstrual period if you are 50 years or more, or 2 years after your last menstrual period if you are under 50 years old.

How long can hormone replacement therapy last?

Most gynecologists are of the opinion that hormone replacement therapy is safe if it lasts no more than 4-5 years. However, there is evidence that treatment can be safe for 7-10 years in a row. Taking hormones for 10 years or more may increase the risk of ovarian cancer and other complications.

Unfortunately, after stopping taking hormones, some symptoms (vaginal dryness, urinary incontinence, etc.) may return.

What side effects can hormone replacement therapy cause?

Side effects may occur during hormone replacement therapy. Some of these effects are safe and go away after a few months, while others are a reason to stop hormonal treatment.

They often appear during hormonal treatment. Most often, this is only a slight spotting that goes away 3-4 months after the start of hormonal therapy. If the spotting lasts longer or appears later than 4 months after the start of hormonal therapy, then the woman needs a more thorough examination to make sure that it is not a polyp or endometrial cancer.

Breast swelling and tenderness are also common side effects of hormonal treatment, but these symptoms resolve after a few months.

Water retention in the body can lead to edema and weight gain.

What are the risks of hormone replacement therapy?

Hormone replacement therapy is undoubtedly an effective method of treatment, and nevertheless, against the background of long-term hormonal treatment, the following complications may develop:

Breast cancer. Whether hormone therapy causes breast cancer is still a matter of debate in the scientific world. Research conducted in this area provides conflicting results. However, most gynecologists are of the opinion that hormone replacement therapy slightly increases the risk of breast cancer, especially with a long duration of treatment in women over 50 years of age.

Studies have shown that using certain hormone replacement therapy drugs for 5 years or more may increase the risk of endometrial cancer. The main sign of endometrial cancer is spotting and irregular uterine bleeding, so when these symptoms appear in a menopausal woman, she needs an examination (endometrial biopsy).

The risk of blood clots may increase in women taking hormonal medications. That is why, if you have previously had thrombosis, hormone replacement therapy is not recommended.

The risk of developing gallstones (cholelithiasis) is slightly increased among menopausal women taking hormonal medications.

Ovarian cancer. Long-term hormonal treatment (10 years or more) increases the risk of ovarian cancer. Hormone replacement therapy lasting less than 10 years does not increase this risk.

How can you reduce the risk of these complications?

To minimize the risk of complications and side effects of hormonal therapy, first of all, it is necessary for your doctor to select the treatment that is right for you. In this case, the doctor must prescribe the smallest dose of medication that gives the desired effect, and treatment should last exactly as long as necessary.

Since hormone replacement therapy can last for years, you need to visit your doctor regularly, even if nothing bothers you:

A month after the start of hormonal treatment, you need to take a biochemical blood test to determine the level of fats (lipids) in the blood, liver function indicators (ALT, AST, bilirubin), a general urine test, and measure blood pressure.

At each subsequent visit: general urine test, blood pressure measurement.

Every 2 years: biochemical blood test to determine the level of fats (lipids) in the blood, liver function indicators (ALT, AST, bilirubin), blood sugar levels, general urinalysis, mammography.

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

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

All hormonal drugs are divided into 2 main groups:

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

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

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

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

The positive side of hormone therapy

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

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

The manifestation of menopausal syndrome is associated with the formation of hot flashes and a sudden sensation of heat, increased sweating followed by chills, psycho-emotional instability, increased blood pressure and its spasmodic nature. Also, an increase in the rhythm of the heartbeat, the appearance of a feeling of numbness at the tips of the fingers, pain in the heart area, sleep disturbance and the appearance of insomnia, depression and other associated symptoms.

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

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

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

The main principles of hormone replacement therapy are:

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

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

HRT drugs

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

Klimonorm

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

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

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

If the menstrual cycle is unfinished and even rare menstrual discharge occurs, treatment should begin on the fifth day after the start of menstruation. If amenorrhea develops at the beginning of the menopausal period, treatment can be started at any time, provided there is no pregnancy.

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

Femoston

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

Together, estradiol and progesterone contribute to:

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

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

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

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

Klimadinon

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

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

Angelique

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

Angeliq is used for:

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

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

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

Angelique contains the necessary hormones during menopause, which are an excellent solution for improving well-being and restoring hormonal imbalances, especially for women over 45-46 years old.

Klimara

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

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

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

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

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

Interesting and educational video

Fatigue, aging skin, insomnia - this is not the whole bouquet of what a woman can feel during menopause.

“You have to endure this, it happens to everyone, you don’t die from it,” our mothers and grandmothers and, unfortunately, many gynecologists assure.

“If I hadn’t started taking hormones on time, I would have lost my youth,” Madonna boldly states in one interview.

Why are our compatriots so afraid of hormone replacement therapy (HRT) during menopause, and abroad women during menopause are required to seek help from doctors so that they can prescribe them a hormonal drug that will help them survive the menopause?

We’ll talk about this on the women’s website “Beautiful and Successful”.

How does menopause occur?

After 40 years, the female body rises to a new level. The new “stage” has a completely medical name - menopause (by the way, “menopause” is literally translated as “step”). This period is directly related to the process of production of sex hormones, or more precisely, with a decrease in the production of these hormones - estrogen and progesterone. Due to their lack, significant changes begin to occur in the female body.

The restructuring of the body for menopause begins at 40-45 years old and ends at 51-53 years old - the time of the last menstruation.

After this age, hormonal changes continue to occur in a woman’s body, and she constantly feels all the delights of menopause. Is it worth enduring the ebbs and flows, depression and headaches all these years if hormonal therapy can help? What should women do with?

Why does menopause have so many symptoms?

The functioning of the mammary glands, genital organs, brain, cardiovascular system, the condition of the skin and hair, the functioning of the liver, large intestine and genitourinary system depend on estrogen, the female sex hormone. The lack of this hormone, which occurs during menopause, immediately affects all systems in the body.

There are more than 30 symptoms that women experience due to menopause after 40 years.

The most common mistake of modern women is that they are accustomed to letting everything take its course, especially if the symptoms are not pronounced. Like, this will pass. But at this time, a woman just needs to undergo the first diagnosis in order to start helping her body in a timely manner.

Why are women afraid of HRT?

In our country there is a “widespread hormone phobia”. Doctors often prescribe hormones for early menopause or after surgery, but, having no experience in using these drugs during menopause, they refuse to use them. Many of our compatriots are afraid of hormones, believing that they:

1. Total chemistry;
2. Contrary to feminine nature and cause cancer;
3. They make you fat and masculine;
4. Affects the liver and stomach;
5. Cause addiction;

So it turns out that there is a mutual responsibility: doctors don’t prescribe – women endure. But why be afraid of what has been practiced abroad for several decades?

How does HRT work?

The work of the female body can be conditionally divided into 2 periods: the first, when it has enough hormones, and the second, when hormones cease to be produced and there is a deficiency. The second period is called menopause (menopause).

Hormone production stops when the ovaries stop producing eggs, or after the female organs are surgically removed. Lack of hormones manifests itself in different ways:

• Hot flashes in women during menopause indicate that she lacks estrogen.
• Weakness and malaise in women during menopause occur due to a lack of another hormone - progesterone.

The principle of action of HRT drugs during menopause is quite simple - the body is given a certain dose of hormones so that this deficiency is not felt. That is, the body receives what nature took from it. New generation drugs cope well with this. Only the drug must be prescribed in a timely manner after mandatory diagnosis.

When should you start taking hormones?

It is better to prescribe hormonal therapy as soon as a lack of estrogen begins, so you need to go for diagnosis at 40–45 years old - at the beginning of the premenopausal period.

It is also mandatory to prescribe HRT for early menopause - the drugs are selected strictly by the doctor after a preliminary examination, and for artificial menopause.

If 5 years have passed since menopause, then it is already too late to prescribe hormones - it is almost impossible to stop the aging process of the female body and help it.

Is it possible to do without hormonal drugs?

Let us remember that the main goal of hormonal therapy is to alleviate a woman’s condition during menopause. Therefore, you can not take hormones, but begin to fight each symptom of menopause separately: take medications for headaches, antidepressants, medications to improve the functioning of the gastrointestinal tract, antipyretics for hot flashes, for osteoporosis, medications for blood pressure, etc. Note that such therapy is also effective, but in comparison with hormonal it is:

• expensive
• troublesome
• not always effective
• psychologically difficult (“do I really need so much medication at this age to feel good?”)

Why take each drug separately if HRT has a complex effect on the cause and does not remove individual symptoms?

Prescribing new generation HRT drugs during menopause will help prevent many problems associated with a woman’s health: reduce the risk of diabetes and Alzheimer’s disease, obesity and skin aging.

Of course, you can go through menopause without HRT. There are alternative options for how to do without hormones during this period.

• Firstly, you need to seriously think about a healthy lifestyle: stop smoking, eat a balanced diet, monitor your sleep and wakefulness, and limit exposure to the sun.
• Secondly, you need to constantly use the services of modern cosmetology, including expensive skin tightening operations and rejuvenation sessions.
• Well, and, of course, we must not forget about homeopathic medicines and dietary supplements, which are so widely popular in the modern world.

New generation HRT drugs

HRT drugs for menopause have always caused controversy for and against. Let's dispel several myths about the unnaturalness and danger of HRT for women's health.

• HRT drugs have gone through a long journey of testing and research. We can consider ourselves lucky - only new generation drugs reach our shelves, which can only be produced by serious pharmacological companies.
• Hormone replacement drugs of the modern generation are completely natural - they have a composition of hormones identical to those produced by the female body.
• The dosage of hormones in the drug is minimal. There is no addiction to hormonal drugs. This is just a remedy that helps a woman survive hormonal changes. After discussing with your doctor, medications can be stopped at any time.
• During menopause, the body does not stop producing male hormones. Natural estrogens, which are included in the main composition of all HRT preparations, are female. It is their production that stops during menopause. Taking female hormones neutralizes the effect of male hormones: it will stop hair growth in unnecessary places, allow you to maintain female shapes and proportions, improve the condition of your skin, and prevent snoring.
• The hormones that make up HRT do not lead to obesity. On the contrary, they stop the production of estrogen in adipose tissue. It is not the use of HRT that leads to obesity during menopause, but the age-related prerequisites for this: physical activity decreases, metabolism slows down.
• Many people are afraid to take HRT, believing that they have a bad effect on the gastrointestinal tract. Modern hormonal drugs do not affect the gastrointestinal tract in any way, and for those who are very afraid for their stomach, alternative forms of the drug have been released - patches, gels, ointments and suppositories, which are absorbed through the skin.
• HRT contains components that prevent cancer, rather than provoke it. The hormonal cause of cancer due to HRT use has not been proven.

A woman who takes hormonal medications during menopause must be observed by a doctor: monitor the condition of the endometrium and vaginal mucosa, mammary glands, hormone levels, etc.

The best HRT drugs

If yesterday doctors considered menopause to be a period in a woman’s life that needs to be overcome, today menopause is considered to be a period of lack of hormones that can be given to the body. A doctor should prescribe HRT after preliminary diagnosis, so the site will only introduce its readers to the list of modern drugs, but we will not recommend them for use. All new generation drugs have a low dosage, which allows you to select the optimal safe dose for each woman. It can be lowered or raised.

• We have received good reviews about the drugs “Femoston”, “Angelik”, “Atarax”, “Grandaxin”, “Sigetin”, etc.

Of course, there are many among us who consider themselves to be opponents of everything hormonal. Homeopathic and herbal remedies will come to the aid of such women, although they are less effective than modern HRT drugs.

Of course, menopause is a natural process in our body. And it’s very good that modern women have the opportunity to choose products that help improve their quality of life during this period.

The whole truth about hormone replacement therapy

I take the liberty to describe the benefits and fears of prescribing hormone replacement therapy (HRT). I assure you - it will be interesting!

Menopause, according to modern science, is not health, it is a disease. Characteristic specific manifestations for it are vasomotor instability (hot flashes), psychological and psychosomatic disorders (depression, anxiety, etc.), urogenital symptoms - dry mucous membranes, painful urination and nocturia - “night trips to the toilet”. Long-term effects: CVD (cardiovascular disease), osteoporosis (low bone density and fractures), osteoarthritis and Alzheimer's disease (dementia). As well as diabetes and obesity.

HRT in women is more complex and multifaceted than in men. If a man needs only testosterone for replacement, then a woman needs estrogens, progesterone, testosterone, and sometimes thyroxine.

HRT uses smaller doses of hormones than hormonal contraceptives. HRT drugs do not have contraceptive properties.

All the materials below are based on the results of a large-scale clinical study of HRT in women: Womens Health Initiative (WHI) and published in 2012 in the consensus on hormone replacement therapy of the Research Institute of Obstetrics and Gynecology. IN AND. Kulakova (Moscow).

So, the main postulates of HRT.

1. You can start taking HRT for another 10 years after the cessation of your menstrual cycle.
(taking into account contraindications!). This period is called the “window of therapeutic opportunity.” Over 60 years of age, HRT is not usually prescribed.

How long is HRT prescribed? - "As much as needs" To do this, in each specific case it is necessary to determine the purpose of using HRT in order to determine the timing of HRT. The maximum period for using HRT: “last day of life – last pill.”

2. The main indication for HRT is vasomotor symptoms of menopause(these are menopausal manifestations: hot flashes), and urogenital disorders (dyspariunia - discomfort during sexual intercourse, dry mucous membranes, discomfort during urination, etc.)

3. With the right choice of HRT, there is no evidence of an increase in the incidence of breast and pelvic cancer, the risk may increase with a duration of therapy of more than 15 years! HRT can also be used after treatment of stage 1 endometrial cancer, melanoma, and ovarian cystadenomas.

4. When the uterus is removed (surgical menopause) - HRT is received in the form of estrogen monotherapy.

5. When HRT is started on time, the risk of cardiovascular diseases and metabolic disorders is reduced. That is, during hormone replacement therapy, normal metabolism of fats (and carbohydrates) is maintained, and this prevents the development of atherosclerosis and diabetes mellitus, since the deficiency of sex hormones in postmenopause aggravates existing ones and sometimes provokes the onset of metabolic disorders.

6. The risk of thrombosis increases when using HRT with a BMI (body mass index) = more than 25, that is, if you are overweight!!! Conclusion: excess weight is always harmful.

7. The risk of thrombosis is higher in women who smoke.(especially when smoking more than 1/2 packs per day).

8. It is desirable to use metabolically neutral gestagens in HRT(this information is more for doctors)

9. Transdermal forms (external, that is, gels) are preferable for HRT, they exist in Russia!

10. Psycho-emotional disorders often prevail during menopause(which does not allow one to discern a psychogenic illness behind their “mask”). Therefore, HRT can be given for 1 month for trial therapy for the purpose of differential diagnosis with psychogenic diseases (endogenous depression, etc.).

11. In the presence of untreated arterial hypertension, HRT is possible only after stabilization of blood pressure.

12. Prescribing HRT is possible only after hypertriglyceridemia has normalized**(triglycerides are the second, after cholesterol, “harmful” fats that trigger the process of atherosclerosis. But transdermal (in the form of gels) HRT is possible against the background of elevated triglyceride levels).

13. In 5% of women, menopausal symptoms persist for 25 years after the cessation of the menstrual cycle. HRT is especially important for them to maintain normal well-being.

14. HRT is not a method of treating osteoporosis, it is a method of prevention(it should be noted that this is a cheaper method of prevention than the cost of treating osteoporosis itself).

15. Weight gain often accompanies menopause., sometimes this is an additional + 25 kg or more, this is caused by a deficiency of sex hormones and related disorders (insulin resistance, impaired carbohydrate tolerance, decreased insulin production by the pancreas, increased production of cholesterol and triglycerides by the liver). This is collectively called menopausal metabolic syndrome. Timely prescribed HRT is a way to prevent menopausal metabolic syndrome(provided that it was not there before, before menopause!)

16. Based on the type of menopausal manifestations, it is possible to determine which hormones a woman lacks in her body, even before taking blood for a hormonal analysis. Based on these signs, menopausal disorders in women are divided into 3 types:

a) type 1 - only estrogen-deficient: weight is stable, no abdominal obesity (at the abdominal level), no decreased libido, no depression and urinary disorders and decreased muscle mass, but there are menopausal hot flashes, dry mucous membranes (+ dyspariunia), and asymptomatic osteoporosis;

b) type 2 (only androgen-deficient, depressive) if a woman has a sharp increase in weight in the abdominal area - abdominal obesity, increasing weakness and decreased muscle mass, nocturia - “night urge to go to the toilet”, sexual disorders, depression, but no hot flashes and osteoporosis according to densitometry (this is an isolated lack of “male” hormones);

c) type 3, mixed, estrogen-androgen deficiency: if all the previously listed disorders are expressed - hot flashes and urogenital disorders are pronounced (dysparunia, dry mucous membranes, etc.), a sharp increase in weight, decreased muscle mass, depression, weakness - then there is not enough both estrogen and testosterone, both of which are required for HRT.

It cannot be said that any of these types is more favorable than the other.
**Classification based on materials from Apetov S.S.

17. The question of the possible use of HRT in the complex treatment of stress urinary incontinence in menopause should be decided individually.

18. HRT is used to prevent cartilage degradation and, in some cases, to treat osteoarthritis. An increase in the incidence of osteoarthritis with multiple joint lesions in women after menopause indicates the involvement of female sex hormones in maintaining the homeostasis of articular cartilage and intervertebral discs.

19. Estrogen therapy has been shown to benefit cognitive function (memory and attention).

20. Treatment with HRT prevents the development of depression and anxiety, which is often implemented with menopause in women predisposed to it (but the effect of this therapy occurs provided that HRT therapy is started in the first years of menopause, or better yet, premenopause).

21. I no longer write about the benefits of HRT for a woman’s sexual function, aesthetic (cosmetological) aspects– prevention of “sagging” of the skin of the face and neck, prevention of worsening wrinkles, gray hair, tooth loss (from periodontal disease), etc.

Contraindications to HRT:

Main 3:
1. History of breast cancer, current or suspected; If there is a hereditary history of breast cancer, a woman needs to undergo a genetic test for the gene for this cancer! And if the risk of cancer is high, HRT is no longer discussed.

2. Venous thromboembolism in history or at present (deep vein thrombosis, pulmonary embolism) and arterial thromboembolic disease at present or in history (for example: angina pectoris, myocardial infarction, stroke).

3. Liver diseases in the acute stage.

Additional:
estrogen-dependent malignant tumors, for example, endometrial cancer or if this pathology is suspected;
bleeding from the genital tract of unknown etiology;
untreated endometrial hyperplasia;
uncompensated arterial hypertension;
allergy to active substances or to any of the components of the drug;
cutaneous porphyria;
dysregulated type 2 diabetes mellitus

Examinations before prescribing HRT:

Taking an anamnesis (to identify risk factors for HRT): examination, height, weight, BMI, abdominal circumference, blood pressure.

Gynecological examination, collection of smears for oncocytology, ultrasound of the pelvic organs.

Mammography

Lipidogram, blood sugar, or sugar curve with 75 g of glucose, insulin with calculation of the HOMA index

Additionally (optional):
analysis for FSH, estradiol, TSH, prolactin, total testosterone, 25-OH-vitamin D, ALT, AST, creatinine, coagulogram, CA-125
Densitometry (for osteoporosis), ECG.

Individually – Doppler ultrasound of veins and arteries

About the drugs used in HRT.

In women 42-52 years old with a combination of regular cycles with cycle delays (as a phenomenon of premenopause), who need contraception, who do not smoke!!!, you can use contraception rather than HRT - Jess, Logest, Lindinet, Mercilon or Regulon / or use an intrauterine system - Mirena (in the absence of contraindications).

Etrogens cutaneous (gels):

Divigel 0.5 and 1 g 0.1%, Estrogel

Combined E/G drugs for cyclic therapy: Femoston 2/10, 1/10, Climinorm, Divina, Trisequence

Combined E/H drugs for continuous use: Femoston 1/2.5 conti, Femoston 1/5, Angelique, Klmodien, Indivina, Pauzogest, Klimara, Proginova, Pauzogest, Ovestin

Tibolone

Gestagens: Duphaston, Utrozhestan

Androgens: Androgel, Omnadren-250

Alternative treatments include
herbal preparations: phytoestrogens and phytohormones. Data on the long-term safety and effectiveness of this therapy are insufficient.

In some cases, a one-time combination of hormonal HRT and phytoestrogens is possible. (for example, with insufficient relief of hot flashes by one type of HRT).

Women receiving HRT should visit their doctor at least once a year. The first visit is scheduled 3 months after the start of HRT. The doctor will prescribe the necessary examinations for monitoring HRT, taking into account the characteristics of your health!

Important! Message from the site administration about questions on the blog:

Dear readers! By creating this blog, we set ourselves the goal of giving people information on endocrine problems, diagnostic methods and treatment. And also on related issues: nutrition, physical activity, lifestyle. Its main function is educational.

Within the framework of the blog, in answering questions, we cannot provide full-fledged medical consultations; this is due to both the lack of information about the patient and the doctor’s time spent in order to study each case. Only general answers are possible in the blog. But we understand that not everywhere it is possible to consult with an endocrinologist at your place of residence; sometimes it is important to get another medical opinion. For such situations, when a deeper dive and study of medical documents is needed, at our center we have a format for paid correspondence consultations on medical documentation.

How to do it? Our center’s price list includes a correspondence consultation on medical documentation, costing 1,200 rubles. If this amount suits you, you can send scans of medical documents, a video recording, a detailed description, everything that you consider necessary regarding your problem and questions that you want answered to the address patient@site. The doctor will see if the information provided can give a full conclusion and recommendations. If yes, we will send the details, you will pay, and the doctor will send a report. If, based on the documents provided, it is impossible to give an answer that could be considered as a doctor’s consultation, we will send a letter stating that in this case, absentee recommendations or conclusions are impossible, and, of course, we will not take payment.

Sincerely, Administration of the Medical Center "XXI Century"

For most women, the menopause is filled with unpleasant symptoms that interfere with the usual flow of life. Therefore, with a timely visit to specialists, a woman is prescribed hormone replacement therapy using new generation drugs. Which can relieve the symptoms of pathological menopause and reduce possible risks of complications.

Klimonorm is one of the new generation HRT drugs

Action HRT in menopause New generation drugs to eliminate symptoms. Consequences of taking drugs

Doctors consider the use of hormone replacement therapy drugs to be the only way to eliminate the symptoms of pathological menopause. Z gt are analogues of female sex steroid hormones. They can be separated on the:

• ZGT, which contain only estrogen.
• ZGT combined action, which contain estrogen and progesterone.

Application gzt Maybe not only during natural menopause, but also during artificial menopause. In any of these cases, the use of drugs should be under the supervision of a specialist, because they have absolute contraindications:

• If a histological examination of the mammary gland confirms the presence of cancer cells.
• Contraindications include not only breast cancer, but also any endometrial cancer.
• Melanomas.
• Vascular disease of the upper or lower extremities. Thrombophlebitis.
• Any diseases that are autoimmune in nature.
• Pathological changes in the liver.
• Diseases biliary ducts
• Any abnormalities in the functioning of the cardiovascular system.
• The presence of estrogen-dependent tumors in the body (endometriosis, uterine fibroids).

Cyclo-Proginova, like other drugs, has a number of contraindications

How do new generation drugs work?

Since all disorders during menopause in a woman’s body are associated with insufficient production of estrogen and an excess of progesterone, the use of drugs gzt helps to fill the deficiency and normalize well-being.

Application gzt new generation eliminates the symptoms of pathological menopause:

• Tides. A short-term increase in upper body temperature, accompanied by increased sweating, rapid heart rate, and a feeling of anxiety.
• Dryness of all mucous membranes. During menopause, women experience a decrease in the overall level of sex hormones in the blood, which leads to problems V: urinary system; excretory and reproductive organ systems. The mucous membranes dry out and become thinner, which leads to the appearance of unpleasant symptoms (incontinence, itching in the perineum, exacerbation of healed STD).
• High blood pressure, tachycardia.
• Systematic disorder of the central nervous system, severe mood swings.

The tides are the brightest a symptom of pathological menopause, which manifests itself as a failure in the thermoregulation of the body by the hypothalamus. This failure is facilitated by lack of estrogen, which easily eliminated by appointment gzt.

Klimen normalizes the menstrual cycle

Consequences of using drugs

Since hormone replacement therapy drugs contain a high content of estradiol, long-term use without consultation with the attending physician is fraught with the occurrence of estrogen-dependent neoplasms.

Therefore, if any symptoms of pathological menopause occur, you should not prescribe therapy yourself. The best solution would be:

• Get tested for the level of sex hormones in the blood.
• Check your thyroid gland for function.
• Consult a gynecologist for appropriate treatment.

What medications are considered HRT drugs? Trade names and methods of use

In pharmacies you can find more than 50 types of drugs used in, under different trade names. They can be divided into several groups, which differ only in the method of administration:

• Orally. Tablets for oral administration.
• Intramuscular injections.
• Transdermal topical drugs.
• Intravaginal introduction.

The method of administering the drug to the body is selected individually, taking into account the severity of the disease or personal preferences. The most common form of drug administration is orally.

Your doctor may offer you a list of drugs with equal pharmacological properties, but different trade names. Because of which, you can independently choose a hormone replacement therapy drug based on your own budget.

Femoston is available in tablet form

The most common remedies that help eliminate the symptoms of pathological menopause: