I can't take estrogen hormone replacement therapy. Hormone replacement therapy: types of HRT, treatment features, drugs

The intensity of changes in the endometrium also decreases. After menopause, the endometrium enters a resting phase, which lasts until the end of a woman’s life. During perimenopause, when fluctuations in hormone levels become unpredictable, acyclic bleeding may occur. Similar problems may occur in women using progestins (mini-pills) for contraception (mainly long-acting drugs). The endometrium has two layers - basal and functional. The functional layer, in turn, is divided into compact and spongy layers. Normally, at the beginning of menstruation, the functional layer is rejected, but the basal layer is preserved, due to which the endometrium is restored during the next cycle. The vessels of the functional layer of the endometrium differ from the vessels of other organs in their structure and unique ability to quickly respond to the influence of hormones. Hormones have little effect on the vessels of the basal layer.

The endometrium is a very sensitive target for hormones. Estrogens increase the proliferation of endometrial cells. Progesterone is an estrogen antagonist; it causes differentiation of endometrial cells in the luteal phase of the cycle and affects the function of differentiated cells. In general, estrogens seem to prepare the endometrium for the action of progesterone.

Against the background of a physiological decrease in function and, accordingly, a decrease in the level of estrogen and progesterone, endometrium appears after several years of postmenopause. Signs of endometrial proliferation in postmenopause are considered pathology.

During perimenopause, both proliferation and secretory changes can be observed in the endometrium.

In postmenopause, the endometrium is thin, atrophic, without mitoses with a compact stroma, but its potential ability to proliferate remains in response to a possible increase in the levels of endogenous estrogens, as well as to exogenous estrogens. The ability of the endometrium to become inactive with prolonged administration of progestins also remains.

The endometrium is the main target organ for sex hormones.

Estrogens cause proliferative changes in the endometrium, while progestogens have the opposite effect. When using estrogen monotherapy in women with a uterus, the incidence of endometrial hyperplasia and endometrium increases. Therefore, during natural menopause, that is, in the presence of a uterus, the use of combined HRT is indicated - cyclic or continuous, depending on the phase of menopause. Estrogen monotherapy is prescribed to women with surgical menopause - after hysterectomy. It should be remembered that after high supravaginal amputation of the uterus, when the cervix is ​​preserved, combined HRT is also prescribed (see HRT preparations).

Bloody discharge due to HRT

Currently, the most accepted in clinical practice is the use of combined HRT (see HRT preparations) for women with an intact uterus in two modes:

• cyclic combined HRT (2- or 3-phase);
• continuous combined HRT.

For perimenopausal women, preference is given to a cyclic HRT regimen: estrogen is prescribed for 21-28 days and progestogen is added in the last 10-12-14 days. This is explained by the fact that during perimenopause there are fluctuations in sex hormones. Therefore, simulating a “cycle”, the first step is to prevent hyperplastic processes in the endometrium with the help of progestogens. With the cyclic regimen of HRT, the occurrence of “withdrawal bleeding” or the so-called menstrual-like reaction is expected. By prescribing HRT in a cyclic mode to women in perimenopause, the goal is not to prolong the “cycles”, but to carry out a kind of prevention of hyperplastic processes in the endometrium.

With the cyclic regimen of HRT (see HRT preparations), “withdrawal bleeding” is expected to occur.

With a cyclic regimen of estrogen/progestagen administration, after 10-14 days of their combined effect “in the second phase,” the histological picture of the endometrium resembles changes in the normal menstrual cycle. When using large doses of progestogens, complete decidualization of the stroma with small atrophic glands occurs. There may also be an atrophic stroma with small atrophic glands.

Endometrial biopsy while taking cyclic HRT is indicated mainly in two cases, regardless of ultrasound data:

• heavy withdrawal bleeding;
• acyclic bleeding.

Combined continuous HRT (see HRT preparations) with estrogens and progestogens is prescribed to postmenopausal women, 2-3 years after the last menstruation, when the fluctuation of sex hormones practically stops.

Against the background of continuous HRT, especially in the first three months, acyclic bleeding of varying intensity may occur, and subsequently their frequency decreases significantly and is observed in most patients.

Despite the fact that in most cases with acyclic bleeding, atrophic endometrium is detected, it is necessary to exclude endometrial pathology, hyperplasia, etc. Endometrial polyps must be excluded before prescribing HRT, since they are not sensitive to the progestogens included in HRT. As studies have shown, the tissues removed from postmenopausal women who received combined HRT are covered with endometrium in the proliferation stage or even hyperplastic endometrium, and in the endometrium around and at the same time it was detected.

The incidence of endometrial hyperplasia when using continuous combined HRT regimens remains low when used for a long time of 5-10 years or more.

It is extremely important to follow all the necessary rules before prescribing HRT (ultrasound of the uterus to determine the thickness of the endometrium). If bleeding appears in the early phase of taking progestogen, it is advisable to increase the dose of progestogen.

Traditionally, we talk more about the role of progestogen reduction than about estrogens. But it is also possible to increase the levels of endogenous estrogens, especially estrone, since in postmenopause the level depends on the following factors:

• on the state of adipose tissue (body weight);
• smoking (more than 10 cigarettes per day);
• on the dose of exogenous estrogens (HRT);
• prolonged cycles of taking estrogen (70 days) + 14 days of progestogens;
• with continuous administration of estrogens without gestagens, 70% of those taking them experience “breakthrough bleeding”;
• increase in estrogen (E2) with a hormonally active tumor.

According to the data of the clinic of gynecological endocrinology of the Scientific Center of Agipology and Pediatrics of the Russian Academy of Medical Sciences, cyclic bleeding is observed in 85-93% of women during two- and three-phase HRT (Femoston 2/10, Klimen, Klimonorm, Divina, Femoston, Trisequence and other HRT drugs). The absence of cyclic bleeding on the background of two- and three-phase drugs for HRT, as a rule, indicates atrophic changes in the endometrium. In postmenopause, against the background of continuous combined HRT (Femoston 1/5), acyclic bleeding was observed in 45% of women during the first 2-2.5 months; subsequently, by the fourth to sixth months, the frequency of discharge decreased and was observed in 5-7% of women.

In order to minimize the side effects of HRT, in recent years there has been a tendency towards the use of low-dose estrogen-gestagens, including 1 mg of estradiol in combination with dydrogesterone (5 mg instead of 10 mg) or with MPA (2,

Ultrasound determines the double thickness of the endometrium (M-Echo in mm), evaluates the type of endometrium, the relative position and relationship of the endometrium and myometrium. It is generally accepted that with M-Echo - 5 mm, diagnostic curettage is not indicated before prescribing HRT. When the endometrial thickness is 6-7 mm, microcurettage is performed (with a vacuum curette), and when the endometrial thickness is more than 7 mm, hysteroscopy and diagnostic curettage are indicated as the “gold standard” of control.

While taking HRT, the nature (duration, intensity and frequency) of bleeding is taken into account using a “menstrual” calendar. During the first 2 years of taking HRT, an ultrasound of the uterus with a transvaginal probe is performed every 6 months.

Monitoring the condition of the endometrium

For some time, the question of the advisability of performing an endometrial biopsy before and during HRT has been discussed. The majority decided to use a transvaginal ultrasound sensor as a control. In doubtful cases, “microcurettage” is performed and, if indicated, hysteroscopy and diagnostic curettage.

According to a large study of 518 women with endometrial thickness less than 5 mm, only 14 (2.7%) had endometrial pathology. Therefore, if the thickness of the endometrium is less than 5 mm, the need for histological examination of the endometrium is doubtful.

Using ultrasound and histological examination of the endometrium in women receiving various HRT regimens, it was shown that with continuous HRT the endometrium is thinner and more often atrophic than with cyclic HRT. Interestingly, with estrogen monotherapy, even with an endometrial thickness of more than 7 mm, histological examination did not reveal pathological changes.

Hormone replacement therapy (HRT) becomes relevant for women after menopause.

The body no longer produces estrogens in the required quantities, and to maintain hormonal hemostasis, a decision must be made to take conjugate drugs.

And if, after removal of the ovaries at a young age, hormone replacement therapy becomes the only option for a full life in the future, during menopause many women are overcome by doubts whether it is worth interfering with the natural course of events and compensating for the decline in hormonal activity.

Such an important decision should be approached with full responsibility and studied everything related to HRT - its purpose, the mechanism of action of the drugs, contraindications and side effects, as well as the possible benefits it provides.

Estrogens (the term “estrogen” is often used) is a group of steroid sex hormones that in women are synthesized by cells and some other organs - the adrenal cortex, brain, bone marrow, lipocytes, subcutaneous fatty tissue and even hair follicles.

Yet the main producer of estrogen is the ovaries.

The exception is Livial.

Means Livial

Livial is a drug for the treatment of symptoms of menopause, which, if discontinued, does not cause bleeding. The main active ingredient of the drug is tibolone.

It has a slight antiandrogenic effect, estrogenic and progestogenic properties.

Tibolone is rapidly absorbed, its working dose is very low, metabolites are excreted mainly in bile and feces. The substance does not accumulate in the body.

Hormone replacement therapy with Livial is used to eliminate signs of natural and surgical menopause, and to prevent osteoporosis due to estrogen deficiency.

Livial is not a contraceptive.

It is prescribed immediately after oophorectomy or one year after the last menstrual bleeding.

In case of overdose, bleeding may occur.

The drug is used with caution for migraines, epilepsy, diabetes, kidney disease, and high blood cholesterol.

Therapy for any type of menopause with tibolone involves daily oral administration of the drug, 1 tablet (2.5 mg) per day for a long period of time.

Improvement occurs after 3 months of taking the drug. It is advisable to take the drug at the same time of day to maintain a constant concentration of the active substance in the blood.

Hormone replacement therapy with Livial may have side effects: fluctuations in body weight, uterine bleeding, swelling of the extremities, headaches, diarrhea, liver dysfunction.

Combined Femoston

Femoston is a combination drug for HRT. The substitutive effect of the drug is provided by 2 components: estrogen - estradiol and progestogen - dydrogesterone.

The dose and ratio of hormones in the drug depends on the form of release:

• 1 mg estradiol and 5 mg dydrogesterone;
• 1 mg estradiol and 10 mg dydrogesterone;
• 2 mg estradiol and 10 mg dydrogesterone.

Femoston contains estradiol, identical to natural, which allows you to compensate for the lack of estrogen and relieve the psycho-emotional component of menopause: hot flashes, increased excitability, mood swings, migraines, a tendency to depression, hyperhidrosis.

Estrogen therapy using Femoston prevents age-related changes in the mucous membranes of the genitourinary system: dryness, itching, painful urination and sexual intercourse, irritation.

Estradiol plays an important role in the prevention of osteoporosis and bone fragility.

Dydrogesterone, in turn, stimulates the secretory function of the endometrium, preventing the development of hyperplasia, endometriosis and cancerous degeneration of endometriocytes, the risk of which increases significantly when taking estrodiol.

This hormone does not have a glucocorticosteroid, anabolic or antiandrogenic effect. In combination, the drug allows you to control cholesterol levels.

Hormone replacement therapy with Femoston is complex and low-dose. It is prescribed for physiological and surgical menopause.

Doses and treatment regimens are selected strictly individually depending on the reason for prescribing the drug.

Replacement therapy with Femoston may be accompanied by side effects such as migraines, nausea, indigestion, leg cramps, vaginal bleeding, chest and pelvic pain, and fluctuations in body weight.

Therapy for porphyria with the use of Femoston is not used.

Angelique drug

The composition of the drug Angeliq includes 1 mg of estradiol and 2 mg of drospirenone. This drug is prescribed to compensate for deficiency and to prevent osteoporosis.

Drospirenone is an analogue of the natural hormone progestogen. This complex treatment is most effective for hypogonadism, ovarian dystrophy and menopause, regardless of its cause.

Angelique, like Femoston, eliminates the clinical manifestations of menopause.

In addition, Angelique has an antiandrogenic effect: it is used to treat androgenetic alopecia, seborrhea, and acne.

Drospirenone prevents the formation of swelling, arterial hypertension, weight gain, and pain in the chest area.

The hormones estradiol and drospirenone potentiate each other's action.

In addition to the classic properties for a replacement therapy drug, Angeliq prevents the malignant degeneration of rectal and endometrial tissue during the postmenopausal period.

The drug is taken once a day, 1 tablet.

Possible side effects: brief bleeding at the beginning of therapy, chest pain, headache, irritability, abdominal pain, nausea, dysmenorrhea, benign neoplasms in the mammary glands and cervix, asthenic syndrome, local edema.

Proginova differs from other drugs used for HRT in that it contains only estradiol in an amount of 2 mg.

The drug is prescribed to compensate for the lack of estrogen after removal of the ovaries and uterus, the onset of menopause, and for the prevention of osteoporosis. If the uterus is preserved, additional progestogen is necessary.

The drug Proginova is prescribed both before and after the onset of menopause after a complete examination.

One package of the drug contains 21 tablets, which are taken once a day during the first 5 days after the start of menstrual bleeding or at any time if the cycle is already completed.

Proginova is taken continuously during the postmenopausal period or cyclically until menopause.

Taking the drug may be accompanied by the usual side effects and contraindications for estradiol.

Modern hormone replacement therapy drugs contain the minimum permissible therapeutic dose of estradiol, and therefore their ability to cause cancer is minimized.

However, taking estradiol alone for a long time (longer than 2 years) increases the risk of developing endometrial cancer. This danger is eliminated by combining estradiol with a progestin.

In turn, the latter contributes to the development of atherosclerosis. Currently, the most effective combinations of hormones for HRT are still being studied, taking into account its effects on the cardiovascular and other body systems.

The goal of scientific research is to develop the most effective replacement therapy regimen with the lowest risk of developing malignant neoplasms and side effects.

As a woman ages, the level of estrogen in a woman's body begins to decrease. This leads to a number of symptoms that cause discomfort. This is an increase in subcutaneous fat, hypertension, dry genital mucosa, and urinary incontinence. Medications can help eliminate and reduce the risk of complications associated with menopause to avoid such an unpleasant condition. Such drugs include “Klimonorm”, “Klimadinon”, “Femoston”, “Angelik”. New generation HRT should be carried out with extreme caution and can only be prescribed by a qualified gynecologist.

Don't want to take hormones during menopause?

If hormone replacement therapy is contraindicated for you or you do not want to use it for other reasons, ask your gynecologist about the possibility of taking a non-hormonal one. The complex of low-molecular polypeptides in the drug normalizes the function of the pituitary gland and the balance of hormones, thereby easing the uncomfortable symptoms of menopause: hot flashes, excessive sweating, headaches, palpitations, sleep disturbances and emotional instability. Conducted double placebo-controlled studies showed a significant decrease in the severity of menopausal disorders during a course of treatment with Pineamin. The recommended course is 10 days and is carried out under the supervision of a doctor. Contact your gynecologist to find out more information about the treatment of menopausal syndrome with the innovative drug Pineamin.

Release form of the drug "Klimonorm"

The medicine belongs to the class of antimenopausal drugs. It is made in the form of two types of dragees. The first type of dragee is yellow. The main substance in the composition is estradiol valerate 2 mg. The second type of dragee is brown. The main components are estradiol valerate 2 mg and levonorgestrel 150 mcg. The medicine is packaged in blisters of 9 or 12 pieces each.

With the help of this medication, HRT is often performed during menopause. New generation drugs have good reviews in most cases. Side effects do not develop if you follow your doctor’s recommendations.

Effect of the drug "Klimonorm"

"Klimonorm" is a combination drug that is prescribed to eliminate the symptoms of menopause and consists of estrogen and gestagen. Once in the body, the substance estradiol valerate is converted into estradiol of natural origin. The substance levonorgestrel added to the main drug is the prevention of endometrial cancer and hyperplasia. Thanks to the unique composition and special dosage regimen, it is possible to restore the menstrual cycle in women with a non-removed uterus after treatment.

Estradiol completely replaces natural estrogen in the body at the moment when menopause occurs. Helps cope with vegetative and psychological problems that arise during menopause. You can also slow down the formation of wrinkles and increase the collagen content in the skin when carrying out HRT during menopause. The drugs help lower total cholesterol and reduce the risk of intestinal diseases.

Pharmacokinetics

When taken orally, the medicine is absorbed in the stomach in a short period. In the body, the drug is metabolized to form estradiol and estrol. Already within two hours the maximum activity of the drug in plasma is observed. The substance levonorgestrel is almost 100% bound to blood albumin. Excreted in urine and slightly in bile. Particular attention should be paid to selecting medications for HRT during menopause. Level 1 drugs are considered potent and can significantly improve the condition of the fairer sex after 40 years. Medicines from this group also include the drug “Klimonorm”.

Indications and contraindications

The drug can be used in the following cases:

• hormone replacement therapy for menopause;
• involutional changes in the skin and mucous membrane of the genitourinary system;
• insufficient estrogen levels during menopause;
• preventive measures for osteoporosis;
• normalization of the monthly cycle;
• therapeutic process for amenorrhea of ​​primary and secondary type.

Contraindications:

• bleeding not associated with menstruation;
• breast-feeding;
• hormone-dependent precancerous and cancerous conditions;
• mammary cancer;
• liver diseases;
• acute thrombosis and thrombophlebitis;
• hypotension;
• diseases of the uterus.

HRT is not always indicated during menopause. New generation drugs (the list is presented above) are prescribed only if menopause is accompanied by a significant deterioration in the woman’s well-being.

Dosage

If you still have your period, then treatment should begin on the fifth day of the cycle. For amenorrhea and menopause, the treatment process can begin at any time of the cycle, unless pregnancy is excluded. One package of the medicine “Klimonorm” is designed for 21 days of use. The product is drunk according to the following algorithm:

• for the first 9 days the woman takes yellow tablets;
• the next 12 days - brown pills;

After treatment, menstruation appears, usually on the second or third day after taking the last dose of the medicine. There is a break for seven days, and then you need to drink the next package. The pills should be taken without chewing and washed down with water. It is necessary to take the drug at a certain time, without missing it.

It is imperative to adhere to the HRT regimen during menopause. New generation drugs may also have negative reviews. You will not be able to achieve the desired effect if you forget to take the pills in a timely manner.

In case of an overdose, unpleasant phenomena such as stomach upset, vomiting and bleeding not associated with menstruation may occur. There is no specific antidote for the drug. In case of overdose, symptomatic treatment is prescribed.

Medicine "Femoston"

The medication belongs to the group of antimenopausal drugs. Available in the form of tablets of two types. In the package you can find a white dragee with a film shell. The main substance is estradiol at a dose of 2 mg. The first type also includes gray tablets. The composition contains estradiol 1 mg and dydrogesterone 10 mg. The product is packaged in blisters of 14 pieces each. The second type includes pink tablets containing 2 mg estradiol.

Replacement therapy is often carried out with the help of this remedy. When it comes to HRT for menopause, medications are selected with special attention. Femoston reviews have both positive and negative. Good statements still prevail. The medication can eliminate many menopausal symptoms.

Action

"Femoston" is a two-phase combination drug for the treatment of postmenopause. Both components of the drug are analogues of the female sex hormones progesterone and estradiol. The latter replenishes the supply of estrogen during menopause, removes symptoms of a vegetative and psycho-emotional nature, and prevents the development of osteoporosis.

Dydrogesterone is a progestogen that reduces the risk of developing uterine hyperplasia and cancer. This substance has estrogenic, androgenic, anabolic and glucocorticoid activity. When it enters the stomach, it is quickly absorbed and then completely metabolized. If HRT is indicated for menopause, the drugs “Femoston” and “Klimonorm” should be used first.

Indications and contraindications

The medication is used in the following cases:

• HRT during menopause and after surgery;
• prevention of osteoporosis, which is associated with menopause

Contraindications:

• pregnancy;
• lactation;
• breast cancer;
• malignant tumors that are hormone-dependent;
• porphyria;
• thrombosis and thrombophlebitis;
• hypersensitivity to components;
• diabetes;
• hypertension;
• endometrial hyperplasia;
• migraine.

HRT will help improve your well-being during menopause. Reviews of the drugs are mostly positive. However, they should not be used without first consulting a doctor.

Dosage

Femoston tablets containing estradiol in a dose of 1 mg are taken once a day at the same time. Treatment is carried out according to a special scheme. In the first 14 days you need to take white tablets. In the remaining 14 days - a medicine of a gray shade.

Pink tablets containing 2 mg estradiol are taken for 14 days. For women whose menstrual cycle has not yet been disrupted, treatment should begin on the first day of bleeding. For patients with irregular cycles, the drug is prescribed after two weeks of treatment with Progestagen. For everyone else, if you don’t have your period, you can start taking the medicine any day. You need to follow the treatment regimen to get positive results from HRT during menopause. New generation drugs will help keep a woman feeling good and prolong her youth.

The drug "Klimadinon"

The medicine belongs to the means for improving well-being during menopause. It has a phytotherapeutic composition. Available in the form of tablets and drops. The tablets are pink with a brown tint. Contains dry cohosh extract 20 mg. The drops contain liquid cohosh extract 12 mg. The drops have a light brown tint and the smell of fresh wood.

Indications:

• vegetative-vascular disorders associated with menopausal symptoms.

Contraindications:

• hormone-dependent tumors;
• hereditary lactose intolerance;
• alcoholism;
• hypersensitivity to components.

It is necessary to carefully study the instructions before starting HRT during menopause. Preparations (patch, drops, pills) should be used only on the recommendation of a gynecologist.

The medicine "Klimadinon" is prescribed one tablet or 30 drops twice a day. It is advisable to carry out therapy at the same time. The course of treatment depends on the individual characteristics of the body.

The drug "Angelique"

Refers to drugs that are used to treat menopause. Available in the form of gray-pink tablets. The drug contains estradiol 1 mg and drospirenone 2 mg. The product is packaged in blisters, 28 pieces each. A specialist will tell you how to properly carry out HRT during menopause. New generation drugs should not be used without prior consultation. can have both benefit and harm.

The medication has the following indications:

• hormone replacement therapy during menopause;
• prevention of osteoporosis during menopause.

Contraindications:

• bleeding from the vagina of unknown origin;
• mammary cancer;
• diabetes;
• hypertension;
• thrombosis.

Dosage of the medicine "Angelique"

One package is designed for 28 days of use. You should take one tablet daily. It is better to drink the medicine at the same time, without chewing and with water. Therapy should be carried out without skipping. Neglecting the recommendations will not only not bring a positive result, but can also provoke vaginal bleeding. Only correct adherence to the regimen will help normalize the menstrual cycle during HRT during menopause.

New generation drugs (“Angelik”, “Klimonorm”, “Klimadinon”, “Femoston”) have a unique composition, thanks to which it is possible to restore female

"Klimara" patch

This medication comes in the form of a patch containing 3.8 mg estradiol. The oval-shaped product is glued to an area of ​​skin hidden under clothing. During the use of the patch, the active component is released, improving the woman’s condition. After 7 days, the product must be removed and a new one applied to a different area.

Side effects from the use of the patch are quite rare. Despite this, the hormonal drug should be used only after consultation with the doctor.

Hormone replacement therapy - abbreviated as HRT - involves the additional introduction into the body of those hormones that are insufficient to maintain normal hormonal levels. Modern medicine actively uses HRT, including during menopause.

Hormone replacement therapy for menopause comes down to the fact that the required amount of sex hormones is introduced into the female body in order to maintain the hormonal levels that change during this period at a relatively constant level. We will talk in detail about HRT.

HRT drugs for women who have entered menopause were first prescribed in the United States, appearing in the 40-50s of the last century. Hormonal treatment very quickly became popular due to the obvious positive results.

Most of the numerous studies have revealed that the cause of such consequences was the use of only one sex hormone in hormonal products -. The corresponding conclusions were drawn, and already in the 70s biphasic tablets appeared.

Their composition includes natural hormones - which inhibits the growth of the endometrium in the uterus.

Constant monitoring of the health of women who use hormones during menopause allows doctors to conclude that positive changes are occurring in the body.

The drugs not only cope with menopausal symptoms, but slow down atrophic changes, reduce blood cholesterol levels, and improve lipid metabolism.

Expert opinion

Alexandra Yurievna

Thus, new generation medications 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. Research by American scientists has shown that HRT should be used to prevent heart attack and atherosclerosis.

Hormonal balance during menopause

Female sex hormones influence the formation of a regular menstrual cycle in the body, which manifests itself as menstruation. Follicle-stimulating hormone (FSH) plays an important role in this process, as well as the following hormones: luteinizing hormone (LH), estrogen and progesterone.

After 40 years, a woman’s body is subject to hormonal changes. They are associated with depletion of the supply of eggs in the ovaries.

In women after 45 years of age, menopause begins, which includes three important stages:

1. – lasts from the first signs of ovarian dysfunction until the last independent menstruation.
2. – one year after the last menstruation during which menstrual function was completely absent.
3. – occurs immediately after menopause and continues until the end of life.

During perimenopause, due to decreased ovarian activity, less estrogen is produced. Since all hormones are very closely interrelated, a deficiency of one will certainly cause a drop in the level of all other female hormones during menopause.

Menstruation comes less often and often without the formation of an egg. Its absence leads to a decrease in the level of progesterone, which is responsible for the mucous membrane of the uterus.

As a result, the endometrium becomes thinner. During menopause, estrogen levels drop to a critical level and provoke a decrease in the levels of other sex hormones.

Menstruation no longer comes because the body no longer has the conditions for tissue renewal. During postmenopause, the ovaries completely stop producing hormones.

What you need to know about hormonal imbalance

The triggering factor for the onset of menopause is age-related depletion of the hormonal function of the ovaries and follicular apparatus, as well as changes in the nervous tissue of the brain. As a result, the ovaries begin to produce less progesterone and estrogens, and the hypothalamus decreases sensitivity 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 lacking. FSH hormones “stimulate” the ovaries, and thanks to this, normal levels of sex hormones are maintained in the blood. But at the same time, the pituitary gland functions under strain and synthesizes an increased amount of hormones. What do blood tests show?

Over time, the decline of ovarian function will lead to the production of estrogen in a smaller volume than normal in women. They will not be enough for the pituitary gland to “launch” its compensatory mechanism. Insufficient levels of hormones provoke changes in the functioning of other endocrine glands and lead to hormonal imbalance.

You should be tested before starting HRT.

Hormonal imbalance is manifested by the following syndromes and symptoms:

1. Climacteric syndrome, which is observed in women during premenopause or menopause. The hallmark of the syndrome is hot flashes - a sudden flow 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, surges in blood pressure, and headaches. Many people experience sleep disturbances, memory loss and depression.
2. 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.
3. Metabolic disorders - increased body weight, swelling of the extremities, etc.
4. Changes in appearance – dry skin, deepening of wrinkles, brittle nails.

Later manifestations of the syndrome are the development of osteoporosis (decreased bone density), as well as coronary heart disease and hypertension. Some ladies may develop Alzheimer's disease.

How can HRT help with menopause?

In fact, menopause is a natural physiological stage in a woman’s life associated with the decline of reproductive function.

All its stages are accompanied by a certain set of symptoms, manifesting themselves with varying severity and severity. They are caused by a deficiency of sex hormones, as well as by the fact that the pituitary gland produces more follicle-stimulating hormone.

Hormone replacement therapy for menopause is treatment with medications containing sex hormones. Whatever hormones the body lacks will be used during HRT. The goal 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, dosages and treatment times vary greatly.

In gynecology, two types of HRT are used:

1. Short-term - the doctor prescribes a course of medication lasting from 12 to 24 months.
   This treatment is aimed at mitigating the symptoms of menopause. It is not used when a woman is in a severe depression or has organ pathologies. Such patients need non-hormonal therapy.
2. Long-term – assumes that the drugs will be continuously taken for 2-4 years, and sometimes up to 10 years.
   It is prescribed to 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.

Hormonal therapy for endometriosis gives very good results. Now this disease has become very common and ranks third after inflammatory processes and uterine fibroids.

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 treatment with hormonal drugs. This method gives good results. If there is no effect after 3-4 months of taking hormones, then the patient is operated on.

How is GTZ 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 functioned for many years thanks to sex hormones. They ensured not only reproductive function, but also normal metabolism and the functioning of all body systems.

But hormonal imbalance contributes to the development of diseases and rapid aging. But it is not advisable 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 test results. In addition, the choice of drugs for hormone replacement therapy depends on the stage of menopause.

Features of HRT in postmenopause

Postmenopause is the final stage of menopause. A woman enters this period much earlier than 60 years of age.

A woman has not had her period for a year or more and needs medications that correspond to the characteristics of her body’s condition:

1. The functioning of the cardiovascular system has deteriorated.
2. The absence of sex hormones provokes vegetative-vascular disorders.
3. Atrophic processes in the genital and urinary organs cause severe discomfort with itching or burning of the mucous membrane.
4. Due to advanced osteoporosis, the risk of fractures increases.

This general list of symptoms of menopause may be supplemented by symptoms of other diseases or may remain unchanged. By taking postmenopausal hormones, most women will be able to improve their health. Thus, she will help her body and also improve her quality of life in general.

Properly selected HRT drugs can:

• reduce the risk of cardiovascular diseases;
• normalize the lipid spectrum of the blood;
• prevent bone destruction;
• have a positive effect on carbohydrate metabolism.

Thus, hormone replacement therapy in postmenopausal women becomes an effective method of preventing complications possible at this stage of menopause.

Who is contraindicated for HRT?

Hormone replacement therapy is carried out with drugs created either on the basis of estrogen 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 during menopause is complex. When the uterus is removed, medications containing only estrogens are prescribed.

After removal of the uterus and ovaries (hysterectomy), it is not necessary to introduce it into the female body. For a number of diseases, the use of hormones is not advisable. They can lead to 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 diseases;
• 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 the following tests: biochemistry, blood clotting, as well as studying hormonal status (the concentration of TSH, FSH, glucose, prolactin and estradiol is detected). If high cholesterol is suspected during menopause, a special test is taken - a lipid profile. To determine bone density, you need to undergo densitometry.

Brief characteristics of the drugs

The following new generation drugs for HRT during menopause can be distinguished, which can restore hormonal imbalance: Klimonorm, Klimadinon, Femoston and Angelique. In addition to the name, we will give a short description of each medicine.

Undoubtedly, only a doctor should prescribe a hormone-containing drug. By self-medicating, a woman can harm her health or aggravate the existing problem.

The drug "Klimonorm"

The medicine comes in the form of a pill. One blister contains 9 pieces of yellow dragees (the main component is 2 mg of extradiol valerate) and 12 pieces of brown dragees (the composition includes 2 mg of extradiol valerate and 150 mcg of levonorgestrel).

In a woman’s body, extradiol valerate is converted into estradiol. It completely 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 woman encounters, but also improves her appearance. By increasing the collagen content in a woman's skin, the formation of wrinkles slows down. Youth is preserved. Reducing total cholesterol levels 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 menstruating starts taking the medicine on the 5th day of her 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 which you need to not drink hubbub for 7 days. Then continue treatment of menopause with the next package of the drug.

The drug "Femoston"

Two types of tablets are available: white film-protected (estradiol 2 mg) and gray (estradiol 1 mg and dydrogesterone 10 mg), which are packaged in blisters of 14 pieces. Used to treat postmenopause. Hormones remove or significantly reduce psychoemotional and vegetative symptoms. The medicine 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 woman 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 on any day.

A woman with an irregular cycle begins to take the drug only after drinking Progestan for two weeks.

The drug "Klimadinon"

The drug contains plant hormones. Available in both tablet and drop form. The tablets are pink with a brown tint (the main component is dry cohosh plant extract 20 mg), and the drops are light brown (contain liquid cohosh extract 12 mg).

The drug is prescribed for vegetative-vascular disorders associated with menopause. The doctor prescribes a course of treatment, taking into account the woman’s hormonal background.

The drug "Angelique"

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 is started to be taken as prescribed by the doctor.

To obtain the effect of treatment with these drugs, you must adhere to the following simple rules:

1. Medicines should be taken at the same time without skipping;
2. Tablets or dragees are not food and therefore cannot be chewed. They are drunk whole, washed down with water.

Therefore, you should neither increase the prescribed course of medications nor stop taking them yourself without consulting your doctor. You need to take hormones until the last day prescribed by your specialist.

Bottom line

At the end of our article, let's summarize the facts we learned:

1. Hormonal 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 occurring after the end of menopause (oncological diseases).
2. Only a doctor can prescribe this method of treatment, since there are a number of contraindications for prescribing hormones.
3. 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 during menopause, their action and side effects.

Dear ladies, what do you think about hormone replacement therapy for menopause?

It does not require treatment, because this is a normal physiological process, not a pathology. But menopause is a difficult “stage” in the life of every woman, affecting absolutely all areas of a woman’s life. The lack of sex hormones affects health, psycho-emotional state, appearance and self-confidence, sex life, relationships with loved ones and even work activity, and the quality of life in general. Therefore, any woman during this period requires help both from professional doctors and reliable support and support from her closest relatives.

How to alleviate the condition during menopause?

• Do not withdraw into yourself, accept the fact that menopause is not a vice or a shame, this is the norm for all women;
• lead a healthy lifestyle ;
• have a good rest;
• review your diet in favor of plant-based and low-calorie foods;
• move more;
• do not give in to negative emotions, receive positivity even from the smallest things;
• take care of your skin;
• observe all rules of intimate hygiene;
• contact doctors in a timely manner for preventive examinations and if there are complaints;
• Follow your doctor’s orders and do not skip taking recommended medications.

• Monitor the condition of the body, identify and prevent the development of diseases associated with menopause;
• if necessary, prescribe treatment with sex hormones - hormone replacement therapy;
• Assess symptoms and recommend medications to relieve them.

• Show patience with a woman’s emotional outbursts;
• do not leave alone with the problems that have piled up;
• the attention and care of loved ones works wonders;
• give positive emotions;
• support with words: “I understand”, “all this is temporary”, “you are so beautiful and attractive”, “we love you”, “we need you” and everything in that mood;
• lighten the household load;
• protect from stress and troubles;
• participate in trips to doctors and other manifestations of care and love.

Treatment of menopause - hormone replacement therapy (HRT)

Hormone replacement therapy has already been successfully used on a large scale throughout the world. Thus, in European countries, more than half of women entering menopause receive it. And in our country only 1 in 50 women receives such treatment. And all this is not because our medicine is lagging behind in some way, but because of many prejudices that force women to refuse the proposed hormonal treatment. But many studies have proven that such therapy for menopause is not only effective, but also absolutely safe.
Factors on which the effectiveness and safety of hormonal drugs for the treatment of menopause depend:

• Timely administration and withdrawal of hormones;
• usually use small doses of hormones;
• correctly selected drugs and their doses, under the control of laboratory tests;
• the use of drugs containing natural sex hormones identical to those produced by the ovaries, and not their analogues, only similar in their chemical structure;
• adequate assessment of indications and contraindications;
• taking medications regularly.

Hormone therapy for menopause: pros and cons

The most common prejudices regarding the treatment of menopause with female hormones:
1. "Menopause is normal, but its treatment is unnatural" , supposedly all our ancestors experienced it - and I will survive it. Until recently, the problems of menopause were a closed and “shameful” topic for women, almost like venereal diseases, so its treatment was out of the question. But women have always suffered during menopause. And we should not forget that women of those times were noticeably different from modern women. The previous generation aged much earlier, and most people took this fact for granted. Nowadays, all ladies strive to look as good and young as possible. Taking female hormones will not only ease the symptoms of menopause, but will also prolong youth both in appearance and in the internal state of the body.
2. "Hormonal drugs are unnatural." New trends against “synthetics”, for a healthy lifestyle and herbal preparations. So, hormonal drugs taken to treat menopause, although produced by synthesis, are natural, since their chemical structure is absolutely identical to estrogen and progesterone, which are produced by the ovaries of a young woman. At the same time, natural hormones that are extracted from plants and animal blood, although similar to human estrogen, are still poorly absorbed due to differences in structure.
3. “Hormonal treatment always means excess weight.” Menopause is often manifested by excess weight, so by correcting hormonal levels, weight gain can be avoided. To do this, it is important to take not only estrogens, but also progesterone in a balanced dose. In addition, many studies have proven that sex hormones do not increase the risk of obesity, but vice versa. While plant hormones (phytoestrogens) will not fight excess weight.
4. “After hormonal therapy, addiction develops.” Hormones are not drugs. Sooner or later, a decrease in sex hormones occurs in a woman’s body; she will still have to live without them. And hormonal therapy with sex hormones only slows down and facilitates the onset of menopause, but does not exclude it, that is, menopause will occur in any case.
5. “Hormones will cause hair to grow in unwanted places.” Facial hair grows in many women after menopause, and this is due to a lack of female sex hormones, so taking HRT will prevent and delay this process.
6. "Hormones kill the liver and stomach." Among the side effects of estrogen and progesterone drugs, there are indeed points regarding liver toxicity. But microdoses of hormones used for HRT usually do not affect liver function; problems can arise when taking drugs against the background of liver pathologies. You can bypass the toxic effect on the liver by replacing tablets with gels, ointments and other dosage forms applied to the skin. HRT has no irritating effect on the stomach.
7. “Hormonal replacement therapy with sex hormones increases the risk of cancer.” The deficiency of sex hormones itself increases the risk of cancer, as does their excess. Properly selected doses of female sex hormones normalize hormonal levels, thereby reducing this risk. It is very important not to use estrogen-only therapy - progesterone neutralizes many of the negative effects of estrogen. It is also important to stop HRT in time; such therapy after 60 years is really dangerous for the uterus and mammary glands.
8. “If I tolerate menopause well, why do I need HRT?” A logical question, but the main goal of hormonal treatment of menopause is not so much the relief of hot flashes as the prevention of the development of diseases associated with menopause, such as osteoporosis, mental disorders, hypertension and atherosclerosis. It is these pathologies that are more undesirable and dangerous.

There are still some disadvantages to hormonal therapy for menopause. Incorrectly selected, namely high doses of estrogen drugs, can really do harm.

Possible side effects from taking high doses of estrogen:

• development of mastopathy and increased risk of breast cancer;
• painful menstruation and severe premenstrual syndrome, lack of ovulation;
• may contribute to the development of benign tumors of the uterus and appendages;
• fatigue and emotional instability;
• increased risk of developing cholelithiasis;
• uterine bleeding due to the development of uterine hyperplasia;
• increased risk of developing hemorrhagic strokes.

• bloody vaginal discharge not associated with the menstrual cycle;
• increased gas formation in the intestines (flatulence);
• when using only estrogen preparations without progesterone, or vice versa, excess weight gain is possible.

In any case, replacement therapy should be carried out under the supervision of a physician. If an increased risk of developing a particular side effect is detected, the dose, schedule, route of administration of hormones and the advisability of further use of HRT are reviewed.

Indications for hormone replacement therapy (HRT) during menopause

• Any pathological menopause (after removal of the uterus, ovaries, radiation and chemotherapy);
• early menopause before the age of 40-45 years;
• severe menopause;
• the presence of complications and the development of diseases associated with menopause: hypertension, atherosclerosis, osteoporosis, polycystic ovary syndrome, urinary incontinence, severe vaginal dryness, etc.;
• desire to improve the quality of life during menopause.

Menopause medications for hormone replacement therapy (tablets, suppositories, creams, gels, ointments, patches)

Group of drugs	List of drugs	Application Features*
The best combined hormonal drugs of the new generation: Estrogen + Progesterone	Tablets and dragees: Klymen; Klimonorm; Angelique; Climodien; Divina; Pauzogest; Aktivel; Revmelid; Cliogest; Cyclo-Proginova; Ovidon and others.	These drugs are usually found in blisters of 21 tablets or dragees, each of them has its own serial number, according to which they must be taken one at a time. Each of these tablets has its own dose of drugs. Doses are adapted to the natural fluctuations of hormones depending on the phases of the menstrual cycle. After the 21st day, take a break for 7 days, then start a new package. Angelique, Femoston, Pauzogest, Actitvel, Revmelid and Kliogest are available in a package of 28 tablets, some of which are placebo, that is, they do not contain hormones (this is a break). These tablets are taken daily and continuously.
Preparations containing only estrogens	Pills: Estrofem; Estrimax; Premarin; Microfollin; Triaclim; Esterlan.	Menopause replacement therapy drugs containing only estrogens are usually used in cases of hysterectomy. If the uterus is preserved, additional progestins are required, this can be an intrauterine system, cream or patch. Estrogens in tablet form are taken daily without interruption. If menopause has not occurred, then they begin on the 5th day of the menstrual cycle.
	Vaginal suppositories, creams and gels: Ovestin cream; Orniona cream; Ovipol Clio; Colpotrophin; Estriol; Estrocad; Estronorm and others.	Vaginal suppositories, creams and gels containing estrogens are used to treat vaginal atrophy and in the presence of problems with the urinary system associated with menopause. The drugs are administered once a day before bedtime. Start with the maximum dose, then gradually reduce. The course of treatment with local estrogens is usually short, on average 1-3 months. When using them, it is necessary to stop taking estrogen in tablet form.
	Gels and ointments for application to the skin: Estrogel; Divigel; Dermestril; Menorest; Octodiol; Plasters: Klimara; Estraderm; Menostar; Estramone; Alora. Subdermal implants with estrogen	Gel Apply daily once a day to the skin of the abdomen, shoulders and lumbar region (where the fat layer is most pronounced) using a special applicator. If the gel is applied correctly, it is completely absorbed into the skin after 2-3 minutes. 1. Intimate hygiene products for menopause are very important not only for eliminating dryness, but also for the daily prevention of various inflammatory processes of the vagina. There are also quite a lot of them on the shelves of stores and pharmacies. These are gels, panty liners, wipes. A woman in menopause should wash herself at least twice a day, as well as after sexual intercourse. Basic requirements for intimate hygiene products: the product must contain lactic acid, which is normally found in vaginal mucus and determines the acid-base balance; should not contain alkalis and soap solutions; must include antibacterial and anti-inflammatory components; the gel for washing should not contain preservatives, dyes, or aggressive fragrances; the gel should not cause irritation or itching in a woman; Panty liners should not be colored or scented, should not consist of synthetic materials and should not injure the delicate intimate area. 2. Correct selection of underwear: it should be comfortable, not narrow; consist of natural fabrics; should not shed or stain the skin; must always be clean; It should be washed with laundry soap or fragrance-free powder, after which the laundry should be rinsed well. 3. Prevention sexually transmitted diseases : monogamy, use of condoms and chemical methods of contraception (Pharmatex, etc.). Vitamins for menopause During menopause, changes occur in many systems, organs and processes in a woman’s body. A lack of sex hormones always leads to a slowdown in metabolism. Vitamins and microelements are catalysts for many biochemical processes in the body of every person. That is, they accelerate metabolic processes, also participate in the synthesis of their own sex hormones and increase defenses, alleviate the symptoms of menopause, hot flashes and improve the tolerance of hormonal therapy. Therefore, a woman after 30, and especially after 50 years, simply needs to replenish her reserves with useful substances. Yes, many vitamins and microelements come to us with food, they are the most useful and are better absorbed. But in the menopausal period this is not enough, so it is necessary to obtain vitamins in other ways - these are medications and dietary supplements (dietary supplements). In most cases, a woman is prescribed