Traditional medicine

Hormone replacement therapy: who needs HRT and why? Modern pharmacological market of hormone replacement therapy drugs Hormone therapy for women after 40.

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 diseases), osteoporosis (decreased density bone tissue 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 materials below are based on the results of large-scale clinical trial 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. V.I. Kulakova (Moscow).

So, the main postulates of HRT.

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

How long is HRT prescribed? - “As much as needed” 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. Maximum term use of 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.When making the right choice HRT has 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 - more cheap way 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, depressed) if a woman has a sharp increase in weight in the abdominal area - abdominal obesity, increasing weakness and decreased muscle mass, nocturia - “nighttime urge to go to the toilet”, sexual disorders, depression, but no hot flashes and no 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.), sharp increase weight, loss of muscle mass, depression, weakness - there is a lack of both estrogen and testosterone, they are both 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. Question about the possible use of HRT in complex therapy Stress urinary incontinence in menopause must be addressed 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 have genetic analysis on the gene for this cancer! And if the risk of cancer is high, HRT is no longer discussed.

2. Venous thromboembolism in history or currently (deep vein thrombosis, pulmonary embolism) and current or history of arterial thromboembolic disease (eg, angina, 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 instead of 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!

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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 everyday 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
Do you have serious illness liver and liver failure
Your blood triglyceride levels are elevated
You have had deep vein thrombosis in your legs
You have
You have
You have

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 test
General urine test
Measuring triglyceride 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 means in the treatment of symptoms of menopause (vaginal dryness, hot flashes, osteoporosis).

Hormones can be prescribed not only in the form of tablets, but also in the form 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.

Attention: the choice of drug is made only by the attending gynecologist. Self-prescribing any of these medications can be dangerous.

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?

During hormone replacement therapy, there may be side effects. 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 spotting last longer, or appeared 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.

Swelling and increased sensitivity breast problems are also a common side effect of hormonal treatment, but these symptoms go away 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 effective method 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. 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 bloody discharge and irregular uterine bleeding, therefore, 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.

Risk of stone formation in gallbladder(cholelithiasis) is slightly increased among postmenopausal 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 most small dose medicine 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 analysis blood to determine the level of fats (lipids) in the blood, liver function indicators (ALT, AST, bilirubin), general urine test, 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.

Over the years, no one remembers who was the first to come up with hormone replacement therapy (HRT). The German Langerhans, who discovered islets in the pancreas, and our compatriot Sobolev, who established their role in the production of insulin, and the Canadians Banting and Best, who obtained insulin from the bovine pancreas in 1922, also distinguished themselves.

It is probably worth including here the one who was the first to comprehend the simple truth: it is not the symptoms that need to be treated, but the disease. His name is unknown, but his tactics helped his descendants: since there is not enough hormone, let’s add it, and everything will immediately fall into place. That's what they did.

Equivalent replacement

The first “experimental subjects” on whom hormone replacement therapy was tested were patients with diabetes mellitus. Unfortunately, the results of insulin therapy were far from perfect. Of course: the hormone was extracted from the first available animals, the methods of its purification left much to be desired, and the administration regimens required improvement. Only in the 1960-1980s did things start to improve, and on the wave of this success the entire now known hormone rose replacement therapy- treatment aimed at replacing missing hormones in the body.

Dwarfism began to be treated with somatotropin - growth hormone, hypothyroidism - with hormones, Addison's disease - with cortisol and aldosterone. Naturally, this also falls into the category of conditions that can be corrected by HRT.

Not all women take menopause for granted and find it positive aspects(like saving on pads and contraceptives). Most people are seriously concerned about the drop in the level of sex hormones (estrogens and progestins), because it is accompanied by mood swings, hot flashes, thinning of the skin, dry mucous membranes of the vulva and vagina, osteoporosis, loss of interest in sexual activity, and neurocirculatory dystonia. In a word, a whole set of unpleasant symptoms.

Hormone replacement therapy was just right for these ladies. By the end of the 20th century, more than 20 million women in the West were taking hormone medications every day, and for many years they did not want to give them up. So far, inquisitive scientists have not been overcome by doubts: is it really useful to interfere with the body’s hormonal levels and give it a dose of the active substance day after day?

Sayechka for fright!

Large-scale studies at that time showed that HRT cures one thing and cripples another. Women who used sex hormones for more than five years really looked great and felt good, but... It turned out that the use of estrogens increases the likelihood of developing breast and endometrial cancer: estrogens stimulate cell division, including cancer cells. Again, hormone replacement therapy then triples the risk of thrombosis and embolism, including pulmonary embolism.

However, the attempt to link HRT with coronary heart disease, hypertension and liver disease failed miserably.

It turned out that all cases of weight gain due to HRT are associated with a late start of treatment, when obesity has already begun, and precisely from a lack of sex hormones. And American doctors, together with the All-Russian Scientific Society of Cardiology, have proven that hormone replacement therapy, on the contrary, improves survival in women with coronary heart disease. The 10-year survival rate for patients who took hormones was 97% versus 60% for those who never took them. If we talk about the risk of cancer, it has been reduced by using combined estrogen-progestogen drugs.

Today to replace the "heavy" hormonal medications low degree of purification came the latest low-dose products of biochemical technologies and genetic engineering. However, many doctors still remain in the camp of opponents of HRT. And here's why.

The main thing that is alarming about the rosy prospect of mass propaganda of HRT is the dosage. All hormones are present in the blood in negligible quantities; their balance is extremely individual and can change from day to day. You can, of course, study the daily rhythm of the production of a particular hormone in the body, but how to calculate the required individual dose of hormone replacement therapy?

Let's open little secret. Until now, all hormones are prescribed in average doses. That is, by and large, with each medication taken, patients deal a powerful blow to their tissue receptors, which have to adapt, roughly speaking, not react so actively to the stimulus. It’s not hard to guess how it will all end: their sensitivity to hormonal drugs gradually decreases, and then disappears completely.

Expert commentary
I prescribe hormone replacement therapy to menopausal women, but when my patients hear about hormones, they often refuse to take them. So I prefer to make do homeopathic remedies or dietary supplements, the effect of which has been verified experimentally. By the way, I take them myself.
Regarding true hormone replacement therapy, I can say that in all my many years of practice I have observed only three cases of complications. These were edema and exacerbation of hypertension.
Zubanova I.V., gynecologist

Another disadvantage: the hormone introduced from outside suppresses the work of the gland that normally synthesizes it. The principle of negative feedback. While a foreign hormone circulates in the blood, practically no own hormone is produced - the gland rests, without receiving an order from above (from the hypothalamus and pituitary gland). If the replacement treatment lasts for a long time, she loses her skills altogether, and her abilities do not return when HRT is stopped.

What to do? The answer lies in competent tactics for treating hormone deficiency:

There is no need to rush to switch to hormonal therapy. Let's remember the basics of endocrinology: failure thyroid gland First they try to cure it with iodine preparations, and to stimulate the work of the ovaries - with various physical procedures. And only if all these methods are ineffective should one resort to hormones as a last resort.
If you can do without HRT, then it is better to do without it. For example, during menopause, hormones are prescribed for osteoporosis and severe menopausal disorders if they cause anxiety to the patient. Contraindications to hormone replacement therapy: malignant tumors, liver or kidney failure, acute thromboembolic diseases
Choose the right medicine. Modern drugs for HRT are divided into herbal hormone-like agents, bioidentical hormones and synthetic analogues natural hormones. The first ones are good from a psychological point of view, because a clear prejudice has formed against hormones, and a rare patient is eager to take them. Synthetic hormones have a rapid and powerful action, but their structure is slightly different from the natural hormones of our body, therefore the production of our own hormones is more actively suppressed. The golden mean is bioidentical hormones.
Choose the optimal route of drug administration. For gastritis, ulcers and other diseases of the upper sections gastrointestinal tract Swallowing HRT tablets is not recommended. Instead, you can give injections, glue hormonal patches and throw special quickly dissolving tablets under the tongue.
Stop in time. You don't have to take hormones your whole life. Practice shows that 2-3 years are enough to relieve menopausal disorders; after stopping the drug, hot flashes and other “delights” of menopause are unlikely to return. Lifelong prescription of hormones is justified only in cases where a woman has had one or both ovaries removed.

HRT against age

IN lately A new direction has appeared in medicine - anti-aging. Having seen enough of the vigorous Western women of Balzac’s age, ours decided not to lag behind and also took up the task of rejuvenating the body.

Expert commentary
Negative attitudes towards hormone replacement therapy are a relic of the past. It remains from the times when endocrinologists, through trial and error, worked out the optimal methods, regimens and dosages of use. hormonal drugs.
Modern endocrinology has in its arsenal the best drugs and a minimum of side effects, which fully corresponds to the main commandment of the doctor: “Do no harm.” Another 10-15 years will pass, and the use of anti-aging therapy methods will become as natural as taking a shower and brushing your teeth.
As experience shows, not a single person who has set out on the path of comprehensive rejuvenation has given up on their intentions.
Sahakyan Zh.M., Ph.D., chief physician Institute of Binary Rejuvenation

Oddly enough, the notorious hormone replacement therapy plays an important role in the fight against aging. However, it has a very distant resemblance to classical HRT.

Here the doctor’s task is to help the patient restore hormonal balance, and with it strength, good appearance and, of course, well-being. Therefore, hormone doses are minimal. They do not treat, but stabilize hormonal levels, bringing their numbers to the upper limit of the corresponding age norm. Doses are not taken out of thin air, but are calculated individually, based on the results of a comprehensive examination of the patient.

The optimal time to prescribe anti-aging therapy is 5 years before the onset of menopause. It is used at the request of the patients, and it can last as long as desired.

However, the first signs of aging are fought not only with hormones. Important role play lifestyle, proper nutrition with individually selected vitamin therapy, physical exercise and, of course, giving up bad habits.

By the way, if you are thinking about how to preserve youth from a young age, do not neglect general recommendations for improving your health, and you may not need any hormone therapy.

Discussion

In general, I'm not particularly in favor of HRT. I know for sure that you can get rid of symptoms with the help of dietary supplements, but when it comes to... unpleasant sensations in the vagina, then you need to act immediately and take suppositories with estriol.

HRT to maintain youth is certainly a great breakthrough in modern medicine, but the pleasure is not cheap and there is a health risk, and a considerable one. there are much safer and less expensive methods of restoring health and beauty after 40 - taking phytoestrogens for normalization hormonal levels(qi-klim, for example)

Hello, a friend of mine was treated for infertility at the Altravita clinic and was prescribed hormonal drugs to stimulate ovulation. She got pregnant and gave birth - that's a plus! But there are questions about how hormones can affect her health in the future?

When I began to understand that the onset of this period was close, I began to feel depressed. A year later, I already felt the first signs (I’m 42 now). I have heard a lot about all sorts of manifestations of menopause - pressure, hot flashes, mood, etc. A work colleague shared everything. She also advised me on a drug that she used herself - Menopace. She is more experienced in this matter than me - she decided to try it. But I said that I wouldn’t take the hormonal drug. She assured me that it consists of a vitamin-mineral complex. And she was right. Now this period is in full swing for me, but there was no particular discomfort due to the drug. I'm saving myself by menopace

12/10/2015 12:06:48, Valeria 772

Little by little, nature took over for me. I already feel some symptoms of menopause. I found salvation for myself and take Menopace - it is not a hormonal drug and you can start drinking it regardless of your cycle. I had little faith in him, but it really helps. Not quickly, but the hot flashes went away after about 3 weeks of use and my mood appeared and my strength increased, but this is not a hormonal drug. I really like it, only they can tell me and I’m saved. I’ve read all sorts of things - I don’t want to take hormonal medications, at least until the doctor prescribes them.

Hello! Help me decide, 3.5 years ago the uterus (fibroids) was removed, menopause symptoms began 1.5 years ago (hot flashes, weakness, dry skin, hair loss) Estrogel was prescribed 1.5 g per day. I've been using it for about 1 year. Please tell me, is it possible in my case to get by with phytohormones, or am I at risk at my age (I’m 41 years old) of getting a bunch of health problems due to the lack of estrogens, and should I take them for some more time? Thank you.

What is absolutely true about hormone replacement therapy! It is she who will help us women get through this difficult period easier. Good medicine will relieve all symptoms of menopause and ensure its prevention severe consequences. I have been taking the German drug “Angelique” for two years now. I feel great. Although I was terribly afraid of hormones... All fears were due to lack of information. It is very important to find a good doctor who will conduct an examination and select exactly what you need.

08/21/2009 03:35:24, Larisa55

For European women, hormone replacement therapy (HRT) during menopause is common.

Our attitude towards her is one of fear and mistrust.
Are we right? Or are the stereotypes outdated?

According to statistics, hormone replacement therapy is used by 55% of English women, 25% of German women, 12% of French women over 45 years of age and... less than 1% of Russian women. It’s a paradox: our women are afraid of HRT drugs, which are identical to their own hormones, they call them “chemistry”, but they calmly take antibiotics - a real foreign chemical. We fearlessly take hormonal contraceptives to avoid unwanted pregnancy, and refuse HRT, which helps, at least, delay unwanted old age. Maybe because we don’t fully understand what we are losing?

Almighty

The imbalance of sex hormones, which increases after 40 years, is not only a gynecological problem. In fact, they rule our lives. “The name “sex hormones” is very arbitrary,” says gynecologist-endocrinologist Sergei Apetov. – They not only affect the reproductive organs, but also perform huge amount functions in the body: monitor cholesterol levels, blood pressure, carbohydrate metabolism, behind the function bladder, calcium content in bones. They also help overcome depression, stimulate libido and give joy to life.”

Hormone replacement therapy is designed to support all this. But hormone phobia is firmly rooted in the minds of our women. “On forums, ladies scare each other with horror stories about HRT, which makes them fat, covered with hair, and even gets cancer. In fact, everything that people are so afraid of happens without hormones: hypertension, diabetes, osteoporosis, heart attack, obesity and even hair growth,” says Professor Kalinchenko.

When to start hormone replacement therapy?

If menstruation has stopped, it means there is no estrogen. This is where, most women are sure, old age sets in. And they are deeply mistaken. Aging begins much earlier, when the amount of estrogen just begins to slide down. Then the first SOS signal enters the pituitary gland, and it reacts by increasing the production of the hormone FSH (follicle-stimulating hormone). This is the first warning: the aging program is set in motion.

That's why From the age of 35, it makes sense for every woman to monitor her FSH level once every six months. If it starts to rise, it means it’s time to make up for the estrogen deficiency. And not only them. « It would be more correct to talk about polyhormonal therapy,” says Leonid Vorslov. “With age, the amount of almost all hormones decreases, and all of them need to be supported.”

Over the years, the level of only two hormones increases: leptin, the hormone adipose tissue, and insulin, which leads to type 2 diabetes. If estrogen and testosterone are maintained at normal levels using hormone replacement therapy, leptin and insulin will stop increasing, which means the risk of obesity, diabetes, atherosclerosis and other diseases will disappear. “The main thing is to start treatment on time,” continues Professor Vorslov. “As soon as a blood test detects an increase in FSH, we can safely say that the amount of estrogen is steadily decreasing and atherosclerosis is secretly beginning to develop.”

But the problem is that the FSH normal range is huge, and it is different for each woman. Ideally, you need to take blood tests for hormones and biochemistry during your peak period – from 19 to 23 years old. This will be your individual ideal norm. And starting from the age of 45, check the results with it annually. But even if you are hearing about FSH for the first time, it’s better late than never: at 30, 35, 40 years old, it makes sense to find out your hormonal status to get closer to critical age there was something to focus on.

Professor Vorslov assures: “If you prescribe hormone replacement therapy when the first harbingers of menopause only appear, then you can prevent osteoporosis, coronary heart disease, hypertension, atherosclerosis, and many other diseases that accompany aging. HRT is not an elixir of immortality; it will not give you extra years of life, but it will greatly improve your quality of life.».

Analysis without analysis

Estrogen levels have decreased if:

the cycle has gone wrong
papillomas appeared,
dry skin and mucous membranes,
pressure rises
there is atherosclerosis.

Testosterone levels have decreased if:

decreased sexual desire,
lost self-confidence
overweight not amenable to diets,
the inside of the shoulders has become flabby,
familiar physical activity seem too heavy.

Men's protection

For a woman, not only estrogens are important, but also testosterone - the male sex hormone that is produced in the adrenal glands. Of course, we have less of it than men, but libido, insulin levels, general tone and activity depend on testosterone.

During the postmenopausal period, when estrogens and gestagens disappear, it is testosterone that will support the cardiovascular system for some time. Those whose levels of this hormone are initially high will more easily endure menopausal syndrome., since testosterone is responsible for our activity and resistance to emotional stress.

It also protects us from age-related bone fragility: the density of the periosteum depends on testosterone. This is why in the West doctors prescribe women not only estrogen-progestin HRT, but also testosterone. Testosterone patches for women have been certified since 2006. And in the near future, European pharmacists promise to create a comprehensive HRT: one tablet will contain progestogen, estrogen, and testosterone.

What frightens many women much more than future fractures is the excess weight they gain after menopause. Moreover, at this age we become fat like an “apple”, that is, instead of having curvaceous, but feminine forms, we acquire an ugly belly. Testosterone will also help here: without it, it is impossible to resist the accumulation of fat.

2 facts about testosterone

IT RESTORES LIBIDO. A deficiency of this hormone can occur when taking certain hormonal contraceptives, particularly those that increase levels of testosterone binding protein. A vicious circle is formed: the woman takes pills in order to maintain a healthy sex life, and as a result does not feel any desire. It may help in this situation additional dose testosterone.

WE ARE AFRAID OF HIM BY INERTIA. In the 50s and 60s of the last century, Soviet doctors prescribed testosterone for uterine fibroids, endometriosis and menopause. The mistake was that women were prescribed the same dosages as men - this actually caused unwanted hair growth and other side effects. Testosterone in the correct doses will bring nothing but benefits.

Be careful, the doors are closing

For different ages dosages of hormones vary: there are drugs for women under 45 years old, from 45 to 50, from 51 and older. During perimenopause (before menopause) it is prescribed high doses, then they are gradually reduced.

Unfortunately, you may be late to jump into the last carriage of the departing train. If, for example, atherosclerosis has already developed, then it has managed to close the estrogen receptors, and no dose of the hormone will make them act. That is why it is so important to start taking sex hormones as early as possible, even if the menopausal syndrome is not yet pressing: you do not suffer from hot flashes, bouts of sweating, insomnia, irritability, hypertension.

There is a term “therapeutic window”. After 65 years, hormone therapy, as a rule, is not prescribed: sex hormones will no longer be able to properly engage in the functioning of the human mechanism. But if hormone replacement therapy is started on time, it can be continued as long as the heart beats. If there are no contraindications.

Hormones and beauty

Anna Bushueva, dermatocosmetologist at the Department of Therapeutic Cosmetology at the Professor Kalinchenko Clinic:
– Any hormonal changes affect the condition of the skin. Cosmetic procedures themselves are effective only up to 40 years of age. After this injection hyaluronic acid, botulinum toxin, peelings are only half the battle; first of all, you need to normalize your hormonal status.

When they do circular lift, excess tissue is cut off, but the quality of the leather remains the same. If there is no estrogen, the skin will be dry, dehydrated, without the proper amount of collagen and elastin. Wrinkles will appear again and again. If you replace estrogen levels with hormone replacement therapy, the emerging wrinkles will not disappear, but will stop getting deeper. And the weight will not increase.

A decrease in testosterone leads to a decrease in muscle mass - the buttocks become flattened, the cheeks and skin sag inner surface shoulders This can be avoided by including testosterone preparations in the HRT course.

Contraindications to hormone replacement therapy

As an experiment, let's go to a commercial diagnostic center. In response to a fairy tale about hot flashes, insomnia, and disappeared libido, the doctor gives a huge list of tests, including complete blood biochemistry, all hormones, pelvic ultrasound, mammography and fluorography. “Does HRT really require a total examination?” – I am surprised, calculating how much eternal youth will cost. “We must exclude all contraindications! What if you have an ovarian cyst or endometriosis? Or is there a problem with the liver? After all, hormones “shut down” the liver. And keep in mind that during hormone replacement therapy you will have to donate blood for hormones and do an ultrasound scan, first every three months, and then every six months!”

After listening to all this, I lost heart. Goodbye youth. To take hormones, you must have the health of an astronaut...

“Don’t be scared,” reassures gynecologist-endocrinologist Sergei Apetov. – Many medical centers really force you to take a lot of unnecessary tests before HRT. This is a relatively honest way of withdrawing money from the population. In fact, the list of contraindications and examinations is much shorter.”

*Two main contraindications to hormone replacement therapy are a history of breast or uterine cancer. Any non-hormone-dependent tumors, including cervical or ovarian cancer, are not a contraindication to HRT. Vice versa, latest research suggest that HRT itself is capable of preventing the development of certain neoplasms (in particular, skin ones).

* With regard to ovarian cysts, it matters what hormones it depends on. If not from sex hormones, but from pituitary hormones, then there are no obstacles to prescribing HRT. By the way, cysts form when the pituitary gland produces large number the already mentioned hormone FSH, and they are just hinting: it’s time to start HRT.

* Fibroids and endometriosis are in most cases compatible with hormone replacement therapy.“Cases where uterine fibroids grew during HRT are extremely rare,” says Sergey Apetov. “It is important to understand that the doses of sex hormones in modern drugs are hundreds of times less than in hormonal contraceptives, which everyone takes indiscriminately.”

* Contraindications may include diseases associated with increased thrombus formation. Most often they are hereditary. “Such women should be prescribed HRT with caution, in small doses, under strict control doctor,” says Leonid Vorslov. “It is necessary to take measures to prevent new blood clots and do everything possible to resolve old ones.”

* If a woman has suffered a real myocardial infarction (one that occurred due to coronary disease heart), which means that the time for HRT, alas, is lost. “A heart attack at a relatively young age suggests that the woman has long had estrogen deficiency and caused the development of atherosclerosis,” explains Professor Vorslov. “But even in this case, there is a chance to start treatment with small doses of estrogen.”

* Fibroadenoma ( benign tumor mammary gland) against the background of doses of estrogen can turn into cancer. Therefore, if it is present, the doctor decides on prescribing HRT individually.

It's not all that scary

In many ways, hormone phobia was generated by a well-known study by American scientists conducted in the 80s of the twentieth century. It showed that hormones can be taken for no more than 5 years, since beyond this period treatment is fraught with stroke, breast and uterine cancer.

“Don’t panic,” reassures Leonid Vorslov. – The results of this study were seriously criticized by scientists in other countries. Firstly, in those years, HRT, unlike modern ones, was not safe for the heart and blood vessels. Secondly, the program included only women over 60 years of age, 25% of whom were over 70 years of age. Moreover, everyone was given the drugs in the same doses, which in itself is a big mistake!”

So what about the tests?

* Mammography, ultrasound of the uterus and ovaries always required.

* It is important to check blood for clotting and glucose levels to avoid diabetes.

* If you are overweight, you should find out what is causing it. Perhaps thyroid dysfunction causes increased production of prolactin, which leads to obesity? Or maybe it's the fault increased activity the adrenal cortex, where hormones are produced that are responsible for the accumulation of fat?

* There is no need to check the liver unless, of course, you have complaints. “Statements that these drugs damage the liver are unproven,” says Sergei Apetov. “There is not a single study on this topic.”

After HRT is prescribed, it is enough to be examined once a year. Also, when starting therapy, it is very important to remember: hormones are not wand. The effect may be reduced due to poor nutrition. Today everyone knows what proper nutrition is: a lot of vegetables and fruits, lean meat, fish several times a week, plus vegetable oil, nuts and seeds.

How do estrogens affect blood vessels?

All arterial vessels lined internally with a thin layer of endothelial cells. Their task is to expand or narrow the vessel in a timely manner, as well as protect it from cholesterol and blood clots. The endothelium depends on estrogens: if it is suddenly damaged, estrogens help it recover. When there are few of them, endothelial cells do not have time to recover. Vessels “age”: they lose elasticity and become overgrown cholesterol plaques, narrow. And since the vessels cover all organs, it turns out that estrogens affect the functioning of the heart, kidneys, liver, lungs... Estrogen receptors are found in all cells of a woman’s body.

Will herbs help?

Recently, phytohormones have been actively promoted as the best and safest remedy against menopausal syndrome. And many gynecologists advise drinking dietary supplements with phytoestrogens during perimenopause.

Plant hormone-like substances really work and help cope with hot flashes, insomnia, and irritability. But few people know that against their background, endometrial hyperplasia (proliferation of the inner layer of the uterus) is more common. This property of estrogen and estrogen-like substances in standard HRT is compensated by gestagen - it does not allow the endometrium to grow. Exclusively estrogen (without gestagen) is prescribed to women if the uterus has been removed. Is it true, latest research show the beneficial effect of gestagen on the central nervous system, and on the mammary glands - it prevents the development of neoplasms. Unfortunately, unlike real estrogens, phytoanalogues have no effect on metabolism, calcium absorption, or the condition of blood vessels.

Plant hormones are a compromise and salvation for those for whom real HRT is contraindicated. But doctor's supervision and regular examinations are also necessary.

Conclusions

Hormone replacement therapy- not at all for pensioners. The sooner you understand your ideal hormone harmony, the longer, healthier and more beautiful you will live.
Hormonophobia is an ancient horror story. There are fewer contraindications to HRT than we used to think. There is no reason for fear if there is a qualified doctor.
HRT will only be truly effective if you eat right and healthy image life.

At the age of 50, women begin menopause. For some of them it happens a little earlier or later. During this period, doctors often prescribe hormone replacement therapy for women after 50 years, the drugs are aimed at normalizing dysfunctional processes in the body. Hormonal imbalance may negatively affect the condition of the skeletal system, musculoskeletal system, and nervous functionality.

Who is suitable for hormone replacement therapy (HRT)

In women, the state of sex hormones is regulated by the work of the ovaries. After the age of 50-55, polycystic ovary syndrome often appears, as a result of which the production of hormones is disrupted. Therefore, hormone therapy is recommended for women:

With increased level testosterone (male hormone);
with increased estrogen levels;
after removal of the uterus and appendages;
With clear signs menopause (frequent hot flashes, sweating, depressive state, mood swings);
with sensation and prolapse of the uterus.

During the menopausal period, problems with functioning may occur. endocrine organs. The functioning of the thyroid gland directly depends on the body's hormonal system. If it fails, hypothyroidism or hyperthyroidism may occur. In this case, drug replacement therapy is also indicated.

After 40 years, women should listen especially carefully to their bodies. Menopause can begin before 50 years of age. This is influenced by heredity. Therefore, it is important to undergo an examination by a gynecologist.

Hormone replacement therapy tablets

Before prescribing a certain drug, it is necessary to take tests to determine the level of hormones in the blood. To do this, a sample is taken from a vein in a laboratory setting.

During menopause there is often a lack of female hormone estrogen. Therefore, therapy is aimed at replenishing it. Common medications include:

Klimonorm — modern drug, the action of which is aimed at normalizing hormone levels. Tablets can reduce symptoms such as frequent mood swings, hot flashes, and severe sweating.

The regimen for taking Klimonorm during menopause begins any day. Please note that you should not skip taking a pill. One of the most common side effects are vaginal discharge.

Femoston is an effective tablet during menopause and after menopause. Basic active ingredients estradiol and dydrogesterone. The drug is indicated for women with reduced level estrogen. Normalizes general condition skeletal system, helps patients with osteoporosis.
Angelique is an anti-climatic drug. Helps improve the condition by eliminating penopausal symptoms. The tablets have a number of side effects. Therefore, before use, you should consult with qualified specialist.

There are a number of drugs containing gestagens. These include Norkolut, Duphaston, Livial. They help cope with menopause in women after 40 years of age.

In addition to synthetic hormonal pills there are drugs plant origin. For example, Hormoplex.

Regimen for taking hormonal drugs after 50-60 years

You should take HRT only after consulting a qualified specialist. He will suggest the optimal regimen for use. The standard option is to take monophasic tablets with gestagens or endrogens. Such drugs can be used to suppress unpleasant symptoms for 6-9 months. In some cases, a long-term regimen of more than 3-5 years is required.

Often, gestagen-endrogen drugs with a combined effect or two or three-phase tablets with a combination of androgens and androgens are prescribed. The dosage regimen depends on the severity of symptoms and concomitant diseases.

If you have surgery, hysterectomy, or endometriosis, your doctor may prescribe several medications. Therefore, it is important to comply with all regulations.

Contraindications for taking hormone replacement therapy

Before taking any medication or hormone replacement therapy for women over 50, you should consult with a qualified healthcare professional. Especially when it comes to hormonal drugs.

For them effective action a long-term plan is needed. Therefore, drugs can cause the following side effects:

increase venous network and thrombosis;
headaches;
weight gain with long-term use;
increased appetite;
engorgement of the mammary glands.

Modern drugs cause minimal side effects. But they are possible, especially in women after 50 years.

The main contraindications for hormone therapy are:

diabetes mellitus;
thrombosis and venous diseases;
malignant formations;
obesity.

It's important to pass full diagnostics body by taking tests for TSH and FSH, general indicators blood and urine. Only after this can you assign conservative therapy, which will help relieve symptoms and will suit individual parameters.