Hormone therapy pros and cons. Means for hormone replacement therapy during menopause

Hormone replacement therapy (HRT) is used to balance the levels of estrogen and progesterone in a woman's body during menopause.

HRT is also called hormone therapy or menopausal hormone therapy. This type of treatment eliminates, and other symptoms characteristic of menopause. HRT may also reduce the risk of developing osteoporosis.

Hormone replacement is also used in male hormone therapy and in the treatment of individuals who have undergone sex reassignment surgery.

As part of this article, we will focus on studying information about hormone replacement therapy used to relieve symptoms in women during.

Fast Facts About Hormone Replacement Therapy

1. Hormone replacement therapy is an effective way to get rid of symptoms and menopause.
2. This type of treatment can reduce the intensity of hot flashes and reduce the risk of osteoporosis.
3. Studies have found a link between HRT and cancer, but this link has not been fully explored at this time.
4. HRT can rejuvenate the skin, but it cannot reverse or slow down the aging process.
5. If a woman is considering using hormone replacement therapy, she should first discuss it with a doctor who is intimately familiar with her medical history.

Benefits of hormone replacement therapy

Menopause can be uncomfortable for a woman and increase health risks, but hormone replacement therapy usually relieves menopausal symptoms and reduces its harmful effects.

Progesterone and estrogen are two important hormones for the female reproductive system.

Estrogen stimulates the release of eggs, and progesterone prepares the uterus for the implantation of one of them.

As the body ages, the number of released eggs naturally decreases.

Along with the decrease in egg production, the volume of estrogen excretion also decreases.

Most women begin to observe these changes in themselves in the second half of the forties. During this period, menopause begins to manifest itself with hot flashes, or other problems.

perimenopause

For some time, women are still observed, although changes are already taking place. This period is called perimenopause, and its duration can be from three to ten years. On average, perimenopause lasts four years.

Menopause

When perimenopause ends, menopause begins. The average age at which this phenomenon is observed in women is 51 years.

Postmenopause

After 12 months from the time of the last menstruation, a woman enters a period. Symptoms usually last another two to five years, but it can last ten years or more.

Women also have an increased risk of osteoporosis after menopause.

Besides the natural aging process, menopause is also brought about with the removal of both ovaries and cancer treatment.

Smoking also speeds up the onset of menopause.

Consequences of menopause

Changes in hormonal levels can cause severe discomfort and increase health risks.

The effects of menopause include:

• dryness of the vagina;
• decreased bone density or osteoporosis;
• problems with urination;
• hair loss;
• sleep disorders;
• hot flashes and night sweats;
• psychological depression;
• reduced fertility;
• difficulty concentrating and memory;
• breast reduction and accumulation of fat deposits in the abdominal region.

Hormone replacement therapy can reduce or eliminate these symptoms.

Hormone replacement therapy and cancer

Hormone replacement therapy is used to relieve the symptoms of menopause, protect against osteoporosis and diseases of the cardiovascular system.

However, the benefits of this type of treatment were called into question after two studies, the results of which were published in 2002 and 2003. It turned out that HRT is associated with endometrial, breast and ovarian cancer.

This has led many people to stop using this type of treatment, and it is now less widely practiced.

Further studies of this issue called into question the above studies. Critics point out that their results were not unambiguous, and because different combinations of hormones can have different effects, the results did not fully show how dangerous or how safe HRT can be.

In the case of breast cancer, the combination of progesterone and estrogen causes one case per thousand women per year.

More recent research has shown that the benefits of hormone replacement therapy may outweigh the risks, but so far there is no certainty in this regard.

Other studies suggest that hormone replacement therapy is able to:

• improve muscle function;
• reduce the risk of heart failure and heart attacks;
• reduce mortality in young postmenopausal women;
• show efficacy in preventing skin aging in some women and when used with caution.

Currently, it is believed that HRT is not as dangerous for women as previously discussed. The considered type of therapy in many developed countries is officially approved for the treatment of menopausal symptoms, the prevention or treatment of osteoporosis.

However, every woman who is considering using hormone replacement therapy should make such a decision carefully and only after talking with a doctor who understands the individual risks.

More data is needed to understand the association between HRT and cancer, and research is ongoing.

It is important to understand that human aging is a natural process. If hormone replacement therapy is able to protect a woman from some age-related changes, then it cannot prevent aging.

Who should not use HRT?

HRT should not be used in the treatment of women who have a history of:

• uncontrolled hypertension or high blood pressure;
• heavy;
• thrombosis;
• stroke
• heart disease;
• endometrial, ovarian, or breast cancer.

It is now believed that the risk of developing breast cancer increases if hormone replacement therapy is used for more than five years. The risk of stroke and blood clotting problems is not considered high for women aged 50 to 59.

This type of treatment should not be used by women who are pregnant or may become pregnant.

One of the most common misconceptions about hormone replacement therapy is that it causes weight gain. Women often gain weight around menopause, but studies have shown that HRT is not necessarily the cause.

Other possible causes of weight gain are reduced physical activity, redistribution of body fat due to changes in hormonal levels, and increased appetite as a result of falling estrogen levels.

A healthy diet and regular exercise will help keep you in shape.

Types of HRT used in menopause

Hormone replacement therapy is done with pills, patches, creams, or vaginal rings.

HRT involves the use of various combinations of hormones and the intake of various forms of the corresponding drugs.

• Estrogen HRT. It is used for women who do not need progesterone after they have had a hysterectomy where their uterus or uterus and ovaries have been removed.

• Cyclic HRT. It can be used by women who are menstruating and have perimenopausal symptoms. Usually such cycles are carried out monthly with the intake of portions of estrogen and progesterone, which are prescribed at the end of the menstrual cycle for 14 days. Or it could be daily doses of estrogen and progesterone for 14 days every 13 weeks.

• Long-term HRT. Used during postmenopause. The patient has been taking doses of estrogen and progesterone for a long time.

• Local estrogenic HRT. Includes the use of pills, creams and rings. It can help in solving urogenital problems, reduce vaginal dryness and irritation.

How does a patient go through the process of hormone replacement therapy?

The doctor prescribes the smallest possible doses to treat the symptoms. Their quantitative content can be found by trial and error.

Ways to take HRT include:

• creams and gels;
• vaginal rings;
• tablets;
• skin applications (plasters).

When treatment is no longer required, the patient gradually stops taking doses.

Alternatives to Hormone Replacement Therapy

Alternative methods for reducing menopausal symptoms include using a ventilator

Women going through perimenopause can use alternative methods to reduce their symptoms.

These include:

• reducing the amount of caffeine, alcohol and spicy foods consumed;
• to give up smoking;
• regular exercise;
• wearing loose clothing;
• sleep in a well-ventilated, cool room;
• using a fan, applying cooling gels and cooling pads.

Some SSRI antidepressants (SSRIs) selective serotonin reuptake inhibitors) help relieve hot flashes. Antihypertensive drugs, clonidine, can also help in this regard.

Ginseng, black cohosh, red clover, soybeans, and intoxicating pepper are believed to be effective for menopausal symptoms. At the same time, reputable health organizations do not recommend regular treatment with herbs or supplements, since no research has established their benefit.

Hormone replacement therapy is an effective treatment for excessive sweating and hot flashes, but before practicing HRT, you should discuss its safety with your doctor.

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

“This must be endured, it happens to everyone, they don’t die from this,” our mothers and grandmothers assure, and, unfortunately, many gynecologists.

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

Why are our compatriots so afraid of hormone replacement therapy (HRT) during menopause, and abroad, women during menopause without fail turn to doctors for help to prescribe a hormonal drug that will help them survive the menopause?

Let's talk about this on the women's website "Beautiful and Successful".

How does the climax come?

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

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

After this age, hormonal changes continue to occur in a woman's body, and she always feels all the delights of menopause. Is it worth it to endure all these years of ebb and flow, depression and headaches, if hormone therapy can help? And what about women with?

Why does menopause have so many symptoms?

The work of the mammary glands, genitals, brain, cardiovascular system, the condition of the skin and hair, the work of the liver, large intestine and genitourinary system depends on estrogen - the female sex hormone. The lack of this hormone, which is observed during menopause, immediately affects all systems in the body.

There are more than 30 symptoms that a woman faces due to menopause after 40 years.

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

Why are women afraid of HRT?

In our country, there is a "general hormonophobia". Physicians often prescribe hormones for early menopause or after surgery, but, having no experience in using these drugs during menopause, refuse to use them. Many of our compatriots are afraid of hormones, believing that they:

1. Solid chemistry;
2. Contrary to feminine nature and cause cancer;
3. From them grow stout and become masculine;
4. Affect the liver and stomach;
5. cause addiction;

So it turns out mutual responsibility: doctors do not prescribe - women endure. But why be afraid of what has been practiced abroad for several decades?

How does HRT work?

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

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

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

The principle of action of HRT drugs during menopause is quite simple - the body is given a certain dose of hormones so that this deficiency is not felt. That is, the body receives what nature has taken from it. The new generation of drugs do an excellent job with this. It is only necessary to prescribe the drug in a timely manner after the mandatory diagnosis.

When should you start taking hormones?

It is better to prescribe hormone therapy as soon as the lack of estrogen begins, so you need to go for diagnostics at 40-45 years old - at the beginning of the pre-menopausal period.

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

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

Is it possible to do without hormonal drugs?

Recall that the main task of hormone therapy is to alleviate the condition of a woman with menopause. Therefore, you can not take hormones, but start fighting each symptom of menopause separately: take headache medications, antidepressants, drugs to improve the functioning of the gastrointestinal tract, antipyretics during hot flashes - for osteoporosis, drugs for pressure, etc. Note that such therapy is also effective, but in comparison with hormonal it is:

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

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

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

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

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

New generation HRT drugs

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

• HRT preparations have come a long way of testing and research. We can consider that we are lucky - only new generation drugs that can only be produced by serious pharmacological campaigns get on our counter.
• Replacement hormonal preparations of the modern generation are completely natural - they have a composition of hormones identical to those produced by the female body.
• The dosage of hormones in the preparation is minimal. Addiction to hormonal drugs does not occur. This is just a tool that helps a woman survive hormonal changes. After discussing with your doctor, you can stop taking the drugs at any time.
• During menopause, the body does not stop producing male hormones. Natural estrogens, which are the main composition of all HRT preparations, are female. It is their production that stops during menopause. The intake of female hormones neutralizes the action of male hormones: it stops hair growth in unnecessary places, allows you to maintain female shapes and proportions, improves skin condition, and prevents snoring.
• Hormones that are part of HRT do not lead to obesity. On the contrary, they stop the production of estrogen in adipose tissue. It is not HRT that leads to obesity during menopause, but age-related prerequisites for this: physical activity decreases, metabolism slows down.
• Many are afraid to take HRT, believing that they have a bad effect on the gastrointestinal tract. Modern hormonal drugs do not affect the gastrointestinal tract in any way, and for those who are very afraid for their stomach, alternative forms of the drug have been released - patches, gels, ointments and suppositories that are absorbed through the skin.
• The composition of HRT includes components that prevent cancer, and do not provoke them. The hormonal cause of oncological diseases due to the use of HRT has not been proven.

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

The best HRT drugs

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

• We met good reviews about the preparations "Femoston", "Angelik", "Atarax", "Grandaxin", "Sigetin", etc.

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

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

Hormone replacement therapy for menopause plays an important role in regulating the pathological changes that occur in the female body during this critical period.

Despite the existence of a number of myths about the great danger of such an event, numerous reviews suggest otherwise.

What hormones are missing?

The result of the development of menopause is a sharp decrease in the ability of the ovaries to produce progesterone, and subsequently estrogen due to the degenerative shutdown of the follicular mechanism and changes in the brain nerve tissues. Against this background, the sensitivity of the hypothalamus to these hormones decreases, which leads to a decrease in the production of gonadotropin (GnRg).

The response is an increase in the work of the pituitary gland in terms of the production of luteinizing (LH) and follicle-stimulating (FSH) hormones, which are designed to stimulate the production of lost hormones. Due to excessive activation of the pituitary gland, the hormonal balance is stabilized for a certain period of time. Then, the lack of estrogen affects, and the functions of the pituitary gland gradually slow down.

Decreased production of LH and FSH leads to a decrease in the amount of GnRh. The ovaries slow down the production of sex hormones (progestins, estrogens and androgens), up to the complete cessation of their production. It is a sharp decrease in these hormones that leads to menopausal changes in the female body..

Read about the norm of FSH and LH during menopause.

What is hormone replacement therapy

Hormone replacement therapy for menopause (HRT) is a treatment that introduces drugs similar to sex hormones, the secretion of which is slowed down. The female body recognizes these substances as natural, and continues to function normally. This ensures the necessary hormonal balance.

The mechanism of action of drugs is determined by the composition, which can be based on real (animal), plant (phytohormones) or artificial (synthesized) ingredients. The composition may contain hormones of only one specific type or a combination of several hormones.

In a number of products, estradiol valerate is used as an active substance, which in a woman's body turns into natural estradiol, which exactly imitates estrogen. Combined options are more common, where in addition to the indicated ingredient, progestogen-forming components are contained - dydrogesterone or levonorgestrel. There are also drugs with a combination of estrogens and androgens.

The combined composition of the new generation of drugs helped to reduce the risk of tumor formations that may occur due to an excess of estrogens. The progestogen component reduces the aggressiveness of estrogen hormones, making their effect on the body more gentle.

There are 2 main treatment regimens for hormone replacement therapy:

1. Short term treatment. Its course is designed for 1.5-2.5 years and is prescribed for a mild menopause, without obvious failures in the female body.
2. Long term treatment. With the manifestation of pronounced violations, incl. in the organs of internal secretion, cardiovascular system or psycho-emotional nature, the duration of therapy can reach 10-12 years.

Indications for the appointment of HRT may be such circumstances:

1. Any phase of menopause. The following tasks are set - premenopause - normalization of the menstrual cycle; menopause - symptomatic treatment and reduced risk of complications; postmenopause - the maximum relief of the condition and the exclusion of neoplasms.
2. Premature menopause. Treatment is needed to stop the inhibition of reproductive female functions.
3. After surgical procedures associated with the removal of the ovaries. HRT helps maintain hormonal balance, which prevents sudden changes in the body.
4. Prevention of age-related disorders and pathologies.
5. Sometimes used as a contraceptive measure.

Points for and against

There are many myths around HRT that frighten women, which sometimes causes them to be skeptical about such treatment. To make the right decision, you need to deal with the real arguments of opponents and supporters of the method.

Hormone replacement therapy provides a gradual adaptation of the female body to the transition to other conditions, which avoids serious disturbances in the functioning of a number of internal organs and systems .

In favor of HRT, speaking such positive effects:

1. Normalization of the psycho-emotional background, incl. elimination of panic attacks, mood swings and insomnia.
2. Improving the functioning of the urinary system.
3. Inhibition of destructive processes in bone tissues due to the preservation of calcium.
4. Prolongation of the sexual period as a result of increased libido.
5. Normalization of lipid metabolism, which reduces cholesterol. This factor reduces the risk of atherosclerosis.
6. Protection of the vagina from atrophy, which ensures the normal condition of the penis.
7. Significant relief of menopausal syndrome, incl. softening of the tides.

Therapy becomes an effective preventive measure to prevent the development of a number of pathologies - cardiac diseases, osteoporosis, atherosclerosis.

The arguments of the opponents of HRT are based on such arguments:

• insufficient knowledge of the introduction into the system of regulation of hormonal balance;
• difficulty in choosing the optimal treatment regimen;
• introduction into natural, natural processes of aging of biological tissues;
• the inability to establish the exact consumption of hormones by the body, which makes it difficult to dose them in preparations;
• unconfirmed real effectiveness in complications in the later stages;
• the presence of side effects.

The main disadvantage of HRT is the risk of such side disorders - pain in the mammary gland, tumor formations in the endometrium, weight gain, muscle cramps, gastrointestinal problems (diarrhea, gas formation, nausea), changes in appetite, allergic reactions (redness, rashes, itching).

NOTE!

It should be noted that with all the difficulties, HRT proves its effectiveness, which is confirmed by numerous positive reviews. A properly chosen treatment regimen can significantly reduce the likelihood of side effects.

Basic drugs

Among the drugs for HRT, there are several main categories:

Estrogen-based products, names:

1. Ethinylestradiol, Diethylstilbestrol. They are oral contraceptives and contain synthetic hormones.
2. Klikogest, Femoston, Estrofen, Trisequens. They are based on the natural hormones estriol, estradiol and estrone. To improve their absorption in the gastrointestinal tract, hormones are presented in a conjugated or micronized version.
3. Klimen, Klimonorm, Divina, Proginova. The drugs include estriols and estrone, which are ether derivatives.
4. Hormoplex, Premarin. They contain only natural estrogens.
5. Gels Estragel, Divigel and Klimara patches are intended for external use.. They are used for serious liver pathologies, pancreatic diseases, hypertension and chronic migraine.

Means based on progestogens:

1. Duphaston, Femaston. They belong to dydrogesterones and do not give metabolic effects;
2. Norkolut. Based on norethisterone acetate. It has a pronounced androgenic effect and is useful in osteoporosis;
3. Livial, Tibolone. These drugs are effective in osteoporosis and are in many ways similar to the previous drug;
4. Klimen, Andokur, Diane-35. The active substance is cyproterone acetate. It has a pronounced antiandrogenic effect.

Universal preparations containing both hormones. The most common are Angelique, Ovestin, Klimonorm, Triaklim.

List of new generation drugs

Currently, new generation drugs are becoming more widespread. They have such advantages - the use of ingredients that are absolutely identical to female hormones; complex impact; the ability to use in any phase of menopause; the absence of most of these side effects. They are produced for convenience in different forms - tablets, cream, gel, patch, injection solution.

The most famous drugs:

1. Klimonorm. The active substance is a combination of estradiol and levonornesterol. Effective for eliminating the symptoms of menopause. Contraindicated in ectopic bleeding.
2. norgestrol. It is a combined remedy. It copes well with a neurogenic type disorder and autonomic disorders.
3. Cyclo-Proginova. Helps increase female libido, improves the functioning of the urinary system. Can not be used for liver pathologies and thrombosis.
4. Klymen. It is based on cyproterone acetate, valerate, an antiandrogen. Fully restores hormonal balance. When used, the risk of weight gain and depression of the nervous system increases. Allergic reactions are possible.

herbal remedies

A significant group of drugs for HRT are herbal remedies and medicinal plants themselves.

Such plants are considered to be quite active suppliers of estrogens.:

1. Soya. With its use, you can slow down the onset of menopause, facilitate the manifestation of hot flashes, and reduce the cardiological effects of menopause.
2. Black cohosh. It is able to alleviate the symptoms of menopause, blocks changes in bone tissue.
3. Red clover. It has the properties of previous plants, and is also able to reduce cholesterol.

On the basis of phytohormones, such preparations are produced:

1. Estrofel. It contains phytoestrogen, folic acid, vitamins B6 and E, calcium.
2. Tibolone. Can be used to prevent osteoporosis.
3. Inoklim, Feminal, Tribustan. Means are based on phytoestrogen. Provide a gradually increasing therapeutic effect in menopause.

Main contraindications

In the presence of any chronic disease of the internal organs, the doctor should evaluate the possibility of conducting HRT, taking into account the characteristics of the female body.

This therapy is contraindicated in such pathologies.:

• uterine and ectopic nature (especially for unexplained reasons);
• tumor formations in the reproductive system and mammary gland;
• uterine diseases and diseases of the mammary gland;
• serious renal and hepatic pathologies;
• adrenal insufficiency;
• thrombosis;
• lipid metabolism anomalies;
• endometriosis;
• diabetes;
• epilepsy;
• asthma.

How to distinguish bleeding from menstruation, read.

Features of the treatment of surgical menopause

artificial or occurs after the removal of the ovaries, which leads to the cessation of the production of female hormones. In such circumstances, HRT can significantly reduce the risk of complications.

The therapy includes such schemes:

1. After removal of the ovaries, but the presence of the uterus (if the woman is under 50 years old), cyclic treatment is used in such options - estradiol and cipraterone; estradiol and levonorgestel, estradiol and dydrogesterone.
2. For women over 50 years old - monophasic estradiol therapy. It can be combined with norethisterone, medroxyprogesterone, or drosirenone. Tibolone is recommended.
3. In the surgical treatment of endometriosis. To eliminate the risk of recurrence, estraradiol therapy is carried out in combination with dienogest, dydrogesterone.

In our country, many patients, and even some specialists, are wary of HRT as charlatanism, although in the West the value of such therapy is highly valued. What is it really and is it worth trusting such a method - let's figure it out.

Hormone therapy - pros and cons

In the early 2000s, when the use of hormone replacement therapy was no longer questioned, scientists began to receive information about the increasing side effects associated with such treatment. As a result, many specialists have stopped actively prescribing drugs for postmenopausal women after 50 years of age. However, recent studies by scientists at Yale University have shown a high percentage of premature death among patients who refuse to take. The results of the survey are published in the American Journal of Public Health.

Did you know? Studies by Danish endocrinologists have shown that the timely administration of hormones in the first two years of menopause reduces the risk of developing tumors. The results are published in the British Medical Journal.

Mechanisms of hormonal regulation

Hormone replacement therapy is a course of treatment to restore a deficiency in the sex hormones of the steroid group. Such treatment is prescribed at the first symptoms of menopause, to alleviate the patient's condition, and can last up to 10 years, for example, in the prevention of osteoporosis. With the onset of female menopause, estrogen production by the ovaries worsens, and this leads to the appearance of various autonomic, psychological and urogenital disorders. The only way out is to replenish the hormone deficiency with the help of appropriate HRT preparations, which are taken either orally or topically. What is it? By nature, these compounds are similar to natural female steroids. The woman's body recognizes them and starts the mechanism for the production of sex hormones. The activity of synthetic estrogens is three orders of magnitude lower than that characteristic of the hormones produced by the female ovaries, but their continuous use leads to the required concentration in.

Important! Hormonal balance is especially important for women after removal or extirpation. Women who have undergone such operations may die during menopause if they refuse hormonal treatment. Female steroid hormones reduce the risk of osteoporosis and heart disease in these patients.

Rationale for the need to use HRT

Before prescribing HRT, the endocrinologist directs patients to mandatory medical examinations:

• study of anamnesis in the sections of gynecology and psychosomatics;
• using an intravaginal sensor;
• examination of the mammary glands;
• study of hormone secretion, and if it is impossible to perform this procedure, the use of functional diagnostics: analysis of a vaginal smear, daily measurements, analysis of cervical mucus;
• allergic tests for drugs;
• study of lifestyle and alternative therapies.

• angina;
• ischemia;
• myocardial infarction;
• atherosclerosis;
• dementia;
• cognitive;
• urogenital and other chronic disorders.

Important! The decision on treatment is made by the patient, and only the patient, based on the recommendations of the doctor.

The main types of HRT

Hormone replacement therapy has several types, and preparations for women after 40 years of age, respectively, contain different groups of hormones:

• estrogen-based monotypic treatment;
• combination of estrogens with progestins;
• combining female steroids with male ones;
• monotypic progestin-based treatment
• androgen-based monotypic treatment;
• tissue-selective stimulation of hormonal activity.

Impact on appearance

Hormonal imbalance accelerates and intensifies age-related changes in women, which affects their appearance and negatively affects their psychological state: the loss of external attractiveness reduces self-esteem. These are the following processes:

• Overweight. With age, muscle tissue decreases, while fatty tissue, on the contrary, increases. More than 60% of women of “Balzac age”, who previously had no problems with being overweight, are subject to such changes. After all, with the help of the accumulation of subcutaneous fat, the female body "compensates" for the decrease in the functionality of the ovaries and thyroid gland. The result is a metabolic disorder.
• Violation of the general hormonal background during menopause, which leads to the redistribution of adipose tissue.
• deterioration in health and During menopause, the synthesis of proteins responsible for the elasticity and strength of tissues deteriorates. As a result, the skin becomes thinner, becomes dry and irritable, loses elasticity, wrinkles and sags. And the reason for this is a decrease in the level of sex hormones. Similar processes occur with hair: they become thinner and begin to fall out more intensively. At the same time, hair growth begins on the chin and above the upper lip.
• Deterioration of the dental picture during menopause: demineralization of bone tissues, disorders in the connective tissues of the gums and tooth loss.

Did you know? In the Far East and Southeast Asia, where the menu is dominated by plant foods containing phytoestrogens, menopause-related disorders are 4 times less common than in Europe and America. Asian women are less likely to suffer from dementia because they consume up to 200 mg of plant estrogens daily with food.

HRT, prescribed in the premenopausal period or at the very beginning of menopause, prevents the development of negative changes in appearance associated with aging.

Hormone therapy drugs for menopause

New generation drugs intended for different types of HRT with menopause are divided into several groups. Synthetic estrogenic products used at the beginning of postmenopause and at its last stage are recommended after removal of the uterus, with mental disorders and impaired performance of the organs of the urinary-genital system. These include such pharmaceutical products as Sygethinum, Estrofem, Dermestril, Proginova and Divigel. Products based on a combination of synthetic estrogen and synthetic progesterone are used to eliminate the unpleasant physiological manifestations of menopause (increased sweating, nervousness, palpitations, etc.) and prevent the development of atherosclerosis, endometrial inflammation and osteoporosis.

Drug regimens

The regimen for taking steroids with HRT depends on the clinical picture and the stage of postmenopause. There are only two schemes:

• Short-term therapy - for the prevention of menopausal syndrome. It is prescribed for a short time, from 3 to 6 months, with possible repetitions.
• Long-term therapy - to prevent late consequences, such as osteoporosis, senile dementia, heart disease. Appointed for 5-10 years.

• cyclic or continuous monotherapy with one or another type of endogenous steroid;
• cyclic or continuous, 2-phase and 3-phase treatment with combinations of estrogens and progestins;
• a combination of female sex steroids with male ones.

Hormone replacement therapy - abbreviated as HRT - is actively used today in many countries of the world. To prolong their youth and replenish sex hormones lost with age, millions of women abroad choose hormonal therapy for menopause. However, Russian women are still wary of this treatment. Let's try to figure out why this happens.

Is it necessary to drink hormones during menopause,or 10 myths about HRT

After the age of 45, the function of the ovaries begins to gradually fade in women, which means that the production of sex hormones is reduced. Along with a decrease in blood estrogen and progesterone comes a deterioration in physical and emotional state. Ahead is menopause. And almost every woman begins to worry about the question: what can she do take with menopause, so as not to age?

In this difficult time, a modern woman comes to the rescue. Because with menopause estrogen deficiency develops, it is these hormones that have become the basis for all medicinal drugs HRT. The first myth about HRT is associated with estrogens.

Myth #1. HRT is not natural

There are hundreds of queries on the Internet on the topic:how to replenish estrogens for a woman after 45-50 years old . No less popular are inquiries about whetherherbal remedies for menopause. Unfortunately, few people know that:

• HRT preparations contain only natural estrogens.
• Today they are obtained by chemical synthesis.
• Synthesized natural estrogens are perceived by the body as their own due to the complete chemical identity of the estrogen produced by the ovaries.

And what could be more natural for a woman than her own hormones, analogues of which are taken for menopause therapy?

Some may argue that herbal preparations are more natural. They contain molecules that are similar in structure to estrogens, and they act on receptors in a similar way. However, their action is far from always effective for relieving the early symptoms of menopause (hot flashes, increased sweating, migraines, blood pressure surges, insomnia, etc.). They also do not protect against the consequences of menopause: obesity, cardiovascular diseases, osteoporosis, osteoarthritis, etc. In addition, their effect on the body (for example, on the liver and mammary glands) is not well understood and medicine cannot vouch for their safety.

Myth #2. HRT is addictive

Hormone replacement therapy for menopause- just a replacement for the lost hormonal function of the ovaries. Preparations HRT is not a drug, it does not disrupt the natural processes in a woman's body. Their task is to fill the estrogen deficiency, restore the balance of hormones, and also facilitate overall well-being. You can stop taking medications at any time. True, it is better to consult a gynecologist before this.

Among the misconceptions about HRT, there are truly crazy myths that we get used to from our very youth.

Myth #3. Mustache will grow from HRT

A negative attitude towards hormonal drugs in Russia arose quite a long time ago and has already moved to a subconscious level. Modern medicine has come a long way, and many women still trust outdated information.

The synthesis and use of hormones in medical practice began in the 1950s. A real revolution was made by glucocorticoids (adrenal hormones), which combined a powerful anti-inflammatory and anti-allergic effect. However, doctors soon noticed that they affect body weight and even contribute to the manifestation of male characteristics in women (the voice became rougher, excessive hair growth began, etc.).

Much has changed since that time. Preparations of other hormones (thyroid, pituitary, female and male) were synthesized. And the type of hormones has changed. The composition of modern drugs includes hormones as "natural" as possible, and this allows you to significantly reduce their dose. Unfortunately, all the negative qualities of outdated high-dose drugs are also attributed to new, modern ones. And this is completely unfair.

Most importantly, HRT preparations contain exclusively female sex hormones, and they cannot serve as a reason for “masculinity”.

I would like to draw attention to one more point. In the body of a woman, male sex hormones are always produced. And that's okay. They are responsible for the vitality and mood of a woman, for interest in the world and sexual desire, as well as for the beauty of the skin and hair.

When ovarian function declines, female sex hormones (estrogens and progesterone) cease to be replenished, while male sex hormones (androgens) continue to be produced. In addition, they are also produced by the adrenal glands. That's why you shouldn't be surprised that older ladies sometimes need to pluck their mustaches and chin hairs. And HRT drugs have absolutely nothing to do with it.

Myth number 4. Get better from HRT

Another unfounded fear is to gain weight while taking drugs hormone replacement therapy. But everything is quite the opposite. Purpose of HRT with menopause can positively affect female curves and shapes. The composition of HRT includes estrogens, which generally do not have the ability to influence changes in body weight. As for the gestagens (these are derivatives of the hormone progesterone), which are part ofnew generation HRT drugs, then they help distribute adipose tissue “according to the female principle” and allow with menopause keep a feminine figure.

Do not forget about the objective reasons for weight gain in women after 45. First: at this age, physical activity noticeably decreases. And second: the influence of hormonal changes. As we already wrote, female sex hormones are produced not only in the ovaries, but also in adipose tissue. During menopause, the body tries to reduce the lack of female sex hormones by producing them in fatty tissues. Fat is deposited in the abdomen, and the figure begins to look like a man's. As you can see, HRT drugs do not play any role in this issue.

Myth number 5. HRT can cause cancer

The fact that taking hormones can provoke cancer is an absolute delusion. There are official data on this topic. According to The World Health Organization, thanks to the use of hormonal contraceptives and their oncoprotective effect, annually manages to prevent about 30 thousand cases of cancer. Indeed, estrogen monotherapy increased the risk of endometrial cancer. But such treatment is a thing of the past. Partnew generation HRT drugs includes progestogens that prevent the risk of developing endometrial cancer (the body of the uterus).

With regard to breast cancer, studies on the effect of HRT on its occurrence have been conducted in abundance. This issue has been seriously studied in many countries of the world. Especially in the USA, where HRT drugs began to be used as early as the 50s of the XX century. It has been proven that estrogens - the main component of HRT preparations - are not oncogenes (that is, they do not unblock the gene mechanisms of tumor growth in the cell).

Myth number 6. HRT is bad for the liver and stomach

There is an opinion that a sensitive stomach or liver problems may be a contraindication for HRT. This is not true. New generation HRT drugs do not irritate the mucosa of the gastrointestinal tract and do not have a toxic effect on the liver. It is necessary to limit the intake of HRT drugs only when there are pronounced liver dysfunctions. And after the onset of remission, it is possible to continue HRT. Also, taking HRT drugs is not contraindicated in women with chronic gastritis or with peptic ulcer of the stomach and duodenum. Even during seasonal exacerbations, you can take the pills as usual. Of course, simultaneously with therapy prescribed by a gastroenterologist and under the supervision of a gynecologist. For women who are especially worried about their stomach and liver, they produce special forms of HRT preparations for topical use. These can be skin gels, patches, or nasal sprays.

Myth number 7. If there are no symptoms, then HRT is not needed.

Life after menopause not all women immediately aggravated by unpleasant symptoms and a sharp deterioration in well-being. In 10 - 20% of the fair sex, the vegetative system is resistant to hormonal changes and therefore for some time they are spared the most unpleasant manifestations during menopause. If there are no hot flashes, this does not mean at all that you do not need to see a doctor and let the menopause go by itself.

Serious consequences of menopause develop slowly and sometimes completely unnoticed. And when after 2 years or even 5-7 years they begin to appear, it becomes much more difficult to correct them. Here are just a few of them: dry skin and brittle nails; hair loss and bleeding gums; decreased sexual desire and dryness in the vagina; obesity and cardiovascular disease; osteoporosis and osteoarthritis and even senile dementia.

Myth number 8. HRT has many side effects

Only 10% of women feel some discomfort when taking HRT drugs. The most susceptible to discomfort are those who smoke and are overweight. In such cases, swelling, migraines, swelling and soreness of the chest are noted. Usually these are temporary problems that disappear after the dosage is reduced or the dosage form of the drug is changed.

It is important to remember that HRT cannot be carried out independently without medical supervision. In each case, an individual approach and constant monitoring of the results are required. Hormone replacement therapy has a specific list of indications and contraindications. Only a doctor after a series of studies will be able tofind the right treatment . When prescribing HRT, the doctor observes the optimal ratio of the principles of "usefulness" and "safety" and calculates at what minimum doses of the drug the maximum result will be achieved with the least risk of side effects.

Myth number 9. HRT is unnatural

Is it necessary to argue with nature and replenish sex hormones lost over time? Of course you do! The heroine of the legendary film “Moscow Does Not Believe in Tears” claims that life is just beginning after forty. And indeed it is. A modern woman at the age of 45+ can live no less interesting and eventful life than in her youth.

Hollywood star Sharon Stone turned 58 in 2016 and she is sure that there is nothing unnatural in a woman’s desire to remain young and active as long as possible: “When you are 50, you feel that you have a chance to start life anew: a new career, a new love ... At this age, we know so much about life! You may be tired of what you did for the first half of your life, but that doesn't mean you have to sit back and play golf in your yard now. We are too young for this: 50 is the new 30, a new chapter."

Myth number 10. HRT is an understudied method of treatment

The experience of using HRT abroad is more than half a century, and all this time the technique has been subjected to serious control and detailed study. Gone are the days when endocrinologists, by trial and error, were looking for optimal methods, regimens and dosages of hormonal drugs for menopause. In Russia hormone replacement therapycame only 15-20 years ago. Our compatriots still perceive this method of treatment as little studied, although this is far from being the case. Today we have the opportunity to use already proven and highly effective products with a minimum number of side effects.

HRT with menopause: pros and cons

For the first time HRT preparations for women in menopause began to be used in the United States in the 1940s and 1950s. As the treatment became more and more popular, it turned out that the risk of disease increases during the treatment period. uterus ( endometrial hyperplasia, crayfish). After a thorough analysis of the situation, it turned out that the reason was the use of only one ovarian hormone - estrogen. Conclusions were made, and in the 70s, biphasic preparations appeared. They combined estrogens and progesterone in one pill, which inhibited the growth of the endometrium in the uterus.

As a result of further research, information was accumulated about positive changes in a woman's body during hormone replacement therapy. To date known that its positive influence extends beyond menopausal symptoms.HRT for menopauseslows down atrophic changes in the body and becomes an excellent prophylactic in the fight against Alzheimer's disease. It is also important to note the beneficial effects of therapy on the cardiovascular system of women. Against the background of taking HRT drugs, doctors fixed improving lipid metabolism and lowering blood cholesterol levels. All these facts make it possible to use HRT today as a prevention of atherosclerosis and heart attack.

Used information from the magazine [Climax - it's not scary / E. Nechaenko, - Magazine “New Pharmacy. Pharmacy assortment”, 2012. - No. 12]

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