Hormone replacement therapy drugs, reviews. Hormone replacement therapy Taking HRT pros and cons

In women, in order to prevent and correct pathological disorders accompanying the menopause, various non-drug, medicinal and hormonal agents are used.

Over the past 15-20 years, specific hormone replacement therapy for menopause (HRT) has become widespread. Despite the fact that there have been discussions for a very long time, in which ambiguous opinions were expressed on this matter, the frequency of its use has reached 20-25%.

Hormone therapy - pros and cons

The negative attitude of individual scientists and practitioners is justified by the following statements:

the danger of interfering with the “fine” system of hormonal regulation;
inability to develop correct treatment regimens;
interference with the natural aging processes of the body;
the inability to accurately dose hormones depending on the body’s needs;
side effects of hormonal therapy in the form of the possibility of developing malignant tumors, cardiovascular diseases and vascular thrombosis;
lack of reliable data on the effectiveness of prevention and treatment of late complications of menopause.

Mechanisms of hormonal regulation

Maintaining the constancy of the internal environment of the body and the possibility of its adequate functioning as a whole is ensured by a self-regulating hormonal system of direct and feedback. It exists between all systems, organs and tissues - the cerebral cortex, nervous system, endocrine glands, etc.

The frequency and duration of the menstrual cycle and its onset are regulated by the hypothalamic-pituitary-ovarian system. The functioning of its individual links, the main ones of which are the hypothalamic structures of the brain, is also based on the principle of direct and feedback communication between each other and with the body as a whole.

The hypothalamus constantly releases gonadotropin-releasing hormone (GnRh) in a certain pulse mode, which stimulates the synthesis and release of follicle-stimulating and luteinizing hormones (FSH and LH) by the anterior pituitary gland. Under the influence of the latter, the ovaries (mainly) produce sex hormones - estrogens, androgens and progestins (gestagens).

An increase or decrease in the level of hormones of one link, which is also influenced by both external and internal factors, correspondingly entails an increase or decrease in the concentration of hormones produced by the endocrine glands of other links, and vice versa. This is the general meaning of the forward and feedback mechanism.

Justification for the need to use HRT

Menopause is a physiological transitional stage in a woman’s life, characterized by involutive changes in the body and the extinction of the hormonal function of the reproductive system. In accordance with the classification of 1999, during the menopausal period, starting from 39-45 years and lasting until 70-75 years, four phases are distinguished - premenopause, postmenopause and perimenopause.

The main triggering factor in the development of menopause is age-related depletion of the follicular apparatus and hormonal function of the ovaries, as well as changes in the nervous tissue of the brain, which leads to a decrease in the production of progesterone by the ovaries, and then estrogen, and to a decrease in the sensitivity of the hypothalamus to them, and therefore to a decrease GnRg synthesis.

At the same time, in accordance with the principle of the feedback mechanism, in response to this decrease in hormones in order to stimulate their production, the pituitary gland “responds” with an increase in FSH and LH. Thanks to this “stimulation” of the ovaries, the normal concentration of sex hormones in the blood is maintained, but with intense function of the pituitary gland and an increase in the content of hormones synthesized by it in the blood, which is manifested in blood tests.

However, over time, estrogen becomes insufficient for the appropriate reaction of the pituitary gland, and this compensatory mechanism is gradually depleted. All these changes lead to dysfunction of other endocrine glands, hormonal imbalance in the body with manifestation in the form of various syndromes and symptoms, the main of which are:

climacteric syndrome, which occurs in premenopause in 37% of women, in 40% - during menopause, in 20% - 1 year after its onset and in 2% - 5 years after its onset; menopausal syndrome is manifested by a sudden feeling of hot flashes and sweating (in 50-80%), attacks of chills, psycho-emotional instability and unstable blood pressure (usually elevated), rapid heartbeat, numbness of the fingers, tingling and pain in the heart area, memory impairment and sleep disturbances , depression, headache and other symptoms;
genitourinary disorders - decreased sexual activity, dryness of the vaginal mucosa, accompanied by burning, itching and dyspareunia, pain when urinating, urinary incontinence;
dystrophic changes in the skin and its appendages - diffuse alopecia, dry skin and increased fragility of nails, deepening of skin wrinkles and folds;
metabolic disorders, manifested by an increase in body weight with a decrease in appetite, fluid retention in tissues with the appearance of facial pastiness and swelling of the legs, decreased glucose tolerance, etc.
late manifestations - a decrease in bone mineral density and the development of osteoporosis, hypertension and coronary heart disease, Alzheimer's disease, etc.

Thus, against the background of age-related changes in many women (37-70%), all phases of the menopausal period can be accompanied by one or another dominant set of pathological symptoms and syndromes of varying severity and severity. They are caused by a deficiency of sex hormones with a corresponding significant and sustained increase in the production of gonadotropic hormones of the anterior pituitary gland - luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Hormone replacement therapy for menopause, taking into account the mechanisms of its development, is a pathogenetically based method that allows one to prevent, eliminate or significantly reduce dysfunction of organs and systems and reduce the risk of developing serious diseases associated with deficiency of sex hormones.

Hormone therapy drugs for menopause

The main principles of HRT are:

Use only drugs similar to natural hormones.
The use of low dosages that correspond to the concentration of endogenous estradiol in young women up to 5-7 days of the menstrual cycle, that is, in the proliferative phase.
The use of estrogens and progestogens in various combinations to eliminate the processes of endometrial hyperplasia.
In cases of postoperative absence of the uterus, it is possible to use only estrogens in intermittent or continuous courses.
The minimum duration of hormone therapy for the prevention and treatment of coronary heart disease and osteoporosis should be 5-7 years.

The main component of drugs for HRT are estrogens, and the addition of gestagens is carried out in order to prevent hyperplastic processes in the uterine mucosa and control its condition.

Tablets for replacement therapy for menopause contain the following groups of estrogens:

synthetic, which are constituent components - ethinyl estradiol and diethylstilbestrol;
conjugated or micronized forms (for better absorption in the digestive tract) of the natural hormones estriol, estradiol and estrone; these include micronized 17-beta-estradiol, which is part of drugs such as Klikogest, Femoston, Estrofen and Trisequence;
ether derivatives - estriol succinate, estrone sulfate and estradiol valerate, which are components of the drugs Klimen, Klimonorm, Divina, Proginova and Cycloproginova;
natural conjugated estrogens and their mixture, as well as ether derivatives in the preparations Hormoplex and Premarin.

For parenteral (cutaneous) use in the presence of severe diseases of the liver and pancreas, migraine attacks, arterial hypertension over 170 mmHg, gels (Estragel, Divigel) and patches (Klimara) containing estradiol are used. When using them and an intact (preserved) uterus with appendages, it is necessary to add progesterone drugs (Utrozhestan, Duphaston).

Replacement therapy drugs containing gestagens

Gestagens are produced with varying degrees of activity and have a negative effect on carbohydrate and lipid metabolism. Therefore, they are used in the minimum sufficient dosages necessary to regulate the secretory function of the endometrium. These include:

dydrogesterone (Duphaston, Femoston), which does not have metabolic and androgenic effects;
norethisterone acetate (Norkolut) with androgenic effect - recommended for osteoporosis;
Livial or Tibolon, which are similar in structure to Norkolut and are considered the most effective drugs in the prevention and treatment of osteoporosis;
Diane-35, Androkur, Klimen, containing cyproterone acetate, which has an antiandrogenic effect.

Combination replacement therapy drugs that include estrogens and progestogens include Triaklim, Klimonorm, Angelique, Ovestin, etc.

Regimens for taking hormonal drugs

Various regimens and regimens of hormonal therapy for menopause have been developed, used to eliminate early and late consequences associated with insufficiency or absence of ovarian hormonal function. The main recommended schemes are:

Short-term, aimed at preventing climacteric syndrome - hot flashes, psycho-emotional disorders, urogenital disorders, etc. The duration of treatment according to a short-term regimen ranges from three months to six months with the possibility of repeating courses.
Long-term - for 5-7 years or more. Its goal is the prevention of late disorders, which include osteoporosis, Alzheimer's disease (the risk of its development decreases by 30%), heart and vascular diseases.

There are three modes of taking tablet drugs:

monotherapy with estrogen or progestogen agents in a cyclic or continuous mode;
biphasic and triphasic estrogen-gestagen drugs in cyclic or continuous mode;
combination of estrogens and androgens.

Hormonal therapy for surgical menopause

It depends on the extent of the surgical intervention performed and the woman’s age:

After removal of the ovaries and a preserved uterus in women under 51 years of age, it is recommended to take a cyclic regimen of estradiol 2 mg with cypraterone 1 mg or levonorgestrel 0.15 mg, or medroxyprogesterone 10 mg, or dydrogesterone 10 mg, or estradiol 1 mg with dydrogesterone 10 mg.
Under the same conditions, but in women 51 years of age and older, as well as after high supravaginal amputation of the uterus with appendages - in a monophasic mode, taking estradiol 2 mg with norethisterone 1 mg, or medroxyprogesterone 2.5 or 5 mg, or a dienost according to 2 mg, or drosirenone 2 mg, or estradiol 1 mg with dydrosterone 5 mg. In addition, it is possible to use Tibolone (belongs to the STEAR group of drugs) at 2.5 mg per day.
After surgical treatment with a risk of relapse - monophasic administration of estradiol with dienogest 2 mg or estradiol 1 mg with dydrogesterone 5 mg, or STEAR therapy.

Side effects of HRT and contraindications to its use

Possible side effects of hormonal therapy during menopause:

engorgement and pain in the mammary glands, the development of tumors in them;
increased appetite, nausea, abdominal pain, biliary dyskinesia;
pastiness of the face and legs due to fluid retention in the body, weight gain;
dryness of the vaginal mucosa or increased cervical mucus, irregular uterine and menstrual-like bleeding;
migraine pain, increased fatigue and general weakness;
spasms in the muscles of the lower extremities;
the occurrence of acne and seborrhea;
thrombosis and thromboembolism.

The main contraindications to hormonal therapy during menopause are as follows:

History of malignant neoplasms of the mammary glands or internal genital organs.
Bleeding from the uterus of unknown origin.
Severe diabetes mellitus.
Hepatic-renal failure.
Increased blood clotting, tendency to thrombosis and thromboembolism.
Lipid metabolism disorders (external use of hormones is possible).
Presence of or (contraindication to the use of estrogen monotherapy).
Hypersensitivity to the drugs used.
Development or worsening of diseases such as autoimmune connective tissue diseases, rheumatism, epilepsy, bronchial asthma.

Timely and adequately used and individually selected hormone replacement therapy can prevent serious changes in a woman’s body during menopause, improve not only her physical but also her mental condition, and significantly increase the level of quality.

the site presents a new column by Tatyana Rogachenko, a recognized beauty expert, owner of the Jean Louis David salon chain. Our columnist devoted the last issue to hormone replacement therapy of natural origin. The topic turned out to be so pressing for you, dear readers, that Tatyana decided to interview a gynecologist-endocrinologist to identify all the pros and cons of this method.

Tatyana Rogachenko decided to once again discuss menopause and hormonal therapy

You know, many in my place would never write a single article after reading the comments. But it’s not so easy to knock me out of the saddle. On the contrary, after seeing your comments, I realized that I need to continue writing in order to eliminate mass illiteracy in matters of at least health.

I am not a doctor. I am a 51-year-old woman who is waiting for hour X. I don’t know where you get your information, but I repeat once again: I do not and never have had a young husband, I gave birth to children myself - without IVF and surrogate mothers and... Although we are discussing menopause and hormonal therapy, not me and my personal life.

Therefore, I addressed the questions I received from you to Vera Efimovna Balan, a gynecologist-endocrinologist, a doctor of the highest category, Doctor of Medical Sciences, professor with more than 35 years of experience.

Doctor of Medical Sciences, Professor, President of the Russian Menopause Association, Head of the outpatient department of the State Budgetary Institution of Healthcare of the Moscow Region MONIIAG, Vera Balan

Tatyana Rogachenko: Many women believe that HRT “leads” to cancer. Tell us in a few words about the pros and cons of this therapy. What side effects can there be during and after stopping taking hormonal medications?

Vera Balan: Menopausal hormone therapy (MHT) is part of a unified strategy to maintain the quality of life and health of women in pre- and early menopause. When prescribing it, certain rules must be followed.

Indications include:

Vasomotor symptoms (hot flashes) with mood changes and sleep disturbances;
Symptoms of urogenital atrophy, sexual dysfunction;
Prevention and treatment of osteoporosis;
Low quality of life associated with menopause, including arthralgia (joint pain), muscle pain and memory loss;
Premature and early menopause;
Ovariectomy (removal of the ovaries).

There are absolute contraindications (including breast cancer) and relative (in which the prescription of therapy depends on the competence of the doctor and the wishes of the patient). For women in all European countries and America, mortality from cardiovascular diseases, and not from cancer, comes first. In Russia, almost 60% of the fair sex die from stroke and heart attack, and in general, from all types of cancer - 14% (from breast cancer - about 4%).

Before prescribing MHT, a number of examinations are carried out, including mandatory mammography (breast examination) and ultrasound. It is important that for every 1000 women, when prescribed in a timely manner, MHT can save 6 lives, prevent the development of heart disease in 8 women and thrombosis in 5 women.

Prescribing MHT to women in early postmenopause and/or under the age of 60 years, both in the form of estrogen monotherapy and a combination therapy regimen, reduces overall mortality by 30-52%!

Early prescription and consideration of contraindications is the basis for safety, high effectiveness and prevention of cardiovascular diseases, osteoporosis, mental disorders and genitourinary disorders, including urinary incontinence. With correctly and individually selected hormone therapy, the risks of complications are minimal.

All drugs in Europe are safer than those taken in America (KEE and medroxyprogesterone acetate, the most unfavorable gestagen for the mammary gland). Combination drugs slightly increase the risk, and estrogen monotherapy, on the contrary, reduces them.

Tatyana Rogachenko is confident that hormone replacement therapy improves the overall health of skin and hair, restores muscle tone, and also heals internal organs and resists many age-related changes

T.R.: When is it necessary to start HRT and what is the duration of therapy?

V.B.: The optimal time to start MHT is early postmenopause and/or age younger than 60 years, or postmenopause no more than 10 years. The debut of MHT after 60 years or after 10 years of postmenopause increases the risk of stroke.

Continue for 4-5 years, but it is possible until the end of your life, especially since micro-dosed drugs have now appeared (for example, Angelique Micro and Femoston mini). In fact, it all depends on personal preference, as long as there are no side effects or contraindications.

Of course, this is not the elixir of youth. However, early initiation of therapy can mitigate or delay:

weight gain and development of abdominal obesity
development of insulin resistance
arterial hypertension
lipid metabolism disorder
loss of bone mineral density
cartilage loss
decreased muscle mass
maintenance of cognitive function
urogenital atrophy

T.R.: Can a woman get pregnant after 50?

V.B.: You can take contraceptives up to 55 years of age, but not just any kind. After one year of menopause, the probability of pregnancy is not 0. However, this is an absolutely psychological thing. If you believe that you can get pregnant, you believe in your youth. There are hormonal criteria and there is no need to go to the point of absurdity. Pregnancy is possible using IVF with a donor egg.

The optimal time to start MHT is early postmenopause and/or age younger than 60 years, or postmenopause no more than 10 years

T.R.: How do you feel about herbal preparations that are sold without a prescription in pharmacies?

V.B.: This is an alternative therapy, it is effective only in mild forms, and in severe forms it is useless.

T.R.: What can you say about the drug “Femoston”*, which is very popular in Russia?

V.B.: A good drug for any period of menopause: from the cyclic regimen to “Femoston mini” for deep postmenopause. It contains dydrogesterone - one of the best gestagens, close to its own progesterone.

T.R.: What can you say about BHRT (bioidentical hormone therapy), are there any specialists on it in Russia?

V.B.: Bioidentical therapy is not supported by the medical community. It is not known what is being mixed, in what dose. I don't think it's safe. I don't know about such specialists.

V.B.: Watch your lifestyle, weight and don’t forget about physical activity. If symptoms appear, you need to find a competent specialist and decide on MHT or an alternative.

And then you make your choice and continue to suffer from ebbs and flows (the most common symptom) or live a full life. And believe me, it’s better to be seriously concerned about this topic than to discuss how terrible I look at 51! Because it's simple envy! But envy is not good!

*There are contraindications. It is necessary to read the instructions for use or consult a specialist.

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

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

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

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

Who needs hormone replacement therapy during menopause?

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

Hormone replacement therapy is prescribed:

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

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

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

Who should not take hormones during menopause?

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

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

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

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

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

What medications are prescribed for hormone replacement therapy?

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

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

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

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

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?

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

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

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

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

What are the risks of hormone replacement therapy?

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

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

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

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

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

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

How can you reduce the risk of these complications?

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

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

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

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

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

Menopause is a rather serious test for a woman. Very simply, the problem can be described as follows: hormonal imbalance is accompanied by a variety of and rather unpleasant symptoms. Hormones have a direct effect on all organs and systems (the body works through neurohumoral regulation). A failure in their coordinated work leads to disturbances and responses in the form of hot flashes, insomnia, weakness, fatigue, etc. (you can read more about symptoms during menopause in the article “”).

A lack of the female sex hormone estrogen causes sudden mood swings and can lead to nervous breakdowns, stress and even severe depression. Additionally, the psycho-emotional state of women at this age is influenced by external signs of natural aging processes, a decrease in sexual desire and attractiveness. It is in order to reduce the severity of symptoms and stabilize hormonal levels that HRT (hormone replacement therapy) is used. Its goal is to replenish the lack of hormones, the level of which gradually decreases during menopause. This solution allows us to successfully solve a number of problems that arise in women.

Unfortunately, many women have prejudices, and they are often afraid or even refuse to take hormones. Their concerns are caused by various reasons (negative reviews, possible side effects, etc.). But medicine does not stand still; the new generation is excellent at helping to relieve negative manifestations. Moreover, they no longer have the negative consequences that are usually attributed to them. Accurate information about modern hormone-containing medications for menopause will help women make the right decision and reduce their critical attitude towards drugs of this type.

What hormones does a woman need?

To understand what hormones need to be taken during menopause, let's consider how it proceeds from the point of view of hormonal balance. This period is usually divided into several phases:

(can last from 5 to 10 years);
(counting starts one year after the last menstruation);
(starts 5 years from the last menstruation and ends at 70 - 75 years).

The body reacts most acutely in the first two periods of menopause. Female hormones gradually cease to be produced by the body. Initially, the regressive process begins in the ovaries, this is facilitated by the depletion of the follicular apparatus. Naturally, the body begins to react to the lack of progesterone and estrogen, including compensatory reactions. At this moment, the pituitary gland begins to intensively produce LH and FSH (luteinizing and follicle-stimulating hormones). Against this background, the sensitivity of hormone-dependent receptors, which also play a role in the normal functioning of the female reproductive system, gradually decreases.

For some time, compensatory mechanisms allow the body to cope. But the synthesis of sex hormones continues to decline, strengthening the function of the pituitary gland no longer gives the desired results, and its sensitivity to their hormonal deficiency decreases. At this moment, more obvious and frequent manifestations of the menopause begin: they stop, and the main systems of the body begin to respond to hormonal changes. Symptoms are varied (there are about 30 manifestations of menopause), most often it affects:

cardiovascular system (hypertension, increased heart rate, increased risk of heart attacks and strokes);
nervous system: suffers especially severely, migraine pain, psycho-emotional instability, etc.;
endocrine system: manifests itself as age-related weight gain, often leading to obesity, thyroid disease, diabetes, etc.;
genitourinary system: in addition to ovarian dysfunction and reduction of the uterus in size, hypotension of all muscles is observed, which leads to painful sensations during sexual intercourse (this is facilitated by a reduction in the volume of secretion in the vagina), accompanied by a frequent urge to urinate (later incontinence is possible), etc.

This is not a complete list of symptoms during menopause that cause discomfort to a woman.

The most typical complaints are vasomotor reactions (“hot flashes”, dizziness, etc.) and psycho-emotional reactions. The risk of developing a number of gynecological diseases, especially hormone-dependent ones, increases. Disturbances in normal hormone synthesis increase the risk of cancer. Should we take adequate measures in such a situation? Naturally, the symptoms of menopause, unpleasant in themselves, carry a number of threats and contribute to the development of various pathological conditions. HRT in this situation may be the only way to relieve acute conditions caused by a lack of hormones.

Menopause itself is a natural process, but it occurs differently for each woman. Hormone replacement therapy is not indicated for everyone; it has a number of contraindications. HRT is not used unless necessary, and drugs are selected taking into account the characteristics of each patient after a comprehensive examination. But to refuse because of prejudice at a time when hormones are simply necessary for the female body means risking your own health in the future.

What is hormone replacement therapy and how does it work?

Preserving a woman’s health is the main goal of HRT. The balance of hormones is disrupted due to natural reasons, but the body's response to such changes can take on a pathological character. Partial compensation for the lack of hormones from the outside is HRT, which relieves the severity of symptoms.

Hormone replacement therapy for menopause can be aimed at restoring the level of hormones from the group of gestagens or estrogens; they can be prescribed in the form of mono- or complex drugs, contain androgens, etc. That is, the variety of modern medications allows you to choose the most effective tactics in each specific case.

The change in hormonal levels occurs gradually; a decrease in the production of one group of hormones during menopause consistently triggers the entire mechanism. As a result, almost the entire body is involved in the process, responding in one way or another to the changes taking place. Each woman’s reactions can proceed in her own way: some calmly experience all periods of menopause, without experiencing any special problems from periodically appearing symptoms. For others, age-related changes in the body occur rapidly and acutely. During menopause, a woman should especially closely monitor her health; this will help her understand in a timely manner when symptoms are becoming alarming and take timely measures.

Does hormone replacement therapy benefit the female body or is it harmful? There is no clear opinion on this matter. Many patients have a negative attitude towards taking hormones themselves, believing that it is easier to survive the unpleasant symptoms of menopause. There is also no clear agreement among doctors on this issue, but recently HRT has been used more and more often.

The goal of hormone replacement therapy is to help the body cope with the lack of hormones with minimal losses. In European countries, HRT has become a standard option for medical care, and is currently actively used in domestic medicine. During menopause, HRT is the simplest and most effective way to get rid of the unpleasant symptoms of menopause and restore the balance of hormones at the time of restructuring of the body.

Hormone therapy - all the pros and cons

For women during menopause, hormone replacement therapy is not always prescribed. There are a number of contraindications for which hormones are strictly prohibited. Doctors' recommendations are based on:

the general condition of the patient’s body;
severity of symptoms;
survey results.

This takes into account exactly what hormone the female body needs during a particular period of menopause.

The benefits of using hormonal drugs during menopause are as follows:

it is possible to compensate for the deficiency of a specific group of hormones;
the severity of symptoms is relieved, menopause is less painful;
the body gets the opportunity to rebuild gradually, without sudden changes in hormone levels;
aging processes slow down;
taking HRT is under medical supervision, which allows you to adjust the course of treatment as necessary;
drugs are selected individually, taking into account the health status of a particular patient.

Such treatment can cause harm if a woman begins to take hormonal drugs uncontrollably, based on reviews from friends or her own opinion. Prescribing such medications by a specialized specialist is a prerequisite for successful hormone replacement therapy without side effects and negative consequences.

Do I need to take hormones during menopause?

Drinking hormones during any of the menopause periods is a completely modern and effective way to relieve unpleasant symptoms and help the body cope with hormonal stress. But this should be done exclusively on the recommendations of doctors and after a comprehensive examination.

The selection of drugs is carried out only after passing tests that show the level of hormones. Symptoms of menopause can appear as a reaction to all hormonal changes, but it is important to determine which one needs replacement. Sometimes combination medications are required.

Hormones during menopause will help correct their balance in the body and relieve acute manifestations that arise as a response to natural age-related changes. The aging process slows down and is less painful. It should be remembered that one of the typical manifestations of menopause is sharp psycho-emotional reactions. HRT will help correct these symptoms. That is, women usually only benefit from its use, which allows us to talk about the benefits of such treatment.

Dosage regimen

How to take hormonal medications during menopause? Only an experienced specialist can solve this issue based on the results of the examination. At the moment, modern medicine offers two tactics:

short-term use: for mild menopause, not complicated by acute reactions, therapy can last 1 – 2 years;
long-term therapy: treatment can be carried out for 2 – 4 years.

It is important to understand that we are talking about a course of taking drugs; with HRT, one drug can be replaced by another. Correction occurs based on the results of tests for hormone levels. The patient needs medical supervision during treatment; this is how the greatest effectiveness can be achieved and any risks can be minimized.

Indications for HRT

Indications for the use of HRT are a number of symptoms that are especially threatening to the female body. These include:

surgical menopause;
risk of developing cardiovascular diseases;
hereditary predisposition to osteoporosis, diabetes mellitus, obesity, hypertension and other pathological conditions.

Hormones should also be taken if menopause causes acute psycho-emotional reactions in order to eliminate the risk of developing neuroses and depressive states.

Contraindications

Menopausal hormone therapy for some pathologies is never prescribed to patients. There are a number of serious diseases that are not compatible with HRT. It is dangerous to prescribe hormones in such cases, so consultation with a specialized specialist and a comprehensive examination are a prerequisite for starting HRT.

Contraindications:

bleeding of unknown etiology;
estrogen-dependent tumors (benign and malignant);
oncological diseases;
some pathologies of the heart and cardiovascular system;
thrombosis, thromboembolism and bleeding disorders associated with increased thrombus formation;
acute and chronic liver diseases, liver and/or kidney failure;
complicated diabetes mellitus;
a number of autoimmune diseases;
individual intolerance to drugs containing hormones.

The use of HRT will be useful and safe only if the medications are selected by a doctor.

Possible side effects

Hormone replacement therapy for menopause can cause a number of side effects, namely:

fluid retention in the body (edema, pastiness);
hypo- or hypersecretion of mucus in the vagina, menstrual-like bleeding;
increased fatigue, weakness, headaches;
various reactions from the gastrointestinal tract;
soreness of the mammary glands;
muscle spasms;
seborrhea and acne.

These and other reactions can manifest themselves singly or in combination; their occurrence requires contacting a doctor to correct treatment tactics.

Main principles of HRT

Hormones for menopause are prescribed based on the results of the examination. The basic principles of modern therapy are:

the use of hormonal drugs similar to natural ones;
low dosages;
the use of combination medications to minimize the risks of endometrial hyperplasia;
duration of the course that stabilizes hormonal levels.

Choosing HRT drugs: types and forms of drugs

Nowadays, choosing the right therapy is not particularly difficult. In addition to a varied combination of hormones, there is also the opportunity to choose the method of administration:

tablets, dragees or capsules;
local application: gels, suppositories, creams, patches;
injections;
subcutaneous implants.

Hormonal therapy for surgical menopause

HRT for menopause is prescribed for patients who have undergone surgery to remove the uterus. Method of using hormones for:

women under 51 years of age with removal of the ovaries and preserved uterus;
women over 51 years of age after amputation of the uterus and ovaries;
after surgical removal of endometriosis, subject to the risk of relapse.

Dispelling myths about HRT

Menopausal hormone therapy is often a source of controversy and fear. Patients refuse HRT, believing that their use can lead to:

addiction;
obesity;
complications from the gastrointestinal tract;
risk of cancer;
long-term negative results.

Many also believe that hormonal drugs are poorly researched and contain a large number of synthetic analogues of natural hormones. Modern HRT is a new generation of drugs that contain a minimal amount of hormones, natural and completely identical to female ones. They need and can be taken, since most symptoms are signs of natural processes during menopause. HRT does not enhance, but slows down their development. Medicines undergo preclinical and clinical trials. And the lack of data on long-term results in domestic medicine is compensated by studies abroad, where HRT has been actively used for several decades.

List of HRT drugs

The principles of hormone replacement therapy for menopause make it possible to select the most effective course of treatment for each patient. After 40 years, a woman should prepare for the upcoming restructuring of her body. At this point, regular examination becomes important and mandatory for maintaining the normal functioning of the body. HRT helps restore hormone levels that will inevitably drop. Even with normal menstruation, it is important to know the concentration of hormones, which will help you use medications that are effective for menopause in a timely manner.

As the synthesis function fades, the main symptoms of menopause increase. After consultation and examination, a drug is prescribed that will help correct hormonal imbalance at the moment. It can be:

. As the name of this group implies, it contains natural analogues of estrogens. These include: Klimadinon, Femicaps, . Each of them is available in tablet form and is taken as a course;
Bioidentical hormones. The combined medications Janine and Femoston in tablets also help relieve symptoms of menopause. as a derivative of progesterone, it is prescribed for its deficiency and to neutralize the effect of estrogen;
Estrogen-containing. Any hormonal product of this type contains synthetic estrogen. The most commonly used are Klimonorm, Premarin, Ovestin;
The androgenic effect for the prevention and treatment of osteoporosis is provided by Norkolut, Livial, Tibolon;
Modern drugs with anti-androgenic effect are represented by Androcur, Klimen, Diane-35;
The best combination products are Triaklim, .

The list of effective remedies is not limited to this list; there are also Klimara and Dermestil patches, Divigel hormonal gel, Ovestin suppositories, etc. An alternative form of release (gels, patches or suppositories) is used if local application is necessary.

Non-hormonal agents

Non-hormonal drugs for menopause as an alternative to HRT, are prescribed in case of individual intolerance or inability to use hormonal drugs. According to the modern classification, this group includes natural phytoestrogens. They are available in the form of homeopathic remedies and. In addition to the remedies listed above, to replace missing hormones during menopause, use:

gels Bonisan, Klimakt Hel;
tea or drops with red brush;
tablets CI-klim, Estrovel;
capsules, Menopace, etc.

How long to take hormones

Hormones should be taken under supervision and as prescribed by a doctor, even if we are talking about dietary supplements, herbal remedies or homeopathic remedies. There are several dosage regimens designed for several years:

monotherapy;
two- and three-phase course;
combined.

Each medicine has its own timing of administration; some drugs can be replaced by others, which is necessary when the symptoms of menopause change.

Content

The age-related changes that occur in the body of a woman entering menopause do not please anyone. The skin becomes dry and flabby, wrinkles appear on the face. Deficiency of sex hormones provokes pressure surges and decreased libido. Hormone replacement therapy helps cope with the symptoms of menopause.

What hormones are missing during menopause?

Hormones during menopause decrease to a critical level, after which the woman stops menstruating. In the last stage of menopause, they cease to be secreted at all, because of this the function of the ovaries fades away. A decrease in the level of sex hormones leads to numerous metabolic disorders, which provokes such phenomena as nausea, tinnitus, and increased blood pressure.

There are three phases of menopause: premenopause, menopause, postmenopause. What unites them is the process of falling hormone levels. In the first half of the menstrual cycle, estrogen (female hubbub) predominates, in the second - progesterone (male). Perimenopause is characterized by a lack of estrogen, which leads to an irregular monthly cycle. During menopause, progesterone levels, which regulate the thickness of the uterine endometrium, fall. During postmenopause, hormone production stops completely, and the ovaries and uterus decrease in size.

Hormonal therapy for menopause

The changes that occur in the female body during menopause manifest themselves as follows:

mood swings;
insomnia, anxiety;
the elasticity and firmness of the skin decreases;
body weight and posture changes;
osteoporosis develops;
urinary incontinence occurs;
pelvic organ prolapse;
development of atherosclerosis, diabetes mellitus;
disruption of the nervous system.

Hormone replacement therapy during menopause helps maintain health. By eliminating the above symptoms, general rejuvenation of the body occurs, changes in figure and atrophy of the genital organs are prevented. However, hormone replacement therapy during menopause also has its disadvantages. With long-term use, it can provoke myocardial infarction and increases the risk of stroke. In addition, homogeneous replacement therapy promotes intravascular blood coagulation.

Is hormone replacement therapy safe for menopause?

Not everyone can take hormonal medications during menopause. First, the doctor prescribes an examination with a therapist, gynecologist, cardiologist, hepatologist and phlebologist. Hormone replacement therapy during menopause is contraindicated if a woman has the following diseases:

uterine bleeding of unknown origin;
malignant tumors of the internal genital organs or mammary glands;
renal or liver failure;
the presence of adenomyosis or endometriosis of the ovaries;
severe stage of diabetes mellitus;
increased blood clotting;
lipid metabolism disorder;
worsening of mastopathy, bronchial asthma, epilepsy, rheumatism;
increased sensitivity to hormone replacement drugs.

Hormonal drugs for menopausal syndrome

Hormonal drugs for menopause of a new generation are selected depending on the duration and severity of the condition, as well as the age of the patient. Women with severe menopause need hormone replacement therapy (HRT). Medicines are prescribed parenterally or orally. Depending on the disorders associated with menopausal syndrome, hormone replacement therapy is selected individually.

Phytoestrogens

During menopause, the level of estrogen in the female body sharply decreases, so bad cholesterol begins to form, fat metabolism is disrupted, and immunity is weakened. To avoid these symptoms, doctors prescribe natural phytohormones during menopause. The use of these drugs does not disrupt hormonal balance, but alleviates symptoms. Dietary supplements with herbal substances act as analogues of natural hormones, which are not sold at a high price. Hormone replacement phytoestrogens include:

Klimadinon. The active ingredient is cosimifuga racemosa extract. With its help, the intensity of hot flashes is reduced and the lack of estrogen is eliminated. Therapy usually lasts three months. The medicine is taken 1 tablet daily.
Femicaps. Helps normalize estrogen, corrects psychological state, improves mineral and vitamin balance. Contains soy lecithin, vitamins, magnesium, passionflower, primrose. Take tablets, 2 capsules per day. Doctors prescribe taking the medicine for at least three months.
Remens. Harmless homeopathic remedy. It has a general strengthening effect on the female body, eliminates the lack of estrogen. Contains sepia, lachesis, cosimifuga extract. 2 courses of three months are prescribed.

Bioidentical hormones

During hormone replacement therapy for menopause, bioidentical hormonal drugs are prescribed. They are included in tablets, creams, gels, patches, and suppositories. These hormones are taken for 3-5 years until secondary menopausal symptoms disappear. Popular bioidentical hormone replacement drugs that are sold at an affordable price:

Femoston. A combined medicine that prolongs a woman’s youth. Contains estradiol and dydrogesterone, which are identical to natural ones. These hormones provide therapy for psychoemotional and autonomic symptoms. Prescribed 1 tablet/day.
Janine. A low-dose combination drug that suppresses ovulation, making it impossible for a fertilized egg to implant. It is used not only for contraception. During menopause, medication is prescribed to release estrogen into the body to relieve the symptoms of menopause.
Duphaston. It is a derivative of progesterone. Resists the negative effect of estrogen on the endometrium, reduces the risk of cancer. It is used according to an individual treatment regimen 2-3 times a day.

Estrogen preparations for women

In gynecology, synthetic estrogen in tablets is used to make life easier during menopause. Female hormones control collagen production and stimulate the nervous system. Preparations containing estrogen:

Klimonorm. Replenishes estrogen deficiency, provides treatment for the mucous membranes of the genitourinary system, and reduces the risk of cardiovascular pathologies. Apply one tablet per day according to the following scheme: 21 days, after a week’s break and the course is repeated.
Premarin. Facilitates the manifestations of menopausal syndrome, prevents the occurrence of osteoporosis. Cyclic use - 1.25 mg/day for 21 days, after - a break of 7 days.
Ovestin. Restores the vaginal epithelium, increases the resistance of the genitourinary system to inflammatory processes. Prescribe 4 mg daily for 3 weeks. The course of therapy or its extension is determined by the doctor.

How to choose hormonal pills during menopause

If a woman does not have health problems during menopause, then there is no need to take hormone replacement medications. HRT is carried out only after consultation with a doctor, since medications have side effects. There are frequent cases of individual intolerance and allergic reactions. The safest are herbal and homeopathic medicines. But they do not help all patients, so clinical indications and consultation with a doctor are required.

Price

All hormonal drugs can be purchased in the pharmacy chain at different prices or purchased in an online store (order from the catalog). In the latter version, the drugs will be inexpensive. Prices for phytoestrogens range from 400 rubles (Klimadinon tablets 60 pcs.) to 2400 rubles. (Femicaps capsules 120 pcs.). The cost of drugs with estrogen varies from 650 rubles (Klimonorm tablets 21 pcs.) to 1400 rubles. (Ovestin 1 mg/g 15 g cream).

Video

Found an error in the text?
Select it, press Ctrl + Enter and we will fix everything!