The menopause is a special period in a woman's life, when, against the background of age-related changes in her body, involutive processes develop in her reproductive system. The result of this process is the cessation of the generative and menstrual function.
Every year there are more and more women in the world who, in the postmenopausal age, maintain significant social activity, and therefore they need medical support for the quality of life, to improve their health against the background of age-related changes. Read about the role of hormone replacement therapy in this support of a woman's standard of living at estet-portal.com.
When is hormone replacement therapy recommended
Currently, there are several phases of menopause: the transition to menopause, menopause (last menstruation), perimenopause (a year after the last menstruation), postmenopause. Isolation of these phases is important from a clinical standpoint, since the hormonal function of the ovaries in a woman, say, continues in the transition period, and one should try to preserve it as long as possible. And during the period of perimenopause, vegetative-vascular and psycho-emotional problems are often observed, requiring an individual approach and medication correction, since they can significantly reduce the quality of life of a woman.
Read also: "Quality of life of a woman during menopause"
The initial period of perimenopause is characterized by relative hyperestrogenism, against which the development of diseases of the mammary glands, endometrial hyperplasia, uterine leiomyoma and even dysfunctional uterine bleeding is possible. Further, against the background of a decrease in estrogen production, metabolic disorders appear, problems with the cardiovascular system develop, urogenital disorders, and sexual dysfunction are often noted. All these disorders have an extremely adverse effect on the quality of life of a woman and need to be corrected.
Multiple studies have shown that the use of hormone replacement therapy for a short period of time certainly brings more benefits than the risk of side effects if patients suffer from hot flashes and night sweats, from osteopenic syndrome and atrophic changes in the genitourinary tract.
How drugs for hormone replacement therapy are selected
The drug for hormone replacement therapy is selected taking into account family history and personal well-being, body weight, the presence of concomitant pathologies, age, current condition and a number of other factors. The order of taking the drugs & nbsp; can be different – both monotherapy and combination therapy, both cyclic and monophasic regimen. Which one to choose – the doctor decides, taking into account the preferences of the patient.
Hormone replacement therapy preparations include components similar in composition to estradiol, which is synthesized in the female body – for example, estradiol valerate, 17.beta.-estradiol. The estrogenic components have, among other things, a significant cardioprotective effect. In addition, the gestagenic component – for the prevention of endometrial hyperplasia and cancer.
Things to do before prescribing hormone replacement therapy
Before starting hormone replacement therapy, a detailed medical history should be taken – clarify hereditary factors, learn about various past diseases, especially oncological ones, ask about the reaction to oral contraceptives, problems with blood vessels, liver, determine the risk of thromboembolism. In addition, the patient must undergo a mandatory medical examination:
- study with oncocytology,
- Ultrasound of genitals,
- mammography,
- assessment of endometrial thickness and structure.
If necessary, an additional blood test is prescribed (including glucose, lipid spectrum, hormonal indicators), coagulogram. You may need to consult such specialists as a neuropathologist, cardiologist, endocrinologist.
When is it recommended to start hormone replacement therapy
In 2006, at the 12th World Congress of Endocrine Gynecology, based on the results of the WHI and MWS studies, it was agreed that hormone replacement therapy should be started as soon as the transition to menopause begins. According to the researchers, this approach allows for the prevention of cardiovascular diseases.
It is recommended to initiate hormone replacement therapy with low-dose estrogen preparations, as there is relative hyperestrogenism during premenopause despite an absolute decrease in estrogen production.
After the start of HRT, it is recommended to conduct the first control of the patient's condition after 3 months, then – check every 6 months. Once a year, it is necessary to do mammography and ultrasound of the genital organs, monitor the coagulogram and lipid metabolism, conduct a cytomorphological study of the cervical epithelium.
You may be interested in reading: "Premature Menopause: Early Old Age or Condition Requiring Correction"
Today, gynecologists have quite a lot of drugs for HRT in their arsenal, so it is possible to select and prescribe individual treatment for each patient – with the determination of the required dosage, the choice of estrogenic and progestogenic components, the preferred route of administration – taking into account the state of health. With constant monitoring of the patient's health status, the benefits of using HRT most often outweigh the risk of developing undesirable consequences.
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