Climacteric syndrome (menopause) - Treatment

Hormone replacement therapy (HRT) is estrogen (ET) or estrogen-gestagen therapy for women in the climacteric period. Clinical symptoms of climacteric syndrome are caused by estrogen deficiency, so the use of estrogen replacement therapy is justified. Progestins are drugs that act like natural progesterone, they are used as hormone replacement therapy to prevent hyperestrogenic conditions (endometrial hyperplasia, genital and breast cancer) against the background of estrogen monotherapy in women with a uterus. Hormone replacement therapy is an effective way to prevent and treat osteoporosis, urogenital atrophy and primary prevention of cardiovascular diseases.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]

Indications for hospitalization

Severe degree of climacteric syndrome or atypical course of menopause.

Goals of treatment of climacteric syndrome

• Maintaining the normal functional state of hormone-dependent tissues.
• Reduction of symptoms of climacteric syndrome.
• Improving the quality of life of older women.
• Prevention of osteoporosis development.

Non-drug treatment of climacteric syndrome

The food contains products containing soy protein (40 mg), which contains 75 mg of phytoestrogens.

Drug therapy for climacteric syndrome

In the treatment of climacteric syndrome, only natural estrogens are used, identical in chemical structure to the estrogens synthesized in the female body.

• Estradiol and derivatives:
  • 17b-estradiol;
  • estradiol valerate;
  • estradiol benzonate;
  • conjugated equine estrogens.
• Estrone:
  • conjugated equine estrogens.
• Estriol:
  • estriol;
  • estriol succinate.

To prevent hyperplastic processes and endometrial cancer, women with an intact uterus need to take progestins in a cyclic or continuous regimen.

Progestogens used in hormone replacement therapy are divided into 2 main groups:

1. Progesterone and progesterone-like compounds:
   • natural progesterone;
   • synthetic derivatives of the compound:
     • dydrogesterone;
     • pregnane derivatives;
     • norpregnane derivatives.
2. Derivatives of 19-nortestosterone.
   • Ethinylated progestogens:
     • estran derivatives: norethisterone, linestrenol;
     • gonand derivatives: levonorgestrel.
   • Non-ethinylated progestogens:
     • dienogest.
   • Antimineralocorticoids:
     • drospirenone.

There are 3 main regimens of hormone replacement therapy:

• monotherapy with estrogens or progestogens;
• combination therapy (estrogen-progestogen) in a cyclic regimen;
• combination therapy (estrogen-gestagen) in a monophasic continuous regimen.

With an intact uterus, the choice of therapy and drug depends on the phase of the climacteric period.

In perimenopause, with an intact uterus, combined cyclic therapy is prescribed. Recommended drugs:

• estradiol valerate 2 mg and levonorgestrel 0.15 mg, course 6-12 months;
• estradiol valerate 2 mg and norgestrel 0.5 mg, course 6–12 months;
• estradiol valerate 1–2 mg and medroxyprogesterone acetate 10 mg, course 6–12 months;
• 17b-estradiol 2 mg and norethisterone acetate 1 mg, course 6–12 months;
• estradiol valerate 2 mg and cyproterone acetate 1 mg, course 6-12 months (indicated for symptoms of hyperandrogenism during menopause).

In the absence of a uterus (after a hysterectomy), estrogen monotherapy is prescribed in intermittent courses or in a continuous mode:

• 17b-estradiol 2 mg.

In postmenopause, combined continuous therapy is used:

• tibolone 2.5 mg - 1 tablet per day;
• 17b-estradiol 2 mg and norethisterone acetate 1 mg - 1 tablet 1 time per day.

In case of contraindications to systemic hormone replacement therapy, the following is recommended:

• estradiol 0.05–0.1 mg, 1 patch applied to the skin once a week - 6–12 months;
• estradiol 0.5-1 mg 1 time per day apply to the skin of the abdomen or buttocks, course 6 months.

[ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ]

Surgical treatment of climacteric syndrome

Do not use in case of climacteric syndrome.

Patient education

A healthy lifestyle is recommended:

• physical exercise;
• eliminating coffee and alcohol;
• quitting smoking;
• reduction or elimination (if possible) of neuropsychic stress.

Further management of the patient

Monitoring is carried out throughout the entire cycle of hormone replacement therapy. It is necessary to carry out once a year:

• mammography;
• Genital ultrasound;
• densitometry.

If pathological symptoms occur in the mammary gland and menometrorrhagia or acyclic bleeding, mammography and ultrasound of the genitals are performed on an emergency basis.