Menopause syndrome (menopause): treatment

Hormone replacement therapy (HRT) is an estrogen (ET) or estrogen-progestational therapy for women in the menopausal period. The clinical symptoms of menopausal syndrome are caused by estrogen deficiency, so the use of estrogen replacement therapy is justified. Progestins - drugs that act like natural progesterone, they are used as hormone replacement therapy to prevent hyperestrogenic conditions (endometrial hyperplasia, genital and breast cancer) against 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 climacteric syndrome or atypical course of menopause.

Objectives of the treatment of climacteric syndrome

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

Non-drug treatment of climacteric syndrome

In food use products containing soy protein (40 mg), which includes 75 mg of phytoestrogens.

Drug therapy of climacteric syndrome

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

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

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

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

1. Progesterone and progesterone-like compounds:
   • natural progesterone;
   • synthetic derivative compounds:
     • dydrogesterone;
     • derivatives of pregnane;
     • derivatives of norepregane.
2. Derivatives of 19-nortestosterone.
   • Ethinylated progestogens:
     • estrans-derivatives: norethisterone, linestrenol;
     • gonan-derivatives: levonorgestrel.
   • Non-ethylene progestogens:
     • dienogest.
   • Antimineralocorticoid:
     • drospirenone.

There are 3 main modes of hormone replacement therapy:

• monotherapy with estrogens or progestogens;
• combined therapy (estrogen-gestagenic) in a cyclic mode;
• combined therapy (estrogen-gestagenic) in monophasic continuous mode.

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

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

• 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 (shown with symptoms of hyperandrogenism in menopause).

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

• 17b-estradiol 2 mg.

In post-menopause 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.

With contraindications to systemic hormone replacement therapy recommend:

• Estradiol 0,05-0,1 mg, 1 adhesive patch on the skin once a week - 6-12 months;
• Estradiol 0.5-1 mg once a day to apply to the skin of the abdomen or buttocks, 6 months.

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

Surgical treatment of climacteric syndrome

Do not use with menopausal syndrome.

Training patient

Recommended healthy lifestyle:

• physical exercises;
• exclusion of coffee and alcohol;
• to give up smoking;
• reduction or exclusion (if possible) of neuropsychic loads.

Further management of the patient

Observation is carried out during the entire cycle of hormone replacement therapy. It is necessary to spend once a year:

• mammograms;
• Ultrasound of the genitals;
• densitometry.

When there are pathological symptoms from the side of the breast and menometrorrhagia or acyclic bleeding, mammography and ultrasound of the genitals are performed urgently.