Hormone replacement therapy for menopause - all the pros and cons. Hormone replacement therapy Hence the moral: each vegetable has its own time

Date: 19.07.2019

The phrase "At 40, life is just beginning!" now it is taken almost literally - after all, modern 40-year-old women live a full life: they reach the peak of their careers, change husbands and lovers, give birth to their second or third child, go to fitness and dance. And the discrepancy between the biological age and the passport is becoming more and more obvious, so the emergence of anti-age (anti-aging) medicine can be called a challenge of the times. As well as the achievements of gynecological endocrinology, which can slow down physical aging.

Substitutional hormone therapy(HRT) is the most discussed method of affecting the female body. Is it possible with its help to prolong youth? Yes, you can. Properly selected hormone therapy really allows a woman to slow down the aging process and relieve her of painful symptoms. transition period, and not only physical, but also emotional, has a positive effect on mood, sleep, appearance and brings back the taste for life.

After all, women are much more prone to depressive moods, they react by changing moods to sharp fluctuations in hormones. For instance, premenstrual syndrome, depression after childbirth or after ovarian surgery, when their function is abruptly turned off. And, of course, the period preceding menopause, when women often become touchy, tearful, aggressive, not very adequate. To maintain not only hormonal, but also emotional balance, medicine now has a lot of "tools". The main one is hormone therapy.

Hormotherapy: dependence on estrogen levels

As long as a woman's estrogen level is normal, she is, in principle, protected from many diseases, and if her menopause occurs prematurely, all risks increase significantly! Therefore, it is very important for women to take care of their health from a young age. In the United States, the following figures were published: by the age of 60, every third woman is without a uterus. There are no Russian statistics yet, but we carry out such operations very often. And if earlier it was believed that hysterectomy (removal of the uterus) allows you to preserve the functions of the ovaries, today we know that 40% of women who undergo surgery turn off this function earlier, so they should definitely prescribe hormone replacement therapy in order to prevent aging processes which are caused by estrogen deficiency.

In general, estrogen-deficient states are always associated with a higher risk of diseases caused by the aging process: these are osteoporosis, and atherosclerosis, and cardiovascular diseases. Heredity is responsible for about 20% of everything that happens to our body. Therefore, firstly, knowing the family history of diseases and taking into account hereditary predisposition, it is possible to identify individual risk factors for each woman and prevent the development of these processes - to draw up a genetic passport. But 80% depend on our lifestyle, that is, on ourselves! It is very important to remember this.

The first signs of aging

The normal age for menopause is 45-55 years. But many metabolic disorders begin much earlier, when there is a deficiency of another important hormone - progesterone. This hormone also regulates most metabolic processes. Therefore, women often note weight gain, redistribution of body fat are very characteristic first signs of aging. Then there is a hormonal "imbalance": the level of estrogen decreases rapidly, and androgens - male hormones - more slowly. Be attentive to what is happening to your body.

Decreased estrogen levels accelerate density loss bone tissue, loss of collagen, including skin collagen. In the first 5 years after menopause, a woman can lose about 30% of all collagen, and this is irreparable! Unfortunately, many women who claim to take care of themselves rarely go to a gynecologist, but limit themselves to visits to a beauty salon.

But the effect of cosmetic procedures depends on the level of estrogen in the body! For example, the introduction of hyaluronic acid and mesotherapy with reduced estrogen are useless. Therefore, anti-aging procedures are most effective if they are carried out under the simultaneous supervision of a gynecologist, endocrinologist and cosmetologist. The effectiveness of hormone replacement therapy depends on many particulars: these are the patient's individual indications, various doses and combinations of hormones, the routes of administration - oral or transdermal.

Hormone therapy for breast cancer is effective if the cancer cells are sensitive to hormones. For this, an immunohistochemical examination is carried out. A biopsy takes a particle of the affected tissue to determine the number of hormone receptors. Detection of estrogen and progestin positivity confirms the presence of cancer cells that have stopped dividing. For their withering away, hormone therapy is used. This method of treatment has a systemic effect on the body, in some cases it is used as a priority treatment for breast oncology in women.

Indications

Therapy is prescribed:

In order to eliminate the remaining pathological segments after surgery and radiation.
Before surgery to reduce the size of the original lesion.
To prevent the appearance of pathology in the other mammary gland, decrease pain.
As part of a combination treatment for relapse or locally advanced disease.
Women at risk for hereditary predisposition.

Types of hormone therapy

Depending on the type of hormonal and anti-hormonal drugs, they block and prevent the development of tumor cells, are designed to stop or enhance the production of female sex hormones. In medicine, 2 types of hormone therapy are used:

Prophylactic (adjuvant).
Therapeutic.

Indications for hormone therapy:

the presence of metastases;
induration after surgery;
big sizes tumors;
growth of a neoplasm in the absence of an increase in the growth of cancer cells.

What drugs are used?

Depending on the ovarian cycle (the presence of menstruation, menopause or postmenopause), the method and treatment regimen changes.

Aromatase blockers are prescribed in the early and late stages of the disease at any time after the removal of the breast tumor. The effect is observed in postmenopausal patients. The drug prevents the production of estrogen by inhibiting the aromatase enzyme, prevents the growth and division of tumor cells.
"Tamoxifen", "Raloxifene" or "Toremifen" is prescribed for women of any age at all stages of the disease before and after surgery. The drug prevents estrogen from reaching cancer cells. Long-term treatment reduces the possibility of recurrence of pathology and neoplasms.
"Faslodex" is prescribed when the first two methods are not effective. The drug, by connecting with estrogen receptors, blocks their development. As a result, tumor cells do not grow.
The effect on the ovaries is medication, with the help surgical intervention(oophorectomy) or radiation exposure.

Treatment regimen

This type of breast cancer treatment is used regularly for 2 to 5 years (sometimes the treatment is longer than 5 years). Treatment regimens are developed individually for each patient, based on clinical picture, the severity of the disease, the general health, and the stage of tumor development. In young patients, during menopause less than 10 years of age and with menopause, hormone therapy begins one week after the end of the postoperative period (after oophorectomy). The treatment lasts for 5 years. For the purpose of prophylaxis, it is recommended to carry out therapy for three years.

Hormone therapy for stage 4 metastatic breast cancer

As a rule, metastatic cancer occurs after 3-5 years at the site of the neoplasm or in nearby tissues. Crayfish mammary gland Stage 4 spreads to the lymph nodes and peritoneum, adrenal glands and ovaries, lungs and liver. Most often, the localization of distant sites is bones (vertebrae, pelvis, humerus and femur and joints).

If the recurrent nodules are small, excision is sufficient. Multiple metastases are treated in a complex way: drug and chemotherapy, hormone therapy, palliative surgery, targeted and palliative care... For small metastases in the lymph nodes after mastectomy (surgery to remove the mammary glands), hormone therapy is considered as the main therapeutic measure... The reason for this is the dissemination process, in which tumor cells spread in the body through the bloodstream and / or lymphatic system.

Complications of this treatment for women

In each patient, the consequences of hormone therapy manifest themselves in different ways (based on the prescribed treatment regimen, the onset of menopause and the state of the body). The symptomatology of side effects varies during therapy. A common complication is stopping menstrual cycle(the phenomenon is temporary or permanent). If the age of menopause (51-52 years) is approaching, with hormone treatment it is possible early manifestation.

If the MC was normal before treatment, it will recover after the end of therapy. For cancer with metastases effective treatment hormone therapy is manifested by attacks of sudden burning. Pain relievers can help cope with the side effect.

In addition, fatigue, sweating and hot flashes may occur. Low doses of antidepressants can help cope with the problem.

Disruption of the gastrointestinal tract (nausea, constipation or diarrhea), lack or increase in appetite, increased body weight occur in 10% of women. If the patient has not gained weight within 6 months of taking hormonal drugs, most likely there will be no weight gain. Nausea and vomiting disappear after 2-3 weeks, and antiemetic drugs are prescribed to eliminate these side effects.

Patients struggle with depression and sudden mood swings with the help of psychotherapy and sedative medications.

With a timely consultation with the attending physician, recommendations are given to eliminate the consequences to improve the condition.

orake.info

Hormone therapy for breast cancer

Hormone therapy has been used for the treatment of breast cancers for over a century. At the end of the 19th century, the first results of the treatment of patients with breast cancer by the method of oophorectomy (removal of the ovaries) were published, which showed good efficiency.

After the oncologists suggested different methods hormone therapy: radiation castration, androgen administration, removal of the adrenal glands, surgical destruction of the pituitary gland, intake of antiestrogens, antiprogestins, aromatase inhibitors.

Over time have been developed effective methods hormone therapy - radiation, surgical, drug.

Today, hormone therapy is an integral part of complex therapy at any stage of breast cancer.

There are two directions of this type of treatment for breast cancer: stopping (inhibiting) the production of estrogen and taking anti-estrogen drugs.

The treatment is chosen by a specialist, taking into account various factors - the age and condition of the patient, the stage of the disease, concomitant diseases. Surgery to remove the ovaries is prescribed only for women with preserved menstrual function or with early menopause; in postmenopausal women, drugs that reduce estrogen levels are effective, in reproductive age use releasing hormones

Breast tumors are classified as hormone-dependent, but only about 40% of patients experience a positive effect from hormone therapy.

It is worth noting that some drugs can replace surgical treatment, for example, taking aromatase inhibitors allows you to avoid removing the adrenal glands, releasing hormones - removing the ovaries.

ilive.com.ua

The use of hormone therapy in the treatment of breast cancer

The mammary gland is a hormone-dependent organ: estrogens, progesterone and prolactin affect the growth and division of its cells, and each does this in different ways. Breast cancer is a site in which cells have mutated, that is, they have changed (and the stronger, the more malignant the tumor), acquired the ability to divide rapidly, displacing normal cells.

Medicines used for therapeutic purposes are not hormones, but substances that block their action on the tumor, thus preventing it from growing. They are not used on their own, but are effective in combination with surgical removal of cancerous growths, radiation therapy, and chemotherapy.

Medications that block hormone receptors give nice results not exclusively in the treatment of mammary carcinoma, but also effectively prevent the development of relapses and metastases of this malignant formation.

Hormone therapy, in the case of breast cancer, and hormone replacement therapy after breast cancer treatment are completely different concepts. In the first case, tumor cells are destroyed by drugs that are included in the synthesis of sex hormones, as a result of which the stimulating effect of estrogens on tumor growth is turned off. Hormone replacement therapy after treatment of pathology is the introduction of synthetic hormones into the woman's body, which will replace those that have disappeared as a result of cancer treatment (especially if surgical removal of the ovaries was used to suppress the growth of education).

How hormone therapy works for cancer

A woman constantly has hormones in her blood:

5 types of estrogens;
3 types of progesterones.

Their level is different in different days cycle, and with menopause, the volume of these hormones is significantly reduced, since the ovaries - the main "producer" of these substances - "turn off" for physiological reasons, only estrogens, synthesized by the adrenal glands and adipose tissue, remain.

Female hormones bind like a "key with a lock" to special structures, receptors, on the surface required cells... The "lock" opens, letting the hormone inside, and then it reacts with the cell nucleus, and thus regulates its reproduction, growth and death. The maximum number of receptors is found in adipose tissue, ovaries and mammary gland.

A cancerous tumor, appearing in the mammary gland, is built from cells that should have been normal, but have changed in the process of division and have not been destroyed the immune system... Many of them were not completely transformed, and the receptors for estrogen and progesterone were preserved in them. Getting to such cells, ordinary female hormones cause their increased division, followed by ingestion into the lymph and blood (metastasis).

Thus, if a woman is diagnosed with breast cancer, and this tumor has receptors for sex hormones (which is most often observed after menopause), doctors have an additional way of influencing her: by disabling the mechanism of hormone delivery to tumor cells, suppress its growth. This is not chemotherapy or radiation of a malignant neoplasm, which can only affect a dividing cell. Here is another way: to disable the ability to divide in all cancer cells.

How to determine if therapy is appropriate

Hormone therapy for breast cancer is indicated if the pathological formation is sensitive to hormones. To determine the sensitivity, an immunohistochemical study of the cells of the biopsy material taken from the patient during the biopsy is performed. According to the results of the study, 65-75% of pathological cells are sensitive to both estrogens and progesterones, in 10% - only to progesterones.

You can understand that hormone therapy is needed here, according to the conclusion issued by the immunohistochemical laboratory:

if it says "ER + / PR +", it means that there are both estrogen and progesterone receptors, and the prescribed hormonal treatment for breast cancer has a 70% chance of defeating the tumor;
"ER + / PR -" or "ER- / PR +", that is, the presence of only one type of receptor predicts success in only 33% of cases;
when it is written that "the hormonal status is not known," it means that on the way from the collection of cellular material from the tumor to the laboratory, it was damaged, a violation of the rules of transportation or storage. The laboratory assistant will write the same words if there are too few cells to carry out immunohistochemical reactions with them;
the conclusion "hormone-negative" (it usually happens in 25% of cases) means that there are too few receptors in the cancer.

In the last two cases, hormone therapy is not performed, since its predicted effectiveness is extremely low.

The detection of estrogen- or progestin-positivity in a cancer means that after its surgical removal, in order for the remaining cancer cells to stop dividing and die out after a while, hormone therapy must be applied. Also, similar treatment can be applied before the intervention - to reduce the size of the pathology and prevent its metastasis. If a malignant neoplasm of the breast is detected at a stage when the operation can no longer be performed, hormone therapy is needed to prolong the life of patients.

Indications

This kind treatment is used for estrogen-positive breast cancers in cases of:

if close relatives had malignant breast formations, and now the woman herself has a defective growth of organ cells;
large tumor size;
Stage 0 cancer;
cancer tends to invade adjacent tissues, nerves and blood vessels;
there are metastases;
after chemotherapy or radiation therapy, as well as after surgical intervention- for the prevention of relapse.

Learn more about breast cancer, its types and treatments by following the link.

Types and choice of hormone therapy

Depending on the purpose of the appointment, hormone therapy can be:

Adjuvant. It is used at the end of the operation to prevent recurrence and metastasis.
Neoadjuvant. It is performed before surgery, mainly in phase 3 cancer and when there are metastases to the lymph nodes. Most of the patients undergoing this therapy are postmenopausal.
Healing. It is used in inoperable patients in order to stop the growth of neoplasms and prolong life.

The drugs are selected depending on several factors:

stages of a cancerous tumor;
whether a woman is in menopause or not;
are there any concomitant diseases that are aggravated by a decrease in the level (or blockade) of estrogen: osteoporosis, arthritis, thrombosis.

How long hormone therapy will last depends on the type of drug chosen, its effectiveness and tolerance.

If blockers of the action of estrogens and progestins cause significant side effects, in some cases, removal of the ovaries can be performed - surgical or radiation. This stops the growth of cancerous growths by reducing the production of sex hormones. After ovarian resection - to prevent recurrence of breast cancer - not estrogen or progesterone blockers are prescribed, but hormones:

androgens (male hormones) - so that the pituitary gland does not stimulate the appearance of new follicles in the already non-existent ovaries;
corticosteroids (dexamethasone, prednisolone) - to turn off the production of estrogen by the adrenal glands;
estrogens - to turn off the function of the ovaries and suppress the secretion of the pituitary gland of those substances that are aimed at stimulating the ovaries;
estrogens, together with corticosteroids, are needed to suppress adrenal and pituitary stimulation of the ovaries, which have already been removed.

Hormone therapy drugs

According to the mechanism of action, drugs are divided into:

Reducing the level of estrogen in the body.
Stopping the connection of female hormones with tumor cell receptors.

Estrogen receptor modulators

Until 2005, hormone therapy was carried out only with an estrogen receptor modulator - Tamoxifen. This drug binds tightly to estrogen receptors, preventing the hormone from reaching them. It is very well studied, and this explains the described side effects of hormone therapy for breast cancer. It turns out that other anti-estrogen drugs may not be better tolerated, they just are not yet so deeply researched.

Other drugs in this group are Raloxifene and Toremifene. They are also widely used and do not increase the risk of liver cancer or endometrial carcinoma like Tamoxifen.

Estrogen receptor blockers

The drugs of this group, for example, Faslodex, destroy the estrogen receptors of the tumor.

Aromatase inhibitors

Basically, in postmenopausal women, estrogens are formed in adipose, muscle, liver and adrenal tissues from male hormones. These reactions take place under the action of the aromatase enzyme. Accordingly, if this enzyme is "turned off", androgens will stop transforming into estrogens, and breast cancer will stop receiving stimulation to grow and divide.

These drugs are now recognized as the most effective for the treatment of breast cancer at any stage. Plus, they have fewer side-effects than estrogen blockers.

The latest generation of this group is Letrozole. It binds to the gene of one of the subunits of aromatase, which converts androgens to estrogens, also inhibiting the synthesis of estrogens in tissues.

Progestins

If the drugs of the first three groups are ineffective, progestins are prescribed for hormone therapy. They reduce the secretion of those pituitary hormones that "command" the production of androgens and estrogens. Also, progestogens block the conversion of estrogens from androgens within the liver tissue.

These drugs have side effects: increased blood pressure, Cushing's syndrome, vaginal bleeding.

Side effects

The following main consequences of hormone therapy for breast cancer can be noted:

In spite of possible complications, the prescribed treatment must be taken - it prolongs life.

ginekolog-i-ya.ru

Hormone therapy for breast cancer: types and drugs

How many women are desperate when they hear this terrible diagnosis. Early diagnosis and the modern development of medicine solve the problem of breast cancer. The use of hormone therapy has proven to be effective in the fight against malignant neoplasms. Tumor growth decreases and even stops.

Hormone-dependent breast tumor

When a woman's body is working, estrogen and progesterone are irreplaceable. Circulating in the blood, they create conditions for cell growth, reproduction and death. Female sex hormones act on healthy and cancer-affected cells and help the body to bear and give birth to a baby. At hormonal disruption there is an excess of hormones. The amount of estrogen increases when it is used to treat:

uterine fibroids;
menstrual irregularities;
polycystic ovary disease.

Hormone-dependent breast cancer occurs when estrogen levels are high. In the tumor focus there are protein molecules - receptors, which, in synthesis with hormones, cause explosive growth neoplasms. Breast cancer treatment with hormone therapy breaks these bonds and helps heal and prevent relapses. The risk group includes women:

with the threat of miscarriage;
have had an abortion;
having malfunctioning ovaries;
who have had a frozen pregnancy.

Women should closely monitor their health, systematically resort to breast examination. With early diagnosis of cancer, the use of hormone therapy gives hope for a complete cure. Symptoms of a hormone-dependent tumor are:

the appearance of seals;
soreness at the site of the neoplasm;
enlarged lymph nodes.

Hormone therapy for breast cancer is not self-administered. A complex effect is used, which includes surgery together with chemotherapy, the use of radiation therapy. Indications for hormone therapy are:

breast cancer prognosis
reducing the risk of becoming invasive;
the ability to avoid relapse;
seals after the operation;
the likelihood of metastases;
cancer that does not respond to chemotherapy;
growth of a neoplasm in the absence of an increase in cancer cells.

Treatment of breast cancer with the influence of hormone therapy solves several problems, each requiring the use of its own drug. The choice of the method of exposure depends on factors:

stage of the disease;
periods of the patient's life - premenopause or postmenopause;
previous treatments;
hormonal status of the tumor;
portability medications;
concomitant diagnoses (arthritis, thrombosis worsen prognosis).

Hormone therapy for breast cancer requires knowledge of the hormonal status of the tumor. For this, clinical studies are carried out, which determine whether the tumor has receptors for hormones and to which ones. They are not found in every malignant neoplasm. The treatment plan depends on the hormonal status. The most favorable option is when there are simultaneously receptors for estrogen, progesterone. Cases are possible:

sensitivity to estrogen only;
negativity to all hormones;
susceptibility to progesterone only;
unknown hormonal status.

There are several types of hormone therapy for breast cancer (BC):

Adjuvant. It is considered prophylactic, it is used to eliminate relapses after tumor removal, radiation therapy and chemotherapy.
Neoadjuvant. Performed before surgery if there is a tumor big size.
Therapeutic. Designed to remove cancer foci, often used for inoperable types of tumors.

Hormonal Breast Cancer Treatment

The consequences of tumor treatment are positive, as hormonal drugs help to effectively solve several problems. The use process implies:

blocking and destroying the secretion of estrogen using selective modulators;
a decrease in the content of the hormone in the blood under the action of aromatase inhibitors;
surgical removal of the ovaries, which are the main supplier of estrogen, or irradiation of their tissues.

Hormone therapy is prescribed depending on the menstrual cycle. At different stages of a woman's life, drugs are used, the effectiveness of which is different. Breast cancer during the period of preservation of the cycle - premenopause - is treated according to the scheme:

Tamoxifen drug early stage(reception can last up to 5 years);
removal of the ovaries - the onset of menopause;
taking aromatase inhibitors.

Hormone therapy for a tumor in the breast when the patient is menopausal (postmenopausal) often leads to a healing effect. The patient first undergoes surgery, followed by chemotherapy or radiation therapy... Thereafter:

aromatase inhibitors (Femara) are prescribed for a period of 5 years;
if a relapse occurs, the drug Fazlodex is used.

If a woman is prescribed hormone therapy, you should prepare - the period of treatment can be long. It will become part of everyday life for a long time. With hormone-dependent cancer, the therapy method gives hope for a complete cure. The likelihood of tumor recurrence is significantly reduced. The main thing is to follow the instructions of the doctors and not to despair.

Aromatase inhibitors

Hormone therapy for breast cancer is aimed at reducing the level of estrogen in the blood. The best effect is observed in postmenopausal women. Often at this stage in a woman's life it is possible to obtain positive consequences... Aromatase inhibitors in breast cancer contribute to this by inhibiting the function of estrogen production. At long-term use drugs, a side effect appears - fragility of bones. In this case, additional calcium supplementation is required. Aromatase inhibitors include:

Femara;
Arimidex;
Aromasin.

Selective estrogen receptor modulators

Antiestrogens occupy a special place in hormone therapy for breast cancer. Their task is to irreversibly block the actions of estrogens. The cell stops receiving the signals that trigger it active growth, the process of death begins. Selective receptor modulators act selectively on breast tissue. Tamoxifen, the main drug, is taken as a pill. It helps women solve their pre-menopausal problems.

It is necessary to visit a doctor regularly to monitor your health, because there is an additional effect from the use of selective modulators. It is not always positive, there are some unpleasant moments:

from exposure to liver cells, cholesterol levels are reduced;
the risk of fractures is reduced due to the stimulation of bone tissue at the cellular level;
there is a risk of uterine cancer formation due to increased cell growth.

There is one drug that completely destroys estrogen receptors - Fazlodex. It is prescribed by injection when aromatase inhibitors and selective modulators do not help. Another way of hormone therapy is by acting on the ovaries. There are three methods of stopping estrogen production:

medication - injections with Zoladex, Lupron;
surgical - removal of the ovaries;
radiation exposure.

Nutrition for hormone-dependent breast cancer

Diet for breast cancer improves the results of hormone therapy, reduces the risk of recurrence. It is required to change the way of cooking - to give preference to boiling and stewing, completely deleting the frying technology. The use of sugar, pickles, animal fats should be limited. It is recommended to completely exclude:

foods with food additives;
preservatives;
fast food;
soda;
coffee;
alcohol.

With breast cancer, the calorie content of the meals should be in accordance with the patient's weight. Nutritionists advise adding garlic and onions to dishes. From meat products it is advisable to introduce lean poultry into the diet. Drink plenty of water. Preference should be given to healthy foods:

fruits;
cereals;
seafood;
vegetable fats;
legumes;
vegetables;
whole grain bread;
oily sea fish;
dairy products;
seaweed;
eggs.

The hormonal background in a woman's body is constantly changing throughout her life. With a lack of sex hormones, the course of biochemical processes is complicated. Can only help special treatment... The necessary substances are introduced artificially. In this way, vitality and activity are prolonged. female body... The drugs are prescribed on an individual basis, because, if you do not take into account the possible consequences, they can adversely affect the condition of the mammary glands and genitals. The decision to carry out such treatment is made on the basis of an examination.

Hormones are regulators of all processes in the body. Without them, hematopoiesis and the formation of cells of various tissues are impossible. With their lack, the nervous system and the brain suffer, serious deviations in the functioning of the reproductive system appear.

There are 2 types of hormone therapy used:

Isolated HRT - treatment is performed with drugs containing one hormone, for example, only estrogens (female sex hormones) or androgens (male).
Combined HRT - several hormonal substances are simultaneously introduced into the body.

Exists various forms release of such funds. Some are found in gels or ointments that are applied to the skin or inserted into the vagina. Medicines of this type are also available in tablet form. It is possible to use special plasters, as well as intrauterine devices... If long-term use of hormonal agents is necessary, they can be used in the form of implants inserted under the skin.

Note: The goal of treatment is not complete recovery. reproductive function organism. With the help of hormones, the symptoms that arise as a result of the wrong course of the most important life-supporting processes in the woman's body are eliminated. This allows you to significantly improve her well-being, to avoid the appearance of many diseases.

The principle of treatment is that in order to achieve maximum success, it should be prescribed in a timely manner, while hormonal disorders have not become irreversible.

Hormones are taken in small doses, moreover, natural substances are most often used, and not their synthetic counterparts. They are combined in such a way as to reduce the risk of negative side effects. Treatment is usually lengthy.

Video: When hormonal treatment is prescribed for women

Indications for the appointment of HRT

Hormone replacement therapy is prescribed in the following cases:

with the onset of an early menopause in a woman due to the depletion of the ovarian reserve of the ovaries and a decrease in the production of estrogen;
when it is required to improve the condition of a patient over the age of 45-50 years with the occurrence of age-related menopausal ailments (hot flashes, headaches, vaginal dryness, nervousness, decreased libido and others);
after removal of the ovaries, carried out in connection with purulent inflammatory processes, malignant tumors;
in the treatment of osteoporosis (the appearance of repeated fractures of the limbs due to a violation of the composition of bone tissue).

Estrogen therapy is also prescribed for a man if he wants to change sex and become a woman.

Contraindications

The use of hormonal agents is absolutely contraindicated if a woman has malignant tumors brain, mammary glands and genitals. Hormonal treatment is not carried out in the presence of blood and vascular diseases and a predisposition to thrombosis. HRT is not prescribed if a woman has suffered a stroke or heart attack, as well as if she suffers from persistent hypertension.

An absolute contraindication to such treatment is the presence of liver diseases, diabetes mellitus, as well as allergies to the components that make up the drugs. Hormone treatment is not prescribed if a woman has uterine bleeding of unknown nature.

Such therapy is not carried out during pregnancy and lactation. There are also relative contraindications to the use of such treatment.

Sometimes, despite the possible Negative consequences hormone therapy, it is still prescribed if the risk of complications of the disease itself is too great. For example, treatment is undesirable if the patient has migraines, epilepsy, fibroids, as well as a genetic predisposition to breast cancer. In some cases, there are restrictions on the use of estrogen preparations without the addition of progesterone (for example, with endometriosis).

Possible complications

Replacement therapy for many women is the only way to avoid severe hormone deficiency in the body. However, the effect of hormonal drugs is not always predictable. In some cases, their use can lead to increased blood pressure, blood clots and blood clots in the vessels of various organs. There is a risk of aggravating existing cardiovascular disease, up to a heart attack or cerebral hemorrhage.

A complication of cholelithiasis is possible. Even a small overdose of estrogen can provoke cancerous tumor in the uterus, ovary or breast, especially in women over 50. The appearance of tumors is more often observed in nulliparous women with a genetic predisposition.

The hormonal shift leads to metabolic disorders and a sharp increase in body weight. It is especially dangerous to carry out such therapy for a period of more than 10 years.

Video: Indications and contraindications for HRT

Preliminary diagnostics

Hormone replacement therapy is prescribed only after special examination with the participation of specialists such as a gynecologist, mammologist, endocrinologist, therapist.

Blood tests are performed for coagulability and the content of the following components:

Pituitary hormones: FSH and LH (regulating the work of the ovaries), as well as prolactin (responsible for the condition of the mammary glands) and TSH (a substance on which the production of thyroid hormones depends).
Sexual hubbubs (estrogen, progesterone, testosterone).
Proteins, fats, glucose, liver and pancreatic enzymes. This is necessary to study the metabolic rate and the state of various internal organs.

Mammography, osteodensitometry ( x-ray examination bone density). In order to make sure that there are no malignant tumors of the uterus, a PAP test (cytological analysis of a smear from the vagina and cervix) and transvaginal ultrasound are performed.

Substitution therapy

The prescription of specific medications and the choice of the treatment regimen are made purely individually and only after it has been carried out. full examination patients.

The following factors are taken into account:

the age and period of life of the woman;
the nature of the cycle (if there is menstruation);
the presence or absence of the uterus and ovaries;
the presence of fibroids and other tumors;
the presence of contraindications.

Treatment is carried out using various techniques, depending on its goals and the nature of the symptoms.

Types of HRT, drugs used

Monotherapy with estrogen-based drugs. It is prescribed only to women who have undergone a hysterectomy (removal of the uterus), since in this case there is no risk of developing endometrial hyperplasia. HRT is performed with drugs such as estrogel, divigel, proginova, or estrimax. Treatment begins immediately after the operation. It lasts for 5-7 years. If the age of a woman who underwent such an operation approaches menopausal, then the treatment is carried out until the onset of menopause.

Intermittent cyclic HRT. This technique is used during the onset of premenopausal symptoms in women under 55 years of age or during the onset of early menopause. A combination of estrogen and progesterone simulates a normal 28-day menstrual cycle.

To carry out hormone replacement therapy in this case, combined agents are used, for example, femoston or climonorm. The klimonorm package contains yellow tablets with estradiol and brown ones with progesterone (levonorgestrel). Within 9 days, yellow pills are taken, then 12 days - brown, after which they take a break for 7 days, during which menstrual bleeding appears. Sometimes, combinations of estrogen and progesterone drugs are used (for example, estrogel and urozhestan).

Continuous cyclic HRT. A similar technique is used in the case when a woman of 46-55 years old has no menstruation for more than 1 year (that is, menopause has come), there are quite serious manifestations of climacteric syndrome. In this case, hormonal agents are taken within 28 days (there is no imitation of menstruation).

Combined intermittent HRT estrogens and progestins are administered in different modes.

It is possible to carry out treatment in monthly courses. At the same time, it begins with the daily intake of estrogen preparations, and from the middle of the month, progesterone-based agents are also added to prevent overdose and the occurrence of hyperestrogenism.

A 91-day course of treatment may be prescribed. At the same time, estrogens are taken for 84 days, progesterone is added from day 71, then a break is taken for 7 days, after which the treatment cycle is repeated. Such substitution therapy is prescribed for women aged 55-60 years who have become postmenopausal.

Combined permanent estrogen-gestagenic HRT. Hormonal drugs are taken without interruption. The technique is used for women over 55 years old, and after 60 years, the doses of drugs are halved.

In some cases, a combination of estrogens with androgens is carried out.

Examinations during and after treatment

Types and doses used medicines may change when signs of complications appear. In order to prevent the appearance dangerous consequences, during therapy, the patient's state of health is monitored. The first examination is carried out 1 month after the start of treatment, then after 3 and 6 months. Subsequently, the woman should be seen by the gynecologist every six months to check the condition of the reproductive organs. It is necessary to regularly undergo mammological examinations, as well as visit an endocrinologist.

Blood pressure is monitored. The cardiogram is periodically taken. Held biochemical analysis blood to determine the content of glucose, fats, liver enzymes. Blood clotting is checked. In the event of serious complications, treatment is adjusted or canceled.

HRT and pregnancy

One of the indications for the appointment of hormone replacement therapy is the onset of early menopause (this sometimes happens at the age of 35 and earlier). The reason is a lack of estrogen. The growth of the endometrium, to which the embryo must attach, depends on the level of these hormones in the woman's body.

For patients of childbearing age for recovery hormonal background combined drugs are prescribed (femoston most often). If the level of estrogen can be increased, then the mucous membrane of the uterine cavity begins to thicken, and in rare cases, conception is possible. This can happen after a woman stops taking the drug after a few months of treatment. If there is a suspicion that pregnancy has occurred, it is necessary to stop treatment and consult a doctor about the advisability of preserving it, since hormones can negatively affect the development of the fetus.

Addition: A woman is usually warned before starting treatment with such means (in particular, femoston) about the need for additional use of condoms or other non-hormonal contraceptive devices.

HRT drugs can be prescribed for infertility caused by the lack of ovulation, as well as during IVF planning. A woman's ability to bear children, as well as the chances of a normal pregnancy, are assessed by the attending physician individually for each patient.

Unfortunately, disappointing statistics indicate that the number of breast cancer patients has increased significantly. Therefore, it is worth knowing which procedures are suitable, as well as the possible consequences of hormone therapy for breast cancer. But it's worth starting in order.

Definition of ailment

Breast / breast cancer, or the more scientific medical name - carcinoma, is nothing more than a malignant neoplasm in the area of glandular tissue. The disease can begin its development, both in the male and female body, despite the delusion of many. Even if not a large percentage - 1% - but such a probability exists. To date, this disease unfortunately, it is gaining momentum and acquiring the status of a scourge of the population.

Attention! This disease is very common in European countries, and very rare in Japan.

It is also worth mentioning the age at which the disease manifests itself statistically more often: in women - from 45 years old, in men - from 62 years old. The peak for both men and women is considered to be the age of 65 years.

Interesting! Although the treatment is very difficult, Lately in developed countries, there is a trend towards an increase in the number of recovered patients. This is primarily due to timely diagnosis and examination.

Hormone therapy

Based on numerous studies in the field of this disease, it has been established that its manifestation in most cases is due to some kind of disturbance in the work of the systems responsible for the production of hormones. It is these failures that lead, first to the formation, and then to the growth of malignant tumors. This means that the hormone therapy procedure for breast cancer is aimed at replacing the wrong hormones. It is used in cases:

when breast cancer is hormone-dependent (has a positive reaction to certain hormones);
when the disease recurs and it comes back.

Based on blocking special drugs, those hormones that the patient's body produces on its own. This also limits the effect of these hormones on the tissues of the body. Hormone therapy for breast cancer is systematic approach to the treatment of the disease, and works better in combination with other methods - surgical intervention, radiation and. The main task of such hormonal treatment is to avoid the recurrence of pathology. On the this moment hormone treatment, as an independent method, is not used.

For your information! The procedure has been one of the most successful methods in the fight against breast cancer for over a hundred years.

Drugs and their mechanism of action

The effectiveness of the treatment is due to the fact that the drugs, influencing the hormones that the female body produces, suppress their influence, and thereby reduce the action of cancer cells, subsequently killing them altogether. Considering that up to 75% of all breast cancers arise precisely due to a malfunction of the hormonal systems (cancer cells have receptors for sensitivity to female hormones- estrogen and progesterone), then such treatment is very effective.

Determination of the number of such receptors is performed using a biopsy. As a result, there are the following analytical conclusions:

75 percent of tumors are diagnosed with ERC + (estrogen receptors), which makes it possible to resort to hormone therapy;
65 percent - PR + (progesterone receptors). Therapy is also possible;
25 percent have a diagnosis of "hormone negative", which makes it impossible to use hormone therapy for breast cancer due to an insufficient number of receptors;
if the rules were not followed during storage of the sample, or its amount was too small, it is possible to conclude that the hormonal status has not been clarified.

Important! Until 2005, one well-known drug was tamoxifen. In the future, other inhibitory substances, for example, aromazine, began to be used.

Types of treatment

The main types of treatment with hormonal drugs include prophylactic, neoadjuvant and healing methods... The first is carried out after the main procedures (for example, surgery), the second - before, to reduce the tumor, and the third - when the operation is not possible, is aimed at reducing the focus or its complete elimination.

These methods differ from each other primarily by the purpose for which they are used. So, distinguish between blocking, elimination or reduction of action. Each of them has its positive aspects and negative consequences. It is possible to determine which method should be chosen only taking into account a number of factors, ranging from the hormonal status of the tumor to the stage of menopause.

Side effects

There are undoubtedly side effects of hormone therapy for breast cancer, since this is a direct effect on one of the most important systems of the female body. However, their effect is not as great as is commonly thought.

The choice in this situation is relative and completely independent. In any case, agreeing or refusing hormonal intervention - there will be pros and cons. The only thing is to study the issue correctly and know what you may encounter.

If you study the reviews of doctors and patients about hormone therapy for breast cancer, it becomes clear that the results and consequences depend on a number of factors - primarily on the drug. Such consequences can last different time- from short-term effects to rather serious ones.

As mentioned above, the effect of the drug and its consequences can be different, however, the general ones can be distinguished:

mood swings, depression;
weight gain, swelling;
untimely arrival of menopause;
throwing into heat;
dryness of the vagina.

The actions of hormone therapy are very individual, therefore, after passing all diagnostic examinations, you should consult with your doctor and determine all possible consequences... However, it is important to carefully weigh the pros and cons, leaning more towards the final disposal of the terrible disease.

In women, for the purpose of prevention and correction pathological disorders accompanying the climacteric period, various non-drug, medication 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 very long time there were discussions in which an ambiguous opinion was expressed on this matter, the frequency of its use reached 20-25%.

Hormone therapy - pros and cons

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

the danger of interference with the "fine" hormonal regulation system;
lack of ability to develop correct schemes treatment;
by interfering with the natural aging processes of the body;
the impossibility of accurate dosing of hormones, depending on the needs of the body;
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

The preservation of the constancy of the internal environment of the organism and the possibility of its adequate functioning as a whole is ensured by the self-regulating hormonal system 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, the onset are regulated by the hypothalamic-pituitary-ovarian system. The functioning of its individual links, the main of which are the hypothalamic structures of the brain, is also based on the principle of direct and feedback between themselves 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 secretion 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, respectively, entails an increase or decrease in the concentration of hormones produced by the endocrine glands of other links, and vice versa. This is what general meaning the mechanism of direct and feedback.

Rationale for the use of 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. According to the classification from 1999, during climacteric, starting from 39-45 years old and lasting up to 70-75 years old, there are four phases - 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 nervous tissue the brain, which leads to a decrease in the production of progesterone by the ovaries first, and then estrogens, and to a decrease in the sensitivity of the hypothalamus to them, and therefore to a decrease in the synthesis of GnRH.

At the same time, in accordance with the principle of the feedback mechanism, the pituitary gland responds to this decrease in hormones in order to stimulate their production by increasing FSH and LH. Thanks to this "spurring" of the ovaries, the normal concentration of sex hormones in the blood is maintained, but already with a tense 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, estrogens become insufficient for the appropriate reaction of the pituitary gland, and depletion of this compensatory mechanism gradually sets in. 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 premenopausal women in 37% of women, in 40% - during menopause, in 20% - 1 year after its onset and in 2% - 5 years after its onset; climacteric syndrome manifests itself sudden feeling hot flashes and sweating (in 50-80%), attacks of chills, psycho-emotional instability and unstable blood pressure(more often increased), palpitations, numbness of the fingers, tingling and pain in the heart, 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, painful urination, urinary incontinence;
dystrophic changes in the skin and its appendages - diffuse alopecia, dryness skin and increased fragility of nails, deepening of skin wrinkles and folds;
metabolic and metabolic disorders, manifested by an increase in body weight with a decrease in appetite, fluid retention in tissues with the appearance of pasty face and swelling of the legs, a decrease in glucose tolerance, etc.
late manifestations - a decrease in bone mineral density and the development of osteoporosis, hypertension and ischemic disease heart, Alzheimer's, etc.

Thus, against the background of age-related changes in many women (37-70%), all phases of the climacteric period may be accompanied by one or another dominant complex 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 justified method that allows you to prevent, eliminate or significantly reduce dysfunctions of organs and systems and reduce the risk of development serious illnesses associated with a 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 women young age up to 5-7 days of the menstrual cycle, that is, in the proliferative phase.
The use of estrogens and progestogens in various combinations, which makes it possible to exclude the processes of endometrial hyperplasia.
In cases of postoperative absence of the uterus, the possibility of using 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.

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

synthetic, which are constituent components - ethinylestradiol and diethylstilbestrol;
conjugated or micronized forms (for better absorption in digestive tract) natural hormones estriol, estradiol and estrone; these include micronized 17-beta-estradiol, which is part of such drugs as Klikogest, Femoston, Estrofen and Trissequens;
ether derivatives - estriol succinate, estrone sulfate and estradiolvalerate, which are components of the drugs Klimen, Klimonorm, Divina, Proginova and Cycloproginov;
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 gels ("Estrajel", "Divigel") and plasters ("Klimara") containing estradiol are used over 170 mm Hg. When using them and intact (preserved) uterus with appendages, it is necessary to add progesterone drugs ("Utrozhestan", "Duphaston").

Substitution 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 required 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, similar in structure to Norkolut and considered the most effective drugs in the prevention and treatment of osteoporosis;
Diane-35, Androkur, Klymen, containing cyproterone acetate, which has an antiandrogenic effect.

Combined drugs of substitution therapy, which include estrogens and progestogens, include Triaclim, Klimonorm, Angelik, Ovestin, etc.

Regimens for taking hormonal drugs

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

Short-term, aimed at preventing climacteric syndrome - hot flashes, psychoemotional disorders, urogenital disorders, etc. The duration of treatment for a short-term scheme is 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 is reduced by 30%), heart and vascular diseases.

There are three modes of taking tablet drugs:

monotherapy with estrogenic or progestogenic agents in a cyclic or continuous mode;
two-phase and three-phase estrogen-progestin drugs in a cyclic or continuous mode;
a combination of estrogens with androgens.

Hormone therapy for surgical menopause

It depends on the amount of surgery performed and the woman's age:

After removal of the ovaries and the preserved uterus in women under 51 years of age, it is recommended to take 2 mg estradiol with cypraterone 1 mg or levonorgestrel 0, 15 mg, or medroxyprogesterone 10 mg, or dydrogesterone 10 mg, or estradiol 1 mg in a cyclic mode 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 diegnost 2 mg, or drosirenone 2 mg, or estradiol 1 mg with didrosterone 5 mg. In addition, it is possible to use Tibolone (belongs to the STEAR group drugs) at 2.5 mg per day.
After surgical treatment with the risk of relapse - taking estradiol with dienogest 2 mg or estradiol 1 mg with dydrogesterone 5 mg in a monophasic mode, or STEAR therapy.

Side effects of HRT and contraindications to its use

Possible side effects of hormone therapy for menopause:

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

The main contraindications to hormone therapy for menopause are as follows:

History of malignant neoplasms of the mammary glands or internal genital organs.
Uterine bleeding of unknown origin.
Severe diabetes mellitus.
Hepatic renal failure.
Increased blood clotting, a tendency to thrombosis and thromboembolism.
Violation of lipid metabolism (external use of hormones is possible).
The presence of or (contraindication to the use of estrogen monotherapy).
Hypersensitivity to the drugs used.
Development or worsening of the course of diseases such as, autoimmune diseases connective tissue, 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 state, and significantly increase the level of quality.