medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-2-82-86medsovet-1728Research ArticleПРЕ- И ПОСТМЕНОПАУЗАPRE- AND POSTMENOPAUSEВЛИЯНИЕ НИЗКИХ ДОЗ ДРОСПИРЕНОНА И 17β-ЭСТРАДИОЛА НА КОРРЕКЦИЮ ПРОЯВЛЕНИЙ КЛИМАКТЕРИЧЕСКОГО СИНДРОМА У ЖЕНЩИН В ПОСТМЕНОПАУЗЕTHE EFFECT OF LOW-DOSE DROSPIRENONE AND 17β-ESTRADIOL FOR CORRECTION OF THE MANIFESTATIONS OF CLIMACTERIC SYNDROME IN POSTMENOPAUSAL WOMENГаспарянС. А.GasparyanS. A.

д.м.н., профессор

MD

ДросоваЛ. Д.DrosovaL. D.ХрипуноваА. А.KhripunovaA. A.

к.м.н.

Ph.D.

Ставропольский государственный медицинский университет Минздрава РоссииРоссияStavropol State Medical UniversityRussian Federation201730122017028286Copyright © Гаспарян С.А., Дросова Л.Д., Хрипунова А.А., 20172017Гаспарян С.А., Дросова Л.Д., Хрипунова А.А.Gasparyan S.A., Drosova L.D., Khripunova A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1728

Вазомоторные симптомы являются наиболее распространенными проявлениями менопаузы, требующими коррекции гормональной терапией (ГТ) эстрогенами и/или их комбинацией с прогестагенами. Последние международные клинические рекомендации признают необходимость использования самых низких эффективных доз ГТ. В качестве ГТ для облегчения симптомов в постменопаузе и профилактики остеопороза используется 17β-эстрадиол в комбинации с дроспиреноном.

В обзоре представлены данные крупнейших рандомизированных контролируемых исследований, в которых была проведена оценка влияния минимально эффективной дозы комбинации эстрадиол/дроспиренон на эндометрий, особенности фармакокинетики и фармакодинамики в зависимости от разных факторов.

Выявлено, что минимальной эффективной дозой для купирования приливов, не оказывающей при этом значительного влияния на состояние эндометрия, является комбинация дроспиренон 0,25 мг/эстрадиол 0,5 мг, которая купирует вазомоторные проявления климактерического синдрома, снижает частоту симптомов вульвовагинальной атрофии, повышая качество жизни больных. 

Vasomotor symptoms are the most common symptoms of menopause, requiring treatment with estrogen and/or progestogen. Recent international guidelines recognize the need to use the lowest effective dose of hormone replacement therapy. Drospirenone (DR) in combination with 17β-estradiol (E2) is used as hormone therapy (HT) for relief the symptoms and prevention of postmenopausal osteoporosis.

The review presents data of 2 large randomized controlled studies that evaluated the lowest effective dose combination DRSP/ E2, the safety of this dose for endometrium, identified features of its pharmacodynamics and pharmacokinetics, depending on various factors. The minimum effective dose for the relief of hot flushes without causing any significant impact on the endometrium is DRSP of 0,25 mg/E2 of 0,5 mg. According to the results of the pharmacokinetic study a correlation between effectiveness of low dose DRSP/E2 with DRSP and E2 exposure levels was showed, and smoking reduces the effectiveness of hormonal therapy. This drug not only copes with moderate to severe hot flushes, but also reduces the incidence of symptoms of vulvovaginal atrophy, improving quality of life. 

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The authors declare that there are no conflicts of interest present.