medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-2-92-99medsovet-1730Research ArticleПРЕ- И ПОСТМЕНОПАУЗАPRE- AND POSTMENOPAUSEМЕНОПАУЗАЛЬНАЯ ГОРМОНОТЕРАПИЯ С ДИДРОГЕСТЕРОНОМ: АСПЕКТЫ ЭФФЕКТИВНОСТИ И БЕЗОПАСНОСТИ УЛЬТРАНИЗКИХ ДОЗMENOPAUSAL HORMONE THERAPY WITH DYDROGESTERONE: ASPECTS OF EFFICACY AND SAFETY OF ULTRA-LOW DOSESСметникА. А.SmetnikA. A.

к.м.н., 

Москва

PhD in medicine, 

Moscow

Научный центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова Минздрава РоссииРоссияKulakov Scientific Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of RussiaRussian Federation201730122017029299Copyright © Сметник А.А., 20172017Сметник А.А.Smetnik A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1730

В ряде исследований показано, что менопаузальная гормонотерапия (МГТ), состоящая из 1 мг 17ß-эстрадиола и 5 мг дидрогестерона, является эффективной для снижения выраженности климактерических симптомов и повышения мине- ральной плотности костей у женщин в постменопаузе [1, 2] и в то же время имеет благоприятные показатели безопасности для эндометрия и паттерна кровотечений [3, 4]. Тем не менее современные руководства рекомендуют использовать для лечения симптомов менопаузы наименьшие эффективные дозы эстрогенов [5–7]. В связи с этим был разработан новый комбинированный режим МГТ с непрерывным использованием сверхнизких доз гормонов – 0,5 мг 17ß-эстрадиола и 2,5 мг дидрогестерона. Использование ультранизких доз эстрогенов позволяет обеспечить защиту эндометрия более низкими дозами прогестагенов. Подобные низкодозовые комбинации МГТ могут снизить частоту возникновения нежелательных явлений, таких как чувствительность молочных желез, маточные кровотечения, сердечно-сосудистые заболевания, ишемический инсульт и венозные тромбоэмболические осложнения, и в то же время сохранить эффективность в отношении климактерических симптомов [8–12]. Появление в арсенале гинекологов ультранизкодозированной МГТ, вероятно, улучшит приверженность пациентов данному режиму лечения. Кроме того, низкие дозы эстрогенов особенно полезны для женщин старшего возраста (более 59 лет).

A number of studies have shown that menopausal hormone therapy (MHT), consisting of 1 mg 17ß-estradiol and 5 mg dydrogesterone, is effective to reduce the severity of menopausal symptoms and increases bone mineral density in postmenopausal women [1] and at the same time has a favorable safety indicators for the endometrium and the pattern of bleeding [2, 3]. Nevertheless, current guidelines recommend the use for the treatment of menopausal symptoms of the lowest effective dose of estrogen [4–6]. In this regard, we developed a new combined mode of MHT with continuous use of ultra-low doses of hormones – 0.5 mg 17ß-estradiol and 2.5 mg of dydrogesterone. The use of ultra-low doses of estrogen protects the endometrium by lower doses of progestogen. Similar combinations of low doses of MHT can reduce the incidence of adverse events, such as the sensitivity of the mammary glands, uterine bleeding, cardiovascular disease, ischemic stroke and venous thromboembolic complications, and at the same time, to maintain effectiveness against menopausal symptoms [7–11]. The appearance of in the arsenal of gynecologists of ultra-low dose MHT is likely to improve the patient’s adherence to this treatment regime. In addition, a low dose of estrogen is particularly useful for older women (>59 years).

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