medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2016-2-74-78medsovet-44Research ArticleПРЕ- И ПОСТМЕНОПАУЗАPRE- AND POSTMENOPAUSEЭволюция менопаузальнои гормонотерапии: от стандартных доз к ультранизкимEvolution of menopausal hormone therapy: from standard to ultra-low dosesБаланВ. Е.BalanV. E.noemail@neicon.ruЖуравельА. С.ZhuravelA. S.noemail@neicon.ruЛопатинаО. В.LopatinaO. V.noemail@neicon.ruОрловаС. А.OrlovaS. A.noemail@neicon.ruМосковский областной научно-исследовательский институт акушерства и гинекологииРоссияMoscow Regional Research Institute of Obstetrics and GynecologyRussian Federation201630122016027478Copyright © Балан В.Е., Журавель А.С., Лопатина О.В., Орлова С.А., 20162016Балан В.Е., Журавель А.С., Лопатина О.В., Орлова С.А.Balan V.E., Zhuravel A.S., Lopatina O.V., Orlova S.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/44

В данной статье представлены распространенность и тяжесть менопаузальных симптомов у женщин в период пре-, пери- и поздней постменопаузы, а также обоснование необходимости их лечения. Определено, что использование менопаузальной гормональной терапии (МГТ) должно быть индивидуализировано и его не следует прекращать исключительно по причине возраста женщины. Представлены результаты многочисленных исследований женщин в период перехода от пре- к пери-и далее к постменопаузе. Рассмотрены ограничения продолжительности приема МГТ, и обоснована потребность в разработке безопасных для длительного использования методов лечения приливов. Доказано, ультранизкодозированный препарат эффективен для лечения как умеренных, так и тяжелых вазомоторных симптомов.

The article tells about the incidence and severity of menopausal symptoms in women during pre-, peri- and post-menopausal periods as well as the rationale for their treatment. It was found that the use of menopausal hormone therapy (MHT) should be individualized and should not be cancelled solely due to the woman's age. The results of numerous studies of women in the transition from pre- to peri- and further to postmenopause are demonstrated. Limitations in the duration of MHT therapy are considered, and the need to develop safer therapies for long-term treatment of hot flushes is substantiated. It is proved that ultra-low-dose medication is effective for the treatment of both moderate and severe vasomotor symptoms.

менопаузальные симптомыМГТдлительность лечения МГТвазомоторные симптомынизко- и ультранизкодозированные системныеэстрогеныmenopausal symptomsMHTduration of MHT treatmentvasomotor symptomslow and ultra-low-dose low systemic estrogensReferenceshttp://www.menopause.org/docs/default-source/2015/2015-nams-hormone-therapy-after-age-65.pdf.http://www.menopause.org/docs/default-source/2015/2015-nams-hormone-therapy-after-age-65.pdf.Сметник В. П. От главного редактора. Климактерий, 2011, 2: 3-53.Сметник В. П. От главного редактора. Климактерий, 2011, 2: 3-53.Сметник В.П., Балан В.Е, Зайдиева Я.З., Майчук Е.Ю, Мычка В.Б. и др. Ведение женщин с сердечно-сосудистым риском в пери- и постменопаузе. Российский кардиологический журнал, 2008, 4: 40-57.Сметник В.П., Балан В.Е, Зайдиева Я.З., Майчук Е.Ю, Мычка В.Б. и др. Ведение женщин с сердечно-сосудистым риском в пери- и постменопаузе. Российский кардиологический журнал, 2008, 4: 40-57.Shufelt CL, Merz CN, Prentice RL et al. Hormone therapy dose, formulation, route of delivery, and risk of cardiovascular events in women: findings from the Women's Health Initiative Observational Study. Menopause, 2014, 21: 260-6.Shufelt CL, Merz CN, Prentice RL et al. Hormone therapy dose, formulation, route of delivery, and risk of cardiovascular events in women: findings from the Women's Health Initiative Observational Study. Menopause, 2014, 21: 260-6.Nachtigall LE, Nachtigall MJ. The perimeno-pause and vasomotor symptoms. Posgraduate Medicine, A special report, 1990: 5-7.Nachtigall LE, Nachtigall MJ. The perimeno-pause and vasomotor symptoms. Posgraduate Medicine, A special report, 1990: 5-7.Raus K, выступление на конференции «Press 2011 - Gynecology and Urology. Phytoneering research and experience summit» (Майорка, 2011).Raus K, выступление на конференции «Press 2011 - Gynecology and Urology. Phytoneering research and experience summit» (Майорка, 2011).The North American Menopause Society. The 2012 Hormone Therapy Position Statement of The North American Menopause Society. Menopause, 2012, 19: 257.The North American Menopause Society. The 2012 Hormone Therapy Position Statement of The North American Menopause Society. Menopause, 2012, 19: 257.Avis NE, Crawford SL, Greendale G et al. The Study of Women's Health Across the Nation (SWAN). Duration of menopausal vasomotor symptoms over the menopause transition [published online ahead of print February 16, 2015]. JAMA Intern Med. doi:10.1001/jamain-ternmed.2014.8063.Avis NE, Crawford SL, Greendale G et al. The Study of Women's Health Across the Nation (SWAN). Duration of menopausal vasomotor symptoms over the menopause transition [published online ahead of print February 16, 2015]. JAMA Intern Med. doi:10.1001/jamain-ternmed.2014.8063.Gartoulla P, Worsley R, Bell RJ, Davis SR. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years [published online ahead of print February 20, 2015]. Menopause.doi: 10.1097/ gme.0000000000000383Gartoulla P, Worsley R, Bell RJ, Davis SR. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years [published online ahead of print February 20, 2015]. Menopause.doi: 10.1097/ gme.0000000000000383Kaunitz AM, Manson JE. EDITORIAL. Failure to treat menopausal symptoms: a disconnect between clinical practice and scientific data. Menopause, 2015, 22 (7): 000/000. DOI: 10.1097/gme.0000000000000457.Kaunitz AM, Manson JE. EDITORIAL. Failure to treat menopausal symptoms: a disconnect between clinical practice and scientific data. Menopause, 2015, 22 (7): 000/000. DOI: 10.1097/gme.0000000000000457.Courtin A, Communal L, Vilasco M et al. Glucocorticoid receptor activity discriminates between progesterone and medroxyprogester-one acetate effects in breast cells. Breast Cancer Res Treat, 2012, 131: 49-63.Courtin A, Communal L, Vilasco M et al. Glucocorticoid receptor activity discriminates between progesterone and medroxyprogester-one acetate effects in breast cells. Breast Cancer Res Treat, 2012, 131: 49-63.Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA, 2011, 306: 1884-1890.Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA, 2011, 306: 1884-1890.Manson et al. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA, 2013, 310: 1353-1368.Manson et al. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA, 2013, 310: 1353-1368.Stefanick ML. Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women's Health Initiative Randomized Trials. JAMA, 2013, 310: 1353-68.Stefanick ML. Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women's Health Initiative Randomized Trials. JAMA, 2013, 310: 1353-68.Kaunitz AM. Hormone therapy and breast cancer risk: trumping fear with facts. Menopause, 2006, 13: 160-163.Kaunitz AM. Hormone therapy and breast cancer risk: trumping fear with facts. Menopause, 2006, 13: 160-163.Courtin A, Communal L, Vilasco M et al. Glucocorticoid receptor activity discriminates between progesterone and medroxyprogester-one acetate effects in breast cells. Breast Cancer Res Treat, 2012, 131: 49-63.Courtin A, Communal L, Vilasco M et al. Glucocorticoid receptor activity discriminates between progesterone and medroxyprogester-one acetate effects in breast cells. Breast Cancer Res Treat, 2012, 131: 49-63.Smith GC, Wood AM, White IR, Pell JP, Hattie J. Birth weight and the risk of cardiovascular disease in the maternal grandparents. Am J Epidemiol, 2010, 171: 736-44.Smith GC, Wood AM, White IR, Pell JP, Hattie J. Birth weight and the risk of cardiovascular disease in the maternal grandparents. Am J Epidemiol, 2010, 171: 736-44.de Villiers TJ, Pines A, Panay N et al. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric, 2013, 16: 316-337.de Villiers TJ, Pines A, Panay N et al. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric, 2013, 16: 316-337.de Villiers TJ, Gass ML, Haines CJ et al. Global Consensus Statement on Menopausal Hormone Therapy. Climacteric, 2013, 16: 203-4.de Villiers TJ, Gass ML, Haines CJ et al. Global Consensus Statement on Menopausal Hormone Therapy. Climacteric, 2013, 16: 203-4.ACOG Practice Bulletin No. 141: Management of Menopausal Symptoms. Obstet Gynecol., 2014, 123: 202-216.ACOG Practice Bulletin No. 141: Management of Menopausal Symptoms. Obstet Gynecol., 2014, 123: 202-216.Greenwald MW, Gluck OS, Lang E, Rakov V. Oral hormone therapy with 17beta-estradiol and 17beta-estradiol in combination with norethin-drone acetate in the prevention of bone loss in early postmenopausal women: dose-dependent effects. Menopause, 2005, 12: 741-8.Greenwald MW, Gluck OS, Lang E, Rakov V. Oral hormone therapy with 17beta-estradiol and 17beta-estradiol in combination with norethin-drone acetate in the prevention of bone loss in early postmenopausal women: dose-dependent effects. Menopause, 2005, 12: 741-8.Archer DF, Schmelter T, Schaefers M, Gerlinger C, Gude K. A randomized, double-blind, placebo-controlled study of the lowest effective dose of drospirenone with 17p-estradiol for moderate to severe vasomotor symptoms in postmenopausal women. Menopause, 2014, 21(3): 227-35. doi: 10.1097/ GME.0b013e31829c1431.Archer DF, Schmelter T, Schaefers M, Gerlinger C, Gude K. A randomized, double-blind, placebo-controlled study of the lowest effective dose of drospirenone with 17p-estradiol for moderate to severe vasomotor symptoms in postmenopausal women. Menopause, 2014, 21(3): 227-35. doi: 10.1097/ GME.0b013e31829c1431.Smetnik V.P. From the editor in chief. Menopause, 2011 2: 3-53.Smetnik V.P. From the editor in chief. Menopause, 2011 2: 3-53.Smetnik V.P., Balan V.E., Zaydieva Ya.Z., Maychuk E.Y., Mychka V.B. et al. Management of women with cardiovascular risk in peri- and postmenopausal periods. Rossiyskiy Kardiologicheskiy Zhurnal, 2008, 4: 40-57.Smetnik V.P., Balan V.E., Zaydieva Ya.Z., Maychuk E.Y., Mychka V.B. et al. Management of women with cardiovascular risk in peri- and postmenopausal periods. Rossiyskiy Kardiologicheskiy Zhurnal, 2008, 4: 40-57.

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