medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-21-192-198medsovet-5984Research ArticleГИНЕКОЛОГИЯGYNECOLOGYВазомоторные симптомы климактерия: только ли приливы жара? Альтернативные (негормональные) методы коррекции с доказанной эффективностью (обзор литературы)Vasomotor menopausal symptoms: is it just hot flashes? Alternative non-hormonal methods of treatment with proven effectiveness (literature review)https://orcid.org/0000-0001-9773-1501КасянВ. Н.KasyanV. N.

к.м.н., доцент кафедры репродуктивной медицины и хирургии,

127473, Москва, ул. Делегатская, д. 20, стр. 1

Victoria N. , Cand. of Sci. (Med.), Associate Professor, Department of Reproductive Medicine and Surgery, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473,

victoria.kasyan@gmail.comhttps://orcid.org/0000-0002-3253-4512АдамянЛ. В.AdamyanL. V.

заведующая кафедрой репродуктивной медицины и хирургии факультета постдипломного образования, 127473, Москва, ул. Делегатская, д. 20, стр. 1; 

академик РАН, д.м.н., профессор, заместитель директора по научной работе, руководитель отделения оперативной гинекологии, 117997, Москва, ул. Академика Опарина, д. 4

 

Academician of RAS, Dr. of Sci. (Med.), Professor, Deputy Director for Science, Head of Department of Gynecological Surgery, 4, Academician Oparin St., Moscow, 117997;

Head of Department of Reproductive Medicine and Surgery, Faculty of Postgraduate Education, 20, Bldg. 1, Delegatskaya St., Moscow, 127473

adamyanleila@gmail.comМосковский государственный медико-стоматологический университет им. А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian FederationМосковский государственный медико-стоматологический университет им. А.И. Евдокимова; Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology; Yevdokimov Moscow State University of Medicine and DentistryRussian Federation202015012021021192198Copyright © Касян В.Н., Адамян Л.В., 20212021Касян В.Н., Адамян Л.В.Kasyan V.N., Adamyan L.V.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/5984

С учетом современной продолжительности жизни в среднем треть своей жизни женщины живут в условии дефицита женских половых гормонов, что негативно сказывается на качестве жизни и уровне заболеваемости лиц старшего возраста. У врачей иных специальностей, помимо акушерства и гинекологии, климактерический период прочно ассоциируется исключительно с приливами жара. Однако в симптомокомплекс ранних менопаузальных симптомов входят нарушения сна, изменения настроения, риск депрессии и соответствующее снижение самооценки, сексуальная дисфункция. Нередко именно преобладание вегетативных симптомов заставляет пациентку искать помощи не только у гинеколога, но и у других специалистов, однако дефицит знаний в вопросах медицины климактерия оставляет их без удовлетворения. В связи с этим терапевтический подход требует комплексного понимания проблемы.

«Золотой стандарт» ведения пациенток в климактерии – менопаузальная гормонотерапия. Однако есть женщины с противопоказаниями к этой группе препаратов или преобладанием именно вегетативных симптомов, когда только гормональной коррекции недостаточно. Среди альтернативных негормональных средств прочное лидерство с доказанной эффективностью в отношении комплекса симптомов занимают ингибиторы обратного захвата серотонина, в частности наиболее популярный для назначения препарат венлафаксин. Также изучены и другие медикаментозные средства, способные купировать как вазомоторные, так и вегетативные симптомы климактерия. В обзоре представлены литературные данные о роли альтернативных средств в коррекции вазомоторных симптомов климактерия наряду с известной эффективностью в отношении вегетативных жалоб для повышения эффективности консультирования женщин старшего возраста. 

Taking into account the modern life expectancy, a third of their lives, on average, women live in conditions of estrogen deficiency, which negatively affects the quality of life and the level of morbidity in older people. For doctors of other specialties, besides ObGyn, the climacteric period is strongly associated exclusively with hot flashes. However, early menopausal symptoms include sleep disturbances, mood changes, the risk of depression and decrease in self-esteem, sexual dysfunction. The predominance of vegetative symptoms makes the patient seek help not only from the gynecologist, but also from other specialists, however, the lack of knowledge in menopause medicine leaves them unsatisfied. In this regard, a therapeutic approach requires a comprehensive understanding of the problem.

The “gold standard” for managing patients with climacteric complaints is menopausal hormone therapy. However, there are women with contraindications to this group of drugs or the predominance of vegetative symptoms, when only hormonal correction is not enough. Among alternative non-hormonal agents, inhibitors of serotonin reuptake, in particular the most popular drug venlafaxine, hold a strong leadership with proven efficacy against a complex of symptoms. Also, other medications have been studied that can stop both vasomotor and vegetative symptoms of menopause. The review presents the literature data on the role of alternative agents in the correction of vasomotor symptoms of menopause, along with the known efficacy against autonomic complaints for increasing the effectiveness of counseling for older women. 

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