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МЕНОПАУЗАЛЬНАЯ ГОРМОНОТЕРАПИЯ С ДИДРОГЕСТЕРОНОМ: АСПЕКТЫ ЭФФЕКТИВНОСТИ И БЕЗОПАСНОСТИ УЛЬТРАНИЗКИХ ДОЗ

https://doi.org/10.21518/2079-701X-2017-2-92-99

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Аннотация

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).

Об авторе

А. А. Сметник
Научный центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова Минздрава России
Россия

к.м.н., 

Москва



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