Redean hormonal therapy at Klimakse: for and against. Climax treatment (menopause)

The menopausal period for many women may be a serious test. The fact is that with the onset of menopause in the body, there is a gradual extinction of the reproductive function, as well as a serious hormonal restructuring, which is reflected in different systems and organs. Hence the symptoms of menopause. In most cases, only special preparations in the composition of substitution hormone therapy can normalize the state of the fair sex. What is this money? What are their testimony for use and is there any contraindications? What drugs of the UGT are appointed most often?

Briefly about Klimakse

The menopausal period is the natural stage in the life of each woman, the next step, and not the disease, as many representatives of the beautiful sex believe, waiting for his offensive with horror. On average, the onset of menopause is 45-55 years old, but it also happens an earlier or later menopause, which is influenced by certain factors.

All changes taking place in the body during this period are a consequence of the lack of female sex hormones due to the turning off function of the ovaries. This may happen with age or forced if there was an operation to remove ovarian, chemothematical and radiation therapy.

The lack of estrogen leads to the appearance of symptoms that may appear in a woman even before the last time was menstruation. Among the early symptoms of menopause, you can allocate such:

• frequent tides of heat;
• increased sweating;
• sharp changes in mood, irritability, feeling of anxiety;
• sleep disorders;
• fast fatiguability;
• changes in blood pressure;
• heart palpitations;
• reduced memory.

Many women do not feel such symptoms or they are poorly pronounced, so they ignore them, which is radically wrong. To the doctor must be handled necessarily to prevent more complex consequences of Klimaks, in particular:

• deterioration of skin, hair, nails;
• unpleasant sensations in the vagina, which is expressed in dryness, itching, pain during sexual contact;
• problems with urination (frequent urge, involuntary urination, cystitis);
• diseases of the heart and vessels (infarction, stroke, increased arterial decrease in sexual entry;
• pressure, atherosclerosis);
• diseases of bones and joints.

What methods of solving the problem exist?

Live menopause Beautiful, not being a hostage of his symptoms, such options will help:

1. Modern cosmetology.
2. Healthy lifestyle. It is very important here to abandon bad habits, balanced and eat well, and also to be physically active, but not overload the body.
3. Treatment with non-neuronal drugs. Each drug chosen exclusively by the doctor is aimed at overcoming a particular symptom. Such treatment is quite expensive, and it is not always possible to give the expected effect.
4. Hormone replacement therapy (UGT). The treatment of hormonal preparations assigned timely treatment will help cope with many unpleasant manifestations of the menopauscical period.

GZT: What is it?

The method of treatment with drugs, as part of which is predominantly female sex hormones are called hormone-plating therapy. Treatment is aimed at eliminating the lack of estrogen and progesterone, and this is caused by a decrease in the production of genital hormones with iron internal secretion.

Hormone-hormone climax therapy may be two types:

• Long. Treatment of major changes in the body, in particular, the work of the heart, vessels, the central nervous system, the internal secretion glands. The course of treatment is 2-4 years, in some cases the treatment can last 10 years.
• Short-term. Treatment of symptoms of menopause. Course of treatment - 1-2 years.

The reception of hormonal drugs requires a clear compliance with the recommendations of the doctor, only in this case one can count on successful treatment. Hormonal preparations of a new generation can reduce soreness and restore mucous membranes, reduce the frequency and intensity of tides, improve the condition of the skin, nails, teeth.

Advantages of hormone-plated treatment

• Hormon-plated drugs of a new generation may contain female sex hormones, as well as thyroid hormones, pituitary glands. There are no male hormones in them. New generation preparations have the most closely close to the composition with natural synthetic hormones, which made it possible to reduce the dosage, and the manifestation of male signs in women, in particular, fragmentation, voices.
• Do not contain narcotic substances, respectively, there is no addiction of the body. You can stop treatment at any time, but only after consulting with the doctor.
• Hormone-containing drugs that are prescribed during climax do not cause weight gain. The reason can be a decrease in physical activity.
• Hormone-containing drugs contain hormones synthesized in the laboratory, in the composition of completely identical hormones that produce a female organism. This causes their wide action. If you compare these preparations with phytogorms, the last many times weaker and only temporarily facilitate the state.
• Progesterone in modern hormonal drugs reduces the risk of estrogen-dependent tumors, and drugs selected individually is good prophylaxis against oncology.
• It is convenient to apply, because the means of the UGT during menopause the drugs of the new generation are produced in various dosage forms. In case of gastrointestinal diseases, such a type of hormonal drugs as a gel or plaster can be used.

Indications and contraindications for treatment hormones

Replacement hormonal therapy Climax is a symptomatic and prophylactic method. Treatment with hormonal drugs is aimed at overcoming already existing symptoms of menopause. If we talk about prevention, it is carried out to reduce the risk of climax complications that may arise due to hormonal changes in the late stage, in particular osteoporosis, arterial hypertension.

GHT is assigned when climax in such cases:

• early menopause;
• heart and vessel pathology;
• high risk of osteoporosis;
• high likelihood of diabetes mellitus.

There are contraindications to the CGT in the presence of such pathologies:

• liver disease;
• thrombosis;
• estrogen dependent tumors;
• heart and vessels (complicated);
• diabetes mellitus (complicated);
• cancer genital organs, mammary glands, endometrial of internal organs;
• uterine bleeding of uncertain nature;
• pregnancy (possible in the early stages of Klimaks).

Can there be side effects of treatment?

UGT has a selective effect, and drugs are prescribed in a low dosage, so the risk side manifestations Changed to a minimum. The adverse reactions of the body may occur in rare cases, and their intensity is poorly expressed.

So, more often than other reactions, a woman may have a lactification of the mammary glands. This phenomenon will be held independently after a few months when the body adapts to the introduction of female sex hormones.

Extremely rarely, such symptoms like nausea and headache.

Alone to cancel the drugs, as changing the dosage, is prohibited. Only a doctor who appointed it can adjust the UGT.

Is it necessary to prepare for replacement hormone therapy?

On their own, hormonal drugs are extremely not recommended. The UGT can be appointed only by a doctor, and the selection of drugs is made by the doctor individually and only after the diagnosis.

The survey consists of laboratory and instrumental methods, which allows to obtain the most complete picture of the state of the female organism.

Diagnostic measures before appointing UGT:

• Ultrasound thyroid glands and abdominal cavities;
• inspection and diagnostics of the mammary glands;
• take a smear from the cervix;
• blood test for hormones;
• fractional pressure measurement.

Other diagnostic methods can be appointed, as well as advice from doctors if a woman has chronic diseases. In this case, it is necessary to reduce the influence of these diseases to the body as much as much as possible, only then the doctor will be able to pick up hormonal drugs that will help reduce climate cultic manifestations.

Mandatory observations by the doctor

When receiving hormone-containing drugs, it is necessary to observe the gynecologist so that the doctor can control the course of treatment and, if such a need arises, correct it to obtain a better effect.

The first time you need to visit the gynecologist 3 months after the start of treatment. Re-visits for control inspection after 6 months. Next, the gynecologist should be visited every six months regularly.

Once a year will also need to do gynecological ultrasound, mammography, as well as a cytological analysis of the smear of the cervix.

Forms of the UGT when climax

Preparations that are part of the UGT can be produced in such dosage forms:

• for oral administration (dragee, tablets, pills);
• for local application (gels, candles, creams, plasters);
• transdermal form (injections, subcutaneous implants).

Each THRT means has both advantages and disadvantages, and can only be prescribed in each individual case individually.

The most convenient form of hormonal drugs are pills, they are quickly absorbed and have low cost, but they are contraindicated with problems with the gastrointestinal tract. In this case, local or transdermal forms of hormones are prescribed, which do not affect the gastrointestinal tract, they can be applied with many drugs, because Do not participate with them.

Popular hormone-containing drugs during climax

Among the most effective drugs Mixed hormone therapy during climax can be allocated such a list:

• pills Femoston;
• tablets Cycle Proginova;
• tablets and Ovrestin Suppositories;
• tablets Ethstresses;
• tablets Angelik;
• tablets TRISEKVENS;
• climate Plaster;
• plastrotril plaster;
• dragee kmmonorm;
• gel Divigel.

These hormonal drugs are the means of a new generation, because hormones are there in minimal doses. They have excellent medical properties, do not cause changes in the functions of the internal organs.

The doctor when assigning each tool calculates the dosage, as well as the mode that will need to be fulfilled.

An independent change in the prescribed dosage doctor may further affect the hormonal level, and the increase in dosage threatens oncology, especially in cases where there is a hereditary predisposition or there are benign tumors.

It can be concluded that replacement hormone therapy can provide substantial support for the feminine body into such a complex climacteric period, especially with pronounced symptoms. Adequately selected drugs are able to reduce unpleasant manifestations menopause, as well as minimize the likelihood of complications. Each medicine and its dosage must be appointed only by a doctor on the basis of a survey conducted. Only in this case can be calculated on the positive effect of therapy.

With the beginning of premanopause in the body of a woman, menopacteric symptoms begged, associated with the deficit level of estrogen content.

Special discomfort causes such manifestations as increased sweating, a quick set of extra kilograms, violation of the rhythm of heartbeat, a feeling of dryness on the mucous membrane of the vagina, manifestation of urinary incontinence. Hormonal drugs can help liquidate all unpleasant menopacteric symptoms.

All hormonal drugs are divided into 2 main groups:

1. Estrogen-containing, appointed mainly after hysterectomy ( surgical removal uterus).
2. Combined tools containing progesterone, providing endometrial protection, as well as estrogen.

Hormonal climax pills are an effective way to get rid of severe mailing consequences. The basis of the treatment of substitution hormone therapy is systematic reception of hormones, observation of a specialist and a periodic examination of the entire organism to identify the pathologies associated with the climacteric period.

It is also necessary to make sure that it is suitable for the body, and there are no contraindications. Deploying hormone therapy during menopause should be appointed only by a qualified specialist.

Consider in more detail why hormonal therapy and its positive parties are appointed.

Positive side of hormone therapy

With the onset of CLIMAKS in women in the body, involutional changes are beginning, characterized by the extinction of the hormonal background, the functionality of the ovaries, the change in the structure of tissues in the brain, leading to a decrease in progesterone production, and after estrogen, and the appearance of appropriate symptoms, manifested in the form:

• Climacteric syndrome. In Prhenopause, he arises in 35% of the female population, in 39-42% in women with the onset of menopause, from 19-22% after 12 months from the beginning of menopause and in 3-5% after 4-5 years after the menopausal period.

The manifestation of climacteric syndrome is due to the formation of tides and a sudden feeling of heat, increased sweating, replacing the chills, psycho-emotional instability, an increase in blood pressure and its hopping character. Also, the participation of the rhythm of the heartbeat, the appearance of a feeling of numbness on the tips of the fingers, pain in the heart of the heart, the breakdown of sleep and the appearance of insomnitz, depressive state and other accompanying symptoms.

• Disorders from gOOD SYSTEM Women showing in the form of a reduction in the libido against the background of a decrease in testosterone content, the appearance of dryness on the mucous surfaces in the vagina region, urinary incontinence, especially during sharp sneezing, cough or fright. There may also be painful sensations during urination.
• Dystrophic changes in the skin and their appendages, accompanied by the formation of diffuse alopecia, dry skin, increased nail plate lone, appearance of deeper wrinkles.
• Violations of metabolic processes in the body: This type of pathological changes is accompanied by a decrease in appetite and simultaneously increasing the mass of subcutaneous fat layers. Also, the fluid from the body begins to be output in slow motion, which leads to the formation of pastosity in the face of the face and the appearance of feet edema.
• The development of late manifestations relating to the formation of osteoporosis arising against the background of a reduction in calcium levels in the bone system of the body, as well as hypertension, ischemia, Alzheimer's disease and other no less serious pathologies.

Consequently, all the menopausal changes flowing in the body of a woman can proceed with the development of certain symptoms with varying degrees of severity.

Hormone-hormone hormone therapy is an effective method that contributes to preventing, eliminating either a significant decrease in violations of the functionality of all organ systems and a decrease in the risk of serious pathological processes formed against the background of hormonal failure.

The main principles of substitution hormone therapy are:

1. Purpose of drugs whose main composition is similar to female sex hormones.
2. Reception of small doses corresponding to the level of content of endogenous estradiols, especially in the proliferative stage.
3. Treatment of various combination of estrogen and progesterons, contributing to the exclusion of endometrial hyperplasia.
4. After hysterectomy (surgical removal of the uterus) the possibility of receiving preparations containing only estrogens.
5. Preventive reception of hormonal drugs aimed at eliminating the occurrence of pathologies such as osteoporosis and heart ischemia should be at least 5 years.

The main active component of hormonal drugs are estrogens. With the addition of gestagens, a peculiar prevention of the hyperplastic process on the mucous membranes of the uterus and the control of its condition is carried out. Consider a list of the most effective hormonal drugs.

Preparations of UGT

The reception of the UGT during menopause and the drugs of the new generation should be prescribed only a qualified specialist.

Klimontorm

This medicine refers to the group of anti-glimacterial drugs. The composition of this drug includes two active components - estrogen and gestagen, the main action of which is aimed at eliminating the climacteric symptoms and the prevention of the occurrence of the cancer tumor of endometrial and hyperplasia.

The unique composition of the drug and compliance with the special method of reception in combination gives the chances of restoring the menstrual cycle in women who did not pass by the procedure of hysterectomy.

The active component of the estradiol contained in Climontore completely replaces the lack of natural estrogen in the body of menopause. This contributes to the elimination of vegetative and psychological problems arising in the menopacteric period on the background of a reduction in testosterone and sexual activity. For proper reception the drug can be achieved to reduce the rate of deep wrinkles, increasing the content of collagen in skin Covers. Moreover, the drug provides a decrease in the level of cholesterol in the blood and the risk of the occurrence of tractologies of the gastrointestinal tract.

With an unfinished menstrual cycle and the manifestation of even rare menstrual discharge, treatment must be started from the fifth day after the start of menstruation. In the development of amenorrhea, at the beginning of the menopausal period, treatment can be started in any period of time, subject to the absence of pregnancy.

One packaging of the drug is designed for a 3-week course of treatment. To achieve the desired result, it is necessary to take hormones according to the prescribed treatment scheme. When taking elevated doses of the drug, adverse reactions of the body may occur, manifested by a stomach disorder, vomiting and bleeding, not related to the menstrual cycle. You can get rid of symptoms of overdose by systematic treatment assigned by the attending physician.

Femoston

Restaurant hormone therapy during the postmenopause period provides for the reception of this two-phase combined drug, if there is no contraindications of a woman. The two active components that are part of this drug - estradiol and progesterone have a similar effect on the body as the natural female sex hormones.

In the aggregate estradiol and progesterone contribute:

• Elimination of vegetative symptoms;
• Eliminate psycho-emotional disorders;
• Prevention of development of osteoporosis, cancer tumor in the field of uterus and hyperplasia.

Tabletized drug Femoston must be taken in the same time period once a day. Treatment should be carried out according to the prescribed scheme. In the first two weeks, it is recommended to drink hormones in white tablets. The next two weeks of course treatment need to take gray tablets.

For women with the prevailing menstrual cycle, treatment is assigned from the first day of menstruation. For those who have disorders in the menstrual cycle, exchange rate treatment is initially appointed using the preparation "Progestagen", then the reception of femoston, according to a special treatment scheme. Women who have completely absent menstrual cycle The drug can be started to take from any moment.

To obtain the desired result, women's hormones in tablets need to drink, strictly observing the treatment regimen, only so you can improve the overall health and delay the upcoming old age.

Klimadinon

This drug belongs to the group of phytogorms containing in its composition. It is prescribed for the treatment of climacteric symptoms and eliminating vegetative disorders, when there are obvious contraindications and can not be taken hormones at menopause.

The treatment diagram and the duration of reception are prescribed depending on the individual characteristics of the body of the woman.

Angelik

Angelica, like Klimming, is drugs when women who help get rid of unpleasant symptoms and improve overall well-being.

The drug Angelica is used for:

• Normalization of general well-being;
• Eliminating unpleasant symptoms with tides and reduce the frequency of their occurrence;
• Osteoporosis prevention;
• Raising testosterone levels, and, consequently, the normalization of sexual activity.

Do not take this medicine With the following factors:

• The presence of bleeding from the vagina of unclear etiology;
• Development of cancer tumor in the field of mammary glands;
• For sugar diabetes, hypertension and veins thrombosis.

Angelica contains the necessary hormones with menopause, which are an excellent solution to improving the well-being and restoration of hormonal imbalance, especially for women older than 45-46 years.

Climate

it hormonal drug, produced in the form of a patch, which contains estradiol at a dose of 3.8 mg. The plaster is glued to a certain area of \u200b\u200bthe skin, after which the release of the active component begins and improving the overall well-being of a woman. Wear one plaster recommended no more than a week. On the last day of the week, it is necessary to replace the reservoir new, be sure to change the place to fix it.

Under the action of the patch in the body, the level of testosterone increases, which has a positive effect on psycho-emotional state and raising libido. There are no special contraindications to the use of the plaster, but before it is used, it is necessary to consult with a specialist.

Women's hormones under the climax under the influence of age-related changes and the transition period are reduced, the worsen state of the woman. Therefore, it is necessary to use the drugs of the UGT capable of saving a woman from violations for a short time vegetative system, reduce testosterone levels and consequences flowing from here: changes in psycho-emotional state. Among other things, hormonal drugs are mainly well absorbed, and do not have adverse reactions.

In order to find out what to drink when climax, it is necessary to complete the full diagnosis of the condition of the body and consult with a specialist.

Spontaneous reception of hormonal drugs may not only be useless for the body, but also dangerous, entailing irreversible consequences. Therefore, take hormonal drugs only to appoint a doctor.

Interesting and informative video

It is constantly expanding how the reading scope to their application is expanding. To date, modern medicine has a wide enough choice. good preparations For UGT, experience in the use of drugs for the UGT, indicating a noticeable predominance of advantages over the risk of HGT, good diagnostic possibilities, which allows to monitor both positive and negative treatment effects.

Although all the data indicating the positive impact of the admission of HRT on health, in general, the risk and advantages of this therapy, according to many authors, can be considered comparable. In many cases, the advantages of long-term reception of the UGT will prevail over the risk in others - the possible risk will translate benefits. Therefore, the use of UGT must comply with the needs and requests of a particular patient, to be individual and constant. When selecting a dose, it is necessary to take into account both the age and weight of the patients and the features of the history, as well as the relative risk and contraindications to use, which will ensure the best result of treatment.

A comprehensive and differentiated approach to the appointment of UGT, as well as knowledge of the peculiarities and properties of components that make up most drugs will avoid possible unwanted consequences and side effects and will lead to a successful achievement of intended goals.

It should be remembered that the use of the UGT is not a prolongation of life, but an improvement in its quality, which may decrease under the influence of the adverse effects of estrogenic deficit. A timely solution of climatic problems is the real way to a good health and well-being, to preserve the performance and improvement in the quality of life, the increasing number of women entering this "autumn" period.

For replacement hormone therapy, facilitating the problems of climacterium and the difficulties of the transition period in most women, various classes of estrogen are used.

• The first group includes native estrogens - estradiol, estrone and estriol.
• The second group includes conjugated estrogens, mainly sulphates - estrone, equiline and 17-beta-dihydroequilin, which are obtained from the urine of pregnant mare.

As is known, the most active estrogen is ethinyl estradiol used in preparations for oral contraception. Its doses that are necessary to relieve climacterial symptoms are equal to 5-10 μg / day, orally. However, due to the narrow range of therapeutic doses, the high probability of developing side effects and not such a favorable effect on metabolic processes, like natural estrogen, this hormone for the purposes of the UGT use is inappropriate.

The following types of estrogen are used most widely at the TGT:

1. Preparations for oral administration
   • Estradiol esters [show] .

     Estradiol to ether

     • Estradiol Valerat.
     • Estradiol benzoate.
     • Estor Succinate.
     • Estradiol hemihydrate.

     Estradiol Valerat is the ether of the crystalline form of 17-beta-estradiol, which, during oral administration, is well absorbed in the gastrointestinal tract (gastrointestinal tract). For oral administration, it is impossible to use the crystalline form of 17-beta-estradiol, since in this case it is practically not absorbed into the gastrointestinal tract. Estradiol Valerat is rapidly metabolized to 17 beta estradiol, so it can be viewed as a predecessor preparation of natural estrogen. Estradiol is not a metabolite or final product of estrogen exchange, and is the main circulating estrogen in women in the premenopausal period. Therefore, estradiol Valerat seems to be an ideal estrogen for replacement hormone oral therapy, given that its goal is to restore hormonal equilibrium to indicators that existed before the ovarian function existed.

     Regardless of the estrogen form used, its dosage should be sufficient both to relocate the most pronounced menopacteric disorders and the prevention of chronic pathology. In particular, the effective prevention of osteoporosis involves the reception of 2 mg estradiol of Valerat per day.

     Estradiol Valerat has a positive effect on the lipid metabolism, manifested by an increase in high density lipoproteins and a decrease in low-density lipoproteins. Along with this, the drug does not have a pronounced action on proteins synthesis in the liver.

     Among oral preparations for the UGT doctors (especially in Europe) are most often prescribed funds containing estradiol Valerat - the prodrug of the endogenous 17 beta estradiol. At a dose of 12 mg of estradiol, Valerat for oral administration as monotherapy or in combination with gestagens showed high efficiency in climacteric disorders (Climodiole preparations, Klimen, Klimonorm, Cycloprogynov, Proginov, Divine, Divitren, Indiline).

     However, drugs containing micronized 17-beta estradiol are not less popular (Fermoston 2/10, Fermoston 1/5).

   • Conjugated estrogens [show] .

     The composition of the conjugated equinastrogen derived from the urine of the cerebral mare includes a mixture of sodium sulfates, estronsulfate (they are about 50%). Most other components of hormones or their metabolites are specific for horses - this is an equilin sulfate - 25% and alfadigidroequilinsulfate - 15%. The remaining 15% is inactive sulfates of estrogen. Equilin has high activity; It is deposited in adipose tissue and continues to act even after stopping the introduction of the drug.

     Estrogens of horse urine and their synthesized analogues have a sharper effect on the synthesis of renin substrate and hormone-binding globulins compared to Estradiol Valeret.

     An equally significant factor is the biological semi-period of the drug. Estrogens of horse urine are not included in metabolism in the liver and other organs, while the estradiol is rapidly metabolized with a half-period of existence of 90 minutes. This explains the very slow excitation of Equilina from the body, which is evidenced by the preservation of its elevated level in serum, noted even three months after the cessation of therapy.

   • Micronized estradiol form.
2. Drugs for intramuscular administration [show]

   For parenteral administration, there are estradiol preparations for subcutaneous administration (classical form - depot - the drug Ginodian depot, which is introduced 1 time per month).

   • Estradiol Valerat.
3. Preparations for intravaginal administration
4. Preparations for transdermal administration [show]

   The most physiological way to create the desired concentration of estrogen in the blood of women should be recognized by the transdermal path of the administration of estradiol, for which the drugs of the caviluses and gel are developed. Climate plaster, applies 1 time per week and provides a permanent level of estradiol in the blood. Divigel and Gel Astrodel is used 1 time per day. Pharmacokinetics of estradiol during its transdermal administration differs from the one that takes place after its oral administration. This difference is primarily the exception of the extensive initial metabolism of estradiol in the liver and a much smaller influence on the liver. With transdermal administration, estradiol turns less in the estrone, which after oral administration of estradiol preparations exceeds the latter in its blood plasma. In addition, after oral administration of estrogen, they are largely subjected to pectic recycling. As a result, when using a plaster or gel, an estrone / estradiol ratio in the blood is taken to normal and the effect of the primary passage of estradiol through the liver disappears, but the beneficial effect of the hormone on vasotor symptoms and bone protection from osteoporosis remains. Transdermal estradiol, compared with oral, about 2 times weaker affects the exchange of lipids in the liver; Does not increase the level of selevator serum globulin and cholesterol content in bile.

   Gel for outdoor use 1 g gel contains: estradiol 1.0 mg, auxiliary substances Q.S. up to 1.0 g Divigel - This is a 0.1% alcohol-based gel, the active substance of which is estradiol hemihydrate. The divigel is packed in an aluminum foil package containing 0.5 mg or 1.0 mg of estradiol, which corresponds to 0.5 g or 1.0 g of the gel. Packaging contains 28 sachets. Pharmacotherapeutic group Redean hormonal therapy. Pharmacodynamics Pharmacodynamics and the clinical efficacy of the divigel is similar to oral estrogen. Pharmacokinetics When applying the gel on the skin estradiol penetrates directly in blood systemThat avoids the first stage of hepatic metabolism. For this reason, the fluctuations in the concentration of estrogen in the plasma with the use of the divigel are expressed significantly less than when using oral estrogen. The transdermal applying of estradiol in a dose of 1.5 mg (1.5 g of divigel) creates a blood plasma concentration of approximately 340 pmol / l, which corresponds to the level of the early follicle stage in women in premopause. During the treatment of the Divigel, the estradiole / estron ratio is preserved at 0.7; whereas when orallying estrogen, it usually drops to less than 0.2. Metabolism and excretion of transdermal estradiol occurs as natural estrogen. Indications for use The divigel is prescribed for the treatment of menopausal syndrome associated with natural or artificial menopause, developed due to surgical intervention, as well as for the prevention of osteoporosis. The divigel should be applied strictly to the appointment of a doctor. Contraindications Pregnancy and lactation. Pronounced thromboembolic disorders or acute thrombophlebitis. Uterine bleeding of unclear etiology. C ^ plane-dependent cancer (breast, ovarian or uterus). Treatery of urinary liver diseases, Dubine Johnson syndrome, Rotor Syndrome. G ^ Perch-durability to composite components of the drug. Method of application and dose The divigel is designed for prolonged or cyclic treatment. Doses are selected by the doctor taking into account the individual characteristics of the patients (from 0.5 to 1.5 mg per day, which corresponds to 0.5-1.5 mg of estradiol per day, in the future, the dose can be adjusted). Typically, treatment is starting from the purpose of 1 mg of estradiol (1.0 g of gel) per day. Patients with the "intact" uterus during the treatment of the Divigel it is recommended to assign a gestagen, for example, a acetate, norethisterone, norethysterone acetate or Dydrohedron within 10-12 days in each cycle. In patients in postmenopausal period, the cycle duration can be increased to 3 months. The dose of Divigel is applied once a day on the skin of the lower part of the front of the abdomen, or alternately on the right or left buttocks. The area of \u200b\u200bapplication is equal in size 1-2 palms. The divigel should not be applied to the dairy glands, face, region of genitals, as well as irritated skin areas. After applying the drug, wait a few minutes until the gel gets up. You should avoid accidental disgust in the eyes. Hands should be flushed immediately after applying the gel. If the patient forgot to apply gel, it should be done as soon as possible, but no later than within 12 hours from the moment of applying the preparation on the schedule. If more than 12 hours passed, then the application of the divigel should be postponed until the next time. With irregular use of the drug, menstrual-like uterine bleeding "breakthrough" may occur. Before the start of therapy, the drug Divigel should pass a thorough medical examination and in the treatment process to visit the gynecologist at least 1 time per year. Under special observation, patients suffering from endometriosis, endometrial hyperplasia, diseases of the cardiovascular system, as well as cerebrovascular disorders, arterial hypertension, tomboembolism in history, impaired lipid metabolism, renal failure, breast cancer in history or family history. During the treatment with estrogen, as well as during pregnancy, some diseases can exacerbate. These include: migraines and strong headaches, benign breast tumors, liver function, cholestasis, cholelyatiasis, pore-Firina, uterine myoma, diabetes, epilepsy, bronchial asthma, otosclerosis, multiple sclerosis. Such patients should be under the supervision of the doctor if they are conducted by therapy of the Divigel. Medicinal interaction There is no data on the likely cross interaction Divigel with other drugs. Side effect Side effects are usually expressed weakly and very rarely lead to discontinuation of treatment. If they are centuries, it is usually only in the first months of treatment. Sometimes there are: the loading of the mammary glands, headaches, swelling, violation of the regularity of menstruation. Overdose As a rule, estrogens are well transferred even in very large doses. Possible signs of overdose are the symptoms listed in the "Sidey" section. The treatment of them is symptomatic. Shelf life is 3 years. The drug cannot be used later specified on the duty packaging. Store at room temperature out of the reach of children. The drug is registered in the Russian Federation. Literature 1. Hirvonen et al. TRANSDERMAL ESTRADIOL GEL IN THE TREATMENT OF THE CLIMACTERIUM: A COMPARISON WITH ORAL THERAPY. Br J of Ob and Gyn 1997, Vol 104; Suppl. 16: 19-25. 2. Karjalainen et al. Metabolic Changes Induced by Pereral Oestrogen and Transdermatjfylktradiol Gel Therapy. Br J of Ob and Gyn 1997, Vol 104; Suppl. 16: 38-43. 3. Hirvonen et al. Effects of Transdermal Oestrogen Therapy in Postmenopausal Women: A Comparative Study of An Oestradiol Gel And An Oestradiol Delivery Patch. Br J of Ob and Gyn 1997, Vol 104; Suppl. 16: 26-31. 4. Marketing Research 1995, Data On Tile, Orion Pharma. 5. Jarvinen et al. Steady-State Pharmacokinetics of Oestradiol Gel In Postmenopausal Women: Effects of Application Area and Washing. Br J of Ob and Gyn 1997, Vol 104; Suppl. 16: 14-18.

   

   • Estradiol.

The existing data on the pharmacological properties of different estrogens indicate the preference of use for the purposes of the UGT mainly preparations containing estradiol.

For 2/3 of all women, the optimal doses of estrogen are 2 mg estradiol (oral) and 50 μg of estradiol (transdermal). However, in each case, in the process of the WGT, women should undergo a survey in the clinic for the correction of these doses. In women, after 65 years, the renal and especially liver clearance of hormones occurs, which requires special caution in the appointment of estrogen in high doses.

There is evidence that the prevention of osteoporosis may be sufficient lower doses of estradiol (25 μg / day).

Currently, there are evidence indicating the presence of pronounced differences in the action of conjugated and natural estrogen preparations on the cardiovascular system and the hemostasis system. In the work of C.E. Bonduki et al. (1998) A comparison of the conjugated estrogen (orally 0.625 mg / day, continuous mode) and 17-beta estradiol (transdermal 50 μg / day) in women in menopause were performed. All women every month for 14 days took the medocaliprogesterone acetate (orally 5 mg / day). It was found that conjugated estrogens in contrast to estradiol cause a statistically significant decrease in antithrombin III in a plasma after 3, 6, 9 and 12 months after the start of therapy. At the same time, both types of estrogen did not affect prothrombin time, factor V, fibrinogen, the number of platelets and the time of Lisa Euglobulin. For 12 months, there were no thromboembolic complications among the participants of the study. According to these results, conjugated estrogens reduce the level of antithrombin III, while the GHT 17 beta estradiol does not affect this indicator. The level of antithrombin III is key in the development of myocardial infarction and thromboembolism.

Antitrombin III deficiency is congenital and acquired. The absence of the ability of conjugated estrogen to have a protective effect in women with myocardial infarction may be due to their influence on the content of antithrombin III in the blood. Therefore, natural estrogens are preferable than oral therapy with conjugated estrogens when appointing HGT patients with risk factors for the development of thrombosis.

In this regard, it should be noted that the wider use of conjugated estrogen drugs in the United States that has historically established until recent years cannot be considered as the best and recommended in all cases. These obvious facts could not be alleged if they did not appear in the literature of statements in favor of the use of drugs of conjugated estrogen, based only on their use of their use in the United States and the existence of a sufficiently large number of studies of their properties. In addition, it is impossible to agree with statements about the best properties among the Gestagennes, which are part of various combinations of HGT, acetate medroxyprogesterone in relation to their influence on the exchange of lipids. Existing data show that among the gestagenists presented in the market, along with progesterone, there are both its derivatives - 20-alpha and 20-beta-dihydrosterone, 17-alpha hydroxyprogesterone and 19-Nortistosteron derivatives, the use of which allows the desired effect .

Hydroxyprogesterone derivatives (C21-Gestagens) are chloromadinone acetate, ciproterone acetate, medroxyprogesterone acetate, Didrogesterone, etc., and 19-Northstosterone derivatives - Norethisteron Acetate, Northestrel, Levonorgestrel, Nortestimat, Dienengest, etc.

The choice of the drug from the group of combined estrogen-gestagenic means is due to a period of age-related hormonal changes in a woman.

Specially designed to increase the efficiency of replacement hormone therapy and preventive use, taking into account the requirements of the maximum safety of the drug. This drug, differing in the optimal ratio of hormones, not only has a positive effect on the lipid profile, but also contributes to a rapid decrease in climatic symptoms. It has not only preventive, but also therapeutic action on osteoporosis.

Climontorm has a high efficiency in atrophic disorders of the urogenital system and skin atrophic disorders, as well as for the treatment of psycho-somatic violations: irritability, depression, sleep disorders, forgetfulness. Klimontorm is well tolerated: more than 93% of all women who host by Cymontorm, only positive changes in their own well-being (CZEKANOWSKI R. et al., 1995).

Klimontorm represents a combination of estradiol Verata (2 mg) and levonorgestrel (0.15 mg), which ensures the following advantages of this drug:

• fast and effective decrease in the severity of menopacteric symptoms;
• prevention and treatment of postmenopausal osteoporosis;
• preservation of the positive effect of estrogen on the atherogenic index;
• antiatropogenic properties of Levonorgestrel provide positive action with changes in the mucous membrane system and the weakness of sphincter;
• against the background of taking a climor, the cycle is well monitored and the phenomena of endometrial hyperplasia is not marked.

Klimontorm should be considered a drug selection for the purposes of the UGT during the period and perimenopause in the majority of women with osteoporosis, psychosomatic disorders, atrophic changes in the mucous membrane system, hypercholesterolemia, hyperitriglyceridemia, with a high risk of colon cancer, Alzheimer's disease.

The dose of Levonorgestrel in Climontore provides good cycle control, sufficient endometrial protection from the hyperplastic effect of estrogen and at the same time preserving the favorable effect of estrogen on the exchange of lipids, the cardiovascular system, prevention and treatment of osteoporosis.

It is shown that the use of Klimming in women from 40 to 74 years for 12 months leads to an increase in the density of spongy and cortical bone tissue by 7 and 12%, respectively (Hempel, Wisser, 1994). The mineral density of lumbar vertebrae in women aged 43 to 63 years old, with the use of Klimming for 12 and 24 months, it increases from 1.0 to 2.0 and 3.8 g / cm 2, respectively. Clemmonorm treatment for 1 year of premenopausal women with remote ovaries is accompanied by restoration to a normal level of bone metal density and bone metabolism markers. Under this parameter, the Cymontorm exceeds Fermoston. Additional androgenic activity of the Levonorgestrel, which is also important, is also very significant and to form a state of mental comfort. If the Klimontorm eliminates or reduces the symptoms of depression, then the femoston in 510% of patients strengthens the symptoms of the depressive mood, which requires interrupting therapy.

An important advantage of Levonorgestrel as the Gestagen is its almost 100% bioavailability, which ensures the stability of its effects, the severity of which is practically independent of the nature of the woman's nutrition, the presence of gastrointestinal diseases and the activity of the liver system, metabolizing xenobiotics during their primary passage. Note that the bioavailability of the Didrogesterone is only 28%, and its effects are therefore subject to noticeable differences, both mezhindividual and an infedion.

In addition, it should be noted that the cyclic (with a seven-day break) Reception of the Klimming provides excellent cycle control and the low frequency of intermented bleeding. Fermoston used in continuous mode, in this regard weaker controls the cycle, which can be associated with the lower progestogenic activity of the Didrogesterone compared to the levonorestrel. If, when taking the climor, the regularity of menstrual bleeding is observed in 92% of all cycles and the number of cases of intermenstrument bleeding is 0.6%, then with the use of femoston, these values \u200b\u200bare 85 and 4.39.8%, respectively. At the same time, the nature and regularity of menstrual bleeding reflects the state of the endometrium and the risk of the development of its hyperplasia. Therefore, the use of Klimming from the point of view of the prevention of possible hyperplastic changes in endometrial is preferable to femoston.

It should be noted that Klimontorm has a pronounced activity regarding the treatment of menopacteric syndrome. When analyzing his operation, 116 women have revealed a decrease in the Cupperm index at from 28.38 to 5.47 (after 3 months it decreased to 11.6) in the absence of influence on arterial pressure and body weight (Czekanowski R. et al., 1995).

At the same time, it should be noted that Klimontorm is favorably different from drugs containing other 19-Nortistosterone (Nortisters) with more pronounced androgenic properties as a gestagena. Nortisteon acetate (1 mg) counteracts the positive effect of estrogen to the concentration of HDP-cholesterol and, in addition, it may increase the level of low density lipoproteins, thereby increasing the risk of cardiovascular pathology.

Women in need of additional protection against hyperplastic processes in endometrials is better to appoint a drug-progona preparation, in which the activity of the gestagne component (Northell) is 2 times higher compared to the Climonorm.

Combined estrogen-gestagne drug. The action is due to the preparation of estrogen and gestagne components. Estrogen component - estradiol is a substance of natural origin and after admission to the body quickly turns into estradiol, identical to the produced by the ovaries of hormone and has effects that have peculiar to it: activates the proliferation of the epithelial of the reproductive system organs, including the regeneration and growth of endometrial in the first phase of the menstrual cycle, the preparation of endometrial to action Progesterone, raising the libido in the middle of the cycle, affects the exchange of fats, proteins, carbohydrates and electrolytes, stimulates the production of globulin liver, binding sex hormones, renin, TG and blood coagulation factors. Thanks to the participation in the implementation of positive and negative feedback in the hypothalamic-pituitary-ovarian system, the estradiol is capable of calling and moderately pronounced central effects. It plays an important role in the development of bone tissue and the formation of the bone structure.

The second component of the drug-progona drug is an active synthetic gestagen - Northell, superior to the strength of the natural hormone of the yellow body progesterone. Promotes the transition of the mucous membrane of the uterus from the proliferation stage in the secretory phase. Reduces the excitability and reduction of the muscles of the uterus and uterine pipes, stimulates the development of the terminal elements of the mammary glands. Blocks the secretion of hypothalamic factors of the release of LH and FSH, inhibits the formation of gonadotropic hormones, is inhibits ovulation, it has insignificant androgenic properties.

The clumen is a combined drug containing natural estrogen estradiol (in the form of Valeret) and a synthetic gestagen with the anti-hydrogenic effect of ciproterone (in the form of acetate). Estradiol, which is part of the climax, fills the estrogen deficiency arising during the natural menopause and after surgical removal of ovaries (surgical menopause), eliminates menopausal disorders, improves the lipid blood profile and ensures the prevention of osteoporosis. Ciproteron is a synthetic gestagenist, protects endometries from hyperplasia, preventing the development of cancer of the uterine mucous membrane.

In addition, Ciproteron is a strong antandrogen, blocks receptors to testosterone and prevents the influence of male genital hormones on target organs. Ciproteron enhances the beneficial effect of estradiol on a lipid blood profile. Thanks to the antandrogen effect, the klimen eliminates or reduces such manifestations of hyperandrogenation in women, as an excess her hair growth on the face ("Lady mustache"), acne (acne), hair loss on the head.

The Kliten prevents the formation of obesity in women on male type (the accumulation of fat in the field of waist and abdomen) and the development of metabolic disorders. When taking a customer during a period of 7-day break, a regular menstrual-like reaction is observed, and therefore the drug is recommended for women during premanopause.

It is a combined, modern, low-volume hormonal drug, therapeutic effects which is due to the part of estradiol and Didrogesteron.

Currently, three varieties of the drug Fermoston is produced - this is a 1/10 femostron, 2/10 femoston and 1/5 femoston (Conti). All three varieties are produced in a single dosage form - tablets for intake (28 tablets in the package), and differ from each other only the dosage of active ingredients. The numbers in the title of the drug indicate the content of the hormone in MG: the first - the content of estradiol, the second - Didrogesterone.

All varieties of femoston have the same therapeutic effect, and various dosages of active hormones allow you to pick up for each woman the optimal drug, which is best suited to her.

Indications for use for all three varieties of femoston (1/10, 2/10 and 1/5) are the same:

1. Replacement hormone therapy of natural or artificial (surgical) menopause in women, manifested with tides, sweating, palpitations, sleep disorders, excitability, nervousness, dryness of the vagina and other symptoms of estrogen deficiency. Fermoston 1/10 and 2/10 can be used in six months after the last menstruation, and Fermoston 1/5 is only a year later;
2. Prevention of osteoporosis and increased bone fragility in women during menopause during the intolerance of other drugs intended to maintain normal bone mineralization, the prevention of calcium deficiency and the treatment of this pathology.

Femoston is not shown to treat infertility, however, in practice, some doctors gynecologists prescribe it to women experiencing problems with conception, to increase the growth of endometrial, which significantly increases the likelihood of implantation of the fertilized egg and the onset of pregnancy. In such situations, doctors use the pharmacological properties of the drug to achieve a certain effect under states that are not indicated to use. This practice of applying drugs is not on the destination is available throughout the world and is called Off-Label Prescriptions.

Fermoston replenishes the lack of genital hormones in the body of a woman eliminating the various disorders (vegetative, psycho-emotional) and sexual disorders, and also warns the development of osteoporosis.

Estradiol, which is part of the femoston, is identical to the natural, produced by the ovaries of a woman. That is why it fills the deficiency of estrogen in the body and provide smoothness, elasticity and slow aging of the skin, slow down the hair loss, eliminates the dryness of the mucous membranes and unpleasant sensations at the sexual act, and also prevent atherosclerosis and osteoporosis. In addition, estradiol eliminates such manifestations of menopausal syndrome, like tides, sweating, sleep disruption, excitability, dizziness, headaches, skin atrophy and mucous membranes, etc.

Didrogesterone is progesterone hormone, which reduces the risk of developing hyperplasia or endometrial cancer. This progesterone hormone does not have any other effects, and is introduced into the femoston specifically to level the risk of hyperplasia and endometrial cancer, which increases due to taking estradiol.

In the postmenopause period, drugs intended for continuous reception should be applied. Of these, additional advantages associated with good tolerability are climodien, since moderate antidegenic activity and optimal pharmacokinetics and optimal pharmacokinetics are included in its composition.

Contains 2 mg of estradiol valerat and 2 mg of dienethest in one tablet. The first component is well known and described, the second is new and it should be described in more detail. The dienogest combined in one molecule, which has almost 100% bioavailability, the properties of modern 19-Norproatagennes and progesterone derivatives. Dienenogest - 17-alpha-cyanomethyl-17-beta-hydroxy-estra-4.9 (10) diode 3-one (C 20 H 25 NO 2) - differs from other derivatives of the norethysterone in that it contains a 17-cyanmetyl group (-CH 2 cm) instead of 17 (alpha) -Ethinyl group. As a result, the size of the molecule has changed, its hydrophobic properties and polarity, which, in turn, influenced the absorption, distribution and metabolism of the compound and gave a dienethest as a hybrid gestagenue, a unique spectrum of effects.

The progestogenic activity of dienethest is especially high due to the presence of a double bond in position 9. Since the dienogest does not have affinity for plasma globin, approximately 90% of its total number is associated with albumin, and it is in fairly high concentrations is in a free state.

The metabolism of dienogest is carried out using several paths - mainly by hydroxylation, as well as by hydrogenation, conjugation and aromatization in fully inactive metabolites. Unlike other derivatives of Northestosterone, which contain an ethylic group, the dienogest does not suppress the activity of enzymes containing cytochrome P450. Due to this, the dienogest does not affect the metabolic activity of the liver, which is its undoubted advantage.

The period of half-life of dienogest in the terminal phase is short enough compared to other progestogencies, similar to such a norethyster acetate and ranges between 6.5 and 12.0 hours. This makes it convenient for its daily use in a single dose. At the same time, unlike other progestogen, the coupon of dienogest with daily oral reception insignificant. Compared with other progestainenes in oral administration, the dienogest has a high value of the ratio of the highlighting of the kidney / feces (6.7: 1). About 87% of the administered dose dose is eliminated after 5 days (mainly with urine in the first 24 hours).

As a result of the fact that the urine is found mainly metabolites, and unchanged dienogest is detected in minor quantities, the blood plasma remains a fairly high amount of unchanged substance until elimination.

The lack of androgenic properties in dienenest makes it a selection drug for use in combination with estrogen in continuous mode of substitution hormone therapy.

In studies on molecular models, it was shown that, unlike other 19-norprogestions, the dienogest not only did not possess androgenic activity, but became the first 19-norproatagen one who was inherent in certain antandogenic activity. Unlike most of the Northestosterone derivatives (for example, Levonorgestrel and Noretinodron), the dienogest does not compete with testosterone for binding to globulin binding sex steroids, and therefore does not increase the free fractions of endogenous testosterone.

Since the estrogen component of substitution hormone therapy stimulates the synthesis of this globulin in the liver, the progestogen with partially androgenic activity can counteract this effect. In contrast, most of the Northestosterone derivatives, which reduce the content of globulin in plasma, the dienogest does not affect estrogen caused to increase its level. Consequently, the use of CLIMODIEND leads to a decrease in the level of free testosterone in serum.

It was shown that the dienogest is also capable of changing the biosynthesis of endogenous steroids. In vitro studies, it was demonstrated that it reduces the synthesis of ovarian steroids, suppressing the activity of 3-beta hydroxysteroiddehydrogenase. Moreover, it was discovered that, like progesterone, the dienogest at the local level reduces the transformation of testosterone into a more active form - dihydrotestosterone - thanks to the inhibition of 5-alpha reductase in the competitive mechanism in the skin.

The dienogest is well tolerated and characterized by the low side effects. In contrast to the estrogen-dependent increase in the level of renin during the control cycle, against the background of the dienethest of increasing renaine was not noted.

In addition, the dienogest causes a smaller aggregation of platelets than the acetate's medroxyprogesterone, and also has antiproliferative effect on breast cancer cells.

Thus, the dienogest is a strong oral progestogen, which is ideal for combined application With estradiol Valeret in the composition of the drug Climodiene for substitution hormone therapy. Its chemical structure determines the combination of the positive properties of 19-norprogestins with such C21-progestogen (Table 2).

Table 2. Pharmacokinetic and pharmacodynamic properties of dienogest

Properties and characteristics	19-Networks	C21-transition genes.	Dieno-gest
High bioavailability when receiving Per OS	+	+
Short period of half-life in plasma	+	+
Strong progestogenic effect on endometrium	+	+
Lack of toxic and genotoxic effects	+	+
Low antigonadotropic activity		+	+
Antiandogenic activity		+	+
Antiproliferative effects		+	+
Relatively low passage through the skin		+	+
With the exception of receptors to progesterone, it does not associate with any other steroid receptors			+
Does not bind to specific steroid-binding transport proteins			+
Lack of adverse liver effects			+
Significant part of the steroid in a free state in plasma			+
In combination with estradiol Valeret, weak cumulation during daily reception			+

Climodiene effectively stops the manifestations and symptoms of climethery associated with a decrease in hormone levels after the onset of menopause. The Cupperm Index at when taking Climodiene for 48 weeks decreased from 17.9 to 3.8, improved verbal and visual memory, eliminated insomnia and respiratory disorders in a dream. Compared to the estradiol monotherapy by Valeret, the velerat estradiol combination with the dienogest has a more pronounced positive effect on atrophic changes in the urinary tract, manifested by dryness of the vagina, disuria, frequent urges to urination, etc.

Climodiene's reception was accompanied by a favorable change in the exchange of lipids, which, firstly, are useful for preventing atherosclerosis, and, secondly, they contribute to the redistribution of fat on the female type, making the figure more feminine.

Specific markers of bone metabolism (alkaline phosphatase, pyridinoline, deoxypyridinoline) When taking climodien, changed in a characteristic way, indicating inhibition of osteoclast activity and pronounced suppression of bone resorption, which indicates a decrease in the risk of osteoporosis.

The description of the pharmacological properties of Climodiene will be incomplete if it is not to note its ability to increase in postmenopausal women the content of endogenous mediators mediators mediated vasodilation, - TsGMF, serotonin, prostacyclin, relaxin, which makes it possible to attribute this drug to drugs with vase settlement activity capable of improving blood circulation.

The use of Climodiene leads to atrophic endometrial changes in 90.8% of women, therefore prevents the development of endometrial hyperplasia. Blood discharges that are relatively often noted in the first months of therapy are reduced with an increase in the duration of treatment. The frequency of unfavorable and side effects is similar in the treatment of women in postmenopausal by other similar preparations. At the same time, there was no adverse effect on chemical laboratory parameters, which is especially important, for hemostasis and carbohydrate exchange.

Thus, it can be concluded that for women during the postmenopause period of choice for a continuous combination mode of substitution hormone therapy is CMODIEN, which, responding to all the necessary standards of efficiency and tolerance, contributes to the preservation of femininity after the onset of menopause.

• provides quick and efficient relief of menopausal symptoms;
• provides reliable "protection" endometrial and better controls breakthrough bleeding, compared with the closet, without reducing the beneficial effects of estrogen;
• contains a dienethostegenic component that does not bind to globulin binding sex steroids, as a result of which endogenous steroids testosterone and cortisol are not crowded out of the sections of their binding with transport proteins;
• reduces testosterone levels in women;
• contains a dienogest with a partial antandrogen effect;
• according to the study of bone metabolism indicators, exhibits the inhibitory effect of estradiol on bone resorption. Dienogest does not counteract this influence of estradiol;
• according to the results of the study of endothelial markers during the treatment period, there is a vasodilator effect of estradiol and nitrogen oxide on the vascular network;
• does not have an adverse effect on the lipid profile;
• does not change the values \u200b\u200bof blood pressure, coagulation factors or body weight;
• improves mood, cognitive function, eliminates insomnia and normalizes sleep in patients with his disorders if they are associated with macaining.

Climodiene is a highly efficient, well-tolerable and convenient to use by a combined drug for substitution hormone therapy, which is designed for long-term use. It will buy all the manifestations of menopausal syndrome and causes amenorrhea after 6 months from the beginning of the reception.

Climodiene is shown for a continuous combined mode of climacteric disorders in postmenopausal women. Additional advantages of climeodios include the antagandagenic properties of the progestogen - dienegest.

A great interest today represents the emergence of a new monophas combined drug Pause-gene for the treatment of patients in postmenopausal.

Pause-gene is a drug of choice for long-term treatment of women who are held longer than the year in postmenopausal and preferring HRT without periodic bleeding.

Pauseogest is a combination of estrogen and progesterone. One pyl's tablet contains 2 mg of estradiol (2.07 mg in the form of estradiol hemihydrate) and 1 mg of norethyster acetate. The drug is produced in the package - 1 or 3 blisters of 28 tablets. Tablets are covered with film shell. The daily dose is 1 tablet and is accepted daily in continuous mode. The drug fills the lack of female sex hormones during postmenopause. The pauseogest stops vegetual-vascular, psycho-emotional and other menopacteric estrogen-dependent symptoms during the postmenopause period, prevents the reduction of bone mass and osteoporosis. The combination of estrogen with a progestogen allows you to protect the endometrium from hyperplasia and at the same time prevent unwanted bleeding. The active substances of the drug are well absorbed when taking inside and are actively metabolized in the intestinal mucosa and when passing through the liver.

Similar to endogenous estradiole, exogenous estradiol hemihydrate, which is part of the pauseogest, affects a number of processes in the reproductive system, hypothalamic-pituitary system and to other organs; It stimulates the mineralization of bone tissue.

Receiving estradiol Gemihydrate once a day provides a stable constant concentration of the drug in the blood. It is excreted entirely within 72 hours after admission to the body, mainly with urine, in the form of metabolites and, partly, unchanged.

Studies of recent years have shown that the role of the gestagne component in the UGT is not reduced only to the protection of the endometrium. Gestagens can relax or strengthen some Estradiol effects, for example, with respect to the cardiovascular and bone system, and also have their own biological effects, in particular, psychotropic effect. Side effects and tolerability of the drug for the UGT are also largely determined by the gestagne component. The properties of the gestagne component in the composition of continuous combination therapy are especially important, since the duration of the reception and the total dose of the gestagen with this mode is greater than with cyclic schemes.

Norethysteon acetate, which is part of the pauseogest, refers to testosterone derivative (C19-Gestagen). In addition to the overall property of the C21-Gestagen derivatives and C19-Gestagennes, the endometrium transformation, the norethisterone acetate has various additional "characteristics", which determine their use in therapeutic practice. It has a pronounced anti-estrogen effect, reducing the concentration of estrogen receptors in target organs and inhibiting the action of estrogen at the molecular level ("down-reg-ulation"). On the other hand, a moderately pronounced mineralocorticoid activity of a acetate Nortisitrone can be successfully used in the treatment of menopauscic syndrome in women with primary chronic adrenal insufficient failure, and androgenic - both to achieve a positive anabolic effect and to replenish androgenic deficiency in menopause, leading to a decrease in sexual attraction.

A number of unwanted effects of the norethyster acetate manifests itself when it passes through the liver and, most likely, is due to the presence of the same residual androgenic activity. Oral administration The norethysteon of acetate prevents the estrogen-dependent synthesis of the apobelkov of lipoproteins in the liver and therefore reduces the beneficial effect of estradiol on the lipid blood profile, and also worsens the tolerance to glucose and contributes to increasing the level of insulin in the blood.

Norethisterone acetate is well absorbed at the reception inside. Displays mainly with urine. With the simultaneous administration of estradiol hemihydrate, the characteristics of the norethisterone acetate do not change.

Thus, the drug pauseogest has a positive effect on all the symptoms of perimem and postmenopause. Clinical data suggests that the pauseogest reduces the destruction of bone tissue, it is preventing the loss of bone mass in postmenopausal, thereby reducing the risk of fractures caused by osteoporosis. The endometrium proliferation arising under the influence of estrogen is effectively inhibited by a continuous admission of the norethysterone acetate. This minimizes the risk of developing hyperplasia and endometrial cancer. Most women on the background of receiving pauseogest in monophasic mode are not observed uterine bleeding, which is preferable for postmenopausal patients. With prolonged reception of the drug Pause-gene (less than 5 years), the risk of developing breast cancer does not increase. The drug is well tolerated. Among the side effects, the heat of dairy glasses, light nausea, rarely - headache, peripheral edema.

Thus, the results of many clinical studies It is evidenced that the arsenal of funds for the UGT in postmenopausus was replenished with another worthy drug with high efficiency, safety, good tolerance, acceptability and convenience in use.

Conclusion

When choosing a drug for SGT, women need to be considered:

• age and weight of patients
• features Anamneza
• relative risk and contraindications to use

Oral drugs	It is better to take women with atrophic skin changes, hypercholesterolemia, it is possible to use smoking women and women with a high risk of developing colon cancer.
Transdermal drugs	It is preferable to use in women with diseases of the gastrointestinal tract, a gallbladder, diabetes, hyperitriglyceridemia and possibly in women after cholecystectomy.
Monotherapy estrogenami	It is shown to women with a remote uterus and possibly women in old age, suffering from heart vessels or Alzheimer's disease.
Combiner Estrogen-Gestagenic Therapy	It is shown to women with a unlucky uterus, as well as women with a remote uterus in the presence of a hyperitrigliseridemy or an emission endometriosis.

The selection of the TGT mode depends on the severity of the climacteric syndrome and its period.

• In Perimenopause, it is preferable to use two phase combined drugs in cyclic mode.
• In postmenopausal, it is advisable to constantly use the combination of estrogen with the Gestagen; Since in this age, women, as a rule, increased insulin resistance and hypercholesterolemia is observed, it is better to use Climodiene - the only drug for continuous reception containing a gestagen with antagandogenic activity.

Redemption hormone therapy (HRT) becomes relevant for a woman after the onset of menopause.

The body no longer produces estrogens in the required quantity, and to maintain hormonal hemostasis have to decide on the reception of conjugated drugs.

And if after removing the ovaries at a young age, replacement hormone therapy becomes the only possibility of full life in the future, during the climax of many women, doubts are overcome whether it is worth interfere with the natural course of events and compensate for the recession of hormonal activity.

To such an important decision, it is worth up with all the responsibility and study everything that is associated with the UGT is its appointment, the mechanism of action of drugs, contraindications and side effects, as well as the possible benefits it gives.

Estrogens (often used the term "estrogen") is a group of steroid genital hormones, which in women are synthesized by cells and some other organs - the bark of the adrenal glands, the brain, bone marrow, lipocytes subcutaneous fatty tissue and even hair follicles.

And yet the main manufacturer of estrogen - ovaries.

An exception is Livial.

Livial

Livial is a drug for the treatment of signs of Klimaks, in case of cancellation of which bleeding does not occur. The main active ingredient of the drug is Tibolone.

It has a light antagandogenic effect, estrogenic and progestogenic properties.

Tibolone is quickly absorbed, its working dose is very low, metabolites are proposed mainly with bile and feces. In the body, the substance does not accumulate.

Hormone-hormone therapy with libal use is used to eliminate the signs of natural and surgical climax, for the prevention of osteoporosis during estrogen failure.

Livial is not a contraceptive.

It is prescribed immediately after ovariectomy or a year after the last menstrual bleeding.

In case of overdose, bleeding is possible.

Preparation with caution is used for migraine, epilepsy, diabetes, kidney disease, high blood cholesterol.

Therapy for any form of a climax using Tibolone provides daily reception of the drug inside 1 tablet (2.5 mg) per day long period of time.

Improvement occurs after 3 months of reception. It is advisable to take the drug at the same time in the same time to maintain a constant concentration active substance in blood.

Harmonial therapy Livialoma may have side effects: body weight fluctuations, uterine bleeding, edema limbs, headaches, diarrhea, liver disorders.

Combined femoston

Fermoston is a combined drug for the UGT. The replacement effect of the drug provides 2 components: estrogen - estradiol and gestagne - Didrogesterone.

The dose and the ratio of hormones in the preparation depends on the form of release:

• 1 mg of estradiol and 5 mg of Didrogesterone;
• 1 mg of estradiol and 10 mg of Didrogesterone;
• 2 mg of estradiol and 10 mg of Didrogesterone.

Femoston contains estradiol, identical to natural, allowing you to compensate for the lack of estrogen and remove the psycho-emotional component of the climax: tides, increased excitability, mood swings, migraine, propensity to depression, hyperhydrosis.

Estrogen therapy with the applications of Fermoston warns age-related changes The mucous membranes of the urogenital system: dry, itching, painful urination and sexual intercourse, irritation.

Estradiol plays an important role in the prevention of osteoporosis and bone fragility.

Didrogesterone in turn stimulates the secretory function of the endometrium, preventing the development of hyperplasia, endometriosis and cancer degeneration of endometriocytes, the risk of which against the background of taking Estrodiol increases significantly.

This hormone does not have glucocorticosteroid, anabolic and antidegenic effect. In the complex, the drug allows you to control cholesterol levels.

Hormone-plating therapy with the use of femoston is complex and low-volume. It is prescribed in physiological and surgical menopause.

Doses and treatment diagrams are strictly individually selected depending on the reason for the purpose of the drug.

The replacement therapy with the use of femoston may be accompanied by such side effects as migraine, nausea, digestive disorders, female cramps, vaginal bleeding, chest pain and pelvis, body weight fluctuations.

Therapy for porphyry with the use of femoston does not apply.

Drug Angelik

The drug Angelica includes 1 mg of estradiol and 2 mg of chospirenone. This drug is prescribed to compensate for the lack and for the prevention of osteoporosis.

Chrospirenone is an analogue of the natural hormone of progestogen. Most effective comprehensive treatment In hypogonadism, dystrophy of ovarian and menopause, regardless of its cause.

Angelica, like Fermoston, eliminates climax clinical manifestations.

In addition, Angelica has an antagandogenic effect: it is used for the treatment of androgenic alopecia, seborrhea, acne disease.

Chrospirenone prevents the formation of swelling, arterial hypertension, increase in body weight, soreness in the chest.

Hormones Estradiol and Chrospirenone potentiate each other's action.

In addition to classic properties for the preparation of substitution therapy, Angelica prevents the malignant reincarnation of the tissues of the rectum and endometrial during the postmenopause period.

The drug is accepted 1 time per day 1 tablet.

Possible side effects: short bleeding at the beginning of therapy, chest pain, headache, irritability, abdominal pain, nausea, dysmenorrhea, benign neoplasms in lactic glands and in the cervix, asthenic syndrome, local edema.

Proginova differs from other drugs used for the GHT in that it contains only estradiol in the amount of 2 mg.

The drug is prescribed to compensate for the lack of estrogen after the removal of the ovaries and the uterus, the onset of menopause and for the prevention of osteoporosis. If the uterus is saved, additional reception of the progestogen is needed.

Preparation Proginov is prescribed before and after the onset of menopause after a complete examination.

One packaging of the drug contains 21 dragees that take 1 time per day during the first 5 days after the start of menstrual bleeding or at any time if the cycle is already completed.

Proginov takes continuously during the postmenopause or cyclically before the onset of menopause.

Reception of the drug may accompany side effects and contraindications for estradiol.

Modern drugs of substitution hormone therapy contain a minimally permissible treatment dose of estradiol, and therefore their property cause cancer, minimized.

Nevertheless, the reception only estradiol for a long time (longer than 2 years) increases the risk of endometrial cancer. This danger removes the combination of estradiol with progestin.

In turn, the latter contributes to the development of atherosclerosis. Currently, the most effective combinations of hormones for GZT are still being studied, taking into account its impact on cardiovascular and other organism systems.

The purpose of scientific research is to develop the most effective scheme substitution therapy with the smallest risk of development of malignant neoplasms and side effects.

For most women, the menopacteric period is filled with unpleasant symptoms that interfere with the usual flow of life. Therefore, with a timely handling of specialists, replacement hormone therapy applies to the use of new generation drugs. Which is able to get rid of the symptoms of pathological climax and reduce possible risks Complications.

Climontorm - one of the drugs of the new generation

Act uGT In Climax. Preparations of a new generation to eliminate symptoms. Consequences of reception drugs

The only means to eliminate the symptoms of pathological climax doctors consider the use of drugs of substitution hormone therapy. Z. gt are analogues of female sex steroid hormones. They can be divided on the:

• UGTwhich includes only estrogen.
• UGT combined action that have in the composition estrogen And progesterone.

Application gZT possibly Not only during the period of natural climax, but also with artificial menopause. In any of these cases, the use of drugs should be under the control of a specialist, because they have absolute contraindications:

• If a histological examination Breast confirmed the presence of cancer cells.
• Contraindications are not only breast cancer, but also cancer of any endometrial.
• Melanoma.
• Vascular disease top or lower extremities. Thrombophlebitis.
• Any diseases that are the nature of autoimmune.
• Pathological liver changes.
• Diseases biliary Duchs.
• Any deviations in the cardiovascular system.
• The presence of estrogen-dependent tumors in the body of estrogen (endometriosis, uterine misa).

Cycle Proginova, like other drugs, has a number of contraindications

How do the drugs of a new generation?

Since all violations in the period of menopause in the body of a woman are associated with insufficient estrogen production and an abrasiveness of progesterone, the use of funds gZT It helps to fill the shortage and normalize well-being.

Application gZT The new generation eliminates the symptoms of pathological climax:

• Riding. A short-term increase in the temperature of the upper body, accompanied by an increased sweating, rapid heartbeat, and a sense of anxiety.
• Dryness of all mucous membranes. During the period of menopause, women have a decrease in the overall level of sex hormones in the blood, which leads to the emergence of problems in: urethra; excretory and system of reproductive function organs. The mucous membranes dry out, dried out, which leads to the appearance of unpleasant symptoms (incontinence, itching in the perineum, exacerbation of healing sTD).
• Elevated blood pressure, tachycardia.
• Systematic disorder of the central nervous system, a pronounced mood difference.

Tides are the most bright symptom of pathological climax, which It takes itself a failure in the body thermoregulation by the hypothalamus. Such a failure contributes lack of estrogen who Easily eliminated by appointment gZT.

Kliten normalizes the cycle of menstruation

The consequences of the use of drugs

Since the preparations of substitution hormone therapy have a large content of estradiol in their composition, then long-term use without consultation with the attending physician is fraught with the emergence of estrogen of dependent tumors.

Therefore, in the event of any symptoms of pathological climax, it is not necessary to assign therapy yourself. The surest solution will be:

• Give the tests to the level of sex hormones in the blood.
• Check thyroid gland On the function.
• To apply for the appropriate treatment to the doctor a gynecologist.

What medications treat the drugs of the UGT. Trade names and methods of application

In pharmacies you can find more than 50 items of drugs used in, under different trade names. They can be divided into several groups that differ from each other only by the method of administration:

• Orally. Tablets for receiving inside.
• Intramuscular injections.
• Transdermal Preparations of local action.
• Intravaginal administration.

The method of administering the drug into the body is selected individually, taking into account the severity of the course of the disease or personal preferences. The most common form of reception of drugs is orally.

The doctor can offer you a choice of drugs with equal pharmacological propertiesbut various trading names. Because of which you can independently select the drug of substitution hormone therapy based on your own budget.

Fermoston is produced in the form of tablets

The most common means to help eliminate the symptoms of pathological climax:

Tradename	Active substance	Pharmacological properties and testimony for use
	The drug includes two main components: levonorgestrel and estradiol.	The drug is prescribed to eliminate the symptoms of pathological climax. Has a number of indications for use: The drug is appointed as means of substitution hormone therapy in atrophic Changes in the structure of mucous membranes, endometrial organs of the reproductive system and pronounced symptoms of estrogen deficiency. With artificial climax in the postoperative period. When dysfunction of appendages. The drug is prescribed as a cycle regulator, when it is violation. The drug has a series of contraindications to use: Ectopic bleeding, not installed etiology. Thrombophlebitis and thromboembolism of various severity. The presence of estrogen of the dependent neoplasms of the reproductive system and breast organs. Pregnancy and lactation period. Special care at the reception of Klimontorm should be paid to the regularity of gynecological and general medical examinations. The reception is contraindicated in combination with oral contraceptives, since the risk of overdose of Klimontorm is great.
	Estradiol Valerat, Northestrel	The drug belongs to the group of drugs that remove the manifestation of menopausal symptoms. The drug does not affect the general hormonal background in the body of a woman, thanks to the content of Estradiol Valerat helps women of reproductive age normalize the menstrual cycle, and during menopause eliminate the symptoms of pathological climax. The drug is successfully used to treat psycho-emotional background pathologies and vegetative disorders. Reduced libido. Increased nervous excitability. Dryness mucous membranes of the genitourinary system. Dry vagina. Muscular and articular pains. The drug has both contraindications: Period of pregnancy and lactation. Ectopic and vaginal bleeding unclear etiology. Histologically confirmed breast cancer. Head tumors. Thrombosis. This drug is not assigned as a contraceptive agent.
	Estradiol Valerat, Ciproteron Acetate	A medicinal product containing estrogen and antagandrogen has a pronounced histogenic property. It is a drug of hormonal replacement therapy, fully restoring the lack of female sex hormones in the body. It can be appointed to women reproductive age to restore the regularity of menstrual bleeding. Thanks to the content of ciproterone acetate, it helps to upgrade the sophisticated epithelium of the uterus, maintaining moisturistics of the mucous membranes of the organs of the genitourinary system. Perfectly eliminates the symptoms of pathological climax and estrogen deficiency period of menopause. It is shown for the use of patients after ovariectomy, in a state of artificial click. But has a number of side effects: A sharp increase in body weight. From the side of the central nervous system, there is observed: the general oppression state, a decrease in mood, is not uncommon for the occurrence of migraine. Frequent cases in the presence of pain in the epigastria, increased gas formation, an increase in appetite, nausea, vomiting. Among other side effects may be observed: skin rashes, allergic reactions, Tachycardia, edema. The use of the drug is prohibited in the case of: pregnancy, lactation, the presence of estrogen dependent tumors.
	Estradiol, Didrogesterone	The drug is used in as replacement hormone therapy In the estrogen lack during the menopause. Perfectly fights with all manifestations of pathological changes in the body in the period menopause, and helps solve the problem with the prevention of osteochondrosis, complications of the cardiovascular system. The drug must be used as long as there is no risk of complications, against the background of the organism's oversaturation. As well as other drugs of substitution hormone therapy, Fermoston has a number of contraindications: During pregnancy and breastfeeding. The presence of confirmed neoplasms with cancer cells. Pathological changes of endometrial of the reproductive system organs, depending on the amount of estrogen in the blood. Tumors and precancerous states of adrenal glands. Pathological changes in the kidneys and liver.
Klimodiene	Estradiol Valerat, Dienenoyst	The drug is an analogue of estradiol Valerat containing preparations, and is a means of a new generation of substitution hormone therapy. Contraindications coincide with the preparations of the same group, but here is a climate of the consequences of overdose: Thrush. Most frequent symptomwhich arises due to the reception of the drug. Mushroom disease is fixed antimicose drugs - symptomatic. Despite the fact that the drug refers to the means of a new generation, often cases of increasing body weight. A woman notices an increase in fatty sediments in the area of \u200b\u200bthe berry muscle, abdomen, and hands. If the patient suffers from arterial hypertension, the use of Climodiene can aggravate the state. The consequence of excessive reception of the drug may be the appearance of reverse effects. That is, a woman will not get rid of tides, and their frequency will increase. That is why the drug should be applied only under the clear control by specialists.