OPTIMIZATION OF MENOPAUSAL HORMONE THERAPY-RELATED RISKS: MONOTHERAPY WITH TRANSDERMAL ESTROGENS OR IN COMBINATION WITH MICRONIZED PROGESTERONE. ADVANTAGES AGAINST VENOUS THROMBOEMBOLISM AND BREAST CANCER


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Abstract

После опубликования результатов исследования «Инициатива во имя здоровья женщин» (WHI) приоритетное значение приобрели вопросы не только эффективности, но и безопасности менопаузальной гормональной терапии (МГТ). Согласно временной гипотезе МГТ безопасна у здоровых женщин в течение 5-7 лет, если она начата до возраста 60 лет и/или в течение 10 лет постменопаузы, когда многие женщин нуждаются в таком лечении. Второй ключевой вопрос - это правильный выбор лечения, принимая во внимание широкий спектр препаратов для МГТ, в том числе парентеральных, имеющийся в арсенале современного врача. Цель исследования. Рассмотреть возможные пути снижения наиболее важных рисков МГТ, такие как венозная тромбоэмболия и рак молочной железы, при использовании монотерапии трансдермальными эстрогенами или в комбинации с микронизированным прогестероном. Материал и методы. Проведен обзор опубликованных после 2002 г. клинических и экспериментальных исследований надлежащего качества, касающихся безопасности МГТ с фокусом на трансдермальный эстрадиол и микронизированный прогестерон. Результаты. Польза и риски МГТ значительно отличаются в зависимости от многих факторов, в том числе от выбора пути введения гормонов. Данные наблюдательных исследований свидетельствуют о более низком риске венозной тромбоэмболии и рака молочной железы при применении трансдермальных эстрогенов у женщин после гистерэктомии или в комбинации с микронизированным прогестероном у женщин с интактной маткой. Заключение. Необходимо проведение рандомизированных контролируемых исследований для подтверждения нейтрального влияния трансдермального эстрадиола и перорального микронизированного прогестерона на главные риски МГТ.

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About the authors

Svetlana Vladimirovna Yureneva

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

MD Moscow 117997, Ac. Oparina str. 4, Russia

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