Algorithms for prevention, diagnosis, and management of unplanned bleeding in women undergoing menopausal hormone therapy

Мұқаба
  • Авторлар: Podzolkova N.M.1,2, Smetnik A.A.3, Yarmolinskaya M.I.4,5, Yureneva S.V.3, Protasova A.E.6, Tapilskaya N.I.4, Ulrikh Е.А.7, Maltseva L.I.8, Dubrovina S.O.9, Enkova E.V.10, Karakhalis L.Y.11, Korennaya V.V.1
  • Мекемелер:
    1. Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation
    2. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow City Health Department
    3. Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
    4. D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology
    5. I.I. Mechnikov North-Western State Medical University, Ministry of Health of the Russian Federation
    6. St. Petersburg State University
    7. V.A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation
    8. Kazan State Medical Academy – Branch of the Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation
    9. Rostov State Medical University, Ministry of Health of the Russian Federation
    10. N.N. Burdenko Voronezh State Medical University, Ministry of Health of the Russian Federation
    11. Kuban State Medical University, Ministry of Health of the Russian Federation
  • Шығарылым: № 8 (2025)
  • Беттер: 230-246
  • Бөлім: Guidelines for the Practitioner
  • URL: https://journals.eco-vector.com/0300-9092/article/view/690490
  • DOI: https://doi.org/10.18565/aig.2025.221
  • ID: 690490

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Given the rapid growth in the number of women aged 40–60 (more than 850 million, with a forecast of over 1 billion in the coming years), the issues of effective management of patients with menopausal symptoms are becoming particularly important. In 85% of women, the cessation of menstruation is accompanied by severe psycho-vegetative, somatic, and metabolic disorders, which significantly reduce the quality of life.

In the Russian Federation, the use of menopausal hormone therapy (MHT) has increased fivefold over the past five years, reaching 6.5% among women aged 45–59 years. This reflects the active involvement of the medical community in supporting informed patient choice and ensuring the safe and clinically appropriate use of MHT. Nevertheless, the use of MHT in the Russian Federation remains lower than in a number of developed countries in Europe and North America, where it exceeds 15%.

Key limiting factors include the legal vulnerability of physicians and insufficient training in therapy individualization, particularly in managing adverse events such as unplanned uterine bleeding (UUB), which occurs in 40% of women during the first six months of therapy.

The document emphasizes the need for personalized MHT, considering age, stage of reproductive aging according to STRAW+10, clinical response, comorbidities, and the dynamic balance of benefit/risk. It presents algorithms for the diagnosis, treatment, and prevention of UUB that were developed on the basis of current scientific evidence, international and national clinical guidelines. A number of key points are based on the consensus opinion of experts, which reflects the practical significance and clinical experience in the context of a limited evidence base on certain aspects of therapy.

The algorithms include the assessment of endometrial cancer risk factors and principles of MHT adjustment in UUB; counseling and management of patients with UUB; bleeding control during cyclic MHT and continuous monophase MHT; аpproaches to the management of patients with UUB undergoing MHT with a LNG-IUS; principles of preventing UUB during MHT.

Special attention is given to step-by-step clinical actions for excluding hyperplastic and neoplastic processes, which are critical for continuing therapy. The tables serve as practical tools for education and clinical decision-making support.

Conclusion: The use of these algorithms will contribute to timely diagnosis of UUB causes, the choice of optimal management strategies, reduction in the frequency of unjustified invasive interventions and MHT discontinuation. This, in turn, can improve the quality of life of patients and achieve better medical and social outcomes.

Толық мәтін

Рұқсат жабық

Авторлар туралы

N. Podzolkova

Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation; Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow City Health Department

Хат алмасуға жауапты Автор.
Email: podzolkova@gmail.co
ORCID iD: 0000-0001-8991-1369

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Leading Researcher

Ресей, Moscow; Moscow

A. Smetnik

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: a_smetnik@oparina4.ru
ORCID iD: 0000-0002-0627-3902

PhD, Head of the Department of Gynecological Endocrinology, Associate Professor at the Department of Obstetrics and Gynecology, IPO

Ресей, Moscow

M. Yarmolinskaya

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology; I.I. Mechnikov North-Western State Medical University, Ministry of Health of the Russian Federation

Email: m.yarmolinskaya@gmail.com
ORCID iD: 0000-0002-6551-4147

Honored Scientist of the Russian Federation, Dr. Med. Sci., Professor, Head of the Department of Gynecology and Endocrinology, Head of the Center for Innovative Methods of Diagnosis and Therapy of Endometriosis, Professor at the Department of Obstetrics and Gynecology

Ресей, St. Petersburg; St. Petersburg

S. Yureneva

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: syureneva@gmail.com
ORCID iD: 0000-0003-2864-066X

Dr. Med. Sci., Professor, Deputy Director for Research, Institute of Oncogynecology and Mammology, Professor at the Department of Obstetrics and Gynecology

Ресей, Moscow

A. Protasova

St. Petersburg State University

Email: protasova1966@yandex.ru
ORCID iD: 0009-0001-3965-8876

Dr. Med. Sci., Professor at the Department of Oncology, Professor, Department of Obstetrics and Gynecology

Ресей, St. Petersburg

N. Tapilskaya

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology

Email: tapnatalia@yandex.ru
ORCID iD: 0000-0001-5309-0087

Dr. Med. Sci., Professor, Head of the Department of Reproductology

Ресей, St. Petersburg

Е. Ulrikh

V.A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation

Email: elenaulrikh@mail.ru
ORCID iD: 0000-0002-2701-8812

Dr. Med. Sci., Professor, Chief Researcher at the Research Laboratory of Oncogynecology and Oncofertility, Professor, Department of Oncology, Leading Researcher

Ресей, St. Petersburg

L. Maltseva

Kazan State Medical Academy – Branch of the Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation

Email: laramalc@mail.ru
ORCID iD: 0000-0003-0999-4374

Dr. Med. Sci., Professor, Honored Scientist of the Russian Federation, Professor at the Department of Obstetrics and Gynecology

Ресей, Kazan

S. Dubrovina

Rostov State Medical University, Ministry of Health of the Russian Federation

Email: s.dubrovina@gmail.com
ORCID iD: 0000-0002-2400-9638

Dr. Med. Sci., Professor, Chief Researcher, Obstetrics and Pediatrics Research Institute, Professor, Department of Obstetrics and Gynecology No. 1

Ресей, Rostov-on-Don

E. Enkova

N.N. Burdenko Voronezh State Medical University, Ministry of Health of the Russian Federation

Email: enkova@bk.ru
ORCID iD: 0000-0001-8885-1587

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology No. 2

Ресей, Voronezh

L. Karakhalis

Kuban State Medical University, Ministry of Health of the Russian Federation

Email: lomela@mail.ru
ORCID iD: 0000-0003-1040-6736

Dr. Med. Sci., Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology No. 2

Ресей, Krasnodar

V. Korennaya

Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation

Email: drkorennaya@mail.ru
ORCID iD: 0000-0003-1104-4415

PhD, Associate Professor at the Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Chief Freelance Specialist in Gynecology of the Moscow Healthcare Department, Deputy Chief Physician for Prospective Development, City Clinical Hospital No. 52

Ресей, Moscow

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1. JATS XML
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2. Table 1. Registered doses of estrogen for HRT

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3. Table 2. Registered dose of estrogen and proportional dose of progestogen

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4. Table 3. Algorithm for finding the optimal solution through motivational counseling

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5. Table 5. Key factors for deciding on the appointment of MHT

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6. Table 7. Major and minor risk factors for endometrial cancer in women receiving HRT

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7. Fig. 1. Tactics of managing women with unplanned bleeding during cyclic MHT

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8. Fig. 2. Tactics of managing women with CVD against the background of continuous monophasic HRT

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9. Fig. 3. Algorithm for treating bleeding on MHT with LNG-IUS

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10. Fig. 4. Algorithm for patient management after discontinuation of MHT in the event of bleeding

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