Management of patients with uterine bleeding during menopausal hormone therapy

2021 ◽  
Author(s):  
А.З. Хашукоева ◽  
М.В. Бурденко ◽  
А.В. Оверко ◽  
Т.Е. Рыжова ◽  
М.С. Сафонина
Keyword(s):  
Life Expectancy ◽  
Hormone Therapy ◽  
Uterine Bleeding ◽  
Menopausal Hormone Therapy ◽  
Menopausal Transition ◽  
Therapeutic Effects ◽  
Climacteric Syndrome ◽  
Climacteric Symptoms ◽  
Long Life ◽  
Selection Of

Тенденции по увеличению продолжительности жизни, которые наблюдаются в последние десятилетия, напрямую затрагивают деятельность акушера-гинеколога ввиду того, что женщинам необходимо не только прожить долгую жизнь, но и снизить количество заболеваний, развитие которых нередко связано с наступлением периода менопаузального перехода и постменопаузы. Задача врачей – помочь пациенткам максимально мягко войти в период постменопаузы, минимизировав проявления климактерического синдрома. В настоящее время наиболее эффективным методом терапии ранних климактерических симптомов является менопаузальная гормональная терапия. В статье рассмотрены современные подходы к проведению менопаузальной гормональной терапии при возникновении менопаузальных расстройств, подходы к подбору менопаузальной гормональной терапии с учетом особенностей каждой конкретной пациентки. Рассматриваются терапевтические эффекты и возможности менопаузальной гормональной терапии, проблемы ее приемлемости, а также ведение пациенток в постменопаузальном периоде с маточными кровотечениями. The trends in life expectancy that have been observed in recent decades directly affect the activities of an obstetrician-gynecologist due to the fact that women need not only to live a long life, but also to reduce the number of diseases, the development of which is often associated with the onset of the menopausal transition and postmenopause. The task of doctors is to help patients to enter the postmenopausal period as gently as possible, minimizing the manifestations of the climacteric syndrome. Currently, the most effective method of treating early climacteric symptoms is menopausal hormone therapy. The article discusses modern approaches to the conduct of menopausal hormone therapy in the event of menopausal disorders, approaches to the selection of menopausal hormone therapy, taking into account the characteristics of each individual patient. The therapeutic effects and possibilities of menopausal hormone therapy, the problems of its acceptability, as well as the management of postmenopausal patients with uterine bleeding are considered.

Vaginal bleeding during menopause hormone therapy. Is it always endometrial cancer? How to choose the appropriate tactics for examination and management of patients?

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 37-43
Author(s):  
Anna E. Protasova ◽  
Irina A. Solntseva ◽  
Ekaterina N. Vandeeva
Keyword(s):  
Endometrial Cancer ◽  
Hormone Therapy ◽  
Genital Tract ◽  
Vaginal Bleeding ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Menopausal Hormone Therapy ◽  
Modern Analysis ◽  
Menopause Hormone Therapy ◽  
Postmenopausal Vaginal Bleeding

The article provides an overview of the possible causes of bleeding from the genital tract in peri- and postmenopausal women. The correct approach to patients with abnormal uterine bleeding during menopausal hormone therapy is described. A modern analysis of data on the diagnosis and treatment of postmenopausal vaginal bleeding against the background of menopausal hormone therapy was carried out. The modern possibilities of endometrial diagnostics and treatment are shown.

Menopausal transition: risks and their prevention

2020 ◽  
pp. 26-30
Author(s):  
L. V. Tkachenko ◽  
N. I. Sviridova
Keyword(s):  
Hormone Therapy ◽  
Sex Hormones ◽  
Crucial Role ◽  
Dosage Forms ◽  
Estrogen Deficiency ◽  
Menopausal Hormone Therapy ◽  
Menopausal Transition ◽  
Cancer Risks ◽  
Compensatory Reactions ◽  
Urogenital Symptoms

The period of the menopausal transition from 40–45 years to menopause – is the crucial period of a woman’s life, in which, against the background of increasing estrogen deficiency, in addition to the appearance of vasomotor, psychological, and urogenital symptoms, complications and exacerbations of accumulated extagenital diseases occur. The loss of the natural balance of sex hormones leads to hyperplastic processes in hormone-dependent tissues, which leads to cancer risks. In solving this problem, menopausal hormone therapy (MHT) can play a crucial role, but this will become possible if, when choosing drugs for MHT, preference will be given to the safest dosage forms that provide the whole spectrum of compensatory reactions, including the prevention of dramatic situations of this age.

Menopausal hormone therapy and cancer risks of reproductive system. Literature review

2019 ◽  
Vol 1 (1) ◽  
pp. 42-50
Author(s):  
Ya. Z. Zaydieva
Keyword(s):  
Literature Review ◽  
Hormone Therapy ◽  
Hormonal Therapy ◽  
Reproductive System ◽  
Menopausal Hormone Therapy ◽  
Menopausal Transition ◽  
Continuous Mode ◽  
Cancer Risks ◽  
Oncological Diseases

Data on risks of development of oncological diseases of bodies of reproductive system in women during menopausal transition and in a postmenopause are submitted at treatment of menopausal frustration by the preparations intended for menopausal hormonal therapy, the containing various doses of estrogen and progestogen used in the cyclic or continuous mode.

Algorithm for management of patients of the period of menopausal transition with recurrence of anomalous uterine bleeding associated with beneficial proliferative changes of endometry

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 49-54
Author(s):  
Sergei D. Sinchikhin ◽  
Ekaterina V. Kostenko ◽  
Lusine V. Stepanyan
Keyword(s):  
Clinical Laboratory ◽  
Morphological Changes ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Menopausal Transition ◽  
Dynamic Monitoring ◽  
Results Of Treatment ◽  
Third Stage ◽  
Uterine Mucosa ◽  
Selection Of

Aim. To compile an algorithm for managing patients during the menopausal transition with a relapse of abnormal uterine bleeding associated with benign proliferative changes in the endometrium and evaluate its outcomes. Materials and methods. The observation of 150 patients aged 4555 years who had recurrence of abnormal uterine bleeding due to benign proliferative changes of the endometrium. All patients underwent hysteroresectoscopic ablation of the endometrium according to the monopolar coagulation-vaporization technique using Olympus equipment (Japan). The patients were divided into two groups. One group was formed by 98 women who, before hysteroscopic ablation of the endometrium, received hormonal preparations for 14 months, with the help of which suppressive changes in the uterine mucosa up to 34 mm were achieved. The other group consisted of 52 patients of the menopausal transition who did not receive preoperative drug therapy, and the thinning of the endometrium before hysterectomy was performed instrumentally. After hysteroresectoscopy, the period of clinical and instrumental observation was 2 years. Results. Based on the results of the study, an algorithm has been compiled for the treatment of women during the menopausal transition with abnormal uterine bleeding, including at the first stage a clinical, laboratory and instrumental examination with the selection of a group of patients to be treated by endometrial ablation, and at the second stage, measures for the preoperative thinning of the uterine mucosa, at the third stage performing hysteroresectoscopic ablation of the endometrium; and at the fourth stage dynamic monitoring during ie 2 years. The preoperatively achieved medical atrophy of the endometrium, followed by hysteroresectoscopy, contributes to an improvement of 20.3% in the results of treatment of patients in comparison with mechanical thinning of the endometrium before hysteroresectoscopy. In general, the developed algorithm increases the effectiveness of anti-relapse treatment to 92.8%. Conclusion. In practical health care, the proposed algorithm should be used, including successive steps. Following the algorithm, a differentiated approach to the choice of therapeutic tactics is carried out, taking into account not only morphological changes in the endometrium, but also the associated gynecological and somatic pathology of the patient, as well as justifying the conduct of preoperative preparation for hysteroresectoscopic ablation of the endometrium and determining the order of subsequent dynamic observation.

scholarly journals Survey-based evaluation of the awareness of pharmaceutical specialists on the pharmacotherapy of climacteric syndrome

2021 ◽  
Vol 14 (2) ◽  
pp. 225-233
Author(s):  
M. A. Chernyavskaya ◽  
I. A. Narkevich
Keyword(s):  
Hormone Therapy ◽  
Medical Information ◽  
Personal Characteristics ◽  
Cardiovascular Effects ◽  
Menopausal Hormone Therapy ◽  
Climacteric Syndrome ◽  
Menopausal Syndrome ◽  
Survey Results ◽  
Important Intermediate ◽  
The Difference

Objective: to evaluate the awareness of pharmaceutical specialists on the pharmacotherapy of climacteric syndrome based on survey results.Material and methods. The authors analyzed 394 surveys of pharmaceutical specialists in Saint-Petersburg. The survey consisted of 13 questions, covered the personal characteristics of the participants (age, education, professional experience) and their knowledge about special medicines and food supplements to control climacteric symptoms, indications, and contraindications.Results. The results showed that pharmaceutical specialists saw the difference between combined oral contraceptives and menopausal hormone therapy, but they do not know about the protective cardiovascular effects of menopausal hormone therapy. Most specialists consider menopausal hormone therapy more effective than phytoestrogens, but they have no idea how it works. For most of them, there is hardly any difference between various classes of phytoestrogens. In their opinion, medical representatives and scientific conferences are the main providers of medical information.Conclusion. The analysis of the level of awareness of pharmaceutical specialists about the pharmacotherapy of menopausal syndrome based on the results of the survey revealed insufficient knowledge among pharmacy workers on a number of fundamental issues. Therefore, it is necessary to develop methodological recommendations on menopausal hormone therapy preparations and phytoestrogens-based drugs for pharmaceutical specialists who act as an important intermediate between a doctor and a patient.

Possible ways to correct severe forms of climacteric syndrome in women with endometriosis

2018 ◽  
pp. 96-101
Author(s):  
N.F. Zakharenko ◽  
◽  
N.V. Kovalenko ◽  
I.N. Retunska ◽  
◽  
...  
Keyword(s):  
Hormone Therapy ◽  
Therapy Group ◽  
Elimination Rate ◽  
Reproductive Function ◽  
Clinical Effectiveness ◽  
Menopausal Hormone Therapy ◽  
Climacteric Syndrome ◽  
Menopausal Syndrome ◽  
Short Period ◽  
Transdermal Estrogen

Modern demographic changes in society are accompanied by an increase of women of the older age group in the general population. During this age period, along with the elimination of reproductive function in women, a complex of pathological symptoms often develops – climacteric syndrome (CS), which displays the maladaptation of various organs and systems that have estrogen receptors. An extremely topical problem of climacteric syndrome is for patients with endometriosis whose quantity is about 50% of the population. The objective: the determination of the effectiveness of the complex of medical therapy developed by us in women with severe forms of COP in the context of endometriosis. Materials and methods. Within 3 months we actively observed 60 women with an endometriosis in the anamnesis and manifestations of severe CS. By randomization, the women were divided into 2 groups depending on the chosen therapy: group 1 consisted of 30 women who, taking into account the above mentioned advantages, received the transdermal estrogen Estrogel, group 2 – 30 patients, whom a therapy by estrogen, phenibut and mebicar was assigned. Patients of both groups were given an intrauterine system with levonorgestrel. In order to conduct a comparative assessment of the clinical effectiveness of various treatment methods, the integral pathology index (IPI) was used in dynamics – before treatment, after 1, 2 and 3 months of therapy. The improvement degree (ID) of the disease clinical picture was also determined. Statistical analysis of the data was carried out on a personal computer using the programs SPSS 2000 (SPSSInc., USA) and Exel 2000 (MicrosoftInc., USA). Results. Our analysis found that as a result of the therapy received, a significant improvement in the scores was observed among patients of both subgroups. During the first two months, the effectiveness of combining menopausal hormone therapy with anti-stress medications in women with severe CS was almost 2 times greater than monotherapy with menopausal hormone therapy (Coefficient of Efficacy 1 = 2.68, Coefficient of Efficacy 2 = 1.62), indicating a faster elimination rate of CS’ symptoms using this combination. The overall effectiveness of the combination of phenybut with mebikar against the background of the use of Estrogel with an intrauterine system with levonorgestrel was 1.41 times higher compared to effectiveness of Estrogel and the levonorgestrel intrauterine system only use. Conclusion. Administration of anti-stress drugs Fenibut&Mebikar combination along with use of menopausal hormone therapy allows to reduce quickly the severity of CS manifestations, especially psychoemotional disorders almost to their full elimination in a relatively short period of time. The proposed scheme of treatment helps to eliminate quickly the symptoms of menopausal syndrome in women with endometriosis, improve and stabilize their psychological profile, restore working capacity, improve adaptation and quality of life. Key words: climacteric syndrome, endometriosis, anti-stress therapy, phenibut, mebicar, transdermal estrogen, Estrogel, intrauterine system with levonorgestrel.

Why does menopausal hormone therapy lead to irregular uterine bleeding? Changes to endometrial blood vessels

2008 ◽  
Vol 23 (4) ◽  
pp. 912-918 ◽  
Author(s):  
M. Hickey ◽  
D.A. Doherty ◽  
I.S. Fraser ◽  
D.M. Sloboda ◽  
L.A. Salamonsen
Keyword(s):  
Hormone Therapy ◽  
Blood Vessels ◽  
Uterine Bleeding ◽  
Menopausal Hormone Therapy
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