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Негормональная коррекция вазомоторных симптомов в пери- и постменопаузе
Негормональная коррекция вазомоторных симптомов в пери- и постменопаузе
Леваков С.А., Боровкова Е.И. Негормональная коррекция вазомоторных симптомов в пери- и постменопаузе. Consilium Medicum. 2016; 18 (6): 14–19. DOI: 10.26442/2075-1753_2016.6.14-19
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Аннотация
Частота климактерических симптомов в перименопаузе достигает 40–60%. Одной из основных причин нейровегетативных реакций, развивающихся при климаксе, являются изменение функционального состояния гипоталамических центров и нарушение секреции нейротрансмиттеров. Проведено проспективное исследование, включившее 30 пациенток с вегетативными проявлениями климактерического синдрома. В течение 3 мес проведена терапия мелатонином (препарат Мелаксен) в суточной дозе 3 мг. Динамика психоэмоциональных состояний оценена по специализированным шкалам самооценки: Спилбергера–Ханина, опроснику А.М.Вейна и модифицированному менопаузальному индексу Купермана. Гормональное исследование проведено перед началом терапии и через 3 мес. Субъективная оценка качества жизни и уровень тревожности у пациенток позволяют отнести их в группу высокого риска по развитию синдрома вегетативной дисфункции. На фоне 3-месячного курса применения мелатонина выявлено улучшение показателей качества жизни пациенток.
Ключевые слова: климактерический синдром, менопаузальная гормональная терапия, вазомоторные симптомы, приливы, мелатонин, Мелаксен, качество жизни.
Ключевые слова: климактерический синдром, менопаузальная гормональная терапия, вазомоторные симптомы, приливы, мелатонин, Мелаксен, качество жизни.
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Frequency of climacteric symptoms in menopausal reaches 40–60%. One of the main reasons of neurovegetative reactions that develop during menopause, is a change in the functional state of hypothalamic centers and violation of neurotransmitter secretion. A prospective study including 30 patients with autonomic manifestations of climacteric syndrome was held. Within 3 months of therapy based on melatonin (Melaxen) in a daily dose of 3 mg was used. Dynamics of psycho-emotional state of self-assessed by a specialized scales: Spielberger–Khanin, A.M.Wayne questionnaire and modified menopausal index by Cooperman. Hormonal study was carried out before treatment and at 3 months. Subjective assessment of the quality of life and the level of anxiety in patients allow them to carry a high risk of developing the syndrome of autonomic dysfunction. Against the background of the 3-month course of the use of melatonin showed improvement of quality of life of patients.
Key words: menopause, menopausal hormone therapy, vasomotor symptoms, hot flashes, melatonin, Melaxen, the quality of life.
Key words: menopause, menopausal hormone therapy, vasomotor symptoms, hot flashes, melatonin, Melaxen, the quality of life.
Полный текст
Список литературы
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21. Osmers R, Friede M, Liske E et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol 2005; 105: 1074.
22. Verhoeven MO, van der Mooren MJ, van de Weijer PH et al. Effect of a combination of isoflavones and Actaearacemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause 2005; 12: 412.
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24. Newton KM, Reed SD, LaCroix AZ et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 2006; 145: 869.
2. National Institutes of Health. National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. Ann Intern Med 2005; 142: 1003.
3. Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am 2011; 38: 489.
4. Soules MR, Sherman S, Parrott E et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertil Steril 2001; 76: 874.
5. Huang AJ, Grady D, Jacoby VL et al. Persistent hot flushes in older postmenopausal women. Arch Intern Med 2008; 168: 840.
6. Rödström K, Bengtsson C, Lissner L et al. A longitudinal study of the treatment of hot flushes: the population study of women in Gothenburg during a quarter of a century. Menopause 2002; 9: 156.
7. Freedman RR. Physiology of hot flashes. Am J Hum Biol 2001; 13: 453.
8. Freedman RR, Roehrs TA. Effects of REM sleep and ambient temperature on hot flash-induced sleep disturbance. Menopause 2006; 13: 576.
9. de Zambotti M, Colrain IM, Javitz HS, Baker FC. Magnitude of the impact of hot flashes on sleep in perimenopausal women. Fertil Steril 2014; 102: 1708.
10. Ziaei S, Kazemnejad A, Zareai M. The effect of vitamin E on hot flashes in menopausal women. Gynecol Obstet Invest 2007; 64: 204.
11. Newton KM, Buist DS, Keenan NL et al. Use of alternative therapies for menopause symptoms: results of a population-based survey. Obstet Gynecol 2002; 100: 18.
12. Keenan NL, Mark S, Fugh-Berman A et al. Severity of menopausal symptoms and use of both conventional and complementary/alternative therapies. Menopause 2003; 10: 507.
13. Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002; 137: 805.
14. Van Patten CL, Olivotto IA, Chambers GK et al. Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. J Clin Oncol 2002; 20: 1449.
15. Upmalis DH, Lobo R, Bradley L et al. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause 2000; 7: 236.
16. Quella SK, Loprinzi CL, Barton DL et al. Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. J Clin Oncol 2000; 18: 1068.
17. Nikander E, Kilkkinen A, Metsä-Heikkilä M et al. A randomized placebo-controlled crossover trial with phytoestrogens in treatment of menopause in breast cancer patients. Obstet Gynecol 2003; 101: 1213.
18. MacGregor CA, Canney PA, Patterson G et al. A randomised double-blind controlled trial of oral soy supplements versus placebo for treatment of menopausal symptoms in patients with early breast cancer. Eur J Cancer 2005; 41: 708.
19. Levis S, Strickman-Stein N, Ganjei-Azar P et al. Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms: a randomized, double-blind trial. Arch Intern Med 2011; 171: 1363.
20. Frei-Kleiner S, Schaffner W, Rahlfs VW et al. Cimicifugaracemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas 2005; 51: 397.
21. Osmers R, Friede M, Liske E et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol 2005; 105: 1074.
22. Verhoeven MO, van der Mooren MJ, van de Weijer PH et al. Effect of a combination of isoflavones and Actaearacemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause 2005; 12: 412.
23. Pockaj BA, Gallagher JG, Loprinzi CL et al. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol 2006; 24: 2836.
24. Newton KM, Reed SD, LaCroix AZ et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 2006; 145: 869.
2. National Institutes of Health. National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. Ann Intern Med 2005; 142: 1003.
3. Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am 2011; 38: 489.
4. Soules MR, Sherman S, Parrott E et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertil Steril 2001; 76: 874.
5. Huang AJ, Grady D, Jacoby VL et al. Persistent hot flushes in older postmenopausal women. Arch Intern Med 2008; 168: 840.
6. Rödström K, Bengtsson C, Lissner L et al. A longitudinal study of the treatment of hot flushes: the population study of women in Gothenburg during a quarter of a century. Menopause 2002; 9: 156.
7. Freedman RR. Physiology of hot flashes. Am J Hum Biol 2001; 13: 453.
8. Freedman RR, Roehrs TA. Effects of REM sleep and ambient temperature on hot flash-induced sleep disturbance. Menopause 2006; 13: 576.
9. de Zambotti M, Colrain IM, Javitz HS, Baker FC. Magnitude of the impact of hot flashes on sleep in perimenopausal women. Fertil Steril 2014; 102: 1708.
10. Ziaei S, Kazemnejad A, Zareai M. The effect of vitamin E on hot flashes in menopausal women. Gynecol Obstet Invest 2007; 64: 204.
11. Newton KM, Buist DS, Keenan NL et al. Use of alternative therapies for menopause symptoms: results of a population-based survey. Obstet Gynecol 2002; 100: 18.
12. Keenan NL, Mark S, Fugh-Berman A et al. Severity of menopausal symptoms and use of both conventional and complementary/alternative therapies. Menopause 2003; 10: 507.
13. Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002; 137: 805.
14. Van Patten CL, Olivotto IA, Chambers GK et al. Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. J Clin Oncol 2002; 20: 1449.
15. Upmalis DH, Lobo R, Bradley L et al. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause 2000; 7: 236.
16. Quella SK, Loprinzi CL, Barton DL et al. Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. J Clin Oncol 2000; 18: 1068.
17. Nikander E, Kilkkinen A, Metsä-Heikkilä M et al. A randomized placebo-controlled crossover trial with phytoestrogens in treatment of menopause in breast cancer patients. Obstet Gynecol 2003; 101: 1213.
18. MacGregor CA, Canney PA, Patterson G et al. A randomised double-blind controlled trial of oral soy supplements versus placebo for treatment of menopausal symptoms in patients with early breast cancer. Eur J Cancer 2005; 41: 708.
19. Levis S, Strickman-Stein N, Ganjei-Azar P et al. Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms: a randomized, double-blind trial. Arch Intern Med 2011; 171: 1363.
20. Frei-Kleiner S, Schaffner W, Rahlfs VW et al. Cimicifugaracemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas 2005; 51: 397.
21. Osmers R, Friede M, Liske E et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol 2005; 105: 1074.
22. Verhoeven MO, van der Mooren MJ, van de Weijer PH et al. Effect of a combination of isoflavones and Actaearacemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause 2005; 12: 412.
23. Pockaj BA, Gallagher JG, Loprinzi CL et al. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol 2006; 24: 2836.
24. Newton KM, Reed SD, LaCroix AZ et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 2006; 145: 869.
________________________________________________
2. National Institutes of Health. National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. Ann Intern Med 2005; 142: 1003.
3. Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am 2011; 38: 489.
4. Soules MR, Sherman S, Parrott E et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertil Steril 2001; 76: 874.
5. Huang AJ, Grady D, Jacoby VL et al. Persistent hot flushes in older postmenopausal women. Arch Intern Med 2008; 168: 840.
6. Rödström K, Bengtsson C, Lissner L et al. A longitudinal study of the treatment of hot flushes: the population study of women in Gothenburg during a quarter of a century. Menopause 2002; 9: 156.
7. Freedman RR. Physiology of hot flashes. Am J Hum Biol 2001; 13: 453.
8. Freedman RR, Roehrs TA. Effects of REM sleep and ambient temperature on hot flash-induced sleep disturbance. Menopause 2006; 13: 576.
9. de Zambotti M, Colrain IM, Javitz HS, Baker FC. Magnitude of the impact of hot flashes on sleep in perimenopausal women. Fertil Steril 2014; 102: 1708.
10. Ziaei S, Kazemnejad A, Zareai M. The effect of vitamin E on hot flashes in menopausal women. Gynecol Obstet Invest 2007; 64: 204.
11. Newton KM, Buist DS, Keenan NL et al. Use of alternative therapies for menopause symptoms: results of a population-based survey. Obstet Gynecol 2002; 100: 18.
12. Keenan NL, Mark S, Fugh-Berman A et al. Severity of menopausal symptoms and use of both conventional and complementary/alternative therapies. Menopause 2003; 10: 507.
13. Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002; 137: 805.
14. Van Patten CL, Olivotto IA, Chambers GK et al. Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. J Clin Oncol 2002; 20: 1449.
15. Upmalis DH, Lobo R, Bradley L et al. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause 2000; 7: 236.
16. Quella SK, Loprinzi CL, Barton DL et al. Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. J Clin Oncol 2000; 18: 1068.
17. Nikander E, Kilkkinen A, Metsä-Heikkilä M et al. A randomized placebo-controlled crossover trial with phytoestrogens in treatment of menopause in breast cancer patients. Obstet Gynecol 2003; 101: 1213.
18. MacGregor CA, Canney PA, Patterson G et al. A randomised double-blind controlled trial of oral soy supplements versus placebo for treatment of menopausal symptoms in patients with early breast cancer. Eur J Cancer 2005; 41: 708.
19. Levis S, Strickman-Stein N, Ganjei-Azar P et al. Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms: a randomized, double-blind trial. Arch Intern Med 2011; 171: 1363.
20. Frei-Kleiner S, Schaffner W, Rahlfs VW et al. Cimicifugaracemosa dried ethanolic extract in menopausal disorders: a double-blind placebo-controlled clinical trial. Maturitas 2005; 51: 397.
21. Osmers R, Friede M, Liske E et al. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstet Gynecol 2005; 105: 1074.
22. Verhoeven MO, van der Mooren MJ, van de Weijer PH et al. Effect of a combination of isoflavones and Actaearacemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause 2005; 12: 412.
23. Pockaj BA, Gallagher JG, Loprinzi CL et al. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol 2006; 24: 2836.
24. Newton KM, Reed SD, LaCroix AZ et al. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy, or placebo: a randomized trial. Ann Intern Med 2006; 145: 869.
Авторы
С.А.Леваков, Е.И.Боровкова*
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*katyanikitina@mail.ru
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*katyanikitina@mail.ru
________________________________________________
S.A.Levakov, E.I.Borovkova*
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*katyanikitina@mail.ru
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*katyanikitina@mail.ru
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