В периоде менопаузального перехода на фоне общих возрастных изменений доминируют инволюционные процессы в репродуктивной системе, связанные с выключением овариальной функции. В настоящее время ведущим методом коррекции климактерического синдрома признается заместительная гормональная терапия, но не все женщины с патологическим течением климакса могут и хотят принимать гормональные препараты. Альтернативный метод купирования менопаузальных расстройств состоит в назначении фитоэстрогенов, что облегчает приливы жара и улучшает общее самочувствие женщин. Однако фитоэстрогены не способны полностью удовлетворить все потребности организма по предотвращению болезней старения, поэтому привлекательно выглядят комплексные препараты, в состав которых вводятся антиоксиданты (например, ресвератрол), полезные для сердечно-сосудистой системы, витамины, предотвращающие развитие остеопороза (витамины D и К). Применение подобных препаратов должно способствовать не только улучшению качества жизни женщин, но и снижению риска кардиометаболических заболеваний и остеопороза.
Ключевые слова: менопауза, приливы жара, качество жизни, остеопороз, фитоэстрогены, генистеин, ресвератрол, витамин D.
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In perimenopusal period for which general age-related changes are typical, involutive processes prevail in reproductive system which are related to ovarian deprivation. Currently, the leading method for management of menopausal syndrome is hormonal replacement therapy, but not all women with pathological climax period can and would like to take hormonal products. The alternative method for management of menopausal disorders is to prescribe phytoestrogens which relieves hot flashes and improves general health status in women. But phytoestrogens are not able to meet all body needs in prevention of age-related diseases, therefore complex drug products which contain antioxidants are attractive (for exampleр, resveratrol), useful for cardiovascular disease, vitamins which prevent osteoporosis (vitamins D and К). The use of such drugs should also improve quality of life in women, but reduce risk of cardio-metabolic diseases and osteoporosis.
Key words: menopause, hot flashes, quality of life, osteoporosis, phytoestrogens, henistein, resveratrol, vitamin D.
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2. Сметник В.П., Ильина Л.М. Роль половых гормонов в развитии метаболических расстройств у женщин в пери- и ранней постменопаузе. Климактерий. 2009; 1: 8–13.
3. Naftolin F, Schneider HP, Sturdee DW et al. Executive Committee of the International Menopause Society. Guidelines for hormone treatment of women in the menopausal transition and beyond. Climacteric 2004; 7: 333–7.
4. Cronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002; 137: 805–13.
5. Wuttke W, Jarry H, Westphalen S et al. Phytoestrogens for hormone replacement therapy? J Steroid Bichem Mol Biol 2002; 83: 133–47.
6. Albertazzi P, Steel SA, Clifford E et al. Attitudes towards and use of dietary supplementation in a sample of postmenopausal women. Climacteric 2002; 5: 374–82.
7. Krebs EE, Ensrud KE, MacDonald R et al. Phytoestrogens for treatment of menopausal symptoms: a systematic review. Obstet Gynecol 2004; 104: 824–36.
8. Geller SE, Studee L. Botanical and dietary supplements for menopausal symptoms: what works, what does not. J Womens Health (Larchmt) 2005; 14: 634–49.
9. Philp HA. Hot flashes a review of the literature on alternative and complementary treatment approaches. Alter Med Rev 2003; 8: 284–302.
10. Blumenthal M. Herbal Medicine: Expanded Commision E Monographs. Newton, MA: Integrative Medicine Communications, 2003.
11. Здоровье женщин и менопауза. Пер. с англ. М.: ГЭОТАР-МЕД, 2004.
12. Genazzani A.R. Non hormonal treatment of hot flushes. Congr book 7th Congr Eur Soc Gynecol, Paris 2007; p. 49.
13. Carrati B, Sanzini E. Biologically-active phytochemicals in vegetable food. Ann Ist Super Sanita 2005; 41: 7–16.
14. Munro IC, Harwood M, Hlywka JJ et al. Soy isoflavons: a safety review. Nutr Rev 2003; 61: 1–33.
15. Ohmichi M, Tasaka K et al. Molecular mechanism of action of Selective Estrogen Receptor Modulator in target tissues. J Endocr 2005; 52 (2): 161–7.
16. Roemheld-Hamm B. Chastberry. Am Fam Physician 2005; 72: 821–4.
17. Unfer V, Casini ML, Costabile L et al. Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study. Fertil Steril 2004; 82: 145–8.
18. Pervaiz S. Resveratrol: from grapevines to mammalian biology. FASEB J 2003; 17: 1975–85.
19. Belleri M, Ribatti D, Savio M et al. αvβ3 Integrin-dependent antiagiogenic activity of resveratrol stereoisomers. Mol Cancer Ther 2008; 7: 3761–70.
20. Dawson-Huges B. Vitamin D, calcium and bone – what`s the latest? Osteoporosis Int 2011; 22 (5): S684–S685.
21. Ginde AA, Scragg R, Schwartz RS, Camargo CA. Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all cause mortality in older U.S. adults. J Am Geriatr Soc 2009; 57 (9): 1595–603.
22. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens 2007; 20 (7): 713–9.
23. Forman JP, Bischoff-Ferrari HA, Willett WC et al. Vitamin D intake and risk of incident hypertension: results from three large prospective cohort studies. Hypertension 2005; 46 (4): 676–2.
________________________________________________
1. Genazzani AR, Gambacciani M, Simoncini T. Menopause and aging, quality of life and sexuality. IMS Statement following 6th IMS Workshop, Pisa, December 2006. Climacteric 2007; 10: 88–96.
2. Сметник В.П., Ильина Л.М. Роль половых гормонов в развитии метаболических расстройств у женщин в пери- и ранней постменопаузе. Климактерий. 2009; 1: 8–13.
3. Naftolin F, Schneider HP, Sturdee DW et al. Executive Committee of the International Menopause Society. Guidelines for hormone treatment of women in the menopausal transition and beyond. Climacteric 2004; 7: 333–7.
4. Cronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002; 137: 805–13.
5. Wuttke W, Jarry H, Westphalen S et al. Phytoestrogens for hormone replacement therapy? J Steroid Bichem Mol Biol 2002; 83: 133–47.
6. Albertazzi P, Steel SA, Clifford E et al. Attitudes towards and use of dietary supplementation in a sample of postmenopausal women. Climacteric 2002; 5: 374–82.
7. Krebs EE, Ensrud KE, MacDonald R et al. Phytoestrogens for treatment of menopausal symptoms: a systematic review. Obstet Gynecol 2004; 104: 824–36.
8. Geller SE, Studee L. Botanical and dietary supplements for menopausal symptoms: what works, what does not. J Womens Health (Larchmt) 2005; 14: 634–49.
9. Philp HA. Hot flashes a review of the literature on alternative and complementary treatment approaches. Alter Med Rev 2003; 8: 284–302.
10. Blumenthal M. Herbal Medicine: Expanded Commision E Monographs. Newton, MA: Integrative Medicine Communications, 2003.
11. Здоровье женщин и менопауза. Пер. с англ. М.: ГЭОТАР-МЕД, 2004.
12. Genazzani A.R. Non hormonal treatment of hot flushes. Congr book 7th Congr Eur Soc Gynecol, Paris 2007; p. 49.
13. Carrati B, Sanzini E. Biologically-active phytochemicals in vegetable food. Ann Ist Super Sanita 2005; 41: 7–16.
14. Munro IC, Harwood M, Hlywka JJ et al. Soy isoflavons: a safety review. Nutr Rev 2003; 61: 1–33.
15. Ohmichi M, Tasaka K et al. Molecular mechanism of action of Selective Estrogen Receptor Modulator in target tissues. J Endocr 2005; 52 (2): 161–7.
16. Roemheld-Hamm B. Chastberry. Am Fam Physician 2005; 72: 821–4.
17. Unfer V, Casini ML, Costabile L et al. Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study. Fertil Steril 2004; 82: 145–8.
18. Pervaiz S. Resveratrol: from grapevines to mammalian biology. FASEB J 2003; 17: 1975–85.
19. Belleri M, Ribatti D, Savio M et al. αvβ3 Integrin-dependent antiagiogenic activity of resveratrol stereoisomers. Mol Cancer Ther 2008; 7: 3761–70.
20. Dawson-Huges B. Vitamin D, calcium and bone – what`s the latest? Osteoporosis Int 2011; 22 (5): S684–S685.
21. Ginde AA, Scragg R, Schwartz RS, Camargo CA. Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all cause mortality in older U.S. adults. J Am Geriatr Soc 2009; 57 (9): 1595–603.
22. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens 2007; 20 (7): 713–9.
23. Forman JP, Bischoff-Ferrari HA, Willett WC et al. Vitamin D intake and risk of incident hypertension: results from three large prospective cohort studies. Hypertension 2005; 46 (4): 676–2.
Авторы
И.В.Кузнецова
ГБОУ ВПО Первый МГМУ им. И.М.Сеченова Минздрава РФ