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Возможности терапии климактерических симптомов с помощью препаратов мелатонина
Возможности терапии климактерических симптомов с помощью препаратов мелатонина
Кузнецова И.В., Бурчаков Д.И. Возможности терапии климактерических симптомов с помощью препаратов мелатонина. Гинекология. 2015; 17 (5): 44–48.
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Аннотация
В период менопаузального перехода у женщин развиваются вазомоторные и психосоматические симптомы. Патогенез этих симптомов связан не только с дефицитом эстрогенов, но и со старением гипоталамо-гипофизарной системы. Мелатонин – мощный гормональный адаптоген, участвующий в работе всех звеньев репродуктивной системы, в том числе на рецепторном уровне. Для оценки его эффективности в терапии климактерических симптомов в исследование были включены 55 женщин в возрасте 45–65 лет. Все участницы исследования получали мелатонин – препарат Мелаксен («Юнифарм, Инк.») в дозе 3 мг в течение 3 мес. На фоне терапии было отмечено уменьшение интенсивности климактерических симптомов по климактерической шкале Грина с 40,96 до 21,36 (47,92%) и улучшение показателей сна по Питтсбургской шкале качества сна с 16,60±4,03 до 7,33±1,95 балла. Таким образом, мелатонин в дозе 3 мг – эффективный метод терапии климактерических симптомов.
Ключевые слова: климактерические симптомы, лечение, мелатонин.
Key words: menopausal symptoms, treatment, melatonin.
Ключевые слова: климактерические симптомы, лечение, мелатонин.
________________________________________________
Key words: menopausal symptoms, treatment, melatonin.
Полный текст
Список литературы
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17. Sturdee DW et al. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011; 14: 302–20.
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19. Hill DA, Hill SR. Counseling patients about hormone therapy and alternatives for menopausal symptoms. Am Fam Physician 2010; 82: 801–7.
20. Tsai SA, Stefanick ML, Stafford RS. Trends in menopausal hormone therapy use of US office-based physicians, 2000–2009. Menopause 2011; 18: 385–92.
21. Kronenberg F, Cushman LF, Wade CM et al. Race/ethnicity and women`s use of complementary and alternative medicine in the United States: results of national survey. Am J Public Health 2006; 96: 1236–42.
22. Reddy SY, Warner H, Gutusso T et al. Gabapentin, estrogen and placebo for treating hot flashes. Obstet Gynecol 2006; 108: 41–8.
23. Fonken LK, Randy JN. The effects of light at night on circadian clocks and metabolism. Endocr Rev 2014; 35 (4): 648–70.
24. Tamura H, Takasaki A, Taketani T et al. Melatonin and female reproduction. J Bstet Gynaecol Res 2014; 40: 1–11.
25. Hill S, Belancio V, Dauchy R et al. Melatonin: an Inhibitor of Breast Cancer. Endocr Relat Cancer 2015; 22: 183–204.
26. Tsutsui K, Ubuka T, Bentley G et al. Review: regulatory mechanisms of gonadotropin-inhibitory hormone (GnIH) synthesis and release in photoperiodic animals. Front Neurosci 2013; 7: 60.
27. Toffol E, Kallenen N, Haukka J et al. Melatonin in perimenopausal and postmenopausal Women: associations with mood, sleep, climacteric symptoms, and quality of life. Menopause 2014; 21 (5): 493–500.
28. Greene J. Constructing a standard climacteric scale. Maturitas 2008; 61: 78–84.
29. Nunes D, Mota R, Machado M. Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease. Braz J Med Biol Res 2008; 41: 926–31.
30. Bruyneel M. Sleep disturbances in menopausal women: aetilogy and practical aspects. Maturitas 2015; 81: 406–9.
31. Parandavar N, Abdali K, Keshtgar S. The effect of melatonin on climacteric symptoms in menopausal women; a double-blind, randomized controlled, clinical trial. Iran J Public Health 2014; 43: 1405-16.
2. Genazzani AR, Gambacciani M, Simoncini T. Menopause and aging, quality of life and sexuality. Climacteric 2007; 10 (2): 88–96.
3. Nelson HD, Haney E, Humphrey L et al. Management of menopause-related symptoms. Evid Rep Technol Assess (Summ) 2005; 120: 1–6.
4. Smetnik V.P., Il'ina L.M. Rol' polovykh gormonov v razvitii metabolicheskikh rasstroistv u zhenshchin v peri- i rannei postmenopauze. Klimakterii. 2009; 1: 8–13. [in Russian]
5. North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause 2004; 11: 11–33.
6. Col NF, Guthrie JR, Politi M, Dennerstein L. Duration of vasomotor symptoms in middle-aged women: a longitudinal study. Menopause 2009; 16:453–7.
7. Politi MC, Schleinitz MD, Col NF. Revisting the duration of vasomotor symptoms of menopause: a meta-analysis. J Gen Intern Med 2008; 23: 1507–13.
8. Freeman EW, Sammel MD, Lin H et al. Duration of menopausal hot flushes and associated risk factors. Obstet Gynecol 2011; 11 (5):1095–104.
9. Loprinzi CL, Barton DL. On hot flash mechanism, measurement, and treatment. Menopause 2009; 16: 621–3.
10. Freedman R. Pathophysiology and treatment of menopausal hot flashes. Semin Reprod Med 2005; 23 (2): 117–25.
11. Skurnick JH, Weiss G, Goldsmith LT et al. Longitudinal changes in hypothalamic and ovarian function in perimenopausal women with anovulatory cycles: relationship with vasomotor symptoms. Fertil Steril 2009; 91 (4):1127–34.
12. Rapkin AJ. Vasomotor symptoms in menopause: physiologic condition and central nervous system approaches to treatment. Am J Obstet Gynecol 2007; 196: 97—106.
13. Freedman RR, Benton MD, Genic RJ, Graydon FX. Cortical activation during menopausal hot flashes. Fertil Steril 2006; 85: 674–8.
14. Freeman EW, Sammel MD, Lin H et al. The role of anxiety and hormonal changes in menopausa hot flashes. Menopause 2005; 12: 258–66.
15. Juang KD, Wang SJ, Lu SR et al. Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women. Maturitas 2005; 52: 119–26.
16. Hodis HN, MackWJ. Postmenopausal hormone therapy in clinical perspective. Menopause, 2007; 14 (5): 944–57.
17. Sturdee DW et al. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011; 14: 302–20.
18. Gompel A, Rozenberg S, Barlow DH. The EMAS 2008 update on clinical recommendations on postmenopausal hormone replacement therapy. Maturitas 2008; 61: 227–32.
19. Hill DA, Hill SR. Counseling patients about hormone therapy and alternatives for menopausal symptoms. Am Fam Physician 2010; 82: 801–7.
20. Tsai SA, Stefanick ML, Stafford RS. Trends in menopausal hormone therapy use of US office-based physicians, 2000–2009. Menopause 2011; 18: 385–92.
21. Kronenberg F, Cushman LF, Wade CM et al. Race/ethnicity and women`s use of complementary and alternative medicine in the United States: results of national survey. Am J Public Health 2006; 96: 1236–42.
22. Reddy SY, Warner H, Gutusso T et al. Gabapentin, estrogen and placebo for treating hot flashes. Obstet Gynecol 2006; 108: 41–8.
23. Fonken LK, Randy JN. The effects of light at night on circadian clocks and metabolism. Endocr Rev 2014; 35 (4): 648–70.
24. Tamura H, Takasaki A, Taketani T et al. Melatonin and female reproduction. J Bstet Gynaecol Res 2014; 40: 1–11.
25. Hill S, Belancio V, Dauchy R et al. Melatonin: an Inhibitor of Breast Cancer. Endocr Relat Cancer 2015; 22: 183–204.
26. Tsutsui K, Ubuka T, Bentley G et al. Review: regulatory mechanisms of gonadotropin-inhibitory hormone (GnIH) synthesis and release in photoperiodic animals. Front Neurosci 2013; 7: 60.
27. Toffol E, Kallenen N, Haukka J et al. Melatonin in perimenopausal and postmenopausal Women: associations with mood, sleep, climacteric symptoms, and quality of life. Menopause 2014; 21 (5): 493–500.
28. Greene J. Constructing a standard climacteric scale. Maturitas 2008; 61: 78–84.
29. Nunes D, Mota R, Machado M. Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease. Braz J Med Biol Res 2008; 41: 926–31.
30. Bruyneel M. Sleep disturbances in menopausal women: aetilogy and practical aspects. Maturitas 2015; 81: 406–9.
31. Parandavar N, Abdali K, Keshtgar S. The effect of melatonin on climacteric symptoms in menopausal women; a double-blind, randomized controlled, clinical trial. Iran J Public Health 2014; 43: 1405-16.
2. Genazzani AR, Gambacciani M, Simoncini T. Menopause and aging, quality of life and sexuality. Climacteric 2007; 10 (2): 88–96.
3. Nelson HD, Haney E, Humphrey L et al. Management of menopause-related symptoms. Evid Rep Technol Assess (Summ) 2005; 120: 1–6.
4. 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. / Smetnik V.P., Il'ina L.M. Rol' polovykh gormonov v razvitii metabolicheskikh rasstroistv u zhenshchin v peri- i rannei postmenopauze. Klimakterii. 2009; 1: 8–13. [in Russian]
5. North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause 2004; 11: 11–33.
6. Col NF, Guthrie JR, Politi M, Dennerstein L. Duration of vasomotor symptoms in middle-aged women: a longitudinal study. Menopause 2009; 16:453–7.
7. Politi MC, Schleinitz MD, Col NF. Revisting the duration of vasomotor symptoms of menopause: a meta-analysis. J Gen Intern Med 2008; 23: 1507–13.
8. Freeman EW, Sammel MD, Lin H et al. Duration of menopausal hot flushes and associated risk factors. Obstet Gynecol 2011; 11 (5):1095–104.
9. Loprinzi CL, Barton DL. On hot flash mechanism, measurement, and treatment. Menopause 2009; 16: 621–3.
10. Freedman R. Pathophysiology and treatment of menopausal hot flashes. Semin Reprod Med 2005; 23 (2): 117–25.
11. Skurnick JH, Weiss G, Goldsmith LT et al. Longitudinal changes in hypothalamic and ovarian function in perimenopausal women with anovulatory cycles: relationship with vasomotor symptoms. Fertil Steril 2009; 91 (4):1127–34.
12. Rapkin AJ. Vasomotor symptoms in menopause: physiologic condition and central nervous system approaches to treatment. Am J Obstet Gynecol 2007; 196: 97—106.
13. Freedman RR, Benton MD, Genic RJ, Graydon FX. Cortical activation during menopausal hot flashes. Fertil Steril 2006; 85: 674–8.
14. Freeman EW, Sammel MD, Lin H et al. The role of anxiety and hormonal changes in menopausa hot flashes. Menopause 2005; 12: 258–66.
15. Juang KD, Wang SJ, Lu SR et al. Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women. Maturitas 2005; 52: 119–26.
16. Hodis HN, MackWJ. Postmenopausal hormone therapy in clinical perspective. Menopause, 2007; 14 (5): 944–57.
17. Sturdee DW et al. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011; 14: 302–20.
18. Gompel A, Rozenberg S, Barlow DH. The EMAS 2008 update on clinical recommendations on postmenopausal hormone replacement therapy. Maturitas 2008; 61: 227–32.
19. Hill DA, Hill SR. Counseling patients about hormone therapy and alternatives for menopausal symptoms. Am Fam Physician 2010; 82: 801–7.
20. Tsai SA, Stefanick ML, Stafford RS. Trends in menopausal hormone therapy use of US office-based physicians, 2000–2009. Menopause 2011; 18: 385–92.
21. Kronenberg F, Cushman LF, Wade CM et al. Race/ethnicity and women`s use of complementary and alternative medicine in the United States: results of national survey. Am J Public Health 2006; 96: 1236–42.
22. Reddy SY, Warner H, Gutusso T et al. Gabapentin, estrogen and placebo for treating hot flashes. Obstet Gynecol 2006; 108: 41–8.
23. Fonken LK, Randy JN. The effects of light at night on circadian clocks and metabolism. Endocr Rev 2014; 35 (4): 648–70.
24. Tamura H, Takasaki A, Taketani T et al. Melatonin and female reproduction. J Bstet Gynaecol Res 2014; 40: 1–11.
25. Hill S, Belancio V, Dauchy R et al. Melatonin: an Inhibitor of Breast Cancer. Endocr Relat Cancer 2015; 22: 183–204.
26. Tsutsui K, Ubuka T, Bentley G et al. Review: regulatory mechanisms of gonadotropin-inhibitory hormone (GnIH) synthesis and release in photoperiodic animals. Front Neurosci 2013; 7: 60.
27. Toffol E, Kallenen N, Haukka J et al. Melatonin in perimenopausal and postmenopausal Women: associations with mood, sleep, climacteric symptoms, and quality of life. Menopause 2014; 21 (5): 493–500.
28. Greene J. Constructing a standard climacteric scale. Maturitas 2008; 61: 78–84.
29. Nunes D, Mota R, Machado M. Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease. Braz J Med Biol Res 2008; 41: 926–31.
30. Bruyneel M. Sleep disturbances in menopausal women: aetilogy and practical aspects. Maturitas 2015; 81: 406–9.
31. Parandavar N, Abdali K, Keshtgar S. The effect of melatonin on climacteric symptoms in menopausal women; a double-blind, randomized controlled, clinical trial. Iran J Public Health 2014; 43: 1405-16.
________________________________________________
2. Genazzani AR, Gambacciani M, Simoncini T. Menopause and aging, quality of life and sexuality. Climacteric 2007; 10 (2): 88–96.
3. Nelson HD, Haney E, Humphrey L et al. Management of menopause-related symptoms. Evid Rep Technol Assess (Summ) 2005; 120: 1–6.
4. Smetnik V.P., Il'ina L.M. Rol' polovykh gormonov v razvitii metabolicheskikh rasstroistv u zhenshchin v peri- i rannei postmenopauze. Klimakterii. 2009; 1: 8–13. [in Russian]
5. North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause 2004; 11: 11–33.
6. Col NF, Guthrie JR, Politi M, Dennerstein L. Duration of vasomotor symptoms in middle-aged women: a longitudinal study. Menopause 2009; 16:453–7.
7. Politi MC, Schleinitz MD, Col NF. Revisting the duration of vasomotor symptoms of menopause: a meta-analysis. J Gen Intern Med 2008; 23: 1507–13.
8. Freeman EW, Sammel MD, Lin H et al. Duration of menopausal hot flushes and associated risk factors. Obstet Gynecol 2011; 11 (5):1095–104.
9. Loprinzi CL, Barton DL. On hot flash mechanism, measurement, and treatment. Menopause 2009; 16: 621–3.
10. Freedman R. Pathophysiology and treatment of menopausal hot flashes. Semin Reprod Med 2005; 23 (2): 117–25.
11. Skurnick JH, Weiss G, Goldsmith LT et al. Longitudinal changes in hypothalamic and ovarian function in perimenopausal women with anovulatory cycles: relationship with vasomotor symptoms. Fertil Steril 2009; 91 (4):1127–34.
12. Rapkin AJ. Vasomotor symptoms in menopause: physiologic condition and central nervous system approaches to treatment. Am J Obstet Gynecol 2007; 196: 97—106.
13. Freedman RR, Benton MD, Genic RJ, Graydon FX. Cortical activation during menopausal hot flashes. Fertil Steril 2006; 85: 674–8.
14. Freeman EW, Sammel MD, Lin H et al. The role of anxiety and hormonal changes in menopausa hot flashes. Menopause 2005; 12: 258–66.
15. Juang KD, Wang SJ, Lu SR et al. Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women. Maturitas 2005; 52: 119–26.
16. Hodis HN, MackWJ. Postmenopausal hormone therapy in clinical perspective. Menopause, 2007; 14 (5): 944–57.
17. Sturdee DW et al. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric 2011; 14: 302–20.
18. Gompel A, Rozenberg S, Barlow DH. The EMAS 2008 update on clinical recommendations on postmenopausal hormone replacement therapy. Maturitas 2008; 61: 227–32.
19. Hill DA, Hill SR. Counseling patients about hormone therapy and alternatives for menopausal symptoms. Am Fam Physician 2010; 82: 801–7.
20. Tsai SA, Stefanick ML, Stafford RS. Trends in menopausal hormone therapy use of US office-based physicians, 2000–2009. Menopause 2011; 18: 385–92.
21. Kronenberg F, Cushman LF, Wade CM et al. Race/ethnicity and women`s use of complementary and alternative medicine in the United States: results of national survey. Am J Public Health 2006; 96: 1236–42.
22. Reddy SY, Warner H, Gutusso T et al. Gabapentin, estrogen and placebo for treating hot flashes. Obstet Gynecol 2006; 108: 41–8.
23. Fonken LK, Randy JN. The effects of light at night on circadian clocks and metabolism. Endocr Rev 2014; 35 (4): 648–70.
24. Tamura H, Takasaki A, Taketani T et al. Melatonin and female reproduction. J Bstet Gynaecol Res 2014; 40: 1–11.
25. Hill S, Belancio V, Dauchy R et al. Melatonin: an Inhibitor of Breast Cancer. Endocr Relat Cancer 2015; 22: 183–204.
26. Tsutsui K, Ubuka T, Bentley G et al. Review: regulatory mechanisms of gonadotropin-inhibitory hormone (GnIH) synthesis and release in photoperiodic animals. Front Neurosci 2013; 7: 60.
27. Toffol E, Kallenen N, Haukka J et al. Melatonin in perimenopausal and postmenopausal Women: associations with mood, sleep, climacteric symptoms, and quality of life. Menopause 2014; 21 (5): 493–500.
28. Greene J. Constructing a standard climacteric scale. Maturitas 2008; 61: 78–84.
29. Nunes D, Mota R, Machado M. Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease. Braz J Med Biol Res 2008; 41: 926–31.
30. Bruyneel M. Sleep disturbances in menopausal women: aetilogy and practical aspects. Maturitas 2015; 81: 406–9.
31. Parandavar N, Abdali K, Keshtgar S. The effect of melatonin on climacteric symptoms in menopausal women; a double-blind, randomized controlled, clinical trial. Iran J Public Health 2014; 43: 1405-16.
Авторы
И.В.Кузнецова1, Д.И.Бурчаков*2
1. ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
2. ФГБУ Эндокринологический научный центр Минздрава России. 117036, Россия, Москва, ул. Дмитрия Ульянова, д. 11
*dr.burchakov@yandex.ru
1. 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;
2. Endocrinology research center of the Ministry of Health of the Russian Federation. 117036, Russian Federation, Moscow, ul. Dmitria Ul'ianova, d. 11
*dr.burchakov@yandex.ru
1. ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
2. ФГБУ Эндокринологический научный центр Минздрава России. 117036, Россия, Москва, ул. Дмитрия Ульянова, д. 11
*dr.burchakov@yandex.ru
________________________________________________
1. 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;
2. Endocrinology research center of the Ministry of Health of the Russian Federation. 117036, Russian Federation, Moscow, ul. Dmitria Ul'ianova, d. 11
*dr.burchakov@yandex.ru
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