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Современные возможности оптимизации локальной гормонотерапии урогенитальных нарушений у женщин на основе комбинированного применения вагинальных форм эстриола и прогестерона
Тюзиков И.А., Жиленко М.И., Поликарпова С.Р. Современные возможности оптимизации локальной гормонотерапии урогенитальных нарушений
у женщин на основе комбинированного применения вагинальных форм эстриола и прогестерона. Гинекология. 2018; 20 (1): 117–125.
DOI: 10.26442/2079-5696_20.1.117-125
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Tyuzikov I.A., Zhilenko M.I., Polikarpova S.R. Modern possibilities of optimization of local hormonotherapy of urogenital disorders in women on the basis of combined use of vaginal forms of estriol and progesterone. Gynecology. 2018; 20 (1): 117–125. DOI: 10.26442/2079-5696_20.1.117-125
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Аннотация
В обзорной статье рассматривается проблема оптимизации локальной гормонотерапии урогенитальных нарушений у женщин с позиций доказательной медицины на основе современной мультифакторной концепции генитоуринарного менопаузального синдрома (ГУМС), которая подразумевает важную патогенетическую роль не только возрастного дефицита эстрогенов, но и других половых гормонов в патогенезе нарушений урогенитального тракта у женщин в пери- и постменопаузе. Показана важная роль биоидентичного прогестерона как метаболически активного гормона, обладающего не только классическими (репродуктивными) физиологическими эффектами в организме женщины, но и целым спектром неклассических (нерепродуктивных) эффектов, которые демонстрируют патогенетическое обоснование целесообразности топического назначения препаратов, содержащих биоидентичный аналог натурального прогестерона в рамках комплексного и персонифицированного лечения различных клинических проявлений ГУМС, особенно у женщин с сопутствующим дефицитом эндогенного прогестерона, который хронологически может развиваться уже после 35 лет, предшествуя возрастному дефициту эстрогенов. Проведена сравнительная характеристика имеющихся лекарственных форм доставки прогестерона, и на примере новейших исследований продемонстрированы патогенетическая целесообразность и эффективность дополнительного назначения топического прогестерона к локальной эстрогенотерапии при наиболее распространенных клинических вариантах ГУМС.
Ключевые слова: менопауза, генитоуринарный менопаузальный синдром, хронические инфекции нижних мочевых путей, мышечная дисфункция тазового дна, синдром хронической тазовой боли, локальная эстрогенотерапия, микронизированный прогестерон, оптимизация.
Ключевые слова: менопауза, генитоуринарный менопаузальный синдром, хронические инфекции нижних мочевых путей, мышечная дисфункция тазового дна, синдром хронической тазовой боли, локальная эстрогенотерапия, микронизированный прогестерон, оптимизация.
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In the review article, the problem of optimization of local hormone therapy of urogenital disorders in women from the perspective of evidence based medicine on the basis of the modern multifactorial concept of genito-urinary menopausal syndrome (GUMS), which implies an important pathogenetic role of not only the age-related estrogen deficiency, but also the deficiency of other sex hormones in the pathogenesis of disorders urogenital tract in women in peri- and postmenopausal women. The important role of bioidentical progesterone as a metabolically active hormone possessing not only classical (reproductive) physiological effects in the body of a woman but also a whole spectrum of nonclassical (nonproductive) effects that demonstrate the pathogenetic justification of the expediency of topical administration of preparations containing a bioidentical analog of natural progesterone within the framework of a complex and personalized treatment of various clinical manifestations of GUMS, especially in women with sop favoring endogenous progesterone deficiency, which can occur chronologically after the 35 years preceding the age of estrogen deficiency. The comparative characteristics of the available dosage forms of progesterone delivery are demonstrated, and the pathogenetic expediency and effectiveness of the additional prescription of topical progesterone to local estrogen therapy in the most common clinical variants of the GUMS is demonstrated using the latest research.
Key words: menopause, genito-urinary menopausal syndrome, chronic infections of the lower urinary tract, muscular pelvic floor dysfunction, chronic pelvic pain syndrome, local estrogen therapy, micronized progesterone, optimization.
Полный текст
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10. Cheong YC, Smotra G, Williams AC. Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database Syst Rev 2014; 3: CD008797.
11. Davis SR, Wahlin-Jacobsen S. Testosterone in women – the clinical significance. Lancet Diabetes Endocrinol 2015; 3 (12): 980–92.
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33. Ciesiółka S, Budna J, Jopek K et al. Influence of Estradiol-17beta on Progesterone and Estrogen Receptor mRNA Expression in Porcine Follicular Granulosa Cells during Short-Term, In Vitro Real-TimeCell Proliferation. Biomed Res Int 2016; 2016: 8431018.
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1. Kaprin A.D., Apolikhin O.I., Sivkov A.V. i dr. Analiz uronefrologicheskoi zabolevaemosti i smertnosti v Rossiiskoi Federatsii za period 2002–2014 gg. po dannym ofitsial'noi statistiki. Eksperimental'naia i klinicheskaia urologiia. 2016; 3: 4–13. [in Russian]
2. Serov V.N. Terapiia urogenital'nykh rasstroistv, obuslovlennykh defitsitom estrogenov. Akush., ginekol., reproduktsiia. 2010; 4 (1): 21–35. [in Russian]
3. Gorbunova E.A., Apolikhina I.A. Atroficheskii tsistouretrit kak odna iz granei genitourinarnogo sindroma. Effektivnaia farmakoterapiia. 2015; 36: 32–8. [in Russian]
4. Manukhin I.B., Tumilovich L.G., Gevorkian M.A., Manukhina E.I. Ginekologicheskaia endokrinologiia. Klinicheskie lektsii. M.: GEOTAR-Media, 2017. [in Russian]
5. Tiuzikov I.A., Kalinchenko S.Iu., Apetov S.S. i dr. Androgeny i SNMP: muzhskaia gendernost' ili nereshennaia problema oboikh polov? Eksperimental'naia i klin. urologiia. 2013; 4: 40–8. [in Russian]
6. Tiuzikov I.A., Kalinchenko S.Iu., Apetov S.S. Defitsit androgenov u zhenshchin v uroginekologicheskoi praktike: patofiziologicheskie mekhanizmy, klinicheskie «maski» i farmakoterapiia transdermal'nymi formami testosterona. Ros. vestn. akushera-ginekologa. 2014; 1: 33–43. [in Russian]
7. Podzolkova N.M., Kuznetsova I.V., Korennaia V.V. Gormonal'naia terapiia v peri- i postmenopauze. M.: GEOTAR-Media, 2013.
[in Russian]
8. Baber J, Panay N, Fenton A. The IMS Writing Group 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19 (2): 109–50.
9. Portman DJ, Gass ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Woman’s Sexual Health and the North American Menopause Society. Maturitas 2014; 79 (3): 349–54.
10. Cheong YC, Smotra G, Williams AC. Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database Syst Rev 2014; 3: CD008797.
11. Davis SR, Wahlin-Jacobsen S. Testosterone in women – the clinical significance. Lancet Diabetes Endocrinol 2015; 3 (12): 980–92.
12. Sedighimehr N, Manshadi FD, Shokouhi N, Baghban AA. Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain. J Bodyw Mov Ther 2018; 22 (1): 92–6.
13. Chollet JA, Carter G, Meyn LA et al. Efficacy and safety of vaginal estriol and progesterone in postmenopausal women with atrophic vaginitis. Menopause 2009; 16 (5): 978–83. DOI: 10.1097/gme.0b013e3181a06c80
14. Levy T, Yairi Y, Bar-Hava I et al. Pharmacokinetics of the progesterone-containing vaginal tablet and its use in assisted reproduction. Steroids 2000; 65 (10–11): 645–9.
15. Severin E.S. Biokhimiia. M., 2003. [in Russian]
16. Hacker N, Moore JG, Gambone J. Essentials of Obstetrics and Gynecology. Saunders, 2004.
17. De Lin'er B. Natural'nyi progesteron i ego osobennosti. Ros. vestn. akushera-ginekologa. 2003; 3: 27–30. [in Russian]
18. Graham JD, Clarcke CL. Physiological action of progesterone in target tissues. Endocr Rev 1997; 18 (4): 502–19.
19. Torshin I.Iu., Gromova O.A., Sukhikh G.T. i dr. Molekuliarnye mekhanizmy didrogesterona (Diufaston®). Polnogenomnoe issledovanie transkriptsionnykh effektov retseptorov progesterona, androgenov i estrogenov. Gynecology. 2009; 11 (5): 9–16. [in Russian]
20. Bitsadze V.O., Akin'shina S.V., Khizroeva D.Kh. i dr. Patogeneticheskoe obosnovanie primeneniia natural'nogo progesterona v akusherskoi praktike. Akush., ginekol., reproduktsiia. 2014; 2: 79–88. [in Russian]
21. Iakushevskaia O.V. Sovremennye podkhody k naznacheniiu progesterona v praktike akushera-ginekologa. Effektivnaia farmakoterapiia. Gynecology. 2012; 14 (4): 12–7. [in Russian]
22. Melcangi RC, Magnaghi V, Galbiati M, Martini L. Steroid effects on the gene expression of peripheral myelin proteins. Horm Behav 2001; 40 (2): 210–4.
23. Genazzani AR, Stomati M, Morittu A et al. Progesterone, progestagens and the central nervous system. Hum Reprod 2000; 15 (Suppl. 1): 14–27.
24. Rainville JR, Tsyglakova M, Hodes GE. Deciphering sex differences in the immune system and depression. Front Neuroendocrinol 2017. pii: S0091-3022 (17)30101-2.
25. Dos Santos RL, da Silva FB, Ribeiro RF Jr, Stefanon I. Sex hormones in the cardiovascular system. Horm Mol Biol Clin Investig 2014; 18 (2): 89–103.
26. Pakulski C. Neuroprotective properties of sex hormones. Anestezjol Intens Ter 2011; 43 (2): 113–8.
27. Baulieu E, Schumacher M. Progesterone as a neuroactive neurosteroid, with special reference to the effect of progesterone on myelination. Steroids 2000; 65 (10–11): 605–12.
28. Tikhomirov A.L., Dubnin D.M. Sravnitel'naia kharakteristika progesterona i sinteticheskikh progestinov v aspekte klinicheskogo ispol'zovaniia pri terapii progesterondefitsitnykh sostoianii. RMZh. 2003; 16: 929–37. [in Russian]
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31. Paulson RJ, Collins MG, Yankov VI. Progesterone pharmacokinetics and pharmacodynamics with 3 dosages and 2 regimens of an effervescent micronized progesterone vaginal insert. J Clin Endocrinol Metab 2014; 99 (11): 4241–9.
32. Ficicioglu C, Gurbuz B, Tasdemir S et al. High local endometrial effect of vaginal progesterone gel. Gynecol Endocrinol 2004; 18 (5): 240–3.
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Авторы
И.А.Тюзиков*1, М.И.Жиленко1, С.Р.Поликарпова2
1. ООО «Клиника профессора Калинченко». 127015, Россия, Москва, ул. Бутырская, д. 4, стр. 2;
2. МОО «Общество специалистов органо-тканевой и плацентарной терапии». 117292, Россия, Москва, ул. Профсоюзная, д. 26/44
*phoenix-67@list.ru
1. ООО «Клиника профессора Калинченко». 127015, Россия, Москва, ул. Бутырская, д. 4, стр. 2;
2. МОО «Общество специалистов органо-тканевой и плацентарной терапии». 117292, Россия, Москва, ул. Профсоюзная, д. 26/44
*phoenix-67@list.ru
________________________________________________
I.A.Tyuzikov*1, M.I.Zhilenko1, S.R.Polikarpova2
1. Clinic of Professor Kalinchenko. 127015, Russian Federation, Moscow, ul. Butyrskaia, d. 4, str. 2;
2. Society of Specialists of Organ-Tissue and Placental Therapy. 117292, Russian Federation, Moscow, ul. Profsoiuznaia, d. 26/44
*phoenix-67@list.ru
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