В манифестации и развитии урогенитальных атрофических процессов, связанных с наступлением менопаузы, ведущую роль играет нарастающий дефицит эстрогенов. Важным обстоятельством является тот факт, что генитоуринарным менопаузальным расстройствам зачастую сопутствуют другие климактерические нарушения. В связи с этим ключевое место в профилактике и коррекции гипоэстрогенных состояний занимает системная менопаузальная гормональная терапия. Среди представителей системной менопаузальной гормональной терапии клиническую эффективность и низкий риск возможных осложнений продемонстрировали препараты, содержащие 17b-эстрадиол в комбинации с дроспиреноном. В литературе имеется значительное количество публикаций, отражающих положительное влияние указанных препаратов на состояние женщины при вазомоторных, психоэмоциональных климактерических расстройствах, снижении костной массы, а также в терапии и профилактике атрофических процессов урогенитального тракта, что позволяет применять указанную комбинацию гормонов в комплексной коррекции как системных, так и местных генитоуринарных менопаузальных нарушений.
In the manifestation and development of urogenital atrophic processes associated with the onset of menopause, the leading role is played by the growing deficiency of estrogens. An important circumstance is the fact that genitourinar menopausal disorders are often accompanied by other climacteric disorders. In this regard, a key place in the prevention and correction of hypoestrogenic conditions is systemic menopausal hormone therapy. Among the representatives of systemic menopausal hormone therapy, clinical efficacy and low risk of possible complications were demonstrated by preparations containing 17b-estradiol in combination with drospirenone. In the literature there is a significant number of publications reflecting the positive effect of these drugs on the condition of women with vasomotor, psychoemotional climacteric disorders, with a decrease in bone mass. Also, these drugs are used in the therapy and prevention of atrophic processes of the urogenital tract. This allows us to apply this combination of hormones in the complex correction of systemic and local genitourinary menopausal disorders.
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11. Notelovitz M. Estrogen therapy in the management to problems associated with urogenital ageing-asimple diagnostic test and the effect of the route of hormone administration. Maturitas 1995; 115 (22): 31–3.
12. Panay N. Genitourinary syndrome of the menopause – dawn of a new era? Climacteric 2015; 18 (1): 13–7.
13. Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19 (2): 109–50.
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16. Тихомирова Е.В. Особенности клиники и лечения урогенитальных расстройств в перименопаузе. Автореф. дис. ... канд. мед. наук. М., 2005. / Tikhomirova E.V. Osobennosti kliniki i lecheniia urogenital'nykh rasstroistv v perimenopauze. Avtoref. dis. ... kand. med. nauk. M., 2005. [in Russian]
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18. Oge T, Hassa H, Aydin Y et al. The relationship between urogenital symptoms and climacteric complaints. Climacteric 2013; 16 (6): 646–52.
19. Calleja-Agius J, Brincat MP. The urogenital system and the menopause. Climacteric 2015; 18 (1): 18–22.
20. Юренева С.В., Ильина Л.М., Якушевская О.В. Менопаузальная гормональная терапия в постменопаузе: качество жизни сегодня и в долгосрочной перспективе. Гинекология. 2016; 18 (1): 24–9. / Yureneva S.V., Ilyina L.M., Yakushevskaya O.V. Menopausal hormone therapy in postmenopausal women: the quality of life today and in the long term. Gynecology. 2016; 18 (1): 24–9. [in Russian]
21. Warming L, Ravn P, Nielsen T, Christiansen C. Safety and efficacy of drospirenone used in a continuous combination with 17b-estradiol for prevention of postmenopausal osteoporosis. Climacteric 2004; 7 (1): 103–11.
22. Gerlinger C, Gude K, Schmelter T et al. 0.5 vs. 1.0 mg estradiol in combination with drospirenone for the treatment of hot flushes. Climacteric 2015; 18 (4): 512–7.
23. Battaglia C, Cianciosi A, Mancini F et al. Angeliq versus Activelle in normotensive postmenopausal women: a prospective, randomized pilot study. Menopause 2009; 16 (4): 803–9.
24. Gambacciani M, Rosano G, Cappagli B et al. Clinical and metabolic effects of drospirenone-estradiol in menopausal women: a prospective study. Climacteric 2011; 14 (1): 18–24.
25. Dinger J, Bardenheuer K, Heinemann K. Drospirenone plus estradiol and the risk of serious cardiovascular events in postmenopausal women. Climacteric 2016; 19 (4): 349–56.
26. Anttila S, Hakkola J, Tuominen P. Methylation of cytochrome P4501A1 promoter in the lung is associated with tobacco smoking. Cancer Res 2003; 63: 8623–8.
27. Archer DF. Drospirenone and estradiol: a new option for the postmenopausal woman. Climacteric 2007; 10 (1): 3–10.
28. Genazzani AR, Schmelter T, Schaefers M et al. One-year randomized study of the endometrial safety and bleeding pattern of 0.25 mg drospirenone/0.5 mg 17b-estradiol in postmenopausal women. Climacteric 2013; 16 (4): 490–8.
29. Lin S-Q, Sun L-Z, Lin J-F et al. Estradiol 1 mg and drospirenone 2 mg as hormone replacement therapy in postmenopausal Chinese women. Climacteric 2011; 14 (4): 472–81.
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1. Meditsina klimakteriia. Pod red. V.P.Smetnik. Iaroslavl': Litera, 2006. [in Russian]
2. Briukhina E.V., Usol'tseva E.N. Srednevremennye menopauzal'nye rasstroistva v kontseptsii kachestva zhizni. Ural'skii med. zhurn. 2014; 4 (118): 57–62. [in Russian]
3. Totchiev G.F., Kotikova N.P. Opportunities to overcome the negative effects of menopause syndrome. Gynecology. 2015; 17 (6): 11–3. [in Russian]
4. Kolpinskiy G.I., Zakharov I.S. Diagnostika i prognozirovanie postmenopauzal'nogo osteoporoza. Kemerovo, 2015. [in Russian]
5. Zakharov I.S., Kolpinskiy G.I., Ponomareva M.V. Comprehensive approach to the prevention and correction of postmenopausal osteoporosis. Gynecology. 2017; 19 (6): 24–7. [in Russian]
6. Heinemann LAJ, Potthoff P, Schneider HPG. International versions of the Menopause Rating Scale (MRS). Health Quality Life Outcomes 2003; 1: 28.
7. Zakharov I.S. Evaluation of menopausal disorders in women with different levels of bone mineral density. Gynecology. 2015; 17 (6): 14–6. [in Russian]
8. Tao MF, Shao HF, Li CB, Teng YC. Correlation between the modified Kupperman Index and the Menopause Rating Scale in Chinese women. Patient Prefer Adherence 2013; 7: 223–9.
9. Gadzhieva Z.K. Funktsional'noe sostoianie nizhnikh mochevykh putei i medikamentoznaia profilaktika narushenii mocheispuskaniia u zhenshchin v klimakterii. Avtoref. dis. ... kand. med. nauk. M., 2001. [in Russian]
10. Ilovayskaya I. Similarity of female central (hypogonadotropic) hypogonadism and postmenopause. Climacteric 2017; 20 (4): 356–61.
11. Notelovitz M. Estrogen therapy in the management to problems associated with urogenital ageing-asimple diagnostic test and the effect of the route of hormone administration. Maturitas 1995; 115 (22): 31–3.
12. Panay N. Genitourinary syndrome of the menopause – dawn of a new era? Climacteric 2015; 18 (1): 13–7.
13. Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19 (2): 109–50.
14. The 2017 hormone therapy position statement of the North American Menopause Society. Menopause 2017; 24 (7): 728–53.
15. Prilepskaya V.N. Genitourinary menopausal syndrome: the potential of estriol. Gynecology. 2018; 20 (1): 5–8. [in Russian]
16. Tikhomirova E.V. Osobennosti kliniki i lecheniia urogenital'nykh rasstroistv v perimenopauze. Avtoref. dis. ... kand. med. nauk. M., 2005. [in Russian]
17. Il'ina L.M., Iureneva S.V., Dubrovina A.V., Ebzieva Z.Kh. Vliianie menopauzy na rabotaiushchikh zhenshchin: faktor, kotoromu ne pridaetsia dolzhnogo znacheniia. Problemy reproduktsii. 2016; 1: 87–94.
18. Oge T, Hassa H, Aydin Y et al. The relationship between urogenital symptoms and climacteric complaints. Climacteric 2013; 16 (6): 646–52.
19. Calleja-Agius J, Brincat MP. The urogenital system and the menopause. Climacteric 2015; 18 (1): 18–22.
20. Yureneva S.V., Ilyina L.M., Yakushevskaya O.V. Menopausal hormone therapy in postmenopausal women: the quality of life today and in the long term. Gynecology. 2016; 18 (1): 24–9. [in Russian]
21. Warming L, Ravn P, Nielsen T, Christiansen C. Safety and efficacy of drospirenone used in a continuous combination with 17b-estradiol for prevention of postmenopausal osteoporosis. Climacteric 2004; 7 (1): 103–11.
22. Gerlinger C, Gude K, Schmelter T et al. 0.5 vs. 1.0 mg estradiol in combination with drospirenone for the treatment of hot flushes. Climacteric 2015; 18 (4): 512–7.
23. Battaglia C, Cianciosi A, Mancini F et al. Angeliq versus Activelle in normotensive postmenopausal women: a prospective, randomized pilot study. Menopause 2009; 16 (4): 803–9.
24. Gambacciani M, Rosano G, Cappagli B et al. Clinical and metabolic effects of drospirenone-estradiol in menopausal women: a prospective study. Climacteric 2011; 14 (1): 18–24.
25. Dinger J, Bardenheuer K, Heinemann K. Drospirenone plus estradiol and the risk of serious cardiovascular events in postmenopausal women. Climacteric 2016; 19 (4): 349–56.
26. Anttila S, Hakkola J, Tuominen P. Methylation of cytochrome P4501A1 promoter in the lung is associated with tobacco smoking. Cancer Res 2003; 63: 8623–8.
27. Archer DF. Drospirenone and estradiol: a new option for the postmenopausal woman. Climacteric 2007; 10 (1): 3–10.
28. Genazzani AR, Schmelter T, Schaefers M et al. One-year randomized study of the endometrial safety and bleeding pattern of 0.25 mg drospirenone/0.5 mg 17b-estradiol in postmenopausal women. Climacteric 2013; 16 (4): 490–8.
29. Lin S-Q, Sun L-Z, Lin J-F et al. Estradiol 1 mg and drospirenone 2 mg as hormone replacement therapy in postmenopausal Chinese women. Climacteric 2011; 14 (4): 472–81.
30. Andreeva E.N., Grigoryan O.R., Absatarova Yu.S. The efficacy of 17b-estradiol and low dosed drospirenone use in postmenopausal women (literature review). Gynecology. 2015; 17 (1): 34–40. [in Russian]
31. Gass MLS, Maki P, Shifren JL. NAMS supports judicious use of systemic hormone therapy for women aged 65 years and older. Menopause 2015; 22 (7): 685–6.
32. Ovsyannikova T.V., Kulikov I.A. Individual choice of menopausal hormone therapy. Gynecology. 2016; 18 (4): 59–62. [in Russian]
Авторы
И.С.Захаров*
ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России. 650056, Россия, Кемерово, ул. Ворошилова, д. 22а
*isza@mail.ru
________________________________________________
I.S.Zakharov*
Kemerovo State Medical University of the Ministry of Health of the Russian Federation. 650056, Russian Federation, Kemerovo, ul. Voroshilova, d. 22a
*isza@mail.ru