Коррекция менопаузальных симптомов у пациенток с гормон-позитивными опухолями органов репродуктивной системы
Коррекция менопаузальных симптомов у пациенток с гормон-позитивными опухолями органов репродуктивной системы
Шабалова О.В., Юренева С.В., Хохлова С.В. и др. Коррекция менопаузальных симптомов у пациенток с гормон-позитивными опухолями органов репродуктивной системы. Современная Онкология. 2020; 22 (3): 154–159.
DOI: 10.26442/18151434.2020.3.200104
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Shabalova O.V., Yureneva S.V., Khokhlova S.V. et al. Managing menopausal symptoms in patients with hormone receptor-positive gynecologic cancers. Journal of Modern Oncology. 2020; 22 (3): 154–159. DOI: 10.26442/18151434.2020.3.200104
Коррекция менопаузальных симптомов у пациенток с гормон-позитивными опухолями органов репродуктивной системы
Шабалова О.В., Юренева С.В., Хохлова С.В. и др. Коррекция менопаузальных симптомов у пациенток с гормон-позитивными опухолями органов репродуктивной системы. Современная Онкология. 2020; 22 (3): 154–159.
DOI: 10.26442/18151434.2020.3.200104
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Shabalova O.V., Yureneva S.V., Khokhlova S.V. et al. Managing menopausal symptoms in patients with hormone receptor-positive gynecologic cancers. Journal of Modern Oncology. 2020; 22 (3): 154–159. DOI: 10.26442/18151434.2020.3.200104
Молодые пациентки с онкологическими заболеваниями органов репродуктивной системы, которые получают лечение, приводящее к выключению функции яичников, часто страдают менопаузальными симптомами, способствующими резкому снижению качества жизни. Климактерические симптомы при ятрогенной менопаузе значительно более выражены по сравнению с симптомами, возникающими после естественной менопаузы, особенно у пациенток с онкологическими заболеваниями органов репродуктивной системы. Они приводят к резкому снижению качества жизни и являются одной из основных причин прекращения эндокринной терапии у пациенток с гормон-позитивными опухолями, что приводит к снижению безрецидивной выживаемости и ухудшению прогноза. Наиболее эффективным методом лечения климактерических симптомов средней и тяжелой степени является менопаузальная гормональная терапия, однако она противопоказана пациенткам с эстрогензависимыми онкологическими заболеваниями в анамнезе ввиду вероятности прогрессирования онкологического заболевания, а также риска венозных тромбозов, частота которых у онкологических больных повышается. В качестве 1-й линии терапии менопаузальных расстройств у женщин с эстрогензависимыми онкологическими заболеваниями органов репродуктивной системы используются негормональные фармакологические и нефармакологические методы коррекции. Среди негормональных нефармакологических методов коррекции активно изучаются иглоукалывание, йога, физические упражнения для контроля массы тела, а также диета, богатая фитоэстрогенами. Наиболее эффективными негормональными методами коррекции вазомоторных симптомов являются селективные ингибиторы обратного захвата серотонина и селективные ингибиторы обратного захвата серотонина и норадреналина. Однако в настоящее время на территории России данные препараты могут быть назначены только врачом-психиатром. Поиск эффективных и безопасных негормональных методов коррекции менопаузальных симптомов у пациенток с гормон-позитивными опухолями органов репродуктивной системы является важной задачей в практике врачей разных специальностей.
Ключевые слова: опухоли органов репродуктивной системы, менопауза, менопаузальные симптомы, климактерический синдром, реабилитация, негормональное лечение.
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Young women with reproductive tract neoplasms who receive treatment leading to termination of ovarian function often suffer from menopause symptoms that contribute to dramatic drop in quality of life. Climacteric symptoms in women with iatrogenic menopause are more severe than in case of natural menopause, especially in women with reproductive tract neoplasms. They lead to dramatic drop in quality of life and are one of the main reasons to stop applying endocrine therapy in women with hormone-positive tumors, which leads to decrease in disease free survival and to decline the prognosis. The most effective treatment option for climacteric symptoms of moderate to severe degrees is menopause hormone therapy; however, such therapy is not suitable for patients with estrogen-dependent tumors in past medical history due to the likelihood risk of progression of cancer, as well as the risk of venous thrombosis, the frequency of which in cancer patients increases. Non-hormonal pharmacological and non-pharmacological correction methods are used as first-line therapy for menopause disorders in women with estrogen-dependent tumors of the reproductive system. Among non-hormonal non-pharmacological correction methods actively study such methods as acupuncture, yoga, exercise to control weight, and a diet rich in phytoestrogens. The most effective non-hormonal methods of correcting vasomotor symptoms are serotonin and norepinephrine reuptake inhibitors. However, currently in Russia these drugs can be prescribed only by a psychiatrist. The finding of effective and safe non-hormonal methods to correct menopause symptoms in women with hormone-positive reproductive tract tumors is the important task in practice among doctors in different specialties.
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77. WHO. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360 – advisory note. 2012.
78. Hickey M, Marino J, Braat S, Wong S. A randomized, double-blind, crossover trial comparing a silicone- versus water-based lubricant for sexual discomfort after breast cancer. Breast Cancer Res Treat 2016; 158: 79–90. DOI: 10.1007/s10549-016-3865-1
79. Marino J, McNamara H, Hickey M. Managing menopausal symptoms after cancer: an evidence-based approach for primary care. Med J Aust 2018; 208: 127–32. DOI: 10.5694/mja17.00693
80. Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturiser composition? Climacteric 2016; 19: 151–61. DOI: 10.3109/13697137.2015.1124259
1 ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии
им. акад. В.И. Кулакова» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*olga.shabalova93@gmail.com
________________________________________________
Olga V. Shabalova*1, Svetlana V. Yureneva1, Svetlana V. Khokhlova1, Zhanna R. Gardanova1,2, Elena I. Ermakova1
1 Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
2 Pirogov Russian National Research Medical University, Moscow, Russia
*olga.shabalova93@gmail.com