Menopausal hormone therapy features in women with estrogen-dependent uterus pathology

М. В. Медведев, Ю. В. Донская

Abstract


In the literature review issues about menopausal hormone therapy in perimenopausal women with considering of recent revised opinion to this treatment are presented.

Derivatives of 19-norsteroid gestagens, particularly levonorgestrel are standard therapy among progestogens with antiproliferative effect on endometrium. Eeffectiveness of new progestogens is compared with levonorgestrel. Levonorgestrel as intrauterine releasing system and an oral version is included in the majority of studies and guidelines dealing with the treatment of chronic heavy menstrual bleedings and endometrial hyperplasia. Thus levonorgestrel has a less pronounced androgenic properties compared to other 19-nortestosterone derivatives, almost without increasing the level of low density lipoproteins, and thus is not increase the cardiovascular risk. Levonorgestrel has a strength anti-proliferative effect on the endometrium and myometrium that superior progesterone derivative almost 2 times.

The combination of estradiol valerate (2 mg) and levonorgestrel (0.15 mg) is reasonable for menopausal hormone therapy in perimenopausal women seeking treatment for endometrial hyperplasia or endometriosis with associated abnormal uterine bleeding. The advantages of such combinations are: high efficiency for atrophic disorders of the genitourinary system; a positive effect on the lipid profile; effective reduction of menopausal symptoms; beneficial effects on the cardiovascular system; increasing bone mineral density; effective protection for endometrial hyperplasia and suppression of genital and extragenital endometriosis; more androgenic activity of levonorgestrel is involved in the formation of the mental comfort and harmonious sexual life.

The author’s conclusion is the combination of estradiol valerate (2 mg) and levonorgestrel (0.15 mg) is the drug of choice for menopausal hormone replacement therapy in perimenopausal and postmenopausal women because of the high efficiency and low incidence of adverse reactions. This drug has therapeutic properties in the treatment of abnormal uterine bleedings, endometriosis and adenomyosis, recurrent endometrial hyperplasia.


Keywords


menopausal hormone therapy; perimenopause; levonorgestrel; endometrial hyperplasia; abnormal uterine bleedings

References


National consensus on management patients in menopause. Reproductive Endocrinology 1.27 (2016): 8–25.

Sturdee, D.W., Pines, A., IMS Writing Group. “Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health.” Climacteric 3.14 (2011): 302–20.

Strawbridge, W.J., Cohen, R.D., Shema, S.J., Kaplan, G.A. “Successful aging: predictors and associated activities.” Am J Epidemiol 2.144 (1996): 135–41.

de Villiers, T.J., Pines, A., Panay, N., et al. “Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health.” Climacteric 3.16 (2013): 316–37.

Baber, R.J., Panay, N., Fenton, A., IMS Writing Group. “2016 IMS Recommendations on women’s midlife health and menopause hormone therapy.” Climacteric 2.19 (2016): 109–50.

Sager, H.B., Linsel-Nitschke, P., Mayer, B., et al. “Physicians’ perception of guideline-recommended low-density lipoprotein target values: characteristics of misclassified patients.” Eur Heart J 10.31 (2010): 1266–73.

Speroff, L. “Postmenopausal hormone therapy and coronary heart disease: clinical implications of recent randomized trial results.” Maturitas 2.35 (2000): 91–105.

Lacey, J.V. Jr. “The WHI ten years later: an epidemiologist’s view.” J Steroid Biochem Mol Biol 142 (2014): 12–15.

Brown, S. “A huge return on investment for the WHI.” Post Reprod Health 4.20 (2014): 129–30.

Masson, W., Siniawski, D., Krauss, J., Cagide, A. “Clinical applicability of the framingham 30-year risk score. Usefulness in cardiovascular risk stratification and the diagnosis of carotid atherosclerotic plaque.” Rev Esp Cardiol 4.64 (2011): 305–11.

Gierach, M., Gierach, J., Junik, R. “The evaluation of lipid profile in patients with metabolic syndrome according to the cardiovascular risk calculated on the basis of SCORE chart.” Endokrynol Pol (2016). DOI: 10.5603/EP.a2016.0020

Lesnyak, O.M., Benevolenskaya L.I. Osteoporosis. Diagnosis, prevention and treatment. Clinical guidelines. Moscow. GEOTAR-Media (2012): 272 p.

Justin, C.T., MacKinnon, C.N.A. “Heavy menstrual bleeding.” Womens Health (Lond Engl) 1.12 (2016): 1.

Bongers, M.Y., Mol, B.W., Brolmann, H.A. “Current treatment of dysfunctional uterine bleeding.” Maturitas 3.47 (2004): 159–74.

Simpson, K.R., Bredesen, D.E. The perimenopause & menopause workbook: a comprehensive, personalized guide to hormone health. Oakland, CA. New Harbinger Publications (2006): 250 p.

Baldwin, M.K., Jensen, J.T. “Contraception during the perimenopause.” Maturitas 3.76 (2013): 235–42.

Chen, E.C., Danis, P.G., Tweed, E. “Clinical inquiries. Menstrual disturbances in perimenopausal women: what’s best?” J Fam Pract 6.58 (2009): E3.

Wildemeersch, D., Schacht, E., Wildemeersch, P. “Performance and acceptability of intrauterine release of levonorgestrel with a miniature delivery system for hormonal substitution therapy, contraception and treatment in peri- and postmenopausal women.” Maturitas 3.44 (2003): 237–45.


GOST Style Citations


1. Національний консенсус щодо ведення пацієнток у клімактерії. Репродуктивна ендокринологія. – 2016. – №1 (27). – С. 8–25.

2. Sturdee, D.W., Pines, A., IMS Writing Group. “Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health.” Climacteric 3.14 (2011): 302–20.

3. Strawbridge, W.J., Cohen, R.D., Shema, S.J., Kaplan, G.A. “Successful aging: predictors and associated activities.” Am J Epidemiol 2.144 (1996): 135–41.

4. de Villiers, T.J., Pines, A., Panay, N., et al. “Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health.” Climacteric 3.16 (2013): 316–37.

5. Baber, R.J., Panay, N., Fenton, A., IMS Writing Group. “2016 IMS Recommendations on women’s midlife health and menopause hormone therapy.” Climacteric 2.19 (2016): 109–50.

6. Sager, H.B., Linsel-Nitschke, P., Mayer, B., et al. “Physicians’ perception of guideline-recommended low-density lipoprotein target values: characteristics of misclassified patients.” Eur Heart J 10.31 (2010): 1266–73.

7. Speroff, L. “Postmenopausal hormone therapy and coronary heart disease: clinical implications of recent randomized trial results.” Maturitas 2.35 (2000): 91–105.

8. Lacey, J.V. Jr. “The WHI ten years later: an epidemiologist’s view.” J Steroid Biochem Mol Biol 142 (2014): 12–15.

9. Brown, S. “A huge return on investment for the WHI.” Post Reprod Health 4.20 (2014): 129–30.

10. Masson, W., Siniawski, D., Krauss, J., Cagide, A. “Clinical applicability of the framingham 30-year risk score. Usefulness in cardiovascular risk stratification and the diagnosis of carotid atherosclerotic plaque.” Rev Esp Cardiol 4.64 (2011): 305–11.

11. Gierach, M., Gierach, J., Junik, R. “The evaluation of lipid profile in patients with metabolic syndrome according to the cardiovascular risk calculated on the basis of SCORE chart.” Endokrynol Pol (2016). DOI: 10.5603/EP.a2016.0020

12. Lesnyak, O.M., Benevolenskaya L.I. Osteoporosis. Diagnosis, prevention and treatment. Clinical guidelines. Moscow. GEOTAR-Media (2012): 272 p.

13. Justin, C.T., MacKinnon, C.N.A. “Heavy menstrual bleeding.” Womens Health (Lond Engl) 1.12 (2016): 1.

14. Bongers, M.Y., Mol, B.W., Brolmann, H.A. “Current treatment of dysfunctional uterine bleeding.” Maturitas 3.47 (2004): 159–74.

15. Simpson, K.R., Bredesen, D.E. The perimenopause & menopause workbook: a comprehensive, personalized guide to hormone health. Oakland, CA. New Harbinger Publications (2006): 250 p.

16. Baldwin, M.K., Jensen, J.T. “Contraception during the perimenopause.” Maturitas 3.76 (2013): 235–42.

17. Chen, E.C., Danis, P.G., Tweed, E. “Clinical inquiries. Menstrual disturbances in perimenopausal women: what’s best?” J Fam Pract 6.58 (2009): E3.

18. Wildemeersch, D., Schacht, E., Wildemeersch, P. “Performance and acceptability of intrauterine release of levonorgestrel with a miniature delivery system for hormonal substitution therapy, contraception and treatment in peri- and postmenopausal women.” Maturitas 3.44 (2003): 237–45.





DOI: https://doi.org/10.18370/2309-4117.2016.29.90-93

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)