lvrachЛечащий ВрачLechaschi Vrach1560-51752687-118110.51793/OS.2022.25.3.004lvrach-893Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYВозраст-ассоциированные заболевания и менопаузальная гормональная терапия – фокус на прогестагеныAge-related diseases and menopausal hormone therapy – focus on progestogenshttps://orcid.org/0000-0002-9441-3468КареваЕ. Н.KarevaE. N.

Карева Елена Николаевна, д.м.н., профессор, кафедра фармакологии; кафедра молекулярной фармакологии и радиобиологии

119019, Москва, Никитский бульвар, 13;

117997, Москва, ул. Островитянова, 1

Elena N. Kareva, Dr. of Sci. (Med.), Professor, Department of Pharmacology; Department of Molecular Pharmacology and Radiobiology

13 Nikitsky Boulevard, Moscow, 119019;

1 Ostrovityanov str., Moscow, 117997

kareva_e_n@staff.sechenov.ruИнститут биодизайна и моделирования сложных систем, Научно-технологический парк биомедицины, Федеральное государственное автономное образовательное учреждение высшего образования Первый Московский государственный медицинский университет имени И. М. Сеченова Министерства здравоохранения Российской Федерации; Федеральное государственное автономное образовательное учреждение высшего образования Российский национальный исследовательский медицинский университет имени Н. И. Пирогова Министерства здравоохранения Российской ФедерацииРоссияInstitute of Biodesign and Complex Systems Modeling, Science and Technology Park of Biomedicine, Federal State Autonomous Educational Institution of Higher Education Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation; Federal State Autonomous Educational Institution of Higher Education Pirogov Russian National Research Medical University Ministry of Health of the Russian FederationRussian Federation202227032022032733Copyright © Карева Е.Н., 20222022Карева Е.Н.Kareva E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.lvrach.ru/jour/article/view/893

Гормональная терапия является наиболее эффективным методом лечения симптомов менопаузы. Польза применения менопаузальной гормональной терапии перевешивает риски у соматически здоровых женщин. Однако ситуация усложняется у женщин с одним или несколькими хроническими заболеваниями. Это в первую очередь возраст-ассоциированные заболевания, такие как гипертоническая болезнь, ожирение, жировая болезнь печени, атеросклероз, сахарный диабет 2 типа, а также варикозная болезнь вен нижних конечностей и другие. В патогенезе перечисленных состояний участвуют факторы, находящиеся под гормональным контролем, поэтому применение гормоноактивных соединений может оказать как саногенетическое влияние, так и усугубить болезненное состояние пациентки. Оптимизация менопаузальной гормональной терапии требует углубленной информации о влиянии гормонов и их синтетических аналогов на биохимические контрольные точки возраст-ассоциированных заболеваний. Фармакологический эффект менопаузальной гормональной терапии зависит не только от дозы и длительности, но и от времени старта, что переводит применение гормонов из терапевтической в профилактическую плоскость. Гестагенный компонент менопаузальной гормональной терапии за счет дополнительных свойств может снижать положительный метаболический эффект эстрогена. Сравнительный анализ свойств гестагенов показал, что микронизированный прогестерон и дидрогестерон являются наиболее безопасными вариантами, с более низким риском сердечно-сосудистых заболеваний, тромбоэмболии и рака молочной железы по сравнению с другими прогестагенами и служат препаратами выбора у женщин с высокой плотностью ткани молочной железы, диабетом, ожирением, курящих и с факторами риска венозной тромбоэмболии. Фармакокинетическое профилирование показывает ряд преимуществ дидрогестерона: надежный количественный учет, отсутствие биологически активных метаболитов (меньше побочных эффектов, в том числе центральных), меньше противопоказаний к назначению. В этой статье мы представляем данные, касающиеся особенностей использования менопаузальной гормональной терапии у женщин с хроническими заболеваниями, такими как ожирение, гипертония, дислипидемия, диабет, венозная тромбоэмболия.

Hormone therapy is the most effective treatment for menopausal symptoms. The benefits of using menopausal hormone therapy outweigh the risks for healthy women. However, the situation is more complicated in women with one or more chronic diseases. These are primarily age-associated diseases, such as hypertension, obesity, fatty liver disease, atherosclerosis, type 2 diabetes mellitus, as well as varicose veins of the lower extremities and others. Factors under hormonal control are involved in the pathogenesis of these conditions, so the use of hormone-active compounds can have both a sanogenetic effect and exacerbate the patient's morbid condition. Optimization of menopausal hormone therapy requires in-depth knowledge of the effects of hormones and their synthetic analogs on the biochemical checkpoints of age-related diseases. The pharmacological effect of menopausal hormone therapy depends not only on the dose and duration, but also on the time of onset, which translates the use of hormones from a therapeutic plane into a prophylactic one. The gestagenic component of MHT, due to additional properties, can reduce the positive metabolic effect of estrogens. A comparative analysis of the properties of progestogens showed that micronized progesterone and dydrogesterone are the safest options, with a lower risk of cardiovascular disease, thromboembolism and breast cancer compared to other progestogens, and are the drugs of choice in women with high breast tissue density, diabetes mellitus, obesity, smokers and risk factors for venous thromboembolism. Pharmacokinetic profiling shows a number of advantages of dydrogesterone: reliable quantitative accounting, the absence of biologically active metabolites (fewer side effects, including central ones), fewer contraindications for prescribing. This article presents data on the features of the use of menopausal hormone therapy in women with such chronic diseases as obesity, arterial hypertension, dyslipidemia, diabetes mellitus, venous thromboembolism.

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The authors declare that there are no conflicts of interest present.