Особенности консультирования пациенток старше 45 лет
Дубровина С.О.
В Российской Федерации в настоящее время более 30 млн женщин старше 45 лет. Ежегодно более 1 млн женщин вступают в менопаузу. Это диктует необходимость для практикующих врачей акушеров-гинекологов проводить грамотное консультирование и рационально оценивать потенциальные риски, обусловленные эстрогенодефицитом. Изменение гормонального баланса андрогенов, эстрогенов и прогестерона в период пери- и постменопаузы влечет за собой патологические изменения со стороны сердечно-сосудистой, опорно-двигательной и нервной систем. На фоне пери- и постменопаузы повышается риск развития ожирения, что будет также влиять на неблагоприятный исход клинической картины. Важно своевременно обращать внимание на пациенток с признаками гипоэстрогении с целью своевременного консультирования и подбора лечебно-профилактических мероприятий. В статье представлены практические аспекты, на которые следует обращать внимание клиницисту.
Заключение: Ключевым аспектом для акушеров-гинекологов в отношении женщины менопаузального периода является повышение качества жизни и увеличение ее продолжительности. Менопаузальная гормональная терапия (МГТ) и своевременный ее старт снижают риск общей смертности на 31%, развития сахарного диабета 2 типа – на 30%, развития переломов – на 30%. При выборе МГТ необходимо учитывать профиль безопасности эстрогенов и гестагенов, входящих в состав. С началом менопаузального перехода продукция эндогенного эстрадиола снижается, и формируется состояние относительной гиперандрогении. Важно найти баланс между всеми гормонами путем подбора адекватных дозировок эстрогена и селективного гестагена в составе МГТ. Важно, чтобы гестагенный компонент не уменьшал, а потенцировал благоприятные эффекты эстрогена. МГТ с дидрогестероном за счет восполнения уровня эстрогенов и высокой селективности гестагена помогает обеспечить баланс активности всех трех половых гормонов – эстрогенов, гестагенов и эндогенных андрогенов в женском организме.
Конфликт интересов: Автор заявляет об отсутствии конфликта интересов.
Финансирование: Исследование не имело спонсорской поддержки.
Для цитирования: Дубровина С.О. Особенности консультирования пациенток старше 45 лет.
Акушерство и гинекология. 2024; 4: 39-50
https://dx.doi.org/10.18565/aig.2024.89
Ключевые слова
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Поступила 10.04.2024
Принята в печать 23.04.2024