akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2020.165akusherstvo-878Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРSpecifics of prescribing menopausal hormonal therapy in patients with the anamnestic endometriosisОсобенности назначения менопаузальной гормональной терапии у больных с эндометриозом в анамнезеhttps://orcid.org/0000-0002-6551-4147ЯрмолинскаяМ. И.YarmolinskayaM. I.

Ярмолинская Мария Игоревна – д.м.н., профессор РАН, профессор, руководитель отдела гинекологии и эндокринологии, руководитель центра «Диагностики и лечения эндометриоза»;

профессор кафедры акушерства и гинекологии

Scopus Author ID: 7801562649. Researcher ID: P-2183-2014. SPIN-код: 3686-3605

199034, Санкт-Петербург, Менделеевская линия, д. 3;

191015 Санкт-Петербург, Кирочная ул., д. 41

Maria I. Yarmolinskaya – MD, Dr Sci Med, Professor of RAS, Head of the Department of Gynecology and Endocrinology, Head of the Сenter «Diagnostics and Treatment of Endometriosis»;

Professor, Department of Obstetrics and Gynecology

Scopus Author ID: 7801562649. Researcher ID: P-2183-2014. SPIN-код: 3686-3605

3 Mendeleevskaya Liniya, Saint Petersburg 199034;

41 Kirochnaya Str., Saint Petersburg 191015

https://orcid.org/0000-0002-5921-3217ШалинаМ. А.ShalinaM. A.

Шалина Мария Александровна – к.м.н., старший научный сотрудник отдела гинекологии и эндокринологии

199034, Санкт-Петербург, Менделеевская линия, д. 3

Maria A. Shalina – MD, PhD, Senior Researcher, Department of Gynecology and Endocrinology

3 Mendeleevskaya Liniya, Saint Petersburg 199034

amarus@inbox.ruhttps://orcid.org/0000-0002-6800-8661СейидоваЧ. И.SeyidovaC. I.

Сейидова Чимназ Идаят Кызы – клинический ординатор

199034, Санкт-Петербург, Менделеевская линия, д. 3

Chimnaz I. Seyidova – MD, Clinical Intern

3 Mendeleevskaya Liniya, Saint Petersburg 199034

ФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д.О. Отта»; ФГБОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Министерства здравоохранения Российской ФедерацииРоссияOtt Research Institute of Obstetrics, Gynecology and Reproductology; Mechnikov North-Western State Medical University, Health Ministry of Russian FederationRussian FederationФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д.О. Отта»РоссияOtt Research Institute of Obstetrics, Gynecology and ReproductologyRussian Federation202009012021146675684Copyright © Yarmolinskaya M.I., Shalina M.A., Seyidova C.I., 20212021Ярмолинская М.И., Шалина М.А., Сейидова Ч.И.Yarmolinskaya M.I., Shalina M.A., Seyidova C.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/878

Administration of menopausal hormone therapy (MHT) in patients with genital endometriosis (GE) is a controversial issue requiring a patient-personalized approach. Current principles for MHT selection and prescription in patients with anamnestic endometriosis are presented, which are based on the guidelines of the International Menopause Society (IMS), The European Menopause and Andropause Society, local and foreign publications retrieved from electronic data bases PubMed, Cyberleninka. The data of our study on observing 724 patients with GE treated with diverse MHT types were presented and analyzed (428 women in perimenopausal period, 296 in postmenopausal period). Patients with endometriosis in perimenopausal and postmenopausal periods showed more prominent manifestations of climacteric and post-ovariectomy syndromes, as well as high risk of reduced bone mineral density (BMD) due to repeated surgery on the ovaries and preceding long-term “antiestrogen therapy”. Custom-compounded MHT based on components combinations, dosage and administration route provides a significantly improved quality of life for patients with endometriosis, prevents loss of BMD and reduces risk of cardiovascular diseases. Using low and ultra-low dose estrogen bioidentical to natural substances in this patient group minimizes a risk of disease recurrence.

Вопрос о назначении менопаузальной гормональной терапии (МГТ) пациенткам с генитальным эндометриозом (ГЭ) является дискуссионным и требует персонифицированного подхода. В обзоре представлены современные принципы подбора и назначения МГТ у женщин с ГЭ в анамнезе на основании клинических рекомендаций Международного общества по менопаузе (IMS), Европейского общества по менопаузе и андропаузе (EMAS), отечественных и зарубежных литературных источников электронных баз PubMed, CyberLeninka. Представлены и проанализированы результаты собственных наблюдений 724 пациенток с ГЭ, получавших различные варианты МГТ (428 женщин в перименопаузальном периоде, 296 – в постменопаузе). Пациентки с эндометриозом в пери- и постменопаузальном периодах имеют более выраженные проявления климактерического и постовариоэктомического синдромов, а также высокий риск снижения минеральной плотности костной ткани (МПК), что обусловлено неоднократными оперативными вмешательствами на яичниках, длительной предшествующей «антиэстрогенной терапией». Индивидуально подобранная МГТ с учетом комбинации компонентов, доз и пути введения обеспечивает достоверное улучшение качества жизни больных эндометриозом, профилактирует потери МПК и снижает риск возникновения заболеваний сердечно-сосудистой системы. Использование низких и ультранизких доз эстрогенов, биоидентичных натуральным, у данной категории пациенток минимизирует риск развития рецидива заболевания.

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