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Hormone replacement therapy (HRT) refers to the treatment of postmenopausal women with estrogen deficiency to supplement estrogen and progesterone to relieve their menopausal symptoms.

Hormone replacement therapy

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Hormone replacement therapy (HRT) refers to the treatment of postmenopausal women with estrogen deficiency to supplement estrogen and progesterone to relieve their menopausal symptoms.

On October 27, 2017, the list of carcinogens published by the International Agency for Research on Cancer of the World Health Organization initially compiled the reference. The estrogen-progestin treatment for menopause (combination) is in the list of carcinogens. ^[1]

During fertility

(1) Alleviate menopausal symptoms such as hot flashes, sweating, irritability, depression, fatigue, sleep disturbances, palpitations, headaches caused by estrogen deficiency;

(2) Treatment of senile urogenital atrophy;

(3) prevention and treatment of postmenopausal osteoporosis;

(4) reduce the incidence of coronary heart disease;

(5) Prevention

There are absolute and relative contraindications: (1) Absolute contraindications: unexplained vaginal bleeding, acute liver disease, chronic severe liver damage, acute vascular embolism (with or without emboli formation), ocular neurovascular disease, and recently occurred Endometrial cancer and breast cancer; (2) relative contraindications: history of seizures, severe hypertension, cystic fibrotic disease of the breast, uterine fibroids,

Collagen disease,

1.Estrogen

natural

The compatibility of estrogen, progesterone and androgen in HRT is as follows:

Estrogen alone

Only for women with hysterectomy who do not need to protect the endometrium. Mainly continuous medication. It should be noted that for women with intact uterus, even if the estrogen is used periodically (such as 30 days per cycle, 25 days with estrogen, and 5 days of withdrawal), it will not prevent endometrial hyperplasia.

Combination of estrogen and progestin

Applicable to women with intact uterus, the purpose of adding progestin may have a coordinating effect on the promotion of new bone formation, in addition to the role of estrogen in promoting endometrial overgrowth. Can be divided into the following two ways. (1) Sequential application of estrogen and progesterone: Simulate the physiological cycle, add progestin for 10 to 14 days per month on the basis of estrogen, and it is divided into two schemes, periodic and continuous. The periodic plan is to stop medication for 4 to 7 days per month: estrogen is used daily in the first 25 days of each month. Progestin is usually added on the 12th to 16th days of the cycle. After 25 days, estrogen and progestin are discontinued. Patients usually experience vaginal bleeding. Continuous regimen: estrogen is used daily, and progestin is added on the first 1 to 14 days of each month or the last 10 to 14 days of each month. Normal withdrawal bleeding usually occurs after 10 days of progestin use. The consistent protocol is more convenient for patients. Sequential therapy with estrogen and progesterone has a high but regular vaginal bleeding rate, which is suitable for women who are younger, early menopause, and can accept periodic vaginal bleeding. (2) Continuous combined application of estrogen and progesterone: The daily combined use of estrogen and progesterone is suitable for older women who are unwilling to have periodic vaginal bleeding, but often have unpredictable vaginal bleeding within half a year of medication.

Progestogen alone

It is used periodically and continuously. The former is suitable for menopause. It is often called a progesterone withdrawal test. For example, 10 mg of MPA per day is used for 5 to 7 days. If vaginal bleeding occurs 7 to 10 days after discontinuation, The estrogen level in the patient is not low, and estrogen is not needed for the time being. For patients with irregular menstruation, using progestin once every 3 months can prevent endometrial hyperplasia and judge the state of estrogen in the body. Continuous short-term use of progestin is suitable for women with severe postmenopausal symptoms who need HRT but have estrogen contraindications.

Androgen

The purpose of adding androgens is to promote protein synthesis, strengthen muscle strength, increase bone density, improve sexual desire, and increase patients' interest in external things.

oral

Is the most commonly used medication in the clinic. After oral administration of the drug, it enters the blood circulation through the enterohepatic circulation and acts on target organs, so the estrogen concentration in the blood easily fluctuates. Steroid hormones have an impact on liver carbohydrate and lipid metabolism, as well as on bile production and excretion. The liver affects the activity of sex hormones by regulating the production of sex hormone binding proteins. Similarly, the level of sex hormones absorbed into the blood also affects the concentration of sex hormone binding proteins.

Parenteral use

Mainly includes transdermal use (skin patch,

Endometrial problems

Endometrial bleeding cannot be avoided in HRT, and estrogen can promote endometrial cell mitosis and promote endometrial hyperplasia. Progesterone can increase the activity of 17E2 dehydrogenase in the endometrium and promote the metabolism of E2. At the same time, it can down-regulate the concentration of estrogen receptors in the nucleus and inhibit DNA synthesis. The role of membrane hyperplasia. It is currently believed that the duration of progestin use per cycle is more important than the dose. A large number of literature studies have confirmed that the long-term use of estrogen for more than 5 years, even if regularly added progestin, women's risk of endometrial cancer is still increased. However, endometrial cancer caused by estrogen therapy has low malignancy, good tissue differentiation, and early detection, so it does not increase the mortality of endometrial cancer. When applying HRT, it should be monitored regularly

Drug name Recommended dosage method Estrogen combined with estrogen 0625, 125mg orally, once daily combined with estrogen ointment 05, 10g vaginal use, once daily micronized estradiol 10, 20mg orally, once daily Levy Love 125, 25mg orally, once a day, half of Esther Gel or 1-dose transdermal, once a day, skin patch, use transdermal nilestriol 1, 2mg, once every 2 weeks

Progesterone Angong Progesterone 4 10mg orally once a day, sequential therapy should be used every cycle

Take 2 mg orally once daily for 10 to 14 days, combined regimen Note: Levial chemical name is 7-methylisonornone, which is a steroid with both estrogen, weak progesterone and androgenic activity. Use alone without progestin.