Page 66 - GALENIKA MEDICAL JOURNAL

Atherosclerosis progresses more rapidly in postmenopau- Sequential therapy is used in women who still have men-
sal women, leading to a progressively increased risk of car- struation (in perimenopause) and continue to have regular
diovascular diseases. monthly bleeding while using it. There are preparations
available in the form of tablets or patches on the pharma-
ceutical market, which are used for three weeks, followed
Peri/postmenopausal treatment by a week-long break during which bleeding occurs. Addi-
tionally, the placement of an intrauterine system with le-
As mentioned earlier, the decline in ovarian function le- vonorgestrel (to protect the endometrium) and the use of
ads to numerous episodes of irregular bleeding from the estrogen preparations are also options to consider.
genital tract. Although these are most commonly dysfun-
ctional bleeding episodes, it is necessary to exclude other Continuous hormone replacement therapy involves da-
organic causes of this bleeding. Only after confirming that ily intake of hormone preparations and is initiated after 12
there is no organic cause for the irregular bleeding, indi- months of amenorrhea (thus in postmenopause), achieving
cating dysfunctional bleeding, can medical treatment be the maintenance of endometrial atrophy, and these women
initiated. For this purpose, gestagen preparations are used, do not experience bleeding. Continuous use also includes
typically given for about 10 days per month (usually from the use of tibolone - a synthetic steroid hormone that acts
the 16th to the 25th day of the cycle). They are administered as an agonist on steroid receptors. Hormone replacement
cyclically over a longer period and are followed by regular therapy can also be administered locally. This form of appli-
bleeding from the uterus. If bleeding does not occur after cation involves the vaginal use of estrogen preparations in
their administration, it indicates postmenopause as the en- the form of cream or vaginal tablets, which affects vaginal
dogenous production of estrogen has ceased. Another opti- mucosal atrophy .
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on for gestagen administration is the use of an intrauterine
device (IUD or "coil") with the addition of gestagen (known Contraindications for hormone replacement therapy
as an intrauterine system with levonorgestrel) for therapeu- include: vaginal bleeding of unknown cause, pregnancy, se-
tic purposes, with local effects on the endometrium to con- vere liver disease, episodes of venous thromboembolism,
trol bleeding, as well as providing additional contraceptive and risk of breast cancer. The most common concerns abo-
effects. ut hormone replacement therapy relate to the risk of breast
cancer. However, modern perspectives indicate that the use
To control the menstrual cycle in premenopausal wo- of hormone replacement therapy slightly increases the risk
men, contraceptive pills can be used, especially if women of breast cancer after 5 years of use. Additionally, it has been
reqire contraception and there are no contraindications. It observed that women who received hormone replacement
has already been mentioned that these women are at risk therapy and developed breast cancer have smaller tumors,
of unintended pregnancy, although the risk is very low. Con- better-differentiated tumors, and negative lymph nodes at
traceptive pills can practically be used up to the age of 50. the time of diagnosis compared to women with breast can-
cer who did not receive hormone replacement therapy. For
In the peri- and postmenopausal periods, hormone the initiation of hormone replacement therapy, in addition
replacement therapy can be utilized. The use of hormone to a thorough medical history, it is necessary to conduct a
replacement therapy in peri- and postmenopause can be breast ultrasound examination as well as mammography,
symptomatic and preventive. Symptomatic use often in- along with liver function tests and coagulation parameter
volves controlling vasomotor symptoms, and managing tests. Routine mammography is advised for all women in
intense mood swings, fatigue, and lethargy. Estrogen the- peri/postmenopause, starting from the age of 40, along
rapy quickly brings these symptoms under control. Within with screening for osteoporosis. An alternative to hormo-
a month, the mentioned symptoms significantly decrease, ne replacement therapy is the use of products containing
and patients experience an improvement in their quality of phytoestrogens. Phytoestrogens are plant polyphenols that
life. The protective effect pertains to its beneficial impact on structurally resemble steroid hormones and exhibit similar
bone mineral density and the development of atherosclero- activity to estrogens .
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sis. A newer indication for protective use is its application in
cases of high risk for developing senile dementia or Alzhei-
mer's disease.
Osteoporosis
If women have a uterus, along with estrogen, it is ne- Osteoporosis is a metabolic bone disorder characteri-
cessary to administer progestin preparations to protect the zed by reduced bone mass and deterioration of bone tissue
endometrium. Unopposed estrogen stimulation can be a microarchitecture, leading to increased bone fragility. This
risk factor for the development of endometrial cancer. In condition compromises overall health with physical, psyc-
women who have had a hysterectomy, there is no need for hosocial, and economic consequences. It represents a chro-
gestagene administration. nic-progressive multifactorial condition. It is most common-
In women with a uterus, hormone replacement thera- ly diagnosed in older Caucasian women, although it occurs
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py can be administered either sequentially or continuously. in sexes, all age groups, and all races .

64 DOI: 10.5937/Galmed2409072B