Hormone m`malo mankhwala a kusintha kwa msambo: zabwino ndi mavuto

Kusiya kwa amuna ndi mutu womwe nthawi zambiri umapereka malingaliro ambiri pakati pa azimayi - omwe amawalandira ndi omwe amawopa. Palinso zokambirana zambiri zokhuza ngati ichi ndichinthu chomwe chiyenera “kuchiritsidwa” kapena ngati zonse zachitika mwachilengedwe, popanda kugwiritsa ntchito mankhwala.

Kwa azimayi ena, kusintha kwa kubereka sikuli kokha kumaliza kwa kubala kwawo. Zimatha kukhudza kwambiri matenda operewera monga shuga mtundu 2 shuga. Amayi omwe ali ndi matenda ashuga ayenera kudziwa kwambiri zakusintha kuposa azimayi ena ambiri.

Ngati kuvunda kwa mayi kumadutsa masiku 28 alionse kapena kuposerapo, ndiye kuti ndi njira yakuwasamba, kusinthasintha kwakukulu kungaoneke. Mutha kukhala ndi maulendo omwe amatha masiku 40 kapena kupitilira nthawi yayitali, ndipo nthawi zina, masiku ovuta amabwera pakatha milungu ingapo. Izi zikachitika, kuchuluka kwa mahomoni anu, estrogen ndi progesterone, amasintha pang'ono. Kusintha kwa ma horoni kungakhudze glucose wamagazi anu, omwe mwa azimayi omwe ali ndi matenda a shuga a 2 angayambitse mavuto.

Pofuna kupewa zovuta za matenda ashuga amtundu wa 2, ndikofunikira kuti magazi anu asungunuke ngakhale zotheka - chinthu chomwe chingakhale chovuta panthawi ya kusamba.

Kuzindikira Zizindikiro Zakugonjera

Zizindikiro zina za kutha kusamba zitha kukhala zolakwika chifukwa cha kuchuluka kwambiri kwa magazi kapena kuchepa kwambiri kwa magazi, kuphatikizapo chizungulire, thukuta, komanso kusakwiya. Ndi zizindikiro ngati izi, zimakhala zovuta kuti mzimayi azindikire kuti ndi chiyani. M'malo mongoganiza, muyenera yang'anani mulingo wamagazi anumukakumana ndi izi. Ngati zizindikiro zikupitilira kapena kusakhala bwino, kufunsa dokotala za njira zamankhwala.

Amayi omwe ali ndi matenda amtundu wa 2 omwe ali onenepa kwambiri amatha kudwala pambuyo pake kuposa anzawo. Zakhazikitsidwa kuti milingo ya estrogen mwa amayi omwe ali onenepa kwambiri ikutsika pang'onopang'ono kuposa omwe ali onenepa kapena abwinobwino.

Mavuto azaumoyo

Amayi omwe ali ndi matenda amtundu wa 2 omwe adadutsa kusamba sangakhalenso ndi kusinthasintha kwa mahomoni omwe amakhudza kuchuluka kwa shuga m'magazi, koma amakhalanso ndi mavuto ena azaumoyo. Ali ndi chiwopsezo chachikulu chotenga matenda a atherosulinosis, kuumitsa ndi kukhazikika kwa makoma amitsempha yamagazi, omwe angayambitse kugunda kapena kugunda kwa mtima. Kulemera pambuyo pakusiya kwachilendo sikwachilendo, koma zikuwoneka kuti ndizofala kwambiri pakati pa amayi omwe ali ndi matenda amtundu wa 2, omwe amawonjezera chiopsezo cha matenda a mtima.

Chifukwa chosiya kusamba komanso kugona mokwanira, ngozi ina imabwera: matenda a mafupamatenda a mafupa. Ngakhale azimayi omwe ali ndi matenda a shuga a 2 sakhala pachiwopsezo chachikulu cha mafupa ngati odwala matenda amtundu wa 1, ali ndi chiopsezo chachikulu cha kupunduka kwa mafupa nthawi yomwe akusamba kuposa azimayi omwe alibe shuga.

Hormone m'malo mankhwala

Hormone replacement tiba (HRT) imakhalabe nkhani yovuta, koma ingakhale njira yabwino kwa azimayi omwe ali ndi matenda ashuga a mtundu wa 2 omwe akukumana ndi mavuto obwera chifukwa chosiya kusamba ndipo amakhala ndi vuto lowongolera kuchuluka kwa shuga m'magazi. Kafukufuku wokhudza chitetezo cha HRT pambuyo kusintha kwa kubereka atakhala ndi zotsutsana, koma madotolo ena akubwerera kuvomerezedwa ndikugwiritsa ntchito mahomoni, komabe mosamala.

Komabe, si madokotala onse omwe amavomereza izi. Nthawi zambiri zimavomerezedwa kuti mayi ayenera kuyamba HRT pokhapokha ngati zizindikiro zake, monga kutentha kwambiri, zikuluzikulu ndipo sizingayendetsedwe m'njira zina. Ngati mayi aganiza kuti asatenge HRT, ayenera kukambirana za chithandizo chake cha matenda ashuga ndi dotolo, chifukwa angafunike Mlingo wochepera kuposa momwe anali asanasiye.

Kusamba kumakhala ndi kusintha kwa mayi aliyense, kugwira ntchito ndi madokotala munthawi yofunikira ino ya moyo kumakuthandizani kuti musinthe bwino.

Chifukwa chake chikhalidwe: aliyense masamba ali ndi nthawi yake

Ukalamba - ngakhale uli wachilengedwe, koma sizotheka kukhala gawo losangalatsa kwambiri m'moyo wa munthu aliyense. Zimabweretsa zosinthika zomwe sizimapangitsa mkazi kukhala wolimbikitsa nthawi zambiri komanso zosiyana. Chifukwa chake, ndi kusamba, mankhwala ndi mankhwala nthawi zambiri amangofunikira kumwa.

Funso lina ndikuti adzakhala otetezeka komanso ogwira ntchito bwanji. Kusunga ndendende pakati pa magawo awiri awa ndivuto lalikulu kwambiri pamakampani azachipatala amakono ndi mankhwala othandiza: kuthamangitsa mpheta, kapena kuthamangitsa njovu ndi slipper sikungathandize, ndipo nthawi zina kumakhala koopsa.

Ma mahomoni ophatikizika

Monga chithandizo chamankhwala cha kusintha kwa mahomoni mu kusintha kwa thupi, kuphatikiza ma mahomoni ophatikizika ndi ma estrojeni oyera angadziwike. Ndi mankhwala ati omwe amalimbikitsidwa ndi dokotala anu zimatengera zinthu zambiri. Izi zikuphatikiza:

• zaka odwala
• zopikisana
• kulemera kwa thupi
• kuopsa kwa zizindikiro za kusamba
• concomitant extragenital matenda.

Phukusi limodzi lili ndi miyala 21. Mapiritsi 9 oyambilira a chikasu ali ndi gawo la estrogen - estradiol valerate mu gawo la 2 mg. Mapiritsi 12 otsalawa amakhala a bulauni ndipo amaphatikizapo estradiol valerate mu 2 mg ndi levonorgestrel pa mlingo wa 150 mcg.

Wothandizirana ndi mahomoni amayenera kutengedwa piritsi limodzi tsiku lililonse kwa milungu itatu, kumapeto kwa phukusili, kupumula kwa masiku 7 kuyenera kuchitika nthawi yomwe kusanza kumayamba. Potenga msambo wopulumutsidwa, mapiritsi amatengedwa kuchokera tsiku la 5, kusamba kosasamba - tsiku lililonse kupatula kukhala ndi pakati.

Gawo la estrogenic limachotsa zisonyezo zoipa za psychoemotional komanso autonomic. Zomwe zimachitika kawirikawiri ndizophatikizira: zovuta za kugona, hyperhidrosis, kutentha kwa moto, maliseche owuma, kuvutikira kwina, ndi ena. Gawo la progestogen limalepheretsa kupezeka kwa njira za hyperplastic ndi khansa ya endometrial.

Cyclo-Proginova

Chotumpacho chili ndi miyala 21. Mapiritsi 11 oyamba ali ndi gawo lokhalo la estrogen - estradiol valerate mu gawo la 2 mg. Mapiritsi 10 otsatira a bulauni ali ndi zigawo za estrogen ndi progestogen: estradiol muyeso wa 2 mg ndi norchedrel mu kipimo cha 0,15 mg. Cyclo-Proginov ayenera kumwedwa tsiku lililonse kwa milungu itatu. Kenako muyenera kusunga kupuma kwa sabata, pomwe magazi amayamba kusamba.

Mbiri yakumaso

Kwa mkazi, estrogen, progestin ndipo, modabwitsa, androgens atha kudziwidwa ngati mahomoni oyambira pakugonana.

Mwakuyandikira, magulu onsewa akhoza kufotokozedwa motere:

• estrogens - mahomoni achikazi,
• progesterone - mahomoni oyembekezera,
• androgens - kugonana.

estradiol, estriol, estrone ndi ena mwa mahomoni a steroid omwe amapangidwa ndi thumba losunga mazira. Ndizothekanso kuphatikiza kwawo kunja kwa njira yolerera: adrenal cortex, minofu ya adipose, mafupa. Omwe amatsogolera ndi androgens (a estradiol - testosterone, komanso estrone - androstenedione). Pakugwiritsa ntchito bwino, estrone ndiwotsika kwambiri ku estradiol ndikuisintha pambuyo kusintha kwa kubereka. Ma mahomoni awa ndi othandizira othandizira pazotsatira izi:

• kusasitsa chiberekero, nyini, fallopian machubu, mammary tiziwalo timene timatulutsa, kukula ndi kufupika kwa mafupa amtali wa malekezero, kukulira kwa chikhalidwe chachiwiri (kukula kwa tsitsi laimayi, kutulutsa kwamkono ndi ziwalo zamkati), kuchuluka kwa gawo la epithelium la kumaliseche ndi chiberekero, kutulutsa ziwalo magazi.
• Mahomoni ochulukirapo amatsogolera ku keratinization yocheperako komanso kuchepa kwa nyini, kumera kwa endometrium.
• Estrogens imasokoneza kuyambiranso kwa minofu ya mafupa, amalimbikitsa kupanga zinthu zamagazi ndikuwongolera mapuloteni, kuchepetsa kuchuluka kwa cholesterol yaulere komanso lipoproteins yotsika, kuchepetsa ngozi za atherosulinosis, kuonjezera kuchuluka kwa mahomoni a chithokomiro, thyroxine m'magazi,
• sinthani ma receptor kuti akhale olingana ndi ma progestin,
• tsitsani edema chifukwa cha kuchuluka kwa madzimadzi kuchokera mu chotengera kulowa malo ophatikizika motsutsana ndi maziko a sodium posungira.

Ma progestin

makamaka imapereka pakati komanso kukula kwake. Amasungidwa ndi adrenal cortex, mafupa am'mimba, ndipo nthawi ya gestation, ndi placenta. Ma steroid awa amatchedwanso progestogens.

• Mwa azimayi osakhala oyembekezera, estrogens amakhala olondola, kupewa kusintha kwa hyperplastic ndi cystic mu mucosa ya uterine.
• Atsikana, kuyamwa kumathandizidwa, ndipo mwa amayi akuluakulu, hyperplasia ya m'mawere ndi mastopathy amaletsedwa.
• Mothandizidwa ndi iwo, mphamvu ya chiberekero ndi ma fallopian amachepetsa, mphamvu zawo pazinthu zomwe zimapangitsa kuti minofu iwonongeke (oxytocin, vasopressin, serotonin, histamine) imachepa. Chifukwa cha izi, ma progestin amachepetsa kupweteka kwa msambo komanso amakhala ndi mphamvu yoletsa kutupa.
• Kuchepetsa chidwi cha minofu ku androgens ndipo ndi okonda androgen, akuletsa kaphatikizidwe ka testosterone yogwira.
• Kutsika kwa milingo ya progestin kumapangitsa kukhalapo ndi kuuma kwa premenstrual syndrome.

Androgens, testosterone, poyambirira, adakwaniritsidwa zaka khumi ndi zisanu zapitazo akuimbidwa milandu yonse yamachimo ndipo amangoonedwa ngati okhazikika mthupi la akazi:

• kunenepa
• zakuda
• kuchuluka kwa tsitsi lakumaso
• hyperandrogenism idangokhala yofanana ndi ovary ya polycystic, ndipo idayankhidwa kuthana nayo m'njira zonse zomwe zikupezeka.

Komabe, ndi kuchuluka kwa zochitika zodziwikiratu, zidapezeka kuti:

• kuchepa kwa androgens kumangoleketsa kuchuluka kwa collagen mu minofu, kuphatikiza pansi
• amachepetsa kamvekedwe ka minofu ndikuwatsogolera osati kutayika kwa mawonekedwe a akazi okha, komanso
• mavuto ndi kwamikodzo kugona
• kunenepa.

Komanso azimayi omwe ali ndi kuchepa kwa androgen momveka bwino ali ndi kutsika kwa chilakolako chogonana ndipo nthawi zambiri maubwenzi ovuta ndi orgasm amalembedwa. Androgens amapangidwa mu adrenal cortex ndi mazira amimba ndipo amayimiriridwa ndi testosterone (yaulere ndi yomangika), androstenedione, DHEA, DHEA-C.

• Mlingo wawo umayamba kutsika bwino mwa akazi pambuyo pa zaka 30.
• Ndi kukalamba kwachilengedwe, samapereka kugwa kwa spasmodic.
• Kutsika kwakukulu kwa testosterone kumawonedwa mwa akazi motsutsana ndi malekezero osokoneza bongo (atachotsa thumba losunga mazira).

Estrogen ndi matumbo

Phunziroli, Filipo ndi anzawo adalowetsa estrogen mu mbewa za postmenopausal. Zochitika zam'mbuyomu zidayang'ana momwe estrogen imagwirira ntchito pama cell a insulin. Tsopano, asayansi akuwona momwe estrogen imalumikizirana ndi maselo omwe amapanga glucagon, mahomoni omwe amakweza milingo yamagazi.

Malinga ndi kafukufuku watsopano, maselo a pancreatic alpha omwe amapanga glucagon amakhudzidwa kwambiri ndi estrogen. Zimapangitsa kuti ma cell amasulidwe glucagon wocheperako, koma mahomoni ambiri otchedwa Glucagon-like Peptide 1 (GLP1).

GLP1 imathandizira kupanga insulini, imalepheretsa kubisalira kwa glucagon, imapangitsa kumverera kovutikira, ndipo imapangidwa m'matumbo.

"Zowonadi, m'maselo amtundu wa L muli ma cell ofanana ndi ma cell a pancreatic alpha, ndipo ntchito yawo yayikulu ndikupanga GP1," akufotokoza a Sandra Handgraaf, m'modzi mwa olemba phunziroli. Sandra anati: "Zomwe taona zikuwonjezeka kwambiri pakupanga kwa GLP1 m'mimba mwake zikuwonetsa kufunikira kwake komwe kumathandizira kuti magawo azikhala ndi chakudya komanso kuchuluka kwa estrogen pa kagayidwe kake konse," akuwonjezera Sandra.

Pama cell aanthu, zotsatira za kafukufukuyu zatsimikiziridwa.

Wolemba nkhani yasayansi pankhani zamankhwala ndi zaumoyo, wolemba pepala lasayansi ndi Akker L. V., Stefanovskaya O. V., Leonova N. V., Khamadyanova S. U.

Kafukufuku adachitika, cholinga chake chinali chofuna kudziwa zotsatira za drospirenone, yomwe ndi gawo la Angelic otsika pang'ono, pa metabolism ya carbohydrate ndi hemostasis mwa odwala omwe ali ndi matenda a shuga 2 a azimayi am'mbuyomu. Tidaphunzira odwala 50 omwe ali ndi vuto la kusintha kwa thupi, omwe ali ndi vuto lakusintha kwachilengedwe, okhala zaka zoposa 2, akudwala matenda a shuga 2. Amayi 30 omwe alibe contraindication adapereka mankhwala ochepetsa Angelik. Tidayesa kagayidwe kazakudya mwa kusala shuga, C-peptide, insulini, kukana kwa insulini kudawerengeredwa ndi index ya Nomo, hemostasis ndi kuwerengetsa kwam'magazi, kuphatikiza, D-dimer poyamba, pambuyo pa miyezi 3 ndi 6 yamankhwala. Munthawi ya chithandizo ndi Angelik, kuchepa kwakukulu kwa glucose ndi insulin kukhudzidwa kunadziwika ndi mwezi wa 6 wa chithandizo, ndipo sizinakhudze momwe boma la hemostasis dongosolo. Zomwe zimapezeka zimatipangitsa kuti tivomereze mankhwala a Angelik kuti alowe m'malo mwa mankhwala opatsirana omwe ali ndi vuto lachiwiri la matenda ashuga, monga othandiza, otetezeka komanso ndi zina zowonjezera zabwino.

ZOPHUNZITSA NDIPONSO ZOSAVUTA: NJIRA ZOSAVUTA ZA REPLACEABLE HORMONAL THERAPY

Kafukufuku yemwe cholinga chake chimakhala chofotokozera kukopa kwa drospirenon yomwe ndi gawo lokonzekera Angeliq, pa kagayidwe kazakudya zamthupi ndi mawonekedwe a hemostasis kwa odwala omwe ali ndi matenda amitundu iwiri 2 a postmenopause. Odwala a 50 omwe ali ndi climacteric syndrome, omwe ali mu kusintha kwachilengedwe, atakhala zaka zoposa 2, mitundu iwiri yodwala matenda a shuga imawunika. Kwa amayi 30 omwe sakuchita zotsutsana ndi Angeliq adayikidwa kukonzekera. Magawo a kusintha kwa chakudya pamimba yopanda kanthu, Ndi-peptide, insulin, mndandanda wa kukana insulini. Magawo a heestasis pamlingo thrombocyte, kuwononga chinthu, D-Dimer poyamba, kudzera mwa 3 ndi miyezi 6 ya chithandizo. Panthawi ya mankhwala pokonzekera Angeliq taona kuchepa kwenikweni mulingo wa shuga ndi insulinresistance pofika miyezi 6 yolandirira Kulimbikitsidwa kwina kwamakina a heestasis. Zambiri zomwe zilipo zimalola kuti akuwongolera kukonzekera kwa Angeliq kuti alowe m'malo mwa mahomoni odwala pambuyo pake, omwe akudwala matenda a shuga 2 omwe ndi othandiza, otetezeka komanso okhala ndi chiwerengero Zowonjezera zabwino.

Zolemba pazaka yasayansi pamutu wakuti "Matenda a shuga ndi kusintha kwa thupi: mwayi wamakono wamankhwala amaloza mahomoni"

L.V. Akker, O.V. Stefanovskaya, N.V. Leonova, S.U. Khamadyanova SUGAR DIABETES NDI CLIMAX: MALO OGULITSIRA A SORSTITUTE HORMONAL THERAPY

Department of Obstetrics and Gynecology No. 2 Altai State Medical University Barnaul, Russia

Kafukufuku adachitika, cholinga chake chinali kudziwa mphamvu ya drospirenone, yomwe ndi gawo la mankhwala ochepetsa Angelique, pa metabolism metabolism ndi hemostasis mwa odwala omwe ali ndi matenda a shuga 2 a azimayi am'mbuyomu.

Tidaphunzira odwala 50 omwe ali ndi vuto lakusintha kwachilengedwe, osatha zaka 2, akudwala matenda amtundu wa 2. Amayi 30 omwe alibe contraindication adapereka mankhwala ochepetsa Angelik.Tidayesa kagayidwe kazakudya mwa kusala shuga, C-peptide, insulini, insulin kukokana adawerengeredwa ndi Noto index, hemostasis ndi cholembera manambala, coagulogram, D-dimer poyamba, atatha 3 ndi miyezi 6 ya chithandizo.

Panthawi ya chithandizo ndi Angelik, kuchepa kwakukulu kwa glucose ndi insulin kukhudzidwa ndi miyezi 6 ya makonzedwe kunadziwika, ndipo sizinakhudze momwe boma la heestasis dongosolo.

Zomwe zimapezeka zimatipangitsa kuti tivomereze mankhwala a Angelik kuti alowe m'malo mwa mankhwala opatsirana omwe ali ndi vuto lachiwiri la matenda ashuga, monga othandiza, otetezeka komanso ndi zina zowonjezera zabwino.

Mawu ofunika: kusintha kwa kusintha kwa thupi, mtundu wachiwiri wa matenda ashuga, kupatsanso mankhwala, kupatsa mphamvu kwa kagayidwe kazakudya, hemostasis.

L.V. Akker, O. V. Stefanovskaja, N. V. Leonova, S. U. Hamadyanova DIABETES NDI CLIMAX: MALO OGULITSIRA A HORMONAL THERAPY

Kafukufuku yemwe cholinga chake chimakhala chofotokozera kukopa kwa drospirenon yomwe ndi gawo lokonzekera Angeliq, pa kagayidwe kazakudya zamthupi ndi mawonekedwe a hemostasis kwa odwala omwe ali ndi matenda amitundu iwiri 2 a postmenopause.

Odwala a 50 omwe ali ndi climacteric syndrome, omwe ali mu kusintha kwachilengedwe, atakhala zaka zoposa 2, mitundu iwiri yodwala matenda a shuga imawunika. Kwa amayi 30 omwe sakuchita zotsutsana ndi Angeliq adayikidwa kukonzekera. Magawo a kusintha kwa chakudya pamimba yopanda kanthu pamimba yopanda kanthu, Ndi-nenTHga, insulin, mndandanda wa kukana insulini. Magawo a heestasis pamlingo thrombocyte, kuwononga chinthu, D-Dimery poyamba, kudzera mwa 3 ndi miyezi 6 ya chithandizo.

Panthawi ya mankhwala pokonzekera Angeliq taona kuchepa kwenikweni muyezo wa shuga ndi insu-lin-kukana ndi 6 mwezi kulandira

Kukhalapo kwa kukopa pamachitidwe a heestasis.

Zambiri zomwe zilipo zimalola kuti akuwongolera kukonzekera kwa Angeliq kuti alowe m'malo mwa mahomoni odwala pambuyo pake, omwe akudwala matenda a shuga 2 omwe ndi othandiza, otetezeka komanso okhala ndi chiwerengero Zowonjezera zabwino.

Mawu osakira: climacterical syndrome, mtundu wa shuga 2, kusintha kwina kwa mahomoni, kusinthana kwa chakudya, heestasis.

Matenda a shuga mellitus (DM) ndi gulu la matenda a metabolic omwe amadziwika ndi hyperglycemia. Ambiri mwa anthu odwala matenda ashuga ali m'magulu awiri ofala kwambiri a etiopathogenetic: mtundu 1 wa matenda ashuga mellitus (DM1) omwe ali ndi vuto la kuperewera kwa insulin ndi mtundu wachiwiri wa matenda ashuga, momwe hyperglycemia imayamba chifukwa cha kuphatikiza kwa insulin komanso kuyankha kwamphamvu kwa insulin-3 , 4. Pokhudzana ndi kusintha kwa kubereka, kufunikira kwakukulu kwambiri kwamatenda

ali ndi matenda ashuga 2. Amakhala ndi 90-95% ya odwala onse omwe ali ndi matenda ashuga.

Kuchulukitsa kwa matenda a shuga kumawonjezereka kwambiri mwa azimayi ochepera zaka 50 ndipo, mwina, kusintha kwa thupi kumakhala ndi gawo lina pakuchulukitsa kwake pakati pa azimayi omwe ali pagulu lakale. Malinga ndi kulembetsa kwa matenda ashuga ku Altai Territory, kuchuluka kwa matenda ashuga 2 mwa azimayi ndi 3,9%. Pa zaka 40 mpaka 49, azimayi 1.1% amadwala matenda ashuga 2, ali ndi zaka 50-59, 2,2%, azaka zapakati pa 60-69, azimayi 8.7%

kuchuluka kwa zaka 70 ndi azimayi 11.3%.

Zatsimikiziridwa kuti mahomoni ogonana amakhala ndi zotulukapo zingapo pazida zosiyanasiyana ndi minyewa. Zotsatira zoyipa kwambiri komanso mawonetseredwe azachipatala a kuchepa kwa estrogen, omwe amakhudza kwambiri moyo wa azimayi pa peri - komanso zaka zaposachedwa, zimaphatikizira chiopsezo chotenga atherosulinosis, matenda oopsa a mtima, matenda a mtima (katatu . Matendawa ndi omwe amatsogolera kwambiri mwa zomwe zimayambitsa kufa kwa azimayi am'mbuyo, ndipo kulumpha kwakuthwa kumayambitsanso matenda kumachitika atayamba kusamba. Koma matenda ashuga ndi mtundu wakale wa zovuta zazing'ono - komanso macrovascular. Chotupa chachikulu chotere cha zotupa zonse zam'mimba sizimachitika ndi matenda ena aliwonse. Matenda a 2 a matenda a shuga ndi matenda a ziwiya zazikulu. Matenda amitsempha yamagazi ndi zotumphukira zamatenda zimayambitsa kuperewera kwambiri komanso kufa kwa odwala omwe ali ndi matenda amtundu wa 2 kuposa matenda opitilira muyeso: nephropathy, neuropathy, retinopathy, ngakhale kuti chiwopsezo cha matendawa chilinso chambiri. Kuphatikiza kwa menopausal syndrome ndi matenda ashuga kumapangitsa kuti zinthu ziziyenderana. Ichi ndichifukwa chake ndikofunikira kuti azimayi azikhala ndi matenda ashuga amtundu wa 2 ndikuchiza mokwanira komanso nthawi yomweyo kulipira molondola kusintha kwa mahomoni omwe ali ndi chizolowezi cha kusamba.

Kwa zaka zambiri, anthu amakhulupirira kuti azimayi omwe ali ndi matenda ashuga amapatsidwa mankhwala okhawo omwe amathandizira kuti asadwale. Chomwe chimayambitsa mfundo iyi chinali chakuti ambiri omwe amagwiritsidwa ntchito mu proT anali ndi vuto pa hemostasis, carbohydrate ndi lipid metabolism, kuchepetsa zotsatira zabwino za estrogen 1,2

Mavuto obwera chifukwa chogwiritsa ntchito HRT mwa azimayi omwe amachepetsa mphamvu ya ntchito yamchiberekero amathandizira kukulitsa ndi kukonza kwa chithandizo chamankhwala, kupangika kwa zigawo zatsopano za mahomoni ndipo, pamaziko awo, mankhwala atsopano ogwira ntchito ndi otetezeka. Mankhwalawa amayenera kuphatikizira kupsa

nkhope (Schering, Germany), yomwe ndi njira yamakono yopititsira patsogolo mankhwala osokoneza bongo ochepa: piritsi lililonse limakhala ndi 1 mg ya estradiol hemihydrate ndi 2 mg ya drospirenone. Kugwiritsa ntchito kwa drospirenone, komwe kumakhala ndi anti-thiandrogenic, mpaka kumatha kuthetsa zovuta za androgens pamachitidwe a metabolic. Kuthetsa kuchuluka kwa sodium yambiri motsogozedwa ndi drospirenone kumapangitsa kuti magazi aziyendetsedwa bwino. Kuphatikiza apo, zabwino za drospirenone pazinthu ndi ntchito ya endothelium, kuwonjezeka kwa zochita za nitric oxide, kuletsa kutembenuka kwa angiotensin 1 mpaka angiotensin 2, komwe kumathandizanso kuchepetsa kuthamanga kwa magazi, kusintha ntchito ya myocardial. Dros-pyrenone ali ndi zabwino pa boma la mbiri ya lipid. Funso limabuka pokhudzana ndi kuchuluka kwa drospirenone pa carbohydrate metabolism mu postmenopausal odwala omwe ali ndi matenda amtundu wa 2 shuga, gawo lofunikira lomwe limatsutsa insulini, komanso ngati zotsatira zake zimaphatikizidwa ndi kukana kwa insulini komanso glycemia wowonjezera.

Vuto linanso ndi vuto la drospirenone pa hemostasis, chifukwa HRT ndi chimodzi mwazinthu zomwe zimapangitsa kuti venous thrombosis ipangidwe.

Mafunso awa anali cholinga cha phunziroli.

Zipangizo ndi njira zakufufuzira

Phunziroli lidaphatikizapo odwala 50 omwe ali ndi vuto la kusintha kwa thupi kwa zaka 40 - 57 (zaka zapakati pa omwe anali nawo phunziroli anali azaka 52 ± 0,5), omwe ali ndi vuto lakubadwa kwachilengedwe kwa zaka zopitilira 2, omwe amadwala matenda a shuga 2 ndipo ali ndi mtundu wam'mimba kunenepa. Zizindikiro za HRT muzochitika zonse zinali kusokonezeka kwa azimayi, mwa zomwe zizindikiro za neurovegetative zinali. Mlingo wovuta kwambiri wa climacteric wapezeka mwa odwala atatu, digiri yapakati mu 20, wofatsa mu 27. Wowerengera pamlingo woyeserera index ya menopausal modified (MMI) isanachitike mankhwala anali ±5 ± 2 point.

Pofuna kukonza matenda okhudzana ndi kusintha kwa menopa, azimayi 30 omwe analibe zotsutsana adapatsidwa mankhwala ochepetsa Angelik. Kuyesedwa kwa azimayi 20 kwawonetsa hypertriglyceridemia, chifukwa chake, gulu ili la odwala linapatsidwa njira ina yothandizira - Clima-dinone (phytoestrogen "Binorica")

kafukufuku woyambitsa ndi lipid-kuchepetsa mankhwala. Pankhani ya matenda a triglycerides pambuyo miyezi itatu yamankhwala, azimayiwo adayankhidwa ndi a Angelik. HRT idalamulidwa kuti ilipire ndi kulipiranso za matenda a shuga. Odwala onse anali ndi luso lodziletsa, zokambirana pophunzitsidwa nawo adakumana nazo zokhudzana ndi kayendetsedwe ka zakudya, ndipo zochita zolimbitsa thupi zidalembedwa.

HRT isanayambike, kuyesedwa koyenera kunalembedwa: ma ultrasound am'mimba ndi ziwalo za m'chiuno, kuwunika kwa ma cytological smears, kuwunika kwa kusintha kwa magazi, kuyeza magazi, kufunsira ndi ophthalmologist, neurologist, nephrologist, zamtima. Kufufuza kwa CS kunachitika pogwiritsa ntchito cholembedwa cha kusintha kwa azimayi (E.V. Uvarova, 1983). Kuti muwone kuchuluka kwa kunenepa kwambiri kapena kunenepa kwambiri, mndandanda wama index (BMI) wawerengedwa. Kukula kwa kunenepa kwam'mimba kunatsimikiziridwa ndi kukula kwa chiuno (OT). Pa RT ya P80 masentimita, kunenepa kwam'mimba kunakhazikitsidwa (malinga ndi gulu la IDF, 2005).

Carbohydrate metabolism inayesedwa pogwiritsa ntchito kuchuluka kwa glycemia, immunoreactive insulin, C-peptide. Kuti tidziwe kukana insulini, tidawerengera index ya Homa.

Zizindikiro za Hemostasis zimayesedwa pogwiritsa ntchito coagulogram, ndende ya D-dimer.

Pulogalamu yonse yozindikira matenda inachitika koyamba kwa mankhwala a azimayi okhudzana ndi kusintha kwa magazi pambuyo pa miyezi itatu ndi isanu ndi umodzi.

Zotsatira za Kuphunzira ndi Kukambirana

Pakafukufuku woyamba, kunenepa kwambiri (BMI 25.0-29 / 9 kg / cm2) kunapezeka mu 15, kunenepa kwambiri I degree (BMI 30.0-34.9 kg / m2) mu 16, kunenepa kwambiri II degree (BMI 35.039.9 kg / m2) mu 15 , Kunenepa kwambiri kwa digiri ya III (BMI -40 kg / m2) mwa odwala 4. Onse anali ndi OT ya □ 80 masentimita, zomwe zimawonetsa kuti anali ndi kunenepa kwambiri pamimba. BMI miyezi itatu ndi isanu ndi umodzi chiyambireni kumwa mankhwalawa sichinasinthe kwenikweni, ngakhale panali njira yodziwika yochepetsera kulemera kwa thupi (BMI inatsika kuchoka pa 32 kg / m2 mpaka 30,67 kg / m2) Kukhazikika kwa chidziwitso chowunika kuchuluka kwa kunenepa kwambiri pamimba (OT) , samangolankhula za kusakhalapo kwa zotsatira zoyipa za mankhwalawa pakugwiritsa ntchito kunenepa kwambiri pamimba, komanso mphamvu yawo yoletsa kulemera (OT idatsika kuchoka pa 99.24 cm ± 1.9 mpaka 95.10 cm ± 1.8)

Kumwa mankhwalawa kwadzetsa kusintha kwabwino kwa kagayidwe kazakudya. Kuchepetsa kuchepa kwama glucose komwe kunapezeka mwezi wachitatu wa ntchito kwa HRT ndikuchepera kwambiri mwezi wachisanu ndi chimodzi, komanso kuchepa kwakukulu kwa insulini pofika mwezi wachisanu ndi chimodzi wa HRT adadziwikanso. (tabu 1,2)

The kuchuluka kwa shuga, insulin, C-peptide mu magazi seramu odwala kulandira mankhwala a Angelik ________

Zizindikiro Pangotha ​​miyezi itatu itatha miyezi isanu ndi umodzi

Kudalirika P1 P 2 P3

Glucose, mmol / L 7.83 ± 0.37 7.61 ± 0.31 6.78 ± 0.23

C-peptide, ng / ml 3.73 ± 0.67 3.35 ± 0.52 2.97 ± 0.4

Insulin, mIU / ml 15.94 ± 1.67 13.59 ± 1.31 13.05 ± 1.49

kumwa mankhwala Angelique ________________

Zizindikiro Poyamba Pakatha miyezi itatu itatha miyezi isanu ndi umodzi

Kudalirika P1 P 2 P3

Homo Index 5.19 ± 0.44 4.3 ± 0.37 3.72 ± 0.45 *

Chidziwitso: 0.02 Sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Fibrinogen, mg / L 3701 ± 48.59 3666.67 ± 24.95 3616.67 ± 23.16

APTT, sec 23.23 ± 0.99 24 ± 0.87 23.35 ± 0.8

RFMC, mg% 4.07 ± 0.17 3.91 ± 0.15 3.86 ± 0.16

Mapulatifomu, masauzande 284.31 ± 4.02 284.31 ± 3.36 285.83 ± 3.66

D-Dimer, ng / ml 100 ± 0 100 ± 0 100 ± 0

Chidziwitso: P Sindikupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

5. Jellinger P. Postprandial hyperglycemia ndi chiopsezo chamtima // Matenda a shuga. - 2004.-№2.— C.2-4.

6. Farquharson CA, Struthers AD. Spironolactone imawonjezera nitric oxide bioactivity, imapitirira endothelial vasodilator kukanika, ndipo imachepetsa mtima angiotensin I / angiotensin II kutembenuka kwa odwala omwe ali ndi vuto la mtima. Circulacion 2000, 101: 594-597

7. Godsland IF. Zotsatira za kuponderezedwa kwa hormone ya postmenopausal pa lipid, lipoprotein, ndi apolipoprotein (a) ndende: analisis of maphunziro ofalitsidwa kuyambira 1974-2000. Fertil Steril 2001, 75: 898-915

8. Hoibraaten E, Qvigstad E, Arnesen H, et al. Chiwopsezo chowonjezereka cha venous thromboembolism munthawi yamahomoni. Thromb Haemost 2000, 84: 961-967

9. Rosendaal FR, Vessey M, Rumley A, et al. Hormonal m'malo mankhwala, protrombotic masinthidwe ndi chiopsezo venous thrombosis. Br J Haematol 2002,1168: 851- 854

Kusamba

Lingaliro la kusintha kwa msambo limadziwika kwa aliyense. Pafupifupi nthawi zonse m'moyo watsiku ndi tsiku, mawuwa amakhala ndi mawu osokosera ngakhale otukwana. Komabe, ndikofunikira kumvetsetsa kuti njira zakukonzanso zokhudzana ndi zaka ndi zochitika zachilengedwe, zomwe siziyenera kukhala chiganizo kapena chizindikiro cha zovuta m'moyo. Chifukwa chake, nthawi yosiya kusamba imakhala yolondola kwambiri pamene, motsutsana ndi zakusintha zokhudzana ndi zaka, njira zoyambira zayamba kugonjera. Mwambiri, kusamba kungagawike m'magawo otsatirawa:

• Kusintha kwa kusintha kwa menoparance (pafupifupi, patadutsa zaka 40-45) - pomwe sizoyendayenda zonse zokhala ndi dzira, nthawi yayitali yazungulira, amatchedwa "kusokonezeka". Pali kuchepa kwa kupanga kwa ma follicle olimbikitsa follicle, estradiol, antimuller mahomoni ndi inhibin B. Poyerekeza ndi kuchepa, kupsinjika kwamaganizidwe, kutulutsa khungu, zizindikiro za urogenital za kuchepa kwa estrogen zitha kuyamba kuwonekera.
• Ndichizolowezi kunena za kusamba ngati kusamba komaliza. Popeza thumba losunga mazira limachoka, kusamba sikumatha pambuyo pake. Chochitika ichi chimakhazikitsidwa mwachangu, patatha chaka chosakhalitsa kusamba. Nthawi yakusamba kwa kusintha kwa msambo ndi munthu payekha, koma pali "chipatala chotentha" kuchipatala: kwa azimayi ochepera zaka 40, kusintha kwa thupi kumawerengedwa ngati msanga, koyambirira - mpaka 45, panthawi yake kuyambira 46 mpaka 54, mochedwa - pambuyo pa 55.
• Perimenopause imadziwika kuti kusintha kwa kubereka ndi miyezi 12 itatha.
• Postmenopause - nthawi pambuyo. Zowonetsa zosiyanasiyana za kusintha kwa kusamba nthawi zambiri zimagwirizanitsidwa ndi postmenopause yoyambirira, yomwe imatha zaka 5-8. Chakumapeto kwa postmenopusing, kutchulidwa kukalamba kwa ziwalo ndi minofu kumawonedwa, kuthana ndi zovuta zamasamba kapena kupsinjika kwa psychoemotional.

Perimenopause

imatha kuyankha ku thupi la mzimayi ngati ziwonetsero za kutalika kwa estrogen komanso kusowa kwa dzira (magazi a chiberekero, kuperewera kwa chifuwa, migraine), ndikuwonetsa kuchepa kwa estrogen. Zotsirizazo zitha kugawidwa m'magulu angapo:

• zovuta zamaganizidwe: kusokonekera, neurotizaption, kukhumudwa, kusokonezeka kwa kugona, kuchepa kwa ntchito,
• phenomena ya vasomotor: kutuluka thukuta kwambiri, kutentha kwambiri,
• Matenda a genitourinary: kuuma kwa ukazi, kuyabwa, kuwotcha, kukodza pokodza.

Zotsatira

imaperekanso zofanana chifukwa cha kusowa kwa estrogen. Pambuyo pake amathandizidwa ndikusinthidwa ndi:

• michere ya metabolic: kudzikundikira kwa mafuta am'mimba, kuchepa kwa chiwopsezo cha thupi kupita ku insulin yake, zomwe zingayambitse matenda a shuga a 2.
• mtima: kuchuluka kwa matenda a atherosulinosis (chonsecho cholesterol, otsika kachulukidwe lipoproteins), mtima endothelial kukanika,
• minofu: Mafupa olimbitsa mafupa olimbitsa thupi omwe amatsogolera ku mafupa,
• machitidwe a atrophic mu khungu ndi kumaliseche, kwamikodzo kusakhazikika, kukodza kwamkodzo, kutupa kwa chikhodzodzo.

Menoparance mahomoni

Chithandizo cha mankhwala a mahomoni mwa azimayi omwe ali ndi kusintha kwa msambo ali ndi ntchito yochotsa estrojeni yofooka, kuyimitsa ndi progestin kupewa hyperplastic ndi oncological njira mu endometrium ndi gland ya mammary. Mukamasankha minyewa, imachokera ku mfundo yakukwanira pang'ono, momwe mahomoni amagwira ntchito, koma alibe zotsatira zoyipa.

Cholinga cha kupangidwako ndikupititsa patsogolo moyo wa mkazi ndikupewa kuchepa kwa kagayidwe kachakudya.

Izi ndizofunikira kwambiri, chifukwa kutsutsana kwa othandizira komanso otsutsa omwe amaloza ma mahomoni achikazi achilengedwe kumakhazikika pakuwunika maubwino komanso kuvulaza kwa mahomoni opanga, komanso kukwaniritsa kapena osakwaniritsa zolinga za mankhwalawa.

Mfundo zachithandizo ndi kuikidwa kwa azimayi azaka zosaposa 60, ngakhale kuti kusamba kosadukiza kotsala kunali mwa mayi osadalipo zaka khumi zapitazo. Zokonda zimaperekedwa kuphatikiza kwa estrogen ndi progestin, pomwe mitundu ya estrogen imakhala yotsika, yolingana ndi ya azimayi achichepere omwe ali mu gawo la kuchuluka kwa endometrial. Mankhwalawa amayenera kuyamba pokhapokha atalandira chilolezo chodwala kuchokera kwa wodwalayo, kutsimikizira kuti akudziwa zonse zomwe zingachitike ndikuchiritsidwaku ndikuzindikira zabwino ndi zovuta zake.

Mukayamba

Mankhwala obwera ndi mahomoni amawonetsedwa:

• vasomotor mavuto ndi kusintha kwa mtima,
• mavuto atulo
• Zizindikiro zakutsokomola kwa genitourinary system,
• kusowa pogonana
• kusamba msanga komanso
• mutaterera,
• okhala ndi moyo wotsika motsutsana ndi msambo wa kusamba, kuphatikizapo chifukwa cha kupweteka m'misempha ndi mafupa,
• kupewa ndi kuchiza matenda a mafupa.

Nthawi yomweyo pangani malo osungira omwe motere ndi momwe azachipatala achi Russia amawonera vutoli. Chifukwa chake kusungidwa, taganizirani pang'ono.

Malangizo apakhomo, ndikuchedwa, amapangidwa pamaziko a malingaliro a International Menopause Society, omwe malingaliro ake m'ndandanda wa 2016 ali ofanana pafupifupi, koma atathandizira kale zinthu, zomwe zonse zimathandizidwa ndi mulingo waumboni, komanso malingaliro a American Association of Clinical Endocrinologists mu 2017, omwe amagogomezera chimodzimodzi pa chitetezo chotsimikizika cha mitundu yosiyanasiyana ya ma gestagen, kuphatikiza ndi mitundu ya mankhwala.

• Malinga ndi iwo, maukadaulo a azimayi pa nthawi ya kusintha kwa amuna ndi amuna akamakula.
• Kuikidwiratu kuyenera kukhala kwamunthu aliyense payekha ndikuzindikira mawonekedwe onse, kufunika kopewa, kukhalapo kwa ma concomitant pathologies ndi mbiri ya mabanja, zotsatira zakusaka, komanso chiyembekezo cha odwala.
• Kuthandiza kwa mahomoni ndi gawo limodzi la magwiridwe onse osintha moyo wa mayi, kuphatikiza zakudya, masewera olimbitsa thupi, kusiya zizolowezi zoyipa.
• Chithandizo cham'malo sayenera kufotokozedwa popanda zizindikiro zomveka za kuchepa kwa estrogen kapena zowoneka chifukwa chakusowa.
• Wodwala yemwe amalandila chithandizo chamankhwala amafunsidwa ku gynecologist kamodzi pachaka.
• Amayi omwe azimayi amasiya kusamba azaka zapakati pa zaka 45 amakhala ndi chiopsezo chachikulu cha mafupa, matenda amtima komanso matenda a dementia. Chifukwa chake, kwa iwo, chithandizo chamankhwala chiyenera kuchitika osachepera mpaka msambo wa kusamba.
• Funso la kupitilirabe mankhwala limasankhidwa payekhapayekha, poganizira zaubwino ndi zoopsa za wodwala wina, popanda zoletsa zovuta zaka.
• Kuchiza kuyenera kuchitika pa mlingo wotsika kwambiri.

Contraindication

Pamaso pa zinthu zotsatirazi, ngakhale zitakhala kuti pali njira zina zochiritsira zosagwiritsidwa ntchito, palibe amene amakupatsani mahomoni:

• magazi amtundu, chomwe sichidziwika,
• matenda a m'mawere,
• khansa ya endometrial
• pachimake kwambiri vein thrombosis kapena thromboembolism,
• pachimake hepatitis
• thupi lawo siligwirizana.

Mapiritsi a estrogen

• Ingotenga.
• Zambiri mwa kugwiritsa ntchito.
• Mankhwalawa ndiokwera mtengo.
• Pali zambiri za izo.
• Zitha kuphatikizidwa ndi progestin piritsi limodzi.

• Chifukwa cha mayamwidwe osiyanasiyana, muyeso wokwanira wa chinthu umafunikira.
• Kuchepetsa mayamwidwe chifukwa cha matenda am'mimba kapena matumbo.
• Zosasonyezedwa kuchepa kwa lactase.
• Phatikizani mapuloteni ophatikizidwa ndi chiwindi.
• Zambiri zimakhala ndi estrone yosagwira bwino kuposa estradiol.

Khungu la pakhungu

• Ndi yabwino kutsatira.
• Mlingo wa estradiol ndiwotsika kwambiri.
• Chiwerengero cha estradiol kuti estrone ndichilengedwe.
• Osapukusidwa mu chiwindi.

• Iyenera kugwiritsidwa ntchito tsiku lililonse.
• Yodula kuposa mapiritsi.
• Zomwe zimasiyanasiyana zingasiyane.
• Progesterone singathe kuwonjezeredwa ndi gel.
• Zothandiza kwambiri pamankhwala a lipid.

Chikopa

• Zambiri za estradiol.
• Sizikhudza chiwindi.
• Estrogen ikhoza kuphatikizidwa ndi progesterone.
• Pali mitundu yokhala ndi mitundu yosiyanasiyana.
• Mutha kusiya kulandira chithandizo mwachangu.

• Kusintha kumasintha.
• Imakhala yolimba ngati yonyowa kapena yotentha.
• Estradiol m'magazi imayamba kuchepa pakapita nthawi.

• Zitha kutumikiridwa chifukwa chosagwira mapiritsi.
• Mwina poika odwala ochepa ochepa matenda oopsa, kuwonongeka kwa kagayidwe kazakudya, ma pathologies am'mimba, migraines.
• Amapereka mwachangu komanso zosafunikira zakudya zomwe zimagwira m'thupi.

Mankhwala amodzi omwe amakhala ndi estrogen kapena progestin.

• Estrogen monotherapy akuwonetsedwa atachotsa chiberekero. Mukuyenda kwa estradiol, estradiolavalerate, estriol mosalekeza kapena mosalekeza. Mapiritsi, matumba, ma gels, zowonjezera zamkati kapena mapiritsi, jakisoni ndi kotheka.
• Pazokha, gestagen amalembedwa kusintha kwa kusintha kwa menopausal kapena perimenopause mu progesterone kapena dydrogesterone pama mapiritsi ndi cholinga chothandiza kuzungulira kwazowongolera komanso njira zochizira.

Kuphatikiza kwa estrogen ndi progestin

• Pakatikati kapena mosalekeza mozungulira (pokhapokha ngati palibe ma endometrial pathologies) - omwe amachitika nthawi ya kusintha kwa nthawi ya menoparance ndi perimenopause.
• Kwa azimayi a postmenopausal, kuphatikiza kwa estrogen ndi progestin nthawi zambiri kumasankhidwa kuti agwiritsidwe ntchito mosalekeza.

Kumapeto kwa Disembala 2017, msonkhano wa azachipatala unachitikira ku Lipetsk, komwe amodzi mwa malo apakati adatengedwa ndi funso la momwe amachiritsira mahomoni m'thupi pambuyo pake. V.E.Balan, MD, pulofesa, Purezidenti wa Russian Association for Menopause adanenanso madera omwe amakonda kulandira chithandizo chamankhwala.

Zokonda ziyenera kuperekedwa kwa transdermal estrogens kuphatikiza ndi progestin, momwe progesterone yoyenerera imafunira. Kuthana ndi izi kumachepetsa chiopsezo cha zovuta za thrombotic. Kuphatikiza apo, progesterone samangoteteza endometrium, komanso ili ndi mphamvu yotsutsana ndi nkhawa, ndikuthandizira kukonza kugona. Mlingo woyenera ndi 0,75 mg wa percutaneous estradiol pa 100 mg ya progesterone. Kwa akazi a perimenopausal, mankhwala omwewo amalimbikitsidwa mwa kuchuluka kwa 1.5 mg pa 200.

Amayi omwe ali ndi vuto lolephera kukonzekera m'mimba

Okhala ndi chiopsezo chachikulu cha kugwidwa, kugunda kwa mtima, kuchepa kwa magazi, mafupa komanso kusowa kwa kugonana, ayenera kulandira mitundu yayikulu ya estrogen.

• Kuphatikiza apo, kuphatikiza kwa njira yolerera pakamwa kungagwiritsidwe ntchito mpaka nthawi yakutha kwa kusintha kwa thupi, koma kuphatikiza kwapadera kwa estradiol ndi progesterone.
• Kwa azimayi omwe ali ndi chilako chochepa chogonana (makamaka motsutsana ndi mazira akutali) ndikotheka kugwiritsa ntchito testosterone mwanjira ya gels kapena patches. Popeza kukonzekera kwakuthupi kwa azimayi sikumapangidwa, amagwiritsa ntchito njira zomwezo mwa abambo, koma pamlingo wotsika.
• Poyerekeza ndi maziko azachipatala, pali zochitika za kuyambitsidwa kwa ovulation, ndiye kuti, pakati pathupi pena paliponse, mankhwala osokoneza bongo sangatengedwe ngati onse olera.

Kufunika kogwiritsa ntchito mankhwala othandizira am'mimba mwa azimayi omwe ali ndi matenda amtundu wa 2 mu kusintha kwa thupi

Pakadali pano, madokotala ambiri ali ndi lingaliro loipa la kulera kwa mahomoni, kaganizidwe kameneka kamasinthidwa kukhala njira yokhazikitsidwa ndi mahomoni (HRT) m'masiku a premenopausal ndi postmenopausal. Mankhwala othandizira kulera pakamwa komanso mankhwala obwezeretsanso mahomoni amaphatikizanso kupatsidwa kwa estrogen, nthawi zambiri kuphatikiza ndi progestogen. Kusiyana kwakukulu ndikuti ndi mankhwala othandizira kulera, ma estrogen opangidwa amaperekedwa mu Mlingo wopitilira muyeso kuti atsekere ovulation, pomwe mankhwala othandizira obwezeretsa mahomoni, kuchepa kwa mahomoni omwe adakhalapo amakonzedwa kokha ndi ma estrojeni achilengedwe, omwe samagwira kwenikweni kuposa omwe amapangidwa ndipo kapangidwe kosiyaniratu. Kuphatikiza apo, ma estrogens achilengedwe pakapangidwe kagayidwe kachakudya ka chiwindi sikukhudza microsomal michere yomwe imakhudzana ndi michere ya fibrinolysis, hemocoagulation ndi renin-angiotensin-aldosterone system.

Nthawi ya kusintha kwa thupi imasinthidwa mwachidule ngati vuto chifukwa cha kuchepa kwa timadzi tambiri tambiri tambiri timadzimadzi, komanso kulandira chithandizo chamankhwala monga chithandizo chofuna kubwezeretsanso vuto la mahomoni a m'mimba. Estrogen monotherapy imaphunziridwa bwino komanso imagwiritsidwa ntchito kwambiri. Kuonjezera ma progestogen mu estrogen monotherapy ndi njira ina yachilengedwe kwambiri ya HRT, komabe, amatha kusokoneza phindu la estrogens, makamaka pamtima.

Pamodzi ndi kuponderezedwa kwa ovulation, zotsatira za estrogen zowonjezera zimayambitsa zovuta za metabolic. Chiyanjano chawo chofunikira kwambiri ndikuwonjezereka kwa zochitika za corticosteroids, zomwe zimatsogolera ku insulin kukana. Kusintha kumeneku sikumawonedwa popereka mankhwala achilengedwe. M'malo mwake, mankhwala olimbitsa thupi am'magazi olimbitsa thupi amathandizira kusintha kwa metabolism.

Malinga ndi kafukufuku wambiri, zimawoneka zoyenera kugwiritsa ntchito mawu oti "mahomoni obwezeretsanso", komabe, zimatenga nthawi kuti onse madokotala ndi amayi apange mtundu wina wolingana ndi womwe kusintha kwa msambo kumayenderana ndi kuphatikizidwa kwa mahomoni.

Ndizodziwika bwino kuti mabuku onse otchuka komanso malingaliro a dokotala yemwe amatsimikizira zovuta zomwe zingachitike chifukwa cha HRT zimakhudza kwambiri odwala. Zikuwoneka kuti, ngakhale kufalitsa kwakukulu kwa HRT, madotolo ndi amayi athu ambiri agwirizana ndi kusasinthika kwa matenda okhudzana ndi menoparance. Kuopa khansa kumapangitsa kuti zikhale zovuta kuthana ndi malingaliro osokoneza bongo: menopausal syndrome ndikosapeweka komwe kuyenera kupirira. Izi zimawonekera makamaka pankhani ya azimayi omwe ali ndi matenda ashuga. Zotsatira za HRT pa carbohydrate metabolism ndi kusowa kwa chidziwitso pamavuto ndi chifukwa chomwe odwala omwe ali ndi matenda osokoneza bongo a HRT, monga lamulo, amakana.

Zomwe zimachititsa kuti madokotala komanso odwala omwe ali ndi matenda ashuga amtundu wa II asinthe, choyambirira, ndi ntchito yoletsedwa ya akatswiri azachipatala komanso ma endocrinologists, ndipo chachiwiri, chikhulupiliro chakuti kubwezeretsa mahomoni kuli ponseponse pakati pa onse odwala ndi madokotala mankhwala ndi matenda ashuga sizigwirizana. Kuphatikiza apo, malingaliro olakwika a chithandizo chamankhwala omwe amachotsa mahomoni achibale ndi abwenzi ali ndi gawo lalikulu kwa odwala omwe ali ndi matenda amtundu II. Zaka, mulingo wamaphunziro ndi moyo wa wodwalayo payekha ndizofunikanso.

Maphunziro a azimayi omwe ali ndi vuto la kusintha kwa msambo kumayambiriro kwa mtundu wachiwiri wa matenda ashuga m'masukulu osamba kuti azimayi amasintha masinthidwe amomwe amachitika mu psychosocial.

Zochitika za menopausal syndrome mwa azimayi omwe ali ndi matenda ashuga a 2

Kuchuluka kwa matenda ashuga kumawonjezeka kwambiri mwa azimayi azaka zopitilira 50. Matenda a shuga ndi ofala kwambiri mwa akazi kuposa amuna amsinkhu umodzi, kuchuluka kwa matenda ashuga mwa akazi azaka 55-64 kumakhala 62% kuposa amuna. Ndizotheka kuti kusintha kwa kubereka kumakhala ndi chidziwitso chokwanira pakuwonjezera kuchuluka kwa anthu odwala matenda ashuga m'badwo uno wa azimayi (Dedov I.I., Suntsov Yu. I.).

Mwa azimayi omwe ali ndi matenda a shuga 2, kutha kwa kusintha kwa thupi kumachitika zaka 48-49, kusintha kwa msambo kumachitika zaka 49-50, kutanthauza zaka ziwiri kapena zitatu m'mbuyomu kuposa azimayi athanzi. Nthawi yayitali ya kusamba ndi zaka 38-39, ndipo nthawi ya kusamba ndi zaka 3.5-4. Odwala ambiri amakhala ndi vuto lochita kutha kusintha kwa matenda amiseche. Poterepa, zodandaula za chikhalidwe cha vegetovascular zimachitika. Kutalika kwa manopelosis popanda kulandira chithandizo ndi HRT pafupifupi zaka ziwiri kapena zinayi. Nthawi yomweyo, mu 62% ya odwala, kuyambika kwa kusintha kwa msambo kumachitika nthawi yophukira-yophukira motsutsana ndi kuwonongeka kwa matenda oyambitsidwa, ndikuwonjezera kwambiri mayendedwe ake.

Mwa amayi omwe ali ndi matenda amtundu wa 2 wodwala, madandaulo a vasomotor ndi chikhalidwe chamalingaliro am'maganizo amabwera patsogolo, zomwe, mwachiwonekere, zimachitika chifukwa cha ma visceral neuropathy omwe adalipo kale komanso kuvutikira kwa dongosolo lamanjenje la autonomic. Madandaulo omwe amapezeka pafupipafupi ndi kutuluka thukuta kwambiri, kutentha kwadzaoneni, kukhumudwa, kukhumudwa, kusakwiya. Nthawi yomweyo, 99% ya odwala amadandaula za kuchepa kwa libido ndi 29% - khungu louma komanso tsitsi. Kukhazikika kwachiwiri ndikukumana ndi urogenital, komwe kumakhazikitsidwa ndi glucosuria yomwe imatenga nthawi yayitali, kukula kwa visceral neuropathy ndikuwonongeka kwa chikhodzodzo. Ponena za zovuta za metabolic, matenda amtima amapezeka mu 69% ya azimayi, osteopenia mwa azimayi omwe ali mu gawo la premenopausal mu milandu 33.3%, mwa azimayi omwe ali mu gawo la postmenopausal mu 50% ya milandu. Kupuma, nthawi ya menopausal syndrome mwa azimayi omwe ali ndi matenda a shuga a 2 komanso azimayi athanzi siyosiyana kwambiri.

Matenda a urogenital mu nthawi ya kusintha kwa shuga

Malinga ndi kafukufuku wathu, azimayi 85% omwe ali ndi matenda amtundu wachiwiri amadandaula zauma, kuyabwa, ndi kuwotera maliseche, 51% - kwa dyspareunia, 45,7% - kwa cystalgia, ndi pafupifupi 30% - chifukwa cha kuchepa kwamitseko. Izi ndichifukwa choti kuchepa kwa milingo ya estrogen pambuyo pa kusamba kumabweretsa njira zakukula kwa atrophic mu mucous membrane wa urethra, nyini, chikhodzodzo, zida za ligamentous zapansi pa pelvic, ndi minofu ya periurethral. Komabe, mwa amayi omwe ali ndi matenda amtundu wa 2 motsutsana ndi kuchepa kwa mphamvu ya estrogen, gawo lofunikira pakukonzekera kwamatenda amkodzo limaseweredwa ndi: kuchepa kwa chitetezo chokwanira, glucosuria wopitilira, chitukuko cha visceral neuropathy ndi kuwonongeka kwa chikhodzodzo. Pankhaniyi, chikhodzodzo cha neurogenic chimapangidwa, urodynamics imasokonezeka, ndipo kuchuluka kwa mkodzo wotsalira pang'onopang'ono kumawonjezeka, zomwe zimapangitsa kuti pakhale matenda oyamba.

Zonsezi pamwambapa zimatsogolera panjira ya atrophic ya mucous membrane wa urethra, nyini, chikhodzodzo, mu zida zapamisili za pansi ndi mafupa a periurethral. Njira izi zimapangitsa kuti pakhale chikhodzodzo cha neurogenic. Mwachirengedwe, zinthu zonse zomwe zimafotokozedwa kuphatikiza ndi kuvuta kwam'maganizo zimaphatikizapo kuchepa kwa chilakolako chogonana mwa 90% mwa akazi. Kuphatikiza pa izi, kusokonekera kwa urogenital kumayambitsa dyspareunia, kenako kuchitika kosagonana, komwe kumakulitsanso kukhumudwa komwe kumachitika chifukwa cha zaka.

The ntchito zofunika kugwiritsa ntchito timadzi am'mimba mankhwala mwa azimayi omwe ali ndi matenda ashuga 2 mu msambo

Pakadali pano, zotsatirazi pa kugwiritsa ntchito HRT ndizomwe zimavomerezedwa.

1. Kugwiritsa ntchito ma estrogen achilengedwe ndi mawonekedwe awo.

2. Kukhazikitsidwa kwa mphamvu ya kuteteza thupi (yaing'ono) ya estrogen, yomwe imafanana ndi kuchuluka kwa estradiol koyambirira koyambirira kwa azimayi achichepere.

3. Kuphatikiza kwa estrogens ndi progestogens kapena (kawirikawiri) ndi androgens, omwe amachotsa njira za hyperplastic mu endometrium.

4. Kuikidwa kwa azimayi omwe adachita hysterectomy, estrogen monotherapy (estradiol) yokhala ndi maphunziro apang'onopang'ono.

5. Kutalika kwa nthawi ya mahospital prophylaxis ndi mankhwala a mahomoni ndi zaka 5-7, ndi nthawi ino yomwe akufunika kuwonetsetsa kupewa matenda a mafupa, myocardial infarction ndi cerebrovascular ngozi.

Muzochitika zamankhwala, njira yofala kwambiri pakamwa yothandizira kupatsa mankhwala mahomoni m'malo mwa azimayi am'mbuyomu, zomwe odwala ndi madokotala amadziwa bwino. Izi zimachitikanso chifukwa chopepuka komanso kutsika mtengo kwa njirayo.

Mpaka pano, ndi maphunziro ochepa okha omwe adawoneka potsatira kuchuluka kwa estrogen mu mankhwala omwe amapezeka a 0,625 mg / tsiku pa metabolism ya carbohydrate mwa azimayi omwe ali ndi matenda a shuga a 2. Hafu ya izo ikuwonetsa kusintha kwa kagayidwe kazakudya, ina - kusakhalapo kwa mphamvu ya kagayidwe kazakudya. Komabe, mphamvu ya estrogenic ya estrogens ndiyosakhalitsa, zimatengera mlingo komanso nthawi yomwe amagwiritsa ntchito ndipo sikuti akupikisana ndi mayikidwewo mwa kusintha kwa kagayidwe kazinthu. Amakhulupirira kuti mlingo wa estrogen wopitilira 1.25 mg / tsiku umabweretsa kuwonongeka kwakukulu mu kulolera kwa glucose ndi insulin kukana. Komabe, malinga ndi kafukufuku wathu, kukhazikitsa pakamwa pa b-estradiol pa 2 mg patsiku sikuwonongeketsa kagayidwe kazakudya ndipo sikukhudza insulin.

Pali njira ziwiri zazikulu zoyendetsera ma estrojeni achilengedwe: pakamwa ndi kholo. Njirazi zimakhala ndi zosiyana ziwiri.

1. Ma estrojeni achilengedwe amasinthidwa pang'ono kuti akhale estrone m'mimba. Estrogens yoyendetsedwa ndi okosijeni imagwira pulayimale yachilengedwe ndi kupangika kwa mitundu yosakhazikika ya biology.Chifukwa chake, kuti tikwaniritse gawo la thupi la estrogens mu ziwalo zomwe tikufuna, kuyang'anira mu supraphysiological Mlingo ndikofunikira.

2. Ma prorogen omwe amayendetsedwa ndi makolo amafikira ziwalo zomwe akutsata pamlingo wocheperako, ndipo chithandiziro chamankhwala chimachepetsedwa, popeza kuphatikiza kwakukulu kwa chiwindi sikumayikidwa.

Conrougated estrogens (Premarin) imapezeka mu mkodzo wa mares. Ndiwosakanizidwa wa zinthu zingapo za estrogenic: estrone ndi equillin. Ku United States, ma estrojeni ophatikizika akhala akugwiritsidwa ntchito kwazaka zopitilira 30. Ku Europe, estradiol ndi estradiol valerate amagwiritsidwa ntchito kwambiri.

Estriol ndi estriol supplement imapereka tanthauzo lotchedwa colpotropic ndipo imagwiritsidwa ntchito kwambiri pazovuta za urogenital. Komabe, estriol imapereka mphamvu yofooka yofunikira.

Ethinyl estradiol, yomwe ndi gawo la njira zakulera zamkamwa, salimbikitsidwa ku postmenoparance HRT chifukwa cha zovuta zomwe zimachitika.

Ndi kholo la estrogen, njira zingapo zoyendetsera ntchito zimagwiritsidwa ntchito. The zokhudza zonse zimatheka ndi mu mnofu, ukazi, percutaneous (mu mawonekedwe a plasters) ndi cutaneous (mawonekedwe a mafuta) makonzedwe. Mphamvu yakumaloko imakwaniritsidwa ndi kukonzekera kwa nyini ya estrogen pokonzekera mafuta, mafuta owonjezera, mphete, mapiritsi azithandizo za urogenital.

Progestogens (progestogens ndi progestins)

Ndi kudya kwa nthawi yayitali kwa estrogens, kuwonjezereka kwa pafupipafupi kwamitundu yosiyanasiyana ya hyperplasia komanso khansa ya endometrial kumadziwika. Chifukwa chake, pakadali pano, popereka mankhwala kwa akazi a peri- and postmenopausal, ndikofunikira kuti cyclically kuwonjezera progestogen ku estrogens mkati mwa masiku 10 mpaka 10 mpaka 14. Kukhazikitsidwa kwa ma estrojeni achilengedwe ndi kuphatikiza kwa progestogens kumatha endometrial hyperplasia. Chifukwa cha gestagens, kusintha kwachinsinsi kwa cyclic kwa endometrium yowonjezereka kumachitika ndipo, motero, kukanidwa kwake kumatsimikiziridwa. Kwa azimayi a postmenopausal, regimen yoyenera kwambiri ndi kuyendetsa mosalekeza kwa progestogens, komwe kumayambitsa endometrial atrophy komanso kusakhalitsa kwa magazi osafunikira.

Zinapezeka kuti kuchepetsa kuchuluka kwa endometrial hyperplasia, kutalika kwa nthawi ya progestogen ndikofunikira kuposa mlingo wa tsiku ndi tsiku. Chifukwa chake, kukhathamiritsa kowonjezereka kwa ma gestagens mkati mwa masiku 7 kumachepetsa zochitika za endometrial hyperplasia mpaka 4%, ndipo mkati mwa masiku 10-12 zimatha. Mlingo wocheperako wa progestogens ndi kayendedwe ka kayendedwe ka kayendedwe ka kayendedwe kazinthu kake kamachepetsa zovuta zawo pa lipoproteins.

Ma progestogen anayi amagwiritsidwa ntchito kwambiri ku Europe: norethisterone acetate, levonorgestrel, medroxyprogesterone acetate ndi dydrogesterone. Chifukwa cha kuwunika kwa zotsatira za mankhwalawa pama metabolism a glucose ndi insulin, dydrogesterone ndi norethisterone acetate amazindikiridwa ngati njira zopanda gawo, pomwe zidapezeka kuti levonorgestrel ndi medroxyprogesterone acetate zimathandizira kukulitsa insulin. Akaphatikizidwa ndi estrogens, progestogens amatha kukhala ndi zotsatira zofanana ndi monotherapy, koma pamenepa zinthu zambiri zowululidwa. Kuphatikiza kwa norethisterone acetate ndi estrogens sikukugwirizana ndi kagayidwe kazachilengedwe. Mosiyana ndi izi, kuphatikiza kwa levonorgestrel ndi medroxyprogesterone acetate ndi estrogens kumatha kubweretsa kulolerana kopanda mafuta m'thupi. Komabe, malinga ndi olemba ena, mankhwalawa odwala omwe ali ndi matenda a shuga a 2, palibe vuto lililonse la HRT pa carbohydrate metabolism mukamagwiritsa ntchito mankhwala a estrogen-progestogen, omwe amaphatikizapo medroxyprogesterone acetate, kwa miyezi itatu. Ichi ndichifukwa chake amakhulupirira kuti ndikusankhidwa kwa mankhwalawa omwe ali ofunikira kwambiri kukhazikitsa HRT mwa odwala omwe ali ndi kusintha kwa msana motsutsana ndi matenda a shuga.

Zaka zaposachedwa, mankhwala amakono ambiri a mahomoni awonekera pamsika wathu, ndipo kuti asankhe olondola HRT, poganizira zomwe zikuwonetsa ndi zotsutsana, chidziwitso chofunikira chimafunikira kuchokera kwa madokotala.

Kwa akazi omwe ali ndi mtundu wachiwiri wa matenda a shuga, pa nthawi ya peri- ndi premenopusing, mankhwala osankhidwa ndi tricequens ndi femoston.

Trisequens ndi mankhwala a magawo atatu omwe amatsutsana ndi kusintha kwa msambo kwa mkazi mu gawo la premenopausal: masiku 12 a 17-b-estradiol, ndiye masiku 10 a 17-b-estradiol 2 mg + norethisterone acetate 1 mg, ndiye masiku 6 a 17-b-estradiol 1 mg.

Femoston ndi kuphatikizika kwa biphasic komwe kumakhala micronized 17-b-estradiol monga gawo la estrogen ndi dydrogesterone ngati gawo la gestagen. Zonsezi ndizofanana mwachilengedwe komanso zachilengedwe zimafanana ndi ma mahoni ogonana amkaziyo.

Mu gawo la postmenopausal, mankhwala osokoneza bongo amagwiritsidwa ntchito popitiliza kuphatikiza mankhwala.

Kliogest ndi mankhwala a monophasic ndipo amagwiritsidwa ntchito mwa akazi a postmenopausal. Ili ndi 2 mg ya 17-b-estradiol ndi 1 mg ya norethisterone acetate.

Mwa azimayi omwe adachita hysterectomy, komanso kuphatikiza ndi chilichonse cha progestogen posankhidwa ndi HRT, mankhwala osankhidwa ndi estrofem, mankhwala a estrogen omwe amaphatikizapo 17-b-estradiol.

Duphaston imapezeka mu 10 mg ndipo ndi progestogen. Mankhwala amagwiritsidwa ntchito pochiza endometriosis, premenstrual syndrome, yachiwiri amenorrhea, kukomoka kwa uterine magazi, ake makonzedwe sikuwonjezera insulin kukana. Itha kugwiritsidwa ntchito ngati gawo la progestogen la HRT kuphatikiza gawo lililonse la estrogen (ndikusankha payekha pazomwe zingalepheretse mkazi wa mitundu yotsiriza).

Njira zopangira HRT zalembedwa pansipa.

1. Estrogen monotherapy - wogwiritsidwa ntchito mwa amayi omwe adachita hysterectomy. Estrogens amatchulidwa mu maphunziro apakati a masabata a 3-4 ndi masiku opumira a 5-7. Kwa azimayi omwe ali ndi matenda a shuga a 2, mankhwalawa ndi okwanira: estrofem (17-b-estradiol 2 mg) kwa masiku 28, ndi njira yolowera yolamulira - dermestril ndi climar.

2. Ma estrogens kuphatikiza ndi progestogens. Mwa akazi omwe ali munthawi ya peri- ndi premenopausal, ma cyclic kapena mankhwala ophatikizika a homoni amagwiritsidwa ntchito.

Chipatala cha ESC RAMS chapeza zambiri pakugwiritsa ntchito mankhwala a Trisequens ndi Cliogest mwa azimayi azaka zapakati pa 42-56, akuvutika ndi CS motsutsana ndi matenda amtundu wa shuga wachiwiri. Oposa 92% ya odwala pofika kumapeto kwa mwezi wachitatu kuyambira chiyambi cha chithandizo chamankhwala kutha kwa vasomotor ndi kusokonezeka kwa malingaliro, kuchuluka kwa libido. Pofika nthawi imeneyi, mpweya woyambira wa glycated hemoglobin (HbA1c) ukutsika kwambiri kuchoka pa 8.1 ± 1.4% mpaka 7.6 ± 1.4%, ndipo kuchepa kwa thupi motsutsana ndi HRT kuli pafupifupi 2.2 kg pakutha kwa mwezi wachitatu chithandizo.

Dziwani kuti azimayi omwe ali ndi matenda ashuga a 2 komanso hypertriglyceridemia ndi omwe ali pachiwopsezo cha CHD. Kukhazikika kwa mitundu ya estrogen kapena yolumikizika kwa estrogen kwa iwo kumatha kuwonjezera milingo ya triglyceride, pomwe 17-b-estradiol ilibe mphamvu. Zotsatira za estrogens zimaphatikizidwanso ndi njira ya kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka ma percutaneous, pomwe palibe gawo la mankhwala kudzera pachiwindi, kuchuluka kwa ma triglycerides amasintha pang'ono kuposa momwe amaperekedwa pakamwa.

Mankhwalawa matenda amtundu wa urogenital komanso kupewa matenda obwera chifukwa cha matenda amtunduwu azimayi omwe ali ndi matenda amtundu wa 2, mu gawo la postmenopausal, ndikofunika kugwiritsa ntchito kukonzekera komwe kumaphatikizapo estriol mwanjira ya kirimu ya ukazi (1 mg / g) ndi supplementories (0.5 mg )

Ovestin amapezeka m'mitundu yosiyanasiyana (mapiritsi, mafuta, zowonjezera zamkati). Zomwe zimagwira ndi estriol. Imakhala alibe machitidwe ndipo imagwira bwino kwambiri pochiza ma urogenital mawonetseredwe a menopausal syndrome.

Kukhazikika kwa glycemia ndi glycated hemoglobin (HbA1c), body index index (BMI) pa HRT mwa azimayi omwe ali ndi matenda ashuga amathandizidwanso ndi zinthu monga, choyambirira, kumachita maphunziro azokambirana ndi azimayi zokhudzana ndi chikhalidwe chakudya cha mtundu II matenda ashuga , kufunika kochulukitsa kuchuluka kwamafuta a nyama ndi zofunika kuchita mthupi m'zakudya, ndipo chachiwiri, kuchepa kwa thupi chifukwa chotsatira zakudya komanso masewera olimbitsa thupi kumakhala ndi zotsatira zabwino.

Malinga ndi zolemba zapakhomo, kuwunika kwa zovuta zomwe zimakhudzana ndi HRT mwa azimayi omwe ali ndi matenda amtundu wa II kumawonetsa kuchepa kwakanthawi poyerekeza ndi anthu ambiri, zomwe zimafotokozedwa ndikuwunika koyenera pamaso pa HRT m'gululi.

Kutengera ndi zomwe tafotokozazi, ndikofunikira kudziwa kuti chidziwitso pakukula kwa kusintha kwa thupi kuyenera kuphatikizidwa mu pulogalamu yophunzitsira azimayi omwe ali ndi matenda ashuga a II. Kusamba kumalumikizidwa ndi kuchepa kwa metabolic rate, komwe kumafunikira ma calorie ochepa kuti akhale ndi thupi. Ngati kuchuluka kwama calories m'gululi la amayi sikuchepetsedwa ndi 20%, ndiye kuti kuchuluka kwa thupi ndi kosapeweka. Pakadapanda kulemedwa kwa thupi komanso kuchepa kwa kadyedwe ka wodwala yemwe ali ndi mtundu wachiwiri wa shuga m'matumbo a nyama, mwachilengedwe, posachedwa, kuwonjezeka kwa kulemera kwa thupi kudzatsogolera pakupitilira kukanira kwa insulin, kuwonjezeka kwa shuga wamagazi ndi kuchuluka kwa mankhwala ochepetsa shuga.

Monga mayi yemwe ali ndi vuto la matenda a shuga, HRT imalepheretsa chiwopsezo cha mafupa, matenda a mtima, kuyimitsa chiwonetsero cha matenda a menopausal komanso kusowa kwa urogenital.

Chifukwa chake, odwala omwe ali ndi menopausal syndrome ndi mtundu wachiwiri wa matenda a shuga ayenera kulimbikitsidwa kuti apatsidwe mankhwala okhala ndi estrogen-progestogen, omwe amaphatikizira gawo la progestogen mu mawonekedwe a dydrogesterone, norethisterone acetate. Ngati mzimayi ali ndi mbiri yolemetsa ya gynecological (uterine fibroids, endometrial hyperplasia, endometriosis), ndikofunikira kugwiritsa ntchito kukonzekera komwe gawo lake la progestational ndi norethisterone acetate, chifukwa ndiomwe ali ndi ntchito yayikulu kwambiri yotsutsana ndi kusintha kwachinsinsi kwa endometrium.

Kusankha kwa mankhwala obwezeretsanso mankhwala a mahomoni (kwakanthawi kochepa kapena kwakanthawi) kuyenera kutsimikiziridwa munjira iliyonse, ndipo chithandizo chamankhwala obwezeretsa mahomoni mu nthawi yayitali amasonyezedwa kwa azimayi omwe ali ndi luso lodziletsa, kulemera kwakuthupi kwamunthu, pamalipiro kapena kulipira kwamatenda oyamba.

Kafukufuku wofunikira pamaso pa utsogoleri wa HRT mwa amayi omwe ali ndi matenda ashuga a 2

• Kusanthula kwakale poganizira zolakwika
• Kufufuza kwamtundu - pelvic ultrasound
• Kupimidwa kwa chifuwa, mammography
• Oncocytology
• Kuyeza kuthamanga kwa magazi, kutalika, kulemera kwa thupi, zinthu zophatikizika, cholesterol yamagazi
• Kuyeza kwa milingo ya hemoglobin ya glycated (HbA1c)
• Muyezo wa glycemia masana
• Kukambirana ndi ophthalmologist, neurologist, nephrologist

Kwa azimayi omwe amachitidwa mankhwala a mahomoni miyezi itatu iliyonse, kuwunikira kuthamanga kwa magazi, kamodzi pachaka ma ultrasound a mamiseche ndi mammogram, kutsimikiza kwa kuchuluka kwa hemoglobin, kudziyang'anira pafupipafupi kuchuluka kwa glycemia, BMI, kukambirana ndi endocrinologist ndi ophthalmologist pa chitetezo cha HRT

Khansa ya m'mawere ndi mankhwala othandizira: oncophobia kapena zenizeni?

• Posachedwa, Britain Medical Journal yapanga phokoso lambiri, lomwe kale linadzilekanitsa pankhondo zazikulu ndi anthu aku America zokhudzana ndi chitetezo ndi mapangidwe apamwamba a statins ndipo adatulukira ku ziwonetserozi kwambiri, zoyenera kwambiri. Kumayambiriro kwa Disembala 2017, magaziniyi idasindikiza zofufuza zaka pafupifupi khumi zapitazo ku Denmark, yomwe idasanthula nkhani za azimayi pafupifupi 1.8 miliyoni azaka zapakati pa 15 mpaka 49 omwe adagwiritsa ntchito njira zosiyanasiyana zakulera kwamakono kwa mahomoni (kuphatikiza kwa estrogen ndi progestin). Zotsatira zake zinali zokhumudwitsa: chiopsezo cha khansa ya m'mawere yomwe imalipo mwa azimayi omwe adalandira kuphatikiza kulera ilipo, ndipo ndiyokwera kuposa kwa iwo omwe amapewa chithandizo chotere. Chiwopsezo chimawonjezeka ndi nthawi ya kulera. Mwa iwo omwe amagwiritsa ntchito njira yotchinjiriza chaka chonse, mankhwalawa amapereka chiwopsezo chimodzi cha khansa kwa azimayi 7690, ndiko kuti, chiwopsezo chathunthu ndichochepa.
• Ziwerengero za akatswiri zomwe zidaperekedwa ndi Purezidenti wa Russian Menopause Association kuti azimayi 25 aliwonse padziko lapansi amafa ndi khansa ya m'mawere, komanso zomwe zimayambitsa imfa ndizomwe zimachitika pamtima.
• Kafukufuku wa WHI amalimbikitsa chiyembekezo, chifukwa chomwe kuphatikiza kwa estrogen - progestin kumayamba kuchulukitsa kwambiri chiwopsezo cha khansa ya m'mawere osati kale kuposa zaka 5 zogwiritsidwa ntchito, zomwe zimapangitsanso kukula kwa zotupa zomwe zilipo (kuphatikiza zero ndi magawo oyamba).
• Komabe, bungwe lowonjezera kusintha kwa anthu padziko lonse lapansi limanenanso zakulimbana kwa zovuta zakusintha kwa mahomoni pachiwopsezo cha khansa ya m'mawere. Kuopsa kwake kuli kokulirapo, kumakulirakulira kuchuluka kwa mzimayi, komanso moyo wocheperako.
• Malinga ndi gulu lomweli, zoopsa zake ndizochepa pogwiritsa ntchito mitundu ya estradiol kapena transmermal kapena ma processor a michere.
• Chifukwa chake, mankhwala obwezeretsanso mahomoni pambuyo pa 50 amathandizira kuonjezera kwa progestin ku estrogen. Mbiri yayikulu yotetezedwa ikuwonetsa progesterone yama micron. Nthawi yomweyo, chiopsezo chobwereranso mwa azimayi omwe kale anali ndi khansa ya m'mawere sichimalola kuti asankhe chithandizo chamankhwala.
• Kuchepetsa vutoli, amayi omwe ali ndi chiopsezo choyambirira cha khansa ya m'mawere ayenera kusankhidwa kuti alandire chithandizo, ndipo mamilogalamu apachaka ayenera kuchitidwa motsutsana ndi maziko a mankhwalawo.

Zolemba za thrombotic ndi coagulopathies

• Ichi ndiye, choyambirira, chiopsezo cha mikwingwirima, infarction ya myocardial, mitsempha yamkati mwakuya komanso pulmonary embolism. Malinga ndi zotsatira za WHI.
• M'mayi oyambira azimayi am'mbuyomu, iyi ndi mtundu wovuta kwambiri wa kugwiritsidwa ntchito kwa estrogen, ndipo umawonjezeka pamene msinkhu wa odwala ukuwonjezeka. Komabe, poyambira zoopsa zochepa mwa achinyamata, sizokwera.
• Transdermal estrogens yophatikizidwa ndi progesterone ndiyotetezeka (deta kuchokera pazopanda maphunziro khumi).
• Kuchulukana kwamitsempha yodutsa kwamitsempha komanso kupweteka kwa m'mapapo ndi pafupifupi milandu iwiri pa azimayi 1000 pachaka.
• Malinga ndi WHI, chiopsezo cha pulmonary embolism ndichotsika kuposa momwe zimakhalira pakubala: +6 milandu pa 10,000 ndi kuphatikiza mankhwala ndi +4 milandu pa 10,000 omwe ali ndi estrogen monotherapy mwa amayi azaka zapakati pa 50-59.
• Matendawa amakhala ovuta kwambiri kwa iwo omwe ali onenepa kwambiri komanso omwe anali ndi zigawo za thrombosis.
• Izi zovuta nthawi zambiri zimachitika mchaka choyamba cha mankhwala.

Komabe, ziyenera kudziwidwa kuti kafukufuku wa WHI anali ndi cholinga chodziwitsa zotsatira zakanthawi yayitali za amayi omwe atha zaka zoposa 10 atasiya kusamba. Phunziroli lidagwiritsanso ntchito mtundu umodzi wokha wa progestin ndi mtundu umodzi wa estrogen. Ndizoyenera kwambiri kuyesa ma hypotheses, ndipo sangayesedwe opanda cholakwika ndi umboni wokwanira.

Chiwopsezo cha matenda opha ziwopsezo ndi chokwera mwa amayi omwe chithandizo chawo chinayambika atakwanitsa zaka 60, ndipo izi ndizosokoneza zamagazi. Pankhaniyi, pali kudalira kwakumwa kwakanthawi kwamlomo wa estrogen (deta kuchokera ku WHI ndi Cochrane maphunziro).

Oncogynecology imayimiridwa ndi khansa ya endometrium, khomo lachiberekero ndi thumba losunga mazira

• Endometrial hyperplasia imakhudzana mwachindunji ndi kutenga ma estrogens apadera. Pankhaniyi, kuwonjezera kwa progestin kumachepetsa chiopsezo cha uterine neoplasms. (Deta kuchokera ku kafukufuku wa PEPI). Komabe, kafukufuku wa EPIC, m'malo mwake, adazindikira kuwonjezeka kwa zilonda zam'mimba panthawi yophatikiza, ngakhale kuwunika kwa madalitsowa kunapangitsa kuti zotsatira zake zikhale zotsatirapo za azimayi omwe amaphunziridwawa. Pakadali pano, International Menopause Society yafunsira kwakanthawi kuti ma progesterone awoneke kukhala otetezeka m'chiberekero pa 200 mg tsiku lililonse kwa masabata awiri ngati mankhwala azotsatira ndi 100 mg tsiku lililonse akaphatikizidwa ndi estrogen kuti azigwiritsa ntchito mosalekeza.
• Kusanthula kwamafukufuku makumi asanu ndi awiri (52) kumatsimikizira kuti chithandizo chamankhwala chokhala ndi mahomoni chimawonjezera chiopsezo cha khansa yamchiberekedwe nthawi pafupifupi 1.4, ngakhale atakhala akugwiritsidwa ntchito kwa zaka zosakwana zisanu. Kwa iwo omwe ali ndi zolembedwa patsamba lino - izi ndi zowopsa. Chosangalatsa ndichakuti zizindikiro zoyambirira za khansa yamchiberekero zomwe sizinatsimikizidwe ngati zitha kubereka, ndipo ndizowona kwa iwo kuti chithandizo chamankhwala amatha kupatsidwa mankhwala, zomwe mosakayikira zidzatsogolera pakupita kwawo patsogolo ndikuthandizira kukula kwa chotupa. Koma lero palibe deta yoyesera pankhani iyi. Pakadali pano, zakhala zikuvomerezedwa kuti palibe chidziwitso chotsimikizika chokhudza ubale wapakati wamahomoni olowa m'malo ndi khansa yamchiberekero, popeza maphunziro onse 52 adasiyana mosiyanasiyana.
• Khansa ya khansa masiku ano imagwirizanitsidwa ndi papillomavirus yaumunthu. Udindo wa estrogen pakukula kwake samamveka bwino. Maphunziro a cohort a nthawi yayitali sanapeze kulumikizana pakati pawo. Koma nthawi imodzimodzi, chiwopsezo cha khansa chimayesedwa m'maiko omwe kafukufuku wokhazikika wokhudzana ndi ma cytological amalola kupezeka ndi kansa wamtunduwu kwa azimayi ngakhale asanadutse. Zambiri kuchokera ku WHI ndi HERS maphunziro adayesedwa.
• Khansa ya chiwindi ndi m'mapapo sizinaphatikizidwe ndi kudya kwamahomoni, palibe chidziwitso chambiri chokhudza khansa ya m'mimba, ndipo pali zokayikitsa kuti ikuchepetsedwa komanso khansa ya colorectal pochiza mahomoni.

Matenda a mtima ndi mitsempha yamagazi

Ichi ndiye chifukwa chachikulu chalemala ndi kufa kwa azimayi am'mbuyo. Amadziwika kuti kugwiritsa ntchito ma statins ndi aspirin sikulinso ndi vuto lofanana ndi amuna. Mu malo oyamba ayenera kuchepa thupi, kulimbana ndi matenda ashuga, matenda oopsa. Kuchiza kwa estrogen kumatha kukhala ndi mphamvu yoteteza mtima ku mtima mukamafika nthawi ya kusintha kwa thupi komanso kusokoneza mtima ndi mitsempha ya magazi ngati nthawi yake yachedwa kupitirira zaka 10 kuchokera pa kusamba komaliza. Malinga ndi WHI, mwa azimayi azaka zapakati pa 50-59, vuto la mtima silinali locheperako panthawi yamankhwala, ndipo panali phindu pokhazikitsidwa ndi matenda a mtima ngati matenda adayamba asanachitike zaka 60. Kafukufuku wowonera ku Finland adatsimikiza kuti kukonzekera kwa estradiol (ndi progestin kapena wopanda progestin) kumachepetsa kufa kwa coronary.

Maphunziro akulu kwambiri m'derali anali DOPS, ELITE, ndi KEEPS. Kafukufuku woyamba wa ku Danish, wopangika chifukwa cha mafupa, mwadzidzidzi adawona kuchepa kwa kufa kwa matenda ammimba komanso kuchipatala chifukwa cha kuphwanya kwamisala pakati pa azimayi omwe ali ndi kusintha kwa kubereka komwe analandila estradiol ndi norethisterone kapena kupita popanda chithandizo kwa zaka 10, kenako natsatiridwa zaka zina 16 .

Yachiwiri yomwe idawunikidwa kale komanso pambuyo pake kuikidwa kwa estradiol (mwa akazi ochepera zaka 6 atachokanso pambuyo pa zaka 10). Kafukufukuyu adatsimikiza kuti kuyambitsidwa koyambirira kwa chithandizo chamankhwala ndikofunikira ndikofunikira pamatumbo a coronary.

Wachitatu anayerekezera ma estrojeni ophatikizika ndi ma placebo ndi estradiol, osapeza kusiyana kulikonse m'sitima ya amayi achichepere athanzi lazaka zopitilira 4.

Urogenicology - njira yachiwiri, kukonza komwe kumayembekezeredwa kuchokera ku kupatsidwa kwa estrogen

• Tsoka ilo, kafukufuku wamkulu ngati atatuyu watsimikizira kuti kugwiritsa ntchito estrogen kokha sikungangokulitsa kukonzekera kwamkodzo, komanso kumathandizira magawo atsopano a kupsinjika kwa zinthu. / Izi zimatha kuwononga moyo wabwino. Kusanthula kwaposachedwa kwamatenda, kochitidwa ndi gulu la Cochrane, kunanenanso kuti mankhwala amkamwa okha ndi omwe amachititsa izi, ndipo ma estrojeni am'deralo amawoneka kuti amachepetsa mawonetsedwe awa. Monga phindu linanso, ma estrogens awonetsedwa kuti athetse chiwopsezo cha kutenga matenda obwereza mkodzo.
• Ponena za kusintha kwa atrophic mu mucosa wamkati ndi kwamikodzo, ma estrojeni ali bwino kwambiri, kuchepetsa kuwuma komanso kusapeza bwino. Nthawi yomweyo, mwayi unakhalabe ndikukonzekera kumaloko.

Mfupa suction (postmenopausal osteoporosis)

Awa ndi dera lalikulu, kulimbana komwe kumakhala nthawi yayitali komanso kuchita khama kwa madotolo osiyanasiyana. Zotsatira zake zoyipa kwambiri ndizovulala, kuphatikizira khosi lachikazi, lomwe limataya mkazi mwachangu, ndikuchepetsa kwambiri moyo wake. Koma ngakhale popanda kuwonongeka, kuchepa kwa mafupa kumayendera limodzi ndi kupweteka kwambiri kwa msana, mafupa, minofu ndi mafupa am'mimba, zomwe ndikufuna kupewa.

Kaya ndi mausiku angati othandizira ma gynecologists pazabwino za estrogen zoteteza kuchuluka kwa mafupa komanso kupewa mafupa akusefukira, ngakhale bungwe la International Organisation for Menopause mu 2016, lomwe malingaliro awo amalembedwa ndi ma protocol apakhomo othandizira kuti alowe m'malo, adatsimikiza kuti ma estrogen ndiye njira yoyenera kwambiri yopewa kupunduka kwa ma fractures ku azimayi oyambilira a postmenopausal, komabe, kusankha kwa mankhwalawa kwa mafupa kuyenera kukhazikitsidwa pabwino komanso mtengo wake.

Rheumatologists pankhaniyi ali amgulu kwambiri. Chifukwa chake ma modulators osankhidwa a estrogen receptors (raloxifene) sanawonetsetse pakupewa kaphatikizidwe ndipo sitingathe kuwaona ngati mankhwala osankhira oyang'anira mafupa, ndikupereka ma bisphosphonates. Komanso, kupewa kwa kusintha kwa mafupa am'mankhwala amapatsidwa kuphatikiza kashiamu ndi vitamini D3.

• Chifukwa chake, estrogen ikhoza kulepheretsa kuchepa kwa mafupa, koma mawonekedwe amkamwa mwawo adaphunziridwa kwambiri mbali iyi, chitetezo chomwe chiri chokayikitsa pokhudzana ndi oncology.
• Palibe chidziwitso chakuchepetsa kwa kuchuluka kwa mankhwalawa chifukwa cha kulandira mankhwala kwalandiridwa, ndiye kuti, estrogeni masiku ano ndi otsika kwambiri pamankhwala otetezeka komanso othandiza kwambiri pokhudzana ndi kupewa komanso kuthetsa zotsatira zoyipa za mafupa.