ʻO ka menopause a me ke ʻano 2 maʻi maʻi maʻi > He hoʻomaʻemaʻe a me ke pale aku

ʻO ke menopause ke kumuhana e ulu pinepine ana i nā manaʻo i waena o ka poʻe wahine - ka poʻe e ʻae iā ia a me ka poʻe makaʻu iā ia. Nui nō paha nā kūkākūkā e pili ana i ke ʻano o kahi mea e ʻālapa ʻia "ai ʻole inā he hanana maoli ka mea āpau, me ka ʻole o ka hana ʻana i nā lāʻau lapaʻau.

No kekahi mau wahine, ʻoi aku ka nui o nā menopause ma mua o ka pau ʻana o kā lākou hānau keiki. Hiki iā ia ke loaʻa ka hopena hohonu i nā maʻi maʻi e like me ke kō diabetes type 2. ^ E Ha yM. Pono nā wahine me nā maʻi maʻi e hoʻomaopopo i nā loli hou aʻe ma mua o ka hapanui o nā wāhine.

Inā hele ka ovulate o kahi wahine i kēlā me kēia 28 mau lā a laila paha, a me ke ala o ka menopause, hiki ke nānā ʻia ka nui o nā loli. Hiki iā ʻoe ke loaʻa i ke kāleka e hele i nā lā he 40 a ʻoi aku paha ma waena o nā manawa, a i kekahi mau pilikia, hiki mai nā lā pilikia loa i kekahi mau pule. Ke kū kēia, e loli nui nā pae o kāu mau hormones, estrogen a me progesterone. Hiki i kēia mau loli hormonal ke pili i kāu kaila koko, aia i nā wahine me ka maʻi diabetes type 2 hiki ke hana i nā pilikia.

I mea e pale aku ai i nā hoʻopiʻi o ka maʻi type 2, he mea nui loa e mālama i ke kaʻe o ka lolo koko ma mua o ka hiki - kekahi mea hiki ke paʻakikī i ka wā menopause.

Ka hoʻomaopopo ʻana i nā ʻōkuhi Menopause

Hiki ke hewa paha kekahi mau hōʻailona o ka menopause no nā hōʻailona o ke kiʻekiʻe o ke koko a ʻano haʻahaʻa paha, me ka dizziness, ka ea, a me ka huhū. Me ia mau hōʻailona like, hiki ke paʻakikī iā ka wahine ke hoʻoholo i ke aha. Ma kahi o ka hoʻopili ʻana, pono ʻoe e nānā i kou pae glucose kokoi kou ʻike ʻana i kēia mau ʻōuli. Inā hoʻomau a lilo ʻole paha nā hōʻailona, e kipa me kāu kauka e pili ana i nā koho lapaʻau.

Hiki i nā wahine me nā maʻi maʻi type like 2 ke makemake e hele i ka menopause ma hope o kā lākou mau hoa me ka maʻi maʻamau o ka maʻi. Ua hoʻokūpaʻa ʻia ʻo nā pae o ka estrogen i ka wahine e ʻoi aku ka nui o ke kaumaha e hāʻule mau lohi ma mua o ka poʻe i ka lalo a i ʻole ka maʻamau.

ʻO nā pilikia olakino

ʻAʻoleʻike hou nā wahine me ka type 2 maʻi i hele aku i nā menopause no ka hōʻemi ʻana i ka hormonal wildal e pili ana i ko lākou kaila koko, akā he mau pilikia ʻē aʻe nō hoʻi, e hoʻomanaʻo mau. Loaʻa iā lākou ka hopena kiʻekiʻe o ka hoʻomohala ʻana i ka atherosclerosis, hoʻopaʻa ʻana a me ka hoʻopaʻi ʻana o nā paia o nā ʻalā, hiki ke hōʻeha i ka hōʻeha a i ʻole ka hōʻeha ʻana o ka naʻau. ʻO ka loaʻaʻana o ka paona ma hope o ka menopause ke ʻano, ʻaʻole ia he mea maʻamau i waena o nā wahine me ka maʻi maʻamau o ka maʻi 2, ka mea e hoʻonui i ka maʻi o ka naʻau.

Me ka menopause a me ke ola kino e noho ana, e hele mai kekahi hanana ʻē aʻe: osteoporosismaʻi kanaka. ʻOiai ʻaʻole nā maʻi āpau me ka maʻi diabetes type 2 e pili ana i ka nui o ka osteoporosis e like me nā mea maʻi me ka maʻi diabetes type 1, he nui loa lākou i ka pōkole o nā iwi i ka manawa o ka menopause ma mua o nā wahine ʻaʻole maʻi maʻi.

Hoʻololi hoʻokalakia Hormone

ʻO ka therapy hapanui o Hormone (HRT) e noho mau ka hoʻopaʻapaʻa, akā hiki paha ke koho no nā wahine me ka maʻi diabetes type 2 ke loaʻa nei nā hōʻailona paʻakikī o ka menopause a loaʻa iā lākou nā pilikia e mālama i ko lākou koko koko i lalo o ka mālama. ʻO nā haʻawina e pili ana i ka palekana o HRT ma hope o ka menopause he mau hopena hakakā, akā eia kekahi e kau nei kekahi mau kauka i ka ʻae ʻana o ka hoʻohana ʻana i ka hormonal, ʻoiai naʻe i kahi ala ʻoi aku.

Eia naʻe, ʻaʻole pono nā kauka a pau i kēia. Ua ʻae ʻia kēlā me ka wahine e hoʻomaka i ka HRT wale nō inā he maʻi koʻikoʻi kēia mau maʻi, e like me ke ahi wela, a ʻaʻole hiki ke mālama ʻia i nā ala ʻē aʻe. Inā hoʻoholo ka wahine ʻaʻole e lawe i ka HRT, pono pono ia e kamaʻilio me kāna maʻi maʻi maʻi lapaʻau me kāna kauka, ʻoiai paha e pono ai nā haʻahaʻa haʻahaʻa ma mua o ka menopause.

Hiki i nā menopause nā loli i kēlā me kēia wahine, ka hana me nā kauka i kēia manawa ola nui e kōkua iā ʻoe e hana i ke hoʻololi maikaʻi loa.

No laila, ʻo ka maikaʻi: i ka manawa āpau kona manawa

Ke waʻa - he kūlohelohe, akā, ʻaʻole ia he hopena maikaʻi loa i ke ola o kēlā me kēia kanaka. Ke lawe mai nei i ia mau loli i kapa ʻole mau i ka wahine i ke ʻano maikaʻi a pinepine hoʻi i ka kūʻē kue. No laila, me ka menopause, nā lāʻau a me nā lāʻau lapaʻau pinepine pinepine e pono ai e lawe.

ʻO kekahi nīnau e palekana ai a palekana lākou. ʻO ka mālama pono ʻana i kahi kaulike ma waena o kēia mau mea ʻelua ka pilikia nui loa o ka ʻenehana lapaʻau hou a me ka lāʻau lapaʻau koʻikoʻi: ʻaʻole ka puhi ʻana i kahi puʻupuʻu mai kahi pū, ʻaʻole hoʻi e alualu nei i kahi elephant me kahi mea kīwaha ʻole he mea ʻole ʻole, a i ʻole ke hōʻino loa i kekahi manawa.

ʻO nā hormones hoʻohui

E like me ke kūpaʻa ʻana o ka hormone i nā menopause, hiki ke kuhikuhi ʻia i nā ʻaelike āpau a me nā estrogens maʻemaʻe. E kau ʻia ka lāʻau lapaʻau e kāu kauka e hilinaʻi i nā mea he nui. E pili ana kēia:

hoʻomanawanui
mau ʻōlelo hoʻohālikelike
ka kaumaha kino kino
ka hōʻeha o nā hōʻailona menopause
hoʻokolohua extragital pathology.

ʻO ka pūpū he 21 papa papa. ʻO nā papa 9 mua o ka melemone i loaʻa i kahi māhele estrogen - estradiol valerate ma kahi waihona o 2 mg. ʻO nā papa he 12 e koe ana he brown i loko o ka waihoʻoluʻu a loaʻa ka estradiol valerate ma ka nui o 2 mg a me levonorgestrel ma ke kaʻe o 150 mcg.

Pono ka lawaleka hormonal e lawe i ka papa ʻaina i kēlā me kēia lā no 3 mau pule, ma hope o ka pau ʻana o ka pākeke, pono ke lawe ʻia kahi hoʻomaha 7-lā i kahi e hoʻomaka ai ka hoʻohemo ʻana. Ma ka hihia o kahi hānai kāne hoʻopakele, ua lawe ʻia nā papa mai ka lā 5, me kahi menstruation maʻamau - ʻo kēlā me kēia lā me ka ʻokoʻa ʻana o ka hāpai ʻana.

Hoʻokuʻu ka mea estrogen i ka hopena psychoemotional a me nā hōʻailona autonomic. ʻO nā hanana pinepine ka mea i loaʻa: nā hiamoe hiamoe, hyperhidrosis, wela wela, kuʻuna maloʻo, ka hana naʻau, a me nā mea'ē aʻe. Mālama ka māhele progestogen i ka hiki ʻana mai o ke kaʻina hana hyperplastic a me ka maʻi endometrial.

NOHO	ʻĀpuka:
ke kumu kūʻai 730-800 ʻōpala ka hemo ʻana o nā hōʻailona menopausal, ka nele o ka mana ma ka paona, ka hoʻohaʻina o nā kūlana naʻau.	ka ulia o ka kahe intermenstrual, ka pono no ka komo ʻana o ka lā lapaʻau, ke helehelena o ke ʻeha i nā kelepaʻi lā, ke ʻano o ke aniani (i kekahi mau maʻi).

Mikili-Proginova

Aia i ka papalō he 21 papa. ʻO nā papa keʻokeʻo mua he 11 wale nō ka māhele o ka estrogen - ka estradiol valerate ma kahi waihona no 2 mg. ʻO kēia mau papa ʻala māmā e 10 e hui pū ana me nā māhele estrogen a me ka progestogen: estradiol ma ka nui o 2 mg a me norgestrel ma loko o kahi waihona ʻo 0.15 mg. Pono ʻo Cyclo-Proginov e lawe i kēlā me kēia lā no 3 mau pule. A laila pono ʻoe e nānā i kahi hoʻomaha i ka hebedoma, kahi e hoʻomaka ai ke koko menstrual.

NOHO	ʻĀpuka:
ka hopena o ka hoʻopau ʻana i nā hōʻailona o ka menopause, wikiwiki ho? i o ka lekiu, ke kumu kūʻai 830-950 ʻōpala ʻO ka hoʻolaʻa libido ka nalowale o na eha.	ka pono no ka loaʻa ʻana o kēlā me kēia lā (kahi hopena maikaʻi wale nō ke lawe nei i ka lāʻau lapaʻau), he ʻano hūnā ka māla ʻana aloha a me ka hui ana o na moena makmary, kuai kumu kuai.

ʻĀina ʻōpiopio

No ka wahine, estrogen, progestins a me, paradoxically, hiki i nā androgens ke manaʻo i nā hana moʻi wahine.

I ka hoʻokūkū paʻakikī, hiki ke wehewehe ʻia kēia mau māhele āpau e like me kēia:

estrogens - hormones o ka wahine kūwaho,
progesterone - he hamala ka hapai,
androgens - kūlike.

ʻO estradiol, estriol, kahi estrone nā mea i hoʻohālikelike i ka hāmeʻe a nā huahana ovaries. Hiki nō hoʻi iā lākou synthesis ma waho o ka ʻōnaehana hana: adrenal cortex, adipose tissue, iwi. ʻO kā lākou hana mua he androgens (no ka estradiol - testosterone, a no ka estrone - androstenedione). I nā ʻōlelo o ka hana kūpono, haʻahaʻa ka estrone i ka estradiol a hoʻololi iā ia ma hope o ka menopause. He mau stimulants kēia mau hana pili i kēia kaʻina hana:

ka make ʻana o ka ʻōpū, vagina, fallopian tubes, mammary glands, grow and ossification of the long bone of the extremities, the development of Second seksual character (female type hair hair grow, pigmentation of the nipples and genitalia), proliferation of the epithelium of the vaginal and uterine mucosa, vaginal mucus secretion, endometrial penial i loko o ka ʻōpū kahe koko.
Hōʻea ka nui o nā hormones i ke keratinization hapa a me ka desquamation o ka pale vaginal, ka ulu o ka endometrium.
Hoʻopilikia ka estrogens i ka hana ʻana i ka iwi o ka iwi, hoʻolaha i ka hana ʻana o nā mea pili koko a hoʻoneʻe i ka protein, hoʻemi i ka pae o ka cholesterol free a me nā lipoproteins haʻahaʻa haʻahaʻa, hoʻemi i nā pilikia o ka atherosclerosis, hoʻonui i ke kiʻekiʻe o ka hormone thyroid, thyroxine i loko o ke koko,
hoʻoponopono i nā kākoi i ke kiʻekiʻe o ka progestins,
hoʻonāukiuki i ka edema ma muli o ke kahe ʻana o ka wai mai loko o ka moku i kahi paʻa intercellular e kū'ē ana i ke kī ʻana o ka waiwai o ka sodium i loko o nā kiko.

Progestins

ʻo ka hāʻawi nui ʻana i ka wā hāpai a me kona kūkulu. Ua huna ʻia lākou e ka cortex adrenal, ka corpus luteum o nā ovaries, a ma ka wā o ka gestation, e ka placenta. Ua kapa ʻia kēia mau lāʻau i nā progestogens.

I nā wahine hāpai ʻole, lilo ke kaulike o ka estrogens, e pale ana i nā hoʻololi ʻana no ka hyperplastic a me ka cystic i ka mucosa ʻōpū.
I nā kaikamahine, ua kōkua ʻia ka hānai ʻana o nā umauma, a i nā wāhine pākeke, pale ʻia ka umauma hyperplasia a me ka mastopathy.
Ma lalo o kā lākou mana, e emi ana ka ʻoihana ma nā ʻōpū a me nā puna fallopian, e hoʻoneʻe ana i kā lākou hiki ke hoʻonaninani i nā ʻōpūʻeha o ka naʻau (oxytocin, vasopressin, serotonin, histamine) i emi. Ma muli o kēia, hōʻemi nā progestins i ka hōʻeha o ka menstruation a loaʻa kahi hopena anti-inflammatory.
E hōʻemi i ka hoʻāʻo ʻana i nā kiko o ka androgens a he antagonist androgen, e pale ana i ke ʻano o ka testosterone ikaika.
ʻO ka emi ʻana o nā pae progestin e hoʻoholo i ka mua a me ka paʻakikī o ka premenstrual syndrome.

ʻO Androgens, testosterone, ma ka mua, he mau makahiki ʻumikumamālima mau makahiki i hoʻopiʻi ʻia mai i nā hewa make a pau i manaʻo ʻia he poʻe hana manuahi wale nō ma ke kino wahine.

ʻopi momona
ʻiliuli
hoonui nui ka lauoho
Ua hoʻohālikelike ka hyperandrogenism kūpono me ka polycystic ovary, a ua kuhikuhi ʻia e hana me ia ma nā ala āpau i loaʻa.

Eia naʻe, me ka hōʻiliʻili o ka ʻike maʻamau, ua hoʻohuli ʻia e:

Hōʻemi ka hoʻololi ʻana i nā androgens i ka pae o ka kolag i nā kiko, me ka papa pelvic
hopohopo i ka leo musia a alakaʻi ʻaʻole wale i ka nalowale o ke ʻano he toned wahine, akā no hoʻi
i nā pilikia me ka piʻokeʻo urinary a
loaʻa ka paona.

Eia kekahi, ʻo nā wahine me ka emi ʻana o ka androgen he maopopo i ka hāʻule i loko o ka makemake moekolohe a ʻoi aku ka paʻakikī o nā pilina me ka orgasm. Hoʻopili ʻia nā Androgens i nā cortex adrenal a me nā ovaries a hōʻike ʻia e nā testosterone (manuahi a hoʻopaʻa ʻole ʻia), androstenedione, DHEA, DHEA-C.

Hoʻomaka lākou i ka hāʻule o ka pae ʻana i ka wahine ma hope o 30 mau makahiki.
Me ka wā kahiko, ʻaʻole lākou e hāʻawi i ka hāʻule spasmodic.
ʻO ka hoʻohaʻahaʻa nui i ka testosterone ka ʻike ʻia o nā wahine e pili ana i ke kua o ke menopause kūloko (ma hope o ka wehe ʻana o ka ʻōpū o nā ovaries).

ʻO ka huaʻala ʻo nā palekene

I ka hana noiʻi ʻana, ua paʻi ʻia ʻo Pilipo a me nā hoa hana i ka estrogen i nā isika postmenopausal. Ua kau mua nāʻike o mua ma ke ʻano o ka hana ʻana o ka estrogen ma nā kōneka pancreatic i hana i ka insulin. I kēia manawa, ua nānā ka poʻe ʻepekema i ka pili ʻana o ka estrogen me nā pūleo e hana ai i nā glucagon, he hormone e hoʻokū i nā pae o ka glucose koko.

Wahi a kahi noiʻi hou, ʻo nā cell alpha pancreatic e hana ana i ka glucagon mea koʻikoʻi loa i ka estrogen. Hoʻopau kēia mau mea i nā seler i ka emi iho o ka glucagon, akā ʻoi aku ka nui o nā hormone i kapa ʻia ʻo Glucagon e like me Peptide 1 (GLP1).

Hoʻonohonoho ka GLP1 i ka hana o ka insulin, poloka i ka huna ʻia o ka glucagon, e hoʻihoʻi i ka manaʻo o ka maʻa mau, a ua hoʻoneʻe ʻia i loko o kahi ʻōpū.

"ʻOiaʻiʻo, aia nā L i nā pūnao e like like me nā pancreatic alpha cell, a ʻo kā lākou hana nui, ʻo ia ka hana o GP1," wahi a Sandra Handgraaf, kekahi o nā mea kākau. "ʻO ka mea i nānā mākou i ka nui o ka hoʻonui ʻana i ka hana o GLP1 i loko o ka ʻawaʻī e hōʻike ana i ka nui o ka hana ʻana o kēia mea i ka mālama ʻana i ke kūpaʻa me ka nui o ka hopena o ka estrogen i loko o ka metabolism holoʻokoʻa," hoʻohui a Sandra.

Ma nā pūnaehana kanaka, ua hōʻoia ʻia nā hopena o kēia noiʻi.

Abstract o kahi ʻepekema ʻōlelo lāʻau i ka lāʻau a me ka mālama olakino, ka mea nāna i kākau i kahi pepa ʻepekema ʻo ʻAkker L. V., Stefanovskaya O. V., Leonova N. V., Khamadyanova S. U.

Ua lawe ʻia kahi hoʻokolohua, ʻo ke kumu o ka hoʻoholo ʻana i ka hopena o ka drospirenone, kahi o ka hoʻomākaukau ʻana i ka haʻahaʻa haʻahaʻa me ko Angelic, ma ka huina o ke kalapona a me ka hemostasis i nā maʻi me ka maʻi diabetes mellitus type 2 i nā wahine postmenopausal. Ua aʻo mākou i nā maʻi 50 me nā maʻi menopausal e noho ana i loko o ka menopause kūlohelohe, he mau manawa ka ʻoi aku ʻo 2 mau makahiki, e loaʻa ana i ka maʻi diabetes type 2. 30 nā wahine i loaʻa ʻole contraindications i hōʻemi ʻia i kahi lāʻau lapaʻau haʻahaʻa loa ʻo Angelik. Ka hoʻohālikelike o ka ʻai kālai waʻa e ka wikiwiki o ka glucose, C-peptide, insulin, kūʻē ka insulin i ka index Nomo, hemostasis e ka helu platelet, coagulation, D-dimer i hoʻomaka, ma hope o 3 a 6 mau malama o ka mālama ʻana. I ka wā o ka mālama ʻana me Angelik, he nui ka hōʻemi o ka glucose a me ka pale o ka insulin i ʻike ʻia e ka mahina 6 o ka hoʻokele, a ʻaʻohe hopena o ka mokuahi o ka ʻōnaehana hemostasis. ʻIke ʻia nā ʻikepili i hōʻike iā mākou e hōʻike i ka lāʻau lapaʻau ʻo Angelik no ka maʻi papalena hormone ma nā mea maʻi postmenopausal e hōʻeha nei i ka type 2 diabetes mellitus ma ke kūleʻa ikaika, palekana a me ka nui o nā waiwai maikaʻi.

ʻO ka DIABETES a me CLIMAX: MODERN OPPORTUNITIES o KA KOMISINA ʻO HORMONAL THERAPY

ʻO ka noiʻi ʻana e hoʻoku ʻia ai ke kumu no ka wehewehe ʻana ka hopena o ka drospirenon kahi ma kahi o ka hoʻomākaukau ʻana i ka Angeliq, ma luna o kahi pakanā o nā pakanā a me kahi kūlana o ka hemostasis i nā mea maʻi me kahi maʻi maʻi maʻi 2 ʻano i kahi postmenopause. 50 nā mea maʻi me ka maʻi climacteric, aia i ke menopause kūlohelohe, ʻoi aku ka lōʻihi ma mua o 2 mau makahiki, 2 mau ʻano ʻeha e nānā ʻia e kahi maʻi maʻi.. ^ E Ha yM. I nā wahine 30 ʻaʻole i loaʻa nā hōʻailona kuhihewa ke koho ʻia ke Angeliq he hoʻomākaukau. Parameter o ka huina o ia kaloli ka nui o ka glucose i ka hina ʻole, me ka-peptide, insulin, kahi mākaʻina o kahi insulin-pale kūlike.. ^ E Ha yM. Nā mea hoʻohalike o ka hemostasis ma kahi kiʻekiʻe thrombocyte, ke kumu kāwili, D-Dimer i hoʻomaka, ma o 3 a me 6 mau malama o ka mālama ʻana. I ka wā mālama ma o ka hoʻomākaukau ʻana ke Angeliq ua ʻike mākou i ka hoʻemi ʻana iho i ka pae o ka glucose a me kahi insulinresistance ma o 6 mahina o ka hoʻokipa He nui ka mana o kahi ma kahi kūlana o kahi hemostasis. Loaʻa nā ʻikepili i loaʻa no ka ʻōlelo ʻana i ka hoʻomākaukau ʻana ke Angeliq no ka hoʻololi ʻana i ka lāʻau hormonal i nā mea maʻi ma ka postmenopause, me ka hōʻeha ʻana i nā maʻi maʻi maʻamau ʻo 2 ʻano like maikaʻi, palekana a loaʻa i kahi helu o nā waiwai kūpono hou.

ʻO ka'ōlelo o ka hana ʻepekema ma ke kumuhana "Diabetes mellitus a me nā menopause: nā hiki i kēia mau lā ke hoʻololi i ka hoʻololi ʻana o ka hormone"

L.V. Akker, O.V. Stefanovskaya, N.V. Leonova, S.U. Khamadyanova ʻO KAHOAʻO A ME KIMIMXIA: ʻO KOA ʻO KA MEA I KE KĀLAI HORMONAL KENE HORMONAL

Ke Keʻena ʻO nā Obstetrics a me Gynecology No. 2 Altai State Medical University Barnaul, Russia

Ua lawe ʻia kahi hoʻokolohua, ʻo ke kumu o ka hoʻoholo ʻana i ka hopena o ka drospirenone, kahi o ka mākaukau haʻahaʻa ʻo Angelique, ma ka metabolio i ka hoʻoliʻi a me ka hemostasis i nā maʻi me ka diabetes mellitus type 2 i nā wahine postmenopausal.

Ua aʻo mākou 50 i nā mea maʻi me ka maʻi menopausal aia i ka menopause kūlohelohe, he mau ka ʻoi aku ma mua o 2 mau makahiki, e loaʻa ana i ka maʻi diabetes type 2. 30 nā wahine i loaʻa ʻole contraindications i hoʻohālikelike ʻia i ka wai lāʻau haʻahaʻa loa ʻo Angelik.Ua loiloi mākou i ka ʻaila neʻe e hoʻoneʻe ana i ka glucose glucose, C-peptide, insulin, i ka pale ʻana i ka insulin i helu ʻia e Noto index, hemostasis e ka helu platelet, coagulogram, D-dimer i hoʻomaka, ma hope o 3 a 6 mau mahina o ka mālama ʻana.

I ka wā o ka mālama ʻana me Angelik, he nui ka hōʻemi ʻana i ka glucose a me ka pale o ka insulin e nā mahina 6 mau pule, ua ʻike ʻia, ʻaʻohe hopena o ka mokuahi o ka ʻōnaehana hemostasis.

ʻIke ʻia nā ʻikepili i hōʻike iā mākou e hōʻike i ka lāʻau lapaʻau ʻo Angelik no ka hoʻōla ʻana o ka hormone i nā mea maʻi postmenopausal e loaʻa ana i ka maʻi mellitus type 2, i ka maikaʻi, palekana a me nā mea hou.

ʻO nā huaʻōlelo nui: nā maʻi menopause, type 2 diabetes mellitus, therapy replacement hormone, hōʻoki kino ka metabolism, hemostasis.

L.V. Akker, O. V. Stefanovskaja, N. V. Leonova, S. U. Hamadyanova DIABETES AND CLIMAX: HALOHEOHE LOA O KA MEA ANA O NA HANAU HORMONAL

50 nā mea maʻi me ka maʻi climacteric, aia i ke menopause kūlohelohe, ʻoi aku ka lōʻihi ma mua o 2 mau makahiki, 2 mau ʻano ʻeha e nānā ʻia e kahi maʻi maʻi.. ^ E Ha yM. I nā wahine 30 ʻaʻole i loaʻa nā hōʻailona kuhihewa ke koho ʻia ke Angeliq he hoʻomākaukau. Parameter o ka huina o ka kaloli ka nui o ka glucose i loko o ka ʻōpū ʻōpū ʻole, Me ka nen-nenTHga, ka insulin, ka mākēkē o ka insulin-kūʻē ana.. ^ E Ha yM. Nā mea hoʻohalike o ka hemostasis ma kahi kiʻekiʻe thrombocyte, ke kumu kāwili, D-Dimery i hoʻomaka, ma o 3 a me 6 mau malama o ka mālama ʻana.

I ka wā mālama ma o ka hoʻomākaukau ʻana ke Angeliq ua ʻike mākou i ka hoʻemi ʻana iho i ka pae o glucose a me kahi insu-lin-ke pale ʻana ma ka 6 mau mahina o ka hoʻokipa ʻana

Hoʻopili i kahi hopena o kahi kūlana o kahi hemostasis.

Loaʻa nā ʻikepili i loaʻa no ka ʻōlelo ʻana i ka hoʻomākaukau ʻana ke Angeliq no ka hoʻololi ʻana i ka lāʻau hormonal i nā mea maʻi ma ka postmenopause, me ka hōʻeha ʻana i nā maʻi maʻi maʻamau ʻo 2 ʻano like maikaʻi, palekana a loaʻa i kahi helu o nā waiwai kūpono hou.

Nā huaʻōlelo: climacterical syndrome, ka maʻi maʻamau āpau 2 ʻano, ke hoʻololi pono i ke ʻano hormonal, ke kāʻei o kahi kalaka, he hemostasis.

ʻO Diabetes mellitus (DM) kahi hui o nā maʻi metabolic e hōʻikeʻia e ka maʻi hyperglycemia. ʻO ka nui nui o nā hihia o ka maʻi maʻi no ka ʻelua ʻāpana etiopathogenetic ʻano nui: type 1 diabetes mellitus (DM1) me ka hapa kūlohelohe ʻana i ka insulin a me ka type 2 diabetes mellitus, kahi e kūleʻa ai ka maʻi hyperglycemia ma muli o ka hui pū ʻana me ka pale o ka insulin a me ka pane ʻana i ka naʻau i hoʻopau ʻia e ka maʻi 3 , 4. E pili ana i ka menopause, kahi hōʻailona koʻikoʻi nui loa

ua loaʻa iā ia ka maʻi 2. ʻO ka 90-95% o nā maʻi āpau me ka maʻi maʻi.

Hoʻonui nui ka pinepine o ka maʻi mellitus i ka wahine i ʻoi aku ma mua o 50 mau makahiki a, inā paha, he hopena koʻikoʻi nā menopause i ka hoʻonui ʻana i ka pā o ka wahine ma o ka makahiki ʻelemakule. Wahi a ka papa inoa o ka maʻi diabetes ma ka Leka o Altai, ʻo ka nui o ka maʻi diabetes i waena o nā wāhine he 3.9%. I nā makahiki 40-49, ua loaʻa ka 1.1% o nā wahine mai ka maʻi diabetes, ma ka makahiki he 50-59 mau makahiki, he 2.2%, i ka makahiki 60-69 mau makahiki, 8.7% o nā wahine

ka heluna kanaka ma luna o nā makahiki he 70 he 11.3% o nā wahine.

Ua hōʻike ʻia he nui nā hopena o nā sex sex i nā ʻano ʻuhane a me nā ʻili. ʻO nā hopena nui loa a me nā hōʻike olakino e pili ana i ka hemahema o ka estrogen, ka mea e pili nui ana i ka maikaʻi o ke ola o nā wahine i ka manawa - a me nā makahiki postmenopausal, i loaʻa i kahi pilikia nui o ka hoʻomohala ʻana i ka atherosclerosis, hypertension arterial, maʻi ʻeha coronary (3 mau manawa), ʻeha hele aʻelima (7 mau manawa) . ^ E Ha yM. Noho kēia mau maʻi i kekahi o nā wahi alakaʻi i waena o nā kumu o ka make ma nā wāhine postmenopausal, a he puha nui i ka hoʻomohokoke ʻia o nā maʻi ma hope o ka hoʻomaka ʻana o ka menopause. Akā heʻano hoʻohālike kuhi ka maʻi maʻi - a me nā hoʻopiʻi macrovascular. ʻAʻole loaʻa kahi maʻi ʻōpiopio nui o ka moʻi vascular holoʻokoʻa me nā maʻi ʻē aʻe. ʻO ka maʻi diabetes type 2 ka maʻi nui o nā moku nui. ʻO nā maʻi Cardiovascular a me nā maʻi vascular peripheral he kumu nui loa ka morbidity a me ka make ma nā poʻe maʻi me ka maʻi type type 2 ma mua o ka triad classical: nephropathy, neuropathy, retinopathy, ʻoiai ke kiʻekiʻe loa ka hopena o kēia mau maʻi. ʻO ka hui pū ʻana o ka maʻi menopausal a me ka maʻi diabetes i hoʻomohala i nā kūlana no ka hoʻopiʻi kūlike. ʻO ia ke kumu he mea nui i ka menopause ke ʻike i ka maʻi maʻamau 2 a e hoʻomaʻamaʻa maikaʻi iā ia a i ka manawa like me ka hoʻoikaika ʻana i nā loli o ka hormonal e ʻano like o ka menopause.

I nā makahiki he nui, ua manaʻoʻiʻo ʻia ka poʻe wahine me ka maʻi maʻi i ka wā i koho ʻia ai ʻo ka hiki ke hoʻololi i ka therapy ʻo hormon (HRT) no ka mālama ʻana a me ka pale ʻana o nā maʻi menopausal. ʻO ke kumu lalo o kēia ʻōlelo ʻoi ka mea i loaʻa i ka hapanui o nā progestogens i hoʻohana ʻia i ka hopena he hopena, he ʻomaʻamaʻa, a me ka metabolidae o lipid, e hōʻemi ana i ka hopena maikaʻi o ka estrogen 1,2

ʻO nā pilikia a me nā pilikia e kū mai nei i ka hoʻohana ʻana iā HRT i nā wahine me ka pau ʻana o ka hana ovarian he hiki ke hāpai i ka hoʻomohala ʻana a me ka hoʻomaikaʻi ʻana i kēia ʻano hana, ka hoʻokumu ʻana o nā ʻenehana hormonal hou a, ma ke kumu, nā lāʻau hou hou a palekana. Pono kēia lāʻau lapaʻau me ke huhu ʻia

helehelena (Schering, Kelemānia), kahi ʻano hou o ka hoʻomau ʻana i ka hoʻohāluhulu a me ka hoʻohiolo ʻana: pākēkē i kēlā me kēia 1 mg o ka estradiol hemihydrate a me 2 mg o drospirenone. ʻO ka hoʻohana ʻana o drospirenone, he hopena anti-thiandrogenic, i kahi mea e hoʻopau ai i ka hopena o androgens e pili ana i nā kaʻina metabola. ʻO ka hoʻopauʻana i ka nui o ka sodium ma lalo o ke kumu o ka drospirenone e hāʻawi i ka hoʻoponopono maikaʻi o ke kahe koko. Eia kekahi, ʻo ka hopena maikaʻi o ka drospirenone ma ke kūlana a me ka hana o ka endothelium, kahi hoʻonui i ka hana o ka nitric oxide, pale i ka hoʻololi ʻana o ka angiotensin 1 i ka angiotensin 2, e kōkua ana i ka hōʻemi i ke koko, e hoʻomaikaʻi i ka hana myocardial, hōʻike ʻia. He hopena maikaʻi ka Dros-pyrenone ma ke kūlana o ka profile lipid. ʻO ka nīnau e pili ana i ka hopena o ka drospirenone ma ka lolo o ka metabolism i nā maʻi postmenopausal me nā maʻi type 2, kahi mea nui no ka kū'ē o ka insulin, a me ka hopena e pili ana i ka piʻi ʻana o ka pale a me ka hoʻonui ʻana i ka glycemia.

ʻO kekahi pilikia kekahi o ka hopena o ka drospirenone ma ka hemostasis, no ka mea ʻo HRT kekahi o nā mea i ka hoʻomohala ʻana o ka thrombosis venous.

Kēia mau nīnau i kēia noi.

Nā kumuhana a me nā noiʻi

Ma loko o ka hoʻopaʻa ʻia i nā mea maʻi he 50 me nā maʻi menopause (CS) nona ka 45 - 57 mau makahiki (ka nui o ka makahiki o nā poʻe ʻikepili ʻo 52 ± 0.5 mau makahiki), ka poʻe ma ka menopause kūlohelohe ma mua o 2 mau makahiki, e loaʻa ana i ka maʻi diabetes type 2 a me kahi ʻōpū o ka ʻōpū. ʻopi momona. ʻO nā ʻōmaka no ka HRT i nā āpau he pilikia menopausal, kahi i lanakila ai nā hōʻailona neurovegetative. Ua ʻike ʻia kahi puʻuwai koʻikoʻi o nā pilikia climacteric i 3 mau mea maʻi, ka awelika awelika i 20, a akahū i 27. ʻO ka helu awelika ma ka nui o ka loiloi o ka loiloi menopausal hoʻololi (MMI) ma mua o ka mālama ʻana he 41 ± 2 mau wahi.

No ka hoʻoponoponoʻana i nā maʻi menopausal, 30 nā wahine i loaʻa ʻole contraindications i kuhikuhi ʻia i kahi hoʻomākaukau haʻahaʻa haʻahaʻa Angelik). ʻO ka loiloi o nā wahine he 20 i hōʻike ʻia ai he hypertriglyceridemia, no laila, ua hāʻawi ʻia kēia ʻano maʻi i kahi ala lapaʻau hou - Clima-dinone (phytoestrogen "Binorica") i hui pū

nā noiʻi noiʻi me ka lipid-hoʻohaʻahaʻa haʻahaʻa. I ka hihia o ka normalization o nā triglycerides ma hope o 3 mau mahina o ka mālama ʻana, ua hoʻohālikelike ʻia kēia mau wahine iā Angelik. Ua kuhikuhi ʻia ʻo HRT no ka uku uku a me ka hoʻohaʻahaʻa o ka maʻi mellitus. Loaʻa i nā maʻi āpau āpau i kā lākou hoʻokele pilikino, ua mālama ʻia nā kūkākūkā pili me lākou e pili ana i nā hiʻohiʻona o ke ʻano kaiʻaiʻai, a ua hoʻākāka ʻia nā hana kino dosed.

Ma mua o ka hoʻomaka ʻana o HRT, ua kau ʻia kahi hōʻike ʻokoʻa: ka ultrasound o nā kelepaʻi mommine a me nā pelvic organ, hoʻokō ʻana o cytological o nā smear cervical, ka loiloi o nā kumu coagulation, ʻimi ʻana me ka ophthalmologist, neurologist, nephrologist, cardiologist. Ua hoʻokō ʻia ka loiloi ʻana o CS ma ke hoʻohana ʻana i kahi kuhikuhi manopausal i hoʻololi ʻia (E.V. Uvarova, 1983). No ka loiloi i ke kiʻekiʻe o ka momona o ka momona a me ka momona, ua helu ʻia kahi index body body (BMI). Ua hoʻoholo ka nui o kaʻeha o ka ʻōpū e ka nui o ka ʻāʻī (OT). I kahi RT o P80 cm, ua hoʻokumu ʻia ka momona o ka ʻōpū (e like me ka helu IDF, 2005).

Loiloi nā kaila kalepona i kālai ʻia me ka hoʻohana ʻana i ke kiʻekiʻe o ka glycemia, insulin immunoreactive, C-peptide. No ka hoʻoholo ʻana i ke kū'ē o ka insulin, ua helu ʻia mākou i ka māka Homa.

Ua loiloi nā hōʻailona Hemostasis e hoʻohana ana i kahi coagulogram, ka ʻike ʻana o ka D-dimer.

ʻO ka papahana diagnostic holoʻokoʻa ma ke ala mua i ka wahine no ka maʻi menopausal ma hope o nā ʻekolu a meʻeono mau malama o ka ʻoihana.

Nā Huaʻōlelo ʻAna a me Kūkākūkā

I ka hoʻomaka ʻana o ka hoʻokolohua mua, loaʻa ka momona nui (BMI 25.0-29 / 9 kg / cm2) i 15, obesity I degree (BMI 30.0-34.9 kg / m2) i ka 16, obesity II degree (BMI 35.039.9 kg / m2) i 15 , III kahi momona nui (BMI -40 kg / m2) i nā maʻi 4. Loaʻa nā poʻe āpau i kahi OT o □ 80 cm, kahi hōʻike e loaʻa ana ko lākou ʻōpū o ka ʻōpū. ʻO BMI ʻekolu a me ʻeono mau mahina ma hope o ka hoʻomaka ʻana i ka lawe ʻana i nā lāʻau lapaʻau, ʻaʻole i loli maoli, ʻoiai aia ke ʻano o ka hoʻēmi ʻana i ka momona o ke kino (hele ka BMI mai ka 32 kg / m2 i ka 30.67 kg / m2). , e ʻōlelo ʻaʻole wale no ka loaʻa ʻole o ka hopena maikaʻi o ka lāʻau lapaʻau i hoʻohana ʻia ma ka nui o ka ʻōpū o ka ʻōpū, akā ʻo kā lākou ʻaeʻake hoʻi i ka hopena o ke kaupaona ʻana (ua hōʻemi ʻia ka OT mai 99.24 cm ± 1.9 a 95.10 cm ± 1.8)

ʻO ka lawe ʻana i ka lāʻau lapaʻau ua alakaʻi i nā loli kūpono i ka ʻaila metabolism. Hōʻike ʻia ka manaʻo i ka hoʻohaʻahaʻa ʻana i ka glucose o ka wikiwiki i ka mahina ʻekolu o ka hoʻohana ʻana o HRT a ua hoʻohaʻahaʻa nui ʻia e ka mahina ʻeono, a ua ʻike pū ʻia ka nui o ka hōʻemi ʻana i ka pale o ka insulin e ka malama ʻeono o HRT. (mau ʻāpana. 1,2)

Ka ʻike o ka glucose, insulin, C-peptide i loko o ka serum koko o nā mea maʻi e loaʻa ana i ka lāʻau lapaʻau Angelik ____________

Kohu Mua Ma hope o 3 mau mahina ma hope o 6 mau mahina

Ka Pono 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

ʻOiai e lawe ʻia ana i ka lāʻau lapaʻau Angelique ________________

Hōʻike ʻia Ma hope o 3 mau mahina ma hope o 6 mau mahina

Ka Pono P1 P 2 P3

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

Kuhi: 0,02 iaʻu ʻaʻole e ʻike i kāu e pono ai? E hoʻāʻo i ka lawelawe palapala koho.

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

Platelets, mano 284.31 ± 4.02 284.31 ± 3.36 285.83 ± 3.66

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

Kaha: ʻAʻole hiki iaʻu ke ʻike i ka mea e pono ai? E hoʻāʻo i ka lawelawe palapala koho.

5. Jellinger P. Postprandial hyperglycemia a me ka hopena cardiovascular // Nā maʻi maʻi. - 2004.-№2.- C.2-4.

6. Farquharson CA, Struthers AD. Hoʻonui ka Spironolactone i ka bioactivity nitric, hoʻomaikaʻi i ka hana o ka endothelial vasodilator, a paʻa i ka maʻi o ke kaniotensin I / angiotensin II i nā mea maʻi me ka hoʻopiʻi o ka naʻau. Circulacion 2000, 101: 594-597

7. Nā akua IF. Nā hopena o ka hoʻonaninani papalima postmenopausal ma ka lipid, lipoprotein, a me ka apolipoprotein (a) ka ʻono: hoʻāʻo ʻana i nā haʻawina i hoʻopuka ʻia mai 1974-2000. Fertil Steril 2001, 75: 898-915

8. Hoibraaten E, Qvigstad E, Arnesen H, et al. Hoʻonui ka puʻu o ka thromboembolism venous ka hopena i ka wā o ka hoʻololiʻana i ka hormone. Haʻaleʻa 2000, 84: 961-967

9. Rosendaal FR, Vessey M, Rumley A, et al. ʻO ka hoʻololi ʻana o nā maʻi hormonal, nā mutations protrombotic a me ka hopena o ka thrombosis venous. Br J Haematol 2002,1168: 851- 854

Menopause

ʻO ka manaʻo o ka menopause ke ʻike ʻia i kēlā me kēia kanaka. Ma aneane i loko o ka nohona mau lā, ke ʻano he leo a he hoʻohiki maoli nō paha ka huaʻōlelo. Eia nō naʻe, he mea kūpono ka hoʻomaopopo ʻana i nā kaʻina hana e pili ana i ka hala ʻana o nā makahiki i nā hanana kūlohelohe maoli, ʻaʻole pono e lilo i kahi ʻōlelo a hōʻailona ʻole i kahi ola. No laila, ʻoi aku ka maikaʻi o ka huaʻōlelo menopause i ka wā e kū'ē ai i ke ʻano o nā loli e pili ana i ka makahiki, hoʻomaka nā ʻano o ka wehe ʻana. Ma keʻano holoʻokoʻa, hiki ke hoʻokaʻawale i ka menopause i loko o kēia manawa:

Huli ka menopausal (ma ka awelika, ma hope o ke 40-45 mau makahiki) - inā ʻaʻole kēlā me kēia me nā hāhina me ke ʻano o ka hua ʻōlohelohe, loli ana ka lōʻihi o ke kau ʻana, a laila ua kapa ʻia lākou "heʻe". I ka emi ʻana o ka hana o ka hormone follicle-stimulate, estradiol, antimuller hormone a me ka inhibin B. E kūʻē i ke ʻano o nā lohi, ke kaumaha ʻana o ka noʻonoʻo, ka holo ʻana o ka ʻili, nā hōʻailona urogenital o ka nele o ka estrogen i hoʻomaka e puka.
He mea maʻamau ia e kamaʻilio e pili ana i ka menopause e like me ka hana ʻana o ka haʻu. Mai ka huli ʻana o nā ovaries, ʻaʻole he hele a pili ka menstruation ma hope o ia. Hoʻokumu ʻia kēia hanana ma ka retrospectively, ma hope o ka makahiki o ka hala ʻana o ke koko kāne. ʻO ka manawa o ka hoʻomaka ʻana o nā menopause he kanaka hoʻokahi, akā he "awelika awelika i ka haukapila": no nā wahine ma lalo o 40, ua manaʻo ʻia nā menopause he mua, i mua - hiki i 45, mau manawa mai 46 a 54, mau hope loa - ma hope o 55.
Ua kapa ʻia ʻo Perimenopause i ka menopause a me 12 mau mahina ma hope o ia.
Postmenopause - wā ma hope o. Hōʻike pinepine ʻia nā hōʻike āpau o ka menopause me ka postmenopause i hoʻomaka, aia i ka 5-8 mau makahiki. Ma ka hope o ka hope o ka postmenopause, i ʻōlelo ʻia i ka ʻōpū ʻana o nā kino a me nā ʻili o ke kino, ua lanakila ʻia ma luna o nā maʻi a me nā kaumaha psychoemotional.

Perimenopause

hiki ke pane i ka kino o ka wahine a me nā manawa o ka kiʻekiʻe o ka nui o ka estrogen a me ka nele o ka hua o ka hua (maʻi o ka ʻōpū, ka ʻōpū o ka umauma, migraine), a me nā hōʻikeʻike o ka nele o ka estrogen. Hiki ke hoʻokaʻawale ʻia ka hope i kekahi mau hui:

pilikia paʻakikī: irritability, neurotizaption, hoʻoʻeha, pilikia hiamoe, hōʻemi i ka hana,
vasomotor mau ʻōhua: huhū nui, wela uila
Nā maʻi genitourinary: maloo o ka ʻōpū, kala, hoʻomaʻemaʻe, hoʻonui ʻia urination.

Kahaiʻālua

hāʻawi i nā mau like like ma muli o ka nele o ka estrogen. Ma hope mai ua hoʻohui ʻia a hoʻololi ʻia e:

ka mea nui o ka metabolic: ʻo ka hōʻiliʻili o ka momona o ka ʻōpū, kahi i hoʻohaʻahaʻa i ka hiki ʻana o ke kino i kāna iho ponoʻī, e hiki ai i ka maʻi diabetes type 2.
cardiovascular: ka nui o ka pae o nā kumu o ka atherosclerosis (ka nui o ka kolamu, ka lipoproteins density haʻahaʻa), vidal endothelial dysfunction,
musculoskeletal: neʻe wikiwiki o ka iwi e alakaʻi i ka osteoporosis,
ʻO nā hana pili i ka atrophic i ka vulva a me ka vagina, ka maʻi urinary, ka urination disorders, ka mumū o ka ʻeha.

Hoʻopau i nā maʻi menopausal hormone

ʻO ka mālama ʻana me nā lāʻau hormonal i loko o nā wahine me ka menopause ke kuleana o ka hoʻololi ʻana o ka estrogens i nele, ke kaupaona ʻana iā lākou me nā progestins e pale ai i nā kaʻina ʻana o ka hyperplastic a me ka oncological i ka endometrium a me ka moʻo molmary. Ke koho ʻana i nā dosages, hele lākou mai ke kumumanaʻo o ka liʻiliʻi haʻahaʻa, ma laila e hana ai nā haki, akā ʻaʻole loaʻa nā hopena.

ʻO ke kumu o ka koho ʻana, ʻo ia ka hoʻomaikaʻi i ke ola o ka wahine a pale aku i nā maʻi hōʻālaʻi.

He mau wahi koʻikoʻi nui kēia, ʻoiai ka hoʻopaʻapaʻa ʻana i nā poʻe kākoʻo a me nā kūʻē o ka hoʻololi no nā ʻōnaehana wahine kūlohelohe e pili ana i ka loiloi ʻana i nā pōmaikaʻi a me nā hōʻeha o nā hormones synthetic, a me ka hoʻokō ʻana a i ʻole ka loaʻa ʻana o nā pahuhopu o ia ʻano hana.

ʻO nā loina o ka lapaʻau, ʻo ia ke kau ʻana i nā wahine ma lalo o 60 mau makahiki he nui, ʻoiai ʻo ka menstruation hope loa i pili i ka wahine ma mua o hoʻokahi makahiki i hala. Hāʻawi ʻia ka makemake i ka hui ʻana o ka estrogens me ka progestins, aʻo ka hapa o ka estrogen he haʻahaʻa, e like me nā poʻe ʻōpio o ka wā proliferation endometrial. Hoʻomaka ʻia ka lāʻau ma hope o ka loaʻa ʻana o ka ʻae hoʻomaopopo mai ka mea maʻi, ka hōʻoia ʻana ua ʻike ʻia ʻo ia me nā hiʻohiʻona a pau o ka ʻano i hāpai ʻia a ʻike hoʻi i kona mau mea hoʻopiʻi a ʻoluʻolu.

I ka manawa hoʻomaka

Hōʻike ʻia nā lāʻau hoʻololi hone no nā:

ʻO ka vasomotor i nā hoʻololi kino,
nā hiamoe hiamoe
nā hōʻailona o ka atrophy o ke ʻano genitourinary,
moekolohe
haunaele a me nā menopause mua,
ma hope o ke kāʻei ʻana,
me ka haʻahaʻa haʻahaʻa ola ma ke kua o ka menopause, me ka hōʻeha ʻana ma nā ʻōpū a me nā ʻāpana,
ka pale a me ka mālama ʻana o osteoporosis.

Hoʻolālā koke ʻoe i kahi mea e pono ai ke ʻano ke nānā ʻana o nā gynecologists o Rūsia i ka pilikia. No ke aha kēia mea hoʻokipa, e noʻonoʻo i ka haʻahaʻa.

Nā kūmole kūloko ʻana, me kekahi lohi, i hoʻokumu ʻia i nā manaʻo o ka International Menopause Society, nona nā loiloi ma ka papa inoa o 2016 i aneane like me ia, akā ua hoʻohui pū ʻia nā mea hōʻike, kēlā me kēia mea i kākoʻo ʻia e nā pae hōʻike, a me nā ʻōlelo manaʻo o ka American Association of Clinical Endocrinologists i 2017, e hōʻike pono ana ma ka palekana palekana i kekahi mau ʻano ʻē aʻe o nā gestagens, hoʻohui ʻana a me nā ʻano o nā lāʻau lapaʻau.

Wahi a lākou, he ʻokoʻa ka hoʻolālā ʻana o nā wahine i ka wā o ka hoʻololi menopausal a ma nā ʻelemakule kahiko.
Pono nā mea koho e hōʻike pono ʻia a nānā pono i nā hōʻike āpau āpau, pono ka pale, ke ala o nā ala e hoʻopili ʻia a me ka mōʻaukala ʻohana, nā hopena noiʻi, me nā manaʻo no ka mea hoʻomanawanui.
ʻO ke kākoʻo Hormal he wahi wale nō o ka hoʻolālā holoʻokoʻa e hōʻāluulu i ka nohona o ka wahine, ʻoi aku kaʻai, ka hoʻomaʻamaʻa ʻana, a me ka hāʻawi ʻana i nā hana maikaʻi ʻole.
ʻAʻole pono ke kau ʻia ka lāʻau lapaʻau me ka ʻole o nā hōʻailona maopopo o ka nele o ka estrogen a i nā hopena kino paha o kēia nele.
ʻO ka mea maʻi e loaʻa ana i ka lapaʻau no ka hoʻokolokolo maʻamau e kono ʻia i ka gynecologist ma kahi o hoʻokahi manawa i hoʻokahi makahiki.
ʻO nā wahine nona ka menopause kūlohelohe a postoperative ma mua o ka makahiki 45 he nui aʻe ka kiʻekiʻe o ka osteoporosis, ka maʻi cardiovascular a me ka maʻi dementia. No laila, no lākou, pono e hoʻokuʻi ʻia ka lāʻau a hiki i ka wā waena o ka menopause.
Hoʻoholo ʻia ka nīnau no ka hoʻomau ʻana o ka hana maʻi pilikino, i ka ʻike ʻana i nā pōmaikaʻi a me nā pilikia no kekahi maʻi maʻi, me ka ʻole o nā palena koʻikoʻi.
Pono e hana ʻia ka lāʻau maʻi ma ka palena haʻahaʻa ʻoi loa.

Nā Hoʻohui

Ma ka manawa o ka liʻiliʻi o kekahi o kēia mau kūlana, ʻoiai inā he mau hōʻike no ke ʻano hoʻohuli ʻana, ʻaʻohe mea i kau i nā ʻenehana:

ka huhū ʻana, ke kumu o ka mea ʻaʻole maopopo.
umauma pale maʻi,
hōʻaia endometrial
ka hopena thrombosis vein hohonu a i ʻole thromboembolism,
maʻi hekaū maʻi
maʻi kūlohelohe i nā lāʻau lapaʻau.

ʻO nā pōpoki Estrogen

Lawe wale ʻoe.
Nui ka ʻike i ka noi ʻana.
Keleu nā lāʻau.
Nui ka poʻe o lākou.
Hiki ke hoʻohui pū me ka progestin i hoʻokahi papa.

No ke ʻano o ka absorption ʻokoʻa, e koi ʻia ke ʻano o ka nui o ka waihona.
Hoʻemi ʻia o ka hoʻihoʻi ʻana ma muli o nā maʻi o ka ʻōpū a i ʻole ka ʻokiʻoki.
ʻAʻole i hōʻike ʻia no ka hemahema o ka lactase.
Hoʻomoʻa i ka synthesis protein ma ka pepeka.
ʻOi aku ka nui o ka estrone haʻahaʻa ʻoi aku ma mua o ka estradiol.

ʻIli kukui

He mea maʻalahi ka noi.
He haʻahaʻa ka haʻahaʻa o ka estradiol.
ʻO ka hoʻohālikelike o ka estradiol i ka estrone he physiological.
ʻAʻole i hoʻokaʻawale i ke ake.

Pono e hoʻokomo i kēlā me kēia lā.
ʻOi aku ke kumukūʻai ma mua o nā pōpoki.
Hiki paha ke ʻoki paha.
ʻAʻole hiki ke hoʻohui ʻia ka Progesterone i ka gel.
ʻOi ka hopena maikaʻi loa ma ka wahī lipid.

ʻIli kūloko

Hōʻike haʻahaʻa estradiol.
ʻAʻole pili ka pōpilikia.
Hiki ke hoʻohui pū me Estrogen a me ka progesterone.
Aia kekahi ʻano me nā ʻano like ʻole.
Hiki iā ʻoe ke ho'ōki i ka mālama ʻana.

Hōʻalo ke ʻano.
ʻO nā lāʻau ʻalo maikaʻi inā ʻōmaʻomaʻa a wela.
ʻO Estradiol i ke koko hoʻomaka e emi i ka wā lōʻihi.

Kia kuhikuhi no ka hiki ole ole o na papa.
ʻOi paha ka koho ʻana i nā mea maʻi me ka hypertension arterial, hoʻonaninani a me ka mea hoʻonāpaʻa i ka hoʻoliʻiliʻi o ka gastrointestinal tract, migraines.
Hāʻawi lākou i kahi hoʻolele wikiwiki a nele i ka waiwai ikaika o ke kino.

Hiki i nā hoʻopiʻi mai nā pōpoki palupalu i ka wā o ka maʻi maʻi.

Hoʻokahi lāʻau lapaʻau e loaʻa ai ka estrogen a i ka progestin.

Hōʻike ʻia ka monstrogen estrogen ma hope o ka wehe ʻana o ka kōpū. Ma ke aʻo ʻana o estradiol, estradiolavalerate, estriol intermittly a mau loa paha. ʻO nā pil, kahiʻehā, nā mea nānā, nā suppositor a vaginal a i ʻole he papa paha, hiki i nā injections.
Hoʻokaʻawale, kuhikuhi ʻia ke gestagen i ka hoʻololi menopausal a i ka perimenopause paha i ke ʻano o ka progesterone a i nā dydrogesterone ma nā papa no ke kumu o ka hoʻoponopono ʻana a me ka hopena o nā kaʻina hyperplastic.

ʻO ka hui pūʻana o ka estrogen me ka progestin

Ma ke ʻano intermittent a i ʻole ka hoʻokau ʻana ma mua o ke ʻano (ʻaʻole i ʻike ʻia nā pathologies endometrial) - hana pinepine ʻia i ka wā menalausal transal a me ka perimenopause.
No nā wahine postmenopausal, koho pinepine ʻia ka hui pū ʻana o ka estrogen me ka progestin no ka hoʻohana mau ʻana.

I ka hopena o Dekemaba 2017, ua mālama ʻia kahi hālāwai kūkā o nā gynecologists ma Lipetsk, kahi o kahi kumu o ke kikowaena i lawe ʻia e ka nīnau no ke kau ʻana i ka hou ʻana o ka wahine ma ka postmenopause. ʻO V.E.Balan, MD, luna ʻolelo, pelekikena o ka Ahahui Lūkini no Menopause ke kau i nā wahi i makemake ʻia o ka ʻoihana hoʻonaninani.

Pono e hāʻawi i ka makemake i nā estrogens transdermal i hui pū me ka progestin, kahi mea makemake ʻia ka progesterone micronized. ʻO ka mālama pono i kēia mau kūlana e hōʻemi i ka hopena o nā hoʻopiʻi thrombotic. Eia kekahi, pale wale ka progesterone i ka endometrium, akā aia pū kekahi hopena anti-hopohopo, e kōkua ana i ka hoʻomaikaʻi ʻana i ka hiamoe. ʻO ka hopena maikaʻi loa he 0.75 mg o ka percutaneous estradiol no 100 mg o ka progesterone. No nā wahine perimenopausal, pono ʻia nā lāʻau like ʻole i ka nui o ka 1.5 mg no 200.

Kaumaha me ka hala ole o ovarian ole hemahema (male mua menopause)

Loaʻa iā lākou nā koina kiʻekiʻe loa no ka hōʻeha, ka puʻuwai puʻuwai, dementia, osteoporosis a me nā pelekikena kiʻi, pono lākou e loaʻa nā kiʻekiʻe o ka estrogen.

Eia kekahi, hiki ke hoʻohana ʻia nā mea hoʻohālikelike waha no lākou a hiki i ka manawa o ka hoʻomaka ʻana o ka menopause, akā, ʻo ka mea koho e like me ka percutaneous o estradiol a me ka progesterone.
No nā wahine me ka makemake haʻahaʻa haʻahaʻa (ʻoi aku ke kū'ē i ke kua o nā ovaries mamao) hiki ke hoʻohana i ka testosterone i ke ʻano o nā gels a i nā patch. ʻAʻole ʻo ia e hoʻomākaukau i ka hoʻomākaukau ʻana o nā kāne wili, ua hoʻohana lākou i nā ʻano like me nā kāne, akā ma ka haʻahaʻa haʻahaʻa.
E kū'ē i ke ʻano o ke ʻano o ka ʻoihana, aia nā hihia o ka hoʻomaka ʻana o ka ovulation, ʻo ia hoʻi, ʻaʻole i haʻalele ʻia ka hapai, no laila, ʻaʻole hiki ke manaʻo ʻia nā lāʻau lapaʻau no ka hoʻohuli ʻana.

ʻO ka pilina o ka hoʻohana ʻana i ka hoʻololi ʻana o ka hāmeʻa hāmeʻa i nā wahine me ka diabetes type type 2 i ka menopause

I kēia manawa, nui nā kauka he ʻano maikaʻi ʻole o ka contraceptives hormonal, hoʻoneʻe pinepine kēia ʻano i ka therapy replacement hormone (HRT) i nā manawa premenopausal a me nā postmenopausal. ʻO ka hoʻōla a me ka hoʻonaninani kūloko ʻana i ka hopena o ka estrogen e pili ana i ka hoʻokele ʻana o ka estrogen, ka mea maʻamau me ka progestogens. ʻO ka ʻokoʻa nui ka ʻoi aku me ka maʻi contraceptive wahaʻawa, mālama ʻia ka estrogens synthetic i nā dosis i ʻoi aku i ka physiological e kāohi ai i ka ovulation, ʻoiai me ka hoʻololi ʻana o nā hāmeʻe, ʻae ʻia ka hemahema o ka hormonal nā mea wale nō, ka mea i emi aʻaʻole i hana hou aku i ka poʻe synthetic a loaʻa he ʻano kūlana ʻē aʻe. Eia kekahi, ʻo ka estrogens kūlohelohe ma ka hana o ka metabolism i loko o ka puʻuwai ʻaʻole e hoʻopilikia i nā enzymes microsomal i pili i nā hanana o ka fibrinolysis, hemocoagulation a me ka renin-angiotensin-ald testosterone.

Hoʻomaopopo ʻia ka manawa o ka menopause ma ke ʻano he ʻano ma muli o ka hemahema o nā hormone ovarian, a me nā hoʻololi hou e like me ka hoʻōla e mālama i ka hoʻōla o ka home prostopausal premenopausal. Ka hoʻopaʻa ʻia ʻana o ka manuahi Estrogen a i hoʻohana pinepine ʻia ai. Hoʻohui ʻana i ka progestogens i ka monogen estrogen he regimen e ʻoi aku a ka nui o ke kino o HRT, akā naʻe, hiki iā lākou ke hōʻoka i nā hopena maikaʻi o ka estrogens, ʻoi aʻe ma ka ʻōnaehana cardiovascular.

Me ka hoʻokuʻu ʻana o ka ovulation, ʻo ka hopena o ke kumu estrogen nui e alakaʻi i ka kaohi kino o ka ʻaina ʻehā. ʻO kā lākou pilina koʻikoʻi ka hoʻonui ʻana i ka hana a corticosteroids, e alakaʻi ana i ka pale ʻana i ka insulin. ʻAʻole mālama ʻia kēia mau loli i ka wā i kuhikuhi ai i nā palena o ka physiological o ka ʻoihana hoʻololi i ka hormone. I ka ʻoiaʻiʻo, hāpai ke hoʻololi i ka hoʻololi o ka hormone physiological me ka estrogen i ka hoʻomaʻamaʻa i ka hana metabolism.

Wahi a ka hapanui o nā haʻawina, ua manaʻo ʻia he kūpono ia e hoʻohana i ka huaʻōlelo o ka "hormone replacement therapy", akā naʻe, pono ka manawa no nā kauka a me nā wahine e hana i kekahi stereotype e like me ka menopause e pili ai me ka hoʻololi ʻana o ka hāmeʻa.

Ua ʻike maikaʻi ʻia nā papa mele kaulana a me ka hiʻohiʻona o ke kauka nāna e hōʻike nei i nā hopena maikaʻi ʻole o HRT i mea ikaika loa e pili ana i nā mea maʻi. Me he mea lā, ʻoiai ka hoʻolaha pālahalaha ʻo HRT, ʻo ka nui o kā mākou mau kauka a me nā wahine i hopena me ka hiki ʻole o nā maʻi menopausal. ʻO ka makaʻu o ka maʻi maʻi paʻakikī e hoʻonāukiuki i ka stereotype: ka maʻi menopausal he inevitability pono e kū i ka ʻokoʻa. Hōʻike maopopo kēia i ka hihia o nā wahine me ka maʻi maʻi. ʻO ka hopena o ka HRT i ka hoʻokaʻawale kalakal a me ka hapa ʻole o ka ʻike i kēia pilikia ke kumu o nā mea maʻi me ka maʻi mellitus mai HRT, ma ke ʻano he kānāwai, hōʻole.

ʻO nā kumu nui no ka maikaʻi ʻole o nā kauka a me nā mea maʻi me ka maʻi II aʻai ke kūlou i ka hōʻola, ʻo ka mea mua, ʻo ka hana i wehe ʻia e nā ʻenekekētani-gynecologists a me nā endocrinologists, a ʻo ka lua, ua manaʻo nui ʻia ka hoʻololi ʻana o ka hāmeʻe i waena o nā mea maʻi a me nā kauka. ʻaʻole kūpono ka ʻoi a me ka maʻi diabetes. Eia kekahi, ʻo ka manaʻo maikaʻiʻole i ka hāmeʻa hoʻololi pumehana o nā hoahānau a me nā hoa he nui ka nui o ka poʻe ma nā mea maʻi me ka maʻi II type. ʻO ke ʻano o ka makahiki, ke kiʻekiʻe o ka hoʻonaʻauao a me ke kūlana o ke ola o ka mea maʻi i kekahi mea nui nō hoʻi.

ʻO ka hoʻonaʻauao o nā wahine me nā maʻi menopausal ma ke kaikuina o ka mellitus type type 2 i nā kula menopause e hiki ai i ka hoʻololi ʻana no ka psychosocial i ke hoʻololi pono ʻana i ka hormone.

Nā hiʻohiʻona o ka papa o nā menopausal syndrome ma nā wahine me ka maʻi maʻamau o 2

Ua hoʻonui maoli ka ulu ʻana o nā maʻi i ka wahine ma mua o nā makahiki he 50. ʻOi aku ka maʻi o ka maʻi diabetes mellitus ma mua o nā kāne o nā makahiki like, ʻo ka nui o ka hoʻomohala ʻana o ka maʻi diabetes i nā wahine he 55-64 mau makahiki he 62% ʻoi aku ka nui ma mua o nā kāne. He mea hiki ke loaʻa ka menopause i ka hopena i ka hoʻonui ʻana i ka maʻi maʻamau o ka maʻi maʻi i kēia ʻano makahiki o nā wahine (Dedov I.I., Suntsov Yu. I.).

I nā wahine me nā maʻi mellitus type 2, ʻo ka hoʻomaka ʻana o nā menopause e loaʻa i nā makahiki 48-49, loaʻa ka menopause i nā 49-50 mau makahiki, ʻo ia hoʻi, ʻelua a ʻekolu mau makahiki ma mua o nā wahine olakino. ʻO ka lōʻihi maʻamau o ka hana menstrual ʻo 38-39 mau makahiki, a ʻo ka lōʻihi o ka menopause he 3.5-4 mau makahiki. ʻO ka hapa nui o nā maʻi he maʻi paʻakikī o ka maʻi menopausal. I kēia hihia, ua lanakila nā ʻōuli o kahi ʻano vegetovascular. ʻO ka lōʻihi o ka maʻi menopausal me ka ʻole o ka mālama ʻana me nā HRT i nā kumukūʻai ʻelua a i ʻehā makahiki. Ma ka manawa like, ma ka 62% o nā maʻi, ka hoʻomaka ʻana o ka menopause i ka manawa o ka hoʻoilo-spring wai kū'ē i ke kaila o ka decompensation o nā maʻi lalo, e hoʻomaikaʻi nui ana i kāna papa.

I ka mau wahine me ka maʻi type 2, nā hoʻopiʻi o kahi vasomotor a me ke ʻano a me ka manaʻo-psychological e hele mai i ke alo o mua, ʻoiai, ʻo ia, aia no ka neuropathy visceral i kēia manawa a me ka luhi o ka pahina ʻokiʻoki autonomic. ʻO nā hoʻopiʻi pinepine loa i hōʻike ʻia, ʻoi aku ka huhū, nā uila wela, palpitations, ke kaumaha, a me ka huhū. Ma ka manawa like, 99% o nā poʻe maʻi e hoʻopiʻi nei i ka hoʻemi ʻana o libido a me 29% - o ka ʻili maloʻo a me ka hāʻule o ka lauoho. I ka lua o nā pilikia he pilikia he urogenital, ka mea i kau i ka glucosuria lōʻihi, ka hoʻomohala ʻana o ka neuropathy visceral me ka hoʻopōʻino i ka pahi. E like me ka luhi o ka metabolic hope, ʻike ʻia nā maʻi cardiovascular ma ka 69% o nā wahine, osteopenia i nā wahine i ka premenopausal phase i ka 33.3% o nā hihia, i nā wahine ma kahi postmenopausal ma kahi o 50% o nā hihia. Ma ke koena, ʻo ka papa o ka menopausal syndrome ma nā wahine me ke ʻano type type 2 mellitus a me nā wahine olakino heʻokoʻa ʻole.

ʻO nā maʻi Urogenital ma ka menopause ma ke ʻano maʻi type 2

Wahi a kā mākou noiʻi, 87% o nā wahine me ka maʻi type II ka ʻōiwi no ka maloʻo, ka ʻeha, a me ka puhi ʻana o ka pūpū, 51% - no dyspareunia, 45.7% - no ka cystalgia, a ma kahi o 30% - no ka maʻi urinary. ʻO kēia no ka lilo ʻana o ka hōʻemi o nā pae estrogen ma hope o ka menopause e hele nei i ka holomua ʻana o nā hana atrophic i ka membrane mucous o ka urethra, vagina, bladder, ligamentous apparatus o ka papa pelvic, a me nā wāwae periurethral. Eia nō naʻe, i nā wahine me ka maʻi type 2 e pili ana i ke kua o ka hemahema o ka estrogen pili, he hana koʻikoʻi i ka hoʻomohala ʻana o nā maʻi urinary e hoʻokani ʻia e: ka emi ʻana o ke ola ʻana, nā glucosuria lōʻihi, ka hoʻomohala ʻana i ka neuropathy visceral me ka hōʻeha pale ʻole. Ma kēia hihia, hoʻokumu ʻia kahi pōpoki neurogen, ua pilikia ka urodynamics, a hoʻonui pinepine ʻia ka nui o ke koena urine, e hoʻokumu ana i nā kūlana maikaʻi no kahi maʻi piʻi.

ʻO nā mea āpau i luna e alakaʻi i nā kaʻina atrophic i holomua i ka ʻōpū o ka urethra o ka urethra, vagina, bladder, i loko o ka ligamentous apparatus o ka papa pelvic a me nā mus periethethral. Ke hoʻomau nei kēia kaʻina hana i ka hoʻokumu ʻana o kahi palaka neurogen. He kūlohelohe, nā kumu āpau i wehewehe ʻia i ka hui pū me ka manaʻo naʻau paʻakikī e pili ana i ka emi ʻana o ka makemake pilikino i 90% o nā wahine. Me kēia, alakaʻi mua ka urogenital i ka dyspareunia, a laila i ka hiki ʻana o ka hana moekolohe, kahi e hoʻonui hou ai i ke ʻano kaumaha i ka manaʻo o ke ʻano o ka makahiki.

ʻO nā kumuwaiwai nui e pili ana i ka hoʻohana ʻana i ka hāmeʻa wikiō hoʻololi i ka wahine me ka maʻi diabetes type 2 i ka menopause

I kēia manawa, ʻike ka mana o kēia mau ʻōlelo pili ma ke hoʻohana ʻana iā HRT.

1. ʻO ka hoʻohana ʻana o nā estrogens kūlohelohe a me kā lākouʻikepili.

2. ʻO ka koho ʻana i nā kiko o ka physiological (liʻiliʻi) o ka estrogen, ka mea e pili ana i ka neʻe o ka estradiol ma ka hoʻomakaʻana o ka proliferation ma mua o nā wahine.

3. ʻO ka hui pū ʻana o ka estrogens me nā progestogens a i ʻole (hemahema) me nā androgens, e hoʻopau ana i nā kaʻina hyperplastic ma ka endometrium.

4. ʻO ke koho ʻana i nā wahine i loaʻa i kahi hysterectomy, ka estrogen monotherapy (estradiol) me nā papa waena.

5. ʻO ka lōʻihi o ka hormone prophylaxis a me ka hormone therapy he 5-7 mau makahiki, ʻo ia ka manawa kēia e pono ai e hōʻoia i ka pale ʻana o osteoporosis, ka myocardial infarction a me ka cerebrovascular accident.

Ma ka hoʻomaʻamaʻa lāʻau lapaʻau, ʻo ka hana maʻamau o ka hana maʻamau i ke ʻano o ka hiki ʻana i ke ʻano maʻi maʻi i ka wahine no postmenopausal, e pili ana i nā maʻi āpau a me nā kauka. ʻO kēia nō hoʻi no ka maʻalahi a me ka maʻalahi o ke kaʻina kumu.

I kēia manawa, ua hōʻike wale ʻia nā haʻawina e pili ana i ka hopena o nā estrogens conjugated i kahi maʻa maʻamau i hōʻike ʻia no ka 0.625 mg / lā ma ka haʻalekōnaena metabolism i nā wahine me ke ʻano maʻi type 2. ʻO ka hapalua o lākou e hōʻike i kahi holomua o nā kaola kalama o ka hana, nā mea'ē aʻe - me ka loaʻa ʻole o kekahi hopena i ke kaohi metabolism. Eia naʻe, ka wā hoʻomaha o ka hopena hyperglycemic o ka estrogens, e hilinaʻi ana i ka maʻa a me ka lōʻihi o kā lākou hoʻohana ʻana a ʻaʻole ia he contraindication i ke koho ʻana me kahi hoʻoponopono kūpono o ka metabolism paʻakai. Ke manaʻoʻiʻo ia he hopena o ka estrogen ma mua o 1.25 mg / lā e alakaʻi i kahi nui o ka hōʻeha i ka hoʻoliʻi glucose a me ka kūʻē o ka insulin. Eia naʻe, e like me kā kā mākou papa noiʻi, hoʻohana ʻia ka waha o b-estradiol ma ke ʻano o 2 mg i kēlā me kēia lā ʻaʻole ia e hoʻopōʻalo i ka metabolism, ʻaʻole ia e pili i ka pale ʻana o ka insulin.

ʻElua mau ʻano nui e hoʻokele ai i nā estrogens kūlohelohe: waha a me ka makua. ʻO kēia mau ala i ʻelua mau mea nui.

1. Ka hoʻololi maoli ʻana o ka estrogens maoli i ka estrone i ka ʻili o ka gastrointestinal. Hoʻokomo ka hoʻokele ʻana i nā estrogens ma mua o ke kaohi o ka metabolism ma loko o ke kao me ka hoʻokumu ʻana o nā hana sulfate e hana ʻole ai.No laila, i ka hoʻokō ʻana o ke kūlana physiological o ka estrogens i nā pōpoki target, pono i kā lākou kūleʻa i nā dosis supraphysiological.

2. Hiki i ka estrogens e lawelawe pū ʻia nā mea i hōʻeha ʻia i nā ʻōpū o lalo, a ua hoʻemi ʻia ka hopena therapeutic, no ka mea, ʻaʻole i hoʻokaʻawale ʻia kā lākou metabolism mua o ka ate.

Loaʻa ka estrogens Conjugated (Premarin) mai ka urine o nā mares. ʻO lākou kahi kāwili ʻana o kekahi mau mea estrogen: ka estrone a me ka equillin. I United States, ua hoʻohana ʻia ka estrogens conjugated no 30 mau makahiki. I ʻEulopa, ʻoi aku ka nui o ka estradiol a me ka estradiol valerate.

ʻO ka Estriol a me ka estriol succinate e hāʻawi i kahi hopena colpotropic i hoʻolaha ʻia a hoʻohana nui ʻia no nā maʻi urogenital. Eia nō naʻe, hāʻawi ka estriol i kahi hopena sistema hina.

ʻAʻole i ʻōlelo ʻia ka Ethinyl estradiol, ka mea i ka waha o ka contraceptives waha, ʻaʻole ʻia no ka postmenopausal HRT ma muli o nā hopena ʻino.

Me ka hoʻokele makua o ka estrogen, ua hoʻohana ʻia nā ala āpau o ke alakaʻi. Loaʻa ka hopena systemic me ka intramuscular, vaginal, percutaneous (ma ke ʻano o nā plasters) a me ka cutaneous (ma ke ʻano o ka hana poni). Loaʻa ka hopena kūloko me ka hoʻokele vaginal o ka hoʻomākaukau ʻana o ka estrogen ma ke ʻano o ka poni, suppositories, nā apo, nā pessaries no ka mālama ʻana i nā maʻi urogenital.

Nā Progestogens (progestogens a me nā progestins)

Me ka hoʻolōʻihi mau ʻana o ka estrogens, he hoʻonui nui aʻe o nā ʻano ʻano o nā ʻano hyperplasia a hiki i ka ʻoiʻana o ka endometrial. No laila, i kēia manawa, i ke koho ʻana i ka lāʻau lapaʻau i ka manawa peri- a me ka wahine ma postmenopausal, pono ia e hoʻohui i ka cyclically e hoʻohui i nā progestogens i nā estrogens i loko o 10-12-14 mau lā. ʻO ke koho ʻana i nā estrogens kūlohelohe me ka hoʻohui o progestogens e kāpae i ka hyperplasia endometrial. Mahalo i nā poʻe gestagens, kahi hapanui o ka hoʻololi ʻana o ka mana o ka endometrium proliferating e kū nei, a laila, ʻike ʻia kona hōʻole ʻia. No nā wahine postmenopausal, ʻo ka hoʻoponoponoimen HRT maikaʻi loa ka hoʻomau mau nei o ka progestogens, ka mea e alakaʻi ai i ka endometrial atrophy a me ka waiho ʻole ʻana o ka hoʻokaʻawale ʻana i ka makemake ʻole.

Loaʻa ʻia e hōʻemi i ka pinepine o ka hyperplasia endometrial, ʻoi aku ka nui o ka lōʻihi o ka lawelawe ʻana o progestogen ma mua o ka lā maʻamau. No laila, kahi hoʻolako o kahi gestagens i loko o nā lā 7 e hōʻemi i ka loaʻa ʻana o ka hyperplasia endometrial i 4%, a i loko o 10 mau lā he hoʻopau ia. ʻO ka hapa haʻahaʻa o nā progestogens a me kā lākou alakaʻi cyclic e hōʻemi i kā lākou hopena maikaʻi ʻole ma ka lipoproteins.

ʻEhā mau progestogens i kēia manawa e hoʻohana nui ʻia ma ʻEulopa: norethisterone acetate, levonorgestrel, medroxyprogesterone acetate a me dydrogesterone. I ka hopena o ke ʻano o ka hopena o kēia mau lāʻau i ka metabolism o ka glucose a me ka insulin, ka dydrogesterone a me ka norethisterone acetate e hoʻomaopopo ʻia me ke ʻano kūlohelohe kumu ʻole, aʻo ia ka mea i loaʻa ka levonorgestrel a me ka medroxyprogesterone acetate i ka hoʻomohala ʻana i ka kūʻē o ka insulin. I ka manawa e hui pū me ka estrogens, hiki i ka progestogens ke hopena like me ka monotherapy, akā ma kēia hihia e hōʻike ʻia nei nā hiʻohiʻona hou. ʻO ka hui pū ʻana o ka acethate norethisterone me estrogens e kūleʻa me ka mahalo i ka metabolism aʻai aʻe. Hoʻohālikelike, nā hui pū ʻana o ka levonorgestrel a me medroxyprogesterone acetate me ka estrogens hiki ke alakaʻi i ka kālepa hoʻoneʻe maikaʻi ʻole. Eia naʻe, e like me kekahi o nā mea kākau, ma ka mālama ʻana o nā poʻe maʻi me ka maʻi type 2, ʻaʻohe hopena maikaʻi ʻole o HRT i ka hōʻea kino o ka metabolism i ka wā e hoʻohana ai i ka lāʻau lapaʻau estrogen-progestogen, kahi i loaʻa iā medroxyprogesterone acetate, no ʻekolu mau mahina. ʻO ia ke kumu i manaʻoʻiʻo ʻia ai ke koho i ka lāʻau lapaʻau e koʻikoʻi nui no ka hoʻokomo ʻana o HRT i nā mea maʻi me ka maʻi menopause e kū'ē i ka maʻi mellitus.

I kēia mau makahiki i hala iho nei, ua puka aku nā ʻano lāʻau lapaʻau hou i kā mākou mākeke, a no ke koho pololei ʻana o HRT, i ka ʻike ʻana i nā hōʻailona a me nā contraindications, pono ke ʻike kumu mai nā kauka.

No nā wahine me ka diabetes mellitus type 2, i ka manawa o ka manawa- a me ka premenopause, nā lāʻau lapaʻau koho he tricequens a me ka wahine.

ʻO Trisequens kahi lāʻau lapaʻau e pili ana i kahi laikini āpau o ka wahine i ka manawa premenopausal: 12 mau lā o 17-b-estradiol, a laila he 10 lā o 17-b-estradiol 2 mg + norethisterone acetate 1 mg, a laila 6 mau lā o 17-b-estradiol 1 mg.

ʻO ka wahine pū, ʻo ia ʻo ka wahine pū me ka wahine a me ka dydrogesterone ma ke ʻano he gestagen. ʻO nā hiʻohiʻona ʻelua a me nā mea hoʻohālike a me nā biologically like like me ka endogenous sex sex o ka wahine.

I ka pili o postmenopausal, hoʻohana ʻia ka ʻoihana cliogest no ka hoʻomau hui pū ʻana.

ʻO Kliogest kahi lāʻau monophasic a hoʻohana ʻia i nā wahine ma ka postmenopausal. Loaʻa iā 2 mg o 17-b-estradiol a me 1 mg o ka norethisterone acetate.

I nā wahine i loaʻa i kahi hysterectomy, a me ka hoʻohui pū me nā mea progestogen wae i loko o ka koho pākahi o HRT, ʻo ka lāʻau lapaʻau ke koho he estrofem, kahi lāʻau lapaʻau estrogen e komo pū me 17-b-estradiol.

Loaʻa ka Duphaston i kahi waihona o 10 mg a he progestogen. Hoʻohana ʻia ka lāʻau lapaʻau e mālama i ka endometriosis, premenstrual syndrome, ka ʻĀmene amenorrhea, ka huhū o ka ʻōpū o ke aho, ʻaʻole ia e hoʻopilikia i kā ka pale ʻana i ka insulin. Hiki ke hoʻohana ʻia e like me ka māhele progestogen o HRT i hui pū me kekahi mehameha o ka estrogen (me kahi koho pilikino e pili ana i ka maʻi ʻole i ka wahine o nā palapala hana a pau).

Palapala ʻia nā HRT e hoʻohālikelike ana i nā ʻōhua pili ma lalo nei.

1. Ka manuahi Estrogen - i hoʻohana ʻia i loko o nā wahine i loaʻa i kahi hysterectomy. Ua ʻōkuhi ʻia nā Estrogens i nā papa waena o nā hebedoma 3-4 me nā lā he 5-7-lā. No nā wahine e loaʻa ana i ka maʻi diabetes type 2, ʻoi aku ka maikaʻi o nā lāʻau lapaʻau: estrofem (17-b-estradiol 2 mg) no 28 mau lā, me ke ala o ka hoʻokele percutaneous - dermestril a me nā climar.

2. Estrogens i hui pū me nā progestogens. I nā wahine i loko o nā manawa perioda a me nā premenopausal, hoʻohana ʻia ka lāʻau cyclic a i ʻole hui pū ʻia.

Heʻike nui ke kola o ka ESC RAMS i ka hoʻohana ʻana o Trisequens a me Cliogest lāʻau i loko o nā wahine he 42-56 mau makahiki, maʻi mai ka CS ma kahi o ke ʻano o ke ʻano maʻi diabetes II. ʻOi aku ma mua o ka 92% o nā mea maʻi ma ka hopena o ke kolu o ka malama mai ka hoʻomaka ʻana o ka hana e ʻike nei i ka nalo ʻana o nā vasomotor a me nā pilikia noʻonoʻo, hāpai libido. I kēia manawa, hōʻemi nui ka pae basal o ka gogemobin glycated (HbA1c) mai 8.1 ± 1.4% a 7.6 ± 1,4%, a me ka emi o ke kau paona ʻana ma ke kino o HRT ma ka awelika 2.2 kg ma ka hopena o ke kolu o ka mahina ʻekolu. hana

Pono e hoʻomanaʻo ʻia he mau wahine me ka maʻi diabetes type 2 a me hypertriglyceridemia he pūʻulu pōpilikia no CHD. ʻO ka hana ʻana o nā ʻano alkylated a i hoʻopili ʻia ai o ka estrogen iā lākou e hoʻonui paha i nā pae triglyceride, aʻo 17-b-estradiol ʻaʻohe mea i kēia hopena. Hoʻololi pū ka hopena o ka estrogens i ke ʻano o kā lākou ʻoihana: me ka hoʻokele percutaneous, inā ʻaʻohe ala o nā lāʻau lapaʻau ma o ke ake, nā ʻano o ka triglycerides e hoʻololi i kahi ka liʻiliʻi ma mua o ka wā e lawelawe ʻia ai.

I ka mālama ʻana i nā maʻi urogenital kūloko a no ka pale ʻana i ka maʻi mau ʻana o nā hanana genitourinary i loko o nā wahine me ka maʻi maʻamau o ka lā 2, ma ke ʻano postmenopausal, pono ia e hoʻohana i nā hoʻomākaukau e komo ana i ka estriol i ke ʻano o ka vaginal cream (1 mg / g) a me nā supositories (0.5 mg )

Loaʻa ka Ovestin i nā ʻano like ʻole (nā papa, ka mea poni, nā manaʻo kūhuna). ʻO ka mea waiwai he estriol. ʻAʻole loaʻa ia kahi hopena systemic a lanakila maikaʻi loa i ka mālamaʻana i nā hōʻike urogenital o ka maʻi menopausal.

Ke kūleʻa nei ke kūleʻa o ka glycemia and glycated hemoglobin (HbA1c), body mass index (BMI) i ka wā ʻo HRT a i nā wahine me ka maʻi maʻi e pili ʻia i nā mea like e like me, ka mea mua, ke hana ʻana i nā ninaninau aʻoaʻo me nā wahine e pili ana i nā ʻano o ka ʻai ʻana i ka ʻano II type II. , ka pono o ka hoʻohaʻahaʻa ʻana i ka nui o nā loina holoholona a me ka hana pilikino i hana ʻia i ke kino i ka meaʻai, a me ka lua, he hōʻemi i ke kaupaona kino ma muli o ka nānā ʻana i ka hana ʻaina a me ka hana ʻana i ka hopena.

Wahi a nā puke moʻokalaleo, kahi hōʻike o nā hopena ʻili e pili ana i ka HRT i nā wahine me ka maʻi type II ke hōʻike nei i ka hapa haʻahaʻa o nā hopena ʻokoʻa i ka wā e hoʻohālikelike ʻia me ka lehulehu kanaka, i wehewehe ʻia e ka nānā ʻana ma mua o HRT i kēia māhele o nā maʻi.

Ma muli o nā mea i hōʻike mua ʻia, pono e ʻike pono ka ʻike e pili ana i ka ʻike ʻana i ke kūkulu ʻana i ka menopause ma nā papahana aʻo i nā wahine me ka maʻi II. Hoʻopili ʻia ka menopause me kahi hoʻohaʻahaʻa i ka pae metabolic, e pono ai i nā mea liʻiliʻi e mālama pono i ke kaumaha o ke kino. Inā ʻaʻole hōʻemi ʻia ka nui o nā kaloria ma kēia māhele o nā wahine ma ka liʻiliʻi o 20%, a laila hiki ʻole ke hoʻonui o ke kaupaona kino. Ma ka haʻalele ʻana o ka hana kino dosed a me ka emi ʻana o ka ʻaina o ka mea maʻi me ka diabetes II type mellitus o ka momona holoholona, kūlohelohe koke koke hoʻi, he piʻi o ka momona kino e alakaʻi i ka holomua o ka kū i ka insulin, he hoʻonui o ke koko koko a me ka hoʻonui ʻana i ka hopena o ka lāʻau hōʻemi i ka hoʻōki.

Ma kahi wahine e maʻi ana i nā makahiki mellitus maʻi, hiki i ka HRT ke pale i ka nui o ka nui o ka osteoporosis, ka maʻi puʻuwai coronary, e hooki i ka hōʻike ʻana o ka menopausal syndrome a me nā maʻi urogenital.

No laila, ʻo ka poʻe maʻi e hoʻomanawanui ana i ka maʻi menopausal me ka diabetes mellitus type 2 e pono e hoʻolālā ʻia e hoʻomaʻamaʻa i ke ʻano maʻi terapi a me nā mea kanu estrogen-progestogen, ka mea i loaʻa i ka māhele progestogen ma ke ʻano o ka dydrogesterone, norethisterone acetate. Inā he moʻolelo koʻikoʻi gynecological a ka wahine (fibroids uterine, endometrial hyperplasia, endometriosis), ʻoi aku ka maikaʻi o ke hoʻohana ʻana i ka hoʻomākaukau no ka mea progestational acetate no ka mea ʻo ia ka hana nui loa e kū'ē i ka hoʻololi o ka secretory o ka endometrium.

ʻO ke koho pono o ka pauna hāmeʻa hoʻololi i ka hormone (pōkole a i ʻole ka lōʻihi) e hoʻoholo i kēlā me kēia hihia, a ʻo ka hoʻōla ʻana o ka hāmeʻe i loko o ke kaohi wā lōʻihi e hōʻike ʻia no nā wahine me ka hiki ke pale pilikino, ʻona kino o ke kino, ma kahi kūlana hoʻēmi a i ʻole subcompensation o ka maʻi i lalo.

Nā noiʻi koʻikoʻi ma mua o ka hoʻokele HRT i nā wahine me ka maʻi maʻamau o 2

ʻO ka mōʻaukala lawe ʻana i nā contraindications
ʻO ka nānā ʻana o ka wā hoʻonaninani - ultrasound pelvic
Hoʻomaka helu ʻōpiopio, ʻōpiopio
Oncocytology
Paena o ke kahe koko, ke kiʻekiʻe, ke kaumaha o ke kino, nā mea coagulation, he kolamu o ke koko
Hoʻomoe i ka pae hemoglobin glycated (HbA1c)
Hoʻonui ka palena o ka glycemia i ka lā
Kūkākūkā me kahi ophthalmologist, neurologist, nephrologist

No nā wahine e hoʻomaʻamaʻa ana i ka hāmeʻe hāmeʻe i kēlā me kēia mau mahina ʻekolu, ka nānā ʻana i ke koko, a hoʻokahi makahiki i ka nānā ʻana i ka ultrasound e pili ana i nā ʻōpū a me nā mammograms, hoʻonā i nā pae o ka hemoglobin glycated, mālama pono iā ʻoe iho i ke kiʻekiʻe o glycemia, BMI, kūkākūkā me ka endocrinologist a me ka ophthalmologist, a me nā ʻikepili a me nā kūkākūkā ʻana. ma ka palekana o HRT

ʻO ka maʻi ʻaʻai pēpē me ka hoʻōla hoʻololi: oncophobia a i ʻole ka manaʻo maoli?

ʻO ka mea i kēia manawa hou, ua nui ke kani ʻana o ka British Medical Journal, ma mua o ka hoʻāhewa ʻia ʻana me ka poʻe ʻAmelika e pili ana i ka palekana a me nā papa inoa o nā statins a puka mai mai kēia mau keʻaila loa. I ka hoʻomaka ʻana o Dekemaba 2017, ua paʻi ka nūpepa i ka ʻikepili mai kahi kokoke i kahi makahiki he ʻumi ma Tenemaka, nāna i hoʻoili i nā moʻolelo o kahi 1,8 miliona mau wahine nona ka makahiki 15 a 49 ka poʻe i hoʻohana i nā ʻano like ʻole o nā contraceptives hormonal hou (kahi hui o estrogen a me nā progestins). Ua huewai nā mea ʻike: ʻo ka loaʻa ʻana o ke kanesa o ka umauma umauma i loko o nā wahine i loaʻa i nā contraceptives i hui pū ʻia, ua ʻoi aku ke kiʻekiʻe o nā mea i haʻalele i kēlā ʻano maʻi. Hoʻonui ka hopena me ka lōʻihi o ka contraception. I waena o ka poʻe e hoʻohana nei i kēia ʻano palekana o ka makahiki, hāʻawi nā lāʻau lapaʻau i kekahi hihia hōʻemi o ka maʻi kanesa no nā wāhine 7690, ʻo ia hoʻi, ʻo ka hoʻonui kiʻekiʻe loa i ka hōʻemi.
ʻO nā helu o nā poʻe loea i hōʻike ʻia e ka pelekikena o ka Lūkini Menopause Lūkini wale no ka 25 mau wahine o ka honua i make i ka ʻōpū o ka umauma, a ʻo ke kumu nui loa o ka make he mau cardiovascular episode, he ʻoluʻolu.
Hoʻomau ka haʻawina ʻo WHI i ka manaʻolana, ma muli o ka hoʻohui ʻana o ka estrogen - progestin i hoʻomaka me ka hoʻonui nui i ka nui o ka ʻōpū o ka umauma ma mua ma mua o ʻelima mau makahiki o ka hoʻohana ʻana, hoʻoulu ʻia ka ulu ʻana o nā ʻōpū o nā mana (ʻoiai me ka maikaʻi ʻole o ka maʻi a me ka hoʻomaka mua ʻana).
Eia naʻe, ke nānā nei ka nohona menopause a puni honua i ka hānō o ka hopena o nā hopena hoʻololi e pili ana i ka hoʻololi ʻana i nā maʻi maʻi umauma. ʻO ke kiʻekiʻe ke kiʻekiʻe, ʻoi aku ka ʻoi aku o ka nui o ke kino kikoʻī o ke kino wahine, a me ka liʻiliʻi ʻole o kona ʻano ola.
Wahi a nā ʻāpana like, ua emi loa nā hopenaʻino me ka hoʻohana ʻana o transdermal a i ʻole nā waha waha o ka estradiol me ka hui pū me ka progesterone micronized (e hoʻohālikelike ana i nā ʻano like synthetic).
Pēlā, ʻo ka hoʻololi ʻana o ka hāmeʻa hormone ma hope o ka 50 e hoʻonui i nā pilikia o ka hoʻohui ʻana i ka progestin i ka estrogen. Hōʻike ka ʻike palekana palekana i ka progesterone micronized. I ka manawa like, ʻo ka loaʻa o ka pilikia o ka hoʻohaʻahaʻa i nā wahine i loaʻa i ke kanikele maʻi mua ʻaʻole e ʻae iā lākou e koho hou i ka hana maʻi maʻi.
No ka hōʻemi i ka pilikia, pono e koho ʻia nā wahine me ka liʻiliʻi haʻahaʻa o ka maʻi umauma o ka maʻi maʻi, no ka hana ʻana i nā maʻi kūlohelohe, a pono e hoʻomaʻamaʻa ʻia nā ʻōmaka makahiki.

Nā moʻolelo thrombotic a me coagulopathies

ʻO kēia ka mea mua, ʻo ka hopena o nā hōʻeha, ka infococa myocardial, thrombosis vein hohonu a me ka embolism pulmonary. E like me nā hopena o WHI.
I nā wahine postmenopausal maʻamau, ʻo kēia ka mea maʻamau ka nui o ka hoʻopiʻi o ka hoʻohanaʻana o ka estrogen, a hoʻonui nui aʻe ka nui o ka wā o nā maʻi. Eia nō naʻe, me ka liʻiliʻi o ka liʻiliʻi i nā poʻe'ōpiopio, ʻaʻole ia i kiʻekiʻe.
ʻO ka transdermal estrogens i hui pū me ka progesterone e palekana iki (ka ʻikepili mai ka liʻiliʻi ma mua o nā haʻawina).
ʻO ka uluʻana o ka thrombosis vein hohonu a me ka embolism pulmonary e like me 2 mau hihia ma kahi o 1000 mau wahine i ka makahiki.
Wahi a WHI, ʻoi ka hopena o ka embolism pulmonary ma mua o ke kakama maʻamau: +6 mau hihia ma kahi 10,000 me ka hui pū ʻana a me nā hihia +4 i kēlā me kēia 10,000 me ka estrogen estrogen i nā wahine he 50-59.
ʻOi aku ka maikaʻi o ka prognosis no ka poʻe lohi a loaʻa i nā manawa thrombosis.
Hoʻopilikia pinepine kēia mau hana i ka makahiki mua o ka ʻoihana.

Eia nō naʻe, pono e hoʻomaopopo ʻia i ka aʻo ʻana o ka WHI i kuhikuhi ʻia i ka hōʻike ʻana i nā hopena o ka hopena lōʻihi o ka poni hoʻololi no nā wahine i nui he mau makahiki ma hope iho o ka menopause. Ua hoʻohana pū ʻia ka noiʻi ʻana i hoʻokahi ʻano o ka progestin a me hoʻokahi ʻano o ka estrogen. He kūpono kūpono ia no nā hoʻokolohua o nā hypotheses, ʻaʻole hiki ke noʻonoʻo ʻia me ka maikaʻi ʻole o nā hōʻike.

ʻOi aku ka nui o ka pilikia o ka hōʻeha ma o ka wahine i hoʻomaka ʻia e kāna ʻoihana ma hope o ke ʻano he 60, a he mea weliweli ischemic kēia o ka neʻe cerebral. Ma kēia hihia, aia kahi hilinaʻi i ka hoʻokele waha lōʻihi o ka hoʻokele estrogen (ʻo ka data mai ka hōʻike ʻo WHI a me Cochrane).

ʻO ka Oncogynecology e hōʻike ʻia ana e ke kano o ka endometrium, ka hika a me nā ovaries

Endometrial hyperplasia e pili pono ana i ka lawe ʻana i ka estrogens hoʻokaʻawale. I kēia hihia, ʻo ka hoʻohui o ka progestin e hōʻemi i nā hōʻeha o nā neoplasms o ka ʻōpū o ka maʻi (PEPI data data). Eia nō naʻe, ua ʻike ʻia ka haʻawina a ka EPIC, me ka hoʻonui ʻana o nā loina endometrial i loko o ka hui pū ʻana, ʻoiai ka loiloi o kēia mau ʻike i nā hopena i hopena i lalo o ka pili o nā wahine i noi ʻia i ka lāʻau. I kēia manawa, ua manaʻo iki ka International Menopause Society e noʻonoʻo i ka progesterone micronized e mālama pono no ka ʻōpū ma kahi o 200 mg pākahi no kēlā me kēia mau pule 2 ma ke ʻano o ka therapy sequential a me 100 mg i kēlā me kēia lā ke hui pū ʻia me ka estrogen no ka hoʻomau mau ʻana.
Ua hōʻoia ʻia kahi loiloi o nā haʻawina 52 e hoʻonui ʻia ana ka lāʻau ʻoi iā ka nui o ka maʻi ovarian ma kahi o 1.4 mau manawa, ʻoiai no ka mea i hoʻohana ʻia ma lalo o 5 mau makahiki. No nā mea i loaʻa wahi liʻiliʻi loa palakahi ma kēia wahi - he mau hōʻeha koʻikoʻi kēia. Kahi manaʻo kupaianaha ʻo kēia mau hōʻailona kumu o ka maʻi ʻukepili o ka poʻe i hoʻopaʻa ʻia ʻaʻole hiki ke hoʻōki ʻia e like me ka menopause, a no ka mea ke kuhikuhi ʻia ka lāʻau lapaʻau e hiki ai iā lākou ke hoʻomau i ka holomua a hoʻomāhuahua i ka ulu ʻana i ka ulu ʻaila. Akā i kēia lā ʻaʻohe huaʻike hoʻokolohua ma kēia kuhikuhi. Ma kēia manawa, ua ʻae ʻia ʻaʻole ʻaʻohe ʻikepili i hoʻopaʻa ʻia e pili ana i ka pilina ma waena o ka loaʻa o ka hoʻololi poni a me nā maʻi ovarian, no ka mea he 52 mau haʻawina ʻē aʻe i kekahi o kahi ʻano like ʻole.
Hoʻopili ʻia nā maʻi maʻi cervical i kēia lā me ka papillomavirus kanaka. ʻAʻohe ʻike ka hana o ka estrogen i kāna hoʻomohala ʻana. ʻAʻole i loaʻa i nā haʻawina lōʻihi cohort i kahi pili ma waena o lākou. Akā i ka manawa like, ua loiloi ʻia nā hōʻeha o nā maʻi ma nā ʻāina e ʻae ʻia nā hoʻokolohua cytological maʻamau i ka ʻike pono ʻana i ka maʻi maʻi o kēia localization i mua o nā menopause. ʻO ka ʻike mai ka noi ʻana o WHI a me HERS ua loiloi.
ʻAʻole i pili pū ka ʻōpū a me ka pūpū o ka pūpū me ka intake o ka hormone, he liʻiliʻi ka ʻike e pili ana i ka ʻōpū o ka ʻōpū, a aia nō nā manaʻo e hoʻemi ʻia a me ke kanesa o ka colorectal i ka wā o ka mālama ʻana i nā hormone.

Ke ala o nā puʻuwai o ka naʻau a me ke koko

ʻO kēia ke kumu nui o ka pilikia a me ka make ma nā wahine ma hope o ka male. Ua hōʻike ʻia ʻaʻole like ʻia ka hoʻohana ʻana o nā statins a me aspirin i ka kāne. I ka hana mua e hele i ka hoʻoemi kaumaha, ʻo ka hakakā me ka maʻi maʻi maʻi, ka maʻi hypertension. Hiki i ka lāʻau lapaʻau e hiki ke loaʻa ka hopena palekana i ka ʻōnaehana cardiovascular i ka wā e hoʻokokoke ai i ka manawa o ka menopause a hoʻopilikia maikaʻi ʻia ka naʻau a me nā kīʻaha koko inā paʻa kona hoʻomaka ʻana i kahi mau makahiki he 10 mai ka menstruation hope. Wahi a ka WHI, ma nā wahine he 50-59, ʻaʻole i emi iki ka hōʻeha ʻana o ka naʻau ma ka wā o ke ʻano maʻi, a he pono i ka hoʻomohala ʻana i ka maʻi naʻau coronary inā hoʻomaka ʻia ka lāʻau ma mua o 60 makahiki. Ua hoʻopaʻa ʻia kahi haʻawina nānā ma Finland i ka hoʻomākaukau ʻana o ka estradiol (me a ʻole ʻole progestin) i ka make coronary.

ʻO nā haʻawina nui loa ma kēia wahi ʻo DOPS, ELITE, a me KEEPS. ʻO ka mea mua, kahi haʻawina Denemania, ka mea i hoʻolaʻa pinepine ʻia i ka osteoporosis, i ʻike pinepine ʻia i ka hoʻokaʻina ʻana o nā make coronary a me nā hale hoʻokipa o ka maʻi myocardial infarction i waena o nā wahine me nā menopause hou nei i loaʻa iā estradiol a me ka norethisterone a hele ʻole me ka lāʻau lapaʻau no nā makahiki 10, a laila hahai ʻia no kekahi 16 mau makahiki. . ^ E Ha yM.

Ua loiloi ka lua ma mua a ma hope iho i ke koho ʻia o ka tableti estradiol (ma nā wahine ma lalo o 6 mau makahiki ma hope o ka menopause a ma hope o 10 mau makahiki). Ua hōʻoia ʻia ka noiʻi ʻana i ka hoʻomaka mua ʻana o ka hana hoʻololi no ka kūlana o nā moku coronary.

ʻO ke kolu ua hoʻohālikelike i ka estrogens e hoʻohui ʻia me ka placebo a me ka percutaneous estradiol, ʻaʻole ʻike i nā ʻokoʻa koʻikoʻi o ka moku o nā moku o nā wahine olakino olakino no 4 mau makahiki.

Urogenology - ke kuhikuhi o ka lua, ke hoʻoponopono e manaʻo ʻia ana mai ka wae ʻana o ka estrogen

ʻO ka mea pōʻino, ʻo ka nui o nā noiʻi he nui i hōʻike ʻia e hiki i ka ʻōnaehana o ka estrogen ʻaʻole i hoʻonui wale i ka maʻi o ka urinary, akā ua kōkua nō hoʻi i nā manawa hou o ka makaʻuʻole o ka hoʻomau. / Hiki i kēlā me ke ʻano e hoʻonāwaliwali i ka maikaʻi o ke ola. ʻO ka loiloi mat hou kahi i lawe ʻia e ka pūʻulu Cochrane, i ʻike aia he maʻi kūlohelohe wale ia i hopena ia, a me ka estrogens kūloko e hoʻēmi i kēia mau hōʻike. E like me ka loaʻa o ka pōmaikaʻi, ua hōʻike ʻia ka estrogens e hōʻemi i ka hopena o ka hopena o ka maʻi urinary kumulā.
ʻO nā hoʻololi o ka atrophic i ka mucosa vaginal a me ka urinary tract, maikaʻi loa nā estrogens i ka maikaʻi loa, e hōʻemi ana i ka maloʻo a me ka hōʻeha. I ka manawa like, noho ka pono me nā hoʻomākaukau o ka vaginal kūloko.

ʻO ka puna lepo (postmenopausal osteoporosis)

He wahi nui kēia, ka hakakā me ka mea i hoʻolaʻa ʻia i nā manawa he nui a me ka hoʻāʻo ʻana i nā kauka o nā ʻano loea like ʻole. ʻO nā hopena weliweli loa loa, ʻo ia hoʻi, ʻo ka ʻīwī wahine, e hōʻole koke ana i ka wahine, e hōʻemi nui ana i ke ʻano o kona ola. Akā me ka ʻole o ka hoʻopunipuni, ka pohō ʻana o ka iwi o ka iwi me ka ʻeha o ke ahulau i nā ʻeha, nā ʻōpū, nā ʻōpū a me nā ʻīlio, nā mea āu e makemake ai e pale aku ai.

ʻO nā nightingales nā gynecologists e pili ana i ka waiwai o ka estrogen no ka mālama ʻana i ka nui o ka iwi a me ka pale ʻana i ka osteoporosis ua wai nui, ʻo ka ʻĀina Hoʻohui Nui no Menopause i ka makahiki 2016, nona nā kolohe e hoʻohana ʻia nā protocols mālama home kūloko, a hoʻopili ʻia i nā estrogens ke koho kūpono loa no ka pale ʻana i nā pōpilikia. nā wahine postmenopausal ʻoiai, ʻo ke koho ʻana i ka mālama ʻana no ka osteoporosis e pono e kau i ke kaulike o ka hopena a me ka uku.

ʻO nā Rheumatologists e pili i kēia mea ka ʻoi aku ka ʻoi palapala. No laila, ʻaʻole i hōʻike ʻia nā modulators selogenors i hoʻokele ʻia o nā estrogen (raloxifene) i ka hana pono ʻana i ka mālama ʻana i nā pōpoki a ʻaʻole hiki ke noʻonoʻo ʻia nā lāʻau lapaʻau e koho ai no ka hoʻokele o ka osteoporosis, e hāʻawi ana i ke ala i bisphosphonates. Pēlā nō hoʻi e hāʻawi ʻia i ka loli o ka osteoporetic i hoʻohui ʻia i nā calcium a me ka vitamin D3.

Pēlā e hiki ai i ka estrogens ke pale i ka nalowale i nā iwi, akā ua aʻo nui ʻia kā lākou mau waha ma ke kuhikuhi ʻana, kahi palekana e pili pono ana i ka oncology.
ʻAʻohe ʻikepili e pili ana i ka hōʻemi ʻana i ka nui o nā pōpilikia i loaʻa i ka lāʻau hoʻokipa i loaʻa ʻole, ʻo ia hoʻi, ʻo ka estrogen i kēia lā ua haʻahaʻa loa lākou i nā mea palekana a ʻoi aku ka maikaʻi ma nā hua e pale a hoʻopau i nā hopena koʻikoʻi o ka osteoporosis.