Due to the total aging of the population, within the framework of the concept of “active longevity”, age-related aspects of women’s health have been paid close attention in the last decade. The physiological features of the menopausal period of life are due to the consequences of estrogen deficiency, while the protective effect of menopausal hormone therapy (MHT) in relation to diseases associated with age and aging leaves no doubt. At the same time, in the context of the ongoing COVID-19 pandemic, there are many open questions related to the appointment of MHT, both in terms of possible additional mechanisms for protecting the vascular wall, and in terms of risks, including against the background of changes in the state of immunity and the coagulation system. New realities require the development and justification of often fundamentally different approaches to the management of patients in gynecological practice, both in connection with coronavirus infection and in the postcovid period. That is why the organization of gynecological care during a pandemic requires a personalized approach to the management of patients with hormone-dependent diseases and the risk of unplanned pregnancy, as well as the development of clear algorithms that can be relied on in the daily work of both a practitioner and health care organizers.
Aim. To assess the safety and efficacy of non-hormonal agents for mild vasomotor symptoms of menopause. Materials and methods. The study included 173 females aged 4855 with mild vasomotor symptoms during the early postmenopausal period. Patients in the study cohort were stratified into two groups by the double-blind method. In group 1 (study), the patients took the homeopathic agent Neoclimsal 1 tablet 4 times a day sublingually until completely dissolved for 4 weeks (n=86). In group 2 (n=87), the patient received a placebo (30 mg of microcrystalline cellulose) in a regimen mimicking the study treatment. Twenty-three patients withdrew from the study due to protocol violation or revoked their consents for reasons not related to medication. At the end of the study, 75 patients remained in both groups. The therapeutic efficacy was assessed based on the Greene and MENQOL scores change. The SF-36 questionnaire was used to evaluate patients' quality of life, and the average rate of falling asleep was calculated to assess the change in sleep disturbance. The change of M-echo and mammography results were reviewed using the BI-RADS scale 12 months after the start of the treatment to assess the agent's safety. Study design: A prospective, double-blind, placebo-controlled study. Results. The course of Neoclimsal, sublingual tablets, reduced the severity of vasomotor symptoms by 2.3 times, the severity of depression by half (p0.001), and at the end of treatment after 12 weeks of observation, the therapeutic effect not only persisted but tended to increase (p0.001). Improvement in the quality of life of patients treated with Neoclimsal was confirmed by an improvement in the MENQOL score by 1.4 times a month after the start of therapy while maintaining the achieved result after 12 weeks of observation (p0.001). The drug's safety is confirmed by the absence of adverse side effects and allergic reactions, the absence of endometrial thickness change within 3 months after the start of treatment, and mammography results using the BI-RADS scale at 12 months. Conclusion. The results indicate the effectiveness of non-hormonal therapy in relieving vasomotor symptoms of mild postmenopause with a high safety profile. The drug has a beneficial effect on sleep disorders, reducing the severity of mental distress and improving the general quality of life.
In the modern paradigm of public health protection, much attention is paid to the health of women in peri- and postmenopause, and a personalized approach prevails. It is generally recognized that the pathogenetic therapy of menopausal disorders is hormone therapy. But the COVID-19 pandemic has made its own adjustments to the routine strategy of choosing menopausal hormone therapy (MHT). The purpose of this review was to analyze studies on the dependence of the effectiveness of MHT on clinical and genetic aspects in the context of the ongoing COVID-19 pandemic. The review highlights the main risks of MHT for thromboembolic diseases and coagulation complications characteristic of COVID-19, discusses genetic predispositions that aggravate the course of the post-COVID period, as well as the effectiveness of estrogens in protecting the vascular endothelium and increasing the number of CD4+ T cells, providing an adequate immune response when infected with SARS-CoV-2. Numerous studies show that the complications characteristic of the severe course of COVID-19 are multifactorial in nature and cannot be unambiguously explained only by genetic predisposition. However, with the development of personalized medicine, special attention should be paid to the study of genetic aspects that can equally contribute to the occurrence of menopausal disorders in healthy women and aggravate the course of the post-pregnancy period. The data presented allow us to conclude that in the context of the ongoing COVID-19 pandemic at the population level, MHT can bring significant benefits to women during menopause due to the beneficial effect of estrogens on vascular walls. Additional study of the relationship between the course of the postcovid period in MHT users and polymorphisms of candidate genes that determine the risks of thrombotic complications and metabolic consequences is required.
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