Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum93143ArticlesСтатьиResearch ArticleMetabolicheskie effekty didrogesterona v sostave preparatov dlya zamestitel'noy gormonal'noy terapiiМетаболические эффекты дидрогестерона в составе препаратов для заместительной гормональной терапииKuznetsovaI. VКузнецоваИ. ВРоссийская медицинская академия последипломного образования, Москва15062010126VOL 12, NO6 (2010)ТОМ 12, №6 (2010)61228122021Copyright ©; 2010, Consilium MedicumCopyright ©; 2010, ООО "Консилиум Медикум"2010Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/93143

Основным методом лечения климактерических расстройств является заместительная гормональная терапия (ЗГТ), которая в виде комбинации эстрогена и прогестагена или при отсутствии матки монотерапии эстрогенами используется более 30 лет для лечения климактерических и урогенитальных расстройств, а также для первичной профилактики переломов вследствие остеопороза [4–6]. Еще один, крайне важный аспект применения ЗГТ – первичная профилактика сердечно-сосудистых заболеваний – в последние годы исчез из перечня показаний, но не утратил своей актуальности и продолжает обсуждаться с позиций потенциальных превентивных эффектов при раннем назначении ЗГТ [7]. Причиной пересмотра показаний к ЗГТ стали результаты клинического исследования «Инициатива во имя здоровья женщин» (Women\'s Health Initiative study – WHI), единственного на настоящий момент масштабного плацебо-контролируемого исследования, в котором применялись наиболее важные клинические конечные точки [8, 9]. Исследование WHI продемонстрировало повышение риска венозной тромбоэмболии, ишемического инсульта и рака молочной железы на фоне использования ЗГТ и во многом изменило отношение к применению гормонов в климактерическом периоде. Половые гормоны, входящие в состав ЗГТ, обладают множественными эффектами, и в настоящее время стало очевидно, что только часть из этих эффектов характеризуется лечебным действием, а другая должна рассматриваться с позиций потенциальных рисков. Безопасность терапии требует серьезного внимания к оценке факторов риска тех или иных осложнений и, соответственно, индивидуальному подбору препарата и режима его ведения, позволяющему их минимизировать

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