Treatment of menopause

• Vaginal dryness: reduced lubrication, discomfort during sexual intercourse.
• Mood changes: irritability, depression, anxiety.
• Urological problems: increased frequency of urination, recurrent urinary tract infections.
• Changes in skin and hair: decreased skin elasticity, dryness, hair loss.
• Sleep disturbances, etc.

Principles of treating climacteric and climacteric states:

Hormonal or bioidentical therapy (pellets):
• Use of natural sources of sex hormones such as soy products, red clover, wild yam (Dioscorea), etc.

Lifestyle correction, including nutrition, physical activity, and sleep disorders…
Compensation for the body's deficient states (if present): iron deficiency, vitamin D, calcium…

EXAMINATION:

1. Gynecological examination, colposcopy, and vaginoscopy…
2. Comprehensive evaluation (biochemical and hormonal profile, Doppler examination of the head, heart, neck, and lower limb vessels, ultrasound examination of all organs and systems including the uterus and ovaries, as well as the lymphatic system)
3. DENSITOMETRY + B-Cross Laps
4. Anti-Müllerian hormone and Inhibin B

NUTRITION:

It is individually selected based on the patient’s complaints, her physical activity, body mass index, and the biochemical deficiencies of the body (if present), as well as taking into account the presence or absence of osteopenia or osteoporosis…
Nutrition according to Budwig-Genesis (a mixture of cottage cheese, flaxseed oil, and blueberry paste with nuts)…

WATER:

1. Drink between 1L to 1. 5L (not forced, but for pleasure), preferably from glass containers (Lauretana, Voda UA, Evian, Fiji, Fiji, Acqua Panna);
The same water should be consumed for 1–2 months, then change to a different source.

2. The pH of the water should be at least 7. 2, with mineralization of 250–300 or lower, OVP up to +200.

MEDICATION TREATMENT:

General:

1. Femoston 1/10, 2/10, 1/5; Livial; Lansetto; Estrogel; Tibolone; Gyde spiral (levonorgestrel 13. 5 mg)
2. Dibase (vitamin D), intramuscular injection
3. Omega-3 Krill
4. Bioidentical pellets with estrogens, progesterone, and testosterone…
5. Cordyceps
6. In cases of symptoms of osteopenia or osteoporosis, special treatment is provided.

Local:

1. Colpotrophin
2. Ovestin
3. Verixa (vaginal suppositories based on natural oils)…

There are natural preparations that may help with climacteric symptoms:

• Soy isoflavones (Isoflavoni di Soia) help balance estrogen levels in the body and may reduce symptoms such as hot flashes and night sweats.

• Red clover extract (Trifolium pratense) is often used to relieve climacteric symptoms such as hot flashes and vaginal dryness.

• Melilot (Melilotus officinalis) extract helps improve circulation and can alleviate climacteric symptoms.

• Chaste tree (Vitex agnus-castus) may help regulate hormonal balance and reduce climacteric symptoms.

• Lemon balm (Melissa officinalis) helps cope with anxiety and insomnia…

• Gingko biloba (Ginkgo biloba) aids in improving cognitive functions and can ease memory and concentration issues sometimes observed during the climacteric period.

• Black cohosh (Cimicifuga racemosa)

INTIMATE HYGIENE:

1. Use a hydrophilic oil instead of soap
2. Intima (for external use)
3. Exclude tampons
4. Use organic cotton sanitary pads…

UNDERGARMENTS:

1. Cotton and linen underwear (not tight, comfortable)

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These preparations stabilize the function of the hypothalamic–pituitary system during the climacteric period, which is achieved by the estrogenic (female sex hormones), progestagenic (hormones similar to those of the corpus luteum), and weak androgenic (hormones similar to male sex hormones) properties of the preparation. In postmenopausal women (in the post-climacteric period), Livial in a daily dose of 2. 5 mg suppresses the secretion of gonadotropins (pituitary hormones that stimulate the activity of the sex glands), does not stimulate endometrial proliferation (an increase in the number of cells in the inner lining of the uterus due to reproduction), prevents the loss of bone mass in the postmenopausal period, reduces the degree of vasomotor disturbances (“hot flashes”, sweating), has a positive influence on libido and mood, as well as a stimulating effect on the vaginal mucosa.

The rationale in treating climacteric:

1. Determine the levels of your sex hormones, pituitary hormones, adrenal and thyroid hormones…
2. Identify any deficiencies: iron, levels of homocysteine and vitamin D, as well as biochemical markers of kidney and liver function…
3. Take into account your complaints regarding well-being, sleep, bowel movements, and urinary frequency, as well as the condition of your skin, hair, and mood…
4. Determine the condition of your vessels (using Doppler): in the brain, heart, neck, and lower limbs… checking for plaques, clots, inflammations…
5. Assess whether you have problems with the lymphatic system and perform imaging (ultrasound) of your liver, kidneys, thyroid, and, in men, of the prostate and urinary bladder, pancreas, liver, and kidneys…
6. Monitor bone density (densitometry)…
7. Nutrition correction…
8. Immune system modulation…
9. All of this is under the control of an experienced physician – a therapist and gynecologist-endocrinologist who is familiar with the modern European and Thai pharmacopoeia…

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CIMICIFUGA + WILD YAM (DIOSCOREA)

The use of herbal preparations such as Cimicifuga racemosa and wild yam (Dioscorea villosa) is possible individually or in combination. Both plants are used to alleviate symptoms related to hormonal imbalance, especially during premenopause and menopause. However, it is important to know the correct regimen for their use and the specifics of their interaction.

Combined use of Cimicifuga and Wild Yam:

• Cimicifuga primarily acts on estrogen-like receptors and can relieve hot flashes, night sweats, and emotional fluctuations.
• Wild yam contains substances that can be converted into progesterone-like compounds, which helps support hormonal balance, especially if there is a progesterone deficiency.

Recommended Regimen:

Cimicifuga:
– Form: extract, capsules, or tablets.
– Dosage: 20–40 mg of Cimicifuga extract per day, divided into 1–2 doses.
For example, 20 mg in the morning and 20 mg in the evening.
– Duration: usually a course lasts from 3 to 6 months with subsequent evaluation. Breaks can be taken after 3–6 months of use.
– Side effects: Cimicifuga may cause mild gastrointestinal disturbances, headaches, and, in rare cases, liver issues with prolonged use.

Wild Yam (Dioscorea):
– Form: capsules, tablets, extract, or cream for external use.
– Dosage: 500–1000 mg of wild yam per day in capsules (depending on the concentration of active substances). If using a cream, it should be applied according to the package instructions, usually on the skin of the thighs or abdomen.
– Duration: 2–6 months, after which it is recommended to take a break and assess efficacy.
– Side effects: generally rare, but may include mild stomach upset and headaches.

COMBINED REGIMEN:

Morning: 1 capsule of Cimicifuga extract (20 mg) + 500 mg of wild yam.
Evening: 1 capsule of Cimicifuga extract (20 mg) + 500 mg of wild yam.
A cream containing wild yam can be applied once a day in a small amount (following the instructions) if preferred.

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REFERENCE INFORMATION:

1. ESTROGENS FOR MHT (Menopausal Hormone Therapy)

Estradiol valerate 2 mg
PROGINOVA* – 21 tablets

Estradiol hemihydrate 0. 15–0. 5 mg packaged in gel
Estradiol hemihydrate 0. 15–0. 5 mg packaged in gel
DIVIGEL* – external gel, 28 sachets per package

Estradiol 2. 5 g aqueous-alcoholic gel 0. 06% contains 1. 5 mg estradiol hemihydrate – 2 clicks; 0. 75 mg – 1 click
ESTROGEL* – external gel in pump bottles

2. OTHER ESTROGENS FOR MHT:

Tibolone 2. 5 mg
LIVIAL*, Velledien, Lady-Bon – 28 tablets

3. PROGESTAGENS FOR MHT

Dydrogesterone 2. 5–10 mg
DYUFASTON* – 28 tablets
Micronized progesterone 100–300 mg
UTROGESTAN*, Prajisan, PROGINORM*, INJESTA* – 14 or 28 capsules

LNG-IUS 20 µg/day
MIRENA* – intrauterine system for up to 8 years

4. COMBINED PREPARATIONS FOR MHT

Estradiol valerate 2 mg
Levonorgestrel 150 µg
KLIMONORM* – 21 tablets

Estradiol valerate 2 mg
Cyproterone acetate 2 mg
KLIMEN* – 21 tablets

Estradiol 17β 2 mg
Norethisterone 1 mg
KLIOGEST* – 28 tablets

Estradiol valerate 1 mg
Medroxyprogesterone 2. 5 mg
INDIVINA 1, 2. 5 – 28 tablets

Estradiol valerate 1 mg
Medroxyprogesterone 5 mg
INDIVINA – 28 tablets

Estradiol valerate 1 mg
Medroxyprogesterone 2. 5 mg
INDIVINA 2/5 – 28 tablets

Estradiol 17β 0. 5 mg
Drospirenone 0. 25 mg
ANGELIC micro* – 28 tablets

Estradiol 17β 1 mg
Drospirenone 2 mg
ANGELIC* – 28 tablets

Estradiol 17β 1 mg
Drospirenone 10 mg
FEMOSTON 1* – 28 tablets

Estradiol 17β 2 mg
Drospirenone 10 mg
FEMOSTON 2* – 28 tablets

Estradiol 17β 0. 5 mg
Drospirenone 2. 5 mg
FEMOSTON mini* – 28 tablets

Estradiol 17β 1 mg
Drospirenone 5 mg
FEMOSTON conti* – 28 tablets

* – Available in Ukraine

PRIVATE CASE: 56 years old, preserved uterus, and a 3 cm interstitial uterine fibroid…

Recommendations for using estrogen patches for MHT at age 55 with a preserved uterus and fibroid:

Estrogen patches are a convenient method of menopausal hormone therapy (MHT), especially in the presence of fibroids and a predisposition to side effects from oral hormone forms. However, when the uterus is preserved, estrogens must always be combined with progestagens to prevent endometrial overgrowth.

Choice of patch:
Patches with pure estradiol:
✅ Climara – 50, 75, 100 µg/day
✅ Estraderm – 25, 50, 100 µg/day
✅ Menostar – a low-dose option (14 µg/day)

• Initial dose: 25–50 µg/day with gradual adjustment.
• Change the patch every 3–7 days depending on the brand.

Need for progestagens (with a preserved uterus):
Since estrogens can stimulate the growth of the endometrium and fibroids, a progestagen is necessary to protect the uterus:

✅ Micronized progesterone (Utrogestan) – 200 mg/day at night (for 12–14 days per month or continuously)
✅ Dydrogesterone (Dyufaston) – 10 mg/day (12–14 days per month or continuously)
✅ Levonorgestrel (Mirena IUS) – if no contraindications exist

• If the fibroid is small (up to 3–4 cm) and not growing, cyclic progestagen use is acceptable.
• If the fibroid is growing or there is a tendency for hyperplasia, a continuous regimen is preferable.

Advantages of patches compared to tablets:
✅ Less strain on the liver and metabolism
✅ Stable hormone levels in the blood (without fluctuations)
✅ Lower risk of thrombosis compared to tablets

Impact on fibroids:
• Low-dose patches (≤50 µg) usually do not cause significant fibroid growth.
• High doses of estrogen (>75 µg) can provoke fibroid growth and bleeding.
• Progestagens help control fibroid growth but do not reduce its size.

If the fibroid grows or if there are acyclic bleedings, it may be necessary to adjust the dosage or change the MHT regimen.

Conclusion:
• An estrogen patch in combination with a progestagen is suitable for you.
• The dosing should be the minimally effective dose (25–50 µg/day).
• Regular monitoring (ultrasound of the uterus and breasts every 6–12 months) is required.