HEALTH OF WOMAN. 2019.2(138): 86–90; doi 10.15574/HW.2019.138.86

Stepanenko T. O. , Chayka K. V. , Shalko M. N. , Zahorodnya O. S.
Shupyk National Medical Academy of Postgraduate Education, Kiev
Bogomolets National Medical University, Kiev

Substitution of estrogen is a proven way of correcting disorders that are associated with menopause. The question of the optimal method for the administration of estrogens, given changes in the cardiovascular system and psychological maladaptation, is controversial.

The objective: to study the effect of alternative schemes of exogenous estrogen administration on the state of endothelial regulation and psychological adaptation of women with RM.

Material and methods. Under observation, there were 74 patients who asked the gynecologist about the termination of menstrual function at the age of less than 40 years. Patients were divided into 3 subgroups – 25 patients of subgroup Ia received classic cyclic hormone replacement therapy, 25 subgroup Ib patients received exogenous drugs in combination oral contraceptives, 24 patients of the subgroup Ic received exogenous estrogens as transdermal patches.

In all groups, the level of reactive and personality anxiety was determined prior to the start of treatment on a special scale. For the study of endothelial regulation, the activity of vascular motor expansion of the shoulder artery under the influence of hyperemia was investigated, the base diameter of the shoulder artery Db was estimated, the shoulder artery diameter after decompression Dd and the increase in the diameter of the shoulder artery after decompression,%, Δ ₁. All of these indicators were studied in patients of all subgroups in 3, 6 and 12 months after initiating the administration of exogenous estrogens. The Kolmogorov-Smirnov criterion (level of psychological adaptation) and Student’s criterion (indicators of endothelial regulation) were used to assess the statistical differences between the groups.

Results. Among all methods of exogenous use of estrogen, oral administration of them in a continuous mode has the most powerful positive effect on psychological adaptation – after 6 and 12 months of therapy, 52% and 76% of patients achieved a low level of situational anxiety, while 48% and 72% personal anxiety, in other subgroups, these proportions were significantly smaller (not more than 42%). The effect on endothelial dysfunction was also more pronounced in patients of the Ia subgroup – they reported a significant increase in the growth of the diameter of the brachial artery during the first year of therapy during the 6 months after starting treatment. Such changes in endothelial regulation are not the same or even the tendency towards them in the groups of other forms of administration of estrogens.

Conclusions. 1. The application of different schemes of exogenous estrogen assignment has a different effect on the psychological adaptation and regulation of cardiovascular function in patients with early menopause. 2. Thus, during 6 months of treatment, 52% of patients taking estrogens in continuous hormone replacement therapy had a low level of situational anxiety, while patients taking hormonal contraceptive cyclical estrogens in only 32 % showed a low level of anxiety, and women who took exogens in the form of a transdermal patch – a lice of 25%. After 12 months, the disagreements became even higher – 76, 40, and 41.6% respectively. 3. The tendency to reduce the level of personal anxiety, outlined after 6 months of treatment, in women who received estrogens in continuous hormone therapy (48% vs. 32 and 33.3% in hormonal contraceptives and transdermal patches), became statistically probable due to year of treatment (72, 40 and 45.8% respectively). 4. In the subgroup receiving estrogens in the mode of continuous substitution hormone therapy, improvement of endothelial function in the form of increase in the growth of the diameter of the brachial artery after decompression was noted during 6 months of treatment, this trend was not found in other subgroups

Key words: early menopause, situational, personality anxiety, endothelial regulation, estrogen therapy.

REFERENCES

1. Striletska II. 2016. Osobystisna tryvozhnist yak skladnyi polideterminovanyi psykhichnyi protses. Insait: zb. nauk. prats studentiv, aspirantiv ta molodykh vchenykh. Red. kol. Shaposhnykova IV, Blynova OIe ta in. Kherson: PP Vyshemyrskyi VS. Vyp. 13: 299–301.

2. Absolom K, Eiser C, Turner L, Ledger W et al. 2008. Ovarian failure following cancer treatment: current management and quality of life. Hum Reprod. 23: 2506–2512. https://doi.org/10.1093/humrep/den285; PMid:18664468

3. Albright F, Smith P, Fraser R. 1942. A syndrome characterized by primary ovarian insufficiency and decreased stature. Am J Med Sci. 204 (5): 625–48. https://doi.org/10.1097/00000441-194211000-00001

4. Avis N, Crawford S, Greendale G et al. 2015. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med  175: 531–539. https://doi.org/10.1001/jamainternmed.2014.8063; PMid:25686030 PMCid:PMC4433164

5. Fenton A. 2015. Premature ovarian insufficiency: Pathogenesis and management. J Midlife Health 6.I.4: 147–153. https://doi.org/10.4103/0976-7800.172292; PMid:26903753 PMCid:PMC4743275

6. Harman S, Black D, Naftolin F et al. 2014. Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Ann Intern Med. 161: 249–260. https://doi.org/10.7326/M14-0353; PMid:25069991

7. Hodis N, Mack W, Henderson V et al. 2016. Vascular effects of early versus late postmenopausal treatment with estradiol/ N Engl J Med. 374: 1221–1231. https://doi.org/10.1056/NEJMoa1505241; PMid:27028912 PMCid:PMC4921205

8. Hormone therapy in primary ovarian insufficiency. Committee Opinion No. 698. American College of Obstetricians and Gynecologists. Obstet Gynecol. 129:e134–41. 2017. https://doi.org/10.1097/AOG.0000000000002044; PMid:28426619

9. Keaney JF, Solomon C. 2016. Postmenopausal hormone therapy and atherosclerosis: time is of the essence. N Eng J Med.  374: 1279–1280. https://doi.org/10.1056/NEJMe1602846; PMid:27028919

10. Madalinska J, van Beurden M, Bleiker E, Valdimarsdottir H, Hollenstein J. 2006.  The impact of hormone replacement therapy on menopausal symptoms in younger high-risk women after prophylactic salpingo-oophorectomy. J. Clin Oncol. 24:3576–3582. https://doi.org/10.1200/JCO.2005.05.1896; PMid:16877724

11. Mikkola T, Clarkson T. 2002. Estrogen replacement therapy, atherosclerosis, and vascular function. Cardiovascular Research 53;I.3: 605–619. https://doi.org/10.1016/S0008-6363(01)00466-7

12. Moolman A, Johannes A. 2006. Unravelling the cardioprotective mechanism of action of estrogens. Cardiovascular Research 69:777–780. https://doi.org/10.1016/j.cardiores.2006.01.001; PMid:16532550

13. Panay N, Kalu E. 2009. Management of premature ovarian failure. Best Pract Res Clin Obstet Gynaecol. 23 (1): 129–40. doi: 10.1016. https://doi.org/10.1016/j.bpobgyn.2008.10.008; PMid:19091633

14. Piccioni P, Scirpa P, D’Emilio I, Sora F et al. 2004. Hormonal replacement therapy after stem cell transplantation. Maturitas. 49: 327–333. https://doi.org/10.1016/j.maturitas.2004.02.015; PMid:15531129

16. Podfigurna-Stopa A, Czyzyk A, Grymowicz M, Smolarczyk R, Katulski K, Czajkowski K, Meczekalski B. 2016. Premature ovarian insufficiency: the context of long-term effects. J Endocrinol Invest. 39 (9): 983–90. https://doi.org/10.1007/s40618-016-0467-z; PMid:27091671 PMCid:PMC4987394.

17. Wharton W, Gleason C, Mill V, Ashana S. Rationable and design of the Kronos Early Estrogen Study (KEEPS) and the KEEPS cognitive and affective sub study (KEEPS cog). Brain Res. 1514: 12–17. https://doi.org/10.1016/j.brainres.2013.04.011; PMid:23603409 PMCid:PMC3731133

18. Wilson R, Wilson T. 1963. The fate of the nontreated postmenopausal woman: a plea for the maintenance of adequate estrogen from puberty to the grave. J Am Geriatric Soc. 11: 347–362. https://doi.org/10.1111/j.1532-5415.1963.tb00068.x; PMid:14001078

19. Writing Group for the Women’s Health Initiative Investigators. Risk and benefits of estrogen plus progestin in healthy menopausal women: principal results from the Women’s Health Initiative randomized control trial. JAMA 288:321–333. 2002. https://doi.org/10.1001/jama.288.3.321; PMid:12117397