Menopausal hormone therapy features in women with estrogen-dependent uterus pathology

In the literature review issues about menopausal hormone therapy in perimenopausal women with considering of recent revised opinion to this treatment are presented.Derivatives of 19-norsteroid gestagens, particularly levonorgestrel are standard therapy among progestogens with antiproliferative effect on endometrium. Eeffectiveness of new progestogens is compared with levonorgestrel. Levonorgestrel as intrauterine releasing system and an oral version is included in the majority of studies and guidelines dealing with the treatment of chronic heavy menstrual bleedings and endometrial hyperplasia. Thus levonorgestrel has a less pronounced androgenic properties compared to other 19-nortestosterone derivatives, almost without increasing the level of low density lipoproteins, and thus is not increase the cardiovascular risk. Levonorgestrel has a strength anti-proliferative effect on the endometrium and myometrium that superior progesterone derivative almost 2 times.The combination of estradiol valerate (2 mg) and levonorgestrel (0.15 mg) is reasonable for menopausal hormone therapy in perimenopausal women seeking treatment for endometrial hyperplasia or endometriosis with associated abnormal uterine bleeding. The advantages of such combinations are: high efficiency for atrophic disorders of the genitourinary system; a positive effect on the lipid profile; effective reduction of menopausal symptoms; beneficial effects on the cardiovascular system; increasing bone mineral density; effective protection for endometrial hyperplasia and suppression of genital and extragenital endometriosis; more androgenic activity of levonorgestrel is involved in the formation of the mental comfort and harmonious sexual life.The author’s conclusion is the combination of estradiol valerate (2 mg) and levonorgestrel (0.15 mg) is the drug of choice for menopausal hormone replacement therapy in perimenopausal and postmenopausal women because of the high efficiency and low incidence of adverse reactions. This drug has therapeutic properties in the treatment of abnormal uterine bleedings, endometriosis and adenomyosis, recurrent endometrial hyperplasia.