Ukwelashwa esikhundleni se-hormone kuhlanganisa, njengoba negama layo liphakamisa, ekunqobeni ukuntuleka kokukhiqizwa kwamahomoni. Lolu hlobo lokwelashwa lunganqunywa ngesikhathi sokuya esikhathini kanye nokunqamuka kokuya esikhathini, ukunxephezela ukumiswa kokukhiqizwa kwamahomoni e-ovarian. Ngakho-ke elinye igama layo, i-menopause hormone therapy (THM).

Njengesikhumbuzo, ukunqamuka kokuya esikhathini kuvame ukuvela phakathi neminyaka engama-50. Ngemva kokuncipha kwe-follicular stock, ukukhiqizwa kwamahomoni e-ovarian (i-estrogen ne-progesterone) kuyayeka, okubangela ukuphela kokuya esikhathini. Owesifazane ubhekwa njengodlule esikhathini sokunqamuka kokuya esikhathini okungenani ngemva kwezinyanga ezingu-12 eyekile ukuya esikhathini.

Ukumisa ukukhiqizwa kwama-hormone kungabangela izimpawu ezihlukahlukene, ezaziwa ngokuthi "i-climacteric disorders": ukushisa okushisayo, ukujuluka ebusuku, ukoma kwesitho sangasese sowesifazane kanye nezinkinga zomchamo. Ukuqina kanye nobude balezi zinkinga ziyehluka phakathi kwabesifazane.

I-HRT ihlose ukukhawulela lezi zimpawu ngokunxephezela ukuntuleka kwe-estrogen emsuka walezi zinkinga ze-climacteric. Kwabesifazane abangenalo i-hysterectomy (abasenesibeletho), i-estrogen ijwayele ukuhlanganiswa ne-progestogen yomlomo ukuvimbela ukuqala komdlavuza we-endometrial ohlobene ne-estrogen.

Lokhu kwelashwa kuyasebenza futhi kunciphisa imvamisa nokuqina kokushisa okushisayo, kuthuthukisa ukomisa kwesitho sangasese sowesifazane kanye nezinkinga zocansi. Ibuye ibe nomthelela wokuvikela kuwo wonke ama-fractures (ama-vertebrae, ama-wrists, ama-hips) kwabesifazane be-postmenopausal, baphetha umbiko we-2004 HAS nge-HRT (1).

I-HRT yanqunywa kabanzi kuze kube sekuqaleni kwawo-2000. Kodwa-ke, phakathi kuka-2000 no-2002 izifundo ezimbalwa zaseMelika, kuhlanganise ne-Women's Health Initiative eyaziwa kangcono ngaphansi kwegama elithi WHI (2), zibike ukwanda kwengozi yomdlavuza webele kanye nomdlavuza webele. isifo senhliziyo kwabesifazane abathatha i-HRT.

Lo msebenzi uholele ekutheni iziphathimandla zezempilo zihlole kabusha ubungozi be-HRT futhi zivumelanise izincomo zazo ngokufanele kulo mbiko ofanayo wezi-2004. Umsebenzi ukhumbula ubungozi obengeziwe obubonwa uma kwenzeka uthatha i-HRT:

• ingozi eyengeziwe yomdlavuza webele: ukwelashwa okuhlanganisiwe kwe-estrogen-progestogen kuholela engcupheni eyengeziwe yomdlavuza webele exhunywe ubude besikhathi sencwadi kadokotela, ikakhulukazi ngemva kweminyaka emi-5 yokusetshenziswa (3). Phakathi kuka-2000 no-2002, i-3% kuya ku-6% yomdlavuza webele kwabesifazane abaneminyaka ephakathi kuka-40 no-65 kwakucatshangwa ukuthi ibangelwa ukwelashwa kwe-hormone yokunqamuka kokuya esikhathini (4);
• ukwanda kwengozi ye-venous thrombosis kuhlanganise ne-pulmonary embolism;
• ukwanda kwengozi yokushaywa unhlangothi. Phakathi kuka-2000 no-2002, u-6,5% kuya ku-13,5% wamacala okushaywa unhlangothi azobangelwa abesifazane abaneminyaka engu-40 kanye ne-65 (5);
• ukwanda kwengozi yomdlavuza we-endometrial uma kwenzeka ukwelashwa kwe-estrogen, yingakho i-progestogen ihlale ihlotshaniswa nayo kwabesifazane ngaphandle kwe-hysterectomy.

Ngakolunye uhlangothi, i-estrogen-progestogen HRT inendima yokuvikela kumdlavuza wekoloni.

I-HRT akufanele inqunywe njalo ngesikhathi sokunqamuka kokuya esikhathini. I-HAS incoma ukuthi uhlole isilinganiso senzuzo / ingozi ngaphambi kokunquma i-HRT. Iphrofayili yowesifazane ngamunye kufanele ifundwe mayelana nezingozi (izingozi zenhliziyo, ingozi yokuphuka, umlando womdlavuza webele) kanye nezinzuzo (ngokumelene nokuphazamiseka kwe-climacteric kanye nokuvimbela i-osteoporosis) ukuze kukhethwe ukwelashwa, indlela yokuphatha (ngomlomo. noma umzila we-transdermal) kanye nobude bayo.

Ngo-2014, i-HAS yavuselela izincomo zayo (6) futhi yakhumbula lezi zinkomba ezilandelayo ze-HRT:

• lapho ukuphazamiseka kwe-climacteric kubonwa njengamahloni okwanele ukuphazamisa izinga lokuphila;
• ukuze kuvinjelwe i-postmenopausal osteoporosis kwabesifazane abasengcupheni eyengeziwe yokwephuka kwamathambo futhi abangabekezeleli noma abaphikisana nezinye izindlela zokwelapha ezikhonjiswe ukuvimbela i-osteoporosis.

Futhi incoma ukunquma ukwelashwa ngethamo elincane kanye nesikhathi esinqunyelwe, futhi kuhlolwe kabusha ukwelashwa okungenani kanye ngonyaka. Ngokwesilinganiso, isikhathi samanje sencwadi kadokotela iminyaka emi-2 noma emi-3 kuye ngokuthuthuka kwezimpawu.

Ngenxa yobungozi obuhlukahlukene obaluliwe, i-HRT iyavinjelwa kulezi zimo ezilandelayo:

• umlando womuntu siqu womdlavuza webele;
• umlando we-myocardial infarction, isifo senhliziyo, isifo sohlangothi noma isifo se-venous thromboembolic;
• ingozi ephezulu yenhliziyo (i-hypertension, hypercholesterolemia, ukubhema, ukukhuluphala) (7).