[Samitin]

Сообщение от camelot

не могли бы Вы подсказать , где почитать про указанный Вами второй протокол лечения?

Насколько я понимаю, приблизительно такая схема:

Effect of an estradiol gel with monthly or quarterly progestogen on menopausal symptoms and bleeding. - Hirvonen E1, Crona N, Wahlström T, Bäckström AC. - Climacteric. 2000 Dec;3(4):262-70. ([Ссылки доступны только зарегистрированным пользователям ]).

OBJECTIVE:
To assess the acceptability, efficacy and endometrial safety of transdermal estradiol gel (Divigel/Sandrena) combined with monthly or quarterly oral progestogen (medroxyprogesterone acetate).

METHODS:
This 12-month, multicenter, open-label study was carried out at 12 study centers in Finland and Sweden. A total of 395 postmenopausal women received 1 mg estradiol in 1 g gel, daily, with oral medroxyprogesterone acetate 10 mg for the first 12 days every month (groups I and III) or every 3 months (group II). The main outcome measures were relief of climacteric symptoms, bleeding patterns and endometrial safety.

RESULTS:
All regimens reduced the severity of hot flushes, sweating episodes and vaginal dryness. In groups I and III, approximately 80% and 70% of women, respectively, had regular monthly withdrawal bleeding (excepting the first cycle), with irregular bleeding in 8.3% and 5.3% of treatment months. In group II, approximately 94% of women had regular tri-monthly withdrawal bleeding, with irregular bleeding in 10.7% of the treatment months. Endometrial hyperplasia was observed in 0.3% of women. More than 87% of subjects completed the study, and 97% of these rated the gel as acceptable or convenient.

CONCLUSIONS:
Both the 1- and 3-month regimens were equally effective in controlling climacteric symptoms and protecting against endometrial hyperstimulation. The bleeding patterns were comparable between groups and were similar to those reported for oral estrogens. Estradiol gel was highly acceptable to the majority of women.

Хотя в АпТуДейте пишут, что более распространенной является схема с ежемесячным приемом прогестагена:

Quarterly progestin regimens — Quarterly progestin regimens are probably not adequate for endometrial protection, and we suggest against this approach. Administration of MPA for 14 days every three months has been investigated as a strategy for women who have difficulty tolerating progestin therapy [50,51]. However, these regimens may be associated with higher than normal rates of endometrial hyperplasia [52]. With increasing concerns about the role of progestin exposure on the risk of breast cancer, there is renewed interest in these types of regimens, particularly with the increasing use of lower doses of estrogens. However, data are not yet available on quarterly progestin regimens for low-dose estrogen.