Phekolo ea phetoho ea li-hormone e kenyelletsa, joalo ka ha lebitso la eona le fana ka maikutlo, ho hlola ho se lekane ha li-hormone. Mofuta ona oa phekolo o ka behoa nakong ea ho khaotsa ho ilela khoeli le ho khaotsa ho ilela khoeli, ho lefella ho emisa tlhahiso ea lihomone tsa mahe a bomme. Kahoo lebitso la eona le leng, menopause hormone therapy (THM).

E le khopotso, hangata ho khaotsa ho ilela khoeli ho etsahala hoo e ka bang lilemo tse 50. Ka mor'a ho fokotseha ha follicular stock, tlhahiso ea lihomone tsa mahe a bomme (estrogen le progesterone) e emisa, e bakang bofelo ba ho ilela khoeli. Ho nkoa hore mosali o ile a khaotsa ho ilela khoeli ka mor’a bonyane likhoeli tse 12 a khaotsa ho ilela khoeli.

Ho emisa tlhahiso ea li-hormone ho ka baka matšoao a sa tšoaneng, a tsejoang e le "climacteric disorders": ho chesa ho chesa, ho fufuleloa bosiu, ho omella ha botšehali le mathata a ho ntša metsi. Ho matla le nako ea mathata ana a fapana pakeng tsa basali.

HRT e ikemiselitse ho fokotsa matšoao ana ka ho lefella khaello ea estrogen tšimolohong ea mafu ana a climacteric. Ho basali ba se nang hysterectomy (ba ntseng ba e-na le popelo ea bona), estrogen e atisa ho kopanngoa le progestogen ea molomo ho thibela ho qala ha kankere ea endometrial e amanang le estrogen.

Kalafo ena e sebetsa 'me e fokotsa makhetlo a mangata le ho teba ha likhahla tse chesang, e ntlafatsa ho omella ha botšehali le mathata a thobalano. E boetse e na le phello e sireletsang ho fractures tsohle (li-vertebrae, wrists, letheka) ho basali ba postmenopausal, e phethile tlaleho ea 2004 HAS ka HRT (1).

HRT e ne e laetsoe haholo ho fihlela mathoasong a lilemo tsa bo-2000. Leha ho le joalo, lipakeng tsa 2000 le 2002 liphuputso tse 'maloa tsa Amerika, ho kenyelletsa le Women's Health Initiative tse tsejoang hamolemo ka tlas'a lebitso la WHI (2), li tlalehile kotsi e eketsehileng ea mofetše oa matsoele le mofets'e oa matsoele. lefu la pelo ho basali ba nkang HRT.

Mosebetsi ona o entse hore ba boholong ba tsa bophelo bo botle ba hlahlobe likotsi tsa HRT le ho fetola likhothaletso tsa bona ho latela tlaleho ena ea 2004. Mosebetsi o hopola likotsi tse ling tse fapaneng tse bonoang nakong ea ho nka HRT:

• kotsi e eketsehileng ea mofetše oa matsoele: kalafo e kopaneng ea estrogen-progestogen e lebisa kotsing e eketsehileng ea mofetše oa matsoele o amanang le nako ea lengolo la ngaka, haholo kamora lilemo tse 5 tsa ts'ebeliso (3). Pakeng tsa 2000 le 2002, 3% ho 6% ea kankere ea matsoele ho basali ba pakeng tsa lilemo tse 40 le 65 ho ne ho nahanoa hore e bakoa ke phekolo ea hormone bakeng sa ho khaotsa ho ilela khoeli (4);
• kotsi e eketsehileng ea venous thrombosis ho kenyelletsa le pulmonary embolism;
• kotsi e eketsehileng ea stroke. Pakeng tsa 2000 le 2002, 6,5% ho 13,5% ea linyeoe tsa stroke li ne li tla ama basali ba lilemo li 40 le 65 (5);
• kotsi e eketsehileng ea kankere ea endometrial ketsahalong ea phekolo ea estrogen, ke kahoo progestogen e lulang e amahanngoa le eona ho basali ba se nang hysterectomy.

Ka lehlakoreng le leng, estrogen-progestogen HRT e na le karolo e sireletsang khahlanong le mofetše oa mala.

HRT ha ea lokela ho fanoa khafetsa nakong ea ho ilela khoeli. HAS e khothalletsa hore ka bomong le hlahlobe tekanyo ea melemo / kotsi pele o fana ka litaelo tsa HRT. Boemo ba mosali e mong le e mong bo tlameha ho ithutoa ho latela likotsi (likotsi tsa pelo, kotsi ea ho robeha, nalane ea mofets'e oa matsoele) le melemo (khahlanong le mathata a climacteric le thibelo ea lefu la ho fokola ha masapo) e le ho khetha kalafo, mokhoa oa eona oa tsamaiso (oral). kapa transdermal route) le nako ea eona.

Ka 2014, HAS e ile ea nchafatsa likhothaletso tsa eona (6) mme ea hopola matšoao a latelang bakeng sa HRT:

• ha mathata a climacteric a nkoa e le lihlong hoo a ka senyang boleng ba bophelo;
• bakeng sa thibelo ea postmenopausal osteoporosis ho basali ba kotsing e eketsehileng ea ho robeha ha masapo le ba sa mamelleheng kapa ba hanyetsanang le liphekolo tse ling tse bontšitsoeng bakeng sa ho thibela lefu la ho fokola ha masapo.

E boetse e khothalletsa ho fana ka phekolo ka tekanyo e fokolang le ka nako e lekanyelitsoeng, le ho hlahloba hape phekolo bonyane hang ka selemo. Ka karolelano, nako ea hajoale ea lengolo la ngaka ke lilemo tse 2 kapa tse 3 ho latela ntlafatso ea matšoao.

Ka lebaka la likotsi tse fapaneng tse boletsoeng, HRT e hanana le maemo a latelang:

• histori ea botho ea kankere ea matsoele;
• histori ea infarction ea myocardial, lefu la pelo, lefu la stroke kapa lefu la venous thromboembolic;
• kotsi e phahameng ea pelo (khatello ea mali, hypercholesterolemia, ho tsuba, boima bo feteletseng) (7).