Femoston 2, 28 pcs., film-coated tablets
Before prescribing or restarting HRT, it is necessary to obtain a complete medical and family history and conduct a general and gynecological examination to identify possible contraindications and conditions requiring precautions. During treatment with the drug, it is recommended to periodically examine women (the frequency and nature of the studies are determined individually). In addition, it is advisable to conduct breast examination and/or mammography in accordance with accepted standards, taking into account clinical indications. The use of estrogens may affect the results of the following laboratory tests: glucose tolerance testing, thyroid and liver function tests.
Generally recognized risk factors for thrombosis and thromboembolism while taking HRT are a history of thromboembolic complications, severe forms of obesity (body mass index more than 30 kg/m2) and systemic lupus erythematosus. There is no generally accepted opinion regarding the role of varicose veins in the development of thromboembolism.
The risk of developing deep vein thrombosis of the lower extremities may temporarily increase with prolonged immobilization, major trauma, or surgery. In cases where prolonged immobilization is necessary after surgery, temporary cessation of HRT should be considered 4–6 weeks before surgery.
When deciding on HRT in patients with recurrent deep vein thrombosis or thromboembolism receiving anticoagulant treatment, the benefits and risks of HRT must be carefully assessed.
If thrombosis develops after starting HRT, the drug should be discontinued. The patient should be informed of the need to consult a doctor if the following symptoms occur: painful swelling of the lower extremities, sudden loss of consciousness, dyspnea, blurred vision.
There is data demonstrating a slight increase in the detection rate of breast cancer in women who received HRT for a long time (more than 10 years). The likelihood of being diagnosed with breast cancer increases with the duration of treatment and returns to normal 5 years after stopping HRT.
Patients who have previously received HRT using only estrogen drugs should be especially carefully examined before starting treatment in order to identify possible endometrial hyperstimulation. Breakthrough uterine bleeding and mild menstrual-like bleeding may occur in the first months of treatment with the drug. If, despite dose adjustment, such bleeding does not stop, the drug should be discontinued until the cause of the bleeding is determined. If bleeding recurs after a period of amenorrhea or continues after discontinuation of treatment, its etiology should be determined. This may require an endometrial biopsy.
Femoston is not a contraceptive. Perimenopausal patients are advised to use non-hormonal contraceptives.
It does not affect the ability to drive a car or use other mechanisms.
Femoston mini tab 2.5mg+0.5mg N28 (Abbott)
The drug is prescribed only in the presence of symptoms that adversely affect the quality of life. Therapy should be continued until the benefits of taking the drug outweigh the risk of side effects. Experience with the drug in women over 65 years of age is limited. Medical examination Before prescribing or resuming therapy with Femoston® mini, it is necessary to collect a complete medical and family history and conduct a general and gynecological examination (including the mammary glands) of the patient in order to identify possible contraindications and conditions requiring precautions. During treatment with Femoston® mini, it is recommended to conduct periodic examinations, the frequency and nature of which are determined individually, but not less than once every 6 months. It is advisable to conduct instrumental research methods (for example, mammography) for additional examination of the mammary glands. Women should be informed about possible changes in the mammary glands, which should be reported to their doctor. The use of estrogens may affect the results of the following laboratory tests: determination of glucose tolerance, study of thyroid and liver functions. Hyperplasia and endometrial cancer In women with a preserved uterus, the risk of developing endometrial hyperplasia and cancer increases with long-term estrogen monotherapy. The risk of developing endometrial cancer when patients use only estrogens depends on the dose and duration of treatment and increases from 2 to 12 times compared with no treatment; the risk may remain elevated for 10 years after stopping therapy. The use of combined drugs for HRT in a continuous mode in women with a preserved uterus can prevent the risk of endometrial hyperplasia and cancer increased by estrogen. For the purpose of timely diagnosis, it is advisable to conduct ultrasound screening and, if necessary, conduct a histological (cytological) examination. Bloody vaginal discharge In the first months of treatment with the drug, “breakthrough” bleeding and/or scant bloody vaginal discharge may be observed. If such bleeding appears some time after the start of therapy or continues after cessation of treatment, its cause should be determined. An endometrial biopsy may be performed to rule out malignancy. Venous thromboembolism HRT is associated with a 1.3-3-fold risk of developing venous thromboembolism (VTE), i.e. deep vein thrombosis or pulmonary embolism. This phenomenon is most likely during the first year of HRT. If there are thromboembolic complications in first-degree relatives at a young age, as well as with a history of recurrent miscarriage, it is necessary to conduct a hemostasis study. If the patient is taking anticoagulants, it is necessary to carefully consider the prescription of Femoston® mini from the point of view of the benefit/risk ratio. Until a thorough assessment of the factors for the possible development of thromboembolism or the initiation of anticoagulant therapy is completed, Femoston® mini is not prescribed. If a thrombophilic condition is detected in a family member and/or in case of seriousness or severity of the defect (for example, deficiency of antithrombin III, protein S or C, as well as a combination of defects), Femoston® mini is contraindicated. Since patients with diagnosed thrombophilic conditions have an increased risk of developing venous thromboembolism, the use of Femoston® mini, which increases this risk, is contraindicated. In most cases, risk factors for developing VTE include: estrogen use, older age, major surgery, prolonged immobilization, obesity (body mass index > 30 kg/m2), pregnancy or the postpartum period, systemic lupus erythematosus and cancer. There is no consensus on the possible role of varicose veins in the development of VTE. To prevent VTE after surgery, prophylactic measures should be considered in all postoperative patients. To prevent VTE in case of prolonged immobilization after surgery, major surgery, surgery on the lower extremities, pelvic area or neurosurgical operation, major trauma, the drug is stopped and resumed only after the woman has restored full mobility. In case of planned surgery, the drug should be stopped 4-6 weeks before surgery. If VTE develops after initiation of therapy, the drug should be discontinued and patients should be informed that they should contact their physician immediately if they experience any potential thromboembolic symptoms (eg, tenderness or swelling of the lower extremities, sudden pain in the chest, shortness of breath). Breast cancer Current evidence suggests an increased risk of developing breast cancer in women taking HRT with combined (estrogen + progestogen) drugs and also, possibly, only estrogens. The risk depends on the duration of HRT use. HRT with combined (estrogen + progestogen) drugs A randomized placebo-controlled trial (results from the Women's Health Initiative (WH1) trial) and epidemiological studies have shown an increased risk of developing breast cancer in women taking HRT with combined (estrogen + progestogen) drugs. The increase is noticeable after approximately three years of therapy. Estrogen Therapy In the WHI study, there was no increased risk of breast cancer in women with a previous hysterectomy who received estrogen-only HRT. The results of observational studies, for the most part, showed a slight increase in the risk of being diagnosed with breast cancer, while this risk was noticeably lower than in women taking combined HRT (estrogen + progestogen) drugs. The increase in risk becomes noticeable after several years of use of HRT drugs, but after stopping therapy it returns to the original level within a few (maximum five) years. Against the background of HRT, especially HRT with combined (estrogen + progestogen) drugs, there is an increase in the density of breast tissue during mammography, which can complicate the diagnosis of breast cancer. Ovarian cancer Ovarian cancer is much less common than breast cancer. Long-term use (at least 5-10 years) of estrogens in monotherapy during HRT is associated with a slight increase in the risk of developing ovarian cancer. Data from some studies, including the WHI, indicate that combined HRT may increase the risk of developing this pathology to the same or slightly lesser extent. Risk of Ischemic Stroke Combination therapy with estrogen and progestogen or estrogen-only therapy is associated with a 1.5-fold increase in the relative risk of ischemic stroke. The risk of hemorrhagic stroke does not increase when using HRT drugs. The relative risk is not affected by age or timing of menopause, but the baseline risk is highly dependent on age, so the overall risk of stroke in women taking HRT will increase with age. Coronary artery disease (CHD) Randomized controlled clinical trials provided no evidence of a protective effect of HRT against myocardial infarction in women with or without coronary artery disease who received combined (estrogen + progestogen) HRT or estrogen alone. HRT with combined (estrogen + progestogen) drugs The relative risk of coronary heart disease during the use of HRT with combined (estrogen + progestogen) drugs increases slightly. Because the absolute risk of CHD is highly dependent on age, the number of additional cases of CHD due to combined HRT (estrogen + progestogen) drugs in healthy premenopausal women is extremely rare, but increases with age. Other Conditions Estrogens can cause fluid retention, which may adversely affect patients with impaired renal or cardiac function. In women with hypertriglyceridemia, while taking drugs for HRT, in very rare cases, the concentration of triglycerides in the blood plasma can significantly increase, which contributes to the development of pancreatitis. Estrogens increase the concentration of thyroxine-binding globulin, which leads to an overall increase in the concentration of circulating thyroid hormones, as measured by determination of plasma protein-bound iodine, thyroxine (T4) concentration - chromatographic or radioimmunoassay, or triiodothyronine (T3) - radioimmunoassay. A labeled triiodothyronine uptake test shows elevated levels of thyroxine-binding globulin. Free T4 and T3 levels remain unchanged. Plasma concentrations of other binding proteins, such as transcortin, sex hormone-binding globulin, may also be increased, resulting in increased concentrations of circulating corticosteroids and sex hormones, respectively. The concentrations of free or biologically active hormones do not change. It is possible to increase the concentration of other plasma proteins (renin-angiotensin-aldosterone system, β-1-antitrypsin, ceruloplasmin). The use of HRT does not improve cognitive function. There are reports of an increased risk of developing dementia in women who start using HRT (combined or estrogen-containing only) after 65 years. Femoston® mini is not a contraceptive. Impact on the ability to drive vehicles. Wed and fur.: Care should be taken when operating vehicles and machinery, taking into account the risk of adverse reactions from the nervous system.
