Drug-mediated correction of negative phlebotropic effects of hormone replacement therapy in women

Tsukanov Yu.T., Tsukanov A.Yu., Bazhenov V.N., Kornienko I.F., Vasilevich V.V.

Postgraduate Medical Training Department of Surgical Diseases under the Federal Educational Facility of Higher Occupational Education «Omsk State Medical Academy of the Russian Public Health Ministry», Omsk, Russia

Objective of the study: to specify a negative effect of hormone replacement therapy (HRT) on lower-limb veins in women and to assess feasibility of its correction with phleboprotectors. Examined were a total of thirty-seven 45-to-68-year-old (average age 55.4±13.7 years) women with the CEAP grade 0-2 chronic venous disease of the legs. Of these, grade C0 was diagnosed in 14 patients, grade C1 in 17, and grade C2 in the remaining six cases. Inclusion criterion: administration of oestrogen-progestin drugs with the replacement purposes. Exclusion criteria: a history of previously sustained operations on the veins and venous sclerotherapy, as well as venous thrombosis. Of the 37 women receiving hormone replacement therapy for more than 4 months, 31 (66.7%) complained of uneasiness and a feeling of dilatation in the crural region, cramps, convulsions, pain, and leg heaviness. Eleven women reported to have had no such complaints prior to HRT, and twenty were found to have an apparent progression of the previously existing complaints. The comparative study using duplex scanning of limb veins before and 4 months after HRT revealed enlargement of the lumens of the common femoral, posterior tibial and great saphenous veins, as well as an increased incidence rate of reflux along the femoral and great saphenous veins. The women after 4 months of HRT were assigned to simultaneously undergo a therapeutic course with Phlebodia 600 taken at a dose of 1 tablet once a day for 2 months. On the background of this therapy, there was a decrease in and gradual disappearance of such symptoms as a feeling of heaviness, pain and dilatation in 31 patients, occurring 7 to 10 days after the beginning of treatment. Thirty (81.0%) women self-assessed the results of treatment with Phlebodia 600 as good, five (13.5%) as satisfactory, and two (5.4%) women reported no positive effect. Duplex scanning performed in women after 2 months of taking the bioflavonoid on the background of the continuing HRT revealed a decrease in the lumens of the common femoral, posterior tibial and great saphenous veins, as well as a decrease in the orthostatic gradient of the veins’ diameter. Also observed was a decrease in the incidence rate of reflux along the femoral and great saphenous veins, with clinically diminished symptoms and improved well-being of the women. A conclusion was drawn that hormone replacement therapy in women for a period longer than 4 months leads to the development of orthostasis-dependent phlebopathy of the lower extremities, manifesting itself in decreased venous tonicity and the development of refluxes. The course of treatment with the phlebotonic notable for high compliance (a single morning administration) for two months was noted to have resulted in a significant decrease in the intensity of both subjective and objective signs and symptoms of phlebopathy secondary to long-term administration of oestrogen-gestagen-containing hormonal drugs.

KEY WORDS: chronic venous disease, orthostasis-dependent phlebopathy, hormone replacement therapy, combined oral contraceptives, duplex scanning, diosmin, phlebodia 600, varicose-vein model.

P. 91

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