Zusammenfassung
Die Hormontherapie in der Peri- und Postmenopause dient der Verbesserung der Lebensqualität und der Prävention von Erkrankungen, die durch einen längerfristigen Östrogenmangel verursacht oder verschlimmert werden. Als primäre Indikation gelten das klimakterische Syndrom und atrophische Veränderungen im Urogenitaltrakt. Die Behandlung sollte mit der niedrigsten effektiven Dosis begonnen und – wenn nötig – nach 4–6 Wochen angepasst werden. Eine Prävention sollte über mindestens 5 Jahre durchgeführt werden. Östrogene verhindern bereits in sehr niedrigen Dosierungen den postmenopausalen Verlust an Knochenmasse und reduzieren das Risiko osteoporosebedingter Frakturen. Bei Frauen unter 60 Jahren ist deshalb die Hormontherapie die geeignete Primärbehandlung zur Prävention der Osteoporose. Die Hormontherapie kann einen günstigen Effekt auf das Zentralnervensystem haben und vor der Entwicklung der Atherosklerose und des Herzinfarkts schützen, sofern sie in der Perimenopause begonnen wird. Sie erhöht aber – mit Ausnahme der transdermalen Applikation – das Risiko venöser thromboembolischer Erkrankungen und des ischämischen Schlaganfalls. Die einzige Indikation für einen Gestagenzusatz stellt die Protektion des Endometriums dar. Da Gestagene das mit den Östrogenen verbundene Brustkrebsrisiko erhöhen und den günstigen Effekt der Östrogene auf psychische Störungen beeinträchtigen können, sind sie möglichst niedrig zu dosieren.
Abstract
The aim of hormone therapy for perimenopausal and postmenopausal women is improvement of quality of life and prevention of diseases which are caused or aggravated by long-term estrogen deficiency. The climacteric syndrome and atrophic urogenital symptoms are the primary indications for hormone therapy. Treatment should be initiated using the lowest effective dose and – if necessary – adapted after 4–6 weeks. Prevention should be carried out for at least 5 years. Very low doses of estrogens may prevent postmenopausal bone loss and reduce the risk of osteoporosis-related fractures. Therefore, in postmenopausal women under the age of 60 years hormone therapy is an appropriate first-line treatment for prevention of osteoporosis. Hormone therapy may exert beneficial effects on the brain and protect from atherosclerosis and myocardial infarction, if started around the time of menopause. However, hormone therapy may increase the risk of venous thromboembolic disease and ischemic stroke, except transdermal use. The only indication for the addition of progestogens is endometrial protection. As progestogens may increase breast cancer risk associated with estrogen treatment and counteract the beneficial effect of estrogens on psychic disorders, they should be used at doses as low as possible.
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Der korrespondierende Autor weist auf folgende Beziehung/en hin: Beratungs- und Referententätigkeiten, Honorare, Reisekostenübernahme durch die Firmen Jenapharm, NovoNordisk, Organon, Grünenthal, Schering, Wyeth.
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Wiegratz, I., Kuhl, H. Praxis der Hormontherapie in der Peri- und Postmenopause. Gynäkologische Endokrinologie 5, 141–149 (2007). https://doi.org/10.1007/s10304-007-0194-9
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DOI: https://doi.org/10.1007/s10304-007-0194-9