Die menopausale Hormontherapie aus internistisch endokrinologischer Sicht

Zusammenfassung

Die menopausale Hormontherapie (MHT) begann 1942 in den USA und wurde weltweit in den 1960er-Jahren wegen der sehr erfolgreichen Behandlung vegetativer und vasomotorischer Beschwerden sehr populär. Diese manifestieren sich in vielen Fällen schon prämenopausal und können über ca. 10 Jahre andauern und die Lebensqualität erheblich einschränken. Viele Frauen stellen sich in dieser perimenopausalen Lebensphase nicht primär beim Gynäkologen, sondern beim Hausarzt oder Kardiologen vor, da Blutdruckschwankungen und insbesondere die typischen nächtlichen Palpitationen Angst machen. Eine fachübergreifende Betrachtung kann unnötige diagnostische Maßnahmen bis zur invasiven Herzkatheteruntersuchung und inadäquate Therapien mit Betablockern, Antidepressiva und Sedativa vermeiden.

Daneben ist es auch in der hausärztlich-internistischen Praxis wichtig, die Auswirkungen sowohl eines Hormonmangels als auch einer Hormontherapie auf innere Organerkrankungen zu kennen. Die Hormontherapie kann vorbestehende Erkrankungen positiv, negativ oder gar nicht beeinflussen. Betroffene Patientinnen erwarten zurecht eine enge Kooperation der Spezialisten – Gynäkologen, Endokrinologen und Internisten –, wenn es um die Entscheidung für oder gegen eine menopausale Hormontherapie (MHT) geht, insbesondere nach den Unsicherheiten, welche die mittlerweile revidierten Ergebnisse der WHI (women’s health initiative) -Studie hervorgerufen hatten.

Abstract

The history of menopausal hormone therapy (MHT) started in 1942 in the US and became very popular in the 1960s worldwide because of the beneficial effects on vasomotor-vegetative and vulvovaginal symptoms. These symptoms may begin already in the premenopausal period, and can last for more than 10 years with reduced quality of life. Many women with vasomotor-vegetative symptoms do not visit a gynaecologist first but primarily a general physician or cardiologist because of instable blood pressure and palpitations, leading to the focus on the heart. To avoid unnecessary examinations and treatment with ß-blockers or antidepressants, an interdisciplinary look is necessary. In most cases, appropriate and low dose hormone replacement will relieve the symptoms and restore quality of life. In addition, it is worthwhile to know about the long-term effect of hormone deficiency as well as replacement on the different organ systems and the possible influences of hormone replacement therapy including contra indications. This is especially necessary after the uncertainties raised after the first deleterious announcements of the currently corrected results of the WHI (women’s health initiative) study.

Schlüsselwörter

menopausales Syndrom - menopausale Hormontherapie - vasomotorisches Syndrom - vulvovaginale Atrophie - Brustkrebsrisiko - koronare Herzerkrankung - Autoimmunerkrankungen

Key words

menopausal syndrome - menopausal hormone therapy - vasomotoric syndrome - vulvovaginal atrophy - coronary heart disease - autoimmune disease

Publication History

Article published online:
04 January 2021

• Literatur

• 1 Cagnacci A, Venier M. The controversial history of hormone replacement threrapy. Medicina 2019; 55: 602 . doi:10.3390/medicina55090602
• 2 Manson JE, Chlebowski RT, Stefanick ML. et al The women’s health initiative hormone therapy trials: update and overview of the health outcomes during the intervention and post-stopping phase. JAMA 2013; 310: 1353-1368 . doi:10.1001/jama.2013.278040
• 3 Rossouw JE, Anderson GL, Prentice RL. et al Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288: 321-333
• 4 Anderson GL, Limacher M, Assaf AR. et al Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative randomized controlled trial. JAMA 2004; 291: 1701-171
• 5 Manson JE, Aragaki AK, Rossouw JE. et al WHI Investigators. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials. JAMA 2017; 318: 927-938 . doi:0.1001/jama.2017.1121
• 6 Schierbeck LL, Rejnmark L, Tofteng CL. et al Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012 Sept 345: e6409 . doi:10.1136/bmj.e6409
• 7 Stuenkel CA, Davis SR, Gompel A. et al Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2015; 100: 3975-4011 . doi:10.1210/jc.2015-36
• 8 Baber RJ, Panay N, Fenton A. IMS Writing Group. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19: 109-150 . doi:10.3109/13697137.2015.1129166. Epub 2016 Feb 12
• 9 The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause 2017; 24: 728-753 . doi:10.1097/GME.0000000000000921
• 10 Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat 2008; 107: 103-111 . doi:10.1007/s10549-007-9523-x
• 11 Hermsmeyer RK, Thompson TL, Pohost GM. et al Cardiovascular effects of medroxyprogesterone acetate and progesterone: a case of mistaken identity?. Nat Clin Pract Cardiovasc Med 2008; 5: 387-395 . doi:10.1038/ncpcardio1234
• 12 Davey DA. Menopausal hormone therapy: a better and safer future. Climacteric 2018; 1-8
• 13 Manson JE, Kaunitz AM. Menopause Management – Getting Clinical Care Back on Track. N Engl J Med 2016; 374: 803-806 . doi:10:1056/NEJMp1514242
• 14 Gaudard AM, de Souza S. et al Bioidentical hormones for women with vasomotor symptoms. Cochrane Database Syst Rev 2016; 8: CD01407 . doi:10.1002/14651858.CD010407.pub2
• 15 Avis NE, Crawford SL, Greendale G. et al Study of Women’s Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med 2015; 175: 531-539 . doi:10.1001/jamainternmed.2014.8063
• 16 David PS, Kling JM, Vegunta S. et al Vasomotor symptoms in women over 60: results from the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS). Menopause 2018; 25: 1105-1109 . doi:10.1097/GME.0000000000001126
• 17 Dennerstein L, Dudley EC, Hopper JL. et al A prospective population-based study of menopausal symptoms. Obstet Gynecol 2000; 96: 351-358
• 18 Caruso S, Cianci S, Amore FF. et al Quality of life and sexual function of naturally postmenopausal women on an ultralow-concentration estriol vaginal gel. Menopause 2016; 23: 47-54 . doi:10.1097/GME.0000000000000485
• 19 Mikkola TS, Tuomikoski P, Lyytinen H. et al Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause 2015; 22: 976-983 . doi:10.1097/GME.0000000000000450
• 20 Heistad DD. Unstable coronary-artery plaques. N Engl J Med 2003; 349: 2285-2287
• 21 Nudy M, Chincilli V, Foy AJ. A systemic review and meta-analysis to examine the “timing hypothesis”of hormone replacement thererapy on mortality, coronary heart disease, and stroke. Int J Cardiol Heart Vasc 2019; 22: 123-131 . doi:1016/j.ijcha.2019.01.001
• 22 Hemelaar M, van der Mooren MJ, Rad M. et al Effects of non-oral postmenopausal hormone therapy on markers of cardiovascular risk: a systematic review. Fertil Steril 2008; 90: 642-672
• 23 Shlipak MG, Angeja BG, Go AS. et al Hormone therapy and in-hospital survival after myocardial infarction in postmenopausal women. Circulation 2001; 104: 2300-2304
• 24 Tuomikoski P, Salomaa V, Havulinna A. et al Decreased mortality risk due to first acute coronary syndrome in women with postmenopausal hormone therapy use. Maturitas 2016; 94: 106-109 . doi:10.1016/j.maturitas.2016.09.015
• 25 Harlow SD, Gass M, Hall JE. et al Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause 2012; 19 (04) 387-395 . doi:10.1097/gme.0b013e31824d8f40
• 26 Cannoletta M, Cagnacci A. Modification of blood pressure in postmenopausal women: role of hormone replacement therapy. Int J Womens Health 2014; 11: 745-757 . doi:10.2147/IJWH.S61685. eCollection 2014
• 27 Mueck AO. Hormonersatztherapie bei internistischen Risikopatientinnen. Gynakol Geburtshilfliche Rundsch 2006; 46: 174-190
• 28 Jiang Y, Tian W. The effects of progersteron on blood lipids in hormone replacement therapy. Lipids in Health and disease 2017; 16: 219 . doi:10,1186/s12944-017-0612-5
• 29 Renoux C, Dell’aniello S, Garbe E. et al Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. BMJ 2010; 340: c2519 . doi:10.1136/bmj.c2519
• 30 Mauvais-Jarvis F, Manson JE, Stevenson JC. et al Menopausal hormone therapy and Type 2 diabetes prevention: Evidence, mechanisms, and clinical implications. Endocrine Reviews 2017; 38: 173-188
• 31 Thurston RC, El Khoudary SR, Sutton-Tyrrell K. et al Vasomotor symptoms and insulin resistance in the study of women’s health across the nation. J Clin Endocrinol Metab 2012; 97: 3487-3494
• 32 Brand JS, van der Schouw YT, Onland-Moret NC. et al Age at menopause, reproductive life span, and type 2 diabetes risk: results from the EPIC-InterAct study. Diabetes Care 2013; 36: 1012-1019
• 33 Appiah D, Winters SJ, Hornung CA. Bilateral oophorectomy and the risk of incident diabetes in postmenopausal women. Diabetes Care 2014; 37: 725-733
• 34 Bereshchenko O, Bruscoli S, Riccardi C. Glucocorticoids, Sex Hormones and Immunity. Front Immunol 2018; 9: 1332 . doi:10.3389/fimmu.2018.01332. eCollection 2018
• 35 Gameiro C, Romao F. Changes in the immune system during menopause and aging. Front Biosci 2010; 2: 1299-1303
• 36 Ghosh M, Rodriguez-Garcia M, Wira CR. The immune system in the menopause: Pros and Cons of hormone therapy. J Steroid Biochem Mol Biol 2014; 142: 171-175
• 37 Iddah MA, Macharia BN. Autoimmune thyroid disorders. ISRN Endocrinology 2013; 2013: 509764 . doi:10.1155/2013/509764
• 38 Janssen OE, Mehlmauer N, Hahn S. et al High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol 2004; 150: 63-69
• 39 Mackay L, Kilbride L, Adamson KA. et al Hormone replacement therapy for women with type 1 diabetes mellitus. Cochrane Database Syst Rev 2013; 6: CD008613
• 40 Alpízar-Rodríguez D, Pluchino N, Canny G. et al The role of female hormonal factors in the development of rheumatoid arthritis. Rheumatology 2017; 56: 1254-1263 . doi:org/10.1093/rheumatology/kew318
• 41 Gilbert EL, Ryan MJ. Estrogen in cardiovascular disease during systemic lupus erythematosus. Clin Therapeutics 2014; 36: 1901-1912
• 42 Cordina-Duverger E, Truong T, Anger A. et al Risk of breast cancer by type of menopausal hormone therapy: a case-control study among post-menopausal women in France. PLoS One 2013; 8 (11) e78016 . doi:10.1371/journal, pone.0078016.eCollection 2013
• 43 Fournier A, Mesrine S, Boutron-Ruault MC. et al Estrogen-progestagen menopausal hormone therapy and breast cancer: does delay from menopause onset to treatment initiation influence risks?. J Clin Oncol 2009; 27: 5138-5143 . doi:10.1200/JCO.2008.21.6432
• 44 Mikkola TS, Savolainen-Peltonen H, Tuomikoski P. et al Reduced risk of breast cancer mortality in women using postmenopausal hormone therapy: a Finnish nationwide comparative study. Menopause 2016; 23: 1199-2203