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Geburtshilfe Frauenheilkd 2001; 61(1): 2-7
DOI: 10.1055/s-2001-10466
Übersicht

Georg Thieme Verlag Stuttgart · New York

Hormonsubstitution im Klimakterium und zerebrovaskuläre Erkrankungen

Postmenopausal Hormone Replacement Therapy and Cerebrovascular DiseasesT. Römer1 , Dolores Foth1 , B. Griewing2
  • 1 Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität zu Köln
  • 2 Neurologische Klinik GmbH Bad Neustadt/Saale
Further Information

Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung

In epidemiologischen und tierexperimentellen Studien wurde der Nachweis erbracht, dass eine postmenopausale Hormonsubstitution das Schlaganfallrisiko senkt. Durch Blutflussuntersuchungen mittels Doppler konnte gezeigt werden, dass Estrogene einen positiven Effekt auf das zerebrovaskuläre Gefäßsystem haben, wobei dieser Effekt durch Gestagene kaum modifiziert wird. Auch morphometrische Untersuchungen, wie ultrasonographisch gestützte Messungen der Intima-Media-Dicke, belegen den positiven Einfluss einer Langzeit-Hormonsubstitution auf das zerebrovaskuläre System. Die Intima-Media-Dicke, die als ein Ausdruck der komplexen Arteriosklerose betrachtet werden kann, nimmt unter Hormonsubstitution ab. Arteriosklerotische Plaques der extrakraniellen zerebrovaskulären Gefäße sind bei Patientinnen, die hormonsubstituiert werden, signifikant seltener zu finden als in einer Vergleichsgruppe gleichaltriger Patientinnen ohne Hormonsubstitution. In einer Studie konnte sogar eine Reduktion dieser Plaques durch eine Estrogensubstitution nachgewiesen werden. Eine Hormonsubstitution kann möglicherweise einen präventiven Effekt hinsichtlich der Entstehung und Ausbreitung der zerebrovaskulären Arteriosklerose haben. Bei Zustand nach Schlaganfall ist derzeit die Indikation zur Hormonsubstitution eher strenger zu stellen, insbesondere bei Vorliegen anderer Risikofaktoren. Aktuell verfügbare Studien und eigene Ergebnisse werden dargestellt und diskutiert.

Summary

Epidemiologic and animal studies have provided evidence that hormone replacement therapy can reduce the risk of stroke. Doppler ultrasound measurements of blood flow show a positive effect of estrogens on the cardiovascular system, which is only slightly modified by progestins. Ultrasound measurements of intima-media thickness showed a positive influence of long-term hormone replacement therapy on the cerebral vasculature. The intima-media thickness, a marker of complex atherosclerosis decreases with hormone replacement therapy. The number of atherosclerotic plaques in extracranial cerebral vessels is significantly lower in patients receiving hormone replacement than in controls. One study suggested that estrogen replacement can lead to regression of atherosclerotic plaques. Hormone replacement therapy may reduce the risk for developing and progression of cerebrovascular atherosclerosis. In patients with a history of stroke the possible benefits of hormone replacement have to be weighed against risks, particularly in patients with other risk factors. We review our results and the literature.

Schlüsselwörter

Hormonsubstitution - Schlaganfall - Plaques - Intima-Media-Dicke

Key words

Hormone replacement therapy - Stroke - Plaques - Intima-media-thickness

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Prof. T. Römer

Klinik für Frauenheilkunde und GeburtshilfeUniversität Köln

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50931 Köln