Hormontherapie im Klimakterium

M. Dören

doi:10.1055/s-2004-829016

DMW - Deutsche Medizinische Wochenschrift, Inhaltsverzeichnis

Dtsch Med Wochenschr 2004; 129(31/32): 1689-1693
DOI: 10.1055/s-2004-829016

Übersichten

Endokrinologie / Gynäkologie
© Georg Thieme Verlag Stuttgart · New York

Hormontherapie im Klimakterium

Postmenopausal hormone therapy M. Dören¹

¹Klinik und Poliklinik für Radiologie und Nuklearmedizin; Charité - Universitätsmedizin Berlin

Abstract

Zusammenfassung

Die Wechseljahre sind eine natürliche Lebensphase. Manche Symptome können mit einer Östrogentherapie behandelt werden. Hitzewallungen sowie genitale Atrophi-sierungserscheinungen können Indikationen dieser Östrogentherapie sein, sofern seitens der ratsuchenden Frauen ein Behandlungswunsch besteht. Eine zusätzliche Gestagentherapie ist bei allen Frauen mit erhaltener Gebärmutter zur Vermeidung von Endometriumneoplasien obligat. Eine Östrogentherapie zur Prävention einer Osteoporose ist aufgrund der kurz- und langfristig bestehenden Risiken einer Lang-zeitintervention nur noch in Ausnahmefällen sinnvoll. Eine ergebnisoffene Beratung von Frauen in den Wechseljahren muss die bisherigen Ergebnisse der WomenŽs Health Initiative und anderer randomisierter, plazebo-kontrollierter prospektiver klinischer Studien berücksichtigen, auch solange „harte Daten” kontrollierter Studien mit klinischen Endpunkten für andere Östrogene und Gestagene außer konjugierten Östrogenen/Medroxyprogesteronazetat fehlen. Die Entscheidung zur Therapie kann letztendlich nur von den Frauen nach eingehender Beratung über komplexe Zusammenhänge getroffen werden.

Summary

The menopausal transition is a natural phase of every womanŽs life. Several symptoms emerging during the climacteric may be treated with estrogens. Hot flushes and symptoms of genital ageing may be relieved by estrogen therapy. Progestin therapy is indicated in all women with an intact uterus to avoid endometrial pathology. Given the present risk-benefit scenario, estrogen therapy is no longer a first-line choice to prevent osteoporosis. Counselling requires integration of recent knowledge provided by the first results of the WomenŽs Health Initiative and other significant randomized, placebo-controlled, prospective clinical studies with clinically relevant outcomes, not the least unless good-quality data regarding other estrogens and progestins, apart from conjugated equine estrogens/medroxyprogesterone acetate are lacking. Women should be enabled to decide upon estrogen therapy after provision of extensive information by their physicians.

Volltext

Referenzen

Literatur

1 Agency for Healthcare Research and Quality, Rockville, MD .Hormone Replacement Therapy and Breast Cancer. File Inventory, Systematic Evidence Review Number 14. August 2002. http://www.ahrq.gov/clinic/prev/hrtbcinv.htm
2 Anderson G L, Judd H L, Kaunitz A M, Barad D H, Beresford S AA, Pettinger M. et al . Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures. JAMA. 2003; 290 1739-1748
3 Arzneimittelkommission der deutschen Ärzteschaft .Hormontherapie im Klimakterium,. www.akdae.de 2003
4 Barrett-Connor E. Cardiovascular endocrinology: an epidemiologist looks at hormones and heart disease in women. J Clin Endocrinol Metab. 2003; 88 4031-4042
5 Barrett-Connor E, Grady D. Hormone replacement therapy, heart disease and other considerations. Ann Rev Public Health. 1998; 19 55-72
6 Beckmann M W, Braendle W, Brucker C. et al . Konsensus-Empfehlungen zur Hormontherapie (HT) im Klimakterium und in der Postmenopause. Frauenarzt. 2003; 44 138-41
7 Borrelli F, Ernst E. Cimicifuga racemosa: a systematic review of its clinical efficacy. Eur J Clin Pharmacol. 2002; 58 235-241
8 Cauley J A, Robins J, Chen Z. et al . Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA. 2003; 290 1729-1738
9 Chlebowski R T, Hendrix S L, Langer R D. et al . Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women. JAMA. 2003; 289 3243-3253
10 Clarke S C, Kelleher J, Lloyd-Jones H, Slack M, Schofield P M. A study of hormone replacement therapy in postmenopausal women with ischaemic heart disease: the Papworth HRT Atherosclerosis Study. Brit J Obstet Gynaecol. 2002; 109 1056-1062
11 Collaborative Group on Hormonal Factors in Breast Cancer . Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52. 705 women with breast cancer and 108.411 women without breast cancer. Lancet. 1997; 350 1047-1059
12 Daling J R, Malone K E, Doody D R. et al . Relation of regimes of combined hormone replacement therapy of lobular, ductal, and other histologic types of breast cancer. Cancer. 2002; 95 2455-2464
13 Emons G, Beckmann M W, Bock K. et al . Konsensusempfehlungen der Deutschen Gesellschaft für Senologie. Hormonsubstitution nach Mammakarzinom. Gynäkologe. 2002; 35 1114-1116
14 Freedman R R, Woodward S. Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am J Obstet Gynecol. 1992; 167 436-439
15 Fugh-Berman A, Kronenberg F. Red clover (Trifolium pratense) for menopausal women: current status of knowledge. Menopause. 2001; 8 333-337
16 Furberg C D, Vittinghoff E, Davidson M. et al . Subgroup interactions in the Heart and Estrogen/progestin Replacement Study. Circulation. 2002; 105 917-922
17 Grady D, Brown J S, Vittinghoff E, Applegate W, Varner E, Snyder T. The HERS Research Group . Postmenopausal hormones and incontinence: the Heart and Estrogen/Progestin Replacement Study. Obstet Gynecol. 2001; 97 16-20
18 Grady D, Herrington D, Bittner V. et al. for the HERS Research Group . Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA. 2002; 288 49-57
19 Greiser E. Hormonersatztherapie und erhöhtes Risiko für Mamma-Ca und Endometrium-Ca in Deutschland. J Menopause. 2001; 2 59-64
20 Greiser E, Steding C, Giersiepen K, Janhsen K. WHI Breast Cancer Results and Public Health Concern. BMJ. 2002; 325 1243
21 Hammar M, Berg G, Lindgren R. Does physical exercise influence the frequency of postmenopausal hot flushes?. Acta Obstet Gynecol Scand. 1990; 69 409-412
22 Hays J, Ockene J K, Brunner R L, Kotchen J M, Manson J E, Patterson R E. et al . Effects of estrogen plus progestin on health-related quality of life. N Engl J Med. 2003; 348 1839-1854
23 Heart Protection Study Collaborative Group . MRC/BHF Heart Protection Study of cholestrol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360 7-22
24 Hofseth L J, Raafat A M, Osuch J R. et al . Hormone replacement therapy with estrogen or estrogen plus medroxyprogesterone acetate is associated with increased epithelial proliferation in the normal postmenopausal breast. J Clin Endocrinol Metab. 1999; 84 4559-4565
25 Hoibraaten E, Abdelnoor M, Sandset P M. Hormone replacement therapy with estradiol and risk of venous thromboembolism: a population-based case-control study. Thromb Haemost. 1999; 82 1218-1221
26 Hoibraaten E, Qvigstad E, Arnesen H, Larsen S, Wickstrom E, Sandset P M. Increased risk of recurrent venous thromboembolism during hormone replacement therapy - results of the randomized, double-blind, placebo-controlled estrogen in venous thromboembolism trial (EVTET). Thromb Haemost. 2000; 84 961-967
27 Holmberg L, Anderson H. for the HABITS steering and data monitoring committees . HABITS (Hormonal replacement therapy after breast cancer - its it safe ?), a randomised comparison: trial stopped. Lancet. 2004; 363 453-455
28 Hulley S, Furberg C, Barrett-Connor E. et al. for the HERS Research Group . Noncardiovascular disease outcomes during 6.8 years of hormone therapy. JAMA. 2002; 288 58-66
29 Hulley S, Grady D, Bush T. et al. for the Heart and Estrogen/progestin Replacement Study (HERS) Research Group . Randomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart disease in Postmenopausal Women. JAMA. 1998; 280 605-613
30 Humphrey L L, Chan B KS, Sox H C. Postmenopausal hormone replacement therapy and the primary prevention of cardiovascular disease. Ann Int Med. 2002; 137 273-284
31 Irvin J H, Domar A D, Clark C, Zuttermeister P C, Friedman R. The effects of relaxation response training on menopausal symptoms. J Psychosomat Obstet Gynecol. 1996; 17 202-207
32 Joffe M M, Byrne C, Colditz G A. Postmenopausal hormone use, screening, and breast cancer: characterization and control of a bias. Epidemiology. 2001; 12 429-438
33 Kronenberg F. Giving hot flushes the cold shoulder - without drugs. Menopause Management. 1993; 2 20-27
34 LeBlanc E S, Janowsky J, Chan B K. et al . Hormone replacement therapy and cognition: systematic review and meta-analysis. JAMA. 2001; 285 1489-1499
35 Lemaitre R N, Heckbert S R, Psaty B M. et al . Hormone replacement therapy and associated risk of stroke in postmenopausal women. Arch Int Med. 2002; 162 1954-1960
36 Lethaby A, Farquhar S, Sarkis A, Roberts H, Jepson R, Barlow D. Hormone replacement therapy in postmenopausal women: endometrial hyperplasia and irregular bleeding (Cochrane Review). Cochrane Database Syst Rev. 2000; 2 CD000402
37 Löwel H, Heier M, Schneider A. et al . Hormontherapie (II): Vergleiche sind zulässig. Deutsches Ärzteblatt. 2003; 100 A-2561-2562
38 MacLennan A, Lester S, Moore V. et al . Oral replacement therapy versus placebo for hot flushes (Cochrane Review). Cochrane Database Syst Rev. 2001; 1 CD002978
39 Manson J E, Hsia J, Johnson K C. et al . Estrogen plus progestin and the risk of coronary heart disease. New Engl J Med. 2003; 349 523-534
40 Marcus R, Wong M, Heath H, Stock J L. Antiresorptive Treatment of Postmenopausal Osteoporosis: Comparison of Study Designs and Outcomes in Large Clinical Trials with Fracture as an Endpoint. Endocrine Reviews. 2002; 23 16-37
41 Mendelsohn M E, Karas R H. The protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999; 340 1801-1811
42 Miller J, Chan B KS, Nelson H D. Postmenopausal estrogen replacement and risk for venous thromboembolism: a systematic review and meta-analysis for the US Preventive Services Task Force. Ann Int Med. 2002; 136 680-690
43 Million Women Study Collaborators . Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 2003; 362 419-427
44 Moehrer B, Hextall A, Jackson S. Oestrogens for urinary incontinence in women. (Cochrane Review). Cochrane Library, Oxford: Update Software 2003 Issue 2
45 Nanda K, Bastian L A, Hasselblad V, Simel D L. Hormone replacement therapy and the risk of colorectal cancer: A meta-analysis. Obstet Gynecol. 1999; 93 880-888
46 National Center for Complimentary Medicine .Alternative Therapies for Managing Menopausal Symptoms. http://nccam.nih.gov/health/alerts/menopause/ 2002
47 National Heart, Lung, and Blood Institute; Office of Research on WomenŽs Health; National Institute of Health; and Giovanni Lorenzini Medical Science Foundation .International Position Paper on WomenŽs Health and Menopause: a comprehensive approach. NIH publication No. 02 - 3284 2002
48 Nelson H D, Humphrey L L, Nygren P, Teutsch S M, Allan J D. Postmenopausal hormone replacement therapy: scientific review. JAMA. 2002; 288 872-881
49 Neves-e-Castro M, Samsioe G, Dören M, Skouby S O. Results from WHI and HERS II - implications for women and the prescriber of HRT. Maturitas. 2002; 42 255-258
50 Newcomb P A, Titus-Ernstoff L, Egan K M. et al . Postmenopausal estrogen and progestin use in relation to breast cancer risk. Cancer Epidemiol Biomarkers Prev. 2002; 11 593-600
51 Newcomer L M, Newcomb P A, Trentham-Dietz A. et al . Detection method and breast carcinoma histology. Cancer. 2002; 95 470-477
52 Perez Gutthann S, García Rodríguez L A, Castellsague J, Duque Oliart A. Hormone replacement therapy and risk of venous thromboembolism: population based case-control study. BMJ. 1997; 314 796-800
53 Pradhan A D, Manson J E, Rossouw J E. et al . Inflammatory biomarkers, hormone replacement therapy, and incident coronary heart disease. JAMA. 2002; 288 980-987
54 Pressemitteilung des Bundesinstituts für Arzneimittel und Medizinprodukte v. 6. 05. 2004:. http://www.bfarm.de/de/Presse/mitteil_2004/index.php?more = 0410.php
55 Rapp S R, Espeland M A, Shumaker S A. et al; The WHIMS investigators . Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the The WomenŽs Health Initiative Memory Study randomised controlled trial. JAMA. 2003; 289 2663-2672
56 Risch H A. Homone replacement therapy and the risk of ovarian cancer. Gynaecol Oncol. 2002; 86 115-117
57 Rosendaal F R, Vessey M, Rumley A. et al . Hormonal replacement therapy, prothrombotic mutations and the risk of venous thrombosis. Br J Haematol. 2002; 116 851-854
58 Scarabin P Y, Oger E, Plu-Bureau G. Estrogen and ThromboEmbolism Risk Study Group . Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet. 2003; 362 428-432
59 Shumaker S A, Legault C, Rapp S R. et al . Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the WomenŽs Health Initiative Memory Study: a randomised controlled trial. JAMA. 2003; 289 2651-2662
60 Solomon C G, Dluhy R G. Rethinking postmenopausal hormone therapy. New Engl J Med. 2003; 348 579-580
61 Stellungnahme der Deutschen Menopause Gesellschaft P> . Hormonsubstitution in Klimakterium und Postmenopause. Gegenwärtiger Erkenntnisstand. J Menopause. 2000; 1-12 ((Suppl 1))
62 The ESPRIT team . Oestrogen therapy for prevention of reinfarction in postmenopausal women: a randomised placebo controlled trial. Lancet. 2002; 360 2001-2008
63 The 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 1701-1712
64 The Writing Group for the PEPI Trial . Effects of oestrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA. 1995; 273 199-208
65 Tice J A, Ettinger B, Ensrud K. et al . Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study: a randomized controlled trial. JAMA. 2003; 290 207-214
66 Tunstall-Pedoe H. Myth and paradox of coronary risk and the menopause. Lancet. 1998; 351 1425-1427
67 Uhler M L, Marks J W, Voigt B J, Judd H L. Comparison of the impact of transdermal versus oral estrogens on biliary markers of gallstone formation in postmenopausal women. J Clin Endocrinol Metab. 1998; 83 410-414
68 Verkooijen H M, Fioretta G, Vlastos G. et al . Important increase of invasive lobular breast cancer in Geneva, Switzerland. Int J Cancer. 2003; 104 778-781
69 Viscoli C M, Brass L M, Kernan W N, Sarrel P M, Suissa S, Horwitz R I. A clinical trial of estrogen-replacement therapy after ischemic stroke. N Engl J Med. 2001; 345 1243-1249
70 Wassertheil-Smoller S, Hendrix S L, Limacher M. et al . Effect of estrogen plus progestin on stroke in postmenopausal women: The WomenŽs Health Initiative: a randomised trial. JAMA. 2003; 289 2673-2684
71 Weiderpass E, Baron J A, Adami H -O. et al . Low-potency oestrogen and risk of endometrial cancer: a case-control study. Lancet. 1999; 353 1824-1828
72 Wells G, Tugwell P, Shea B. et al . V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocrin Res. 2002; 23 529-539
73 WHO Scientific Group on Research on The Menopause .WHO technical report series 866,. Geneva, Switzerland 1996
74 Williamson J, White A, Hart A. et al . Randomised controlled trial of reflexology for menopausal symptoms. Brit J Obstet Gynaecol. 2002; 109 1050-1055
75 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

Dr. med. Univ.-Prof. Martina Dören

Charité - Universitätsmedizin Berlin, Klinik und Poliklinik für Radiologie und Nuklearmedizin, Klinisches Forschungszentrum Frauengesundheit

Hindenburgdamm 30

12200 Berlin

eMail: martina.doeren@charite.de