Das klimakterische Syndrom der Patientin mit Mammakarzinom: Risiken und Nutzen der Behandlungsoptionen

Einleitung

Patientinnen mit primärem Mammakarzinom leiden nicht selten unter den Folgen der Therapie. Gerade Langzeit-Nebenwirkungen sind bei der relativ guten Prognose der Erkrankung von Bedeutung. Solche Nebenwirkungen können durch Operation, Strahlentherapie, Chemotherapie oder endokrine Therapie hervorgerufen werden. Viele Patientinnen leiden an Symptomen des Östrogenmangels. Zu deren Behandlung kommt eine Reihe von verschiedenen Methoden in Betracht. Gesunde Frauen erhalten zur Therapie von Östrogenmangelerscheinungen häufig Östrogene ggf. in Kombination mit Gestagenen. Östrogene haben unter allen heute verfügbaren Methoden die beste Wirkung auf klimakterische Beschwerden, insbesondere Hitzewallungen und Schweißausbrüche. In den letzten Jahren wurde eine Reihe von vermuteten Nebenwirkungen u. a. auch aus randomisiert-kontrollierten Studien bestätigt (Thromboembolien, Schlaganfall, Brustkrebs, u. a.). Zusätzlich bewahrheiteten sich zwar positive Effekte auf Osteoporose und osteoporotische Frakturen. Die über viele Jahre vermutete Prävention von kardiovaskulären Erkrankungen ist aber aufgrund jüngerer Untersuchungen nicht vorhanden oder zumindest zweifelhaft. Gesunde Frauen sollten derzeit nur bei bestehender Indikation, d. h. in der Regel zur Behandlung von klimakterischen Beschwerden und/oder Urogenitalatrophie eine Hormontherapie erhalten. Bei Frauen mit behandeltem Brustkrebs ist eine Hormontherapie kontraindiziert. Diese Patientinnen können allerdings aufgrund einer natürlichen postmenopausalen Situation oder therapiebedingt viele Jahre unter klimakterischen Beschwerden leiden. Es ist daher wichtig, nach Alternativen der Behandlung dieser relevanten Probleme zu suchen. In diesem Heft werden die verschiedenen Optionen sowie deren Nutzen und Risiken dargestellt.

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