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DOI: 10.1055/s-2007-990486
© Georg Thieme Verlag KG Stuttgart ˙ New York
Klimakterium und Hormonersatztherapie
Publikationsverlauf
Publikationsdatum:
13. Februar 2008 (online)
![](https://www.thieme-connect.de/media/frauenheilkunde-u2d/200801/lookinside/thumbnails/10.1055-s-2007-990486-1.jpg)
Kernaussagen
Im perimenopausalen Übergang kommt es zu einer ovariellen Erschöpfung und damit zu einem Estrogenmangel. Dies kann zu klinischen Beschwerden bei den Patientinnen führen. Der Einsatz einer Hormonersatztherapie ist dann möglich. Gegenüber den ursprünglich angestrebten Behandlungszielen einer HRT ist mittlerweile nur noch die Behandlung subjektiver Beschwerden geblieben wie Hitzewallungen, eine lokale Behandlung der urogenitalen Atrophie sowie die Behandlung der hormonabhängigen Osteoporose, wenn keine Alternativen in der Therapie vorliegen bzw. subjektive Beschwerden ohnehin eine Hormonersatztherapie indizieren. Eine Abwägung der Vor- und Nachteile muss dennoch für jeden individuellen Fall erfolgen.
Die Hormonersatztherapie ist systemisch oder lokal möglich, immer abhängig vom individuellen Beschwerdebild. Bei der oralen Therapie unterscheidet man dabei eine reine zyklische Gestagentherapie, eine sequenzielle Hormonersatztherapie mit einem durchgängig gegebenen Östrogen und einem zyklisch applizierten Gestagen in Transformationsdosis sowie die kontinuierlich kombinierte Hormonersatztherapie, bei der Gestagen und Östrogen täglich ohne Pause kombiniert gegeben werden. Hinsichtlich bestehender Begleiterkrankungen oder den Risiken hierfür sind bei der Auswahl der am besten geeigneten HRT-Präparate einige Faktoren zu beachten.
Literatur
- 1 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
- 2 The Women's Health Initiative Study Group . Design of the Women's Health Initiative clinical trial and observational study. Control Clin Trials. 1998; 19 61-109
- 3 ██. Menostar – a low-dose estrogen patch for osteoporosis. Med Lett Drugs Ther. 2004; 46 69-70
- 4 Anderson G L, Judd H L, Kaunitz A M et al. Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial. J Am Med Assoc. 2003; 290 1739-1748
- 5 Anderson G L, Limacher M, Assaf A R et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. J Am Med Assoc. 2004; 291 1701-1712
- 6 Manson J E, Allison M A, Rossouw J E für die WHI und WHI-CACS Investigators et al. Estrogen Therapy and Coronary-Artery Calcification. N Engl J Med. 2007; 356 2591-602
- 7 Ashraf M S, Vongpatanasin W. Estrogen and hypertension. Curr Hypertens Rep. 2006; 8 368-376
- 8 Beckmann M W, Braendle W, Brucker C et al. Konsensusempfehlungen zur Hormontherapie im Klimakterium und in der Postmenopause. Frauenarzt. 2004; 45 620-624
- 9 Beral V. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 2003; 362 419-427
- 10 Birkhäuser M. Klinische Bedeutung von gestagenen Partialwirkungen. Gynäkol Endokrinol. 2006; 4 52-64
- 11 Canonico M, Straczek C, Oger E et al. Postmenopausal hormone therapy and cardiovascular disease: an overview of main findings. Maturitas. 2006; 54 372-379
- 12 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: the Women's Health Initiative Randomized Trial. J Am Med Assoc. 2003; 289 3243-3253
- 13 Daly E, Vessey M P, Hawkins M M et al. Risk of venous thromboembolism in users of hormone replacement therapy. Lancet. 1996; 348 977-980
- 14 Eriksen B. A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women. Am J Obstet Gynecol. 1999; 180 1072-1079
- 15 Espeland M A, Hogan P E, Fineberg S E et al. Effect of postmenopausal hormone therapy on glucose and insulin concentrations. Diabetes Care. 1998; 21 1589-1595
- 16 Espeland M A, Rapp S R, Shumaker S A et al. Conjugated equine estrogens and global cognitive function in postmenopausal women: Women's Health Initiative Memory Study. J Am Med Assoc. 2004; 291 2959-2968
- 17 Ettinger B, Ensrud K E, Wallace R et al. Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomized clinical trial. Obstet Gynecol. 2004; 104 443-451
- 18 Frattarelli J L, Bergh P A, Drews M R et al. Evaluation of basal estradiol levels in assisted reproductive technology cycles. Fertil Steril. 2000; 74 518-524
- 19 Greiser C M, Greiser E M, Dören M. Menopausal hormone therapy and risk of ovarian cancer: systematic review and meta-analysis. Hum Reprod Update. 2007; , im Druck
- 20 Grodstein F, Stampfer M J, Manson J E et al. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med. 1996; 335 453-461
- 21 Gudermann T. Endokrinpharmakologie. In: Leidenberger F, Strowitzki T, Ortmann O (Hrsg). Klinische Endokrinologie für Frauenärzte. 3. Aufl. Springer, Heidelberg, New York 2005
- 22 Herrington D M, Reboussin D M, Klein K P et al. The estrogen replacement and atherosclerosis (ERA) study: study design and baseline characteristics of the cohort. Control Clin Trials. 2000; 21 257-285
- 23 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
- 24 Hulley S, Grady D, Bush T et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen / progestin Replacement Study (HERS) Research Group. J Am Med Assoc. 1998; 280 605-613
- 25 Kantor J, Kessler L J, Brooks D G, Cotsarelis G. Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol. 2003; 121 985-988
- 26 Kim D J, Barrett-Connor E. Association of serum proinsulin with hormone replacement therapy in nondiabetic older women: the Rancho Bernardo Study. Diabetes Care. 2006; 29 618-624
- 27 Kuhl H. Klimakterium, Postmenopause und Hormonsubstitution. 3. Aufl. Uni-Med, Bremen 2006
- 28 Landgren B M, Collins A, Csemiczky G et al. Menopause transition: Annual changes in serum hormonal patterns over the menstrual cycle in women during a nine-year period prior to menopause. J Clin Endocrinol Metab. 2004; 89 2763-2769
- 29 Ludwig M, Jacobeit J W, Schroer A, Schulte H M. Prämature Ovarialinsuffizienz. Gynäkol Endokrinol. 2004; 2 227-239
- 30 Maclennan A, Broadbent J, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004; 4 CD002978
- 31 Manson J E, Hsia J, Johnson K C et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003; 349 523-534
- 32 Martin P L, Greaney M O, Burnier A M et al. Estradiol, estrone, and gonadotropin levels after use of vaginal estradiol. Obstet Gynecol. 1984; 63 441-444
- 33 Martinez C, Basurto L, Zarate A et al. Transdermal estradiol does not impair hemostatic biomarkers in postmenopausal women. Maturitas. 2005; 50 39-43
- 34 Miller J, Chan B K, Nelson H D. Postmenopausal estrogen replacement and risk for venous thromboembolism: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2002; 136 680-690
- 35 Miro F, Parker S W, Aspinall L J et al. Relationship between follicle-stimulating hormone levels at the beginning of the human menstrual cycle, length of the follicular phase and excreted estrogens: the FREEDOM study. J Clin Endocrinol Metab. 2004; 89 3270-3275
- 36 Mueck A O, Römer T. Stoffwechsel und Hormonsubstituion. Thieme, Stuttgart, New York 2002
- 37 Notelovitz M, Funk S, Nanavati N, Mazzeo M. Estradiol absorption from vaginal tablets in postmenopausal women. Obstet Gynecol. 2002; 99 556-562
- 38 Pansini F, De P D, Albertazzi P et al. Sequential addition of low dose of medrogestone or medroxyprogesterone acetate to transdermal estradiol: a pilot study on their influence on the endometrium. Eur J Obstet Gynecol Reprod Biol. 1996; 68 137-141
- 39 Perez G S, Garcia Rodriguez L A, Castellsague J, Duque O A. Hormone replacement therapy and risk of venous thromboembolism: population based case-control study. Brit Med J. 1997; 314 796-800
- 40 Rapp S R, Espeland M A, Shumaker S A et al. Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. J Am Med Assoc. 2003; 289 2663-2672
- 41 Rosenberg L U, Magnusson C, Lindstrom E et al. Menopausal hormone therapy and other breast cancer risk factors in relation to the risk of different histological subtypes of breast cancer: a case-control study. Breast Cancer Res. 2006; 8 R11
- 42 Rossouw J E, Anderson G L, Prentice R L et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. J Am Med Assoc. 2002; 288 321-333
- 43 Rushton D H. Nutritional factors and hair loss. Clin Exp Dermatol. 2002; 27 396-404
- 44 Rushton D H, Ramsay I D. The importance of adequate serum ferritin levels during oral cyproterone acetate and ethinyl oestradiol treatment of diffuse androgen-dependent alopecia in women. Clin Endocrinol (Oxf). 1992; 36 421-427
- 45 Scarabin P Y, Oger E, Plu-Bureau. Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet. 2003; 362 428-432
- 46 Shumaker S A, Legault C, Kuller L et al. Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study. J Am Med Assoc. 2004; 291 2947-2958
- 47 Stefanick M L, Anderson G L, Margolis K L et al. Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. J Am Med Assoc. 2006; 295 1647-1657
- 48 Stute P, Kiesel L. Klimakterium und Hormontherapie. Geburtsh Frauenheilk. 2006; 66 R1-R28
- 49 Tufan E, Elter K, Durmusoglu F. Assessment of reproductive ageing patterns by hormonal and ultrasonografic ovarian reserve tests. Hum Reprod. 2004; 19 2484-2489
- 50 van Zonneveld P, Scheffer G J, Broekmans F J et al. Do cycle disturbances explain the age-related decline of female fertility? Cycle characteristics of women aged over 40 years compared with a reference population of young women. Hum Reprod. 2003; 18 495-501
- 51 Varma R, Sinha D, Gupta J K. Non-contraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS) – a systematic enquiry and overview. Eur J Obstet Gynecol Reprod Biol. 2006; 125 9-28
- 52 Vexiau P, Chaspoux C, Boudou P et al. Effects of minoxidil 2 % vs. cyproterone acetate treatment on female androgenetic alopecia: a controlled, 12-month randomized trial. Br J Dermatol. 2002; 146 992-999
- 53 Wildemeersch D, Janssens D, Vrijens M, Weyers S. Ease of insertion, contraceptive efficacy and safety of new T-shaped levonorgestrel-releasing intrauterine systems. Contraception. 2005; 71 465-469
- 54 Yoo J-W, Lee C H. Drug delivery systems for hormone therapy. J Controlled Rel. 2006; 112 1-14
- 55 Zandi P P, Carlson M C, Plassman B L et al. Hormone replacement therapy and incidence of Alzheimer disease in older women: the Cache County Study. J Am Med Assoc. 2002; 288 2123-2129
Prof. Dr. med. M. Ludwig
Endokrinologikum Hamburg · Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Pränatale Medizin
Lornsenstraße 4–6
22767 Hamburg
eMail: Michael.Ludwig@endokrinologikum.com