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Frauenheilkunde up2date 2008; 2(1): 71-91
DOI: 10.1055/s-2007-990486
Gynäkologische Endokrinologie und Reproduktionsmedizin

© Georg Thieme Verlag KG Stuttgart ˙ New York

Klimakterium und Hormonersatztherapie

M. Ludwig, U. Hugo, C. Grave
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Publication Date:
13 February 2008 (online)

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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.

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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