Therapie klimakterischer Beschwerden – auch bei Patientinnen mit Mammakarzinom

Mammakarzinompatientinnen können während adjuvanter Therapiemaßnahmen bzw. nach abgeschlossener Primärtherapie unter den Folgen einer natürlichen oder therapieinduzierten Ovarialinsuffizienz leiden. Da eine HRT das Risiko für ein Rezidiv nach behandeltem Mammakarzinom steigern kann, soll eine HRT bei Frauen nach Mammakarzinom nicht durchgeführt werden [1], [2]. Dieser Beitrag zeigt Therapiealternativen auch für diese Patientinnen.

Schlüsselwörter

Mammakarzinom - HRT - Karzinomrisiko - klimakterische Beschwerden

• Literatur

• 1 AWMF. Peri- and Postmenopause – Diagnosis and Interventions. Guideline of the German Society of Gynecology and Obstetrics (S3-Level, AWMF Registry No. 015–062). Im Internet (Stand: 15.08.2020): http://www.awmf.org/leitlinien/detail/ll/015-062.html
• 2 NICE. Menopause Full Guideline, Methods, evidence and recommendations. Version 1.5, 12 November 2015. National Institute for Health and Care Excellence (NICE) Guideline. Im Internet (Stand: 15.08.2020): https://www.nice.org.uk/guidance/ng23/evidence/full-guideline-pdf-559549261
• 3 Avis NE, Colvin A, Bromberger JT. et al. Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: Study of Womenʼs Health Across the Nation (SWAN). Neurology 2009; 72: 1850-1857
• 4 MacLennan A, Broadbent JL, Lester S. et al. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev 2004; (04) CD002978
• 5 Sweetland S, Beral V, Balkwill A. et al. Million Women Study Collaborators. Venous thromboembolism risk in relation to use of different types of postmenopausal hormone therapy in a large prospective study. J Thromb Haemost 2012; 10: 2277-2286
• 6 Manson JE, Chlebowski RT, Stefanick ML. et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Womenʼs Health Initiative randomized trials. JAMA 2013; 310: 1353-1368
• 7 Cody JD, Jacobs ML, Richardson K. et al. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2012; (10) CD001405
• 8 Andersson KE, Chapple CR, Cardozo L. et al. Pharmacological treatment of urinary incontinence. Incontinence – 5th Int Consult on Incont ICUD-EAU 2013: 625 – 728.
• 9 Lethaby A, Marjoribanks J, Kronenberg F. et al. Phytooestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev 2013; (12) CD001395
• 10 Dodin S, Blanchet C, Marc I. et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst Rev 2013; (07) CD007410
• 11 van Driel CM, Stuursma A, Schroevers MJ. et al. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG 2018; 126: 330-339 doi:10.1111/1471-0528.15153
• 12 Wagenlehner F, Schmiemann G, Fünfstück R. et al. Interdisziplinäre S3 Leitlinie zur Prävention und Management unkomplizierter und erworbener Harnwegsinfektionen bei Erwachsenen – Epidemiologie, Diagnostik, Therapie. AWMF-Register-Nr. 043/044 (2017). Im Internet (Stand: 15.08.2020): https://www.awmf.org/uploads/tx_szleitlinien/043-044l_S3_Harnwegsinfektionen_2017-05.pdf
• 13 NICE Guideline. Urinary incontinence in women: the management of urinary incontinence in women, Clinical guideline Published: 11 September 2013. Im Internet (Stand: 15.08.2020): https://nice.org.uk/guidance/cg171
• 14 Collins JA, Blake JM, Crosignani PG. Breast cancer risk with postmenopausal hormonal treatment. Hum Reprod Update 2005; 11: 545-560
• 15 Farquhar CM, Marjoribanks J, Lethaby A. et al. and the Cochrane HT Study Group. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2005; (03) CD004143 Review. Update in: Cochrane Database Syst Rev 2009; (2): CD004143
• 16 Holmberg L, Iversen OE, Rudenstam CM. et al. HABITS Study Group. Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst 2008; 100: 475-482 Erratum in: J Natl Cancer Inst 2008; 100: 685 Erratum in: J Natl Cancer Inst 2008; 100: 685
• 17 Holmberg L, Anderson H. HABITS (hormonal replacement therapy after breast cancer-is it safe?), a randomised comparison: trial stopped. Lancet 2004; 363: 453-455
• 18 Fahlén M, Fornander T, Johansson H. et al. Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial. Eur J Cancer 2013; 49: 52-59 doi:10.1016/j.ejca.2012.07.003
• 19 Kenemans P, Bundred NJ, Foidart JM. et al. Safety and efficacy of tibolone in breast-cancer patients with vasomotor symptoms: a double-blind, randomised, non-inferiority trial. Lancet Oncol 2009; 10: 135-146
• 20 American College of Obstetricians and Gynecologistsʼ Committee on Gynecologic Practice. Farrell R. ACOG Committee Opinion No. 659: The Use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstet Gynecol 2016; 127: e93-e96 doi:10.1097/AOG.0000000000001351
• 21 Donders G, Neven P, Moegele M. et al. Ultra-low-dose estriol and Lactobacillus acidophilus vaginal tablets (Gynoflor^®) for vaginal atrophy in postmenopausal breast cancer patients on aromatase inhibitors: pharmacokinetic, safety, and efficacy phase I clinical study. Breast Cancer Res Treat 2014; 145: 371-379