Schlaganfallrisiko unter oraler Kontrazeption und postmenopausaler Hormonersatztherapie

Zusammenfassung

Die medikamentöse Therapie mit weiblichen Geschlechtshormonen ist eine sehr oft und weltweit angewandte Behandlung. Sowohl die orale Kontrazeption als auch die postmenopausale Hormonersatztherapie haben eine Vielzahl möglicher Nebenwirkungen, u. a. ein erhöhtes Risiko vaskulärer Erkrankungen. In diesem Artikel diskutieren wir Risiken und Nutzen dieser Therapien, insbesondere in Bezug auf das Schlaganfallrisiko. Zusammenfassend kann die kombinierte orale Kontrazeption, sofern korrekt gynäkologisch indiziert, als relativ sichere Behandlung bezeichnet werden. Allerdings besteht besonders unter zusätzlichen vaskulären Risikofaktoren eine erhöhte Wahrscheinlichkeit, einen Schlaganfall zu erleiden; das absolute Risiko ist jedoch gering (etwa vier gegenüber nur einem ischämischen Infarkt pro 10 000 Frauen-Jahre, mit bzw. ohne Therapie). Die postmenopausale Hormonersatztherapie ist zur Primär- und Sekundärprävention vaskulärer Erkrankungen ungeeignet. Auf der Basis der Östrogen-Monotherapie-Studie an hysterektomierten Frauen zur Sekundärprophylaxe kardiovaskulärer Erkrankungen, die im März 2004 vom NIH abgebrochen wurde, wird die Östrogen-Monotherapie nur noch für mittelschwere bis schwere klimakterische Beschwerden, und dann so kurz wie möglich und in topischer statt oraler Applikation, empfohlen.

Abstract

The use of female hormones constitutes a well-established and widespread therapy. However, oral contraception as well as postmenopausal hormone replacement therapy have a multitude of possible side-effects, like an increased risk of vascular diseases. In this article we discuss the risks and benefits of these therapies, in particular the adherent risk of stroke. In summary, based on a correct gynaecological indication oral contraception can be seen as a relatively safe therapy. Although there is an increased risk of vascular events especially in patients with additional vascular risk factors, the absolute increment in risk is small (about 4 vs. only 1 ischemic stroke per 10 000 women-years, current vs. without therapy). According to recent large clinical trials postmenopausal hormone replacement therapy is unsuitable in primary or secondary prevention of vascular disease. After the preliminary termination of a study using estrogens in women with hysterectomy as a secondary prevention of cardiovascular disease in March 2004 by the NIH the use of this therapy should be prescribed only for short-time in cases of moderate or severe postmenopausal complaints with preferably topical application instead of oral therapy.

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