Hormontherapie im Klimakterium

Zusammenfassung

Die Wechseljahre sind eine natürliche Lebensphase. Manche Symptome können mit einer Östrogentherapie behandelt werden. Hitzewallungen sowie genitale Atrophi-sierungserscheinungen können Indikationen dieser Östrogentherapie sein, sofern seitens der ratsuchenden Frauen ein Behandlungswunsch besteht. Eine zusätzliche Gestagentherapie ist bei allen Frauen mit erhaltener Gebärmutter zur Vermeidung von Endometriumneoplasien obligat. Eine Östrogentherapie zur Prävention einer Osteoporose ist aufgrund der kurz- und langfristig bestehenden Risiken einer Lang-zeitintervention nur noch in Ausnahmefällen sinnvoll. Eine ergebnisoffene Beratung von Frauen in den Wechseljahren muss die bisherigen Ergebnisse der WomenŽs Health Initiative und anderer randomisierter, plazebo-kontrollierter prospektiver klinischer Studien berücksichtigen, auch solange „harte Daten” kontrollierter Studien mit klinischen Endpunkten für andere Östrogene und Gestagene außer konjugierten Östrogenen/Medroxyprogesteronazetat fehlen. Die Entscheidung zur Therapie kann letztendlich nur von den Frauen nach eingehender Beratung über komplexe Zusammenhänge getroffen werden.

Summary

The menopausal transition is a natural phase of every womanŽs life. Several symptoms emerging during the climacteric may be treated with estrogens. Hot flushes and symptoms of genital ageing may be relieved by estrogen therapy. Progestin therapy is indicated in all women with an intact uterus to avoid endometrial pathology. Given the present risk-benefit scenario, estrogen therapy is no longer a first-line choice to prevent osteoporosis. Counselling requires integration of recent knowledge provided by the first results of the WomenŽs Health Initiative and other significant randomized, placebo-controlled, prospective clinical studies with clinically relevant outcomes, not the least unless good-quality data regarding other estrogens and progestins, apart from conjugated equine estrogens/medroxyprogesterone acetate are lacking. Women should be enabled to decide upon estrogen therapy after provision of extensive information by their physicians.

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