Mehr Risiken als Nutzen? - Hormonersatztherapie in der Menopause

Zusammenfassung

Obwohl das Risiko für Herzkreislauferkrankungen bei Frauen in der Menopause, in der die natürliche Hormonproduktion sistiert, deutlich zunimmt, kann dieses Risiko nicht durch eine Hormonersatztherapie vermindert werden. Die alleinige postmenopausale Östrogentherapie ist mit einer leichten Erhöhung der Schlaganfallrate und der Rate an Lungenembolien verbunden, ohne einen günstigen Effekt auf die Prävalenz koronarer Ereignisse zu haben. Die Kombinationstherapie mit Östrogenen und Progesteron führt sowohl zu einer erhöhten Rate an Schlaganfällen und Lungenembolien als auch an koronaren Ereignissen, Brustkrebs und Demenz. Die alleinige und die kombinierte Hormongabe reduzieren die Frakturrate. Die Risiko-Nutzen-Abwägung ergibt jedoch insgesamt keinen günstigen Effekt. Bei der Medikamenten-Anamnese sollte auch die Hormonersatztherapie berücksichtigt und die Patientinnen entsprechend den neuesten, evidenzbasierten Richtlinien beraten werden. Aufgrund der Risiken, die mit der Hormonersatztherapie verbunden sind, ist es derzeit nur noch bei schweren, therapierefraktären Wechseljahrsbeschwerden gerechtfertigt, eine Hormonersatztherapie einzusetzen, wobei die Dauer so kurz wie möglich gehalten werden sollte. Da es keine therapeutischen Maßnahmen gibt, die sich in randomisierten Studien als wirksam und nebenwirkungsarm erwiesen haben, ist die Erforschung von Alternativen zur Behandlung von Menopausensymptomen von großer Bedeutung.

Summary

Inspite of the increased risk for coronary artery disease after menopause, in which hormone production ceases, the risk cannot be lowered by hormone replacement therapy. The use of estrogen alone is associated with a slight increase in stroke and pulmonary emboli without a positive effect on coronary event rate. The combined use of estrogens and gestagens is associated both with an increase in risk for stroke and pulmonary emboli as well as an increased risk for coronary events, breast tumors and dementia. The isolated estrogen use and the combined hormone use reduce the fracture rate. Risk-benefit-ratio does not show an overall beneficial effect. Obtaining the drug and medication history from the patient should always include hormone therapy. All patients should be advised according to evidence based guidelines. Due to the increased risk associated with hormone therapy at present it is only advised to use hormones in severe menopausal symptoms, refractory to other treatment modalities. The duration of use should be as short as possible. Since other in randomized studies proven, effective and well tolerated alternatives are not available, research on alternative treatments of menopausal symptoms is of utmost importance.

Key Words

menopause - hormones - hormone replacement therapy - estrogen

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1 Heart and Estrogen/progestin Replacement Study

2 Estrogen Replacement and Atherosclerosis

3 EStrogen in the Prevention of ReInfarction Trial

4 Women's Estrogen for Stroke Trial

5 Papworth Hormone Replacement Therapy and Atherosclerosis Survival Enquiry

6 Postmenopausal Hormone Replacement Against Atherosclerosis

7 Estrogen in the Prevention of Atherosclerosis

8 Women's International Study of Long Duration Oestrogen after Menopause

9 Women's Health Initiative

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