Hormontherapie im Wandel der Zeit

 

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Zusammenfassung

Trotz zahlreicher Studien in den letzten Jahren gilt weiterhin, dass ausschließlich Patientinnen mit klimakterischen Beschwerden und Therapiewunsch behandelt werden. Zur Primärprävention von Erkrankungen wie koronare Herzerkrankung, Osteoporose oder Depression ist eine peri- oder postmenopausale Hormontherapie nicht zu empfehlen. Das Risiko für Thrombosen, Lungenembolien und Schlaganfälle ist insbesondere bei älteren Frauen durch eine orale Hormontherapie erhöht. Bei jüngeren, frühmenopausalen Frauen ergibt sich ein deutlich günstigeres Nutzen-Risiko-Profil, sodass hier die Verordnung wieder großzügiger erfolgen kann. Vasomotorische Symptome werden systemisch, rein urogenitale lokal behandelt. Die Auswahl des Präparates erfolgt nach genauer Risikostratifizierung, in Abhängigkeit der Symptome und Vorliebe der Patientin. Eine transdermale Östrogen-Applikation – bei Frauen mit intaktem Uterus in Verbindung mit „natürlichem“ Progesteron – erscheint die beste Therapieoption bei Frauen mit erhöhten kardiovaskulären Risiken.

Abstract

Despite several studies in the last years, only women with menopausal symptoms who desire therapy are treated. There is still no recommendation for menopausale hormone therapy for primary prevention of diseases such as coronary artery disease, osteoporosis or depression. The risk of thrombosis, pulmonary embolism and stroke is elevated especially for elderly women with oral hormone therapy. Benefits may exceed risks in younger, early-menopausal women, for whom hormone therapy may be prescribed more liberally. Systemic hormone therapy is for vasomotor symptoms, local therapy for the genitourinary syndrome of menopause. Choice of formulation depends on the individual risk due to symptoms and favours of the patients. With moderate to high cardiovascular risk profile, a transdermal route of estrogen application – in women with an intact uterus in combination with micronized progesterone – seems to be the best option.

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