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Gynäkologische Endokrinologie

, Volume 16, Issue 2, pp 94–102 | Cite as

Die ältere Patientin mit Wallungen

Ist eine menopausale Hormontherapie erlaubt?
  • M. Birkhäuser
  • den Zürcher Gesprächskreis
Leitthema
  • 116 Downloads

Zusammenfassung

Die erste Publikation zur Women’s Health Initiative (WHI) hat wegen einer tendenziösen Darstellung der Ergebnisse zu einem negativen Bild der menopausalen Hormontherapie (MHT) geführt. Dies behindert bis heute die Behandlung der Frauen ≥ 10 Jahre nach der Menopause resp. älter ≥ 65 Jahre mit vasomotorischen Symptomen (VMS; etwa 25 %). Die Analyse der WHI nach 18 Jahren zeigt bei den heute nun im Mittel 81-jährigen Frauen, dass sich das Risiko für die globale, die karzinombedingte und die kardiovaskuläre Mortalität unter MHT nicht erhöht. Bei den zu Beginn 50- bis 59-jährigen Frauen war die Gesamtmortalität unter konjugierten equinen Östrogenen signifikant erniedrigt, ebenso die Mortalität bedingt durch Demenz und Morbus Alzheimer. Diese Ergebnisse decken sich mit denjenigen der Danish Osteoporosis Prevention Study (nach 16 Jahren) und der Nurses’ Health Study (nach 36 Jahren). Zudem könnten VMS ein Risikofaktor für chronische Krankheiten sein, die von Östrogenen günstig beeinflusst werden. Bei älteren Frauen ≥65 Jahre mit störenden VMS besteht keine Kontraindikation zur transdermalen Weiterführung der MHT. Transdermales Östradiol erhöht die thromboembolischen und zerebrovaskulären Risiken nicht. Die gültigen Empfehlungen zur MHT stimmen darin überein, dass die Dauer der MHT nicht willkürlich begrenzt werden soll.

Schlüsselwörter

Menopause Konjugierte equine Östrogene Transdermale Applikation Venöse Thromboembolie Schlaganfall Mortalität Kardiovaskuläres Risiko 

Older female patients with hot flushes

Is menopausal hormone therapy allowed?

Abstract

Due to its biased presentation of the results, the first publication of the Women’s Health Initiative (WHI) data led to a negative image of menopausal hormone therapy (MHT). Even now, this impedes the treatment of women ≥10 years after menopause or aged ≥65 years suffering from vasomotor symptoms (VMS, approximately 25%). Analysis of the WHI data after 18 years shows that the risk for total mortality and mortality due to cancer and cardiovascular diseases has not increased in the now 81-year-old (mean) women. In the subgroup of the initially 50 to 59-year-old women, the total mortality under conjugated equine estrogen was significantly decreased, as was mortality due to dementia and Alzheimer’s disease. These results are congruent with those of the Danish Osteoporosis Prevention Study (after 16 years) and of the Nurses’ Health Study (after 36 years). Additionally, VMS might be a risk factor for chronic diseases, which might be positively influenced by estrogens. There are no contraindications in women ≥65 years suffering from VMS to continue transdermal MHT. Transdermal estradiol does not increase the thromboembolic and cerebrovascular risk. All valid guidelines on postmenopausal treatment agree that there is no mandatory limitation for the duration of MHT.

Keywords

Menopause Conjugated equine estrogens Administration, cutaneous Venous thromboembolism Stroke Mortality Cardiovascular risk 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Birkhäuser gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Gynäkologische Endokrinologie und ReproduktionsmedizinUniversität BernBaselSchweiz

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