Der Gynäkologe

, Volume 43, Issue 4, pp 301–307

Herz-Kreislauf-Risiko und Hormontherapie in der Postmenopause

Leitthema

Zusammenfassung

Die S3-Leitlinie zu Hormontherapie (HT) in der Postmenopause macht auf ungesicherte Indikationen aufmerksam und warnt vor bestehenden Risiken. Bis heute gibt es keine geeigneten Studien, die einen Nutzen einer postmenopausalen HT zur kardiovaskulären Prävention ausreichend belegen. In einer Subgruppenanalyse der Women’s Health Initiative (WHI) ließ sich in der Gruppe der 50- bis 59-Jährigen ein Trend zu Risikominderung erkennen, während bei Beginn einer HT in höherem Alter kein Nutzen nachgewiesen werden konnte. Im ersten Behandlungsjahr muss mit einer vorübergehenden Risikoerhöhung für kardiovaskuläre Ereignisse gerechnet werden. Unter einer HT kommt es zu einem zusätzlichen ischämischen Insult pro 1000 Frauenjahre; das Risiko ist für Frauen zwischen 50 und 59 geringer. Das Thromboserisiko von 1:1000 pro Jahr im Alter von 50 bis 60 steigt im ersten Jahr einer HT auf das Drei- bis Vierfache, um dann bei etwa 2 pro 1000 Frauenjahren zu bleiben. Das Risiko steigt deutlich mit Alter, Adipositas und Genmutationen (wie Faktor-V-Leiden). Bei transdermaler Applikation ist es vermutlich geringer, was die Bevorzugung dieser Anwendungsform bei erhöhtem Thromboserisiko begründen kann. Aus Gründen der Wirksamkeit und Sicherheit sollte eine systemische HT zur Behandlung klimakterischer Beschwerden früh in der Postmenopause eingeleitet werden. Die viel diskutierte kardiovaskuläre Risikoerhöhung während einer langfristigen kombinierten HT hat sich nicht bestätigt, eine mögliche Prävention in der frühen Menopause bleibt offen.

Schlüsselwörter

Hormontherapie Postmenopause Herz-Kreislauf-Erkrankungen S3-Leitlinie 

Cardiovascular risk and postmenopausal hormone therapy

Abstract

The S3 guideline on postmenopausal hormone therapy cautions on unclarified indications and gives fair warnings as to established risks. As yet no appropriate study has sufficiently proven a benefit from postmenopausal hormone therapy for cardiovascular prevention. In a subgroup analysis of the Women’s Health Initiative (WHI) a trend towards lower risk was recognizable, whereas no cardiovascular benefit in primary and secondary prevention was identified when the therapy was started at higher age. During the 1st year a somewhat higher cardiovascular risk must be taken into account. On hormone therapy one ischemic stroke per 1000 women years may occur in excess, whereby the risk is lower at the age of 50 to 60 years. Still, stroke remains a serious incident. The baseline risk for thrombosis of 1 per 1000 per year at the age of 50 to 60 years rises three to four times during the 1st year of hormone therapy and remains at twice the baseline risk thereafter. That risk increases with age, obesity, and thrombogenic mutations such as factor V deficiency. Probably the risk is lower on transdermal hormones, which though not ascertained may be reason enough for their preferential use in cases of elevated thromboembolic risk. For reasons of safety and effectivity, systemic hormone therapy for treating climacteric symptoms should be initiated early in postmenopause. The hotly debated cardiovascular risk in long-term combined hormone therapy has not been confirmed, and the possibility of preventive measures during early menopause is still open.

Keywords

Hormone therapy Postmenopause Cardiovascular disease S3 Guideline 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • E. Windler
    • 1
  • A.O. Mueck
    • 2
  • B.C. Zyriax
    • 1
  • O. Ortmann
    • 3
  1. 1.Endokrinologie und Stoffwechsel des AlternsUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  2. 2.Schwerpunkt für Endokrinologie und MenopauseUniversitäts-Frauenklinik Tübingen, Landesinstitut für Frauengesundheit Baden-WürttembergTübingenDeutschland
  3. 3.Klinik für Frauenheilkunde und GeburtshilfeUniversität RegensburgRegensburgDeutschland

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