Skip to main content
SpringerLink
Log in

Individualisierte Hormontherapie in Peri- und Postmenopause

Individualized hormone therapy in the peri- and postmenopausal period

  • CME Zertifizierte Fortbildung
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Die Einleitung und Überwachung einer Hormontherapie in der Peri- und Postmenopause ist ein wesentlicher Bestandteil des frauenärztlichen Alltags. Ein maßgeschneidertes Therapiekonzept unter Berücksichtigung der individuellen Bedürfnisse der Patientin ist heute ein vorrangiges Ziel. Der Leidensdruck der Patientin muss gegen die Risiken einer Hormongabe abgewogen werden. Eine Reihe von Kriterien ist vor Festlegung der Therapie zu beachten. Neben den dominanten Symptomen sind die ovarielle Restfunktion sowie das Risikoprofil der Patientin entscheidend. Insbesondere bei vaskulären Risikofaktoren sollte einer transdermalen Östrogengabe der Vorzug gegeben werden. Bei noch vorhandenem intaktem Uterus ist zusätzlich zur Östrogengabe der Einsatz eines Gestagens zwingend, wobei die ausreichende transformatorische Wirkung des Gestagens am Endometrium zu beachten ist, außerdem das Suppressionspotenzial bezüglich der hypophysär-ovariellen Achse sowie die Partialwirkungen an diversen Rezeptoren.

Abstract

Initiation and surveillance of menopausal hormone therapy is important in the gynecological care of patients. Tailored therapy that meets the patient’s needs and simultaneously considers her individual risks is a major goal in proper counseling. The individual impairment of quality of life has to be weighed against the risks of hormone therapy. In addition to dominant symptoms, the patient’s risk profile and still existent follicular activity are crucial. In patients with vascular risk factors, estrogen should be administered transdermally. In women with an intact uterus, progestin administration is mandatory in addition to estrogen therapy and the delivered dose must be sufficient for transformation of the endometrium. When choosing an appropriate progestin, its hormonal potency to suppress the hipopituitary–ovarian axis and its partial effects on different steroid receptors should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Manson JE, Chlebowski RT, Stefanick ML et al (2013) Menopausal hormone therapy and health outcomes during the interventions and postintervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA 310:1353–1368

    Article  CAS  PubMed  Google Scholar 

  2. Shapiro S, de Villiers TJ, Pines A, Sturdee DW, Baber RJ, Panay N, Stevenson JC, Mueck AO, Burger HG (2014) Risks and benefits of hormone therapy: has medical dogma now been overturned? Climacteric 17:215–222

    Article  CAS  PubMed  Google Scholar 

  3. Lobo RA, Davis SR, de Villiers TJ, Gompel A, Henderson VW, Hodis HN, Lumsden MA, Mack WJ, Shapiro S, Baber RJ (2014) Prevention of diseases after menopause. Climacteric 17(5):540–556

    Article  CAS  PubMed  Google Scholar 

  4. de Villiers TJ, Pines A, Panay N, Gambacciani M, Archer DF, Baber RJ, Davis SR, Gompel AA, Henderson VW, Langer R, Lobo RA, Plu-Bureau G, Sturdee DW (2013) Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric 16(3):316–337

    Article  PubMed  Google Scholar 

  5. Mueck AO (2009) Hormonersatztherapie – praktische Konsequenzen aus der Gesamtevidenz. J Gynäkol Endokrinol 19(1):10–17

    Google Scholar 

  6. Schierbeck LL, Rejmark L, Tofteng CL et al (2012) Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 345:e6409

    Article  PubMed  Google Scholar 

  7. Chen WY, Manson JE, Hankinson SE, Rosner B, Holmes MD, Willett WC, Colditz GA (2006) Unopposed estrogen therapy and the risk of invasive breast cancer. Arch Intern Med 166:1027–1032

    Article  CAS  PubMed  Google Scholar 

  8. Kuhl H (2005) Breast cancer risk in the WHI study: the problem of obesity. Maturitas 51(1):83–97

    Article  PubMed  Google Scholar 

  9. MacLennan AH, Broadbent JL, Lester S, Moore V (2004) Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes (Review). Cochrane Database Syst Rev 4:CD002978. Review

    PubMed  Google Scholar 

  10. Kuhl H (2005) Pharmacology of estrogens and progestogens: influence of different routes of administration. Climacteric 8(Suppl 1):3–63

    Article  CAS  PubMed  Google Scholar 

  11. Canonico M (2014) Hormone therapy and hemostasis among postmenopausal women: a review. Menopause 21(7):753–762

    Article  PubMed  Google Scholar 

  12. Løkkegaard E, Andreasen AH, Jacobsen RK, Nielsen LH, Agger C, Lidegaard Ø (2008) Hormone therapy and risk of myocardial infarction: a national register study. Eur Heart J 29(21):2660–2668

    Article  PubMed  Google Scholar 

  13. Schenck-Gustafsson K et al (2011) EMAS position statement: managing the menopause in the context of coronary heart disease. Maturitas 68:94–97

    Article  PubMed  Google Scholar 

  14. Renoux C, Dell’aniello S, Garbe E, Suissa S (2010) Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. BMJ 340:c2519

    Article  PubMed  Google Scholar 

  15. Løkkegaard E, Jovanovic Z, Heitmann BL, Keiding N, Ottesen B, Hundrup YA, Obel EB, Pedersen AT (2003) Increased risk of stroke in hypertensive women using hormone therapy: analyses based on the Danish Nurse Study. Arch Neurol 60(10):1379–1384

    Article  PubMed  Google Scholar 

  16. Mueck AO, Seeger H (2005) Smoking, estradiol metabolism and hormone replacement therapy. Curr Med Chem Cardiovasc Hematol Agents 3(1):45–54

    Article  CAS  PubMed  Google Scholar 

  17. Liu B, Beral V, Balkwill A, Green J, Sweetland S, Reeves G, Million Women Study Collaborators (2008) Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study. BMJ 337:a386

    Article  PubMed Central  PubMed  Google Scholar 

  18. Hale GE, Hughes CL, Burger HG, Robertson DM, Fraser IS (2009) Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition. Menopause 16(1):50–59

    Article  PubMed  Google Scholar 

  19. Levine H, Watson N (2000) Comparison of the pharmacokinetics of Crinone 8 % administered vaginally versus Prometrium administered orally in postmenopausal women. Fertil Steril 73:516–521

    Article  CAS  PubMed  Google Scholar 

  20. Kuhl H, Schneider HP (2013) Progesterone – promoter or inhibitor of breast cancer. Climacteric 16(Suppl 1):54–68

    Article  CAS  PubMed  Google Scholar 

  21. Allen NE, Tsilidis KK, Key TJ et al (2010) Menopausal hormone therapy and risk of endometrial carcinoma among postmenopausal women in the European Prospective Investigation into Cancer and Nutrition. Am J Epidemiol 172:1394–1403

    Article  PubMed  Google Scholar 

  22. Fournier A, Dossus L, Mesrine S et al (2014) Risks of endometrial cancer associated with different hormone replacement therapies in the E3N cohort, 1992–2008. Am J Epidemiol 180:508–517

    Article  PubMed  Google Scholar 

  23. Jane FM, Davis SR (2014) A practitioner’s toolkit for managing the menopause. Climacteric 17(5):564–579

    Article  CAS  PubMed  Google Scholar 

  24. Schaudig K, Schwenkhagen A, Banz C, Diedrich K (2008) Differenzierter Einsatz von Gestagenen in der Peri- und Postmenopause. Gynäkologe 41:884–893

    Article  CAS  Google Scholar 

  25. Kuhl H (2006) Klimakterium, Postmenopause und Hormonsubstitution, 3. Aufl. UNI-MED, Bremen

    Google Scholar 

  26. Schindler AE, Campagnoli C, Druckmann R et al (2003) Classification and pharmacology of pro gestins. Maturitas 46(Suppl 1):S7–S16

    Article  CAS  PubMed  Google Scholar 

  27. Burger HG (2002) Androgen production in women. Fertil Steril 77(Suppl 4):S3–S5

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Praxis für Gynäkologische Endokrinologie, Gynäkologicum, Hormone Hamburg, Dres. Schaudig & Schwenkhagen, Altonaer Str. 59, 20357, Hamburg, Deutschland

    Katrin Schaudig & Anneliese Schwenkhagen

Authors
  1. Katrin Schaudig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anneliese Schwenkhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katrin Schaudig.

Ethics declarations

Interessenkonflikt

K. Schaudig und A. Schwenkhagen haben von folgenden Firmen Vortragshonorare bzw. Honorare für eine Beratertätigkeit erhalten: Abbott/Mylan; Gedeon Richter; MSD; Jenapharm; KADE Besins; Bayer; Shionogi.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Additional information

Redaktion

B. Toth, Heidelberg

I. Wiegratz, Frankfurt

M. von Wolff, Bern

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schaudig, K., Schwenkhagen, A. Individualisierte Hormontherapie in Peri- und Postmenopause. Gynäkologische Endokrinologie 14, 31–43 (2016). https://doi.org/10.1007/s10304-016-0054-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10304-016-0054-6

Schlüsselwörter

Keywords

Search

Navigation