Skip to main content
  • 2358 Accesses

Auszug

Weitgehend zeitgleich mit dem Sistieren der ovariellen Estradiolproduktion erleben ca. 70% der Frauen mittelschwere bis schwere vasomotorische, psychische und somatische Beschwerden, die sich durch eine Estrogenbehandlung lindern oder häufig völlig beseitigen lassen. Gleichzeitig nehmen nach der Menopause prognostisch wichtige Erkrankungen wie Osteoporose und Herzinfarkte z. T. exponentiell zu. Nach dem Ergebnis von Beobachtungsstudien kann dies durch eine frühzeitige Estrogenbehandlung verhindert werden. In Anlehnung an andere endokrinologische Prinzipien wie etwa die Substitution von Schilddrüsenhormonen hat dies zum Begriff der >Hormonersatztherapie< oder >Hormonsubstitution < (>hormone replacement therapy<), im Weiteren als HRT bezeichnet, geführt, die nun schon über 40 Jahre lang angewandt wird. Nutzen und Risiken dieses Therapieprinzipes werden im Folgenden nach der evidenzbasierten Datenlage abgehandelt.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  • Barrett-Connor E, Grady D (1998) Hormone replacement therapy, heart disease, and other considerations. Annu Rev Public Health 19: 55–72

    Article  PubMed  CAS  Google Scholar 

  • Beckmann M, Bock K, Braendle W et al. (2003) Hormonsubstitution nach Mammakarzinom. Konsensus-Empfehlungen der Deutschen Gesellschaft für Senologie. Frauenarzt 44: 395–397

    Google Scholar 

  • Birkhäuser M, Braendle W, Breckwoldt M, Keller PJ, Kuhl H, Runnebaum B (2000) 23. Arbeitstreffen des ≫Zürcher Gesprächskreises≪. Empfehlungen zur Substitution mit Östrogenen und Gestagenen im Klimakterium und in der Postmenopause. Frauenarzt 41: 599–602

    Google Scholar 

  • Brincat M, Galea R, Muscat Baron Y (1995) Menopausal connective tissue changes and Alzheimer’s disease. Eur Menopause J 2(Suppl 1): 31–35

    Google Scholar 

  • Bush TL, Whiteman M, Flaws JA (2001) Hormone replacement therapy and breast cancer: a qualitative review. Obstet Gynecol 98: 498–508

    Article  PubMed  CAS  Google Scholar 

  • BVF und DGGG (2003) HRT und Brustkrebs-Gemeinsame Stellungnahme des Berufsverbandes der Frauenärzte und der Deutschen Gesellschaft für Gynäkologie. Frauenarzt 44: 1048–1051

    Google Scholar 

  • Cardozo I, Bachmann G, McClish D et al. (1998) Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: Second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol 92: 722–727

    Article  PubMed  CAS  Google Scholar 

  • Cogliano V et al. (2005) Carcinogenicity_of combined oestro-gen-progestagen contraceptives and menopausal treat-ment. Lancet Oncology 6: 552–553

    Article  PubMed  Google Scholar 

  • Collaborative Group on Hormonal Factors in Breast Cancer (1997)Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52.705 women with breast cancer and 108.411 women without breast cancer. Lancet 350: 1047–1059

    Article  Google Scholar 

  • Eicher W, Mueck AO (1994) Normalität oder Krankheit-Be-schwerden der Wechseljahre. Sexualmedizin 10: 276–279

    Google Scholar 

  • Eicher W, Mueck AO (1996) Die Behandlung östrogenmangel-induzierter Sexualstörungen. Gynäkol Geburtsh Rund-schau 36: 83–89

    Article  CAS  Google Scholar 

  • EMAS (2004) European Menopause and Andropause Society statements on postmenopausal hormonal therapy. Ma-turitas 48: 19–25

    Google Scholar 

  • Ettinger B, Ensrud KE, Wallace R et al. (2004) Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomized clinical trial. Obstet Gynecol 104: 443–451

    PubMed  CAS  Google Scholar 

  • Fantl JA, Cardozo LA, McClish DK and the Hormones and Urogenital Therapy Committee (1994) Estrogen therapy in the management of urinary incontinence in postme-nopausal women: a meta-analysis. First report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol 83: 112–128

    Google Scholar 

  • Garbe E, Suissa S (2004) Issues to debate on the Women’s Health Initiative (WHI) study. Hormone replacement therapy and acute coronary outcomes: methodological issues between randomized and observational studies. Human Reprod 19:8–13

    Article  CAS  Google Scholar 

  • Garbe E, Levesque L, Suissa S (2004) Variability of breast cancer risik in observational studies of hormone replacement therapy: a meta-regression analysis. Maturitas (J Europ Menopause Soc) 47: 175–183

    CAS  Google Scholar 

  • Glazier G, Bowman MA (2001) A review of the evidence for the use of phytoestrogens as a replacement for traditional estrogen replacement therapy. Arch Intern Med 161: 1161–1172

    Article  PubMed  CAS  Google Scholar 

  • Gohlke-Bärwolf C, Regitz-Zagrosek V, Mueck AO, Strasser RH (für die Deutsche Gesellschaft für Kardiologie) (2002)Stellen-wert der Hormonersatztherapie zur Prävention der Korona-ren Herzerkrankung bei Frauen. Z Kardiol 91: 430–435

    Article  PubMed  Google Scholar 

  • Grady D, Rubin SM, Petitti DB et al. (1992) Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Int Med 1016–1037

    Google Scholar 

  • Grady D, Gebretsadik T, Kerlikowski K, Ernster V, Petitti D (1995) Hormone replacement therapy and endometrial cancer risk: a meta-analysis. Obstet Gynecol 85: 304–315

    Article  PubMed  CAS  Google Scholar 

  • Grady D, Herrington D, Bittner R et al. (2002) Cardiovascular disease outcomes during 6.8 years of hormone therapy. Heart and Estrogen/progestin Replacement Study Fol-low-up (HERS II). JAMA 288: 49

    Article  PubMed  Google Scholar 

  • Grodstein F, Newcomb PA, Stampfer MJ (1999) Postmenopau-sal hormone therapy and the risk of colorectal cancer: a review an meta-analysis. Am J Med 106: 574–582

    Article  PubMed  CAS  Google Scholar 

  • Grodstein F, Manson JE, Stampfer MJ (2006) Hormone therapy and coronary heart disease: The role of time since meno-pause and age of hormone initiation. J Women’s Health 15: 35–44

    Article  Google Scholar 

  • Hadji P, Rabe T, Ortmann O et al. (2002) Möglichkeiten und Grenzen der Osteoporoseprrävention durch Östrogene und Gestagene. Geburtsh Frauenheilk 62: 436–445

    Article  Google Scholar 

  • Hanke H, Hanke S, Ickrath O et al. (1997) Estradiol concentrations in premenopausal women with coronary heart disease. Coronary Artery Dis 8: 511–515

    CAS  Google Scholar 

  • Hauser GA, Huber P, Keller J, Lauritzen C, Schneider HPG (1996) Evaluation der klimakterischen Beschwerden (Menopau-se Rating Scale, MRS). Zentralbl Gynakol 116:15–23

    Google Scholar 

  • Henderson VW, Paganini-Hill A, Miller BL et al. (2000) Estrogen for Alzheimer’s disease. Neurology 54: 295–301

    PubMed  CAS  Google Scholar 

  • Hendrix SL, Cochrane BB, Nygaard IE et al. (2005) Effects of estrogen with and without progestin on urinary incontinence. JAMA 293:935–948

    Article  PubMed  CAS  Google Scholar 

  • Herrington DM et al. (2002) Factor V Leiden, hormone replacement therapy, and risk of venous thromboembolic events in women with cororary disease. Arterioscler Thromb Vasc Biol 22: 1012–1017

    Article  PubMed  CAS  Google Scholar 

  • HERS Study Group (2003) Glycemic effects of postmenopausal hormone therapy. Ann Intern Med 138: 1–9

    Google Scholar 

  • Hulley S, Grady D, Bush T, Furberg C et al. (1998) Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 280:605–613

    Article  PubMed  CAS  Google Scholar 

  • Hulley S, Furberg C, Barrett-Connor E et al. (2002) Noncardio-vascular disease outcomes during 6.8 years of hormone therapy. Heart and Estrogen/progestin Replacement Study Follop-up (HERS II). JAMA 288: 49–57

    Article  PubMed  Google Scholar 

  • IMS (International Menopause Society) (2004a) Response of the International Menopause Society to EMEA recom-mendation. Climacteric 7: 2

    Google Scholar 

  • IMS (2004b) Guidelines for hormone treatment of women in the menopausal transition and beyond. Climacteric 7: 333–337

    Article  CAS  Google Scholar 

  • Kenemans P (2005) Editorial. Maturitas 51:1–3

    Article  PubMed  Google Scholar 

  • Kenemans P, Speroff L (2005) Amsterdam_Menopause Consen-sus Statement on Tibolone. Maturitas 51: 21–28

    Article  PubMed  CAS  Google Scholar 

  • Krebs EE, Ensrud KE, MacDonald R, Wilt TJ (2004) Phytoestro-gens for treatment of menopausal symptoms: a systematic review. Obstet Gynecol 104: 824–836

    PubMed  CAS  Google Scholar 

  • Kuhl H (1998) Pharmakologie von Sexualsteroiden. Gynäkolo-ge 31: 832–847

    Google Scholar 

  • LeBlanc ES et al. (2001) Hormone replacement therapy and cognition: systematic review and meta-analysis. JAMA 285: 1489–1499

    Article  PubMed  CAS  Google Scholar 

  • Lippert TH, Seeger H, Mueck AO (1999) Klinisch-pharmakologi-sche Besonderheiten der konjugierten equinen Östrogene: Ist ihre Anwendung zur postmenopausalen Hormonsubsti-tution noch zeitgemäß? Arzneimitteltherapie 17:362–36

    Google Scholar 

  • Lokkegaard E, Jovanovic Z, Heitmann BL (2003) Increased risk of stroke in hypertensive women using hormon therapy. Analyses based on the Danish Nurse Study. Arch Neurol 60: 1379–1384

    Article  PubMed  Google Scholar 

  • MacLennan SC, MacLennan AH, Ryan P (1995) Colorectal cancer and oestrogen replacement therapy. A meta-analysis of epidemiologic studies. Med J Aust 162: 491–493

    PubMed  CAS  Google Scholar 

  • MacLennan A, Lester S, Moore V (2001) Oralestrogen replacement therapy vs. tiplacebo for hot flushes: a systematic review. Climacteric 4: 58–74

    Article  PubMed  CAS  Google Scholar 

  • Manson JE, Hsia J, Johnson KC et al. (2003) Estrogen plus progestin and the risk of coronary heart disease. New Engl J Med 349: 523–534

    Article  PubMed  CAS  Google Scholar 

  • Mikkola TS, Clarkson TB (2002) Estrogen replacement therapy, atherosclerosis, and vascular function. Cardiovascular Res 53: 605–619

    Article  CAS  Google Scholar 

  • Million Women Study Collaborators (2003) Breast cancer and hormone-replacement therapy in the Million Women Stu-dy. Lancet 363: 419–427

    Google Scholar 

  • Million Women Study Collaborators (2005) Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 365: 1543–1551

    Article  CAS  Google Scholar 

  • Moehrer B, Hextall A, Jackson S (2003) Oestrogens for urinary incontinence in women. Cochrane Database Syst Rev 2: CD001405

    PubMed  Google Scholar 

  • Mueck AO (2002) Arteriosklerose und Hormonsubstitution-Nutzen oder Risiken? Gynäkologe 35: 965–974

    Google Scholar 

  • Mueck AO (2003a) Primär-und Sekundärprävention kardio-vaskulärer Erkrankungen durch Hormonsubstitution in der Postmenopause. Gynäkologe 36: 197–209

    Google Scholar 

  • Mueck AO (2003b) WHIMS-Risiko für Demenzen vaskulär verursacht? Geburtsh Frauenheilk 63:685–686

    Article  Google Scholar 

  • Mueck AO (für Berufsverband der Frauenärzte, BVF) (2004) Änderungender Zulassungen für die HRT. Frauenarzt 45: 524

    Google Scholar 

  • Mueck AO (2005) HRT oder Alternativen-Neuorientierung nach WHI? Geburtsh Frauenheilk 65: 323–325

    Article  Google Scholar 

  • Mueck AO (2006) Hormonersatztherapiebei internistischen Ri-sikopatientinnen. Gynäkol Geburtsh Rundsch 46: 174–190

    Article  Google Scholar 

  • Mueck AO, Kiesel L (2005) Bewertungvon Tibolon als eine der postmenopausalen Therapieoptionen. Frauenarzt 46: 572–574

    Google Scholar 

  • Mueck AO, Römer T (Hrsg) (2002) Stoffwechsel und Hormon-substitution. Thieme Stuttgart, S 75–86

    Google Scholar 

  • Mueck AO, Seeger H (2003a) Erhöhtes Brustkrebsrisiko unter HRT bedingt durch Gestagene? Geburtsh Frauenheilk 63: 1296–1298

    Article  Google Scholar 

  • Mueck AO, Seeger H (2003b) Smoking, estradiol metabolism and hormone replacement therapy. Drug Research 53:1: 1–11

    PubMed  CAS  Google Scholar 

  • Mueck AO, Seeger H (2004) Effect of hormone therapy on BP in normotensive and hypertensive women. Maturitas 49: 189–203

    Article  PubMed  CAS  Google Scholar 

  • Mueck AO, Wallwiener D (2003) Hormonsubstitution nach Endometriumkarzinom. Onkologe 9: 1255–1261

    Article  Google Scholar 

  • Mueck AO, Wallwiener D (2004) Hormonsubstitution nach Mammakarzinom. Senologie 1: 7–9

    Google Scholar 

  • Mueck AO, Seeger H, Lippert TH (2002) Estradiolmetabolism and malignant disease-review. Maturitas 43:1–10

    Article  PubMed  CAS  Google Scholar 

  • Mueck AO, Kuhl H, Braendle W (für Deutsche Menopause Gesellschaft) (2004) Ergebnisse und Kommentare zu der WHI-Studie mit Estrogen-Monotherapie. Geburtsh Frau-enheilk 64: 917–922

    Article  Google Scholar 

  • Mueck AO, Ortmann O, Geisthövel F, Rabe T, Kiesel L, Wallwie-ner D (2005) Sind kombinierte Kontrazeptiva und HRT karzinogen? Stellungnahme zur Bewertung der WHO. Frauenarzt 46: 740–742

    Google Scholar 

  • Mueck AO (federführend für: Deutsche Gesellschaft für Gynä-kologie und Geburtshilfe, Berufsverband der Frauenärzte, Deutsche Menopause Gesellschaft, Deutsche Gesellschaft für Gynäkologische Endokrinologie und Fortpflanzungs-medizin, Dachverband für Reproduktionsbiologie und-Medizin, Deutsche Gesellschaft für Senologie) (2006) Anwendungsempfehlungen_zur Hormonersatztherapie im Klimakterium und in der Postmenopause. Frauenarzt 47: 494–495

    Google Scholar 

  • Mulnard RA, Cotman CW, Kawas C et al. (2000) Estrogen replacement therapy for treatment of mild to moderate Alzheimer disease. JAMA 283: 1007–1015

    Article  PubMed  CAS  Google Scholar 

  • Naessen T, Rodriguez-Macias K (2001) Serum lipid profile im-proved by ultra low doses of 17β estradiol in elderly women. J Clin Endocrinol Metab 86:2757–62

    Article  PubMed  CAS  Google Scholar 

  • NAMS (North American Menopause Society) (2000a) The role of isoflavones in menopausal health: Consensus Opinion. Menopause 7: 215–229

    Google Scholar 

  • NAMS Consensus Opinion (2000b) North American Meno-pause Society. Effects of menopause and estrogen replacement therapy or hormone replacement therapy in women with diabetes mellitus. Menopause 7: 87–95

    Google Scholar 

  • Nanda K, Bastian LA, Hasselblad V, Simel DL (1999) Hormone replacement therapy and the risk of colorectal cancer: a meta-analysis. Obstet Gynecol 93: 880–888

    Article  PubMed  CAS  Google Scholar 

  • Nanda K et al. (2002) Hormone replacement therapy and the risk of death from breast cancer: a systematic review. Am J Obstet Gynecol 186: 325–334

    Article  PubMed  CAS  Google Scholar 

  • Nelson HD, Humphrey LL, Nygren P, Teutsch SM, Allan JD (2002) Postmenopausal hormone replacement therapy. JAMA 288: 872–881

    Article  PubMed  CAS  Google Scholar 

  • Ortmann O (federführend für die DGGG, Deutsche Gesell-schaft für Gynäkologie und Geburtshilfe) (2004) Konsen-susempfehlungenzur Hormontherapie im Klimakterium und in der Postmenopause. Geburtsh Frauenheilk 64: 1024–1028

    Article  Google Scholar 

  • Petru E, Benedicic C (2004) Phytoöstrogene: Potentiell un-günstige Effekte. Frauenarzt 45: 536–541

    Google Scholar 

  • Rabe T, Mueck AO, Geisthövel F et al. (2006) Hormonersatzthe-rapie-Nutzen und Risiken. Gemeinsame Stellungnahme der Deutschen Gesellschaft für Gynäkologische Endo-krinologie und Fortpflanzungsmedizin (DGGEF) und der Deutschen Menopause Gesellschaft. J Reproduktionsmed Endokrinol 3: 155–165

    CAS  Google Scholar 

  • Rapp SR et al. (2003) Effect of estrogen plus progestin on global cognitive function in postmenopausal women. The Women’s Health Initiative Memory Study. JAMA 289: 2663–2672

    Article  PubMed  CAS  Google Scholar 

  • Salpeter SR, Walsh JM, Greyber E, Ormiston TM, Salpeter EE (2004) Mortality associated with hormone replacement therapy in younger and older women: a meta-analysis. J. Gen Intern Med;19: 791–80

    Article  PubMed  Google Scholar 

  • Salpeter SR, Walsh JM, Greyber E et al. (2006) Coronary heart disease events associated with hormone therapy in younger and older women. A meta analysis. J Gen Intern Med 21:401–410

    Article  Google Scholar 

  • Scarabin PY, Oger E, Plu-Bureau G et al. (2003) Differential association of oral and transdermal oestrogen replacement therapy with venous thromboembolism risk. Lancet 362: 428–432

    Article  PubMed  CAS  Google Scholar 

  • Schneider HPG (2002) The view of the International Menopau-se Society on the Women’s Health Initiative. Climacteric 5: 211–216

    Article  PubMed  CAS  Google Scholar 

  • Schneider HPG, Mueck AO, Birkhäuser M (für die International Menopause Society) (2005) Empfehlungen zur Hormon-behandlung von Frauen während und nach den Wechsel-jahren. Frauenarzt 46: 96–101

    Google Scholar 

  • Seeger H, Wallwiener D, Mueck AO (2004) Influence of stromaderived growth factors on the estradiol-stimulated proliferation of human breast cancer cells. Eur J Gynec Oncology 25: 175–177

    CAS  Google Scholar 

  • Seibel MJ (2001) Evaluation des osteoporotischen Frakturrisi-kos. Dt Ärztebl 25:A1681–A1689

    Google Scholar 

  • Shapiro S (2003) Risks of estrogen plus progestin therapy: a sensitivity analysis of findings in the Women’s Health Initi-ative randomized controlled trial. Climacteric 6:302–310

    Article  PubMed  CAS  Google Scholar 

  • Shapiro S (2004) The Million Women Study: potential biases do not allow uncritical acceptance of the data. Climacteric 7: 3–7

    Article  PubMed  Google Scholar 

  • Shumaker SA et al. (2003) Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women. The Women’s Health Initiative Memory Study. JAMA 289: 2651–2662

    Article  PubMed  CAS  Google Scholar 

  • Torgerson DJ, Bell-Syer SEM (2001) Hormone replacement the-rapy and prevention of nonvertebral fractures. A meta-analysis of randomized trials. JAMA 285: 2891–2897

    Article  PubMed  CAS  Google Scholar 

  • Weisberg E, Ayton R, Darling G et al. (2005) Endometrial and vaginal effects of low dose estradiol delivered by vaginal ring or vaginal tablet. Climacteric 8: 23–92

    Article  CAS  Google Scholar 

  • WHI Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333

    Article  Google Scholar 

  • WHI Investigators (2003) Influence of estrogen plus progestin on breast cancer and mammography in healthy postme-nopausal women. JAMA 289: 3243–3253

    Article  Google Scholar 

  • WHI Investigators (2004a) Effects of conjugated equine estro-gen in postmenopausal women with hysterectomy. JAMA 291: 1701–1712

    Article  Google Scholar 

  • WHI Investigators (2004b) Estrogen plus progestin and risk of venous thrombosis. JAMA 292: 1573–1580

    Article  Google Scholar 

  • WHI Investigators (2004c) Lower incidence of diabetes seen among hormone therapy users in Women’s Health Initia-tive. Diabetologica 47: 1175–1187

    Article  CAS  Google Scholar 

  • Witteman JCM, Grobbee DE, Kok FJ, Hofman A, Valkenburg HA (1989) ncreased risk of atherosclerosis in women after the menopause. Br Med J 298: 642–644

    Article  CAS  Google Scholar 

  • Wuttke W, Jarry H, Westphalen S, Christoffel V, Gorkow C, Seidlova-Wuttke D (2002) Phytoöstrogene-eine Alternative zur Standard-Hormonersatztherapie? Gynäkologe 35:1007–1020

    Google Scholar 

  • Yaffe K, Sawaya G, Lieberburg I, Grady D (1998) Estrogen therapy in postmenopausal women. Effects on cognitive function and dementia. JAMA 279: 688–695

    Article  PubMed  CAS  Google Scholar 

  • Zandi PP, Carlson MC, Plassman BL et al. (2002) Hormone replacement therapy and incidence of Alzheimer Disease in older women. The Cache County Study. JAMA 288: 2123–2129

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Medizin Verlag Heidelberg

About this chapter

Cite this chapter

Mueck, A.O. (2007). Hormonersatztherapie. In: Therapiehandbuch Gynäkologie und Geburtshilfe. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-30098-4_32

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-30098-4_32

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-30097-7

  • Online ISBN: 978-3-540-30098-4

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics