Postmenopausale Hormontherapie und Mammakarzinomrisiko

Numerous observational and randomized clinical studies suggest that long-term postmenopausal hormone therapy may be associated with an increased risk of invasive breast cancer. That risk seems to be elevated especially when combined estrogen-progestin therapy (EPT) is used. The longer EPT has been prescribed, the more this risk becomes evident. Five years following cessation of EPT, the risk of invasive breast cancer is thought to have returned to normal values. Furthermore, the breast cancer risk associated with estrogen-only therapy (ET) seems to be lower than with combination EPT. However, ET is recommended only among patients having undergone hysterectomy due to an elevated risk of endometrial cancer. In clinical practice the duration of both EPT and ET should be limited. Furthermore, illustrating the potential benefits and risks is of particular importance when counseling patients.     

Postmenopausale Hormontherapie und Mammakarzinom

Zusammenfassung Die Diskussion um die Hormonersatztherapie (HRT) zur Prävention von Herzerkrankungen und Osteoporose hat Auswirkungen auf die Behandlungsentscheidung, doch bisher fehlt eine klare Leitlinie. Die WHI-Studie wurde abgebrochen, da das vorab festgelegte noch zu tolerierende Risiko, ein Mammakarzinom unter Hormontherapie zu entwickeln, überschritten wurde. Eine neuere Metaanalyse zeigte eine Erhöhung des Brustkrebsrisikos mit der Dauer der HRT. Die kombinierte Östrogen/Gestagen-Therapie scheint mit einem höheren Risiko für ein Mammakarzinom verbunden zu sein als die Östrogenmonotherapie. Es ist allerdings ein einheitlicher Befund in vielen Studien, dass Brustkrebse bei HRT-Anwenderinnen günstigere prognostische Kriterien aufweisen. Eine Metaanalyse hat 11 Studien, überwiegend Beobachtungsstudien, einbezogen und fand keine Erhöhung der Rezidivrate durch eine HRT nach Brustkrebs. Als Hilfe für die Praxis wird die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe Anfang 2003 eine Konsensusempfehlung zur Hormonbehandlung klimakterischer und postmenopausaler Frauen herausgegeben. Abstract Although the current discussion on the use of hormone replacement therapy (HRT) for the prevention of heart disease and osteoporosis is important for decisions on treatment, there are at present no generally accepted recommendations. The WHI study was stopped prematurely because the level of tolerated risk for the development of breast cancer was exceeded. A new meta-analysis showed an increase in the risk of breast cancer with the duration of HRT. The combined estrogen/gestagen therapy appears to involve a higher risk than the use of estrogen alone. However, a common finding in many studies is that breast cancer in women on HRT therapy shows better prognostic criteria. One meta-analysis, which included 11 predominantly observational studies, found that there was no higher risk of relapse caused by HRT after breast cancer. In order to assist medical practitioners, the German Society for Gynaecology and Obstetrics will publish a consensus recommendation on hormone treatment for menopausal and postmenopausal women at the beginning of 2003.     

Postmenopausale Hormontherapie und Mammakarzinom

Die Gynäkologie - Die Diskussion um die Hormonersatztherapie (HRT) zur Prävention von Herzerkrankungen und Osteoporose hat Auswirkungen auf die Behandlungsentscheidung, doch bisher fehlt...     

Hormontherapie und schizophrene Psychosen

The influence of estrogens on the genesis and course of psychological disorders has been discussed for a long time. Studies support the hypothesis that estrogens offer protection from schizophrenia by cerebral effects and have an influence on the beginning and course of the disease. This hypothesis offers a plausible explanation for gender differences in the age when first signs of the disease appear and the course of the disease. Women are relatively protected from schizophrenia between the menarche and menopause. In the postmenopausal period a second peak in first-time diseases occurs in women but not in men. The risk of exacerbation of schizophrenia increases not only in the postmenopausal period but also during the perimenstrual cycle phase and under other conditions where low estrogen levels are present. A deterioration of the psychopathology has been demonstrated even in the perimenstrual cycle phase. The presence of primary hypoestrogenemia in schizophrenic women is evident and independent of hyperprolactinemia caused by classical antipsychotic drugs. The results of studies do not yet allow therapy recommendations to be derived because the therapeutic value of estrogens in the treatment of schizophrenic women still has to be determined.     

Individualisierte Hormontherapie in Peri- und Postmenopause

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.     

Hormontherapie in der Peri- und Postmenopause und Malignomrisiko

Many human neoplasms, in particular gynecological cancer, are hormone-dependent malignancies. Whether hormones, like estrogens and progestogens, are cancer causing or cancer stimulating is currently under discussion. Similar to endogenous hormones, hormone therapy of peri- and postmenopause under different conditions can also lead to tumor growth or tumor reduction. This article provides evidence of the influence of peri- and postmenopausal hormone therapy on gynecological and colon cancer risk.     

Herz-Kreislauf-Risiko und Hormontherapie in der Postmenopause

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.     

Hormontherapie in der Peri- und Postmenopause und Malignomrisiko

Hormone therapy (HT) with sex steroids in perimenopausal and postmenopausal women is often used for relief of postmenopausal symptoms. A possible tumor growth is one of the concerns of physicians and patients who are considering HT. Many malignant diseases of the female genital tract and breasts are hormone-dependent. It is known that the duration and amount of estrogen exposure in women correlates with the risk of breast cancer. On the other hand treatment with estrogen receptor blockers and aromatase inhibitors is highly effective in the treatment and prevention of breast cancer. In this article the known relevant changes of various cancer risks due to sex steroids are presented. A detailed assessment of the overall evidence on this issue is given in the S3 guidelines on hormone therapy in perimenopausal and postmenopausal women.     

Hormontherapie in der Peri- und Postmenopause

Breast, endometrial, and ovarian cancers are endocrine-dependent. Estrogens and progestogens can have a proliferative effect on tumor growth. Hormone therapy during and after menopause can raise or lower the risk of a malignoma. This article explains its influence on the risk of mammary, endometrial, ovarian, cervical, and colorectal cancers.     

Leitliniengerechte Hormontherapie in der Peri- und Postmenopause

Postmenopausal endocrine therapy is one of the most commonly prescribed forms of pharmacotherapy. It should only be performed if there are clear indications which are named in the S3 guidelines. Contraindications must be respected and the individual patient health status has to be considered.     

Praxis der Hormontherapie in der Peri- und Postmenopause

The aim of hormone therapy for perimenopausal and postmenopausal women is improvement of quality of life and prevention of diseases which are caused or aggravated by long-term estrogen deficiency. The climacteric syndrome and atrophic urogenital symptoms are the primary indications for hormone therapy. Treatment should be initiated using the lowest effective dose and – if necessary – adapted after 4–6 weeks. Prevention should be carried out for at least 5 years. Very low doses of estrogens may prevent postmenopausal bone loss and reduce the risk of osteoporosis-related fractures. Therefore, in postmenopausal women under the age of 60 years hormone therapy is an appropriate first-line treatment for prevention of osteoporosis. Hormone therapy may exert beneficial effects on the brain and protect from atherosclerosis and myocardial infarction, if started around the time of menopause. However, hormone therapy may increase the risk of venous thromboembolic disease and ischemic stroke, except transdermal use. The only indication for the addition of progestogens is endometrial protection. As progestogens may increase breast cancer risk associated with estrogen treatment and counteract the beneficial effect of estrogens on psychic disorders, they should be used at doses as low as possible.     

Aktuelles zur Hormontherapie in der Peri- und Postmenopause

Die Hormontherapie in der Peri- und Postmenopause (HT) hat eine Reihe von Nutzen und Risiken. Momentan wird der potenzielle präventive Effekt auf kardiovaskuläre Erkrankungen diskutiert. Eine protektive Wirkung ist möglich, aber nicht klar nachzuweisen, wohl aber Risikoerhöhungen bei vorbestehenden Belastungen. Das Brustkrebsrisiko wird in Abhängigkeit der Zusammensetzung der HT und der Anwendungsdauer nicht beeinflusst bzw. erhöht. Alternativen zur HT sind nicht oder weniger wirksam zur Behandlung von klimakterischen Beschwerden.     

Postmenopausale Osteoporose

The importance of postmenopausal osteoporosis is steadily growing because of its increasing incidence, high impact on the quality of life, mortality and healthcare economics. The diagnosis of osteoporosis is based on the risk factor assessment, clinical examination, laboratory diagnostics and bone densitometry. The gold standard for diagnosis of osteoporosis is the measurement of bone mineral density by dual-energy X?ray absorptiometry (DXA). The aim of the diagnostics is the assessment of fracture risk and subsequent treatment recommendations. For the prevention of osteoporosis a daily intake of 1000 mg calcium and a vitamin D intake of 1000–2000 IU per day is recommended. As a consequence of increased fracture risk, further antiresorptive treatment is effective in reducing the fracture incidence. Timely diagnosis and effective treatment can reduce morbidity and mortality rates and significantly improve the quality of life.     

Hormontherapie (HT) in der Peri- und Postmenopause

Hormone therapy (HT) in the peri- and postmenopause is one of the most significant endocrinological therapy options in gynecological practice. The most important indications include the treatment of vasomotor symptoms and vaginal atrophy. Local HT has positive effects even on recurrent urinary tract infections. Under certain conditions, it can also be used for osteoporosis prophylaxis. However, alongside these positive effects, there are also certain risks to be considered, which are time-dependent as well as dependent on individual parameters (e.g., age, general health). Women considering HT require comprehensive information on the benefits and risks of this treatment.