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Gynäkologische Endokrinologie

Erschienen in:

21.09.2016 | Hormonsubstitution | Arzneimitteltherapie

Menopausale Hormontherapie bei internistischen Erkrankungen

verfasst von: Prof. Dr. Martin Birkhäuser

Erschienen in: Gynäkologische Endokrinologie | Ausgabe 4/2016

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Zusammenfassung

Postmenopausale Frauen leiden zusätzlich zu klimakterischen Beschwerden oft an internistischen Krankheiten. Daher ist es wichtig zu wissen, wann, in welcher Form und in welcher Dosis eine menopausale Hormontherapie (MHT) verordnet werden darf und in welchen Situationen sie kontraindiziert ist. Zur Verminderung des Risikos einer MHT bei internistischen Grundkrankheiten gelten folgende Grundregeln: Sofern keine Kontraindikationen bestehen, wird die MHT innerhalb des „günstigen Fensters“ begonnen (in einem Alter <60 Jahren bzw. innerhalb von 10 Jahren ab Menopause). Zu bevorzugen ist eine transdermale MHT. Ein First-Pass-Effekt ist bei den meisten internistischen Krankheiten unerwünscht. Verwendet werden sollte die niedrigste wirksame Dosis. Praktisch alle bekannten Nebenwirkungen der MHT sind dosisabhängig. Bei alleinigen urogenitalen Symptomen sollte nur eine vaginal-lokale Östrogengabe erfolgen. Metabolisch neutrale Gestagene, wie Progesteron, Dydrogesteron und Dienogest, oder eine nichtorale Gestagengabe sind zu bevorzugen, Medroxyprogesteronacetat ist zu vermeiden. Zyklische Schwankungen der Serumspiegel sollten vermieden werden. Angiopathien, z. B. bei Hypertonie, systemischem Lupus erythematodes oder Diabetes mellitus, sind eine absolute Kontraindikation gegen die MHT. Liegen keine Angiopathien vor, ist eine transdermale MHT bei den gleichen Grundkrankheiten nach genauer Nutzen-Risiko-Evaluation oft vertretbar. So ist bei einer stabilen, gut eingestellten arteriellen Hypertonie ohne Gefäßschäden eine transdermale MHT erlaubt. Bei Unklarheiten muss das weitere Vorgehen mit dem verantwortlichen Internisten abgesprochen werden.

Andersson C, Innala E, Bäckström T (2003) Acute intermittent porphyria in women: Clinical expression, use and experience of exogenous sex hormones. A population-based study in northern Sweden. J Intern Med 254:176–183PubMed

Appelberg J, Isoniemi H, Nilsson CG et al (1998) Safety and efficacy of transdermal estradiol replacement therapy in postmenopausal liver transplanted women. A preliminary report. Acta Obstet Gynecol Scand 77:660–664PubMed

Ayala F, Santoianni P (1993) Drug-induced cutaneous porphyria. Clin Dermatol 11:535–539PubMed

Baber RJ, Panay N, Fenton A, for the IMS Writing Group (2016) IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 19:109–150PubMed

Barr RG, Wentowski CC, Grodstein F et al (2004) Prospective study of postmenopausal hormone use and newly diagnosed asthma and chronic obstructive pulmonary disease. Arch Intern Med 164:379–386PubMed

Barrett-Connor E, Cox DA, Song I et al (2009) Raloxifene and risk for stroke based on the framingham stroke risk score. Am J Med 122:754–761PubMed

Birkhäuser M, Bürki R, De Geyter C, Imthurn B, Schiessl K, Streuli I, Stute P, Wunder D (2015) Expertenbrief Nr. 42. Aktuelle Empfehlungen zur Menopausalen Hormon-Therapie. gynécologie (SGGG). http://www.sggg.ch/fachthemen/expertenbriefe. Zugegriffen: 22. Dez. 2015

Birkhaeuser M (2002) Depression, menopause and estrogens: Is there a correlation? Maturitas 41(Suppl. 1):S3–S8

Boardman HM, Hartley L, Eisinga A et al (2015) Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev 3:CD002229PubMed

10.

Bonds DE, Lasser N, Qi L et al (2006) The effect of conjugated equine oestrogen on diabetes incidence: The Women’s Health Initiative ran- domised trial. Diabetologia 49:459–468PubMed

11.

Brownley KA, Hinderliter AL, West SG et al (2004) Cardiovascular effects of 6 months of hormone replacement therapy versus placebo: Differences associated with years since menopause. Am J Obstet Gynecol 190:1052–1058PubMed

12.

Bulaj ZJ, Franklin MR, Phillips JD et al (2000) Transdermal estrogen replacement therapy in postmenopausal women previously treated for porphyria cutanea tarda. J Lab Clin Med 136:482–488PubMed

13.

Buyon JP, Petri MA, Kim MY et al (2005) The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: A randomized trial. Ann Intern Med 142:953–962PubMed

14.

Canonico M, Plu-Bureau G, Scarabin PY (2011) Progestogens and venous thromboembolism among postmenopausal women using hormone therapy. Maturitas 70:354–360PubMed

15.

Canonico M, Plu-Bureau G, Lowe GD et al (2008) Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: Systematic review and meta-analysis. BMJ 336:1227–1231PubMedPubMedCentral

16.

Canonico M, Oger E, Plu-Bureau G, Estrogen and Thromboembolism Risk (ESTHER) Study Group, Estrogen and Thromboembolism Risk (ESTHER) Study Group (2007) Hormone therapy and venous thromboembolism among postmenopausal women: Impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation 115:840–845PubMed

17.

Canonico M, Oger E, Conard J, ES-trogen and THromboEmbolism Risk (ESTHER) Study Group (2006) Obesity and risk of venous thromboembolism among postmenopausal women: Differential impact of hormone therapy by route of estrogen administration. The ESTHER Study. J Thromb Haemost 4:1259–1265PubMed

18.

Carr MC (2003) The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 88:2404–2411PubMed

19.

Chugh PK (2012) Lupus: Novel therapies in clinical development. J Intern Med 23:212–218

20.

Cirillo DJ, Wallace RB, Rodabough RJ et al (2005) Effect of estrogen therapy on gallbladder disease. JAMA 293:330–339PubMed

21.

Clements D, Rhodes J (1993) Hormone replacement therapy in chronic active hepatitis; A case report. Gut 34:1639–1640PubMedPubMedCentral

22.

Collins P, Rosano G, Casey C et al (2007) Management of cardiovascular risk in the peri-menopausal woman: A consensus statement of European cardiologists and gynaecologists. Eur Heart J 28:2028–2040PubMed

23.

de Lauzon-Guillain B, Fournier A, Fabre A et al (2009) Menopausal hormone therapy and new-onset diabetes in the French Etude Epidemiologique de Femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort. Diabetologia 52:2092–2100PubMedPubMedCentral

24.

de Villiers TJ, Gass ML, Haines CJ et al (2013) Global consensus statement on menopausal hormone therapy. Climacteric 16:203–204PubMed

25.

D’Elia HF, Larsen A, Mattsson LA et al (2003) Influence of hormone replacement therapy on disease progression and bone mineral density in rheumatoid arthritis. J Rheumatol 30:1456–1463PubMed

26.

Erel CT, Brincat M, Gambacciani M et al (2010) EMAS position statement: Managing the menopause in women with epilepsy. Maturitas 66:327–328PubMed

27.

Espeland MA, Stefanick ML, Kritz-Silverstein D et al (1997) Effect of postmenopausal hormone therapy on body weight and waist and hip girths. J Clin Endocrinol Metab 82:1549–1556PubMed

28.

Forsblad-d’Elia H, Carlsten H (2011) Hormone replacement therapy in postmenopausal women with rheumatoid arthritis stabilises bone mineral density by digital x‑ray radiogrammetry in a randomised controlled trial. Ann Rheum Dis 70:1167–1168PubMed

29.

Gdansky E, Beller U, Neuman M et al (1995) Regression of hepatic tumors during transdermal estradiol replacement therapy. Acta Obstet Gynecol Scand 74:75–78PubMed

30.

Gleason CE, Dowling NM, Wharton W et al (2015) Effects of hormone therapy on cognition and mood in recently postmenopausal women: Findings from the randomized, controlled KEEPS-Cognitive and Affective Study. PLOS Med 12:e1001833PubMedPubMedCentral

31.

Grodstein F, Manson JE, Stampfer MJ et al (2008) Postmenopausal hormone therapy and stroke: Role of time since menopause and age at initiation of hormone therapy. Arch Intern Med 168:861–866PubMedPubMedCentral

32.

Grodstein F, Manson JE, Stampfer MJ (2006) Hormone therapy and coronary heart disease: The role of time since menopause and age at hormone initiation. J Womens Health (Larchmt) 15:35–44

33.

Grodstein F, Colditz GA, Stampfer MJ (1994) Postmenopausal hormone use and cholecystectomy in a large prospective study. Obstet Gynecol 83:5–11PubMed

34.

Haenggi W, Riesen W, Birkhaeuser MH (1993) Postmenopausal hormone replacement therapy with Tibolone decreases serum lipoprotein(a). Eur J Clin Chem Clin Biochem 31:645–650PubMed

35.

Haggerty CL, Ness RB, Kelsey S et al (2003) The impact of estrogen and progesterone on asthma. Ann Allergy Asthma Immunol 90:284–291PubMed

36.

Henderson VW, Benke KS, Green RC, Cupples LA, Farrer LA (2005) Postmenopausal hormone therapy and Alzheimer’s disease risk: Interaction with age. J Neurol Neurosurg Psychiatr 76:103–105 (for the MIRAGE Study group)PubMedPubMedCentral

37.

Hendrix SL, Wassertheil-Smoller S, Johnson KC et al (2006) Effects of conjugated equine estrogen on stroke in the Women’s Health Initiative. Circulation 113:2425–2434 (WHI Investigators)PubMed

38.

Hodis HN. ELITE – Does the trial outcome confirm or refute the timing hypothesis of hormone therapy? Presented at the 14th World Congress on Menopause, May 1–4, 2014, Cancun, Mexico.

39.

Holmqvist P, Hammar M, Landtblom A‑M, Brynshilden J (2010) Age at onset of multiple sclerosis is correlated to use of combined oral contraceptives and childbirth before diagnosis. Fertil Steril 94:2835–2837PubMed

40.

Horreau C, Pouplard C, Brenaut E et al (2013) Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: A systematic literature review. J Eur Acad Dermatol Venereol 27(Suppl 3):12–29PubMed

41.

Hulley S, Grady D, Bush T et al (1998) Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in post- menopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA 280:605–613PubMed

42.

Kask IC (2006) Cardiac syndrome X in women: The role of oestrogen deficiency. Heart 92(Suppl III):iii5–iii9. doi:10.1136/hrt.2005.070318

43.

Kos-Kudła B, Ostrowska Z, Marek B et al (2001) Effects of hormone replacement therapy on endocrine and spirometric parameters in asthmatic postmenopausal women. Gynecol Endocrinol 15:304–311PubMed

44.

Lateef A, Petri M (2012) Hormone replacement and contraceptive therapy in autoimmune diseases. J Autoimmun 38:J170–J176PubMed

45.

Løkkegaard E, Pedersen AT, Heitmann BL et al (2003) Relation between hormone replacement therapy and ischaemic heart disease in women: Prospective observational study. BMJ 326:426–430PubMedPubMedCentral

46.

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

47.

MacGregor EA (2012) Perimenopausal migraine in women with vasomotor symptoms. Maturitas 71:79–82PubMed

48.

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

49.

Margolis KL, Bonds DE, Rodabough RJ et al (2004) Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: Results from the Women’s Health Initiative Hormone Trial. Diabetologia 47:1175–1187 (Women’s Health Initiative Investigators)PubMed

50.

McColl KE, Wallace AM, Moore MR et al (1982) Alterations in haem biosynthesis during the human menstrual cycle: Studies in normal subjects and patients with latent and active acute intermittent porphyria. Clin Sci (Lond) 62:183–191

51.

Mercuro G, Zoncu S, Piano D et al (1998) Estradiol-17beta reduces blood pressure and restores the normal amplitude of the circadian blood pressure rhythm in postmenopausal hypertension. Am J Hypertens 11:909–913PubMed

52.

Mikkola TS, Tuomikoski P, Lyytinen H et al (2015) Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause 22:976–983PubMed

53.

Mikkola TS, Tuomikoski P, Lyytinen H et al (2015) Increased cardiovascular mortality risk in women discontinuing postmenopausal hormone therapy. J Clin Endocrinol Metab. doi:10.1210/jc.2015-1864 PubMed

54.

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

55.

Nappi RE, Sances G, Sommacal A et al (2006) Different effects of tibolone and low-dose EPT in women with primary headache. Menopause 13:818–825PubMed

56.

Olié V, Canonico M, Scarabin PY (2011) Postmenopausal hormone therapy and venous thromboembolism. Thromb Res 127(Suppl 3):S26–S29PubMed

57.

Olié V, Plu-Bureau G, Conard J et al (2011) Hormone therapy and recurrence of venous thromboembolism among postmenopausal women. Menopause 18:488–493PubMed

58.

Olié V, Canonico M, Scarabin PY (2010) Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women. Curr Opin Hematol 17:457–463PubMed

59.

Olsson R, Mattsson LA, Obrant K et al (1999) Estrogen-progestogen therapy for low bone mineral density in primary biliary cirrhosis. Liver 19:188–192PubMed

60.

Peterson S, Peto V, Rayner M, Luengo-Fernandez R, Gray A (2005) European cardiovascular disease statistics, 2. Aufl. British Heart Foundation, London

61.

Redmond AM, James AW, Nolan SH et al (2004) Premenstrual asthma: Emphasis on drug therapy options. J Asthma 41:687–693PubMed

62.

Renoux C, Dell’aniello S, Garbe E et al (2010) Transdermal and oral hormone replacement therapy and the risk of stroke: A nested case-control study. BMJ 340:c2519–c2519. doi:10.1136/bmj.c2519 PubMed

63.

Renoux C, Dell’Aniello S, Suissa S (2010) Hormone replacement therapy and the risk of venous thromboembolism: A population-based study. J Thromb Haemost 8:979–986PubMed

64.

Rocca WA, Bower JH, Maraganore DM et al (2007) Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology 69:1074–1083PubMed

65.

Rosano GM, Collins P, Kaski JC et al (1995) Syndrome X in women is associated with oestrogen deficiency. Eur Heart J 16(5):610–614 (May)PubMed

66.

Ruan X, Seeger H, Mueck AO (2012) The pharmacology of dienogest. Maturitas 71:337–344PubMed

67.

Salam MT, Wenten M, Gilliland FD (2006) Endogenous and exogenous sex steroid hormones and asthma and wheeze in young women. J Allergy Clin Immunol 117:1001–1007PubMed

68.

Salmon JE, Roman MJ (2008) Subclinical atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus. Am J Med 121(Suppl 1):S3–S8PubMedPubMedCentral

69.

Sánchez-Guerrero J, González-Pérez M, Durand-Carbajal M et al (2007) Menopause hormonal therapy in women with systemic lupus erythematosus. Arthritis Rheum 56:3070–3079PubMed

70.

Sassa S, Bradlow HL, Kappas A (1979) Steroid induction of delta-aminolevulinic acid synthase and porphyrins in liver. Structure-activity studies and the permissive effects of hormones on the induction process. J Biol Chem 254:10011–10020PubMed

71.

Scarabin PY, Oger E, Plu-Bureau G, EStrogen and THromboEmbolism Risk Study Group (2003) Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet 362:428–432PubMed

72.

Schatz M, Dombrowski MP, Wise R et al (2003) Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immunol 112:283–288PubMed

73.

Siersema PD, De Man RA, Wilson JHP et al (1994) Porphyria cutanea tarda and focal nodular hyperplasia. Eur J Gastroenterol Hepatol 6:371–374

74.

Shakir YA, Samsioe G, Nerbrand C et al (2004) Combined hormone therapy in postmenopausal women with features of metabolic syndrome. Results from a population-based study of Swedish women: Women’s Health in the Lund Area study. Menopause 11:549–555 (Women’s Health in the Lund Area study)PubMed

75.

Shao H, Breitner JC, Whitmer RA et al (2012) Hormone therapy and Alzheimer disease dementia: New findings from the Cache County Study. Neurology 79:1846–1852 (Cache County Investigators)PubMedPubMedCentral

76.

Schierbeck LL, Rejnmark L, Tofteng CL et al (2012) Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: Randomised trial. BMJ 345:e6409–e6409. doi:10.1136/bmj.e6409 PubMed

77.

Shlipak MG, Angeja BG, Go AS et al (2001) Hormone therapy and in-hospital survival after myocardial infarction in postmenopausal women. Circulation 104:2300–2304PubMed

78.

Shumaker SA, Legault C, Kuller L et al (2004) Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women’s Health Initiative Memory Study. JAMA 291:2947–2958 (Women’s Health Initiative Memory Study)PubMed

79.

Shumaker SA, Legault C, Rapp SR 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: A randomized controlled trial. JAMA 289:2651–2662 (WHIMS Investigators)PubMed

80.

Stanford KI, Mickleborough TD, Ray S et al (2006) Influence of menstrual cycle phase on pulmonary function in asthmatic athletes. Eur J Appl Physiol 96:703–710PubMed

81.

Straczek C, Oger E, de Jonage-Canonico YMB, Estrogen and Thromboembolism Risk (ESTHER) Study Group (2005) Prothrombotic mutations, hormone therapy, and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration. Circulation 112:3495–3500PubMed

82.

Tackett AH, Bailey AI, Foody JM et al (2010) Hormone replacement therapy among postmenopausal women presenting with acute myocardial infarction: Insights from the GUSTO-III trial. Am Heart J 160:678–684PubMed

83.

Tavani A, Negri E, Parazzini F et al (1993) Female hormone utilisation and risk of hepatocellular carcinoma. Br J Cancer 67:635–637PubMedPubMedCentral

84.

Uhler ML, Marks JW, Voigt BJ et al (1998) Comparison of the impact of transdermal versus oral estrogens on biliary markers of gallstone formation in postmenopausal women. J Clin Endocrinol Metab 83:410–414PubMed

85.

Wassertheil-Smoller S, Hendrix SL, Limacher M et al (2003) Effect of estrogen plus progestin on stroke in postmenopausal women: The Women’s Health Initiative: A randomized trial. JAMA 289:2673–2684 (WHI Investigators)PubMed

86.

Wenger NK (2016) Juggling multiple guidelines: A woman’s heart in the balance. J Womens Health 25:213–221

87.

Writing Group for the PEPI Trial (1995) Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA 273:199–208

88.

Zhang J, Chen L, Delzell E et al (2014) The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis 73:1301–1308PubMed

Titel: Menopausale Hormontherapie bei internistischen Erkrankungen
verfasst von: Prof. Dr. Martin Birkhäuser
Publikationsdatum: 21.09.2016
Verlag: Springer Medizin
Schlagwörter: Hormonsubstitution
Gestagene
Medroxyprogesteron
Dydrogesteron
Estradiol
Dienogest
Erschienen in: Gynäkologische Endokrinologie / Ausgabe 4/2016
Print ISSN: 1610-2894
Elektronische ISSN: 1610-2908
DOI: https://doi.org/10.1007/s10304-016-0090-2

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