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Dtsch Med Wochenschr 2021; 146(01): 41-47
DOI: 10.1055/a-1180-3127
Review

Die menopausale Hormontherapie aus internistisch endokrinologischer Sicht

Menopausal hormone therapy: internal-endocrine point of view
Roland Gärtner
1   Medizinische Klinik Innenstadt der LMU, München
,
Werner Albrich
2   Frauenärzte fünf Höfe, München
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Zusammenfassung

Die menopausale Hormontherapie (MHT) begann 1942 in den USA und wurde weltweit in den 1960er-Jahren wegen der sehr erfolgreichen Behandlung vegetativer und vasomotorischer Beschwerden sehr populär. Diese manifestieren sich in vielen Fällen schon prämenopausal und können über ca. 10 Jahre andauern und die Lebensqualität erheblich einschränken. Viele Frauen stellen sich in dieser perimenopausalen Lebensphase nicht primär beim Gynäkologen, sondern beim Hausarzt oder Kardiologen vor, da Blutdruckschwankungen und insbesondere die typischen nächtlichen Palpitationen Angst machen. Eine fachübergreifende Betrachtung kann unnötige diagnostische Maßnahmen bis zur invasiven Herzkatheteruntersuchung und inadäquate Therapien mit Betablockern, Antidepressiva und Sedativa vermeiden.

Daneben ist es auch in der hausärztlich-internistischen Praxis wichtig, die Auswirkungen sowohl eines Hormonmangels als auch einer Hormontherapie auf innere Organerkrankungen zu kennen. Die Hormontherapie kann vorbestehende Erkrankungen positiv, negativ oder gar nicht beeinflussen. Betroffene Patientinnen erwarten zurecht eine enge Kooperation der Spezialisten – Gynäkologen, Endokrinologen und Internisten –, wenn es um die Entscheidung für oder gegen eine menopausale Hormontherapie (MHT) geht, insbesondere nach den Unsicherheiten, welche die mittlerweile revidierten Ergebnisse der WHI (women’s health initiative) -Studie hervorgerufen hatten.

Abstract

The history of menopausal hormone therapy (MHT) started in 1942 in the US and became very popular in the 1960s worldwide because of the beneficial effects on vasomotor-vegetative and vulvovaginal symptoms. These symptoms may begin already in the premenopausal period, and can last for more than 10 years with reduced quality of life. Many women with vasomotor-vegetative symptoms do not visit a gynaecologist first but primarily a general physician or cardiologist because of instable blood pressure and palpitations, leading to the focus on the heart. To avoid unnecessary examinations and treatment with ß-blockers or antidepressants, an interdisciplinary look is necessary. In most cases, appropriate and low dose hormone replacement will relieve the symptoms and restore quality of life. In addition, it is worthwhile to know about the long-term effect of hormone deficiency as well as replacement on the different organ systems and the possible influences of hormone replacement therapy including contra indications. This is especially necessary after the uncertainties raised after the first deleterious announcements of the currently corrected results of the WHI (women’s health initiative) study.

Schlüsselwörter

menopausales Syndrom - menopausale Hormontherapie - vasomotorisches Syndrom - vulvovaginale Atrophie - Brustkrebsrisiko - koronare Herzerkrankung - Autoimmunerkrankungen

Key words

menopausal syndrome - menopausal hormone therapy - vasomotoric syndrome - vulvovaginal atrophy - coronary heart disease - autoimmune disease


Publication History

Article published online:
04 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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