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Schwerpunkt: Hormonersatztherapien

Hormonersatztherapie bei internistischen Risikopatientinnen

Mueck A.O.

Author affiliations

Schwerpunkt für Endokrinologie und Menopause, Institut für Frauengesundheit Baden-Württemberg, Universitäts-Frauenklinik Tübingen, Tübingen, Deutschland

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Gynäkol Geburtshilfliche Rundsch 2006;46:174–190

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Article / Publication Details

First-Page Preview
Abstract of Schwerpunkt: Hormonersatztherapien

Published online: October 31, 2006
Issue release date: October 2006

Number of Print Pages: 17
Number of Figures: 3
Number of Tables: 7

ISSN: 1018-8843 (Print)
eISSN: 1423-0011 (Online)

For additional information: http://www.karger.com/GGR

Abstract

Für eine Hormonersatztherapie (HRT) gelten absolute und relative Kontraindikationen, die in den Fachinformationen primär unter Annahme von Gruppeneffekten nach dem «Worst-case»-Prinzip gelistet sind, um forensischen Anforderungen zu genügen. Bei starkem Leidensdruck kann es aber sinnvoll erscheinen, eine HRT auch bei erhöhtem Risiko durchzuführen. Zur Risikominimierung ergibt sich neben einer allgemeinen Dosisreduktion eine differenzierte Wahl der Präparate vor allem bezüglich der Gestagenkomponente und Applikationsform. Für internistische Risikopatientinnen ist dabei häufig die Bevorzugung von transdermalem Östradiol in Form von Pflastern oder Gelen und neutralen Gestagenen wie Progesteron und Dydrogesteron bzw. Kombipflaster zur komplett transdermalen HRT zu empfehlen. In der Women’s Health Initiative, einer Studie mit einem kardiovaskulär stark belasteten Kollektiv, ergaben sich als wichtigste Risiken venöse Thrombosen und Hirninsulte, im hohen Alter auch Herzinfarkte. Im direkten Zusammenhang damit haben die Risikogruppen mit Diabetes, Hypertonie und Dyslipoproteinämie sowie allgemein Raucherinnen besondere Bedeutung. Weitere häufige internistische Risikogruppen sind Frauen mit Schilddrüsenerkrankungen und Leber-/Gallenwegserkrankungen; seltene, aber prognostisch wichtige Erkrankungen wie Porphyrien und Lupus erythematodes gelten als relative Kontraindikationen. Die Datenlage bei diesen Risikogruppen wird dargestellt und praktische Empfehlungen werden gegeben.

© 2006 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Schwerpunkt: Hormonersatztherapien

Published online: October 31, 2006
Issue release date: October 2006

Number of Print Pages: 17
Number of Figures: 3
Number of Tables: 7

ISSN: 1018-8843 (Print)
eISSN: 1423-0011 (Online)

For additional information: http://www.karger.com/GGR


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