Kernaussagen
Im perimenopausalen Übergang kommt es zu einer ovariellen Erschöpfung und damit zu
einem Estrogenmangel. Dies kann zu klinischen Beschwerden bei den Patientinnen führen.
Der Einsatz einer Hormonersatztherapie ist dann möglich. Gegenüber den ursprünglich
angestrebten Behandlungszielen einer HRT ist mittlerweile nur noch die Behandlung
subjektiver Beschwerden geblieben wie Hitzewallungen, eine lokale Behandlung der urogenitalen
Atrophie sowie die Behandlung der hormonabhängigen Osteoporose, wenn keine Alternativen
in der Therapie vorliegen bzw. subjektive Beschwerden ohnehin eine Hormonersatztherapie
indizieren. Eine Abwägung der Vor- und Nachteile muss dennoch für jeden individuellen
Fall erfolgen.
Die Hormonersatztherapie ist systemisch oder lokal möglich, immer abhängig vom individuellen
Beschwerdebild. Bei der oralen Therapie unterscheidet man dabei eine reine zyklische
Gestagentherapie, eine sequenzielle Hormonersatztherapie mit einem durchgängig gegebenen
Östrogen und einem zyklisch applizierten Gestagen in Transformationsdosis sowie die
kontinuierlich kombinierte Hormonersatztherapie, bei der Gestagen und Östrogen täglich
ohne Pause kombiniert gegeben werden. Hinsichtlich bestehender Begleiterkrankungen
oder den Risiken hierfür sind bei der Auswahl der am besten geeigneten HRT-Präparate
einige Faktoren zu beachten.
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Prof. Dr. med. M. Ludwig
Endokrinologikum Hamburg · Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin
und Pränatale Medizin
Lornsenstraße 4–6
22767 Hamburg
Email: Michael.Ludwig@endokrinologikum.com
