Hormontherapie bei gynäkologischen, nichtmalignen Erkrankungen

Zusammenfassung Etwa ein Drittel aller Frauen in der Postmenopause erlebt klimakterische Beschwerden, die zur Hormonersatztherapie Anlass geben. Der therapeutische Nutzen einer Östrogensubstitution ist dabei eindeutig belegt, zumal Östrogenmangelerscheinungen letztlich alle Organsysteme betreffen können. Eine besondere Herausforderung stellt dabei die Hormonsubstitution der postmenopausalen Frau mit Endometriose und/oder Myomen dar, denn beide benignen Erkrankungen sind hormonabhängig und können durch eine Hormonersatztherapie negativ beeinflusst werden. Beide Erkrankungen treten selten postmenopausal auf, können jedoch die Lebensqualität der betroffenen Frauen stark beeinflussen. Eine HRT ist aber auch bei diesen Patientinnen möglich, sofern im Vorfeld eine genaue Nutzen-Risiken-Evaluation erfolgt und die HRT denjenigen Patientinnen vorbehalten ist, die unter starken klimakterischen Beschwerden leiden. Bei einer aktiven postmenopausalen Endometriose bzw. symptomatischem Myom sollte zunächst operativ behandelt werden. Soll eine Östrogentherapie erfolgen, muss das Risiko einer malignen Entartung bedacht werden. In jedem Fall ist die Kombinationstherapie einer Östrogenmonotherapie vorzuziehen. Aktuelle Daten weisen darauf hin, dass eine HRT mit Tibolon und Aromataseinhibitoren erfolgversprechend und nebenwirkungsarm zu sein schein. Abstract About one third of all postmenopausal women need hormone replacement therapy (HRT) and hypoestrogenism affects most organ systems. The therapeutic benefit of HRT is well proven and in postmenopausal women with endometriosis and/or uterine myoma represents a special challenge. Both benign diseases are estrogen-dependent and can be negatively influenced by HRT. Cases of endometriosis/uterine myoma in postmenopausal women are rare but can severely influence the quality of life of those women affected. A HRT is still feasible as long as the advantages and disadvantages are taken into account but should be reserved for patients with severe hypoestrogenism. In cases of active endometriosis and symptomatic myoma surgical therapy should be preferentially performed. As estrogen replacement can be associated with a higher risk of recurrence or malignant transformation, combined preparations should be chosen instead of estrogen monotherapy. Although there is no firm evidence tibolone and aromatase inhibitors appear to be the optimal choice. Similar content being viewed by others Literatur Punnonen R, Klemi PJ, Nikkanen V (1980) Postmenopausal endometriosis. Eur J Obstet Gynecol Reprod Biol 11(3):195–200 Fatemi HM, Al-Turki HA, Papanikolaou EG et al (2005) Successful treatment of an aggressive recurrent post-menopausal endometriosis with an aromatase inhibitor. 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