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Europäische Gynäkologen analysieren WHI-Hormonstudie amerikanischer Kardiologen
... In der letzten Zeit sind zahlreiche Stellungnahmen und Konsensusempfehlungen als Reaktion auf die öffentliche und fachliche Diskussion der im vorigen Abschnitt diskutierten Studien erschienen [26][27][28][29][30][31][32]. Im folgenden wollen wir diese Empfehlungen resümieren und aus unserer Sicht ergänzen: ...
Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, combination, duration of use, route of administration, and timing of initiation. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing or discontinuing HT. For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is most favorable for treatment of bothersome VMS and for those at elevated risk for bone loss or fracture. For women who initiate HT more than 10 years from menopause onset or are aged 60 years or older, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, and venous thromboembolism. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss, with shared decision making and periodic reevaluation. New and emerging menopausal therapies have the potential to relieve menopausal symptoms and to create a target treatment.
After some 60 years of ever-increasing utilization, hormonal contraception (HC) has made a major impact in the lives of women worldwide. This chapter discusses the different meaning that family planning has taken today in industrialized and in developing countries, the reason being that in the former fertility is almost always at, or below, replacement level, whereas in the latter—with the notable exception of China—it is still well above it.
The decline in the reproductive capacity of women in the late fourth to fifth decade of life is accompanied by diverse sequelae, including vasomotor symptoms, an increased risk of osteoporosis, psychogenic disturbance and cardiovascular and cerebrovascular disease. Attempts to ameliorate losses in oestrogen through hormone replacement therapy (HRT) have, however, courted significant controversy relating both to increased risks of malignancy and vascular events, thereby standing as an exemplar for the difficulty in managing hormone balance during ageing. Dehydroepiandrosterone (DHEA) represents the most abundant sex steroid in plasma in men and women, but its serum concentration goes down to 10–20% of its maximum level by around the age of 70 years. Evidence suggest that lower levels of are associated with cardiovascular, cognitive and sexual impairment in women. Further aspects need to be better investigated, before drawing definitive conclusions on DHEA replacement therapy.
Women of all ages have a higher incidence of depression than men. The lifetime incidence of endogenous depression in women is twice the incidence in males. Through their brain receptors, oestrogens modulate the metabolism of serotonin and noradrenalin, as do antidepressants, and influence therefore mood, mental function, and cognition. In women having a particular vulnerability, the menopausal transition might trigger a depressive disorder. Similarly, the dramatic fall of sexual steroids after delivery including oestrogens is followed in some women by a postpartal depression.
Zusammenfassung Die Indikationen für die Messungen der Knochendichte bei der Frau während der Postmenopause aus Vorgeschichte und Befund werden eingehend erörtert. Die verschiedenen Möglichkeiten der quantitativen Messverfahren wie DXA, periphere Computertomographie und Ultraschallmethodik werden in ihrer klinischen Brauchbarkeit für die gynäkologische Praxis und in ihrem prädiktiven Wert für das reale Frakturrisiko gewürdigt.
Women have a higher incidence of depression than men. The lifetime incidence of endogenous depression in women is twice the incidence in males. Because depression in the elderly is an important public health concern, an eventual correlation between menopause and depression is of practical importance. The relevant literature is reviewed. There are suggestive data that estrogen deficiency may increase the susceptibility for depression. Furthermore, here is suggestive evidence from observational studies and a limited number of randomized, controlled trials that estrogen therapy after menopause improves mood and cognition. However, the clinical relevance of estrogen administration is unproved. There are weak data that estrogens might be considered for mild depressive symptoms attributed to hot flushes, sleep disturbances, or other climacteric symptoms. No hard data exist to indicate whether estrogen could be used as adjunct therapy for other depressive disorders during the menopausal transition or postmenopausal period, but newer findings suggest that estrogens may improve the effect of serotonin reuptake inhibitors.
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