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Abstract

HRT – update for practicing physicians

Indications according to the labelling of most products used for »Hormone Replacement Therapy« (HRT), recently also named as »Menopausal Hormone Therapy«, are climacteric symptoms, vaginal and urological complaints as well as the primary prevention of postmenopausal osteoporosis, the latter one currently is restricted, although no better alternatives exist. Other possible preventive benefits to date are not labelled as indications but should be considered individually: thus with an early start of treatment an effective prevention of myocardial infarction can be achieved. The risk for colorectal cancer also is reduced, even after short-term treatment, including the risk of Alzheimer?s Disease, which, however, needs start of HRT already during age about 50 years to prevent a disease which mostly is in old age. Generally no secondary preventive effects can be anticipated. Regarding risks particularly ischemic strokes should be considered, especially in elderly hypertensive patients. Each patient should be adequately informed about breast cancer risk as compared to other risk factors. Experimental data and observational studies suggest lower risk of breast cancer using more natural progestogens like progesterone and dydrogesterone, but more data on this issue are needed. Hormonal side-effects are dose-dependent, therefore for estrogens as well as for progestogens the lowest effective dosage should be used. Women with hysterectomy should be treated only with estrogens. Transdermal HRT often is the therapy of choice, especially for patients with preexisting risk factors or internal diseases. No temporal limitations exist for an indicative HRT. However, at least annual examinations are recommended as well as regular preventive examinations, whether with or without HRT.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(1): 4–21

Keywords
Hormonal replacement therapy (HRT), risks, benefits, practical aspects

Alfred O. Mueck1, Kai J. Bühling2
1 Schwerpunkt für Endokrinologie und Menopause,
Universitäts-Frauenklinik, Landesinstitut für Frauengesundheit
Baden-Württemberg, Tübingen
2 Klinik und Poliklinik für Gynäkologie,
Universitätsklinikum Hamburg-Eppendorf, Hamburg
Reviewer: Anne Schwenkhagen, Hamburg,
und Petra Stute, Bern

Mueck A.O. HRT ... Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(1): 4–21 publiziert 31.03.2014 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2014 ISSN 1614-8533