文摘
Up to 2002 estradiol (E2) substitution was used by 50 % of women after the menopause. After initial publication of the Women’s Health Initiative (WHI), which questioned the use of hormone replacement, the proportion drastically decreased. In view of the poor data evaluation the results of the WHI have meanwhile been put into perspective. In accordance with the Governing Body on Osteology (DVO) E2 substitution should be approved for women with a high risk of fractures and has been assigned to efficiency level A for fracture prevention. For ostoporosis prevention, E2 substitution is graded as acceptable when other medications are incompatible or contraindicated with this indication. Scientifically, the restrained DVO decision with respect to E2 is poorly justified. The frequency of contraindications for E2 is in the range of 0.1 %. The previously postulated risk of breast cancer cannot be completely excluded but is meanwhile questionable. Bisphosphonates cannot prevent a 3–5 % annual loss of collagen in the first years after the menopause. Only E2 substitution can counteract this. Calcium and vitamin D are not alternatives to estradiol. With prevention of osteoporosis and the associated facilitation of physical activity, further positive effects are promoted, in particular the prevention of coronary heart disease. In the USA the use of E2 substitution is accepted for prevention of osteoporosis, independent of climacteric complaints. For this purpose the US Food and Drug Administration approved a transdermal patch with 0.014 mg E2. Gestagens do not have to be given because there is no risk of endometrial proliferation.
