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Breast cancer

Treatment of klimakterischer discomfort with Mammakarzinom


From the klimakterischen symptoms which are caused by the extinction of the endocrine Ovarialfunktion vasomotorische discomfort presses especially often like heat ebullitions and sweat outbreaks as well as urogenitale atrophy to a treatment. There there come disgruntlements, nervousness, sleeplessness and impulse poverty. Other disturbances conditioned by the estrogen lack are an osteoporosis, by Lipidveränderungen conditioned increase of coronary heart illnesses, cerebrale insults (strokes) as well as supposed also M. Alzheimer. By the therapy of the tumour illness itself can be induced with still prämenopausalen patients an iatrogene menopause with especially violent symptoms or become the already existing discomfort considerably aggraviert.

Problems of the hormone substitution

The successful therapy the quality of life decisively interfere with to klimakterischen discomfort by an estrogen substitution seems during and after Mammakarzinomerkrankung problematic:

1- The Hormaonsubstitutuion seems to develop the risk a Mammakarzinom to raise (relative risk (RR) =1,5; see chapter "Diagnostics", "Risk factors").

2- A big number of Mammatumoren owns estrogen receptors.

3- The elimination of the Ovarialfunktion, the gift of anti-estrogens and Aromatasehemmern belong to the most actual strategies with the Mammakarzinom.

4- In Einezelfällen draw ions were observed by Mammakarzinommetastasendurch the ending of a hormone substitution.

Other observations contradict against it an injurious estrogen influence.

1- Estrogens were used successfully to the treatment of the Mammakarzinoms.

2- A deterioration of the forecast does not enter by a pregnancy after treatment of a Mammakarzinoms (see chapter "Mammakarzinoms and pregnancy").

3- The patients who carried out a hormone substitution after a Mammakarzinomerkrankungen thereby showed no obviously worse illness course.
With women with advanced Mammakarzinom draw ions were observed by a combined estrogen

4- Gestagen therapy.


While the therapy of the klimakterischen symptom complex must be already used with patients without Mammakarzinomerkrankung quite individually and the sensitive guidance is demanded by the handler, this is valid within the scope of a Mammakarzinoms in still reinforced magnitude. Hence, because of the absence of dependable studies the hormone substitution with Mammakarzinompatintinnen is still an unsolved clinical dilemma. It should be tried first to improve the complaint picture without system broad hormonal substitution (see the following step plan).

Step plan for the application of different therapy possibilities, in particular with vasomotorischen discomfort
Step I: Symptomatic measures Homöopathika phyto therapeutics organ preparations physical therapy relaxation procedure
Step II: Medikamentöse, non-hormonal measures Alpha-adrenerge antagonists: Clonidin, Methyldopa combinations with psychiatric drugs
Step III: Hormonal measures Gestagene: Medroxyprogesteronacetat (MPA), Norethisteron, Tamoxifen estrogens monophasich continuously in combination with Gestagenen.

With the substances of the step 1 and 2 the border infuses itself to the placebo only hard. However, this is unimportant with the treatment of the vasomotorischen discomfort. The subjectively felt complaint improvement is vital. Account should be taken with psychiatric drugs the power of a dependence development by which a longer lasting treatment becomes problematic. If no sufficient alleviation of the discomfort is reached by the preparations of the steps 1 and 2, an attempt with a Gestagen treatment should be made first. Moreover 5 (-100) mg / days Medroxyprogesteronacetat (MPA) or 5 - 10 mg Norethisteron seem suitable. With it an improvement of the symptomatology can be often reached. Although there is no secure knowledge about the influence of low Gestagendosen on Mamma-or Mammakarzinomgewebe, is a stimulation of tumour growth or the induction of a Rezidivs or. not to fear of a Metastasierung probably, the Gestagene work at least in high tins with the Mammakarzinom antiproliferativ. While Tamoxifen affects with some patients favourably, her symptoms do not react other or even with a deterioration. If no improvement of the discomfort is reached by all up to now called measures and the quality of life of the patients is limited too strongly, an estrogen substitution can become necessary. The substitution of the Ovarialsteroide we as a continuous monophasische estrogen Gestagen combination recommended because thereby possibly the risk of a tumour stimulation can be decreased. The therapy should occur with the lowest effective tins and be checked after some months the need of the substitution. Sensible leisure activity and clothes, Undergoing a Kneipp cure and therapeutic exercises-medical Baths, Relaxation procedures, avoiding of alcohol, caffeine and sharp spices are recommendable as supporting measures with all steps. The hormone receptor status in the primary tumour has no direct influence on the decision for and against an estrogen substitution. However, one will be able to express himself with estrogen receptor negatives illnesses lighter for an estrogen substitution. Also a fixed waiting period between primary tumour treatment and beginning of a possible hormone substitution cannot be prescribed. If the complaint symptomatology becomes only after an interval of 3 - to 5 years so distinctive that estrogens become necessar, one will lighter be able to decide on the hormone substitution. Before an estrogen treatment is begun, a renewed tumour growth (Lokalrezidiv/Metastasierung) must be excluded. During the auxiliary teachers hormonal or zytostatischen treatment of the Mammakarzinomerkrankung are valid suitable recommendations. The step 1 and 2 have first priority. Described under the same conditions as on top, a hormone substitution is possible in combination with Zytostatika. While Tamoxifen can promote the Lubrikation in the dissolution area, it leads with some patients too otherwise rather to a strengthening of the postal menopause symptomatology. In these cases one can begin with a creeping Tamoxifendosierung or with low-measured Gestagen.


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