Correspondence

In Reply

Dtsch Arztebl Int 2012; 109(42): 714. DOI: 10.3238/arztebl.2012.0714b

Ortmann, O; Lattrich, C

LNSLNS

It is entirely correct to say that osteoporosis is one of the health risks in women after the menopause and should therefore be treated. It is rare in perimenopausal women and does not cause the classic problems associated with the climacteric (vasomotor complaints, vaginal atrophy). Treating these problems was the main focus of our article. Several methods are available to treat osteoporosis (see “AWMF S3-Leitlinie Prophylaxe, Diagnostik und Therapie der Osteoporose bei Frauen ab der Menopause, bei Männern ab dem 60. Lebensjahr” [S3 guideline on the prophylaxis, diagnostic evaluation and therapy of osteoporosis in postmenopausal women and men aged 60 or older]), so that hormone therapy with estrogens for the treatment of osteoporosis can be recommended only where these methods are contraindicated. The most recent evaluation of the WHI study showed that after a mean follow-up of 11.8 years, the incidence of breast cancer is lowered for a mean duration of monotherapy with estrogen (ET) of 5.9 years (hazard ratio 0.77, 95% confidence interval 0.62 to 0.95, P=0.02) (1). The Million Women Study, however, found an increase in the incidence of breast cancer resultant to ET, so that the real situation cannot be evaluated conclusively from the existing data (2). ET can be given only to women who have had hysterectomies; in most women, combined estrogen-gestagen therapy is required, which leads to an increase in the risk of breast cancer after long-term use (>3–5 years) (3).

DOI: 10.3238/arztebl.2012.0714b

Prof. Dr. med. Olaf Ortmann, Dr. med. Claus Lattrich

Klinik für Frauenheilkunde und Geburtshilfe
Universitätsklinikum Regensburg
am Caritas-Krankenhaus St. Josef
olaf.ortmann@klinik.uni-regensburg.de

Conflict of interest statement

Professor Ortmann has received honoraria for acting as an expert adviser from Dr Wolff Pharma and research support from Medinova. Dr Lattrich declares that no conflict of interest exists.

1.
Anderson GL, Chlebowski RT, Aragaki AK, et al.: Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomised placebo-controlled trial.
Lancet Oncol 2012; 13: 476–86. Epub 2012 Mar 7. CrossRef MEDLINE
2.
Beral V, Reeves G, Bull D, Green J; Million Women Study Collaborators: Breast cancer risk in relation to the interval between menopause and starting hormone therapy. J Natl Cancer Inst 2011; 103: 296–305. Epub 2011 Jan 28. CrossRef MEDLINE PubMed Central
3.
The 2012 Hormone Therapy Position Statement of The North
American Menopause Society: Menopause 2012; 19: 257–71. MEDLINE PubMed Central
4.
Ortmann O, Lattrich C: The treatment of climacteric symptoms.
Dtsch Arztebl Int 2012; 109(17): 316–24. VOLLTEXT
1.Anderson GL, Chlebowski RT, Aragaki AK, et al.: Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomised placebo-controlled trial.
Lancet Oncol 2012; 13: 476–86. Epub 2012 Mar 7. CrossRef MEDLINE
2. Beral V, Reeves G, Bull D, Green J; Million Women Study Collaborators: Breast cancer risk in relation to the interval between menopause and starting hormone therapy. J Natl Cancer Inst 2011; 103: 296–305. Epub 2011 Jan 28. CrossRef MEDLINE PubMed Central
3. The 2012 Hormone Therapy Position Statement of The North
American Menopause Society: Menopause 2012; 19: 257–71. MEDLINE PubMed Central
4.Ortmann O, Lattrich C: The treatment of climacteric symptoms.
Dtsch Arztebl Int 2012; 109(17): 316–24. VOLLTEXT