Behandeling van overgangsklachten


onder medeverantwoordelijkheid van de redactiecommissie

Overgangsklachten zijn moeilijk in harde medische maten vast te leggen. Gezien het hoge responspercentage op placebo, zal men in de praktijk bij als niet te ernstig ervaren overgangsklachten kunnen volstaan met goede uitleg en geruststelling. Alleen bij ernstige en zeer hinderlijke klachten, kan men de mogelijkheid bieden kortdurend gebruik te maken van hormonale suppletietherapie (HST). HST is niet geïndiceerd voor langdurig en preventief gebruik, gezien het risico van relatief, ernstige bijwerkingen (Gebu 2002; 36: 109-115).

 


In de periode rond de overgang kunnen bij vrouwen klachten ontstaan door verminderde aanmaak van oestrogenen. Ofschoon vrouwen in deze periode verschillende klachten kunnen presenteren, worden meestal alleen vasomotorische klachten, menstruatiestoornissen en urogenitale atrofie aangemerkt als directe gevolgen van de hormonale veranderingen die rond de overgang plaatsvinden.1 Atypische klachten, zoals vermoeidheid, slaapstoornissen, emotionele instabiliteit, depressie en hoofdpijn, zijn dan op te vatten als indirecte gevolgen. Zo zullen sommige vrouwen bijvoorbeeld slecht slapen door vasomotorische klachten. In Gebu 2001; 35: 71-77 is aandacht besteed aan preventieve postmenopauzale oestrogeensuppletie. Daarin werd geconcludeerd dat het niet raadzaam is om voor de preventie van arteriële ziekte, de ziekte van Alzheimer en (in het algemeen ook) postmenopauzale fracturen, hormonale suppletie toe te passen. Recent zijn nieuwe gegevens gepubliceerd die deze conclusie verder ondersteunen. In dit artikel wordt de behandeling van vasomotorische klachten en urogenitale atrofie beschreven, maar blijven menstruatiestoornissen buiten beschouwing. Achtereenvolgens komen aan de orde: fysiologie, hormonale (suppletie)therapie, tibolon en niet-hormonale middelen: clonidine en fyto-oestrogenen. Ten slotte wordt een plaatsbepaling gegeven.

 





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Auteurs

  • dr F.M. Helmerhorst, drs D. Bijl