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Systemische Therapie der Endometriose: Alternativen zur Hormontherapie

Systemic therapy in endometriosis: alternatives to hormone therapy

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Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Endometriose ist eine der häufigsten gutartigen, jedoch chronischen Erkrankungen der Frau in der reproduktiven Lebensphase. Hauptsymptome sind chronische, i.d.R. zyklusabhängige Unterbauchschmerzen und Infertilität. Ätiologie und Pathogenese sind noch unzureichend geklärt, eine kurative Therapie existiert bisher nicht. Neben der operativen Entfernung ist die medikamentöse Behandlung die zweite wichtige Therapiesäule. Bei Kinderwunsch ergibt sich zudem oft die Indikation für eine assistierte Reproduktion.

Diskussion

Vorrangiges Ziel der medikamentösen Therapie ist das Erreichen eines hypoöstrogenen Zustands. Hierfür kommen hormonelle Therapeutika, insbesondere orale Kontrazeptiva (OC), Gestagene und GnRH(„gonadotropin releasing hormone“)-Analoga infrage. Im Rahmen experimenteller Verfahren stehen Aromataseinhibitoren, GnRH-Antagonisten, selektive Östrogenrezeptormodulatoren (SERM) und selektive Progesteronrezeptormodulatoren (SPRM) zur Verfügung. Alternativ zur Hormontherapie können neben nichtsteroidalen antiinflammatorischen Medikamenten (NSAID) auch COX(Cyclooxygenase)-2-Inhibitoren, Angiogeneseinhibitoren und Immunmodulatoren eingesetzt werden. Alternative Ansätze, insbesondere bei ausgeprägter Schmerzsymptomatik, stellen zum einen die multimodale Schmerztherapie dar, sowie komplementäre Verfahren, z. B. Akupunktur, Physiotherapie und Phytotherapie.

Fazit

Ein evidenzbasierter Effekt dieser Therapien konnte bisher nicht durch randomisierte kontrollierte Studien eindeutig belegt werden. Der Beitrag fasst die systemischen Alternativen zur Hormontherapie zusammen.

Abstract

Background

Endometriosis is a one of the most common, benign but chronic diseases in women of reproductive age. The main symptoms are chronic and as a rule cycle-dependent pelvic pain and infertility. The etiology and pathogenesis of endometriosis are still unclear, a curative therapy is still lacking and the established options for therapy are mostly symptomatic. Other than surgical removal in this case laparoscopy is the gold standard, drug therapy plays an important role. In cases of infertility there is often an indication for assisted reproductive treatment.

Discussion

The main aim of drug therapy is to achieve a hypoestrogenic state; therefore, oral contraceptives, gestagens and gonadotropin-releasing hormone (GnRH) analogues are used. Experimental options include aromatase inhibitors, GnRH antagonists, selective estrogen receptor modulators (SERM) and selective progesterone receptor modulators (SPRM). Furthermore, nonsteroidal anti-inflammatory drugs (NSAIRs), cyclooxygenase (COX)-2 inhibitors, angiogenesis inhibitors and immunomodulators can also be used.

Conclusion

Especially for women with severe pelvic pain syndrome a multimodal pain therapy should be offered, for example, acupuncture, physiotherapy or phytotherapy are complementary treatment options, although not being evidence based. This study gives an overview of current non-invasive non-hormonal treatment options.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Braun, S.D. Schäfer und L. Kiesel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland

    J. Braun, S.D. Schäfer & L. Kiesel

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  1. J. Braun
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  2. S.D. Schäfer
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  3. L. Kiesel
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Correspondence to J. Braun.

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Braun, J., Schäfer, S. & Kiesel, L. Systemische Therapie der Endometriose: Alternativen zur Hormontherapie. Gynäkologe 48, 237–242 (2015). https://doi.org/10.1007/s00129-014-3421-1

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  • DOI: https://doi.org/10.1007/s00129-014-3421-1

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