Zusammenfassung
Zur endokrinen Therapie des heterogenen polyzystischen Ovarsyndroms (PCOS) stehen verschiedene Strategien zur Verfügung, die individuell auf die Patientin abgestimmt werden. Sind hyperandrogenämische Symptome wie Akne und Hirsutismus zu behandeln, wird antiandrogen therapiert und ein Zyklus etabliert. Orale Kontrazeptiva mit antiandrogenen Gestagenen sind dazu Mittel der ersten Wahl, in schwereren Fällen werden zusätzlich höher dosierte Gestagene eingesetzt. Bei Kinderwunsch erfolgt eine ovarielle Stimulation, ideal mit niedrig dosiertem FSH. Die Risiken einer ovariellen Überstimulation und höhergeradigen Mehrlingsschwangerschaft sind zu beachten. Zur Behandlung einer Insulinresistenz können Insulinsensitizer eingesetzt werden. Sie führen in einem großen Anteil der Patientinnen zu Ovulationen, durch Kombination mit einer ovariellen Stimulation lässt sich dieser Effekt noch weiter verbessern.
Abstract
Different strategies exist for endocrine therapy in the heterogenic polycystic ovary syndrome (PCOS), which can be customized for the individual patient. When hyperandrogenemic symptoms as acne and hirsutism are present, an antiandrogenic therapy and the establishment of a cycle is desired. Oral contraceptives containing antiandrogenic progestins are the drugs of choice, in severe cases additional progestin of a higher dosage is required. In case of infertility an ovarian stimulation is performed, preferably with low dose FSH. Care has to be taken to avoid ovarian hyperstimulation and higher grade multiples. To ameliorate insulin-resistance, insulin-sensitizers can be chosen. They will lead to ovulations in a significant number of patients. Combining them with an ovarian stimulation regimen will yield even higher ovulation rates.
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Schüring, A.N., Kiesel, L. Hormonelle Therapie des polyzystischen Ovarsyndroms (PLOS). Gynäkologe 38, 333–341 (2005). https://doi.org/10.1007/s00129-005-1673-5
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DOI: https://doi.org/10.1007/s00129-005-1673-5