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Medikamentöse Behandlung der Endometriose

Drug treatment of endometriosis

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Endometriose ist eine chronische Erkrankungen bei geschlechtsreifen Frauen. Von ihnen sind etwa 10-15% betroffen. Das Kardinalsymptom ist die Dysmenorrhö, die vielfach in chronische Unterbauchschmerzen übergeht. Auf zellulärer Ebene lässt sich eine Progesteronresistenz nachweisen sowie die Aktivierung multipler Entzündungsprozesse. Die medikamentöse Therapie zielt daher auf folgende Aspekte ab: Analgesie, Antiinflammation und Erhöhung des Progesteronangebotes bei Deprivation von Östrogen. Zum Einsatz kommen in erster Linie nichtsteroidale Antirheumatika, Gestagen-Monopräparate, gestagenbetonte Kontrazeptiva, gestagenhaltige Intrauterinspiralen und GnRH(„gonadotropin releasing hormone“)-Analoga. In Deutschland sind Dienogest und Danazol zur Behandlung der Endometriose zugelassen. Letzteres wird wegen des Nebenwirkungsprofils kaum mehr verschrieben. In den USA wurde Elagolix als oral verfügbarer GnRH-Antagonist bei endometrioseassoziierten Schmerzen zugelassen. Weitere Medikamente sind in klinischer Erprobung.

Abstract

Approximately 10–15% of women suffer from endometriosis, a chronic disease of pubescent females. While dysmenorrhoea is seen as the cardinal symptom of endometriosis, many patients complain of chronic pelvic pain. Progesterone resistance as well as inflammation characterizes endometriosis on a cellular level. Systemic treatment focuses on analgesia, anti-inflammation, and elevation of progesterone levels. Non-steroidal anti-rheumatic drugs (NSAR), progestins, combined oral contraceptives, intrauterine systems (IUS) loaded with progestogen, and gonadotropin releasing hormone (GnRH analoges) are used. In Germany, dienogest and danazol are licensed for endometriosis treatment. The latter is rarely prescribed due to its androgenic side effects. Elagolix, which is an orally administered GnRH antagonist, has been licensed in the US to treat endometriosis-associated pain. Additional drugs are currently under investigation in preclinical and clinical studies.

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Authors and Affiliations

  1. Landeskrankenhaus Villach, 9500, Villach, Österreich

    Elisabeth Janschek

  2. Universitätsklinik für Frauenheilkunde und Geburtshilfe, 8036, Graz, Österreich

    Monika Martina Wölfler

  3. Zentrum für Frauenheilkunde und Geburtshilfe, Justus Liebig Universität Gießen, Klinikstr. 33, 35392, Gießen, Deutschland

    Magdalena M. Zeppernick &  Ivo Meinhold-Heerlein

Authors
  1. Elisabeth Janschek
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  2. Monika Martina Wölfler
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  3. Magdalena M. Zeppernick
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  4. Ivo Meinhold-Heerlein
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Corresponding author

Correspondence to Ivo Meinhold-Heerlein.

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Interessenkonflikt

I. Meinhold-Heerlein gibt an, von der Firma Bayer Reisekosten und von den Firmen Jenapharm und Gedeon Richter Forschungsunterstützung erhalten zu haben.E. Janschek, M.M. Wölfler und M.M. Zeppernick geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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L. Kiesel, Münster

W. Janni, Ulm

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Janschek, E., Wölfler, M.M., Zeppernick, M.M. et al. Medikamentöse Behandlung der Endometriose. Gynäkologe 53, 658–665 (2020). https://doi.org/10.1007/s00129-020-04663-7

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  • DOI: https://doi.org/10.1007/s00129-020-04663-7

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