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Gynäkologische Endokrinologie

, Volume 11, Issue 4, pp 277–288 | Cite as

Endometriumhyperplasie und -karzinom

Hormonelle Therapieoptionen
  • T. RömerEmail author
CME Zertifizierte Fortbildung
  • 186 Downloads

Zusammenfassung

Endometriumhyperplasien können Blutungsstörungen verursachen und zudem echte Präkanzerosen des Endometriumkarzinoms sein. In der Diagnostik ist die Vaginalsonographie richtungweisend. Sie kann zur weiteren Differenzialdiagnostik mit einem Gestagentest kombiniert werden. Zur definitiven Abklärung ist eine Hysteroskopie mit fraktionierter Abrasion erforderlich. Histologisch ist eine exakte Klassifikation der Endometriumhyperplasie einzufordern. Zur medikamentösen Therapie der Endometriumhyperplasie ohne Atypien sind Gestagene in oraler Applikation über 6 Monate oder alternativ eine intrauterine Gestagentherapie mit dem Levonorgestrel-Intrauterinsystem geeignet. Nach der Behandlung komplexer und atypischer Hyperplasien sind stets Kontrollhistologien erforderlich. Liegt eine Hyperplasie mit Atypien oder eine frühe Form des Endometriumkarzinoms bei Patientinnen mit Kinderwunsch vor, ist eine medikamentöse Therapie nur unter strengsten klinischen und sonographischen Kontrollen möglich.

Schlüsselwörter

Präkanzerosen Gestagene Hysteroskopie Vaginalsonographie Gestagentest 

Endometrial hyperplasia and endometrial cancer

Hormonal treatment options

Abstract

Endometrial hyperplasia can cause bleeding disorders and some are also precancerous lesions of an endometrial cancer. Vaginal sonography plays an important role in the diagnosis of endometrial hyperplasia. This can be combined with a sonographically supported progestin test for further differential diagnosis. For a definitive diagnosis, hysteroscopy and curettage is the method of choice. An exact histological classification of endometrium hyperplasia is necessary. For medical treatment of endometrial hyperplasia without atypia, cyclic or continuous treatment with an oral progestin or alternatively intrauterine progestin treatment by a levonorgestrel intrauterine system (LNG-IUS) may be useful. After treatment of complex or atypical hyperplasia, control of histological specimen is necessary. In atypical hyperplasia or early stage of endometrial cancer in patients who desire a pregnancy, conservative therapy should be used cautiously and only in combination with strict clinical and sonographical controls.

Keywords

Precancerous lesions Progestins Hysteroscopy Vaginal ultrasonography Progestin test 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Römer hat Honorare für Vorträge von Bayer HealthCare, MSD, Jenapharm, Hologic, Ethicon, Vifor und Gedeon Richter erhalten und ist in Beratergremien für Bayer HealthCare, MSD, Gedeon Richter und Vifor tätig. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Gynäkologisch-Geburtshilfliche AbteilungEvangelisches Krankenhaus Weyertal gGmbHKölnDeutschland

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