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Medikamentöse Therapie der Endometriose und Adenomyose

Pharmacological therapy of endometriosis and adenomyosis

  • Leitthema
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Hintergrund

Die medikamentöse Therapie der Endometriose stellt den behandelnden Arzt immer wieder vor Probleme. Dabei kommt es nicht nur auf die Auswahl der Präparate an, sondern auch auf den richtigen Zeitpunkt für die entsprechende Therapie.

Zielsetzung

Ziel dieser Arbeit ist es, die verschiedenen medikamentösen Therapieoptionen der Endometriose darzustellen und eine Hilfe bei der Entscheidungsfindung zu geben. Des Weiteren wird auch auf die Wahl zwischen operativer und medikamentöser Therapie eingegangen.

Material und Methoden

Die aktuell verfügbaren Medikamente werden dargestellt und anhand der aktuellen Datenlage und der aktuellen Leitlinien bewertet.

Ergebnisse

Als medikamentöse, hormonelle Therapieoptionen kommen zyklische orale Kontrazeptiva, verschiedene Gestagenpräparate und Gonadotropin-Releasing-Hormon(GnRH)-Analoga infrage. Der Off-label-Einsatz von Aromatasehemmern ist nach strenger Indikationsstellung möglich. Im Bereich der oralen GnRH-Antagonisten und der selektiven Progesteronrezeptormodulatoren werden weitere Präparate zur Behandlung der Endometriose erwartet.

Schlussfolgerungen

Zahlreiche hormonelle Therapieoptionen stehen zur Verfügung, wobei die meisten derzeit „off label“ zum Einsatz kommen. Bei ausbleibendem Erfolg einer medikamentösen Therapie stellt das operative Vorgehen eine Alternative dar. Im Hinblick auf die lange Latenz zwischen Erstauftreten der Symptome und Diagnosestellung und angesichts der Beschwerden bei fehlendem konservativem Therapieerfolg sollte aber nicht zu lange mit einer operativen Therapie gewartet werden. Zudem ist eine sichere Diagnosestellung nur mittels Laparoskopie und histologischer Sicherung möglich.

Abstract

Background

The pharmacological therapy of endometriosis is a cornerstone in the therapy of endometriosis. Not only the right choice of the medication, but also the differentiation between the necessity of medical therapy or surgical intervention is a challenge in the therapy of endometriosis.

Objective

The aim of this article is to demonstrate the different options for medical treatment, thus, providing support in the differentiation between the necessity of medical or surgical treatment.

Material and methods

Various medical treatment options are presented and evaluated with regard to the current literature and guidelines.

Results

Different treatment options are available like oral contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) analogues. The off-label use of aromatase inhibitors is possible in some cases. New treatment options as selective progesterone receptor modulators (SPRM) and oral GnRH antagonists are expected in the future.

Conclusion

There are numerous options for the treatment of endometriosis; however, most are used as off-label therapy. If medical treatment is not successful, surgery is an alternative. In view of the long latency between the first onset of symptoms and the diagnosis of endometriosis and due to the associated severe symptoms, surgery should not be delayed too long if medical treatment is not successful. A reliable diagnosis is only possible by laparoscopy and histological confirmation.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Thorben Ahrens

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Ahrens, T. Medikamentöse Therapie der Endometriose und Adenomyose. Gynäkologische Endokrinologie 14, 9–14 (2016). https://doi.org/10.1007/s10304-015-0042-2

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