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Patientinnenzentrierte Aspekte der Endometriose

Patient-centered aspects of endometriosis

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Zusammenfassung

Die Endometriose ist eine häufige gutartige Erkrankung. Sie ist definiert durch das Auftreten endometriumartiger Zellverbände außerhalb der Gebärmutterhöhle. Zu Ätiologie und Pathogenese wurden zahlreiche Theorien entwickelt. Es wird ein breites Spektrum vom klinisch bedeutungslosen Zufallsbefund bis zu schweren Verläufen mit Organdestruktion beobachtet. Leitsymptom ist der zyklisch auftretende Unterbauchschmerz, nicht selten besteht eine Sterilität. Die Diagnose wird im Allgemeinen durch eine Laparoskopie gesichert. Medikamentöse Therapien bestehen in der Unterdrückung der zyklischen ovariellen Aktivität, während die operative Therapie die Destruktion und Exzision von Endometrioseherden oder die Entfernung erkrankter Organe zum Ziel hat. Bei gleichzeitig bestehender Sterilität sollte diese vorrangig behandelt werden.

Abstract

Endometriosis is a frequent benign condition. It is defined as the occurrence of cell complexes resembling the endometrium outside the uterine cavity. Numerous theories regarding etiology and pathogenesis have been proposed. A broad spectrum ranging from clinically meaningless random findings to severe conditions involving organ destruction can be observed. The most important symptom is cyclical lower abdominal pain, and coincident infertility is not infrequent. Diagnosis is commonly confirmed by laparoscopy. Medical therapies lead to the suppression of cyclical ovarian function, while surgery aims at destruction or excision of endometriosis foci or the removal of affected organs. If infertility is present, this should be treated with priority.

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Literatur

  1. American Society for Reproductive Medicine (1997) Revised American Society for Reproductive Medicine classification of endometriosis. Fertil Steril 67: 817–821

    Article  Google Scholar 

  2. Arici A, Oral E, Bukulmez O et al. (1996) The effect of endometriosis on implantation: results from the Yale University in vitro fertilization and embryo transfer program. Fertil Steril 65: 603–607

    PubMed  CAS  Google Scholar 

  3. Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37: 747–753

    Article  PubMed  CAS  Google Scholar 

  4. Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilisation. Fertil Steril 77: 1148–1155

    Article  PubMed  Google Scholar 

  5. Bazot M, Darai E (2005) Sonography and MR imaging for the assessment of deep pelvic endometriosis. J Minim Invasive Gynecol 12: 178–185

    Article  PubMed  Google Scholar 

  6. Beretta P, Franchi M, Ghezzi F et al. (1998) Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 70: 1176–1180

    Article  PubMed  CAS  Google Scholar 

  7. Bergqvist A, Ljungberg O, Skoog L (1993) Immunohistochemical analysis of oestrogen and progesterone receptors in endometriotic tissue and endometrium. Hum Reprod 8: 1915–1922

    PubMed  CAS  Google Scholar 

  8. Bragheto AM, Caserta N, Bahamondes L, Petta CA (2007) Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging. Contraception 76: 195–199

    Article  PubMed  CAS  Google Scholar 

  9. Brinton LA, Gridley G, Persson I et al. (1997) Cancer risk after a hospital discharge diagnosis of endometriosis. Am J Obstet Gynecol 176: 572–579

    Article  PubMed  CAS  Google Scholar 

  10. Chapron C, Fritel X, Dubuisson JB (1999) Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments. Hum Reprod 14: 329–332

    Article  PubMed  CAS  Google Scholar 

  11. Chopin N, Vieira M, Borghese B et al. (2005) Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification. J Minim Invasive Gynecol 12: 106–112

    Article  PubMed  Google Scholar 

  12. Cramer DW, Missmer SA (2002) The epidemiology of endometriosis. Ann N Y Acad Sci 995: 11–22

    Article  Google Scholar 

  13. Demirol A, Guven S, Baykal C, Gurgan T (2006) Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 12: 639–643

    Article  PubMed  Google Scholar 

  14. D’Hooghe TM, Denys B, Spiessens C et al. (2006) Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Fertil Steril 86: 283–290

    Article  Google Scholar 

  15. Ebert AD, Bartley J, David M (2005) Aromatase inhibitors and cyclooxygenase-2 (COX-2) inhibitors in endometriosis: new questions–old answers? Eur J Obstet Gynecol Reprod Biol 122: 144–150

    Article  PubMed  CAS  Google Scholar 

  16. ESHRE (2007) guidelines.endometriosis.org/introduction.html

  17. Eskenazi B, Mocarelli P, Warner M et al. (2002) Serum dioxin concentrations and endometriosis: a cohort study in Seveso, Italy. Environ Health Perspect 110: 629–634

    PubMed  CAS  Google Scholar 

  18. Gomes MK, Ferriani RA, Rosa e Silva JC et al. (2007) The levonorgestrel-releasing intrauterine system and endometriosis staging. Fertil Steril 87: 1231–1234

    Article  PubMed  CAS  Google Scholar 

  19. Hadfield R, Mardon H, Barlow D, Kennedy S (1996) Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod 4: 878–880

    Google Scholar 

  20. Hughes E, Fedorkow D, Collins J, Vandekerckhove P (2002) Ovulation suppression for endometriosis (Cochrane Review). In: The Cochrane Library, Issue 3. Oxford: update software

  21. Ishii K, Takakuwa K, Mitsui T, Tanaka K (2002) Studies on the human leukocyte antigen DR in patients with endometriosis: genotyping of HLA-DRB1 alleles. Hum Reprod 17: 560–563

    Article  PubMed  CAS  Google Scholar 

  22. Kennedy S (2003) Genetics of endometriosis: a review of the positional cloning approaches. Semin Reprod Med 21: 111–118

    Article  PubMed  Google Scholar 

  23. Koninckx PR, Kennedy SH, Barlow DH (1998) Endometriotic disease: the role of peritoneal fluid. Hum Reprod Update 4: 741–751

    Article  PubMed  CAS  Google Scholar 

  24. Leyendecker G, Herbertz M, Kunz G, Mall G (2002) Endometriosis results from the dislocation of basal endometrium. Hum Reprod 17: 101–112

    Article  Google Scholar 

  25. Leyendecker G, Kunz G, Wildt L et al. (1996) Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanisms of rapid sperm transport in patients with endometriosi and infertility. Hum Reprod 11: 1542–1551

    PubMed  CAS  Google Scholar 

  26. Ling FW (1999) Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol 93: 51–58

    Article  PubMed  CAS  Google Scholar 

  27. Loh FH, Tan AT, Kumar J, Ng SC (1999) Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril 72: 316–321

    Article  PubMed  CAS  Google Scholar 

  28. Marcelli F, Collinet P, Vinatier D et al. (2006) Ureteric and bladder involvement of deep pelvic endometriosis. Value of multidisciplinary surgical management. Prog Urol 16: 588–593

    PubMed  Google Scholar 

  29. Marcus SF, Edwards RG (1994) High rates of pregnancy after long-term down-regulation of women with severe endometriosis. Am J Obstet Gynecol 171: 812–817

    PubMed  CAS  Google Scholar 

  30. Metalliotakis IM, Cakmak H, Fragouli YG et al. (2008) Epidemiological characteristics of women with and without endometriosis in the Yale series. Arch Gynecol Obstet: Epub ahead of print

    Google Scholar 

  31. Meyer R (1919) Über den Stand der Frage der Adenomyositis und Adenomyome im allgemeinen und insbesondere über Adenomyositis seroepithelialis und Adenomyometritis sarcomatosa. Zentralbl Gynakol 43: 745–750

    Google Scholar 

  32. Moen MH, Muus KM (1991) Endometriosis in pregnant and non-pregnant women at tubal sterilization. Hum Reprod 6: 699–702

    PubMed  CAS  Google Scholar 

  33. Navot D, Rosenwaks Z, Margalioth EJ (1987) Prognostic assessment of female fecundity. Lancet 2: 645–647

    Article  PubMed  CAS  Google Scholar 

  34. Nothnick WB (2001) Treating endometriosis as an autoimmune disease. Fertil Steril 76: 223–231

    Article  PubMed  CAS  Google Scholar 

  35. Olive DL, Pritts EA (2001) Treatment of endometriosis. N Engl J Med 345: 266–275

    Article  PubMed  CAS  Google Scholar 

  36. Olivennes F, Feldberg D, Liu HC et al. (1995) Endometriosis: a stage by stage analysis–the role of in vitro fertilization. Fertil Steril 64: 392–398

    PubMed  CAS  Google Scholar 

  37. Pagidas K, Falcone T, Hemmings R, Miron P (1996) Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer. Fertil Steril 65: 791–795

    PubMed  CAS  Google Scholar 

  38. Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparascopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 96: 304–307

    Article  PubMed  CAS  Google Scholar 

  39. Prentice A, Deary AJ, Goldbeck-Wood S et al. (2000) Gonadotrophin-releasing hormone analogues for pain associated with endometriosis (Cochrane review). In: The Cochrane Library, issue 2

  40. Ramey JW, Archer DF (1993) Peritoneal fluid: its relevance to the development of endometriosis. Fertil Steril 60: 1–14

    PubMed  CAS  Google Scholar 

  41. Reimand K, Talja I, Metsküla K et al. (2001) Autoantibody studies of female patients with reproductive failure. J Reprod Immunol 51: 167–176

    Article  PubMed  CAS  Google Scholar 

  42. Rier SE, Martin DC, Bowman R et al. (1993) Endometriosis in rhesus monkeys (Macaca mulatta) following chronic exposure to 2,3,7,8,-tetrachlorodibenzo-p-dioxin. Fundam Appl Toxicol 21: 433–441

    Article  PubMed  CAS  Google Scholar 

  43. Sallam HN, Garcia-Velasco JA, Dias S, Arici A (2006) Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 1

  44. Sampson JA (1925) Heterotopic or misplaced endometrial tissue. Am J Obstet Gynecol 10: 649–664

    Google Scholar 

  45. Schneider A, Touloupidis S, Papatsoris AG et al. (2006) Endometriosis of the urinary tract in women of reproductive age. Int J Urol 13: 902–904

    Article  PubMed  Google Scholar 

  46. Schweppe KW (2003) Endometriose – eine Erkrankung ohne Lobby. Zentralbl Gynakol 125: 233

    Article  PubMed  Google Scholar 

  47. Sillem M, Prifti S, Neher M, Runnebaum B (1998) Extracellular matrix remodelling in the endometrium and its possible relevance to the pathogenesis of endometriosis. Hum Reprod Update 4: 730–735

    Article  PubMed  CAS  Google Scholar 

  48. Surrey ES (1999) Add-back therapy and gonadotropin-releasing hormone agonists in the treatment of patients with endometriosis: can a consensus be reached? Add-Back Consensus Working Group. Fertil Steril 71: 420–424; Review

    Article  PubMed  CAS  Google Scholar 

  49. Sutton CJG, Pooley S, Ewen SP, Haines P (1997) Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain asociated with mild to moderate endometriosis. Fertil Steril 68: 1070–1074

    Article  PubMed  CAS  Google Scholar 

  50. Treloar SA, Wicks J, Nyholt DR et al. (2005) Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26. Am J Hum Genet 77: 365–376

    Article  PubMed  CAS  Google Scholar 

  51. Tu FF, As-Sanie S, Steege JF (2006) Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. J Reprod Med 51: 185–189

    PubMed  Google Scholar 

  52. Tu FF, Holt J, Gonzales J, Fitzgerald CM (2008) Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. Am J Obstet Gynecol 272: e1–e7

    Google Scholar 

  53. Tuttlies F, Keckstein J, Ulrich U et al. (2005) ENZIAN-Score. Eine Klassifikation der tiefen infiltrierenden Endometriose. Zentralbl Gynakol 127: 275–281

    Article  PubMed  CAS  Google Scholar 

  54. Ulrich U, Richter O, Wardelmann E et al. (2003) Endometriose und Malignom. Zentralbl Gynakol 125: 239–242

    Article  PubMed  CAS  Google Scholar 

  55. Ulrich U (2007) Diagnostik und Therapie der Endometriose. Zusammenfassung der aktuellen S2k-Leitlinie der DGGG. Frauenarzt 48: 654–656

    Google Scholar 

  56. Urbach DR, Reedijk M, Richard CS et al. (1998) Bowel resection for intestinal endometriosis. Dis Colon Rectum 41: 1158–1164

    Article  PubMed  CAS  Google Scholar 

  57. Vercellini P, Cortesi I, Crosignani PG (1997) Progestins for symptomatic endometriosis: a critical analysis of the evidence. Fertil Steril 68: 393–401

    Article  PubMed  CAS  Google Scholar 

  58. Vercellini P, Crosignani PG (1992) Epidemiology of endometriosis. In: Brosens I, Donnez J (eds) The current status of endometriosis – research and management. Carnforth, Pearl River (Parthenon)

  59. Vercellini P, Frontino G, De Giorgi O et al. (2003) Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril 80: 560–563

    Article  PubMed  Google Scholar 

  60. Vercellini P, Frontino G, De GO et al. (2003) Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Fertil Steril 80: 305–309

    Article  PubMed  Google Scholar 

  61. Waller KG, Shaw RW (1993) Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up. Fertil Steril 59: 511–515

    PubMed  CAS  Google Scholar 

  62. Yap C, Furness S, Farquhar C (2004) Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev 3: CD003678

    PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor ist regelmäßig als Vortragsredner für Bayer Schering Pharma AG und gelegentlich für andere pharmazeutische Unternehmen tätig. Diese Tätigkeit hatte keinerlei Einfluss auf die Erstellung des Manuskripts.

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  1. Abteilung Gynäkologie und Geburtshilfe, Kreiskrankenhaus Emmendingen, Gartenstr. 44, 79312, Emmendingen, Deutschland

    M. Sillem

  2. Frauenklinik und Hebammenschule, Klinikum Aschaffenburg, Aschaffenburg, Deutschland

    A.T. Teichmann

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  1. M. Sillem
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Correspondence to M. Sillem.

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Sillem, M., Teichmann, A. Patientinnenzentrierte Aspekte der Endometriose. Gynäkologe 41, 533–543 (2008). https://doi.org/10.1007/s00129-008-2180-2

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