{"paper_id":"0158d24f-1ea0-49b1-81d5-bb1fe85fc4cb","body_text":"Zusammenfassung\nHintergrund\nDie 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.\nZielsetzung\nZiel 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.\nMaterial und Methoden\nDie aktuell verfügbaren Medikamente werden dargestellt und anhand der aktuellen Datenlage und der aktuellen Leitlinien bewertet.\nErgebnisse\nAls 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.\nSchlussfolgerungen\nZahlreiche 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.\nAbstract\nBackground\nThe 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.\nObjective\nThe 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.\nMaterial and methods\nVarious medical treatment options are presented and evaluated with regard to the current literature and guidelines.\nResults\nDifferent 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.\nConclusion\nThere 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.\nSimilar content being viewed by others\nLiteratur\nAbou-Setta AM, Al-Inany HG, Farquhar CM (2006) Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev (4):CD005072\nAllen C, Hopewell S, Prentice A et al (2009) Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev (2):CD004753\nBadawy AM, Elnashar AM, Mosbah AA (2012) Aromatase inhibitors or gonadotropin-releasing hormone agonists for the management of uterine adenomyosis: a randomized controlled trial. Acta Obstet Gynecol Scand 91:489–495\nBarbieri RL (1998) Endometriosis and the estrogen threshold theory. Relation to surgical and medical treatment. J Reprod Med 43:287–292\nBrown J, Pan A, Hart RJ (2010) Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev (12):CD008475. doi: 10.1002/14651858.CD008475.pub2\nCarr B, Dmowski WP, O’Brien C et al (2014) Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod Sci 21:1341–1351\nCheewadhanaraks S, Choksuchat C, Dhanaworavibul K et al (2012) Postoperative depot medroxyprogesterone acetate versus continuous oral contraceptive pills in the treatment of endometriosis-associated pain: a randomized comparative trial. Gynecol Obstet Invest 74:151–156\nChishima F, Hayakawa S, Sugita K et al (2002) Increased expression of cyclooxygenase-2 in local lesions of endometriosis patients. Am J Reprod Immunol 48:50–56\nCho S, Jung JA, Lee Y et al (2014) Postoperative levonorgestrel-releasing intrauterine system versus oral contraceptives after gonadotropin-releasing hormone agonist treatment for preventing endometrioma recurrence. Acta Obstet Gynecol Scand 93:38–44\nChwalisz K, Perez MC, Demanno D et al (2005) Selective progesterone receptor modulator development and use in the treatment of leiomyomata and endometriosis. Endocr Rev 26:423–438\nDiamond MP, Carr B, Dmowski WP et al (2014) Elagolix treatment for endometriosis-associated pain: results from a phase 2, randomized, double-blind, placebo-controlled study. Reprod Sci 21:363–371\nDuffy JM, Arambage K, Correa FJ et al (2014) Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 4:CD011031\nDunselman GA, Vermeulen N, Becker C et al (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29:400–412\nFedele L, Bianchi S, Raffaelli R et al (1997) Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril 68:426–429\nFerrari F, Arrigoni F, Miccoli A et al (2015) Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation. Radiol Med (im Druck)\nFerrero S, Gillott DJ, Venturini PL et al (2011) Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review. Reprod Biol Endocrinol 9:89\nFerrero S, Remorgida V, Maganza C et al (2014) Aromatase and endometriosis: estrogens play a role. Ann N Y Acad Sci 1317:17–23\nGuzick DS, Huang LS, Broadman BA et al (2011) Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril 95:1568–1573\nHart RJ, Hickey M, Maouris P et al (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev (2):CD004992. doi: 10.1002/14651858.CD004992.pub3\nHudelist G, Fritzer N, Thomas A et al (2012) Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 27:3412–3416\nJacobson TZ, Duffy JM, Barlow D et al (2009) Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev (4):CD001300. doi: 10.1002/14651858.CD001300.pub2\nLall Seal S, Kamilya G, Mukherji J et al (2011) Aromatase inhibitors in recurrent ovarian endometriomas: report of five cases with literature review. Fertil Steril 95:291.e215–e298\nLv D, Song H, Li Y et al (2009) Pentoxifylline versus medical therapies for subfertile women with endometriosis. Cochrane Database Syst Rev (3):CD007677. doi: 10.1002/14651858.CD007677.pub2\nNawathe A, Patwardhan S, Yates D et al (2008) Systematic review of the effects of aromatase inhibitors on pain associated with endometriosis. BJOG 115:818–822\nPopp LW, Schwiedessen JP, Gaetje R (1993) Myometrial biopsy in the diagnosis of adenomyosis uteri. Am J Obstet Gynecol 169:546–549\nSasson IE, Taylor HS (2009) Aromatase inhibitor for treatment of a recurrent abdominal wall endometrioma in a postmenopausal woman. Fertil Steril 92:1170.e1171–e1174\nSchweppe K-W (2013) Fortschritte in der medikamentösen Therapie der Endometriose. Endometriose-Zentrum Ammerland, Westerstede. http://www.cme-medipoint.de/fortbildungen/Endometriose_CME.pdf\nStrowitzki T, Marr J, Gerlinger C et al (2010) Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 25:633–641\nTakayama K, Zeitoun K, Gunby RT et al (1998) Treatment of severe postmenopausal endometriosis with an aromatase inhibitor. Fertil Steril 69:709–713\nUlrich U, Buchweitz O, Greb R et al (2014) National German Guideline (S2k): guideline for the diagnosis and treatment of endometriosis: long version – AWMF Registry No. 015–045. Geburtshilfe Frauenheilkd 74:1104–1118\nVercellini P, Somigliana E, Vigano P et al (2010) Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online 21:259–265\nWalter AJ, Hentz JG, Magtibay PM et al (2001) Endometriosis: correlation between histologic and visual findings at laparoscopy. Am J Obstet Gynecol 184:1407–1411. (Diskussion 1411–1403)\nXiong Y, Yue Y, Shui L et al (2015) Ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for the treatment of patients with adenomyosis and prior abdominal surgical scars: a retrospective study. Int J Hyperthermia 31:777–783\nYap C, Furness S, Farquhar C (2004) Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev (3):CD003678\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nInteressenkonflikt\nT. Ahrens gibt an, dass kein Interessenkonflikt besteht.\nDieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.\nAdditional information\nRedaktion\nW. Küpker, Baden-Baden\nRights and permissions\nAbout this article\nCite this article\nAhrens, T. Medikamentöse Therapie der Endometriose und Adenomyose. Gynäkologische Endokrinologie 14, 9–14 (2016). https://doi.org/10.1007/s10304-015-0042-2\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s10304-015-0042-2","source_license":"CC0","license_restricted":false}