{"paper_id":"363cdef9-33f7-4021-98ec-56b2c1705202","body_text":"Zusammenfassung\nEndometriose ist die häufigste benigne Erkrankung der Frau. Jede Form der Endometriosetherapie ist eine symptomatische, keine kurative Behandlung. Indikationen für eine konservative Therapie sind peritoneale Verlaufsformen und nicht vorhandener Kinderwunsch. Auch bei Ablehnung einer Operation oder fehlender Operabilität kann konservativ behandelt werden. Bei chronisch rezidivierenden Verläufen ist auch an eine adjuvante Therapie zu denken. Neben nichtsteroidalen antiinflammatorischen Substanzen (NSAID) werden hormonelle Therapeutika (z. B. orale Kontrazeptiva, Gestagene, GnRH-Analoga) eingesetzt, intrauterin/intravaginal auch Gestagene. Zu experimentellen Verfahren zählen GnRH-Antagonisten, Aromataseinhibitoren, COX (Zyklooxygenase)-2-Hemmer, selektive Östrogen- bzw. Progesteronrezeptormodulatoren (SERM/SPRM), Angiogeneseinhibitoren und Immunmodulatoren. Derzeitiger Goldstandard sind GnRH-Agonisten, möglicherweise werden sie in dieser Rolle von Dienogest abgelöst.\nAbstract\nEndometriosis is the most frequent benign disease of females. All modes of endometriosis therapy are symptomatic but not curative. Indications for conservative treatment are peritoneal disease and not wanting to become pregnant. Conservative therapy is also an option in case of unwillingness or inability to be operated. In case of chronically recurrent disease, adjuvant conservative therapy can be considered. Aside from NSAID, hormonal therapy with oral contraceptives, gestogens and gonadotropin-releasing hormone (GnRH) agonists can be prescribed. Historically danazole and gestrinone have also been used. Special forms of treatment are intrauterine or intravaginal therapy with gestogens. Experimental treatment options are GnRH antagonists, aromatase inhibitors (AI), COX-2 inhibitors, SERM, SPRM, angiogenesis inhibitors, and immunomodulators. The gold standard is GnRH agonist treatment. This role might shift to dienogest in the future.\nSimilar content being viewed by others\nLiteratur\nKennedy S, Bergqvist A, Chapron C et al (2005) ESHRE Special interest group for endometriosis and endometrium guideline development group. ESHRE Guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698–2704\nVercellini P, Fedele L, Aimi G et al (2006) Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predicitive value of the current system. Hum Reprod 21:2679–2685\nSallam HN, Garcia-Velasco JA, Dias S et al (2006) Long-term pituitary down regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 1:CD004635\nVercellini P, Cortesi I, Crosigniani PG (1997) Progestins for symptomatic endometriosis: a critical analysis of the evidence. Fertil Steril 68:393–401\nAllen C, Hopewell S, Prentice A (2005) Non-steroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 19(4):CD004753\nDavis L, Kennedy S, Moore J et al (2007) Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 3:CD001019\nPrentice A, Deary A, Goldbeck-Wood S et al (2007) Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev 3:CD000346\nSelak V, Farquhar C, Prentice A et al (2001) Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev 4:CD000068\nRotondi M, Labriola D, Rotondi M et al (2002) Depot leuprorelin acetate versus danazol in the treatment of infertile women with symptomatic endometriosis. Eur J Gynaecol Oncol 23:523–526\nCobellis L, Razzi S, Fava A et al (2004) A danazol-loaded intrauterine device decreases dysmenorrheal, pelvic pain, and dyspareunia associated with endometriosis. Fertil Steril 82:239–240\nRazzi S, Luisi S, Calonaci F et al (2007) Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis. Fertil Steril 88:789–794\nSurrey ES (2006) The role of progestins in treating the pain of endometriosis. J Minim Invasive Gynecol 13:528–534\nWaller KG, Shaw RW (1993) Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up. Fertil Steril 59:511–515\nBedaiwy M, Casper R (2006) Treatment with leuprolide acetate and hormonal add-back for up to 10 years in stage IV endometriosis patients with chronic pelvic pain. Fertil Steril 86:220–222\nBarbieri RL (1992) Hormone treatment of endometriosis: the estrogen threshold hypothesis. Am J Obstet Gynecol 166:740–745\nHornstein MD, Yuzpe AA, Burry KA et al (1995) Prospective randomized double-blind trial of 3 versus 6 months of nafarelin therapy for endometriosis associated pelvic pain. Fertil Steril 63(5):955–962\nVercellini P, Somigliana E, Viganò P et al (2009) Endometriosis: Current therapies and new pharmacological developments. Drugs 69(6):649–675\nHarada T, Momoeda M, Taketani Y et al (2008) Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind randomized trial. Fertil Steril 90:1583–1588\nSeracchioli R, Mabrouk M, Frascà C et al (2010) Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial. Fertil Steril 94(2):464–471\nBergqvist A, Theorell T (2001) Changes in quality of life after hormonal treatmen of endometriosis. Acta Obstet Gynecol Scand 80:628–637\nVercellini P, De Giorgio O, Mosconi P et al (2002) Cyproterone acetate vs. a continous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis. Fertil Steril 77(1):52–61\nCosson M, Querleu D, Donnez J et al (2002) Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multi-center, randomized study. Fertil Steril 77:684–692\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(3):633–641\nKöhler G, Faustmann TA, Gerlinger C et al (2010) A dose ranging study to determine the efficacy and safety of 1, 2 and 4 mg of dienogest daily for endometriosis. Int J Gynaecol Obstet 108(1):21–25\nSchindler AE, Henkel A, Moore C et al (2009) Effect and safety of high dose dienogest (20 mg/day) in the treatment of women with endometriosis. Arch Gynecol Obstet\nPetta CA, Ferriani RA, Abrao MS et al (2005) Randomized clinical trial of a levonorgestrel releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod 20:1993–1998\nVercellini P, Viganò P, Somigliana E (2005) The role of the levonorgestrel-releasing intrauterine device in the management of symptomatic endometriosis. Curr Opin Obstet Gynecol 17:359–365\nCrosigniani P, Luciano A, Ray A et al (2006) Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod 21:248–256\nVercellini P, Somigliana E, Daguati R et al (2008). Postoperative oral contraceptive exposure and risk of endometrioma recurrence. Am J Obstet Gynecol 198:504e1–504e5\nViganò P, Somigliana E, Parazzini F et al (2007) Bias versus causality: interpreting recent evidence of association between endometriosis and ovarian cancer. Fertil Steril 88:588–593\nModugno F, Ness RB, Allen GO et al (2004) Oral contraceptive use, reproductive history, and risk of epithelial ovarian cancer in women with and without endometriosis. Am J Obstet Gynecol 191:733–740\nVercellini P, Pietropaolo G, De Giorgio O et al (2005) Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. Fertil Steril 84:1375–1387\nAudebert A, Descamps P, Marret H et al (1998) Pre- or post-operative medical treatment with nafarelin in stage III-IV endometriosis: a French multicenter study. Eur J Obstet Gynecol Reprod Biol 79(2):145–148\nYap C, Furness S, Farquhar C (2004) Pre and postoperative medical therapy for endometriosis surgery. Cochrane Database Syst Rev 3:CD003678\nOxholm D, Knudsen UB, Kryger-Baggesen N et al (2007) Postmenopausal endometriosis. Acta Obstet Gynecol Scand 4:1–7\nSoliman NF, Hillard TC (2006) Hormone replacement therapy in women with past history of endometriosis. Climacteric 9:325–335\nFedele L, Bianchi S, Raffaeli R et al (1999) Comparison of transdermal estradiol and tibolone for the treatment of oophorectomized women with deep residual endometriosis. Maturitas 32:189–193\nLindsay PC, Shaw RW, Bennink HJ et al (1996) The effect of add-back treatment with tibolone (Livial) on patients treated with the gonadotropin-releasing hormone agonist triptorelin (Decapeptyl). Fertil Steril 65:342–348\nKupker W, Felberbaum RE, Krapp M et al (2002) Use of GnRH antagonists in the treatment of endometriosis. Reprod Biomed Online 5:12–16\nSeli E, Berkkanoglu M, Arici A (2003) Pathogenesis of endometriosis. Obstet Gynecol Clin North Am 30:41–61\nAilawadi RK, Jobanputra S, Kataria M et al (2004) Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study. Fertil Steril 81:290–296\nAmsterdam LL, Gentry W, Jobanputra S et al (2005) Anastrozole and oral contraceptives: a novel treatment for endometriosis. Fertil Steril 84:300–304\nSoysal S, Soysal ME, Ozer S et al (2004) The effects of postsurgical administration of goserelin plus anastrozole compared to goserelin alone in patients with severe endometriosis: a prospective randomized trial. Hum Reprod 19:160–167\nMatsuzaki S, Canis M, Pouly JL et al (2004) Cyclooxygenase-2 expression in deep endometriosis and matched eutopic endometrium. Fertil Steril 82:1309–1315\nBarrier BF, Bates GW, Leland MM et al (2004) Efficacy of anti-tumor necrosis factor therapy in the treatment of spontaneous endometriosis in baboons. Fertil Steril 81(supppl 1):775–779\nKoninckx PR, Craessaerts M, Timmerman D et al (2008) Anti-TNF-alpha treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial. Hum Reprod 23:2017–2023\nDonnez J, Smoes P, Gillerot S et al (1998) Vascular endothelial growth factor (VEGF) in endometriosis. Hum Reprod 13:1686–1690\nBecker CM, Sampson DA, Rupnick MA et al (2005) Endostatin inhibits the growth of endometriotic lesions but does not affect fertility. Fertil Steril 84(Suppl 2):1144–1155\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\nChwalisz K, Mattia-Goldberg C, Lee M et al (2004) Treatment of endometriosis with the novel selective progesterone receptor modulator (SPRM) Asoprisnil. Fertil Steril 82:S83–S84\nInteressenkonflikt\nDer korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nSchäfer, S., Kiesel, L. Chronische Endometriose: medikamentöse Therapie. Gynäkologe 43, 918–924 (2010). https://doi.org/10.1007/s00129-010-2591-8\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00129-010-2591-8\nSchlüsselwörter\n- Östrogenrezeptormodulatoren\n- Gonadotropin-releasing-Hormon\n- Dienogest\n- Hormonelle Therapie\n- Dyspareunie\n- Individualisierte Medizin","source_license":"CC0","license_restricted":false}