{"paper_id":"f3dca1d1-abd5-42d8-b17c-c7c16d3afa00","body_text":"Zusammenfassung\nGnRH(Gonadotropin-releasing Hormon)-Analoga sind seit langem in Form der GnRH-Agonisten in der Behandlung der Endometriose und des Uterus myomatosus etabliert. Im Laufe der letzten Jahre haben sie jedoch an Bedeutung verloren. Ihre Anwendung beschränkt sich auf Fälle schwerer Anämie bei symptomatischem Uterus myomatosus als systemische Therapie vor der Operation, bei Endometriose kommen sie postoperativ zum Einsatz, sind aber durch potente Gestagene ersetzt worden. Die schweren Nebenwirkungen des Steroidentzugs machen eine langfristige Behandlung fraglich. Peptidische GnRH-Antagonisten hingegen erlauben es, als intermediäres Depot eine basale Östradiolsekretion zu erhalten. Die Titration der Östradiolserumkonzentrationen in das therapeutische Fenster ermöglicht Symptomfreiheit ohne Anzeichen von Stimmungsschwankungen, Hitzewallungen, Verlust der Libido oder weiterer unerwünschter Nebenwirkungen bei Patientinnen mit Endometriose. Auf der Basis dieser Erkenntnisse wurden nichtpeptidische oral wirksame GnRH-Antagonisten entwickelt. Diese oral aktiven sehr kleinen Moleküle sind wirksam bei der Behandlung der Dysmenorrhö und chronischen endometriosebedingten Beschwerden. Langfristige Erfahrungen, auch in Bezug auf mögliche Nebenwirkungen und Komplikationen, müssen jedoch noch abgewartet werden.\nAbstract\nGonadotropin-releasing hormone (GnRH) agonists have been a well-established tool for treatment of endometriosis and uterine fibroids for many years. However, in recent years they have lost importance. Their application is now restricted to cases of severe anemia with symptomatic uterine myomas as primary systemic therapy before surgery, while in endometriosis they are used postoperatively, but have been replaced by potent progestins. The severe side effects of sexual steroid deprivation render long-term application questionable. In contrast, applied as an intermediate depot formulation, peptide GnRH antagonists enable residual estradiol secretion to be maintained. Titration of serum estradiol concentrations in the therapeutic timeframe achieves freedom from symptoms without mood swings, hot flashes, libido loss, and other undesired effects in women with endometriosis. Based on these results, new nonpeptidic orally active GnRH antagonists have been developed. These orally active very small molecules are effective for treatment of dysmenorrhea and chronic endometriosis-associated pain. 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Neue Behandlungsmöglichkeiten der Endometriose mit GnRH-Antagonisten. Gynäkologe 53, 522–528 (2020). https://doi.org/10.1007/s00129-020-04633-z\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00129-020-04633-z","source_license":"CC0","license_restricted":false}