Medikamentöse Therapie der Endometriose und Adenomyose

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.

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.

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.

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

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.

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. Similar content being viewed by others Literatur Abou-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 Allen C, Hopewell S, Prentice A et al (2009) Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. 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Medikamentöse Therapie der Endometriose und Adenomyose. Gynäkologische Endokrinologie 14, 9–14 (2016). https://doi.org/10.1007/s10304-015-0042-2 Published: Issue date: DOI: https://doi.org/10.1007/s10304-015-0042-2