Medikamentöse Therapie der Endometriose – ein Update

Zusammenfassung Die Endometriose ist eine der häufigsten gynäkologischen Erkrankungen. In den meisten Fällen ist heute eine klinische Diagnostik möglich, sodass zunächst eine primäre medikamentöse Therapie erfolgen kann, wenn keine absoluten Operationsindikationen bestehen. Da es sich um eine chronische Erkrankung handelt, sind medikamentöse Langzeitbehandlungen sowohl in der primären Therapie als auch in der adjuvanten Therapie nach Operationen zu bevorzugen. Kombinierte orale Kontrazeptiva haben einen positiven Effekt auf die Dysmenorrhö, aber meist nicht auf die anderen Symptome. Des Weiteren sind hier entsprechende Kontraindikationen zu beachten und es ist mit einer potenziellen Progression der Erkrankung unter der Anwendung von kombinierten oralen Kontrazeptiva zu rechnen. Gestagene haben deshalb einen sehr hohen Stellenwert, da sie in der Langzeittherapie bei einem günstigen Nebenwirkungsprofil sehr effektiv sind. Dienogest hat hier gegenüber anderen Gestagenen klinisch relevante Vorteile. GnRH-Analoga und in Zukunft auch GnRH-Antagonisten stellen eine Second-line-Therapieoption dar. Für die Therapie der Adenomyosis ist die Anwendung eines Levonorgestrel-Intrauterinpessars mit 52 mg zu favorisieren. Der Stellenwert der medikamentösen Endometriosetherapie hat in den letzten Jahren deutlich zugenommen. Similar content being viewed by others Literatur Verwendete Literatur Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA et al (2019) Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 220:354.e1–e12 AWMF Leitlinie (2020) Diagnostik und Therapie der Endometriose (Nr. 015/045) Bahamondes L, Petta CA, Fernandes A, Monteiro I (2007) Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhea. Contraception 75:134–139 Becker C et al (2022) ESHRE guideline: endometriosis. 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Hum Reprod Update 27(1):96–107 Weiterführende Literatur Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A (2017) Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 1:CD4753 Author information Authors and Affiliations Corresponding author Ethics declarations Interessenkonflikt T. Römer erhielt Honorare für Vorträge und Advisory Boards von folgenden Firmen: Aristo, Bayer, Gedeon Richter, Exeltis, Theramex. Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Additional information Hinweis des Verlags Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral. Dieser Beitrag wurde in der Zeitschrift Journal für Gynäkologische Endokrinologie/Schweiz 4 · 2022 erstveröffentlicht. Zweitveröffentlichung mit freundlicher Genehmigung des Autors Rights and permissions About this article Cite this article Römer, T. Medikamentöse Therapie der Endometriose – ein Update. Wien klin Mag 26, 134–140 (2023). https://doi.org/10.1007/s00740-023-00494-z Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00740-023-00494-z