Rezidivierende Endometriose?ein Kofaktor der vorzeitigen Menopause?

Zusammenfassung Ektopes endometriumähnliches Gewebe wird als Endometriose bezeichnet. Sie ist eine Erscheinung der reproduktiven Lebensphase der Frau. Unter dem hormonellen Einfluss im weiblichen Zyklus verhält sie sich wie orthotopes Endometrium. Die Pathogenese der Endometriose ist letztlich noch ungeklärt. Verschiedene Modelle versuchen Erklärungen für die Entstehung zu liefern (Transplantat- und Metaplasietheorie). Die Endometriose kann mechanische Hindernisse, Störungen im Mediatorsystem und im Gleichgewicht der Wachstumsfaktoren, immunologische Phänomene und eine Störung der Homöostase des peritonealen Milieus erzeugen. Ein besonderes Problem stellt aber die durch sie bedingte Sterilität dar. Es entwickeln 10–20% aller Frauen in der reproduktiven Phase eine Endometriose; 17% der Endometriosepatientinnen weisen eine Oligo- oder Anovulation auf. Bei infertilen Frauen kann von einer Endometrioseprävalenz von 25–70% ausgegangen werden. Dabei scheint eine verminderte ovarielle Reserve zumindest mit ursächlich zu sein. Die Störungen sind vielschichtig. Eine rezidivierende Endometriose kann eine wichtige Rolle spielen. Eine früh auftretende Endometriose neigt besonders zu Rezidiven. Die in der Folge in therapeutischer Absicht durchgeführten Operationen können aber die Ovarfunktion weiter schwächen. Eine medikamentöse Therapie kann günstig auf das ovarielle System wirken und so die Erfüllung eines unerfüllten Kinderwunsches noch möglich werden lassen. Im 5-Jahres-Follow-up werden Rezidivraten von 20–80% beschrieben. Die Endometriose sollte als chronische Erkrankung der Frau betrachtet und behandelt werden. Dabei gilt es, ein Maximum an Lebensqualität bei möglichst niedrigem therapeutisch bedingtem Nebenwirkungsspektrum zu erreichen. Summary Endometriosis is a poorly understood condition characterized by the presence of endometrium-like stroma and glands outside the uterine cavity which can predominantly be detected in the reproductive phase of women. The pathogenesis is still unclear, whereas growth of endometrial lesions can be promoted by estrogens. There is still controversy about the underlying mechanisms which are attributed to Sampson's theory of retrograde menstruation (transplant theory) or Meyer's theory of metaplasia of the coelomic epithelium. Another observation is the alteration of the immune system in women suffering from endometriosis. In most of the cases endometriosis presents with pain and dysmenorrhoea or infertility. The prevalence in infertile women has been estimated as up to 70%. Other symptoms are dysbalanced menstrual cycles with signs of oligoovulation and anovulation. Up to date surgical and medical therapy of endometriosis are based on histological confirmation achieved by diagnostic laparoscopy. Whether the surgical approach or continued medical treatment is in favor of the patients' well-being, is still under debate. New concepts tend to comprehend endometriosis as a chronic disease which may be proven by the fairly high percentage of recurrence. There is a marked tendency for the development of a premature menopause. Similar content being viewed by others Literatur Aboulghar MA, Mansour RT, Serour GI, Al-Inany HG, Aboulghar MM (2003) The outcome of in vitro fertilization in advanced endometriosis with previous surgery: a case-controlled study. Am J Obstet Gynecol 188:371–375 Adamson GD (1997) Treatment of endometriosis-associated infertility. Semin Reprod Endocrinol 15:263–271 Adamson GD, Baker VL (2003) Subfertility: causes, treatment and outcome. 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Rezidivierende Endometriose—ein Kofaktor der vorzeitigen Menopause?. Gynäkologische Endokrinologie 1, 115–127 (2003). https://doi.org/10.1007/s10304-003-0032-7 Issue date: DOI: https://doi.org/10.1007/s10304-003-0032-7