GnRH-Analoga in der Endometriosetherapie

Zusammenfassung GnRH-Analoga sind gegenwärtig die effektivsten Medikamente zur Regression der Endometrioseherde und zur Reduktion der endometriosebedingten Beschwerden. Kombiniert mit einer niedrig dosierten so genannten Add-back-Medikation ist die Behandlung effektiv und nebenwirkungsarm. Die verschiedenen GnRH-Analoga, die in Deutschland auf dem Markt sind, unterscheiden sich nicht hinsichtlich ihrer Wirksamkeit, jedoch haben Depotpräparationen die beste Compliance. Der gezielte Einsatz der Medikation postoperativ oder anstatt einer Operation, zur Rezidivprophylaxe oder zur Rezidivtherapie hängt von der individuellen Situation der Patientin und von Lokalisation, Aktivität, Wachstumstyp und Schweregrad der Endometriose ab. Abstract GnRH analogues are currently the most effective medications used to achieve regression of islands of endometriosis and attenuate endometriosis-related symptoms. In combination with low-dose add-back medication they are effective and their side effects are few and tolerable. The different types of GnRH analogues available in Germany do not differ in effectiveness, but patient compliance is best with depot preparations. Whether GnRH analogues are used after or instead of surgery, to prevent recurrences or to treat recurrences depends on the individual situation of the patient and on the proliferative activity, localisation, type and stage of the endometriosis. Similar content being viewed by others Literatur Abbott JA, Hawe J, Clayton RD, Garry R (2003) The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow up. Hum Reprod 18: 1222–1227 Barhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilisation. Fertil Steril 77: 1148–1155 Bianchi S, Busacca M, Agnoli B (1999) Effects of 3 months therapy with danazol after laparoscopic surgery for stage III/IV endometriosis: a randomised study. Hum Reprod 14: 1335–1337 Busacca M, Somigliana E, Bianchi S (2001) Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III–IV: a randomised controlled trial. Hum Reprod 16: 2399–2402 Freundl G, Gödtke K, Gnoth C (1998) Steroidal ‚add-back‘ therapy in patients treated with GnRH agonists. Gynaecol Obstet Invest 45: 22–30 Hemmings R (1998) Combined treatment of endometriosis. GnRH agonists and laparoscopic surgery. J Reprod Med 43: 316–320 Hippach M, Hinrichs I, Schweppe KW (2003) Möglichkeiten der Langzeittherapie bei rezidivierender Endometriose. Zentralbl Gynakol 125: 303 Hornstein MD, Yuzpe AA, Burry KA (1995) Prospective randomised double-blind trial of 3 versus 6 months of narfarelin therapy for endometriosis associated pelvic pain. Fertil Steril 63: 955–962 Hornstein MD, Hemmings R, Yuzpe AA (1997) Use of narfarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertil Steril 68: 860–864 Hughes E, Fedorkow D, Collins J (2004) Ovulation suppression for endometriosis (Cochrane Review). The Cochrane Library, Issue 3. John Wiley & Sons Ltd, Chichester Kampe D, Sahl AC, Schweppe K-W (2003) Prä- und postoperative Endometriosetherapie mit GnRH-Agonisten in Depotform: drei- versus sechsmonatige Behandlungsdauer. Zentralbl Gynakol 125: 304 Kennedy S, Bergqvist A, Chapron C (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20: 2698–2704 Kiesel L, Schweppe K-W, Sillem M (1996) Should add-back therapy for endometriosis be deferred for optimal results? Br J Obstet Gynaecol 103: 15–17 Lee PA, Houk CP (2005) Outcome among adult females after treatment of central precocious puberty (CPP) with GnRH analogue (GnRH-A). 8th International Symposium on GnRH-Analogues, Geneva, Abstract 68 Lunenfeld B, Insler V (eds) (1996) GnRH-analogues: the state of the art. Parthenon, Lancaster New York Malinak LR (1993) Surgical treatment and adjunct therapy of endometriosis. Int J Gynaecol Obstet 40: 43–47 Marcoux S, Maheux R, Berube S (1997) Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 337: 217–222 Meldrun DR, Chang RJ, Lu J (1982) Medical oophorectomy using a long-acting GnRH agonist: a possible new approach to the treatment of endometriosis. J Clin Endocrinol Metab 54: 1081–1083 Mori H, Taketani Y, Uemura T (1999) Rates of endometriosis recurrence and pregnancy 1 year after treatment with intranasal buserelin acetate (Suprecur) (a prospective study). J Obstet Gynaecol Res 25: 153–164 Muzii L, Marana R, Caruana P (2000) Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: a prospective, randomised trial. Am J Obstet Gynecol 183: 588–592 Parazzini F (12999) Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomised trial. Gruppo Italiano per lo Studio dell‘ Endometriosi. Hum Reprod 14: 1332–1334 Prentice A, Deary AJ, Bland E (2003) Progestagens and anti-progestagens for pain associated with endometriosis. The Cochrane Library, Issue 3. John Wiley & Sons Ltd, Chichester Radwanska E (1999) The effect of GnRH agonist suppression on the outcome of infertility treatment in women with endometriosis. 5th International Symposium on GnRH Analogues, Geneva, Abstract 86 Regidor PA (2005) GnRH-agonists and endometriosis: comparison of nasal spray and depot formulations. 8th International Symposium on GnRH-Analogues, Geneva, Abstract 60 Regidor PA, Regidor M, Ruwe B (2001) Prospective randomised study comparing the GnRH-agonist leuprorelin acetate and the gestagen lynestrenol in the treatment of severe endometriosis. Gynecol Endocrinol 15: 202–209 Regidor PA, Wagner I, Ruwe M (2002) Morphometric analyses of endometriotic tissues to determine their grade of activity. Gynecol Endocrinol 16: 235–243 Rickes D, Nickel I, Kropf S (2002) Increased pregnancy rates after ultra long postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril 78: 757–762 Rickes D, Weiß M, Nickel I (2003) Ovarielle Ansprechbarkeit auf rekombinante Gonadotropine nach ultralanger „Dornregulation“ mit GnRH-Analoga. Zentralbl Gynakol 125: 306 Ruwe M, Donhuijsen K, Regidor PA (1998) Endometriose: klinische, histologische und morphometrische Befunde vor und nach Gn-RH-Agonisten-Therapie. Zentralbl Gynakol 120: 391–398 Schultze-Mosgau A, Driesinger G, Altgassen C et al. (2005) New developments in the use of peptide gonadotropin-releasing hormone antagonists versus agonists. Expert Opin Investig Drugs 14: 1085–1097 Schweppe KW (1984) Klinik und Morphologie der Endometriose. Schattauer, Stuttgart New York Schweppe KW (1999) Aktive – inaktive Endometriose – eine prognose- und therapierelevante Differentialdiagnose. Zentralbl Gynakol 121: 330–335 Schweppe KW (2005) The use of GnRH analogues before and after surgery for endometriosis – clinical problems and experiences. 8th International Symposium on GnRH-Analogues, Geneva, Abstract 37 Schweppe KW, Ring D (2002) Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the menstrual cycle. Fertil Steril 78: 763–766 Shaw RW (1992) The role of GnRH analogues in the treatment of endometriosis. Br J Obstet Gynaecol 99: 9–12 Surrey ES, Hornstein MD (2002) Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long term follow up. Obstet Gynecol 99: 709–719 Surrey ES, Silverberg KM, Surrey MW (2002) Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilisation – embryo transfer in patients with endometriosis. Fertil Steril 78: 699–704 Sutton CJG, Ewen SP, Whitelaw N (1994) Prospective, randomised, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertil Steril 62: 696–700 Templeton A, Morris JK, Parslow W (1996) Factors that affect outcome of in-vitro fertilisation treatment. Lancet 348: 1402–1406 Tinneberg HR, Manolopoulos K (2005) Reproductive medicine: comparison of depot formulations of GnRH-agonists, daily injections and nasal spray. 8th International Symposium on GnRH-Analogues, Geneva, Abstract 59 Uemura T, Shirasu K, Katagiri N (1999) Low-dose GnRH agonist therapy for the management of endometriosis. J Obstet Gynaecol Res 25: 295–301 Uemura T, Yoshikata H, Ishikawa M (1999) Effects of pre-treatment with GnRH-agonists on bone mineral density in patients with endometriosis. 5th International Symposium on GnRH-Analogues, Geneva, Abstract 45 Vercellini P, Crosignani PG, Fadini R (1999) A gonadotropin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis. Br J Obstet Gynaecol 6: 672–677 Waller KG, Shaw RW (1993) Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up. Fertil Steril 59: 511–515 Zupi E, Marconi D, Sbracia M (2004) Add-back therapy in the treatment of endometriosis-associated pain. Fertil Steril 82: 1303–1308 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Schweppe, KW. GnRH-Analoga in der Endometriosetherapie. Gynäkologische Endokrinologie 4, 113–119 (2006). https://doi.org/10.1007/s10304-006-0145-x Issue date: DOI: https://doi.org/10.1007/s10304-006-0145-x