Patientinnenzentrierte Aspekte der Endometriose

Zusammenfassung Die Endometriose ist eine häufige gutartige Erkrankung. Sie ist definiert durch das Auftreten endometriumartiger Zellverbände außerhalb der Gebärmutterhöhle. Zu Ätiologie und Pathogenese wurden zahlreiche Theorien entwickelt. Es wird ein breites Spektrum vom klinisch bedeutungslosen Zufallsbefund bis zu schweren Verläufen mit Organdestruktion beobachtet. Leitsymptom ist der zyklisch auftretende Unterbauchschmerz, nicht selten besteht eine Sterilität. Die Diagnose wird im Allgemeinen durch eine Laparoskopie gesichert. Medikamentöse Therapien bestehen in der Unterdrückung der zyklischen ovariellen Aktivität, während die operative Therapie die Destruktion und Exzision von Endometrioseherden oder die Entfernung erkrankter Organe zum Ziel hat. Bei gleichzeitig bestehender Sterilität sollte diese vorrangig behandelt werden. Abstract Endometriosis is a frequent benign condition. It is defined as the occurrence of cell complexes resembling the endometrium outside the uterine cavity. Numerous theories regarding etiology and pathogenesis have been proposed. A broad spectrum ranging from clinically meaningless random findings to severe conditions involving organ destruction can be observed. The most important symptom is cyclical lower abdominal pain, and coincident infertility is not infrequent. Diagnosis is commonly confirmed by laparoscopy. Medical therapies lead to the suppression of cyclical ovarian function, while surgery aims at destruction or excision of endometriosis foci or the removal of affected organs. If infertility is present, this should be treated with priority. Literatur American Society for Reproductive Medicine (1997) Revised American Society for Reproductive Medicine classification of endometriosis. Fertil Steril 67: 817–821 Arici A, Oral E, Bukulmez O et al. (1996) The effect of endometriosis on implantation: results from the Yale University in vitro fertilization and embryo transfer program. Fertil Steril 65: 603–607 Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37: 747–753 Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilisation. Fertil Steril 77: 1148–1155 Bazot M, Darai E (2005) Sonography and MR imaging for the assessment of deep pelvic endometriosis. J Minim Invasive Gynecol 12: 178–185 Beretta P, Franchi M, Ghezzi F et al. (1998) Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 70: 1176–1180 Bergqvist A, Ljungberg O, Skoog L (1993) Immunohistochemical analysis of oestrogen and progesterone receptors in endometriotic tissue and endometrium. Hum Reprod 8: 1915–1922 Bragheto AM, Caserta N, Bahamondes L, Petta CA (2007) Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging. Contraception 76: 195–199 Brinton LA, Gridley G, Persson I et al. (1997) Cancer risk after a hospital discharge diagnosis of endometriosis. Am J Obstet Gynecol 176: 572–579 Chapron C, Fritel X, Dubuisson JB (1999) Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments. Hum Reprod 14: 329–332 Chopin N, Vieira M, Borghese B et al. (2005) Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification. J Minim Invasive Gynecol 12: 106–112 Cramer DW, Missmer SA (2002) The epidemiology of endometriosis. Ann N Y Acad Sci 995: 11–22 Demirol A, Guven S, Baykal C, Gurgan T (2006) Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 12: 639–643 D’Hooghe TM, Denys B, Spiessens C et al. (2006) Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Fertil Steril 86: 283–290 Ebert AD, Bartley J, David M (2005) Aromatase inhibitors and cyclooxygenase-2 (COX-2) inhibitors in endometriosis: new questions–old answers? Eur J Obstet Gynecol Reprod Biol 122: 144–150 ESHRE (2007) guidelines.endometriosis.org/introduction.html Eskenazi B, Mocarelli P, Warner M et al. (2002) Serum dioxin concentrations and endometriosis: a cohort study in Seveso, Italy. Environ Health Perspect 110: 629–634 Gomes MK, Ferriani RA, Rosa e Silva JC et al. (2007) The levonorgestrel-releasing intrauterine system and endometriosis staging. Fertil Steril 87: 1231–1234 Hadfield R, Mardon H, Barlow D, Kennedy S (1996) Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod 4: 878–880 Hughes E, Fedorkow D, Collins J, Vandekerckhove P (2002) Ovulation suppression for endometriosis (Cochrane Review). In: The Cochrane Library, Issue 3. Oxford: update software Ishii K, Takakuwa K, Mitsui T, Tanaka K (2002) Studies on the human leukocyte antigen DR in patients with endometriosis: genotyping of HLA-DRB1 alleles. Hum Reprod 17: 560–563 Kennedy S (2003) Genetics of endometriosis: a review of the positional cloning approaches. Semin Reprod Med 21: 111–118 Koninckx PR, Kennedy SH, Barlow DH (1998) Endometriotic disease: the role of peritoneal fluid. Hum Reprod Update 4: 741–751 Leyendecker G, Herbertz M, Kunz G, Mall G (2002) Endometriosis results from the dislocation of basal endometrium. Hum Reprod 17: 101–112 Leyendecker G, Kunz G, Wildt L et al. (1996) Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanisms of rapid sperm transport in patients with endometriosi and infertility. Hum Reprod 11: 1542–1551 Ling FW (1999) Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol 93: 51–58 Loh FH, Tan AT, Kumar J, Ng SC (1999) Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril 72: 316–321 Marcelli F, Collinet P, Vinatier D et al. (2006) Ureteric and bladder involvement of deep pelvic endometriosis. Value of multidisciplinary surgical management. Prog Urol 16: 588–593 Marcus SF, Edwards RG (1994) High rates of pregnancy after long-term down-regulation of women with severe endometriosis. Am J Obstet Gynecol 171: 812–817 Metalliotakis IM, Cakmak H, Fragouli YG et al. (2008) Epidemiological characteristics of women with and without endometriosis in the Yale series. Arch Gynecol Obstet: Epub ahead of print Meyer R (1919) Über den Stand der Frage der Adenomyositis und Adenomyome im allgemeinen und insbesondere über Adenomyositis seroepithelialis und Adenomyometritis sarcomatosa. Zentralbl Gynakol 43: 745–750 Moen MH, Muus KM (1991) Endometriosis in pregnant and non-pregnant women at tubal sterilization. Hum Reprod 6: 699–702 Navot D, Rosenwaks Z, Margalioth EJ (1987) Prognostic assessment of female fecundity. Lancet 2: 645–647 Nothnick WB (2001) Treating endometriosis as an autoimmune disease. Fertil Steril 76: 223–231 Olive DL, Pritts EA (2001) Treatment of endometriosis. N Engl J Med 345: 266–275 Olivennes F, Feldberg D, Liu HC et al. (1995) Endometriosis: a stage by stage analysis–the role of in vitro fertilization. Fertil Steril 64: 392–398 Pagidas K, Falcone T, Hemmings R, Miron P (1996) Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer. Fertil Steril 65: 791–795 Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparascopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 96: 304–307 Prentice A, Deary AJ, Goldbeck-Wood S et al. (2000) Gonadotrophin-releasing hormone analogues for pain associated with endometriosis (Cochrane review). In: The Cochrane Library, issue 2 Ramey JW, Archer DF (1993) Peritoneal fluid: its relevance to the development of endometriosis. Fertil Steril 60: 1–14 Reimand K, Talja I, Metsküla K et al. (2001) Autoantibody studies of female patients with reproductive failure. J Reprod Immunol 51: 167–176 Rier SE, Martin DC, Bowman R et al. (1993) Endometriosis in rhesus monkeys (Macaca mulatta) following chronic exposure to 2,3,7,8,-tetrachlorodibenzo-p-dioxin. Fundam Appl Toxicol 21: 433–441 Sallam HN, Garcia-Velasco JA, Dias S, Arici A (2006) Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 1 Sampson JA (1925) Heterotopic or misplaced endometrial tissue. Am J Obstet Gynecol 10: 649–664 Schneider A, Touloupidis S, Papatsoris AG et al. (2006) Endometriosis of the urinary tract in women of reproductive age. Int J Urol 13: 902–904 Schweppe KW (2003) Endometriose – eine Erkrankung ohne Lobby. Zentralbl Gynakol 125: 233 Sillem M, Prifti S, Neher M, Runnebaum B (1998) Extracellular matrix remodelling in the endometrium and its possible relevance to the pathogenesis of endometriosis. Hum Reprod Update 4: 730–735 Surrey ES (1999) Add-back therapy and gonadotropin-releasing hormone agonists in the treatment of patients with endometriosis: can a consensus be reached? Add-Back Consensus Working Group. Fertil Steril 71: 420–424; Review Sutton CJG, Pooley S, Ewen SP, Haines P (1997) Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain asociated with mild to moderate endometriosis. Fertil Steril 68: 1070–1074 Treloar SA, Wicks J, Nyholt DR et al. (2005) Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26. Am J Hum Genet 77: 365–376 Tu FF, As-Sanie S, Steege JF (2006) Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. J Reprod Med 51: 185–189 Tu FF, Holt J, Gonzales J, Fitzgerald CM (2008) Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. Am J Obstet Gynecol 272: e1–e7 Tuttlies F, Keckstein J, Ulrich U et al. (2005) ENZIAN-Score. Eine Klassifikation der tiefen infiltrierenden Endometriose. Zentralbl Gynakol 127: 275–281 Ulrich U, Richter O, Wardelmann E et al. (2003) Endometriose und Malignom. Zentralbl Gynakol 125: 239–242 Ulrich U (2007) Diagnostik und Therapie der Endometriose. Zusammenfassung der aktuellen S2k-Leitlinie der DGGG. Frauenarzt 48: 654–656 Urbach DR, Reedijk M, Richard CS et al. (1998) Bowel resection for intestinal endometriosis. Dis Colon Rectum 41: 1158–1164 Vercellini P, Cortesi I, Crosignani PG (1997) Progestins for symptomatic endometriosis: a critical analysis of the evidence. Fertil Steril 68: 393–401 Vercellini P, Crosignani PG (1992) Epidemiology of endometriosis. In: Brosens I, Donnez J (eds) The current status of endometriosis – research and management. Carnforth, Pearl River (Parthenon) Vercellini P, Frontino G, De Giorgi O et al. (2003) Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril 80: 560–563 Vercellini P, Frontino G, De GO et al. (2003) Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Fertil Steril 80: 305–309 Waller KG, Shaw RW (1993) Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up. Fertil Steril 59: 511–515 Yap C, Furness S, Farquhar C (2004) Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev 3: CD003678 Interessenkonflikt Der korrespondierende Autor ist regelmäßig als Vortragsredner für Bayer Schering Pharma AG und gelegentlich für andere pharmazeutische Unternehmen tätig. Diese Tätigkeit hatte keinerlei Einfluss auf die Erstellung des Manuskripts. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Sillem, M., Teichmann, A. Patientinnenzentrierte Aspekte der Endometriose. Gynäkologe 41, 533–543 (2008). https://doi.org/10.1007/s00129-008-2180-2 Published: Issue date: DOI: https://doi.org/10.1007/s00129-008-2180-2