Chronische Endometriose: medikamentöse Therapie

Zusammenfassung Endometriose ist die häufigste benigne Erkrankung der Frau. Jede Form der Endometriosetherapie ist eine symptomatische, keine kurative Behandlung. Indikationen für eine konservative Therapie sind peritoneale Verlaufsformen und nicht vorhandener Kinderwunsch. Auch bei Ablehnung einer Operation oder fehlender Operabilität kann konservativ behandelt werden. Bei chronisch rezidivierenden Verläufen ist auch an eine adjuvante Therapie zu denken. Neben nichtsteroidalen antiinflammatorischen Substanzen (NSAID) werden hormonelle Therapeutika (z. B. orale Kontrazeptiva, Gestagene, GnRH-Analoga) eingesetzt, intrauterin/intravaginal auch Gestagene. Zu experimentellen Verfahren zählen GnRH-Antagonisten, Aromataseinhibitoren, COX (Zyklooxygenase)-2-Hemmer, selektive Östrogen- bzw. Progesteronrezeptormodulatoren (SERM/SPRM), Angiogeneseinhibitoren und Immunmodulatoren. Derzeitiger Goldstandard sind GnRH-Agonisten, möglicherweise werden sie in dieser Rolle von Dienogest abgelöst. Abstract Endometriosis is the most frequent benign disease of females. All modes of endometriosis therapy are symptomatic but not curative. Indications for conservative treatment are peritoneal disease and not wanting to become pregnant. Conservative therapy is also an option in case of unwillingness or inability to be operated. In case of chronically recurrent disease, adjuvant conservative therapy can be considered. Aside from NSAID, hormonal therapy with oral contraceptives, gestogens and gonadotropin-releasing hormone (GnRH) agonists can be prescribed. Historically danazole and gestrinone have also been used. Special forms of treatment are intrauterine or intravaginal therapy with gestogens. Experimental treatment options are GnRH antagonists, aromatase inhibitors (AI), COX-2 inhibitors, SERM, SPRM, angiogenesis inhibitors, and immunomodulators. The gold standard is GnRH agonist treatment. This role might shift to dienogest in the future. 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Gynäkologe 43, 918–924 (2010). https://doi.org/10.1007/s00129-010-2591-8 Published: Issue date: DOI: https://doi.org/10.1007/s00129-010-2591-8 Schlüsselwörter - Östrogenrezeptormodulatoren - Gonadotropin-releasing-Hormon - Dienogest - Hormonelle Therapie - Dyspareunie - Individualisierte Medizin