Medikamentöse Therapie der Endometriose

Zusammenfassung Die medikamentöse Therapie der Endometriose verfolgt einen symptomatischen Ansatz, ist nicht kausal und kann die natürliche Fertilität nicht beeinflussen. Die Durchführung einer hormonellen medikamentösen Therapie verhindert das gleichzeitige Erfüllen eines Kinderwunsches. Bei einer Therapiedauer von 6 Monaten sind die hormonellen Therapieoptionen bezüglich der Schmerzreduktion gleichwertig. Die Auswahl der Behandlungsform und der Dauer sollten symptomorientiert erfolgen, nicht in Abhängigkeit von der Ausdehnung der Erkrankung. Aufgrund des Nebenwirkungsprofils ist als First-line-Therapie orale Kontrazeptiva (OC)oder Gestagenen zu empfehlen, GnrH-Analoga in der Second-line-Therapie. Bei fehlendem Kinderwunsch kann mit C und Gestagenen ggf. auch eine Dauertherapie unter Beachtung des Nebenwirkungsprofils erfolgen. Am besten sollten OC und Gestagene im Langzyklus eingesetzt werden. Dabei kann eine gute Wirkung insbesondere auf die Dysmenorrhö, allerdings nur eine mäßige Wirkung auf andere typische Beschwerden erwartet werden. GnRH-Analoga sollten im Add-back-Verfahren eingesetzt werden und sind eine sinnvolle Alternative nach histologischer Sicherung der Erkrankung und bei fehlender Wirksamkeit von OC und Gestagenen. Ist eine assistierte Reproduktion geplant, sollte ggf. das Ultralangprotokoll mit GnRH-Analoga-Stimulation erwogen werden. Andere Substanzklassen sind spezifischen Indikationen vorbehalten und haben keinen Stellenwert in der Routinetherapie. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Preview Unable to display preview. Download preview PDF. Similar content being viewed by others Literatur Vercellini P, Fedele L, Aimi G et al (2006) Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current system. 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