Therapie der Endometriose unter Berücksichtigung der Aktivitätsgrade

Karl-Werner Schweppe
In: Der Gynäkologe · 2002 · vol. 35(3) , pp. 255–261 · doi:10.1007/s00129-002-1158-8 · W194274323
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⚙ AI-generated summary by gemini-2.5-flash-lite+body, 2026-07-14 ⓘ

This study indicates that active endometriosis impairs fertility and requires treatment, while inactive endometriosis does not affect fertility and needs no therapy unless secondary damage is present.

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The paper discusses medical and/or surgical treatment of endometriosis with attention to lesion activity grades, focusing on how active proliferating implants produce pain through biochemical and mechanical mechanisms, whereas regressive/inactive foci do not require therapy for pain-related mechanisms. It also addresses fertility outcomes, noting that advanced endometriosis stages are mechanical sterility factors, and that some studies suggest mild endometriosis treatment does not improve pregnancy rates. The main conclusion is that discrepancies in the literature can be explained by whether endometriosis is active (which can impair fertility and respond to therapy in terms of earlier and higher pregnancy rates) versus inactive (which does not impair fertility), with an explicit caveat that even inactive disease may warrant surgery when secondary fibrosis or scars cause mechanical pain. This paper is centrally about endometriosis — it proposes that treatment decisions should be guided by the activity grade of endometriotic lesions.

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Zusammenfassung Eine medikamentöse und/oder operative Endometriosebehandlung bei aktiv wachsenden Herden mit Schmerzsymptomatik ist sinnvoll. Inaktive, regressive Herde induzieren keine Schmerzmechanismen; als klinisch irrelevante Befunde bedürfen sie keiner Therapie. Sekundärschäden wie Fibrose, Adhäsionen u. ä. stellen aber auch bei inaktiver Endometriose eine Indikation zur operativen Sanierung dar. Fortgeschrittene Endometriosestadien sind mechanische Sterilitätsfaktoren. Geringgradige Endometriosen im Bereich des kleinen Beckens ohne anatomische Destruktion der Reproduktionsorgane werden als funktionelle Sterilitätsursachen diskutiert. Einige klinische Untersuchungen zeigen jedoch, dass die Schwangerschaftsraten nach einer medikamentösen oder operativen Endometriosebehandlung nicht höher sind. Die hier dargestellten Daten liefern Hinweise darauf, dass eine inaktive, nicht proliferierende Endometriose die Fruchtbarkeit nicht beeinträchtigt, während eine aktive Erkrankung als relevanter Sterilitätsfaktor einzustufen ist und einer suffizienten Therapie bedarf. Abstract Active proliferating implants in endometriosis cause pain by inducing biochemical and mechanical mechanisms. Medical and/or surgical treatment is indicated. Regressive and inactive foci induce no mechanisms which cause pain, therefore therapy is not necessary. In contrast, even in inactive endometriosis surgery can be beneficial when fibrosis and scars secondary to the disease cause pain mechanically. Severe stages of endometriosis cause sterility by mechanical disturbance of the reproductive organs. Endoscopic surgery is an effective treatment. Some data in the literature demonstrate that treatment of mild endometriosis – surgically or medically – does not improve infertility. The data of this paper indicate that the conflicting findings in the literature can be explained by the fact that inactive endometriosis does not cause infertility. On the other hand active disease reduces fertility and medical or surgical therapy will lead to earlier achievement of pregnancy and higher pregnancy rates. Similar content being viewed by others Author information Authors and Affiliations Rights and permissions About this article Cite this article Schweppe, KW. Therapie der Endometriose unter Berücksichtigung der Aktivitätsgrade. Gynäkologe 35, 255–261 (2002). https://doi.org/10.1007/s00129-002-1158-8 Published: Issue date: DOI: https://doi.org/10.1007/s00129-002-1158-8

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