Pharmakologisches Update gynäkologische Endokrinologie, Reproduktionsmedizin und Kontrazeption

und Methoden Die Übersicht basiert auf einer Recherche in einschlägigen Suchmaschinen, z. B. Pubmed, Auswertung von EMA(European Medicines Agency)-Daten und Fachinformationen. Ergebnisse Zur Behandlung des Klimakteriums sind insbesondere in den USA östrogenfreie Pharmaka wie SERM (selektive Östrogenrezeptormodulatoren) bereits zugelassen, ebenso SSRI (selektive Serotoninwiederaufnahmeinhibitoren) bei klimakterischen Beschwerden. Ulipristal für die Myomtherapie hat die Indikation für eine operative Intervention verschoben, Dienogest zur hormonellen Behandlung der Endometriose ist bezüglich Schmerzreduktion äquivalent zu GnRH-Analoga. Zur hormonellen Stimulation in der assistierten Reproduktion werden in Kürze mehrere Biosimilars zur Verfügung stehen. Neuartige FSH-Moleküle befinden sich in der Entwicklung. Jaydess® ist ein für 3 Jahre eingesetztes kleines Gestagen-Intrauterinsystem zur Kontrazeption, das grundsätzlich auch für Nulliparae geeignet ist, wenn auch nicht in primärer Indikation. Diskussion Alternativen in der Behandlung des klimakterischen Syndroms sind verfügbar, mit einer neuen Risiko-Nutzen-Bewertung im Vergleich zur herkömmlichen Hormontherapie. Operative Eingriffe bei Endometriose und Myomen sind möglicherweise reduzierbar. Hormonelle Stimulation in der Reproduktionsmedizin kann individuell auf eine größere Vielfalt von Gonadotropinpräparaten abgestimmt werden. Intrauterine Kontrazeption wird auch für Frauen möglich, für die die Einlage von intrauterinen Gestagenspiralen bisher vergleichsweise schwierig war.

Background Many new pharmaceuticals have recently been developed for gynecological endocrinology, assisted reproduction techniques (ART) and hormonal contraception, leading to a reevaluation of current treatment concepts.

This update provides new data on hormonal treatment of climacteric syndrome, endometriosis, fibroids, hormonal stimulation prior to ART and intrauterine hormonal contraception.

A standard PubMed research has been performed. Furthermore, data from the European Medicines Agency (EMA) and information from pharmaceutical companies were included.

In the USA estrogen-free drugs, such as selective estrogen receptor modulators (SERM) and selective serotonin reuptake inhibitors (SSRI) are registered for treatment of diverse climacteric symptoms. Ulipristal can be used for fibroid treatment, leading to a postponement of surgical interventions with certain indications and dienogest is a potent gestagen for the treatment of endometriosis equivalent to gonadotropin-releasing hormone (GnRH) analogues for pain relief. Biosimilars for controlled ovarian stimulation in ART have been developed and will shortly be introduced into the market. Novel follicle stimulating hormone (FSH) molecules are being developed. Jaydess® is a small device with progestins for intrauterine contraception, allowing contraception for 3 years which is principally suitable even for nulliparae but not in primary indications.

New alternatives in the treatment of climacteric syndrome avoid estrogen administration and might therefore lead to a reevaluation of the risks and benefits of hormonal therapy. Surgical interventions for endometriosis and fibroids will be further reduced. Controlled ovarian hyperstimulation for ART can be planned with a larger variety of gonadotrophin preparations. Small intrauterine devices might open access to this type of hormonal contraception for women with previously difficult insertion of intrauterine devices. Similar content being viewed by others Literatur Arce JC, Rasmussen BB (2013) Vortrag auf dem European Bioanalysis Forum, Barcelona. http://bcn2013.europeanbioanalysisforum.eu/slides/PDF/P1-Med-3%20Joan-Carles%20Arce%20and%20Birgitte%20Buur%20Rasmussen%20.pdf Donnez J, Tatarchuk TT, Bouchard P et al, PEARL I study group (2012) Ulipristal acetate versus placebo for fibroid treatment before surgery. 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Gynäkologe 47, 466–471 (2014). https://doi.org/10.1007/s00129-013-3283-y Published: Issue date: DOI: https://doi.org/10.1007/s00129-013-3283-y