Medikamentöse Therapie der chronischen Endometriose

Zusammenfassung Endometriose ist die häufigste benigne Erkrankung der geschlechtsreifen Frau. Neben der operativen Therapie sind Medikamente die zweite therapeutische Säule. Jede Form der Endometriosetherapie ist eine symptomatische, nicht eine kurative Behandlung. Indikationen für eine konservative Therapie sind peritoneale Verlaufsformen und nicht vorhandener Kinderwunsch. Auch bei Ablehnung einer Operation oder nicht gegebener Operabilität kann konservativ behandelt werden. Bei chronisch rezidivierenden Verläufen ist ggf. auch an eine adjuvante Therapie zu denken. Neben nichtsteroidalen antiinflammatorischen Medikamenten (NSAID) kommen hormonelle Therapeutika, wie orale Kontrazeptiva (OC), Gestagene (auch intrauterin oder intravaginal) und GnRH(„gonadotropin releasing hormone“)-Analoga, zum Einsatz. Die intrauterine Gabe von Levonorgestrel hat einen hohen Stellenwert insbesondere bei Adenomyosis uteri. Zu experimentellen Verfahren zählen GnRH-Antagonisten, Aromataseinhibitoren, Cyclooxygenase (COX)-2-Hemmer, selektive Östrogenrezeptormodulatoren (SERM), selektive Progesteronrezeptormodulatoren (SPRM), Angiogeneseinhibitoren und Immunmodulatoren. Als Referenzstandard bezüglich der Effektivität der Beschwerdelinderung werden GnRH-Agonisten betrachtet, künftig werden sie in dieser Rolle möglicherweise von Dienogest abgelöst werden. Jede Endometriosebehandlung sollte sich nach den individuellen Beschwerden und Bedürfnissen der einzelnen Patientin richten. Abstract Endometriosis is the most frequent benign disease of women during their reproductive years. Operative and conservative therapies are the two pillars of endometriosis treatment. All modes of endometriosis therapy are considered 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 undergo operation. In case of chronically recurrent disease, adjuvant conservative therapy can be considered. Aside from nonsteroidal anti-inflammatory drugs (NSAID), hormonal therapy with oral contraceptives, gestogens (either interuterine or intravaginal), and gonadotropin-releasing hormone (GnRH) agonists can be chosen. Historically danazole and gestrinone have also been used. Especially intrauterine administration of levonorgestrel plays an important role in the treatment of adenomyosis uteri. Experimental treatment options are GnRH antagonists, aromatase inhibitors, cyclooxygenase (COX)-2 inhibitors, selective estrogen receptor modulators (SERM), selective progesterone receptor modulators (SPRM), angiogenesis inhibitors, and immunomodulators. The standard baseline treatment is oral contraceptive or gestogen treatment. 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