Medikamentöse Therapie der Endometriose

Stefanie Burghaus
In: Die Gynäkologie · 2026 · vol. 59(8) , pp. 524–532 · doi:10.1007/s00129-026-05522-7 · W7167493993
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This review details drug therapy for endometriosis, recommending individualized, symptom-oriented treatment with progestins and GnRH antagonists as first-line options, and GnRH agonists for refractory cases.

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The paper reviews medication-based treatment for endometriosis, focusing on symptom control—especially pain—and suppression of disease activity, based on the current S2k guideline and summarized literature rather than new patient data. It reports that individualized, symptom- and context-oriented therapy should consider the patient’s situation, desire for children, and side-effect profiles, with progestins and oral GnRH antagonists (after prior surgery) as first-line options. GnRH agonists are described as effective for therapy-refractory cases or specific situations but requiring careful side-effect management. This paper is centrally about endometriosis — it outlines guideline-based principles and first-line pharmacologic options for controlling endometriosis-associated pain and disease activity.

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Zusammenfassung Die medikamentöse Therapie stellt einen zentralen Baustein in der Behandlung der Endometriose dar und zielt primär auf die Kontrolle schmerzassoziierter Symptome sowie die Suppression der Krankheitsaktivität ab. Die aktuelle S2k-Leitlinie empfiehlt eine individualisierte, symptomorientierte Therapie unter Berücksichtigung der individuellen Situation der Betroffenen, einem vorhandenen Kinderwunsch und dem Nebenwirkungsprofil. Gestagene und orale GnRH(Gonadotropin-releasing-Hormon)-Antagonisten (diese nach vorausgegangener Operation) bilden die First-Line-Therapie. GnRH-Agonisten sind wirksame Optionen bei therapierefraktären Verläufen oder speziellen Situationen, erfordern jedoch ein differenziertes Nebenwirkungsmanagement. Die Wahl der Therapie sollte stets im Kontext eines langfristigen Krankheitsmanagements erfolgen. Abstract Drug therapy is a central component of endometriosis treatment and is primarily aimed at controlling pain-related symptoms and suppressing disease activity. The current S2k guideline recommends individualized, symptom-oriented therapy that takes into account the patient’s specific situation, any desire to have children, and the side effect profile. Progestins and oral gonadotropin-releasing hormone (GnRH) antagonists (these after previous surgery) constitute first-line therapy. Although GnRH agonists are effective options for treatment-refractory cases or specific situations, they require careful management of side effects. The choice of therapy should always be made within the context of long-term disease management. Similar content being viewed by others Datenverfügbarkeit Alle dieser Arbeit zugrunde liegenden Daten sind in diesem Artikel enthalten. Literatur Burghaus S, Schafer SD, Bar KJ et al (2026) Diagnosis and Therapy of Endometriosis. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/045, April 2025). Geburtshilfe Frauenheilkd 86:133–188 Strowitzki T, Faustmann T, Gerlinger C et al (2015) Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Womens Health 7:393–401 Mitchell JB, Chetty S, Kathrada F (2022) Progestins in the symptomatic management of endometriosis: a meta-analysis on their effectiveness and safety. BMC Womens Health 22:526 Giudice LC, As-Sanie S, Arjona Ferreira JC et al (2022) Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2). Lancet 399:2267–2279 Donnez J, Taylor HS, Taylor RN et al (2020) Treatment of endometriosis-associated pain with linzagolix, an oral gonadotropin-releasing hormone-antagonist: a randomized clinical trial. Fertility and sterility 114:44–55 Jensen JT, Schlaff W, Gordon K (2018) Use of combined hormonal contraceptives for the treatment of endometriosis-related pain: a systematic review of the evidence. Fertility and sterility 110:137–152.e131 Fedele L, Bianchi S, Frontino G (2008) Hormonal treatments for adenomyosis. Best practice research Clinical obstetrics gynaecology 22:333–339 Abbas AM, Samy A, Atwa K et al (2020) The role of levonorgestrel intra-uterine system in the management of adenomyosis: A systematic review and meta-analysis of prospective studies. Acta obstetricia et gynecologica Scandinavica 99:571–581 Lee KH, Jung YW, Song SY et al (2018) Comparison of the efficacy of diegnogest and levonorgestrel-releasing intrauterine system after laparoscopic surgery for endometriosis. J Obstet Gynaecol Res. https://doi.org/10.1111/jog.13703 Wu D, Hu M, Hong L et al (2014) Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis. Archives of gynecology and obstetrics 290:513–523 DiVasta AD, Feldman HA, Gallagher J S et al (2015) Hormonal Add-Back Therapy for Females Treated With Gonadotropin-Releasing Hormone Agonist for Endometriosis: A Randomized Controlled Trial. Obstetrics and gynecology 126:617–627 Cao X, Chang HY, Xu JY et al (2020) The effectiveness of different down-regulating protocols on in vitro fertilization-embryo transfer in endometriosis: a meta-analysis. Reproductive biology and endocrinology : RB&E 18:16 Liu S, Xie Y, Li F et al (2021) Effectiveness of ultra-long protocol on in vitro fertilization/intracytoplasmic sperm injection-embryo transfer outcome in infertile women with endometriosis: A systematic review and meta-analysis of randomized controlled trials. The journal of obstetrics and gynaecology research 47:1232–1242 Förderung Für diese Arbeit wurde keine Förderung erhalten. Author information Authors and Affiliations Corresponding author Ethics declarations Interessenkonflikt S. Burghaus gibt an, dass kein Interessenkonflikt besteht. Der vorliegende Beitrag basiert auf einer Zusammenfassung der aktuellen Literatur und Leitlinien und enthält keine eigenen Studien an Menschen oder Tieren. Daher waren weder ein Ethikvotum noch eine Zustimmung gemäß der Deklaration von Helsinki erforderlich. Additional information Redaktion Stefanie Burghaus, Erlangen Tanja Fehm, Düsseldorf Sebastian D. Schäfer, Münster Uwe A. Ulrich, Berlin Hinweis des Verlags Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral. QR-Code scannen & Beitrag online lesen Rights and permissions About this article Cite this article Burghaus, S. Medikamentöse Therapie der Endometriose. Gynäkologie (2026). https://doi.org/10.1007/s00129-026-05522-7 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s00129-026-05522-7 Schlüsselwörter - Hormone - Gestagentherapie - Gonadotropin-releasing-Hormon - Schmerztherapie - Partizipative Entscheidungsfindung

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