Neue Behandlungsmöglichkeiten der Endometriose mit GnRH-Antagonisten

Zusammenfassung GnRH(Gonadotropin-releasing Hormon)-Analoga sind seit langem in Form der GnRH-Agonisten in der Behandlung der Endometriose und des Uterus myomatosus etabliert. Im Laufe der letzten Jahre haben sie jedoch an Bedeutung verloren. Ihre Anwendung beschränkt sich auf Fälle schwerer Anämie bei symptomatischem Uterus myomatosus als systemische Therapie vor der Operation, bei Endometriose kommen sie postoperativ zum Einsatz, sind aber durch potente Gestagene ersetzt worden. Die schweren Nebenwirkungen des Steroidentzugs machen eine langfristige Behandlung fraglich. Peptidische GnRH-Antagonisten hingegen erlauben es, als intermediäres Depot eine basale Östradiolsekretion zu erhalten. Die Titration der Östradiolserumkonzentrationen in das therapeutische Fenster ermöglicht Symptomfreiheit ohne Anzeichen von Stimmungsschwankungen, Hitzewallungen, Verlust der Libido oder weiterer unerwünschter Nebenwirkungen bei Patientinnen mit Endometriose. Auf der Basis dieser Erkenntnisse wurden nichtpeptidische oral wirksame GnRH-Antagonisten entwickelt. Diese oral aktiven sehr kleinen Moleküle sind wirksam bei der Behandlung der Dysmenorrhö und chronischen endometriosebedingten Beschwerden. Langfristige Erfahrungen, auch in Bezug auf mögliche Nebenwirkungen und Komplikationen, müssen jedoch noch abgewartet werden. Abstract Gonadotropin-releasing hormone (GnRH) agonists have been a well-established tool for treatment of endometriosis and uterine fibroids for many years. However, in recent years they have lost importance. Their application is now restricted to cases of severe anemia with symptomatic uterine myomas as primary systemic therapy before surgery, while in endometriosis they are used postoperatively, but have been replaced by potent progestins. The severe side effects of sexual steroid deprivation render long-term application questionable. 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Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Additional information Redaktion R. Felberbaum, Kempten W. Küpker, Baden-Baden T. Strowitzki, Heidelberg G. Emons, Göttingen K. Diedrich, Lübeck Rights and permissions About this article Cite this article Küpker, W., Felberbaum, R. Neue Behandlungsmöglichkeiten der Endometriose mit GnRH-Antagonisten. Gynäkologe 53, 522–528 (2020). https://doi.org/10.1007/s00129-020-04633-z Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00129-020-04633-z