Die medikamentöse Therapie der Patientin mit Endometriose

Die Therapie der Endometriose richtet sich unter anderem nach dem Ausmaß der Symptomatik, dem aktuellen bzw. dem zukünftigen Kinderwunsch sowie dem Alter der Patientin. Therapieoptionen sind die medikamentöse, die operative sowie die Schmerztherapie. Der vorliegende Artikel stellt die medikamentösen krankheitsspezifischen Therapieformen, die Art und Dauer der Therapie sowie den Zeitpunkt des Therapiebeginns vor.

Schlüsselwörter

Endometriose - medikamentöse Therapie - Rezidivprophylaxe - Prävention

• Literatur

• 1 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) e.V., Österreichische Gesellschaft für, Gynäkologie und Geburtshilfe (OEGGG), Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG), AWMF. Diagnostik und Therapie der Endometriose. AWMF-Registernummer 015/045. Leitlinienklasse S2k. 2020 Accessed July 09, 2023 at: https://register.awmf.org/assets/guidelines/015-045l_S2k_Diagnostik_Therapie_Endometriose_2020-09.pdf
• 2 Hirsch M, Begum MR, Paniz É. et al. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 2018; 125: 556-564
• 3 Becker CM, Bokor A, Heikinheimo O. et al. ESHRE guideline: endometriosis. Hum Reprod Open 2022; 2: hoac009
• 4 Parazzini F, La Vecchia C, Franceschi S. et al. Risk factors for endometrioid, mucinous and serous benign ovarian cysts. Int J Epidemiol 1989; 18: 108-112
• 5 Brown J, Crawford TJ, Allen C. et al. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 2017; (01) CD004753
• 6 Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev 2012; (03) CD002122
• 7 Strowitzki T, Marr J, Gerlinger C. et al. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 2010; 25: 633-641
• 8 De Paula Andres M, Alves Lopes L, Baracat EC. et al. Dienogest in the treatment of endometriosis: systematic review. Arch Gynecol Obstet 2015; 292: 523-529
• 9 Vercellini P, Bracco B, Mosconi P. et al. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril 2016; 105: 734-743.e3
• 10 Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil Steril 2012; 97: 616-622.e1–3
• 11 Lee KH, Jung YW, Song SY. et al. Comparison of the efficacy of diegnogest and levonorgestrel-releasing intrauterine system after laparoscopic surgery for endometriosis. J Obstet Gynaecol Res 2018; 44: 1779-1786
• 12 Davis L, Kennedy SS, Moore J. et al. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 2007; (03) CD001019
• 13 BfArM; Bundesinstitut für Arzneimittel und Medizinprodukte. Venöse Thromboembolien und kombinierte hormonale Kontrazeptiva. Accessed June 10, 2023 at: http://www.bfarm.de/DE/Arzneimittel/Pharmakovigilanz/KOK/_node.html
• 14 Dunselman GAJ, Vermeulen N, Becker C. et al. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29: 400-412
• 15 Ferrero S, Gillott DJ, Venturini PL. et al. Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review. Reprod Biol Endocrinol 2011; 9: 89
• 16 Nawathe A, Patwardhan S, Yates D. et al. Systematic review of the effects of aromatase inhibitors on pain associated with endometriosis. BJOG 2008; 115: 818-822
• 17 Hughes E, Brown J, Collins JJ. et al. Ovulation suppression for endometriosis. Cochrane Database Syst Rev 2007; (03) CD000155
• 18 Werbrouck E, Spiessens C, Meuleman C. et al. No difference in cycle pregnancy rate and in cumulative live-birth rate between women with surgically treated minimal to mild endometriosis and women with unexplained infertility after controlled ovarian hyperstimulation and intrauterine insemination. Fertil Steril 2006; 86: 566-571
• 19 Sallam HN, Garcia-Velasco JA, Dias S. et al. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 2006; (01) CD004635
• 20 Seracchioli R, Mabrouk M, Manuzzi L. et al. Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis. Hum Reprod 2009; 24: 2729-2735
• 21 Vercellini P, Somigliana E, Vinganò P. et al. Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online 2010; 21: 259-265
• 22 Zorbas KA, Economopoulos KP, Vlahos NF. Continuous versus cyclic oral contraceptives for the treatment of endometriosis: a systematic review. Arch Gynecol Obstet 2015; 292: 37-43
• 23 Adachi K, Takahashi K, Nakamura K. et al. Postoperative administration of dienogest for suppressing recurrence of disease and relieving pain in subjects with ovarian endometriomas. Gynecol Endocrinol 2016; 32: 646-649