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Frauenheilkunde up2date 2017; 11(01): 27-41
DOI: 10.1055/s-0042-122581
Allgemeine Gynäkologie
Georg Thieme Verlag KG Stuttgart · New York

Die medikamentöse Therapie der Patientin mit Endometriose

Johannes Lermann
,
Janina Hackl
,
Stefanie Burghaus
,
Thomas Hildebrandt
,
Christine Fahlbusch
,
Stefan P. Renner
,
Matthias W. Beckmann
Further Information

Publication History

Publication Date:
10 April 2017 (online)

Also available at
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Symptome und Ausprägung einer Endometrioseerkrankung können vielschichtig sein. Therapeutisch steht die operative Resektion der Endometrioseläsionen im Vordergrund. Prä- und postoperativ ist eine medikamentöse Therapie zu diskutieren, in individuellen Fällen auch ohne vorherige histologische Sicherung. Zu beachten ist der Off-Label-Use bestimmter medikamentöser Therapien bei oftmals geringer Datenlage.
Kernaussagen

Finden sich endometriale Zellen außerhalb des Cavum uteri, resultiert eine Endometriose mit zum Teil vielfältiger Beschwerdesymptomatik. Die Endometriose ist häufig chronisch und tritt mit einer Prävalenz von 4–30 % bei Frauen im gebärfähigen Alter auf; etwa die Hälfte der Frauen mit Fertilitätsproblematik ist davon betroffen. Aufgrund der Vielfalt der Symptome, die häufig weder mit dem Schweregrad noch mit der Lokalisation der Endometrioseläsionen korrelieren, steht die Laparoskopie mit histologischer Abklärung im Zentrum der Diagnostik. Als therapeutischer Goldstandard bei gesicherter Diagnose gilt die operative Entfernung der Endometrioseherde, ggf. prä- und postoperativ flankiert von einer medikamentösen Therapie. Unter Umständen kann auch eine alleinige medikamentöse Therapie erfolgen. Die medikamentösen Optionen zur Therapie der Endometriose werden mit folgender Zielsetzung eingesetzt:

  • Linderung der Schmerzen

  • Erhöhung der Schwangerschaftsraten

  • Reduktion der Rezidivraten

Dies funktioniert meist nur in Kombination mit einer oder mehreren sanierenden Operationen. Vieles, wie die postoperative Rezidivprophylaxe oder die kontinuierliche Einnahme kombinierter Kontrazeptiva, ist durch prospektive randomisierte Vergleichsstudien unzureichend belegt.

Auch unter einer medikamentösen Rezidivprophylaxe nach sanierender „R0“-Operation ist die Neigung des Wiederauftretens der Beschwerden hoch.

 

  • Literatur

  • 1 Knapp V. How old is endometriosis? Late 17th- and 18th century European descriptions of the disease. Fertil Steril 1999; 72: 10-14
    CrossrefPubMedGoogle Scholar
  • 2 Mahmood TA, Templeton A. Prevalence and genesis of endometriosis. Hum Reprod 1991; 6: 544-549
    CrossrefPubMedGoogle Scholar
  • 3 Moen MH, Schei B. Epidemiology of endometriosis in a Norwegian county. Acta Obstet Gynecol Scand 1997; 76: 559-562
    CrossrefPubMedGoogle Scholar
  • 4 Viganò P, Parazzini F, Somigliana E. et al. Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 2004; 18: 177-200
    CrossrefPubMedGoogle Scholar
  • 5 Witz CA, Burns WN. Endometriosis and infertility: is there a cause and effect relationship?. Gynecol Obstet Invest 2002; 53 (Suppl. 01) 2-11
    CrossrefPubMedGoogle Scholar
  • 6 Simpson JL, Elias S, Malinak LR. et al. Heritable aspects of endometriosis. I. Genetic studies. Am J Obstet Gynecol 1980; 137: 327-331
    CrossrefPubMedGoogle Scholar
  • 7 Renner SP, Strick R, Oppelt P. et al. Evaluation of clinical parameters and estrogen receptor alpha gene polymorphisms for patients with endometriosis. Reproduction 2006; 131: 153-161
    CrossrefPubMedGoogle Scholar
  • 8 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
    PubMedGoogle Scholar
  • 9 Walter AJ, Hentz JG, Magtibay PM. et al. Endometriosis: correlation between histologic and visual findings at laparoscopy. Am J Obstet Gynecol 2001; 184: 1407-1411 discussion 1411–1413
    CrossrefPubMedGoogle Scholar
  • 10 Ulrich U, Nawroth F, Dorn C. Endometriose, Klinik, Diagnostik und Therapie. In: Ludwig M. Gynäkologische Endokrinologie und Reproduktionsmedizin. München: Hans Marseille; 2010: 219-227
    Google Scholar
  • 11 Abbott J, Hawe J, Hunter D. et al. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril 2004; 82: 878-884
    CrossrefPubMedGoogle Scholar
  • 12 Garry R. The effectiveness of laparoscopic excision of endometriosis. Curr Opin Obstet Gynecol 2004; 16: 299-303
    CrossrefPubMedGoogle Scholar
  • 13 Ulrich U, Buchweitz O, Greb R. et al. National German guideline (S2k): Guideline for the diagnosis and treatment of endometriosis: long version – AWMF Registry No. 015-045. Geburtshilfe Frauenheilkd 2014; 74: 1104-1118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Dunselman GA, Vermeulen N, Becker C. et al. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29: 400-412
    CrossrefPubMedGoogle Scholar
  • 15 Treloar SA, Bell TA, Nagle CM. et al. Early menstrual characteristics associated with subsequent diagnosis of endometriosis. Am J Obstet Gynecol 2010; 202: 534.e1-534.e6
    CrossrefPubMedGoogle Scholar
  • 16 Missmer SA, Hankinson SE, Spiegelman D. et al. Reproductive history and endometriosis among premenopausal women. Obstet Gynecol 2004; 104: 965-974
    CrossrefPubMedGoogle Scholar
  • 17 Hediger ML, Hartnett HJ, Louis GM. Association of endometriosis with body size and figure. Fertil Steril 2005; 84: 1366-1374
    CrossrefPubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 Nouri K, Ott J, Krupitz B. et al. Family incidence of endometriosis in first-, second-, and third-degree relatives: case-control study. Reprod Biol Endocrinol 2010; 8: 85
    CrossrefPubMedGoogle Scholar
  • 20 Harada T, Momoeda M, Taketani Y. et al. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril 2008; 90: 1583-1588
    CrossrefPubMedGoogle Scholar
  • 21 Kirshon B, Poindexter 3rd AN. Contraception: a risk factor for endometriosis. Obstet Gynecol 1988; 71: 829-831
    PubMedGoogle Scholar
  • 22 Strathy JH, Molgaard CA, Coulam CB. et al. Endometriosis and infertility: a laparoscopic study of endometriosis among fertile and infertile women. Fertil Steril 1982; 38: 667-672
    PubMedGoogle Scholar
  • 23 Vessey MP, Villard-Mackintosh L, Painter R. Epidemiology of endometriosis in women attending family planning clinics. BMJ 1993; 306: 182-184
    CrossrefPubMedGoogle Scholar
  • 24 Allen C, Hopewell S, Prentice A. et al. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 2009; (02) CD004753
    PubMedGoogle Scholar
  • 25 Allen C, Hopewell S, Prentice A. Non-steroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 2005; (04) CD004753
    PubMedGoogle Scholar
  • 26 Kennedy S, Bergqvist A, Chapron C. et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20: 2698-2704
    CrossrefPubMedGoogle Scholar
  • 27 Marjoribanks J, Proctor M, Farquhar C. et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2010; (01) CD001751
    PubMedGoogle Scholar
  • 28 WHO. Scoping Document for WHO Guidelines for the pharmacological treatment of persisting pain in adults with medical illnesses. 2012 Im Internet: http://www.who.int/medicines/areas/quality_safety/guide_on_pain/en/ Stand: 20.01.2017
    PubMedGoogle Scholar
  • 29 Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev 2010; (12) CD008475
    PubMedGoogle Scholar
  • 30 Guzick DS, Huang LS, Broadman BA. et al. Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. Fertil Steril 2011; 95: 1568-1573
    CrossrefPubMedGoogle Scholar
  • 31 Zupi E, Marconi D, Sbracia M. et al. Add-back therapy in the treatment of endometriosis-associated pain. Fertil Steril 2004; 82: 1303-1308
    CrossrefPubMedGoogle Scholar
  • 32 Davis L, Kennedy SS, Moore J. et al. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 2007; (03) CD001019
    PubMedGoogle Scholar
  • 33 Vercellini P, Frontino G, De Giorgi O. et al. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril 2003; 80: 560-563
    CrossrefPubMedGoogle Scholar
  • 34 Proctor ML, Roberts H, Farquhar CM. Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev 2001; (04) CD002120
    PubMedGoogle Scholar
  • 35 Göretzlehner G. Menstrual bleeding – must that be? Extended use of oral hormonal contraception. Zentralbl Gynakol 2005; 127: 302-307
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Anderson FD, Hait H. A multicenter, randomized study of an extended cycle oral contraceptive. Contraception 2003; 68: 89-96
    CrossrefPubMedGoogle Scholar
  • 37 Mahutte NG, Arici A. Medical management of endometriosis-associated pain. Obstet Gynecol Clin North Am 2003; 30: 133-150
    CrossrefPubMedGoogle Scholar
  • 38 BfArM. Medizinprodukte. Venöse Thromboembolien und kombinierte hormonale Kontrazeptiva. 2016 Im Internet: http://www.bfarm.de/DE/Arzneimittel/Pharmakovigilanz/KOK/_node.html/ Stand: 20.01.2017
    PubMedGoogle Scholar
  • 39 Ludwig M. Kontrazeption – ab wann und wie lange?. Gynäkologe 2015; 48: 634-642
    CrossrefGoogle Scholar
  • 40 Vercellini P, Barbara G, Somigliana E. et al. Comparison of contraceptive ring and patch for the treatment of symptomatic endometriosis. Fertil Steril 2010; 93: 2150-2161
    CrossrefPubMedGoogle Scholar
  • 41 Prentice A, Deary AJ, Bland E. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev 2000; (02) CD002122
    PubMedGoogle Scholar
  • 42 Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev 2012; (03) CD002122
    PubMedGoogle Scholar
  • 43 Luciano AA, Turksoy RN, Carleo J. Evaluation of oral medroxyprogesterone acetate in the treatment of endometriosis. Obstet Gynecol 1988; 72: 323-327
    PubMedGoogle Scholar
  • 44 Telimaa S, Ronnberg L, Kauppila A. Placebo-controlled comparison of danazol and high-dose medroxyprogesterone acetate in the treatment of endometriosis after conservative surgery. Gynecol Endocrinol 1987; 1: 363-371
    CrossrefPubMedGoogle Scholar
  • 45 Strowitzki T, Faustmann T, Gerlinger C. et al. Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151: 193-198
    CrossrefPubMedGoogle Scholar
  • 46 Petraglia F, Hornung D, Seitz C. et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet 2012; 285: 167-173
    CrossrefPubMedGoogle Scholar
  • 47 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
    CrossrefPubMedGoogle Scholar
  • 48 Kohler G, Faustmann TA, Gerlinger C. et al. A dose-ranging study to determine the efficacy and safety of 1, 2, and 4 mg of dienogest daily for endometriosis. Int J Gynaecol Obstet 2010; 108: 21-25
    CrossrefPubMedGoogle Scholar
  • 49 Andres Mde P, Lopes LA, Baracat EC. et al. Dienogest in the treatment of endometriosis: systematic review. Arch Gynecol Obstet 2015; 292: 523-529
    CrossrefPubMedGoogle Scholar
  • 50 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
    CrossrefPubMedGoogle Scholar
  • 51 Klipping C, Duijkers I, Remmers A. et al. Ovulation-inhibiting effects of dienogest in a randomized, dose-controlled pharmacodynamic trial of healthy women. J Clin Pharmacol 2012; 52: 1704-1713
    CrossrefPubMedGoogle Scholar
  • 52 Vercellini P, Vigano P, Somigliana E. The role of the levonorgestrel-releasing intrauterine device in the management of symptomatic endometriosis. Curr Opin Obstet Gynecol 2005; 17: 359-365
    CrossrefPubMedGoogle Scholar
  • 53 Petta CA, Ferriani RA, Abrao MS. et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod 2005; 20: 1993-1998
    CrossrefPubMedGoogle Scholar
  • 54 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
    CrossrefPubMedGoogle Scholar
  • 55 Schweppe KW. Guidelines for the use of GnRH-analogues in the treatment of endometriosis. Zentralbl Gynakol 2005; 127: 308-313
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Sagsveen M, Farmer JE, Prentice A. et al. Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density. Cochrane Database Syst Rev 2003; (04) CD001297
    PubMedGoogle Scholar
  • 57 Hornstein MD, Surrey ES, Weisberg GW. et al. Leuprolide acetate depot and hormonal add-back in endometriosis: a 12-month study. Lupron Add-Back Study Group. Obstet Gynecol 1998; 91: 16-24
    CrossrefPubMedGoogle Scholar
  • 58 Hornstein M, Gibbons W. Endometriosis: Long-term treatment with gonadotropin-releasing hormone agonists. 04.10.2016 Im Internet: https://www.uptodate.com Stand: 20.01.2017
    PubMedGoogle Scholar
  • 59 Busacca M, Somigliana E, Bianchi S. et al. Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III—IV: a randomized controlled trial. Hum Reprod 2001; 16: 2399-2402
    CrossrefPubMedGoogle Scholar
  • 60 Hornstein MD, Yuzpe AA, Burry KA. et al. Prospective randomized double-blind trial of 3 versus 6 months of nafarelin therapy for endometriosis associated pelvic pain. Fertil Steril 1995; 63: 955-962
    PubMedGoogle Scholar
  • 61 Vercellini P, Crosignani PG, Fadini R. et al. A gonadotrophin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis. Br J Obstet Gynaecol 1999; 106: 672-677
    CrossrefPubMedGoogle Scholar
  • 62 Hornstein MD, Hemmings R, Yuzpe AA. et al. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertil Steril 1997; 68: 860-864
    CrossrefPubMedGoogle Scholar
  • 63 Strowitzki T, Thoene C, von Wolff M. Medikamentöse Behandlung der Endometriose. Journal für Fertilität und Reproduktion 2003; 3: 13-18
    Google Scholar
  • 64 Attar E, Bulun SE. Aromatase and other steroidogenic genes in endometriosis: translational aspects. Hum Reprod Update 2006; 12: 49-56
    CrossrefPubMedGoogle Scholar
  • 65 Ebert AD, Bartley J, David M. Aromatase inhibitors and cyclooxygenase-2 (COX-2) inhibitors in endometriosis: new questions – old answers?. Eur J Obstet Gynecol Reprod Biol 2005; 122: 144-150
    CrossrefPubMedGoogle Scholar
  • 66 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
    CrossrefPubMedGoogle Scholar
  • 67 Nawathe A, Patwardhan S, Yates D. et al. Systematic review of the effects of aromatase inhibitors on pain associated with endometriosis. Br J Obstet Gynaecol 2008; 115: 818-822
    CrossrefPubMedGoogle Scholar
  • 68 Rose PG, Alvarez B, Maclennan GT. Exacerbation of endometriosis as a result of premenopausal tamoxifen exposure. Am J Obstet Gynecol 2000; 183: 507-508
    CrossrefPubMedGoogle Scholar
  • 69 Altintas D, Kokcu A, Kandemir B. et al. Comparison of the effects of raloxifene and anastrozole on experimental endometriosis. Eur J Obstet Gynecol Reprod Biol 2010; 150: 84-87
    CrossrefPubMedGoogle Scholar
  • 70 Stratton P, Sinaii N, Segars J. et al. Return of chronic pelvic pain from endometriosis after raloxifene treatment: a randomized controlled trial. Obstet Gynecol 2008; 111: 88-96
    CrossrefPubMedGoogle Scholar
  • 71 Merviel P, Lourdel E, Sanguin S. et al. Interest of selective progesterone receptor modulators in endometriosis. Gynecol Obstet Fertil 2013; 41: 524-528
    CrossrefPubMedGoogle Scholar
  • 72 Kupker W, Felberbaum RE, Krapp M. et al. Use of GnRH antagonists in the treatment of endometriosis. Reprod Biomed Online 2002; 5: 12-16
    CrossrefPubMedGoogle Scholar
  • 73 Diamond MP, Carr B, Dmowski WP. et al. Elagolix treatment for endometriosis-associated pain: results from a phase 2, randomized, double-blind, placebo-controlled study. Reprod Sci 2014; 21: 363-371
    CrossrefPubMedGoogle Scholar
  • 74 Carr B, Dmowski WP, OʼBrien C. et al. Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod Sci 2014; 21: 1341-1351
    CrossrefPubMedGoogle Scholar
  • 75 Hughes E, Brown J, Collins JJ. et al. Ovulation suppression for endometriosis. Cochrane Database Syst Rev 2007; (03) CD000155
    PubMedGoogle Scholar
  • 76 Deaton JL, Gibson M, Blackmer KM. et al. A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 1990; 54: 1083-1088
    PubMedGoogle Scholar
  • 77 Tummon IS, Asher LJ, Martin JS. et al. Randomized controlled trial of superovulation and insemination for infertility associated with minimal or mild endometriosis. Fertil Steril 1997; 68: 8-12
    CrossrefPubMedGoogle Scholar
  • 78 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
    CrossrefPubMedGoogle Scholar
  • 79 Benaglia L, Somigliana E, Santi G. et al. IVF and endometriosis-related symptom progression: insights from a prospective study. Hum Reprod 2011; 26: 2368-2372
    CrossrefPubMedGoogle Scholar
  • 80 Benaglia L, Somigliana E, Vercellini P. et al. The impact of IVF procedures on endometriosis recurrence. Eur J Obstet Gynecol Reprod Biol 2010; 148: 49-52
    CrossrefPubMedGoogle Scholar
  • 81 Coccia ME, Rizzello F, Gianfranco S. Does controlled ovarian hyperstimulation in women with a history of endometriosis influence recurrence rate?. J Womens Health (Larchmt) 2010; 19: 2063-2069
    CrossrefPubMedGoogle Scholar
  • 82 Donnez J, Nisolle M, Gillet N. et al. Large ovarian endometriomas. Hum Reprod 1996; 11: 641-646
    CrossrefPubMedGoogle Scholar
  • 83 Muzii L, Marana R, Caruana P. et al. The impact of preoperative gonadotropin-releasing hormone agonist treatment on laparoscopic excision of ovarian endometriotic cysts. Fertil Steril 1996; 65: 1235-1237
    PubMedGoogle Scholar
  • 84 Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998; 4: 312-322
    CrossrefPubMedGoogle Scholar
  • 85 Bragheto AM, Caserta N, Bahamondes L. et al. Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging. Contraception 2007; 76: 195-199
    CrossrefPubMedGoogle Scholar
  • 86 Fedele L, Bianchi S, Raffaelli R. et al. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril 1997; 68: 426-429
    CrossrefPubMedGoogle Scholar
  • 87 Fong YF, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception 1999; 60: 173-175
    CrossrefPubMedGoogle Scholar
  • 88 Kitawaki J. Adenomyosis: the pathophysiology of an oestrogen-dependent disease. Best Pract Res Clin Obstet Gynaecol 2006; 20: 493-502
    CrossrefPubMedGoogle Scholar
  • 89 Sheng J, Zhang WY, Zhang JP. et al. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception 2009; 79: 189-193
    CrossrefPubMedGoogle Scholar
  • 90 Renner SP, Rix S, Boosz A. et al. Preoperative pain and recurrence risk in patients with peritoneal endometriosis. Gynecol Endocrinol 2010; 26: 230-235
    CrossrefPubMedGoogle Scholar
  • 91 Renner SP, Lermann J, Hackl J. et al. Chronische Erkrankung. Endometriose. Geburtshilfe Frauenheilkd 2012; 72: 914-919
    Article in Thieme ConnectGoogle Scholar
  • 92 Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev 2004; (03) CD003678
    PubMedGoogle Scholar
  • 93 Abou-Setta AM, Houston B, Al-Inany HG. et al. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev 2013; (01) CD005072
    PubMedGoogle Scholar
  • 94 Vercellini P, Somigliana E, Viganò 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
    CrossrefPubMedGoogle Scholar
  • 95 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
    CrossrefPubMedGoogle Scholar
  • 96 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
    CrossrefPubMedGoogle Scholar