Ursachen und Therapie von uterinen Blutungsstörungen

Zusammenfassung

Blutungsstörungen gehören zu den häufigsten gynäkologischen Problemen. Die Ursachen von Blutungsstörungen und insbesondere deren Häufigkeit ist abhängig von dem Lebensalter der betroffenen Frau. In der Prä- und Perimenopause sind hormonelle Ursachen mit bis zu 90 % und organische Veränderungen des Uterus wie Myome, Adenomyosis uteri oder Endometriumspolypen mit bis zu 70 % die häufigsten Ursachen. Gerinnungstörungen sind, insbesondere bei jungen Mädchen und Frauen ohne andere erkennbare Ursache, Grund für verstärkte Blutungen. Die Behandlung der Blutungsstörung leitet sich aus der Ursache ab, allerdings führt das therapeutische Ablaufschema, wenn kein Kinderwunsch besteht, in vielen Fällen zu gleichen symptomatischen Maßnahmen. Bei der Behandlung von verstärkten Blutungen werden hauptsächlich folgende Therapieregime eingesetzt, die in der Reihefolge ansteigender Effektivität genannt werden: Gestagen, Östrogen-Gestagen-Kombination, Mirena und Endometriumsablation ggf. Myomenukleation mit vergleichbarer Erfolgsrate und schließlich die Hysterektomie. Die Embolisation der Arteria uterina bei Myomen oder Adenomyosis uteri, nicht-steriodale Antiphlogistika und Antifibrinolytika stellen Alternativen dar, deren Einsatz im Einzelfall sinnvoll sein kann. Die Arbeit gibt einen Überblick über die verschiedenen Ursachen, sinnvolle diagnostische Maßnahmen und Therapiemöglichkeiten von uterinen Blutungssstörungen.

Abstract

Bleeding disorders are one of the most frequent gynecological problems. The causes of bleeding disorders, and their frequency in particular, vary depending on the age of the woman affected. In premenopause and perimenopause, the most frequent causes are hormonal, in up to 90 % of cases, as well as organic changes in the uterus such as myomas, adenomyosis uteri, or endometrial polyps, in up to 70 % of cases. Coagulation defects cause increased bleeding, particularly in girls and young women, with no other recognizable cause. The treatment of bleeding disorders is causally based, although if the woman does not wish to have children, the therapeutic algorithm in many cases leads to similar symptomatic measures. The following therapeutic approaches, listed in order of increasing efficacy, are mainly used in the treatment of increased bleeding: gestagen, estrogen-gestagen combination, levonorgestrel (Mirena®) and endometrial ablation or myoma enucleation, with comparable success rates, and finally hysterectomy. Embolization of the uterine artery in myomas or adenomyosis uteri, nonsteroidal anti-inflammatory drugs, and antifibrinolytic agents represent alternatives that may be useful in individual cases. The paper provides an overview of the various causes, useful diagnostic measures, and treatment options in uterine bleeding disorders.

Menorrhagie - Endometriumsablation - Mirena - Myomenukleation - Hysterektomie

myomectomy - hormones - endometrial ablation - hysterectomy

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