Finden sich endometriale Zellen außerhalb des Cavum uteri,
resultiert eine Endometriose mit z. T. 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 Vergleichstudien unzureichend belegt.
Auch unter einer medikamentösen Rezidivprophylaxe nach
sanierender „R0”-Operation ist die Neigung des Wiederauftretens
der Beschwerden hoch.
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