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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
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Publikationsverlauf

Publikationsdatum:
10. April 2017 (online)

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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.

 

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