Zusammenfassung
Die Behandlung der Endometriose konzentriert sich auf zwei Hauptziele: die Verringerung
von Schmerzen und die Therapie der Infertilität. Die Schmerztherapie bei Endometriose
wurde bisher gut untersucht. So waren alle medikamentösen Behandlungsformen der Plazebobehandlung
überlegen. Vergleicht man die Anwendung von Gestagenen, Antikonzeptiva, GnRH-Analoga
und Danazol, so war keine dieser Therapieformen der anderen signifikant überlegen.
Eine deutliche Reduktion der Schmerzen bei Endometriose kann auch durch das Einsetzen
einer levonorgestrelhaltigen Spirale erreicht werden. Eine operative Therapie mit
Destruktion der Endometrioseherde und Ausschälung von Endometriomen scheint bei Schmerzen
ebenfalls effektiv zu sein. Jedoch ist die Rate an Endometriose-Rezidiven relativ
hoch. Bei anderen Patientinnen treten erneute Schmerzen durch die postoperative Bildung
von Adhäsionen auf. Die Behandlung der endometrioseassoziierten Infertilität ist im
internationalen Vergleich umstritten: So war man bisher davon ausgegangen, dass eine
medikamentöse Therapie alleine die Fertilitätsraten bei Endometriose nicht steigern
kann. Aktuelle Studien zeigen aber den Benefit einer Therapie mit GnRH-Analoga über
3 bis 6 Monate nach Operation und vor den Methoden der assistierten Reproduktion (ART).
Im Falle von Kinderwunsch profitieren Patientinnen der schwergradigen Endometriosestadien
von einer chirurgischen Therapie. Die Methoden der assistierten Reproduktion mit ovarieller
Stimulation, intrauteriner Insemination und In-vitro-Fertilisation (IVF) scheinen
ebenfalls effektiv zu sein, aber zu einem geringeren Prozentsatz als bei infertilen
Patientinnen ohne Endometriose. Hiebei ist die IVF der Insemination deutlich überlegen.
Die betroffene Patientin und ihr behandelnder Arzt sollten die möglichen Behandlungsoptionen
diskutieren und die Therapie wählen, die eine optimale Besserung ihrer Beschwerden
verspricht, wobei der Wunsch nach Erhalt der Fertilität berücksichtigt werden sollte.
Zusätzlich berichten wir von einigen innovativen, bisher noch nicht etablierten Ansätzen
der Endometriosetherapie.
Abstract
The treatment of endometriosis focuses upon two main goals: the reduction of pain
and the therapy of infertility. The treatment of pain associated with endometriosis
has been well investigated. All major medical therapies proved to be better than placebo
treatment. Comparing progesterone, oral contraceptives, GnRH analogs and danazol,
no single treatment modality seems to be superior to the others. A marked reduction
of endometriosis-associated pain can also be reached by the insertion of a levonorgestrel-releasing
intrauterine system. A surgical procedure seems to be effective for the treatment
of pain; however, the rate of recurrence is high. Other patients suffer from pain
as a consequence of postoperative adhesion formation. The treatment of endometriosis-associated
infertility is debated in the international literature: most authors reported that
medical treatment does not improve fertility in endometriosis patients. In addition,
however, new studies demonstrated the benefit of GnRH analogs for 3 to 6 months after
surgery for the outcome of ART. The fertility of endometriosis patients can be improved
by surgical procedures in severe endometriosis. The methods of assisted reproduction
with ovarian stimulation, intrauterine insemination or IVF are successful, but to
a lower extent compared to infertile patients without endometriosis. Especially for
endometriosis patients, IVF has higher success rates compared to insemination. The
affected patient and her physician should discuss possible treatment options and chose
the therapy which improves her complaints, keeping in mind her reproductive wishes.
In addition, we describe several innovative, not yet established, approaches in endometriosis
treatment.
Schlüsselwörter
Endometriose - Schmerzen - Infertilität - Therapie
Key words
Endometriosis - pain - infertility - treatment
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PD Dr. Daniela Hornung
Universitätsfrauenklinik
Ratzeburger Allee 160
23538 Lübeck
Email: D.Hornung@macnews.de
