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Frauenheilkunde up2date 2011; 5(2): 89-100
DOI: 10.1055/s-0030-1271356
Allgemeine Gynäkologie und gynäkologische Onkologie

© Georg Thieme Verlag KG Stuttgart ˙ New York

Die medikamentöse Therapie der Patientin mit Endometriose

J. Lermann, S. Burghaus, A. Müller, P. G. Oppelt, M. W. Beckmann, S. P. Renner
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Publication Date:
09 March 2011 (online)

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Kernaussagen

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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Dr. med. J. Lermann

Frauenklinik der Universitätsklinik Erlangen

Universitätsstraße 21–23

91054 Erlangen

Email: Johannes.Lermann@uk-erlangen.de

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