Endometriose – Altbewährtes und Neues in Diagnostik und Therapie

Despite about 40,000 incident cases of endometriosis in women of the reproductive years in Germany every year and following morbidity because of chronic pelvic pain and infertility, the disease is underrepresented in daily clinical practice as well as scientific work. Concerning diagnostics, clinical examination and ultrasound are still the most important skills. Non-invasive markers have not been established yet. Finally, the diagnosis can only be confirmed via resection and histological analysis of endometriotic tissue. Operation and hormonal therapy are the main therapeutic options. Minimally invasive resection or coagulation of every visible lesion is the most desirable surgical strategy. Because of the risk of complications, operations are less often indicated in patients with only little symptoms over the last years. After an operation, women without current desire to have children should get hormonal prophylaxis for recurrent disease. In many cases primary hormonal therapy is possible as well. First line hormonal therapy consists in gestagen-only preparations or combined oral contraceptives. GnRH-analogues are used much less widely because of more severe side effects and less applicability than a long-term therapy. Women with endometriosis suffer more often from unfulfilled wish to have children, even if the underlying mechanisms are still unclear. Medical treatment does not improve fertility. The decision between surgical and artificial reproductive therapy has to be made individually in every case in close consultation with the patient.