Die medikamentöse Behandlung der Endometriose

Endometriosis is characterised by proliferating endometrial tissue outside the uterine cavity. Main symptoms are dysmenorrhea and/or chronic pelvic pain and sterility. About 10 % of all women of the reproductive age have endometriosis. Therapy is mainly directed to the alleviation of symptoms and if the woman is willing to become pregnant - At the achievement of pregnancy. Generally, the aim of therapy are improvement of the quality of life and prophylaxis of recurrent disease after a surgical intervention. Medication options include symptomatic pain therapy, particularly with non-steroidal antiinflammatory drugs like ibuprofen or naproxen, and endocrine therapy. As endometriosis depends on the proliferation stimulating effect of estrogen, both estrogen inhibiting and antagonist strategies are successful. First line therapy usually consists of combined oral contraceptives in a long cycle, but in Germany as off-label-use for this indication. Pure progestins in various applications are an effective and well tolerated alternative. GnRH analogues are available in various applications like a daily nasal spray, or as a monthly/three monthly subcutaneous/intramuscular depot. Because of its side effects, GnRH analogues should be used only if the other medical options are not sufficient and only after the endometriosis had been diagnosed by histology. Surgery is the gold standard to assure the diagnosis, and is necessary in cases of advanced endometriosis with insufficient response to endocrine therapy in order to relieve pain and decrease disease burden. Otherwise, the indi-cation for surgery should be handled restrictively. Preoperative endocrine therapy is not useful prior to operations in order to facilitate the surgical conditions. In cases of endometrio- sis-related sterility, endocrine treatment should not delay specific sterility treatment.