Die Mehrzahl der Endometrioseherde befindet sich im Bereich der inneren Genitalien, allen voran an den Ovarien, den Eileitern sowie an den Sakrouterinligamenten. Und die ist nicht selten. Zwischen dem Auftreten der ersten Symptome und der Diagnosestellung liegt im Mittel eine Zeitspanne von sechs bis acht Jahren. Viele Frauen versuchen sich deshalb selbst zu helfen, indem sie Analgetika einnehmen. Dann sollte operativ eingegriffen werden.
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This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Endometriosis is a chronic disease primarily affecting women of childbearing age, in which endometriotic lesions form outside the uterus, typically leading to painful symptoms, fatigue, and infertility.
The symptoms of endometriosis may cause significant impairment in quality of life and represent a substantial economic burden to patients, families, and society. There is no cure for endometriosis; management consists of alleviating pain and other symptoms, reducing endometriotic lesions, and improving quality of life.
Recurrence after surgical intervention is common, while the clinical evidence to support the efficacy and safety of many medications currently used in endometriosis is limited. Dienogest is an oral progestin that has been investigated extensively in the treatment of endometriosis in two clinical programs performed in Europe and Japan, including dose-ranging, placebo-controlled, active comparator-controlled, and long-term up to 65 weeks studies. These studies demonstrated that dienogest 2 mg daily effectively alleviates the painful symptoms of endometriosis, reduces endometriotic lesions, and improves indices of quality of life.
Dienogest showed a favorable safety and tolerability profile in these studies, with predictable adverse effects, high rates of patient compliance, and low withdrawal rates. This review article describes the clinical trial evidence that characterizes the efficacy and safety of dienogest in endometriosis, including two studies characterizing dienogest in long-term use.
The relevance of these findings to the management of endometriosis in clinical practice is discussed. These lesions cause a chronic, inflammatory reaction, which can lead to the formation of scar tissue and adhesions.
Endometriosis places a considerable economic burden on families and on society. An international survey reported that this delay is, on average, seven years. Errors in diagnosis, with the potential for inappropriate therapy, are also common, creating anxiety and frustration, and contributing further to the burden of endometriosis.
A definitive diagnosis of endometriosis requires laparoscopy, ideally combined with confirmatory histology, to characterize endometriotic lesions. The main aims of treatment are to alleviate pain and other symptoms, reduce endometriotic lesions, and improve the quality of life of affected individuals. A number of medical and surgical therapies are available to treat endometriosis, which may, on occasion, be used in combination.
No single treatment is ideal for all patients and the management approach chosen should be directed to the individual needs of each patient. As endometriosis is a chronic disease, consideration should be given not only to the efficacy but also to the long-term safety and tolerability of the treatment options that are available.
Surgery Surgical intervention includes ablation of endometriotic lesions, removal of endometriotic cysts, and division of adhesions. Medical therapy Nonsteroidal anti-inflammatory drugs are frequently used by women with endometriosis in an attempt to achieve analgesia, although clinical trial evidence to support the efficacy of these agents in endometriosis is lacking. These agents and the combined oral contraceptives COCs share a common hormonal mechanism of action in endometriosis.
COCs are widely used to treat the symptoms of endometriosis, although they are not approved for this indication in the majority of countries because of the absence of supportive trial evidence.
However, a common problem with long-term continuous COC regimens is breakthrough bleeding. This is often treated by discontinuing the COC for a few days and then restarting therapy. GnRH agonists are an established therapy for endometriosis that can be administered via either intramuscular, subcutaneous, or intranasal routes.
Although GnRH agonists provide effective pain relief and reduce the progression of endometriotic implants, 29 the hypoestrogenic state that they induce is associated with effects such as accelerated bone mineral density loss, hot flushes, and vaginal dryness. The optimal regimens for add-back therapy are not yet established. Oral, parenteral, intrauterine, or implantable progestins have been used for decades in the treatment of endometriosis, although for many of these agents there is a lack of supportive evidence from controlled clinical trials.
Dose-finding data are lacking for most progestins, and there are few comparative data to indicate the benefits of one progestin over another. The progestins that are approved for use in endometriosis vary between countries. This medication carries a black box warning concerning possible bone mineral loss. The preparation is not available in Europe. When administered continuously, progestins are effective in many women for the management of pain and other symptoms of endometriosis, with beneficial effects also relating to amenorrhea and anovulation.
However, certain progestins are effective in endometriosis only at high doses when compared with use in other indications, 33 , 34 which may increase the likelihood of adverse effects, such as weight gain and androgenic effects, and elevate the risk of cardiovascular adverse events. Dienogest in endometriosis Dienogest is an oral progestin that has been investigated systematically for the treatment of endometriosis in dose-ranging, placebo-controlled, active comparator-controlled, and long-term trials performed in Europe and Japan Figure 1.
Based on this trial evidence, dienogest has received approval as a monotherapy for the treatment of endometriosis in Europe, Japan, Australia, and Singapore.
Dienogest in long-term treatment of endometriosis
Neue Indikation für Dienogest
Zafrilla: Dienogest-Generikum bei Endometriose
Dienogest: neue Therapieoption bei Endometriose