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Abstract

Endometriosis

Endometriosis has no pathognomonic symptomatology therefore in each case of chronic pelvic pain, menstrual disorders or unclear lower abdominal pain it has to be taken in consideration. Usually endometriosis is diagnosed by invasive laparoscopy. It is reasonable to complete surgical removal of the disease and the adhesions during the same operation. Endoscopic surgery is gold standard today, but for the different techniques no differences are scientific proven with respect to efficacy and recurrences. Different types of endometriosis on one hand (peritoneal disease, ovarian endometrioma and deep infiltrating endometriosis) and different therapeutic goals on the other hand (pain relief, removal of an adnexal mass, pregnancy) afford different individual therapeutic strategies. The age of the patient has to be taken in consideration too. Medical treatment options play an additional role after surgery, as GnRH-agonists or the new progestin dienogest are reducing the recurrence rates significantly and are increasing the recurrence free interval. In special cases continuous medication or intermittent medication are indications instead of surgery. Because endometriosis is a chronic disease with a stage related recurrence rate, symptomatic treatment for pain relief might be sufficient enough in some cases or is given in addition to endocrine medication.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(3): 206–225

Keywords
Endometriosis, diagnosis, surgical therapy, medical therapy, individual thera

Karl-Werner Schweppe
Ammerland Klinik, Akademisches Lehrkrankenhaus der
Universität Göttingen, Endometriosezentrum, Westerstede
Reviewer: Gülden Halis, Berlin,
und Uwe Ulrich, Berlin

Schweppe K.-W. Endometriose Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(3): 206–225 publiziert 30.11.2014 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2014 ISSN 1614-8533