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Medikamentöse konservative Therapie des Uterus myomatosus

  • Markus WallwienerEmail author
Leitthema

Zusammenfassung

Die Diagnose Uterus myomatosus stellt derzeit noch die häufigste Indikation zur Hysterektomie dar. Mit dem Ziel eines organerhaltenden Vorgehens steigt jedoch die Nachfrage nach sicheren und effektiven medikamentösen Therapieoptionen. Es werden bereits verschiedene hormonelle und nichthormonelle Therapien eingesetzt, für die Myomtherapie zugelassen sind jedoch nur GnRH(„gonadotropin-releasing hormone“)-Analoga und der selektive Progesteronrezeptormodulator (SPRM) Ulipristalacetat (UPA). Beide Substanzklassen führen innerhalb von Tagen bis Wochen zu einem Blutungsstopp sowie, bei längerfristiger Anwendung, zu einer Reduktion des Myomvolumens. Aufgrund des jeweiligen Nebenwirkungsprofils ist die Anwendung zeitlich begrenzt empfohlen.

Schlüsselwörter

Progesteronrezeptoren Hysterektomie Uterine Blutung Tranexamsäure Ulipristalacetat 

Conservative drug treatment of uterine myoma

Abstract

The diagnosis of uterine myoma is still the most frequent indication for hysterectomy; however, the demand for safe and effective medicinal treatment options increases with the aim of an organ-preserving approach. Various hormone and non-hormone therapies are already successfully used in practice but only gonadotropin-releasing hormone (GnRH) analogues and the selective progesterone receptor modulator (SPRM) ulipristal acetate (UPA) are officially approved for treatment of uterine fibroids. Both substance classes lead to cessation of abnormal uterine bleeding within days to weeks and longer term use leads to a reduction of the myoma volume. Due to the respective side effects, it is recommended to use both substances for a limited time only.

Keywords

Receptors, progesterone Hysterectomy Uterine hemorrhage Tranexamic acid Ulipristal acetate 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Wallwiener erhielt Honoraria für Kongressbeiträge.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Ahrendt HJ, Tylkoski H, Rabe T, Szczes A, Friedrich C, Roehl FW, Kitay A, Roemer T, Foth D (2016) Prevalence of uterine myomas in women in Germany: data of an epidemiological study. Arch Gynecol Obstet 293(6):1243–1253.  https://doi.org/10.1007/s00404-015-3930-8 CrossRefPubMedGoogle Scholar
  2. 2.
    Ali M, Al-Hendy A (2018) Uterine fibroid therapy: the pharmacokinetic considerations. Expert Opin Drug Metab Toxicol 14(9):887–889.  https://doi.org/10.1080/17425255.2018.1506766 CrossRefPubMedGoogle Scholar
  3. 3.
    Archer DF, Stewart EA, Jain RI, Feldman RA, Lukes AS, North JD, Soliman AM, Gao J, Ng JW, Chwalisz K (2017) Elagolix for the management of heavy menstrual bleeding associated with uterine fibroids: results from a phase 2a proof-of-concept study. Fertil Steril 108(1):152–160 e154.  https://doi.org/10.1016/j.fertnstert.2017.05.006 CrossRefPubMedGoogle Scholar
  4. 4.
    Bryant-Smith AC, Lethaby A, Farquhar C, Hickey M (2018) Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev 4:CD249.  https://doi.org/10.1002/14651858.CD000249.pub2 CrossRefPubMedGoogle Scholar
  5. 5.
    Cook D, Rocker G, Giacomini M, Sinuff T, Heyland D (2006) Understanding and changing attitudes toward withdrawal and withholding of life support in the intensive care unit. Crit Care Med 34(11 Suppl):S317–S323.  https://doi.org/10.1097/01.CCM.0000237042.11330.A9 CrossRefPubMedGoogle Scholar
  6. 6.
    Deng L, Wu T, Chen XY, Xie L, Yang J (2012) Selective estrogen receptor modulators (SERMs) for uterine leiomyomas. Cochrane Database Syst Rev 10:CD5287.  https://doi.org/10.1002/14651858.CD005287.pub4 CrossRefPubMedGoogle Scholar
  7. 7.
    Deutsche Gesellschaft für Gynäkologie und GEburtshilfe (DGGG) (2015) S3-Leitlinie: Indikation und Methodik der Hysterektomie bei benignen Erkrankungen. https://www.awmf.org/uploads/tx_szleitlinien/015-070l_S3_Indikation_Methodik_Hysterektomie_2016-11.pdf%5B (Stand:05.11.2018)Google Scholar
  8. 8.
    Donnez J (2018) Liver injury and ulipristal acetate: an overstated tragedy? Fertil Steril 110(4):593–595.  https://doi.org/10.1016/j.fertnstert.2018.06.044 CrossRefPubMedGoogle Scholar
  9. 9.
    Donnez J, Arriagada P, Donnez O, Dolmans MM (2018) Emerging treatment options for uterine fibroids. Expert Opin Emerg Drugs 23(1):17–23.  https://doi.org/10.1080/14728214.2018.1446943 CrossRefPubMedGoogle Scholar
  10. 10.
    Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J, Kasilovskiene Z, Dumitrascu MC, Fernandez H, Barlow DH, Bouchard P, Fauser BC, Bestel E, Loumaye E (2016) Long-term medical management of uterine fibroids with ulipristal acetate. Fertil Steril 105(1):165–173 e164.  https://doi.org/10.1016/j.fertnstert.2015.09.032 CrossRefPubMedGoogle Scholar
  11. 11.
    Donnez J, Tatarchuk TF, Bouchard P, Puscasiu L, Zakharenko NF, Ivanova T, Ugocsai G, Mara M, Jilla MP, Bestel E, Terrill P, Osterloh I, Loumaye E, Group PIS (2012) Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med 366(5):409–420.  https://doi.org/10.1056/NEJMoa1103182 CrossRefPubMedGoogle Scholar
  12. 12.
    Donnez J, Tomaszewski J, Vazquez F, Bouchard P, Lemieszczuk B, Baro F, Nouri K, Selvaggi L, Sodowski K, Bestel E, Terrill P, Osterloh I, Loumaye E, Group PIS (2012) Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 366(5):421–432.  https://doi.org/10.1056/NEJMoa1103180 CrossRefPubMedGoogle Scholar
  13. 13.
    Donnez J, Vazquez F, Tomaszewski J, Nouri K, Bouchard P, Fauser BC, Barlow DH, Palacios S, Donnez O, Bestel E, Osterloh I, Loumaye EP III, Group PIES (2014) Long-term treatment of uterine fibroids with ulipristal acetate. Fertil Steril 101(6):1565–1573.  https://doi.org/10.1016/j.fertnstert.2014.02.008 (e1561-1518)CrossRefPubMedGoogle Scholar
  14. 14.
  15. 15.
    EMYA® Fachinformation, Stand: Juli 2018. https://www.fachinfo.de/suche/fi/014045
  16. 16.
    Fauser BC, Donnez J, Bouchard P, Barlow DH, Vazquez F, Arriagada P, Skouby SO, Palacios S, Tomaszewski J, Lemieszczuk B, William AR (2017) Safety after extended repeated use of ulipristal acetate for uterine fibroids. PLoS ONE 12(3):e173523.  https://doi.org/10.1371/journal.pone.0173523 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Felberbaum R, Küpker W, Krapp M, Gehl B, Ludwig M, Diedrich D (2001) Preoperative reduction of uterine fibroids in only 16 days by administration of a gonadotrophinreleasing hormone antagonist (Cetrotide). Reprod Biomed Online 3(1):14–18CrossRefGoogle Scholar
  18. 18.
    Foth D et al (2017) Symptoms of uterine myomas: data of an epidemiological study in Germany. Arch Gynecol Obstet 295:415–426CrossRefGoogle Scholar
  19. 19.
    Kamath MS, Kalampokas EE, Kalampokas TE (2014) Use of GnRH analogues pre-operatively for hysteroscopic resection of submucous fibroids: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 177:11–18.  https://doi.org/10.1016/j.ejogrb.2014.03.009 CrossRefPubMedGoogle Scholar
  20. 20.
    Kriplani A, Srivastava A, Kulshrestha V, Kachhawa G, Agarwal N, Bhatla N, Hari S (2016) Efficacy of ormeloxifene versus oral contraceptive in the management of abnormal uterine bleeding due to uterine leiomyoma. J Obstet Gynaecol Res 42(12):1744–1752.  https://doi.org/10.1111/jog.13105 CrossRefPubMedGoogle Scholar
  21. 21.
    De Milliano I, Van Hattum D, Ket JCF, Huirne JAF, Hehenkamp WJK (2017) Endometrial changes during ulipristal acetate use: A systematic review. Eur J Obstet Gynecol Reprod Biol 214:56–64.  https://doi.org/10.1016/j.ejogrb.2017.04.042 CrossRefPubMedGoogle Scholar
  22. 22.
    Pohl O, Zobrist RH, Gotteland JP (2015) The clinical pharmacology and pharmacokinetics of ulipristal acetate for the treatment of uterine fibroids. Reprod Sci 22(4):476–483.  https://doi.org/10.1177/1933719114549850 CrossRefPubMedGoogle Scholar
  23. 23.
    Qin J, Yang T, Kong F, Zhou Q (2013) Oral contraceptive use and uterine leiomyoma risk: a meta-analysis based on cohort and case-control studies. Arch Gynecol Obstet 288(1):139–148.  https://doi.org/10.1007/s00404-013-2797-9 CrossRefPubMedGoogle Scholar
  24. 24.
    Römer T, Doubek K, Foth D, Hadji P, Neulen J, Prömpeler HJ, Renner S, Schippert C, Thaler CJ, Umlandt A (2017) Symptomatischer Uterus myomatosus – Zielgerichtete medikamentöse Therapie. Frauenarzt 58:497–503Google Scholar
  25. 25.
    Sayyah-Melli M, Mobasseri M, Gharabaghi PM, Ouladsahebmadarek E, Rahmani V (2017) Comparing the effect of aromatase inhibitor (letrozole) + cabergoline (Dostinex) and letrozole alone on uterine myoma regression, a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 210:257–264.  https://doi.org/10.1016/j.ejogrb.2016.11.001 CrossRefPubMedGoogle Scholar
  26. 26.
    Schreiber CA, Teal SB, Blumenthal PD, Keder LM, Olariu AI, Creinin MD (2018) Bleeding patterns for the Liletta((R)) levonorgestrel 52 mg intrauterine system. Eur J Contracept Reprod Health Care 23(2):116–120.  https://doi.org/10.1080/13625187.2018.1449825 CrossRefPubMedGoogle Scholar
  27. 27.
    Sinai Talaulikar V (2018) Medical therapy for fibroids: an overview. Best Pract Res Clin Obstet Gynaecol 46:48–56.  https://doi.org/10.1016/j.bpobgyn.2017.09.007 CrossRefPubMedGoogle Scholar
  28. 28.
    Singh SS, Belland L (2015) Contemporary management of uterine fibroids: focus on emerging medical treatments. Curr Med Res Opin 31(1):1–12.  https://doi.org/10.1185/03007995.2014.982246 CrossRefPubMedGoogle Scholar
  29. 29.
    Song H, Lu D, Navaratnam K, Shi G (2013) Aromatase inhibitors for uterine fibroids. Cochrane Database Syst Rev 1(0):CD9505.  https://doi.org/10.1002/14651858.CD009505.pub2 CrossRefGoogle Scholar
  30. 30.
    Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, Diamond MP, Surrey E, Johnson NP, Watts NB, Gallagher JC, Simon JA, Carr BR, Dmowski WP, Leyland N, Rowan JP, Duan WR, Ng J, Schwefel B, Thomas JW, Jain RI, Chwalisz K (2017) Treatment of Endometriosis-associated pain with Elagolix, an oral GnRH antagonist. N Engl J Med 377(1):28–40.  https://doi.org/10.1056/NEJMoa1700089 CrossRefPubMedGoogle Scholar
  31. 31.
    Williams AR, Bergeron C, Barlow DH, Ferenczy A (2012) Endometrial morphology after treatment of uterine fibroids with the selective progesterone receptor modulator, ulipristal acetate. Int J Gynecol Pathol 31(6):556–569.  https://doi.org/10.1097/PGP.0b013e318251035b CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Allgemeine Frauenheilkunde und GeburtshilfeUniversitäts-FrauenklinikHeidelbergDeutschland

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