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Ganzheitliche Behandlung der Endometriose

Holistic treatment of endometriosis

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Zusammenfassung

Hintergrund

Die durch Endometriose bedingten Schmerzphänomene sind vielfältig. Neben nozizeptiven Schmerzen kommt es auch zu einer noziplastischen Reaktion mit zentraler Sensitivierung. Daher treten neben den klassischen zyklischen Beschwerden wie schwerer Dysmenorrhö, zyklischen Unterbauchschmerzen, Dyspareunie, Dysurie und Dyschezie auch zunehmend atypische Schmerzen wie azyklische Unterbauchschmerzen, eine Ausstrahlung der Schmerzen, unspezifische Blasen- und Darmbeschwerden oder auch Depressionen auf. Im Rahmen der diffusen Beschwerdeproblematik werden oft nicht nur Gynäkolog*innen von den betroffenen Patientinnen konsultiert, sondern auch Kolleg*innen anderer Disziplinen (Innere Medizin, Gastroenterologie, Orthopädie, Schmerztherapie, Psychologie etc.).

Fragestellung

Die Komplexität der Erkrankung Endometriose wird dargestellt. Die sich daraus ergebenden Ansätze zur multimodalen, interdisziplinären, ganzheitlichen Therapie werden beschrieben.

Ergebnisse

Neben hormonellen und operativen Therapien, die meist in gynäkologischer Hand liegen, sollten interdisziplinär eine optimale schmerztherapeutische Begleitung, Ernährungsberatung, psychologische Begleitung und physiotherapeutische Behandlung ins Behandlungskonzept aufgenommen werden. Der vorliegende Beitrag soll einen Überblick über mögliche Behandlungsstrategien bei chronisch symptomatischer Endometriose geben.

Schlussfolgerung

Mithilfe einer multimodalen Therapie unter Berücksichtigung der komplexen pathophysiologischen Veränderungen können die komplexen Beschwerden, die die Lebensqualität signifikant einschränken, deutlich verbessert werden.

Abstract

Background

The pain phenomena caused by endometriosis are manifold. In addition to nociceptive pain there is also a nociplastic reaction with central sensitization. Atypical symptoms, such as acyclic lower abdominal pain, radiating pain, nonspecific bladder and intestinal complaints or even depression increasingly occur in addition to the classical cyclic complaints, such as severe dysmenorrhea, cyclic lower abdominal pain, dyspareunia, dysuria and dyschezia. Due to the diffuse range of symptoms, affected patients often consult not just gynecologists but also specialists from other disciplines (internal medicine, gastroenterology, orthopedics, pain therapy, psychology etc.).

Objective

The complexity of endometriosis is presented. The resulting approaches to multimodal interdisciplinary holistic treatment are described.

Results

Interdisciplinary concepts should be involved in the optimal treatment of endometriosis patients along with hormonal and surgical treatment, mostly under the supervision of a gynecologist and pain management, dietary changes, psychological support and physiotherapeutic management should also be included. This article provides an overview of possible treatment strategies for chronic symptomatic endometriosis.

Conclusion

Based on multimodal treatment strategies and regarding the complex pathophysiological alterations of this disease, the complex complaints that significantly impair the quality of life of endometriosis patients can be greatly improved.

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  1. Klinik für Gynäkologie, Endometriosezentrum Charité, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Sylvia Mechsner

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Correspondence to Sylvia Mechsner.

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Interessenkonflikt

S. Mechsner gibt an, Beratungstätigkeiten für Bayer, Gedeon Richter, Johnson & Johnson und Roche durchgeführt zu haben sowie Vorträge im Rahmen von Fortbildungsveranstaltungen gesponsert durch die Firmen bzw. Fortbildungsorganisationen Das FORTBILDUNGSKOLLEG GmbH, Jenapharm, Gedeon Richter, Johnson & Johnson, Stiftung Endometriose-Forschung, Arbeitsgemeinschaft Endometriose (AGEM), NORSAN und Organon gehalten zu haben.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Einige Abschnitte dieses Beitrags basieren auf dem Beitrag Endometrioseschmerz beherrschen derselben Autorin [42].

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Mechsner, S. Ganzheitliche Behandlung der Endometriose. Schmerz 37, 437–447 (2023). https://doi.org/10.1007/s00482-023-00747-0

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