Kontrazeption bei Frauen mit Epilepsie

Epilepsy is one of the most common neurological disorders. For women with epilepsy collaboration between neurologists and gynecologists is crucial. To prevent unintended pregnancies and impaired seizure control the bidirectional interactive potential of antiepileptic drugs (AEDs) and hormonal contraceptives needs to be taken into account. Enzyme-inducing AEDs (EI-AED) may reduce the efficacy of hormonal contraceptives. To improve contraceptive safety monophasic combined oral contraceptives (COCs) should be used continuously without a hormone-free interval if used in combination with EI-AEDs. The progestin component should be well above the ovulation inhibiting dose. Progestin-only pills (POPs) are likely to be ineffective if used in combination with EI-AEDs. Subdermal progestogen implants (Implanon/Nexplanon/Implanon NXT) are not recommended for patients on EI-AEDs because of published high failure rates. High-dose injectable contraceptives appear to be effective; however they are not the first choice due to potential serious side effects. According to the World Health Organization (WHO) the use of copper intrauterine devices or the new levonorgestrel-releasing intrauterine system (IUS) may be an alternative for many women with epilepsy in need of contraception even if used in combination with EI-AEDs.     

Neurogonadale Interaktionen bei Frauen mit Epilepsie

The clinical management of women with epilepsy (WWE) is a complex problem for clinicians. The reproductive endocrine function is affected by multidirectional neurogonadal interactions between epileptic and interictal impulses of the central nervous system resulting in an unbalanced hypothalamic-pituitary function, the neuroactive potential of gonadal steroids and the endocrine modulation of antiepileptic drugs. Based on known pathophysiological facts and clinical observations, relevant clinical scenarios and therapeutic options are discussed in this article.     

Therapieoptionen bei karzinomerkrankten Frauen mit Kinderwunsch

As oncologic treatment grows more successful, the longevity of affected patients also increases. This in turn demands increased attention to long-term complications resulting from that treatment, including loss of ovary function and fertility resulting from cytostatically-induced gonadotoxicity. Many new options for retaining fertility are available, some of them still best classified as experimental; their number has especially increased of late. One example is transposition of the ovaries out of the radiation field before isolated radiotherapy. Oocytes, fertilized ova, embryos, and ovarial tissue can now be conserved cryogenically. Also, GnRH analogs can protect the gonads. Some of the options, including cryoconservation of embryos, are not legal in Germany. Many technical questions still require clarification, as do details of reimbursement. Nonetheless the ability to become pregnant despite tumor-specific therapy has come to assume great importance. This is reflected by the new German network called FertiPROTEKT which makes available on a national basis methods for preserving fertility.     

Kontrazeption bei Epilepsie

Ohne Zusammenfassung     

Kontrazeption bei Jugendlichen

In Germany we are still confronted with the problem of increasing rates of pregnancies in minors. It is our responsibility to give a detailed sexual enlightenment, an explanation of the physiological development of the female body and adequate advice on contraception. Oral contraceptives combined with the use of condoms is the most popular form of contraception in juveniles. Oral contraceptives are also medically indicated by dysmenorrhea, menorrhagia after exclusion of organic causes and by polycystic ovary (PCO) syndrome. The effect of oral contraceptives on bone metabolism is not yet sufficiently explained due to a lack of data but should not be a reason to refrain from their use.     

Kontrazeption bei Sportlerinnen

Athletic training might influence the endocrine regulation of the menstrual cycle, and some aspects of physical performance are probably influenced by the phase of the menstrual cycle. The interdependency between hormonal treatment and physical performance is discussed controversially. Altogether, a wide inter-individual variety exists. First places and medals have been reached and won by athletes during all phases of their menstrual cycle – independent of the endogenous hormonal regulation or hormonal contraception. In elite sports, athletes are characterised by different phenotypes. Athletes participating in strength sports have more muscles mass, while athletes in composite sports like gymnastics or figure skating weigh less than women who are not physically active or who are doing recreational sport. Questions concerning the best possible practice of contraception might occur in any gynaecological consultation. This article discusses special aspects concerning the choice of a contraceptive method for female athletes and the effects of different methods of contraception on physical performance of athletes.     

Immunologische Störungen bei Frauen mit habituellen Aborten

Ohne Zusammenfassung     

Wachstumsfaktoren,Kohlehydrat-und Fettstoffwechsel bei Frauen mit Polyzystischem Ovar-Syndrom

Zusammenfassung In einer Studie an 19 Frauen mit PCO-S konnte bei jenen des “androgenen Typs” (n=13) mittels Insulinrezeptorbestimmungen an Erythrozyten, wie auch mittels Erfassung von peripheren Kohlenhydratstoffwechselparamentern eine Insulinresistenz festgestellt werden. In diesen F?llen scheint der Hyperinsulinismus kausale Bedeutung für die Pathogenese des PCO-S zu besitzen. Als Ursache erh?hter Insulinkonzentrationen mu? die Zunahme von Fettgewebe, insbesondere aber erh?hte Somatomedin-C-Plasmakonzentrationen die bei Frauen mit PCO-S dieses Typs beobachtet werden k?nnen, angesehen werden.     

Zyklische Veränderungen von verschiedenen Zytokinen bei gesunden Frauen und Frauen mit Endometriose

Ohne Zusammenfassung     

Umwelttoxikologische Belastungen bei Frauen mit Uterusmyomen und/oder Endometriose

Ohne Zusammenfassung     

Extrakardiale Doppler-Untersuchungen bei fetalen Herzfehlern

There have been few studies using Doppler measurements (umbilical artery, middle cerebral artery, ductus venosus) in fetuses with isolated heart disease. As a consequence of their hemodynamics, some specific cardiac lesions show significant alterations in fetal blood flow compared to controls. An increased pulsatility of the umbilical artery has occasionally been observed in those fetuses with the most severe obstructive lesions and reverse perfusion via the ductus arteriosus. In contrast to fetuses with intrauterine growth restriction and brain sparing following general redistribution, those with hypoplastic left heart or complete transposition of the great arteries may have isolated cerebral vasodilatation with decreased pulsatility of the middle cerebral artery as an adaptive local response to moderate hypoxia. An increased pulsatility of the ductus venosus has been described, especially in right heart lesions with increased right-atrial pressure, usually without being associated with cardiac compromise.     

Intrauterine Therapie bei fetalen Herzfehlern

The life-threatening effects of therapy-refractory fetal arrhythmias, severe semilunar valve obstructions as well as other rare congenital cardiac malformations have inspired the development of various experimental prenatal treatment approaches in animal and human studies. Some of these novel fetal cardiac interventions are currently under clinical evaluation by a few centers. They may not only serve as potentially lifesaving treatment approaches but also improve postnatal quality of life and the prognosis in selected patients. Following an adequate learning curve supervised by ethics committees, the overall outcome and quality of postnatal life of the treated neonates will ultimately determine whether fetal cardiac interventions will become better therapeutic alternatives to currently available postnatal procedures. The aim of this article is to provide the interested reader with a short and critical appraisal of these novel therapeutic approaches.