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Gynaecology

In gynaecology, everything revolves around the topic of women's health. This includes the prevention, detection and treatment of diseases of the female reproductive and sexual tract, such as the uterus, fallopian tubes, ovaries and breasts. The existing diseases, how the contraceptive pill or the emergency contraceptive (morning-after) pill can be used to prevent pregnancy and how to use an early pregnancy test is shown here.

Birth control pill – hormonal contraceptives

Lots of women rely on birth control through specific hormones every month. For example, the birth control pill can be a so-called combined pill that contains oestrogens and gestagens. These pills are characterised by high protection against unplanned pregnancy, in general high tolerability, and maintaining regular periods. However, some women do not tolerate this kind of pill. They often have physical complaints, such as oedema, breast tenderness, headache, and abdominal pain. These symptoms are usually caused by oestrogens. An oestrogen-free pill containing the active substance Desogestrel is suitable for women who have these symptoms. Not only do they offer all of the advantages women know from the combined pill but, in contrast to the combined pill, they can also be used to prevent pregnancy during breast-feeding. Other advantages are the 12 hour time window and that the pill is taken every day without a break, without the 7 day long pause.

However, not every "pill" is equally well tolerated. Rather, an individually adapted medical prescription is always required. You can find information and service about contraception using the birth control pill here.

Morning after pill: How, for how long, and how it works

The morning after pill is a medicine that is used after unprotected sex or in emergencies, for example after accidents with contraception, in order to prevent a pregnancy. For example, if a woman forgot to take her birth control pill, or was vomiting or had diarrhoea, the contraceptive effect is not ensured. This also happens when a condom slipped off or broke. In these cases, the morning after pill can be considered an option as an absolute emergency pill when pregnancy is not desired. As a general rule: The morning after pill is not a regular birth control method and should be used only in emergencies. And: It must be taken as soon as possible after unprotected sex.

How does the morning after pill work?

First of all it should be explained that: The morning after pill does not have an abortive effect. It prevents an undesired pregnancy before the egg cell is fertilised and pregnancy occurs. This works because the emergency contraceptive pill delays ovulation until the male sperm cells become infertile. Because the menstrual cycle differs from woman to woman, the exact day of ovulation cannot be predicted. Therefore, the morning after pill has to be taken as soon as possible after unprotected sex. Since 2015, the emergency contraceptive pill can be obtained in pharmacies without a prescription in Germany.

Endometriosis – Causes and signs of this abdominal disorder

Almost all women are familiar with period pain and cramps. However, many of them are unaware of the fact that this could also be due to a painful uterine disorder. This is known as endometriosis – benign, usually painful tissue growths on the uterine lining (endometrium) outside the uterus.1  The adjacent organs such as the ovaries, fallopian tubes or the lower abdominal area are also frequently affected. Doctors also refer to these growths as endometriosis foci. Endometriosis is one of the most common disorders of the female abdomen, predominantly affecting women of reproductive age. A first indication of this disorder is usually abdominal pain, which mostly goes hand-in-hand with menstruation, or during or after sexual intercourse. It may also be accompanied by other symptoms such as nausea, vomiting or diarrhoea and can radiate into other parts of the body, such as the back. Since period pain is often perceived as normal for many women, classifying the symptoms as endometriosis is a lengthy process. For most women, the symptoms only subside after the last menstrual period at the onset of menopause. This illustrates the long-term suffering experienced by affected women who, as a result of the disorder, depend on the intake of medication for years and possibly on recurring surgery.

The course of endometriosis differs in those affected. Although the growths may occasionally, but very rarely, regress on their own, they can also become larger and even lead to cysts. If the uterine lining adheres to the area around the ovaries or the fallopian tubes, there is a high probability that the fertility of those affected is impaired.

Endometriosis treatment

As endometriosis is not yet fully curable, the aim of treatment is to relieve the symptoms associated with the disorder. One option is medicinal treatment – an advanced disorder may also require surgical removal of the growths. Medicinal treatment can include painkillers, hormonal contraceptives or stronger hormone preparations.

Hormonal contraceptives can be a treatment option for mild endometriosis and if contraception is desired at the same time. Only gestagen monopreparations are officially approved for the treatment of endometriosis on its own. The use of hormonal combination preparations for the treatment of endometriosis is a so-called “off-label use”, the costs of which are not covered by health insurance. Please also note that hormone preparations that inhibit the growth of endometriosis foci are not suitable for women who wish to become pregnant. Painkillers are only a short-term solution. Surrounding organs affected by endometriosis may necessitate surgery, during which the endometriosis foci are removed under general anaesthesia, e.g. using a laser procedure. Any cysts that may have formed can also be surgically removed to alleviate the symptoms.

In addition, it can help affected women to change their lifestyle and integrate more exercise, stress reduction or a dietary change into their everyday life.2 The latter serves not only to counteract the pain, but also to regain quality of life. This is because pain and inflammatory processes in the body are regulated by certain hormones, the so-called prostaglandins. Although they have an anti-inflammatory and analgesic effect, they also promote inflammation and pain-sensitisation. A balanced diet can promote the formation of the “good” prostaglandins by removing certain foods with high fatty acid content from the diet. This means, for example, reducing consumption of or even doing without sausage, meat, milk or cheese and even turning your back on your beloved croissants or chips. In addition to a change in diet, additional relaxation methods such as yoga exercises can also help to cope better with the pain and to strengthen the abdomen. Heat, e.g. from a hot-water bottle, may also provide relief. However, these suggestions do not replace a visit to the doctor.

1 Ebert AD. Endometriose: ein Wegweiser für die Praxis. Walter de Gruyter GmbH & Co KG, 2019.
2 Kaiser B, Korell M. Ergebnisse der Ernährungsberatung bei Frauen mit Endometriose. Journal für Gynäkologische Endokrinologie 2008 (2)

Early pregnancy test: Function, application and significance

A woman does not always notice the beginning of a pregnancy. Only a reliable pregnancy test can provide certainty as to whether the fertilised egg has successfully implanted in the uterus. With an early pregnancy test, pregnancy can be determined relatively soon after sexual intercourse. How such an early pregnancy test works and what has to be taken into account is explained below.

What is an early pregnancy test?

An early pregnancy test basically serves the same purpose as a conventional pregnancy test: it is intended to provide clarity about whether a pregnancy exists or not. An early pregnancy test can already determine whether a woman is pregnant before the next period is likely to be missed. The Schwangerschaftstest Aristo® Frühtest, for example, provides meaningful results in most cases as early as the 10th day after conception.

Also, the function and handling is largely the same as that of a normal rapid pregnancy test. In its basic function, the test indicates the increased concentration of the pregnancy hormone hCG ("human Chorionicgonadotropin") in urine. Early pregnancy tests are generally suitable for both professional and private use at home. The Schwangerschaftstest Aristo® Frühtest, for example, is a urine test and is easy to use so that it can be applied without medical supervision or instructions.

Informative value of the early pregnancy test: When can you start testing?

The much-cited morning sickness is known from many movies, but it is not necessarily an occurring pregnancy sign. Even if there is no menstruation, morning vomiting or nausea, there are only uncertain signs of pregnancy. Only an early pregnancy test or another test can give certainty, i.e. a proof of an increased hCG level and a subsequent medical examination.

Tip: If the urine sample taken for an early pregnancy test is too watery, it is possible that it contains too little hCG and the test may therefore be falsely negative. If you expect to become pregnant, you should use morning urine and repeat the test after 48 hours.

How does the early pregnancy test work?

The Schwangerschaftstest Aristo® Frühtest is able to detect an hCG concentration of only 10 mIU per milliliter of urine in only five minutes. The test is based on immunochromatographic technology. The urine sample is placed in the oval well in the test cassette, which contains a test strip with glass fibre paper. The test strip is coated with hCG antibodies in the form of a lyophilized conjugate, which react as soon as they come into contact with the hCG hormone at a certain concentration.

The urine flows through a suction pad onto a chromatographic membrane. On the membrane the urine dissolves the lysophilized conjugate of the test strip. If the urine sample reacts, the hCG antigen binds to the antibodies in the colloid solution. Visually, the reaction of a positive sample is expressed by the appearance of a pink line in the test field "T". For every early pregnancy test that has been performed correctly, a pink line also appears in the control field C.

How safe and reliable is an early pregnancy test?

Despite the early possible date of application, an early pregnancy test is safe. The Schwangerschaftstest Aristo® Frühtest, for example, gives the user a 99.9 percent certainty of the result from the tenth day after conception.

Thanks to the sensitive early pregnancy test, it is possible to detect an existing pregnancy even before the actual start of menstruation. If the test is negative and there is still a presumption of pregnancy, it is advisable to repeat the test after the period has not yet set in and to consult a doctor. Only a few days after the period has not yet started, the implantation of the fertilised egg can be visualised in the vaginal ultrasound and thus be recognised as a reliable sign of pregnancy.

Is it possible to test with an early pregnancy test during the period?

The onset of menstruation is excluded if pregnancy is present. However, in early pregnancy slight bleeding can occur, for example implantation bleeding. This can be misinterpreted as period bleeding. Pregnancy despite period or period despite pregnancy does not exist.

If pregnancy is suspected and there is still bleeding, you should make sure that only urine and no blood gets onto the test strip when using an early pregnancy test. If bleeding persists despite a positive early pregnancy test or pregnancy rapid test, you should consult a doctor immediately.

What is hCG and what significance does the hormone have for the early pregnancy test?

A pregnancy test is carried out by measuring the concentration of the hCG hormone in the blood or - as in the case of the early pregnancy test - in the urine. The hormone hCG is also called the "pregnancy hormone". The abbreviation stands for "human Chorionicgonadotropin". This is a glycoprotein hormone that is only produced in the uterus during pregnancy. Since hCG is already produced in increased concentration shortly after conception and an immediate increase in concentration is apparent in the first trimester, it is an ideal marker to detect pregnancy.

 

In the early course of pregnancy, from the beginning of five days after the implantation of the fertilised egg up to the tenth to twelfth week of pregnancy, the hCG concentration in the blood rises continuously. In the first weeks of pregnancy, the hormone levels double approximately every second day:

  • third week after implantation: Less than 50 IU/litre
  • fourth week after implantation: Less than 40 IU/litre
  • 10th to 12th week: Up to 230,000 IU/litre

From this point on the concentration slowly decreases again until the end of the pregnancy. At the time of birth, values between 940 and 65,000 IU/litre are considered normal. Eleven to 17 days after the birth normal values are measured again.

What is the difference between a urine test and a blood test?

In the blood, the concentration of the pregnancy hormone hCG is correspondingly higher in all phases of pregnancy and also in normal conditions. The values given above all refer to the hCG concentration in the blood. In urine, however, the concentration is correspondingly lower.

In the context of a blood test, proof of an existing pregnancy can therefore be provided even earlier: one week before the expected period, i.e. six to nine days after fertilisation. You cannot carry out the blood test yourself, but blood must be taken by a doctor or laboratory. During the blood test the hCG content in the blood is determined. In this way, it is possible to determine whether a pregnancy is present and how far the pregnancy has already progressed. The urine test in the form of the early pregnancy test, on the other hand, only provides reliable results from the 10th day after conception, but can be carried out at home in private practice.

What is the difference between an early pregnancy test and a rapid pregnancy test?

Contrary to the early pregnancy test, a pregnancy rapid test, for example the Schwangerschaftstest Aristo® Schnelltest, is only informative from the first day of the absence of the period. It provides a positive result from an hCG hormone level of 25 mIU per millilitre.

The principle of application, the mode of operation and the waiting time until a result is displayed are identical for the early pregnancy test and the rapid pregnancy test. The only difference is the sensitivity of the measurement, since the early pregnancy test already reacts to 10 mIU per milliliter hCG and can therefore be used earlier than the rapid test to detect pregnancy.

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