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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 and how the contraceptive pill or the emergency contraceptive (morning-after) pill can be used to prevent pregnancy 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)

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