[Menstrual bleeding -- must that be? Extended use of oral hormonal contraceptives]. / Blutungen -- muss dass sein? Ovulationshemmer ohne Pause.

More and more women request less menstruation and would refuse temporarily or completely gladly onto the menstruation and the accompanying symptoms. Through the continuous conquest of the oral hormonal contraceptive pills in the long-cycle treatment can the loss of blood reduced, breakthrough bleeding and spotting can be decreased or prevented and the complaints occurring with menstruation as well as menstruation conditional provocations for cycle dependent illnesses can be reduced or prevented. The long cycle is a genuine alternative for these women to the improvement in living quality and hygiene even if for this purpose extensive great studies are not yet available.

[Status of problems with administration of hormonal contraceptives]. / Problemsituationen unter der Einnahme hormonaler Kontrazeptiva.

Following the application of oral hormonal contraceptives situations may occur which need fast clarification. In this report we discuss the practical aspects of forgetting to take hormonal contraceptives, the risk for birth defects, the time when to restart taking oral contraceptives after delivery and abortion, the indications for stopping the application, the taking of oral contraceptives under anticoagulant therapy, the behaviour during migraine, the raising need of ethinylestradiol in the case of epilepsy, the procedure in case of oligophrenia, the prevention of the rheumatoid arthritis as well as special questions in cases of diabetes mellitus and gestational diabetes.

[Effect of estradiol valerate and chlormadinone acetate in hormone replacement therapy in postmenopause on Kupperman index, body weight, blood pressure, lipids, enzymes and electrolytes]. / Der Einfluss von Estradiolvalerat und Chlormadinonacetat während der Hormonersatztherapie in der Postmenopause auf Kupperman-Index, Körpergewicht, Blutdruck, Lipide, Enzyme und Elektrolyte.

Kupperman-index, weight, blood pressure, serum lipids, blood count, thrombocytes, fibrinogen, thrombine time, electrolytes, enzymes, serum proteins, bilirubine and other parameters were studied in 16 healthy post-menopausal women treated for 18 months with 2 mgs estradiol valerate continuously sequentially combined with the antiandrogenic progestogen chlormadinone acetate (CMA) 2 mgs from 1st to 12th every month of treatment. The women were examined after the 1st, 3rd, 6th, 12th, and 18th month during the last 3 days of the progestogen phase, where the CMA had been added to the estradiol valerate for at least 12 days. The combined estradiol-CMA therapy resulted in a significantly reduced Kupperman-index. The total serum cholesterol- and LDLC-levels were also reduced and the HDL-cholesterol and HDLC-cholesterol-quotient increased. Triglycerides, weight, blood pressure, enzymes, and other parameters were unchanged. The positively metabolic effects of estradiol valerate were not altered after the chlormadinone acetate in a sequential regime.

Twenty-four hours hormone secretion profiles of cortisol and estradiol in preterm labour.

We investigated the 24 hour hormone secretion profiles in women with preterm labour. Although estradiol secretion seems to be unaffected, we found an variable estradiol-cortisol-shift due to a cortisol increase. Cortisol circadian secretion persists in preterm labour, but maximum secretion is moved to midday. Further investigations are necessary to study the basic mechanisms underlying this process.

Naloxone stimulation test in women with hypothalamic amenorrhea: a preliminary report.

We researched the possibility of the induction of ovulation by means of chronic opioid receptor blockade in 4 women with hypothalamic amenorrhea. Daily 4 mg naloxone were given as a bolus injection intravenously. By means of continuous determination of LH, FSH, 17-beta-estradiol (E2) and progesterone as well as of sonographic folliculometry follicular growth and subsequent ovulation should have been proved. Neither we found alterations of the basal values of LH, FSH, E2 and progesterone, nor we observed a follicular growth. These results lead us to the conclusion to put a naloxone stimulation test before further therapy. In this way opioid mediated hypothalamic ovarian insufficiencies can be registered and a therapy optimum can be reached early.

[Uterine abnormality and fallopian tube damage--surgical correction in one session?]. / Uterusfehlbildung und Tubenschaden--operative Korrektur in einer Sitzung?

From 1983 to 1990 15 metroplasties were carried out at the Department of Obstetrics and Gynecology Greifswald. 11 of these operations were combined with a microsurgical tubal operation. For the diagnostics of uterus malformation and tubal damage as many methods as possible (hysterosalpingography, laparoscopy with chromotubation, hysteroscopy and sonography) should be used. A postoperative life birth rate of 62.5% shows that an operative correction of uterus malformation and tubal damage in one session is justified. Metroplasty is also indicated at primary tubal sterility with simultaneous uterus malformation. A caesarean section is not primarily indicated after metroplasty.

[Pharmacokinetics of synthetic sex steroids in hormonal contraceptives]. / Pharmakokinetik synthetischer Sexualsteroide in hormonalen Kontrazeptiva.

The pharmacokinetics of synthetic contraceptive steroids are dependent on several factors: e.g. body weight, ethnic factors, dosage of steroids, particle size, absorption, metabolism, elimination, affinity to proteins (SHBG, albumine), interaction etc. The dosage-dependent changes of pharmacokinetics progestagens and estrogens are presented. Besides, the principle of interactions between estrogens and progestagens and other drugs is discussed. Pharmacokinetic studies of oral contraceptive steroids should be designed according to the recommended modus of application. The analysis of the involved steroids, estrogen and progestagen, and of the combined pill should be carried out with regard to age, season and duration of application.

[The prognostic value of pre- and postoperative adhesion score and chromopertubation score in sterility operations on the fallopian tubes. 1. Comparison of pre- and postoperative laparoscopic findings]. / Uber den prognostischen Wert von prä- und postoperativem Adhäsions-Score (AS) und Chromopertubations-Score (CPS) bei Sterilitätsoperationen an den Tuben. 1. Mitteilung: Vergleich prä- und postoperativer Laparoskopie-Befunde.

With 97 female patients who underwent a microsurgical operation of sterility the respectively less damaged tube has been assessed during the diagnostic laparoscopy and during the second-look-laparoscopy with the help of an adhesions-score and a chromopertubation-score. On 92 tubes only one operation was carried out, whereas on five tubes the proximate operation was combined with a distal one. After all methods of operations markedly better adhesions-scores and chromopertubations-scores were achieved. The postoperative adhesions-score was in 79.4% of all cases better than preoperative original value. The chromopertubation-score was postoperatively better in 72.2% of the tubes. 25.8% were macroscopically unobtrusive during the second-look-laparoscopy. After combined distal and proximal operations on one tube favorable postoperative laparoscopic results could be achieved, too.

[The prognostic value of pre- and postoperative adhesion scores (AS) and chromopertubation scores (CPS) in tubal interventions for sterility. 2. Postoperative rate of conception in relation to pre- and postoperative laparoscopy findings in tubal interventions for sterility]. / Uber den prognostischen Wert des prä- und postoperativen Adhäsions-Scores (AS) und Chromopertubations-Scores (CPS) bei Sterilitätsoperationen an den Tuben. 2. Mitteilung: Postoperative Konzeptionsrate in Abhängigkeit von prä- und postoperativen Laparoskopiebefunden bei Sterilitätsoperationen an den Tuben.

In 97 female patients the respectively less damaged tube has been laparoscopically assessed with the help of on adhesions-score and a chromopertubation-score. The correlation to postoperative fertility has been examined. The rate of conception of patients who underwent a laparoscopic examination was 28.8%. The live birth rate was 17.5%, the rate of spontaneous abortions was 2.1% and the rate of ectopic pregnancies 9.2%. The preoperative adhesions-score doesn't allow prognostical statements, whereas the postoperative adhesions-score closely correlated with the postoperative rate of conceptions. Female patients with a preoperative partial tubal occlusion (CPS = 1) postoperatively chances of conceptions twice as high as female patients with a preoperatively total tubal occlusion (CPS = 2). A postoperative total tubal occlusion (CPS = 2) is a primary indication for in-vitro fertilization.

[Possibility of ovulation induction using naloxone in women with hypothalamic amenorrhea]. / Untersuchungen zur Möglichkeit einer Ovulationsinduktion mittels Naloxon bei Frauen mit hypothalamischer Amenorrhoe.

Within the study we treated 6 women suffering from hypothalamic amenorrhea with 4 mg naloxone intravenous daily. The duration of the study was at most 30 days. The estimation of hormonal baseline and changes occurs daily, furthermore everyday sonographic folliculometry. In 2 patients the chronic opiate receptor blockade leads to a drastic stimulation of gonadotropin secretion. One of these women (responder in Naloxone-Test) has a long standing elevation of LH and FSH resulting in an ovulation 2 days past end of the therapy. The other women (non-responder in Naloxone-Test) reaches a follicular growth till 17 mm follicle diameter following in preterm atresia during therapy. In another woman (minimal-responder in Naloxone-Test) occurs a short and weak elevation of gonadotropins without any basic stimulation of the hypothalamic-pituitary-ovary axis. The results of this study show that: 1. it's possible to discern an opioid mediated hypothalamic amenorrhea and 2. a Naloxone-Test or Naloxone-Stimulation-Test should be put before starting a therapy with opiate antagonists in hypothalamic amenorrhea.

[Experiences with labor induction at term with a PGE2 gel (Prepidil Gel) in unripe cervix]. / Erfahrungen bei der Geburtseinleitung am Termin mit einem PGE2-Gel (Prepidil-Gel) bei unreifer Zervix.

The induction of labour was started with an intracervical administration of 0.5 mg PGE2-Gel (Prepidil) in 30 gravidae at or near term with an unripe score of the cervix and for a medical indication. After excluding patients, where labour had already started subsequent to this measure, induction of labour was continued randomised with PGE2-gel intravaginal versus intravenous oxytocin. The progress of labour, the neonatal condition, and paraclinic values were examined. In 11 cases, labour had already started after the intracervical administration of PGE2. The Bishop-score of the other gravidae was improved in the mean from 2.5 +/- 1.1 to 5.5 +/- 1.7. Was the induction carried out with PGE2 vaginal, the rate of success rose to 5 of 9, and after infusion of oxytocin in 6 of 10 cases. The continued PGE2 vaginal inductions were insignificantly slower (p greater than 5%) than the inductions continued which oxytocin. The mean duration of labour was 7.7 +/- 3.4 hours in the PGE2-group and 4.5 +/- 2.6 hours in the oxytocin group. No disadvantages resulted for mother and child from the vaginal administration of PGE2. Because of the high rate of acceptance, vaginal administration of PGE2 is a suitable method for the safe induction of labour.