Universitatsfrauenklinik Heidelberg

Heidelberg, Germany

Universitatsfrauenklinik Heidelberg

Heidelberg, Germany
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Junkermann H.,Universitatsfrauenklinik Heidelberg
Onkologe | Year: 2017

Background: Mammography screening is partly being questioned in public. Objective: Description of advantages and disadvantages of participation in mammography screening programs. Material and methods: Analysis of international primary literature, reviews and statements of expert panels. Results: Concerning the reduction of breast cancer mortality, the established mammography screening programs achieve or surpass the results of the randomized studies on which they were based. Disadvantages, such as overdiagnosis and false positive suspicious findings, which are inherent to any early detection program, have to be balanced against this advantage. The quantitative assessment of these advantages and disadvantages requires a high level of epidemiological expertise. The majority of qualified expert panels recommend mammography screening for the age group 50–70 years. Rejection partially results from incomplete or inadequate analysis of the studies. Conclusion: Participation in mammography screening programs can be recommended for women in the appropriate age group. Individual women should be placed in a position to be able to decide on participation on the basis of the results of the programs and own preferences as much as possible. © 2017 Springer Medizin Verlag GmbH

Goeckenjan M.,Universitatsklinikums Carl Gustav Carus Dresden | Germeyer A.,Universitatsfrauenklinik Heidelberg
Gynakologe | Year: 2015

Background: Climacteric syndrome is considered a vegetative imbalance and it shows symptoms that are typical of this stage of life. The symptoms are caused by physiological adjustments to the transition from a fertile phase of life to the hormonal-vegetative continuum after the menopause. The main domain of traditional Chinese medicine (TCM) is in this area: balancing vegetative and neurohumoral dysfunctions.Aim: This review provides an outlook on the careful diagnosis of climacteric symptoms and multiple interventions provided by TCM. These treatment options may serve as an alternative to hormonal replacement.Results: The effects of ancient formulas of TCM herbal remedies are being studied in modern scientific settings. Additionally, several randomized controlled studies have focused on the effect of acupuncture — although there is debate on whether it can be evaluated with evidence-based medicine.Discussion: Different TCM treatment options such as acupuncture, phytotherapy, changes in lifestyle and nutrition, relaxation methods, and kinesiotherapy as well as an improved understanding of physiologic processes can facilitate the transition towards postmenopause for women in the Western world. © 2015, Springer-Verlag Berlin Heidelberg.

Gawlik S.,University of Heidelberg | Gawlik S.,Universitatsfrauenklinik Heidelberg | Muller M.,University of Heidelberg | Hoffmann L.,University of Heidelberg | And 6 more authors.
Archives of Women's Mental Health | Year: 2014

Depressive disorders have shown an increasing prevalence over the past decades. Growing evidence suggests that pregnancy and childbirth trigger depressive symptoms not only in women but likewise in men. This study estimates the prevalence of paternal perinatal depressiveness in a German community sample and explores its link to partnership satisfaction as well as birth-related concerns and concerns about the future. Data was gathered in a longitudinal study over the second and third trimester of their partner's pregnancy up to 6 weeks postpartum. In a two-stage screening procedure, 102 expectant fathers were assessed for symptoms of depression, anxiety, and partnership satisfaction using the Edinburgh Postnatal depression Scale (EPDS), the State/Trait Anxiety Inventory, a self-constructed questionnaire for birth concerns and the Questionnaire of Partnership. The prevalence of elevated depressive symptoms among expectant fathers was 9.8 % prenatally and 7.8 % postnatally. Prenatal relationship quality, prenatal EPDS scores, and birth concerns were significantly associated with and explained 47 % of the variance in paternal postnatal depressive symptoms. The prevalence of paternal depressive symptoms is a significant concern. Our findings point out the need for implementing awareness and screening for depressiveness in fathers in clinical routine in Germany as well as the necessity of developing a screening instrument for paternal birth-related anxiety. © 2013 Springer-Verlag Wien.

Schuetz F.,University of Heidelberg | Schuetz F.,Universitatsfrauenklinik Heidelberg
Breast Care | Year: 2011

The first procedure in primary breast cancer is usually the surgical excision of the tumor. However, a medical therapy is necessary in almost all patients to treat the systemic component of the disease. Which medical approach is recommended depends on the biology of the tumor itself. Endocrine-responsive tumors must be treated by an endocrine therapy according to their menopausal status. In HER2/neu-overexpressing tumors, the monoclonal antibody trastuzumab is part of the standard treatment in combination with chemotherapy. Hormone receptor-negative and non-HER2/neu-overexpressing tumors as well as endocrine-responsive tumors with a high proliferation index or additional risk factors must be treated with chemotherapy as well. This review article gives further information about the available agents and schedules. Copyright © 2011 S. Karger AG, Basel.

Gawlik S.,University of Heidelberg | Gawlik S.,Universitatsfrauenklinik Heidelberg | Waldeier L.,University of Heidelberg | Muller M.,University of Heidelberg | And 3 more authors.
Archives of Women's Mental Health | Year: 2013

There is a high prevalence of depression in Germany and all over the world. Maternal depressive symptoms during pregnancy have been shown in some studies to be associated with an increased risk of preterm birth and low birth weight. The influence of maternal depressive symptoms during pregnancy on preterm delivery and fetal birth weight was investigated in a prospective single-centre study. A sample of 273 healthy pregnant women was assessed for symptoms of antepartum depression. Symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ). Symptoms of anxiety were assessed using the State/Trait Anxiety Inventory. Patients who scored above the cutoff were contacted by phone for a Structured Clinical Diagnostic interview. Neonatal measurements were obtained from the birth registry of the Department of Obstetrics. Baseline data were assessed with a self-styled data sheet. Prevalence of elevated depressive symptoms was 13.2 % when measured with the EPDS and 8.4 % with the PHQ. According to DSM-IV criteria, only four (EPDS) respective two (PHQ-D) of these patients could be diagnosed with a depressive disorder and ten (EPDS) respective seven (PHQ) with an anxiety disorder. There was no significant influence on preterm birth or birth weight. Maternal depressive symptoms are self-reported. Elevated subclinical symptoms of depression and anxiety during pregnancy are common. However, this study showed no evidence that these symptoms are associated with adverse pregnancy outcome. © 2012 Springer-Verlag Wien.

As only one third of perimenopausal and postmenopausal women suffer from severe climacteric symptoms and the duration may vary substantially, treatment is not a general issue for this age group. However, prevention of age-related conditions is useful for every woman. Complementary and alternative medicine offers many options for self care which are suitable for prevention as well as for alleviating various troublesome symptoms. As non-pharmacological approaches have no risk of drug-drug interactions and a favorable risk profile in general they may even be tried if sound evidence is incomplete. In contrast biologically based treatment should be administered under physician guidance and monitored because there is a general potential for drug-drug interactions and evidence for long-term application is almost lacking. Moreover in cases of supplementary use additional awareness of quality problems due to the regulatory status is needed. Individual procedures should be used in a stepwise manner taking symptom patterns, individual risks, possibilities and experiences into account. © 2013 Springer-Verlag Berlin Heidelberg.

Goeckenjan M.,Universitatsfrauenklinik Heidelberg
Gynakologe | Year: 2012

Positive and negative lifestyle factors can affect the outcome of pregnancy. In epidemiological and case-control studies, it was clearlyshown that the premature birth rate increasesmarginally but significantly in the presence of negative lifestyle factors. Specificaspects such as social inequality, individualcoping strategies for severe life events, and the theory of summation of the individual factors are discussed. For antenatal, subpartal, and postpartal care, gynecologists should keep in mind the knowledge of different psychological and social factors that increase the risk for preterm delivery. These factors should be routinely addressed when taking the medical history and during follow-up visits. It is important to stress the potentially negative effects of risky lifestyle factors and to promote positive life aspects as multidisciplinary support in problematic social situations, regular physical exercise, and promotion of coping strategies. This counseling is one of the important primary and secondary preventive key issues in the context of preterm delivery, although the effectiveness of those interventions has not been shown. © Urban & Vogel 2012.

Frank-Herrmann P.,Universitatsfrauenklinik Heidelberg | Strowitzki T.,Universitatsfrauenklinik Heidelberg
Gynakologe | Year: 2012

Gonadal dysgenesis (GD) belongs to the group of disorders/differences of sex development (DSD) and is based on an inborn faulty or missing development of the gonads. In complete loss of function or if no testosterone and no testicular anti-mullerian hormone (AMH) is produced, streak gonads and a female phenotype (usually with uterus) arise even in cases of a male karyogram. Leading symptom is primary, hypergonadotropic amenorrhea with normal body height and usually without associated anomalies, with the exception of the Turner syndrome and other rare syndromes. A partial loss of function of the gonads leads to premature ovarian failure (POF) in 46,XX GD and to ambiguous external genitalia in 46,XY GD. In cases with Y in the karyogram, the gonads must be removed due to the risk of up to 30% of malignant development. Associated anomalies, adrenocortical insufficiency and short stature necessitate an interdisciplinary approach, hormone therapy for induction of breast development and prevention of osteoporosis should be initiated by gynecologists. © Springer-Verlag 2012.

Fluhr H.,Universitatsfrauenklinik Heidelberg | Sohn C.,Universitatsfrauenklinik Heidelberg
Gynakologische Endokrinologie | Year: 2014

Trend: Especially in industrial countries, the number of women having their children after the age of 40 years is increasing for a number of reasons. Risk and risk factors: This development is accompanied by an increased rate of miscarriages, ectopic pregnancies, and stillbirths in comparison to younger women. It is still a matter of debate whether the moderately elevated risk for hypertensive pregnancy disorders and gestational diabetes is solely caused by maternal age or due to pre-existing medical conditions. © 2013 Springer-Verlag Berlin Heidelberg.

Frank-Herrmann P.,Universitatsfrauenklinik Heidelberg | Strowitzki T.,Universitatsfrauenklinik Heidelberg
Gynakologische Endokrinologie | Year: 2016

Background: Couples wishing to conceive try to optimize the chances of becoming pregnant by timing intercourse to fall on those days which they think are fertile; however, the fertile window exhibits extensive variation, even in relatively regular cycles. Women can acquire qualified information concerning their current state of fertility by cycle observation using natural family planning (NFP) methods, also called fertility awareness methods. Objective: The aim of this review is to illuminate the current state of the art on optimizing conception with the help of self-observation of cycle parameters. Material and methods: Scientific publications (peer reviewed) concerning the correlation of self-observed cycle parameters with the day of ovulation, the probability of conception within the self-observed fertile window and time to pregnancy studies including timing intercourse. The data are predominantly derived from prospective cohort studies of several European and American databases. Results: According to conception probability analyses women are able to identify the days when intercourse is most likely to result in pregnancy by observing cervical secretions (externally at the vulva). There is a close correlation between self-observed parameters and ovulation in the cycle. The results of the time-to-pregnancy studies suggest that pregnancy rates are better in fertile women as well as in subfertile women when self-observation of the fertile window and fertility-focused intercourse are applied. Conclusion: Previous results justify the integration of fertility awareness methods into the management of subfertility. Cycle observation is a non-invasive, safe and cost-effective first-line method; nevertheless, further randomized controlled studies are necessary. © 2016, Springer-Verlag Berlin Heidelberg.

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