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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. Source

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

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. Source

Schuetz F.,University of Heidelberg | Schuetz F.,Universitatsfrauenklinik Heidelberg
Breast Care

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. Source

Goeckenjan M.,Universitatsklinikums Carl Gustav Carus Dresden | Germeyer A.,Universitatsfrauenklinik Heidelberg

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. Source

Goeckenjan M.,Universitatsfrauenklinik Heidelberg

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. Source

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