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)

The emergency contraceptive pill, also called the morning-after pill, is an emergency contraceptive. It can be used if the usual contraceptive method has failed and if there has been unprotected sexual intercourse. If this emergency occurs, you should know how the emergency contraceptive pill works and what you should bear in mind when taking it so that an unwanted pregnancy is prevented.

How does the morning-after pill work?

The principle of the emergency pill is to delay ovulation so that the egg is not fertilised in the first place and pregnancy cannot occur. Essentially, the emergency contraceptive pills have the following effect:

• They postpone ovulation.
• Therefore, the fertile window is postponed and thus it can prevent pregnancy from occurring, provided that ovulation and fertilisation have not yet occurred.

The emergency pills with the active ingredient Levonorgestrel (e.g. Levonoraristo®) or with the active ingredient Ulipristal Acetate (e.g. Ulipristal Aristo®) postpone the time of ovulation by about five days. This prevents sperm that entered the body during the contraceptive range from meeting a fertilisable egg (sperm can only survive in the female body for about 5 days).

However, if the egg has already been released at the time of the contraceptive range, the morning-after pill will no longer work. So, the sooner you react, the more likely it is that you will be able to prevent an unwanted pregnancy.

The time at which you take the pill is therefore crucial. Read "When can the emergency pill be taken?" below.

If the morning-after pill has been effective, your period will usually start at the normal time. However, menstruation may start a few days earlier or even later. There is no bleeding immediately after taking the emergency pill, as it does not cause an abortion, but only postpones the time of ovulation.

What should you bear in mind when taking the morning-after pill?

The morning-after pill is an emergency contraceptive and not a regular contraceptive method. This means that its use should be an exception. Repeated use in case of another contraceptive range is not recommended.

The "morning-after pill" does not offer you any protection for the rest of your cycle. Until your next period starts, you should therefore definitely use a contraceptive method that uses a physical barrier, such as a condom. This also applies to women who regularly use a hormonal contraceptive method, such as the birth control pill. You should continue to take the Birth control pill as usual after using the "morning-after pill".

The emergency pill is taken unchewed with a little water, regardless of meals. If you vomit within three hours of taking the pill, you should take another "morning-after pill" with the identical active ingredient.

Tip: Are you looking for more information on the contraceptive pill or other topics related to women's health? Then take a look at our "Gynaecology" advice section.

When can the emergency pill be taken?

As a general rule, the sooner you take the emergency pill after unprotected sex, the better. You should take a preparation with the active ingredient Levonorgestrel as soon as possible, within the first twelve hours after the contraceptive range and within a maximum of 72 hours (3 days) after the unprotected sexual intercourse.

For an emergency pill or "morning-after pill" with the active ingredient Ulipristal Acetate, this also applies: the sooner, the better. However, you should take this emergency pill at the latest 120 hours, i.e. five days, after unprotected sexual intercourse.

Is the morning-after pill available on prescription?

The morning-after pill has been available without a prescription in pharmacies since 2015. Here, the customer should be prepared for an intensive consultation, as it is important to clarify many facts before taking the pill. In exceptional cases, a third person can procure the "morning-after pill" on behalf of the customer at the pharmacy, provided they attend the counselling session at the pharmacy and are able to answer the questions, for example about the contraceptive method usually used and any previous illnesses. Click here to go to the pharmacy finder in your area.

How safe is the morning-after pill?

Even the morning-after pill cannot offer 100 per cent certainty to prevent an unwanted pregnancy. For example, if ovulation has already taken place, the pill can no longer work, and sperm meeting the fertilisable egg is possible.

If your next menstrual period is more than five days late or if your bleeding is unusually heavy or light, you should take a pregnancy test and see your gynaecologist if necessary.

What side effects can the morning-after pill cause?

In some circumstances, the "morning after pill" can cause the following side effects: Nausea, some irregular bleeding until your next period, pain in the lower abdomen, tiredness, headache, vomiting, altered periods (late or earlier than normal), irregular bleeding or spotting, tenderness of the chest, diarrhoea or dizziness, abdominal pain, rash, hives (urticaria), itching (pruritus), swelling of the face, pelvic pain, painful period.

If your period is more than five days late or unusually light or heavy, you should see your doctor as soon as possible. As the emergency pill may contain Lactose Monohydrate as an ingredient, intolerance symptoms may occur if you suffer from such an intolerance. In this case, you should consult a doctor before taking the pill.

Who should not take the morning-after pill?

It is not advisable to take the morning-after pill if any of the following statements regarding your medical history apply:

• You have a small intestine disease that prevents the absorption of an active drug ingredient.
• You suffer from liver disease.
• You have already had an ectopic pregnancy (abdominal pregnancy).
• You have already suffered from salpingitis (inflammation of the fallopian tubes).

In these cases, consult your doctor before taking this medicine.

You should also not take the emergency pill, or only take it with restrictions if the following applies:

• You are already known to be pregnant.
• You are currently breastfeeding. In this case, you should not breastfeed for eight hours after taking the emergency pill with the active substance Levonorgestrel. After taking the emergency pill with Ulipristal Acetate, a breastfeeding break of seven days is required.

Does the emergency pill work if I take other medicines?

The effect of the emergency pill can be affected by taking some other medicines. For example, in the case of the active ingredients Levonorgestrel as well as Ulipristal Acetate, the effect may be impaired if you have taken any of the following medicines during the last four months:

• Barbiturates or other medicines to treat epilepsy, for example, Primidone, Phenytoin and Carbamazepine.
• Medicines for tuberculosis, for example, Rifampicin or Rifabutin
• Medicines for HIV, for example Ritonavir or Efavirenz
• Medicines for fungal infections, for example, Griseofulvin.
• Herbal remedies with St. John's wort (Hypericum perforatum) as an ingredient.

Therefore, during the counselling interview, always state all the medicines you are taking or have taken in the last four weeks.

Vaginal fungus is an infectious disease that is widespread and affects many women at least once in their lives. The positive news is that it is usually easily treatable. Fungal infection can occur when the vaginal flora becomes unbalanced. Vaginal fungus is usually caused by yeast fungi. Typical symptoms are itching and burning of the vagina as well as a whitish, crumbly discharge. However, with the right preparations, vaginal fungal infections can be treated easily and effectively.

Vaginal fungus: these symptoms are typical

A fungal infection of the vagina is usually harmless. However, it often causes discomfort that affects physical and mental well-being, as well as sexuality. In addition, it should be noted that the infection can be transmitted through close physical contact. The following signs are typical of vaginal fungus:z:

• severe itching and burning in the vagina as well as in the external genital area.
• swelling and reddening of the vulva
• whitish coatings in the area of the labia and clitoris
• yellowish-white and crumbly discharge that is odorless
• pain during urination
• pain during sexual intercourse
• Nodules on the skin surface of the intimate area

If the discharge from the vagina smells unpleasant (a so-called "fishy smell"), the cause is often not a vaginal fungus, but a bacterial infection (bacterial vaginosis). This must be treated by a doctor in any case.

What are the causes?

Fungal infections of the genital area can usually be attributed to the yeast Candida albicans which colonizes a wide variety of mucous membranes in small numbers in humans and is part of the normal flora. In combination with other microorganisms such as lactic acid bacteria and a well-functioning immune system, the yeast fungus does not trigger any symptoms. However, when the healthy flora is disturbed and the number of lactic acid bacteria decreases, the pH increases (> 4.5) and the flora becomes less acidic. A normally acidic pH inhibits the growth of bacteria and fungi in the vagina. Once the ph value gets out of balance, the harmless Candida fungi are able to multiply.

The natural vaginal environment can be disturbed by:

• too intensive, but also a lack of or incorrect intimate hygiene.
• stress or psychological strain
• tight clothing or synthetic underwear
• a weakened immune system
• certain underlying diseases such as diabetes mellitus
• hormonal changes, especially during pregnancy or menopause
• taking medications such as antibiotics, immunosuppressants, cortisone or chemotherapeutic agents
• fungal transmission through unprotected sexual intercourse

 

What are the options for vaginal mycosis treatment?

Women who suffer from a vaginal fungal infection can usually treat it well themselves. So-called antifungals, which are presented in the form of suppositories, tablets or ointment, inhibit the growth of the vaginal fungus.

For optimal control of the infection, a combination of external and internal application is helpful. For local treatment, an over-the-counter vaginal therapeutic agent such as Clotrimazol Aristo® 2% vaginal cream can be used. Affected persons apply this deep into the vagina once a day with the aid of an enclosed applicator. In addition, the cream can also be applied to the external genitalia.

The best time for application is in the evening before going to bed, because this allows the antifungal agent to remain in the vagina as long as possible to combat vaginal mycosis. The duration of application is also important. If treatment is too short, a new infection can occur. Therefore, even if symptoms improve, people affected should always adhere to the prescribed duration of treatment. Always read the package insert and consult your doctor or pharmacist.

If partners also suffer from symptoms, the treatment should be carried out as couple therapy to avoid infections and future infections.

If the symptoms of the fungal infection are particularly severe and cannot be reduced even by local therapy, you should consult a gynecologist. Systemic use of an antimycotic in tablet or capsule form may be necessary to adequately combat the vaginal fungus.

Caution: Treatment with home remedies such as yogurt, vinegar or garlic must be avoided at all cost! Although there are persistent rumors that the lactic acid bacteria in yogurt in particular ensure a healthy vaginal environment, these can actually harm the vaginal flora and additionally promote fungal growth.

Tips for the prevention of vaginal fungus

You can prevent fungal infections of the vagina with a few simple rules:

• Clean the vagina only with warm water and avoid soap or intimate lotions that may affect the pH.
• Refrain from wearing synthetic underwear. It can cause a buildup of heat and moisture, which promotes fungal growth. Instead, wear underwear made of breathable fabrics such as cotton.
• Damp underwear - for example due to sweating during sports - or wet swimwear should be changed quickly.
• Do not use plastic-coated or even perfumed pads or panty liners during menstruation. These can irritate the sensitive mucous membrane and promote the growth of vaginal fungus.
• Women who suffer from sensitive vaginal mucous membranes should avoid using tampons. These can dry out the mucous membranes.
• When using paper after going to the toilet, it is recommended to always wipe from the front (vaginal entrance) to the back (anus). Conversely, pathogens from the intestines can enter the vagina and cause a change in the environment there.
• Eat as little sugary foods as possible. Fungi feed on sugar, which is why it favors their growth. A balanced, healthy diet reduces the risk of vaginal fungus.
• Diabetic women should regularly check their blood sugar. If the sugar level is elevated, this can lead to a proliferation of yeast fungi in the vagina.
• If vaginal fungus occurs more frequently, probiotic and prebiotic preparations from the pharmacy can provide support.

 

Vaginal fungus during pregnancy

Due to the hormonal changes during pregnancy and breastfeeding, the risk of vaginal fungal infection sometimes increases. If pregnant or breastfeeding women are affected by vaginal fungus, they should definitely see a gynecologist. Not all of the common medicines are also approved for pregnant women, as in some cases it is unclear whether they could harm the unborn baby. In nursing mothers, harmful agents could be transferred to the baby through breast milk.

However, with proper treatment, vaginal fungus does not pose a risk to the baby in pregnant or breastfeeding women. Local medications against vaginal mycosis such as creams and vaginal tablets can often be used without hesitation, but orally applied active ingredients often cannot.

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.

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.