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Schwerpunkt 40 Jahre Pille Familienplanungs- RUNDBRIEF Ausgabe Juni 2000 Nr. 1/2 Inhalt Einleitung 3 Hormonelle Kontrazeption: 40 Jahre Pille 4 – Entwicklungen, die zur Herstellung der Pille führten 4 – Weiterentwicklung der Pille von 1960 bis heute 8 – Die gesellschaftspolitische Bedeutung der Pille 12 – Hormonelle Kontrazeptiva heute in Deutschland 14 – Anwendung der hormonalen Kontrazeptiva nach dem heutigen 17 Wissensstand – Wechselwirkungen 24 Anhang (Ende des Dokuments) – Medikamente, die die Sicherheit A1 der Pille beeinträchtigen können – Liste hormonaler Kontrazeptiva A2 IPPF Informationen – Gestagen-Implantate 27 Forum – Vorgeburtliche Untersuchungen: 28 Möglichkeiten und Grenzen Veranstaltungskalender 29 Stichwortverzeichnis 1999 31 Deutsche Gesellschaft für Familienplanung, Sexualpädagogik und Sexualberatung e.V., Bundesverband e.V., Sexualberatung und Sexualpädagogik für Familienplanung, Gesellschaft Deutsche Stresemannallee 3, 60596 Frankfurt am Main, Telefon 069/639002 Impressum: 2000 Herausgeber: PRO FAMILIA-Bundesverband Redaktion: Dr. med. Ruth Eichmann, Frankfurt am Main Dr. med. Ines Thonke, Frankfurt am Main Dr. med. Jutta Walter, Heidelberg Anschrift: PRO FAMILIA-Bundesverband Stresemannallee 3 60596 Frankfurt am Main Gefördert von der Bundeszentrale für gesundheitliche Aufklärung (BZgA). Familienplanungs- RUNDBRIEF Juni 2000 Nr. 1/2 3 In der Rubrik „HINWEISE“ wird wie üblich in dem Einleitung jeweiligen Familienplanungs-Rundbrief Aktuelles aus der Medizin zu finden sein, das von besonde- rer Bedeutung für die Beratungspraxis ist. Lite- raturneuerscheinungen und Ankündigungen von Veranstaltungen runden die einzelnen Familien- planungs-Rundbriefe ab. In Übereinstimmung mit der gewohnten Gliede- rung befasst sich der erste Familienplanungs- Beibehalten wird ferner der Abschnitt, in welchem Rundbrief des Jahres mit einer Vorschau auf die aktuelle Informationen der IPPF (International im laufenden Jahr geplanten Schwerpunktthe- Planned Parenthood Federation) aufgenommen men. Dafür vorgesehen sind: werden, soweit sie medizinischen Inhalts sind. Auf die Rubrik „FORUM“ mit Informationen aus 1. Hormonelle Kontrazeption: 40 Jahre Pil- den Beratungsstellen und den Familienplanungs- le. zentren (FPZ) weist die Redaktion nachdrücklich (Doppelheft Nr. 1 und Nr.2) hin. Sie ist vorgesehen für Beiträge aus dem 2. Künstliche Befruchtung. Aktueller Stand Verband und kann durch die Vorstellung von in Deutschland und im Ausland. (Nr. 3) Diskussionspapieren, Projekten oder auch Erfah- 3. Menstruation. (Nr. 4) rungen eine sinnvolle Möglichkeit darstellen, die Zu diesen Schwerpunktthemen seien folgende innerverbandliche Diskussion und Kommunikati- Bemerkungen zusammengefasst. on im Bereich Familienplanung zu verbessern. Für das Doppelheft 1/2 2000 liegt bereits ein Vor 40 Jahren wurde die erste Pille in den USA Bericht aus Baden-Württemberg vor und zwar zugelassen. Die hormonelle Kontrazeption spielt zum Thema „Vorgeburtliche Untersuchungen, seit dem eine bedeutende Rolle in der Schwan- Möglichkeiten und Grenzen“. Mit diesem Bericht gerschaftsverhütung. Auch wenn sich diese Me- soll auch u.a. die Diskussion über die vorgeburtli- thode über viele Jahre bewährt hat, sind wir doch chen Untersuchungen angeregt werden. gehalten, das Thema mit Blick auf die Bedürfnis- se von Frauen immer wieder zu überprüfen und Am Ende von Heft 1/2 2000 ist das Stichwortver- neue Erkenntnisse im Familienplanungs- zeichnis der Familienplanungs-Rundbriefe 1 bis Rundbrief kontinuierlich aufzunehmen. Wir sehen 5/1999 zusammengestellt. den 40. Geburtstag als geeigneten Zeitpunkt an, dem Verband ein umfangreiches Übersichtsheft zum Thema zur Verfügung zu stellen. Neben einem geschichtlichen Überblick über die Ent- wicklung der hormonellen Kontrazeption wird die gesellschaftspolitische Bedeutung der Pille be- leuchtet und auf die aktuellen Erkenntnisse ein- gegangen, die für die Verordnung der Pille wich- tig sind. Ausnahmsweise entfällt in diesem Dop- pelheft der Abschnitt HINWEISE. Es gibt ständig neue Forschungsergebnisse in der Reproduktionsmedizin. Auch die Richtlinien für die Praxis der künstlichen Befruchtung erfah- ren aus unterschiedlichen Gründen Änderungen bzw. werden in der Öffentlichkeit kontrovers dis- kutiert. Anfragen zu diesen Themen erreichen des öfteren die Beratungsstellen der PRO FAMI- LIA. In Heft 3 des Familienplanungs-Rundbriefes wird deshalb über den gegenwärtigen Stand der künstlichen Befruchtung in Deutschland berichtet und auf Unterschiede zu internationalen Vorge- hensweisen eingegangen. Schließlich wird sich Heft 4/2000 mit dem Thema „Menstruation“ befassen und insbesondere auf Störungen und ihre Behandlung eingehen. Familienplanungs- 4 Juni 2000 Nr. 1/2 RUNDBRIEF Nach dem derzeitigen Wissensstand sind die Hormonelle ältesten Beschreibungen von Verhütungsmitteln auf ägyptischen Papyri gefunden worden, deren Anfertigung mehr als 4000 Jahre zurückliegt. Kontrazeption Diese Verhütungsmittel sind zum einen aus Pflanzen gewonnene Produkte und zum anderen 40 Jahre Pille mechanische Barrieren. In beiden Fällen wurde das Verhütungsmittel in die Scheide eingeführt. Darüber hinaus erwähnen spätere Quellen z.B. Fällt das Jubiläum „40 Jahre Pille“ in das Jahr spezifische Verhaltensweisen, wie das Tragen 2000 oder 2001? Vor diese Frage sah sich das von Amuletten oder auch die Verabreichung be- Redaktionsteam bei der Planung des Famili- sonderer Getränke und Speisen zum Zwecke der enplanungs-Rundbriefes gestellt, als eine Ent- Schwangerschaftsverhütung. scheidung fällig war, wann ein zu diesem Jubi- läum vorgesehenes Referat über hormonelle Kontrazeption erscheinen sollte. Entschieden Beginn der Hormonforschung wurde zugunsten des Jahres 2000 und für einen Beitrag im Doppelheft 1/2 des Familienplanungs- Der Gedanke eines hormonellen Verhütungsmit- Rundbriefes. Das erste hormonelle Verhütungs- tels konnte erst aufkommen, als Anfang des 20. mittel, „die Pille“, wurde nämlich unter dem Mar- Jahrhunderts die Grundlagen der biologischen kennamen „Enovid“ am 11. Mai 1960 von der und insbesondere der hormonellen Abläufe der FDA (Food and Drug Administration) in den USA Fortpflanzung weitgehend geklärt waren. Bereits zugelassen. Ein Jahr später, am 1. Juni 1961, Mitte des 19. Jahrhunderts sind Ansätze einer kam „Anovlar“, die erste europäische Pille, in wissenschaftlichen Forschung über die Fortpflan- Deutschland auf den Markt. zung zu verzeichnen. Theodor Bischoff in Deutschland und Felix Pouchet in Frankreich Am Anfang dieses Referats wird die geschichtli- erkannten fast gleichzeitig, dass die Eierstöcke che Seite von Forschung und Entwicklung zum der Frau in regelmäßigen Abständen ein Ei her- Thema hormonelle Empfängnisverhütung umris- vorbringen. Allerdings irrten sie sich im Zeitpunkt sen bis zum Zeitpunkt der erfolgreichen Herstel- dieses sogenannten Eisprungs, den sie während lung der ersten „Pille“. Daran anschließend wer- der Menstruation vermuteten. den die Weiterentwicklungen behandelt, die die- ses Medikament von seinen Anfängen bis heute Anfänge der Hormonforschung im weitesten Sin- erfahren hat. Nicht unerwähnt bleiben die umwäl- ne können Emil Knauer, einem Wiener Gynäko- zenden gesellschaftlichen Auseinandersetzun- logen, zugeschrieben werden. Ihm gelang es gen, die durch die Einführung der „Pille“ ausge- 1890 durch Transplantation von Eierstöcken ge- löst wurden. schlechtsreifer Nagetiere auf nichtgeschlechts- reife Weibchen, bei den Empfängertieren Merk- Ein weiterer Teil des Referats behandelt die ak- male der Geschlechtsreife hervorzurufen. Eine tuellen Erkenntnisse, die bei der Verordnung genaue Erklärung seiner Versuchsergebnisse hormoneller Kontrazeptiva von Bedeutung sind konnte Knauer nicht geben. Er vermutete, dass und verweist auf nichtkontrazeptive Indikationen derartige „feminisierende Veränderungen“ durch der „Pille“. Außerdem wurde eine aktualisierte ein „Fruchtbarkeitsferment“ ausgelöst wurden, Liste mit Medikamenten erstellt, die die Sicherheit das mit einem noch unbekannten Sekret der Ei- der Pille beeinträchtigen. erstöcke in Verbindung zu bringen sei. Wie wei- Im Anhang findet sich eine Liste der gegenwärtig terführende Forschungen zeigten, produzieren in Deutschland auf dem Markt erhältlichen Präpa- außer den Eierstöcken auch andere Drüsen des rate. Organismus chemische Stoffe, die als Boten- stoffe über den Blutkreislauf zu Zielorganen ge- langen und dort bestimmte Wirkungen auslösen. Seit dem Jahre 1905 werden solche Botenstoffe Entwicklungen, die zur Herstel- unter dem Sammelnamen „Hormone“ zusam- lung der Pille führten. mengefasst. Diese Bezeichnung ist abgeleitet von dem griechischen Wort „horman“ für „veran- Seit eh und je versuchten die Menschen, Mittel lassen“ oder „Aktivität anregen“. und Wege zu ersinnen, um einerseits eine Schwangerschaft zu verhüten und andererseits Einen weiteren Schritt zur Klärung der Fortpflan- eine Schwangerschaft herbeizuführen. zungsprozesse vollzog 1921 der Arzt und Phy- Familienplanungs-Rundbrief 2000 Nr. 1/2 Familienplanungs- RUNDBRIEF Juni 2000 Nr. 1/2 5 siologe Ludwig Haberlandt aus Innsbruck. Er nen verhindere, sobald ein Ei befruchtet sei. Also pflanzte den Eierstock eines trächtigen Tieres könne eine schwangere Frau nicht noch einmal einem nichtträchtigen Tier ein, wonach er ein schwanger werden. An Tierexperimenten wies unmittelbares Aussetzen des Eisprungs beo- Haberlandt nach, dass nach Verpflanzung von bachtete. Eierstöcken trächtiger Kaninchen und Meer- schweinchen auf entsprechende nichtträchtige Schließlich stellten 1928 Georg W. Corner jr. und Tiere, die Empfängertiere nicht schwanger
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