You have never been to an OB-GYN? You would like to avoid becoming pregnant unintentionally? You have questions regarding contraception? You would like to get vaccinated against cervical cancer?

Then you should come to my teenager clinic. There, I will answer all your questions regarding sexuality, vaccination, sex, menstrual pain etc. Your friend or your mother is more than welcome to join you for your appointment. FYI: everything we talk about is confidential, also in front of your parents.

 

There is almost no other country that offers as many choices for contraception as Germany. But which one is the right one for me? The answer to this question can be found during contraception consultation that provides you with detailed explanations on all possible options. Here, it is not only important to balance pros and cons, but to decide which contraception fits to each woman.

»The Pill«

There is a great variety of “pills”, but all have one thing in common: they contain a progestin that suppresses the ovulation and an estrogen that stabilizes the bleeding. There are different kinds of gestagen that have different effects (e.g. on skin, hair), as well as more potent ethinylestradiol compared to the close to nature estradiol. Every single woman’s needs determine which pill is the best choice for her.

»Mini Pill« (gestagen only)

There is only one contraceptive progestin-only pill. It suppresses the ovulation and is therefore a safe contraceptive but does not contain estrogen, which is used for stabilization of bleeding in combined pills. However, estrogen is responsible for the risk of thrombosis in combined pills, therefore the mini pill can also be used by patients with a high risk for thrombosis.

Contraceptive vaginal ring (e.g. NuvaRing®)

Contraceptive vaginal rings contain similar hormones as combined pills, however, these are constantly absorbed by the vaginal mucosa. Thus, the patient does not have to remember a daily application, the ring only has to be changed once a month.

Contraceptive skin patch (e.g. Evra®)

The contraceptive skin patch contains similar hormones as combined pills. It has to be changed weekly and therefore does not require daily preoccupation with taking a pill.

Three-month injection (e.g. Depo-Clinovir®)

This depot injection contains a progestin that suppresses the ovulation and is hence very safe. It is applied every three months. However, the ovarian function can be suppressed so intensely, that the woman has very low concentrations of estradiol left in her blood. This increases the risk for osteoporosis which is why the injection should not be used longer than two years.

Contraceptive implant (e.g. Implanon®)

The contraceptive implant contains a progestin and is implanted under the skin of the upper arm. It releases the hormone continuously for three years and thereby suppresses the ovulation reliably.

Copper IUD (various products with use of 5-10 years)

The copper IUD (loop) is a very safe, hormone-free way of contraception. It is inserted in the uterus and releases copper ions, which prevent sperms from ascension into the uterus for at least 5 years. Some IUDs are also approved for 10 years. A disadvantage of copper IUDs is the increase of menstrual bleeding and pain.

Hormonal IUD (Mirena®, Kyleena®)

The hormonal IUD is inserted in the uterus and releases a hormone for 5 years. This causes a thinning of the uterus mucosa and a decrease of menstrual bleeding and often pain. The hormone prevents the sperms from ascending into the uterus.

Copper IUD (Gynefix®)

The copper IUD (chain) is an alternative to the copper loop. It is fixed through a knot that is implanted into the uterus muscle. According to a big study, the side effects (bleeding, pain) are comparable to the ones of a copper loop. The risk of perforating the uterus is four times higher, the risk of a pregnancy doubled compared to a copper loop.

You can find more information here:

https://www.youtube.com/watch?v=yY2mLtnebuY

Your menstrual cycle is irregular? You have menstrual pain or irregular bleedings? You suffer from skin- or hair alterations or acne? Various hormonal disorders, starting from thyroid dysfunction (see thyroid disorders), elevated male hormones (see PCO-Syndrome) or a prolactinoma can be the cause for this. A detailed interview, as well as special examinations will help find the cause for the majority of problems. Subsequently, I can present the best options for therapy and choose the right one with you.

Thyroid disorders are among the most common disorders of the hormonal system. Usually, the problems are caused by a thyroid hypofunction. This can be due to an iodine deficiency or due to inflammatory processes in the thyroid. I will clarify the possible causes in the practice and will examine the thyroid with high-resolution sonography and color duplex sonography (analysis of blood flow). Additionally, I can advise you in the interaction of thyroid disorders with family planning, as well as the therapy of thyroid disorders during pregnancy. For further examinations like scintigraphy, biopsy or thyroid surgery, I will transfer you to specialized colleagues.

PCO syndrome is a hormonal disorder that leads to an overproduction of male hormones, usually from the ovaries. For the diagnosis of a PCO syndrome, 2 of the following 3 criteria have to be fulfilled:

  1. Menstrual cycle abnormalities (prolonged cycles) or amenorrhea (absence of menstrual bleeding)
  2. Signs of elevated male hormones (e.g. acne, loss of hair) or proof of elevated levels of male hormones in the blood
  3. Ovaries with increased follicle production (more than 12)

The consequences of elevated male hormones can be acne, thinning of the scalp hair, loss of hair, growth of facial hair, as well as menstrual cycle abnormalities. Moreover, women with PCO syndrome suffer from diabetes more often. The therapy is dependent from the specific symptoms, as well as from the patient’s plans. If there is a wish for children, a light stimulation treatment can be the road to success.

 

“We have used contraceptives for years and now it does not work with a pregnancy”, this, or something similar, is how many couples start talking about the problem. But when does it even become a “problem”? From studies we know that the chance of a pregnancy for a healthy couple is 25% per cycle. After 6 months, an average of over 50% is pregnant – if everything is fine.

At the same time, fertility decreases with age. That is why, with increasing age, possible disturbing factors should be eliminated. These could be hormonal reasons, as well as a closure of the tubes. Factors on the male side should be examined, too. Additionally, research shows that various micronutrients increase the chance of a pregnancy.

Ideally, patients with a wish to have a child sign up together with their partner to plan all future steps. Please bring all results of previous examinations to your appointment.

When we finally have all relevant results, I will be able to plan further steps with you. Here, it is especially important to me to foreground your wishes and plans.

Pregnancy is one of the most fascinating moments in a woman’s and couple’s life. In most of the cases, a pregnancy is medically uncomplicated. In my practice, I perform all screenings based on the maternity guidelines, complemented by some meaningful examinations that have not been included in the guidelines, yet.

Toxoplasmosis

Toxoplasmosis is transmitted through unwashed lettuce or cat feces. It manifests through unspecific symptoms that are similar to a cold, often in combination with lymph node swelling. About half of the German population has gone through a toxoplasmosis infection and is protected against it. During pregnancy, toxoplasmosis can harm the child, as long as the infection is not detected and treated. That is why we recommend every pregnant woman to undergo a screening to evaluate the immune status.

Parvovirus B19 (fifth disease)

A parvovirus B19 infection, often known as fifth disease of childhood, manifests without symptoms or cold-like symptoms. Only 20% of patients develop the characteristic skin rash. Around 60-70% of all pregnant women are immune against the disease. However, since an infection during pregnancy can harm the child, we recommend a screening at the beginning of pregnancy, especially if the woman is in contact with children.

Cytomegalic inclusion disease

Cytomegalic inclusion disease is also among the common infections during pregnancy. For the woman, an infection usually occurs without symptoms. However, it can cause harm to the child. Luckily, only a small number of children of infected women suffer from disabilities. If you want to know whether you are immune against the virus, you can do a screening.

Cervix measurement

The maternity guidelines require a manual examination of the cervix. Studies show that a measurement of cervical length is even more accurate. That is why I am measuring it in every pregnancy check-up.

Oral Glucose Tolerance Test (OGTT)

Around 5% of all pregnant women suffer from gestational diabetes. The disease can manifest itself through an increased weight gain or growth of the child. That is why it is important to detect elevated blood glucose levels in pregnant women early.

B streptococcus smear

An infection with B streps is initially not dangerous for the woman. However, during birth, the bacteria can be transmitted to the child and cause severe infections. This is why I recommend conducting a B streptococcus smear in the last trimester. If it turns out to be positive, antibiotics are administered during birth to protect the child from an infection.

3D ultrasound

I give my best during the pregnancy check-ups to take 3D pictures of your baby, which I will be happy to give to you.

I have summarized a lot of information all around pregnancy in my book called “Der Schwangerschaftsratgeber”.

https://www.amazon.de/Schwangerschaftsratgeber-Prof-Dr-Kai-B%C3%BChling/dp/B00FRLT8UA

Starting from week 9+0

Non-invasive prenatal testing (NIPT)

By now, it is possible to test the presence of chromosomal aberrations with almost 100% certainty with a simple blood-draw of the pregnant woman. The benefits, as well as the boundaries of the testing, are explained during a special consultation.

Between 11+0 and 13+6 weeks (preferably 13+2 weeks)

First trimester screening

Another possible examination, which is not included in the maternity guidelines yet, is the screening of the so-called nuchal fold (NT, Nuchal translucency scan) using ultrasound. For reliable results, the scan has to take place exactly between the 11th and before the end of the 14th week. From the combination of the woman’s age, the gestational age and the scan results, an individual risk for the presence of a trisomy 21, the so-called “Down syndrome”, can be calculated. Furthermore, markers associated with heart malformations can be detected during the examination, which is why it also makes sense after having completed a NIPT.

Between 18+0 and 22+0 weeks

Organ ultrasound (“fine diagnosis”, exclusion of malformations)

Around 20 weeks of pregnancy, we can conduct an ultrasound of all your baby’s visible organs. Through this, most of the malformations can be excluded with a high certainty.

Thanks to special qualifications, I can offer you all prenatal diagnosis screenings in my practice.

For all ultrasounds, we use the high-end GE Voluson E 8 RSA device. Of course, we also conduct all blood flow examinations (color duplex sonography, fetal pulse detection), as well as 3D ultrasound.

Color duplex sonography

Color duplex sonography enables us to evaluate the blood flow through the vessels of the woman and the fetus. We are conducting all of these examinations in our practice.

You have myomas, bleeding disorders or unclear findings on your ovaries? You are more than welcome to come to my practice for a differentiated ultrasound. Through the use of high-resolution ultrasound, even very small changes can be detected and evaluated. Based on these examinations, I can propose further options of therapy.

For early detection of different cancers, screenings are recommended at least once a year. Under a hormone therapy, it is often reduced to 6 months.

In my practice, I conduct all reasonable gynecologic screenings and put a special emphasis on the use of modern diagnostic options, such as high-resolution ultrasound, thin film cytology and screening of the HPV status.

By request, I can also conduct the annual check-up labs (hormonal status, liver- and kidney function, as well as a blood count).

Every 10th woman suffers from breast cancer. As alarming as this number, as good are the new treatments for breast cancer. A requirement, however, is the early detection. That is why a breast cancer screening is offered to all women between 50 and 69 years since 2009. However, breast cancer can also break out before and after. Additionally, the interval of the screening (every 2 years) is highly controversial and the patient does not find out whether the mammary gland tissue is radiopaque and whether the breast is well evaluable. For this reason, I established the breast clinic in my practice, which is led by Dr. med. Heino Hille. He has specialized on breast ultrasound for many years.

The ultrasound is conducted with the high-end GE Voluson E8 RSA device.

The menopause ranges over a period of several years. The symptoms vary from minimal changes to a severe impairment of quality of life. In contrast, the spectrum of possible therapies is as broad (lifestyle and dietary changes, natural remedy, hormone replacement therapy).
For some patients, a change in dietary and lifestyle habits is sufficient, for others, St. John’s wort helps and yet others are only feeling well with a hormone replacement therapy. It is my goal to find the best therapy for you after having clarified the medical conditions.

My special focus lies on excluding other hormonal conditions, like a hypothyroidism, which can cause similar symptoms. Furthermore, I want to prevent other diseases like osteoporosis, heart- and vascular diseases etc.
The premature manifestation of menopause (under the age of 40) is called climax praecox. It can be caused by measurable or non-measurable genetic changes. When consulting women with this problem, we have to specially emphasize topics like the wish to have a child or hormone replacement therapy.

Here, you can find my book about menopause: https://www.amazon.de/Wechseljahre-Ratgeber-Frauen-Wechseljahresbeschwerden-Patientenratgeber/dp/3867480265

Pain during sexual intercourse after having given birth, incontinence and the so-called vulvo-vaginal atrophy (characterized through itching and burning) are common problems which no one likes to talk about.

Since June 2016, I am the first doctor in northern Germany to offer vaginal laser treatment with MonaLisa Touch®. It only takes a few minutes, is pain-free and, according to recent studies, leads to a clear improvement of the following symptoms in 95% of patients:

  • Aconuresis (urine incontinence)
  • Vulvo-vaginal atrophy (dryness, itching, hormone deficit)
  • Dyspareunia (pain during sexual intercourse)
  • Lichen sclerosus (please bring histology results to your appointment)

Further information and treatment results can be found here:

Vaginallaser Flyer PDF

This video gives an explanation of how the treatment works:

https://www.youtube.com/watch?v=G7hU3yDIDzo

The range of symptoms concerning bladder and pelvic floor reaches from light urinary incontinence, e.g. after working out or pregnancy, to heavy impairments due to a descent of the uterus and/or bladder. After a detailed diagnosis, several therapies are possible: lifestyle changes, work-out, pelvic floor gymnastics, medication, pessary therapy, surgical therapy and, newly, vaginal laser treatment (see vaginal laser treatment). I am more than happy to consult you in finding the individually best therapy for you.

Stay young? Avoid ageing?

We probably cannot succeed in this, but why not “age healthy”?
Our civilization leads to an ever-expanding life expectancy – through a better quality of life but also through the development of medical treatments.
But does this lead to a healthier living? We are always reachable, often stressed-out and are overweighed. According to recent research, we are in a leading position in overweight. Overweight not only causes heart- and vascular diseases, but also raises the risk for cancer – and thereby decreases the higher life-expectancy which we worked so hard for.
Imagine a 90-year old man. What does he look like? Most of you will imagine him to be slim and small. Is he so slim because he is so old? Or is he so old because he reduced his risks through his low weight? Probably the latter.
As the president of the german society for women’s health (deutsche gesellschaft für frauengesundheit e.V., www.frauengesundheit.de), I don’t only chase this question with my research, but I also pass on my knowledge to colleagues in seminars. You as my patient can directly profit from my knowledge and experience and receive consultation during my prevention clinic.
Based on your personal goal, I can offer several blood and hormonal check-ups or I can perform an ultrasound of your thyroid. Furthermore, I can calculate your individual risk for heart- and vascular diseases based on the measurement of the wall thickness of your carotic artery, as well as special blood results.
But all of the diagnosis has no benefit, if you don’t draw the right conclusions from it. In the setting of the prevention clinic, we talk about all the results and work on an individual plan to improve your quality of life.

Everything wonderful in the world was born from the love to a woman. Maxim Gorki