Aims Breakthrough bleeding or even unwanted pregnancies have been reported in women during concomitant therapy with oral contraceptives and St John's wort extract. The aim of the present study was to investigate the effects of St John's wort extract on oral contraceptive therapy with respect to ovarian activity, breakthrough bleeding episodes and the pharmacokinetics of ethinyloestradiol and 3-ketodesogestrel. Methods Eighteen healthy females were treated with a low-dose oral contraceptive (0.02 mg ethinyloestradiol, 0.150 mg desogestrel) alone (control cycle) or combined with 300 mg St John's wort extract given twice daily (cycle A) or three times daily (cycle B). Ovarian activity was assessed by measuring follicle maturation and serum oestradiol and progesterone concentrations. The number of breakthrough bleeding episodes and the pharmacokinetics of ethinyloestradiol and 3-ketodesogestrel were assessed under steady-state conditions. Results During concomitant administration of low-dose oral contraceptive and St John's wort, there was no significant change in follicle maturation, serum oestradiol or progesterone concentrations when compared with oral contraceptive treatment alone. However, significantly more subjects reported intracyclic bleeding during cycles A (13/17 (77%), P < 0.015) and cycle B (15/17 (88%), P < 0.001) than with oral contraceptives alone (6/17 (35%)). The AUC(0,24 h) and C max of ethinyloestradiol remained unchanged during all study cycles, whereas the AUC(0,24 h) and C max of 3-ketodesogestrel decreased significantly from 31.2 ng ml -1 h to 17.7 ng ml -1 h (43.9%; 95% confidence interval (CI) -49.3, -38.5, P = 0.001) and from 3.6 ng ml -1 to 3.0 ng ml -1 (17.8%; CI -29.9, -5.7, P = 0.005), respectively, during cycle A and by 41.7% (CI -47.9, -35.6; P = 0.001) and by 22.8% (CI -31.2, -13.3; P < 0.001) during cycle B respectively, compared with the control cycle. Conclusions There was no evidence of ovulation during low-dose oral contraceptive and St John's wort extract combination therapy, but intracyclic bleeding episodes increased. Bleeding irregularities may adversely effect compliance to oral contraceptives and together with St John's wort-induced decreases in serum 3-ketodesogestrel concentrations, enhance the risk of unintended pregnancies.

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Kindheit, Medizin und Küche. Die Autorin, die sich auf die physiologischen Grundlagen des Geruchs-und Geschmackssinns bezieht, erzählt von ihren Erfahrungen als Kinderärztin und von dem Platz, den die Kunst des Ernährens von Babys und Kindern innerhalb der Familie und der Kollektivität einnimmt. Sie veranschaulicht ihr Anliegen mit Beispielen aus der Praxis und zeigt die Bedeutung der Sprache bei der Weitergabe des Essensverhaltens, das bei der Entwicklung der individuellen und sozialen Identität der späteren Erwachsenen mitwirkt.