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Pubertät leitet von der Kindheit ins Erwachsenenalter über. Die Hypothalamus-Hypophysen-Gonaden-Achse ist während der fetalen und neonatalen Entwicklung aktiviert und fällt danach bis zur Pubertät in eine Ruhephase. Die Pubertät beginnt mit einer Reaktivierung der gonadalen Achse. Es gibt keine allgemeinen Richtlinien dazu, in welchem Alter beim Ausbleiben von Pubertätsmerkmalen eine Abklärung erfolgen muss. Da eine Pubertas tarda dramatische Folgen für die geistige und soziale Entwicklung während der Adoleszenz haben kann, soll bei Mädchen eine erste Evaluation spätestens im Alter von 13 Jahren erfolgen. Bei starkem psychosozialem Druck, der wegen des Entwicklungsrückstands gegenüber Gleichaltrigen auf einem betroffenen Kind lasten kann, muss sie schon früher eingeleitet werden. Ein wichtiger Aspekt, der die Patientin und ihre Eltern oft beunruhigt, sind die möglichen Spätfolgen einer Pubertas tarda für die Fertilität. In der Regel sind bei hypogonadotropem Hypogonadismus die Aussichten auf eine erfolgreiche Schwangerschaft gut, wenn bei Kinderwunsch eine der Diagnose entsprechende adäquate Follikelreifungsinduktion durchgeführt wird. Dieser Beitrag soll dem Nichspezialisten eine Übersicht zu diesem Thema geben.",{"EN":547},"Pubertas tarda bei hypogonadotropem Hypogonadismus",{"VOID":549},"Marshall WA, Tanner JM (1970) Variations in the pattern of pubertal changes in boys. Arch Dis Child 45:13–23\nLee PA (1980) Normal ages of pubertal events among American males and females. J Adolesc Health Care 1:26–29\nGrumbach MM, Styne DM (1998) Puberty: ontogeny, neuroendocrinology, physiology, and disorders. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR (Hrsg) Williams textbook of endocrinology, 9. Aufl. WB Saunders, Philadelphia, S 1509–1625\nBrämswig J, Dübbers A (2009) Disorders of pubertal development. Dtsch Arztebl Int 106(17):295–304\nKahl HSRA, Schlaud M (2007) Sexuelle Reifung von Kindern und Jugendlichen in Deutschland. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50:677–685\nReindollar RH, Tho SPT, McDonough PG (1989) Delayed puberty: an updated study of 326 patients. Trans Am Gynecol Obstet Soc 8:146–162\nTanner JM (1962) Growth at adolescence. Charles C Thomas, Springfield\nHerman-Giddens ME, Slora EJ, Wasserman RC et al (1997) Secondary sexual characteristics and menses in young girls seen in office practice: a study from the pediatric research in office settings network. Pediatrics 99:505–512\nKaplowitz PB, Oberfield SE, Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society (1999) Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Pediatrics 104:936–941\nLargo RH (1983) Pubertal development in Swiss girls. Helv Paediatr Acta 38(3):229–243\nKaplowitz P (2004) Clinical characteristics of 104 children referred for evaluation of precocious puberty. J Clin Endocrinol Metab 89:3644–3650\nParent A‑S, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon J‑P (2003) The timing of normal puberty and the Age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 24(5):668–693\nSedlmeyer IL, Palmert MR (2002) Delayed puberty: analysis of a large case series from an academic center. J Clin Endocrinol Metab 87:1613–1620\nWinter S, Ousidhoum A, McElreavey K, Raja Brauner R (2016) Constitutional delay of puberty: presentation and inheritance pattern in 48 familial cases. BMC Pediatr 16:37–44\nBonjour J‑P (1998) Delayed puberty and peak bone mass. Eur J Endocrinol 139:257–259\nReiter EO, Lee PA (2002) Delayed puberty. Adolesc Med 13(1):101–118\nReiter EO, Kaplan SL, Conte FA, Grumbach MM (1975) Resposivity of pituitary gonadotropins to luteinizing hormone-releasing factor in idiopathic precocious puberty, precocious thelarche, precocious adrenarche and in patients treated with medroxyprogesterone acetate. Pediatr Res 9:111–115\nGourmelen M, Pham-Huu-Trung MT, Girard F (1979) Transient partial GH deficiency in prepubertal children with delay of growth. Pediatr Res 13:221–224\nLanes R, Bohorquez MDSL, Leal V, Hernandez G, Borges M, Hurtado E et al (1986) Growth hormone secretion in patients with constitutional delay of growth and pubertal development. J Pediatr 109:781–783\nHarrington J, Palmert MR (2012) Distinguishing constitutional delay of growth and puberty from isolated hypogonadotropic hypogonadism: critical appraisal of available diagnostic tests. J Clin Endocrinol Metab 97:3056–3067\nDwyer AA, Phan-Hug F, Hauschild M, Elowe-Gruau E, Pitteloud N (2015) Hypogonadism in adolescence. Eur J Endocrinol 173:R15–R24\nBierich JR (1989) Therapy with growth hormone—old and new indications. Horm Res 32:153–165\nLoche S, Cambiaso M, Setzu S et al (1994) Final height after growth hormone therapy in non-growth-hormone-deficient children with short stature. J Pediatr 125:196–200\nBernasconi S, Street ME, Volta C, Mazzardo G (1997) Final height in non-growth hormone deficient children treated with growth hormone. The Italian multicentre study group. Clin Endocrinol 47(3):261–266\nKallmann FJ, Schönfeld WA, Barrera SE (1944) The genetic aspects of primary eunuchoidism. Am J Ment Defic 48:203–236\nQuinton R, Duke VM, Robertson A et al (2001) Idiopathic gonadotrophin deficiency: genetic questions addressed through phenotypic characterization. Clin Endocrinol 55:163–174\nBrioude F, Bouligand J, Trabado S et al (2010) Non-syndromic congenital hypogonadotropic hypogonadism: clinical presentation and genotype–phenotype relationships. Eur J Endocrinol 162:835–851\nLewkowitz-Shpuntoff HM, Hughes VA, Plummer L et al (2012) Olfactory phenotypic spectrum in idiopathic hypogonadotropic hypogonadism: pathophysiological and genetic implications. J Clin Endocrinol Metab 97:E136–E144\nde Morsier G (1954) Etudes sur les dysraphies cranio-encephaliques. I. Agénésie des lobes olfactifs (Télencéphaloschizis latéral) et des commisures calleuse et antérieure (Télencéphaloschizis median). La dysplasie olfacto-génitale. Schweiz Arch Neurol Psychiatr 74:309–361\nde San Maestre JA (1856) Teratologia: falta total de los nervios olfactorios con anosmia en un individuo en quien existía una atrofia congénita de los testículos y miembro viril. Siglo Med 3:211–221\nPalmert MR, Dunkel L (2012) Clinical practice. Delayed puberty. N Engl J Med 366:443–453\nMitchell AL, Dwyer A, Pitteloud N, Quinton R (2011) Genetic basis and variable phenotypic expression of Kallmann syndrome: towards a unifying theory. Trends Endocrinol Metab 22:249–258\nEaster A, Treasure J, Micali N (2011) Fertility and prenatal attitudes towards pregnancy in women with eating disorders: results from the Avon Longitudinal Study of Parents. BJOG 118(12):1491–1498\nBulik CM, Sullivan PF, Fear JL et al (1999) Fertility and reproduction in women with anorexia nervosa: a controlled study. J Clin Psychiatry 60(2):130–135\nMicali N, dos-Santos-Silva I, De Stavola B et al (2014) Fertility treatment, twin births, and unplanned pregnancies in women with eating disorders: findings from a population-based birth cohort. BJOG 121:408–416\nPark JK, Lee EJ, Kim SH (2012) Optimal surgical approaches for Rathke cleft cyst with consideration of endocrine function. Neurosurgery 70:250–257\nZada G, Laws ER (2010) Surgical management of craniopharyngiomas in the pediatric population. Horm Res Paediatr 74:62–66\nJackman S, Diamond F (2013) Pituitary adenomas in childhood and adolescence. Pediatr Endocrinol Rev 10:450–459\nArmstrong GT, Chow EJ, Sklar CA (2009) Alterations in pubertal timing following therapy for childhood malignancies. Endocr Dev 15:25–39\nChandler WF, Barkan AL (2008) Treatment of pituitary tumors: a surgical perspective. Endocrinol Metab Clin North Am 37:51–66\nColao A, Savastano S (2011) Medical treatment of prolactinomas. Nat Rev Endocrinol 7:267–278\nLenz AM, Root AW (2012) Empty sella syndrome. Pediatr Endocrinol Rev 9(4):710–715\nLeyendecker G, Wildt L (1982) Pulsatile treatment with gonadotropin-releasing hormone (Gn-RH). Geburtshilfe Frauenheilkd 42:689–699\nBirkhaeuser MH (1989) Pulsatile Therapie mit LH-RH. Arch Gynecol Obstet 246(Suppl 1):38–44\nLeyendecker G, Wildt L (1996) From physiology to clinics—29 years of experience with pulsatile GnRH. Eur J Obstet Gynecol Reprod Biol 65:S3–S12\nHadžiomerović D, Wildt L (2006) Hypothalamische Ovarialinsuffizienz. Gynakol Endokrinol 4:27–32\nLunenfeld B, Insler V (1995) In: Wallach EE, Zacur HE (Hrsg) Reproductive medicine and surgery. Mosby-Year Book, St. Louis, p. 617\nWildt L, Leyendecker G (1987) Induction of ovulation by the chronic administration of naltrexone in hypothalamic amerorrhea. J Clin Endocrinol Metabol 64:1334–1335\nVillanueva C, Argente J (2014) Pathology or normal variant: what constitutes a delay in puberty? Horm Res Paediatr 82:213–221\nBeier KM, Bosinski HAG, Loewit K (2005) Sexualmedizin, 2. Aufl. 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Gynäkologe 53:29–34. https:\u002F\u002Fdoi.org\u002F10.1007\u002Fs00129-019-04504-2\nD’Alonzo M, Bounous VE, Villa M, Biglia N (2019) Current evidence of the oncological benefit-risk profile of hormone replacement therapy. Medicina 55(9):573. https:\u002F\u002Fdoi.org\u002F10.3390\u002Fmedicina55090573\nRossouw JE, Anderson GL, Prentice RL et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288(3):321–333. https:\u002F\u002Fdoi.org\u002F10.1001\u002Fjama.288.3.321\nAnderson GL, Limacher M, Assaf AR et al (2004) Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 291(14):1701–1712. https:\u002F\u002Fdoi.org\u002F10.1001\u002Fjama.291.14.1701\nManson JE, Chlebowski RT, Stefanick ML et al (2013) Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA 310(13):1353–1368. https:\u002F\u002Fdoi.org\u002F10.1001\u002Fjama.2013.278040\nBeral V, Reeves G, Bull D, Green J, Million Women Study Collaborators (2011) Breast cancer risk in relation to the interval between menopause and starting hormone therapy. J Natl Cancer Inst 103(4):296–305. https:\u002F\u002Fdoi.org\u002F10.1093\u002Fjnci\u002Fdjq527\nFournier A, Dossus L, Mesrine S et al (2014) Risks of endometrial cancer associated with different hormone replacement therapies in the E3N cohort, 1992–2008. 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Eur J Cancer 84:60–68. https:\u002F\u002Fdoi.org\u002F10.1016\u002Fj.ejca.2017.07.012\nAWMF Leitlinie Peri- und Postmenopause – Diagnostik und Interventionen",{"VOID":702},"10.1007\u002Fs41974-020-00151-x","https:\u002F\u002Flink.springer.com\u002Farticle\u002F10.1007\u002Fs41974-020-00151-x",[705],{"id":706,"sortIndex":23,"researcher":22,"roles":707,"affiliations":708,"properties":717},"94525a50-0991-41f0-8bcd-d7ed20d97841",[118],[709],{"id":710,"sortIndex":23,"affiliation":711,"properties":22},"3afc2672-5394-43c2-b02f-6b999002540d",{"id":710,"createTime":22,"updateTime":22,"relativeEntities":712,"slug":22,"properties":713,"entityType":22,"verifyStatus":22,"verifyTime":22,"verifyNote":22,"languages":22,"translateLanguages":22,"viewCount":22,"url":22,"parentIds":716,"statistic":22},[],{"title":714},{"VI":715},"Krankenanstalt Rudolfstiftung, Wien, Österreich",[],{"title":718},{"VI":719},"Birgit Anker",{"url":703,"publisher":721,"properties":759},{"id":6,"createTime":7,"updateTime":8,"relativeEntities":722,"slug":10,"properties":723,"entityType":20,"verifyStatus":21,"verifyTime":22,"verifyNote":22,"languages":22,"translateLanguages":22,"viewCount":23,"subjectFields":727,"manageAffiliations":740,"indexDatabases":746,"url":22,"thumbnailPath":22,"statistic":754,"gsStatistic":22,"type":91,"analyzePriority":22},[],{"issn":724,"title":725,"eissn":726},{"VOID":15},{"EN":17},{"VOID":13},[728,732,736],{"id":26,"createTime":22,"updateTime":22,"relativeEntities":729,"label":730,"description":731,"parentId":22,"standard":22,"scholarHubFieldId":22},[],{"EN":29},{},{"id":32,"createTime":22,"updateTime":22,"relativeEntities":733,"label":734,"description":735,"parentId":22,"standard":22,"scholarHubFieldId":22},[],{"EN":35},{},{"id":38,"createTime":22,"updateTime":22,"relativeEntities":737,"label":738,"description":739,"parentId":22,"standard":22,"scholarHubFieldId":22},[],{"EN":41},{},[741],{"id":45,"createTime":22,"updateTime":22,"relativeEntities":742,"slug":22,"properties":743,"entityType":22,"verifyStatus":22,"verifyTime":22,"verifyNote":22,"languages":22,"translateLanguages":22,"viewCount":22,"url":22,"parentIds":745,"statistic":22},[],{"title":744},{"EN":49},[],[747],{"id":53,"indexDatabase":748,"url":64,"indexYears":65,"academicFieldIds":753,"indexDatabaseRanking":70},{"id":55,"createTime":22,"updateTime":22,"relativeEntities":749,"label":750,"description":751,"key":61,"publicationTags":752,"standard":22},[],{"EN":58,"VI":58},{"EN":58,"VI":60},[63],[67,68,69],{"impactFactor":23,"impactFactorByYear":755,"i10Index":23,"i10IndexLast5Year":23,"totalPublication":75,"totalPublicationByYear":756,"totalCitation":83,"totalCitationByYear":757,"totalCitationPerPublication":87,"totalCitationPerPublicationByYear":758,"hindexLast5Year":85,"hindex":85},{"2020":73,"2021":74},{"2017":77,"2018":78,"2019":79,"2020":80,"2021":81,"2022":78,"2023":82},{"2018":85,"2019":86,"2020":85},{"2018":89,"2019":90,"2020":74},{"pages":760,"volume":762},{"VOID":761},"123-124",{"VOID":763},"30","2020-09-16",2020,[63],{"id":768,"createTime":769,"updateTime":770,"relativeEntities":771,"slug":772,"properties":773,"entityType":109,"verifyStatus":110,"verifyTime":770,"verifyNote":112,"languages":22,"translateLanguages":22,"viewCount":23,"primaryUrl":782,"fullTextUrl":22,"authors":783,"publicationType":131,"publisherRelationship":799,"citationCount":22,"citationInfo":22,"publishDate":843,"publishYear":844,"citationAnalyzeStatus":21,"lastCitationAnalyze":22,"indexDatabases":845,"openAccess":22,"references":22,"isForceReanalyzing":181},"9901b0a3-65e8-4eb5-b3b9-6286d82998cc","2024-01-30T15:39:34.811+00:00","2025-02-24T09:55:40.796+00:00",[],"Kontrazeption-%C3%BCber-40-was-ist-zweckm%C3%A4%C3%9Fig-und-wie-lange-ist-sie-sinnvoll",{"abstract":774,"title":776,"references":778,"doi":780},{"EN":775},"Frauen über 40 Jahre sind sexuell aktiv und benötigen eine effektive Kontrazeption, um Schwangerschaften zu vermeiden. Diese Altersgruppe hat andere Erfordernisse, die die Wahl der richtigen kontrazeptiven Methoden beeinflussen. Diese Altersgruppe hat möglicherweise bereits perimenopausale Symptome oder veränderte Blutungsmuster, die mit hormonellen Kontrazeptiva beeinflusst werden können. Zusätzlich treten bei Frauen über 40 häufiger Krankheiten auf. Dadurch sind bestimmte Kontrazeptiva unter Umständen nicht oder nicht mehr geeignet. Zudem gibt es generelle Unterschiede im Vergleich zu jüngeren Frauen, bedingt durch die niedrigere Schwangerschaftsrate, die veränderte Häufigkeit des Geschlechtsverkehrs oder höhere Compliance bei der Anwendung von Kontrazeptiva. Diese Übersicht beleuchtet die Auswahl der geeigneten Kontrazeptiva bei dieser Altersgruppe und wann die Kontrazeption im späteren Alter beendet werden sollte. Die meisten Empfehlungen basieren auf Leitlinien und auf systematischen Reviews. 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CMAJ 185(7):565–573\nFaculty of Sexual & Reproductive Healthcare (FSRH) (2017) Guideline: Contraception for Women Aged Over 40 Years, first published in July 2010, Updated November 2017. https:\u002F\u002Fwww.guidelinesinpractice.co.uk\u002Fwomens-health\u002Fcontraception-for-women-aged-over-40-what-when-and-for-how-long\u002F453901.article\nHarlow SD et al (2012) Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging, CLIMACTERIC 2012; Early Online, S 1–10\nBundersministerium für Bildung und Frauen (2015) https:\u002F\u002Fbildung.bmbwf.gv.at\u002Ffrauen\u002Fgender\u002Fgender_index_2015.pdf\nhttps:\u002F\u002Fwww.bpb.de \u002Fnachschlagen \u002Fzahlen-und-fakten\u002Fsoziale-situation-in-deutschland\u002F61538\u002Faltersgruppen\nThe Writing Group for the WHI Investigators (2002) Risks and benefits of estrogen plus progestin in healthy post-menopausal women: Principal results of the Women’s Health Initiative randomized controlled trial. JAMA 288(3):321–333\nThe Women’s Health Initiative Steering Committee (2004) Effects of Conjugated Equine Estrogen in Postmenopausal Women With Hysterectomy. The Women’s Health Initiative Randomized Controlled Trial. JAMA 291:1701–1717\nStuenkel CA et al (2015) Treatment of symptoms of the menopause... Guideline. J Clin Endocrinol Metab 100(11):3975–4011\nBeral V et al (2005) Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 365(9470):1543–1551\nSpencer AL, Bonnema R, McNamara MC (2009) Helping women choose appropriate hormonal contraception: update on risks, benefits, and indications. Am J Med 122:497–506\nHaider A, Shaw JC (2004) Treatment of acne vulgaris. JAMA 292:726–735\nLindh I, Ellstrom AA, Milsom I (2012) The effect of combined oral contraceptives and age on dysmenorrhoea: an epidemiological study. Hum Reprod 27:676–682\nGillum LA, Mamidipudi SK, Johnston SC (2000) Ischemic stroke risk with oral contraceptives: a meta-analysis. JAMA 284:72–78\nGillum LA, Mamidipudi SK, Review JSC (2001) current oral contraceptive use increases the risk for ischaemic stroke. Evid Based Med 6:60\nAnonymous (1995) Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet 346:1575–1582\nGierisch JM et al (2013) Oral contraceptive use and risk of ...cancers. Cancer Epidemiol Biomarkers Prev 22(11):1931–1943\nAnonymous (1998) Cardiovascular disease and use of oral and injectable progestogenonly contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Contraception 57:315–324\nLidegaard Ø, Løkkegaard E, Jensen A et al (2012) Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med 366:2257–2266\nKaunitz AM (2008) Clinical practice. Hormonal contraception in women of older reproductive age. N Engl J Med 358:1262–1270\nACOG (2006) ACOG practice bulletin no. 73: use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol 107:1453–1472\nESHRE Capri Workshop Group (2009) Female contraception over 40. Hum Reprod Update 15(6):599–612\nAnonymous (2010) US Centers for Disease Control and Prevention. US medical eligibility criteria for contraceptive use, 2010. 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