Wie gefährlich ist die Pille?

Die Bilder von Céline im Pflegeheim machen betroffen, sehr betroffen. Die früher gesunde junge Frau erlitt 2008 eine Lungenembolie mit Herzstillstand und als Folge davon einen Sauerstoffmangel im Gehirn. Sie ist seither schwer behindert und pflegebedürftig. Sie nahm damals die Anti-Baby-Pille ‚Yasmin’ ein.

Dass so etwas möglich ist, erstaunt und schockiert viele Menschen. Die Geschichte von Céline und Berichte über die Pillen sind im Moment fast täglich in den Medien. Aktueller Anlass ist eine Gerichtsverhandlung, die sich mit einer Klage von Célines Familie gegen den Pharmakonzern Bayer beschäftigt.

Meist zwei Hormone

Die Anti-Baby-Pillen beinhalten meistens zwei Hormone, ein Oestrogen und ein Gelbkörperhormon (Gestagen). Diese Kombination erhöht das Thromboserisiko im Körper der Frauen.

Thrombosen sind Blutgerinnsel, die sich in den Venen der Beine oder im Becken bilden. Wenn sich die Gerinnsel ablösen, werden sie mit dem Blut mitgeschwemmt und gelangen so in die Lungen, wo sie die kleinen Blutgefässe verstopfen, es entsteht eine Lungenembolie. Diese kann unter Umständen tödlich sein oder wie bei Céline zu einer schweren Schädigung der Gesundheit führen.

Thrombose-Risiko schon seit Jahren bekannt

Dass die kombinierten Anti-Baby-Pillen die Entstehung einer Thrombose und Lungenembolie bei Frauen begünstigen können, ist schon seit Jahrzehnten bekannt. Aber wissen das auch die Frauen, die mit der Pille verhüten, wissen das ihre Partner oder Eltern?

Alle Pillen, die zwei Hormone beinhalten erhöhen das Thromboserisiko, auch der Verhütungsring und das Verhütungspflaster tun dies. Nach der heutigen Einschätzung der Spezialisten besteht aber beim Thromboserisiko ein Unterschied zwischen älteren und neueren Pillenpäparaten. Die neueren Präparate (auch 3. und 4. Generation genannt) haben ein höheres Thromboserisiko als die älteren Präparate (2. Generation). Die Experten beurteilen dieses Risiko aber auch da immer noch als klein. Es ist z.B. auch mit den neuen Pillen-Präparaten deutlich tiefer als während einer Schwangerschaft oder im Wochenbett.

Das Risiko für eine Thrombose oder Embolie ist im ersten Anwendungsjahr am höchsten.

Verhütungsmittel, welche nur Gelbkörperhormon beinhalten, erhöhen das Thromboserisiko nicht, sie haben aber andere Nachteile.

Wir wissen, dass gewisse weitere Faktoren das Risiko zusätzlich erhöhen: wenn eine Frau beispielsweise raucht, wenn sie übergewichtig ist, oder wenn Familienmitglieder an Thrombosen oder Embolien erkrankt sind. Mit dem Alter steigt das Risiko ausserdem bei jeder Frau an.

Leider gibt es bis heute kein Verhütungsmittel ohne Nachteile oder Risiken!

Hormonelle Verhütungsmittel sind Medikamente mit Risiken und Nebenwirkungen. Wenn der Eindruck besteht, es handle sich bei der Pille um ein Life-Style-Produkt, so ist das falsch.

Es gehört zu meinen Aufgaben als Gynäkologin zusammen mit meiner Patientin das Verhütungsmittel zu finden, das ihren aktuellen Bedürfnissen und ihrer Lebenssituation entspricht. Dabei informiere ich die Frau über die Vor- und Nachteile der Methode genau und erkläre und evaluiere im gemeinsamen Gespräch die mit der jeweiligen Methode verbundenen Risiken.

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Ein Kommentar zu Wie gefährlich ist die Pille?

  1. Chrigel Marti, Internist sagt:

    Mehr Sicherheit für weniger Geld!

    Dass kombinierte Anti-Baby-Pillen Thrombosen und Lungenembolien begünstigen, sei seit Jahrzehnten bekannt. Aber wissen das auch die Frauen, die mit der Pille verhüten, wissen das ihre Partner oder Eltern? fragt die Frauenärztin Brigitte Hostettler im obigen Beitrag. Meine Frage: Ja wissen denn die auch, dass bei neueren Pillen das Thrombose- und Embolierisiko etwa doppelt so hoch ist wie bei den älteren Produkten? Und wissen sie, dass die neueren und riskanteren Pillen etwa um die Hälfte teurer sind? Beides bezweifle ich rundweg. Denn:

    Eine erdrückende Mehrheit der Frauen (80% oder mehr), welche mit der Anti-Baby-Pille verhüten, verwenden in der Schweiz eine der neueren Pillen. Dies zeigen alle Statistiken, die ich gesehen habe. Woran mag das liegen? An der Verhütung werde nicht gespart. Convenience und Verträglichkeit seien wichtige Argumente! verrät mir eine befreundete Apothekerin.

    Frage: Sind denn die älteren Pillen so viel schlechter verträglich? Dazu eine erfahrene Frauenärztin: Alle Neuanwenderinnen (Hinweis: bei diesen ist das Embolierisiko am höchsten) erhalten von mir grundsätzlich eine ältere Pille der zweiten Generation. Falls sie eine neuere Pille der dritten Generation möchten, dann verweise ich auf das höhere Thromboserisiko. Meine Patientinnen sind grösstenteils zufrieden mit einer Pille der zweiten Generation. Mir scheint: Bei dieser Frauenärztin erhalten die Frauen mehr Sicherheit für weniger Geld als anderswo.

    Während zum Beispiel die deutschen Gesundheitsbehörden für Erstanwenderinnen und für Frauen unter dreissig Jahren klar die älteren Pillen mit niedrigem Embolierisiko empfehlen, konnten sich in der Schweiz die zuständigen Behörden und Fachgesellschaften bis jetzt nicht zu einem solchen Schritt entschliessen.

    Wie ausdrücklich Frauen selbst an den teureren und gleichzeitig risikoreicheren Pillen interessiert sind, kann ich nicht beurteilen. Was man sich aber leicht ausrechnen kann: würden die neueren Pillen nur noch als Reservemedikamente eingesetzt bei jenen, welche Mühe mit den älteren Produkten haben, käme es in der Schweiz zu einem Umsatzeinbruch in zweistelliger Millionenhöhe. Zumindest diese Interessenlage ist klar.

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