5.2) Reproductive Health Flashcards
What are the sex steroid hormones?
Oestrogen progesterone and androgens
What are the sex steroid hormones derived from?
Cholesterol
What type of receptor are the steroid hormone receptors?
How do they exert their effect?
Nuclear receptors
Exert effects through gene transcription and subsequent production of proteins
What are the actions of oestrogen?
- endometrial proliferation
- sodium and water retention
- raises HDL, lowers LDL
- decreases bone resorption (reduces osteoclast activity)
- impaired glucose tolerance
- increases blood coagulability
What are the side effects of oestrogen?
- breast tenderness
- nausea/vomiting
- water retention
- thromboembolism
- impaired glucose intolerance
- endometrial hyperplasia and cancer
- ovarian metaplasia and cancer
- breast hyperplasia and cancer
What are the actions of progesterone?
- secretory endometrium (dominant in secretory phase of cycle)
- anabolic
- increases bone mineral density
- fluid retention
- mood changes
- maintains pregnancy
What are the side effects of progesterone?
- weight gain
- fluid retention
- acne
- nausea/vomiting
- irritability, depression, PMS
- lack of concentration
What are the actions of testosterone?
- androgenic- male secondary sex characteristics (voice changes, body hair, aggression)
- anabolic- growth, increased muscle mass
What are the side effects of testosterone?
- acne
- voice changes
- increases aggression
- increased body hair/male pattern baldness
What are the different types of hormonal contraceptives?
Short or long-acting reversible contraception
What are the actions of hormonal contraceptives?
Preventing ovulation, fertilisation or implantation
What are the pharmacokinetic properties of oestrogen? (Absorption/metabolism/excretion)
Natural and synthetic oestrogens well absorbed in the GI tract.
Readily absorbed from skin and mucous membranes.
Metabolism- liver
Excretion- in urine as glucuronides and sulfates
What are the pharmacokinetic properties of progesterone? (Administered?, metabolism, excretion)
Injected progesterone is bound to albumin with some stored in adipose tissue (can last ~3months)
Oral bioavailability is low (oral= low dose/injected= high dose)
Metabolised by liver
Metabolites excreted in the urine conjugated to glucuronic acid
What is the relationship between COCP and POP contraceptives and CYP 450 enzymes?
Metabolised by CYP enzymes in the liver.
Efficacy is thus reduced by CYP enzyme inducing drugs ie carbamazepine or phenytoin
What is the action of COCP?
Prevents ovulation
Secondary actions- reduces endometrial receptivity to implantation, thickens cervical mucus
What are some adverse effects of COCP?
- increased risk of VTE
- increased risk of stroke
- increased risk of breast cancer and cervical cancer
What are some of the contraindications of COCP prescription?
- smoker> 35 years (generic RF for stroke/VTE)
- previous VTE
- high BMI
- HTN
- IHD/stroke
- migraine with aura (increased risk stroke)
- breast cancer
- cirrhosis (metabolised by liver- could effect clearance)
What is the POP? What is the action of this therapy?
Progesterone only pill
Low dose progesterone (does not effect HPG axis)
Thickens cervical mucus
Secondary actions- reduced cilia activity in fallopian tubes (if pregnancy was to occur, more likely to be ectopic)
What is the mode of administration of POP?
Taken orally ODS
No breaks
What are the advantages of POP treatment?
- reliable if used correctly (up to 99%)
- can be used if COCP contraindicated
What are the disadvantages of POP therapy?
- no STI protection
- strict timing, so effectiveness is user dependent
- can cause menstrual irregularities
- increased risk of ectopic pregnancy
- progesterone related side effects— acne, changes to mood etc
