65: Estrogens & Progestins

Question 1

LH –>

FSH –>

Answer 1

theca cell

granulosa cell

Question 2

estrogen and progesterone exert both negative and positive feedback to regulate gonadotropin release. positive feedbcack occurs…

Answer 2

mid-ovarian cycle which induces ovulation

Question 3

• high frequency low amplitude LH secretion
• estrogen rises
• endometrial proliferation

Answer 3

follicular phase (1-13)

Question 4

estrogen induced gonadotropin surge

Answer 4

ovulation (d. 14)

Question 5

• rise in estrogens and progesterone

- endometrial differentiation under control of progesterone

Answer 5

luteal phase (15-28)

Question 6

if implantation does not occur…

Answer 6

steroidogenesis is not maintained and endometrial lining is shed

Question 7

endometrial proliferation v differentiation

Answer 7

estrogen
progesterone

progesterone also prepares for implantation, decreases uterine contractions

Question 8

increase LDL increase fat deposition

Answer 8

progesterone - also increases fasting glucose levels

estrogen decreases LDL and increases HDL and triclycerides

estrogen also antiresorptive in bone, increases plasma prtns from liver and increases expression of coagulation factors and decreases antithrombin in blood

Question 9

key regulator during follicular phase =

luteal phase =

Answer 9

estrogen

progesterone

Question 10

• decreases uterine contractions and porstaglandin production
• maintains relaxin secretion
• increases viscosity of cervical mucous

Answer 10

progesterone

Question 11

synthetic steroidal estrogens

Answer 11

ethinyl estradiol

mestranol

Question 12

risks from using estrogen in HORMONE REPLACEMENT THERAPY

Answer 12

increased risk CAD, Stroke, PE, invasive BC

decreased risk colorectal CA, hip fracture

Question 13

MOA estrogens as contraceptive

Answer 13

suppress ovulation via negative feedback

Question 14

MOA estrogen as acne treatment

Answer 14

suppress steroidogenesis and decrease free testosterone concentrations by increasing levels of SHBG

Question 15

4 pharmacological uses of estrogen

Answer 15

hypogonadism
HRT
contraception
acne

Question 16

key adverse effects of estrogen

Answer 16

breast tenderness
endometrial hyperplasia
increased blood coagulation

Question 17

cancer risks

• HRT combo therapy
• HRT estrogen monotherapy
• contraceptive

Answer 17

increased risk invasive BC

increased risk of endometrial CA

reduced risk of ovarian and endometrial CA

Question 18

adverse effects of estrogen : what is their rationale?
endometrial hyperplasia
cholestasis
increaseed blood coagulation
migraine
cancer
bloating

Answer 18

• estrogen induced endometrial proliferation
• changes in cholesterol bile salt ration and changes in hepatic bile caniculi function
• decreases antithrombin and increases factors II, VII, IX, X
• potential sign of increased blood coagulation
• endometrial and breast CA
• loss of intravascular fluid

Question 19

never give ______ alone for birth control

Answer 19

estrogen

Question 20

• commonly combined with estrogen for HRT

- used as a long acting contraceptive (depo-provera)

Answer 20

medroxyprogesterone

Question 21

-combinational or progestin only contraception

Answer 21

norethindrone or norgestrel

Question 22

____ less efficacious in suppressing ovulation

Answer 22

progestins

but work just as well in contraception because of increasing mucous viscosity as well

Question 23

therapeutic uses of progestins:

• contraceptive
• HRT
• dysmenorrhea
• endometriosis

Answer 23

• alone or in combo with estrogen
• decrease risk of endometrial hyperplasia caused by estrognes
• decrease endometrial mass and decrease prostaglandin production
• decrease endometrial proliferation by regulating ER expression and stimulating differentiation of endometrial cells

Question 24

key adverse effects progestins

Answer 24

• breakthrough bleeding - changes in enometrial vasculature
• impaired glucose tolearnace (increased fasting glucose)
• changes in lipid metabolism (opposite effect on LDL and HDL compared to estrogen*) (increase LDL and decrease HDL)

Question 25

adverse effects related to 19-nortestosterone effects

Answer 25

• acne
• hirsutism

because of teh androgenic effects of synthetic progestins (19 nor testosterone derivative)

Question 26

birth control treat acne with ____, cause acne with _____

Answer 26

estrogen

19 nor compounds

Question 27

“type” of hormone birth control and related hormone

A. oral pill
B. injectable
C. implantable
D. IUD
E. Transdermal
F. Vaginal Rign

Answer 27

A = estrogens and progestins or progestins alone (monthly, quarterly, or yearly)

B= estrogens and progestins or progestins alone (monthly or quarterly)

C= progestins alone (3 year)

D = progestins alone or copper (5 year)

E = estrogens and progestins (monthly)

G = estrogens and progestins (monthly)

Question 28

oral pill can never be…

Answer 28

estrogen alone

Question 29

mechanism of action for hormone birth control

Answer 29

suppress LH and FSH surge

alter cervical mucus

alter endometrium

Question 30

emergency contraceptives (2) which is favored?

Answer 30

levlen - hormone combo

plan B - leonorgestrel (progestin only) **favored because lower failure rate

Question 31

contraindications of estrogen containing contraceptives

Answer 31

history of breast cancer or cancer of female reproductive tract

thromboembolic disorders

liver disease

history of cardiovascular disease

smokers 35 yo+

Question 32

interactions with hormone birth control

Answer 32

• HIV agents
• St Johns wort (induce hormone metabolism)
• anticonvulsants
• antibiotics lower contraceptive effectiveness