6a. Sex Hormones and HRT Flashcards
What are the three main sex hormones?
Progesterone, oestrogen, and testosterone.
Where do progesterone and oestrogen bind?
Intracellularly.
What are the actions of progesterones around the body?
Secretory endometrium, anabolic, increased bone density, fluid retention, mood changes.
What are the side effects of progesterones around the body?
Weight gain, fluid retention, acne, nausea and vomiting, irritability, lack of concentration.
What are the actions of oestrogen around the body?
Mild anabolic, sodium and water retention, raised HDL and lowered LDL, decreased bone reabsorption, improve blood coagulability.
What are the side effect of oestrogen around the body?
Nausea and vomiting, water retention, risk of thromboembolism, impaired glucose tolerance, endometrial hyperplasia and cancer.
What makes up the combined oral contraceptive pill?
Synthetic oestrogens and 1st-4th generation progesterone.
How does COCP work?
Acts on endocrine system and reproductive tract to prevent ovulation and cause cervical mucus and endometrial thickening.
What are the ADRs of COCP?
Generally minor although increased risk of DVT, raising blood pressure, increased risk of gall stones, decreased glucose tolerance, and increased risk of stroke.
How is COCP metabolised?
In phase I and II hepatic pathways.
How do broad-spectrum antibiotics reduce efficacy of COCP?
Intestinal flora cleared so reduced re-uptake into circulation.
Which drugs impact COCP metabolised via CYP?
Inducers - PCBRAS - phenytoin, carbamazapine, barbiturates, rifampicin, alcohol, and sulphonylureas.
Which risk factors should be assessed before starting a patient on the COCP?
BMI, blood pressure, migraines, smoking history.
What advice should be given about taking COCP?
Take it every day, any vomiting or diarrhoea may make the drug ineffective, and blood pressure needs to be checked every 3-6 months.
What is are the actions of the progesterone only pill?
Main: cause cervical mucus thickening. Secondary: endometrial thickening, endocrinological effects.
What are the negatives of using POP rather than COCP?
Narrower window of use, less reliable, more side effects.
Who should be given the POP?
Women who have contra-indications for COCP.
How can long term contraception be given using progesterone?
Implants - IM, SC, IUD. These last from 3 months to 5 years.
What is the purpose of hormone replacement therapy?
Prevent the symptoms of the menopause and limit the effects of osteoporosis.
What are the risks of HRT?
Increased risk of endometrial cancer and ovarian cancer, increased risk of breast cancer, increased risk of stroke, increased risk of DVT.
What does the action of selective oestrogen receptor modulators depend on?
Tissue specific expression of oestrogen receptors, genes associated with these receptors, or presence of transcription factors.
What is the action and site of action of clomiphene?
Oestrogen antagonist acting on pituitary, induces ovulation by inhibiting negative feedback.
What is the agonist/anatagonist actions of tamoxifen and raloxifene?
Anti-oestrogenic in breast tissue, oestrogenic in endometrium, protects against osteoporosis.
