CH 64 Estrogens and Progestins (Non-Contraceptive Application)

Question 1

Menstrual Cycle phases

Answer 1

Follicular Phase (Days 1–14):
* Low estrogen/progesterone at start → triggers GnRH release → ↑ FSH and LH
* FSH stimulates follicle growth → follicles release estrogen
* Estrogen promotes endometrial proliferation

Ovulation (Mid-cycle):
* Estrogen surge → positive feedback → LH surge → ovulation

Luteal Phase (Days 15–28):
* Corpus luteum secretes progesterone and estrogen
* Progesterone stabilizes endometrium, prepares uterus for implantation
* If no pregnancy → hormone levels drop → menstruation

Question 2

Physiologic effect of estrogen

Answer 2

• Promotes development of female secondary sex characteristics
• Stimulates endometrial proliferation
• Maintains bone density
• Improves skin elasticity and vascular tone
• Modulates lipid profile (↑ HDL, ↓ LDL)

Question 3

Physiologic effect of progestin (progesterone)

Answer 3

• Stabilizes and prepares endometrium for implantation
• Decreases uterine contractility
• Increases body temperature
• Modulates mood and CNS function
• Supports pregnancy

Question 4

hormonal contraceptive side effects

Answer 4

ACHES
A - abdominal pain
C - chest pain
H - headaches (severe)
E - eye problems (blurry vision)
S - swelling and aching in the upper and lower legs

Question 5

What are the main benefits of estrogen-containing HRT?

Answer 5

Relief of vasomotor symptoms, improved bone density, urogenital health, mood, and possibly reduced colorectal cancer risk.

Question 6

Why is progesterone added to estrogen in HRT for women with a uterus?

Answer 6

To protect against estrogen-induced endometrial hyperplasia and cancer.

Question 7

What is the breast cancer risk associated with estrogen + progesterone HRT?

Answer 7

Increased risk, especially with long-term use (>3–5 years).

Question 8

What is the breast cancer risk associated with estrogen-only HRT?

Answer 8

Possibly neutral or slightly decreased in women without a uterus.

Question 9

What are the cardiovascular risks of HRT?

Answer 9

Increased risk of stroke and blood clots, especially if started late after menopause.

Question 10

What cancer risks are associated with estrogen-only HRT?

Answer 10

Increases endometrial cancer risk if uterus is intact; slightly increased ovarian cancer risk.

Question 11

How does HRT affect osteoporosis?

Answer 11

Estrogen reduces bone loss and fracture risk.

Question 12

What are the benefits of avoiding HRT?

Answer 12

Avoids increased risk of breast cancer, endometrial cancer (with unopposed estrogen), stroke, and VTE.

Question 13

What are the risks of not using HRT?

Answer 13

Increased risk of osteoporosis, persistent menopausal symptoms, vaginal atrophy, and reduced quality of life.

Question 14

When is HRT considered safest and most beneficial?

Answer 14

When started before age 60 or within 10 years of menopause, at the lowest effective dose and shortest duration.