Chapter 64 Estrogen and Progestins: Non-Comtraceptive Application Flashcards
What is Estrogen? What is Progestin? Essential fx?
Promotes female maturation
Estrogen helps with bone mineralization and lipid metabolism
Prinicipal endogenous estrogen: ESTRADIOL
Principal progestational hormone: PROGESTERONE
Menstrual cycle? (review)
Days 1-14 Follicular phase
Days 24-28 Luteal phase
Full cycle is 28 days
Purpose of the menstrual cycle? What hormone helps with uterine changes? What hormones helps with regulation of the menstrual cycle?
Coordinating ovarian and uterine events –> Uterine changes are brought by estrogen and progesterone
Anterior pituitary hormones such as FSH and LH regulate the menstrual cycle
What produces estrogen? Major estrogen? Can men produce estrogen too?
Ovary, major estrogen produced is estradiol
Yes! Small amounts are converted testosterone to estradiol and estrone by the testes
Estrogen’s effect on primary and secondary sex characteristics?
Reproductive organs, ductal growth in breast, thickening of vaginal epithelium, proliferation of uterine epithelium, endocervical mucus secretion
What does estrogen do for the body? Too much?
Effects - Bone mass, cholesterol, suppress blood coagulation
A/e - Endometrial hyperplasia, carcinoma, breast cancer, ovarian cancer, CV events
What can estrogen do therapeutically?
Hormone tx, female hypogonadism, acne
Selective Estrogen Receptor Modulators (SERMs) do what?
Activate/Block estrogen receptors selectively
Used to provide benefits of estrogen while avoiding drawbacks
NO SERMs offer all benefits and reduce all drawbacks
Tamoxifen (Nolvadex®) does what? Protects from? Can produce? Increase risk for?
Is a SERM activating estrogen used for breast cancer tx by inhibiting cell growth and protecting against osteoporosis
Produces hot flashes
Increases r/f endometrial cancer and thromboembolism
Raloxifene (Evista®) does what? Indications?
Similar to tamoxifen (Protects against breast cancer, osteoporosis, induces hot flashes and thromboembolism)
Prevent/tx for osteoporosis
Prevention of breast cancer in HIGH risk women
What is the main difference between Tamoxifen and Raloxifene?
Raloxifene does not activate estrogen receptors in the
endometrium; therefore, raloxifene does NOT carry a risk of uterine cancer
Progestin acts like what? Produced by? Therapeutic use?
Progesterone; ovaries and placenta
Postmenopausal hormone tx, amenorrhea, dysfx uterine bleeding, carcinoma and hyperplasia
Progestin a/e?
Potential teratogenic, avoid during EARLY pregnancy
Gynecologic effects; breast cancer when used in combo with estrogen (low risk)
What are menopausal hormone therapy benefits?
Physiologic dose of estrogen (w/ or w/o progestin)
Manage symptoms of loss of estrogen in menopause d/t loss of ovarian follicle fx (primary source of estrogen) decline
Los sof estrogen causes what?
BUSH-L acronym?
Bone loss
Urogenital atrophy
Sleep disturbances
Hot flashes
Lipid dysfcx
What are basic regimens for estrogen hormone replacement therapy? What is the purpose?
Estrogen mono-therapy OR estrogen + progestin
To control menopausal symptoms by replacing estrogen that was lost r/t menopause
What considerations should you have regarding estrogen replacement therapy with a woman who still has her uterus?
For women with a uterus, the progestin is present for one
reason only: to counterbalance estrogen-mediated
stimulation of the endometrium which can cause
endometrial hyperplasia and cancer.
For women who DO NOT HAVE A UTERUS, the progestin is
unnecessary and is therefore omitted.
What are menopausal hormone therapy risks?
CV events: stroke, MI, PE
Endometrial cancer r/t unopposed estrogen
Breast & ovarian cancers
