Contraception Flashcards
Define: Menopause
normal physiological response to depletion of ovarian follicles (average age 52)
What are the symptoms of menopause?
decrease estrogen, increase luteinizing hormone (LH) and follicle stimulation hormone (FSH) lead to hot flashes, night sweats, vaginal dryness, decreased libido, mood swings, sleep disturbances, osteoporosis
What is the treatment for menopause?
hormone replacement therapy, natural or synthetic estrogens
What are the therapeutic uses of estrogen receptor agonists?
-combination oral contraceptives
-primary hypogonadism
-postmenopausal hormone replacement therapy
What are the adverse effects of estrogen receptor agonists?
-uterine bleeding
-cancer (small chance of breast with prolonged use, increased risk of endometrial carcinoma- progestin use can reduce risk)
What are the contraindication of estrogen receptor agonists?
-estrogen dependent cancer of endometrium or breast
-undiagnosed genital bleed, liver disease, thromboembolic disorder
-heavy smoker
What are the therapeutic uses of estrogen receptor antagonists?
estrogen receptor positive breast cancer
What are the estrogen receptor antagonist?
fluvestrant, elacestrant
What are the therapeutic uses of aromatase inhibitors?
act as estrogen inhibitors
-metastatic breast cancer
-prevent recurrences of breast cancer
What are the aromatase inhibitors?
anastrozole, letrozole, exemetane
What are the therapeutic uses of long-acting GnRH agonists?
act as estrogen inhibitors
-treatment of endometriosis
-breast cancer
What are the long-acting GnRH agonists?
nafarelin, goserelin, leuprolide
What are the therapeutic uses of progestin?
-contraceptives
-hormone replacement therapy
What are the adverse effects of progestin?
progestin with androgenic activity: weight gain, hair growth, acne
What is the current recommendation for hormone replacement therapy?
postmenopuasal women should use HRT only to treat bothersome symptoms and use lowest possible dose and shortest duration
What is the major mechanism of hormonal contraception?
prevent ovulation
What are the minor mechanisms of hormonal contraception?
-changes in cervical secretions that retard sperm movement through the cervix
-endometrial changes that prevent implantation
-altered motility in fallopian tube
What effects does estrogen have on cervical mucus?
before ovulation, thinner more alkaline mucus that is suitable for sperm transport and survival
What effects does progesterone have on cervical mucus?
after ovulation and during pregnancy, thicker and more viscous
What are some considerations when choosing a contraceptive preparation?
-begin with minimum dose possible (estrogen = 0.03-0.035mg)
-in combo with progestin consider the androgenic activity due to side effects
What are the health benefits of contraceptives?
-reduction of ovarian and endometrial cancer
-more regular period
-endometriosis, PMS symptoms, hirsutism (inappropriate growth of body hair)
What are the mild-moderate adverse effects of contraception?
-nausea, breast pain/tenderness, edema
-weight gain, hair growth, depression, tiredness, acne (progestin)
-early to mid-cycle spotting= not enough estrogen
-late cycle spotting= not enough progestin
What are severe adverse effects of contraception?
-superficial or deep vein thrombosis (estrogen increase blood coagulation)
-MI
-thrombotic hemorrhagic stroke
-jaundice, gallbladder disease, hepatoma
-depression
What are contraindications for contraception?
history or presence of:
-thromboembolic disease
-MI
-coronary artery disease
What hormone is plan B?
L-Norgestrel
