Contraception

Question 1

Define: Menopause

Answer 1

normal physiological response to depletion of ovarian follicles (average age 52)

Question 2

What are the symptoms of menopause?

Answer 2

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

Question 3

What is the treatment for menopause?

Answer 3

hormone replacement therapy, natural or synthetic estrogens

Question 4

What are the therapeutic uses of estrogen receptor agonists?

Answer 4

-combination oral contraceptives
-primary hypogonadism
-postmenopausal hormone replacement therapy

Question 5

What are the adverse effects of estrogen receptor agonists?

Answer 5

-uterine bleeding
-cancer (small chance of breast with prolonged use, increased risk of endometrial carcinoma- progestin use can reduce risk)

Question 6

What are the contraindication of estrogen receptor agonists?

Answer 6

-estrogen dependent cancer of endometrium or breast
-undiagnosed genital bleed, liver disease, thromboembolic disorder
-heavy smoker

Question 7

What are the therapeutic uses of estrogen receptor antagonists?

Answer 7

estrogen receptor positive breast cancer

Question 8

What are the estrogen receptor antagonist?

Answer 8

fluvestrant, elacestrant

Question 9

What are the therapeutic uses of aromatase inhibitors?

Answer 9

act as estrogen inhibitors
-metastatic breast cancer
-prevent recurrences of breast cancer

Question 10

What are the aromatase inhibitors?

Answer 10

anastrozole, letrozole, exemetane

Question 11

What are the therapeutic uses of long-acting GnRH agonists?

Answer 11

act as estrogen inhibitors
-treatment of endometriosis
-breast cancer

Question 12

What are the long-acting GnRH agonists?

Answer 12

nafarelin, goserelin, leuprolide

Question 13

What are the therapeutic uses of progestin?

Answer 13

-contraceptives
-hormone replacement therapy

Question 14

What are the adverse effects of progestin?

Answer 14

progestin with androgenic activity: weight gain, hair growth, acne

Question 15

What is the current recommendation for hormone replacement therapy?

Answer 15

postmenopuasal women should use HRT only to treat bothersome symptoms and use lowest possible dose and shortest duration

Question 16

What is the major mechanism of hormonal contraception?

Answer 16

prevent ovulation

Question 17

What are the minor mechanisms of hormonal contraception?

Answer 17

-changes in cervical secretions that retard sperm movement through the cervix
-endometrial changes that prevent implantation
-altered motility in fallopian tube

Question 18

What effects does estrogen have on cervical mucus?

Answer 18

before ovulation, thinner more alkaline mucus that is suitable for sperm transport and survival

Question 19

What effects does progesterone have on cervical mucus?

Answer 19

after ovulation and during pregnancy, thicker and more viscous

Question 20

What are some considerations when choosing a contraceptive preparation?

Answer 20

-begin with minimum dose possible (estrogen = 0.03-0.035mg)
-in combo with progestin consider the androgenic activity due to side effects

Question 21

What are the health benefits of contraceptives?

Answer 21

-reduction of ovarian and endometrial cancer
-more regular period
-endometriosis, PMS symptoms, hirsutism (inappropriate growth of body hair)

Question 22

What are the mild-moderate adverse effects of contraception?

Answer 22

-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

Question 23

What are severe adverse effects of contraception?

Answer 23

-superficial or deep vein thrombosis (estrogen increase blood coagulation)
-MI
-thrombotic hemorrhagic stroke
-jaundice, gallbladder disease, hepatoma
-depression

Question 24

What are contraindications for contraception?

Answer 24

history or presence of:
-thromboembolic disease
-MI
-coronary artery disease

Question 25

What hormone is plan B?

Answer 25

L-Norgestrel