Contraception & Post-Menopausal Therapy

Question 1

Outline the general pharmacology of sex steroids

Answer 1

Oestrogen, progesterone, androgen all originate from cholesterol

Question 2

Understand the differences in contraceptive mechanisms of COCP and POP

Answer 2

COCP - suppression of ovulation, adverse effect on cervical mucus and endometrium
*metabolised by CYP induces so beware interactions
POP - adverse effect on cervical mucus and endometrium, poor cycle control

Question 3

Appreciate the main side effects and drug interactions of COCPs and POPs

Answer 3

COCPs - DVT–>PE, MI, stroke, gallstones, impaired glucose tolerance
POPs - acne, depression, lack of concentration
Drug interactions as metabolised by CYP enzymes

Question 4

Understand how differences in sex steroid PKs are related to administrative routes

Answer 4

Routes of administration - oral, transdermal, implants, nasal, vaginal
Steroid transport bound to sexual hormone binding globulin and albumin
Metabolites excreted in urine

Question 5

Understand the use of anti-oestrogens

Answer 5

Treatment of anovulation

E.g. Tamoxifen, clomiphene

Question 6

Understand the use of anti-progesterones

Answer 6

Partial agonist to progesterone receptor
Used in medical termination of pregnancy, induction of labour
E.g. Mifepristone

Question 7

Understand the use of anti-androgens

Answer 7

Competes with didehydrotestosterone
Used as a COCP, to treat acne, hirsuitism
E.g. Cryproterone

Question 8

Describe the clinical management options for menopause

Answer 8

HRT - sequential/continuous combined
Risks of endometrial, ovarian, breast cancer, increased IHD, stroke, VTE
*do not give oestrogen alone if woman has a uterus due to unopposed action –> cancer

Question 9

Understand hormonal regulation of the female reproductive cycle

Answer 9

Estrogen, progesterone, LH, FSH