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Endocrinology Y2 > Contraceptives, HRT and SERMs > Flashcards

Contraceptives, HRT and SERMs Flashcards

1
Q

What is climacteric

A

Period of transition to the menopause

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2
Q

what is menopause

A
  • Permanent cessation of menstruation

- Loss of ovarian follicular activity

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3
Q

Average age of menopause

A
  • Average age 51 (range 45-55)
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4
Q

Symptoms of menopause? (6)

A
  • Hot flushes (head, neck, upper chest)
  • Urogenital atrophy and dyspareunia
  • Sleep disturbance
  • Depression
  • Decreased libido
  • Joint pain
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5
Q

What happens to levels of oestradiol and inhibin during menopause and why

A

Low levels of oestradiol and inhibin B because of the follicular atresia

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6
Q

What are the Gonadotrophin levels in menopause

A

there is less negative feedback due to oestrogen and inhibin levels falling bc of follicular atresia so gonadotrophin levels go up
So in a 55 year old woman you’d expect the LH and FSH to be HIGH

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7
Q

2 main complications of menopause?

A
  1. Osteoporosis

2. Cardiovascular disease

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8
Q

pathogenesis of osteoporosis in menopause

A

Oestrogen deficiency leads to Loss of bone matrix

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9
Q

pathogenesis of Cardiovascular disease in menopause

A

Oestrogen protects against CVD, this goes when oestrogen goes and by 70- men and women gave the same risk of CVD

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10
Q

what does HRT aim to control

A

the vasomotor symptoms (hot flushes)

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11
Q

what does HRT consist of

A

oestrogen and progestogen

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12
Q

What does oestrogen do if prescribed by itself

A
  • Causes endometrial proliferation Prevents endometrial hyperplasia
  • Risk of endometrial cancer if you just give oestrogen
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13
Q

what conditions do you only prescribe E in HRT and why

A

If they’ve had a hysterectomy, as then they have no uterus so no worry of endometrial hyperplasia

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14
Q

what is a hysterectomy

A

uterus removal

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15
Q

4 ways of administering E?

A
  • Oral oestradiol (1mg)
  • Oral conjugated equine oestrogen (0.625mg)
  • Transdermal (patch) oestradiol (50microgram/day)
  • Intravaginal For those with dyspareunia
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16
Q

How to avoid the high first pass metabolism of E?

A
  • Ethinyl oestradiol A semi-synthetic oestrogen Ethinyl protects from first pass metabolism
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17
Q

Side effects of HRT? (5)

A
  • Breast cancer
  • Coronary heart disease
  • Deep vein thrombosis (DVT)
  • Stroke
  • Gallstones
18
Q

What population has an increased risk of CHD if they take HRT?

A

women who entered menopause 10< years ago

19
Q

What population do not have an increased risk of CHD if they take HRT?

A

women who entered menopause <10 years ago

20
Q

why it can be bad for older women to take oestrogen

A

as it has prothrombotic effects and older women may have a level of atherosclerosis

21
Q

Why might adding progesterone to oestrogen be not good

A

it negates some of its cardioprotective effects

22
Q

What actions does tibolone have

A
  • Oestrogenic, progestogenic and weak androgenic actions
23
Q

What does tibolone increase the risk of

A

stroke

breast cancer

24
Q

What does tibolone reduce the risk of

A

fracture risk

25
Q

What type of drug is raloxifene

A

SELECTIVE OESTROGEN RECEPTOR MODULATOR (SERM)

26
Q

what does raloxifene do

A
  • Oestrogenic in BONE:
     Reduces risk of vertebral fractures
  • ANTI-oestrogenic in BREAST and UTERUS
     Reduces breast cancer risk
27
Q

bad thing about raloxifene (3)

A
  • Does not reduce vasomotor symptoms

- Increases risk of fatal stroke and venous thromboembolism (VTE)

28
Q

what does TAMOXIFEN do and what is it used for

A
  • Anti-oestrogenic on breast tissue

- Used to treat oestrogen-dependent breast tumours and metastatic breast cancers

29
Q

Reasons for menopause before 40 (4)

A
  • Autoimmune
  • Surgery
  • Chemotherapy
  • Radiation
30
Q

What do combined oral contraceptives consist of

A

Oestrogen (ethinyl oestradiol) + progestogen (e.g. lovonorgestel or norethisterone)

31
Q

What does the combined oral contraceptive do

A

Suppresses ovulation

32
Q

What does oestrogen and progesterone do together in a combined oral contraceptive

A

E+P: Negative feedback actions at hypothalamus/pituitary axis

33
Q

What does progesterone do in a combined oral contraceptive

A

Thickens cervical mucus

34
Q

How does an oral combined contraceptive suppress ovulation

A

 E+P: Negative feedback actions at hypothalamus/pituitary axis
 P thickens cervical mucus

35
Q

When do you prescribe progesterone only contraceptives

A

When oestrogens are contra-indicated Smoker, >35yrs old, migraine with aura

36
Q

What is key about taking the progesterone only contraceptive

A

Must be taken same time every day

37
Q

Half life and duration of action of the progesterone only contraceptive

A

 Short half-life

 Short duration of action

38
Q

How often do you taken the EP contraceptive pill

A
  • Take for 21 days (or 12 weeks), stop for 7 days
39
Q

Emergency contraception? (3)

A
  • Copper IUD (intrauterine contraceptive device)
  • Levonorgestrel (within 72 hours)
  • Ulipristal (up to 120hrs after intercourse)
40
Q

What activity does ulipristal have

A

Anti-progestin

Endocrinology Y2 (18 decks)

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