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Year 2 Endocrinology > Contraceptives, HRT and SERMs > Flashcards

Contraceptives, HRT and SERMs Flashcards

1
Q

What is menopause?

A

Permanent cessation of menstruation with a loss of ovarian follicular activity

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2
Q

What is the average age and the age range for menopause?

A

Age 51

Range 45-55

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3
Q

What is the climacteric period?

A

The period of transition period

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4
Q

What are symptoms of menopause?

A

Hot flushes (head, neck, upper chest)
Urogenital atrophy and dyspareunia (painful sex)
Sleep disturbance
Depression
Decreased libido
Joint pain
Symptoms usually diminish or disappear with time

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5
Q

What happens to the reproductive axis in menopause?

A

No oestradiol and no inhibin,

no neg feedback so LH and FSH goes up

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6
Q

What are complications of menopause

A

Osteoporosis - 10 fold increased risk of fracture

Cardiovascular disease - protected against CVD before menopause but after that they have same risk as men

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7
Q

Why is osteoporosis a complication of menopause

A

Due to the oestrogen deficiency, there is a loss of bone matrix. Thin bones

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8
Q

Why is HRT given during menopause?

A

To control vasomotor symptoms (hot flushes)

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9
Q

What do you prescribe as HRT for menopause?

A

A mix of oestrogen and progesterone. Progesterone is given to protect against risk of endometrial carcinoma from endometrial proliferation

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10
Q

What hormones would you prescribe for HRT for menopause if the patient has had a hysterectomy?

A

Oestrogen only as no risk of endometrial cancer

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11
Q

What are the different HRT formulations can you give for menopause?

A

Cyclical - E every day and P (12-14 days)

Continuous combined hormones

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12
Q

What are the different ways you can administer HRT for menopause?

A

Oral oestradiol (1mg)
Oral conjugated equine oestrogen (0.625mg)
Transdermal (patch) oestradiol (50microgram/day)
Intravaginal

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13
Q

What is the bioavailability of oestradiol like?

A

Well absorbed but low bioavailability - first pass metabolism

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14
Q

What is an example of conjugated oestrogen?

A

Estrone sulphate

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15
Q

What is ethinyl estradiol? What does the ethinyl group do?

A

A semi-synthetic oestrogen - the ethinl group protects the molecule from first pass metabolism

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16
Q

How can most oestrogens be administered?

A

Via transdermal skin patches

17
Q

What are side effects of HRT for menopause?

A 
Breast cancer
Coronary heart disease
Deep vein thrombosis
Stroke
Gallstones
18
Q

What is the absolute risk of complications in HRT for healthy symptomatic post menopausal women in their 50s taking HRT for five years

A

VERY LOW

19
Q

What kind of beneficial effects do oestrogen have on women when given in HRT

A

Beneficial effects on lipid profile and endothelial function but in older women >60 it has prothrombotic and proinflammatory effects with an increased risk of atherosclerosis as well!

20
Q

What is tibolone?

A

It is a synthetic prohormone

21
Q

What are the effects of tibolone?

A

Oestrogenic, progestogenic and weak androgenic actions. Reduces fracture risk but increased risk of stroke and breast cancer

22
Q

What is raloxifene?

A

A selective oestrogen receptor modulator - binds to oestrogen receptors but have different effects

23
Q

What is the effect of raloxifene in bone?

A

Reduces risk of vertebral fractures

24
Q

What is the effect of raloxifene in breast and uterus?

A

Reduces breast cancer risk

25
Q

What does raloxifene do to vasomotor symptoms?

A

It does not reduce them. It increase the risk of VTE and fatal stroke

26
Q

What is tamoxifen used to treat?

A

Oestrogen dependent breast tumours and metastatic breast cancers due to anti-oestrogenic effect on breast tissue

27
Q

What is premature ovarian insufficiency?

A

Menopause occuring before the age of 40

28
Q

How common is premature ovarian insufficiency?

A

Happens in 1% of women

29
Q

What are the causes of premature ovarian insufficiency?

A

Autoimmune
Surgery
Chemotherapy
Radiation

30
Q

What do combined oral contraceptive pills contain?

A

Oestrogen (ethinyl oestradiol) and progestogen (levonorgestrel or norethisterone)

31
Q

How do the combined oral contraceptive pills work?

A

E&P have negative feedback actions at the hypothalaus and pituitary
P thickens cervical mucus

32
Q

When should you use progesterone only contraceptive pill?

A

When oestrogens contra-indicated so if smoker (oestrogen not good for coronary arteries), >35 years old or has a migrane with aura (makes it worse)

33
Q

When must you take progesterone only contraceptive?

A

At exactly the same time each day due to short half life and short action duration

34
Q

What are emergency post coital contraceptions?

A

Copper IUD (intrauterine contraceptive device)
Levonorgestrel
Ulipristal

35
Q

How does the copper IUD work?

A

It affects sperm viability and function

36
Q

When is a copper IUD viable as an example of emergency contraception?

A

5 (up to 7) days after unprotected intercourse

37
Q

When is levonorgestrel viable as emergency contraception?

A

Within 72 hours after intercourse

38
Q

When is ulipristal viable as emergency contraception?

A

Up to 120 hours after intercourse

39
Q

What does ulipristal do?

A

Anti-progestin activity that delays ovulation by as much as 5 days and impairs implantation

Year 2 Endocrinology (21 decks)

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