contraceptives, HRT and SERMS

Question 1

define menopause and climactric, and hormone that goes up

Answer 1

permanent end to menstruation- due to no ovarian follicular activity

climacteric is transition period

LH/FSH

Question 2

symptoms of menopause

Answer 2

hot flushes (heat) in head, neck and chest (vasomotor ie vessel dilation)

urogenital atrophy and dyspareunia (painful sex)

sleep problems, depression, low libido and joint pain

Question 3

complications of menopause

Answer 3

osteoporosis- low oestrogen causes loss of bone matrix= increased fracture risk (oestrogen is anabolic for bones)

CVD- women have lower CVD risk than men before menopause due to oestrogen, but have same risk by 70

Question 4

benefit of HRT

Answer 4

controls hot flushes

Question 5

how to give HRT and when this is not needed

Answer 5

just oestrogen alone will cause endometrial proliferation= risk of cancer, so progestogens given as well to combat this

not needed after hysterectomy

Question 6

HRT formulations

Answer 6

given cyclically (oestrogen every day with prog. every 14 days) or continuous combined

oestrogen given orally as oestradiol/ conjugated oestrogen or via patch or intravaginally- dosage via patch much lower as doesn’t go through metabolism when given orally

Question 7

side effect of HRT

Answer 7

absolute risk for postmenopausal women taking HRT for 5 yrs very low

side effects include Breast cancer, CHD, deep vein thrombosis (BCD), stroke and gallstones

Question 8

HRT and CHD

Answer 8

womens health initiative showed increased CHD risk, but women were on average in 60’s, so HRT risk of CHD in younger menopausal risk low

Question 9

effects of oestrogen + progesterone in terms of CHD at different ages

Answer 9

oestrogen go for lipid profile+ endothelial function in younger women, but in older women is prothrombotic and proinflammatory= increased risk of atherosclerosis

progesterone negates oestrogen effects- should be given to older women, NOT younger women

Question 10

tibolone what is it and problem

Answer 10

prohormone with oestrogeni, progestogenic and slight androgenic action, reducing fracture risk, although risk of stroke and breast cancer are slightly increased

Question 11

raloxifene- what is it and problem

Answer 11

a selective oestrogen receptor modulator (SERM), which has oestrogenic effects in bone, but anti-oestrogenic effects in breast, reducing breast cancer risk

however does not prevent hot flushes, and increases of venous thromboembolism/storke

Question 12

tamoxifen

Answer 12

anti-oestrogenic in breast tissue to treat breast cancer

Question 13

premature ovarian insufficiency causes

Answer 13

autoimmune, surgery, chemotherapy or radiation

Question 14

combined oral contraceptives- what it does and how to take it

Answer 14

oestrogen and progestogen given to surpress ovulation- both has - feedback, and progestogen thickens cervical mucus (more difficult for sperm to penetrate)

take for 3 weeks, top for 1 week

Question 15

progesterone only contraceptive

Answer 15

given when combination harmful (combination has increases CHD) eg to smokers (smoking already a risk factor to CHD, don’t want to make it worse)

taken same time each day as has short half life/duration

long acting preparations can be given via intra-uterine system

Question 16

emergency contraception

Answer 16

copper IUD- affects sperm function, with effectiveness same in overweight women: other contraceptives may only work up to 72 hrs, this is effective from 5-7 days

levonorgestrel- within 72 hrs

ulipristal (up to 120hrs)- anti-progestin activity to delay ovulation and implantation