Endo 10 - Contraceptives, HRT and SERMs Flashcards

1
Q

What is the medical term for painful sex

A

Dyspareunia

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2
Q

Name a common symptom of menopause

A

Insomnia - sleep disturbance

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3
Q

What is menopause?

What is the transition period called just before menopause

A

Menopause = permanent cessation of menstruation - loss of ovarian follicular activity. Avg age = 51

Climacteric = transition period just before menopause, may have irregular periods

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4
Q

What are the symptoms of menopause

A
  1. Hot flushes (head, neck, upper chest)
  2. Urogenital atrophy and dyspareunia
  3. Sleep disturbance
  4. Depression
  5. Loss of libido
  6. Joint pain

Symptoms usually diminish with time

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5
Q

What hormonal changes occur during menopause

A

LH and FSH increase - as low estradiol and inhibin so less -ve feedback

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6
Q

Oestrogen is anabolic. Name 2 complications of menopause

A
  1. Osteoporosis - oestrogen deficiency causes loss of bone matrix - 10x increased risk of fracture
  2. CVD - oestrogen is cardioprotective - but women have the same risk of men by 70.

Oestrogen cardioprotective as it has beneficial effects on lipid profile and endothelial function

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7
Q

How is HRT given to prevent hot flushes?

A

Oestrogen and Progesterone given. This prevents endometrial hyperplasia.

  • Giving oestrogen alone risks endometrial carcinoma (as oestrogen promotes endometrial proliferation)

BUT if hysterectomy patient (removed uterus), then can give just oestrogen

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8
Q

What are the 2 formulations by which the HRT (E+P) can be given?

A
  1. Cyclical: Oestrogen (E) daily and Progesterone (P) every 12-14 days
  2. Continuous combined
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9
Q

What are the different methods of administering oestrogen

A
  1. Oral
  2. Oral conjugated equine oestrogen
  3. Transdermal patch
  4. Intravaginal
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10
Q

Name 3 oestrogens that are prescribed

A
  1. Oestradiol - well absorbed but low bioavailability due to high first pass metabolism - so higher dose requied
  2. Oestrone sulphate
  3. Ethinyl estradiol - semisynthetic oestrogen - ethanol group protects molecule from first pass metabolism

Most oestrogen can be given transdermally

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11
Q

Which form of oestrogen is used in oral contraceptives?

A

Ethinyl oestradiol

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12
Q

What are the side effects of HRT (E+P)

A
  1. Breast cancer
  2. CHD
  3. DVT
  4. Stroke
    (5. Gallstones)

Absolute risk of complications for healthy symptomatic postmenopausal women in their 50s is very low with HRT (5 years) - watch out though, women in their 60s have higher baseline risk (due to atherosclerosis etc, and they are older than menopausal age range)

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13
Q

Explain why HRT (E+P) will have different effects in younger and older people

A

Oestrogen has beneficial effects on lipid profile and endothelial function (in younger people). But synthetic progestins negate these effects

In older women (>60), atherosclerosis is higher. Also susceptible to prothrombotic and pro inflammatory effects of oestrogen, which contributes to increased CHD risk in older women

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14
Q

Describe Tibolone

A

Synthetic prohormone

  • It has oestrogenic, progestogenic and weak androgenic actions.
  • Reduces fracture risk
  • Increases stroke risk (and breast cancer risk) so not commonly prescribed
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15
Q

What is a SERM, and give an example of one

A

Selective oEstrogen Receptor Modulator

Raloxifene = SERM

Oestrogenic in bone - reduces risk of fractures

Anti-oestrogenic in breast and uterus - reduces breast cancer risk

However, it doesn’t reduce vasomotor (hot flush) symptoms and increased risk of venous thromboembolism and fatal stroke

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16
Q

Describe tamoxifen

A

It has anti-oestrogenic effects on breast tissue

Treats oestrogen-dependent breast tumours and metastatic breast cancers

17
Q

What are the HRT drugs that are prescribed

A

Tibolone, Raloxifene (SERM), Tamoxifen

These are not prescribed for osteoporotic reasons, only for Hot flushes, etc

Not prescribed for people with heart disease or over 60

18
Q

What is premature ovarian insufficiency(/failure)

How would it present in patients

A

Menopause occurring before 40

Causes may be autoimmune or iatrogenic (i.e. chemotherapy, surgery, radiation)

With high FSH, high LH and low oestradiol

19
Q

Describe combined oral contraceptives (COCP) that may be given

A

Oestrogen (ethinyl estradiol) and Progestogen (norethisterone or levonorgestrel)

The combined E+P suppresses ovulation - both E+P have negative feedback on Hyp/Pit so less FSH/LH = no ovulation

P also thickens cervical mucus

Must be taken for 21 days then stop for 7 days

20
Q

When is the progesterone only contraceptive pill given

A

When oestrogens contraindicated - i.e. smoker, >35 years old, migraine with aura - because oestrogen has prothrombotic, proinflammatory effects

21
Q

Describe the progesterone only pill

A

It is given when patient has cardio/vascular risks, as oestrogen may exacerbate these.

  • Taken same time each day, because short half life
  • Long acting preparations can be given via an intra-uterine system
22
Q

Name emergency contraception options

A
  1. Copper IUD (intrauterine device) - must exclude pregnancy first.
    - Affects sperm viability and function, and can be used in overweight/obese women
    - 5 (upto 7) days after unprotected sex
  2. Progesterone only contraceptive - Levonorgestrel - within 72 hours after sex
  3. Ulipristal - anti-progestin activity
    - delays ovulation by 5 days
    - impairs implantation
    - upto 120 hours after intercourse