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Endocrinology > Endo 10 - Oral Contraceptives, Menopause and HRT > Flashcards

Endo 10 - Oral Contraceptives, Menopause and HRT Flashcards

1
Q

Define Menopause

A

Permanent cessation of menstruation - amenorrhoea for 12 months

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2
Q

What is the average age of menopause?

A

51yo (45-55)

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3
Q

What does climacteric period mean?

A

The period of transition. normal regular cycles become irregular and then progresses to amenorrhoea

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4
Q

What are some of the symptoms of menopause?

A
  • hot flushes
  • urogenital atrophy
  • dyspareunia
  • sleep disturbance
  • decreased libido
  • depression
  • joint pain
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5
Q

What do the ovaries produce that feeds back to the HPG axis?

A

Oestradiol and inhibin B -

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6
Q

How do oestradiol and inhibin B effect the system?

A

Inhibits HPG axis

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7
Q

What happens to this feedback loop during menopause?

A

Loss of ovarian function so less production of oestradiol and inhibin B so less negative feedback on the HPG axis

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8
Q

What would you expect the LH and FSH levels to be in a menopausal woman?

A

High as loss of inhibition from oestradiol and inhibin B

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9
Q

What are the main complications of menopause?

A

osteoporosis as oestrogen is protective in bone

cardiovascular disease

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10
Q

What is the main risk of giving oestrogen as part of HRT?

A

Endometrial hyperplasia - increased risk of endometrial carcinoma

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11
Q

How is this effect of oestrogen prevented?

A

Give progesterone as well

blocks the effect of oestrogen on the endometrium

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12
Q

In which patients would you give only oestrogen as part of HRT?

A

Hysterectomy

no uterus

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13
Q

Describe the two formulations of HRT?

A

Cyclical - take oestradiol every day, and then ;ast 12 days take progesterone
Combined continuous - take a little of both each day

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14
Q

State 4 types of oestrogen preparations

A

oral oestradiol
oral conjugated equine oestradiol
transdermal oestradiol
intravaginal

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15
Q

Why do you need to give a higher dose of oestradiol if you give oral?

A

High first pass metabolism

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16
Q

Name a semi synthetic oestrogen that is used in oral contraceptives

A

ethinyl oestradiol

17
Q

What does the ethinyl group do on ethinyl oestradiol?

A

Protect the molecule from first pass metabolism

18
Q

What is the difference in the dose of oestrogen given in HRT and oral contraceptive?

A

HRT - a little to control symptoms of menopause

contraceptive - loads to suppress HPG axis

19
Q

State some of the side effects of HRT use?

A

Breast cancer
Venous Thromboembolism
Stroke
Gallstone

20
Q

How does HRT affect cardiovascular risk?

A

increased risk of cardiovascular incidents
time the exposure
older patients more at risk

21
Q

Name a synthetic prohormone that has oestrogenic, progesteronic and weak androgenic effects?

A

Tibolone

22
Q

What type of drug is Raloxifene?

A

SERM - selective oestrogenic receptor modulator

23
Q

How does raloxifene work?

A

bone = oestrogenic effects so reduces risk of fractures

breast and uterus = anti oestrogenic so reduces risk of cancer

24
Q

What are the problems with raloxifene?

A

increased risk of stroke and VTE

25
Q

What is tamoxifen?

A

Anti-oestrogenic in breast

26
Q

What is tamoxifen used for?

A

treatment of oestrogen dependent breast tumours

27
Q

What is the term given to menopause before the age of 40?

A

Premature ovarian insufficiency

28
Q

What could cause premature ovarian insufficiency?

A

autoimmune
surgery
chemotherapy
radiotherapy

29
Q

What type of oestrogen is in the oral combined contraceptive pill?

A

Ethinyl oestradiol

30
Q

What type of progesterone is in the COCP?

A

levonorgestrel or norethisterone

31
Q

When would you use the progesterone only pill>/

A

when oestrogen is contraindicated e.g. cardiovascular risk

32
Q

What must be remembered when taking the COCP?

A

take at the same time every ay

33
Q

What is the name given to the long acting intra-uterine progesterone device?

A

Mirena

34
Q

What are the three types of emergency contraception?

A
  1. Copper IUD - affects sperm viability and function
  2. Levonorgestrel - 72 hours - high dose progesterone
  3. Ulipristal - 120 hours - anti progestin, imparis implantation

Endocrinology (18 decks)

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