Endo 10 - Oral Contraceptives, Menopause and HRT Flashcards
Define Menopause
Permanent cessation of menstruation - amenorrhoea for 12 months
What is the average age of menopause?
51yo (45-55)
What does climacteric period mean?
The period of transition. normal regular cycles become irregular and then progresses to amenorrhoea
What are some of the symptoms of menopause?
- hot flushes
- urogenital atrophy
- dyspareunia
- sleep disturbance
- decreased libido
- depression
- joint pain
What do the ovaries produce that feeds back to the HPG axis?
Oestradiol and inhibin B -
How do oestradiol and inhibin B effect the system?
Inhibits HPG axis
What happens to this feedback loop during menopause?
Loss of ovarian function so less production of oestradiol and inhibin B so less negative feedback on the HPG axis
What would you expect the LH and FSH levels to be in a menopausal woman?
High as loss of inhibition from oestradiol and inhibin B
What are the main complications of menopause?
osteoporosis as oestrogen is protective in bone
cardiovascular disease
What is the main risk of giving oestrogen as part of HRT?
Endometrial hyperplasia - increased risk of endometrial carcinoma
How is this effect of oestrogen prevented?
Give progesterone as well
blocks the effect of oestrogen on the endometrium
In which patients would you give only oestrogen as part of HRT?
Hysterectomy
no uterus
Describe the two formulations of HRT?
Cyclical - take oestradiol every day, and then ;ast 12 days take progesterone
Combined continuous - take a little of both each day
State 4 types of oestrogen preparations
oral oestradiol
oral conjugated equine oestradiol
transdermal oestradiol
intravaginal
Why do you need to give a higher dose of oestradiol if you give oral?
High first pass metabolism
Name a semi synthetic oestrogen that is used in oral contraceptives
ethinyl oestradiol
What does the ethinyl group do on ethinyl oestradiol?
Protect the molecule from first pass metabolism
What is the difference in the dose of oestrogen given in HRT and oral contraceptive?
HRT - a little to control symptoms of menopause
contraceptive - loads to suppress HPG axis
State some of the side effects of HRT use?
Breast cancer
Venous Thromboembolism
Stroke
Gallstone
How does HRT affect cardiovascular risk?
increased risk of cardiovascular incidents
time the exposure
older patients more at risk
Name a synthetic prohormone that has oestrogenic, progesteronic and weak androgenic effects?
Tibolone
What type of drug is Raloxifene?
SERM - selective oestrogenic receptor modulator
How does raloxifene work?
bone = oestrogenic effects so reduces risk of fractures
breast and uterus = anti oestrogenic so reduces risk of cancer
What are the problems with raloxifene?
increased risk of stroke and VTE
