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eLCRS - 엔도 > Endo 10: Oral COntraceptives, Menopause, HRT > Flashcards

Endo 10: Oral COntraceptives, Menopause, HRT Flashcards

1
Q

What is menopause?

A

permanent cessation of menstruation due to loss of ovarian follicular activity

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2
Q

What is the average age of menopause

A

51

range: 45-55

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3
Q

What is meant by climacteric

A
  • period of transition period

- normal regular cycles –> irregular cycles –> amenorrhoea

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4
Q

What are some symptoms of menopause

A
  • hot flushes
  • urogenital atrophy + dyspareunia (painful sex)
  • sleep disturbance
  • depression
  • decreased libido
  • joint pain
    (symptoms disappear with time)
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5
Q

Describe the recap of hypothalamic-pituitary gonadal axis

GnRH from hypothalamus stimulates anterior pituitary to make ____

  • allows ovaries to make _______ + ________
  • Oestradiol + inhibin inhibits ____ + _____
A

GnRH from hypothalamus stimulates anterior pituitary to make LH

  • allows ovaries to make estradiol + inhibit B
  • Oestradiol + inhibin inhibits LH + FSH
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6
Q

What changes occur during menopause to the hypothalamic pituitary gonadal axis?

A
  • due to follicular atresia: Low levels of estradiol + inhibin B
  • so there is less -ve feedback
  • so gonadotrophin levels go up
  • so in menopausal women, LH + FSH = high
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7
Q

What are some complication related to menopause ?

A
  • osteoporosis

- cardiovascular disease

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8
Q

How is osteoporosis related to complications of menopause?

A
  • oestrogen deficiency
  • causes loss of bone matrix
  • results in 10x increased risk of fracture
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9
Q

How is cardiovascular disease related to menopause?

A
  • females are protected against CVD before the menopause

- by the age of 70 they have the same risk of CVD as men

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10
Q

What is hormone replacement therapy (HRT) ?

A

they control vasomotor symptoms (hot flushes)

  • e.g oestrogen / progestogens
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11
Q

what is the effect of oestrogen as HRT?

A

oestrogen:
- causes endometrial proliferation
- -> but there is risk of endometrial carcinoma

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12
Q

In HRT, what is the effect of using both E + P?

A
  • prevents endometrial hyperplasia
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13
Q

if the patient has had hysterectomy, you would ONLY give __________
because you don’t need to worry about endometrial proliferation

A

if the patient has had hysterectomy, you would only give OESTROGEN
because you don’t need to worry about endometrial proliferation

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14
Q

What are some Oestrogens used for HRT ?

A
  • Estradiol = well absorbed
  • -> but low bioavailability
  • Estrone Sulphate
  • -> conjugated oestrogen
  • Ethinyl Estradiol
  • -> semi synthetic oestrogen
  • -> ethanol group protects molecule from 1st pass metabolism

note:transdermal skin patches

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15
Q

List some side effect of oestrogen administration

A
  • breast cancer
  • coronary heart disease
  • deep vein thrombosis
  • stroke
  • gallstones
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16
Q

note: the absolute risk of complication for healthy symptomatic postmenopausal women in their 50s taking HRT for 5 years five years = very low

but increases risk of CHD in older women

WHY

A

oestrogen has protective effects for women up to their 50s

in younger:

  • oestrogen has beneficial effects on lipid profile and endothelial function
  • but progesterone negates these effects of estrogen

for older women:

  • atherosclerosis
  • they become more prothrombotic and proinflammtory
17
Q

there is increased/ decreased risk of CHD with HRT

A

there is increased risk of CHD with HRT for those

18
Q

What is Tibolone?

A

Tibolone:

  • is a synthetic pro hormone
  • which has estrogenic/progestogenic/and weak androgenic effects
19
Q

Tibolone reduces the risk of ______

It increases the risk of _______

A

Tibolone reduces the risk of
fracture

It increases the risk of stroke

note: there can also be an increase in risk of breast cancer

20
Q

What is Raloxifene ?

A

Raloxifene = a selective oestrogen receptor modulator (SERM)

  • estrogenic in bone
  • ANTI estrogenic in breast + uterus
21
Q

Raloxifene increases the risk of _____ and _____

A

Raloxifene increases the risk of VTE and fatal stroke

22
Q

What is tamoxifen ?

A

Tamoxifen:
- it is anti-oestrogenic on the breast tissue

  • it is used to treat oestrogen dependent breast tumors + metastatic breast cancers
23
Q

What is premature ovarian insufficiency?

A
  • menopause occurs before the age of 40
24
Q

What could premature ovarian insufficiency be due to?

A

could be due to:

  • autoimmune
  • surgery
  • chemotherapy
  • radiation
25
Q

How would you treat premature ovarian insufficiency?

A
  • HRT
26
Q

What is the oestrogen + progestogen commonly used in the oral contraceptive pill?

A

oestrogen:
- etinyl oestradiol

progestogen:
- levonorgestrel
- norethisterone

27
Q

How does estrogen + progesterone act as a combined oral contraceptive?

A
  • Both E + P = causes suppression of the hypothalamus + pituitary
  • P –> also thickens cervical mucous
28
Q

How is combined oral contraceptive taken?

A
  • taken orally
  • take for 21 days
  • stop for 7 days
29
Q

When is progesterone only contraceptive used?

A
  • it is used when oestrogen are contra-indicated
  • -> if there is a risk of thrombosis
  • -> because oestrogen has pro-coagulant effects

e.g in smokers >35 age

30
Q

How is progesterone only contraceptive taken?

A
  • take orally
  • taken at the same time each day
  • > due to short half life + short duration of action
  • long acting preparations ma be given via intra uterine system (mirena)
31
Q

What are 3 main methods of emergency (post-coital) contrception?

A
  • Copper IUD
  • Levonotgestrel
  • Ulipristal
32
Q

How does Copper IUD work?

A
  • it excludes pregnancy first
  • affects sperm viability + function
  • it inhibits fertilization.
  • 5-7 days after unprotected intercourse
33
Q

what is levonorgestrel ?

A
  • high dose progesterone

- given within 72 hours

34
Q

What is Ulipristal?

A
  • has anti progestin activity
  • delays ovulation by up to 5 days
  • impairs implantation

note: up to 5day after intercourse

eLCRS - 엔도 (20 decks)

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