Endo 10: Oral COntraceptives, Menopause, HRT Flashcards
What is menopause?
permanent cessation of menstruation due to loss of ovarian follicular activity
What is the average age of menopause
51
range: 45-55
What is meant by climacteric
- period of transition period
- normal regular cycles –> irregular cycles –> amenorrhoea
What are some symptoms of menopause
- hot flushes
- urogenital atrophy + dyspareunia (painful sex)
- sleep disturbance
- depression
- decreased libido
- joint pain
(symptoms disappear with time)
Describe the recap of hypothalamic-pituitary gonadal axis
GnRH from hypothalamus stimulates anterior pituitary to make ____
- allows ovaries to make _______ + ________
- Oestradiol + inhibin inhibits ____ + _____
GnRH from hypothalamus stimulates anterior pituitary to make LH
- allows ovaries to make estradiol + inhibit B
- Oestradiol + inhibin inhibits LH + FSH
What changes occur during menopause to the hypothalamic pituitary gonadal axis?
- 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
What are some complication related to menopause ?
- osteoporosis
- cardiovascular disease
How is osteoporosis related to complications of menopause?
- oestrogen deficiency
- causes loss of bone matrix
- results in 10x increased risk of fracture
How is cardiovascular disease related to menopause?
- females are protected against CVD before the menopause
- by the age of 70 they have the same risk of CVD as men
What is hormone replacement therapy (HRT) ?
they control vasomotor symptoms (hot flushes)
- e.g oestrogen / progestogens
what is the effect of oestrogen as HRT?
oestrogen:
- causes endometrial proliferation
- -> but there is risk of endometrial carcinoma
In HRT, what is the effect of using both E + P?
- prevents endometrial hyperplasia
if the patient has had hysterectomy, you would ONLY give __________
because you don’t need to worry about endometrial proliferation
if the patient has had hysterectomy, you would only give OESTROGEN
because you don’t need to worry about endometrial proliferation
What are some Oestrogens used for HRT ?
- 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
List some side effect of oestrogen administration
- breast cancer
- coronary heart disease
- deep vein thrombosis
- stroke
- gallstones
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
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
there is increased/ decreased risk of CHD with HRT
there is increased risk of CHD with HRT for those
What is Tibolone?
Tibolone:
- is a synthetic pro hormone
- which has estrogenic/progestogenic/and weak androgenic effects
Tibolone reduces the risk of ______
It increases the risk of _______
Tibolone reduces the risk of
fracture
It increases the risk of stroke
note: there can also be an increase in risk of breast cancer
What is Raloxifene ?
Raloxifene = a selective oestrogen receptor modulator (SERM)
- estrogenic in bone
- ANTI estrogenic in breast + uterus
Raloxifene increases the risk of _____ and _____
Raloxifene increases the risk of VTE and fatal stroke
What is tamoxifen ?
Tamoxifen:
- it is anti-oestrogenic on the breast tissue
- it is used to treat oestrogen dependent breast tumors + metastatic breast cancers
What is premature ovarian insufficiency?
- menopause occurs before the age of 40
What could premature ovarian insufficiency be due to?
could be due to:
- autoimmune
- surgery
- chemotherapy
- radiation
