Endocrine-2 (Female Reproductive) Flashcards
Therapeutics
GnRH (pulse generator)
↓
FSH & LH
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Ovary
What does pulsatile release of GnRH from the hypothalamus stimulate?
Pituitary release in pulses of FSH/LH
What does FSH stimulate?
Ovarian follicle development
What do ovarian follicles release?
Estradiol
What does estradiol stimulate?
Growth of endothelial lining (“positive” feedback)
What do LH surges trigger?
Ovulation
In increase in estradiol/progesterone levels maintains what?
Uterine lining
Day 1 to ovulation is called the ________ phase.
follicular
Ovulation to menstruation is called the __________ phase.
luteal
Estrogen
Reproductive organs mature
What does estrogen decrease?
Reabsorption of bone
What does estrogen increase?
Coagulability of blood
What does continuous/unopposed estrogen for long periods of time lead to?
Abnormal hyperplasia
What does progesterone maintain?
Endometrial lining (in pregnancy)
What is androstenedione?
A weak androgen
What does testosterone have?
Significant androgen activity
What is the brand name for a copper-IUD?
Paragard
What is the duration of a copper-IUD’s use?
10 years
What is the mechanism of action in a copper-IUD?
- Non-hormonal
- Continual release of Cu++ into uterus
What are the side effects of a copper-IUD?
Heavier flow, abdominal cramps
What is the duration of a levonorgestrel IUD?
3-5 years
What is the mechanism of action in a levonorgestrel IUD?
- Progestin ONLY
- Local release of progestin into uterus
What are the side effects of a levonorgestrel IUD?
Changes in bleeding patterns, amenorrhea
What is the brand name for etonogestrel?
Nexplanon
What is the duration of the etonogestrel implant?
3 years
What is the mechanism of action in the etonogestrel implant?
- Progestin ONLY
- Controlled progestin release
- Suppresses ovulation
What is a prominent side effect of the etonogestrel implant?
Unpredictable bleeding
What are some considerations when using long-acting reversible contraception?
- Return to fertility in 1-2 cycles
- Effectiveness is NOT decreased with weight
- Efficacy
What are combination hormonal contraceptives?
Continuous administration of estrogen + progestin
What do combination hormonal contraceptives suppress?
GnRH release from hypothalamus
What does the estrogen component of combination hormonal contraceptives do?
- Prevents ovulation
- Provides cycle control
- Prevents ADEs
What enzymes are part of the elimination component of combination hormonal contraceptives?
CYP450 3A4 enzymes
What doses do ethinyl estradiol come in?
50mcg, 35mcg, 30mcg, 20mcg, 10mcg
What is a good starting dose of ethinyl estradiol for women?
20mcg
What dose of ethinyl estradiol is good to use for women with adherence issues?
30mcg/35mcg
What does the progestin component of combination hormonal contraceptives do?
Provides most contraceptive effect
What does the progestin component of combination hormonal contraceptives suppress?
LH levels
What does the progestin component of combination hormonal contraceptives decrease?
Ovary response to FSH
What is drospirenone?
Analog of spironolactone, anti-aldosterone/mineralcorticoid
What are some risks of estrogen?
- Venous thromboembolism
- CV disease
- Hypertension
- Breast cancer
- Headaches
What E/P ratio do you use for monophasic cycles?
Equal E/P dose
What E/P ratio do you use for biphasic cycles?
Same E/ different P in 2 phases
What E/P ratio do you use for triphasic cycles?
Vary the E/ or P/ or both
What should you do if you miss 2 or more combination hormonal contraceptive pills?
Use a non-hormonal backup until hormonal pills have been taken for 7 days
What is an example of a progestin-only contraceptive?
Norethidrone (Micronor)
What is the mechanism of action in norethidrone?
Increases thickness of the cervical mucus
Are there placebo pills in norethindrone packs?
No
What dose of tablets do norethindrone come in?
0.35mg
What is an over the county progestin only pill?
Norgestrel
What strength do norgestrel pills come in?
0.075mg
What is the brand name of norgestrel?
Opill
What is the name for the depo-injection?
depo-MedroxyProgesterone Acetate (DMPA)
What is the mechanism of action of DMPA?
Suppresses FSH/LH (no ovulation)
What are the adverse effects of DMPA?
- Unpredictable bleeding
- Weight gain
- Decreased bone mineral density
What is a form of emergency contraception that comes in a prescription only?
Ulipristal acetate (Ella)
What is the dose that ulipristal acetate comes in?
30mg
What is the mechanism of action of ulipristal acetate?
Inhibits/delays ovulation
What does ulipristal acetate block?
Progesterone from binding to its receptor
When should ulipristal acetate be administered?
Up to 5 days after unprotected intercourse
What is a form of emergency contraceptive that is available over the counter?
Levonorgestrel (Plan B)
What dose does levonorgestrel come in?
1.5mg
What is the common directions for levonorgestrel?
Take as soon as possible after unprotected sex
The sooner you take it the better it will work
What are some adverse effects of levonorgestrel?
Mild headache, fatigue, dizziness, breast tenderness
Menarche
1st period that occurs
Menopause
When a woman has had no cycles for 12 months or longer
What are characteristics of perimenopause?
- Irregular cycles
- Unpredictable fertility
- Increases FSH levels
How is perimenopause diagnosed?
- Bleeding changes
- Increased FSH levels
What are examples of drug therapy for menopause symptoms?
- OTC vaginal moisturizers
- Vaginally inserted estrogen (local effect)
What are some examples of vaginal estrogen products?
- Creams
- Tablets
- Rings
Is progestin needed in vaginal estrogen products?
No
What are examples of estrogen products for systemic symptoms/hormone therapy?
- Conjugated equine estrogens (Premarin)
- Estradiol (Estrace)
What are examples of progestin products for systemic symptoms/hormone therapy?
- Medroxyprogesterone acetate (Provera)
- Levonorgestrel IUD
For women with a uterus, do they need estrogen therapy alone or estrogen + progestin?
Estrogen + progestin
For women WITHOUT a uterus, do they need estrogen therapy alone or estrogen + progestin?
Estrogen therapy alone
For women with “okay” FSH/LH levels and something “wrong” with their hormonal balance, what can they use to induce ovulation?
Clomiphene citrate (Clomid)