Endocrine HRT Flashcards

1
Q

What is menopause?

A

The permanent cecassion of menstruations because of loss of ovarian follicular activity

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2
Q

What is the normal age in which menopause occurs?

A

It normally occurs between the age of 45-55 (average 51) but can be later

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3
Q

What is Climactenic?

A

The transition period before menopause when periods start to become irregular

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4
Q

What are the symptoms of menopause?

A
  • Hot Flushes
  • Urogenital atrophy, dyspareunia (painful sex)
  • Sleep disturbance
  • Depression
  • Decreased libido
  • Joint pain
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5
Q

What happens to the symptoms of menopause?

A

They normally diminish/ disappear within time

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6
Q

What are the hormonal changes in menopause?

A

Loss of negative feedback of oestrogen/inhibin on hypothalamus lading to an increase in LH and FSH

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7
Q

What are the major complications during and after menopause?

A
  1. Osteoporosis
    • due to oestrogen deficiency
    • resutling in a 10fold increase of fractures
  2. CVS riks
    • before menopause: oestrogen has protective effect on CVS diesease
    • This effect is lost after menopause (because loss of oestrogen)
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8
Q

When would you consider a HRT?

A

When someone has extreme burden of the symptoms of menopause (e.g. hot flushes)

–> HRT helps with vasomotor symptoms

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9
Q

Which Hormone(S) are replaced in HRT?

Why?

A
  1. Oestrogen
    • promotes endometrial proliferation
    • risk of endometrial carcinoma
  2. Progestarone
    • to prevent endometrial hyperplasia
    • not necessary in hysterectomy
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10
Q

What two forms of formulations are there to administer HRT?

A
  1. Cyclical (Estrogen every day + 12-14 days Progesterone)
  2. Continous combined
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11
Q

Via which routes can oestrogen be administered?

A
  • Orally
    • estradiol
    • oral conjugated equine oestrogen
  • Transdermal
  • Intravaginal
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12
Q

In which chemical forms can oestrogen be administered?

What are each characteristic

A

Estradiol: high absorbance but also high fist pass metabolism –> low bioavailibility

Estrone sulphate (conjugated oestrogen)

Ethinyl estradiol :a semi-synthetic oestrogen. The ethinyl group protects the molecule from first pass metabolism

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13
Q

What are the side effects of HRT?

How likely are they to occur?

A
  1. Breast cancer
  2. Coronary heart disease
  3. Deep Vein Thrombosis
  4. Stroke
  5. Gallstones

–> very low risk if a healthy, postmenopausal symptomatic woman in her 50s taking HRT for 5 years

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14
Q

What are the effects of oestrogen and progesterone in HRT on Coronary heart disease?

A

For young women:

  • Oestrogen:
    • beneficial effects on lipid profile &
    • endothelial function
  • Synthetic progestins:
    • Negate these effects of estrogen

Older women (>60):

  • • Atherosclerosis
    • Susceptible to prothrombotic & proinflammatory effects of oestrogen

–> Oestrogen replacement is good in younger women, bad in older women

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15
Q

What is Tibolone?

When is it used?

A

Prohomone with oestrogenic+ progesterongnic + slightly androgenic effects

reduces fracture risk

Increases Risk of Stroke

Might increase risk of Breast cancer

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16
Q

What is Raloxifene?

When is it used?

What are the risk and side effects?

A

•Selective oestrogen receptor modulator

  • Oestrogenic in bone:
    • Reduces risk of vertebral fractures
  • Anti-oestrogenic in breast & uterus
    • reduces breast cancer risk
  • Does not reduced vasomotor symptoms
  • increases risk of VTE (venout thromboemolism) & fatal stroke
17
Q

What is Tamoxifen?

When is it used?

A
  • Anti-oestrogenic on breast tissue
  • Used to treat oestrogen-dependent breast tumours & metastatic breast cancers
18
Q

What is premature ovarian insuficciency?

How often does this occur?

A

•Menopause occurring before the age of 40

(in about 1% of women)

19
Q

What are the causes of premature ovarian insufficiency?

A
  • Autoimmune
  • Surgery
  • Chemotherapy
  • Radiation
20
Q

Explain the mechanism and use of combined oral contraceptives

A

Oestrogen (ethinyl oestradiol) + Progestogen (e.g. levonorgestrel or norethisterone)

  • Suppress ovulation:
    • E&P: negative feedback actions at hypothalamus/pituitary
    • P thickens cervical mucus

•Take for 21 days (or 12 weeks), stop for 7 days (normally stop after 5 years to let body recover)

21
Q

What is the clinical use and indication of progesterone only oral contraceptive?

A

It is taken when:

  • When oestrogens contra-indicated
  • –-> smoker, > 35 yrs old, migraine with aura
  • Must be taken at the same time each day
    • Short half-life
    • Short duration of action

•Long acting preparations may be given via an intra-uterine system

22
Q

Which methods are the for emergency (post coital) contraception?

A
  1. Copper IUD (intrauterine contraceptive device)
    • exclude pregnancy first
    • affects sperm viability and function
    • Effectiveness not reduced in overweight/obese women
    • 5 (up to 7) days after unprotected intercourse
  2. Levonorgestrel (within 72 hours)
  3. Ulipristal (up to 120 hours after intercourse)
    • Anti-progestin activity
    • delay ovulation by as much as 5 days
    • Impairs implantation