Endocrine: Sex hormones

Question 1

In terms of oestrogenic activity, what oestrogens have a more appropriate profile for hormone replacement therapy?

Estradiol
Ethinylestradiol
Estriol
Estrone
Mestranol

Answer 1

The natural oestrogens (estradiol, estrone and estriol) have a more appropriate profile than the synthetic (ethinylestradiol and mestranol) oestrogens.

Question 2

What activity does tibolone have?

Answer 2

Oestrogenic, progestogenic and weak androgenic activity.

Question 3

Oestrogen therapy is given cyclically or continuously for a number of gynaecological conditions. If long-term therapy is required in woemn with a uterus, what should normally be added to reduce the risk of cystic hyperplasia of the endometrium?

Answer 3

A progestogen should normally be added in women with a uterus to reduce the risk of cystic hyperplasia of the endometrium.

Question 4

Why are oestrogens no longer used to suppress lactation?

Answer 4

Association with thromboembolism.

Question 5

Menopausal atrophic vaginitis may be treated in what ways?

Answer 5

1. HRT with small doses of an oestrogen (with a progestogen in women with a uterus) can treat menopausal symptoms such as vaginal atrophy.
2. Topical vaginal oestrogen preparations used for a few weeks and repeated if necessary

Question 6

Why does tibolone as HRT in women with a uterus not require a progestogen as well?

Answer 6

Tibolone combines oestrogenic and progestogenic activity with weak androgenic activity; it is given continously, without cyclical progetogen.

Question 7

Clonidine may be used to reduce what symptoms of menopause in women who cannot take an oestrogen? Why might it not be used?

Answer 7

Clonidine may be used to reduce vasomotor symptoms in women who cannot take an oestrogen, but it may cause unacceptable side-effects.

Question 8

There is an increased risk of coronary heart disease in women who start combined HRT more than how many years after menopause?

Answer 8

more than 10 years after.

Question 9

It is estimated that using all types of HRT, including tibolone, increase the risk of breast cancer within how many years of initiating treatment?

Answer 9

1-2 years

Question 10

The increased risk of breast cancer from the use of HRT is linked to the duration of use. This excess risk disappears within how many years of stopping?

Answer 10

5 years of stopping.

Question 11

Does HRT use increase risk of ovarian cancer?

Answer 11

Small increased risk of ovarian cancer, which disappears within a few years of stopping.

Question 12

Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and pumonary embolism. This risk is especially seen when?

Answer 12

The first year of use.

Question 13

What effect does HRT have on stroke risk?

Answer 13

Slightly increase the risk of stroke.

Tibolone increases the risk of stroke about 2.2 times from the first year of treatment.

Question 14

A woman with a uterus normally requires oestrogen with cyclical progestogen for the last __ to __ days of the cycle or a preparation which involves continuous administration of an oestrogen and a progestogen.

Answer 14

10-14 days

Question 15

Continuous combined preparations or tibolone are not suitable for use when?

Answer 15

In the perimenopause or within 12 months of the last menstrual period.

Question 16

An oestrogen alone is suitable for continuous use in what women?

Answer 16

Those without a uterus, however, in endometriosis, endometrial foci may remain despite hysterectomy and the addition of a progestogen should be considered in these circumstances.

Question 17

Ethinylestradiol is licensed for short-term treatment of symptoms of oestrogen deficiency, for osteoporosis prophylaxis if other drugs cannot be used and for the treatment of what else?

Answer 17

Femal hypogonadism and menstrual disorders.

And also for the palliative treatment of prostate cancer.

Question 18

Raloxifene hydrochloride is licensed for the treatment and prevention of postmenopausal osteoporosis; unlike HRT, raloxifene does not reduce what?

Answer 18

Menopausal vasomotor symptoms.

Question 19

There are two main groups of progestogen, what are they?

Answer 19

1. Progesterone and its analogues (dydrogesterone and medroxyprogesterone acetate)
2. Testosterone analogues (norethisterone and norgestrel).

Question 20

The newer progestogens, such as desogestrel, norgestimate and gestodene, are all derivatives of what?

Answer 20

Norgestrel, testosterone analogue.

Question 21

Where endometriosis requires drug treatmet, it may respond to a progestogen, e.g. norethisterone, administered on a continuous basis or

Answer 21

Danazol and gonadorelin analogues are also available.

Question 22

Why are oral progestogens not widely used for menorrhagia?

Answer 22

They are relatively ineffective compared with tranexamic acid or, particularly where dysmenorrhoea is also a factor, mefenamic acid.

Question 23

In pregnant women with antiphospholipid antibody syndrome who have suffered recurrent miscarriage, what may decrease the risk of fetal loss?

Answer 23

Low-dose aspirin and a prophylactic dose of a low molecular weight heparin may decrease the risk of fetal loss.

Question 24

What type of drug is ulipristal acetate?

Answer 24

A progesterone receptor modulator with a partial progesterone antagonist effect used in the pre-operative treatment of moderate to severe symptoms of uterine fibroids; it is also used as an hormonal emergency contraceptive.

Question 25

What is tibolone used for?

Answer 25

Short-term treatment of oestrogen deficiency.

Osteoporosis prophylaxis in women at high risk of fractures when other prophylaxis is contra-indicated or not tolerated.