Endometriosis/Menorrhagia

Question 1

Leuprolide

Answer 1

Endometriosis
- GnRH agonists
- used in conjx w/ Hormone replacement therapy to reduce ADE
- injectable, intranasal, subcutaneous implant
- better patient compliance, side effects are more tolerable than danazol.
MOA
- initially there is a flare up (called *flare effect) of LH and FSH
- then GnRH agonist down regulates and desensitizes LH and FSH, which means there is a decrease of gonadal hormones (specifically estradiol)
ADE
- caused by estrogen def. similar to menopause
- hot flashes, vaginal dryness, insomnia, bone demineralization/osteoporosis
- Chronic use produced “medical oophorectomy”.

Question 2

Danazol

Answer 2

Endometriosis
- synthetic androgen
MOA
- induces amenorrheic state through inhibition of gonadotropin production via feedback inhibition of pituitary-ovarian axis.
ADE
• (Androgen excess effects): Oily skin, acne, weight gain, deepening of the voice, and facial hirsutism
• (Estrogen deficiency effects): Emotional lability, hot flashes, vaginal dryness, and reversible breast atrophy
- *once stopped, voice still deep
Contraindications
- women w/ c/i to HRT
- risk or hx of thrombosis

Question 3

Tranexamic Acid

Answer 3

Menorrhagia
MOA
- treats heavy menstrual bleeding by inhibiting fibrinolysis and the breakdown of clots.
- reversibly bind to the lysine-binding site on plasminogen, blocking plasminogen binding to fibrin thus inhibiting its conversion to plasmin on the surface of fibrin
C/I
- women with contraindications to hormonal therapy since it also may increase risk of thrombosis as well as women with history of risk or hx