Estrogens and progestins

Question 1

steroidogenesis in the ovary is regulated by what compounds?

Answer 1

LH and FSH (gonadotropins)

Question 2

which cells are required for estradiol synthesis?

Answer 2

theca and granulosa

Question 3

what are the features of follicular phase of ovarian cycle?

Answer 3

1. high frequency, low amplitude LH secretion
2. estrogen rises
3. endometrial proliferation

Question 4

what is the main feature of ovulation? which day does it occur?

Answer 4

estrogen induced gonadotropin surge

day 14

Question 5

what are the features of the luteal phase of the ovarian cycle?

Answer 5

1. rise in estrogen and progesterones

2. endometrial differentiation under control of progesterone

Question 6

which hormone is absolutely required for ovulation?

Answer 6

LH

Question 7

what is the effect of estrogen on the endometrium?

Answer 7

endometrial proliferation

Question 8

what is the effect of progesterone on the endometrium?

Answer 8

endometrial differentiation
preparation for implantation
decrease uterine contractions

Question 9

how does progesterone influence glucose metabolism?

Answer 9

leads to glucose intolerance

Question 10

which hormone is the key regulator during the luteal phase of the menstrual cycle?

Answer 10

progesterone

Question 11

which hormone is the key regulator during the follicular phase of the menstrual cycle?

Answer 11

estrogen

Question 12

what are the effects of estrogen on lipids?

Answer 12

decrease LDL
increase HDL
increase TGs

Question 13

what is the effect of estrogen on bone?

Answer 13

antiresorptive

Question 14

what is the effect of estrogen on the liver?

Answer 14

increase plasma proteins

Question 15

what are the effects of estrogen on the blood?

Answer 15

increase coag factors

decrease antithrombin

Question 16

what is important about ethinyl estradiol?

Answer 16

addition of ethinyl group to estrogen increases half life up to 13-27 hours

Question 17

what are the risks of long term estrogen plus progesterone in healthy postmenopausal women?

Answer 17

increased coronary heart disease
increased stroke
increased PE
increased invasive breast cancer

Question 18

what is the main mechanism of estrogen use on contraception?

Answer 18

negative feedback pressure on HPG axis

suppresses LH surge

Question 19

what is responsible for suppression of acne in birth control?

Answer 19

estrogenic component of BC preparations

Question 20

how does estrogen inhibit acne?

Answer 20

inhibits steroidogenesis

decreases free testosterone concentrations

Question 21

what are the adverse effects of estrogen?

Answer 21

breast tenderness
endometrial hyperplasia
increased blood coagulation

Question 22

in which situation can you use estrogen alone for hormone replacement therapy?

Answer 22

hysterectomy - no risk of endometrial cancer

Question 23

what are the two backbone molecules for the progestins?

Answer 23

progesterone

19-nortestosterone

Question 24

what are the important progestins?

Answer 24

medroxyprogesterone (MPA)
norethindrone
norgestrel

Question 25

how do progestins differ from estrogens for ovulation? what about for BC in general? why?

Answer 25

progestins are less efficacious than estrogens at suppressing ovulation for BC, they are just as efficacious progestin effect on cervical glands (increasing viscosity)

Question 26

what are the therapeutic uses for progestins?

Answer 26

contraceptives HRT dysmenorrhea endometriosis

Question 27

what is the risk of unchallenged estrogen use?

Answer 27

continued proliferation

Question 28

what is the rationale for progestin use in HRT?

Answer 28

decrease risk of endometrial hyperplasia caused by estrogens

Question 29

what is the rationale for progestin use in dysmenorrhea?

Answer 29

decrease endometrial mass and PG production

Question 30

what is the rationale for progestin use in endometriosis?

Answer 30

decrease endometrial proliferation by regulating ER expression and stimulating differentiation of endometrial cells

Question 31

what are the adverse effects of progestin use?

Answer 31

``` breakthrough bleeding impaired glucose tolerance hirsutism acne lipid metabolism ```

Question 32

what are the general MOAs of combined estrogen-progestin BC and progestin-only pills or implants?

Answer 32

1. prevent pituitary release of hormones that stimulate ovulation 2. suppress LH and FSH surge 3. alter cervical mucus 4. alter endometrium

Question 33

which oral BC pill is progestin only?

Answer 33

norethindrone

Question 34

what are the contraindications of estrogen containing contraceptives?

Answer 34

1. known or suspect breast cancer 2. thromboembolic disorders 3. liver disease 4. CV disease hx 5. smokers 35 yo or older