Female Repro: MHT and SERMs/TSECs Flashcards
Describe the symptoms when MHT would be used.
Hot flashes Night sweats Vaginal Dryness Sleep disturbances Mood/Cognitive Issues Urinary incontinence
Who would estrogen alone be prescribed to?
In women WITHOUT a uterus
Who would combo estrogen and progestin be given to?
In women WITH a uterus
-decreases risk for endometrial cancer
What are the available estrogen forms?
Estradiol
Conjugated Estrogens
Esterified Estrogens
Estropipate (less common)
Describe the available progestinic drugs?
Medroxyprogesterone
Progesterone
Methyltestosterone (less common)
-more androgens
What are some net positives from estrogen use? (NOT BENEFITS)
Decreases bad cholesterol (LDL), increases good (HDL)
-lowers risk of MI/CAD
Decreases osteoclasts=less osteoporosis
What are some net negatives from estrogen use? (NOT HARMS)
Decreases ATIII and increases platelets and clotting factors
-more DVTs and strokes!
What are the overall harms to estrogen+progesterone combo? (7)
Breast Cancer Coronary Heart disease Dementia Gallbladder disease Stroke Embolisms Urinary incontinence
What are the overall benefits for estrogen+progesterone use? (3)
Decreases:
- Diabetes
- Fractures
- Colorectal cancer
What are some overall harms to estrogen only in women WITHOUT a uterus?
Dementia Gallbladder disease Stroke Embolisms Urinary incontinence
What are some overall benefits to estrogen only in women WITHOUT a uterus?
Decreases:
- Diabetes
- Fractures
- Breast cancer
Again, when is the only time you would prescribe MHT?
To treat vasomotor symptoms and vaginal changes
What age group is MHT have benefits most outweigh the risks?
Those who are 50-59
For women with vaginal symptoms only, what medications can be prescribed? (2)
Topical Estrogen
Ospemifine
What age group has lowest risk of blood clots/stroke?
Those 50-59
-see above with MOST BENEFIT
How long should you prescribe MHT and at what doses?
Shortest time (less than 3 years is best) and lowest dose possible! -decreases risks of cancer and DVTs
Clinical indication for Ospemifene?
Moderate-to-severe dyspareunia
-painful intercourse
Vaginal dryness
MOA of ospemifene?
Agonst at ER receptor in vagina, antagonist at breast
Side effects from ospemifene? (3)
Worsening of hot flashes/sweating
Coagulation
Endometrial thickening
Contraindications for ospemifene? (3)
Vaginal bleeding
Thromboembolisms
Estrogen-induced neoplasia
-uterine/ovarian/breast
What drug can be prescribed to treat vasomotor symptoms in those WITH a uterus and have had adverse reactions to progestins?
Bazedoxifene
Clinical use for bazedoxifene? (2)
Treat moderate to severe vasomotor symptoms associated with menopause in those WITH a uterus
and
Prevention of post-menopausal osteoporosis in women with a uterus
MOA of bazedoxifene
TSEC==SERM combined with estrogen
Antagonistic at endometrium and breast, estrogenic at bone
How does bazedoxifene differ from other SERMs? (2)
Has been shown to destroy HER2 malignant cells
Does not stimulate endometrial proliferation
Side effects of bazedoxifene?
Increases risks of:
Breast Cancer Coronary Heart disease Dementia Gallbladder disease Stroke Embolisms Urinary incontinence
Clinical use for clomiphene?
Infertility in anovulatory women
-those with amennorrhea, PCOS, and dysfunctional bleeding
MOA of clomiphene
Blocks inhibitory effects of estrogen on hypothalamus GnRH and pituitary FSH/LH release
-increases gonadotropes=stimulates ovaries to develop follicles
When is comiphene given usually?
Orally between cycle days 5 and 9
Side effects of clomiphene?
Multiples births
Ovarian cysts
Hot flashes
Luteal-phase dysfunction
