Female Sex Hormones Flashcards
State the women’s hormonal cascade
(Slide 2)
What does estrogen contribute to?
-Cognitive health (memory)
-Bone health (Bone density)
-Cardiovascular health (reduces lipids, increases NO which improves vascular reactivity)
What hormone works with progesterone for female sexual and reproductive health?
Estrogen
Which parts of the body produce estrogen?
-Ovaries
-Adrenal Glands
-Fat Tissue
What are the three types of estrogen made by the body
Estrone (E1)
Estradoil (E2)
Estrial (E3)
Describe where Estrone is made and when it is produced
Made in ovaries. Only estrogen hormone the body produces after menopause (in reduced amounts).
When is estradoil made?
In ovaries during reproductive years
Describe where estriol is produced and when it is produced
Produced by placenta during pregnancy
What is the weaker form of estrogen?
Estrone
What is the most common type of estrogen in reproductive years?
Estradiol
What type of estrogen is produced by both male and females?
Estradiol
What can too much estradiol cause?
Loss of sex drive, osteoporosis and depression
What can very high levels of estradiol cause?
Increase risk of uterine and breast cancer
What can low levels of estradiol cause?
Weight gain and cardiovascular disease
Function of Estriol
Helps the uterus grown and prepares the body for delivery
When do estriol levels peak?
Just before birth
Function of Estrogen: With Ovaries
Stimulate growth of egg follicle
Function of Estrogen: With Vagina
Maintains thickneess of the vaginal wall and promotes lubrication.
Function of Estrogen: With Uterus
Maintains mucous membrane that lines the uterus. Regulates flow and thickness of uterine mucus secretions
Function of Estrogen: With breasts
Formation of breast tissue; stops milk production after weaning
Estrogen Roles Overall (4)
- Improves skin elasticity
- Promoting reproductive health
- Decreasing plaque buildup
- Regulating menstrual cycle
- Preserving bone density
Estrogen Effects: on Blood vessels
Regulates cholesterol
Estrogen Effects: On Brain
Sustains body temp
Estrogen effects: On Breasts
Stimulates Development
Estrogen Effects: On Vagina
Maintains thick vaginal lining
Estrogen Effects: On Bones
Controls bone mass
Effects of Progesterone: Pregnancy
Thicken the endometrial lining in preparation to nourish an egg after conception
Progesterone Role: Overall (5)
- Retains bone density
- Produces calming effects in brain
- Supports circulatory vigor
- Assists with liver and kidney health
- Boosts reproductive functions
Progesterone Effects: Breasts
Reduces tenderness, cyst formation
Progesterone Effects: Uterus
Inhibits contractions during pregnancy
Progesterone Effects: Vagina
Protects cervix from infection
Progesterone Effects: Immune System
Increases anti-inflammatory agents
Progesterone Effects: Cardiovascular System
Lowers blood pressure
Appetite Suppressants are also known as
Stimulants (amphetamines)/sympathomimentics
Appetite Suppressants mimic the ____ nervous system which can cause what effects?
Sympathetic Nervous System; cardiac side effects
Appetite Suppressants _____ energy consumption and ______ and ______ appetite centrally
Increase; thermogenesis; depress
Stimulants are _____ substances
Controlled
Describe the mechanism of stimulants
Enhance the sympathomimentic response to epi and norephinephrine leading to possible hypertension and cardiotoxicity
What needs to be used with caution with stimulants?m What should be done during the appointment?
Epinephrine; monitor vital signs due to strong risk for hypertension, cardiac stimulatory effects
What are some effects of using stimulants in the oral cavity?
-Bruxism
-Metallic Taste
-Xerostomia
Appetite Suppressant/Stimulants:
Benzophetamine Class
Class III
Appetite Suppressant/Stimulants:
Methamphetamine Class
Class II
Appetite Suppressant/Stimulants:
Phendimetrazine Class
Class III
Appetite Suppressant/Stimulants:
Phentermine Class
Class IV
Appetite Suppressant/Stimulants:
Phentermine and Topiramate Class
Class IV
What drug is used as inhibitor of fat absorption
Orlistat
Orlistat is a ____ inhibitor
Lipase
Mechanism of Orilstat
Inhibits gastric and pancreatic lipases, which inhibits absorption of fats by 30%
Orilstat Side Effects
GI
Natrexone and Bupropion (Contrave): Describe what it is and what needs to be used with caution
-Opioid antagonist with an antidepressant
-Caution with vasoconstrictor (raises epi in CNS)
Describe what liraglutide is used for
-Glucagonlike-peptide receptor agonist used for diabetes
-Used for chronic weight management in patients with BMI of 30 kg or higher plus one weight-related comorbidity (HTN, diabetes)
How do you evaluate success of liraglutide
Evaluate patient after 16 weeks- if patient hasn’t lost at least 4% of body weight, discontinue drug
Side Effects of liraglutide
-Increased heart rate
-Xerostomia
Weight Loss Drugs: What are not controlled substances
-Orilstat
-Liraglutide
-Naltrexone & Buproprion
What do birth control pills contain? (3)
-Either combo of synthetic estrogen and progestin
-Progestin only
How do oral contraceptives work?
Prevent pregnancy by stopping ovulation.
Ensure that hormone levels do not fluctuate throughout the month.
icHow do oral contraceptives work?
Prevent pregnancy by stopping ovulation.
Ensure that hormone levels do not fluctuate throughout the month
What do oral contraceptives thicken? Why?
Thicken mucus in the cervix to prevent sperm from reaching the egg
What are other uses of oral contraceptives?
Decreasing premenstrual symptoms and reducing the severity of hormone-related acne.
MOA: Estrogen
Inhibits FSH which inhibits ovulation
MOA: Progesterone
Progesterone inhibits LH -> inhibits follicular growth which alters endometrial development
Which form of oral contraceptives significantly increases the risk of clotting events/stroke
Patch
Which single entity preparation is for rape and incest cases?
DES (Diethyl stillbestrol)
Uses for RU-486 (Mifepristone)
Medical termination of intrauterine pregnancy; off-label treatment of certain cancers to control hyperglycemia secondary to hypercortisolism in cushing’s syndrome
What are progestin preparations available in?
Available as capsules, in vaginal gels, implants, intrauterine devices and injections
Depot medroxyprogesterone acetate: Protects against pregnancy for ___ weeks
13 weeks
Depot medroxyprogesterone acetate requires ____ injections a year
4 injections
Depot medroxyprogesterone acetate: Mechanism
-Stops ovulation
-Thickens and decreases the amount of cervical mucus making it difficult for sperm to enter the uterus and fertilize an egg.
-Thins the lining of the uterus.
Etonogestrel (Nexplanon): Overview
-Inserted into upper arm
-Lasts for 3 years
-Can be removed at any time.
What do the patch form contain?
-Contains the hormones estrogen and progestin
How long is the patch form worn?
Worn once a week for three weeks for a total of 21 days
Patch Contraceptive: Drugs delivered by patch therapy=
More concentrated form
What are some risk of birth control?
-Heart attack
-Stroke
-Blood clots
-Pulmonary embolism
-Nausea and vomiting
-Headaches
-Irregular bleeding
-Weight changes
-Breast tenderness and swelling
-Risk increase in women over the age of 35, especially if smokes
Oral contraceptive oral manifestation
-Mimic effects of pregnancy on the gingiva
-Exacerbate inflammatory response to local irritants
Oral Contraceptives & Gingivitis: What do current studies show with association between drug and gingivitis
No association between low-dose oral contraceptives and gingivitis
Describe how oral contraceptives affect healing after extraction. What causes it?
-2-3x increase in risk of dry socket and post-operative pain
-May be related to fibrinolytic effects of drug interfering with blood clotting
When should extractions be done when a patient is on birth control
Consider scheduling extraction on days 23 to 28 of oral contraceptive cycle when estrogen level is lowest
Which drugs are not affected by oral contraceptives?
-Tetracycline
-Doxycycline
-Ampicillin
-Metronidazole
-Fluconazole
-Fluoroquinolones
When should a second form of contraception should be used?
When using rifampin or ariseofluvin
Short term goal of Hormone replacement therapy
Relief from symptoms of menopause
Long term effect of Hormone Replacement Therapy
Prevention of CV disease and osteoporosis
Hormone Replacement Therapy Agents (3)
-Estrogens
-Progestins
-Testosterone
What hormone is in synthetic estrogens
Estradoil
