Menopause, HRT & Oral Contraceptives

Question 1

Define menopause.

Answer 1

• Permanent cessation of menstruation
• Loss of ovarian follicular activity
• Average age 51 (range 45-55)

Question 2

What is the name of the transition period of menopause?

Answer 2

climacteric

Question 3

Name some symptoms of menopause.

Answer 3

Hot flushes

Urogential atrophy and dysareunia.

Sleep disturbance.

Depression.

Decreased libido.

Joint pain.

Symptoms diminish with time.

Question 4

What hormonal changes occur in menopause?

Answer 4

reduced oestrogen secretion.

Increased GnRH and LH/FSH to try stimulate secretion.

Question 5

Name and explain some complications of menopause.

Answer 5

Osteoporosis.

• oestrogen deficiency
• loss of bone matrix
• 10 fold increased risk of fracture..

CVD

• protected against CVD before menopause
• by age 70, ame risk as men

Question 6

Why are both oestrogens and progesterons administered in HRT?

Answer 6

oestrogen stimulates endometrial proliferation which increases rich of endometrial carcinoma.

Progoesterone to prevent endometrial hyperplasia.

Question 7

What is the goal of menopause treatment?

Answer 7

control symptoms.

Question 8

How is HRT administered?

Answer 8

Cyclical - Oestrogen everyday with Progesterone every 12-14 days.

Or continuous combined treatment

Question 9

How might oestrogen be administered?

Answer 9

Oral estradiol

Oral conjugated equine oestrogen

Transdermal past oestradiol

Intravaginal

Question 10

Why are transdermal oestrogen doses much lower than oral?

Answer 10

Though well absorbed, estradiol has a low bioavailability.

(estrone sulphate - conjugated oestrogen)

(ethinyl estrdiol - semi-synthetic oestrogen, protected from first pass metabolism)

Question 11

Name some side effects of HRT.

Answer 11

• Breast cancer
• Coronary heart disease
• Deep Vein thrombosis
• Stroke
• Gallstones

Absolute risk of complications for healthy, symptomatic postmenopausal women in their 50s is very low.

Question 12

What is the effect of HRT on women’s health?

Answer 12

In younger women - beneficial effect on lipid profile and endothelial function

in older women with ahtersclerosis - unhealthy (pro thrombotic and pro inflammatory)

Question 13

How does synthetic progesterone modify the effect of oestrogen on cardiovascular disease risk in young women?

Answer 13

Negates the reduced risk.

Question 14

What is the effect of the synthetic prohormone tibolone?

Answer 14

• Oestrogenic, progestogenic & weak androgenic actions
• Reduces fracture risk
• Increased risk of stroke (RR: 2.2)
• increased risk of Breast Ca

Question 15

What is raloxifene?

Answer 15

A selective oestrogen receptor modulator.

Question 16

What effects does Raloxifene have?

Answer 16

Oestrogenic effects in bone

• reduce risk of vertebral fractures

Anti-oestrogenic in breasts and uterus

-reduced breast cancer risk.

Does not reduce vasomotor symptoms

Increased risk of VTE and fatal stroke.

Question 17

What is tamoxifen used for?

Answer 17

Anti-oestrogenic on breast tissue

Used to treat oestrogen-dependent breast tumours and metastatic breast cancers.

Question 18

What is premature ovarian insufficiency?

Answer 18

Menopause before age of 40 (1% women).

Question 19

What might cause premature ovarian insufficiency?

Answer 19

Autoimmune

Surgery

Chemotherapy

Radiation.

Question 20

What are the components of the combined oral contraceptive pill?

Answer 20

oestrogen (ethinyl oestradiol) + progestogen (e.g. levonorgestrel or norethisterone).

Question 21

How does the combined oral contraceptive work?

Answer 21

E and P - -ive feedback actions at hypothalamus/pituitary

P thickens cervical mucus.

Question 22

Outline the administration pattern of the combined oral contraceptive pill.

Answer 22

Take for 21 days, stop for 7 days.

Question 23

When are progesterone only contraceptives used?

Answer 23

when oestrogens are contra-indicated (smoker, etc.)

Question 24

Why must the progesterone pill be taken at the same time each day?

Answer 24

Short half life

Short duration of action

(long acting preparations may be given via intra-utrine system)

Question 25

Name 3 methods of emergency cantraception.

Answer 25

Copper IUD (intrauterine contraceptive device) (5-7 days)

Levonorgestrel (within 72 hours)

Ultipristal (within 120 hours)

Question 26

How does ulipristal work?

Answer 26

anti-progestin activity.
delay ovulation by as much as 5 days

impair implantation

Question 27

How does the Copper IUD work?

Answer 27

Reduce sperm viability and function.