Menopause, HRT & Oral Contraceptives Flashcards
Define menopause.
- Permanent cessation of menstruation
- Loss of ovarian follicular activity
- Average age 51 (range 45-55)
What is the name of the transition period of menopause?
climacteric
Name some symptoms of menopause.
Hot flushes
Urogential atrophy and dysareunia.
Sleep disturbance.
Depression.
Decreased libido.
Joint pain.
Symptoms diminish with time.
What hormonal changes occur in menopause?
reduced oestrogen secretion.
Increased GnRH and LH/FSH to try stimulate secretion.
Name and explain some complications of menopause.
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
Why are both oestrogens and progesterons administered in HRT?
oestrogen stimulates endometrial proliferation which increases rich of endometrial carcinoma.
Progoesterone to prevent endometrial hyperplasia.
What is the goal of menopause treatment?
control symptoms.
How is HRT administered?
Cyclical - Oestrogen everyday with Progesterone every 12-14 days.
Or continuous combined treatment
How might oestrogen be administered?
Oral estradiol
Oral conjugated equine oestrogen
Transdermal past oestradiol
Intravaginal
Why are transdermal oestrogen doses much lower than oral?
Though well absorbed, estradiol has a low bioavailability.
(estrone sulphate - conjugated oestrogen)
(ethinyl estrdiol - semi-synthetic oestrogen, protected from first pass metabolism)
Name some side effects of HRT.
- 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.
What is the effect of HRT on women’s health?
In younger women - beneficial effect on lipid profile and endothelial function
in older women with ahtersclerosis - unhealthy (pro thrombotic and pro inflammatory)
How does synthetic progesterone modify the effect of oestrogen on cardiovascular disease risk in young women?
Negates the reduced risk.
What is the effect of the synthetic prohormone tibolone?
- Oestrogenic, progestogenic & weak androgenic actions
- Reduces fracture risk
- Increased risk of stroke (RR: 2.2)
- increased risk of Breast Ca
What is raloxifene?
A selective oestrogen receptor modulator.
What effects does Raloxifene have?
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.
What is tamoxifen used for?
Anti-oestrogenic on breast tissue
Used to treat oestrogen-dependent breast tumours and metastatic breast cancers.
What is premature ovarian insufficiency?
Menopause before age of 40 (1% women).
What might cause premature ovarian insufficiency?
Autoimmune
Surgery
Chemotherapy
Radiation.
What are the components of the combined oral contraceptive pill?
oestrogen (ethinyl oestradiol) + progestogen (e.g. levonorgestrel or norethisterone).
How does the combined oral contraceptive work?
E and P - -ive feedback actions at hypothalamus/pituitary
P thickens cervical mucus.
Outline the administration pattern of the combined oral contraceptive pill.
Take for 21 days, stop for 7 days.
When are progesterone only contraceptives used?
when oestrogens are contra-indicated (smoker, etc.)
Why must the progesterone pill be taken at the same time each day?
Short half life
Short duration of action
(long acting preparations may be given via intra-utrine system)
Name 3 methods of emergency cantraception.
Copper IUD (intrauterine contraceptive device) (5-7 days)
Levonorgestrel (within 72 hours)
Ultipristal (within 120 hours)
How does ulipristal work?
anti-progestin activity.
delay ovulation by as much as 5 days
impair implantation
How does the Copper IUD work?
Reduce sperm viability and function.
