Menopause, HRT, Oral contraceptives Flashcards
What is menopause
Permanent cessation of menstruation
Loss of follicular activity
Av. age 51 (45-55)
What is ‘climacteric’
The transition period where the menstrual cycle becomes irregular until they stop.
Symptoms of Menopause (7)
Hot flushes
Urogenital atrophy
Dyspareunia
Sleep disturbance
Depression
Decreased libido
Joint pain
Describe the normal HPG Axis
GnRH is released from the hypothalamus
Stimulates the pituitary gland to release LH/FSH
Acts on the ovaries to release oestradiol/Inhibin B
Oestradiol/inhibin has negative feedback on the pituitary gland and hypothalamus
Describe how the normal HPG axis changes during menopause
Ovaries stop producing oestradiol/inhibin B which means less negative feedback
This results in an increase in LH and FSH released from the pituitary
Describe 2 complications associated with menopause
Osteoporosis
- oestrogen deficiency
- loss of bone matrix
- 10 fold increased risk of fracture
Cardiovascular disease
- females are protected against this before menopause
- same risk by age 70
Why are oestrogen and progestogen given
Oestrogen = replacing the oestradiol that has been lost and promotes endometrial proliferation
Progestogen = Prevents the risk of endometrial hyperplasia
A woman enters a clinic after being diagnosed with menopause, after looking at her history it shows that she had a hysterectomy. What HRT should be used?
Only oestrogen
Progestogens won’t be needed as the lining of the endometrium doesn’t need to be shed (no uterus)
What are the different HRT formulations (4)
Oral estradiol (1mg)
Oral conjugated equine oestrogen (0.625mg)
Transdermal oestradiol (50 microgram/day)
Intravaginal
Oestrogen everyday (progestogen every 12-14 days)
examples of oestrogen hormone replacements
Estradiol = Well absorbed, low bioavailability (first-pass metabolism)
Estrone sulphate = conjugated oestrogen
Ethinyl estradiol = semi-synthetic oestrogen (Ethinyl provide protection from the first-pass metabolism)
Side effects of taking HRT for menopause (5)
Breast cancer
Coronary heart disease
Deep Vein Thrombosis
Stroke
Gallstones
What are the effects of estrogen
Beneficial effects on the lipid profile and endothelial function
What are the effects of oestrogen and progesterone on women over 60
- atherosclerosis
- susceptible to prothrombotic and proinflammatory effects of eostrogen
What is the effect of synthetic progestins
Negate the effects of oestrogen
Tibolone (structure and use)
Synthetic prohormone
oestrogenic, progestogenic and WEAK androgenic action
↓ fracture risk
↑ risk of stroke and breast cancer
Raloxifene (structure/use)
Selective Oestrogen Receptor Modulator
Oestrogenic = bone = ↓ risk of vertebral fractures
Anti-oestrogenic = breast/uterus = ↓ breast cancer risk
No decrease in vasomotor symptoms = increased risk of VTE and fatal stroke
Tamoxifen uses
Anti-oestrogenic on breast tissue
> used to treat oestrogen dependent and metastatic breast cancers
Describe premature ovarian insufficiency and the possible causes (4)
Menopause occurring before the age of 40 (seen in 1% of women)
CAUSES:
Autoimmune
Radiation
Chemotherapy
Surgery
Describe how combined oral contraceptives work
Oestrogen(ethinyl oestradiol) + progesterone (levonorgestrel/norethisterone)
Suppresses ovulation
> E/P = negative feedback at the hypothalamus and pituitary
> P = thickens the cervical mucus
Take for 21 days and stop for 7 days
When are progesterone-only contraceptives used
If the patient is a:
Smoker
>35 years
migraine with aura
Why must a progesterone-only contraceptive be taken at the same time every day
They have a short half-life and short duration of action
Long-acting preparations can be administered via the intra-uterine system
What are the different emergency (post-coital) contraceptions
Copper IUD (Intrauterine contraceptive device)
Levonorgestel
Ulipristal
Describe the use of the copper IUD
- Exclude pregnancy first
- Affects sperm viability and function
- Effectiveness is not reduced in overweight or obese women
- Up to 5/7 days after unprotected sex
When can levonorgestrel be used
Up to 72 hrs after unprotected intercourse
Outline the use of ulipristal
Can be used up to 120 hrs after intercourse
Anti progestin activity
Delays ovulation by as much as 5 days
Impairs implantation
