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Y2 LCRS Endocrinology > Menopause, HRT, Oral contraceptives > Flashcards

Menopause, HRT, Oral contraceptives Flashcards

1
Q

What is menopause

A

Permanent cessation of menstruation

Loss of follicular activity

Av. age 51 (45-55)

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2
Q

What is ‘climacteric’

A

The transition period where the menstrual cycle becomes irregular until they stop.

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3
Q

Symptoms of Menopause (7)

A

Hot flushes

Urogenital atrophy

Dyspareunia

Sleep disturbance

Depression

Decreased libido

Joint pain

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4
Q

Describe the normal HPG Axis

A

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

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5
Q

Describe how the normal HPG axis changes during menopause

A

Ovaries stop producing oestradiol/inhibin B which means less negative feedback

This results in an increase in LH and FSH released from the pituitary

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6
Q

Describe 2 complications associated with menopause

A

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
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7
Q

Why are oestrogen and progestogen given

A

Oestrogen = replacing the oestradiol that has been lost and promotes endometrial proliferation

Progestogen = Prevents the risk of endometrial hyperplasia

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8
Q

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?

A

Only oestrogen

Progestogens won’t be needed as the lining of the endometrium doesn’t need to be shed (no uterus)

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9
Q

What are the different HRT formulations (4)

A

Oral estradiol (1mg)

Oral conjugated equine oestrogen (0.625mg)

Transdermal oestradiol (50 microgram/day)

Intravaginal

Oestrogen everyday (progestogen every 12-14 days)

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10
Q

examples of oestrogen hormone replacements

A

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)

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11
Q

Side effects of taking HRT for menopause (5)

A

Breast cancer

Coronary heart disease

Deep Vein Thrombosis

Stroke

Gallstones

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12
Q

What are the effects of estrogen

A

Beneficial effects on the lipid profile and endothelial function

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13
Q

What are the effects of oestrogen and progesterone on women over 60

A
  • atherosclerosis
  • susceptible to prothrombotic and proinflammatory effects of eostrogen
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14
Q

What is the effect of synthetic progestins

A

Negate the effects of oestrogen

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15
Q

Tibolone (structure and use)

A

Synthetic prohormone

oestrogenic, progestogenic and WEAK androgenic action

↓ fracture risk

↑ risk of stroke and breast cancer

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16
Q

Raloxifene (structure/use)

A

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

17
Q

Tamoxifen uses

A

Anti-oestrogenic on breast tissue

> used to treat oestrogen dependent and metastatic breast cancers

18
Q

Describe premature ovarian insufficiency and the possible causes (4)

A

Menopause occurring before the age of 40 (seen in 1% of women)

CAUSES:

Autoimmune

Radiation

Chemotherapy

Surgery

19
Q

Describe how combined oral contraceptives work

A

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

20
Q

When are progesterone-only contraceptives used

A

If the patient is a:

Smoker

>35 years

migraine with aura

21
Q

Why must a progesterone-only contraceptive be taken at the same time every day

A

They have a short half-life and short duration of action

Long-acting preparations can be administered via the intra-uterine system

22
Q

What are the different emergency (post-coital) contraceptions

A

Copper IUD (Intrauterine contraceptive device)

Levonorgestel

Ulipristal

23
Q

Describe the use of the copper IUD

A
  • 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
24
Q

When can levonorgestrel be used

A

Up to 72 hrs after unprotected intercourse

25
Q

Outline the use of ulipristal

A

Can be used up to 120 hrs after intercourse

Anti progestin activity

Delays ovulation by as much as 5 days

Impairs implantation

Y2 LCRS Endocrinology (2 decks)

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