OCP Flashcards
where is most estrogen produced?
ovaries
who makes estrogen in premenopausal women
granulosa cells or fetoplacental unit during pregnancy
what is the predominant estrogen type in postmenopausal women
estrone
where is estrone made
liver and adipose tissue
what is the most potent estrogen
17beta-estradiol
rank the potency of estrogens from strongest to weakest
- 17beta-estradiol
- estrone
- estiol
all gonadal hormones are synthesized from what
cholesterol
what converts androstenedione or testosterone to steroidal estrogens
aromatization of the A ring - catalyzed by aromatase
what estrogens does the placenta make and how?
estrone and estriol
DHEA
all 3 estrogens are excreted how from body
along with glucuronide and sulfate conjugates
estrogen impact on ovaries
- stimulate follicular growth
- too much , atrophy of ovaries
estrogen impact on uterus
endometrial growth
estrogen impact on vagina
- cornification of epithelial cells
- thickening and stratification of epithelium
estrogen impact on cervix
- increase cervical mucous
- lowers viscosity ( favors sperm access)
estrogen impact on cholestrol
hypocholesterolemic effect
estrogen impact on electrolytes
retention of Na, Cl and water by kidney
where is progesterone secreted
corpus luteum
adrenal cortex
testis
once fertilization occurs what hormone is secreted
hCG
during 2nd and 3rd month of pregnancy what does the placenta secrete
E2 and P
name 3 actions of progestrone
- development of secretory endometrium
- increase viscosity
- maintain pregnancy
what happens to the women body when progesterone levels decline
menstruation
how is GnRh, FSH, and LH secreted. what phase are they secreted in
GnRH: intermittent
FSH and LH: pulsatile
Follicular phase
both LH and FSH stimulate what in the follicular phase
Graafian follicle growth
FSH by it self stimulates what in the follicular phase
maturation and estrogen production
by granulose cells
What are estrogen effects on pituitary during early follicular phase
inhibitory
What are estrogen effects on pituitary during midcycle follicular phase
positive
what is essential for ovulation
LH surge
what follows LH surge
follicle rupture within 24-48 hours
progesterone is under influence of what hormone
LH
what are 3 therapeutic uses for estrogen and progestins
contraception
postmenopausal hormone therapy
when is conjugated estrogens used
post menopausal
what is the difference between third generation and second generation contraceptives
third: less acne, nausea, lipid changes
how does monophasic contraceptive work
- constant estrogen and progesterone for 21 days
- iron or placebo 7 days
how does biphasic contraceptive work
2 different levels of progesterone
constant amount of estrogen
how does triphasic contraceptive work? 3 versions
- 3 levels of progesterone/ constant estrogen
- 1 dose of progesterone, 3 doses estrogen
- 21 days of estrogen/progesterone
What is the goal for extended COC
attempt to alter the number of pill free interval days
what is YAZ FDA approved for
premenstrual dysphoric disorder -PMDD
What is the combination of YAZ
EE and drospirenone (DSRP)
what is the combination of Yasmin? what is difference of Yaz and Yasmin
EE and drospirenone (DSRP)
Yasmin not FDA approved for PMDD
What are symptoms for Mircette
fewer menstrual symptoms such as:
estrogen-withdrawal headaches, bloating, and menstrual pain
Drospirenone is a derivative of what drug? side effect
spironolactone
- hyperkalemia
what is the combination for Seasonale
levonorgestral - EE
how is Seasonale taken
84 days straight
7 days placebo
Compare Seasonique and Seasonale
Seasonque: 7 days of EE instead of placebo
- better follicular suppresion
- less unscheduled bleeding
how is Lybrel taken
365 days
- no placebo or pill free days
what is the combination for Lybrel
EE and Levonorgestrel
advantage for transdermal contraceptive
avoids first pass effect through liver
- less adverse effect on liver
disadvantages for transderma contraceptive
skin irritation/rash
thrombosis
what estrogen is used in monophasic CO
mestranol converts to ethinyl estradiol
name 3 types of progestins
pregnanes
estranes
gonanes
what is adjusted in pill when side effects occur
progestational and androgenic activity
Name progestational and androgenic activity
Levonorgestrel and Norgestrel
what progesterone has lowest androgenic activity
Desogestrel
Norgestimate
Gestodene
Drosperinone
What progesterone has anti-androgen and anti-mineralocortcoid
Drosperinone
what are side effects of Drosperinone
hyperkalemia
less weight gain
reduces acne
how do COC work
- inhibit ovulation
- thicken endocervical fluid - reduces sperm penetration
- endometrium unsuitable for eggl implanation
how does progesterone work in COC
diminishes frequency and amplitude of GnRH and LH
how does estrogen work in COC
suppresses pituitary release of FSH in follicular phase ( negative feedback)
when are monophasic COC effective ? triphasic ?
within 21 days
triphasic: 7 days
what happens when dosing varies?
- increase failure in the beginning of pack
- increase adverse effects due to greater fluctuations in hormones
what are side effects that are most important factor for discontinuation of OC
- nausea, headache, migraines, weight gain
- higher incidence of thrombosis formation
- increase platelet aggregation
- higher levels of hepatic coagulation factors
- incidence of hypertension in some patients
what is the greatest contraindication for OC
cigarette smoker over age 35
what are 5 risks for OC
- venous thromboembolism
- myocardial infarction
- stroke
- gall bladder disease
- breast cancer
what are non-contraceptive benefits for OC
- increase bone mineral density
- decrease acne
- decreased epithelial ovarian cancer
when do you to adjust lower estrogen
- nausea and vomiting
- headaches and migraine
- CYCLIC weight gain
- hypermenorrhea
- leg cramps, edema
- hypertension
when do you to adjust higher estrogen
- vasomotor symptoms ( hot flashes)
- early spotting or bleeding between
- hypomenorrhea
when do you to adjust less progesterone
depression
reduced breast size
when you adjust to less androgenic activity
acne or oily skin
NONCYCLIC weight gain
when do you adjust to higher progesterone dose
late bleeding
hypermenorrhea
what do you if you miss 1 dose of OC
days 22-28
days 1-21
22-28: take remaining pills on schedule
1-21: take pill as soon as discovered
– max is 2 pills a day
when is greatest potential for failure of pill if you miss it
first 5 days
what do you if you miss 2 doses of OC
days 1-14
days 15-21
1-14: take extra pill for 2 days
15-21: stop pack and start new cycle
what drug can women with migraines and depression use
Minipill - progesterone only
if a mother just delivered and they are not nursing, when can they start OC
4 weeks after delivery
- greater than 2 weeks due to risk of blood clots
nursing mothers should use what OC
Minipill - progesterone only
why can’t smoker take OC
smoking induces P450
- therefore smokers must use higher doses of estrogen and progesterone
- this leads to greater failure if pills missed due to increased clearance
OC should not be taken with other drugs
Tetracycline, PENICILLIN V, erythromycin and ampicillin
