Oral contraceptives Flashcards
Estrogen is 70% bound to what in blood?
SHBG. If you give estrogen, SHBG will increase to balance out the increased estrogen (keeping free hormone levels normal)
Progesterone is transported via?
Transcortin
MOA of estrogen?
Acts thru nuclear receptors (ER-alpha & beta). Affects gene transcription by binding HRE
Give me 8 actions of estrogen
- Breast development
- Increase HDL & decrease LDL (favorable)
- Inhibit osteoclastic activity (favorable)
- Widen pelvis
- Increase libido
- Increase binding proteins & clotting factors
- Build up myometrium
- Closes epiphysial plate
Metabolism of estrogen?
Hepatic. Synthetic estrogen is metabolized much slower than intrinsic estrogen
AE’s of estrogen therapy?
- Mastalgia
- Breast enlargement
- Breakthrough bleeding
- CV events (estrogen is prothrombotic)
Progesterone actions? (give me 6)
- Pregnancy maintenance
- Development of breast secretory units
- Inhibits uterine contraction
- Increases insulin
- Bad for cholesterol (increase LDL)
- Increases core body temp
5 theraputic uses for estrogen/progesterone therapy?
- Contraceptive
- Hormone replacement- treats effects of menopause like osteoporosis
- Dysfunctional uterine bleeding
- Luteal phase dysfx (give progesterone)
- Ovulation induction- ER blockers (Clomiphene & Fulvestrant) –> increase in LH/FSH –> stimulates ovulation
What are the ER blockers?
Clomiphene & Fulvestrant
T/F: Estrogen therapy causes an increased cancer risk?
True: can stimulate endometrial, breast, uterus, testis, bone, & kidney cancer. DES can cause clear cell carcinoma
When it comes to CVD, what effects do estrogen & progesterone have?
Estrogen decreases risk for CVD. Progesterone increases risk
T/F: Estrogen therapy can lead to increased risk of stroke & DVT
True- especially in a patient that SMOKES!
Most effective means of contraception?
IUDs, progestin implants, & sterilization
Least effective means of contraception?
Barrier & calendar methods
Most popular contraceptive?
Hormone pills
Difference between mono/multiphasic OCP?
Mono has fixed doses in each pill. Multi has different doses
Aside from keeping you kid free, what benefits do OCPs have? (6)
- Decrease risk for ovarian/endometrial cancer
- Decrease dysmenorrhea
- Menstrual regularity
- Increase Hb
- Increase SHBG –> decrease free T –> decreased acne
- Used off label for PCOS
What can decrease effectiveness for OCPs? (5)
- Antibiotics
- Rifampin
- Anti-retrovirals
- Anti-convulsants
- St. John’s Wort (herb)… Yes, I typed st. john’s wart at first, but then googled it and found out it is in fact not a wart..
What is the estrogen component of combined E/P OCP? What is the progestin component?
Estrogen: Ethinyl estradiol or Mestranol
Progestin: Norethindrone, Norgestrel, or Levonorgestrel
Of the 2 (E and P) which has better things assc with it?
Estrogen! Can lead to breast enlargement and increased excitability (nice)
Progestin: can lead to weight gain and acne
E/P therapy is contra’d in what? (3)
- CV things (like thromboembolic state, CVD, MI, CAD)
- Hyperlipidemia
- Woman cancers (breast, ovarian, endometrial)
How does the progestin only pill work?
It DOES NOT block ovulation! It impairs sperm transport by thickening cervical mucus & thickens endometrium to impair implantation. Higher risk of failed therapy
Why give progestin only pill?
When woman is breast feeding, or if she is a smoker..
**“If a woman is on estrogen and she’s smoking, she’s asking for a clot” -Guljan
AE’s of a combo P/E transdermal patch?
- Less effective in obese women
- Break through bleeding in first 2 cycles
- Skin reaction
