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LCRS Y2: Endocrinology > Oral contraceptives, menopause and HRT > Flashcards

Oral contraceptives, menopause and HRT Flashcards

1
Q

What are the benefits of oestrogen treatment in menopause?

A

Benefits for lipid profile and endothelial function

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2
Q

Recall the most common combinations for combined oral contraceptives

A

Oestrogen component = ethinyl oestradiol

Progesterone component = levonorgesterel or norethisterone

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3
Q

What are the 2 main mechanisms of action of the combined oral contraceptive pill

A
  1. O+P have negative feedback effect on hypothalamoadenohypophysial axis
  2. P = thickens cervical mucus
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4
Q

Recall 2 indications for progesterone-only contraceptive therapy

A

= CONTRA-indications for oestrogen therapy (which is better)

  1. Smoking (reduce CV risk)
  2. Old (>35!)
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5
Q

Why does oestrogen-only contraceptive have to be taken at the same time each day?

A

Short half life

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6
Q

Recall 3 possible drugs that can be used as an emergency post-coital pill?

A
  1. Copper IUD
  2. Levonogesterel
  3. Ulipristal
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7
Q

Recall the mechanism of action of a copper IUD as a EPCP

A

IUD = intrauterine device = exclude pregnancy and decrease viability of sperm fx

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8
Q

How long post-coitally will levonogesterel still be effective?

A

72 hours

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9
Q

How long post-coitally will ulipristal still be effective?

A

120 hours

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10
Q

Define menopause

A

Permanent cessation of menstruation

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11
Q

What is the term given to the transition period before menopause?

A

Climacteric

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12
Q

What is the average age at which menopause occurs?

A

51

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13
Q

Recall 6 symptoms of climacteric

A
  1. Sleep disturbance
  2. Vasomotor action (hot flushes)
  3. Dyspareunia due to urogenital atrophy
  4. Depression
  5. Decreased libido
  6. Dysarthria
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14
Q

What are the 3 most commonly cited complications of menopause?

A

Vasomotor symptoms, CVD, osteoperosis

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15
Q

Why are post-menopausal women at so much higher risk of osteoperosis?

A

Loss of bone matrix –> 10 x higher fracture risk

Oestrogen inhibits PTH-stimulated osteoclast activity

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16
Q

By what age do men and women have equal risk of CVD

A

70

17
Q

Why is oestrogen not usually prescribed alone?

A

Carries risk of endometrial hyperplasia

18
Q

In what case might you give an oestrogen-only HRT?

A

Hysterectomy

19
Q

What are the 2 different options for O and P combination in HRT?

A
  1. Cyclical - O with P for last 2 days of each fortnight

2. Daily combined

20
Q

Recall 3 methods of administration of HRT and reasons for each choice

A
  1. Oral (patient preference)
  2. Transdermal patch (patient preference)
  3. Intravaginal (dyspareunia = main complaint)
21
Q

What is premature ovarian insufficiency?

A

Menopause before age of 40

22
Q

What is the prevalence of premature ovarian insufficiency?

A

1%

23
Q

Recall 4 possible causes of premature ovarian insufficiency

A
  1. AI
  2. Surgery
  3. Chemotherapy
  4. Radiation
24
Q

Describe the bioavailability of HRT

A

Oestradiol has high first-pass metabolism therefore bioavailability = low

25
Q

Other than pure oestradiol, in what 2 other forms can oestrogen be administered

A
  1. Conjugated (eg oestrone sulphate)

2. Semi-synthetic (eg ethinyl oestradiol)

26
Q

Recall 5 potential side effects of HRT

A
  1. Breast cancer
  2. CVD
  3. DVT
  4. Stroke
  5. Gallstones
27
Q

Recall 2 examples of oestrogenic drugs

A

Tibolone, raloxifene

28
Q

Recall 3 functions of oestrogen in the HPA axis

A
  1. Inhibit LH and FSH
  2. Enhance lipid profile
  3. Decrease viscosity of cervical mucous for sperm penetration
29
Q

Recall 3 functions of progesterone in the HPA axis

A
  1. Inhibit aldosterone
  2. Induction of growth of alveolar system of breast
  3. Increase thermogenesis
30
Q

Why is oestrogen not administered orally?

A

Extensive FPM

31
Q

Recall the name of a conjugated oestrogen molecule

A

Oestrone sulphate

32
Q

Recall the name of a synthetic oestrogen and why it has this structure

A

Ethinyl oestradiol

Ethinyl group protects it from FPM

33
Q

Which drug is contra-indicated in high-risk patients for thrombosis?

A

Combined oral contraceptive

34
Q

Recall the biochemical profile of a menopausal woman

A

GnRH, LH and FSH = high

Oestrogen = low

35
Q

What is tibolone?

A

Synthetic prohormone with oestrogenic, progetogenic and weak androgenic actions

36
Q

Which menopause drug is most suitable in a family with a history of endometrial hyperplasia and why?

A

Raloxifene does not share the pro-oestrogenic effects of tamoxifen on the endometrium

LCRS Y2: Endocrinology (18 decks)

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